The NHS Confederation recognises the importance of tackling healthcare associated infection (HCAI) issues in the NHS and is working to support members in this.

Current position

Infection control is at the top of the board agenda in the NHS. The release of Health Protection Agency quarterly figures on HCAIs in November 2007 show progress in the reduction in MRSA rate, demonstrate how the NHS is committed to addressing this problem how, with the right focus, it can deliver. Tackling clostridium difficile (often abbreviated to 'c. diff') is a different challenge from MRSA and making full information available will help.

The Department of Health announced a health infection strategy in January 2008 and we welcome the extra funding dedicated for controlling infection. We are clear that a zero tolerance approach to infection must be embedded in the ethos of all NHS staff to ensure that infection rates continue to decline.

In January 2008, health secretary Alan Johnson updated Parliament on the progress of deep cleaning in acute trusts. He said that 80 per cent of trusts have started and that all other trusts have plans agreed to start in the next few weeks. He made clear that the needs of each hospital will vary according to local need and configuration of services, giving the example of a newly built hospital not requiring as intensive a programme as others.

HCAIs are widely recognised as an intractable problem for the NHS and the solutions will need everyone - including the local community - to work together. The hygiene code is helping boards take control of the problem.

The Healthcare Commission's Maidstone Hospital report in 2007 shows it is important to learn from those occasions when things go wrong and to make sure it does not happen again.

What we are calling for

We want to see sensible HCAI surveillance measures and for the information from them to be made public. If targets are to be set in this area we want organisations to set stretching local targets and for these to be aggregated up to monitor national progress.

We will continue to work with the Health Protection Agency to expedite development of a national surveillance system for HCAI that meets the needs of the NHS and which provides robust comparable data to improve informed decision-making.

In spring 2008 the NHS Confederation is producing a short report to help support boards in understanding their responsibilities in relation to HCAI. The report will highlight key lessons from recent Healthcare Commission findings, high quality assurance systems and ideas from leading edge practice in the field.

We regularly meet with key national agencies such as Department of Health and National Patient Safety Agency on the subject of quality and safety in the NHS and remain active in policy developments in this area.

Background information

Any HCAI is an extremely serious matter and it should be emphasised that these figures represent a very small proportion of the 10 million inpatients that the NHS treats in hospitals every year.

In February 2000 the National Audit Office report The Management and Control of Hospital Acquired Infection in NHS Acute Trusts in England (HC 230 Session 1999-00) noted that at any one time, 9 per cent of patients had an infection that had been acquired during their hospital stay. The effects varied from extended length of stay and discomfort, to, in around 5000 patients a year, death. These infections were costing the NHS as much as £1bn a year and around 15 per cent were said to be preventable by better application of good practice, releasing resources of £150m for alternative NHS use. The figure of 9 per cent was arrived at in studies published in 1981 and 1996, and this may be out of date. However, it is certain that many of these cases are due to bacteria which are increasingly difficult to treat due to the evolution of antibiotic resistance.

Not all HCAI is preventable, but up to 30 per cent may be. The problem of HCAI is not new - MRSA (methicillin resistant staphylococcus aureus) is a common antibiotic resistant form of staphylococcus aureus (SA). It first appeared in the 1960s and by 1997 was considered endemic in NHS hospitals. MRSA bacteraemia has been used as a 'marker' for HCAI, generally because good information about it is available. It is estimated that action to tackle MRSA will also have an impact on other HCAIs such as clostridium difficile.

The Department of Health with the (then) NHS Modernisation Agency promoted the Saving Lives website and service improvement tools for NHS organisations to better tackle HCAIs. The NHS Confederation supported these initiatives by publishing a summary briefing for members and offered workshops to members about the Saving Lives programme in January 2006. Our Saving Lives briefing, issue 123, published in October 2005 includes links to further tools for NHS organisations.

NHS Confederation representation

Our chief executive Gill Morgan has joined the NHS Chief Executive's and Chief Medical Officer's National Patient Safety Forum to collaborate with other key organisations in the drive to deliver safer healthcare.

How we involve members

We hold topic specific seminars and meetings to inform our policy positions - invitations either appear in our email bulletin Interchange Alert or are sent out individually.

We work through member networks such as Future Health Care Network (FHN) and Health Services Research Network (HSRN) to capture and share emerging research findings and new practice in tackling patient safety.

To become involved in our work programme on quality and patient safety please contact Jane Austin.