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Mrs. Betty Williams (Conwy) (Lab): Will the hon. Gentleman take this opportunity to apologise publicly to patients in north Wales for the misleading statistics provided by the Leader of the Opposition? Those statistics led an old lady to ask me whether she should go into hospital, because the Leader of the Opposition had told her that she should be afraid of MRSA.

Mr. Lansley: People the length and breadth of the country were asking, "Can I be safe if I go into hospital?" Conservative Members' objective, which we have set out time and again, is to make hospitals safe so that people going into hospital know that those who treat them have the ability to deliver the necessary standard of care. In the run-up to the election, Nursing Times carried out a survey of nurses, and the Government should apologise for its astonishing findings: 27 per cent. of nurses said that their cleaning services were poor or very poor; 68 per cent. said that they did not have 24-hour-a-day cleaning available on their wards; 48 per cent. said that they did not have a designated uniform-changing area; and 41 per cent. said that there was not enough time to clean beds between patients. Listening to the Government during the election campaign, one would have imagined that the fault for deficiencies in cleanliness and infection control in hospitals lay with front-line NHS staff. That has never been our argument. Our argument has been that the Government have never provided the support and framework necessary to deliver better infection control.

Let me give one example. The Secretary of State for Health has discovered that food hygiene standards in the food manufacturing industry are higher than hygiene standards in hospitals. Where was the Secretary State's predecessor when, on three occasions last year, we highlighted exactly that fact? We asked precisely when the Government would introduce hazard analysis
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and critical control point technology, which is used in the food industry and which the chief medical officer said in December 2003 should be applied through a pilot scheme and an evaluation in the NHS. Has that happened? Not a bit of it. We have asked the questions time and again, and the National Patient Safety Agency, the Department of Health and other organisations talked about it in December 2003, but they do not get on and do it. The rapid review panel did not meet for eight months; there has been no urgency and no action from the Government.

Dr. Brian Iddon (Bolton, South-East) (Lab): Is not the real problem that only one drug will counteract the effects of MRSA at the moment: vancomycin? What is the hon. Gentleman's party's policy for replacing that drug or ensuring that more drugs are available in future?

Mr. Lansley: The hon. Gentleman will know that there are a number of technologies, and I will give him one example. A company in my constituency, Phico Therapeutics Ltd, received grants—the Secretary of State for Health should be interested in this—from the Department of Trade and Industry to develop a new type of antibiotic to beat MRSA. The hon. Gentleman is a scientist so he will appreciate that rather than being a normal antibiotic, the drug impacts on the DNA of the bacterium. If the drug is successful in use, the bacterium will not be able progressively to develop resistance to it by reproducing, so it could be a very effective antibiotic. Has the Department of Health taken an interest? [Interruption.] It is a rhetorical question because I know the answer, which is that the Department of Health has done nothing about it. In December 2003, the chief medical officer said that £3 million would be spent on additional research to support infection control activity. I understand that as of last week, little of that money has been spent.

We learnt many things during the election campaign, but I shall now say a word or two about the specific legislation highlighted in the Gracious Speech. [Interruption.] We are here to help patients in the NHS, but the Under-Secretary of State for Education and Skills, the hon. Member for Corby (Phil Hope) does not seem to understand that.

Four measures were anticipated in the Gracious Speech. We have called repeatedly for action on mental health; one only has to go back to the start of the previous Parliament, when mental health legislation was promised but was not delivered. I do not dispute that the Government should bring forward legislation on mental health, NHS redress, public health and choice and diversity. They are all necessary, but there are potential problems with all of those measures.

With mental health, the starting point has to be appropriate treatment for patients and an understanding that the definition of mental illness should be clear and confined rather than stretching into other areas such as sexual orientation and dependency on drugs or alcohol. Ensuring compliance with treatment is a vital component in the delivery of successful treatment for those with mental illness, because if there is no co-operation, there is often no treatment at all. Therefore, compulsion should be a last resort.
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The principles of legislation in Scotland, with which some Members present will be familiar, were set out. They include the idea that compulsion should be a last resort, and we established that principle in our manifesto. However, the Government seem instead to be working towards legislation that treats coercion and compulsion as the general choice for psychiatric services. There are enormous dangers in that approach. Instead of patients being in secure in-patient psychiatric beds, there is a real danger that they will be out in the community. By introducing community treatment orders more widely than is necessary, the Government will make them available to the services, and close in-patient psychiatric beds. As a result, patients in the community will find that the stigma of compulsion has apparently been applied to them. The assumption in the community will be that all those patients are a threat to other people, which they may not be. Many patients may well be treated in the community when in fact, they should be in in-patient beds not only for their benefit, but for the safety of the public. So there is a serious potential problem with the structure of the Government's legislation.

Lembit Öpik (Montgomeryshire) (LD): Does the hon. Gentleman also agree that another important element is access to the facilities? There is no point in pushing through this legislation if—as in many rural areas, including much of Wales—one cannot obtain the services that the Government require people with mental illness to access.

Mr. Lansley: The hon. Gentleman makes a good point. There is a risk that the structure of the legislation will lead the Government to assume that community treatment orders can be applied. By their very nature, such orders will tend to pre-empt services, and the general level of access to services will diminish, particularly in rural areas. Action does need to be taken, and to give the Government due credit, they have tried to push measures such as early intervention. However, those will be lost as a consequence of their proposals. So I urge the Government to think very hard about their proposal.

The pre-legislative scrutiny Joint Committee rightly called for substantial amendments to the legislation, and our amendment to the motion makes it clear that we want that to happen.

John Bercow (Buckingham) (Con): I had the privilege of sitting on that Joint Committee. Given both the importance and the sensitivity of mental health legislation, does my hon. Friend agree that there are two overriding requirements in this context? First, the Government must include in the Bill all the main features and should not seek to sneak through substantial change via order-making powers and secondary legislation. Secondly, in bringing forward an important proposal that ought to attempt to command cross-party support, my hon. Friend should, through the usual channels, seek to ensure that there is adequate time to debate the matter on the Floor of the House, so that the Government, if they have the confidence to do so, can test the veracity of, and support for, their arguments.

Mr. Lansley: I am sure that all Opposition Members will agree with the latter point; in fact, I agree with the
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former point as well. The proposed legislation as structured relies far too heavily on order-making powers and on the use of codes of practice, instead of the relevant provisions being included in it. The Bill does not include the principles to be applied in designing mental health services, as the Scottish legislation does. My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) and his colleagues published only yesterday a document including independent contributions on the structure of the legislation, which I commend to the Secretary of State and to the whole House.

I shall make one or two points about national health service redress. The Government do not appear to be considering the introduction of conditional fee arrangements in clinical negligence cases beyond the point of fact finding and investigation. I commend that approach; otherwise, there is a risk under the legislation that the process of fact finding and fault finding will simply lead either to a distortion of fact finding, because it is combined with fault finding, or to fault finding simply feeding more and more clinical negligence cases that do not necessarily have merit, but are funded through legal aid. There is a serious problem with the introduction of no-fault provision in respect of birth defects. The definitions will be intensely difficult to make and where does one draw the line—during pregnancy, with congenital birth defects, or with medical accidents occurring shortly after birth? It will be extremely difficult to deal with that problem.

I have already spoken about hygiene and public health. The Government intend to introduce a provision on hygiene, which is interesting, but in the light of all that I have said about what needs to be done on cleanliness and infection control in hospitals, they hardly seem to be acting with any urgency to deliver. Indeed, they have not even acted with the urgency recommended to them by the chief medical officer, who suggested legislation to introduce enforcement powers for dealing with hygiene in hospitals. He wrote to Ministers in October last year urging legislation in the last parliamentary Session. Ministers did not act on that, but are proposing to do so now.

The problem with imposing fines on the NHS and on hospitals if they do not meet hygiene standards is that it is a counsel of despair and an admission of failure. We need a successful NHS, and during the election campaign we set out clearly how we could provide specific additional help to get technologies and other forms of support through to front-line staff in order to deliver improved infection control.

The Government are also proposing a partial ban on smoking in public places—a typical Labour Government approach in that the rhetoric is all there, but the actual proposal is utterly unworkable. Apart from anything else—[Interruption.] I am sorry that I neglected to mention the Minister of State, Department of Health, the hon. Member for Doncaster, Central, so I mention her now. Doncaster metropolitan borough council reported to the British Medical Association that 36 per cent. of their pubs do not serve food. If a ban on smoking in pubs is linked to whether pubs serve food, we shall end up with a large number of pubs, particularly in northern and midlands cities and in less prosperous
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areas, continuing to allow smoking because they do not serve food. It will not deliver the objective that Ministers want. In Leeds, 88 per cent. of pubs reported to the BMA that they did not serve food; clearly, the impact of the legislation will be to increase health inequalities.

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