House of Commons
Tuesday 23 January 2007
The House met at half-past Two o’clock
[Mr. Speaker in the Chair]
Oral Answers to Questions
The Secretary of State was asked—
The Government and the Scottish Executive are working closely together to ensure maximum participation in the combined elections on 3 May.
As my hon. Friend knows, leaders of all the major political parties have urged a high turnout in the May elections. Will he redouble his efforts and, in particular, seek the help of the media to explain to their readers and viewers why it is so important that they turn out on 3 May to ensure that they get the Government they deserve?
My hon. Friend raises an important matter. The upcoming elections are vital for Scotland’s future, and I hope that in the run-up to the elections the key issues at stake will be given a good airing in the media. At stake are two different visions of Scotland. One is of a confident Scotland playing a full role in the United Kingdom, continuing to invest in schools and in skills, and continuing to address the big challenges that face our country in the 21st century. The other vision of Scotland’s future is one mired in years of constitutional wrangling, with uncertainty about what our currency will be and who will set the monetary framework, with Scotland isolated from our key allies, out of the European Union and completely irrelevant. It is a big election and there are big issues at stake.
The Minister knows that in normal democracies, debates play a major part in encouraging turnout of voters. The Secretary of State for Scotland regularly appears on television debates instead of the First Minister, who seems unwilling or unable to take part. Will he encourage Jack McConnell to stop running away and take part, at least between police interviews?
The hon. Gentleman’s leader had the opportunity to be in the Scottish Parliament and debate with Jack McConnell every day of the year, but he chose to run away from the Scottish Parliament to come here to lead a rump group. Now he wants to go back, but he wants to stay as an MP here. He wants to be a Member of the Scottish Parliament for a constituency and he wants to be on the list. The elections are not just about debates on television. They are about real, substantive issues, a vision of a Scotland that would be isolated under him, which would not have its own currency, which would not set its own monetary policy framework, and which would be isolated in Europe because his party would take us out of the European Union. His party has no clue how to address the great big challenges facing Scotland today. That is why, once again, as in every single election, it will be rejected by the Scottish voters.
One of my concerns about the upcoming Scottish elections is that many of the migrants from various parts of the European Union working in Scotland may not be aware of their right to vote and the need to register to vote. What discussions has my hon. Friend had with the Scottish Executive to ensure full participation for all those legally living, working and paying taxes in Scotland?
My hon. Friend raises an important issue. When we passed the Electoral Administration Act 2006, there was great concern about how we would make sure that the new migrants in the country from Poland and elsewhere in the EU who are entitled to vote in these elections would be made aware of the fact that they could vote and would be encouraged to be put on the electoral register. That is why we have given additional financial support to electoral registration officers to drive up registration and to put out information in other languages, including Polish, so that all those who are living in Scotland and making a financial contribution to Scotland, and who are entitled to vote in the elections, get the opportunity to do so.
The Scottish Executive and the Scotland Office published their response to the Arbuthnott Commission today. I find both responses disappointing. Does the Minister share my consternation that the Scottish Executive should dismiss the Arbuthnott Commission’s recommendation to split the Scottish parliamentary and local government elections, without presenting any evidence that that would increase turnout, whereas all the evidence shows that it will increase confusion? Does he agree that the Scottish Executive and his Government are showing contempt for the people of Scotland by bringing about two major electoral changes on one day?
I am disappointed that the hon. Gentleman is disappointed. We have taken one of the key recommendations from the Arbuthnott report to combine the ballot papers in the Scottish Parliament elections, so that Scottish voters are not presented with one ballot paper for the first-past-the-post constituency and another for the regional list, which did generate some confusion. We have worked hard with the Electoral Commission and others to produce a design that would be colour coded and make things as simple as possible when people cast their vote. The decision on the date of the local elections is entirely a matter for the Scottish Executive, but I share their view that combining the elections on the same day will help turnout.
Does the Minister accept that voter participation is not just about the number of people who turn up at the polling station but the number of validly cast votes? What level of improperly cast ballots is unacceptable? Will he and the Scottish Executive move away from the system that they, along with their Liberal Democrat chums, foisted on the people of Scotland?
It is important to distinguish between a genuine mistake when filling in a ballot paper and voter fraud, to which I believe that the hon. Gentleman refers. There is no evidence of significant voter fraud in Scotland. If he has any, he should present it. We included provisions in the Electoral Administration Act 2006 to combat voter fraud. I remind him that he spent a large part of his career as a member of the Social Democratic party, which promoted the single transferable vote system.
Does my hon. Friend agree that, given the new electoral system for the local government elections in Scotland, we should do everything we can to ensure that it is publicised as widely as possible so that we get the maximum possible turnout?
I agree. The Electoral Commission has a key role to play in that. It recently made three significant grants available to: the Leonard Cheshire foundation, which helps ensure that people with disabilities can vote; Outside the Box, which helps those with learning disabilities, and the Council of Ethnic Minority Voluntary Sector Organisations. We want to ensure that everyone in Scotland, regardless of creed, colour and disability, can participate in the elections. It is also important that Members of Parliament do our bit to ensure that as many people as possible are registered to vote. We must encourage our councils and electoral registration officers to undertake that. We have a clear vision: everyone who is entitled to vote must be allowed to do so, and there must be minimum fraud and the highest possible turnout.
There is concern in all parties about low turnout among young people in elections. Next May, for the first time in Scotland, 18-year-old candidates, including the Liberal Democrat challenger in the First Minister’s constituency, will stand for election. I hope that the Minister and the First Minister welcome the implementation of that new law. When will the Government take the next step and encourage more young people to play an active part in the political process by introducing voting at 16?
First, the hon. Lady could have said that it is a reform introduced by the Government that allows 18-year-olds to stand as candidates. That provision did not fall out of a clear blue sky. It underlines our commitment to engaging with young people and ensuring that they play a full part.
The Electoral Commission has done a great deal of work on voting at 16. Opinion is evenly divided about whether that is a good idea even among 16 and 17-year-olds. I am not especially attracted to the proposal, but we can keep an open mind on it. I stress that, for young people, the vision of Scotland that invests in them, their future and education and skills will contrast with a vision of Scotland that mires us in years of constitutional argument so that, in the meantime, any business thinking of investing in the United Kingdom will not choose Scotland. That is not a good future for young people.
Does my hon. Friend agree that the best way in which to encourage people to get involved in the democratic process is to demonstrate the importance of politics and how it enhances the quality of their lives? I am sure that he will take every opportunity to remind the electorate of what the Scottish Labour Government have done for the people of Scotland.
I certainly will. I shall specifically consider the performance of the Scottish education system, which has long been acknowledged to be excellent. Thanks to our additional investment in schools, and the strength of the UK economy, which has allowed the Scottish Executive to increase investment in schools massively, we have even better results. We now need to move forward to consider, for example, skills and skills academies, which will be to the fore on Labour’s agenda for the future of Scotland. We have an optimistic vision for that future, in which young people will be encouraged to stay and play a full part.
On average, correspondence from the First Minister to the Secretary of State for Scotland has been sent within the 20-day target time scale set by the Scottish Executive.
That is a most illuminating answer. On 6 November 2006, I wrote to the First Minister to ask how many people waited more than six months for a national health service operation, in breach of the Government’s guarantee. I appreciate that the question might be embarrassing for the First Minister, but, despite a chasing letter, I have yet to receive a reply. Is not that shameful?
I understand that the Health Minister in the Scottish Executive has written a reply to the hon. Gentleman, in which he apologises for the delay in responding to him. He also points out that waiting times and waiting lists in Scotland are falling, that the number of patients with a guarantee waiting more than 18 weeks is the lowest ever recorded, and that deaths from cardiac disease, cancer and stroke are all falling after years of increasing. Those things have not happened by accident. They have happened because the UK Government made available to the Scottish Executive record sums of money to invest in the health service, yet the hon. Gentleman voted against every penny—
Is it not the case that the Scotland Office has sent a pitiful 350 official letters since 2005, while receiving, on average, seven letters a day from a concerned and anxious public? Does the Minister think that that represents good value for money? Will he explain what exactly is the point of the Scotland Office, given this overwhelmingly burdensome activity?
Given that some of those letters are from the hon. Gentleman and his hon. Friends, he is adding to the enormous burden of work that the Scotland Office has to do. All appearances to the contrary, the Scotland Office is a remarkably slim and lean organisation. If the hon. Gentleman looks across Whitehall and across the devolved Administrations, he will see in the Scotland Office a highly efficient organisation that carries out its activities in a very efficient way.
I have regular discussions with ministerial colleagues on a range of issues. As my right hon. Friend the Secretary of State for Trade and Industry confirmed to the hon. Gentleman last week, the lack of gas infrastructure west of Shetland is a key constraint on present development. We have established a group from industry and Government to work together on that. In addition, we have changed the licensing scheme to encourage development. About 60 blocks have been licensed, and activity is under way.
I thank the Secretary of State for that answer. The whole country benefits from developments in the North sea, and the Scotland Office should be well placed to impress upon the Government just how much high-tech industry and how many manufacturing jobs are developed on the back of such activity, and exactly what the export potential is. It is crucial to find new provinces and to open up new fields before we decommission the old ones. In his answer to me last week, the Secretary of State for Trade and Industry spoke a lot about the problems of getting the oil out, but the crucial factor in the west of Shetland basin is the need to get the gas fields together. It is the cost of bringing together the small gas fields that is inhibiting production.
I am certainly happy to reiterate the hon. Gentleman’s points to my right hon. Friend the Secretary of State for Trade and Industry. The hon. Gentleman is right to acknowledge the significant potential west of Shetland. It represents about 17 per cent. of the UK’s remaining oil and gas reserves, and presents a considerable challenge, on which the Government are working with industry.
I hear the claim that Norway should be a lodestar for us in using that finite commodity more effectively. Norway has about twice the UK’s oil reserves, yet Norwegians pay a higher top rate of tax, a higher basic rate of income tax, higher VAT, higher employers’ national insurance contributions and higher duties. That is something that the whole House should consider.
My right hon. Friend the Secretary of State and I have regular discussions regarding immigration matters, but we have had no discussions on those issues with the European Commissioners.
I do not have those figures here, but I am happy to write to the hon. Gentleman with them. Scotland and the Scottish economy have benefited from the inward migration of people from the accession states. Scotland has near record low levels of unemployment and near record high levels of economic activity. That situation never occurred during the 18 years when the hon. Gentleman’s party was responsible for the economy.
When my hon. Friend does meet the Commissioners to discuss immigration, will he emphasise the tremendous benefits that we have gained from the immigrants who have come to work in Scotland from the EU accession states? Will he also raise with them the need for a speedy implementation of the temporary workers directive, because it is clear that, in some parts of Scotland and elsewhere, the people who are coming in are being forced to work under certain conditions because they are in gangs? They are not getting proper holiday pay, sickness pay or pension benefits. The only way to ensure that such people are not exploited is to have the same rules for everyone, so that every temporary worker and everyone coming in from elsewhere in the EU works under the same conditions as UK employees.
My hon. Friend is right to point out the economic contribution that individuals from the A8 countries are making in Scotland. They are entitled to the same employment protection as everyone else, including rights to the minimum wage. It is important that those workers receive the minimum wage and are not used to undercut wage rates throughout Scotland. He mentioned the issue of gangs, and he is sitting beside our hon. Friend the Member for Paisley and Renfrewshire, North (Jim Sheridan) who, through his gangmaster legislation, has done more than anyone else to highlight the issue, for which I pay tribute to him. It is absolutely right that people coming into this country are treated fairly and on a level playing field with everyone else.
How would the Secretary of State find time to meet European Commissioners when he is so busy standing in for the First Minister in debates on Scotland. Has not the reality of Scotland’s European representation been laid bare by the leaked memo from the head of the European office of the Scottish Executive, which says that UK Departments ignore Scottish representations, that Scottish Ministers have to wait outside the Council of Ministers while decisions are made and that,
“Scotland no longer has a hard-hitting voice within Cabinet”?
Is that a reference to the Secretary of State, or just to the reduced status of his office?
I am delighted that the hon. Gentleman has raised the issue of that report, which gives me the opportunity to read out its conclusion—[Interruption.] He would do well to listen to this. It states:
“Scotland’s voice in Europe is stronger as part of the UK. As one of the big 4 Member States within the EU, the UK is a very powerful player. There is no more effective a position for Scotland than having one of the most influential Member States representing Scotland’s interests within all 3 of the EU institutions.”
His argument is completely demolished.
For once I can agree with the Minister. Can he shed a little light on the lack of clarity in relation to the future role of European Commissioners in respect of immigration and all other issues in Scotland if it were torn out of the United Kingdom, and if it had to reapply, as it surely would, for EU membership?
It is entirely clear that if Scotland were to secede from the member state country, it would secede from the European Union, and would have to reapply. The French have recently altered their constitution to show that Scotland would not be allowed back in the EU unless there was a yes vote in a referendum in France. We would therefore be handing over Scotland’s future membership of the EU to the French electorate. Even were that not the case, the hon. Member for Banff and Buchan (Mr. Salmond) proposes to take Scotland out of the common fisheries policy, which means that he would not even be at the Fisheries Council to take part in such discussions. Twenty-five countries would be debating the common fisheries policy in one room, and he would be in the next room, talking to himself. I know that he is never happier than when talking to himself, but that will do Scotland no good at all.
Military Bases (Security)
I have regular discussions with my right hon. Friend the Secretary of State for Defence on a number of issues.
Scotland has a proud tradition of peaceful protests, and I have taken part in many for causes in which I believe, not with the sole purpose of getting arrested for a cheap photo opportunity. Does the Secretary of State agree that the recent irresponsible conduct of some MSPs, who say that they aspire to run our country, has been not only a waste of police time but has deprived some of our poorest communities of the increased police presence that they richly deserve?
I recognise, as does my hon. Friend, the right to peaceful protest. Those elected representatives who organised some kind of pantomime arrest at Faslane should answer to their constituents as to whether they regard that as a good use of police time when we face challenges such as antisocial behaviour, and not least when the police have been given new powers to deal with such issues, notwithstanding the opposition of some parties represented in this Chamber.
Has the Secretary of State had discussions with the Ministry of Defence about the so-called Trident tax and its possible effects on the MOD budget and therefore on security in military bases in Scotland? [Interruption.] If so, did he consider whether the tax might be illegal, and whether it was in fact pointless to impose any tax, because any taxes collected would result in cuts in the Scottish Executive budget in the long run? [Interruption.]
Order. I must tell members of the Scottish National party that it is only courteous to allow hon. Members to be heard in the Chamber. That also applies when Ministers are replying. [Interruption.] I am trying to put the case against intervening, and there is the hon. Member for North-West Leicestershire (David Taylor) opening his mouth. That does not help.
The story that appeared in the Scottish newspapers at the weekend about the so-called “tax on the taxpayer” tells us far more about Opposition parties’ desperate need for headlines than about any serious attempt at policy-making. Once again we have a party that, while professing to want independence in Europe, seems intent on ignoring European Union law.
Green Energy Generation
Since 1999 the Government have committed £29 million to the research and development of marine energy technologies. In addition, we have created the marine renewable deployment fund with a further £50 million allocated to help projects move from the research stage to demonstration. Moreover, we have invested in infrastructure. That investment includes £15 million for the European Marine Energy Centre in Orkney, a dedicated test facility for wave and tidal technology developers.
In the normal course of events, we discuss such matters with the Scottish Executive. However, it is entirely consistent to recognise in statute—as the Bill will—the considerable change described in the Stern report and other academic studies of the science of climate change.
I pay tribute to the labour-led Executive in Scotland. They have taken a pioneering role, particularly in relation to renewables, and recognise not just the challenge but the responsibility to develop such technologies in the years ahead.
The Secretary of State will be aware of the immense potential for tidal energy in the Pentland firth and, indeed, other remoter areas off the coast of Scotland. Is he also aware that one of the potential barriers is the lack of transmission capacity? Does he agree with the many experts who now believe that an undersea interconnector would be a more effective way of reducing the lack of transmission than pylons?
A number of technical challenges will need to be overcome in what is still, at this stage, a relatively immature technology. The main challenge is to move that technology forward. I assure the hon. Gentleman that all such matters are given due consideration. They have been dealt with in discussions that I understand he has had with my hon. Friend the Under-Secretary of State, and also in other discussions that take place in Government, particularly with the Department of Trade and Industry.
My right hon. Friend the Secretary of State and I have regular discussions with Home Office Ministers on matters that affect Scotland.
When the Minister next meets the Minister responsible for immigration, will he convey to him the revulsion that is widely felt in Scotland at the practice of dawn raids, especially when children are involved? It is now matched by the revulsion at a new practice involving the luring of children and whole families to immigration offices for signing-on purposes.
If the Minister will not listen to the people of Scotland, will he listen to the United Nations Refugee Agency, the United Nations High Commissioner for Human Rights, Amnesty International and the Commissioner for Children and Young People in Scotland? They all deplore the practice as well.
Absolutely no one wants early-morning removals to continue. They can only ever be justified as a last resort, when families and individuals have been invited to leave over and over again, when they have been offered financial assistance to leave over and over again, and when they have refused to leave over and over again. If we are to have an immigration and asylum policy that has any meaning at all, we must reserve the right as a nation to say no to some people, and if they refuse to go we must reserve the right to remove them by force if necessary. I do not want to see that happen. I want to see a situation, which we will have under the new asylum model, where decisions are made much more quickly, one caseworker works with individuals throughout their case, and individuals, when they have exhausted their appeals and are invited to leave the country, actually leave.
Communities and Local Government
The Secretary of State was asked—
The pre-Budget report stated that Sir Michael’s report would be published around the time of the Budget 2007. In developing the White Paper, the Government took full account of his work to date on the future role and function of local government. That included in particular his discussion paper on the future role and function of local government, national prosperity, local choice and civic engagement, which was published in May last year.
May I thank my hon. Friend for his response and ask him to confirm that, while Sir Michael Lyons is due to report in March and further legislation may be required at that time, it is the Government’s current intention, on the back of the White Paper, to increase the amount of funding that councils receive that is not ring-fenced? Will the Minister confirm that he will increase the sums pooled in local area agreements?
I thank my hon. Friend for that important question, which gives me the opportunity to confirm that that is the case. The Government’s policy is to have a presumption against ring-fencing in funding. May I tell the House through you, Mr. Speaker, that this year the local area agreements will receive £520 million of pooled money and that that will rise to up to £1.5 billion in the financial year 2007-08, so I can confirm that the answer to the question is yes.
I think that the hon. Gentleman is referring to Sir Michael Lyons report rather than the White Paper. I appreciate the importance of his question. The answer to that question is that neither I nor the Government know what Sir Michael is going to report on that matter. Of course the distribution of non-domestic rates is a hugely important part of local government funding, contributing around £17.5 billion this year, so we await his report with interest.
I am sure that my hon. Friend will agree that if Sir Michael’s report is to be a success, it will have to find ways of ensuring that local authorities can raise more of the money that they spend. It is also important that it finds a way of dealing with the perversity of gearing in local government finance, and a way of giving local authorities incentives to consider favourably planning applications for business and commercial developments. Is not the easiest way to do that simply to denationalise the business rate and to give control of the rate back to local authorities?
I am aware of my hon. Friend's long-standing advocacy of that point. I note that he said it was the easiest way; he did not say that it was easy. It would be best if I were not drawn on that matter. Suffice it to say that the Government have introduced the local authority business growth incentives scheme that incentivises and rewards local authorities that achieve a growth in the number of businesses created, or indeed a slowdown if it is in a negative area. That scheme will be distributing some £1.5 billion. That is real money from which local authorities are benefiting.
Last night, the Minister said that the Lyons’ review had to be delayed until after the Local Government and Public Involvement in Health Bill to deal with form and function first, but after the publication of the Lyons interim review Sir Michael made it clear that he had views about devolution and fewer targets, and he warned against another massive restructuring, so what is it in the Lyons review that the Government are trying to hide?
I was as confused by that question as I was by the hon. Lady’s contribution to last night’s debate. I repeat what I said: it makes perfect sense—to me it is common sense, and I think that the Opposition are trying to find ways to oppose for the sake of opposing—to have the White Paper and the Bill on local government functions before looking at financial proposals and any legislation that might be produced, because if that is required, it will have to be introduced in the next parliamentary Session.
In his report of last May, Sir Michael Lyons clearly stated his views about political boundaries being redrawn. That has nothing to do with finance, but everything to do with form and function. In the interests of common sense, will the Government now give an assurance that Sir Michael will be asked to give evidence to the Bill Committee, as requested?
I cannot give that guarantee. With respect, I think that the hon. Lady is rather confused about what her own policy is. The Opposition have asked for a permissive regime that would allow local authorities to put forward proposals for restructuring, where they wish to do so. The deadline for initial proposals is the end of the current week, and I suspect that there will be proposals from local authorities of all types and all political colours from across the country. Some of them will be Conservative and some will not, and I await all the proposals with interest.
Central and local government have an agreed formula to distribute grant to local authorities. Not all councils receive the grant that that formula dictates. Can the Minister give an assurance that at the end of the next comprehensive spending review all councils will receive the agreed level of grant?
No, I cannot guarantee that. My hon. Friend again raises that important point on behalf of his four-star council. To be fair, it is a point that has been raised by Members of various parties. It concerns authorities that would receive more money if the Government had not put in a floor to protect those authorities that would lose significant amounts quickly if we had not put in that damping effect. The Government’s position is that we retain damping to protect those authorities, but as we move into the next financial settlement, which will be for a three-year period from April 2008 onwards, we will review decisions in the light of that important announcement.
The Minister has just repeated what he said in yesterday’s debate, which is that he thinks that it is an advantage to Members that we are considering his Bill prior to the Lyons report. It is my understanding that that view is not shared by Sir Michael himself, nor by many in the local government family who find it astonishing that we are being expected to take one set of decisions without being aware of what the Government intend to do in respect of another set. Can the Minister say exactly what he thinks the advantage is in our dealing with the Bill in the dark without the Lyons report; and can he give us an assurance that when the Lyons report is published he will take quick action to abolish the council tax and to repatriate the uniform business rate to local councils?
I strongly advise the hon. Gentleman who speaks for the Liberal Democrats seriously to revise his policy on business rates. At present, £17.5 billion is redistributed through the non-domestic rating system, as opposed to £3.335 billion through the remainder of the revenue support grant—RSG. Of that £17.5 billion, some four or five councils contribute almost 10 per cent. The redistributive effect of the national non-domestic rates—NNDR—in the absence of the dedicated schools budget from the RSG renders his policy one that would significantly damage the poorer areas of this country. Therefore I cannot give him the guarantee that he asks for.
When considering the Lyons review findings, can my hon. Friend look at better developing ways to ensure that those—sometimes not insubstantial—areas of the country that have pockets of deprivation and real need but which are located in local authorities that are considered to be affluent do not miss out on the additional funding that they need and deserve?
I commend my hon. Friend for raising again a problem that one of the local authorities in his constituency faces. Members of different parties point to wards or sub-ward areas that have poverty and deprivation that are not recognised in either the neighbourhood renewal fund or, it is argued, the RSG—although it is, of course, weighted within the RSG. I cannot give my hon. Friend the commitment that such changes will be made in the current financial period, but I do give the commitment that I will look at it for the future spending review period.
Travellers (Crays Hill)
The Secretary of State is considering a number of planning appeals in relation to Dale Farm. As this case is under active consideration, and for reasons of procedural propriety, it is not possible to comment on its details. A decision is expected by 28 February.
I thank the Minister for that answer, but she will be aware of recently published research by the Echo newspaper that casts doubt on claims by Travellers at Dale Farm that they have nowhere else to go, should the pending inquiry decision go against them. On Thursday, representatives from the settled community will visit Parliament to press for this research to be considered before the Government’s decision, and for a Government-led inquiry into the issue in general. In the interests of fairness, will the Minister consider meeting this delegation, as we know that the Department has had contact with Travellers from Crays Hill?
There have been no meetings between the Department’s Ministers and Travellers concerning this application. For reasons of propriety, it is not appropriate for Ministers to meet any of the parties while this matter is under consideration, as the hon. Gentleman well knows. So this is not a question of Ministers not wanting to take the full range of issues into consideration; this is a procedural point, and he serves his constituents ill by suggesting that we can do otherwise.
Community Land Trusts
Community land trusts are an interesting and promising new option for delivering affordable housing. The Housing Corporation and English Partnerships are working with a number of potential community land trusts, with the aim of getting some viable pilot schemes established.
I thank my hon. Friend for his question and he is absolutely right to say that we need to look at the evidence to see how these projects can contribute to our affordable housing targets, and whether tenants should be able to have a greater say over their own estates and housing developments, and what difference that would make. That is precisely why the Housing Corporation and English Partnerships are working with a number of potential projects to help them get up and running. They hope to have a number up and running by this summer, and some on site by the end of next year.
Supplementary planning gain, or, to use its proper name, a roof tax, will certainly make land scarcer and more expensive. How does the Secretary of State equate the need to build more affordable housing, which I accept, with that tax?
The hon. Gentleman knows that we have the Planning-gain Supplement (Preparations) Bill in place, so that we can consider all the issues in detail. Frankly, our proposals, which look seriously at the need for more infrastructure provision and the need to finance it, are far more credible than the position adopted by the Conservatives, who have no proposals whatsoever for funding greater infrastructure.
Does my right hon. Friend know that the northern housing forum recently met the Minister for Housing and Planning, my hon. Friend the Member for Pontefract and Castleford (Yvette Cooper), to suggest that land already in council ownership should be allowed to be released at nil, or below market, value, so that houses affordable to ordinary people could be built on it?
I am aware of the meeting that has recently taken place between Bolton At Home and my hon. Friend the Minister for Housing and Planning, and I know that this was one of the issues considered at that meeting. It has come up with an incredibly interesting and innovative proposal to use local authority land so that people have much greater access to low-cost home ownership. I understand that that bid is in with the Northern Housing Challenge and will be considered, and I hope that a shortlist will be announced soon.
I am grateful to the Secretary of State for her warm words about community land trusts and will take them as an implicit endorsement of our policy to use them as a way of increasing housing supply and aiding low cost home ownership. I am sure that she will be aware that the Scottish community land unit provides pre-development support for those who wish to set up CLTs and has access to money from the Big Lottery Fund. We are all aware that Scottish expertise will be playing a bigger part in the Labour party in the months to come, so can the Secretary of State assure me that she will pre-empt that move by learning from Scotland and making money available from the Big Lottery Fund for those in England and Wales who wish to access low-cost home ownership through CLTs?
May I say how wholeheartedly I welcome the hon. Gentleman’s commitment to look at all sources of funding and, indeed, land for new affordable housing. Indeed, we will look at any option that he or anyone else puts forward to increase the supply of land for that purpose. I read recently of the hon. Gentleman’s claim that his new-found interest in community land trusts was inspired by the Levellers of the English civil war. I am rather more interested in the current civil war in the Conservative party on whether to build new homes for affordable housing. Indeed, only last month the hon. Gentleman said, “I think”—
Yes, we will provide further funding for improving council housing. So far the decent homes programme has cut the number of homes failing the decency standard by some 1.4 million and has delivered 720,000 new boilers and central heating systems for council and social housing across the country.
While I recognise the Government’s focus on that particular policy and the increased investment, my surgeries are still inundated with residents who want to move to better properties, people desperate for homes, and others who want simple things such as central heating or some repairs. What help or hope can my hon. Friend offer to my constituents?
My hon. Friend raises an important point. We have said that all council and social housing needs to meet the decency standards. It is shocking that we inherited a £19 billion backlog in repairs and maintenance in 1997. We will, by 2010, have invested £40 billion in improving those homes, including putting in modern kitchens and central heating, tackling fuel poverty and cutting carbon emissions from those homes.
I appreciate the Minister’s comments about council housing and the social rented sector in general. However, part of the commitment made in the decent homes charter was to private sector vulnerable households. I am aware that in Rochdale, for example, 66 per cent. of all private sector vulnerable households are unfit, largely because of thermal comfort issues. In view of the fact that across the north-west last year 303 old people died of hypothermia, what further action will the Department take to deal with private sector vulnerable households?
The hon. Gentleman raises an important point. I know that the arm’s length management organisation in Rochdale has almost completed its programme and, thanks to the £100 million provided by the Labour Government, will have refurbished and modernised more than 16,000 homes in the area, ensuring that they meet the proper standards for central heating and insulation. The hon. Gentleman is right to say that we need to support private sector homes to ensure that pensioners in particular are not living in cold homes. The warm front programme has already assisted 1.2 million households across the country and we want to go further in helping to warm and insulate more such households.
Of course the Government deserve congratulations for tackling the enormous backlog of repairs and improvements that they inherited in 1997, but could we not go further, with an additional source of funds, and stop the process by which good local authority landlords, who have long provided decent, affordable housing in an accountable framework, are coercing tenants into stock transfers that they do not want, employing consultants and spending many millions of pounds on a process that is utterly wasteful?
We have provided additional funding to councils so that they can refurbish their homes, and it amounts to a 30 per cent. increase per home since 1997. Using that additional funding and their own resources, nearly 100 councils will be able to bring their stock up to the decency standard over the next few years. The additional funding has been provided through the ALMO programme and stock transfers and is a very substantial investment in existing homes, but my hon. Friend will accept that we must make sure that there is investment in building new homes, for which there is also a serious need.
One consequence of the Government’s mismanagement of EU migration is the great strain placed on social and private sector housing in some parts of the country. What are the Government going to do about the exploitation of EU migrants by unscrupulous landlords? Also, the poor condition of many houses in multiple occupation is a major problem in places such as Peterborough, where we have 6,500 people on the council waiting list. What are the Government going to do about that?
I am sure that the hon. Gentleman welcomes the measures in the Housing Bill, which give local authorities powers to deal with serious problems with private sector landlords and to require proper licences for HMOs. He should urge his council to use those powers.
The hon. Member for Peterborough (Mr. Jackson) also mentioned the pressures on social housing and private housing. The Government’s response is very clear: we believe that we need to build more homes. The Conservative party have opposed that.
My Department has made considerable progress over the past year, delivering on a range of commitments set out in the Respect action plan. For example, my right hon. Friend the Prime Minister and I earlier this month announced new regulations that will give arm’s-length management organisations and tenant management organisations powers to apply for antisocial behaviour orders.
I congratulate my right hon. Friend on the measures that she has introduced, and I am pleased to hear that her Department is working well with other Departments. Councils have been given the tools and powers necessary to bring people to justice and to protect victims of antisocial behaviour, but does she agree that it is time they used them? How can she make sure that they do?
I do not suppose that my hon. Friend knows that Bolton was the first local authority in the country to sign up to the Respect standard on housing management, which plays an important role in tackling antisocial behaviour. However, he is right to suggest that councils, housing associations and other relevant partners all over the country must play their full role in cracking down on antisocial behaviour. They must use all the tools at their disposal, including ASBOs, as antisocial behaviour can blight the lives of vulnerable people.
Does the Secretary of State agree that ASBOs and fixed-penalty notices do not stop youngsters reoffending, and will she look favourably on our proposal for a national school-leaver programme? Working with the Duke of Edinburgh trust, for example, the programme would encourage young people to take up positive activities, to the benefit of the whole community.
The hon. Lady will be aware of the Government’s proposals to encourage young people to be much more involved in their local communities, with activities both on and off school sites, but I cannot agree that ASBOs are not effective. They deal with the hard core of criminals, and I understand that the people who receive them have, on average, 31 convictions each. Moreover, the other measures that can be taken before that point is reached are highly successful in curbing antisocial behaviour, or stopping it altogether.
What liaison is there between the Department and local groups involved in dealing with antisocial behaviour? I draw my right hon. Friend’s attention to the work of Inspector Nick Mills and his team in the Vauxhall and Kirkdale areas of Liverpool, and the pioneering work of the Liverpool community justice centre.
I should be interested in hearing more about that pioneering work. There are examples of innovative practice across the country. As a result of the Local Government and Public Involvement in Health Bill, which is passing through Parliament and had its Second Reading last night, I hope that local councils will work to the same community safety targets, with the police working to a target agreed with the local authority, the probation service and youth action teams. They will all be working towards the same objective: to combat antisocial behaviour and improve community safety. That will help people to create not only a culture of respect but also better places to live.
My Department leads across Government on the prevention aspect of the Government’s counter-terrorism strategy. We also have responsibility for promoting community cohesion, including ensuring that extremists who promote hatred are marginalised. My Department has particular responsibilities for working effectively with local government and engaging with communities to acknowledge and tackle violent extremism at grass-roots level.
I am grateful to my hon. Friend for that answer and I am sure he will agree that one of the best ways to stop extremists spreading their corrosive poison in our communities is for every decent person to reject the ugliness of extremism with their vote at the ballot box. What is my hon. Friend’s Department doing to raise awareness of the importance both of voting in elections to defeat extremism and of getting into communities to stop that poison at the roots?
I commend the work that my hon. Friend has done in his constituency to tackle this difficult problem. My Department has a funding stream of about £5 million, which is available to local authorities to help them to put together strategies to tackle those who promote violent extremism. My Department is in conversation with my hon. Friend’s local authority in Stoke-on-Trent.
What lessons did my hon. Friend learn from the visit to Leicester he made with the Minister for Women and Equality about the way in which a city such as Leicester, where the local authority has worked with the local community for many years, is able to combat racism and extremism?
The most important lesson from Leicester is that a strong inter-faith dialogue, talking and agreeing joint action and involving young people—as Leicester has done—makes an investment in the community that reaps rewards for many generations. Indeed, the rest of the country looks to Leicester to lead on the issue.
I am tempted to say not enough. In 2004, the National Census of Local Authority Councillors in England and Wales—the employers organisation—reported that of the 18,195 councillors covered by survey responses, only 1,333, which is just 7.3 per cent., were under 40. The review of the incentives for and barriers to becoming councillors announced in the local government White Paper will examine the factors influencing that situation.
I think my hon. Friend will agree that that really is not good enough. We must achieve a better age profile. I was elected to a local authority at 22; I left at 39 to come to the House. A sad indictment, because I was one of the youngest councillors and I was leaving the local authority. What can my hon. Friend do to encourage more young people to recognise the importance for their lives of having that voice? We must persuade them that politics is important and that it makes a difference for them.
Not many of us want to discuss grey hair in the Chamber.
I agree with my hon. Friend the Member for Chorley (Mr. Hoyle); I was 38 when I left my local authority, Essex county council, and I was replaced by somebody older. It is incumbent on all of us involved in politics not only to set an example to younger people in our constituencies and to engage them, but also to identify the problem. The review outlined in the White Paper, which will look at barriers and incentives, will help us to encourage young people to get involved. I hope that in our political parties we, too, can take on that role.
I got involved in local government as a county councillor in my late 20s and resigned because, like the hon. Member for Chorley (Mr. Hoyle), I came to this House, but does the Minister agree that what is really important is the commitment of people to local government, not their age? Experience surely counts for something. Does she value it?
It would be very foolish to stand before the House and say that I did not value the experience of hon. Members and councillors. However, what we generally want to see are local authorities and a Parliament that are genuinely reflective of society. That means people of all ages being involved, so of course experience is greatly valued, but so is the introduction of new and younger members—to councils and Parliament as well.
Local Government Finance
The local government finance settlement for 2006-07 was approved by the House on 6 February 2006.
The Minister will be aware that my local council of Wandsworth received a much lower than average grant uplift this year—in spite of being graded excellent by the Audit Commission and in spite of being rated as the best value for taxpayers’ money council in the whole country. How can he justify my local taxpayers getting such a raw deal from Whitehall when the council is doing such a good job?
I challenge the hon. Lady’s assumption that her constituents are getting a raw deal. Indeed, we specifically provided a floor to protect authorities such as hers that do not suffer the same deprivation—I am not denying that there is some deprivation in her area—as other authorities. Rather than criticise us, I would have thought that the hon. Lady would be thanking the Government for providing a floor to protect the grant, which has been above inflation throughout the Government’s period of office.
I beg to ask leave to move the Adjournment of the House, under Standing Order No. 24, to discuss a specific and important matter, which I believe should have urgent consideration, namely,
“the situation surrounding the wreck MSC Napoli now lying off the coast in Lyme bay in my constituency of East Devon”.
I would like to take this opportunity to thank the Minister of State, Department for Transport, the hon. Member for South Thanet (Dr. Ladyman) for his courtesy in keeping me informed at all stages. I should also like to record my thanks to the Secretary of State’s representative, Robin Middleton, and his staff at the Maritime and Coastguard Agency, to Devon and Cornwall constabulary, to the Environment Agency and others in the emergency services who are working tirelessly to mitigate what could have been a far worse situation.
The sensitivity of all this is exacerbated by the fact that the Jurassic and Triassic coastline in east Devon and west Dorset is a UNESCO world heritage site. The coastline also includes a number of sites of special scientific interest.
The media images from the beach in Branscombe show that some members of the public are behaving in a dangerous free-for-all and quite unacceptable manner. The police have felt disempowered at times, not least in their inability to close off the beach straight away. Ministers need to revisit the legislation when events of this nature occur. Although 103 containers have been lost from the ship, to date only 53 have been located on shore. Fifty tonnes of dirty fuel have been washed ashore. Although clean-up operations have commenced and work has begun to discharge the bunker fuel into a reception vessel, that could take a week, during which time the ship, which is between 17° and 25° down at the stern, depending on the tide—is at the mercy of the weather. I am travelling to Brussels tomorrow to meet Jacques Barrot, the Transport Commissioner, to see what lessons can be learned from this incident and to find out what help can be provided to clean up the environmental damage.
My constituency is largely dependent on tourism and we will need assistance to deal with the fall-out of this incident—in the short and long term—particularly when the wreck is likely to remain where she is for at least a year. My constituents need to be reassured that none of the costs of cleaning this up will have to be met by the council tax payers of East Devon. They also seek reassurance that no more damage will be done to the environment from any protracted clean-up operation and that every step possible is being taken to protect the wildlife affected by the spillage.
Many questions surrounding the beaching of MSC Napoli need to be answered and I believe that the House should have the opportunity, at the earliest time available, to question Ministers about the events surrounding that unfortunate incident.
I have listened carefully to what the hon. Member has said and I have to give my decision without stating any reasons. I am afraid that I do not consider that the matter is appropriate for discussion under Standing Order No. 24, so I cannot submit the application to the House.
On a point of order, Mr. Speaker. I wonder whether you can indicate whether the Secretary of State for Transport has said that—at the appropriate time, when all the appropriate information has been gathered—he will make a statement to the House on the grounding of the MSC Napoli.
Intergovernmental Contracts (Provision of Information)
I beg to move,
That leave be given to bring in a Bill to require the provision to Parliament of certain information relating to intergovernmental contracts; and for connected purposes.
The Bill is designed to deal with an absurdity and a scandal, and its genesis is easy to explain. A short while ago, as a member of the Public Accounts Committee, I was prompted to ask why the National Audit Office report on the al-Yamamah arms deal had not been published—a simple enough inquiry, not especially original and not without wider interest. The Committee convened in special session to answer the question. It met in camera, and I am not, frankly, allowed to tell the House what was said or who was there, although I will say that some eminent people were there—people who do not usually attend that Committee.
I can also say what the outcome, the conclusion, was: we discovered that no one on the Committee—none of the customarily fierce interrogators on the committee, nor the Chairman, nor a single living Member—has a right to see the document, even though it is about a Government contract, even though we can see every other NAO report ever written and even though it was written by a man who is technically a servant of the House.
The only Member who was ever gifted the privilege of reading was the former Member for Ashton-under-Lyne, Lord Sheldon. Once the reading had been delegated to him, it seemed that no living soul could clap eyes on it again. My Bill seeks to rectify that absurdity. It would not ensure the publication of the NAO report. It would not undo the past. It seeks simply to provide a mechanism whereby Parliament’s right at least to scrutinise the doings of Government can be preserved.
The Bill would apply only to commercial contracts in which the Government are involved. There is force in the argument that, if some of those contracts were exposed to prolonged public debate, the kind of economic benefits that they were designed to secure would be defeated, thus putting at risk jobs, embarrassing international partners or jeopardising other national, perhaps security, interests. I accept that those who point that out make a serious moral claim, but I cannot accept that the House must forfeit the right to examine such a claim and establish whether it has substance or is simply a claim made to cover up a less ethical position.
When the Serious Fraud Office inquiry was dropped before Christmas in a cunning Government plan that even Baldrick might have bettered, I suggested in the Chamber to the Solicitor-General that the understandable suspicion provoked, and now snowballing, could be allayed by allowing wider access to the report, perhaps on a confidential basis. He pointed out correctly that that was a matter for the House, but he and I both knew that that meant that it was matter for the business managers—the Whips—who can block indirectly or directly any attempt to change the status quo, and believe you me, they will.
The Bill is an attempt to establish procedure whereby, if sufficient Members make application to the Leader of the House—he is here now—for the scrutiny of documents such as the al-Yamamah report, he must refer those documents to a relevant Committee of the House for scrutiny, perhaps with appropriate caveats. Parliament’s right to scrutiny would thus be minimally preserved. I would add that the Committee must refer the issue back to the House if, and only if, apparent evidence of a breach of national or international law was found.
I strongly believe that such a minimal mechanism needs to exist, if only to show that Parliament is not reduced to the supine, ludicrous position where it is not even allowed to read its own papers, simply because the Government, with a host of obviously shoddy arguments, tell us that it can do us no good.
We all know that there are pros and cons. Jobs may be lost if we go one way; international and public respect will definitely be lost if we go another. The battle for orders and influence is on one side, and the battle for commercial ethics is on the other. And we can come down on either side irrespective of whether we are moral pragmatists or moral purists. Whatever side we are on, however, we all have to recognise that the Government’s current position is simply unsustainable and, like all unsustainable positions, it will only get worse. Thanks to their cack-handed approach, no one now believes that the serious fraud squad was getting nowhere. Everyone now believes that BAE gave out bribes and the Saudis took them. Accusation and allegation, and naming and shaming fill the pages of The Guardian. The media have, de facto, painted a worse picture than the dear old National Audit Office ever could, or does. Imagination flourishes in the face of the shiftiness that sits on reports, stops investigations and mistakenly tries to rope the intelligence services into the whole charade. The Saudis are not now being criticised; they are being demonised. Our European allies are outraged and the corrupt regimes of the world are smugly vindicated by our apparent and cynical display of grubby realpolitik.
Parliament perhaps ought to try to rescue the Government from themselves. The Government are aiming for closure, but are opening can after can of worms. The clear plea in the recent official Saudi press release to be able to move on and acknowledge some of the changes made in the kingdom goes completely unheard. That press release, which is on the website, says explicitly:
“the government of Saudi Arabia today will not and does not condone fraudulent or corrupt behaviour of any kind and would take firm action against anyone found to be involved in fraudulent activity or found accepting or offering bribes of any kind. This is against the law. This should clarify any misperceptions about the Kingdom. We cannot rewrite the past, but we must look…towards the future.”
Without even the most minimal checks and balances on international contracts, the present is clouded by a miasma of suspicion and allegation from which neither BAE, nor Saudi Arabia, nor the Government can get clear. That damages them and wider human and commercial interests. All reputations—including those of Parliament and the Public Accounts Committee—are in the collective mire. To do nothing to avoid further repetition of past mistakes is itself culpable.
I am reminded of the Government’s approach to the British citizens wrongly accused of bomb outrages in Saudi Arabia. I was involved, to an extent, in that matter. What did the Government’s hesitant and limp-wristed approach on behalf of innocent Britons lead to? It led to two years of appalling publicity for Saudi Arabia, two years of suffering for the innocent and time bought for the al-Qaeda cell that made and planted the bombs. Let us have no lectures about security from the Government. If we wish BAE to have a business reputation as unsurpassed as its technical excellence, if we wish for an equal and understanding friendship with the kingdom of Saudi Arabia and its people, and if we wish for protection against the next scandal or allegation that is going to ripen, whether from Tanzania or elsewhere, self-evidently we cannot leave matters to the Government. Parliament must assert its right to scrutiny or abjectly acknowledge its impotence. I beg all Members to support the Bill.
Question put and agreed to.
Bill ordered to be brought in by Dr. John Pugh, Nick Harvey, Mr. Michael Moore, Susan Kramer, Dr. Vincent Cable, Lynne Featherstone, Norman Lamb, Simon Hughes and Mr. Paul Burstow.
Intergovernmental Contracts (Provision of Information)
Dr. John Pugh accordingly presented a Bill to require the provision to Parliament of certain information relating to intergovernmental contracts; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 23 March, and to be printed [Bill 49].
[3rd Allotted Day]
Health Care-acquired Infections
I beg to move,
That this House, while recognising the commitment and efforts of NHS staff to minimise infection rates, is alarmed at the continuing high levels of healthcare-acquired infections; notes that the NHS is not on track to meet the target for reducing MRSA bloodstream infections in 2008 and that new highly virulent MRSA strains are emerging; is shocked at increasing rates of Clostridium difficile infection which the Department of Health now regards as endemic in the health service; calls on the Government and the NHS to accelerate actions to combat levels of healthcare-acquired infections, including reduced bed occupancy rates, increased isolation facilities and single rooms, improved hand hygiene, enhanced hospital cleaning incorporating novel processes, and the rigorous screening of patients; commends the adoption of a uniform policy within NHS trusts; calls for the piloting by the NHS of a ‘search and destroy’ strategy against the most virulent strains of MRSA and Clostridium difficile; and demands that the Government report six-monthly to the House on the action it is taking to combat healthcare-acquired infections.
I want to start, as our motion does, with a recognition of the work that the NHS does to seek to minimise infection. I am sure that many hon. Members visit hospitals, particularly their local hospital, and have occasion to discuss infection control measures, and I am sure that they appreciate the effort being made. I recall visiting a hospital a year or so ago and speaking to a sister in charge of a ward. I appreciated what she had achieved, as there had been orthopaedic patients on that ward for a substantial period, without any infections occurring. One then realises just how much the matter comes down to individual members of staff. I talked to the chief executive as we left that ward, and asked to visit the adjoining stroke ward. He said, “Unfortunately, we can’t do that, because it’s closed at the moment due to an infection.” That made me realise that control of the measures taken on wards makes a big difference.
We introduced the motion today simply because we have raised infection control issues many times over the past three years, and we want action and need progress. The House needs an opportunity to learn why that action has not been taken, and why that progress has not been made. Our motion this afternoon is intended to provide precisely that opportunity. Let us consider where we are on the issue, and what has been done. In 2005-06, some 7,097 MRSA—methicillin-resistant Staphylococcus aureus— bloodstream infections were reported. That was a reduction of 8 per cent. in relation to the 2003-04 baseline for the Government’s target of halving the number of MRSA bloodstream infections by 2008. However, that should be put in context, because the number of deaths associated with MRSA has tripled since 1997. As we said back in 2004, halving MRSA rates would in fact do no more than bring them back to the levels that pertained at the end of the 1990s. Of course, the bloodstream infections that are the subject of the Government’s target do not include surgical site infections.
Since the Government’s target was introduced, and even in recent months, more serious and more toxic forms of MRSA have appeared, including PVL—I will not attempt to give its scientific name—a dangerous form of MRSA in which a toxin that attacks leukocytes is emitted. It can lead to conditions such as necrotising fasciitis, which can lead to death in a matter of hours—within 72 hours. Serious and highly toxic forms of MRSA are appearing in hospitals, but the particular form that I mentioned is generally associated with community-acquired MRSA.
Was my hon. Friend as surprised as I was to learn of the move to tell nurses that, to try to avoid cross-infection with the more difficult forms of MRSA, they should no longer simply sterilise their hands using a sterilising wash, but should make it a regular practice to wash their hands? Was he as surprised as I was to hear that injunction, given that one might expect nurses to wash their hands as a matter of course?
In my view, it has always been standard practice in hand hygiene both to use alcohol-based hand rubs and to wash one’s hands in between patients. My hon. Friend’s interesting point brings me to the next issue. Interestingly, for reasons that I do not quite understand, the Government did not make any reference to Clostridium difficile in their amendment to our motion. One of the consequences of the Government’s MRSA target has been a welcome increase in the availability and use of alcohol hand rubs in health care institutions, but that has not been effective in tackling the spread of Clostridium difficile, which requires washing with soap and water, too. One can see how it has come about that the Government’s narrow targeting has contributed to the dangers, which have been increasing with Clostridium difficile. The Government have not responded to those dangers.
I will give way to the hon. Lady in a moment, but first I wish to put the figures on the record. There are several times as many cases of Clostridium difficile as there are of MRSA. There were approximately 1,300 deaths in which C.difficile was an underlying cause in the last year for which figures were available. Some 2,247 deaths were associated with C.difficile, which is an increase from 975 in 1999, and is twice the number of deaths associated with MRSA. The Government, however, ignore that in their amendment.
I agree that there has been a huge effort by staff and the Government to improve infection control. Without wishing to sound too much like an old soldier, 25 years ago, I worked in an operating theatre, and I am surprised by the laxity of procedures now. Some staff, for instance, wear jewellery while in uniform, do not follow aseptic procedures, or wear scrubs outside theatre. A St. Thomas’s-trained sister would have scalped people for such surprising practices a few years ago, but the procedures that she enforced do not appear to be part of basic training today.
I accept the point that the hon. Gentleman is making, and I shall come on to it later. It is addressed by the motion, which deals with the availability of facilities, particularly in hospitals, to support the adoption of a policy on uniforms. First, however, I promised the hon. Member for Milton Keynes, South-West (Dr. Starkey) that I would give way to her.
The moment has passed, but I was seeking to emphasise the fact that a distinction must be made between the level of those increasingly drug-resistant infections in hospital and in the community at large. Hospitals operate against a rising base line, and the hon. Gentleman has ignored that key fact.
It is interesting that the hon. Lady should say so, as I have been speaking for only seven minutes. I shall come on to talk about the technology that would allow us to distinguish between the rising incidence of infections in hospitals and their prevalence. I accept that, in many cases, infections are introduced to hospitals by admissions from the community, and were acquired in the community. New technologies make it possible to make that distinction more quickly, but that leads to the question whether a policy of screening all admissions should be introduced as a result. I shall come on to that in a minute, too.
Outbreaks of C.difficile are very serious. At Stoke Mandeville, for example, there were 330 cases, in 33 of which, it is believed, the infection led to death. There have been cases in Maidstone, Leicester—the Secretary of State will know about that—and Nottingham. As with MRSA, we are dealing with more virulent strains of the infection such as the 027 strain. Other infections are a problem, too, such as GRE—glycopeptide-resistant enterococci—Acinetobacter and multi-drug resistant TB. I do not dispute for a moment the fact that the Government face a challenging environment, given the prevalence of more toxic infections.
The hon. Gentleman will recognise that that is not a new problem. Indeed, my mother died of MRSA in 1996 under the previous Government. [Interruption.] I am not seeking to blame anyone; I certainly would not do so for the death of my own parent. May I ask the hon. Gentleman whether he shares the Patients Association’s concerns that there does not appear to be a national across-the-board view about infection control, and that there are variations at local level? We need more information, and people at Hereford county hospital, where my mother died 11 years ago, believe that there should be broader view at the top to make sure that there is a common set of practices to control infection.
I understand the point that the hon. Gentleman makes. He is right to point out that the number of deaths associated with MRSA, which was 49 in 1993, began to rise sharply in 1995 and 1996, as the trend line shows. I do not dispute that. The question is what we are doing now, as much larger numbers of people are dying of causes associated with the infections. Should we specify how every hospital and every member of the NHS should work? Of course not, but we should ensure that the actions that would clearly help, and which are spelled out as necessary by the Health Protection Agency and in the Government’s guidance to the NHS, are supported and pushed through by the Government where that has previously not been the case.
I commend my hon. Friend for not ignoring Clostridium difficile, which is ignored in the Government’s amendment, as he pointed out. That is in marked contrast to the leaked memo, in which the Department of Health official states that Clostridium difficile is now
“endemic throughout the health service”.
Does my hon. Friend agree that more worrying is the response to which the health official refers—that the Government seek to manage by way of local targets—which is described as a “cop-out”?
Indeed, it is a cop out. The Government must do one of two things. They must set a target and put in place the measures that will deliver it, or they should support the NHS in its local targets. The Government cannot have it both ways. They say, “It is not our responsibility. The NHS hospitals must decide what to do”, then they say they want to set a target and achieve it.
My hon. Friend mentioned the leak in the Health Service Journal of an internal Department of Health memorandum, in which the director of health protection stated of MRSA bloodstream infections:
“Although the numbers are coming down, we are not on course to hit that target and there is some doubt about whether it is in fact achievable”.
That is interesting, and a frank admission internally in the Department of Health.
On 30 November 2004 I had an exchange with the present Home Secretary, the right hon. Member for Airdrie and Shotts (John Reid). I said—forgive me for quoting myself:
“If he did not pluck a target out of the air, will he tell the House where the evidence base is for his assertion that by 2008 the NHS should aim to halve the current rate of MRSA?”
The then Secretary of State for Health replied:
“I am saying that that is where we will be without a shadow of a doubt. . . Where did I get that target? I got it on official advice”—[Official Report, 30 November 2004; Vol. 428, c. 526.]
We never saw the evidence or the official advice. Now we see the official advice inside the Department. Officials do not believe that the target can be achieved. I think they are wrong about that. It can be achieved. They never believed that it would be achieved, and they did not give the Secretary of State the advice on the basis of which he plucked his target out of the air. That is just one more example of the right hon. Gentleman in his progress around Whitehall, with his Cabinet colleagues following in their dustcarts.
It is important to redouble efforts. It is absurd that Ministers say, “The target is marvellous. We will not achieve it, but the target is marvellous.” The target has probably contributed to a lack of attention to Clostridium difficile and a 17 per cent. increase in the infection, which has killed twice as many people as has MRSA. Ministers think that the sum total of their objective is a target for MRSA bloodstream infections, rather than to deliver proper infection control across the NHS. They would rather hit the MRSA target, or pretend that they will, than deliver the actions that are necessary. Redoubling our efforts, if the Minister asks—
No, I shall make progress. I have been speaking for 15 minutes. There is much more to say about what needs to be done.
Let me give the Minister another example. Back in 2004 my right hon. and learned Friend the Member for Folkestone and Hythe (Mr. Howard), then Leader of the Opposition, and I challenged the Prime Minister and the Secretary of State on the finding in the National Audit Office report that managers were putting targets ahead of infection control advice. The Prime Minister told us that that would not happen, that patient safety would come first and that managers would never do such a thing. Yet the Healthcare Commission report into the Clostridium difficile outbreaks at Stoke Mandeville stated:
“Other managerial imperatives were given greater priority than the control of infection… The director of infection prevention and control had not persuaded the board to give sufficient priority to the control of infection in general and to the control of C. difficile in particular.”
[Interruption.] Labour Members appear to find listening to the Healthcare Commission describing how 33 people died of an outbreak of infection associated with Clostridium difficile funny.
The report continued:
“The achievement of the Government’s targets was seen as more important than the management of the clinical risk inherent in the outbreaks of C. difficile. This was a significant failing.”
When did the outbreak occur? It happened between October 2004 and June 2005. Ministers were complacent at the time and they are complacent today.
I have a letter from the director of nursing and patient services at Maidstone and Tunbridge Wells NHS Trust to a constituent whose mother contracted C. difficile in Maidstone and subsequently died. It states:
the Kent and Sussex hospital—
“given its age and design is I am afraid totally unsuited to the management of infection and the support of barrier nursing for patients with infectious diseases… The Ward sister… is relatively new… I will ask that her manager ensures, as part of her personal development plan this year that infection control is a key part of her development.”
Should not that have been the case anyway?
Yes. Unfortunately, one of the serious outbreaks took place at Maidstone. We have not received the results of further investigations into some of the outbreaks and it is wrong to assume that the failings at Stoke Mandeville occurred elsewhere. However, I would be surprised if similar failings had not arisen in other places. The Government should have done something about it at the time.
The Minister of State, Department of Health, the hon. Member for Leigh (Andy Burnham) asked what actions we would take and mentioned redoubling efforts. Let us consider bed occupancy rates. In 2000, the Government promised the National Audit Office that those rates would go down, but they have gone up. Professor Barry Cookson of the Health Protection Agency rightly said:
“What all the evidence shows is that we have to get bed occupancy rates to 85 per cent. but the Government has clearly got its waiting list targets and has signed up to them.”
What has happened? We have 9,000 fewer beds than we had 21 months ago. Five per cent. of the NHS hospital sector’s bed capacity has disappeared in that time. That is not a consequence of the increasing average length of stay or higher day case rates, but a result of budget cuts.
Unfortunately, my health authority and trusts have the same problem. Dr. Martin Woolaway, the director of public health for my authority, stated in a report to the NAO about preventing infections:
“Preventing infections continues to be adversely affected by high bed occupancy, the movement of patients and the lack of beds to allow separation of elective and trauma patients.”
Neither of my hospital trusts have isolation wards. That is sadly endemic.
That is disgraceful. Last year, 40 per cent. of nurses reported that they did not have sufficient time to clean beds thoroughly between patients. That is central to proper infection control.
What about undertaking wider surveillance and inspection instead of the Government’s narrow targets? The Minister asked what he should have done in response to the memorandum from the director of health protection. He should have said that the Government would redouble their efforts, not only in relation to MRSA bloodstream infections but a wider range of infections. He should have agreed to disseminate that data and ensured that people could act on the information.
What about cleaning? The Minister is apparently interested in that and believes that the problem will be solved by in-house cleaning. Why, two years after the publication in 2004 of the model cleaning contract, which was trumpeted as a way of ensuring high standards of cleaning, could Norman Rose of the Business Services Association say that
“in about all the contract renewals over the past two years, Trusts have requested that contractors do not quote on the basis of the 2004 Cleaning Standards as they cannot afford it”?
What is the point of in-house or out-sourced cleaning if the management does not try to fulfil the cleaning contract and the model cleaning standards?
What about the rapid review panel? I am not sure which Minister is now responsible for that. It might be one of the Ministers in the Chamber today, or their colleague in the other place. The rapid review panel was supposed to expedite the introduction of new processes and technologies into the NHS that would be useful in combating infections. Of the 168 products that were assessed, three received a recommendation 1, which meant that they were already in use. Everything else got a recommendation 2 or 3.
Every company that I have spoken to has the same story about this process. They put together their dossier and provided a great deal of information. That took months, and they received no feedback. They were told that they would be given a recommendation. They were told, “Your product might well be useful. Off you go and prove it yourself. Run a clinical trial. Sell it to the NHS.” Those were things that they could and would have done themselves, but for the fact that they thought that the rapid review panel was there to help them to introduce those processes. Instead, it is a paper exercise with a committee that publishes obiter dicta from its throne, and nobody in the NHS is required to do anything about this at all. No one in the Department of Health uses health technology development budgets, for example, to take forward those technologies and prove that they work. Nothing gets done as a result of the so-called rapid review panel.
Those technologies are out there, however. Last Wednesday, I was at the recently established centre for health care-acquired infections at Nottingham university. In one of the presentations at its launch, it reported on portable clean air technology systems that have demonstrable benefits in reducing MRSA infections, and on a hydrogen peroxide vapour system that has very promising benefits for eliminating Clostridium difficile. But where is the support for that?
The National Audit Office report stated that more than half of the trusts had undertaken a risk assessment to determine what level of isolation facilities they required, yet only a quarter of those had put the measures in place, and that that had usually happened only in conjunction with new build or major capital projects. That is not good enough, and these things are not happening fast enough.
Last June, the Scottish health technology assessment reported that three isolation beds per 25-bed ward should be provided to back up a policy of screening all admissions. Will the Secretary of State commit today to providing the necessary capital resources to put in three isolation beds per 25-bed ward in order to support a policy of screening all admissions? The point was raised earlier about tackling community- acquired infection—[Interruption.] No, you are the Government. I am sorry, Mr. Deputy Speaker. They are the Government, yet they sit on the Front Bench and ask me what I would do. Crikey!
I was talking about screening. Before the last election, my right hon. and learned Friend the Member for Folkestone and Hythe and I said that, as a Government, we would spend the money necessary to introduce the screening of all admissions. The Government have done nothing about that until the document of November 2006 that they have just published. It states:
“The logical conclusion of risk factor assessments and the results of modelling studies”—
the Department of Health always provides us with a good read—
“is that the most appropriate approach to the reduction of MRSA carriage in the population, and resultant MRSA infections, is the universal screening of all admissions to hospitals.”
Instead of just handing out that document and letting trusts review their policies, will the Government put in place the isolation facilities that would enable the screening of all admissions to hospitals? They say that that should happen, but it is not happening.
I saw the equipment at the centre for health care-acquired infections at Nottingham university, and it was extremely interesting. Professor Richard James is taking the DNA testing of bacteria to the next stage, which will enable us rapidly to identify the different strains of infection, and of MRSA in particular. Being able to identify the genetic fingerprint of the different strains will enable us to determine the extent to which the MRSA infection in a hospital is the result of a community-acquired MRSA or a hospital-acquired MRSA. This will help us to understand the prevalence of those infections in hospitals.
The hon. Gentleman has acknowledged that our hospitals now have in place one of the most comprehensive MRSA surveillance systems, so that we can track precisely what is going on. This debate is all very well and good, but will he commit himself to supporting a national health care infection reduction target—yes or no?
That was a completely pointless intervention. We went into the last election with a commitment to a comprehensive programme of tackling infections, not just with a target. We included a commitment to a mandatory surveillance system that was wider than both the one that the Government had at the time and the one that they have implemented now. When we are in government, it will be our responsibility to ensure a comprehensive system of infection control.
That brings me to two final points. The hon. Member for Somerton and Frome (Mr. Heath) asked about uniforms. It is important to know what the Government are planning in that regard. The Leader of the Opposition has made it clear that we want the code of practice, which the Government put laboriously into legislation last year, to reflect the need for changing, showering and laundering facilities in hospitals. I accept that that will not be cheap, but it is not provided for in the code of practice, and the Government appear unable to commit to it. At the moment, the Royal College of Nursing tells us that half of nurses are not able to change at work, six out of 10 are not able to shower at work—we are all able to shower in Portcullis house, and nurses certainly need that facility at work—and six or seven out of 10 are not able to have uniforms laundered at work.
The issue relates to nurses’ working conditions, the standards that they want to maintain, a comprehensive approach to hygiene in hospitals and the confidence that the public have in the system on which they depend. The Minister said that Chris Beasley, the chief nursing officer, intended to set up an expert group to consider uniforms policy, which was to report in spring 2006. The latest reply in December 2006 said that it will report in spring 2007. Once again, the Government are all talk; there is no action.
Finally, in relation to “search and destroy”, the chief medical officer published “Winning Ways” in December 2003, which set out clearly the success—that is what he called it—that the Danes and the Dutch had achieved with a search and destroy strategy against MRSA. In September 2004, I challenged the Government to say whether they would have a search and destroy strategy. Their answer was that they were getting experts from abroad to come to the country and tell us what we should be doing. I challenged them again to say what they were doing. Lo and behold, more than three years later, Michael White wrote in last week’s Health Service Journal that the chief medical officer had sent a team to the Netherlands to find out about search and destroy strategies.
We knew in December 2003 that a search and destroy strategy was a possibility. I know why Ministers did not implement it: it is costly, and it would take six years, according to modelling by Nottingham university, for such a strategy to deliver a result whereby MRSA and other infections were no longer endemic in the NHS. The then Secretary of State, the right hon. Member for Airdrie and Shotts, said, “I want a target now, and I want it all to be running in the middle of the next Parliament.” He made it up, and it is not good enough. It is not good enough that the Government are not taking action, and it is not good enough that their amendment makes no reference to the commitment and work of NHS staff in combating infections, makes no reference at all to C. difficile, and contains no commitment to further action to deal with infections.
The purpose of the debate and our motion is straightforward: we are calling for there to be no more excuses, no more complacency, no more targets that distort the task of dealing with infections, and no more rhetoric without results. The Government must commit themselves to action. Our motion sets out the kinds of actions required, which would support and enable the NHS to deliver the highest standards of infection control anywhere in the world, which we need and should aspire to have. Our motion, not least because Ministers have not volunteered any time since the election to discuss infection control, would require Ministers to come to the House every six months to tell us what they have been doing. I commend the motion to the House.
I beg to move, To leave out from “House” to the end of the Question, and to add instead thereof:
“welcomes the top priority given to reducing healthcare-acquired infections by this Government; recognises that the Government is the first ever to collect data on these infections including establishing the world’s most comprehensive MRSA surveillance system; further welcomes the new code of practice for health and social care providers introduced under the Health Act 2006 to reduce infections like MRSA and the new duty on the Healthcare Commission to ensure service providers comply with the code; welcomes the Government setting a target to halve rates of MRSA by 2008; notes the progress towards achieving this target; acknowledges that more must be done to achieve this goal; and therefore welcomes the priority given to reducing healthcare-acquired infections in the operating framework of the NHS in 2007 and the additional £50 million given to NHS trusts in December 2006 to tackle healthcare associated infections.”
I spent yesterday morning with staff and patients at the Royal Marsden hospital in London, an NHS foundation trust that is giving superb care to some of our country’s most seriously ill cancer patients. Because patients’ safety is the hospital’s top priority, it takes infection control extremely seriously. I spent some time with Jen Watson, the senior sister in the critical care unit, who told me about some of the measures being taken. They include regular training in infection control every year for every member of staff, screening of all patients for MRSA when they arrive at the trust, isolation for any patient who is either at risk or diagnosed with MRSA, and alerting the rest of the hospital through the electronic patient record. That is a useful reminder to those who persist in saying that electronic patient records are a threat to high-quality health care rather than a real improvement.
There are aprons for every staff member in critical care, including doctors, and for every visitor. There are differently coloured aprons for those dealing with different beds in order to reduce the risk of cross-infection. Although the unit has the highest-risk patients in the hospital, it has the lowest cross-infection risks. There is alcohol gel by every bed, and every visitor as well as every staff member is strongly encouraged to use it. There is thorough cleaning and a weekly inspection by the ward sister with the cleaning staff. That applies not just to the critical care unit, but throughout the hospital.
Did the Secretary of State look out of the window and see nurses getting out of their cars in their uniforms, having just dropped their children off at nurseries, or sitting in cars in which they had probably driven their dogs to take them for a walk? What use are the precautions that she has described when nurses are wearing their uniforms home and then wearing them back to the hospital? What is the point of all those procedures when basic, fundamental steps are not being taken?
I am astonished at the hon. Lady’s attack on the integrity and hygiene of dedicated nurses at the Royal Marsden and, indeed, other hospitals. The point about a hospital taking infection control as seriously as the Royal Marsden does and introducing the measures that I have described, along with others, is that infection rates fall. Last year, for instance, the Royal Marsden aimed to lower its MRSA bloodstream infection rates to four cases in that year. In fact, it managed to reduce the number of cases to just two, and it made sure that it learned lessons from each of those cases.
The detailed description that Sister Watson gave me of the scrupulous attention that the Royal Marsden pays to infection control—attention that is replicated by thousands of staff throughout the NHS in very many hospitals—is a good reminder of what dedicated NHS staff do every day of the week to give patients the safest possible care.
May I press the Secretary of State on the question raised by my hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries)? Does she believe that it is in the interests of hygiene for nurses to wear their uniforms between hospital and home, and between home and hospital? If the answer is no, what does she propose to do about it?
I think that it is for the board and matrons of each hospital trust to establish the uniforms policy for that trust. I note with some bemusement that while on the one hand the Conservatives propose to abolish all targets, on the other they are telling every hospital where it should put its washing machines. That is an absurd position.
As the hon. Member for Hereford (Mr. Keetch) reminded us in referring to his mother’s death some years ago, hospital-acquired infections are not a new problem and are not confined to this country. We know that MRSA rates have been increasing every year since the early 1990s, and Conservative Members have acknowledged that. We knew when we were elected 10 years ago that there was a serious problem with MRSA and, more broadly, health care-acquired infections, and we have been doing more to tackle it. We were the first Government in the world to introduce mandatory reporting of MRSA—we did that in 2001. In 2004, we set the national target, to which the hon. Member for South Cambridgeshire (Mr. Lansley) referred, for the NHS to halve MRSA bloodstream infection rates by March 2008.
If the hon. Gentleman and the Conservative party think that the question of laundering nurses’ uniforms is the central issue when it comes to controlling infections—we have already had two interventions in about two minutes on the same point—they are not listening in the real world and they are not listening to the experts.
I will make a little more progress before I give way again.
As I say, we were the first Government in the world to introduce mandatory reporting. We followed that up with our target, since when MRSA rates have been falling—not simply because we set a target, but because we focused on the issue with the NHS and we supported it in taking the right action.
It is worth remembering the scale of the problem that was emerging. MRSA rates began to increase in the early 1990s. Figures from the Health Protection Agency reporting system show that in the last four years of the disastrous Conservative health policy from 1993 to 1996 MRSA rates were doubling, or nearly doubling, every year—an exponential growth in MRSA rates. I have no doubt that if we had not introduced mandatory reporting, made that a top priority for the NHS and set a target, those MRSA rates would have continued to rise. Instead, we first slowed the increase, then we got it down to single figures, and now the NHS is cutting the number of cases. Not only has there been an 8 per cent. reduction in MRSA rates in the past two years, but over the past two years in the NHS in the winter period, when hospitals are at their busiest, there has been an 11 per cent. reduction in MRSA rates.
The Secretary of State mentioned the Health Protection Agency. One of the things that it has identified as being a factor behind hospital-acquired infections is bed occupancy rates. Can she comment on the fact that my local trust, Epsom and St. Helier University Hospitals NHS Trust, has decided to cut 200 beds across the trust—one in four of the beds—thus requiring each bed to be used more intensively? Occupancy rates, therefore, will go up. Surely that is a false economy, and there will be a rise in infection rates unless there is very careful investment to deal with the infection consequences of beds being over-occupied.
The hon. Gentleman raises an important point. For every hospital, patient safety has to be the No. 1 priority. As he will understand, as hospitals do more day care surgery and bring down the lengths of stay by ensuring that patients go home when it is right and clinically safe for them to do so—instead of staying in hospital for an unnecessarily long time, which happens too often—they need fewer beds, while giving patients better care with better health outcomes.
On the issue of the relationship between occupancy rates and MRSA and other infections, hospitals throughout the country with high bed-occupancy rates are also reducing their health care-acquired infection rates.
On my numerous visits to the Royal Shrewsbury hospital, I have noticed that sometimes relatives of patients come to see their loved ones more than two at a time—sometimes three or four at a time—and sit on the beds. Does the Secretary of State agree that it is vital that the Government, via the media, get through to people that they should be very careful what they do when they go to see their relatives? They should not sit on beds. The nurses do not want to enforce that rule, but it is important.
The hon. Gentleman raises an important point. Many hospitals have introduced protected hours for visiting and controls on numbers, and several NHS foundation trusts engage their members in decisions on such restrictions. However, I must say that, once again, the hon. Gentleman is asking the Government to decide. Does he want us to set a target for the number of visitors that there should be at any one time, or where they should sit?
Let me say a little more about targets. We set the target of halving the MRSA rate, and I am sure that if we had not set that target the rate would have been going up rather than down and that we would have a much bigger problem than we already have. However, we always said that the target would be challenging—my right hon. Friend the Member for Airdrie and Shotts (John Reid) said that at the time. There is no point in setting easy targets. We need to set challenging targets in order to ensure that everybody makes the greatest possible effort to deal with a problem that affects the NHS as a whole.
The Opposition are against targets. They have been busy telling the press that they will get rid of all the NHS targets. The hon. Member for South Cambridgeshire has confirmed that they want to get rid of targets—in other words, he has confirmed that he does not believe that the Government should focus on the top priority issues for patients and the NHS by setting a target for reducing the MRSA rate.
Does the Secretary of State believe that the Government should have a view on what constitutes good practice? In answering questions on issues such as nurses’ uniforms and visiting hours, she said that she did not have a view. Does she have a view on whether it is right for people no longer to wear masks in operating theatres, because people have frequently been told that they cannot be afforded and that there is no money for them? Does she believe that masks being worn in such circumstances constitute good practice?
I will shortly come on to the action that we have been taking, and supporting the NHS to take, to get the infection rates down, but the hon. Gentleman might find it useful and interesting to look at “Saving Lives: Our Healthier Nation”, one of the pieces of useful guidance and support that we have been giving to the NHS to ensure that action follows the setting of targets.
The Conservatives need to deal with this issue. If they really believe that targets should go, do they think that the NHS should be trying to halve MRSA rates by 2008, or not? Do they want waiting times to fall? Do they want cancer patients—people urgently referred by their GP because they might have cancer—to be got through their appointment with their specialist and their diagnostic tests, and to be started on their treatment, within 62 days? That is the target that we have set, and which has helped to transform cancer care in the past 15 months alone. Do they believe that that target should be maintained and achieved, or do they not mind what the MRSA rates and the cancer waiting times are? In other words, are the Conservatives prepared to set national standards for the NHS and to ensure that they will be followed through, or will they give up, as they did when they had their disastrous years in government?
The Secretary of State has strayed into saying that if there are no targets there are no standards, but of course there are standards. We have been very clear about standards. Our point about targets can be seen in respect of MRSA; they have focused so narrowly on one measure of MRSA infection that other forms of MRSA infection—C. difficile, Acinetobacter and Panton-Valentine leukocidin or PVL—are not being addressed with the comprehensive action that is required.
The Secretary of State talks about all the actions that she is taking and the documents that are being published. Let me ask her a question about the matron’s charter of October 2004. It has a lovely chart that shows how matrons will have the authority to withhold payment. Have matrons actually exercised such a power to withhold payment on any occasion since October 2004?
Almost every time I visit an NHS hospital I meet matrons who every day act to improve patient care and uphold the highest standards that all of us want. The House and the public now know that the Conservatives would scrap the targets that are helping to reduce infection rates.
Let me deal with C. difficile—
No; I want to make a little more progress before I give way again.
It is perfectly true that the national target that we set in 2004 related to MRSA and not to C. difficile, which is also an increasing problem in hospitals not only in Britain, but in almost every developed country in the world. I make two points about that. First, because the MRSA target has focused the attention of every hospital—from the board right down to every ward—on better infection control, it is helping to deal not only with MRSA but with C. difficile and other infections. Secondly, we are seeing very different rates of C. difficile in different hospitals, particularly in respect of the latest, most difficult, strain. That is why, in the operating framework that we set for 2007-08, in which we confirmed that infection control was one of the NHS’s top four priorities for the coming year, we also said that we expected every acute hospital, with its local primary care trust, to set a challenging target for bringing down its C. difficile rates, where that was needed.
I am very grateful to the Secretary of State for giving way. Is she really saying that it is appropriate to have a national target for MRSA, despite considerable variation around the country, but local targets for C. difficile because of massive variation? That simply does not make sense.
That is precisely what I am saying. We set a national target for MRSA because that was a nationwide problem. Although some trusts had very low rates, in most hospitals we expected—rightly—to see very significant reductions in MRSA infections. As I said earlier, and as has been confirmed in many conversations with the experts—the NHS front-line staff—it was because we set that target and focused on MRSA specifically and infection control generally that the infection rate started to come down. However, given that some hospitals are really struggling with outbreaks of the most recent and difficult strain of C. difficile, but others have it well under control, rather than trying to set a national target it makes much more sense to say to the service, as we have done, “Let us have challenging local targets agreed between the hospital and the PCT, but reported nationally not only to ourselves, but to the Healthcare Commission and, most important of all, to the patients themselves.”
I thank the Secretary of State. She will recall, because we have corresponded on the matter, that C. difficile has been a serious problem in Oldchurch hospital, in my constituency. As she is also aware, we now have the new Romford hospital. The death of my late constituent, Mr. Patrick Martin, in 2005 caused a great deal of anguish, but a public inquiry has not been called. Will the Secretary of State please reassure my constituents that although there has not been a proper inquiry and investigation into that incident, the same problem will not be transferred from Oldchurch hospital to the new Romford hospital? Surely it is time that we had a full public inquiry into Mr. Martin’s sad and tragic death.
The hon. Gentleman has indeed written to me about the tragic death of Mr. Martin, and I should obviously like to extend my condolences to Mr. Martin’s family. Although it is never possible to eradicate MRSA completely, given the complexities of modern medicine, every avoidable death from MRSA—or any other hospital-inquired infection—is one death too many. That is why, as part of the clinical governance arrangements in the NHS that we have been strengthening since we were elected, it is essential that every hospital learns the lessons from any one of these preventable deaths—and, indeed, from every incident of MRSA or outbreak of C. difficile, even if it does not lead to a death. I am glad that the hon. Gentleman mentioned the new Romford hospital, which is one of more than 80 new hospitals that, under our Government, have been built or are in the process of being built for NHS staff and patients.
I want to stress that even with 12 million people admitted to hospital every year, and such tragic cases as the one to which the hon. Gentleman has just referred, the risk of MRSA bloodstream infection remains very low, with fewer than two cases for every 10,000 hospital bed days. However, we also know that we can and must do more with all such infections. That is why in 2005 the chief nursing officer launched the national programme “Saving Lives”, which was based on the best available information, guidance and practice from the UK and internationally. The programme was designed to focus the efforts of every hospital on a small number of high impact clinical interventions, and it has done so. All the evidence shows that if a hospital implements those measures consistently, it will reduce the rate of all those serious infections.
Let me quote Peter Wilson, the consultant microbiologist at University College London Hospitals Foundation Trust:
“Even though UCLH had high levels of MRSA bacteraemia in 2001, we have been successful in reducing them substantially by being focussed on the task and gaining the full support of the chief executive.”
He says that the trust has introduced
“wound surveillance and rapid MRSA screening in addition to increased use of hand gel and hand hygiene education.”
“Any hospitals using similar strategies should be able to achieve the MRSA target. Antibiotic control has also ensured low levels of C difficile.”
The Secretary of State is probably entirely right to say that proper interventions and protocols can reduce bacteraemia in the hospital environment, although part of the equation is having the capacity to isolate cases, which comes back to the bed occupancy issue that my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) raised earlier. However, can anything be done to reduce the proportion of the resident population of Staphylococcus aureus that is methicillin resistant? Is there any public health measure that has been shown to be effective in achieving that?
The hon. Gentleman makes an extremely important point. Hospitals have found, as a result of the monitoring that we have asked them to do, that MRSA is present in some 20 per cent. of patients admitted from nursing homes and 7 to 8 per cent. of patients admitted as emergency cases. At this point, the most useful action, and one that we strongly recommend to the NHS, is to screen high risk patients, especially elderly people, those coming in for orthopaedic surgery—emergency cases as well as elective—and patients coming in from nursing homes. That is precisely the guidance that the chief medical officer and chief nursing officer issued last year to supplement the guidance that we had already issued in “Saving Lives”.
I am surprised by those remarks because I have read “Saving Lives” on the summary of best practice in screening for MRSA, and I quoted from that document in my earlier remarks the conclusion that the best way to deal with it was universal screening of all admissions. The Secretary of State is now saying that her recommendation is different from what her own document said.
The guidance that we issued last year on screening recommends strongly to trusts that they focus their efforts on those most at risk—[Interruption.] Well, I will send the hon. Gentleman a copy of the document because I have just been looking at it. It sets out in great detail the different groups of patients most at risk of MRSA and other infections—[Interruption.]
Order. The hon. Member for South Cambridgeshire (Mr. Lansley) may not like the answer that he is getting to his question, but he must listen to it without continually intervening from a sedentary position.
I am grateful to you, Mr. Deputy Speaker.
We have issued that further guidance and we expect it and other guidance to be implemented. However, a critical element in the action needed to ensure that targets are taken seriously and achieved is our investment in improvement teams. Those teams work directly with the acute hospital trusts that are finding it most difficult to get infection rates down. In the past year, they have worked with more than 50 trusts, and that is exactly the same approach that we adopted in our work to improve accident and emergency services. Our aim then was to get rid of the appallingly long waits on trolleys in corridors that people had to suffer, and to cut waiting times. For example, when the teams began work, people were waiting for hip replacement operations for 18 months or even two years.
That is an example of how we set a target, focus attention on it and then send in improvement teams to work with those hospitals that are struggling the most, but we have done more than that. The hon. Member for South Cambridgeshire spoke rather scornfully about the Health Act 2006, but I think that it represents a hugely important step forward, as it gives us the power to introduce a statutory code of practice as part of our campaign to save the lives of more NHS patients.
The 2006 Act came into effect last October and it requires every NHS trust to have proper systems in place to deliver effective infection control. The Healthcare Commission will assess compliance with the code of practice, as part of the checks on the quality of health care that it makes on behalf of all patients. Already, 41 trusts have carried out self-assessment exercises and declared that they were not doing enough to control infections. The Healthcare Commission is following up each of them to ensure that effective remedial action has been taken.
If the Healthcare Commission finds that a trust has not taken effective remedial action to deal with infection control problems, it will be able to issue statutory improvement notices that require the trust to remedy the failure within a specified period. I assure the House that it will have no hesitation in doing so.
I thank the Secretary of State for giving way—[Interruption.] I am delighted that her Front-Bench colleagues have woken up enough to hear my intervention. The right hon. Lady talked about quality control, but is not what she said at odds with the Local Government and Public Involvement in Health Bill that we debated yesterday? Under that Bill, the public and patient involvement forums are to be turned into local involvement networks. The forums’ ability to hold trusts accountable for their performance in respect of hospital-acquired infections is a very important element in ensuring that targets are met, but do not the new proposals simply water that down?
The hon. Lady is absolutely wrong. The system is not being watered down, as the success of the patient and public forums provides the basis for the much stronger system being put in place with the local involvement networks. We have been able to make an enormous difference to the quite shocking standards of hospital hygiene that we found when we were elected 10 years ago, precisely because of the work of patient environmental assessment action teams that go into hospitals and make unannounced inspections on behalf of patients and the public.
Although all of our work—with “Saving Lives”, the new screening guidance, the new code of practice, stronger powers for the Healthcare Commission and with the improvement teams—was having an effect, we remained unsatisfied. Infection rates for MRSA were falling, but not fast enough, so last month we announced a further allocation of £50 million in capital funding—[Interruption.] The hon. Member for South Cambridgeshire should listen, as he was asking for more capital funding. That £50 million in capital funding was made available to enable hospital trusts to buy equipment and carry out work so that they could further improve hygiene and reduce the risk of infection.
I can announce that, as of today, £45 million of that £50 million fund has already been released to trusts. They are using the money to build more single rooms for isolation treatment, to install more hand-washing basins and to modernise bathrooms, and to put in safe storage containers for dirty linen where they are needed. Trusts are also using the money to acquire new equipment for the heavy duty, deep steam cleaning of infected rooms and wards, and they are buying new wipe clean computer keyboards for theatres and new equipment for microbiology laboratories. Further investment in the national health service, made possible by the record investment that our Government are making in the NHS—investment that the Conservatives voted against—[Interruption.] They do not like to hear that, but they will hear it. That investment would be put at risk every year by the Conservatives’ new economic policy; they would cut funding for the NHS and other public services to pay for tax cuts.
We know that getting infections under control has to be a top priority for the NHS, which is exactly what we said in the NHS operating framework for the next financial year. Cut infection rates, cut waiting times further, reduce health inequalities and achieve financial health—the top four priorities for the NHS for 2007-08. Those are all targets that the Conservatives would scrap. All those achievements would be put at risk by their health and economic policies.
I commend the amendment to the House.
The debate has clearly been inspired by the leaking of the now infamous Department of Health memorandum, which painted a disturbing picture of the trends in health care-acquired infections. In the aftermath of the leak of that document, the headline focus was on the MRSA target, but as the hon. Member for South Cambridgeshire (Mr. Lansley) rightly said, the previous Secretary of State made an absolute commitment not merely to move towards that target but to meet it. It is right, therefore, that the Government should be held to account on their progress in achieving that absolute commitment.
What did the memorandum highlight? It said that the target would not be reached—indeed, that it may never be reached. That was the view of the director of health protection at the Department of Health. It was not the case that merely a few trusts were performing badly; there was underperformance across the NHS—116 trusts were underperforming. I fully acknowledge that MRSA rates are coming down, which has not been achieved from the mid-1990s onwards, when rates were rising considerably.
The whole NHS is off course by a massive 27 per cent., compared to the absolute target set by the previous Secretary of State. Perhaps most disturbingly, according to the director of health protection, Clostridium difficile is endemic throughout the health service. The Secretary of State said that the situation was variable, which I accept, but almost all trusts are reporting cases. There are far more cases of C. difficile than MRSA, and far more people are dying from it. In 2004 there were 360 deaths from MRSA but 1,300 from C. difficile, and in 2005-06 there were 51,000 cases of C. difficile.
Rather disturbingly, the memorandum reported that measures to combat MRSA do not seem to have an effect on cutting rates of C. difficile. Among the over-65s, incidence of C. difficile increased by 17 per cent. between 2004 and 2005. According to the director of health protection, there is evidence that many trusts do not take the problem seriously enough—an issue to which I shall return. As the Conservative spokesman pointed out, the memo provides compelling evidence of the extent to which the Government’s obsession with targets can be counter-productive and unhelpful in achieving a focus on the highest priorities.
How did we end up with the MRSA target? Why focus only on that infection? Back in 2004 there were rapid rises in MRSA infection, which, as the Secretary of State will remember well, caused a political storm. The response, of course, was to set a tough target, but it was a target only for MRSA, because that was the media story. The memo is revealing about what civil servants think of the value of that target. Three of the six options for how to manage the bad news involved changing the target. It could be extended by adding something on C. difficile, which would show equal concern for that, or changed to cover hospital-associated infections generally without mentioning any specific ones. Switching to locally set targets was another option that would allow C. difficile to be included in local targets. Another option was scrapping the targets altogether or extending the time scale.
It seems to me that that hardly demonstrates a massive commitment to a target that the Secretary of State put such store by. The director of health protection appears to have a different view from that of the Secretary of State about the significance and value of this specific target. One is left with a clear sense that the original target was entirely arbitrary, as the hon. Member for South Cambridgeshire said, and that the director of health protection took the view that it would be sensible to acknowledge that it neglected other infections, and that changing it might well get trusts to take the problem of C. difficile more seriously.
The conclusion, though, was to plough on with the existing target—however narrow, however much it ignored the bigger problems of C. difficile, and however unattainable it was. As we have heard, the focus for C. difficile is to go for local rather than national targets, but the truth is that the target for MRSA, set on the basis of political calculation, distorts clinical priorities. I shall return later to the issue of how other targets may be compromising efforts to combat these infections.
There is nothing in the Conservative motion with which to disagree. It is right to highlight the challenge that we face and the seriousness of the issue when so many people are dying as a result of infections picked up in hospital. However, it falls short in one crucial respect. Remarkably, it says nothing about the role of antibiotics in health care-acquired infections. If the motion were a prescription for how to tackle the problem, it would be seriously deficient for that reason.
On antibiotics, I would like to highlight the work of Professor Liebowitz, a world authority on hospital-wide infection, at the Queen Elizabeth hospital in King’s Lynn. That hospital has achieved the Government’s MRSA target and also cut the incidence of C. difficile very significantly—by more than 20 per cent. in the last two years. What Professor Liebowitz stresses is the importance of stopping the prescription of the so-called broad-spectrum antibiotics and looking at alternatives. Just last week, she told the Norfolk health and scrutiny committee:
“It’s really frustrating if you have got really good infection control, everybody is washing their hands, but still doctors continue to treat with the same antibiotics”—
thus undermining everyone else’s efforts in seeking to control these awful infections.
Those concerns were echoed in a national survey of NHS acute trusts in England, carried out by the Health Protection Agency and the Healthcare Commission, which specifically looked into C. difficile. Crucially, what the survey found was that the most effective measure in preventing and managing infection is the appropriate administration of antibiotics in hospitals. Given that that is the advice of the Health Protection Agency, it seems incredible that hardly any reference has been made to it in our debate so far.
In common with other hon. Members, my hon. Friend has referred to the washing of hands, which is so important. However, would he accept that it is not so much the washing as the disinfecting of the hands that is so important—and also ensuring that the hands are not re-infected through bracelets or rings? The skin must be properly disinfected before injections or tubes are put into the skin. It is not just washing but disinfecting the skin that is crucial here.
I absolutely accept my hon. Friend’s point and I will come on to some broader comments about infection control in a few moments, but let me just finish on the question of antibiotics.
The advice was that trusts should have policies in place to reduce the inappropriate administration of broad-spectrum antibiotics and the regular monitoring of the use of antibiotics through audit and feedback to prescribers. Those findings are also reflected in the results of the European Commission-funded research project, which reported in September 2005. Antibiotic use has a significant impact on MRSA in European hospitals: the hospitals with the highest MRSA prevalence also had the greatest antibiotic use. So not only is the Government’s approach flawed for the reasons that I have explained, but the motion leaves out probably the most significant factor in tackling the problem.
The questions that I would put to the Secretary of State are these: what specific steps are the Government taking to shift the prescribing of antibiotics away from broad-spectrum antibiotics? How successful are those steps? What are the trends in prescribing? I do not know whether she wants me to give way to her, but I would be very interested in what she has to say on those specific points. I see that she does not want me to give way, but I very much hope that the Minister will deal with them in his response to the debate—that would be encouraging news.
The motion rightly deals with a range of infection control measures, which the evidence suggests are also important in dealing with the incidence of health care-acquired infections. What is remarkable is the extent to which the Dutch have been successful in keeping rates of infection much lower by adopting a zero-tolerance approach—the “search and destroy” strategy referred to in the motion. The Netherlands uniformly screens for MRSA and isolates those infected. Staff are sent home and wards are often closed down. However, the key to enabling that approach to work is to have enough beds for isolation, as well as good staff-patient ratios.
No, I am not intervening on the antibiotics issue, although that is an extremely important point and one that we have endorsed in the guidelines. Is the hon. Gentleman aware that in the Netherlands the rate of hospital-acquired infections is about 7 per cent., and that in England it is about 8 per cent.? Although there are undoubtedly lessons that we can learn, and are learning, from our colleagues in the Netherlands, I deplore the fact that the hon. Gentleman is talking down the achievements of the NHS in that way.
I am not talking down the achievements of the NHS in any sense whatsoever; I am saying that we should be prepared to learn the lessons if measures have been seen to be effective in other countries. Indeed, the Conservative spokesman referred to the fact that the Government had previously accepted that there were lessons to be learned from abroad. It appears that that is no longer the case, and I am saddened that there seems to be a move away from objectivity and rationality to rather cheap point scoring.
I return to the key point that sufficient beds are needed to make the approach work—especially to ensure that isolation is possible and achievable. Bed occupancy in the Netherlands is about 60 per cent. In the UK it is nearly 85 per cent., and in many acute hospitals it is much higher. In 2004-05, 88 trusts—one fifth of the total—had occupancy rates of over 90 per cent. According to the evidence, there is a direct correlation between occupancy rates and infection. Frequently acute trusts are full, on black alert. I have just discovered that the Norfolk and Norwich hospital was on black alert—in other words, absolutely full—on 27 days in the year to the end of October 2006. That is not uncommon; it is frequently the case in many very busy acute hospitals.
In 2000 the National Audit Office highlighted concerns over bed occupancy, as well as the pressure on hospitals to keep down waiting lists. Not a political party, but the independent NAO recommended a modest reduction in occupancy rates to 82 per cent., but that has not been achieved. Why has it not been achieved? One of the main reasons is an aggressive cut in the number of beds: 6,000 were lost in 2005-06.