Hospitals: Infection Control (Hansard, 8 March 2000)

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of kings Heath)
My Lords, the Government take infection control seriously and have developed a strong programme of measures to ensure that the NHS strengthens hospital infection control arrangements. The most recent steps include the issue of National Priority Guidelines that cite improvement as an essential task for NHS organisations.

Baroness Young
My Lords, I thank the Minister for that reply. However, is he aware not only of the National Audit Office's statement that 5,000 patients die annually from infections, but also that the cost to the health service is £1 billion a year? Is he satisfied that nurses' training includes what most of us regard as elementary precautions on cleanliness and hygiene in hospitals? Is he aware also that nowadays many people say that if we go into hospital we should be sure to take cleaning materials and disinfectant because we will find that the bathrooms in particular are extremely dirty?

§ Lord Hunt of Kings Heath
My Lords, first, I am aware of the figure of £1 billion and the suggestion that 5,000 deaths are caused by hospital-acquired infection. But those figures must be treated with caution. The 5,000 deaths figure was extrapolated from statistics in the United States. It is hard to put a firm figure on the numbers because those who have an infection and die in hospital are often sick with other conditions as well. However, regrettably I accept that some patients die because of an acquired infection. I accept also that the cost to the NHS is considerable in financial terms.
There are two aspects to cleanliness. First, I agree that we need a strong culture in the NHS which ensures that everyone recognises their responsibility to act in the most hygienic way possible. This is a major responsibility for nurses and doctors who set the conditions and tone for everyone else. But over the past few years the NHS suffered also because of the move to compulsory competitive tendering in relation to cleaning services, and undoubtedly that reduced cleaning standards.

§ Baroness Masham of Ilton
My Lords, is the Minister aware that the report stated that some chief executives did not take adequate interest in hospital-acquired infection? Is it not time that infections such as MRSA become notifiable?

§ Lord Hunt of Kings Heath
My Lords, the Chief Medical Officer is at the moment developing a strategy for tackling communicable diseases and will be looking 1043 at a number of areas where we can improve the way in which we approach the difficult problem of MRSA, which was identified by your Lordships' committee a couple of years ago.
The noble Baroness is quite right that the NAO stated that some chief executives were not taking their responsibilities seriously enough. That is why we ensured that the National Priority Guidelines made clear that that must be an essential priority and we remind NHS boards and chief executives of their clinical governance responsibilities through the new standards on infection control issued last November and the health circular issued in February this year. With a programme of action in place to ensure that we obtain effective measures to control and prevent infection so far as it is possible to do so, I believe that we can turn this situation round.

§ Lord Clement-Jones
My Lords, in relation to the question raised by the noble Baroness, Lady Masham of Ilton, is the Minister aware, on a reading of the National Audit Office report, that there had been many previous reports on this matter and that the single issue on which the Department of Health could be most effective is by making things like MRSA a notifiable infection? Or does he prefer—washing his hands of the issue—the theory of the NAO report, that it is the Treasury that failed to provide the necessary resources for infection control? I offer both those theories.

§ Lord Hunt of Kings Heath
My Lords, the single most important way of reducing hospital infection is the determination of those who lead individual organisations at local level to recognise that this is a serious problem. The whole basis on which this Government approach the matter is to make it clear to NHS trusts and their chief executives that this is a matter that warrants their personal attention, that they need proper infection control measures in place at local level and that all staff should be aware of the importance of good cleanliness, handwashing and everything else that will contribute to an effective policy.

§ The Countess of Mar
My Lords, is the Minister aware—I do not suppose he will be—that my mother trained at Great Ormond Street and Guy's Hospital in the 1920s and 1930s? Most of her junior nursing time was spent cleaning, even down to polishing castors on beds. They understood in those days that infection was from cross-contamination. With the introduction of antibiotics those cleaning regimes rather fell off. Now that we have antibiotic resistance, is it not time that scrupulous attention is paid not just to washing hands, but to keeping wards clean and checking that there is no peeling paint, as there is at St. Thomas' Hospital, for example, the flagship hospital of London?

§ Lord Hunt of Kings Heath
My Lords, it is important that cleaning as a service in hospitals is as effective as possible. I have no doubt whatever that in the past decade those standards have not been as good as they 1044 ought to be. We are in the process of reviewing our policy on market testing of support services such as cleaning. We are making it clear in guidelines that those who have to make judgments about support services need to ensure that within the specifications and the judgments as to where contracts are placed, quality and patient satisfaction is as important as cost.

§ Lord Pilkington of Oxenford
My Lords, is the Minister aware that when my wife was in St. Thomas' Hospital two years ago, she had to clean out a bath that was covered in blood?

§ Lord Hunt of Kings Heath
My Lords, I was not aware of that. The noble Lord illustrates a problem that the NHS has faced for a considerable number of years. In tackling the issues of cleanliness in hospital wards, we must ensure that the cleaning services are appropriate. Equally, it is important that ward sisters, who play such a crucial leadership role, have sufficient control to ensure that the cleaning services are acceptable and that they lead by example in terms of personal cleanliness and in ensuring that doctors, nurses and other staff wash their hands and do all the things that are necessary.