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Mr. Heald: I beg to move, That the clause be read a Second time.
Mr. Deputy Speaker: With this it will be convenient to discuss the following: Amendment (a) to the proposed clause, in line 5, leave out—
'(i) The National Institute for Clinical Excellence.'.
Amendment (b) to the proposed clause, in line 8, leave out—
'(iv) The Council for the Regulation of Health Care Professionals.'.
New clause 4—Public health functions of the Commission for Health Improvement—
'The Commission for Health Improvement shall have such further functions as may be prescribed relating to the management, coordination, provision or quality of public health services for which prescribed NHS bodies, service providers, local authorities or other bodies have responsibility.'.
New clause 10—The Commission for Health Improvement: amendments to section 20 of the Health Act 1999—
'(1) Section 20 of the Health Act 1999 is amended as follows:—
(2) After paragraph (1) (e) there is inserted—
"(f) the function of conducting reviews of and making reports on the guidance on priorities for the NHS set out by the Secretary of State, regional directors of the health service, and Strategic Health Authorities"
(3) After subsection (1) there is inserted—
"(1A) in carrying out the functions set out in subsections 20(1)(a) to (e) the Commission shall, where appropriate, review, investigate and report on the guidance on priorities for the NHS set out by the Secretary of State, regional directors of the health service, and Strategic Health Authorities."
(4) Subsections (3) and (4) are repealed'.
Amendment No. 89, in clause 12, page 17, line 15 after "others", insert—
'(including but not limited to the National Institute for Clinical Excellence, the relevant royal colleges, regional directors of the Health Service, the NHS Executive and the Secretary of State)'.
Amendment No. 88, in page 17, line 29 at end insert—
'(1C) The criteria referred to in subsection (1A)(b) shall be agreed between the Commission, the Secretary of State and the relevant royal colleges, which shall take due account of the adequacy of resources available to meet the performance indicators.'.
Government amendments Nos. 29 to 32, and 57 and 58.
Mr. Heald: In a world of reform by soundbite, where the answer to every issue is to set up a new commission, a new institute, a new agency or a new committee, surely there comes a time—[Interruption.]
Mr. Deputy Speaker: Order. Hon. Members who are interested in holding private conversations—[Interruption.] Order. That includes the hon. Member for Worsley (Mr. Lewis). Hon. Members who are not interested in listening to the debate would serve their colleagues better by leaving the Chamber.
Mr. Heald: Surely there comes a time to rationalise, and new clauses 3 and 4 would do just that. New clause 3 would combine the functions of the National Institute for Clinical Excellence, the Commission for Health Improvement, the National Care Standards Commission and the Council for the Regulation of Health Care Professionals in one body known as the health inspectorate.
The Government have a piecemeal approach to reform: an issue arises, a committee is set up. That has led to a plethora of commissions, institutes and the like. It has also led to particular issues to do with the National Care Standards Commission and the CHI. The NCSC will monitor and inspect private sector providers. The CHI will inspect the same providers if NHS patients are at their premises. Surely only one body should do that work.
We know that Government policy is changing fast. Only last year the Secretary of State was saying that the national health service was "thankfully" a monopoly provider. The right hon. Gentleman said that
- "by and large, we thankfully have one monopoly provider and that is the NHS. As long as a Labour Government are in power, that will remain the position."—[Official Report, 26 June 2001; Vol. 370, c. 500.]
- "Where we need to get to is a position where the NHS is no longer a monopoly provider of care but it does become a monopoly funder of care."
Having given us the NHS plan in 2000 and the Bill in 2001, the right hon. Gentleman has now come up with another big idea to rescue the day. The reason is that, despite his promises and despite his words, he was wrong. There has been no delivery: all talk, no delivery.
Today we have heard about foundation hospitals. As the changes are made, the case for an all-embracing health inspectorate grows. There would be no demarcation disputes between private sector monitoring and public sector monitoring. There would be less red tape and better co-ordination. There would be fewer burdens on busy clinicians, nurses and other staff. Indeed, if some of the comments are to be believed, the Government will embrace a national health service provided by third parties and will simply act as a regulator. In that case, why do we need this plethora of commissions, inspectorates and the like? Surely it makes sense to rationalise the situation.
Under new clause 4, we would extend the role of the CHI to cover the monitoring, inspection, reporting, co-ordination, management and quality of public health. On 10 January, the chief medical officer announced a new committee—the national infection control and health protection agency—which will assess the threat of new and emerging infections and diseases and implement vaccinations. That is necessary simply because of the Government's lamentable failure in public health.
In a report published in February 2000, the National Audit Office exposed huge discrepancies in performance between hospitals. It found that infections caught while in hospital were killing about 5,000 people a year and infecting about 100,000. The very old, the very young, those undergoing invasive standard procedures and those with suppressed immune systems were particularly susceptible. Hospital staff were not practising basic hygiene. The NAO found that infection rates could be reduced by 15 per cent. by better application of existing knowledge and realistic infection control practices.
The NAO also found that there was insufficient funding, that there was no up-to-date information and that hospital infections were costing the health service £1 billion a year. It said that the NHS could save hundreds of millions of pounds if it tackled infection seriously, and that the high number of patients occupying beds and contributing to the problem could be improved.
Against that background of the Government's failure to take public health and infection seriously, exactly what happens when Labour is in power can be shown by referring to certain diseases. The number of tuberculosis cases has risen enormously in recent years. In
September 1999, the Department of Health asked the health authorities to suspend routine immunisation in schools for 10 to 14-year-olds because of a shortage of vaccine, yet that programme has still not been fully reinstated.The number of BCG vaccinations fell from 518,000 in 1997 to 137,000 in 2001—a decrease of almost 400,000—yet the number of TB cases reached a 15-year high. According to the British Thoracic Society, the number of adults and children with the respiratory disease TB was at record levels. The figure rose by a fifth between 1987 and 1988, and London has become the capital for TB.
The rise in sexually transmitted diseases has been remarkable, too. Between 1999 and 2000, the incidence of syphilis increased by 51 per cent.; gonorrhoea increased by 25 per cent.; and chlamydia by 12 per cent. We have seen a similar picture with other diseases. So there is an epidemic of TB and sexually transmitted diseases are increasing.
Dr. Evan Harris: I am interested in the hon. Gentleman's topic; it used to be my field, but I am little confused—perhaps I am missing some amendments—about its relevance to new clause 3, about which important issues remain to be discussed. He refers to important issues, but they are not necessarily connected with new clause 3.
Mr. Heald: Perhaps I have been so speedy in my remarks that the hon. Gentleman has not noticed that I have moved on to new clause 4, under which we would require the CHI to take an interest in public health services. The reason why that is important is the Government's neglect of very important issues, such as those diseases, and the hon. Gentleman might make common cause with us about that. Certainly, when the Select Committee report on public health was debated recently in Westminster Hall, he and I agreed that the Government have an appalling public health record.
Although the chief medical officer has belatedly set up yet another committee, the hon. Gentleman may agree—certainly his amendments to new clause 3 suggest it—that it would be better to have one effective body than to have committee upon committee upon committee. On 10 January, the chief medical officer reported that he was setting up the national infection control and health protection agency, but the new clause suggests that the Commission for Health Improvement could deal with such issues as well.
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