NHS trusts face fines for poor hygiene

A survey published in June showed that one in four NHS trusts in England failed to meet minimum standards on hygiene. Fines of up to £50,000 will be imposed on NHS trusts which breach hygiene regulations in a crackdown on hospital infections.

Inspectors will have powers to prosecute dirty hospitals and clinics, and impose sanctions ranging from fixed penalty fines to closure of wards, clinics or services.

The fresh measures are part of the Government's drive to protect patients against superbugs, including MRSA and Clostridium difficile.

Public anxiety has been increased by incidents such as the 90 deaths attributed to C. difficile at Maidstone and Tunbridge Wells NHS Trust over two and half years. The deaths of a further 255 patients were judged to have been hastened by the bug.

Hospitals that fail to meet minimum hygiene standards will be issued with fixed penalty notices with fines of up to £4,000. Obstructing an inspector or failing to provide documents or information will attract fixed penalty fines of £1,250.

More serious offences, such as failure to act on an improvement notice following an outbreak of infection could lead to prosecution, carrying a maximum £50,000 fine.

The measures are contained in a document released by the Department of Health setting out proposed powers for the Care Quality Commission (CQC), the Government inspectorate that will replace the Healthcare Commission next year.

David Nicholson, chief executive of the NHS, says in a foreword to the document: "Patients keep telling us that contracting a healthcare-associated infection is one of their biggest concerns. It is crucial that we focus on bringing infection rates down even further and protecting patients, staff and visitors from the risk of infection."

The CQC will have responsibility for overseeing all hospitals in England, both NHS and private, as well as care homes for the elderly, GP surgeries and private clinics. Under regulations to be introduced in April 2009, hospitals and clinics will have to register for an operating licence with the CQC, which will be conditional on meeting minimum standards on hygiene.

A survey published in June showed that one in four NHS trusts in England failed to meet minimum standards on hygiene for the second year running, potentially putting patients at risk.

The Healthcare Commission, which published the survey, said the findings showed that, despite huge political pressure, a minority of trusts had still failed to put the necessary measures in place. Sanctions were an inevitable next step, it said.

Anna Walker, chief executive of the commission, warned in June that NHS trusts had 10 months to get their act together. "This is a wake up call," she said.

Britain has some of the worst problems with hospital infections in Europe, despite recent falls, and the issue has been at the top of the political agenda for the past three years. Polls show worries about bugs such as MRSA have overtaken concerns about hospital waiting times.

The hygiene code covers infection control, decontamination of equipment and the cleanliness of the hospital environment.

A Department of Health spokeswoman said: "This is a toughening up of the regulations around infection control."

Jo Webber, of the NHS Confederation, representing NHS trusts, said: "NHS trusts are absolutely clear that they have a responsibility to maintain high standards of hygiene. Where there are problems they would hope that the CQC would work with them to resolve those difficulties. Fines should be a last resort."

The proposals are out for consultation until October.

From:
nhs-trusts-face-fines-for-poor-hygiene-891487.html

Health Direct is appalled at labour's complacency. Not only is this an admission that nothing will be done about cleanliness for months, but an obvious remedy is available- prosecute the paperpushers and staff responsible for the poor hygiene. Unfortunately, hundreds of people are going to die prematurely before labour stops it's pathetic no blame culture.

NHS managers get away with murder as MRSA superbug hospital escapes criminal charges

The hospital trust at the centre of Britain's worst recorded hospital MRSA superbug outbreak which led to the death of 331 patients has escaped prosecution.

Clostridium difficile contributed to the deaths of the patients over two-and-a-half years at three Kent hospitals a health watchdog report found.

Appalling standards of care, crowded wards, financial problems, a shortage of nurses and poor hygiene all led to the outbreak the Healthcare Commission found in a highly critical report in October.

However after studying that report, Kent Police and the Health and Safety Executive said there would be no charges over the deaths at hospitals run by the Maidstone and Tunbridge Wells NHS Hospital Trust.

Assistant Chief Constable Allyn Thomas said: "Whilst the report makes for grim and at times distressing reading, our review has not identified any information that would indicate a need or duty to conduct a criminal investigation into the Trust at this time."

Relatives of those who died in the outbreak reacted angrily to the announcement.

Steve Stroud, whose 77-year-old stepmother Doreen Ford died in Maidstone Hospital said he was "disgusted" by the decision.

Mr Stroud, husband of former Bucks Fizz singer Cheryl Baker, said: "This is disgusting. Someone has got to be held to account over all these deaths and if it is not the hospital trust, then who the hell can it be?

"Someone really should have to carry the can over this... for no charges to be pressed is really disgusting. I can't believe it".

Baker, described the death of her mother-in-law as "legalised killing".

She said: "The Trust is to blame, I know that, everyone knows it and it makes my blood boil.

"Those patients didn't die by chance, they died because they contracted C diff at the Trust because of poor hygiene and care, so they are to blame, without a shadow of a doubt."

The Healthcare Commission had found the infection probably or definitely killed 90 people and was a factor in a further 241 deaths.

It also criticised the then chief executive of the trust, Rose Gibb, who left before the findings were published and is now reported to be fighting for a payout of several hundred thousand pounds.

But police said the report held no evidence that the deaths amounted to manslaughter.

For the trust or one of its employees to have committed gross negligent manslaughter, it would be necessary to identify a single act that was grossly negligent and caused a death.

Geoff Martin, of campaign group Health Emergency, said: "The decision not to bring charges over the catastrophic management failures at Maidstone and Tunbridge Wells sends out a signal that no matter how many people die, those at the top can bail out without taking the rap.

"Maidstone and Tunbridge Wells was possibly the worst single, corporate failure in the history of the NHS. It doesn't get any worse than 90 deaths and it's massive kick in the teeth to the friends and relatives of those who died that no-one will be properly called to account.

David Nicholson, NHS chief executive, said: "Whilst criminal proceedings have not been brought in this instance, the Trust's failure to protect and care for patients during the outbreaks of Clostridium difficile between 2004 and 2006 was wholly unacceptable."

From:
http://www.telegraph.co.uk/news/2474303/Superbug-hospital-escapes-criminal-charges.html

Clostridium difficile rates still rising

The number of infections caused by Clostridium difficile are continuing to rise.

Graham Tanner, chairman of National Concern for Healthcare Infections, said: “It should be remembered that over four years, more than 20,000 patients have suffered an MRSA infection, and in excess of 200,000 contracted C. difficile.”

In 2007-08 the number of MRSA cases fell to 4,438 - 588 above the target, Health Protection Agency data show. However, in the first quarter of this year a trend of falls in C. difficile bloodstream infections was reversed, with a 6 per cent rise: there were 10,586 cases of C. difficile blood infections in patients aged 65 and over.

A total of 966 cases of MRSA were reported - an 11 per cent drop on the previous quarter and an average of 322 cases a month. In 2004 John Reid, as the Health Secretary, said that infections of methicillin-resistant Staphyloccocus aureus should be cut to a monthly average of 321. At the time that was said to be unachievable. Even within the Department of Health, leaked documents last year showed there was serious concern it would not be met.

But the recent fall in cases suggests that high-profile initiatives such as the “deep clean” of all hospitals and introduction of a mandatory “hygiene code” may have had the desired effect.

MRSA and C. difficile are carried by some healthy people, but the bacteria can cause illness when they grow unchecked, elderly hospital patients being particularly at risk. Annual figures showed a decline for both infections.

Alan Johnson, the Health Secretary, described the decreases as a remarkable achievement.

“Our strategy is clearly having an impact, with our challenging target now within touching distance, but this is not an issue we can be complacent about and we will continue to focus our efforts on reducing infections further,” he said.

Andrew Lansley, the Conservative Shadow Health Secretary, said that the Government would not have met its MRSA target had it measured the yearly rates to March.

To achieve half of the 7,700 MRSA infections in 2003-04, the NHS would have had to limit rates to just 3,850 cases this financial year, he said.

“Every case of a hospital infection is one too many, but in four years Labour hasn't even been able to halve MRSA rates, he said. “They have only got round to admitting they have missed the target by moving the goalposts. This shows just how much they've dithered and delayed over tackling hospital infections.”

Murray Devine, Safety Advisor for the Healthcare Commission, the NHS regulator, added: “This is great news for patients. There's no question that there has been a very significant turn around, but the challenge isn't over. This improvement has got to be sustained and infection rates brought down further.”

From
http://www.timesonline.co.uk/tol/life_and_style/health/article4353861.ece

NHS at 60- MRSA superbug infections are patients biggest fear

NHS at 60- MRSA superbugs and fear of picking up a superbug infection is the public's main concern about NHS hospital care, a UK-wide BBC poll shows. Of the 1,040 people quizzed, 40% listed the risk of potentially deadly infections such as MRSA and Clostridium difficile as their top NHS concerns.

In a separate finding, 31% said they would consider avoiding NHS surgery for fear of getting an infection.


Despite the concerns raised by the survey, 82% of respondents said they were proud of the health service, with half claiming it was still the envy of the world.

The most widely-cited concern after infections was the wait people face for treatment.

Despite the NHS in England, Scotland, Wales and Northern Ireland making shorter waits a priority, one in four people still cited this as a concern.

In England, which is the furthest ahead in reducing waits, no-one should be waiting longer than 18 weeks by the end of the year.

One in 10 polled also said that both the lack of staff and mixed-sex accommodation was their biggest concern.

However, it is superbugs which dominate people's thoughts in the poll carried out by ICM Research for the BBC.

Just 33% of respondents said they were confident that the NHS would protect them from picking up an infection in hospital.

In contrast, 94% were confident that the NHS would provide good care in an emergency such as a car crash, and 86% were confident it would deliver a baby safely.

Ministers have made tackling bugs a priority, launching initiatives such as this year's £50m deep clean of wards.

Infection rates are even higher in Scotland, while in Wales and Northern Ireland they are slightly lower.

Dr Hamish Meldrum, chairman of the British Medical Association, said the findings on infection were of "huge concern".

He said: "We understand why people are so concerned about hospital-acquired infections and although infection rates are coming down, no-one can be happy with the levels that still exist.

"We owe it to patients to be able to prove to them that hospitals are a safe place to go to benefit from the help modern medicine can provide."

Professor John Appleby, chief economist of the independent think thank The King's Fund, said media coverage had fuelled fears about hospital infections.

A Department of Health spokeswoman said it had "come a long way in tackling infections, but any avoidable infection is one too many".

"We have introduced a raft of measures that we know will reduce infection and are already having an impact," she said.

From:
http://news.bbc.co.uk/1/hi/health/7475561.stm

Superbugs MRSA and Clostridium difficile record numbers of patients deaths

Record number of patients are dying in hospitals and nursing homes after contracting superbugs, new figures show. Deaths from C difficile in 2006 were almost double those in 2005

MRSA and Clostridium difficile were linked to more than 8,000 deaths in England and Wales in 2006, up from 5,300 the previous year.

The first ever breakdown of deaths from both infections by location released by the Office for National Statistics shows that the vast majority of patients died from the bugs in hospital.

The deadly infections also killed small numbers of patients in nursing homes and hospices.

In total there were 6,424 deaths from C difficile in all three locations in 2006, almost double the 3,719 deaths caused by the infection in 2005. MRSA was responsible for 1,625 deaths, up from 1,621 the previous year.

The worst hospital for C difficile deaths in England or Wales was the Royal United Hospital in Bath, which had 268 deaths from the infection between 2002 and 2006.

The George Eliot hospital in Nuneaton, Warwickshire, the Walsgrave Hospital in Coventry and the Royal Infirmary in Leicester all had more than 200 deaths caused by the infection over the same period.

Maidstone hospital in Kent, which was part of one of the worst outbreaks of the infection in the country when more than 90 patients died at three hospitals run by Maidstone and Tunbridge Wells NHS Trust died from the bug, had 113 cases over the same period.

With 94 deaths Derriford Hospital in Plymouth had the highest number of deaths from MRSA cases between 2002 and 2006.

Over the same period, The Queen Alexandra Hospital in Portsmouth recorded 81 deaths from MRSA, Maelor Hospital Wrexham 79 deaths and the Musgrove Park Hospital in Taunton, Somerset 77 deaths.

More than 1,100 hospitals, hospices and nursing homes had at least one death from C difficile in the last five years and more than 900 had at least one death from MRSA.

The Office for National Statistics cautioned that many of the hospitals who recorded large numbers of deaths from both infections were also more likely to have high patient numbers generally. The data, collected from death certificates, also shows only where patients died, not where they acquired the infections initially or where they received other treatment before their death.

A spokesman for Help the Aged said he was "concerned" at the wide variation between hospitals.

He added: "We know that older people are at greater risk of hospital acquired infections, so any rise will affect them more heavily."
Worst ten hospitals for deaths from superbugs

Number of deaths from MRSA 2002 - 2006
Derriford Hospital, Plymouth 94
Queen Alexandra Hospital, Portsmouth 81
Maelor Hospital, Wrexham 79
Musgrove Park Hospital, Taunton 77
Royal Sussex County Hospital, Brighton 75
General Infirmary, Leeds 70
Addenbrookes Hospital, Cambridge 68
Birmingham Heartlands Hospital 67
Norfolk and Norwich University Hospital 65
General Hospital, Southampton 64

Number of deaths from C difficile 2002 - 2006

Royal United Hospital, Bath 268
George Eliot Hospital, Nuneaton 235
Walsgrave Hospital, Coventry 233
Royal Infirmary, Leicester 203
General Hospital, Kettering 200
Birmingham Heartlands Hospital 177
General Hospital, Leicester 169
Frimley Park Hospital 164
Sunderland Royal Hospital 152
General Hospital, Southampton 149

From:
Superbugs-MRSA-and-Clostridium-difficile-killing-record-numbers-of-patients.html

Deaths from superbug Clostridium Difficile quadruple

The number of deaths in Britain linked to the potentially deadly superbug Clostridium difficile has quadrupled in just five years, a report warns.

More than 6,000 people died in 2006 after becoming infected with the gut infection in hospitals across England and Wales - a more than four-fold rise compared with 2001 figures, the Office of National Statistics says.

Meanwhile, the number of deaths linked to MRSA rose by more than one third, with the infection mentioned on almost 1,700 death certificates in 2006.

The figures follow an admission by the Department of Health's most senior experts in infection control that the main reason for a 50-fold increase in cases of Clostridium difficile in less than two decades is the failure of hospitals to follow hygiene rules drawn up 14 years ago.

Research by the Liberal Democrats found half of hospital trusts still do not put infected patients in their own rooms, while just one in five puts aside dedicated isolation wards in case of an outbreak.

Last year more than 50,000 people in England and Wales were infected with the infection, which is often triggered by a course of antibiotics. Although the elderly are most vulnerable to C. difficile, one in five cases involves those below the age of 65.

Infection experts said the labour Government had prioritised targets and finances at the expense of safety.

Dr Mark Enright, professor of microbiology at London's Imperial College, said hospitals often suffered the worst outbreaks when managers were afraid to miss targets requiring emergency patients to be admitted within four hours, even if wards were overcrowded or harbouring infection.

The worst-ever outbreak of the disease, at hospitals run by Maidstone and Tunbridge Wells trust, killed 90 people in 2005 and 2006.

An independent investigation said pressure to meet waiting targets was one of the reasons the crisis spiralled out of control.

Prof Hugh Pennington, emeritus professor of bacteriology at Aberdeen University, said patients across Britain had paid a heavy price for the collective failure of hospitals and governments to take infection seriously.

"The failure to invest in proper isolation facilities was wrong; too many people have suffered and perished as a result," he said.

Health spokesman Norman Lamb said two successive governments had failed to ensure recommendations from their own experts were followed.

He criticised the current labour prime minister for introducing "headline-grabbing gimmicks with little scientific value", such as the recent "one off" deep-clean of all hospitals, and a new short-sleeves uniform policy, instead of ensuring that hospitals were detecting and isolating infected patients.

From:
Deaths-from-hospital-superbug-Clostridium-Difficile-quadruple

Superbugs deaths now at 10,000 a year

Superbugs kill at least 10,000 people in Britain each year — 20 times the number who die of Aids. Why isn’t the labour government spending more on finding out why?

Warnings about the dangers of antibiotic overuse started to emerge from laboratories, but because relatively few patients were affected and nobody knew what to do about it, the situation was ignored. Antibiotics continued to be consumed in ever-growing quantities by sick humans and farm animals alike.

The problem took off in 1991, when Britain contributed its own supercharged strain to the world lexicon of multi-drug-resistant superbugs. MRSA-16 first appeared in Northamptonshire, rapidly infecting 400 patients and 27 staff in three hospitals.

Within 18 months it had been reported in 135 more hospitals. Nobody knows how it spread. Along with another British strain, MRSA-15, it went on to infect patients around the world, a pattern that continues.

A meticulous Health Protection Agency study, mapping how the new strains popped up unexpectedly in new hospitals, was published in the Journal of Clinical Microbiology in 2004. But it was too long after the event to shed any light on how the infection had carried. Now research funding is focused on firefighting – casting around for ways to damp down the effects of the pathogens.

It is not just MRSA that is sweeping across Britain like a plague.

Streptococcus, enterococcus and Escherichia coli (E coli) are among a host of bugs emerging in resistant forms and causing everything from pneumonia to tuberculosis, bone destruction and lethal damage to the heart. In addition, we are facing “hyper-virulent” new strains of the bacteria Clostridium difficile (C diff), which have colonised the sites left free by the effect of antibiotics, which kill off many harmless bacterial colonies in their path.

Although C diff is not resistant to treatment, its spores linger indefinitely and, until recently, NHS staff were largely unaware of how to kill them. Consequently, it is the biggest killer of the current superbugs.

In 2006 it was mentioned on the death certificates of 6,480 people, against 1,652 deaths officially attributed to MRSA. However, these figures are recognised to be underestimates, as many superbug deaths are never identified.

Mandatory surveillance of MRSA bloodstream infections is a recent innovation, the number of people carrying it with no symptoms is not recorded, and the formal collection of figures for death and disease associated with C diff (which causes unstoppable diarrhoea or gut perforation) only began in April 2007. The government estimates the annual cost of treatment for such cases to be over £1 billion.

Officially, the total number of MRSA infections is 7,000-8,000 a year, while C diff is running at an annual 55,600 cases. Many experts believe the real total for all superbug infections is nearer 300,000 – how many are fatal is believed to be vastly higher than the official figures suggest. There is no way of knowing the true figure, as relatively few people are tested.

Meanwhile, a variety of new resistant pathogens are waiting in the wings. In September 2006, a variation of Staphylococcus aureus that produces a toxin called Panton-Valentine leukocidin (PVL) claimed its first British victims. Since then, anxiety over this threat has escalated. The pathogen selectively attacks the young rather than the old; it gets into bones and joints, causing crippling damage.

A multi-drug-resistant version of a common food-poisoning bug, ESBL (extended-spectrum beta-lactamase) E coli, is also causing anxiety. First identified in the 1980s, it has spread steadily to cause an average of 30,000 cases of blood poisoning and urinary-tract infections a year.

Although it has officially been blamed for 57 deaths so far, the true total is believed to be many thousands. Government scientists think the source is meat and milk, colonised by superbugs as a result of overuse of agricultural antibiotics.

From:
http://www.timesonline.co.uk/tol/news/uk/health/article3582299.ece

Health Direct laments the disaster that is labour's superbug strategy. Which causes between 3 and 4 times the number of deaths compared to UK traffic accidents.

Superbugs- children hit by playground superbug PVL-MRSA

A new form of the superbug MRSA attacks its victims, usually children, with frightening speed, doctors are warning. One of those who has seen the effects is Sherean Roberts, whose son Daniel, 10, was infected after a trivial fall from a playground slide in north London.

Within two days he had suffered septic shock and total organ failure. Despite treatment with huge volumes of antibiotics, he was not expected to survive.

Daniel had been struck by Panton-Valentine leukocidin (PVL), a toxin that combines with MRSA, the methicillin-resistant staphylococcus aureus bacterium that causes thousands of infections in hospitals.

The PVL-MRSA infection can get into the skeleton, where it is particularly hard to treat with drugs. Instead, doctors have to remove infected bone.

Daniel was in a coma for a month and has had to undergo five operations to scrape out the infected bone in his leg and hip. He is now largely confined to a wheelchair. “One day he was playing happily, and the next day he couldn’t see, speak or move,” said Roberts, 33. “The doctors didn’t know what to say to me, they didn’t know what was happening.

“They tried drug after drug and nothing seemed to work. It was a terrifying experience that you would not wish on anyone. We still don’t know how much the bones will grow back or how well he will recover.”

David Hunt, a children’s orthopaedic surgeon at St Mary’s hospital, Paddington, said the infection had eaten away the bone in Daniel’s hip and leg.

“The most worrying element of Daniel’s story is that although he complained that his leg began to hurt after the fall, there was no sign of broken skin, bruising or other damage to allow the bacteria into his bloodstream,” said Hunt. “It is very alarming. We don’t know enough about these organisms. They are appearing in new forms and what happened here is going to happen more frequently.”

The phenomenon of PVL combining with MRSA was first identified in the United States several years ago. The Sunday Times established that reports of cases in Britain have occurred from the south coast to Birmingham.

They include a six-year-old girl left brain-damaged after she fell off her scooter and contracted the infection in her shin bone, from where it spread throughout her body; a boy of nine crippled after a graze playing football; a girl of 12 who fell while dancing; and a 13-year-old who banged his leg on the side of his bed, suffering similar near-fatal infections.

One 11-year-old in a boarding school did not appear to have had an accident that could have led to the bacteria taking hold.

Specialists in the condition accuse the labour government of ignoring warnings about the seriousness of PVL-MRSA, failing to mount adequate infection surveillance and blocking the use of a costly treatment to tackle it.

Professor Richard Wise, a leading microbiologist, says he warned a labour government health minister three years ago of the threat. Wise said the minister told civil servants: “This needs to be sorted, get it sorted.”

Yet the special advisory committee on antimicrobial resistance, which Wise chaired, was later disbanded, and a commitment to provide £250,000 to study the bug was not honoured. “It does seem strange to set up specialist advisory committees and then take no notice of the advice they give,” said Wise last week.

A deputation of three experts from the Intensive Care Society and specialist infectious diseases societies met officials to try to persuade them to change guidelines on the treatment of PVL. At present the use of intravenous immunoglobulin, a blood product that costs £2,500 a treatment, is not approved by the NHS. Doctors say it can save lives.

“We are bracing ourselves for much more of this,” said Nick Clarke, professor of paediatric orthopaedic surgery at Southampton University, whose team treated the case of the boarding school child and another nine-year-old victim.

“MRSA has not only mutated to get round antibiotics but it has also picked up this PVL toxin, which even seems to change once it has infected someone. There are grave fears about this in the paediatric orthopaedic community worldwide.”

A number of other cases, particularly of young adults, have involved PVL pneumonia, a “necrotising” infection that can eat away a fatal level of lung tissue within 48 hours.

One victim was Kirstie Bristow, 23, of Torpoint, Cornwall, who contracted it while pregnant two years ago. Luckily an Australian locum doctor recognised the symptoms and arranged emergency treatment. She was unconscious for three weeks and given only a 50% chance of survival. “I am so lucky to be alive,” she said recently. “It’s important people know what to look for and act quickly.”

Marina Morgan, a consultant microbiologist in Exeter, Devon, said the Health Protection Agency (HPA), had no idea of the real level of risk: “I have had eight cases of PVL pneumonia in Exeter alone and three of them have been fatal,” she said. “It is worrying and it will get worse.”

The latest HPA figures show the number of recorded PVL infections DOUBLED from 224 in 2005 to 496 in 2006. A Department of Health spokesman said research on the prevalence of PVL was now being planned.

According to other figures to be reported on Panorama on BBC1 tonight, 10 times as many elderly patients die from the superbug clostridium difficile in Britain as in any other country in the world. The health department denies the comparison.

From:
http://www.timesonline.co.uk/tol/life_and_style/health/article3822582.ece

MRSA superbug rises show deep clean did not work

MRSA superbug infections caught in hospital are still at unacceptable levels and Labour is failing to tackle the problems of fatal bugs in the correct way, the Conservatives said.

New figures released showed C.Difficile infection cases had gone down but there were still nearly 10,000 cases in those aged over 65.

And while MRSA cases have dropped over the past year they rose slightly in the last quarter of 2007.

Figures released by the Office for National Statistics (ONS) in February showed a huge rise in the number of death certificates mentioning C diff.

In England and Wales, there was a 72% rise, from 3,757 mentions in 2005 to 6,480 in 2006.

Death rates involving C diff increased by 77% among males and 66% among females between 2005 and 2006.

Rates went up from 37 to 65.5 per million males, and from 38.6 to 64.2 per million females.

Andrew Lansley, the Shadow Health Secretary, said: “From start to finish, Labour's attitude to hospital infections has been woefully misguided. For years even their own advisers have been telling them that the way to tackle the problem is to identify infected patients as early as possible and then isolate them to make sure others don't catch it.

"But Labour have ignored the experts and Gordon Brown has stubbornly chosen to put time, money and effort into a 'deep clean' which made a good headline but wasn't backed up by any evidence.

"These figures are for the period when the 'deep clean' started. If it had been effective we would be expecting to start to see a decrease in the number of infections, not another rise.”

The new data shows there were 1,087 cases of MRSA during October to December 2007.

This represents a 0.6% increase on the previous quarter, when 1,080 cases were reported to the Health Protection Agency.

In the same quarter in 2006 there were 1,543 cases.

Meanwhile, figures for the bug Clostridium difficile (C diff) showed an 8% drop, to 9,872 cases in patients aged 65 and over between October and December 2007 compared with the previous quarter.

However, the HPA warned that changes to how NHS trusts report their C diff figures could have influenced the result, as some data may be incomplete.

The HPA stressed it could not be confident that the apparent reduction was an accurate reflection of the current situation.

Dr Duckworth, who is head of the HPA's healthcare-associated infection and antimicrobial resistance department, said: “Over the last year cases of MRSA bloodstream infection have been steadily falling.

"We would obviously like to have seen the trend continued in this quarter and hope that ongoing surveillance will show that this plateau is not indicative of a levelling trend, but we need to see next quarter's figures.

"The NHS has faced a great challenge in turning around the seemingly unstoppable rise in MRSA bloodstream infections that we saw throughout the 1990s.

"The substantial decreases seen in recent quarters clearly demonstrate the huge efforts made by our NHS colleagues to combat these infections.

"Although the current figures indicate a plateau, variations in the rate of decrease over time are not unexpected and are not necessarily a cause for alarm.”

Professor Peter Borriello, director of the HPA's centre for infections, said: “The reduction of healthcare-associated infections is a big challenge throughout the world.

"The Agency continues to support the hard work of our NHS colleagues in combating these infections and the never-ending battle to fight all types of infection.”

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/04/24/nmrsa124.xml

Health Direct notes that once again labour's dithering is literally killing people with preventable early deaths at the same time as wasting yet more taxpayers' money.

Vital year of reform for healthy looking NHS claims nhs spin

The National Health Service faces a critical year that will shape its performance over the next decade, according to David Nicholson, its chief executive.

After some years of financial turmoil, the service is about to record a near £2bn surplus, with NHS foundation trusts - the freestanding, self-governing health service businesses - holding another £1.5bn or so of cash in the bank.

Since April 1, patients have had a choice of any accredited hospital, public or private, for routine treatment. By the end of this year the maximum wait will be 18 weeks, with the average much shorter. And hospital acquired infections - patients' "number one priority" along with hospital cleanliness, according to Mr Nicholson - are finally on their way down.

So in its 60th anniversary year, "on the big safety, money and access issues we will have delivered something quite significant", Mr Nicholson said in an interview with the Financial Times. But while "that is good, it is not good enough", he said as he underlined that the NHS was still in the process of transforming "from one system to another".

That, he stressed, "is not a trivial, piecemeal change. This is a fundamental change in the way health care is delivered".

The NHS had moved from the huge expansion in spending and staff after 2000, to introducing new incentives for commissioning and for choice, and now needed to make services more personalised and responsive to patients.

Key to that would be giving patients far more information, while getting primary care trusts - which purchase care on patients' behalf - "to focus their absolute attention on the benefits to their patients and communities" rather than "always looking after the provider parts of the NHS".

Private sector hospital providers have been expressing disillusionment as the apparent scale of opportunities open to them has shrunk, although Mr Nicholson said private sector interest in providing primary care remained vibrant.

But he added: "I cannot imagine an NHS service in 10 years' time that does not have significantly more private engagement at almost every level - whether it is in the provider arm, or supporting and developing commissioning, or whether it is the direct provision of services. It seems to me that is the nature of the system we are trying to move towards."

The new system has brought tensions. Monitor, the regulator for the foundation trusts, complained recently that the Department of Health still seemed to be trying to subject them to command and control by telling them to appoint extra matrons and to have hospital "deep cleans" to control MRSA infections.

Mr Nicholson acknowledged that in the new system "I haven't got the ability to tell them how to do it. That is absolutely true". But he had every right to tell any NHS provider that they must tackle hospital infections in the wake of the big death toll at the Maidstone NHS Trust.

"I don't want to have a spat with the regulator. I think Monitor is doing a fantastic job." But he added: "It is not public confidence in individual organisations that suffers [in a case such as Maidstone]. It is public confidence in the whole system. I have a responsibility to defend that reputation, and I have a right to express a view."

With the NHS having significant sums of unspent capital, and with the intention being to run the same level of surplus this year to even out expenditure over the three-year spending round, the service was now "in a good place", he said, with ample funds to meet its immediate objectives.

But it had to prove it could complete the reforms and use the money well.

"It is a big test. That is why 2008 is so important. When we look back, whether we have exploited this position well will be the judgment of how successful the NHS is over the next 10 years."

http://www.ft.com/cms/s/0/1661d598-0117-11dd-a0c5-000077b07658.html

Health Direct asks why if the NHS is so financially healthy and can afford cancer drugs aren't doctors being allowed to prescribe them?

Private hospital groups have shown limited enthusiasm for labour's plans to outsource treatments. As one executive put it, their fear is that Whitehall's "push" for private sector provision was "less pronounced than it appeared to be a few years ago".

Private sector providers complain that ministers have a habit of decreeing that the market should be opened - then failing to check their spin has been implemented. Somewhere down the Whitehall chain, companies complain, change is blocked - whether by disapproval of the profit motive, turf wars or an ideology-fuelled conviction that public services should remain in the public domain.

Hospital managers to blame for MRSA, say eight out of 10 Brits

Today all NHS hospitals should have completed a "deep clean" in an effort by the Department of Health to tackle superbugs according to Gordon Brown.

New research shows that the British public lays the blame for MRSA squarely at the feet of hospital managers, rather than cleaners, doctors, patients or visitors.

In fact, Brits are now so worried about contracting the superbug, that it ranks as one of their top three concerns when choosing a hospital.

Today's findings from a study commissioned by Bupa of over 1000 adults in Great Britain, show that the British public not only holds managers responsible for dealing with MRSA, but also blames them for the high level of the superbug in NHS hospitals.

Eight out of 10 said that hospital management are responsible for the rise of MRSA, making them 10 times more to blame than cleaners, 80 times more guilty than doctors and 100 times more to blame than patients.

Concern over the superbug has risen to such an extent that when Brits consider which hospital to choose for treatment, the rate of MRSA is now one of their top three issues - along with waiting times and the reputation of the hospital itself.

According to the study, people also now rate the level of MRSA in a hospital as on a par with the reputation of the consultant handling their treatment.

But while fears about MRSA are high, Brits are not prepared to travel to find a clean hospital - they want one on their doorstep. In fact, seven out of 10 people said they would not go more than 20 miles to find a hospital with a low rate of MRSA.

Dr Paula Franklin, deputy medical director at Bupa UK Health Insurance, commented: "Clean hospitals have become so important to the British public that they now represent the biggest reason why people buy health insurance, with two out of three people taking out health insurance because they want to make sure they are treated in a clean hospital.

"While our survey shows the public place the blame for superbugs squarely at the door of hospital management, people need to be alert to the fact that MRSA is largely brought into hospitals by patients and visitors. Greater awareness is needed so that everyone - and not just hospital staff - can play a part in the fight against superbugs".

From:
http://www.bupa.co.uk/about/html/pr/310308_mrsa.html

Health Direct points out that contrary to our esteemed leader- Gordon Stalinist Brown's promises up to twenty per cent of hospitals will fail even to miss this deadline.

Superbug related deaths up by 72 per cent to 6,480- nearly twice UK road deaths

The number of death certificates mentioning clostridium difficle has risen by almost three quarters in one year, official figures reveal.

The large increase comes after the Government ordered doctors to note healthcare acquired infections on death certificates whether it is the underlying cause of death or not.

This figures from the Office of National Statistics show the 6,480 death certificates in 2006 mentioned the bug, which takes hold in vulnerable patients often after a course of antibiotics. The previous year just 3,757 certificates mentioned it.

Data from the Health Protection Agency, which collects the total number of reported cases of infection from hospitals, shows there were 51,892 cases in patients over the age of 65 in 2005, rising to 55,636 in 2006.

Meanwhile, the number of death certificates mentioning MRSA levelled off at 1,652 in 2006. In one in three of these cases the infection was the main cause of death.

Figures from the HPA show the total number of cases of MRSA blood stream infection is dropping from 7,233 in 2004/5 to 7,096 in 2005/6 and down to 6,383 in 2006/7.

In 2005, the Government’s Chief Medical Officer Sir Liam Donaldson issued guidelines saying where a patient dies with an infection it should be put on the death certificate.

The proportion of patients where the death certificate shows C.diff was the cause of death has remained stabled at around 55 per cent of all certificates mentioning the bug.

Murray Devine, head of safety at Healthcare Comission said: “The sharp increase in reported deaths from C difficile is disturbing - but not surprising because it shows that previous deaths rates were probably seriously under-reported.”

She added: “Recent steps taken to combat the spread of C. difficile and MRSA won’t yet be fully reflected in these figures.”

The rise in the number of death certificates mentioning C.diff is due to better reporting and overall infection rates are dropping, Prof Brian Duerden, the Government’s Chief Microbiologist said.

He said: “The Chief Medical Officer wrote to the NHS in July 2005 to make clear that we wanted infections such as MRSA and C. difficile to be reported more accurately on death certificates. These statistics from 2006 show that this move has worked and our figures are now in line with other developed countries.

“Since 2006 we have taken significant steps to tackle infections. These include stringent hand-washing guidance for the NHS, a bare below the elbows dress code, putting matrons back in charge of cleanliness on their wards and an ongoing deep clean of every ward.

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/02/28/nsuperbug228.xml

MRSA spin row as NHS publishes new superbug figures

The labour government is within touching distance of hitting its MRSA target, but opposition parties have accused ministers of manipulating the data.

Latest figures show there were 1,072 cases of the superbug in England from July to September last year. This approaches the target of half the 1,925 average quarterly 2003-4 figure, but ignores the seasonal fluctuations.

But the Tories and Lib Dems accused ministers of moving the target back so it takes account of the period directly after the £50m deep clean of hospitals.

The latest quarterly figure represents an 18% fall on the previous quarter and comes after steady falls since September 2006. Decreases have also been seen elsewhere in the UK.

"There are too many people suffering from these infections. It is terribly important that trusts maintain the pressure." Murray Devine, of the Healthcare Commission

In 2004, the then health secretary John Reid set a target of halving the rates by March 2008. But last year a leaked Department of Health memo suggested the goal was likely to be missed.

But the precise details of the target were never set out at the time and the labour government has now told the BBC News website it will consider it met if there are 963 cases or less in the quarter April to June.

Shadow health secretary Andrew Lansley said: "It appears the government are selectively choosing data to try and fix an outcome. It's no coincidence that the time frame they selected is after hospitals finish their deep clean programme."

Lib Dem health spokesman Norman Lamb said: "This is disturbing evidence of the government manipulating figures to hit a target. "By shifting the numbers around in this way, they are far more likely to hit a target which had previously seemed out of reach."

Labour has denied manipulating the figures - pointing out measuring a period earlier than April to June would give a rate before the target date of the end of March.

The latest hospital infection figures from the Health Protection Agency also showed that Clostridium difficile rates were falling.

There were 10,734 cases of C difficile in patients aged 65 and over in England between July and September 2007.

This was a 21% decrease on the previous quarter, when 13,669 cases were reported, and a 16% drop on the same period in 2006.

Labour has set a target of reducing C difficile by 30% over the next three years.

Murray Devine, head of safety at the Healthcare Commission, which inspects hospitals on infection, prevention and control, said: "MRSA is clearly moving in the right direction and the signs on C difficile are encouraging.

From:
http://news.bbc.co.uk/1/hi/health/7215551.stm

Sacked NHS chief wins £75000 pay-off after C Diff scandal

The sacked chief executive of an NHS trust criticised for a host of outbreaks of Clostridium difficile is to get a £75,000 pay-off, it emerged today.

Alan Johnson, the Health Secretary, had been critical of the decision to award Rose Gibb a pay-off of half of her annual salary when she left Maidstone and Tunbridge Wells NHS Trust.

Ms Gibb left the trust by mutual agreement last year after a damning report from the Healthcare Commission revealed appalling hygiene standards, leading to at least 90 deaths.

Today, however, the trust board said it had determined to pay her the minimum to which she is entitled by law - six months’ pay in lieu of notice. Her salary was £145,000 to £150,000 a year, the trust said.

Ms Gibb could contest the payment, claiming unfair dismissal, so the argument may not yet be over. The trust said it had taken legal advice “and, following that advice, she will be paid only her legal entitlement of six months salary."

The report said “significant failings” at all levels contributed to more than 1,000 patients being infected with the bug across three hospitals run by the trust.

Inadequate staffing levels, dirty wards and too much focus on debts and labour Government targets all contributed to two serious outbreaks of C diff in the autumn of 2005 and early 2006, the study said.

Nurses were found to have told some patients with diarrhoea to “go in their beds”. The affected hospitals were the Kent and Sussex Hospital, Pembury Hospital and Maidstone Hospital.

Former Bucks Fizz star Cheryl Baker has previously called for Maidstone Hospital to stop admitting patients who were vulnerable to C diff. Her mother-in-law Doreen Ford, 77, died there from septicaemia while infected with the bug.

The Trust was the subject of an undercover BBC investigation in May 2004 - months before the 2005 and 2006 outbreaks of C diff.

It found evidence of blood stains ingrained on the floor and clinical waste skips containing bags full of old dressings and bodily fluids left open in corridors used by visitors and patients.

From:
http://www.timesonline.co.uk/tol/news/uk/health/article3247289.ece

Ward cleaning is reassurance spin admits Johnson

The £50m a year that the labour government is to spend on routinely deep cleaning hospital wards is being spent to reassure the public rather than as a provenly effective way to tackle hospital acquired infections like MRSA admitted Alan Johnson the Health Secretary.

Microbiologists warned on the day that Gordon Brown, the prime minister, announced the "deep clean" policy that such routine annual cleans would be ineffective and the medical journal The Lancet has since said they will not affect the risk of infection.

Challenged by MPs on the Commons' health committee that the policy was really "more a publicity exercise than evidence based", Mr Johnson said that would be "a fair point to make if the only thing we were announcing was deep clean".

From:
http://www.ft.com/cms/s/0/2836088a-9ee7-11dc-b4e4-0000779fd2ac.html

Brown's claim to competence is already finished - kaput. He sold our gold reserves at giveaway prices, vandalised our pension schemes with the sledgehammer of tax, opened the doors to unchecked immigration (ministers have no idea how many foreign workers are here), demanded unconscionable sacrifices from our Armed Forces (for which they pay in blood), and managed the nation's money so ineptly that, despite a long period of economic growth, the United Kingdom is on course this year for a £40 billion shortfall in public finances, £6 billion more than Brown predicted in his last Budget.

On July 24, 2006 Health Direct posted NHS targets blamed as crowded wards increase risk of superbugs when we noted that there is a scientific correlation between high bed occupancy rates with high MRSA superbug ineffections, and deaths.

Government targets to cut NHS hospital waiting times are putting patients at increased risk of infection with the superbug MRSA, an official report has revealed. An internal policy review conducted by the Department of Health, leaked to The Independent, has for the first time shown that there is a direct link between the number of patients in hospital - measured by bed occupancy - and MRSA rates. Ministers have denied there is a link.

The most crowded hospitals, with occupancy rates over 90 per cent, have MRSA rates that are over 42 per cent higher than average, according to the report. Those with occupancy rates above 85 per cent have MRSA rates 16 per cent above average.

The findings of the review are considered so sensitive that two attempts by The Independent to obtain the report under the Freedom of Information Act were rejected. Reducing bed occupancy in all NHS trusts to a maximum of 85 per cent would save 1,000 cases of MRSA a year, it says.

The latest figures for 2004-05 show that 88 NHS trusts in England, one fifth of the total, had occupancy rates over 90 per cent and almost half (45 per cent) had occupancy rates over 85 per cent.

Patients losing faith in the NHS, claims survey

Growing concern among the public about falling standards in the NHS is revealed in another new health survey notes Health Direct.

Despite the huge amounts invested in the health service by the Government in recent years, fears over its future continue to grow among patients. The survey's findings show high levels of concern across the entire health service.

Nearly half of those questioned by the Patients Association said they wanted to see further cuts in waiting times for treatment, an urgent reduction in infections such as MRSA and Clostridium difficile (C. diff) and an increase in the number of doctors, nurses and other healthcare staff.

Leading Patient Association trustee Ann Alexander, a solicitor who specialises in health cases, said: "We have to make sure that the health service has adequate numbers of healthcare professionals capable of providing treatment within a reasonable amount of time in a safe environment.

"We don't want people put off by the fear of catching serious infections in hospital to the extent they feel they have to go abroad for treatment."

The survey comes as new figures reveal that last year about 70,000 Britons spent more than £315 million paying for treatment in overseas hospitals and clinics to escape long NHS waiting lists and high rates of infection.

The amount is expected to grow substantially over the coming years. The numbers of patients seeking treatment abroad is forecast to rise to almost 200,000 by the end of the decade, as revealed last week by Health Direct last week ; Record numbers go abroad for health treatments

That could mean as much as £886 million being spent by Britons on foreign treatment.

Keith Pollard, of the information website Treatment Abroad, who carried out the study, said: "Despite huge investment in the NHS over the past 17 years, patients from the UK are voting with their feet and travelling abroad."

A fifth of those questioned by the Patients Association identified a reduction in waiting times as their main priority. Fifteen per cent said cuts in hospital infections would make the greatest difference to them and 14 per cent wanted to see more staff on duty.

The findings follow the publication of official figures which show the labour Government is failing to meet its target for reducing the spread of hospital infections.

Cases of C. diff increased by seven per cent in hospital patients over the age of 65. Cases of MRSA fell by 10 per cent from a high of 7,096, but this was not enough to meet the Government's pledge to halve the rate by next year.

However, despite grave concerns over the NHS, the Patients Association survey found a clear majority rejects any move towards creating an insurance-based health care system on US or French lines.

More than 40 per cent support the current method of funding the NHS through national taxation. Twenty four per cent of those who took part, however, back a tax deductible insurance policy as a way of paying for treatment.

The survey, shows an overwhelming majority want an end to Britain's healthcare "postcode lottery" where availability of drugs and treatments depends on location.

The Patients Association is still collecting responses to its survey at www.patientsassociation.org.uk.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/11/04/nhs104.xml

Hospitals failing superbug targets as 8.2pc of patients acquire bugs

Hospital superbugs are endemic in Britain's wards and the Government is failing to meet its targets to reduce them, new watchdog figures have disclosed. Cases of Clostridium difficile increased by seven per cent in hospital patients over the age of 65 from 51,829 in 2005 to 55,620 last year – an extra 3,791 cases.

The figures, released yesterday by the Health Protection Agency, cast doubt on whether targets set by the Government to reduce C diff cases by 30 per cent in the next four years can be met.

It comes after at least 90 patients died from C diff at Maidstone and Tunbridge Wells Hospital trust and contributed to the deaths of around 200 others in Britain's worst superbug outbreak.

Alan Johnson, the Health Secretary, said yesterday that the hospital's board may have acted illegally when trying to pay off Rose Gibb, the trust's chief executive, with £250,000 days before a damning report into the outbreak was published.

Signalling a clampdown on the "gravy train" managers who take large payoffs, Mr Johnson blocked the massive severance package.

Managers often receive pension benefits and large lump sums to leave failing trusts, only to re-appear in another hospital within months.

David Nicholson, the NHS chief executive, has today written to all hospital trusts warning them when severance deals are not acceptable.

The Health Protection Agency data showed cases of MRSA fell by 10 per cent last year, with 6,381 reported between April 2006 and March 2007, compared with 7,096 the previous year – but even that is not enough to meet the Government promise to halve the rate by 2008.

In January, a leaked Department of Health memo suggested that the target would never be met and rates of MRSA would only be reduced by a third and not half. Please see the posting by Health Direct below.

Richard James, Professor Of Microbiology at Nottingham University, said: "The target rate for MRSA reduction was over-ambitious and a lot of people suspected it would not be achieved. The Government have given themselves a longer period with C diff, but it remains to be seen if that will be hit."

Mr Johnson insisted he was confident of hitting the target.

"These figures today are very encouraging," he told BBC Radio 4.

Georgia Duckworth, from the HPA Centre For Infections, said the rise in C diff was slowing down and "going into the plateau" as results for April to June 2007 show a 13 per cent drop compared with the same period last year, with 13,660 cases, down from 15,639.

She said the drop in MRSA was impressive and constituted a "major achievement".

However, a spokesman for the Patients Association said the alarming rate of infection in Britain's hospitals — which sees 8.2 per cent of patients pick up a bug each year — was a "disgrace".

Figures for glycopeptide-resistant enterococcal (GRE bacteria), which causes wound infections and blood poisoning, also show an increase in infection rates with 903 cases reported in 2005/06 compared to 758 in the previous year.

From:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/11/02/nhos102.xml

On 11 Jan 07 Health Direct posted NHS hospitals may never achieve MRSA superbug targets

The NHS is not on track to meet its MRSA target and perhaps never will, a leaked government memo says. In November 2004, then health secretary John Reid pledged MRSA rates would be halved by April 2008.

But the memo, sent to ministers by a Department of Health official, said it would only be cut by a third by then. It also reportedly recommended ways to handle the news in the media. Dr Mark Enright, from Imperial College, said the target was "unrealistic".

On the one hand Health Direct is pleased that Alan Johnson is waking up to the disgrace that is thousands of preventable deaths, on the other hand the figures for summer are usually lower than those for winter- so worse may be expected.

Targeted cleaning is key to MRSAsuperbugs

Targeted cleaning to tackle MRSA hotspots is the key to reducing hospital infections, an expert says. Microbiologist Dr Stephanie Dancer said cleaning should focus on objects which people frequently touch rather than on "catch-all blitzes".

She found bed linen, gowns and tables were a more common source of the superbug than floors, the Lancet Infectious Diseases study said.

The most common MRSA superbugs sites are:
Bed linen - 41% of sites contaminated
Patient gown - 40.5%
Overbed table - 40%
Floor - 34.5%
Furniture, bed-rails, side-rails - 27%

Dr Dancer, from Glasgow's South General Hospital, said the problem was that hospital cleaning tended to concentrate on areas of visible dirt such as floors.

But she said they would be much more effective if they targeted hotspots that hands came into contact with regularly.

She added that without such strategies, campaigns to get people to wash their hands were not effective.

Bed linen, patient gowns and overbed tables were the most common sources with over 40% of these sites contaminated. Door handles, bed-rails, furniture and taps were also common sources, she said.

Dr Dancer also claimed that the cleaning did not even need to be done with state-of-the-art cleaning agents.

"Hot soapy water is enough," she said.

"Governments across the UK need to reconsider their approaches. We are just trying to remove visible dirt from areas such as floors when this is not the best approach," she added.

She also criticised the Department of Health in England for the plans for a deep clean of hospitals. "It is like using a sledgehammer to crack a nut. And anyway it will only have an impact in the first week and then hospitals will be dirty again."

Chief Nursing Officer Christine Beasley said the government was using a range of measures, including enforcing hygiene rules with the threat of fines.

But she defend deep cleaning as an "important tool".

She added: "Infection control is a complex problem that needs a range of solutions and the fact is there is no single remedy."

From:
http://news.bbc.co.uk/1/hi/health/7069897.stm

Health Direct notes that most of the experts' suggestions for solving the MRSA superbugs crisis are sadly lacking from Stalinist Brown's centralist dictat:

On Sept 26, 2007 Health Direct posted: Gordon Stalinist Brown pledge on NHS funding and MRSA

Hospitals are to use new deep clean techniques in which wards are stripped and subjected to steam cleaning and high strength disinfectant in an attempt to reduce outbreaks of MRSA and C difficle superbugs.

Record numbers go abroad for health treatments

Record numbers of Britons are flying abroad for medical treatment to escape NHS waiting lists and the rising threat of hospital superbugs. More than 70,000 Britons will have treatment abroad this year, a figure that is forecast to rise.

Thousands of "health tourists" are going as far as India, Malaysia and South Africa for major operations – such is their despair over the quality of health services.

The first survey of Britons opting for treatment overseas shows that fears of hospital infections and frustration with NHS waiting lists are fuelling the increasing trend.

More than 70,000 Britons will have treatment abroad this year – a figure that is forecast to rise to almost 200,000 by the end of the decade.

Patients needing major heart surgery, hip operations and cataracts are using the internet to book operations to be carried out thousands of miles away.

India is the most popular destination for surgery, followed by Hungary, Turkey, Germany, Malaysia, Poland and Spain. But dozens more countries are attracting custom.

Research by the Treatment Abroad website shows that Britons have travelled to 112 foreign hospitals, based in 48 countries, to find safe, affordable treatment.

Almost all of those who had received treatment abroad said they would do the same again, with patients pointing out that some hospitals in India had screening policies for the superbug MRSA that have yet to be introduced in this country.

Andrew Lansley, the shadow health secretary, said the figures were a "terrible indictment" of labour government policies that were undermining the efforts of NHS staff to provide quality services.

The findings come amid further revelations about the Government's mishandling of NHS policies, and ahead of official statistics that will embarrass ministers: