Health Bill

These always creep in, my Lords. I hope that the House will respect the vote—indeed, it was a free vote—in favour of extending the smoke-free provisions to both licensed premises and private membership clubs. I believe the comprehensive smoke-free legislation that the House will now consider was not just the best outcome in public health terms but also the best outcome in terms of representing the strong public support there is for a total ban. A December 2005 opinion poll commissioned by Cancer Research UK and the public health charity ASH revealed that over 70 per cent of respondents supported a total ban on smoking in public places and workplaces. Noble Lords will no doubt also be aware of the strong support the full ban has with those who see at first hand the harm that smoking causes. For example, Professor Dame Carol Black, president of the Royal College of Physicians, said:"““The ban will lead to up to a million people quitting smoking and in the long term thousands of lives will be saved.  The UK now recognises smoking as one of our greatest avoidable threats to health and accepts the need to manage it effectively.  There are still more measures to be taken and we urge the Government to continue along the path of effective tobacco control.  We shall be with them at every step””." The BMA’s head of ethics, Dr Vivienne Nathanson, said:"““Every day around 30 people die in the UK as a result of second hand smoke. Yesterday’s vote will mean the beginning of the end to these frightening statistics””." Professor Alex Markham, Cancer Research UK, said:"““This is the most important advance in public health since Sir Richard Doll identified that smoking causes lung cancer 50 years ago””." Lastly, I quote Mr Peter Cardy, the chief executive of Macmillan Cancer Relief, who said:"““We are delighted that Parliament has seen sense and has taken the single most effective step it can to cut horrible, painful lung cancer deaths. As Macmillan Cancer Relief knows only too well, smoking and passive smoking cause nine out of 10 lung cancers. This move will, quite rightly, protect the health of staff working in pubs and membership clubs as well as their patrons””." This is truly an important and historic Bill. Through the smoke-free provisions, thousands of lives will be saved every year and many thousands more people will be spared the misery of watching friends and family die prematurely. Hundreds of thousands of people will be helped to give up smoking and to take back control of their own health. And millions more will be protected from the dangers of second-hand smoke in virtually all enclosed public places. Before moving on to the other important provisions in this Bill, I turn briefly to Chapter 2 of Part 1 of the Bill. Here, we have taken a power to enable us to raise the minimum age for sale of tobacco products through secondary legislation. On 8 December 2005, my colleague, Caroline Flint, the Under-Secretary of State for Public Health, announced the Government’s plans to hold a full public consultation on whether the age for sale of tobacco products to children and young persons should be raised from the current minimum age of 16. However, discussion of this issue in the other place during the passage of the Bill revealed cross-party support for the Government taking a power now, in the Health Bill, to enable the minimum age to be raised through secondary legislation at a future point. This will enable the Government to take swift action should change be deemed desirable in the light of the consultation without the need for further primary legislation. This consultation will begin shortly. Part 2 of the Bill reinforces the measures that we have taken to tackle healthcare-associated infections. I know that this issue remains a key public concern and patients quite rightly expect to be treated in a clean and safe environment. Not all of these infections can be prevented, but minimising healthcare-associated infections is a top priority. That is why we have set a target to halve MRSA bloodstream infections by 2008. We were the first government to require surveillance for MRSA and we are using this data to help drive down infection rates. These actions are beginning to have an effect and some specialist hospitals have shown particular progress. But we are not complacent. The provisions in this Bill build on the progress to date and will further sharpen the focus on infection control in the following ways. First, the new provisions will enable the Secretary of State to issue a code of practice on healthcare-associated infections which will be legally binding on any English NHS body. The code is based on existing best practice, and a draft was well received when it was consulted on earlier this year. Copies of the latest version of the draft code are in the Library. Secondly, we will back this up by giving the Healthcare Commission new duties to ensure that the relevant NHS bodies observe the code. Thirdly, where the commission feels the code is not being properly observed, it will have the power to serve an improvement notice where it judges that this is the most appropriate course of action. Finally, if there are significant failings in the provision of health care involving performance against the code, the commission will be under a duty to report this to the Secretary of State, and to monitor in the case of NHS foundation trusts. The commission may recommend that we take special measures to remedy the situation. The measures we decide to take in response to a report could range from practical assistance, such as drawing on the support of a trust that has successfully implemented the code, to more formal intervention at board level. The provisions in the Bill will build on existing good work to give a firm statutory footing to good practice in infection control and hygiene practice in the NHS. We will have clearer direction and tough sanctions for trusts that fail to deliver. I am confident that the code and the new powers for the Healthcare Commission will ensure that patients receive the quality of care in this important area that they rightly expect. I note that the Opposition health spokesman in another place, Andrew Lansley, emphasised at Third Reading the necessity for the measures described in the code. Part 3 of the Bill deals with drugs, medicines and pharmacies. This includes provisions to strengthen the management of controlled drugs throughout the UK, in response to some of the shortcomings identified by Dame Janet Smith in the Shipman inquiry’s fourth report. Many improvements in clinical governance have already taken place since Shipman was practising, but this legislation will bring a greater focus to the management of controlled drugs in particular. The Bill gives every healthcare body a duty to appoint an ““accountable officer”” to take personal responsibility for the use of controlled drugs within that organisation. There will also be a new duty on all NHS bodies and relevant local organisations to share intelligence and agree joint action where there are concerns about the misuse of controlled drugs. I am confident that this legislation will strengthen the safeguards against that very small minority who would divert these drugs for personal abuse, financial gain or, in a few rare but extreme cases, criminal purposes. The remainder of Part 3 and Chapter 1 of Part 4 of the Bill deal with pharmacies. It has long been recognised that we are not making best use of the pharmacy workforce, particularly in community pharmacy. To address this, the provisions in this Bill will free pharmacists throughout the UK from the dispensing bench so they can expand the range of services that can be provided from the pharmacy. There are services that can add real value to the health of the community, such as advice on smoking cessation or medicines-use reviews for patients with long-term conditions. And we know from our ““Your Health, Your Care, Your Say”” consultation just how well regarded our community pharmacists are, and that many people really appreciate the advice and help pharmacists can give. At the same time as freeing up the pharmacists, we are also reforming the entry requirements for the provision of pharmacy services across England and Wales. The Bill implements the final elements of a balanced package of reforms for England in response to the Office of Fair Trading’s 2003 report on the restrictions on NHS pharmacy applications known as ““control of entry””. I read with interest the debate in the other place on the ophthalmic provisions in this Bill. Quite rightly, there was acknowledgement that we have some of the best ophthalmic services in the world. But there was some concern and misunderstanding that the provisions in this Bill are seeking to tamper with this excellent service. This is not the case. What we are seeking to do is remove restrictions on whom PCTs can contract with to provide the sight-testing service to reflect the reality of service provision and help to facilitate market entry. Secondly, the new framework for ophthalmic services will also permit the commissioning of enhanced services or additional services—the type of services that are often available only in the less convenient secondary care setting, but doing this within the community setting. That is what our review of ophthalmic services is looking at: how we can make better use of the skills and resources in the primary care setting. The provisions in this Bill simply provide a new framework for such services to be provided. While PCTs have some powers to commission enhanced services, we think that a more coherent and flexible framework, such as that used for other primary care services, will support that activity and help PCTs to deliver better care for patients. In particular, there will be powers to require the provision of additional ophthalmic services across England. The new framework clearly provides opportunities for primary ophthalmic providers to provide a much wider range of services. Currently, the 1977 Act provides only for the commissioning of the sight-testing service. I know that there are been concerns about whether the new framework will mean that we move away from the current nationally negotiated contract and central funding arrangements for the sight test. On that point, I reiterate what my colleague, Caroline Flint, said in the other place. We have no intentions to move away from how the sight-testing service currently operates; in other words, patients will be able to choose their general ophthalmic services contractor and contractors will be able to have a general ophthalmic services contract, provided that they meet agreed national criteria, subject, as now, to local decisions on matters such as quality of service. We also plan to continue to have a centrally negotiated and funded sight-test fee with access to sight tests not being constrained by individual PCT budgets. These provisions will help PCTs to deliver better outcomes, more choice and even more convenient ophthalmic services for patients, and provide a real opportunity for providers of primary ophthalmic services. I turn to the protection of the NHS from fraud. The Bill will give the NHS Counter Fraud and Security Management Service modest new powers to continue to fight fraud in the NHS and to make it a safer place to work. The counter-fraud service has been highly successful in ensuring that money provided for provision of healthcare services in the NHS is spent as intended and not lost to fraud. By the end of the last financial year, it had produced a financial benefit of £675 million, which represents a 13 to one return on its total budget since 1999. Its role in deterring fraud is considerable. The new provisions in the Bill will simply enable the counter-fraud service to require the production of documents relating to specific investigations, such as asking for the pay records and duty roster of a private care home when an NHS employee has been working while also claiming sick leave from an NHS trust. It will not include powers of entry, search, seizure or arrest. In that respect, the counter-fraud service will continue to be supported by the police. The last substantive part of the Bill is Part 5, which will establish a new non-departmental public body, the appointments commission, to replace the current NHS Appointments Commission. These provisions respond to the Public Administration Committee report in 2003 on Government by Appointment. The committee found that the NHS Appointments Commission was working well and that other government departments could benefit from using its services. This Bill provides the legal framework to do just that and reconfirms our commitment to an independent appointments process. There are also a number of minor and technical provisions in the Bill relating to the administration of the social care bursary scheme; the audit arrangements for special health authorities; the injury cost recovery scheme in the NHS; the transfer of criminal liability in the NHS; and provisions to remove out-of-date references to Welsh health authorities. I shall not go into any further details here. In conclusion, this is an important and wide-ranging Bill that will have a tangible impact on the health of the public both inside and outside the hospital setting. It will remove tobacco smoke from virtually all the country’s enclosed workspaces, leading to an estimated 600,000 fewer smokers, more lives saved, and up to £100 million per year in savings to the NHS. It will better protect patients from healthcare-associated infections; modernise the provision of pharmacy services, ensuring we make best use of pharmacists’ skills; give our counter-fraud service enhanced powers to target those who defraud the NHS; and it will make a number of technical changes to improve the working aspects of health and social care. I commend the Bill to the House. Moved, That the Bill be now read a second time.—(Lord Warner.)