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Health Care-Associated Infections

Of all the reports that hon. Members may have read recently, none is more damning or more distressing to read than the Healthcare Commission's report into the outbreaks of C. difficile at Maidstone and Tunbridge Wells NHS Trust. I have no doubt that the sense of betrayal among local people is immense. The success of the NHS is largely down to the confidence and trust that people have in the organisation and its staff. There is no doubt that the majority of NHS staff continue to work to achieve exactly that end. The rise in health care-acquired infections has seen the loss of that trust, a loss of confidence and an increasing sense that NHS staff are no longer in control of their own decision making. We have heard some excellent speeches. I did not entirely follow the speech made by the hon. Member for Livingston (Mr. Devine), but I am concerned that his attempt to focus on the events of 20 years ago or more was simply an opportunity to deflect attention from the failures of the Government today. As a former nurse, I thank my hon. Friend the Member for Ilford, North (Mr. Scott) for his tribute to nurses across the country. He gave a particularly evocative account of two of his constituents, one of whom sadly died. He also raised the issue of large payouts to senior managers, which continues to concern a number of hon. Members, particularly when those managers have presided over significant failures in trusts. He was generous, however, in his praise of the Secretary of State. The hon. Member for Vale of Glamorgan (John Smith) was also generous in his political stance and raised the important issue of venous thromboembolism. The hon. Member for Wellingborough (Mr. Bone) mentioned his concern for his constituents, who are served by a hospital with the worse C. difficile rates in the country. As well as paying tribute to all NHS staff, he also mentioned the experiences of one of his constituents. My right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) talked about authority and accountability on the ward through the ward sister. I am sure that I speak for all hon. Members when I say that her anecdote about a nurse who went to use a syringe that had fallen on the floor was truly shocking. She also mentioned the confused role of senior nurses, nurses covering shortages and form-filling. She spoke with her usual and much-welcomed common sense. The hon. Member for Cleethorpes (Shona McIsaac) spoke passionately about the prescription of broad spectrum antibiotics. She paid tribute to her local trust, which I gather is a centre of excellence. She also mentioned the fact that figures can be extremely misleading. My hon. Friend the Member for Tunbridge Wells (Greg Clark), like my right hon. Friend the Member for Maidstone and The Weald, was particularly touched by the recent events, which left 90 people dead, while 270 deaths had C. difficile cited as a contributory factor. My hon. Friend has campaigned long and hard for a new hospital and has been particularly concerned about the issues associated with built structures, nurses and their uniforms and the practices that are followed. No one knows better than him the urgency with which the matter needs to be dealt. My hon. Friend the Member for Tiverton and Honiton (Angela Browning) mentioned leg ulcers. Labour Members mentioned research and the overuse of antibiotics. In particular, the hon. Member for Bridgend (Mrs. Moon) mentioned treatment with maggots. My hon. Friend the Member for Westbury (Dr. Murrison) talked about the need for the Government to face up to the situation and cited individual constituents' experiences. My hon. Friend the Member for South Cambridgeshire (Mr. Lansley) spoke from the Front Bench and focused in particular on screening, isolation and bed occupancy. He also referred to the Government's plans for a deep clean. In particular, he noted that the Department of Health had said that there was no central programme for that, nor any plans to monitor progress, and that it was a matter for local determination. In addition, the Department said that no dates had been set for commencement or completion of the deep clean, that there would be no new money for it nor any repeat programme. Finally, my hon. Friend noted that the Department had supplied no news on training—perhaps the Minister will be able to bring us up to date about exactly what training will be given to help NHS staff to achieve this so-called deep clean. It seems to me, and I am sure to many Opposition Members, to be no more than a gimmick. A Healthcare Commission report was published in July in response to requests from the chief medical officer for ways to reduce infection rates. It stated:"““We found evidence that a significant number of trusts were also experiencing difficulties in reconciling the management of””" health care-acquired infections"““and cleanliness with the fulfilment of targets””." It would be awfully welcome if the Secretary of State listened to this bit, as it is the one that I do not think that he entirely understands. He needs to grasp the difference between targets and outcomes. He does not support outcome-driven activity, but he does support process-driven targets. For exactly the reasons cited in the Healthcare Commission report to which I have referred, he needs to pay attention because, if he continues with his obsession with targets, we will not see any improvements. The report found that 45 per cent. of trusts were experiencing difficulties with accident and emergency targets. In addition, 29 per cent. of trusts told the commission about difficulties with waiting times and lists for the treatment of in-patients, while 36 per cent. reported that they had experienced difficulties reconciling the management of health care-acquired infections and cleanliness with the fulfilment of financial targets. The Secretary of State continues to deny that evidence. Moreover, the report found that 46 per cent. of trusts do not have a programme to check the cleaning of beds and the spaces around them. Only 48 per cent. of trusts report all health care-acquired infections, and 19 per cent. report none. Another 26 per cent. report less than half of such infections, and 62 per cent. do not audit readmission to hospital of people suffering from them. The report is truly damning about what is going on. Until the Secretary of State starts to listen, and to accept the causes and consequences of health care-acquired infections, rates will continue to rise. Protesting about the progress that has been made while denying the figures and causes will not get anywhere. The right hon. Gentleman asked that this debate be non-party political, but he must accept the facts. The problems are to do with bed-occupancy rates, targets, competing priorities, antibiotic prescribing habits, the number of nurses on wards and the number of hand basins available per bed. They are also to do with our built structure, and with training, monitoring, audit and the need to change practices on the basis of that audit. The Secretary of State maintains that infection rates here are similar to those in the rest of Europe, but I doubt that that is any comfort to the relatives of the 90 patients who died in west Kent. We must adopt a ward-to-board approach, but hospital boards must be able to make decisions on the basis of clinical need, not of Government targets. That means that some targets must be let slip sometimes, but a culture in which senior managers do not listen to what is happening at ward level because they fear not meeting Government targets and thus getting sacked will mean that what happened at the Maidstone and Tunbridge Wells NHS Trust will occur again. I urge the Government to look again at the debate. I urge them to rise to the challenge that health care-acquired infections raise. I urge them to return to decisions made on clinical grounds by clinical staff in clinical settings. I urge hon. Members to support the motion.