|Health and Social Care (Community Health and Standards) Bill
Mr. Hutton: In a sense, the Committee is demob-happy this afternoon, which is not surprising, given that we all lead other lives.
The hon. Gentleman is expounding a very interesting constitutional principle. One thing that I have learned, not only in government but in opposition, is that when Opposition parties table very long, complicated amendments, we never have any explanatory notes or memorandums from them. That is a constitutional theory that he might like to develop.
Chris Grayling: I can safely say to the Minister that, if we come face to face again across the Committee Room and if he is puzzled by any of the amendments that I have been involved in tabling, I would be delighted to take a phone call from him and explain them to him.
Dr. Harris: The constructive point, which I hope is still just within order, is that if GPs vote tomorrow to support, or make an announcement that they support, the new contract, and the Government then table a huge number of new clauses on Report as we expect, a
Column Number: 901set of explanatory notes will be welcome and very important.
Chris Grayling: The hon. Gentleman makes a very good point. Clearly, that is on a different level from this issue.
Mr. Hutton: We shall certainly do that.
Chris Grayling: I am grateful for that. So, setting that point aside—
The Chairman: Order. That is exactly what I was going to say. Can the hon. Gentleman carry on with his comments on the amendment?
Chris Grayling: It is quite extraordinary that the Government are introducing in Committee a measure to abolish the residual PHLS before the House has debated the formation of the new organisation. Up to now, there has been only a Government announcement to the press. The Minister will correct me if I am wrong, but I think that there has been no statement to the Chamber about the plans, although there have been several written answers. The Government have made no formal statement to the House and have offered it no opportunity to debate the change.
This is quite a substantial change. The Government are bringing together a significant number of previously autonomous and separate bodies, and they are transferring laboratory services from a central organisation that provides a national monitoring network of outbreaks of disease and potential incidents of biological and chemical attack. That structure has been totally changed. The laboratories that would have provided that on-the-ground service have been transferred into local NHS trusts.
Mr. Lansley: On that point, which is relevant to something that I hope to say if I catch your eye, Mr. Griffiths, that does not include all laboratories. Nine regional laboratories have been retained as part of the Health Protection Agency, including the one on Addenbrooke's site in my constituency.
Chris Grayling: My hon. Friend makes an important point of clarification, but none the less, of the 44 public health laboratories, the vast majority—80 per cent.—have transferred to local trusts.
The reality is that a major change has taken place, which we are being asked finally to rubber-stamp today in the amendments. We are being asked to approve the abolition of the PHLS before the House has had the opportunity to debate the formation of the Health Protection Agency. I commend the hon. Member for Oxford, West and Abingdon on his prayer against the measure, which I very much support. I confess to having been beaten to something by his team—not a frequent occurrence. I can update him—that Committee sitting is due to be held on 26 June.
That will be the first opportunity that the House will have to discuss the changes and to decide whether it wants to establish a special health authority. Six days earlier, a Standing Committee is being asked to finalise the abolition of the predecessor body. That seems constitutionally bizarre and, at the very least, an improper approach to the processes of the House. In
Column Number: 902my view, such significant changes should be debated properly before final decisions are taken. That is what next week's debate will enable MPs to do, but many months too late. The Government seem to believe that they can produce their policies, enact them and then ask the House for approval as an afterthought; that cannot be right.
I turn to the residual point. We know that most laboratories were transferred to NHS trusts or to the Health Protection Agency on 1 April. There is now only a residue of the previous organisation. The Minister made reference to the culture development operations at the PHLS, saying that no decisions have yet been taken about them and that the measure will not be enacted before the rest of the package. He will be aware that there has been considerable speculation, not least among staff, that the end process of the exercise will be privatisation or some form of trade sale of the culture operations.
Can I ask the Minister if that is one of the possibilities being considered? If he does not intend to privatise what is effectively a business—he made reference to whether the NHS had to secure the future supply of such cultures—is he considering a closure? Is he looking to buy cultures for the laboratories from third-party sources in future, or does he intend to retain the operation as a state-owned business? I would be grateful if he could clarify that for the Committee.
Will the Minister also clarify another point of confusion following the establishment of the HPA? One of the responsibilities that the former public health laboratories had was the monitoring of food. There may have been poisons in food, such as toxins put in deliberately. Let us consider the example of a food scare in relation to baby food. The message would have gone out from the centre of the PHLS to the different laboratories to say that they needed to investigate the matter. Laboratory staff would have gone to supermarkets and bought supplies of the brand of baby food concerned, and run tests on it. That would happen all around the country, and as a result, they would have been able to identify whether they were dealing with a one-off incident or a significant incident spread over a broad geographic area.
I understand that, with the dismantling of the public health laboratories, a number of the trusts taking over laboratories have declined to take responsibility for food, water and environmental microbiology. If a number of NHS trusts have declined to take over responsibility for key areas such as food monitoring, do those responsibilities still remain with the residual body of the PHLS? In today's discussion, are we seeking to abolish those bodies? If it is not the case that the residual body has retained responsibility, when did the transfer of responsibility for the monitoring of food take place, and where has it gone? Who is now responsible for the monitoring of foods as previously carried out by the PHLS?
I also want to ask about the residual financial liabilities for the PHLS. It was not clear from written
Column Number: 903answers that I received before 1 April what would happen to those liabilities. Have they been transferred to the Health Protection Agency, and if so, in what amount? If not, do they remain with the Public Health Laboratories Board, and if so, in what amount? If they remain with the Public Health Laboratories Board, what will happen to those liabilities when the measure is enacted? Is that simply a liability that will be absorbed by Government? Will the Minister explain that?
Lastly, I would like to ask the Minister about a further dimension of the statutory and legal issue. He made mention of the fact that the establishment of the HPA as a non-departmental public body was not in the Bill and would have to return as future legislation. Clearly the legislative timetable in the House is extremely full, and it is certain to be some time before that can take place. Will the Minister explain more clearly, given the time frame that we have discussed in relation to the policy change, why it was not possible to start work on the relevant drafting much earlier?
Given that it has proved possible to bring forward an amendment that would allow the abolition of a core residual body, why was it not possible to establish the Health Protection Agency as a non-departmental public body? Is that because of disputes that remain between the Scottish Executive and the Government in Westminster over the relationships between the different parts of the National Radiological Protection Board in England and Scotland, and the reluctance in Scotland to have a national body covering that area? I would be grateful if the Minister would clarify those points for the Committee.
Mr. Lansley: I want to comment on the Health Protection Agency. I hope that you will bear with me, Mr. Griffiths. My remarks will not necessarily relate precisely to the residual functions, but I hope that you will give me a little latitude.
The Chairman: I am listening carefully.
Mr. Lansley: Indeed. I shall try to stick as closely as I can to the subject. I suspect that I shall not be present if there is a discussion about the establishment of the special health authority next week.
My hon. Friend the Member for Epsom and Ewell raised a number of questions, to which it would be interesting to have the answers. I had understood that, as far as the east of England was concerned, responsibility for food, water and the environment had gone to Chelmsford to a separate laboratory under the HPA. It will be interesting to see if that is how things work.
Chris Grayling: My hon. Friend will be aware that the original intention was that responsibility for food would remain within the individual local laboratories. In some cases, the trusts have refused to take responsibility.
Mr. Lansley: My hon. Friend makes an interesting point. I would be interested to hear the Minister's response.
Column Number: 904
The Minister expressed his appreciation of what is being done by the Public Health Laboratory Service. I just wanted to add my appreciation to that. About 100 staff work in the laboratory at Addenbrooke's in my constituency and we appreciate the value of the work that they do. During the past few weeks—my hon. Friend the Member for West Chelmsford (Mr. Burns) will be aware of this—the only identified SARS case in the east of England, which originated in Chelmsford, was identified in an ambulance and transferred to Addenbrooke's. The laboratory at Addenbrooke's and the communicable disease surveillance centre at Colindale would do the work associated with dealing with that virus. To give another example, I know that many Members will be concerned, as Ministers are, about the level of hospital-acquired infections. The laboratory at Addenbrooke's is taking a leading role in the expanded reporting on hospital-acquired infections that Ministers are rightly expecting of NHS hospitals—going beyond methicillin-resistant Staphylococcus aureus.
The laboratories are involved in vital tasks. Although the structure has changed, I want to ensure that there will be co-ordination between a range of different functions extending to the support of emergencies, including chemical, biological and radiological releases into the environment. All that activity should certainly be brought together in relation to emergency responses. The draft Civil Contingencies Bill was published elsewhere today. That is a further instance of the way in which things need to be connected properly to create a more effective route for dealing not only with naturally occurring diseases, but with emergencies that might arise through terrorism.
It would be useful to explore a number of issues with the Minister. I will not necessarily raise questions; I will talk about my feelings about how things will develop. As I discussed with my hon. Friend the Member for Epsom and Ewell, not all the laboratories have transferred to the host trusts. In particular, the laboratory at Addenbrooke's, which is one of the nine regional laboratories, continues to be directly provided as a laboratory of the Health Protection Agency and the staff are the agency's staff. On the face of it, that is not a problem, but in the context of the Bill a different question arises. The Committee will have heard more often than it would have thought likely about the likelihood of the Addenbrooke's NHS trust becoming a first wave foundation hospital. One of the consequences of that is that Addenbrooke's may be an early implementer of ''Agenda for Change''. As the Minister knows, that may well lead to the exercise of additional pay flexibilities in that context at Addenbrooke's from an early date.
That is fine; I have no problem with it, and it is highly desirable that it should happen, but if the Health Protection Agency is not implementing ''Agenda for Change'' at the same time as Addenbrooke's, staff of the same character from the same professional groups on the same site might be earning different amounts as a result. There would be difficult consequences for recruitment for the Health
Column Number: 905Protection Agency laboratory on the Addenbrooke's site, even if that were only transitional. I hope that the Minister will bear that in mind, not in order to delay the implementation of ''Agenda for Change'', but perhaps to ensure that if those two things are to happen, they can at least happen alongside each other on the same site, which would be much better for management reasons.
It is also true that the way in which the pathology and microbiology of hospitals in the Cambridge area are being managed is increasingly a matter of networks. I opened the new laboratories at Papworth hospital, which is also seeking to be a first-wave foundation trust. One consultant and several functions there are in practice managed by Papworth and Addenbrooke's together. In effect, a clinical network is already established between different hospitals, including the West Suffolk hospital, which has no intention of becoming a foundation trust in the first instance. We have a network, and a range of laboratory managements will actively run such matters together. However, the Addenbrooke's laboratory sits outside in the Health Protection Agency and is on a contract to the trust.
It is not for me to prejudice management discussions and I am not expert enough to be able to say whether it would be right for the laboratory to transfer to Addenbrooke's and be part of Addenbrooke's management, but I certainly hope that the Department can confirm that it is thinking carefully about that and is in active discussions with Addenbrooke's. If it is to have the management independence implied by foundation status, Addenbrooke's should be able to manage its pathology and microbiology activity as well. To do that, it would be better for it to own the laboratory, and contract to, and provide a service for, the Health Protection Agency, rather than the other way round.
One of the principle issues that stands between the present situation and that event is the structure of funding, which my hon. Friend the Member for Epsom and Ewell mentioned. If I understand it correctly, apart from Addenbrooke's contract with the trust, there is the question of core funding. The purpose of core funding is, in theory, the provision of funding to allow research and development, to provide for the public health and emergency activities of the laboratory and to allow an excess of capacity in the laboratory, beyond what the trust itself would purchase, to meet surges in demand. Particularly in the case of an outbreak in infection, that would enable it to respond with all the necessary laboratory capacity. However, in practice, core funding has tended to subsidise trusts' normal day-to-day activities.
If PCTs are to commission such activity from trusts in future, they will look carefully at what precisely the laboratories offer. If a PCT is to be responsible for core funding, instead of just having ring-fenced funds that are automatically transferred from the trust for laboratory activity, it will want to know more specifically what it is buying from the trust. It might not necessarily pursue the same route that has been pursued in the past: paying for surge capacity, paying
Column Number: 906for research, and supporting and subsidising the trust's activities. My point is that one must be more sure about the level of funding that will be provided through the primary care trusts to laboratories that pass into the ownership of the hospital trusts or, in Addenbrooke's case, the foundation trust. If the Minister cannot help on that matter today, I hope that he can clarify how the core funding will work soon.
I have one other point, which is allied to the point about ''Agenda for Change''. In the past—I am trying to remember precisely when—I have tackled the Department of Health on the status of a number of health service professions and their ability to recruit. Addenbrooke's high reputation means that it is not difficult to recruit medical staff and, in particular, senior medical staff.
It is difficult to recruit biomedical scientists, who are an essential part of the laboratory process at Addenbrooke's. Not only do I want the question of ''Agenda for Change'' to be resolved, but there is a wider question about the recruitment of staff for the Public Health Laboratory Service or the Health Protection Agency. It is certainly possible for a biomedical scientist to become a clinical scientist and even to reach consultant status. In the past, I have argued to Ministers that we should be more open to the possibility of people moving between professions, or, more to the point, biomedical scientists, while remaining within the profession, should be able to acquire the status associated with clinical scientists up to and including consultants. For a graduate profession, biomedical scientists lack status within the NHS and their pay levels are very low compared with their qualifications and other professions.
Having said that, I must declare a family interest: some 32 years ago my father was chairman of the Institute of Biomedical Science. When Labour Members were decrying Conservative Members' recognition of and support for the values of the NHS—my hon. Friend the Member for West Chelmsford may be entertained by this—I was sitting here and looking across the river because on the day that the NHS was created, my father was working in a laboratory in County hall for London county council. He became an NHS employee on that day and worked for it for the rest of his working life—happily, he is still alive—including working at East Ham memorial hospital for about 30 years before retiring in 1983. He was always an NHS employee, and he and I have always subscribed to the values of the NHS.
|©Parliamentary copyright 2003||Prepared 19 June 2003|