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Give explicit instruction to the CPPIH regarding the risks associated with TUPE and current redundancy plans.
If those points are not clarified by the time the commission is abolished it may run up a huge bill that it will be unable to pay.
My final point about part 1 relates to the Healthcare Commission and problems with the NHS complaints procedure that have been mentioned by other Members. The complaints process must be independent and fair, but with the removal of the commission from it we shall lose the automatic involvement of independent experts. In a complaint, especially where there are clinical problems, the involvement of knowledgeable, independent clinical specialists is essential.
Mr. Stephen OBrien: The hon. Gentleman makes a powerful point about something that, as he knows, goes back a full eight years to the appalling loss of community health councils when they were summarily axed in England. CHCs were the one place where a complainant could be confident that there was an independent person to hold their hand and help them. That independence was important, as he says.
I thank the hon. Gentleman for that intervention. Independence is crucial. That obligatory independence will be lost in the complaints process that will result from the removal of the Healthcare
Commission. It will be left to people in an internal complaints process to decide whether to include an independent view. Will they want to do so? Of course not. That is a huge weakness in the proposals. The hon. Member for Pendle (Mr. Prentice) pointed out that there would be a tremendous increase in the number of cases taken to the ombudsman. In a briefing, Age Concern noted that there could be a massive increase in the ombudsmans load if the proposals go ahead. I strongly press the Minister to write some independence into the proposed complaints procedure.
My final points relate to part 5. What may for me be the most important clause in the Bill has not yet been mentioned: clause 129, Duty of Primary Care Trusts, which deals with the arrangements for improving the quality of health care. It reveals that for the last six years, since I have been a Member, I have been taking entirely the wrong approach to complaints. I have been tackling providers about the service that they provide, but clause 129 indicates that I should have been tackling the commissioners because they have the right to remove the service.
In the Queens Speech debate on health, I described some of the appalling things that were happening in my patch and in others. Not long ago, I had a meeting with the chief executive and the chair of our primary care trust and I was encouraged. Even at that stage, the chair had received many complaints about the quality of care and was beginning to realise that it was the duty of the PCT as commissioner to point out the problems and try to get them rectified. I am pleased that clause 129 is in the Bill; it is short but it must not be lost, because it is crucial.
Clauses 132 and 133 relate to the weighing and measuring of children in England and Wales. Obesity in children has been mentioned by the hon. Member for Dartford, at length, and by the hon. Member for Romsey (Sandra Gidley). The Select Committee on Health held an inquiry into obesity in 2003-04. Recommendation 45 stated:
We recommend that throughout their time at school, children should have their Body Mass Index measured annually at school, perhaps by the school nurse, a health visitor, or other appropriate health professional. The results should be sent home in confidence to their parents, together with, where appropriate, advice on lifestyle, follow-up.
At the time, we were slightly attacked as it was thought our proposals would stigmatise obese children. I did not think that argument had any force at all because there was evidence that parents were unaware that their children had a problem.
The importance of public health issues, especially obesity, has been recognised for a long time. Public health came to the fore in the 1880s with the great recognition that bacteria caused disease. As time is not at an absolute premium, I should like to remind the House of Sir Walter Scotts words in the novel The Surgeons Daughter, published in the 1820s. He bemoaned the poor recompense for a Scottish village doctor compared with his English counterpart:
The burgesses of a Scottish borough are rendered by their limited means of luxury, inaccessible to gout, surfeits and all the comfortable chronic diseases which are attendant on wealth and indolence.
There the mothers of the state never make a point of pouring, in the course of every revolving year, a certain quantity of doctors stuff through the bowels of their beloved children.
As long ago as 1820, the problems of idleness and affluence were recognised. I do not say that we should return to poverty, but I welcome the Bills emphasis on public health, especially the measures aimed at spotting overweight childrennot to stigmatise them, but to tackle the problem.
Mr. Charles Walker (Broxbourne) (Con): I am grateful to be called to speak in this incredibly well attended debate.
When I heard that there was to be a debate on health I had intended to talk about my constituency, to tell the House that it is important that Cheshunt gets an urgent care centre when the PCT reports back in a couple of weeks time. I had planned to tell the House what a wonderful job my council has done in supporting health service infrastructure in Broxbourneand long may that continue. However, I am not going to do that, because it has absolutely nothing to do with the Bill. It would be totally gratuitous of me to use this opportunity to get those things off my chest.
I would particularly like to focus on the work of the care quality commission. In my constituency, there is a growing loss of confidence in the NHS and in hospital care among sections of the people whom I represent. The NHS still provides high levels of service to the vast majority of patients, but over the past few years there has been an increase in hospital-borne and hospital-acquired infections. That is causing unease, and it is causing some to be fearful of being admitted to hospital. It is important to address those fears, because hospital is a place where people should go to get well. It is a place that puts people back on their feet, but if well-meaning people start to fear going to hospital, that will undermine confidence in the NHS, which will be to the detriment of us all.
Over the past few years, there have been a number of well-publicisedI will not call them disastersvery unfortunate events that have led to people dying unnecessarily. They occurred at Tameside in Manchester, and there have been problems with C. difficile at Stoke Mandeville, and most recently at Maidstone. I am trying to understand how we in this country have got to the position in which people die in hospital from diseases that are preventable. I admit that some bugs are developing resistance to antibiotics and other treatments, but the idea that people go to hospital and fall ill and die from disease is extremely worrying. I am trying to understand why the growth in the number of such illnesses has occurred over the past few years. The issue is important in the context of the care quality commission and its work in trying to identify the problem, disassemble it and then come up with solutions that actually work.
When I am canvassing in my constituency, I talk to a lot of people who work at Chase Farm hospital. As you may know, Mr. Deputy Speaker, the hospital faces a fairly rocky and uncertain future and I am met on the doorstep by nurses and orderlies who are often in tears when I speak to them about what is going on in their hospital and its future. They tell me about low morale, that people do not know whether they will have a job in a years time and that it is difficult to recruit. They tell me about a lack of pride in the place, which is very worrying when set next to the fact that Chase Farm
hospital has battled for many years against diseases such as MRSA. It is fighting bravely to remove them, but it would be much easier for the hospital to get to grips with such diseases if there was a sense of common and shared purpose among the staff. When the care quality commission considers hospital-borne infections and how standards could be improved, it cannot put to one side the fact that the morale in the hospital with which it is dealing is a contributory factor.
One example of where I think the NHS is making mistakes relates to the subject of nurse morale. I was talking to a nurse who had finished her shift for the day and was getting ready to leave. She noticed that an elderly lady in one of the wards had not been fed that evening. Being a conscientious nurse and a human being, she decided to stay on and feed her. The nurse knew that if she left, those on the incoming shift would not take it upon themselves to feed that elderly woman. The window of opportunity would have been lost, so the nurse stayed back in her own time and made sure that that elderly person had supper and nutrition. That is important, because we know that a number of elderly people in care do not receive proper nutrition. Indeed, some are starved to near death.
The nurse fed the elderly lady, got into her car and travelled 25 miles home. When she got home, she listened to her messages, including one from a hospital manager saying, Please come back to the hospital, because you have not finished your paperwork. The nurse knows full well that such a message would not have been left if the elderly patient had gone unfed. If the nurse had done the paperwork, not fed the patient and gone home, nobody would have cared and that telephone call would not have been made. She has now left the NHS, which is a great loss to us all.
The care quality commission must not allow people to get off the hook of accountability. Too often in these debates, a smokescreen is thrown up about who is in charge and about contract cleaners. My view is that the chief executives are in charge of their hospitals and they have to take ultimate responsibility for their being well run. I know that chief executives work under very difficult conditions. They have targets imposed on them and they have to meet benchmarks and work extremely hard to keep Whitehall happy. However, that is no excuse, and it must never be an excuse, for allowing people to lie in their own faeces, to lie in their own vomit, to go unfed and not to be cared for. That is an abrogation of responsibility on the part of those chief executives.
Chief executives are paid considerable sums of money. Some earn well over £200,000, and with large sums of money come huge levels of responsibility. Too often, I feel that chief executives think that they are running a hospital well if they are sitting in their ivory tower surveying all those they command. I am not going to compare running a hospital with running a business; the two are very different. However, I will make the following comparison. Some successful people running enormous businesses make sure that they spend at least one day a week out in the business making sure that they know what the customer experience is like and that their customers are getting what they want. We need some more of that in the
NHS. We should have strong management teams in the NHS that allow chief executives to get out of their ivory tower and their offices and to spend time on the shop floor.
Sandra Gidley: That is possible under the existing regime. The new chief executive at Winchester hospital makes sure that he eats hospital food under an assumed patient name once a week. He does a lot of things to be on the wards to see what is going on and carries out cleanliness inspections. Some would say that he should not have to do that, but that approach seems to be delivering results and more could learn from that lesson.
Mr. Walker: The hon. Lady has made an important point. Some say that that should not be the case; I say that it absolutely should be the case. We need to see chief executives on the wards.
Before the hon. Lady helpfully intervened, I was about to say that I was amazed when we were shown pictures of Maidstone hospital and saw the filth and the squalor that were allowed to go unaddressed. Any serious senior manager worth their salt would have dealt with that. What we saw was disgraceful. As I have said, with responsibility comes leadership and we need leadership in the NHS.
Ideally, I hope that the care quality commission will be a passing phenomenon. I hope that we have it for five or six years, but that there will then be chief executives of sufficient quality to mean that it is accepted that hospitals are of such a uniformly high standard that we do not need to burden them with more regulation and more inspection. Until that time is reached, I very much see the need for the commission.
In my final couple of minutes, I wish to deal with the issue of obesity and the weighing and measuring of children at school. Obesity is a huge problem. Short of people just closing their mouths and not eating, it is very difficult to address. I do not mean that flippantly because, in particular, we need to address the problem of obesity in children. Obesity in childhood can have an impact on a persons health outcomes throughout their life and place additional costs on the NHS. Perhaps the Minister can explain matters further either here or in Committee, if I am lucky enough to serve on itthat is not a hint, because I am very busy at the moment. [ Interruption. ] That was an own goal.
We weigh and measure children at school, but to what end? Is it just another form-filling exercise, or is there a strategy to utilise the information and make sure that our young people and their families get the support that they need to live healthy lifestyles and lose weight? We cannot really remove exercise from the equation. Many teachers in my primary and secondary schools give up huge amounts of their personal free time to lead sports activities in the afternoon or evening. We need to encourage more teachers to do that, and if need be, we should make it worth their while financially.
Mr. Deputy Speaker, you have indulged me on occasions this evening and I thank you very much for your patience.
Hywel Williams (Caernarfon) (PC):
I am pleased to make a contribution to this important debate. I accept
that, to an extent, the Bill focuses on the health sector and health care. However, I am a former social worker, a former teacher of social workers, and a one-time member of the Central Council for Education and Training in Social Work in Wales. I echo the words of the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble): it is important that social care is not lost in the emphasis on health. The voice of the user must not be lost, either. That is one of the fundamental principles of social work and social care, and certainly something to which I attached great importance when I was teaching.
Much of the Bill applies to England, but there are some points that are particularly relevant to Wales. I want to emphasise that there might be some cross-border issues and I seek reassurance from the Minister that they have been taken fully into consideration. The Welsh Affairs Committee is mindful of the implications of cross-border issues for health care in Wales and will conduct an inquiry early in the new year.
There are particular arrangements in Wales. I would like reassurance that, for example, any implications of changes to the inspectoral arrangements in England have been taken into consideration. In Wales, we have our own body for regulating social workers: Cyngor Gofal Cymru, or the Care Council for Wales. It is separate from the General Social Care Council and operates on its own. Both bodies were set up under the Care Standards Act 2000. The Care Council is, like the General Teaching Council, a devolved body. However, the Care Council operates in the same area as the corresponding body in England and I am not wholly convinced that the operation of one will not have some influence on the operation of the other.
The care quality commission in England will combine health and social care and inspection. As I have said, I am concerned about whether there will be implications for the inspectoral arrangements in Wales, particularly on a cross-border basis and when staff move from one employer to another across the border.
The Care Council for Wales has a productive interface with health in Wales. There are regular meetings and training matters are discussed. However, it is important to realise that the work of the Care Council for Wales is not just focused on health. Its work also involves education, housing and community development matters. It works to a social model, not a health model. The care quality commission in England will combine health and social care inspection. Will the Minister let me know, either later or by means of a letter, what, if any, implications the Bill has for the inspectoral arrangements in Wales and the Care Council for Wales? Have there been discussions with the National Assembly Government and, if so, what were the conclusions?
I have a particular example. Should the Care Council wish to change, vary or develop its work, I take it that that could be achieved through regulation, under clause 114. I note that clause 115 states that the standard of proof that is to be applied may not be varied in Wales, as compared to England. Will the Minister confirm that the power through regulation will be sufficient and that there will be no need to transfer legislative competence over the Care Council for Wales to the National Assembly? Will there be a need for legislative competence orders? They are already coming through and can take some
time. Has he had any discussions with the National Assembly for Wales on the matter? I might be worrying unnecessarily, but I would value an assurance from the Minister.
Clause 116 is on the training of mental health professionals. The regulation-making power for that lies with the Care Council for Wales. It is a Welsh matter, but again I hope that the Minister or his officials have had the opportunity to discuss it with the National Assembly. I am going into some detail, but I not seeking a place on the Committee. The Bill is largely concerned with matters in England.
My second group of concerns is about the Welsh language and the implications under the Welsh Language Act 1993. The provision of services by a public body is subject to the Welsh Language Board and operates under a Welsh language scheme that has been approved by the Welsh Language Board. I am thinking in particular of developing needs in relation to mental health. When people are assessed for compulsory admission, a language choice is available. To some extent, that will be a matter of regulation for the Care Council for Wales. However, the Mental Health Act Commission is being merged under the Bill. I want to be reassured that Welsh language issues have been taken into consideration.
I think great changes are going to be carried out in relation to mental health legislation in Wales. I mentioned compulsory admission. There is going to be a legislative competence order, which we hope will transfer to the National Assembly the right to legislate in this area. That is being proposed by a Conservative Member of the Assembly. The point is that the care quality commission will take on the duties of the Mental Health Act Commission in Wales and I want to be reassured that it will have a Welsh language scheme from day one. There was a discussion some time ago when the Childrens Commissioner for England was set up and had some duties as far as children in Wales were concerned. I had a long session with the relevant Minister to try to persuade her to set up a Welsh language scheme from day one. After 13 questions, she agreed to write to me, and eventually we got a Welsh language scheme. However, that scheme needs to be there from day one. After all, patients will have concerns from day one, particularly on the difficult matter of mental health.
There is considerable expertise in Wales on language matters, particularly in relation to social care and mental health. Looking at schedule 9, it seems that the principles of the Welsh Language Act should underpin provisions such as paragraph 2(e), which refers to standards of conduct, and paragraph (9), which imposes conditions for regulation.
I look to the Minister for reassurance that those particularly Welsh issues have been taken into account. Generally, I welcome the Bill, as other Members have.
Angela Browning (Tiverton and Honiton) (Con): I apologise to the House for the fact that I was not present at the beginning of the debate, but I wrote to the Speaker last week to explain why I would be late. I meant no discourtesy to the House. I have a particular interest in the Bill and I wish to make a brief contribution on Second Reading.
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