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Jane Kennedy: I know that the hon. Lady is going to say that they are only words, but in fact they are pretty strong words and I hope that she will accept the intent behind them. However, I shall give way to hear what she has to say.
Mrs. Dorries: "Clean" is a matter of perception. We can say, "You look clean", but we cannot see viruses and bacteria, as I said earlier. How can a ward manager know whether a uniform is clean and fit for purpose if they do not know what bacteria or viruses are living on it? If it has been worn at home, it could have been worn while the member of staff picked up their child from school or went shopping in the supermarket. How could a ward manager be expected to know that?
The areas of greatest risk are patients who are very poorly and have woundspeople who are going into hospital for invasive procedures, including something as simple as the insertion of a drip, or for some form of operation. It is appropriate that, in those cases, suitable additional protective clothing be worn. Indeed, such practice is widespread. Plastic aprons and gloves are worn by those who are going to spend some time with such patients, even visitors. The point that the hon. Lady makes about how clean a uniform looks is unarguable and patently true, but including in the code a requirement on the NHS to ensure that uniforms are
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of a required standard of cleanliness is a very forceful step to take. I hope that she is to some extent reassured
Mrs. Dorries: Many years agoI do not want to say how manyplastic aprons and gloves were commonplace throughout wards. Before a nurse went to any patient, she would take off her existing apron and put on a new one; indeed, that is what I did. Aseptic technique was drilled into us as nurses. Everything that we did involved aseptic technique, particularly when dealing with patients who were vulnerable and at risk. That same mental attitude toward asepsis and changing gowns and gloves is no longer present in wards; it simply does not happen any more. In the past, the provision of such gowns was prescribed. Would it not be appropriate, therefore, for the code to make reference to the provision of freely available gowns, so that what happened in the 1970s and 1980sthe constant changing of gowns and gloveshappens again?
Jane Kennedy: I do not accept the hon. Lady's description of what happens now: I have indeed seen that level of concentration on aseptic techniques, but I hear what she is saying. In my view, we should not strengthen the code in the way that she describes at this point, but I will reflect on this issue. We will have time to take such concerns on board as the Bill progressesI hopethrough the other place. I have sought to provide some reassurance on how seriously we are taking these issues, and the requirement that we have included in the code, measured as it will be by the Healthcare Commission, will be sufficient. However, we continue to listen on these issues.
In Committee, the hon. Lady gave a graphic description of a visit to a hospital in which she met a nurse with what she assumed was spaghetti Bolognese over the front of her uniform. As I said in Committee, had I been that nurse's manager, I would have expected her to have washed her uniform, or at least to have worn another one. However, as the hon. Lady says, one cannot always tell whether a uniform is free of germs, even if it has been washed, just as one cannot always guarantee that one's hands are totally free of germs.
I believe that the code as drafted would give NHS trusts a legal duty to ensure that such things do not happen. It would give relevant NHS bodies a legal duty to ensure that their staff had clean uniforms. How they achieve that would be up to them, which is what I meant when I said that the code is outcome-based. I realised that the hon. Lady did not have the benefit of the latest draft of the code, and she is obviously still disappointed with the current version. I hope that the redrafted code addresses some of the concerns and reassures hon. Members. While I approve of the amendment's overall aim of ensuring that staff have clean uniforms, I am afraid that we disagree with the methods proposed to achieve that aim.
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Finally, for the sake of clarity, I should make it clear that in the Oxford study that I mentioned earlier, I meant 90 per cent. of the 25 per cent. of patients with MRSA who had been in contact with a hospital. I hope that that is clearer.
For the reasons that I have given, I hope that the amendments will have served the purpose of probing the Government's intentions in bringing forward the code and amending it as we have. I hope that the hon. Member for Westbury will withdraw his amendment, but if he does not I shall have to ask my hon. Friends to resist it.
Dr. Murrison: Given that the code is an evolving document, we may hope for future amendments to it along the lines that we have proposed tonight. We look to the Healthcare Commission to advise on and supervise the code. With that in mind, I beg to ask leave to withdraw the amendment.
Sandra Gidley: These amendments seek to amend clause 32, which deals with applications for provision of pharmaceutical services. It may be worth spending a little time on the context of these amendments. As the House knows, following the Office of Fair Trading consultation a couple of years ago, new pharmacies are controlled by something called the control of entry regulations. Any application to open a new pharmacy has to go before the primary care trust or the Assembly in Wales and has to pass certain tests.
It is also worth remembering that pharmacies are private contractors that have a contract with the national health service. Historically, that has been to deliver dispensing services, but that has recently changed with the introduction of the new pharmacy contract. That seeks to extend the role of pharmacists, which is widely regarded as a good thing.
Instead of just relying on dispensing, the contract is divided into levels of service. The standard services are those that all pharmacies should supply, and include services such as dispensing and health promotion. Advanced services are developing gradually and the first, which has been successful so far, is the medicines use reviewor MURwhich has benefited many patients. So far, so good. The potential exists for enhanced services, such as smoking cessationI had to mention that tonightand monitoring the progress of disease or providing services to care homes. Commissioning of such enhanced services has been very patchy. Some primary care trusts have been very good and tried to embrace new services, but others have ignored the opportunity completely. Some of the evidence shows that the future of the enhanced services next year looks shaky, to say the least. However, that is probably a debate for another day.
Clause 32 applies only when a primary care trust has two applications before it to provide pharmaceutical services in a similar locality. Each pharmacy must pass the existing test as to whether it is necessary or desirable.
As drafted, clause 32 would mean that an NHS contract could be awarded according to promises made in relation to the commercial part of the business. That is wrong and unenforceable, and various problems arise. I admit that the Government have consulted on the proposal, but most respondents rejected it. All the contractors who were consulted did so, regardless of whether they represented single, independent contractors or large multiples.
The contractors' objections revolved around a few simple propositions. They said that no request for a certain level of medicine pricing could be enforced, as no
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price could be guaranteed in the long term. Contractors could promise the earth, but how could that be monitored by the PCT on a regular basis? What would happen if circumstances changed? For example, a certain price for over-the-counter medicines might be allowed, but the company or pharmacist involved could renege on the deal.
The best analogy that I can come up with is with the contracts awarded to NHS dentists. Such dentists spend two or three years building up their patient lists, but then decide that they do not want to provide dentistry on the NHS. In those circumstances, the PCT has no control over what happens, and it is the question of control that is important here.
It is difficult to see how a PCT can balance different offers in different applications. For example, one pharmacy might offer a certain price for over-the-counter medicines, while another offers an enhanced delivery service. How can the first offer be compared with the second? Who decides what is best for patients? During the consultation, the concern was raised that the proposal could lead to more application refusals being contested, and therefore to a possible increase in the number of judicial reviews.
What happens if a pharmacy is sold, quite legitimately, to an independent contractor or a different group? The buyer might have different marketing or pricing policies, or want to offer a different range of services. How will that be dealt with?
It has been argued that the proposal will help disadvantaged communities, as they would have access to cut-price medicines. I have worked in such communities, and my experience is that that is not really a consideration. People who live in such areas know that they can get free prescriptions from their GPs, and are happy to do so. As a result, that argument is something of a red herring.
Very often, businesses in disadvantaged communities are run by independent contractors. At first, they might not be able to offer big attractions in respect of cut-price medicines, but their commitment to the community can mean that they choose to plough some of the profits back into developing future services. Traditionally, that is what has happened in pharmacy, but the clause could put a stop to pharmacists' very realistic desire to do the best that they can within the constraints of their budgets.
In short, the clause is unworkable as it stands, being difficult both to monitor and sustain. If the Minister is committed to proceeding with it, I hope that she will at least review the new system after it has been in place for a year or 18 months. In that way, she will be able to see whether any of the problems that I have highlighted are based in reality rather than in fear.
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