Clause
15
Applications
by registered
persons
Mr.
O'Brien:
I beg to move amendment No. 12, in
clause 15, page 7, line 6, at
end insert—
‘(1A) Except in
case A or B, a person taking action under subsection (1) is entitled to
financial compensation.
(1B)
the Secretary of State shall by regulations establish the amount of
compensation to be granted under subsection
(1A).’.
We
are now dealing with applications by registered persons. The amendment
would enable the registered person to claim back part of the
registration fee if he or she were not remaining registered for the
duration of the registration period. As drafted, the registered person
forfeits any such money if he is advised to cancel his registration. If
that is the aim of the Bill, it seems a little unfair. It could be,
perhaps at the outside edge, a perverse incentive and if we, as
legislators, are to make sure that we keep our eye always on the
principle of fairness, it could be something of an asymmetric approach.
I hope that the Minister will either give me a satisfactory reassurance
or be willing to reconsider the possibility of being able to claim back
at least part of the registration fee, when the registered person does
not remain registered for the duration of the registered
period.
Mr.
Bradshaw:
I agree that it is important that providers are
treated fairly in the process. My understanding of the effect of the
proposal is that when the Care Quality Commission takes normal action,
registered persons have the right to make representations to the
commission and if they are not satisfied they have an independent right
of appeal to a tribunal. In that case, the action would not take effect
until after an appeal was heard, so there should be no material effect
on the person or the provider, and therefore no need for
compensation.
If the CQC
takes urgent action, which we discussed earlier, the action would bite
straight away to protect patients and service users. In those cases, if
the commission had acted improperly there may be a case for
compensation, as businesses could have been affected. However, the
first priorities of the commission are its duties to patient and
service safety and we expect it to carry out those responsibilities
extremely
carefully.
Mr.
O'Brien:
That was relatively reassuring. We will study the
issue of fairness as we progress through the Bill. On the basis that
anything that will help to improve the sense of equilibrium and
fairness is welcomed by hon. Members on both sides of the Committee, I
beg to ask leave to withdraw the
amendment.
Amendment,
by leave,
withdrawn.
Clause
15 ordered to stand part of the
Bill.
Clause
16
Regulation
of regulated
activities
Greg
Mulholland (Leeds, North-West) (LD): I beg to move
amendment No. 151, in clause 16, page 7, line 44, at end
insert—
‘( ) Make provision
in relation to nutritional standards in relation to regulated
activities.’.
The
Chairman:
With this it will be convenient to discuss
amendment
No. 165, in
clause 16, page 8, line 31, at
end insert—
‘( ) Regulations
made under this section may make provision for the prevention and
management of malnutrition and may include such provision as the
Secretary of State considers appropriate for the purpose of
safeguarding individuals (whether receiving health or social care or
otherwise) from the risk, or any increased risk, of
malnutrition.’.
Greg
Mulholland:
We now come to the vital subject of nutrition,
which remains a huge issue in hospitals and care homes. The latest
figures from the annual survey of the British Association for
Parenteral and Enteral Nutrition, conducted in September 2007, state
that 28 per cent. of people in hospitals and care homes are at risk of
malnutrition. That is more than one in four people, which we cannot
accept, especially as the figures show big increases with
age.
The focus in the
last 18 months to two years has been on the need for better nutrition
in schools. The Government have taken that point on board and are doing
something to address it, but the same focus is needed on nutrition in
care homes and hospitals.
My hon. Friend the Member for
Sutton and Cheam (Mr. Burstow) introduced a very good
ten-minute Bill on nutrition in care homes two years ago and put the
case strongly, but since then, as the CSCI figures for 2006-07 show, 23
per cent. of people in care homes that provide nursing and 21 per cent.
in other care homes were in places that failed to meet the minimum
nutritional standards.
We are not talking about
meeting an adequate level of nutrition; the minimum nutrition standard
says little about what sort of nutrition people in care homes should
have, which is why it is scarcely more than a piece of paper. More than
one in five people in care homes today still do not receive the minimum
nutrition that the Government laid down, which is a matter of great
concern. In October, the Government published the nutrition action plan
and although I shall be interested to hear further details about it,
things do not appear to be getting much better.
People in hospitals are still
at risk of malnutrition, which in Britain today is simply unacceptable.
The Age Concern report, “Hungry to be Heard”, published
in 2006, said that six in 10 older people in hospital are at risk of
becoming malnourished, or of their condition becoming worse. As we
know, age and the conditions associated with age are a huge problem,
meaning that this group remains very significant, though there are of
course other vulnerable people, including the mentally ill and
vulnerable children.
There is a huge associated
cost, as the Government are well aware. BAPEN estimated in 2005 that it
costs the taxpayer £2.6 billion to deal with the malnutrition
caused in care homes alone. Surely the Bill is an opportunity to
address some of the issues in terms of frameworks, so it makes sense to
have nutrition specifically mentioned in the measure, and in terms of
amendment No. 165, it makes absolute sense. We have talked about
making
“provision in
relation to nutritional standards in relation to regulated
activities”,
which is important. Amendment No. 165 goes
on to talk about
“provision for the prevention and
management of malnutrition”.
No doubt the hon. Member
for Eddisbury will go into more detail about that. We would be minded
to support that proposal, and I would like to know his thoughts on
amendment No. 151. The Minister acknowledges that more needs to be done
to address the issue of inadequate nutrition and the possibility of
malnutrition both in care homes and in hospitals. If this is not the
place to do something about it, what is, and when will it
happen?
Mr.
O'Brien:
I rise in support of the amendment that has just
been moved. As the hon. Gentleman rightly said, amendment No. 165 moves
beyond simply making provision; it also looks at nutritional standards
and seeks to make
“provision for the prevention and
management of malnutrition and may include such provision as the
Secretary of State considers appropriate for the purpose of
safeguarding individuals (whether receiving health or social care or
otherwise) from the risk, or any increased risk, of
malnutrition”.
In our
combined amendments, we seek to impose action on malnutrition on the
CQC. Our amendment is drafted in the same terms as subsection (5) on
health care acquired infections. I hope the amendment will commend
itself strongly to the Minister on that basis, as there is no greater
flattery than to be copied, which is precisely what I have
done.
In 2006-07,
139,127 patients were discharged from hospital in a state of
malnourishment—an 84 per cent. increase from the 1997-98 total
of just 75,431 patients. Those are Government figures. In 2006-07,
130,594 patients were admitted to hospital in a state of
malnourishment, an 85 per cent. increase on the 1997-98 total of
70,658. The Government had previously admitted to slightly more than a
mere 2,000 patients being discharged from hospital in a state of
malnourishment. Last year, the nutritional state of at least 8,500
patients worsened while they were in hospital. In the Minister’s
own trust, the Royal Devon and Exeter NHS Foundation Trust, 782
patients were admitted with malnutrition, nutritional anaemia or other
nutritional deficiency, and 850 were discharged in such a state. That
is where deep concern about malnutrition and nutritional standards
arises, because some patients are going home or back to their care
setting worse off than when they entered hospital, in terms of
malnutrition or associated
deficiencies.
6.45
pm
It is estimated
that MRSA affected about 6,000 people in 2006-07. C. difficile has
affected about 56,000 people, according to the Government’s
figures in “Clean, safe care: Reducing infections and saving
lives”, which was published on 8 January this year. I have given
figures on malnutrition in an effort to impress on the Government why
the amendment is of the most vital concern. It cannot have escaped the
Minister’s notice that the figures that I recently put into the
public domain have struck a serious chord not only at a national level,
but throughout all the regions and local areas. Many hon. Members have
read the figures
and taken up such issues with the chief executive of their hospital
trust. That is the right action to have taken. We are faced with an
absolute scandal. A
study undertaken by the National Patient Safety Agency in the summer of
2007 found that some of the greatest barriers to NHS staff undertaking
nutritional screening were the lack of weighing scales—we shall
return to that point—and the lack of time and training to allow
nursing staff to support nutrition. The Healthcare Commission is meant
to inspect whether nutritional needs are being met, but the 34 trusts
discharging the highest number of malnourished patients actually met
the Healthcare Commission’s quality requirements, so the
existing system is clearly not working. I hope that the Minister agrees
that a stronger legislative incentive is
needed.
As we are
dealing with the complementarity of the two amendments, I wish to flag
up Age Concern’s “Hungry to be Heard” campaign. We
are talking about not only malnutrition, but human rights. This is of
the deepest concern to members of the Committee, as has been ably
highlighted and articulated by the hon. Member for Luton, North.
“The Human Rights of People in Healthcare”, the recent
report by the Joint Committee on Human Rights, noted that malnutrition
and dehydration in care settings breached articles 2, 3 and 8 of the
European convention on human rights. It
recommended
“that the
forthcoming merged inspectorate for health, social care and mental
health adopts a human rights
framework”—
that
is the precise issue that the hon. Member for Luton, North has sought
to advance—
“with
the intention that the framework informs all of the
inspectorate’s work and so makes it more effective in fulfilling
its statutory
duties”.
Our
amendment would make sure that the issue was tackled in care homes as
well as by health care providers, given the wide remit of the CQC. I
therefore very much hope that the Minister will recognise the power of
my argument. He clearly intends the Bill to address health
care-acquired infections, but why is he not equally prepared for the
Bill to cover malnutrition? Given that the statistics are based
entirely on the Government’s figures and show that they must be
judged to be failing miserably, surely the amendment would be one of
the best and most urgent ways of combating malnutrition by giving it
legislative power and
effect.
I hope that
the Minister will recognise that we drafted the amendment in the spirit
of improving the health and safety of patients. We made sure that it
contained constructive proposals that would be worthy of his
consideration and
support.
Angela
Browning:
I support my hon. Friend on one of the most
important subject areas of the Bill. Amendment No. 165 and amendment
No. 151, which was tabled by the Liberal Democrats, seek to address the
problem. The Minister now has the opportunity to put into the Bill the
words
“prevention and
management of malnutrition”,
which are so
important.
I
previously raised the subject in the Committee that considered the Bill
that became the Mental Capacity Act 2005. I received a full broadside
from the Royal
College of Nursing for mentioning it, and it sent me
literature showing how individual hospitals were dealing with the
problem. That is all very good, but we are talking about the situation
at the heart of care. Addressing the problem of malnutrition should be
mainstreamed throughout every hospital and care home. It is an
indictment of our position today that we are even suggesting in 2008
that such a subject needs to be put into a Bill because there is still
a problem after many
years. I
will not go into the details of my experience, but I have reached an
age at which I have had to care for several elderly relatives,
including single people with no spouse, my mother, who died four years
ago, and my step-father. My personal experience involving one
family in hospitals around the home counties was that I felt that I had
to organise teams of family members to go
in.
Kelvin
Hopkins (Luton, North) (Lab): The hon. Lady is talking
about someone in care who is visited by relatives and friends. There
should be much more concern about those who have no one
visiting—those who are isolated, and perhaps without mental
capacity, who would need some kind of human rights basis to ensure that
they were cared for properly.
Angela
Browning:
The hon. Gentleman is absolutely right. When I
was visiting my mother in hospital, the lady in the bed opposite was in
just such a position. She had a niece who was able to come in once a
week. Fortunately, she happened to come in one afternoon just as her
aunt had slipped into a diabetic coma. It was really unbelievable that
it needed a relative to come in by chance to reverse that.
I want to
flag up why management is important. I mentioned in an earlier debate
that people in the public sector sometimes start working in silos. That
is no criticism of individuals. I worked in the health
service—in a hospital—in the 1970s. However, there are
real problems, especially on trauma wards to which elderly people are
admitted. A lot of the focus is on getting people to theatre and caring
for people post-operatively, but there are people on the ward with
fractured hips and so on. We should consider the day-to-day management
of those people as individuals, rather than just the operation that
they have undergone. With elderly people, the question of malnutrition
is often not just that they have not eaten sufficient food or
sufficiently nutritionally balanced meals. As people get older, their
bodies sometimes do not process certain elements as well as they did
when they were younger. There are conditions associated with elderly
people in hospital, such as certain behaviours and vitamin-specific
deficiencies. It is not always the case that the patient has not eaten
sufficient foods with a particular vitamin content. Sometimes the body
is getting old and not processing that well enough, which is something
that can be addressed.
When considering malnutrition,
the need for management is important. When one goes on to a ward or
into a nursing or residential home, one needs to know who is in charge.
When I go on to a hospital ward to visit a relative, I want to know who
is in charge because I want to know who is taking responsibility for
the overall care of that relative.
Angela
Browning:
I will give way in a moment. I will not bore the
Committee, because I have told the House enough times, but I remember
when my step-father was in the last few weeks of his life and in
hospital with cancer. He had macular degeneration and his eyesight was
very poor. I once went in to see him when they brought the food round
and he was having sandwiches. I said to him, “Why are you having
sandwiches; what else was there?” Because his eyesight was poor
and he knew that he could not cope with a knife and fork and a plate of
hot food on his own, he had opted for sandwiches for three days because
he felt that he could eat those tidily on his own, without any support.
It was very sad. As hon. Members can imagine, I went to find the person
who was in charge to have a little word about
that.
Mr.
O'Brien:
I thought I would intervene before we got to bit
about who is in charge because I was beginning to quake. If this issue
is not dealt with in the Bill, current good practice will be lost. Such
practice includes serving food in hospitals on red trays to those who
are vulnerable to bring the matter to nurses’ attention. Nurses
often get it in the neck on this issue, but I do not think that it is
at all their fault—often they are not given the chance. They
have to deal with data inputting and all sorts of things that take them
away from that hand-holding bedside care, which is after all what they
want to do.
My
intervention also gives me the opportunity to register with the Chair
that if a Division is called on amendment No. 151, I wish to reserve
the position to have amendment No. 165 taken
separately.
Angela
Browning:
I am grateful to my hon. Friend. He is quite
right to flag up the fact that there is good practice. I must pay
tribute to Wokingham hospital, which looked after my mother during the
last few weeks of her life. The nutritional care there was a classic
example of nursing practice at its very best. She was weighed
regularly, and as she became unable to take solids, her diet was
changed to mashed food and puree. Not only that, the nurses chatted to
her and found out what she needed, and there was somebody in charge.
That was very
important.
I
will conclude by saying to the Minister that yes, there is good
practice, but—I return to my first remarks—the issue
should not be whether someone is lucky enough to be in a hospital in
which there is good practice. Good practice should be the norm
everywhere.
I have
one final point, in which I have an interest because I am now a
pensioner. People are allowed to say, “I can’t believe
that.” I notice no one did. This returns us to a point raised by
the hon. Member for Luton, North, and Age Concern will bear this out.
People are living longer and there are many women who still live longer
than men. In the coming decade or 20 years, more and more ladies will
be single or widowed with no immediate family to look after them in
hospital. The problem is not unique to women, but the demographics show
that that is often the situation.
Kelvin
Hopkins:
One other point is that as society moves on,
people and families become more mobile and no longer live in tightly
knit communities. It is sometimes more difficult for people to visit
than it might have been in the past.
Angela
Browning:
That is right, and sometimes people are in
hospital or care for many years. Things can be difficult for families
for all sorts of reasons. For example, they might live abroad. I think
that we have talked about the subject in the House for long enough.
Something must be done now, and the Bill offers a unique opportunity
for us to get that really good practice everywhere. People will
otherwise feel afraid—and I mean afraid—to go into
hospital. If I were frail, as some of my relatives were, and there was
no bossy niece or daughter to come and find out who was in charge, I
would be afraid. That is an indictment on the country and the services
that are provided. We can do something about that in the
Bill.
Mr.
Bradshaw:
I think that I made it clear during the
evidence-giving session that I share the strong views of members of the
Committee on the importance of good food and nutrition in hospitals.
Given the amount of time that we have rightly dedicated to discussing
the matter, it is fair to put on record what provision there is at the
moment. There is often a degree of ignorance about this—not
among hon. Members, but out
there.
One of the core
standards on which the Healthcare Commission monitors, lists and ranks
hospitals is food. Core standard 15a
states:
“Where
food is provided, healthcare organisations have systems in place to
ensure that patients are provided with a choice and that it is prepared
safely and provides a balanced
diet”,
while 15b
says:
“Patients’
individual nutritional, personal and clinical dietary requirements are
met, including any necessary help with feeding and access to food 24
hours a day.”
For
assessment against core standard 15, the Healthcare Commission will use
the following criteria, which were signed off by the Secretary of State
in 2007-08. Patients should be offered
“a choice of food in line with the
requirements of a balanced diet...reflecting the needs and
preferences and rights, (including faith and cultural needs), of its
server-user population.”
The preparation,
distribution, handling and serving of food is carried out in accordance
with food safety legislation and national guidance including the Food
Safety Act 1990, the Food Safety (General Food Hygiene) Regulations
1995 and EC regulation
852/2004.
Core
standard 15b requires patients to have
“access to food and drink 24 hours
a day”.
The criterion
for assessment
is:
“The
nutritional, personal and clinical dietary requirements of individual
patients are assessed and met, including the right to have religious
dietary requirements met”,
and that patients requiring assistance
with eating and drinking are provided with appropriate
support.
7
pm
Those
are the core standards, and I absolutely accept that, as the hon.
Member for Tiverton and Honiton said, performance is not always up to
those standards. If hon. Members care to be really nerdish, they can go
and look at the Healthcare Commission’s annual health check of
all the hospitals in the country, and examine the details. They could
compare and list every hospital’s performance in its food
provision, and whether it complies with those standards. What we must
do, as the hon. Lady rightly said, is to bring everyone’s
standards up to those of the best.
The hon.
Member for Leeds, North-West, who spoke on behalf of the Liberal
Democrats, highlighted the fact that in the autumn, the Under-Secretary
of State for Health, my hon. Friend the Member for Bury, South
(Mr. Lewis), who leads on social care, launched the national
action plan to address the issue of older people and nutrition. That
plan followed two nutrition summits in March and July last year, which
were attended by leading charities, clinicians, nutrition experts and
care home representatives. There was an acknowledgment that good food
is important, and that standards have risen. Patient environment action
team assessments showed an increase from only 17 per cent. of food
being good in 2002 to more than 34 per cent. of food being excellent in
2005-6. The results for 2006-07 showed a continued increase to 44 per
cent. being
excellent.
The
Healthcare Commission’s national in-patient survey shows that 53
per cent. of adults rated the food that they ate in hospital as good or
very good. The better hospital food programme was launched in 2001 to
introduce five key improvements: 24-hour service, NHS snack boxes,
additional snacks twice a day, a hot meal in the evening, and menus
including three dishes created by leading chefs. An awful lot is
already happening on the ground with food and nutrition, but I accept
the points made by hon. Members, and acknowledge that more can be
done.
In
December, we published our annual operating framework, which recognised
for the first time the importance of including regard for the patient
experience as one of the NHS’s five main priorities. If there is
one thing that comes up time and again in consultation with the public
on their experience as patients, apart from the question of how they
are treated by staff and receptionists, it is the quality of food and
the way in which it is delivered. I hope that by including that
important issue in the five main priorities that the Government have
given the health service, we will continue to see further
improvements.
Anne
Milton:
My hon. Friend the Member for Eddisbury referred
to best practice, and the Minister’s focus is the nutritional
value of the food that people are given to eat. The issue should not be
about best practice; it should be about standard practice. We have
talked about dignity and human rights, but the issue is about people
who cannot get food to their mouths, and leave hospital malnourished.
It is outstandingly awful and a poor reflection on management that more
is not being done. Nurses cannot always be blamed, because it is
question of the time available to them to meet patients’
needs.
Mr.
Bradshaw:
That is exactly why it is important to draw the
Committee’s attention—and I am sorry to have detained
Committee members by speaking at such length—to those core
standards. They are already in place and include any necessary help
with feeding. The hon. Lady is absolutely right: the issue is not just
about the quality of food, and whether it is organic or locally
produced, although such improvements are a good thing. During a visit
to west Cornwall, I witnessed a fantastic initiative to replace almost
all food—up to 85 per cent.—of the food served
in Cornish hospitals with local produce. That has increased the quality
of meals and patient satisfaction and reduced costs, and
the reduced number of food miles has reduced the impact on the
environment. Good things are happening, but the hon. Lady is absolutely
right that the issue is not just about
food.
As
the hon. Member for Tiverton and Honiton said, a patient could be
receiving the diet they need, but a problem such a failure to process
vitamins might need additional attention. That is exactly why we added
the new requirements to the core standards. To return to the impact of
the amendments, as I have said before, we are about to put the
requirements subject to registration under the Bill out to
consultation. I encourage hon. Members and outside bodies who have
argued strongly that nutrition, food, and the way in which they are
delivered, should be included in the core requirements, to continue to
do so, as they will be pushing at an open door. However, we should be
careful to strike a balance, as we do not want to tie the hands of a
new independent regulator in advance of setting it up. However, its
representatives attended the evidence session at which the subject was
discussed at some length last week, and I hope that they will read the
report of this Committee sitting and take note of the points that hon.
Members’ have made.
From the
conversations that I have had with Anna Walker, I know that she feels
extremely strongly about the matter. I think that I am right in saying
that the Healthcare Commission highlighted food as an important issue
in its press release and commentary on last year’s annual health
check. The issues have therefore been taken on board, and I hope that
the new regulator will do so, too. I have provided the Committee with
examples of the way in which key delegated powers will be used, not
just because I feel strongly about the topic but because we discussed
it at length in our evidence-taking sessions. They include a possible
registration requirement
in
“making sure people
get the nourishment they
need.”
The examples are
not final versions, and it will be necessary to consult on them. They
illustrate how registration would work in practice and demonstrate the
importance that I personally attach to the issue of food. I think that
the example helps to demonstrate that the Bill is sufficiently wide as
it stands to allow regulations of the kind that have been requested to
be made if required. On that basis, I ask the hon. Gentleman to
withdraw the amendment.
Greg
Mulholland:
That was a lengthy but useful and at times
passionate discussion of an important issue. Some notable points were
made, such as the hon. Member for Eddisbury’s observation that
although the number of people affected by health care-acquired
infections is an enormously important subject, that figure is far lower
than the number of people affected by malnutrition. That shows how
important the issue is. The hon. Member for Tiverton and
Honiton’s account of her personal and professional
experience—I am not implying anything about her age or stage of
life, but merely referring to the experience that she shared with the
Committee—added greatly to the debate. I am glad that the human
rights side of the debate was brought out, as the issue is central to
the human rights thread that I discussed on the first day of our
clause-by-clause consideration of the Bill. Some of us believe that
that thread should run more obviously through the Bill than it
does.
I accept what the Minister said
about the existing provisions and the Healthcare Commission’s
core standard 15. I do not think that anyone is suggesting that the
amendments would resolve the problem of insufficient nutritional
standards and malnutrition in health care and care homes. However, I
still believe that they are essential if we are to make such provision
part of the new regulatory framework. I am slightly concerned about the
fact that the Minister hoped that the regulatory framework would take
the matter on board. It must do so, and the framework should be set out
to ensure that it does
so.
I
acknowledge, too, the fact that the Minister has given us a little more
information about the national action plan. The challenge for
Government, which the Minister accepts, is to come up with a range of
measures to address the situation. We see whether that is the right
plan and whether it works. I do not believe that what the Minister said
changes the need for good nutrition, as well as the need to avoid
malnutrition, to be built into the new regulatory framework. That is
important, because nutrition is fundamental to the effectiveness of
health and social care. Poor nutrition undermines health, it costs the
taxpayer an awful lot of money, and it has an effect on patients,
service users and their families. I would have welcomed the Minister
saying that he would consider and discuss the matter
further.
Mr.
Bradshaw:
The hon. Gentleman implies that I hoped that
nutrition would be part of the regulatory framework. I expect that it
will, but it is not for me to pre-empt a decision by the House. We will
consult on the regulatory framework, and I doubt that we shall retreat
from the importance that is laid on nutrition in the current framework.
However, that is a decision for the House to make following the
consultation—it is not one for me to make in
Committee.
Greg
Mulholland:
I entirely accept what the Minister says, but
the Committee could make a decision today to cite nutrition and the
avoidance of malnutrition in the
Bill.
Mr.
O'Brien:
I can see where the hon. Gentleman is going. He
has the support of my party and myself, and I endorse what he is
saying. I accept that the Minister is sincere and thorough in what he
seeks to achieve, but I have already flagged up to the Chairman of the
Committee my hope that the question on amendment No. 165, which I
tabled with my hon. Friends, is put separately, and I hope that the
Minister might suddenly decide to accept it.
Importantly,
the Minister has not moved from his reliance on consultation. We must
therefore ask which is the cart and which is the horse: we have an
obligation to suggest that malnutrition is of the greatest importance,
alongside the other factors mentioned in clause 16(3). We must remember
that the Healthcare Commission states that 34 of the most malnourished
trust areas meet the current care standards. The system is clearly not
working, and new legislation is patently
necessary.
Greg
Mulholland:
I thank the hon. Gentleman for clarifying his
position and making his case. I fully accept the Minister’s
sincere commitment to dealing
with the problem, but as he has not indicated that there will be further
consideration of the question of whether nutrition should be mentioned
in the Bill, alas, we are in a fundamental disagreement. We, along with
the official Opposition, believe that the matter is too important, and
too central to the essential purpose of the Bill, to accept what the
Minister
says.
Mr.
Bradshaw:
The hon. Gentleman will accept that the safety
and quality of care is mentioned in the Bill and that, in most cases,
malnutrition jeopardises such care. It is important that I put that on
the record before he presses the amendment to a
Division—unnecessarily, in my
view.
Greg
Mulholland:
I hear what the Minister says, and I hope that
no more notes are passed to him before I finish my brief
contribution.
Mr.
O'Brien:
Following what the Minister has just said,
where is the consistency, given that hospital-acquired infections are
included in the Bill? We seek parity, because the question of nutrition
is of at least equal importance to that
problem.
Greg
Mulholland:
I think that the points have now been made,
and we have a fundamental disagreement. I shall therefore press the
amendment to
Division.
Question
put,
That the amendment be
made:—
The
Committee divided: Ayes 7, Noes
9.
Division
No.
3
]
Question
accordingly
negatived
.
7.15
pm
Mr.
O'Brien:
I beg to move amendment No. 167, in
clause 16, page 8, line 11, at
end insert—
‘(l) impose
requirements as to the need to reduce health inequalities and
discrimination on the basis of disability (as defined in Part 1 of the
Disability Discrimination Act
1995).’.
The
amendment can be dispatched pretty quickly. It would add a new
paragraph to subsection (3), making the reduction of health
inequalities part of the Care Quality Commission’s remit, and
ensuring that the commission would have to give due regard to the
Disability Discrimination Act 1995. I am relatively confident that our
approach on both those issues will find favour with Members on both
sides of the Committee.
Under a previous amendment, I
put on the record the latest Government figures on health inequalities
and discussed inequality gaps in circulatory disease mortality, infant
mortality and life expectancy. Those figures were obtained from
Government publications. Rather than take up the Committee’s
time going through those figures again, I pray them in aid of this
amendment.
I am sure
that all members of the Committee will recall that Anna Walker of the
Healthcare Commission commented during oral evidence
that:
“The
registration requirements explicitly say that they cannot bite on
public health issues, only on health care
issues.”——[Official Report, Health and Social
Care Public Bill Committee, 8 January 2008; c. 12,
Q13.]
That is also relevant to
clause 19.
I must
make an additional point about the amendment. It seems sensible that
the commission should have regard to the Disability Discrimination Act
in relation to its inspection of health care premises and in any
inspection it makes of health care assessments. That is also related to
a previous point. I hope that the Minister will take those points on
board.
Angela
Browning:
Colleagues and Members on both sides of the
House will have received a report from Mencap on this issue in recent
months. The report is particularly relevant to people with learning
disabilities who are admitted to hospital wards. Clearly, the
1995 Act is not being enforced in those circumstances. The inspection
process needs to be
strengthened.
Mr.
O'Brien:
I shall maintain strict confidentiality, but I
have a constituent in his 40s who is seriously affected by
Asperger’s syndrome. Recently, he has repeatedly been admitted
to the general ward in the local hospital, which has been something of
a challenge for him, for the staff at the hospital and for his
increasingly elderly parents. Having the rights and opportunities that
would give him protection equal to that of others who might avail
themselves of those services has proved extraordinarily challenging. My
hon. Friend makes an absolutely valid and cogent point.
Perhaps with those two
examples, the Minister will think that it is in the Government’s
interests to ensure that there is no such difficulty. I hope that
rather than rely on the more generic definitional and scope phraseology
that is characteristic of the Bill, he will find it appropriate to
consider health inequalities, which is clearly a difficult area, with a
particular focus on the Disability Discrimination
Act.
Greg
Mulholland:
In the interests of brevity, I shall make only
a few comments. I wish to put on record again the need for the Bill to
address the hugely important issue of the health inequalities that
result from disability, particularly certain forms of disability.
People who have learning difficulties or mental health conditions are
far more likely to contract a range of conditions, but such people are
unlikely to receive health checks.
The Minister is aware of the
issue and I know that he wants to tackle it. The amendment would be
useful because regulatory arrangements should encompass the need to
reduce health inequalities, as he would acknowledge. It is an important
issue and it would be
sensible to put the measure in the Bill. I look forward to what he has
to say on whether the matter can be addressed in the Bill or in other
ways.
Mr.
Bradshaw:
It is pleasing to hear that reducing health
inequalities and discrimination based on disability is a priority that
is shared by all hon. Members on both side of the Committee. The
Government were recently criticised for granting more time to the
independent body that sets the allocation formula for primary care
trusts because it wanted more time specifically to look at what more
could be done to reduce health inequalities. That did not go down well
in all quarters, but it illustrates that the Government’s
overriding priority is the reduction of some of the glaring health
inequalities.
The
amendment would include specific references to those two issues within
the scope of the registration requirements. As I have said repeatedly
this afternoon, those requirements will soon be subject to public
consultation. I encourage those who are interested in the matter to
respond to the consultation. However, we do not believe that we need to
specify those matters in the Bill. Let me give one example. It may not
be within the power or ability of a specific provider, depending on the
nature of the provider, to reduce health inequalities. However, if,
following the consultation, registration requirements on health
inequalities and the reduction of disability on the basis of
discrimination were identified as practical and appropriate, the clause
as drafted will enable us to cover that in regulations.
As I have already mentioned,
the new Care Quality Commission may also take action when providers do
not meet the requirements of any other legislation that it considers
relevant. That is in the Bill. Hence, if there are elements or
requirements under the Disability Discrimination Act 1995 that the
commission thinks are relevant and are being breached, they can be
included for registration purposes. The commission will have the power
to act if providers do not meet the requirements.
I understand and sympathise
with the motivations behind the amendment, but the Government consider
it unnecessary, because the Bill will enable regulations to be made
when appropriate, and for intervention to be made when the 1995 Act is
breached. I therefore ask the hon. Member for Eddisbury to withdraw the
amendment.
Mr.
O'Brien:
In the light of what the Minister said, it would
be disproportionate to press the amendment to a Division. The matter
might, however, be tabled for consideration on Report, and I dare say
that it will be a key point in another place if the Minister chooses
not to reflect our helpful discussion. I beg to ask leave to withdraw
the amendment.
Amendment, by leave,
withdrawn.
Kelvin
Hopkins:
I beg to move amendment No. 231, in
clause 16, page 8, line 11, at
end insert—
‘(l) impose
requirements on registered social care service providers to comply with
Codes of Practice issued by the General Social Care Council under
section 62(1)(b) of the Care Standards Act
2000.’.
The
Chairman:
With this it will be convenient to discuss
amendment
No. 232, in
clause 16, page 8, line 11, at
end insert—
‘(l) impose
requirements as to the registration of the social care
workforce.’.
Kelvin
Hopkins:
I shall be brief. I concede from the start that
this is a probing amendment and I shall not press it to a Division. It
is important, however, to give some kind of guidance to the new
commission—the new regulator—and ideally the Bill would
include the codes of practice established by the General Social Care
Council.
The council
was recently established by a measure enacted by the Labour Government,
so it is not out of date. I hope that the measure would involve a
simple carry-over and that my hon. Friend the Minister will ensure that
it happens, whether by inclusion on the face of the Bill or as a code
of practice issued by the
Commission.
Mr.
O'Brien:
I too shall be brief. I recognise that the
amendment is probing. It is helpful to the Committee that the hon.
Gentleman has sought to ensure that concerns encompassed by the
amendments are put on the record. The experience from the registration
of social workers and student social workers is that, without clear
compulsion, registration will happen slowly and inconsistently
throughout the sector. In the consultation on the arrangements for the
registration of domiciliary care workers, there was general agreement
that compulsion should be in place to ensure that registration takes
place in a timely fashion and to ensure a level playing field in the
delivery of social care services.
Having said
that, there is a further debate to be had about the registration of the
social care work force, most immediately about domiciliary care
workers, but also, as I flagged in relation to clause 5, about any
Government plans to regulate informal carers. That must be seen as a
complementary issue, riding parallel to the one raised in the
amendments. It is important that the matter is debated properly before
an amendment such as No. 232 is included in the Bill. The hon.
Gentleman is therefore right in his judgment that the amendments should
be considered probing, but they reflect important considerations, which
I hope the Minister will
consider.
Greg
Mulholland:
I rise to speak briefly to amendment No. 232,
which I tabled. First, let me say that we fully support amendment No.
231, which was tabled by the hon. Member for Luton, North. To some
extent, it is a tidying-up exercise and gives some of the clarity that
the Bill lacks about the codes of practice for social
care.
Amendment No.
232 is a probing amendment, but a beautifully simple one. It would
impose specific requirements on the registration of the social care
work force. The reason for tabling it is that this is an important
issue. As the Minister will acknowledge, the GSCC makes it absolutely
clear that it believes that social care providers registered with the
new CQC should employ only workers who are registered with it. We agree
with that and I would be interested to know the Minister’s views
on it.
As the hon.
Member for Eddisbury has said, without the necessary powers and the
monitoring of employer compliance, that requirement is probably not
worth the paper that it is written on. We must make this measure work
to ensure that people have confidence that all social care workers,
including students, who treat service users are properly registered. I
am sure that the Minister will agree with that. Is this not, therefore,
an opportunity to push towards that
position?
Mr.
Bradshaw:
Clause 16 is about allowing regulations to be
made that set the requirements that providers and managers of regulated
activities must comply with in order to provide or manage services.
Those will include crucial requirements that are needed to ensure that
services are of an appropriate quality and to secure the health, safety
and welfare of patients and service
users.
Amendment No
231 would make express provision for regulations to impose requirements
on providers of regulated activities to comply with the GSCC codes of
practice. The GSCC has issued these codes for social care workers and
social care employers, as required under section 62 of the Care
Standards Act 2000. They provide a clear guide for those who work in
social care settings about the standards of conduct that workers and
their employers should meet. The GSCC expects those registered with the
CSCI to comply with the codes of
practice.
7.30
pm
The CSCI
currently uses the codes of practice when inspecting care providers
against the national minimum standards. I agree with my hon. Friend the
Member for Luton, North that the system has worked well. In future, the
commission itself will set the criteria by which compliance is
assessed, and although we will be consulting on the registration
requirements shortly, as I have repeatedly said, we would expect the
new commission to continue to use the codes of practice in its
assessment of compliance with requirements in future. I therefore see
no reason for changing these arrangements when the new commission is
established.
Amendment
No. 232 would make express provision for regulation to make
requirements as to the registration of the social care work force. The
Care Quality Commission will not be responsible for the registration of
social care workers; that role is carried out by the social care work
force regulators, such as the General Social Care Council. Such a
provision would duplicate legislation under section 55 of the Care
Standards Act 2000, which gives regulatory powers to extend
registration of the social care work force. It is illogical to have
these powers resting with two
bodies.
As we
discussed earlier, the commission will register managers of certain
services where they have significant amounts of autonomy and where
there is little supervision. We would, of course, expect all providers
to employ appropriate staff to deliver the activities that they are
registered to provide. That is essential to ensure that the services
are safe and of acceptable quality. Clause 16 already states that
regulations may
“make
provision as to the persons who are fit to carry on or manage a
regulated activity”
and
“the
manner in which a regulated activity is carried
on”.
That will enable
requirements to be made about the appropriateness of social care
workers. The amendment is therefore unnecessary.
We will be consulting shortly
and I urge those with an interest to participate in this consultation.
In the light of that, I ask my hon. Friend the Member for Luton, North
to withdraw his
amendment.
Kelvin
Hopkins:
In the light of my hon. Friend’s
assurances, I am happy not to press the amendment to a vote. I beg to
ask leave to withdraw the
amendment.
Amendment,
by leave,
withdrawn.
Mr.
O'Brien:
I beg to move amendment No. 16, in
clause 16, page 8, line 21, at
end insert—
‘(5A) The
Commission shall be required to report annually to Parliament on the
action it has taken in respect of regulations made in accordance with
subsection
(5).’.
The
Chairman:
With this it will be convenient to discuss the
following amendments: No. 14, in
clause 16, page 8, line 22, leave
out from ‘means’ to end of line 31 and insert
‘such infections as the Secretary
of State shall by regulation
define’.
No.
15, in
clause 16, page 8, line 39, at
end add—
‘(10) In respect of
such cases as the Commission has taken action on the prevention and
control of health care associated infections, within the regulations
established under subsection (5), the Secretary of State shall be
required to make a written statement to
Parliament,’.
No.
25, in
clause 25, page 13, line 33, at
end insert—
‘(5A) The
Commission shall notify Parliament of any notices served due to
breaches in regulations made under section
16(5).
Mr.
O'Brien:
We arrive at the discussion on health care
associated and health care acquired infections. Of course, amendment
No. 25 would add new subsection (5A) to clause 25. The amendments are
intended to do no more than finesse the Government’s approach to
health care acquired infections and to make the Government more
accountable to Parliament, through the CQC, for their
performance.
There is
a debate to be had about why the Government saw fit to include
explicitly in the Bill health care acquired infections but not, for
example, malnutrition, as we have said. MRSA affected about 6,000
people in the last financial year and, according to the
Government’s own figures, clostridium difficile affected 56,000
people, as was cited in an earlier discussion. The Committee’s
fear will be that the clause is less about benefiting patients and more
about politics, both in general and specifically.
I would argue that the clause
is about keeping the Prime Minister’s back as he blunders
through health policy. For example, on Sunday 6 January, the Prime
Minister promised, on “The Andrew Marr
Show”:
“If
you go to hospital you will get screened by next year for MRSA or C.
difficile.”
That was
later reported by the BBC under the headline,
“Brown pledges superbug
screening: All patients entering NHS hospitals in England will be
screened for MRSA and clostridium
difficile.”
No one from
the Government sought to correct that story. However, two days later,
on 8 January, the Health Secretary’s infection control strategy,
“Clean, safe care: Reducing infections and saving lives”,
reported on clostridium
difficile:
“Screening
for colonised patients is inappropriate (most potential cases would not
be identified, and it requires a stool sample), and colonisation
without symptoms is not considered to increase risk of
transmission.”
The
Secretary of State for Health was admitting that the Prime Minister
was, on that occasion,
wrong.
The Government
have failed for years to isolate infected patients, which the evidence
says would work. Professor Pat Troop, chief executive of the Health
Protection Agency, said in 2004:
“The most effective way
of controlling the spread of both Staphylococcus aureus and MRSA in
hospitals is through early detection and appropriate isolation and
treatment.”
The
Government’s own best practice guidance from the Department of
Health states that
the
“current scientific
thinking recognises the evidence of many years’ experience that
the isolation of patients with suspected or proven infection is
effective in reducing
transmission”
of hospital
infections. The Department notes that
“Some countries have
been particularly successful in controlling MRSA. Notable is the
experience of the Netherlands. The Dutch strategy has been based on a
policy of ‘search and destroy’. This involves screening
patients for MRS A and isolating those found to be positive (colonised
or
infected)”.
It
is vital that we recognise that series of reheated promises. With this
group of amendments, the Committee has an opportunity to reinforce
through legislation the message that the Government must get this
right.
Anne
Milton:
Does my hon. Friend agree that nurses are terribly
constrained? Nurses tend to be on the front line and they get it in the
neck when things go wrong, so unless we give them the resources they
need to combat infection, such as the opportunity to isolate patients,
we will not make real
progress.
Mr.
O'Brien:
I am very grateful to my hon. Friend. Her
experience and practice in the profession gives her a particular
authority. She reinforces a clarion call from nurses to be allowed to
do what they know to be the right thing in order to give the best care
and protection to patients.
There has
been a series of reheated promises from 2003 to the present day,
including promises on the appropriate provision of single rooms and
isolation facilities for infected patients. The I gave all come from
press releases from the Department itself over the past five years, yet
there has been a significant failure to deliver. In the Bill, the
Committee has an obligation not to duck the issue, not to try to
pretend that it is not happening, not to be too sympathetic to the
Government and not to fail to embarrass the Government. The Government
happen to have been the people on watch during this failure, so they
must take it in the neck, and it is right that we hold their feet to
the fire. The amendments are an opportunity to do just that.
Back in 1998,
during the Labour party’s first year in power, isolation rooms
were turned into offices, and by 2003 there were very few trusts with
proper isolation facilities. I shall not take up the Committee’s
time by reeling off the statistics, but I would not put this argument
to the Committee unless it was well supported. In 2005, there had been
little progress on isolation facilities; in 2007, three quarters of
trusts still lacked isolation facilities; and as we reach 2008, fewer
than 50 hospitals have had a deep clean. On top of that, money has been
taken from local NHS trusts to pay for it.
In the light
of that failure, there is a strong argument for the CQC to report
regularly to Parliament on the Government’s performance, as
amendment No. 16 proposes. I hope that the Government do not lack the
confidence to accept that proposal and that they will regard the
amendment as a part of the frank accountability that is expected both
by people whom they wish to see in receipt of great health care, and by
all of us, so that we can be confident that the Government tackle the
problem in the right way.
While
debating this group of amendments, I should alert the Committee to the
fact that there is no new money backing up the Government’s
proposals. I am sure the Committee well knows the following arguments,
but the Department of Health originally said that deep cleaning could
cost as much as £50 million, and then admitted that the figure
was only an indicative amount. The Department also admitted that
strategic health authorities will be expected to manage the funding of
the programme from within their own regional financial plans. Now, the
Government have gone even further and confessed that the money will be
found not even by SHAs; instead, local NHS trusts will foot the
bill.
On the first
deep clean at the Maidstone and Tunbridge Wells NHS trust, which is
clearly of great topical import, the Department said:
“The funding for deep
cleaning at Maidstone and Tunbridge Wells NHS Trust is coming from
primary care trust lodgements held at the South East Coast SHA for
strategic purposes.”—[Official Report, 5 December
2007; Vol. 468, c. 1316W.]
So we
have that from the Government themselves. Amendment No. 16 seeks to
ensure that there is genuine commitment to back up the
Government’s
rhetoric.
Amendment
No. 14 is a probing amendment that arises from a concern about the Bill
as drafted. Why has the Minister opted for the measure as drafted,
rather than a statement of names, for example MRSA or C. diff? Is it
sufficiently narrow to exclude non-health care associated infections,
but sufficiently broad to capture health care associated infections?
There is a further political concern, given the Secretary of
State’s statutory influence over the commission, that as new
“super-bugs” arrive—as sure as eggs are eggs, they
will—the Secretary of State will try to prevent them from being
treated as health care associated infections by the commission, in
order to massage the Government figures. The Committee is surely under
an obligation not to let the Government have licence to do that. The
health and safety of patients is too important to allow that risk to
leave this room. Obviously if the matter is left to regulations, the
Secretary of State still has the power to do nothing about it—it
is power that matters—but at least if amendment No. 14 is
accepted, he loses any clandestine power he might have.
Amendment No. 15 arises out of
the incidents at Maidstone and Tunbridge Wells. Although it would not
protect against the delays that happened there, as there were delays in
the publication of the Healthcare Commission report on compliance with
the hygiene code, it would give right hon. and hon. Members an alert as
to when action is taken by the commission, and as such would lead to
freer and, hopefully, franker debate in Parliament. Amendment No. 25
seeks to generate a similar report as regards notices served on service
providers.
The
Minister needs to answer a number of questions in this area. He must
also grab the opportunity provided by the amendments to accept our
earnest intent to give effect, through those who are best qualified to
help it happen, to efforts to tackle one of the most appalling concerns
that people have about our health service. They fear that when going
into a health care setting, they risk coming out either with a hospital
acquired information or, worse still, not coming out at all because
they will succumb to it.
We must find
a way to support the Government in achieving our aims. We cannot wait
for another Government. We have to get on with it. The amendments give
us that opportunity. I genuinely hope that the Minister will not think
that I am just taking an opportunity to have a good old bash at him and
his team. Far from it. This problem is of such importance—we see
this all across our constituencies. Like other hon. Members, I have a
number of constituents who have either lost loved ones through hospital
acquired infections or who continue to suffer from very serious
conditions that they acquired when they should have been being treated.
I hope that the Minister will take very seriously what we propose in
the amendments, which are central to the integrity of the Bill. Unless
the Minister can satisfy us on this, we will press them to a
vote.
Greg
Mulholland:
I apologise for taking up the
Committee’s time, but I want to make some brief comments. As the
Minister would probably accept, the Bill is being touted, not by the
Government but elsewhere, as one that will first and foremost tackle
health care acquired infections. That is one of the problems of having
so many different and varied parts to a Bill, which is often
inevitable. In many ways the public see this as the number one issue in
the Bill.
To echo the
hon. Member for Eddisbury, just before Christmas I called on a
constituent who had various health care problems. She told me that she
was not prepared to travel from Otley into Leeds for an operation
because she did not want to catch MRSA. Of course, perception and
reality are not always the same, but the perception and fear is an
issue in itself, in addition to tackling the reality of health care
acquired infections, which the Minister has made it clear he is very
keen to
do.
The
Bill sets out to deal with health care acquired infections, and we are
considering a framework for how we can do that together—I echo
the comment that we have to work together and we will support the most
appropriate measures. We are trying to put in place the strongest, the
best and the most appropriate framework for enabling people to deal
with such infections. I believe
that the amendments are helpful. Surely it makes sense to have some
statutory reporting procedure as part of the framework for dealing with
health care acquired infections, and of course it makes sense to have
parliamentary accountability as part of
that. 7.45
pm
Mr.
O’Brien:
I am deeply grateful for the hon.
Gentleman’s support. To make it absolutely clear, one would want
to press amendments Nos. 16, 15 and 25. I made it clear that amendment
No. 14 was a probing amendment. The hon. Gentleman is offering his
support. I wanted to make it clear precisely what I hope we will have
an opportunity to vote
on.
Greg
Mulholland:
I thank the hon. Gentleman for his
clarification. I simply wish to ask the Minister a question. As part of
the framework that we all want to see, are some of these
suggestions—not amendment No. 14 but the other
amendments—useful? If not, what will be there in their place? If
they will not be in the Bill, how will they be brought in to ensure
that we have the best and strongest framework possible for dealing with
this very real problem that we all want to be dealt with as strongly as
possible?
Mr.
Bradshaw:
In spite of the invitation from the hon. Member
for Eddisbury, I have to say that I suspect that the amendments are
more about the Opposition’s desire to have a run-around on
health care-associated infections, rather than to address the substance
of the amendments and their impact on policy. The reason for that is
perhaps that, as the hon. Gentleman is well aware, both MRSA and C.
difficile rates are falling steadily, which is very welcome. I think
that, as a consequence of that, the amendments have been grabbed out of
thin air to give the Opposition an excuse to discuss the
issue.
The amendments
are flawed. Amendment No. 15 would require the commission to report to
Parliament every time that it took any action related to any
requirement in the regulations connected with the prevention and
control of health care-associated infections. Amendment No. 25 would
place a similar requirement on the commission, but is limited to the
issuing of warning notices rather than any action. Amendment No. 16
would require the commission to make an annual report to Parliament
specifically on the action that it had taken regarding regulations
under clause 16 relating to health care-associated
infections.
I
understand and sympathise with the Opposition’s desire to ensure
that Parliament is kept fully abreast of action that the commission is
taking, but I question whether the proposed approach is proportionate.
Of course it will be important that the public have a full picture of
how the services in their area are performing. They do already, through
a number of measures. I have already described the annual health check.
When the CQC goes in on an issue of health care-associated infections,
given the new enforcement powers that the Bill gives it—the
ability to intervene earlier—it will be entirely free to
publicise its activities at any time when it is taking action. However,
it is up to the commission to make a judgment as to whether and how
much it wants to publicise every single action that it takes in a
particular area. That is why we have made provision in clause 83 for
regulations to set out when the commission must publish details of the
enforcement action that it has
taken. That
flexibility is very important. It is up to the commission to decide on
the most proportionate response. For example, we expect the commission
to be on top of any breach of registration requirements and to respond
appropriately. In the majority of cases, that will probably mean a
low-level response to nip the problem in the bud—for example, by
specifying the issue of concern and alerting the person to what needs
to be done to prevent the matter from escalating. I do not imagine that
Parliament would consider it a good use of its time for reports to be
laid every time that the commission takes action of that
type.
On
amendment No. 25, warning notices are intended to be used for
first-time or minor offences. The issuing of a notice should encourage
a provider to change their behaviour to comply with the requirements.
If the failure is remedied within the set timetable or has already been
put right when the notice was issued, no further action may be deemed
necessary in respect of the specific incident. If, however, such
matters were referred to Parliament, the issuing of a warning notice
would not represent a low-level intervention, in that the provider
concerned would be named to Parliament. In those circumstances in which
this requirement would apply, it would rather undermine the intended
purpose of a warning notice. While I understand the Opposition’s
concern about parliamentary accountability, I believe that the
reporting requirements in the Bill are perfectly adequate and that the
proposed amendments would place considerable and unacceptable extra
burdens on parliamentary time.
Under clause 77, the commission
is obliged to report annually to Parliament on a range of matters,
including the provision of NHS care during the year. That is the same
as the current position with regard to the Health Commission and CSCI.
I know that Parliament finds such reports both informative and useful.
If the Secretary of State decides that there are particular matters on
which more detail is needed, subsection (5) of that clause allows them
to specify other reports and information that the commission must
provide. We would expect that annual report to cover health
care-associated infections. We see no need to require the commission to
submit this section of the report separately, as amendment No. 16 would
require us to
do.
Turning to
amendment No. 14, the definition of health care-associated infections
used in the Bill is the same as that used in the Health Act 2006, in
which we legislated to establish the code of practice on infection
control. It also included the same exemption that we have used here to
exclude circumstances in which the individual is deliberately exposed
to an infection as part of the provision of health care. Admittedly,
that is not as common a practice as it once was, but there are still
vaccines and inoculations that work on the principle of deliberate
exposure. For example, I understand that patients were sometimes
deliberately exposed to a virus to raise their temperature as part of
their therapy. Amendment No. 14 requires us to set out the kinds of
infections that should be exempt in regulations. I am opposed to that
amendment because
the current wording makes it clear that only those infections to which a
person is exposed deliberately as part of their health care are exempt.
The proposed amendment does not include such a safeguard. That means
that potentially any kind of infection could be exempt. More
importantly, listing particular exemptions and regulations would make
this clause much more cumbersome in its operation. We are aware
of how viruses such as flu are constantly evolving and mutating. We
have seen the potential threat from new viruses such as severe acute
respiratory syndrome. In the event that a new health care treatment is
developed that involves the deliberate exposure of patients to
infection, this clause, as amended, would prevent us from using it
until the revised regulations had been made. On that basis, I urge the
hon. Gentleman to withdraw that and the other three
amendments.
Mr.
O'Brien:
I have listened carefully to the Minister, and he
reasonably thinks that this is a desperately important area. I am
grateful for the support from the hon. Member for Leeds, North-West.
Given the way that the amendments are grouped, I want to flag up that
although I am happy to withdraw amendment No. 14, which I declared at
the outset was a probing amendment, I would wish to make any further
consideration of amendments Nos. 15 and 25 dependent on the outcome of
pressing amendment No. 16 to a
vote.
Question put,
That the amendment be
made.
The
Committee divided: Ayes 7, Noes
9.
Division
No.
4
]
Question
accordingly negatived.
Amendment proposed: No.
165, in clause 16, page 8, line 31, at end
insert—
‘( ) Regulations
made under this section may make provision for the prevention and
management of malnutrition and may include such provision as the
Secretary of State considers appropriate for the purpose of
safeguarding individuals (whether receiving health or social care or
otherwise) from the risk, or any increased risk, of
malnutrition.’.—[Mr.
Stephen
O'Brien.]
Question
put
, That the amendment be
made:—
The
Committee divided: Ayes 7, Noes
9.
Division
No.
5
]
Question
accordingly negatived.
Mr.
O'Brien:
I beg to move amendment No. 13, in
clause 16, page 8, line 38, leave
out from first ‘section’ to ‘consultation’
and insert ‘must be taken into account
in’.
The
Chairman:
With this it will be convenient to discuss
amendment No. 22, in clause 18, page 9, line 45, leave out from first
‘section’ to ‘consultation’ and
insert
‘must be taken
into account in
any’.
Mr.
O'Brien:
In the light of amendment No. 16, Mr.
Hood, you rightly noticed that I did not want to take further action on
the other probing amendments in that group, which were not
withdrawn.
This is
the final group of amendments in this clause. The Bill as drafted
requires the Secretary of State to consult before making regulations
under clause 16. Hon. Members will be familiar with the various issues
that have to be consulted on, which are listed in subsection
(3).
Clause 18
requires the Secretary of State to consult on a draft code of practice
relating to health care-associated infections before publication.
However, in respect of both cases, subsection (6) states:
“Consultation undertaken
by the Secretary of State before the commencement of this section is as
effective for the purposes of this
section”
and must be
taken into account in any consultation undertaken after that time. The
amendments probe why the Government have drafted the Bill in those
terms and seek assurance that proper consultation will be undertaken
where necessary. Clause 16 specifies a number of areas in which
regulations might be made and clause 18 deals with the code of
practice.
There is a
code of practice that was last updated on 11 January, and the Bill as
drafted provides that the Secretary of State need not consult where
consultation has already happened; it is a matter for his judgment. As
my record in the House will show, I do not want to double up any form
of bureaucracy, but it is important that the clause should not allow
the Secretary of State to avoid the necessary consultation.
I turn the
Committee’s attention to clause 16(3)(k), which relates to
complaints. I would have discussed amendment No. 83 in that respect,
but it would not be in order for me to do so as it was not selected.
However, I hope that the concerns I have outlined show that the
subsection as drafted could preclude further important consultation on
the regulations. We will have a longer debate on complaints later in
the Bill, as the subject will have to be discussed. We must also take
into account what we believe is a track record that leaves something to
be desired by a Government who have often sought to avoid consultation
on key matters. I have alluded already to my experience with community
health councils and the NHS 10-year plan some time
ago.
8
pm
There are
several questions for the Minister on this first group of amendments.
First, can he tell the Committee why the clauses are drafted in this
way and, in particular, which previous or current consultations he is
referring to? Secondly, will he support a strong local complaints
procedure in both health and social care bodies? Thirdly, how will he
ensure that the CQC can monitor such complaints in case of necessary
interventions?
Let us
not be in any doubt about how important it is to have confidence in a
complaints procedure, which, at the moment, the Bill is remarkably
short in supplying. On that basis, I hope that the Minister will be
persuaded by the merit of our arguments in support of these amendments
and that, however much they may be probing amendments, they will give
him pause for thought.
Mr.
Bradshaw:
The problem that we have with these amendments
is that subsection (9) makes it clear that the Secretary of State can
carry out consultations related to the code of practice prior to the
clause coming into force. The impact of this amendment would be to
nullify that. However, in order to deliver the new registration scheme
to the timetable, which we have all been discussing this afternoon and
during previous sittings, we need to have regulations and the code of
practice in place by April 2009. That means that we need to begin the
consultation on the draft regulations before commencement of this
clause. Therefore, subsection (9) allows that consultation to be
carried out before the clause has been commenced.
I can understand why some
people may think it hasty for the Government to consult on draft
regulations before the clauses in the Bill have been commenced.
However, we believe that it is important that, if Parliament sees fit
to approve this Bill, the new commission should be able to make use of
the stronger powers that the Bill is giving it, particularly in
relation to the issue that the hon. Gentleman said he was concerned
about—tackling health care-associated infections at the earliest
opportunity. To hold the new commission back from doing that until
commencement would constitute unnecessary delay.
In practice,
the proposed amendment would mean a delay, because we would have to
wait until after commencement before further consultation would be
possible, and any consultation undertaken before commencement would
inform the subsequent consultation but would not be valid on its own.
We want the new powerful and independent regulator to be able to build
on the work of the existing regulators and to do so as quickly and as
seamlessly as possible, particularly in relation to the issues of
safety, quality and health care-acquired infections. I believe that
that is particularly important, given that those are priorities stated
not just by the Government but by the public and by Opposition parties,
and we would not want this crucial work to be delayed by further
consultations, particularly given that there will already have been a
wide-ranging consultation on the regulations and the code of practice
under this Bill. That is why I ask the hon. Gentleman to withdraw his
amendment.
Mr.
O'Brien:
I said earlier that I regard these amendments as
probing ones, and I think that this has
been a useful exposition. As I also said earlier, I hope that the
amendments have provided food for thought, that the Minister will not
regard this issue as done and dusted, and that he will reflect upon it
as he considers what he might want to bring back on Report. That said,
I beg to ask leave to withdraw the amendment.
Amendment, by leave,
withdrawn.
Clause
16 ordered to stand part of the Bill.
Further
consideration adjourned.
—[Steve
McCabe.]
Adjourned
accordingly at four minutes past Eight o’clock till Thursday 17
January at Nine
o’clock.
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