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Lord St John of Bletso: My Lords, while welcoming the partnership—
Baroness Farrington of Ribbleton: Order.
Lord Elton: My Lords, I believe that it is our turn.
The more people who benefit and the more swiftly they do so, which is welcome, the more unfair it is to those who do not. What does the Minister propose to do about those who, scandalously, have to wait for four years?
Lord Warner: Well, my Lords, under this Government, some have managed to get digital hearing aids, which is more than was possible under the previous administration. I remind the noble Lord that digital hearing aids were then available only privately for up to
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£2,500 per aid. By the PPP, we have knocked the price down to as low as £55. I do not think that we need too many lectures from the noble Lord.
Lord St John of Bletso: My Lords—
Business of the House: Debates this Day
The Lord President of the Council (Baroness Amos) My Lords, I beg to move the Motion standing in my name on the Order Paper.
Moved, That the debates on the Motions in the names of the Baroness Gardner of Parkes and the Lord Hanningfield set down for today shall each be limited to two and a half hours.—(Baroness Amos.)
On Question, Motion agreed to.
Constitution Committee
House Committee
Science and Technology
Deputy Chairmen of Committees
The Chairman of Committees (Lord Brabazon of Tara): My Lords, I beg to move the four Motions standing in my name on the Order Paper.
Moved, That a Select Committee be appointed to examine the constitutional implications of all public Bills coming before the House; and to keep under review the operation of the constitution;
That, as proposed by the Committee of Selection, the following Lords be named of the committee:
L. Acton, V. Bledisloe, L. Carter, L. Elton, B. Gould of Potternewton, B. Hayman, L. Holme of Cheltenham (Chairman), L. Lang of Monkton , L. MacGregor of Pulham Market, B. O'Cathain, E. Sandwich, L. Smith of Clifton;
That the committee have power to appoint specialist advisers;
That the committee have power to adjourn from place to place;
That the committee have leave to report from time to time;
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That the minutes of evidence taken before the Constitution Committee in the last Session of Parliament be referred to the committee;
That the minutes of evidence taken before the committee from time to time shall, if the committee think fit, be printed.
Moved, That a Select Committee be appointed to supervise the general administration of the House and guide the work of the Management Board; to agree the annual Estimates, Supplementary Estimates and the three-year spending forecasts; to approve the House of Lords Annual Report; and to approve changes in employment policy;
That, as proposed by the Committee of Selection, the following Lords together with the Chairman of Committees be named of the committee;
B. Amos (Lord President), L. Barnett, L. Burlison, L. Hunt of Wirral, L. Lloyd of Berwick, L. McNally, L. Renfrew of Kaimsthorn, L. Sharman, L. Strathclyde, L. Williamson of Horton;
That the committee have leave to report from time to time;
That the reports of the Select Committee from time to time shall be printed, notwithstanding any adjournment of the House.
Moved, That a Select Committee be appointed to consider science and technology and that, as proposed by the Committee of Selection, the following Lords be named of the Select Committee:
L. Broers (Chairman), B. Finlay of Llandaff, L. Mitchell, L. Patel, L. Paul, B. Perry of Southwark, B. Platt of Writtle, B. Sharp of Guildford, L. Soulsby of Swaffham Prior, L. Sutherland of Houndwood, L. Taverne, L. Turnberg, L. Winston, L. Young of Graffham;
That the committee have power to appoint sub-committees and that the committee have power to appoint the chairmen of sub-committees;
That the committee have power to co-opt any Lord for the purposes of serving on the committee or any sub-committee;
That the committee have leave to report from time to time;
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That the committee and any sub-committee have power to adjourn from place to place;
That the committee and any sub-committee have power to appoint specialist advisers;
That the minutes of evidence taken before the Science and Technology Committee or any sub-committee in the last Session of Parliament be referred to the committee;
That the minutes of evidence taken before the committee from time to time shall, if the committee think fit, be printed.
Moved, That, as proposed by the Committee of Selection, the following Lords be appointed as the panel of Lords to act as Deputy Chairmen of Committees for this Session:
V. Allenby of Megiddo, L. Ampthill, L. Boston of Faversham, L. Brougham and Vaux, L. Carter, L. Cope of Berkeley, L. Elton, B. Fookes, L. Geddes, B. Gould of Potternewton, L. Grocott, L. Haskel, B. Hooper, B. Lockwood , L. Lyell, C. Mar, B. Pitkeathley, B. Ramsay of Cartvale, V. Simon, B. Thomas of Walliswood, L. Tordoff, B. Turner of Camden, V. Ullswater.—(The Chairman of Committees.)
On Question, Motion agreed to.
Hospital-acquired Infections
Baroness Gardner of Parkes rose to call attention to government health policies, with particular reference to initiatives designed to reduce hospital-acquired infections; and to move for Papers.
The noble Baroness said: My Lords, "hospitalism" is an interesting word, and one that I had never heard until I looked up the biography of Joseph Lister. This debate today could well be called a debate on hospitalism, the name applied in the mid-19th century to often fatal post-operative infection. "The operation was a success, but the patient died", was the famous saying. Now we have hospital-acquired infection.
In my days as a dental student, we heard much of Lister, known as the father of antiseptic surgery. I was not aware that he was a Member of your Lordships' House, taking the title Lord Lister of Lyme Regis in
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1899. Lister noticed that many people survived the trauma of an operation but died shortly after of what was then known as "ward fever".
Work on ward cleanliness and the link between germs and health was being studied in Hungary, where Dr Semmelweiss argued that if a doctor went from one patient to another without clean hands, the doctor could pass on to the next visited patient a potentially life-threatening disease. He insisted that doctors washed their hands in disinfectant. Deaths of his patients fell from 12 per cent to just 1 per cent, but he was an isolated pioneer and his findings were ignored. Sadly, he himself died of blood poisoning in 1865.
Lister was influenced by his work and that of Louis Pasteur, whose work established the existence of bacteria at about that time. In 1865, Lister was convinced that microbes carried in the air caused diseases to be spread in wards. By disinfecting the air during his operations, the death rate fell from over 45 per cent to 15 per cent.
It is interesting to hear that similar ideas are now being suggested to reduce the spread of MRSA. At lunchtime I saw the announcement on television of just such a machine in modern form, which, the Secretary of State says, will solve the problem completely. Lister introduced strict antiseptic procedures into hospital routine. He washed his hands before operations and cleaned the instruments and dressings. That was when there was a great increase in medical provision, higher standards of nursing, larger hospitals and, with the introduction of anaesthetics, many more surgical interventions. The need to keep germs at bay was clear.
When I trained as a dentist, instruments were usually sterilised by boiling, although some practitioners continue simply to soak their instruments in an antiseptic solution. Injections of local anaesthetic were made by dropping tablets into sterile water, the solution then being drawn up into the reusable syringe and needle. Those were normal procedures. As hepatitis B became a risk, boiling was no longer effective, and dentists had to move to sealed sterile injections and new disposable needles. Autoclaving became the normal form of sterilisation for instruments and dressings. New infective organisms required new precautions.
Penicillin, the miracle drug, widely used by doctors and dentists, was originally effective against staphylococcus aureus infection. In the 1950s, strains of staphylococcus aureus became resistant to penicillin and by the 1960s strains were developing resistance to a stronger antibiotic, methicillin. This resistant strain, methicillin resistant staphylococcus aureus, is now commonly known as MRSA. Almost everyone knows or has heard of someone who has suffered MRSA infection. The stories are harrowing and the outcome too often fatal. The only treatment now is with an even more powerful antibiotic, which has unfortunate renal side effects. Resistance to that, VRSA, is now being reported.
The overuse of antibiotics has been one of the causes of the MRSA problem. Patients demand antibiotics from practitioners, even when they are told that they will have no effect on their condition. Education in those matters of patients and practitioners is very important. I
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am concerned by the commercial promotion at present of all sorts of disinfectants for home use, in washing-up liquid, toilet cleaners, even hand washes. There is a risk that we will destroy the normal immunity that people develop as they contact organisms in everyday life. Homes are not the same as hospitals.
MRSA is now endemic in many UK hospitals. MRSA cases have increased by 600 per cent in the past decade. In 2002, it was the listed cause of 800 deaths, although it was believed that there were probably nearer 5,000 cases. Some London hospitals have seven times worse rates than those in the least affected parts of England.
A family friend, living until recently in Russia, decided to return to England for the birth of her baby. It was an unlucky decision, as she contracted MRSA. The hospital was dirty. She was put into isolation, in a single room with its own bathroom, the floor of which was dirty and stained with blood, not hers. She was extremely ill and separated from the baby for some weeks. Eventually she recovered, but it made her wonder why she had thought England could offer better care than Russia.
Some of the large London teaching hospitals are disadvantaged by the fact that they are tertiary referral centres and patients are sent to them from a wide area. Smaller hospitals cannot handle cases and, concerned by the seriousness of the patient's condition, send them up the line for diagnosis and treatment. As there is a shortage of single rooms where referred cases can be isolated, once a case is diagnosed as MRSA it can necessitate the closure of a whole ward. Tables showing the hospitals with high MRSA infection rates do not make allowance for the fact that many may be referrals.
Medicine has continued to make great progress, but harmful organisms have, too, and dealing with those is the challenge today. Mutation of organisms is a major problem, as we know from the constantly changing HIV virus, for which there is treatment but no cure. There have been many cases of haemophiliacs contracting transfusion-transmitted hepatitis B and C and HIV infections through defective blood products.
The latest risk is of transmission of new variant Creutzfeld-Jacob disease (vCJD). A number of patients are known to be at risk, as some blood donors developed vCJD and died of it after giving blood. Two recipients of that blood have now developed vCJD. The blood products were used particularly for haemophilia cases. An estimated 6,000 haemophilic patients have received blood products from that plasma.
New variant CJD is a major concern for the future, as there is no blood test for the condition and the incubation period remains unknown. The infectious particles are known as "prions". Fortunately, the risk is still considered low and the risk for haemophiliacs is not considered to be more than 1 per cent above that of other citizens.
An interesting incident arose when one of those haemophilic patients needed a gastroscopy and biopsy of his stomach a month ago. It was performed routinely by
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the gastroenterologist, who was then told that the brand-new video endoscope, worth about £35,000, must go immediately into indefinite quarantine. That has compromised the hospital's routine endoscopy service to the disadvantage of many thousands who would have been treated during the planned lifetime of the endoscope. The new rule was implemented without warning or consultation with the gastroenterologists. Was it an over-reaction? The use of recombinant clotting factors for all haemophiliacs would eliminate the risks of transmissible infectious diseases. However, recombinant is still not available for English patients aged over 40.
To prevent transmission of vCJD, some measures have been tried and found to be unsatisfactory, such as the use of disposable instruments for tonsillectomies, now discontinued. It is important to keep a sense of proportion when balancing the loss of the endoscopy service against the possible risk. It is not an easy decision.
Hospital-acquired infections other than MRSA are also widespread, but the remedy is easier to find. Some years ago my husband contracted salmonella and was admitted to an isolation hospital. As no one knew how to cure the infection, he was treated by "shotgun pharmacy": 35 tablets a day. He was the only patient admitted with salmonella; all the others had picked up the infection in other hospitals, where they were being treated for some entirely different condition. The removal of Crown immunity from hospital kitchens has improved standards of hygiene, but food safety remains highly relevant. There are still too many cases of patients developing malnutrition in hospital, making them more vulnerable to any opportune infection.
Hospital standards of cleaning are a matter of great importance in the control of MRSA. It is not just that contract cleaners are used in many hospitals; it is the degree of difficulty that cleaners, whatever pride they take in doing a good job, have in gaining access to the areas to be cleaned. In many hospitals, wards designed as four-bed wards have had an extra bed added. That means that the beds are so much closer together that there is not the necessary physical space for cleaning to be carried out thoroughly. Combine that with the occupancy level—in many cases, it is more than 100 per cent, as hospitals under pressure operate a "hot bed" policy, sometimes using the same bed twice in a day—and you have a recipe for rampant cross-infection.
The National Audit Office says that the best estimate for the cost of hospital-acquired infection or my "hospitalism" is around £l billion a year. Have we returned to the pre-Lister situation? Is it for us to convince all hospital staff of the need to clean their hands between patients by washing or the use of special wipes?
Basic hygiene is of the utmost importance. The human skin is nature's barrier to protect us; when it is pierced by surgery, by accident or by equipment, we are vulnerable. That is why it is much more important for those who are injured or are recovering from surgery to avoid contact with infectious organisms.
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Sterilising equipment and ensuring that cross-infection is avoided in the use of in-dwelling urinary catheters and central venous catheters is essential in minimising the risk to patients.
Recognition of the need for basic hygiene in hospital for patients, staff and visitors remains essential and must be put into practice. Combining those old traditional ways with any new ways—such as the new way suggested today, which, I hope, will prove effective—must help to reduce the prevalence of germs and the risk of infection in the hospital. We will need more detail about the announcement made today, but we must all hope that the new spray control method will play a major part in controlling infection. I beg to move for Papers.
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