Clostridium Difficile

Nick de Bois Excerpts

Tuesday 9th November 2010 Commons Chamber

[Mr Burrowes]

I am glad that the Minister fully shares my concern. It is good to know that hospitals cannot expect any additional payment for treating those who have suffered a recurrence during those 30 days. However, I ask him whether there could be any sanctions on trusts that sadly fail to reduce the rate of infection.

Along with the Department of Health, my constituent Graziella has produced a leaflet, which my hon. Friend the Minister helpfully distributed just before the debate. It is called “C. difficile—now you are going home”, and it sets out the best ways for patients to protect against the infection spreading. It is intended to be given to patients so that they can be aware of the risks and know how to prevent other vulnerable people from catching the infection. However, although both Graziella and I would like to see this leaflet distributed by every hospital and GP, there is no requirement that that happen. Many patients return home without the information in that fantastic leaflet about how best to protect themselves and others. Will the Minister consider requiring—or, in the more localising language that Conservative Members prefer, incentivising—hospitals to provide the leaflet or similar information to all patients leaving their charge who have had the infection?

Although improvements have been made in acute trust hospitals such as my local North Middlesex university hospital, it is important that we do not lose sight of the need to pay attention to what is happening in our primary care trusts. In fact, in every month of last year, PCTs reported far more cases of C. diff than acute trusts. Enfield PCT, which is by no means extraordinary in this regard, reported 144 cases in patients aged over two in just the past year.

[Nick de Bois (Enfield North) (Con)]

To pick up on my hon. Friend’s point about Enfield, as he knows, at our local hospital, Chase Farm, there has been an extraordinary improvement in recent months, particularly since August. That is essentially down to a massive concentration of effort on this one problem, and there, in part, lies the solution.

[Mr Burrowes]

I am grateful to my hon. Friend, and I support the work that has happened. It has very much been prompted by Graziella, who has been going from ward to ward to ensure that what people say is being done is, in fact, reflected in their actions.

We also need to get to grips with the problem of C. diff in the community. In the past, there has been too little interest in what happens to a patient once they leave the hospital walls, and too little attention to the problem of infection being spread between hospital and home, or worse, between hospital and care home. Sadly, many of my hon. Friends will have witnessed that situation. That two-way corridor of infection must be addressed, as must the associated lack of care that care home residents can sometimes receive, as they are sadly away from the public eye.

Given the clear danger of allowing infections to spread within an enclosed community of elderly and vulnerable people, I would be interested to know what the Department is doing to monitor cases within the care home setting, and specifically to monitor whether cases are being reported consistently and dealt with promptly and according to the most recent hygiene code.

As we move boldly to a health care system that puts the patient and their recovery at the heart of every decision, it is essential that health care-associated infections such as C. diff are on GPs’ radars, especially as they take on responsibility for commissioning in their area. There needs to be an assumption in favour of testing for the infection when patients are suffering from diarrhoea. GPs must also be properly aware of the need to check up on patients, and avoid prescribing them certain drugs that are known to increase the risk of infection and the likelihood of patients suffering from severe symptoms. The C. diff support group has identified a number of worrying cases of GPs prescribing antibiotics. I also ask colleagues to look on its website and check out Imodium, which is known negatively to affect patients suffering from C. diff.

In December 2008, the Department of Health’s report on C. diff strongly recommended that

“all cases of diarrhoea among people in the community aged two years and above should be investigated for C. diff unless there are good clinical reasons not to.”

Such good practice needs to be extended to all GPs. Does the Minister know what more the Government can do to ensure that GPs are fully briefed on C. diff and that they are responding to this knowledge efficiently and consistently?

Perhaps the Minister would consider enabling the NHS computer systems in both hospitals and GP surgeries to tag an alert to Imodium and other drugs that are known to increase the risk of C. diff in vulnerable patients. Doctors intending to prescribe such drugs would be reminded to consider whether the patient might have the infection before doing so.

As for the careful monitoring of patients in the community, I would be interested to know what, if any, guidelines GPs follow with regard to the treatment of patients with C. diff. Perhaps the Department would be willing to provide such advice to doctors. Doctors could perform a simple blood test on elderly patients in the community to provide an early warning against the possibility of renal failure.

I very much welcome the Health Secretary’s attendance today and his commitment to comprehensive, trustworthy and easy-to-understand information on how to look after patients’ health. The data on C. diff infection rates already exist and can be found online, but they are often inaccessible in their format. They can be sketchy and incomplete at best.

Yesterday, NHS Choices listed 12 hospitals within five miles of one of the postcode areas in my constituency. Of those 12 hospitals, data on the prevalence of C. diff cases within the last 12 weeks were available for only two of those hospitals—North Middlesex University hospital and St Ann’s hospital. On the same day, the Department published business plans with a focus on transparency. To ensure that we see even more marked improvements in the next three years, will the Minister tell us what he intends to do to ensure that “easy to understand” information is available, especially on those websites that patients are most likely to use and at those locations that they are most likely to frequent?

Finally, I look forward to the time when the Minister can declare to the House that preventable healthcare-associated infections such as C. diff can be eradicated. However, I am conscious, as the Minister will be, of George Bush’s regret when he prematurely declared “mission accomplished” and there is much to be done before we can get near to such a declaration. I hope that this debate, which supports the great work of campaigners such as my constituent Graziella Kontkowski, can move us closer to a time when we have no need to raise this important issue in the House again.