§ Mr. Andrew Mackinlay (Thurrock)My debate today is on the subject of methicillin-resistant staphylococcus aureus, to which I shall refer from here on as MRSA.
MRSA is a bacterium that is resistant to treatment by the usual range of antibiotics. Although it is not necessarily more virulent than other infections, the range of treatment options is more limited because of patients' resistance to the more commonly used antibiotics.
Many of us harbour MRSA without its causing us any harm, but carriers can pass it on to vulnerable patients with serious, sometimes fatal, consequences. MRSA contributes to the deaths of thousands of people in hospitals, yet it goes unrecorded and even unrecognised by the Department of Health.
The Government's failure to take measures to control MRSA is causing serious infections that are difficult to treat. That in turn leads to an increase in the drugs bill and in other treatment costs, and it can lead also to the need to close down wards and special units, thereby disrupting the running of hospitals. That will continue until and unless the Minister or his successor recognises that we face a problem of epidemic proportions.
The seriousness of the problem was demonstrated in May 1994 when a military hospital in Cambridge had to be closed for a week. Screening showed that there was a problem at the hospital, and the Ministry of Defence took rigorous preventive measures, including the application of antibiotics. It would be much more difficult to do the same in a national health service hospital; but the incident underscored how seriously the Ministry of Defence took the matter in a hospital for which it was responsible.
I became aware of MRSA after listening, in November of last year, to a moving speech in the other place by my good friend Lord Fitt of Belfast, whose wife, a lifelong sufferer from asthma, went into hospital to be treated for that condition but fell victim to MRSA and subsequently died. He drew the attention of the other place to the scale of the problem and to the hazards that it posed for people with respiratory complaints, people suffering from septicaemia, and in general the weak and the elderly.
More recently, one of my constituents also fell victim to MRSA. On 24 January he was admitted to Basildon hospital with a bad chest infection, later diagnosed as pneumonia. On 5 February his daughter was told that he had MRSA. Being of an inquiring mind and deeply concerned about her father's condition, she found out what MRSA was: that it is a life-threatening condition. She complained that the hospital had not been completely frank with her or explained the seriousness of the problem.
My constituent's daughter also asked whether anyone else had been infected. It was confirmed that a lady had recently been transferred to another hospital in the trust group where screening is performed, even though I understand that it is not done at Basildon hospital. Orsett hospital is in Thurrock; incidentally, the trust has tried in the past to close it down. It is still under threat—just another example, I suppose, of "what we have, quite rightly, we wish to hold".
On 6 February my constituent's daughter was told that her father had been given an antibiotic. She challenged that because the hospital had told her earlier that antibiotics 855 were not available to treat the condition. That caused some consternation at the other end of the telephone line. She was then told that her father was not actually being given an antibiotic to combat MRSA. Further inquiries elicited the information that Basildon hospital did not test for MRSA, as that was considered too expensive.
Unfortunately, my constituent died on 8 February. The death certificate mentioned pneumonia; it did not say that MRSA had made a big contribution to the death.
I did a bit of ferreting around in the Library and discovered that 15 hon. Members, including my hon. Friend the Member for Huddersfield (Mr. Sheerman), who is with me this morning, had already probed the Department about this tremendous scandal, but their efforts had hitherto not been fully co-ordinated; neither had the Government been arraigned for their dilatory stewardship. Furthermore, five Lords besides Lord Fitt, I discovered, had raised the matter in another place.
I then tabled my own questions, the answers to which revealed widespread ignorance on the part of the Minister and the Department of Health about which hospitals screen for MRSA. They had no knowledge of the incidence of the infection in the UK because of the lack of screening; they did not know which hospitals kept antibiotics to combat MRSA; and they clearly did not know the number of deaths in which it has been a contributory factor. I asked the Secretaries of State for Scotland, for Wales and for Northern Ireland parallel questions. Their replies, too, showed the same widespread ignorance of the scale of this epidemic—and breathtaking indifference to it.
The Minister was able to reveal, from the voluntary reporting undertaken by some hospitals, that 177 English hospitals had more than 19,000 patients affected by MRSA last year—up from 2,200 in 1992. But the total incidence of this virulent bacterium was unknown.
§ Mr. Barry Sheerman (Huddersfield)Has my hon. Friend made any international comparisons? One of the frightening things that I have learnt is that some other countries appear to have used antibiotics much more carelessly than we have, and are suffering from an epidemic of MRSA as a result. Cannot we learn from the mistakes that they have made?
§ Mr. MackinlayCertainly, but my charge this morning is that the Department of Health is doing very little in any direction and is indifferent to the size of the epidemic.
My replies from the Minister showed some confusion as well. He said that some new treatment was still at an early stage of development, but he also told me in a separate answer that two antibiotics are effective against all strains of MRSA—yet many hospitals, including Basildon, do not stock them. It appears to be the luck of the draw; someone may be taken to a hospital that has the drug, whereas someone else may not. My constituent's daughter was told that the antibiotics were not available. I suspect that the truth is that there were cost implications. That is the most worrying aspect of all.
From the limited answers that I was able to obtain, it became increasingly clear that while the contagion remained static between 1989 and 1991, it had increased by 8.1 per cent. by 1994. However, by the first half of 1995, it had increased by 13.5 per cent.
I also asked what was recorded on death certificates. My constituent's death certificate did not mention MRSA, and I understand that Lady Fitt's death certificate did not state 856 that MRSA had contributed to her death. Ironically—my question shows how these matters are treated in this country—the Chancellor of the Exchequer had to answer the question on death certificates. I cannot help feeling that that shows that the matter has budgetary implications.
It is clear that, in many of our hospitals, doctors are not fulfilling the conditions and instructions that they are given on completing death certificates. They are charged with giving the primary cause of death, but in the second part of the form they are supposed to say what else contributed to the death. Doctors are not mentioning MRSA, either through ignorance or because they are being leaned on to cover up and keep quiet the fact that the disease contributes to so many deaths. If doctors do not fulfil those requirements, they are not behaving professionally and are vulnerable to litigation. They must be much more frank with the loved ones of people to whose deaths MRSA has contributed.
What is the Minister doing to prevent and contain the spread of MRSA outside hospitals? His Department seems breathtakingly complacent. We know that the disease presents a problem in nursing homes; to pretend otherwise is irresponsible. I understand that the brief that the Minister will read to us in a few moments says that he has issued a leaflet to nursing homes. That is as effective as banging on a door with a wet sponge. It does not underline the seriousness of the problem.
The Department of Health is reluctant to do anything about the problem, because it has budgetary implications for the nursing home service. Moreover, hospitals do not want to recognise the problem because of its budgetary implications. In short, there is a conspiracy of silence. There is wilful ignorance, on the part both of the NHS establishment in Whitehall and of hospitals and other agencies, which do not want to recognise the scale of the problem. Consequently, good people are being put in jeopardy and deaths caused unnecessarily.
When I was ferreting around in the Library, I came across a document that I believe the Department of Health placed there inadvertently. It is a working party report that gives guidelines for the control of epidemic MRSA. It was prepared by Mr. G. Duckworth, secretary to the working party on hospital infection, and it was published in August 1990. I believe that the Department did not mean the document to be in the Library, but meant some other document to be there. Under the heading, "Cost implications of EMRSA", the document says:
Infection control costs are always difficult to assess, but there is general agreement that the costs of ignoring strains of EMRSA are higher than those of controlling them, particularly when the costs of potential legal action are included. Litigation by an infected patient is a growing hazard of MRSA outbreaks in hospitals and it is therefore important to demonstrate that well-documented and effective control measures are implemented.No such effective control measures are being implemented by the NHS. It is an extremely patchy map, and the document goes on to give some of the costs involved.The document also says that great care needs to be taken in ambulances. The information that I have from going round the ambulance service is that the recommended procedure is not being applied by the ambulance service. People will be infected in our ambulances because the Government refuse to recognise the cost implications and the scale of the scandal. It is sometimes hazardous to be in an ambulance where the proper control procedures have not been applied.
857 The document also refers to the fact that agency staff in hospitals may be MRSA carriers. I return to the point that I made at the beginning: there is inadequate screening in hospitals of patients and staff. In hospitals with a high staff turnover—agency staff go from one hospital where they might be screened to another where they are not—the danger of increasing infection is enormous. I hope that people who read our deliberations will demand to see a copy of the document to which I referred. Has the Minister read it? I want to be charitable to him and say that the Department has probably not told him the naked truth about the scale of the problem, and he may not have seen the document until I pursued the matter with his private office.
The real problem is cost. The noble Baroness Cumberlege alluded to that in the debate in another place to which I referred earlier. I implore the Minister to be bold and to understand that failure to recognise the problem and deal with it immediately means that a bigger burden on the NHS is looming. It will be dealt with by another Minister, because the Government will lose the election. I do not wish to speak in a party political manner today; I am simply frustrated at the Government's failure to recognise the big additional burden on the NHS budget. You, Mr. Deputy Speaker, will hear about MRSA time and again, whether or not I am in the House after the election, because the problem will not go away. Whoever occupies the Treasury Bench will have to deal with it.
I cannot help but recall that this Government refused to recognise the problems of E. coli, Gulf war syndrome and, until late in the day and at enormous cost, mad cow disease. MRSA is a problem of similar proportions. It beggars belief that the Department of Health has not addressed it with greater skill, determination and resolve before now.
Hospitals have also tried to keep the problem under drapes and have displayed wilful ignorance. If the debate achieves nothing else, it will flag up to hospital trusts the fact that the possibility of litigation is enormous. The Department of Health, too, will be vulnerable to litigation, because the debate is making it clear on the Floor of the House that this is a large-scale problem. Even if the Department of Health and the hospital trusts do not listen, their insurers will. They must know that there is a significant possibility of substantial damage claims by the loved ones of people who have died as a consequence of the indifference to and lack of planning on combating MRSA. Doctors will be vulnerable to the charge of not behaving professionally if they do not complete death certificates in a full and comprehensive manner, as is their duty.
Local newspaper editors throughout the country must ask their hospitals whether they screen for MRSA and, if not, why not. They must ask whether they follow the isolation procedures set down in documents to be found in corners of the House of Commons Library, rather than being flagged up as instructions to hospital trusts, and, if not, why not. They must ask whether ambulances follow the procedures laid down and, if not, why not. They must ask whether the hospitals stock the appropriate antibiotics and, if not, why not. They must also ask whether the hospital knows in how many instances MRSA has contributed to death and, if not, why not.
What support is the Department of Health giving to Professor Brian Austen of Heriot-Watt university, in developing a new drug to combat MRSA? Has the 858 Department considered new products that I understand are being developed—basically paints and cleaners—that kill all known microbes and, if used within hygiene management programmes, minimise some of the super-bugs such as MRSA?
I am sorry if I have spoken in rather trenchant terms, but in the five years that I have been in the House, I have rarely felt so strongly about what I consider to be an NHS establishment cover-up. I do not charge any one individual, but believe that, nationally and locally, the national health service has recognised the problem, but has been afraid that it will throw its budgets out of proportion and that Ministers and incoming Ministers will be embarrassed. The problem has therefore been swept under the carpet, which is why I called this wilful ignorance.
I appeal to the Minister in his remaining period in office to give forthright instructions to everyone concerned to address the problem. I hope that he will ensure that his successor picks that up after the general election.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Horam)I am glad to have the opportunity to reply to the hon. Member for Thurrock (Mr. Mackinlay), even though he has left me only 11 minutes to do so. He made an extremely concerned speech, on which I congratulate him. The issue causes concern not only to the hon. Gentleman and the hon. Member for Huddersfield (Mr. Sheerman), but to many people outside the House, and rightly so.
It is important to get the matter in perspective. We should acknowledge the problem, but it has existed for many years—indeed, decades. The hon. Member for Thurrock was ill advised to introduce party politics and matters such as E. coli. The problem has existed under both parties in government. It has not arisen overnight—it has been there for decades. I want the hon. Gentleman to recognise that, and I am glad that he is nodding to that effect.
The problem is containable, and the United Kingdom has an excellent record in containing it. The hon. Gentleman said that there was a failure to control the MRSA problem on the part of hospitals and the Department. That is not the case. Infection control is strong in the UK. We are a world leader in the control of MRSA and other infections.
Health authorities require all hospitals to have adequate infection control systems in place, and control teams must coverall facilities. Of course, from time to time, as the hon. Gentleman pointed out in connection with a Ministry of Defence hospital, fairly extreme isolation measures must be taken. They are taken when necessary, and our infection control methods are world leaders.
The hon. Member for Huddersfield spoke about international comparisons. One of the reasons why we are a world leader in the field is that we issue antibiotics only on prescription. Some other countries do not do that. That is one reason why they have epidemics, which we manage to avoid. We keep control at that level as well, not only through what we rightly demand of our hospitals, through the contracts that we impose on them, through health authorities and by other means. The charge of failure to control is ill founded. Hospitals take considerable measures to control the problem and are world leaders in that respect.
859 The matter has been debated before, as the hon. Member for Thurrock knows. The hon. Member for Leyton (Mr. Cohen) raised it in an Adjournment debate in December 1995, and the hon. Member for Newport, West (Mr. Flynn) raised it as part of another Adjournment debate a year later. The issue has therefore been discussed in Parliament. I insist that there is no indifference, ignorance or conspiracy of silence on the Government's part. I am glad to have the matter discussed in the House.
As the hon. Member for Thurrock said, MRSA is a relatively antibiotic-resistant form of the bacterium staph. aureus, which is one of the commonest and most ubiquitous of all the bacteria with which we are surrounded. As many as one in three of us are carrying it—on our skin or in our nose or throat—and normally it does us no harm. It does, however, have the ability to cause infection, which is most likely to occur if the skin is cut or if resistance to infection is lost or compromised for any other reason.
Mostly, the type of infection will be trivial, but for patients who are in hospital, it can sometimes be serious, as the hon. Gentleman noted. Many hospital patients have catheters and drips of various sorts going into their body, which provide an easy route for bacteria such as staph. aureus. Many patients have had operations, so they have a wound that can become infected. Some have poor resistance to infection because of their illness or their treatment, and are vulnerable to serious infection such as septicaemia or pneumonia. Staph. aureus can cause all those problems—a range of infections from the trivial to the life-threatening.
MRSA acts in exactly the same way as staph. aureus and causes the same range of infections. It is no worse than staph. aureus; it is simply a particular kind of staph. aureus. Eight out of 10 people who carry MRSA come to no harm at all. If it does cause an infection, the range of problems is just the same. The infections are no worse than those caused by the ordinary bacterium.
The reason why MRSA is seen as more of a problem is that, if an infection develops, it is more difficult to treat because many of the commonly used antibiotics are no longer effective against it. However, I repeat that the infection is treatable. As I said to the hon. Member for Thurrock, and as he confirmed in his remarks, at least two antibiotics are effective against MRSA.
§ Mr. SheermanWill the Minister comment on the point that my hon. Friend eloquently highlighted: do we know how many people are dying from such an infection, and how many hospitals have a good record or a bad record? There must be public recognition of the extent of the problem. The Minister is playing it down. May we have some facts and figures, and some visibility?
§ Mr. HoramI am about to come to that. First, I should like to say, in response to the hon. Member for Thurrock, that all hospitals will have stocks of the antibiotics necessary to treat MRSA. Whether those antibiotics are used is a clinical decision. I hope that that reassures the hon. Gentleman.
On the extent of the problem, to which both hon. Gentlemen referred, I repeat that it is not new. The media have only recently taken an interest in it, but it has existed for a long time. Official figures from the Public Health Laboratory Service show that the peak of the problem occurred in 1986. I have figures from 1983 to 1996. The 860 problem fluctuates as various strains come and go, as various antibiotics deal with the various strains and as new ones develop. We may be at a higher point than previously, but not as high as a decade ago. The problem is not worse than it has ever been in this country.
To add to the information from the Public Health Laboratory Service, two big surveys were conducted, in 1980 and 1992–93. They show a constant proportion of MRSA in the system. It was no worse in 1992–93 than in 1980.
Let us also get in perspective the number of patients affected. I stated in a reply to one of the hon. Gentleman's questions that there were 2,107 incidents last year in the entire health service. In any one year, 8.4 million people go into the hospital service.
§ Mr. MackinlayThe Minister does not know that, does he? That figure represents only what has been voluntarily reported to him. My complaint is that his Department does not know, because it does not require screening in all hospitals and reporting by all hospitals.
§ Mr. HoramThose figures come from the Public Health Laboratory Service, which, as the hon. Gentleman knows, is a well-established service that serves the needs of hospitals and which they have an obvious self-interest in developing and complying with. There is trust and confidence in the service, which provides us with a reasonable feel for what is happening on the ground floor.
It is not right to say that there is no information. I have given quite a lot of information to the hon. Gentleman. There is a plethora of information, because the PHLS makes weekly and monthly reports on infections such as MRSA. It is unfair of the hon. Gentleman to say that there is any kind of cover-up. A wealth of information is available from a tried and trusted system.
The hon. Gentleman accuses the Department of not doing enough about the problem. We are improving our information. We are piloting a new system of national surveillance, and 40 hospitals in total have taken part. From next month or shortly afterwards, bloodstream infections will be reported. In July, wound infections will be reported. In addition to the extensive information already available, that new information will become available.
There are differing expert opinions on the validity, practicality and worth of large-scale screening. The practical problems are plain. Screening for MRSA requires swabs from different parts of the body on different days. It takes at least a fortnight to go through the testing procedures. If someone is going into hospital for an emergency operation, we cannot tell him to wait for a fortnight while we find out whether he has MRSA. There are practical problems, which the hon. Gentleman should understand.
Where there are vulnerable people in vulnerable wards, screening takes place. That is a good example of a practical approach to deal with the worst of problems. A new national surveillance scheme is to be introduced—
§ It being Two o 'clock, the motion for the Adjournment of the House lapsed, without Question put.
§ Sitting suspended, pursuant to Standing Order No. 10 (Wednesday sittings), till half-past Two o'clock.