| Previous Section | Index | Home Page |
Miss Melanie Johnson: I reiterate that we do not expect the Bill to be amended in the light of the review. I realise that the hon. Gentleman may have written his speech and may want to demonstrate his commendable understanding of the calendar, which is fantastic—we are indeed approaching the beginning of July—but I gave him the assurance that he seeks in my opening remarks.
Mr. Lansley: I also understand that the Minister is reading from her brief. At least I wrote my speech.
The Minister says that she does not expect that anything announced will require amendments to the Bill. I was not necessarily talking about amendments to the Bill. If the intention were, for example, to transfer functions relating to infection control to the HPA from the National Patient Safety Agency, it would be perfectly possible to do so without changing the powers in the Bill. If the Government intended to change the HPA's staffing or expenditure, that would be possible without changing the Bill. However, Conservative Members will debate the HPA's objectives and how it can achieve them. Hitherto, we have been conducting that debate on the basis that the HPA will proceed with its current, planned staffing and expenditure. If the Minister says that the HPA's current, planned staffing and expenditure will be maintained when the review's results are announced in July, that is a different assurance from the one that she has already given to me. Perhaps she would like to give us that assurance—no, I did not think so.
If the Minister cannot give us that assurance, it might be interesting to consider whether the Department is doing its job in the review. A number of agencies duplicate functions. It is always difficult to work out precisely what all those agencies are doing, but I suspect that some of the Department's work, particularly in the Government offices for the regions, some of the Health Development Agency's work and perhaps the National Patient Safety Agency's work in relation to infection control and, in particular, hospital or health-care acquired infection and MRSA may well complement but possibly duplicate the HPA's work. That raises questions about whether a further review of the HPA's functions should take place. I have chided the Minister, and it is a pity that she did not tell us that further efforts will be made to try to rationalise the functions of the arm's-length bodies and indeed the Department in that respect. That may be necessary if that is the HPA's purpose.
The Bill will not simplify the relationship between the HPA and the NHS. For example, most of the old PHLS laboratories have transferred to NHS trusts. The Minister will remember the debates that we had last year on the Health and Social Care (Community Health and Standards) Bill. One of the questions asked at that time, to which I do not recall seeing clear answers subsequently, was the extent to which trusts will receive the necessary core funding through primary care trusts
21 Jun 2004 : Column 1107
to support surges in capacity for emergencies and the research and development undertaken by microbiologists in those laboratories. That is one of the issues on which it would be helpful if the Minister responded. Last year we were debating the theory. In practice, have PCTs passed to the microbiology laboratories for which they are now responsible the necessary funding for those purposes?
I mentioned last year—I confess that this has particular constituency relevance—that the PHLS laboratory at Addenbrooke's in my constituency would not be transferred to the trust but would remain with what is now the HPA. That raised a question among the biomedical scientists employed there.
As an early implementer of the "Agenda for Change" proposals, Addenbrooke's was introducing—indeed, is introducing—new pay arrangements for its laboratory staff. On the same site, however, the biomedical scientists working for the HPA do not have access to the "Agenda for Change" job evaluations and consequent pay arrangements.
I am sure that the Minister has that in mind. She might be able to tell me whether there will be further delay. "Agenda for Change" is already delayed until December. Last year, the Minister of State, Department of Health, the right hon. Member for Barrow and Furness (Mr. Hutton), made it clear that there was a transitional issue, but that it would be minimised because of the relatively short time before the implementation of "Agenda for Change". The implementation date has moved from October to December, stretching out what might be a difficulty in the relative position of staff on one site.
The relationship with primary care trusts is important. The Minister said that there are memorandums of understanding with every PCT, but that does not quite solve the problems. The problems go deep into whether public health issues are sufficiently resourced, focused on and prioritised in PCTs. Can public health functions be appropriately managed among 303 PCTs across the country? I am not in a position to judge such things; I have to judge them on the basis of what directors of public health and those in PCTs around the country have told me. They feel that the system is too fragmented and marginalised and that only reactive work can be undertaken. The Minister made it clear that public health objectives, particularly on issues such as infection control, must be proactive. I am afraid that, crudely put, managers of PCTs are sacked when they do not meet hospital waiting list targets, but are not sacked for failing to meet any public health objectives. So all the effort and focus goes on the former. That raises the question whether, if it is possible for PCTs to sign a memorandum and not necessarily discharge their functions, and to let the HPA carry on its responsibilities, the public health effort overall will become disconnected.
The Minister waxed eloquently on how things must be integrated, which brings me to an important point. If everything were properly co-ordinated, a strategy for dealing with infectious diseases could be established, implemented and followed through by one body. One would imagine that that is what the Government set out to do. It is curious, therefore, that time and again the chief medical officer in the Department of Health and his teams of people set strategies, but it is the HPA that
21 Jun 2004 : Column 1108
is meant to be in the business of implementing infectious disease control and strategies thereby. As the NHS responds to the Department of Health and not to the HPA, the Department must turn the so-called strategies into action plans. What is going on? That is not happening; there is discontinuity between the two. I shall come to that in respect of a number of specific examples.
I want to refer to hospital-acquired infection and MRSA. The MRSA rate has more than doubled since 1997. The Minister will no doubt remind us that mandatory reporting was introduced in April 2001 and say that that shows that there was under-reporting previously. However, even with the previous reporting arrangements, the rate has more than doubled since 1997 and we now know that the level is about 50 per cent. higher than previous reports suggested.
I am sure that the Minister and other hon. Members have met constituents who have suffered from MRSA infection, whether after hospitalisation or otherwise. It is a life-threatening infection, especially among elderly and vulnerable people. The question that we must ask is: is it inevitable?
Methicillin-resistant Staphylococcus aureus accounts for only 1 per cent. of Staphylococcus aureus incidents in Dutch and Danish hospitals, whereas the proportion in England is more than 40 per cent. As for variation within the UK, the incidence can be seven times worse in Yorkshire than in Cambridgeshire. I am sorry to plug my constituency again, but the Minister and I visited Papworth hospital on Friday to join the celebration of 25 years of heart transplant surgery at the hospital. I recall on a previous visit talking with the medical microbiologist who is responsible for infection control at Papworth—the necessity of minimising infection among immuno-suppressed transplant patients is obvious, and the measures taken at Papworth are stringent. The hospital is not new—anything but. Staff at Papworth often work in difficult and cramped conditions in rather aged buildings, but they achieve extremely low rates of hospital-acquired infection, and I suspect that that is part of the reason why Cambridgeshire has such a good overall result.
There is no inevitability about the rate of hospital-acquired infections—it could be far lower. Just a few weeks ago, I visited Redditch hospital—I had expressed an interest in visiting the stroke services and the ward for stroke patients, but we had an interesting visit to the orthopaedic ward. The nurse in charge of the orthopaedic ward told me that that no one with an infection was coming on to her ward. If someone was to be referred to her ward, she would know whether they had an infection, and if they had, they would, in effect, be kept in isolation and barrier nursing would be used. She was adamant: no one was going to acquire an infection while they were on her ward. The reason we were unable to visit the stroke ward next door was that there was infection in that ward.
That tells us that what is needed is the ability to manage wards properly. There must be the power to ensure that risks are not taken, that infection is kept out, and that standards of hygiene and measures such as hand-washing are enforced.
| Next Section | Index | Home Page |