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Howe: The alarming spread of MRSA in hospitals

Speech in the House of Lords on the Government's proposals for dealing with methicillin resistant staphylococcus aureus (MRSA) in hospitals.

The House will be indebted to the noble Lord, Lord Ashley, for giving us an opportunity to debate an issue that has very serious implications for patients in the National Health Service. The noble Lord brought the facts home to us most powerfully.

Hospital-acquired infections are no joke. For the individual, their effects vary from mild discomfort to prolonged disability and, in some very serious cases, death. The statistics for such matters are always difficult to collate but, in 2000, the National Audit Office estimated that at any one time about 9 per cent of in-patients had a hospital-acquired infection, which equates to at least 100,000 infections a year.

Apart from the cost to human health, there is of course a significant attendant cost to the NHS itself, a good proportion of which—perhaps a third, according to the PHLS—could probably be avoided by better hospital procedures. Because of that, there is an opportunity cost in terms of beds that could otherwise be occupied by patients waiting for hospital treatment.

Those rather depressing facts form the general backdrop to this debate. If we consider hospital-acquired infections as a whole, MRSA accounts for about a quarter of them. It causes wound and bloodstream infections, which can be particularly serious. Those who are debilitated, sick or who have weakened immune systems are susceptible to it. Anyone who has an open wound, such as a bedsore, or a tube going into their body, is potentially prey to it.

It is not for people such as us, mere parliamentarians—of course, I exempt the medical parliamentarians—to try to tell NHS managers and the medical professions how to do their job. I venture to say that it is not for Ministers to do that either. We know what the NAO has said about how MRSA is transmitted and how such transmission might be better prevented. We can note that with considerable interest. We can welcome the fact that there are infection control guidelines and that CHI will monitor how they are implemented.

The job for the Government is perhaps threefold. It is, surely, to facilitate the compilation of reliable data to enable everyone to be clear about the nature and scale of the problem; to ensure that systems are in place that hold the NHS to account; and to facilitate and encourage research that may one day lead to an elimination of the infection.

On statistics, the Government have made a useful start by making it mandatory for all hospitals to report MRSA infections. The first comprehensive set of annual figures was published last October. What was interesting—and alarming—about those figures was the large increase in the rate and number of infections compared with the old voluntary reporting methods. The statistics also revealed considerable regional variations in prevalence, with London, for example, registering three times the rate seen in the West Midlands. It is clear that, taken as a whole, the UK's record compares unfavourably with that of every other country in the EU apart, I believe, from Greece. That is not a cause for pride, but it is at least a help that we are beginning to get a feel for how extensive the problem is. We have a benchmark.

As we heard, blood infection rates from MRSA vary considerably between hospitals. The rates tend to be higher in the South East and lower in the North. A relatively high rate seen in one hospital is not necessarily a reflection of that hospital's clinical procedures. We must always bear in mind the case mix, the levels of risk typically seen in the hospital's patients and the number of patients transferred from other hospitals or care homes when already infected with MRSA.

It is therefore difficult to compare one hospital with another on a crude basis, but we ought to be able to monitor trends. It is too early to know what progress has been made since March 2002, which marked the end of the first year's mandatory reporting. The noble Lord, Lord Hunt, last month quoted figures that possibly indicated a levelling out of infection rates in the nine months to last September. Since then, press reports have shown a substantial leap in the rates between 2001 and 2002. The PHLS apparently detected a rising trend; the Department of Health, on the other hand, was more cautious in its interpretation.

Whatever trends emerge, it is obviously important that the figures submitted by acute trusts, as in any other area of data-gathering, are subject to audit. It would be helpful if the Minister could tell me how that is being done.

There are still a few antibiotics that can successfully cure MRSA in its more common manifestations. However, as reports come in of bacteria that are resistant even to the last resort antibiotic—Vancomycin—we do not need doctors to tell us that we are living on the edge of a very dangerous precipice. In California, a new strain of MRSA is being spread with alarming ease among healthy people outside hospitals.

Although the bug is currently treatable, the fear is that it will soon acquire resistance. It is welcome that much is being done to disseminate good clinical practice by means of workshops in acute trusts and the publication of manuals. I am also conscious that NICE guidelines for infection control and prevention are due for publication very soon if they have not already been published. It would be helpful to hear about those from the Minister.

More research is needed. MRSA is a scourge affecting just about every country in the world. Can the Minister give any indication of what research programmes are being conducted in the UK, or abroad, in this field? I read recently of some promising work being done at Strathclyde University. It involves introducing water-borne viruses into dressings and stitches. Those benign viruses have been created to target and kill the three most common strains of MRSA found in UK hospitals.

I understand that the initial trials are due to take place on animals and that if those are successful, studies on patients could be conducted within three years or so. The particular technique has been patented by the university and may have many other applications in combating infectious diseases.

Research is long term and its results uncertain. Nevertheless, I am sure that it is essential for there to be no defeatism about MRSA. A report by Eurosurveillance, a body funded by the European Commission, stated unequivocally that, "it is possible to suppress and prevent MRSA from becoming endemic in hospitals".

It then cites the rigorous isolation procedures in force in Dutch hospitals, which have notched up an impressive record in preventing the spread of MRSA once detected. It is good to see such an authoritative body being so categorical and positive.

But positive thinking should never be obscured by false expectations. The public should not be led to believe—as I fear that they have been—that salvation lies in improving standards of hospital cleanliness. As the noble Lord, Lord Clement-Jones, said, it is striking that 13 of the top 20 worst offending trusts for MRSA received the highest cleanliness rating. Hospital cleanliness is vital, but there is no direct correlation between the general standards of cleanliness on wards and the prevalence of MRSA, and Ministers should not allow anyone to believe that there is.

The direction of travel that the Government have charted for the NHS will enable difficult problems such as MRSA to be tackled even more effectively. I refer to the drive towards greater local accountability, the devolution of budgets and, in particular, the foundation trusts. Best practice must be disseminated, but it will make its presence felt most effectively if hospital doctors, nurses and managers claim ownership of it and can see its direct relevance for them, for their hospital and for their patients.

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