Clause 15 - Code of practice: improvement notices
Health Bill
9:45 am
Steve Webb (Shadow Secretary of State for Health, Health; Northavon, Liberal Democrat)
I beg to move amendment No. 103, in clause 15, page 11, line 30, at end insert
‘and
(d)specify what sanctions will be applied if the healthcare body fails to comply with the improvement notice.’.
As the Minister hinted, clause 15 deals with the issuance of improvement notices where problems are identified. Amendment No. 103 is intended to probe what sanctions would be imposed if a health care institution failed effectively to tackle health care-acquired infections.
There have been various noises from the Government about the nature of the sanctions. At one stage, it was suggested that there might be criminal sanctions—legal action—against people at the top of hospital boards, but that seems to have gone. It would interesting to hear the Minister clarify the basis on which the Government rejected that suggestion. I am sceptical about whether it would have been a good idea.
I want to draw the Committee’s attention to remarks made by the chief medical officer, who said as recently as December 2003 that, despite all the guidance that had been issued to the NHS, there had been little improvement in tackling health care-acquired infections. The chief medical officer lists a number of aspects of the problem, one of which is that
“evidence-based countermeasures of known effectiveness are not being implemented consistently or rigorously in the majority of hospitals.”
People understand that such things are serious. We have heard the figure of 5,000 fatalities a year mentioned, although I gather that that is out-of-date and based on overseas information. Perhaps the Minister will confirm her latest estimates. Perhaps effective things can be done, but are being done only sporadically, not systematically; the point of a code of practice and an improvement notice is to try to tackle that problem. However, we all respond best to incentives. Our amendment says that the improvement notice ought to contain some indication of what will happen if the notice is not acted on.
On reading the Bill, and linking it to the Health and Social Care (Community Health and Standards) Act 2003, I found some indication of what might happen and what the ultimate sanctions would be, but I hope that the Minister can flesh that out in a number of respects. What time line does she anticipate between an infection problem arising in one department, for example, and the Healthcare Commission picking it up and giving the trust some time to do something about it before getting into the formalities of improvement notices?
When is the improvement notice issued, and how long does the Minister envisage the trust being given to sort things out? Will she just give us an indication? The worry is that I cannot see any indication of the time scales about which we are talking. Clearly, these things need to be tackled urgently, if people are dying because of failures of process. It is important that there is some indication, not merely of how long it will take, but what will happen if things are not done by a certain deadline.
The concept of a sanction is not ours; it came from the Secretary of State, who said in the debate in the House on 24 May 2005 that the Bill
“will establish a statutory code of practice, improved inspection arrangements and”—
this is the critical bit—
“as a last resort, appropriate sanctions in the both the NHS and the independent sector”. [Official Report, 24 May 2005; Vol. 434, c. 574.]
Unless our amendment is agreed, it is not clear whether those improvement notices will be explicit about the sanctions. They may say, “We expect certain things to be done”, but it is not clear whether they will say, “by a certain time” or, simply, “they must be done”.
We have talked about eventually sacking the board, or bringing somebody else in. There is talk in the guidance notes of possibly bringing in the infection control manager from another trust. We are interested in getting the infection sorted out, which has to be the priority. As the hon. Member for Westbury said, we are interested not in a blame culture, but in effective action. I am concerned that hospitals and trusts are under so much pressure from central Government, with a panoply of targets, benchmarks and league tables, and all the rest of it.
Those of us who are under pressure often react to the one who shouts the loudest. If the infection control improvement notice is not up front and explicit about sanctions, perhaps some of the other pressures will be more powerful. For example, if there is a conflict between targets on waiting times and infection, and an infection control manager says “Shut the ward; it’s the only way to deal with things”, will the trust weigh the relative penalty for failure on either front and work out which is the most serious? If the improvement notice has no indication of a clear sanction, and the trust is unafraid of the consequences of not dealing with it compared with the implications of going down in the legal table or facing a penalty for not meeting another Government target, they might not make infection control the priority, which we believe is vital.
I have one other observation: I get a sense that part of the sanction mechanism is almost naming and shaming; it is about reputation, perhaps gained or lost formally through the league tables. I presume that I will know if my local trust is served with an infection control improvement notice, and perhaps the Minister will confirm that it will be made public. There are arguments on both sides of that debate. Perhaps merely the fact that people’s professional colleagues, patients and, I suppose in the NHS these days, business units know what is going on will, in itself, be an incentive, but there needs to be more than that.
I hope that the Minister will confirm that the stick as well as the carrot will be used. She must tell us the time scale for the implementation of the enforcement and improvement notices and ensure that because of how they are implemented trusts will take them very seriously.