Committee of Public Accounts


Publication of the Committee's 52nd Report, Session 2008-09

Edward Leigh MP, Chairman of the Committee of Public Accounts, today said:

"Healthcare associated infections cost the NHS more than £1 billion per year and can lead to serious disability and in some cases death. This is the third time that this Committee has reported on the subject and it is disappointing that the Department of Health still has not taken on board a number of key recommendations.

"There has been progress. The Department has achieved significant reductions in MRSA bloodstream and Clostridium difficile infections, for which it set national targets. But, in so doing, it has taken its eye off the ball regarding all other healthcare associated infections - which actually constitute most by far (four-fifths) of all infections. The best available evidence is that other - just as deadly but also avoidable - infections, such as surgical site infections and pneumonias, have increased.

"Progress in combating these other infections is being bedevilled by a lack of potentially life-saving information. The Department is refusing to introduce mandatory surveillance of all hospital acquired infections - as we have recommended twice. If it had, it would now have a better grip on what is going on and be able to reduce the risks of patients getting these infections. And the NHS still has no idea how many patients are dying from the other healthcare associated infections.

"Antibiotic resistance constitutes one of the greatest threats to controlling infection and yet the Department has chosen to ignore yet another recommendation in our previous report: that there should be a national electronic prescribing system. This would link data on infections to prescribing to make sure antibiotics are being used effectively."

Mr Leigh was speaking as the Committee published its 52nd Report of this Session which, on the basis of evidence from the Department and NHS, examined progress in reducing healthcare associated infections in hospitals.

Every year over 300,000 patients in England acquire a healthcare associated infection whilst in hospital. These infections cost the NHS more than £1 billion a year. They are caused by a variety of organisms and lead to a range of symptoms from minor discomfort to serious disability. For some they can be fatal, and in 2007, there were 9,000 deaths recorded with Meticillin resistant Staphylococcus aureus (MRSA) or Clostridium difficile infections as the underlying cause of a contributory factor.

This is our third report on this key indicator of quality and safety of NHS care. In 2000, our predecessor Committee concluded that the NHS did not have a grip on the extent and costs of hospital acquired infection and that without robust data it was difficult to see how they could target activity and resources to best effect. In 2005, this Committee found that the progress in improving infection prevention and control had been patchy and there was a distinct lack of urgency on key issues such as ward cleanliness and compliance with good hand hygiene.

The Department's hands on approach to what seemed, in 2004, to be an intractable problem, has been successful in reducing Meticillin resistant Staphylococcus aureus (MRSA) bloodstream and C. difficile infections. Hospitals cleanliness has improved and the priority given to reducing these two targeted infections has started to have an impact on hospital trusts overall infection prevention and control. This progress has not, however, been matched on other healthcare associated infections. The best available evidence from voluntary reporting of other healthcare associated bloodstream infections, however, suggests that these infections may be increasing. Indeed, as a result of the Department's decision to disregard a key recommendation from previous Committee of Public Account reports€”to introduce mandatory surveillance of all hospital acquired infections€”there is still no robust comparable data on the extent and risks of at least 80% healthcare associated infections.

There has also been limited progress in improving information on, and understanding of, hospital antibiotic prescribing and the evidence that is available on other bloodstream infections, which can be just as serious as MRSA, suggests the problem may be growing and that antibiotic resistant organisms are increasing.