Question to the Department of Health and Social Care:

To ask Her Majesty's Government, further to the Written Answer by Baroness Blackwood of North Oxford on 4 June (HL15832), what assessment they have made of (1) the future costs to the NHS as a result of the spread of carbapenem-resistant Enterobacteriaceae, (2) the costs of new measures introduced in 2019 specifically to prevent the transmission of such Enterobacteriaceae, and (3) the views of infection control nurses on investment to prevent the transmission of such Enterobacteriaceae.

Public Health England (PHE) has predicted future spread and the health and cost impact to the National Health Service of the Enterobacteriaceae Escherichia coli and a national outbreak of a highly-resistant organism, reflecting carbapenem-resistant Enterobacteriaceae. The models used in this assessment are published in the paper A Risk Assessment of Antibiotic Pan-Drug-Resistance in the UK: Bayesian Analysis of an Expert Elicitation Study. A copy of the paper is attached.

Such predictions are highly uncertain. There remain unknowns regarding transmission, efficacy of interventions and the additional hospital stay for infected patients (constituting a large part of the cost to the NHS).

PHE has worked with NHS colleagues, estimating the cost of controlling a carbapenemase-producing Enterobacteriaceae (CPE) outbreak in five London hospitals to be over £1 million. Monitoring costs alongside implementation of PHE’s upcoming update of the CPE toolkit for health and social care is an important component of enabling cost-effectiveness evaluation.

Staff interviewed about the challenges of implementing the existing CPE toolkit highlighted maintaining awareness and training as key challenges, alongside infection prevention resourcing. An analysis of the responses was published in the paper An evaluation of a toolkit for the early detection, management, and control of carbapenemase-producing Enterobacteriaceae: a survey of acute hospital trusts in England. A copy is attached.