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Lord Hunt of Kings Heath: I have been rather surprised by the suggestion that quality is not at the forefront of all the department's thinking in its strategic leadership for the health service. That is why we have set up so many of the bodies that the noble Baroness, Lady Noakes, referred to earlier, such as the National Patient Safety Agency and the Commission for Health Improvement and various other mechanisms. One of the Government's key aims, through the department, has been to improve the overall quality, safety and standard of services to the public.
Section 18 of the 1999 Act came up with the duty of quality to rectify an anomaly that had existed in the NHS for far too long. Although there were financial duties on NHS organisations, before 1999 Act there was no statutory duty on the NHS relating to the quality of the patient care that it provided. That is but one action that we have taken to improve quality generally in the health service. The department has set and implemented an integrated programme of measures to monitor and improve the quality of the healthcare provided by the NHS, as set out in A First Class Service in 1998, strengthened in the NHS Plan in 2000 and taken further still through the recent listening exercise involving patients and the public in healthcare. It is why we also established the quality taskforce in the department, under the co-chairmanship of the Chief Medical Officer and the Chief Nursing Officer. Quality permeates all the department's thinking and policy development. The noble Earl, Lord Howe, has debated waiting lists with me on a number of occasions. He will know that we have made it abundantly clear to the health service that, in meeting waiting list targets, clinical priorities must always come first.
On the duty of quality and the issues that the noble Baroness has raised, surely we need to go back to
Section 1 of the 1977 Act, which in large part replicates the original 1946 Act, setting out the key aim of the health service. It states:
- "It is the Secretary of State's duty to continue the promotion in England and Wales of a comprehensive health service designed to secure improvement—
- a) in the physical and mental health of the people of those countries, and
- b) in the prevention, diagnosis and treatment of illness,
- and for that purpose to provide or secure the effective provision of services in accordance with this Act".
As for Amendment No. 93, the risk seems to be that it would get in the way of the Department of Health's accountability, via Ministers, to Parliament on all aspects of securing healthcare for those who need it. My experience of the past three years is that Department of Health Ministers are very accountable to Parliament. When I think of the number of Parliamentary Questions answered daily, the number of debates in your Lordships' House, the vigour of the Select Committee hearings that I have attended, I am absolutely certain that Parliament has endless opportunities to hold Ministers to account and for Ministers to come to both Houses to explain their own performance.
Although of course I accept that parliamentary scrutiny of a publicly funded NHS is crucially important, I do not believe that the amendment as proposed would help that. I think that, in some ways, it would detract from ministerial accountability to Parliament. Surely our parliamentary democracy must rest on that direct line of accountability.
Baroness Northover: I thank the Minister for that reply, and the noble Earl, Lord Howe, for his very detailed support. The Minister's comments seemed to bear out some of what I was saying. He referred to the original 1946 Act and also to the 1977 Act, and yet, in the 1999 Act, it was felt necessary, despite that previous legislation, to establish a duty of quality. As the noble Earl pointed out, it is very striking that it includes health authorities, primary care trusts and so on, but does not include the Department of Health, which established the duty. It seems a trifle odd that the department should not be included.
Lord Hunt of Kings Heath: The department's overriding responsibility was enshrined in the 1946 Act and confirmed in the 1977 Act. The duty of quality was established for NHS organisations because, as experience has shown, discussions in the boards of NHS organisations revolved primarily around management, finance and human resource issues but only very rarely touched on quality issues. Consequently, the specific duty of quality was introduced. In its reviews of clinical governance, CHI has focused particularly on the degree to which the
boards of those NHS organisations have addressed clinical governance and quality issues. That is why NHS organisations were dealt with in that way.
Baroness Northover: I thank the Minister for that comment. I should be very interested to see the agendas within the Department of Health, but I do not suppose that they are available. I also wonder whether they include items contributing to the quality debate.
Lord Hunt of Kings Heath: I assure the noble Baroness that quality and patient safety issues are paramount in the many discussions held on the fourth floor of Richmond House. As I said, the Chief Nursing Officer and the Chief Medical Officer—who are very powerful individuals with very distinguished records on quality and safety—are leading our quality programmes. I can therefore assure the noble Baroness that quality is a full part of all our considerations in developing policy and managing performance in the NHS.
Baroness Northover: I thank the Minister for that reply. I would not in any way wish to detract from what has been done in trying to introduce a duty of quality in other parts of the health service. If anything, as I said, I should like that duty to be extended. I shall read what the Minister had to say. Meanwhile, I beg leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Baroness Northover moved Amendment No. 94:
- Page 17, line 31, at end insert "including the provision of accessible information for patients, and monitoring the provisions of health and safety legislation and infection control measures"
The noble Baroness said: This amendment seeks to ensure the provision of accessible information to patients and also the monitoring of health and safety legislation and infection control measures. All those elements are important to the quality of patient care. We should perhaps have dealt with them in separate amendments, but, if we had, it would have made the night even longer.
Clearly it is vitally important that information is accessible not only to parliamentarians but to patients. As we shall undoubtedly hear when we discuss patient complaints, things often go wrong because information is not available. Not only should patients be physically well treated, but their more general welfare should be addressed. Access to information is a part of that.
Health and safety regulations relate particularly to staff, and it is essential that they are properly addressed and assessed. The BMA has concluded, however, that, despite existing legislation and guidance, health and safety are still not universally guaranteed throughout the NHS. The NHS has a responsibility under the Health and Safety at Work etc. Act 1974, and various other regulations on the management of health and safety, to ensure the safety of all employees, contractors, and members of the
public as patients and visitors. Each NHS trust and primary care trust has a statutory duty to provide an environment that is safe,
- "as far as is reasonably practicable",
- "the best available technology not entailing excessive cost".
As part of its inspection process, CHI would be in a prime position to observe whether premises, equipment, practices and procedures in each trust are sufficient to enable best clinical practice. It seems reasonable, therefore, that the Bill should be amended to ensure that that function is covered by CHI.
Although infection has—as Nightingale made clear—always been an issue, it has become a key one in recent years. However, post-antibiotics, there was certainly an optimism that infection was well and truly under control. That optimism has long since passed. Problems such as new variant CJD have introduced areas of concern. It is clearly essential that infection control is properly monitored. One issue which arose in dealing with the problem of disposable instruments, once it became evident that instruments could be a means of infection, was that many hospitals simply did not know which instruments had been used on whom. However, some did know. Clearly, one of CHI's functions should be to spread and encourage best practice. I beg to move.
Earl Howe: I am delighted, once again, to support the noble Baroness, Lady Northover, in this amendment. In reading Subsection 4 of Section 18 of the 1999 Act—again we are hampered by not having the wording fully in front of us—I cannot help thinking that much hinges on the meaning of the word "services". Healthcare is defined in that subsection as,
- "services for or in connection with the prevention, diagnosis or treatment of illness".
- "the provision of accessible information for patients".
I should have thought that, on a strict legal interpretation, that was a service, and that that part of the amendment is therefore unnecessary. If the emphasis is on the word "accessible", again, I should have thought that accessibility was bound up with the notion of quality. However, having uttered that caveat, I have much sympathy with the suggestion that those words should be included. It is not so very long ago that patients were expected to accept the treatment they were offered by doctors and be grateful for it. The idea of informing patients about the treatment they were receiving or might receive or about services that they could access was considered somewhat eccentric. So, despite any strict legal interpretations, I am in favour of making this provision explicit, if only as a means of recognising that we are trying to move away from paternalist medicine.
The next part of the amendment has an even stronger claim to our attention. Monitoring the provisions of health and safety legislation and
infection control measures does not seem to me to be a service. However, it is an integral part of being a good employer, as the noble Baroness pointed out, and providing public health services in the broadest sense. As we were informed by the Minister on Monday, much of the monitoring function in the public health context will rest with the PCTs. My only faint worry here is that if we pursue the amendment to its logical end there would be a duty on PCTs and trusts to make arrangements to monitor the quality of monitoring. It is perhaps for discussion what we might understand that to mean.While the duty of quality already extends to monitoring the quality of healthcare, the noble Baroness made a good point in drawing our attention to health and safety requirements—which surely do not constitute healthcare—and measures which might be in place to deliver the public health agenda, which again need not in all cases fall under the heading of healthcare.
9 p.m.
Baroness Masham of Ilton: I support the amendment and, in so doing, ask the Minister who will be in overall charge of infectious control and send out the guidelines to our hospital trusts? With the increase of tuberculosis, it must be a health and safety issue to nurse someone in an open ward. I am sure that the Minister knows of the case of the young girl a few weeks ago who was diagnosed with pneumonia. She had tuberculosis; she was sent home and died. This is an important issue. Such infectious diseases are on the increase.
Can the Minister tell us the position regarding matrons? We were promised matrons. I believe that someone has been appointed in Birmingham. Matrons have much to do with cleanliness, which concerns the importance of the amendment.
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