Health Bill

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Standing Committee E

Thursday 15 December 2005

(Afternoon)

The Committee consisted of the following Members:

Chairmen: Mr. Eric Illsley, Ann Winterton, †Mr. Martin Caton

†Blunt, Mr. Crispin (Reigate) (Con)

†Butler, Ms Dawn (Brent, South) (Lab)

†Dorries, Mrs. Nadine (Mid-Bedfordshire) (Con)

Engel, Natascha (North-East Derbyshire) (Lab)

†Ennis, Jeff (Barnsley, East and Mexborough) (Lab)

†Flint, Caroline (Parliamentary Under-Secretary of State for Health)

†Hodgson, Mrs. Sharon (Gateshead, East and Washington, West) (Lab)

†Joyce, Mr. Eric (Falkirk) (Lab)

†Kennedy, Jane (Minister of State, Department of Health)

†Kidney, Mr. David (Stafford) (Lab)

†Lansley, Mr. Andrew (South Cambridgeshire) (Con)

†Merron, Gillian (Lord Commissioner of Her Majesty's Treasury)

†Murrison, Dr. Andrew (Westbury) (Con)

†Reed, Mr. Jamie (Copeland) (Lab)

†Webb, Steve (Northavon) (LD)

†Williams, Stephen (Bristol, West) (LD)

†Young, Sir George (North-West Hampshire) (Con)

John Benger, Gordon Clarke, Committee Clerks

†attended the Committee

[Mr. Martin Caton in the Chair]

Health Bill

Clause 13

Code of practice relating to health care associated infections

Amendment proposed [this day]: No. 104, in clause 13, page 8, line 7, leave out 'may' and insert 'shall'.—[Dr. Murrison.]

1.5 pm

Question again proposed, That the amendment be made.

The Minister of State, Department of Health (Jane Kennedy): Thank you, Mr. Caton, and welcome to our deliberations. I propose to consider the suggestion that was made by the hon. Members for Northavon (Steve Webb) and for Westbury (Dr. Murrison) that there is not much in the Bill for hon. Members to get their teeth into and that it does not say much. They seemed to question its purpose. I reiterate that the draft code was made available and I draw the Committee's attention to the fact that in July we published the ''Action on Health Care Associated Infections in England'' document, which set out the overall strategy, bringing together all the different initiatives, including the ''Clean Your Hands'' campaign and the target of reducing the number of MRSA bacteremia. It pulls together in one sensible strategy many different facets of announcements that have been made.

Mrs. Nadine Dorries (Mid-Bedfordshire) (Con): In the document to which the Minister refers, the Secretary of State says that the draft code of practice builds on what has been done already, yet in ''Winning Ways'', the chief medical officer says:

''What will not work is simply continuing with the present style of implementation, which has failed to deliver results''.

The Secretary of State is saying that she wants to build on what the chief medical officer says has failed. Will the Minister clarify why the draft code of practice should build on what has already failed?

Jane Kennedy: The final code of practice will lay down a standard that the Healthcare Commission will be able to use to inspect all hospitals and health care providers. Putting the code into the Bill will give statutory force to much previous guidance. That is why the draft code of practice, which was published in the July document, states:

''The purpose of this Code of Practice is to set out criteria by which all levels of management in NHS Bodies should ensure that patients are cared for in a clean environment, where the risk of HCAI is kept as low as possible.''

That will be absolutely clear. I reiterate that all the different strategies, including the ''Clean Your Hands'' campaign, are being pulled together to ensure that those who are in charge of providing care can be measured to that standard by the Healthcare
 
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Commission through ongoing inspections. Today's report was a one-off snapshot—as it was described—of that process. The intention is quite clear; the code will give statutory force to what we propose.

Mr. Andrew Lansley (South Cambridgeshire) (Con): Will the Minister confirm that the first occasion on which a code of this kind was raised in the Department was October 2004? I recall, as will my right hon. Friend the Member for North-West Hampshire (Sir George Young), the Secretary of State being given powers in the Health and Social Care (Community Health and Standards) Act 2003 to specify standards. Why was that not used to encapsulate the codes of practice? If it was desirable to do that and the Department was discussing it, why was it not done then? That would clearly have given statutory backing to the code and would have directly informed the Healthcare Commission's subsequent publication of standards that have to be met generally, rather than this being added on afterwards.

Jane Kennedy: Either way, we would have required a legislative vehicle. This is the first such vehicle with which we have the opportunity to create the statutory environment within which the code will operate.

Mr. Lansley: What the Minister says is just plain wrong. I served on the Standing Committee that considered the Health and Social Care (Community Health and Standards) Bill, so I know that it contained a measure that specifically gave the Secretary of State the power to set standards for the NHS and did not say that the Secretary of State is constrained from publishing those standards in the form of a code of practice. In fact, that has been done through the mechanism of endorsing the standards framework set out by the Healthcare Commission, but it was perfectly possible to use the power in the 2003 Act.

Jane Kennedy: That may well have been the case, but we believed at that time that that was not the appropriate way to do it.

Mr. Lansley: Why?

Jane Kennedy: I will want to look back at what was said and at what the considerations were in order to be able to give a more detailed answer on the dates and times. Since I took up my post in May, tackling health care-acquired infection has been one of our priorities. I was keen to ensure that we got a draft code into the public domain as soon as possible so that we could have wide consultation on the measures and standards against which hospitals should be judged when it comes to the codes of cleanliness and hygiene that the Bill establishes.

The Committee will not be surprised to hear that we want Members to resist amendment No. 104. It would serve no practical purpose since it only obliges the Government to do what we clearly intend to do anyway, so that there is no need for such a code. The architecture that we are using is not new or something that we have thought up; we have tried this route before. The hon. Member for South Cambridgeshire (Mr. Lansley) referred to the 2003 Act, and we are building on the process of establishing the standards in that Act. We have followed the model that permits rather than obliges the Secretary of State to publish
 
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standards. We are proposing an effective set of statutory obligations that can be linked to the need to take action. We should not impose a duty on the Secretary of State that may not in future be necessary or useful. I would have thought that the Conservative Members would not be blind to that argument.

Mr. Lansley: Now we are hearing more of an answer to my previous question. Will the Minister admit to the Committee that the reason why we have a code of practice in the legislation is that a code of practice with which sanctions to the extent of criminal liability would be associated was originally intended, and Ministers subsequently decided not to include such sanctions but were already committed to a code of practice? In reality, the code of practice that we have in front of us is and was capable of being implemented under the 2003 legislation.

Jane Kennedy: The hon. Gentleman may well have a point with his last remark; I certainly was interested in the debate about whether it was necessary to apply criminal sanctions where there was a significant failure. On reflection, given the responses that we have had and after listening to what those in the national health service were saying, and given the powers of the Healthcare Commission, my view was that it was better not to make a criminal sanction available. We believe that giving the commission extra powers to measure against a statutory code is satisfactory.

Mrs. Dorries: The sanctions that the Minister is describing are weak, are they not? The most severe sanction that can be imposed is the suspension of a board. [Interruption.] Well, I am not sure whether suspending a board will make a hospital any cleaner. Modern matrons were given a charter some time ago under which they can withhold payments from cleaning contractors, which is far more effective than suspending a member of a trust board or the board itself. If a charter that gives modern matrons the right to suspend cleaners' payments has not worked, how on earth will suspending an individual work?

Jane Kennedy: I think that the hon. Lady is absolutely wrong. The sanctions that the Healthcare Commission has are extremely severe. The threat of removing the whole board of management of a hospital is very serious and focuses the minds of those who serve on NHS trust boards. In the first instance, that is what we are considering, and I believe that that is sufficient sanction. Also, I was persuaded by the argument that we would be criminalising system failure. It is difficult to prove criminal liability in such a case, because it is hard to demonstrate that one individual is criminally liable if a whole institution is failing.

1.15 pm

We recognise, as do those in charge, chief executives and trust boards, that the onus needs to be at the highest level—on those who are responsible for the running of hospitals—to ensure that they are focused and that they make a member of their board responsible for overseeing the code and for taking seriously other factors affecting health care-acquired infections.
 
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Prepared 15 December 2005