Antibiotic Resistance

Lord Young of Cookham Excerpts

Wednesday 15th October 2014 Westminster Hall

[Sir George Young (North West Hampshire) (Con)]

It is a pleasure to follow the hon. Member for Inverclyde (Mr McKenzie), who set out clearly the problems of antibiotic resistance. I compliment my hon. Friend the Member for York Outer (Julian Sturdy) on his choice of subject and on how he developed the argument and presented the case, ending with a three-point action plan, which I hope that the Minister will be able to smile on when she responds to the debate.

Over the recess, I read Dame Sally Davies’s book, “The Drugs Don’t Work”, which was published last year. It is concise and understandable by a layman, but deeply alarming, particularly as it comes from the country’s chief medical officer. She warned that antibiotic resistance should be treated as seriously as terrorism when we rank threats against this country. The hon. Gentleman and my hon. Friend set out the problems as the risks of antibiotic resistance become greater because of over-prescription and overuse. At the moment we are all preoccupied with Ebola, which is a virus and not a bacterium, but many lower-profile cases of new strains of antibiotic-resistant bacteria are being introduced into NHS hospitals as a result of the admission of patients who have recently arrived from overseas.

As my hon. Friend the Member for York Outer said, if we do not raise our game against the superbugs, the chief medical officer warns that a cut finger could lead to a festering death. Each year across Europe, some 25,000 people die from drug-resistant-bacterial infections. As he said, the new antibiotic-resistant threat is from the less well known, so-called gram-negative bacteria, which have names such as Klebsiella, Pseudomonas and Acinetobacter. In many parts of the world, those bacteria are either untreatable or only treatable by a toxic antibiotic called colistin, which was discovered in the 1940s. Its use carries huge risks, as my hon. Friend said, because of its toxicity. The new strains of gram-negative bacteria create severe clinical problems for patients in intensive care units or other critical care units, such as oncology or transplant. The highly antibiotic-resistant bacteria affect very sick patients, who are found in intensive care and other high-risk units. Some of those bacteria lead to death rates of 50%.

Again as my hon. Friend said, no new gram-negative antibiotics are at an advanced stage in the drug discovery pipeline, so the historical approach of relying on the pharmaceutical industry to come up with a solution will not come to our rescue this time. He explained why we have a classic case of market failure. The business case against developing antibiotics is powerful. It can take 10 years and cost more than £1 billion to bring a new drug to market and, because those bacteria evolve fast and rapidly become resistant to new antibiotics, the research needs to be ongoing. Even if a successful drug is developed, a course of antibiotics might only last a week, so the revenue potential of any new drug is relatively low. My hon. Friend contrasted that with investment in statins, for example, which a patient may take for the rest of his or her life without developing resistance, so in a sense the question of where to put the money is a no-brainer. As a result, AstraZeneca is scaling back research into antibiotics and Roche has issued warnings about the terms of trade.

There is some good news. The severity and acuity of the problem is beginning to be recognised. WHO published a document highlighting the problem in April, and President Obama signed the Generating Antibiotics Incentives Now legislation. As both the previous speakers said, we await Jim O’Neill’s report next spring on why the industry has failed to deliver any new antibiotics. It is not clear, however, how the market failure can be addressed without Government intervention of some sort —my hon. Friend the Member for York Outer outlined a number of possible solutions. It would be helpful if the Minister could confirm that she has an open mind about changing the terms of trade with the pharmaceutical industry, if that proves to be the only way forward.

I am interested in the subject because I have in my constituency a firm called Bioquell, which manufactures equipment and provides specialist services that eradicate micro-organisms—bacteria, viruses and fungi. Its new Pod product comprises single-patient rooms that can be rapidly deployed in hospitals. Crudely put, they can turn a “Nightingale” ward into US-style single rooms. The single-patient room Pod product is generating interest from hospitals around the world worried about Ebola.

As became clear in one of our exchanges on Monday following the statement by the Secretary of State for Health, hospital structures throughout the world vary. Most intensive care units in France and the USA comprise single-patient rooms, whereas most ICUs in the UK comprise open, multi-bed units, which are often linked to high infection rates. We therefore need to have tools available to combat the threat from antibiotic-resistant organisms, which differ from country to country.

At the moment, Bioquell is involved in the decontamination of health care facilities around the world that have housed Ebola patients. Those include three hospitals in the United States, as well as hospitals in the UK, France and Holland. Recently, 20 of the company’s single-patient room Pods have been deployed in the middle east to help a hospital combat the spread of viruses. A small technology company from Andover—this ties in with my hon. Friend’s third point—is therefore leading specialist decontamination work in Europe and the US, helping to combat Ebola through the provision of safe single rooms.

I ask the Minister for an assurance that the contribution companies such as Bioquell can make will not be overlooked. The NHS is sometimes slow to adopt new technology, but when it faces substantial capacity and cost pressures due to an ageing population, the adoption of new technology must form a key part of the solution to those ever-growing pressures.

We rightly celebrate our knowledge-based economy. My hon. Friend the Minister’s Department has done much to export life sciences, to encourage med-tech industries and to generate export earnings. In return, however, the Government must support British innovation in the NHS. It is unrealistic to expect companies to be successful at exporting if they do not have a robust domestic market.

I end with the point my hon. Friend made about public interest. I hope the debate he has initiated will begin to drive the issue up the agenda, and bring home to the public and, I suspect, many of our colleagues the real threat antibiotic-resistant bacteria pose to the NHS. I do not think our colleagues appreciate that, with these new strains of bacteria, the NHS faces a major challenge, with high associated death rates, and no effective antibiotics exist. Unchecked, these bacteria will limit the ability of the NHS to provide many of the life-saving procedures we all take for granted, and the costs to the NHS will increase substantially. That means there must be a positive response to Jim O’Neill and active engagement with companies at the cutting edge of research in this field so that we can begin the fight back against these antibiotic-resistant bacteria.

[Several hon. Members]

rose—

Community Hospitals

Lord Young of Cookham Excerpts

Wednesday 3rd September 2014 Westminster Hall

[Sir George Young (North West Hampshire) (Con)]

May I begin by saying that it is a pleasure to serve under your chairmanship, Mr Owen, and by joining my hon. Friend the Member for Dover (Charlie Elphicke) in his warm welcome to our hon. Friend on the Front Bench, who will make his maiden ministerial speech in Westminster Hall? I also congratulate my hon. Friend the Member for Dover on his choice of subject. As we approach a general election, it is worth remembering that a Member of Parliament actually lost his seat in 2001 because of a perceived lack of commitment to a community hospital, but my hon. Friend’s powerful speech will have consolidated his position in Dover and Deal on health-related matters. Listening to his speech and reading some of the comments made about the NHS, one can understand the concern that district general hospitals and specialist services might sap the life blood out of community hospitals, some of which are fighting to hang on to what they have or even face closure. I want to speak briefly in the debate to show that, so far as North West Hampshire is concerned, the opposite is now happening.

I have no district general hospitals in my constituency—Basingstoke and Winchester are the nearest DGHs and are in next-door constituencies—but I do have the Andover War Memorial hospital in my largest town and what has happened there over the past few years shows what can be done. In 2012, a new trust was formed, amalgamating Basingstoke, Winchester and Andover hospitals and there were fears that Andover, as the smallest, would be squeezed as services were centralised. In fact, the opposite has happened, and I commend what Mary Edwards, the chief executive of the combined trust and Elizabeth Padmore, the chair, have done to bring services to Andover and so reduce the need for people who live in and around the town to drive to the nearest DGH—and most people have to drive as access by public transport is difficult. The process has actually helped the DGHs by reducing pressure on some of their services, not least on car parking, and has made it easier to recruit and retain NHS staff, as not everyone in Andover wants to work in Basingstoke or Winchester.

In Andover, as in other towns, the hospital has always had a strong claim on people’s loyalties, and we have to take note of that. Nowadays, however, one cannot make the case for investment on emotion alone; there has to be a hard-nosed business case to back it up. My hon. Friend drew on some research that underlines the need to invest in community hospitals. The reality is that bigger is better for some procedures, but smaller is better for others, and the position is not static as medical technology develops. A modern health service needs to make intelligent decisions about its assets to get the best value out of them.

After careful analysis of the best way forward by the new trust, we have seen service development in Andover and investment in the fabric, which has capitalised on the skills and commitment of the existing staff, whose energy and professionalism I pay tribute to, and has generated additional investment through, for example, an active league of friends. It has also helped to restore confidence in the NHS decision-making process as local people see the outcomes of the new method of running the NHS. For example, we now have a mobile chemotherapy unit that visits Andover weekly, avoiding a 50-mile round trip to Basingstoke or 30-mile round trip to Winchester, which was done in partnership with Hope for Tomorrow. A new minor injuries unit opened in 2010 and is run by highly skilled nurse practitioners with back-up support from the consultants in emergency medicine at the DGHs. We have a modern out-patients department to replace a building that dates from the era of “Carry on Nurse”. Instead of local folk having to travel to a DGH to see a consultant, consultants from nearly all the specialties now come to Andover. We have a mobile MRI scanner, and operations under local anaesthetic are now also taking place in Andover. The Hampshire hospitals birthing unit has just opened and is run by local midwives and provides ante and post-natal care. More and more local families are choosing a midwife-supported birth, and they can either have the baby at home or in the birthing unit.

The hospital campus is large and has always been used intelligently. The Countess of Brecknock hospice, run independently by a charitable trust, is next to the hospital. More consultants in palliative medicine are now based there and it is developing a hospice-at-home service. Also next to the hospital is a nursing home, funded and run by the county council on land provided by the NHS.

At this point, the cynic might ask what is so remarkable about a large building calling itself a hospital providing services for people who are ill, but that is to miss the point. The NHS must adapt and change if it is to continue to provide a quality service, which means specialisation where necessary and localisation where it is not and investment in both DGHs and community hospitals

I have two requests for the Minister—one general and one specific. First, I endorse the plea made by my hon. Friend the Member for Dover for an assurance that the Government support the continued provision of more services locally, as is happening in North-West Hampshire, and will encourage the trust to continue with its strategy of providing more services in the town, such as transferring patients who have had critical treatment elsewhere for rehabilitation in the hospital. We are pleased with what we have, but our appetite has been whetted and we want more. I was tempted to say, “Dover Andover again,” but I will not.

Secondly, and more specifically—I do not expect an answer this morning—the ugliest building in Andover is the Andover health centre, which houses a GP practice on the hospital campus owned by the trust. Not only is it ugly, it is past its sell-by date as a place where GPs can practise. Indeed, the trust wants to demolish it next year. The site could be sold for housing, for which there is great need, and could generate a capital receipt for reinvestment in health services. The dialogue between the various agencies of the NHS to relocate the practice, which is the largest in Andover with some 15,000 patients, has gone on for at least four years with no end in sight. It started off with the primary care trust, but now involves NHS England, the clinical commissioning group and the trust. The practice wants to be relocated near the hospital, where land is available, and there are advantages in having GPs next door. We need to resolve the matter before the Care Quality Commission looks too hard at the current building. In conclusion, I ask my hon. Friend the Minister to indicate that he will take a personal interest in the matter and use his influence to bring the dialogue to a satisfactory conclusion.