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Mr. O'Brien: Did the four categories in the right hon. Gentleman’s local trust include an identification of whether the patients who sadly lost their lives had a hospital-acquired infection, even if it was not the prime cause of death? Was malnutrition, which I raised earlier, considered as a possible cause?
Mr. McCartney: Hospital-acquired infection deaths are rightly identified separately as part of the reporting system.
People get admitted to the acute sector for all sorts of reasons, but there is usually an indication of whether the case is a survivable event. In some areas, death rates are high because of the poor quality of the structure of health care and morbidity within the community. However, that does not and should not explain away someone going into hospital and dying prematurely or unexpectedly.
In the regime for improving quality, we must ensure that there is a transparent, independent system across the NHS for that to happen. When problems are identified, is the NHS trust simply left to deal with it, or is there a role for it to communicate the actions and reports to the Healthcare Commission? My hon. Friend the Minister might say, “Actually, we have that assessment in place,” and that would be welcome. But it seems to me that this is one of the areas that the Care Quality Commission could have assessed: driving up the quality of professional care and aftercare, and ensuring that organisational and cultural issues are addressed in trusts with a poor record of sustaining life when certain types of individual go into hospital for certain types of treatment.
I hope that that is helpful to my hon. Friend. Good luck to him in introducing the new commission. It is a welcome initiative.
5.6 pm
Mr. Bradshaw: I will begin with the points made by my right hon. Friend the Member for Makerfield. It is quite refreshing to be reminded by him that once there was no independent regulation of the health care system, and that it is only because of this Government’s introduction of the Healthcare Commission, and now its transmogrification into the integrated regulator of health and social care, that we have independent regulation. He is absolutely right to stress the importance of having independent regulation, both in terms of public confidence and in terms of helping to drive up standards. It will continue to do so.
Let me reassure my right hon. Friend about the role that the Care Quality Commission will play in monitoring and helping to drive up standards. He might be aware that the Healthcare Commission will examine in close detail the sort of data he mentioned: data on serious untoward incidents and unusually high mortality rates in particular trusts or particular specialties within particular trusts. On the back of such discoveries and research, the Healthcare Commission already conducts investigations. I think that I am right in saying—someone will correct me if I am wrong—that one of the reasons why the commission went into the Maidstone and Tunbridge Wells trust in the first place was that it noticed an unusually high mortality level there. The Care Quality Commission will continue to do that, using the new powers that we are giving it.
I do not want to go in too much detail on our discussions during the passage of the Bill on moving the independent complaints process from the present two-tier system. Now, people go through the Healthcare Commission first, and if they are not satisfied, they can go to the health ombudsman. We decided to change that system because we felt that the current one can take rather a long time and it can be quite confusing to have there are two different independent bodies to which people can take their complaints.
That does not mean, however, that the Care Quality Commission will not have a locus to monitor how trusts deal with complaints and what actions they take as a result, including learning lessons from those complaints, as my right hon. Friend suggested. Trusts’ performance will be measured partly by how many complaints they receive, how they deal with them and what evidence they can show that they have put action in place to address the substance of those complaints, including changing practice if necessary.
My right hon. Friend mentioned the importance of not excluding care homes. I shall come to that in more detail in a moment, in response to points made by the hon. Members for Eddisbury and for Leeds, North-West, but I will say that from April this year, all hospitals will be required to screen people entering the hospital for MRSA. My right hon. Friend is right to identify the problem of infections brought from the care sector into hospitals. Some hospitals have already introduced pre-screening, and it has a significant positive effect. I hope that that will help deal with some of the problems that he mentioned.
The hon. Member for Eddisbury asked why we were beginning with healthcare-associated infections. We tend to refer to them as healthcare-associated infections, rather than healthcare-acquired infections, for the very reason my right hon. Gentleman described. Often the infection may be associated with health care, but it is not necessarily acquired in hospital; it can be brought in from the community.
The reason for beginning with HCAIs was twofold. The first was the level of public concern about the problem, but secondly we felt it was right, given the enormous task that the Care Quality Commission faces with the whole registration requirement for the first time. We discussed this at some length during the passage of the Bill and we also had conversations with Anna Walker and with Baroness Young and Cynthia Bower, the chair and chief executive of the new Care Quality Commission, about how they thought best to manage this process.
It would be wrong to call it a dry run as it is happening for real, but in order not to overburden the Care Quality Commission in its first year of operation or divert it from its very important job of reviews and looking into problems in the health service, we agreed to focus solely on the single issue of HCAIs vis- -vis the registration requirement. The NHS specifically is the only bit of the health and social care system at the moment that is not registered. The rest, such as care home and other sectors are registered under existing health care registration legislation. We therefore thought that it made sense to do those two things.
The hon. Member for Eddisbury repeated his claim that there was a correlation between bed occupancy rates and HCAIs. We have had this debate many times before. I simply repeat to him that there is no evidence to suggest that there is such a correlation. Indeed, some of the hospitals most successful at reducing HCAIs have been those with the highest bed occupancy rates. They have also been very successful at getting waiting times down. He also repeated the accusation that the deep clean was a gimmick. Again, I reject that strongly. As my right hon. Friend the Member for Makerfield said, it has been helpful as part of an overall package of measures. If one speaks to anyone who has been involved in the deep clean at hospital level, from the cleaning staff upwards, they will confirm that it has helped to change the culture in many cases in hospitals to help us to deliver the progress that we have achieved in getting infection rates down.
The hon. Member for Eddisbury asked whether I had had a conversation with Anna Walker about the level of fines. I think from memory that when Anna Walker gave evidence to the pre-hearing, she was under the impression that a £50,000 fine was the maximum that any provider could be fined. That is for a single offence, however, so it is theoretically possible that a provider could be given multiple fines of £50,000 for a series of offences. As soon as I had clarified that with Anna Walker, she said that she was happy that the penalty would be significant enough in the Maidstone and Tunbridge Wells case.
That is not the only sanction. People lose their jobs, boards are sacked and chief executives are sacked. In extremis, there was a police investigation in Maidstone and Tunbridge Wells; if the police and the Crown Prosecution Service had felt that there was the evidence, there could have been a prosecution for manslaughter too, so the £50,000 multiple is not the very maximum that could happen in the worst possible scenario.
We did not want to overburden the NHS with the possibility of huge fines. What we are really interested in is changing behaviour and having a system that acts as a deterrent for bad management, rather than simply levying massive fines on hospitals, which may make life for a struggling hospital even more difficult than it was in the first place. However, funds thus gained would be recycled through the NHS and so not lost to the NHS.
The hon. Member for Leeds, North-West asked why the registration requirement did not bring in dental and medical practices at this stage—the emphasis is “at this stage”. In 2010, the registration requirements will extend from the NHS to bring in the other independent and voluntary health and care providers, including care homes. We have indicated our intention to register GP, medical and dental practices, but only after 2010. Again, that brings us back to the Care Quality Commission and capacity issues.
Mr. McCartney: My hon. Friend has had a lot of technical questions to answer, so I apologise, but he has not indicated what the relationship between the commission and the ombudsman will be and whether there is the capacity to transfer cases or parts of cases to professional bodies, if there has been a breach of professional ethics.
Mr. Bradshaw: I beg my right hon. Friend’s pardon and I apologise. Currently, the Care Quality Commission makes recommendations to professional bodies when it reviews certain types of service, and it will continue to behave in exactly the same way. The commission can make recommendations to professional bodies in exactly the same way as it does at present, if data, whistleblowing or research cause it to believe that there is a problem in a service, either across the country or in an individual trust. However, I think that my right hon. Friend is talking about generic problems that may occur in some specialities—for example, the report on the quality of service for people with learning disabilities. The Care Quality Commission will not deal with individual complaints; the health care ombudsman will deal with those.
Question put and agreed to.
That the Committee has considered the draft Health and Social Care Act 2008 (Registration of Regulated Activities) Regulations 2009.
5.17 pm
Committee rose.
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