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Health: Hospital-acquired Infections

I congratulate the noble Lord, Lord Patel, on having tabled this Question and on the extremely powerful way in which he spoke to it. It is a question of the first importance for healthcare in our country. If we want a comparison to put the matter into proportion, almost three times as many people are killed by hospital-acquired infections every year as are killed on our roads. The figures look as though they may be on a downward trend and some encouraging statistics have been released today, which no doubt the Minister will be able to refer us to in detail. However, over the 15 years from 1990, the graph showed a massive rise. The increase in C. difficile infections was fiftyfold, and looking simply at the five years to 2006, deaths from C. difficile went up by more than 400 per cent. 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 Curve—the 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 Ways—Working 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 year’s 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 nothing—of course, it should—but it is not the most significant driver, so it appears, in the direction of travel. Still less is it the case that a hospital’s 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 last year, the Prime Minister promised that deep cleaning would be repeated at least every 18 months, but we now know from Written Answers that there are no plans to repeat the first deep clean exercise and no plans to assess how effective the first deep clean actually was. Perhaps that is understandable, because it turns out that the majority of hospitals did not use the key products recommended by the Health Protection Agency, such as hydrogen peroxide vapour. No one should think that deep cleaning of itself will make more than a tiny dent in the statistics. 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, "““make sure every hospital is clean and safe””." 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. In January, the Prime Minister went on the ““Andrew Marr Show”” and made an impressive-sounding promise. He said: "““If you go to hospital, you will get screened by next year for MRSA or C. difficile””." There was no correction of that story from any government source, but two days later the Health Secretary's infection control strategy reported on C. difficile and said this: "““Screening for colonised patients is inappropriate. (Most potential cases would not be identified …)””." In other words, screening for C. difficile is not going to happen, because it is pointless. Mr Brown should not have said what he did. 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: "““Three quarters of trusts indicated that they had problems implementing isolation policies due to inadequacies in the number and fitness for purpose of isolation rooms””." 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 not—I leave the matter open—it 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 confident—as they have a right to do—that hospital is a safe place to be.