 House of Commons |
Session 2007 - 08 Publications on the internet General Committee Debates Health and Social Care |
Health and Social Care Bill |
The Committee consisted of the following Members:John Benger, Celia Blacklock,
Committee Clerks
† attended
the Committee
Public Bill CommitteeThursday 17 January 2008(Morning)[Derek Conway in the Chair]Health and Social Care BillFurther written evidence to be reported to the HouseH&SC 26 Equality
and Human Rights
Commission
H&SC 27
Unison
H&SC 28 Parliamentary
Ombudsman and Health Service
Ombudsman
9
am
Mr.
Stephen O'Brien (Eddisbury) (Con): On a point of order,
Mr. Conway. I thank the Minister for his two letters that we
have received this morning, one on the cost of the new commission and
one on complaints handling, which relate to an undertaking given in our
proceedings. However, I was a bit disappointed that, while the second
letter on complaints identified my question about the backlog of
complaints—column 123 of the Official Report—it
did not contain the figures. It stated merely that the backlog has now
reduced significantly and the Healthcare Commission is now meeting the
service level agreement target agreed with the Department of Health to
close 95 per cent. of cases within 12 months. I should be grateful to
receive the figures in respect of the backlog. Given that we may be
debating schedule 5, depending on progress, either today or Tuesday, I
should appreciate the Minister providing us with those figures during
this morning’s sitting. I ask him, through you, Mr.
Conway, whether that might be
possible.
The
Chairman:
Fortunately, Chairmen of Public Bill Committees
are not responsible for the content of ministerial replies. That is a
great relief to us all. I am sure that the Minister may want to refer
to the matter during this morning’s proceedings, but it is not a
point of order for the Chair. I am sure that he will deal with it in
due
course.
Clause 17Code
of practice relating to health care associated
infections
Mr.
O'Brien:
I beg to move amendment No. 17, in
clause 17, page 8, line 41, leave
out ‘may’ and insert
‘shall’.
The
Chairman:
With this it will be convenient to discuss the
following amendments: No. 18, in
clause 17, page 9, line 3, at
end insert—
‘(2A) The code
of practice must make reference
to—
(a) screening for
admissions,
(b) bed occupancy,
and
(c) the frequency and
extent of cleaning in healthcare
premises.’.
No. 19, in
clause 17, page 9, line 7, at
end add—
‘(3A) The Secretary
of State shall publish each revision of the
code.’.
No.
20, in
clause 17, page 9, line 7, at
end add—
‘(3A) The Secretary
of State shall report to Parliament in respect of those cases
where—
(a) regulations
made under section 16 are breached,
and
(b) the Code of Practice
under this section is
breached.’.
No.
21, in
clause 18, page 9, line 13, at
end insert—
‘(c) lay the
draft code before
Parliament.’.
Mr.
O'Brien:
The amendments build on the themes that were
discussed in the debate on clause 16 to ensure effective combating of
health care associated infections and clarity in reporting that to
Parliament. The Health Act 2006 makes provision for the Secretary of
State to issue a code of practice relating to the prevention and
control of HCAIs. It was updated most recently on 11 January 2007. As
the explanatory notes say, the new code will replace that code and
extend it to all regulated activities, not only NHS
bodies.
Amendment
No. 17 queries why the drafting stands at “may” not
“shall”, given the Government’s apparent
commitment to the code of practice. That is such an easy one that I am
hoping the Minister will get us off to a flying start this morning and
accept it, without any cavil. Amendment No. 18 would include in the
code action particularly on screening, bed occupancy and the frequency
and extent of cleaning in health care
premises.
During the
oral evidence sessions, Anna Walker from the Healthcare Commission
noted that the extra powers given to the commission would not have
prevented the outbreaks of infection at Maidstone and Tunbridge Wells
NHS Trust, a point that will be important to the discussions on future
clauses. However, she noted that the key was
to
“get proper infection
control processes in
place.”
She also
said:
“if we find a trust
which is cavalier about putting the right processes in, then the
penalties will be
helpful”,
and that the
reality is
“usually more
fundamental than that—the team does not understand the processes
it needs in place to solve that
problem.”——[Official Report, Health and Social
Care Public Bill Committee, 8 January 2008; c.
24.]
Hence, it is crucial that
the code of practice gets matters right and that the Committee supports
the
amendments.
It
is reported on page 16 of the current code that it makes provision for
screening for methicillin-resistant Staphylococcus aureus. The policy
should make provision for admission screening, which should include
screening of all elective admissions by March 2009, and for screening
of emergency admissions at presentation as soon as it is practical.
However, as we know, the Secretary of State has axed the Prime
Minister’s promise of screening for clostridium difficile. The
Committee may recall that on 6 January on “The Andrew Marr
Show” the Prime Minister said:
“If you go into hospital
you will get screened by next year for MRSA or C.
difficile”.
That was
later reported on 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, but two days later on 8 January 2008, in
the document “Clean, Safe Care: Reducing Infections and Saving
Lives”, the Secretary of State’s infection control
strategy reports on clostridium difficile
that
“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 is obviously admitting that the Prime Minister was
wrong. The code makes no provisions for bed occupancy other than saying
that on the movement of
patients:
“There
should be evidence of joint working between the ICT and the bed
managers in planning patient admissions, transfers, discharges and
movements between departments and other healthcare facilities. Where
necessary, ambulance trusts may need to be involved in such
planning.”
That sounds
like a handbook for shepherding patients. We have all heard anecdotal
stories of patients being kept in ambulances to control hospital
admissions and targets. In April 2001 in response to the Select
Committee on Public Accounts the Government
said:
“Health
Authorities should plan bed numbers in order to achieve a bed occupancy
rate of no more than 82 per cent, in
2003-04.”
After that, the
bed occupancy rate went up. It is still at 84.5 per cent. and in many
parts of hospitals it is way above that. In the past year, the
Government have reduced the number of acute and general beds in the
national health service by the largest proportion since 1982. We have
seen a reduction of 6,000 acute and general beds, which has taken us
down to a figure of 127,000. However, the NHS plan said that there
would be an increase of 2,000 beds to take the figure up to
135,000.
Last year,
The Independent said that the Department had conducted a review
suggesting that reducing bed occupancy to a maximum of 85 per cent.
would save 1,000 cases of MRSA a year. Just last week we heard that the
Worcestershire royal hospital is running so close to capacity that it
has had to cancel operations, send some patients home, send others to
the downgraded Kidderminster hospital and enter into punitive
negotiations with the independent sector treatment centre there. The
hospital in Worcester runs with an occupancy rate that is consistently
above 90 per cent.
The
third factor that I have outlined should also be considered: the
frequency and extent of cleaning in health care premises. As I have
discussed on a number of occasions during the Committee’s
proceedings, the Prime Minister’s commitment to deep clean
appears to be something of a whitewash. Not only have fewer than 50
hospitals actually had the deep clean, but it is being paid for from
primary care trust lodgements—the top-slicing that the
Government imposed on local health economies to solve their own central
financial crisis. The deep clean is important, but it is the
maintenance of a clean environment through ongoing cleaning,
particularly the search and destroy approach to HCAIs, which we have
committed to, that would really bring down MRSA rates.
The current code of practice
imposes processes and managerial structures on cleaning, rather than
focusing on the nature of cleaning itself and the outcomes
required. Given that it is often the refrain of those who make rather
obtuse points on the matter, I wish to state that the cleaning services
at Maidstone and Tunbridge Wells NHS Trust were not outsourced; they
were absolutely
in-house.
Amendment
No. 21 will formally give Parliament sight of the draft code, which
hon. Members from all parties will want the Government to get right. As
the points I have outlined show and as we discussed on Tuesday, that is
an area where the Government are failing. Parliamentary debate will
introduce a more effective strategy and a clear priority focus for
parliamentarians and the legislature on one of the key problems in our
constituencies at the present time.
Amendment No. 19 is
self-explanatory. If the Secretary of State revises the code, it must
be published. Amendment No. 20 is similarly self-explanatory and would
give hon. Members an early warning of health care associated infection
issues in hospitals across the country and in our
constituencies.
As
the Committee will be aware—it was widely reported on the news
last night and this morning—Leslie Ash yesterday settled for
£5 million, although there were some reports that it was just
£500,000, with the Chelsea and Westminster hospital over her
methicillin-sensitive Staphylococcus aureus suffering. Yesterday,
The Times reported that legal arguments had begun in the Court
of Session in Edinburgh. Judges are to decide whether the case brought
by 71-year-old Elizabeth Miller, a great grandmother who contracted the
MRSA superbug in hospital, should proceed to a full hearing. She is
suing NHS Greater Glasgow and Clyde for £30,000, which could
pave the way for hundreds of other sufferers to claim millions of
pounds in damages.
Therefore, the key issue is
whether, by virtue of these amendments, we would be able to give the
necessary priority, focus and parliamentary scrutiny to the revised
code of practice, which is required to be published by the Government.
The Government themselves proclaim that they are focused on dealing
with the matter. We would demand that of any Government given the
desperate situations that arise as a result of hospital associated
infections.
In
looking at this group of amendments, I hope that the Minister will
agree that screening, bed occupancy, and the frequency and extent of
the cleaning in health care premises, in particular a search and
destroy strategy, are key to effective control of health care
associated infections. I hope that he will agree with Anna Walker that
the problem is more often to do with teams that do not understand the
processes that are needed to combat health care associated infections
than a cavalier attitude towards putting in the right
processes.
Also,
why has the Secretary of State reneged on the Prime Minister’s
commitment to screen for C. difficile? Why are bed occupancy rates
still so high under this Government and why is no mention made of those
rates under the current code of practice? Why should right hon. and
hon. Members not be formally alerted when the regulations under
paragraph 16(5) of the code are breached? How regularly would the
Minister expect such breaches and, we would argue, reports to happen? I
have high expectations that the Minister will be persuaded by those
arguments and accept our
amendments.
Sandra
Gidley (Romsey) (LD): I understand the motivation behind
these well-intentioned amendments. I want to query a few points on
amendment No. 18 because it attempts to detail what should go into the
Bill. I have some concerns about the list, not because of what is in it
but because of what is not. I do not believe that the list is
comprehensive. For example, new paragraph (c) refers to the frequency
and extent of cleaning in health care premises, but there is no mention
of personal hygiene standards or the responsibility of the individual
health care workers or even the antibiotic policy which, if we are
talking about C. difficile, is just as important, if not more so, as
cleanliness. At the moment, I feel that if those aspects are in the
Bill, undue emphasis could be placed on the procedures and processes
outlined in new paragraph (c), and we might not be able to tackle the
overall picture. With the emerging nature of resistant infections,
situations may arise which require a change in practice. We need to
retain some flexibility so that we can face existing and future
challenges.
9.15
am
Mr.
O'Brien:
I accept the hon. Lady’s fair
question. In principle, I think that she is very sympathetic to what we
are trying to achieve here. It is clear that a Bill that does not
contain anything of this nature would look rather weak because it
leaves everything for others to decide. It would be far better not to
seek to be comprehensive, because things will move on and change. At
this stage it is absolutely clear that the three things cited are
fundamental and unlikely to change, and therefore, rather than have a
comprehensive list, it is important to identify a focus of activity to
allow for prioritisation. At the moment, in terms not only of the Bill
but of the way in which the Government are dealing with the matter in
general, this issue is not sufficiently high on the agenda, and this an
attempt to raise it. I accept that the amendment could have been more
comprehensive, but the danger of that is that one then ends up trying
to include everything, rather than prioritising.
Sandra
Gidley:
I thank the hon. Gentleman for his explanation. I
am still not entirely convinced. His timing was impeccable, as I was
just about to sit down and draw my remarks to a
close.
The
Minister of State, Department of Health (Mr. Ben
Bradshaw):
The hon. Lady is right. As the hon. Gentleman
says, it is important that we get these codes right, but as the hon.
Lady pointed out, scientific advances and knowledge change continually;
we are constantly developing new ways of tackling the challenges,
including health care acquired infections. We all hope that some way
down the track, if we continue the welcome, significant and sustained
fall in health care acquired infections that the Government have
achieved in recent years, we will not be worrying so much about this
issue, but there may be something else that poses challenges to the
health service.
The
problem that I have with the amendment tabled by the hon. Gentleman is
the same as that expressed by the hon. Lady. The terms of the amendment
would place us in a straitjacket, which in the medium and long term
could be unhelpful. I expect that it was tabled as a means for having a
run-around on some of the Opposition’s old chestnuts about
health care acquired infections.
Mr.
Bradshaw:
I will give way to the hon. Lady in a second; I
just want to put one or two things on the record to correct errors made
by the hon. Gentleman. The figure on the deep clean is 80 per cent. of
hospitals, and it is already well under way. The £57 million sum
for the deep clean is new money for hospitals, out of the £270
million of new money announced in the comprehensive spending review.
One example of the unhelpful straitjackets that the amendments would
create for the health service concerns bed occupancy rates. As I am
sure the hon. Gentleman is aware, the latest research on bed occupancy
shows that, although up until 2003-04 there may have been a correlation
between high bed occupancy rates and MRSA, since then bed occupancy is
“statistically insignificant.” That is a good example of
how changes in practices and experience show that putting ourselves in
a straitjacket, as the Conservatives are asking us to, could be quite
unhelpful. That is true of the guidance and the issues discussed on
Tuesday, such as the requirement for the Secretary of State, rather
than the independent Healthcare Commission, to report to Parliament
about every single little thing that is going on. As the hon. Member
for Romsey rightly says, such an approach would mean putting oneself in
a rigid system of being required to do things that are no longer
important.
Angela
Browning:
I am somewhat shocked to hear the Minister use
the expression “old chestnut” in respect of
hospital-acquired infections. I am a member of the Public Accounts
Committee. On two separate occasions, his permanent secretary appeared
before it and if he had used that expression to it, he would certainly
have been put in his place. The permanent secretary will return to the
Committee within the next year on this very subject. It is far too
serious a subject for the Minister to describe as an “old
chestnut.” He has the option of bringing the contents of the
amendment back on Report, redrafted by his officials. If he feels that
this issue will disappear in a few years’ time—I hope
that he is right—something approaching a sunset clause would be
appropriate. In other words, let us put it in the Bill because it is
important, not an “old chestnut”, and if in five or 10
years it is no longer regarded as necessary, the wording of a sunset
clause would mean that it would die a natural death as the need for it
disappeared. This issue is serious, and I hope that the Minister will
talk to his permanent secretary about his experience before the Public
Accounts Committee. I doubt that he thought that it was an “old
chestnut”.
Mr.
Bradshaw:
The hon. Lady, inadvertently I am sure,
misunderstands my point. I was not saying that the issue of health care
acquired infections is an old chestnut—it is an extremely
serious issue and that is why it is in the Bill, and why the Government
have a £270 million programme to tackle it. It is why I welcome
the significant and sustained falls in health care acquired infections
that we have achieved in recent years, and I hope that that continues.
However, it would be wrong to issue guidelines that are so specific
that they are inflexible with regard to the new, independent Care
Quality Commission, which we are setting up to help us continue to
drive down infection rates.
The
“old chestnuts” that I referred to are some of the issues
that are regularly raised by the Opposition, based, I believe, on a
misunderstanding or an out-of-date understanding of our progress on
health care acquired infections. I gave the example of bed occupancy. I
am not suggesting for a moment that it is not a serious issue; it is.
The Government are tackling it, and we are making welcome progress.
There has been a 10 per cent. reduction in MRSA in the last year, a 7
per cent. reduction in C. difficile, and a 32 per cent. reduction in
health care acquired infections overall since the base year of 2003-04.
I want that progress to continue, but it will not be helped by putting
the new independent body into the straitjacket provided by these
amendments.
Anne
Milton (Guildford) (Con): I welcome the Minister’s
reference to the science, and I would be grateful if he gave us the
source of the information about bed-occupancy rates. One of the
problems with the treatment of health care acquired infections is that
precious little science is used. It will be interesting to see what
happens next year—when there will not be £270 million,
and when PCTs and trusts will have to make their own decisions on where
they spend their money—and whether it is felt that the deep
clean was worth it and should be
prioritised.
Mr.
Bradshaw:
The research that I referred to is a public
document published in December—the McCormick report. However,
the hon. Lady is absolutely right. I do not want to detain the
Committee by going through the entire list of things that have been
happening and are happening to help us make this progress, but it is
important that we have sustained investment. That is why we welcomed
the comprehensive spending review settlement, which is very good as far
as our Department is concerned and constitutes a 4 per cent. real
increase in spending in the health service for each of the next three
years. I am not sure whether the Conservative party is still committed
to meeting that spending.
Returning to the substance of
the amendments, I do not think that they would be helpful. I understand
why they were tabled—to give the Opposition a chance to repeat
the inaccuracies that were presented to us on Tuesday—but they
would be unhelpful in our efforts to continue the sustained
progress.
Mr.
O'Brien:
I suspect that the rest of the Committee, if they
would wipe the smiles of their smug faces, would be equally disturbed
and appalled by the Minister’s performance. We could do without
smug party points. We are dealing with the deaths of 270 people at
Maidstone and Tunbridge Wells that could have been avoided with better
procedures. That was a disgraceful performance by the Minister, and I
am shocked.
Judy
Mallaber (Amber Valley) (Lab): Is the hon. Gentleman
seriously suggesting that it is disgraceful to try to promote part of
what is being done to deal with this very serious issue? Every member
of the Committee agrees that is a very serious issue; is it really
disgraceful to point out where we have made, and are committed to
continuing, improvements, and to put that on the
record?
Mr.
O'Brien:
We all wish to see the best measures to tackle
this. What we do not like is the smug approach taken by a Government
who know that they have an
inbuilt majority, and who therefore think that the
entire procedure of scrutinising the Bill is a waste of time and rather
wish that they were not here. Far from it. We are absolutely committed
and very sincere about the amendments and we shall be voting on them.
This is not a game to get some happy little comments on the record. It
is a serious question of trying to get the best performance and
prioritisation for dealing with this issue in parliamentary terms. This
has become serious because of the tone and attitude of the Minister in
responding to a matter of this seriousness. We should recognise, on the
record, that that should be repelled.
Richard
Burden (Birmingham, Northfield) (Lab): May I clarify the
hon. Gentleman’s intentions? If I understood his reply to the
hon. Member for Romsey, he acknowledged that his amendments may well be
defective.
Richard
Burden:
Ah—so the hon. Gentleman thinks that the
list in amendment No. 18 is complete and comprehensive, and that is why
he wishes to press it to a Division. If the amendment is defective, he
should withdraw it; if it is not, he should press it to a Division.
Which is
it?
Mr.
O'Brien:
I am sure that the hon. Gentleman was listening
when I responded to the hon. Lady. I said that the purpose of the
amendment was not to be comprehensive, but to highlight and prioritise
matters on which Parliament must focus.
Of course, the amendment would
give flexibility. We have the Report stage and the Bill will be
scrutinised in another place, so the Government could recognise that
they can tweak it. If they do not tweak it, and if they choose simply
to resist and to make the measures generic and unspecific, that raises
questions about the prioritisation of, and focus on, the requirement
for accountability to Parliament. There should at least be a tie-in
with the Public Accounts Committee, as my hon. Friend the Member for
Tiverton and Honiton so ably pointed out, so that there is annual
scrutiny, not least in the person of the permanent secretary. We need
to tie-in the prioritisation of parliamentary accountability rather
than relying, as we will under the Bill, on an Executive who seem not
to take the measure with the seriousness that it deserves. They seem to
think that the intention behind the amendments is partisan point
scoring, which it quite patently is not. I rest my
case.
Sandra
Gidley:
I think that the hon. Gentleman would be best
advised to rethink the matter on Report. I am concerned about
unintended consequences. For example, if we are too prescriptive about
bed occupancy regulations, we could create a conflict. When a person is
in an emergency situation, will a hospital official say, “We
cannot accept you because we would be in breach of the bed occupancy
regulations”? That person could die not because of MRSA, but
because they had to be moved to another hospital. Whatever capacity any
Government build into the health system, those situations will arise.
The hon. Gentleman must think through all the consequences of the
amendment. It is well intentioned, but we need to ensure that the
situation I described does not arise.
“The
code of practice must make reference
to”.
So the measure would
not be exclusive; rather, the intention is to draw attention to
prioritisation. Furthermore, if the science says that bed occupancy
rates are indeed leading to MRSA, she cannot surely be suggesting that
a hospital should accept a person if that would lead to their getting
MRSA. On the contrary, the whole point of the science is that it should
be a matter of judgment if someone who should otherwise obviously be
accepted into a hospital is almost certain to contract
MRSA.
Mr.
O'Brien:
I am not going to give way because the principle
at stake in the amendments is clear. They would prioritise what the
code of practice refers to. They would not provide an exclusive or
comprehensive list, and they would not restrict flexibility, but we do
not want the Government to feel that they can simply be trusted to do
the right things at the right time, because their track record so far
is deeply
disappointing.
I am
disappointed with the tone and substance of the Minister’s
reply, so I shall press the amendment to a Division.
Question put, That the
amendment be
made:—
The
Committee divided: Ayes 5, Noes
10.
Division
No.
6
]
AYESNOES
Question
accordingly negatived.
Clause 17 ordered to stand
part of the Bill.
|
| |
| ©Parliamentary copyright 2008 | Prepared 18 January 2008 |