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Lord Hunt of Kings Heath: My Lords, the risk assessment report will be published soon. Noble Lords will be glad to know that it will also be available on the Department of Health's website. The noble Lord is right to say that at its meeting last November SEAC welcomed the overall risk reduction strategy. Indeed, it also welcomed the advances that are being made with regard to decontamination, which plays an important part in the way in which we deal with these issues. It endorsed the concept of using tonsils in a pilot scheme to see how single instrument use would work in practice. However, the noble Lord is right. There are other procedures, particularly in relation to brain and posterior eye surgery, where single instrument use may need to be considered. We are committed to working with and talking to the profession about the practicalities of that.
Lord Winston: My Lords, is the Minister aware of any evidence which shows that disposable instruments are better than or preferable to instruments which are properly cleaned and denuded of all protein during the cleaning process before sterilisation?
Lord Hunt of Kings Heath: My Lords, the risk assessment programme carried out by SEAC certainly made the point that the first line of attack must be to ensure that proper decontamination processes are in place. The issue of single instrument use must be considered as a second line of attack. It is important
that hospital decontamination procedures are right. That is why the Government have authorised expenditure of £200 million over two years and why we are putting into place a strong performance management approach to decontamination. That is where we need to focus many of our efforts.
Baroness Gardner of Parkes: My Lords, is the Minister able to confirm the figures published in a paper which says that civil servants have calculated the cost of introducing disposable instruments at £630 million a year? If abdominal surgery were to be included, that figure would reach over £2 billion--that is, 4 per cent of the national health budget. Therefore, does the Minister agree that it is particularly important to move ahead with the halted programme of research into whether instruments can transfer infection? Will he confirm that £30 million has been set aside by the Government for that research, which was agreed two years ago but then halted? When will that programme of research start?
Lord Hunt of Kings Heath: My Lords, with regard to the research programme, we are funding a portfolio of research projects in relation to the decontamination of surgical instruments. That funding totals more than £3 million. The programme is being overseen by a Department of Health steering group. Of course, I agree with the noble Baroness that it is important that the research is developed as speedily as possible. So far as concerns the overall costs suggested by the noble Baroness, the cost of single-use instruments for tonsils is estimated at £25 million per year. If we were to consider back-of-the-eye procedures, the cost would be between approximately £450 million and £500 million.
Baroness Masham of Ilton: My Lords, does my noble friend agree that CJD is particularly difficult to deal with because it is a prion, which makes it impossible to disinfect surgical instruments?
Lord Hunt of Kings Heath: My Lords, yes. SEAC concluded that tonsillectomies should be chosen for specific attention because prions have been found in the tonsil tissue of people who died of variant CJD. Moreover, most tonsil surgery is carried out on children, who have their lives ahead of them. It was on the basis of the SEAC risk assessment that the decision was made to phase in single-use instruments in relation to tonsils.
Lord Swinfen: My Lords, the Minister's answer seems to indicate that instruments are not being properly cleaned or sterilised in some hospitals, which could lead to the passing on of diseases other than CJD. What steps are the Government taking to ensure that all surgical instruments are properly cleaned and sterilised?
Lord Hunt of Kings Heath: My Lords, the noble Lord is right--concerns have been expressed about the standards of decontamination procedures in
our hospitals. That is why the Government announced a £200 million programme to modernise decontamination and sterilisation procedures. We have issued a circular to the NHS emphasising the importance of its urgently reviewing its management arrangements and the need to carry out a health and safety audit. We have appointed a high-level support team to go into individual trusts to help them to get right their decontamination procedures. We want new training programmes to be established to reinforce those points. We take this matter very seriously.Prison Sentences
3.22 p.m.
Lord Hooson asked Her Majesty's Government:
- What is their response to the recent lecture by the Lord Chief Justice to the Prison Reform Trust on ways to reduce the number of people sent to prison.
The Parliamentary Under-Secretary of State, Home Office (Lord Bassam of Brighton): My Lords, the Lord Chief Justice put the case for reduced reliance on short-term prison sentences and for increased use of community penalties. The Government believe that, although many offenders can be effectively punished in the community, prison is the right response for serious and dangerous offenders. In the case of persistent offenders, short-term prison sentences may be appropriate where community sentences have been shown to be ineffective.
Lord Hooson: My Lords, although I thank the Minister for that Answer, does he appreciate that that is an inadequate way to deal with a lecture by this country's foremost criminal judge, who has particular knowledge of prison conditions following his Strangeways inquiry 10 years ago? Is the Minister inviting a considered and careful response from the Home Secretary? Is it not important to do so from the public's point of view? The Minister will know from yesterday's Question Time of the bad conditions in prisons. They are caused by too many prisoners being sent to prison and by the fact that accommodation is not available. Everyone is adversely affected, including prison staff and prisoners. The whole outlook of this country is gradually being changed by the constant demand in the media for longer prison sentences. What is the Government's response to that?
Lord Bassam of Brighton: My Lords, I have the greatest respect for the Lord Chief Justice, as does my right honourable friend the Home Secretary. We obviously believe that prisons are an appropriate place to send those who are sentenced when the offences are serious and persistent and, in particular, when violent or sexual offences are involved. That is how we use prisons; our policies are clear and firm.
On the noble Lord's general comments on prisons, of course there are bad examples of bad prisons. In the main, however, we are confident that the Prison
Service is doing a first-rate job, and it should be supported in that regard. For every negative report on prisons and the Prison Service, there are many positive reports.
Lord Acton: My Lords, is my noble friend aware that the noble and learned Lord said in his lecture:
- "There should be a Board responsible for women in the criminal justice system. Its responsibilities in relation to women should be similar to that of the Youth Justice Board. It should regard its primary responsibility to be to contain the growth of the women prison population"?
Lord Bassam of Brighton: My Lords, I am most grateful to my noble friend for that thoughtful question. The Lord Chief Justice's suggestion is very helpful and it reflects well on the work of the Youth Justice Board. We shall obviously consider the matter in the most positive light and give it very careful consideration.
Lord Ackner: My Lords, I have two questions for the Minister. First, do the Government accept that the single most corrosive element in the Prison Service is that of overcrowding? That means that the programmes that are designed to reduce the reconviction rate and to prevent re-offending are neglected. Secondly, do the Government agree with the observation that was made by the Lord Chief Justice towards the end of his lecture? He said:
- "What would have a greater effect on overcrowding than anything that I can propose would be an announcement by the Government that it fully accepts the damaging effects of prison overcrowding and that it attaches highest priority to eliminating this problem".
Lord Bassam of Brighton: My Lords, I certainly agree that overcrowding is undesirable. The Government's policy is directed towards reducing it as much as possible. The situation that persisted in the early 1990s, in which many prisoners occupied cells that contained three prisoners, no longer obtains. We no longer have trebling but, sadly, we do have doubling. I inform your Lordships' House that, as of November last year, some 10,000 prisoners were held two to a cell in cells that were designed for one. We have brought the figures down, and our building programme is designed to tackle overcrowding. We no longer have the 30 per cent overcrowding that persisted in 1990-91. Investment in the Prison Service and in expanding the prison estate has begun to tackle that problem. Overcrowding is a government priority, and we are determined to tackle the problem.
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