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Clostridium Difficile

I am grateful to the Secretary of State for responding to my urgent question. I am sorry that he did not consider it right to volunteer a statement, given the scandalous events to which he refers, and I am surprised that, in the course of responding, he made no mention at all of the report from the Healthcare Commission in July 2006 relating to the outbreaks of clostridium difficile at Stoke Mandeville, and the clear relationship between the findings at Stoke Mandeville then and the findings at Maidstone and Tunbridge Wells. At the end of the executive summary in the report into the Maidstone and Tunbridge Wells Trust, there was a long discussion about how both trusts had let down patients in exactly the same way. The report went on to say:"““Governance arrangements were weak or overridden by other imperatives””" in both cases,"““including targets relating to finance and access.””" The report continued:"““While it should be noted that improvements have subsequently been made at Stoke Mandeville, it seems unlikely that these similarities are coincidental. We are concerned that, if organisations are struggling, they should not compromise patient safety by making decisions and taking actions that put some patients at risk.””" So when the Secretary of State says that the events at Maidstone and Tunbridge Wells are wholly exceptional, I hope that indeed they are, but they are not an isolated case. We have had other cases, and the common link between them is that managers in the national health service have been more focused on the Government's targets and the Government's imperatives than on patients' safety. I find it utterly astonishing that we should be here time and again, including in debates in Opposition time, most recently in January, pressing the Government to take the necessary action to deal with the incidence of infection. The Secretary of State referred to the virulence of C. difficile, but he did not give us the figures. In 2001, 1,214 death certificates included a mention of clostridium difficile. By 2005, the figure was 3,807—comparable to that for deaths from road traffic accidents in this country. Between 2005 and 2006, there was a further 7 per cent. increase in the number of cases of C. difficile reported in national health service hospitals. What was happening last year? Yesterday, we discovered from The Sunday Telegraph that last October the Government received internally from the head of the infection unit at the Department of Health a report saying that they should put in place a programme costing £270 million, including £200 million specifically for isolation facilities. What did the Government do last October in response to that report? When we pressed Ministers about the impact of targets, as we have done repeatedly, did the Secretary of State and his predecessors not understand that, back in the middle of 2004, NHS staff in the clean your hands campaign were continuously being told to use alcohol rubs to reduce the incidence of MRSA? Staff should do that; however, as the Maidstone report makes clear, too many staff did not understand that at the same time they had to continue to use soap and water and a proper routine for hand washing to combat clostridium difficile. As we have seen MRSA figures peak and come down, we have also seen clostridium difficile figures rising dramatically, so that deaths from that are at least double those associated with MRSA. Where are the other measures that could and should have been taken to tackle clostridium difficile? We know that there are cleaning technologies that will be increasingly effective, including dry hydrogen peroxide vapour cleaning systems. We know, for example, that nurses across the NHS have been looking for support in accessing Flexiseal, a faecal management system—but they are not getting it. We know why, as they report back to us, the Royal College of Nursing and others—it is due to cost concerns on the part of management. Ministers constantly tell us that the health service is receiving unprecedented increases in resources; surely now is when resources should be devoted to infection control, isolation facilities and the relevant technologies. In his response to my question, the Secretary of State has said nothing about the target announced last Wednesday—I say ““announced”” advisedly; it was issued by the Under-Secretary of State for Health, the hon. Member for Brentford and Isleworth (Ann Keen), to the BBC, but not to anybody else, in a press release. The chief executive's report to the NHS last week did not mention it at all. What is the target? Suddenly, the Government now say that the response to the problems is to have a new target to reduce clostridium difficile by 30 per cent. by 2011 on a 2008 baseline. We do not even know what the baseline is. Frankly, we cannot carry on as we are. There is no tolerable level of clostridium difficile at 70 per cent. below the current level. If a hospital thought that, it would think entirely the wrong thing, and it is wrong for the Government to point hospitals in that direction. I have been in hospitals—good hospitals—whose attitude is one of zero tolerance. That is the attitude for which we have been arguing for four years, and what the chief medical officer mentioned in the ““Winning Ways”” report of December 2003. However, the Government are not promoting it. Last Thursday, all those who were deeply shocked by what was reported at Maidstone and Tunbridge Wells NHS trust will have heard the Secretary of State blame the trust board and management and no one else. However, when did he receive the draft report? Why did he not act on it then? Why is he acting on it only now, when the public are shocked and outraged at what has happened and he has to recover his position? When he blamed the trust board, why did he not acknowledge that faults have continued at Stoke Mandeville hospital, at Maidstone and Tunbridge Wells NHS Trust and at other trusts? All that means that the Government's policy is also implicated. Those who were shocked by what happened at Maidstone and Tunbridge Wells will want to know that it will never happen again. The Secretary of State will be able to reassure them only if he changes the Government's policy and ensures that patient safety, instead of the Government's misplaced targets, becomes the imperative.