NHS Reform & Health Care Professions

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Dr. Richard Taylor (Wyre Forest): My name is attached to amendment No. 160, but I support amendment No. 161, which was tabled by the hon. Member for Oxford, West and Abingdon (Dr. Harris). However, I am primarily interested in amendment No. 160. I thoroughly approve of the vagueness of the wording in clause 11, when it refers to

    ''the environment in which services are provided.''

I presume that ''environment'' is meant to be vague, because it includes all hospitals, practices, clinics and facilities where health care is provided. I approve of that. The amendment attempts to make more specific some of the Commission for Health Improvement's functions. As has been said, we are interested in the health and safety issues, especially cross-infection. I remind the Committee of the recent seminar held by the Patients Association, which pointed out the

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tremendous risk of the transmission of very serious infections through the re-use of surgical equipment. Policies in units that have allowed that to happen are somewhat lax. It is crucial that the CHI is able to inspect for that sort of thing. The amendment is designed to add teeth to the clause, so that cross-infection is inspected meticulously during CHI inspections.

Mr. Simon Burns (West Chelmsford): As the hon. Member for Wyre Forest said, the clause is vague in its definition of the environment in which such services are provided. The hon. Gentleman welcomed that vagueness because he thought that it would make the clause all-embracing in its interpretation. I have a lot of sympathy with his point. However, as hon. Members who have received the BMA briefing on the amendment will know, at this stage in the consideration of the Bill such vagueness must be explained further to reassure Members that the provision will enhance the inspection process and the standards to be imposed on our hospitals and patient care, rather than being so vague that nobody knows what it means and it achieves nothing. I suspect that the latter analysis is inaccurate and that the Minister will reassure us that such vagueness will enhance the process. As the BMA rightly said, the amendment is probing. We want to find out how the Minister and the Department envisage matters.

As the hon. Members for Oxford, West and Abingdon and for Wyre Forest pointed out, it is important that we monitor what goes on in our hospitals more closely and more effectively, and that we improve the quality of health care. We all rightly recognise that the quality of health care is not simply confined to the quality of patient care that individuals receive, however important that is. It also includes a whole host of other issues, such as cleanliness and the administration and bureaucracy involved in running hospitals.

Hon. Members have mentioned the responsibilities of the NHS under the Health and Safety at Work, etc. Act 1974. I was especially interested in the fact that the BMA said in its briefing, from which the hon. Member for Oxford, West and Abingdon has quoted, that the NHS had a responsibility to ensure the safety of all employees, contractors and members of the public as patients and visitors. The BMA has also said that each NHS trust and primary care trust had a statutory duty to provide an environment that was safe so far as was reasonably practicable, and to use the best practical means to achieve its objectives.

Such issues are especially important in an area such as mine. There was a desperately unfortunate tragedy at Broomfield hospital in my constituency in the summer, when a blockage in an oxygen tube resulted in the death of an 11-year-old boy who went into hospital simply because he had injured his finger in the spokes of his bicycle. Due to his age, the clinical decision was that he needed a general anaesthetic before the damaged finger could be repaired, and that had tragic consequences. In the light of that tragedy—and others,

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fortunately not as serious, that regularly occur in the health service—one needs the best monitoring and checking of standards.

It is equally crucial that we use all means available to ensure that our hospitals are as clean as possible. The number of patients who become infected as a result of the conditions in hospital is a serious problem. The National Audit Office recently identified the fact that, as a result of failures of cleanliness in the NHS, around one in 11 hospital patients at any time has an infection caught in hospital. That is apparently equivalent to at least 100,000 infections a year. The old, the young and those who undergo invasive procedures are the most vulnerable.

Most people would find it incredible that, when they go into hospital to be treated for and hopefully cured of the medical condition from which they suffer, they might pick up an infection that compounds the problem and proves fatal in some cases. In my youth, we were brought up to think that hospitals were not only warm but spotlessly clean. It is sad that those standards have not been maintained in recent years. The problem is serious. The amendment would strengthen the powers of inspection and the duties placed on bodies within the NHS to seek to improve and enhance standards and quality of care. In some areas, those standards have deteriorated so much that they are a serious scandal.

Dr. Harris: With the narrowness of the Government's extension of the definition of health care, focusing on the environment in which services are provided might mean that a hospital is found liable for failures if that environment is grubby. I recently asked a parliamentary question that revealed that the cost of repair and maintenance backlogs throughout health authorities and hospitals in England and Wales was £52 billion. Even the best manager will not be able to conjure up that sort of funding to ensure that the environment in which services are provided look adequate, let alone function adequately.

Mr. Burns: The hon. Gentleman makes an interesting and important point. Without getting sidetracked, I must say that it will be interesting to hear the Minister's reply, given the views and concerns that have been expressed. I hope that the Minister will be able to reassure us that amendment No. 160 is unnecessary because enough provisions exist in existing legislation and in the Bill to overcome the concerns and fears that hon. Members have expressed. If that were so, I would be delighted.

Similarly, I hope that the Minister will give a better explanation of what he and the parliamentary draftsmen mean by ''environment'' in the context of the clause. I hope that, however vague the wording may seem to us non-lawyers, it is suitably widespread and all-embracing to fulfil the functions that we hope for from the clause.

Dr. Andrew Murrison (Westbury): National health service hospitals are potentially very hazardous places; indeed, that is true of all hospitals and medical facilities. My hon. Friend the Member for West Chelmsford (Mr. Burns) referred to the cosy image of

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health services, but by and large the environment is not sparklingly clean, and violence is often visited on health practitioners. There are also biohazards, and we have recently heard a lot about prions in relation to surgical instruments. Radiation hazards are also a problem for patients and practitioners, and we have heard about the problem of violence in accident and emergency departments. In short, hospitals are hazardous places.

We know that the Health and Safety Executive is under-resourced and overstretched, and although it attempts to exert its inspection function, it is not equipped for a specialised task that needs independent and expert overseeing. The Patients Association report that was published last month, and to which the hon. Member for Wyre Forest referred, is the most telling document that I have seen in relation to those matters. We should give some attention to the report, which is a compilation of reports from a variety of authorities, including the Infection Control Nurses Association, the Institute of Sterile Services Management and the National Association of Theatre Nurses. The report takes the form of a survey of 300 members of those associations.

The survey stated:

    ''Almost a third of respondents . . . said that they did not think that the CE mark guaranteed instrument sterility.''

That is a serious finding. The report also stated that

    ''one-fifth of respondents do not currently have an infection control policy in place relating to decontamination issues.''

That is extremely worrying.

    ''Only just over half of respondents (56 per cent.) said that their hospital had a single-use policy committee in place, despite this being a suggestion from the Department of Health.''

The survey is worrying, and the Bill presents a good opportunity for the Government to embed health and safety and infection control, which are both aspects of quality, in the national health service in a way that is not happening at present.

11 am

To return to my original premise, we need to start thinking of hospitals as hazardous places. The Health and Safety Executive is used to dealing largely with factories. The industry that we are considering is, one might say, a factory with a multitude of fairly unregulated processes. It is not a production line and cannot be well regulated. Many unexpected events are built in to the activities of clinicians in hospitals; that makes things hazardous. That is why we need to attend particularly to health and safety and, of course, infection control.

I support the amendment, and particularly the attempt to embed health and safety and infection control in the national health service at this seminal time of change.

Dr. Taylor: I am grateful for a second bite of the cherry, Mr. Hurst. I shall be brief.

The Royal College of Nursing has raised several issues about quality that have not been mentioned yet, the first of which is nutrition. There have been reports

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recently, sadly, of elderly patients not receiving the correct food, or enough of it, in hospitals. Secondly, privacy and dignity are always matters of concern. Any hon. Members who have been in hospital recently may have been asked whether they would like to be called by their Christian name or a title. I have spoken to elderly ladies who have been greatly bothered when junior nurses called them by their Christian names. That is a small matter, but it is a matter of dignity, which comes under the heading of quality.

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