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.

It is up to the hon. Gentleman to ask the Secretary of State for Transport. As I have stated, I have not given any reason why I have refused this matter, and I do not want to say any more about it.

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].

We now come to the main business. I inform the House that in both debates, I have selected the amendment in the name of the Prime Minister to the motion.

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.

rose—

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.

rose—

I give way to my hon. Friend, who had an interesting and important debate last week.

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.

rose—

Perhaps the Minister will explain where that target came from.

Now that the hon. Gentleman has seen the advice that was put to Ministers, what does he think is the right response—to redouble efforts or, as he appeared to conclude yesterday, to scrap the target?

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—

Will the hon. Gentleman give way?

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 hospital,”—

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.

rose—

rose—

I will give way to the hon. Member for Enfield, Southgate (Mr. Burrowes).

May I press the Minister again? Why is it that this country, almost uniquely in Europe, supports the practice of nurses’ uniforms being laundered at home rather than by industrial laundering, which would ensure proper thermal disinfection?

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.

Will the Secretary of State give way?

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—

Will the Secretary of State give way?

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.

Local targets?

Local targets, because there is such local variation in the incidence of C. difficile, which is not something that one can say about MRSA.

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.”

rose—

The hon. Gentleman is being very persistent; I give way.

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.”

He claims:

“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.