Health Bill

The hon. Gentleman should ask the Department of Health and the Secretary of State about that. The Department published a report that showed that there was no correlation between the contracting-out of cleaning services and the levels of infection. NHS hospitals with contracted-out cleaning are as likely to have high levels of infection as those with in-house cleaning. However, there is a correlation between the quality of cleaning and rates of infection, and that is why I mentioned the model cleaning contract. The code of practice should directly reflect the standards in the model cleaning contract. The Government propose to legislate to transfer the responsibility and budgets for general ophthalmic services to PCTs, which raises three issues. First, why are the Government pre-empting the review of general ophthalmic services that is expected to report shortly? Would it not be more sensible to legislate after the review? It will be difficult, in the circumstances, for people to take seriously the Government’s approach to the review. Secondly, the Secretary of State made the comparison with dental services, but that is exactly what people working in ophthalmic services are afraid of. How many letters of complaint have MPs had in recent years, before the publication of the Bill, about the quality of local ophthalmic services compared with the number of letters about quality of and access to dental services? Those figures tell the story. As with the 2003 legislation, the Government propose to legislate for a transfer of responsibility to primary care trusts. The National Audit Office made it clear that PCTs did not have the expertise to conduct the commissioning of dental services and still less, probably, do they have the expertise to conduct the commissioning of ophthalmic services. What will PCTs do? Under current circumstances, in which—in the last financial year—91 PCTs broke their statutory duty to break even, they will be given an additional budget that they will use to try to offset their overall financial problems. People working in ophthalmic services are rightly worried that the consequence will be a reduction in quality and a reduction in access. From a Government who say that they are about choice, what will we have? A reduction in choice for patients, because it will no longer be true that those who are registered with the General Ophthalmic Council will automatically be able to supply services locally to NHS patients; that may be restricted by primary care trusts in ways that we cannot at the moment even anticipate. Finally, the Secretary of State transferred from the Department of Trade and Industry, where she was previously responsible for competition policy, the issues relating to community pharmacies after the consequences of the review of control of entry regulations. I told her before, in that respect, that one needed to have regard to the health issues associated with maintaining community pharmacies—and I say it again. We should not underestimate the difficulties that might accrue if, in the course of this legislation, we were significantly to shift the balance of advantage towards the large stores with their new pharmacies, which are able to provide a service with relatively limited amounts of professional pharmacy cover. The pharmacists are concerned—and I share their concern—that we strike the right balance in the span of control of pharmacists and the responsibility that they take for the provision of services. At my count, the Bill has nine issues. Perhaps I have not done justice to any of them, but we will do them all justice later in the Bill’s passage. Most of it is a shell, into which regulations are intended to pour decisions. During its passage, we in Parliament should make a few decisions about what goes into it and what happens to our constituents. I hope that we shall do that in a substantive way in respect of smoking by striking out the Government’s partial ban, and I leave it to my colleagues and those across the House, perhaps on a free vote, to determine what goes in its place. I hope that we will get to hard outcomes and clear measures for reducing the impact of health care-associated infections. I hope that we will maintain choice in ophthalmic services, that we will give certainty to pharmacists and protect the profession, and that the Bill, while making progress, will be amended substantially during its passage. On the basis that I hope and expect that the House will amend the Bill, it is not my intention to ask my colleagues to divide against the Bill tonight.