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Health Care-Associated Infections

I accept that. None the less, we must take the report very seriously, and I have quoted directly from it. Although the Secretary of State talks, rightly, about avoiding top-down targets, but they have often led to over-full hospitals. The report mentions the pressure of targets. The Secretary of State shakes his head, but page 8 of it says:"““The trust struggled with a number of objectives which they regarded as imperative. These occupied senior managers' time and compromised control of infection, and hence the safety of patients.””" Page 9 says:"““We are concerned that where trusts are struggling with a number of problems that consume senior managers' time, and are under severe pressure to meet targets relating to finance and access, concern for infection control may be undermined.””" There is specific reference to A and E targets:"““One senior manager said that because of other pressures and 'over-heating' in the trust, the A&E target was delivered at the price of chaos elsewhere in the system.””" The Secretary of State has to understand that Maidstone is not alone; those concerns apply across the NHS. Trusts often feel that they are bamboozled by targets. He has accepted in other contexts that an over-reliance on top-down targets sometimes has perverse effects. I am in a sense challenging him to concede that that is a factor in the problem, as the Healthcare Commission recognises. Does he accept what the commission says? If so, is he prepared to ensure that hospitals are given guidance stating that, although there are other priorities, this must be the top priority? The third issue that the Healthcare Commission deals with is the pressure of finances, which is a Government responsibility and leads, among other things, to cuts in nursing staff. The report says:"““Both trusts had undergone difficult mergers, were preoccupied with finances, and had a demanding agenda of reconfiguration and private finance initiative… Additionally, the impact of financial pressures was to reduce further already low numbers of nurses and to put a cap on the use of nurses from agencies and nursing banks.””" Does the Secretary of State accept that in the past two years intense financial pressures on trusts to balance their books have sometimes had perverse consequences? That appears to have been the case at the trusts in question. The next issue in the report raises is the MRSA target. What concerns me is that, by targeting only reductions in MRSA, the former Secretary of State imposed what I regard as a political target of halving the MRSA rate by 2008, without paying any attention to C. difficile, which was increasing very rapidly. Again, the Healthcare Commission raises concern about that issue. Page 7 of its report says:"““Before the outbreak it only monitored the MRSA rate, as there was a national performance target in relation to MRSA, though not as regards C. difficile.””" So the trust's attention was focused on MRSA, not on the bigger problem of C. difficile. The strategic health authority has a role as well, as the report says that, before August 2006,"““the SHA was not aware of the relevant performance of trusts with regard to rates of C. difficile infection.””" That body is supposed to monitor the performance of trusts in its area. Commenting on the role of the Health Protection Agency, the report says that meetings with directors of infection prevention and control in Kent ““focused on MRSA”” and that there"““was no local monitoring of C. difficile””." Again, the focus was on what the Government chose to target—I think for political reasons—rather than on the growing problem of C. difficile. Again, targets distorted clinical priorities. Does the Secretary of State accept that setting arbitrary targets for MRSA, at a time when other hospital-acquired infections were increasing, had perverse consequences and was dangerous and damaging? The next issue is antibiotic prescribing. All the professionals I have talked to say that that is the central and most important issue when dealing with C. difficile. I was surprised that the motion makes no reference to antibiotic prescribing. [Interruption.] I know that the Conservative spokesman talked about it. The Government amendment also misses it out. The Healthcare Commission report says:"““Antibiotics need to be seen, like all medication, as potentially dangerous drugs””." In 2005, a study of 300 European hospitals showed that the highest levels of MRSA were associated with hospitals using a high level of antibiotics, particularly the broad spectrum antibiotics that we have debated previously. The Health Protection Agency and Healthcare Commission report in 2006 said that 38 per cent. of trusts did not have restrictions in place to prevent inappropriate antibiotic use. The Government have issued new guidance on antibiotic use, but is it being monitored? Have trusts implemented the new guidance, and is it being applied effectively? It is clearly important that the prescriptive rules are applied. When I visited Hereford county hospital last week, I was told that a new policy on antibiotics had been introduced earlier this year and had had a dramatic effect. Beyond Maidstone, the Conservative spokesman referred to the importance of screening and he was right to question why it has taken so long to introduce it. The Government say that they will introduce it for non-emergency cases by next year and for emergency cases within the next three years. In Hereford, I was told that screening of emergency cases had been implemented earlier this year. If that hospital and a small percentage of others—the Conservative spokesman referred to a survey he had undertaken—can do it, why cannot all hospitals? Does it really need to take three years to implement screening for emergency cases across the country? I will conclude by setting out what we see as the priorities. First, I urge the Government to undertake a thorough, robust review of the impact of overcrowding in our hospitals. Overcrowding does not necessarily mean that a certain scenario will happen, but all the evidence indicates that there is a link, which needs to be addressed. The trends are in the wrong direction. Secondly, there needs to be zero tolerance of failures of infection control. We need to get the mindset right. If senior hospital managers have failed in their duties to control infection, that needs to be treated as gross misconduct—it is that serious—rather than their getting a pay-off and a comfortable early retirement. That principle needs to apply throughout the trust, from the most senior people to those working on the wards. There should be no pay-offs. I acknowledge that the Secretary of State indicated that himself. The next point is that matrons must be in charge of the staff in the ward, even if those staff happen to be employed by an independent contractor. The matron needs to have the power to remove an individual from the ward if they are not meeting the required standard. There has been discussion about the Dutch approach. I recognise that rates in the Netherlands are not much lower, but we ought to acknowledge its good practice and strict process to deal with outbreaks. The Secretary of State is right that that is possible only because of the space in Dutch hospitals, but that brings us back to the occupancy rate. There needs to be space for isolation, and to enable a hospital to have some slack in the system. He is right that historical underfunding in this country resulted in too much pressure on the system, but staff need to be sent home if they are infected. There need to be changing facilities for staff. Again, the Secretary of State is right: it may not be appropriate to impose such measures from above, but surely the Department of Health needs to say that all hospitals should, as a matter of best practice, have changing facilities for staff, so that they do not have to travel home on a bus in their uniform. We need monitoring of death certificates to ensure that it is common practice to record hospital-acquired infections when they are a contributory factor to death. The Healthcare Commission report found, in the sample from Maidstone that it considered, that in 20 per cent. of cases where C. difficile was not mentioned on the death certificate, it was a contributory factor. In other words, if we simply looked at death certificates, we would understate the scale of the problem. In many cases—I have come across the issue as a constituency MP—people who have died in hospital had C. difficile but there was no reference to it on the death certificate. We need common good practice on the issue, so that we can accurately assess the scale of the problem. The rules on antibiotic prescribing should be rigorously applied, too. Finally, it is important to give the patient the power and the right to raise concerns in hospital about failures in hygiene standards. There must be a mechanism through which the patient feels able to raise concerns in hospital without feeling that they will suffer in some way. I recognise that the Government have taken steps to address the issue of hospital-acquired infections, but the question is whether they are doing enough, and are doing the right things. Today, I have raised a series of issues that the Healthcare Commission highlighted, and that fall within the Government's responsibility. If the Government intend to criticise the trust—and it is right that they should—they must also acknowledge their role and what they can do to address the concerns that the commission raises. I think that we all agree that the issue has to be treated as a top priority, so that we can ensure that people are safe when they visit hospitals, care homes and nursing homes.