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-Ã -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. I
was asked how the Care Quality Commission would identify where there
was a problem. It will do so in the same way as the Healthcare
Commission has done until now, through a mixture of officially
published data,
complaints, whistleblowing and spot checks. Those means have all been
important in helping the HCC to do its job and that will continue under
the CQC. I was asked about the CQC’s decision to drop annual
reporting, but I am not sure whether that is right. My briefing
suggests that it is not and that the 2008 Act requires the CQC to
report each year, laying its reports before Parliament on the provision
of adult social care. However, I will write to the hon. Gentleman to
confirm that, if he would find it reassuring. If I have not responded
to any of his other points, I will write to him on those as
well. 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.
Resolved,
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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