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There may be a number of reasons why malnutrition, for example, is not picked up when someone is admitted to hospital. It might be part of a more serious condition for which they are being treated or operated on, and it is diagnosed only when they are recovering from the more serious condition for which they are being treated or operated on. That explains why their final treatment episode might be for malnutrition, when their initial treatment was not. Hence the allegation made by the hon. Gentleman that people were becoming malnourished in hospital is not the case. Similarly, it might be that,
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when recovering from a serious operation, a patients loses their appetite, so their final treatment in hospital is for malnutrition, but that does not mean that they are discharged with malnutrition. So I hope that that helps to clear up that point.

Mr. John Gummer (Suffolk, Coastal) (Con): I wonder whether, as part of a continuing campaign, it would be possible for the Minister to refer all this to the people who invented these phrases. In the end, people ought to understand this information. Although elegant in his presentation, the Minister has made it clear that this is pretty difficult for people to understand. If we are to try to follow this properly, can we not speak in English? The word “episode” does not mean that in any other form. Perhaps the national health service would be kind enough to try to communicate with us more reasonably.

Mr. Bradshaw: I absolutely agree with the right hon. Gentleman. As a result of my desire for clarity, I went back after our discussions in Committee to try to shed some light on the issue. I am sorry if I have not managed to do it with more clarity. A better phrase for episode is what one is being treated for during a particular period of one’s stay in hospital. As I am trying to say, someone may be treated for a range of different things while they are in hospital. What they are treated for at the end of their stay in hospital might be different from what they were admitted to hospital for. I simply tried to clear up the misunderstanding that has arisen as a result of how the hon. Member for Eddisbury interpreted some answers to parliamentary questions that led him wrongly to suggest that people were being discharged with malnutrition. They are not being discharged with malnutrition.

Mr. Gummer: I very much accept the help that the Minister is giving, but I come back to the point that, if we are to pass on information, the importance of that information and truth is not what leaves the lips but what is heard in the ears. If people cannot understand what is said either in an answer to a question or, more likely, at the heart of the NHS, is it not important that we recast it in such a way that it does not need the Minister’s intervention for anyone to understand it?

Mr. Bradshaw: The reason why it needed my intervention was the misunderstanding on behalf of the hon. Member for Eddisbury. I hope that, when he reads Hansard tomorrow, he will see that I have cleared it up; but if I have not, I will write to him in a further attempt to do so.

Mr. Stephen O'Brien: I bore with the Minister right the way through to make sure that he said the whole of what he had to read out. I entirely share the concern of my right hon. Friend the Member for Suffolk, Coastal (Mr. Gummer) about the use of English, but that is another matter. I am sure that the Minister will be the first to agree that I have based all these malnutrition arguments and the question of whether it has got worse or better over the past 10 years entirely on Government statistics produced in response to my written parliamentary questions, which were then given ministerial answers. From what the Minister has just said and assuming that we can find a common form of language that we are likely to understand, it seems to me that, if I was to
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retable those questions, he might undertake to give the answers to me in a way that everyone can understand. If he wants to demonstrate that malnutrition has not got worse in hospital stays in this country over the past 10 years, I hope that his answer will bear that out; but as things stand on the record, I am right and, at the moment, he is wrong.

Mr. Bradshaw: Anyone who has fairly followed my record in this place will know that I always try to answer questions succinctly. Perhaps I tried to answer the hon. Gentleman’s written questions too succinctly. If I had given a little bit more detail, as I have given the House today, he might not have been led to make the claim that he made in Committee and during this debate.

The hon. Gentleman asked why we were making separate provision for health care-acquired infections yet not giving nutrition the same level of importance. The separate provision for health care-associated infections is already in existing legislation. We already have the code of conduct that Parliament approved during the introduction of the code of practice as part of the National Health Service Act 2006. That provides a framework on how services can prevent and control health care-associated infections and has been well received in the field. It would not make sense to remove that vital guide for tracking infections. May I take the hon. Gentleman to task for accusing the Government of failing to get infection rates down? He will know that since we were in Committee, we have reported a 40 per cent. decrease in MRSA since 2003-04 and a 16 per cent. decrease in C. diff in the past year alone.

We do not desire areas such as nutrition to be neglected. Indeed, in everything that I have said about the subject both in the Chamber and in Committee, I have reconfirmed the importance that should be placed on nutrition. We have acknowledged throughout our debates on the Bill that the commission is best placed to set the specific criteria by which providers are assessed for compliance with registration requirements. However, I have said before, and I will say again, that we intend that registration requirements will make reference to nutrition. The Committee was shown examples of how they might look and copies were placed in the Library. Hon. Members will be aware that we will issue consultation on the issue shortly. In that spirit, I invite the hon. Gentleman to withdraw the motion.

Mr. O'Brien: I listened very carefully to the Minister. Interestingly, the hon. Member for Tamworth (Mr. Jenkins) unwittingly put his finger on the fact that although health care-associated infections are mentioned in the Bill, malnutrition is not. He suggested that it would be dangerous to add anything more to the Bill. However, malnutrition affects 137,000 people, whereas 6,000 are affected by MRSA, for example. If we want to demonstrate that addressing malnutrition is of equal importance, we will want a reference to it in the Bill. On that basis, I urge my colleagues to join me in the Lobby in support of new clause 15.

Question put, That the clause be read a Second time:—

The House divided: Ayes 186, Noes 263.
Division No. 77]
[6.30 pm


Afriyie, Adam
Alexander, Danny
Ancram, rh Mr. Michael
Arbuthnot, rh Mr. James
Atkinson, Mr. Peter
Bacon, Mr. Richard
Baldry, Tony
Barker, Gregory
Barrett, John
Beith, rh Mr. Alan
Bellingham, Mr. Henry
Beresford, Sir Paul
Bone, Mr. Peter
Boswell, Mr. Tim
Brady, Mr. Graham
Brake, Tom
Brazier, Mr. Julian
Breed, Mr. Colin
Brokenshire, James
Brooke, Annette
Browne, Mr. Jeremy
Browning, Angela
Burns, Mr. Simon
Burrowes, Mr. David
Burt, Alistair
Burt, Lorely
Carmichael, Mr. Alistair
Carswell, Mr. Douglas
Cash, Mr. William
Chope, Mr. Christopher
Clappison, Mr. James
Clark, Greg
Clarke, rh Mr. Kenneth
Clifton-Brown, Mr. Geoffrey
Cormack, Sir Patrick
Cox, Mr. Geoffrey
Davey, Mr. Edward
Davies, David T.C. (Monmouth)
Davies, Philip
Davis, rh David (Haltemprice and Howden)
Djanogly, Mr. Jonathan
Dorries, Mrs. Nadine
Duddridge, James
Duncan, Alan
Duncan Smith, rh Mr. Iain
Dunne, Mr. Philip
Ellwood, Mr. Tobias
Evennett, Mr. David
Fabricant, Michael
Fallon, Mr. Michael
Farron, Tim
Featherstone, Lynne
Field, Mr. Mark
Foster, Mr. Don
Fox, Dr. Liam
Francois, Mr. Mark
Gale, Mr. Roger
Garnier, Mr. Edward
Gauke, Mr. David
George, Andrew
Gibb, Mr. Nick
Gidley, Sandra
Gillan, Mrs. Cheryl
Goldsworthy, Julia
Goodman, Mr. Paul
Goodwill, Mr. Robert
Gray, Mr. James
Grayling, Chris
Green, Damian
Greening, Justine
Greenway, Mr. John
Grieve, Mr. Dominic
Gummer, rh Mr. John
Hague, rh Mr. William
Hammond, Mr. Philip
Hammond, Stephen
Hands, Mr. Greg
Harper, Mr. Mark
Harris, Dr. Evan
Harvey, Nick
Hayes, Mr. John
Heath, Mr. David
Hemming, John
Hendry, Charles
Herbert, Nick
Hoban, Mr. Mark
Hollobone, Mr. Philip
Holloway, Mr. Adam
Horam, Mr. John
Howard, rh Mr. Michael
Howarth, David
Howarth, Mr. Gerald
Hughes, Simon
Hunt, Mr. Jeremy
Hunter, Mark
Jack, rh Mr. Michael
Jackson, Mr. Stewart
Jenkin, Mr. Bernard
Kawczynski, Daniel
Key, Robert
Kirkbride, Miss Julie
Knight, rh Mr. Greg
Kramer, Susan
Laing, Mrs. Eleanor
Lamb, Norman
Lancaster, Mr. Mark
Lansley, Mr. Andrew
Laws, Mr. David
Leech, Mr. John
Leigh, Mr. Edward
Letwin, rh Mr. Oliver
Lewis, Dr. Julian
Liddell-Grainger, Mr. Ian
Lidington, Mr. David
Llwyd, Mr. Elfyn
Loughton, Tim
Mackay, rh Mr. Andrew
Maclean, rh David
Main, Anne
Maples, Mr. John
Maude, rh Mr. Francis
May, rh Mrs. Theresa
McIntosh, Miss Anne
McLoughlin, rh Mr. Patrick
Mercer, Patrick
Miller, Mrs. Maria
Milton, Anne
Mitchell, Mr. Andrew
Moore, Mr. Michael
Moss, Mr. Malcolm
Murrison, Dr. Andrew
Neill, Robert
Newmark, Mr. Brooks
O'Brien, Mr. Stephen
Ottaway, Richard
Paterson, Mr. Owen

Penning, Mike
Penrose, John
Pickles, Mr. Eric
Price, Adam
Prisk, Mr. Mark
Pritchard, Mark
Pugh, Dr. John
Randall, Mr. John
Rennie, Willie
Robathan, Mr. Andrew
Robertson, Hugh
Robertson, Mr. Laurence
Russell, Bob
Sanders, Mr. Adrian
Scott, Mr. Lee
Selous, Andrew
Shapps, Grant
Shepherd, Mr. Richard
Simmonds, Mark
Simpson, Mr. Keith
Soames, Mr. Nicholas
Spicer, Sir Michael
Spink, Bob
Spring, Mr. Richard
Streeter, Mr. Gary
Stunell, Andrew
Swayne, Mr. Desmond
Swinson, Jo
Swire, Mr. Hugo
Syms, Mr. Robert
Taylor, Dr. Richard
Teather, Sarah
Thurso, John
Tredinnick, David
Turner, Mr. Andrew
Vaizey, Mr. Edward
Vara, Mr. Shailesh
Walker, Mr. Charles
Wallace, Mr. Ben
Waterson, Mr. Nigel
Watkinson, Angela
Webb, Steve
Whittingdale, Mr. John
Wiggin, Bill
Willetts, Mr. David
Williams, Mr. Roger
Williams, Stephen
Wilson, Mr. Rob
Wright, Jeremy
Young, rh Sir George
Tellers for the Ayes:

Mr. John Baron and
Mr. Nick Hurd

Abbott, Ms Diane
Ainger, Nick
Ainsworth, rh Mr. Bob
Anderson, Mr. David
Anderson, Janet
Armstrong, rh Hilary
Atkins, Charlotte
Austin, Mr. Ian
Austin, John
Baird, Vera
Balls, rh Ed
Barlow, Ms Celia
Barron, rh Mr. Kevin
Battle, rh John
Bell, Sir Stuart
Benn, rh Hilary
Benton, Mr. Joe
Betts, Mr. Clive
Blackman, Liz
Blears, rh Hazel
Blizzard, Mr. Bob
Blunkett, rh Mr. David
Borrow, Mr. David S.
Bradshaw, Mr. Ben
Brennan, Kevin
Brown, Lyn
Brown, rh Mr. Nicholas
Brown, Mr. Russell
Browne, rh Des
Burden, Richard
Burnham, rh Andy
Caborn, rh Mr. Richard
Cairns, David
Campbell, Mr. Alan
Campbell, Mr. Ronnie
Caton, Mr. Martin
Cawsey, Mr. Ian
Challen, Colin
Chapman, Ben
Chaytor, Mr. David
Clark, Ms Katy
Clarke, rh Mr. Charles
Clarke, rh Mr. Tom
Clelland, Mr. David
Clwyd, rh Ann
Coaker, Mr. Vernon
Coffey, Ann
Cooper, Rosie
Corbyn, Jeremy
Cousins, Jim
Cruddas, Jon
Cryer, Mrs. Ann
Cummings, John
Cunningham, Mr. Jim
Cunningham, Tony
Curtis-Thomas, Mrs. Claire
Darling, rh Mr. Alistair
David, Mr. Wayne
Davidson, Mr. Ian
Davies, Mr. Dai
Davies, Mr. Quentin
Dean, Mrs. Janet
Denham, rh Mr. John
Devine, Mr. Jim
Dhanda, Mr. Parmjit
Dismore, Mr. Andrew
Dobbin, Jim
Donohoe, Mr. Brian H.
Dowd, Jim
Drew, Mr. David
Eagle, Angela
Eagle, Maria
Efford, Clive
Ellman, Mrs. Louise
Etherington, Bill
Field, rh Mr. Frank
Fisher, Mark
Flello, Mr. Robert
Flint, rh Caroline
Follett, Barbara
Foster, Mr. Michael (Worcester)
Francis, Dr. Hywel
Gapes, Mike

Gibson, Dr. Ian
Gilroy, Linda
Goodman, Helen
Griffith, Nia
Griffiths, Nigel
Grogan, Mr. John
Gwynne, Andrew
Hall, Mr. Mike
Hamilton, Mr. David
Hamilton, Mr. Fabian
Hanson, rh Mr. David
Harman, rh Ms Harriet
Harris, Mr. Tom
Havard, Mr. Dai
Healey, John
Henderson, Mr. Doug
Hepburn, Mr. Stephen
Heppell, Mr. John
Hesford, Stephen
Heyes, David
Hill, rh Keith
Hillier, Meg
Hodge, rh Margaret
Hodgson, Mrs. Sharon
Hoey, Kate
Hoon, rh Mr. Geoffrey
Hope, Phil
Hopkins, Kelvin
Howarth, rh Mr. George
Howells, Dr. Kim
Hoyle, Mr. Lindsay
Hughes, rh Beverley
Illsley, Mr. Eric
Irranca-Davies, Huw
James, Mrs. Siân C.
Jenkins, Mr. Brian
Johnson, rh Alan
Johnson, Ms Diana R.
Jones, Helen
Jones, Mr. Kevan
Jowell, rh Tessa
Kaufman, rh Sir Gerald
Keeble, Ms Sally
Keeley, Barbara
Keen, Alan
Keen, Ann
Kelly, rh Ruth
Kemp, Mr. Fraser
Kennedy, rh Jane
Khan, Mr. Sadiq
Kidney, Mr. David
Kilfoyle, Mr. Peter
Knight, Jim
Kumar, Dr. Ashok
Ladyman, Dr. Stephen
Laxton, Mr. Bob
Lazarowicz, Mark
Lepper, David
Lewis, Mr. Ivan
Linton, Martin
Lloyd, Tony
Love, Mr. Andrew
Lucas, Ian
Mackinlay, Andrew
Mactaggart, Fiona
Mahmood, Mr. Khalid
Mann, John
Marris, Rob
Marsden, Mr. Gordon
Marshall, Mr. David
Marshall-Andrews, Mr. Robert
Martlew, Mr. Eric
McAvoy, rh Mr. Thomas
McCabe, Steve
McCarthy, Kerry
McCarthy-Fry, Sarah
McCartney, rh Mr. Ian
McFadden, Mr. Pat
McFall, rh John
McGovern, Mr. Jim
McGuire, Mrs. Anne
McIsaac, Shona
McKechin, Ann
McKenna, Rosemary
McNulty, rh Mr. Tony
Meacher, rh Mr. Michael
Meale, Mr. Alan
Michael, rh Alun
Miliband, rh Edward
Miller, Andrew
Mitchell, Mr. Austin
Moffat, Anne
Moffatt, Laura
Mole, Chris
Moon, Mrs. Madeleine
Morden, Jessica
Morgan, Julie
Mullin, Mr. Chris
Munn, Meg
Murphy, Mr. Denis
Murphy, Mr. Jim
Murphy, rh Mr. Paul
Naysmith, Dr. Doug
Norris, Dan
O'Brien, Mr. Mike
O'Hara, Mr. Edward
Olner, Mr. Bill
Osborne, Sandra
Owen, Albert
Palmer, Dr. Nick
Pearson, Ian
Plaskitt, Mr. James
Pound, Stephen
Prentice, Bridget
Prentice, Mr. Gordon
Primarolo, rh Dawn
Prosser, Gwyn
Purchase, Mr. Ken
Purnell, rh James
Rammell, Bill
Raynsford, rh Mr. Nick
Reed, Mr. Andy
Reed, Mr. Jamie
Reid, rh John
Riordan, Mrs. Linda
Robertson, John
Robinson, Mr. Geoffrey
Ruane, Chris
Ruddock, Joan
Russell, Christine
Ryan, rh Joan
Salter, Martin
Sarwar, Mr. Mohammad
Seabeck, Alison
Shaw, Jonathan
Sheerman, Mr. Barry
Sheridan, Jim
Simon, Mr. Siôn
Skinner, Mr. Dennis
Slaughter, Mr. Andy
Smith, rh Mr. Andrew
Smith, Ms Angela C. (Sheffield, Hillsborough)
Smith, Angela E. (Basildon)

Smith, Geraldine
Snelgrove, Anne
Soulsby, Sir Peter
Southworth, Helen
Spellar, rh Mr. John
Starkey, Dr. Phyllis
Strang, rh Dr. Gavin
Straw, rh Mr. Jack
Stuart, Ms Gisela
Sutcliffe, Mr. Gerry
Taylor, Ms Dari
Taylor, David
Timms, rh Mr. Stephen
Tipping, Paddy
Todd, Mr. Mark
Trickett, Jon
Truswell, Mr. Paul
Turner, Dr. Desmond
Turner, Mr. Neil
Twigg, Derek
Vaz, rh Keith
Vis, Dr. Rudi
Walley, Joan
Waltho, Lynda
Watson, Mr. Tom
Watts, Mr. Dave
Whitehead, Dr. Alan
Wicks, Malcolm
Williams, rh Mr. Alan
Williams, Mrs. Betty
Wills, Mr. Michael
Wilson, Phil
Winnick, Mr. David
Winterton, rh Ms Rosie
Woolas, Mr. Phil
Wright, David
Wright, Mr. Iain
Tellers for the Noes:

Mr. Frank Roy and
Siobhain McDonagh
Question accordingly negatived.
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Clause 2

The Commission’s functions

6.45 pm

Mr. Bradshaw: I beg to move amendment No. 62, page 2, line 10, after ‘by’, insert ‘or on behalf of’.

Mr. Deputy Speaker (Sir Alan Haselhurst): With this it will be convenient to discuss the following: Government amendments Nos. 143 and 63 to 65.

Amendment No. 142, in page 28, line 26, clause 57, at end insert—

‘(5) The Secretary of State may, after consulting the Commission, by regulations make provision specifying conditions which would result in additional inspections for the purposes of the Commission’s functions under Chapter 2.’.

Government amendments Nos. 66 to 74.

Mr. Bradshaw: Amendments Nos. 62 to 64 and 143 are Government amendments, so I shall speak to them first. Amendments Nos. 62 and 65 are significant and will be of particular interest to the House.

On amendment No. 62, clause 2 ensures that the commission must have regard in everything it does to the public’s views on the services that fall within its remit, and to their levels of satisfaction with those services. The clause received a great deal of attention when the Bill was considered in Committee. User and carer involvement in the commission’s work was also a recurring theme, and hon. Members from both main Opposition parties tabled amendments on that issue.

As I have made clear on a number of occasions, the Government believe that involving and listening to users, patients, their carers and the public will be a central responsibility for the new commission. The Bill already requires the commission to appoint an advisory committee, and we will expect the commission actively to involve patients and service users as well as others with an interest, such as service providers and commissioners.

There will be a wide range of bodies with an interest in a particular issue or representing particular groups,
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and we want to ensure that the commission hears their views. For that reason, Government amendment No. 62 proposes to make it explicit that a duty to have regard to the views of the public includes views expressed by representative bodies on behalf of members of the public. That requires the commission to engage with those acting on behalf of members of the public; that might include local involvement networks, charities or other representative groups. I hope that hon. Members will recognise that the proposed measures are a valuable addition to the Bill that will address their concerns and indeed go further, and I hope that they can accept the amendment.

Amendments Nos. 63, 64, 66, 67 and 143 are minor technical amendments designed to ensure consistency in drafting with the Care Standards Act 2000, which will continue to apply to children’s services and services in Wales. Amendment No. 65 is another significant amendment. When we considered the Bill in Committee, the hon. Member for Romsey (Sandra Gidley) tabled an amendment to oblige the commission to publish its inspection reports. I said that I would be happy to consider the matter, and amendment No. 65 is our response to that commitment.

Clause 57 requires the commission to produce a report when it undertakes an inspection and to send a copy to the provider or manager in question. As it stands, the clause allows the commission to choose whether to publish the report. As I said in Committee, there is no explicit duty on the current commission to publish reports either, although it normally makes them available online. However, I made it clear that I agree absolutely that the public should have access to the commission’s inspection findings. Having had the opportunity to review the drafting, I am happy to introduce amendment No. 65, which will oblige the commission to publish its inspection reports. I trust that hon. Members will feel able to accept the amendment.

Amendment No. 68 is a consequential amendment that relates to section 134(6) of the Mental Health Act 1983. It will update a reference to section 121 of that Act. It is necessary because the relevant part of section 121 will be replaced, through schedule 3 to the Bill, by proposed new clause 134A. Amendments Nos. 69 to 74 are minor consequential amendments, necessitated by the Bill, to the list in schedule 5.

I turn to amendment No. 142, the only Opposition amendment in the group. It seeks to allow the Secretary of State to specify in regulations specific circumstances in which the Care Quality Commission would be required to carry out additional inspections; such regulations could be made only after consultation with the commission itself. As I said in Committee, I understand the intention behind the amendment—that is, to allow an ability to set specific triggers for the commission to carry out additional inspections. However, clause 57 already allows regulations to prescribe important aspects of inspection if necessary; there is no need to be more prescriptive.

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