Health Bill

I accept what the hon. Gentleman is saying, but it was making the surveillance mandatory that led to increased reporting, because the information was required to be reported. That raised the reporting of the infection to a different level. We need to remember that people who die with MRSA are often already seriously ill with another condition. It is therefore difficult to say with any certainty whether they would have recovered from their underlying condition if they had not acquired the infection. However, none of the brief discussion that we have just had should distract us from the seriousness of the issue. I am grateful to my hon. Friend the Member for Stafford (Mr. Kidney) for taking the time to visit his local hospital. I am pleased to say that the ““Clean your hands”” campaign to which he referred has had a 100 per cent. sign-up in the NHS. It has been taken up very rapidly. My hon. Friend also described the board level buy-in at Stafford, which is essential if the whole organisation is to take on the change of culture necessary to reduce bacteraemia levels. My hon. Friend also asked us to consider the relationship between hospitals and care homes, where more screening could perhaps usefully be developed. We accept that screening works, and we are trialling ways of determining how a patient should be managed, having used the screening to identify whether they have a health care-acquired infection. Those trials are taking place in three different trusts, one of which is being sponsored by the Department of Health. We shall get the results in September 2006, and they will enable us to learn a lot about how trusts should respond to screening, having applied it. A study carried out in Oxford showed that more than 90 per cent. of those diagnosed with an MRSA infection had had previous contact with the health care system and might have contracted the infection during their earlier treatment. All of this highlights the complex nature of the problem that we are grappling with. I am grateful to the hon. Member for Westbury for his acknowledgement of the improvements in the code, and I accept that further improvements could probably be made. However, I want him and his hon. Friends to think carefully before pressing the amendments to a vote if they feel tempted to do so. As we discussed in Committee, amendments such as these would introduce inappropriate detail into the Bill, raising expectations and giving the impression that certain measures were more important than others. For example, hand hygiene and the decontamination of instruments are not mentioned in the amendments, but they are of equal importance. All aspects of infection control must be taken seriously and implemented if the fight against health care-associated infection is to be successful. However, I recognise that the amendments are the result of real concerns and I will try to allay those worries in the course of my speech. Clause 13 inserts three new sections into the Health and Social Care Act 2003. Amendment No. 12 would add eight new paragraphs to section 47A. The first of these, proposed new paragraph (c), is aimed at ensuring that each trust has a director responsible for"““cleanliness and health care associated infection control””." While I understand the aim of trying to clarify lines of responsibility, this proposal could compromise the role of the director of infection prevention and control. The code of practice—hon. Members might like to refer to pages 5 to 7 of the draft—will require an NHS body to establish appropriate management systems and the appointment of a director of infection prevention and control. As my hon. Friend the Member for Stafford pointed out, most hospitals now do that, and all health care providers will do so as a result of this code and the one that will follow it, which will allow regulation to the same standard that applies in the independent and voluntary sector. In response to proposed new paragraph (d), which aims to ensure that the senior infection control nurse reports directly to the"““Director responsible for cleanliness and health care associated infection control””," I would like to point out that the draft code already gives the director of infection prevention and control—that is a long title, but I cannot think of any way of shortening it—responsibility for the infection control team. Proposed new paragraph (e) suggests that the code should specify the action that the trust director and board must take concerning ward closures when they receive an adverse report. I genuinely believe that that is too prescriptive. The code, as it is written, will require an NHS body to have criteria for advising closure and have arrangements in place for redirecting admissions. It is not that we think it unnecessary to bear these things in mind, but the amendment is too prescriptive in that sense. The policy will be developed with input from the infection control team locally, so local policy will reflect local circumstance— but while it is important for us to have a policy, we do not want to prescribe the content from the centre. I think it was the hon. Member for Windsor (Adam Afriyie) who said that we should resist the urge to be too prescriptive, and I commend his comments to his colleague. People on the ground should be allowed to make such decisions with the benefit of their local knowledge. Paragraph (f) is intended to ensure that there is pre and post-discharge surveillance for patients undergoing surgical procedures. We agree that both kinds of surveillance are beneficial, and the code of practice will encourage NHS bodies to introduce them. However, we will not make them mandatory at this stage as there are significant technical barriers, with which I shall deal shortly. I direct Members to page 17 of the draft code on surveillance. Paragraph (g) is linked to amendments that were tabled and discussed in Committee, and I have had a conversation with the hon. Members for Westbury and for South Cambridgeshire about the code. The paragraph implies that it should contain requirements relating to the number of infection control nurses. I do not want to include such requirements in a code dealing with infection prevention and control. I think that infection prevention and control should be everyone’s business; it should not be left to a cohort of infection control nurses. Setting a ratio of specialist infection control staff to beds, rather than challenging the culture in the organisation, will encourage people to see the job as one to be performed by those people alone. Appropriate management and clinical governance systems are required, and that will be dealt with by the code of practice. Paragraphs (h) and (i) suggest that there should be requirements relating to isolation facilities, and that standards relating to cleaning services should be defined. Pages 6 and 7 of the code deal with those suggestions. I can, I hope, reassure the House that the code will cover important matters of that kind. The draft code already requires NHS bodies to ensure that they have adequate isolation facilities to prevent the spread of infection. ““Adequate”” should not be interpreted as a dismissive term. It means what it says: it means enough to deal with the circumstances that might arise. The draft code also requires NHS bodies to have a cleaning plan giving details of the standards of cleanliness needed in each part of their premises. While I accept the strength of the arguments advanced in Committee and today, I feel that the code strikes the right balance, although we will keep it under constant review. Paragraph (j) suggests that the code should require hospitals to record infection data by clinical department. We agree that analysis of surveillance by clinical department brings considerable benefit, and we now collect information on MRSA bloodstream infections by specialty in trusts. Enhanced surveillance allows us to do that. The code will encourage the NHS to undertake such analyses in the context of a range of organisms. We have been criticised for not proceeding with work on post-discharge surveillance. Let me explain the practical problems. Believe it or not, there is currently no agreed definition of wounds. There is a lack of computer access when it comes to visiting patients outside health care institutions, and not all health care providers have full access to patient records. That applies to, for instance, midwives visiting women who have had caesarean sections. Notwithstanding those problems, we are working with experts on plans to improve the position. I hope that the hon. Gentleman accepts that we take the points that he and his hon. Friends have made seriously. We are working to make the code flexible and proportionate, and also to make it reflect the concerns that have been expressed. Although the amendment expresses reasonable anxieties, I consider it unnecessary and hope that the hon. Gentleman will accept my reassurances. Amendments Nos. 35 and 37 would also include inappropriate detail about the code of practice in the Bill. Including their requirements in the code would present practical difficulties in relation to enforcement. We have been working hard with the Healthcare Commission to ensure that the code is enforceable—an issue raised by the hon. Member for Westbury—and we are concentrating on the outcomes that really matter. On clothing, the bottom line is that NHS staff have clean, hygienic uniforms. Clause 4(g) of the code as drafted includes the following requirement:"““Every NHS Body must ensure that Staff uniforms are clean and fit for the intended purpose””."