My Lords, information on all healthcare-associated infections is not collected centrally. The best available information is from the mandatory surveillance system, managed by the Health Protection Agency. During 2010, 1,630 MRSA bloodstream infections and 23,208 Clostridium difficile infections were reported in England. Of these, an estimated 818 and 11,547 cases respectively were acquired after admission to an acute National Health Service trust. Data on other infections subject to mandatory surveillance are not yet available for this period.
My Lords, according to the British Medical Journal, about 7 per cent of patients in hospital in Europe develop healthcare-associated infections. In the past there was a shortage of beds in hospitals, but what is the position now? Is there still a shortage of beds, and how many hospital patients acquired an infection in 2010?
My Lords, we expect all provider trusts to have sufficient isolation units for those patients in whom an infection is identified. I am not quite sure whether this is what lay behind the noble Lord’s question, but there is no evidence to support a link between higher bed occupancy rates and higher rates of healthcare-associated infections. The number of beds occupied in a trust, in other words, should not have a bearing on the infection rate in that hospital.
Does the Minister agree that the length of stay that a patient has increases the risk, particularly among elderly patients? Can he tell me how many elderly patients are now staying in hospital for greater lengths of time because they are not being discharged into appropriate local authority provision?
The noble Baroness is quite right that delayed discharge poses a risk, not only in terms of infection but in terms of mobility and other issues that affect the elderly. We are clear that if this problem is to be eased, further funding is required at local authority level, which is why we have made available up to £1 billion over the period of the spending review to ensure that the issue is addressed.
My Lords, the noble Baroness will know that a code of practice was issued some time ago, which the CQC uses to ensure that the registration requirements of a provider have been complied with. It is clear that the decline in numbers of hospital-acquired infections has coincided with the issue of that guidance. We believe that it has made a material difference. I am not aware that there has yet been systematic evidence-gathering of whether the guidance has had an effect, but it appears that it has.
The noble Baroness is absolutely right. The headline figures disguise considerable variations between the best and worst performers. Our approach has been to adopt a zero tolerance policy to all avoidable healthcare-associated infections. To support that we have introduced a number of specific actions, including establishing clear objectives under the NHS operating framework, which are requirements for all trusts to meet, and for primary care organisations, and extending to health and social care settings the regulations on infection prevention and control. We have also increased the requirements on publishing data trust by trust.
My Lords, I welcome very much the fact that the Government have continued to bear down on this issue, which of course my Government made great strides on when we were in office. Can the Minister assure the House that the funding to continue bearing down on it will be ensured from a national level?
My Lords, as the noble Baroness knows, we expect trusts and primary care organisations to utilise funds from within their global budgets to meet the requirements that I have just outlined, such as those in the NHS operating framework. These requirements are mandatory, and it appears that over the past few years, trusts and primary care organisations have really got to grips with this problem.
My Lords, the Government are to be commended on insisting that all hospitals publish their infection rates for Clostridium difficile and MRSA on a weekly basis, which we can monitor on the website. It is interesting to note that one or two hospitals stand out by consistently having higher numbers while the rest make dramatic reductions. What is important, however, is that there has been no reduction in central venous line or other central line infections. I hope that the Government have a strategy similar to the one on MRSA and C. difficile to insist that hospitals reduce their rates of central line infections.
My Lords, the noble Lord makes an important point. We have consciously limited the extent to which it is a requirement to publish data to the most prevalent infections that need to be addressed. That is not to say that other types of infection are less important; they are extremely important. However, we would expect a ward-to-board policy to operate within each trust so that the boards of trusts bear down on these infections as hard as on others.