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Dr. Julian Lewis (New Forest, East) (Con):
I, too, am concerned about the number of deaths occurring in
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quite major hospitals near my constituency. What role does my hon. Friend see for the HPA in raising standards of cleanliness and in ensuring that barriers to infection are instituted in hospital wards, so that there is better protection?
Mr. Lansley: I am grateful to my hon. Friend for asking that interesting question. The HPA's role is important, but it is essentially about surveillance—discovering the extent to which there is infection and the extent to which it is acquired in hospital, and reporting on the circumstances. However, there is discontinuity between that role and setting out the action plan—what is to be done about the problem. It was the chief medical officer who followed up previous documentation by publishing in December "Winning Ways", his action plan for dealing with MRSA and hospital-acquired infection. It is not the HPA's responsibility to set out how the NHS goes about preventing hospital-acquired infections. I shall not go through everything that the chief medical officer said about spending additional money on research and development, having directors of infection control in each hospital, minimising the use of invasive procedures and reinforcing guidance.
Disappointingly, the Government have not understood that this is fundamentally about good practice and giving patients a basis on which they can make judgments about hospitals and about where they are referred for treatment. People rarely know the infection rates, including those for MRSA, of local hospitals to which they may be referred. Unfortunately, there has to be a scandal before people begin to learn about conditions in their local hospital. It should not be like that. Patients should know such things, which would enable them to exercise choice. We will make such information available, which is a powerful illustration of the way in which the NHS will be incentivised and required to respond to patients' priorities. Hospital-acquired infection rates, particularly those for MRSA, should be routinely published to facilitate patients' decisions about where they wish to have their elective treatment. As a result, hospital management, instead of ticking performance indicator boxes to say that they have a process in place and have appointed a director of infection control, will bring down infection rates.
At the moment, the Government fool themselves and the public by publishing cleanliness standards. In 2003, according to the Government, there were no hospitals with poor cleanliness standards; 78 per cent. had good standards, up from 22 per cent. in 2000. However, 15 of the 20 hospitals with the worst MRSA rates were given a good cleanliness record, so there is no relationship in the Government's mind between cleanliness and the levels of hospital-acquired infection, particularly for MRSA. However, for the public, a high incidence of MRSA is critical to their judgment about whether or not a hospital is clean.
Dr. Julian Lewis:
Surely, if my hon. Friend is right and the HPA's main function is surveillance, he is making a strong case that it has a lot more to do in its new form than it ever had to do in its old form if it is to carry out that function effectively.
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Mr. Lansley: Yes, I am making that point, and that work has to be done in a way that ensures that the agency's responsibilities and those of the Department of Health are meshed together. However, it is not just about the agency's or Department's functions but about managers' response. More research and development is needed so that new technologies can be introduced to support effective infection control. Like many Members, I have been to see people who are working on new technologies, some of which have been piloted in hospitals across the country. Their introduction is urgently needed, and the agency could certainly help with that. We need to make progress on dealing with the problem, because we cannot necessarily resist not only MRSA but VRSA—vancomycin-resistant Staphylococcus aureus.
Dr. Murrison : VRSA is even worse.
Mr. Lansley: As my hon. Friend can substantiate from his medical knowledge, VRSA is very serious. MRSA is a dangerous infection, but at least we have an antibiotic to respond to that threat. However, that antibiotic is not effective against VRSA, so people suffering from it would have serious problems.
Certain things need to be achieved to close the gap between the role of the Department and that of the HPA. On Second Reading, immediately after the Minister in another place, Lord Warner, had spoken, my noble Friend Lord Fowler made a speech about HIV/AIDS and sexual health—there is no one better qualified to make a speech on the subject than him—and he regretted that the Minister had not spoken about the issue, particularly HIV.
Neither did the Minister responsible for public health say anything about sexual health or HIV/AIDS when she introduced the Bill to this House this afternoon.
Miss Melanie Johnson indicated dissent.
Mr. Lansley: I beg the Minister's pardon. She referred to HIV/AIDS, but she did not tell us what the Government were proposing to achieve additionally in relation to it, or about any specific functions that were planned for the HPA in that regard.
In the 1980s, as Secretary of State, my noble Friend Lord Fowler led a powerful, hard-hitting public health campaign. It was about not only HIV but safe sex, and it was intended to be communicated to the wider population and to create peer pressure among young people who might otherwise engage in unprotected sex. It was effective, and it was one of the reasons why, until recently, the rates of HIV infection acquired in the United Kingdom were substantially below those of other countries. From memory, I believe that the numbers in this country were a quarter of those in France.
More recently, however, the incidence of HIV has risen. Indeed, the incidence of acquired infections has risen pretty much across the board. The levels of chlamydia and gonorrhoea infection have more than doubled, and the level of syphilis infection has increased by a staggering nine times the previously recorded infection rate. The HPA's latest update report states that, over the preceding year, there had been a 20 per
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cent. increase in the number of those living with HIV in the UK, and that there had been an increase in heterosexual acquired HIV as well as an increase in the number of people entering the UK from sub-Saharan Africa who were infected with the virus.
The HPA has had things to say in that regard, but will the Government act? The question is whether they will go beyond a national strategy and set out standards to which the NHS has to respond. In terms of the Government's structuring of such matters, that would involve a national service framework for sexual health. In the absence of such a framework, the money that the Government say that they are investing will not necessarily get through to, for example, the genito-urinary clinics and will not help to bring down the time that people have to wait for treatment.
I accept that there are exceptions regarding waiting times. I was at St. Mary's hospital in Paddington today, which continues to see patients virtually immediately—certainly on a same-day basis. However, that is the exception rather than the rule. The average waiting time for treatment across the country has lengthened; it is now between 10 and 12 days, and in some places it is as long as six weeks. That service simply does not meet people's needs. To combat sexual health problems, we must not only provide an immediate service for patients—for whom these are sensitive issues—but minimise the risk of onward transmission and infection. Over the course of weeks, there could be a multiplication of such risks for the population generally. Have the Government proposed such a national service framework? No, they have not, and it will fall to us to do so if they do not.
Tuberculosis—especially multi-drug-resistant TB—is a serious global problem that is rapidly also becoming our problem.
Mr. Francois: I apologise to my hon. Friend for interrupting his flow, but I shall have to depart in a moment to go up to European Standing Committee A, which overlaps with this debate, and I want to put one suggestion on the record before I go. My hon. Friend will be aware that an element of the Bill deals with homeland security, and that the HPA has a potential role in that regard. The paragraph of schedule 1 that deals with staff states:
"The Agency may appoint such staff and on such conditions of service as it thinks fit."
May I suggest, through my hon. Friend, that it might be useful if the HPA were to appoint liaison officers to serve with both the regular regiment responsible for chemical, biological, radiological and nuclear issues in homeland defence and the contingency reaction forces that would need to react to a CBRN incident, so that, in such a dreadful eventuality, HPA liaison staff would be there on the ground with the appropriate military units and would be able to make an initial response that could be communicated back to the agency? We know from experience in other countries that the early identification of a threat is critical to saving lives.
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