Stephen O'Brien (Shadow Minister, Health; Eddisbury, Conservative)

I beg to move amendment No. 17, in clause 17, page 8, line 41, leave out ‘may’ and insert ‘shall’.

Derek Conway (Old Bexley & Sidcup, Conservative)

With this it will be convenient to discuss the following amendments: No. 18, in clause 17, page 9, line 3, at end insert—

‘(2A) The code of practice must make reference to—

(a) screening for admissions,

(b) bed occupancy, and

(c) the frequency and extent of cleaning in healthcare premises.’.

No. 19, in clause 17, page 9, line 7, at end add—

‘(3A) The Secretary of State shall publish each revision of the code.’.

No. 20, in clause 17, page 9, line 7, at end add—

‘(3A) The Secretary of State shall report to Parliament in respect of those cases where—

(a) regulations made under section 16 are breached, and

(b) the Code of Practice under this section is breached.’.

No. 21, in clause 18, page 9, line 13, at end insert—

‘(c) lay the draft code before Parliament.’.

Stephen O'Brien (Shadow Minister, Health; Eddisbury, Conservative)

Sandra Gidley (Shadow Minister, Health; Romsey, Liberal Democrat)

I understand the motivation behind these well-intentioned amendments. I want to query a few points on amendment No. 18 because it attempts to detail what should go into the Bill. I have some concerns about the list, not because of what is in it but because of what is not. I do not believe that the list is comprehensive. For example, new paragraph (c) refers to the frequency and extent of cleaning in health care premises, but there is no mention of personal hygiene standards or the responsibility of the individual health care workers or even the antibiotic policy which, if we are talking about C. difficile, is just as important, if not more so, as cleanliness. At the moment, I feel that if those aspects are in the Bill, undue emphasis could be placed on the procedures and processes outlined in new paragraph (c), and we might not be able to tackle the overall picture. With the emerging nature of resistant infections, situations may arise which require a change in practice. We need to retain some flexibility so that we can face existing and future challenges.

Stephen O'Brien (Shadow Minister, Health; Eddisbury, Conservative)

I accept the hon. Lady’s fair question. In principle, I think that she is very sympathetic to what we are trying to achieve here. It is clear that a Bill that does not contain anything of this nature would look rather weak because it leaves everything for others to decide. It would be far better not to seek to be comprehensive, because things will move on and change. At this stage it is absolutely clear that the three things cited are fundamental and unlikely to change, and therefore, rather than have a comprehensive list, it is important to identify a focus of activity to allow for prioritisation. At the moment, in terms not only of the Bill but of the way in which the Government are dealing with the matter in general, this issue is not sufficiently high on the agenda, and this an attempt to raise it. I accept that the amendment could have been more comprehensive, but the danger of that is that one then ends up trying to include everything, rather than prioritising.

Sandra Gidley (Shadow Minister, Health; Romsey, Liberal Democrat)

I thank the hon. Gentleman for his explanation. I am still not entirely convinced. His timing was impeccable, as I was just about to sit down and draw my remarks to a close.

Ben Bradshaw (Minister of State (Health Services; Minister for the South West), Department of Health; Exeter, Labour)

The hon. Lady is right. As the hon. Gentleman says, it is important that we get these codes right, but as the hon. Lady pointed out, scientific advances and knowledge change continually; we are constantly developing new ways of tackling the challenges, including health care acquired infections. We all hope that some way down the track, if we continue the welcome, significant and sustained fall in health care acquired infections that the Government have achieved in recent years, we will not be worrying so much about this issue, but there may be something else that poses challenges to the health service.

The problem that I have with the amendment tabled by the hon. Gentleman is the same as that expressed by the hon. Lady. The terms of the amendment would place us in a straitjacket, which in the medium and long term could be unhelpful. I expect that it was tabled as a means for having a run-around on some of the Opposition’s old chestnuts about health care acquired infections.

Angela Browning (Deputy Chairman, The Conservative Party; Tiverton & Honiton, Conservative)

Will the Minister give way?

Ben Bradshaw (Minister of State (Health Services; Minister for the South West), Department of Health; Exeter, Labour)

I will give way to the hon. Lady in a second; I just want to put one or two things on the record to correct errors made by the hon. Gentleman. The figure on the deep clean is 80 per cent. of hospitals, and it is already well under way. The £57 million sum for the deep clean is new money for hospitals, out of the £270 million of new money announced in the comprehensive spending review. One example of the unhelpful straitjackets that the amendments would create for the health service concerns bed occupancy rates. As I am sure the hon. Gentleman is aware, the latest research on bed occupancy shows that, although up until 2003-04 there may have been a correlation between high bed occupancy rates and MRSA, since then bed occupancy is “statistically insignificant.” That is a good example of how changes in practices and experience show that putting ourselves in a straitjacket, as the Conservatives are asking us to, could be quite unhelpful. That is true of the guidance and the issues discussed on Tuesday, such as the requirement for the Secretary of State, rather than the independent Healthcare Commission, to report to Parliament about every single little thing that is going on. As the hon. Member for Romsey rightly says, such an approach would mean putting oneself in a rigid system of being required to do things that are no longer important.

Angela Browning (Deputy Chairman, The Conservative Party; Tiverton & Honiton, Conservative)

I am somewhat shocked to hear the Minister use the expression “old chestnut” in respect of hospital-acquired infections. I am a member of the Public Accounts Committee. On two separate occasions, his permanent secretary appeared before it and if he had used that expression to it, he would certainly have been put in his place. The permanent secretary will return to the Committee within the next year on this very subject. It is far too serious a subject for the Minister to describe as an “old chestnut.” He has the option of bringing the contents of the amendment back on Report, redrafted by his officials. If he feels that this issue will disappear in a few years’ time—I hope that he is right—something approaching a sunset clause would be appropriate. In other words, let us put it in the Bill because it is important, not an “old chestnut”, and if in five or 10 years it is no longer regarded as necessary, the wording of a sunset clause would mean that it would die a natural death as the need for it disappeared. This issue is serious, and I hope that the Minister will talk to his permanent secretary about his experience before the Public Accounts Committee. I doubt that he thought that it was an “old chestnut”.

Ben Bradshaw (Minister of State (Health Services; Minister for the South West), Department of Health; Exeter, Labour)

The hon. Lady, inadvertently I am sure, misunderstands my point. I was not saying that the issue of health care acquired infections is an old chestnut—it is an extremely serious issue and that is why it is in the Bill, and why the Government have a £270 million programme to tackle it. It is why I welcome the significant and sustained falls in health care acquired infections that we have achieved in recent years, and I hope that that continues. However, it would be wrong to issue guidelines that are so specific that they are inflexible with regard to the new, independent Care Quality Commission, which we are setting up to help us continue to drive down infection rates.

The “old chestnuts” that I referred to are some of the issues that are regularly raised by the Opposition, based, I believe, on a misunderstanding or an out-of-date understanding of our progress on health care acquired infections. I gave the example of bed occupancy. I am not suggesting for a moment that it is not a serious issue; it is. The Government are tackling it, and we are making welcome progress. There has been a 10 per cent. reduction in MRSA in the last year, a 7 per cent. reduction in C. difficile, and a 32 per cent. reduction in health care acquired infections overall since the base year of 2003-04. I want that progress to continue, but it will not be helped by putting the new independent body into the straitjacket provided by these amendments.

Anne Milton (Shadow Minister, Health; Guildford, Conservative)

I welcome the Minister’s reference to the science, and I would be grateful if he gave us the source of the information about bed-occupancy rates. One of the problems with the treatment of health care acquired infections is that precious little science is used. It will be interesting to see what happens next year—when there will not be £270 million, and when PCTs and trusts will have to make their own decisions on where they spend their money—and whether it is felt that the deep clean was worth it and should be prioritised.

Ben Bradshaw (Minister of State (Health Services; Minister for the South West), Department of Health; Exeter, Labour)

The research that I referred to is a public document published in December—the McCormick report. However, the hon. Lady is absolutely right. I do not want to detain the Committee by going through the entire list of things that have been happening and are happening to help us make this progress, but it is important that we have sustained investment. That is why we welcomed the comprehensive spending review settlement, which is very good as far as our Department is concerned and constitutes a 4 per cent. real increase in spending in the health service for each of the next three years. I am not sure whether the Conservative party is still committed to meeting that spending.

Returning to the substance of the amendments, I do not think that they would be helpful. I understand why they were tabled—to give the Opposition a chance to repeat the inaccuracies that were presented to us on Tuesday—but they would be unhelpful in our efforts to continue the sustained progress.

Stephen O'Brien (Shadow Minister, Health; Eddisbury, Conservative)

I suspect that the rest of the Committee, if they would wipe the smiles of their smug faces, would be equally disturbed and appalled by the Minister’s performance. We could do without smug party points. We are dealing with the deaths of 270 people at Maidstone and Tunbridge Wells that could have been avoided with better procedures. That was a disgraceful performance by the Minister, and I am shocked.

Judy Mallaber (PPS (Rt Hon Baroness Ashton of Upholland, President of the Council (Leader of the House of Lords)), Privy Council Office; Amber Valley, Labour)

Is the hon. Gentleman seriously suggesting that it is disgraceful to try to promote part of what is being done to deal with this very serious issue? Every member of the Committee agrees that is a very serious issue; is it really disgraceful to point out where we have made, and are committed to continuing, improvements, and to put that on the record?

Stephen O'Brien (Shadow Minister, Health; Eddisbury, Conservative)

We all wish to see the best measures to tackle this. What we do not like is the smug approach taken by a Government who know that they have an  inbuilt majority, and who therefore think that the entire procedure of scrutinising the Bill is a waste of time and rather wish that they were not here. Far from it. We are absolutely committed and very sincere about the amendments and we shall be voting on them. This is not a game to get some happy little comments on the record. It is a serious question of trying to get the best performance and prioritisation for dealing with this issue in parliamentary terms. This has become serious because of the tone and attitude of the Minister in responding to a matter of this seriousness. We should recognise, on the record, that that should be repelled.

Richard Burden (Birmingham, Northfield, Labour)

May I clarify the hon. Gentleman’s intentions? If I understood his reply to the hon. Member for Romsey, he acknowledged that his amendments may well be defective.

Stephen O'Brien (Shadow Minister, Health; Eddisbury, Conservative)

Not defective.

Richard Burden (Birmingham, Northfield, Labour)

Ah—so the hon. Gentleman thinks that the list in amendment No. 18 is complete and comprehensive, and that is why he wishes to press it to a Division. If the amendment is defective, he should withdraw it; if it is not, he should press it to a Division. Which is it?

Stephen O'Brien (Shadow Minister, Health; Eddisbury, Conservative)

I am sure that the hon. Gentleman was listening when I responded to the hon. Lady. I said that the purpose of the amendment was not to be comprehensive, but to highlight and prioritise matters on which Parliament must focus.

Of course, the amendment would give flexibility. We have the Report stage and the Bill will be scrutinised in another place, so the Government could recognise that they can tweak it. If they do not tweak it, and if they choose simply to resist and to make the measures generic and unspecific, that raises questions about the prioritisation of, and focus on, the requirement for accountability to Parliament. There should at least be a tie-in with the Public Accounts Committee, as my hon. Friend the Member for Tiverton and Honiton so ably pointed out, so that there is annual scrutiny, not least in the person of the permanent secretary. We need to tie-in the prioritisation of parliamentary accountability rather than relying, as we will under the Bill, on an Executive who seem not to take the measure with the seriousness that it deserves. They seem to think that the intention behind the amendments is partisan point scoring, which it quite patently is not. I rest my case.

Sandra Gidley (Shadow Minister, Health; Romsey, Liberal Democrat)

I think that the hon. Gentleman would be best advised to rethink the matter on Report. I am concerned about unintended consequences. For example, if we are too prescriptive about bed occupancy regulations, we could create a conflict. When a person is in an emergency situation, will a hospital official say, “We cannot accept you because we would be in breach of the bed occupancy regulations”? That person could die not because of MRSA, but because they had to be moved to another hospital. Whatever capacity any Government build into the health system, those situations will arise. The hon. Gentleman must think through all the consequences of the amendment. It is well intentioned, but we need to ensure that the situation I described does not arise.

Stephen O'Brien (Shadow Minister, Health; Eddisbury, Conservative)

I am grateful to the hon. Lady, but the amendment states:

“The code of practice must make reference to”.

So the measure would not be exclusive; rather, the intention is to draw attention to prioritisation. Furthermore, if the science says that bed occupancy rates are indeed leading to MRSA, she cannot surely be suggesting that a hospital should accept a person if that would lead to their getting MRSA. On the contrary, the whole point of the science is that it should be a matter of judgment if someone who should otherwise obviously be accepted into a hospital is almost certain to contract MRSA.

Sandra Gidley (Shadow Minister, Health; Romsey, Liberal Democrat)

Will the hon. Gentleman give way?

Stephen O'Brien (Shadow Minister, Health; Eddisbury, Conservative)

I am not going to give way because the principle at stake in the amendments is clear. They would prioritise what the code of practice refers to. They would not provide an exclusive or comprehensive list, and they would not restrict flexibility, but we do not want the Government to feel that they can simply be trusted to do the right things at the right time, because their track record so far is deeply disappointing.

I am disappointed with the tone and substance of the Minister’s reply, so I shall press the amendment to a Division.