Health Bill

I am never churlish—cross, perhaps, but never churlish. I agree with the Secretary of State that we have engaged in constructive discussion at every stage in the Bill’s progress. That was very true in Committee, where the hon. Member for Barnsley, East and Mexborough (Jeff Ennis) and my right hon. Friend the Member for North-West Hampshire (Sir George Young) rightly pressed for an increase in the age at which tobacco can be purchased. I am delighted that we have moved in that direction. However, even though I have no doubt that another place will respect the decision of the House on a free vote, and with a significant majority at that, it should consider issues relating to smoking including definitions, what additional places will be specified under the legislation, under what circumstances private vehicles might be specified, and whether vehicles used for work are to be included in the smoke-free provisions. Those are important matters, and some valuable work will no doubt be done in another place. We have not discussed specialist tobacconists, but I hope Ministers will understand the desire for them not to be put out of business. I should also mention penalties, which we discussed in Committee. I was not entirely happy with the scale of penalties that the Government proposed. In some respects they have been increased, which the Minister thinks appropriate, but I hope that that will be reconsidered in another place and weighed up relative to other legislative penalties. As our last group of amendments made clear, the nature of the regulatory provisions and how they are to be made is important. In addition to the remarks of my hon. Friend the Member for Westbury (Dr. Murrison), we suggested in Committee that it might be better for the regulations to be made by affirmative procedure in the first instance, rather than by affirmative procedure in every case. Subsequent technical amendments to the regulations could be made by negative procedure, but the initial regulations, which will contain substance as well as technicalities, might well be made on an affirmative basis. We discussed infection control previously and had the opportunity to raise some of the issues on Report and in discussions with the Minister in Committee and elsewhere. The issues are important and intractable. As the Minister will acknowledge, the latest six-monthly MRSA statistics do not show the progress that she and we might have wished. That demonstrates the difficulty of making progress and the necessity for the measures described in the code to be implemented effectively. Isolation facilities must not only be appropriate but must follow a risk assessment. We need to work on the design of hospitals and ensure that the necessary facilities are built in from the outset. Clinical data, which the Minister agreed should be collected by a clinical department, should be used as a performance management tool in hospitals to deliver improved infection control, should be a basis on which health care providers are held to account, and should be used by them better to inform public debate about infection control. One of the central issues that we constantly try to highlight is the distinction between prevalence and incidence. Not all incidents of infection in hospitals are by any means the consequence of infection being contracted in hospital. Distinguishing between the two can make an enormous difference to public understanding. I hope that another place will take a substantial interest in those matters and in model cleaning contracts, nursing uniforms and standards. Committees in another place have done significant work on those aspects in the past, and I hope they will follow it up. We hope that the pharmacy contract will increasingly be implemented innovatively. Only a few weeks ago, we discussed the White Paper and the desire for greater opportunities for people to be screened for disease and to initiate for themselves more checks on their health status. It is perfectly clear that pharmacies can do a great deal in that direction, and the pharmacy contract always allows that. The issue is whether primary care trusts are contracting for such an approach. One aspect that needs to be followed up is not merely legislating or contracting for such possibilities, but ensuring that the structure of commissioning inside primary care trusts with regard to pharmacies allows for them. One issue that we have not had a further opportunity to discuss is the span of control of a pharmacist, and I hope that those in another place will pursue it. The professional confidence that we place in pharmacists is important, and the profession itself attaches considerable importance to that. Many pharmacists do not want to move beyond the rule of one pharmacy, one pharmacist, or if they do, it is only in very exceptional circumstances and it must be delineated. I do not think that we have yet arrived at a point at which it is delineated in the Bill, and I hope that that will be pursued further. On general ophthalmic services, the Secretary of State made it clear that PCTs should pursue the maximum choice consistent with value for money for the Exchequer. That must be true. Many people are wondering precisely what the motivation is for the legislation and what is going wrong in general ophthalmic services that demands such a change. Currently, optometrists and registered opticians can offer services, and patients can use them; they have maximum choice, and there does not seem to be a difficulty with that. If we are to move to a new design, let us ensure that those things continue. Let us ensure that the central funding is clearly set out, either in the legislation or in ministerial commitments for the future, so that the free sight test is available and cannot be compromised by budgetary pressures on individual primary care trusts; that the scope of the sight test can be adapted in line with best clinical practice as we move forward; that optometrists and opticians are able and encouraged to provide sight tests and related tests that not only focus on the basic question of visual field, but go beyond to trying to detect disease to the maximum extent; and that the free sight test itself is not infringed in years to come. We have spent almost three months on the legislation. In many ways, it has ended up where I suspect many of us thought and said it would, although not necessarily as easily as it should have done. Many parts of the Bill are of a nature that commands consensus across the House. On smoking, many of my colleagues object—[Hon. Members: ““Yes.””] I know that they object to what the House has decided, but frankly, it was always our view that the matter was best dealt with on a free vote. Since we have at last come to that and the House has taken a decision on a free vote, for my part, whether or not I agree precisely with the outcome, I think that that is a fair basis for the House to reach its conclusion. I am content for the legislation as a whole to go to another place in its current form, and I hope that it will be further improved there.