Source · Select Committees · Public Accounts Committee
Recommendation 29
29
Accepted
Poor condition of NHS estate significantly hinders effective infection prevention and control efforts.
Conclusion
A significant obstacle to preventing infections is also the poor condition of the NHS estate.73 Dr Partridge told us that in many hospitals patients are close together and share toilets in facilities that are difficult to clean, and that this increases the risk of infections spreading. He said that in his experience there were lower rates of transmission in newer wards.74 When we asked NHS England, it agreed that much of the estate was not fit for purpose in terms of infection prevention and control. It said that there has been insufficient investment in the NHS estate. It is working to ensure that infection prevention and control measures are at the heart of the standardised designs being developed for new hospitals, including providing single rooms on wards. Where possible, it also intends to incorporate these improvements when carrying out backlog maintenance.75 Dr Partridge explained how UKHSA’s modular ward at Porton Down will carry out research which may help to guide the refurbishment of hospitals as well as new builds.76
Government Response Summary
The government agrees with the conclusion, setting a Summer 2026 target. They are embedding AMR in strategies and plans, developing an IPC Workforce and Education Strategy by September 2025, integrating AMR prevention into training for 2026 graduates, and using UKHSA's modular ward research to inform new hospital designs and refurbishment.
Government Response
Accepted
HM Government
Accepted
5.1 The government agrees with the Committee’s recommendation Target implementation date: Summer 2026 5.2 The government is prioritising AMR and infection control across the healthcare system. This includes embedding AMR into national and regional strategies, local Integrated Care Board (ICB) plans, clinical pathways, and provider contracts. AMR is, and will continue to be included in, performance and accountability frameworks for the NHS. 5.3 NHSE is supporting the workforce to reduce infections through: • A forthcoming infection prevention and control (IPC) Workforce and Education Strategy (September 2025), which will define national to provider-level responsibilities for embedding AMR and IPC. • Publishing a 10-year workforce plan to ensure that the number of medical specialty training places meets future NHS demands. • Integrating AMR prevention into undergraduate and postgraduate training for those graduating in 2026. • Publishing a capability framework for antimicrobial stewardship (AMS) roles, building on the existing framework for IPC staff. • Working with regulators to ensure AMR competencies are part of professional registration standards. • With UKHSA, implementing TARGET AMS tools across general practice. 5.4 Actions to address AMR in the NHS estate include: • Inclusion of emerging evidence on AMR into NHSE’s technical guidance and standards for existing estate. • Establishment of a cross-function working group on water safety to assess AMR risks within the built environment. • The New Hospital Programme, working with partners to deliver the next generation of NHS hospitals, aims to reduce AMR through innovative approaches to design and care models, informed by research and learnings from past healthcare failures. 5.5 The government agrees with the Committee’s recommendation Target implementation date: Spring 2027 5.6 As set out in the NAP, UKHSA has clear commitments to advance understanding around the spread of infection through using its modular ward. The modular ward will generate evidence on how the hospital environment contributes to the spread of AMR infection and how wards should be designed, refurbished and operated to enhance IPC. 5.7 UKHSA are studying environmental reservoirs of AMR organisms and assessing the effectiveness of controls in the built environment to prevent their spread. This includes investigating the impact of hand wipes and vacuums to prevent toilet aerosolisations. Evidence is being inputted into recommendations on surface cleaning and disinfection. The model ward will directly contribute to this through delivering training to IPC specialists. 5.8 Mitigating the risks associated with water and wastewater systems is a particular focus. The modular hospital ward is currently being used to inform sink, shower and toilet installation and design. Data are being used to inform the New Hospital Programme, enhancing existing guidance (NHS Estates Technical Bulletin (NETB) No.2024/3) and supporting and informing IPC strategies. 5.9 In addition to carrying out its own programme of research, UKHSA provides visiting academic researchers access to the modular ward facility and supports training programmes.