HL Deb 11 March 2003 vol 645 cc1232-5

3 p.m.

Lord Ashley of Stoke

asked Her Majesty's Government:

How many hospital patients have (a) become seriously ill or (b) died as a result of methicillin resistant staphylococcus aureus (MRSA) in hospitals in each of the past five years.

The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)

My Lords, the mandatory reporting of MRSA bloodstream infections started in April 2001 and provides the best data on serious infections. From April to December 2001 and January to September 2002 there were 5,471 and 5,380 reports respectively.

Although routine mortality statistics do not provide data on MRSA, a recent research study found that in 1998 MRSA was reported as the underlying cause of 114 deaths and as contributing to a further 284 deaths on death certificates in England and Wales.

Lord Ashley of Stoke

My Lords, this Government have done far more on MRSA than any previous one. But does my noble friend agree that, despite that, the growth of this so-called superbug is a real threat to our hospital system, especially as we seem to be entering a new phase in the battle between bacteria and antibiotics? Does he agree that the requirements are, first, for a change in hospital management of patients, secondly, for more cash to be provided on top of that which the Government have given already—I appreciate that—and, thirdly, for pressure on the pharmaceutical companies, which are not doing anything like the kind of research on new antibiotics that they should be doing?

Lord Hunt of Kings Heath

My Lords, my noble friend is right to point to the seriousness of the problem, which affects almost every healthcare system throughout the world. Certainly, we are very concerned to make sure that we take effective action. The Chief Medical Officer has produced an infectious disease strategy. We require local action to be taken by the NHS. We are making sure that, with statutory reporting of MRSA, there is a baseline on which to judge improvements and progress by individual trusts. I agree with my noble friend that it is very important that we should invest in research in this area.

Lord Clement-Jones

My Lords, my honourable friend Paul Burstow has pointed out that a survey of hospital infection control teams showed that they believed that they were severely under-resourced in tackling superbugs such as MRSA. Does the Minister accept that further resource is needed and will he and his colleagues rectify the situation?

Lord Hunt of Kings Heath

My Lords, we have put specific funding into infection control initiatives. But this is such an important and core part of the provision of services that it is right to look to individual trusts to invest sufficiently of their own resources in both infection control teams and the other actions needed. Principally, that is ensuring that all staff in every hospital are aware of the seriousness of the issue; that they are aware of the need for good cleanliness; that there is audit of the figures for MRSA and other HAI infections when those figures become available; and that there is strict action to try to reduce the number of those infections.

Baroness Gardner of Parkes

My Lords, is the Minister aware that the problem of MRSA goes wider than the hospitals and that the infection is now occurring in the community? I have already tabled a Question on this subject, but the noble Lord's answers today lead me to think that he might be covering it. Is he aware that there is a great need for guidance? My own GP has had two cases in his surgery. He claims there is insufficient guidance as to how to deal with diagnosis and disinfection of the premises, which is important in general practice as it is in hospitals.

Lord Hunt of Kings Heath

My Lords, that is a fair question. There is no doubt that there is a need for guidance for those working in community and primary care. The matter has been referred to the National Institute for Clinical Excellence. We expect it to publish guidelines in the spring of this year.

Lord Chan

My Lords, does the Minister agree that we also need to work on the prevention of such infections? That starts in primary care, with general practitioners being reminded of how to use antibiotics. Is there any guidance on that to remind GPs?

Lord Hunt of Kings Heath

Yes, my Lords. There is continuous guidance to GPs in that area. I must pay tribute to the House of Lords Select Committee report on antimicrobial resistance, which has informed government action in this important area. It is also worth informing the House that while much can be clone to tackle the infections, the evidence is that not all infections can he prevented. The study that I have seen suggests that perhaps between 10 per cent and 30 per cent of infection could be avoided through strengthened arrangements for prevention and control. But there is no doubt that this represents a formidable challenge to healthcare systems the world over.

Earl Russell

My Lords, does the Minister agree that one cannot watch hospital staff, and particularly nursing staff, at work without becoming aware that they are desperately overworked? Therefore, laying on them extra responsibilities, however urgent, must raise a consideration of staffing levels.

Lord Hunt of Kings Heath

My Lords, I pay tribute to nurses and other staff working in the National Health Service. There is no doubt that they work under considerable pressure. I am glad to report to the noble Earl that we are seeing increases in the numbers of nurses and doctors working in the health service. We have increased the number of training places. Over the next few years, I confidently expect even more members of staff to enter the health service, which I hope will relieve the pressures identified by the noble Earl.

Baroness Masham of Ilton

My Lords. is the Minister aware that many people have queried the fact that when MRSA is a contributory factor to death. it has not been written on the death certificate? What consultation are the Government having with coroners regarding that matter?

Lord Hunt of Kings Heath

My Lords, the noble Baroness will know that more general work is being undertaken by the Home Office in relation to coroners. I shall pass on her comments to that department. There is a problem about the recording of deaths on death certificates. It may well record the illness of very ill patients and not mention the impact or involvement of MRSA. There is no doubt that that is a problem in identifying the number of deaths. The Office for National Statistics is currently undertaking a survey of deaths. I hope that that will provide more accurate information in the future. In addition, the WHO has recently recommended introducing codes for antibiotic resistance from 2006. I hope that will provide better data for the National Health Service and other healthcare systems.

Lord Dubs

My Lords, does my noble friend agree that one of the crucial aspects is prevention of the infection once it has entered a ward? The way to deal with that is through the training and supervision of all the staff working in the wards.

Lord Hunt of Kings Heath

My Lords, I agree with my noble friend. That is where the infection control teams play such an important role. It is very important that emphasis is placed in staff training and continuous development on the need for good practice in the ward and other clinical areas. It is also important that those messages are repeated.

Earl Howe

My Lords, what assessment has been made regarding the prevalence of MRSA outside hospitals, particularly in care homes, and what risk does that pose for the importation of this infection into the health service?

Lord Hunt of Kings Heath

My Lords, I am aware of the issues reported in relation to care homes. There are no centrally held statistics on care homes and the admission of patients with MRSA or indeed other hospital-acquired infections. We have not received evidence of refusal to take patients because hospital-acquired infection is a significant problem. I accept that we need to check out that issue. I also believe that as local action plans are taken forward it is important that factors affecting care homes should be taken fully into consideration.

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