NHS Reform & Health Care Professions

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The Minister of State, Department of Health (Mr. John Hutton): This has been a good debate, and I take it to have been a constructive attempt to get to the bottom of the provisions. It may help if I explain the intention of clause 11, as I think that there was some confusion about it on the part of the hon. Member for Oxford, West and Abingdon.

In simple terms, clause 11 is intended to widen the definition of health care in section 18 of the Health Act 1999 to include, in broad terms, the patient environment. The clause supports the expanding role that we envisage for the Commission for Health Improvement. If the Bill becomes law, the commission will be able to examine the wider patient environment.

Several hon. Members spoke about what is meant, for our purposes, by the word ''environment''. It is important that discussion of the quality of care given by hospitals—NHS providers and others—should not be confined to issues of clinical care. As the hon. Member for Wyre Forest pointed out, with practical emphasis, quality goes much wider and deeper than that. We simply want to allow the commission to conduct a wider range of inspections based on the expanded definition of the duty of quality.

We envisage ''environment'' covering, for the purpose of the clause—I am not giving an exhaustive list, but suggesting our thinking—the cleanliness of hospital wards, which would clearly not be covered by the current definition of health care; the cleanliness of waiting areas and other parts of the hospital; and the quality of the food given to patients. The hon. Member for Wyre Forest noted the importance of food, in his remarks about nutrition. Many aspects of the environment in which NHS care is given are relevant. The clause would establish a broader view of quality.

The hon. Member for Oxford, West and Abingdon wanted to know whether the Commission for Health Improvement would be able to consider the quality of commissioning. It can already do that. The commission can certainly examine the quality of commissioning by NHS bodies in reviewing arrangements for improving and monitoring the quality of NHS care under section 20(1)(b) of the Health Act 1999.

Hon. Members made important points about cross-infection and the importance of maintaining a safe, sterile environment in hospitals.

Dr. Harris: Will the Minister repeat his reference to the Health Act 1999?

Mr. Hutton: I referred to section 20(1)(b).

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The issue of cross-infection is important. I am sure that hon. Members will be conscious of the action that we have taken to bring about improvements in that respect. That includes issuing, in November 1999, national standards for hospital-acquired infection. Those standards are being reviewed by the Department, with the help of interested professional groups. I know that the chief medical officer is working on those issues. The Department of Health commissioned evidence-based guidelines for preventing hospital infection and those were published in January as a supplement to the Journal of Hospital Infection. The guidelines cover general principles for preventing infection in hospital, and for the prevention of infections associated with specific clinical procedures.

Hon. Members may know that all acute NHS trusts must, as of April this year, participate in the national surveillance of hospital-acquired infection. Data from that exercise will be available from April next year. That is the first stage in developing a comprehensive NHS surveillance service. One of the problems has been the lack of consistent definitions and data about methicillin-resistant staphylococcus aureus and other acquired infections. We are obviously anxious to ensure that the necessary information is obtained to allow us to make progress.

Dr. Harris: When the Minister referred to section 20(1)(b), I thought that he meant section 21(b). Section 20(1)(b) refers to

    ''the function of conducting reviews of, and making reports on, arrangements by Primary Care Trusts or NHS trusts for the purpose of monitoring and improving the quality of health care for which they have responsibility''.

No specific mention is made of commissioning or, indeed, the Department of Health policies on which those commissioning policies must be based.

Mr. Hutton: The commission is able, under section 20(1)(b) to examine the quality of the commissioning process. We are in no doubt about that, and neither is the commission. It is perfectly proper for the commission to focus on that, if it chooses.

We need to focus our concern on the amendment, and I hope that what I have said about health and safety legislation and infection control measures—with which the hon. Gentleman's amendment No. 160 deals—makes matters clear. We consider that section 18 of the Health Act 1999, once amended under the Bill, would enable those issues to be taken fully into account. NHS bodies are already required to comply with health and safety legislation, and the service is obliged to follow extensive departmental guidance on infection control measures; a matter that the Commission for Health Improvement can pursue. In view of all that, the amendment would have no practical consequence, as it would provide for exactly what is happening.

The hon. Member for Oxford, West and Abingdon raised an important issue that is not covered by the amendment, although he suggested that he might want to return to it later; perhaps on Report. He said that the Commission for Health Improvement should have a duty to inspect the quality of decisions made in the

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Department of Health in the process of forming policy. We must be clear; that is our job. It should not be given to someone else. It is the role of Parliament and the job of Members in this place to hold Ministers to account for their decisions.

The hon. Gentleman raises a fair point about there being one standard for Ministers and one for the NHS, but he is confusing two separate issues. Ministers must be properly accountable to this place for the quality not only of their decisions, but of the care available to our constituents. In turn, we have a responsibility to put in place a range of measures designed specifically to improve quality of care. That is why we now have arrangements to set national standards through the national service framework. It is why we have the Commission for Health Improvement—it has been given an expanded role in the Bill to go into every corner of the NHS and consider the quality of care and the patient environment—and the National Institute for Clinical Excellence, which provides clear guidance to the service about the availability of new drugs and treatments.

Such arrangements are precisely the right ones for Ministers to put in place. Ultimately, the accountability for decisions is inappropriate for the commission. It should rest with Members of Parliament in this place.

Dr. Harris: I am grateful to the Minister for the considered and thoughtful way in which he is responding, and I accept his point, to an extent. However, I shall give an example of my concern about Department of Health guidance. If the CHI has the power to consider commissioning policies that might be based on a direction from the Department that says, ''Thou shalt commission to ensure maximum waiting times that shall not be exceeded,'' can it take a view on whether that is a sensible, quality-based, patient-centred approach?

Mr. Hutton: In a sense, some of the hon. Gentleman's concerns may be the subject of a fuller debate on clause 14, which entrusts to the commission the responsibility for publishing an annual report on the state of the NHS.

The hon. Gentleman made a point about the role of the commission, which clearly will comment on the quality of patient care, in the widest sense of that definition. Through these measures, the commission is being given greater independence from the Department, an important step that contradicts the hon. Gentleman's obsessive theory about micro-management of the NHS. The debate has been full, and we have been over the course on this issue many times.

We should return to clause 11 or we will find ourselves in some trouble. It provides an important extension of the duty of quality, which I accept has the deliberate intention of expanding the remit of the commission to the consideration of patient quality. That has to be good for our constituents. We all know that we are as likely to hear complaints about hospital

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food, cleanliness, general tidiness and civility—the hon. Member for Wyre Forest mentioned the last of those—as we are complaints about the quality of care.

If we start from the proposition that the commission is the right repository of the relevant functions, the right set of structures are in place to drive up the quality of care in the NHS, given that the commission is at arm's length from the Government, has the fullest remit that we can construct for it and is consistent with established lines of accountability, under which Ministers and their decisions are accountable to the House.

Dr. Harris: I congratulate the Government on making the Commission for Health Improvement more independent, and for recognising that that was the correct conclusion for the Kennedy report to recommend. However, I want to return to my specific point. Under the Bill or the existing powers, will the commission have the ability to judge whether the commissioning of services to provide maximum waiting times as an end-point is good for quality of care? Will it be able to comment on such policies? That is an example; I would not want to appear obsessed.

Mr. Hutton: We have to consider the subject in a slightly broader context. Inspection of the national health service is not a role only for the Commission for Health Improvement. For example, value-for-money issues are the remit of the Audit Commission, and I know only too well that that commission's writ runs freely across the value-for-money agenda of the NHS. Indeed, the commission has done so recently in relation to the issues raised by the hon. Gentleman, such as clinical priorities and setting reasonable targets to reduce waiting.

I, my colleagues in the Government and, I hope, my hon. Friends believe that our constituents' most important concern about the NHS is the length of time that they have to wait. We are travelling in absolutely the right general direction to so organise the services provided and funded by the NHS that we can reduce that time. I believe that it is possible to do that without distorting clinical priorities. We make it clear in guidance to the service that care should ultimately be determined according to clinical priority; indeed, that is the first sentence of the guidance. It is not the job of Ministers, nor should it ever be, to decide which patients are treated first, or last. That is the job of clinicians, as we have always tried to spell out.

11.15 pm

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