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Mr. Philip Hollobone (Kettering) (Con):
I am grateful to my hon. Friend for raising the issue of hospital-acquired infections. Does he agree that while many of us are worried about the uncleanliness of many of our local
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hospitals, it is a particular concern for vulnerable elderly patients, many of whom are now sadly frightened of going into hospital because of the infections they may pick up there?
Mr. Lansley: I understand exactly the point that my hon. Friend makes and he is right. At the heart of what we need to achieve is an assurance that action will be taken by the NHS that delivers vastly improved infection control procedures across the board, so that our constituents are reassured. I have visited Kettering district general hospital and I know that it is a very good hospital, butas my hon. Friend knowsthe public need reassurance.
I shall give my hon. Friend an example of the kind of measures that need to be taken. We have pressed on the Government for a long time the need for more comprehensive recording of data on infections by clinical department. That is not only because that is the basis on which action should be taken inside a hospital, but because it provides more meaningful measures for those outside the hospital. For example, when I visited the Lister hospital in Stevenage, there was much local concern about the level of MRSA infections. When I talked to staff, it became clear that the hospital's problem was associated with the fact that as well as being a district general hospital it was also a regional centre of excellence for kidney dialysis. It had problems with access to operating theatre time and the extent to which patients on dialysis had to be catheterised, which led to infections. Those distinctions were not known and understood by the local public, because the one figure published by the Government showed that the hospital had a lot of MRSA. The public need to know what is really going on. Information is at the heart of the issue, but the Government continue to resist the National Audit Office's proper call for data to be published by clinical department.
Mr. Devine : In Scotland, over a 15-year period when the Conservatives were in power, compulsory competitive tendering and cuts in cleaning services led to the loss of 15,000 jobs. MRSA increased as the number of domestics in hospitals was reduced. At least this Government have faced up to a problem that the Conservatives denied was happening.
Mr. Lansley: The hon. Gentleman should ask the Department of Health and the Secretary of State about that. The Department published a report that showed that there was no correlation between the contracting-out of cleaning services and the levels of infection. NHS hospitals with contracted-out cleaning are as likely to have high levels of infection as those with in-house cleaning. However, there is a correlation between the quality of cleaning and rates of infection, and that is why I mentioned the model cleaning contract. The code of practice should directly reflect the standards in the model cleaning contract.
The Government propose to legislate to transfer the responsibility and budgets for general ophthalmic services to PCTs, which raises three issues. First, why are the Government pre-empting the review of general ophthalmic services that is expected to report shortly? Would it not be more sensible to legislate after the review? It will be difficult, in the circumstances, for
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people to take seriously the Government's approach to the review. Secondly, the Secretary of State made the comparison with dental services, but that is exactly what people working in ophthalmic services are afraid of. How many letters of complaint have MPs had in recent years, before the publication of the Bill, about the quality of local ophthalmic services compared with the number of letters about quality of and access to dental services? Those figures tell the story. As with the 2003 legislation, the Government propose to legislate for a transfer of responsibility to primary care trusts. The National Audit Office made it clear that PCTs did not have the expertise to conduct the commissioning of dental services and still less, probably, do they have the expertise to conduct the commissioning of ophthalmic services.
What will PCTs do? Under current circumstances, in whichin the last financial year91 PCTs broke their statutory duty to break even, they will be given an additional budget that they will use to try to offset their overall financial problems. People working in ophthalmic services are rightly worried that the consequence will be a reduction in quality and a reduction in access. From a Government who say that they are about choice, what will we have? A reduction in choice for patients, because it will no longer be true that those who are registered with the General Ophthalmic Council will automatically be able to supply services locally to NHS patients; that may be restricted by primary care trusts in ways that we cannot at the moment even anticipate.
Finally, the Secretary of State transferred from the Department of Trade and Industry, where she was previously responsible for competition policy, the issues relating to community pharmacies after the consequences of the review of control of entry regulations. I told her before, in that respect, that one needed to have regard to the health issues associated with maintaining community pharmaciesand I say it again. We should not underestimate the difficulties that might accrue if, in the course of this legislation, we were significantly to shift the balance of advantage towards the large stores with their new pharmacies, which are able to provide a service with relatively limited amounts of professional pharmacy cover. The pharmacists are concernedand I share their concernthat we strike the right balance in the span of control of pharmacists and the responsibility that they take for the provision of services.
At my count, the Bill has nine issues. Perhaps I have not done justice to any of them, but we will do them all justice later in the Bill's passage. Most of it is a shell, into which regulations are intended to pour decisions. During its passage, we in Parliament should make a few decisions about what goes into it and what happens to our constituents. I hope that we shall do that in a substantive way in respect of smoking by striking out the Government's partial ban, and I leave it to my colleagues and those across the House, perhaps on a free vote, to determine what goes in its place.
I hope that we will get to hard outcomes and clear measures for reducing the impact of health care-associated infections. I hope that we will maintain choice in ophthalmic services, that we will give certainty to pharmacists and protect the profession, and that the Bill, while making progress, will be amended
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substantially during its passage. On the basis that I hope and expect that the House will amend the Bill, it is not my intention to ask my colleagues to divide against the Bill tonight.
Mr. Kevin Barron (Rother Valley) (Lab): I shall first declare an interestI am a lay member of the General Medical Council. I have been very conscious in recent years of the events surrounding the deeds of Dr. Harold Shipman, so I want to start by commenting on the measures in the Bill that go some way to redress some of the issues that were found when the Shipman inquiry reported in July 2004 about the regulation of controlled drugs in the community.
The case of Harold Shipman was a very dark chapter in the history of doctors in this country. The fact that he was able to obtain such large quantities of controlled drugs, and the failure of the system to detect his inappropriate use of those drugs over many years, had to be not just found, but corrected if we are to ensure that, hopefully, it never happens again. Dame Janet Smith identified serious weaknesses in the system of regulation of controlled drugs and highlighted the need to introduce a number of changes to strengthen the system, while acceptingas I think we all mustthat no system can be totally immune from fraud.
I congratulate the Government on clause 16, which relates to the appointment of accountable officers and provides details of their responsibilities. I understand that those new senior executive posts were proposed in Dame Janet's fourth report, although the report uses the term "proper officer" rather than "accountable officer". Under clause 16, accountable officers will have overall responsibility for the management and use of controlled drugs in such organisations, as well as the arrangements for the audit, inspection and training of staff who work with controlled drugs, thereby ensuring better patient safety than in the past.
Dr. Stoate : Dame Janet concluded that the control of such drugs should be passed to the Royal Pharmaceutical Society, yet clause 18 refers to a constable or other officer being responsible. Do you think that that point needs clarification? Does my right hon. Friend agree that that needs to be brought out properly before the Bill is passed?
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