Health Bill

My Lords, I declare an interest: I chair St George’s, University of London, I am a trustee of Cancer Research UK, and am involved in a number of health-related organisations and charities through my company, Cumberlege Connections. I start by thanking the Minister for his very clear exposition of this Bill. It is a complicated Bill. He described it as ““diverse””, and I agree. It has something like nine component parts. Sadly much of what is in it is to be left to regulation. Like him, though, I believe there are elements in the Bill that will have a tangible impact on the positive health of the nation, but of course there are other elements that will need robust scrutiny and debate. As is customary in this House, we will seek to amend and improve in weeks to come. Sir George Young, when a junior health Minister, coined the memorable phrase that a decision at the Cabinet table could do more to improve the nation’s health than an incision on the operating table. Yet the Cabinet has had real problems in reaching a decision on smoking. It has been for individual Members of Parliament to decide, and I have no quarrel with that. It is right that in this House we should also have a free vote. It is perhaps surprising that it has taken over 50 years of compelling research to bring Parliament to consider whether smoking should be banned in workplaces. For me the hero in all this has been the remarkable Sir Richard Doll, who sadly died last year. This is neither the time nor the place to laud the great man, but I remember his survey of family doctors when I was a child. My chain-smoking father was a participant. He was so convinced by the results that he quit smoking. He urged his patients to follow suit, but the majority were totally unconvinced, and did not. The medical profession believed the research was so compelling that the public would need no further persuasion; they would be convinced and stop of their own accord. Some did, of course, and the reduction from 45 per cent of the population who smoked in 1974 to today’s rate of 25 per cent is progress, albeit small. What is a concern, however, is the number of teenagers who smoke: 26 per cent, and their number is increasing. Teenagers are not worried by their own mortality, a distant concept, but are obsessed by image, which is of immediate concern. We know that once they have started, it is very hard for people to stop. This Bill, with its emphasis on banning smoking in workplaces, turns smoking from a social activity into an activity for loners—hopefully not a cool image, but one to be rejected by teenagers. Having read the brief from FOREST, I have no doubt there will be a debate on the legitimacy of the science. That is inevitable, and robust questioning is healthy. To my mind, however, the two reports of the Department of Health’s Scientific Committee on Tobacco and Health are overwhelming in both their evidence and conclusions. I am convinced that second-hand smoke kills; ventilation does not work; smoke-free legislation helps reduce smoking prevalence and does not increase smoking in the home; a comprehensive law would reduce health inequalities; private members’ clubs are workplaces too; exemptions discriminate against workers and could lead to legal challenges; partial legislation is unfair, unjust, inefficient and unworkable; a comprehensive smoke-free law will provide an even playing field for business; the public supports going smoke-free; and a smoke-free UK makes sense. My reservations in this part of the Bill are purely aesthetic: they concern the rash of notices that will deface every building. I hope that we will be able to enforce the law with a degree of consent and without plastering every available building with another, bossy, unsightly notice. Part 2 is entitled ““Prevention and Control of Health Care Associated Infections””. Traditionally hospitals have been seen as places for cure, treatment, therapy and respite; places of compassion and care. Today they are seen by some as frightening places, places that harbour hospital-acquired infections. For some people, hospitals are now scary places, to be avoided if at all possible. MRSA is probably the best-known of the superbugs, but we should not ignore the other organisms, such as Clostridium difficile, VRE and Acinetobacter which are causing increasing problems. These and other infections have been emerging over recent years at the same time as initiatives have been under way to try and combat the spread. The Government have been slow to act and the problem has got and is getting worse. We have some of the highest rates of MRSA in Europe. The financial cost to the NHS is estimated to be in excess of £1 billion a year. But the cost to individuals and their families is beyond measure. In 1978 Clostridium difficile—C.diff—was first linked to making the elderly sick in hospitals. In Canada, about five years ago, C.diff mutated and started to kill patients, younger people. This new hyper virulent strain has spread down the east coast to the US and has also arrived in the UK. Stoke Mandeville Hospital was the first British hospital to admit publicly to having the strain, which was linked to a number of deaths. This C.diff mutation should be a salutary lesson to us. If a similar mutation was to happen to MRSA and if it were to become resistant to Vancomycin, the antibiotic used to treat MRSA—if VRSA were to get a hold as MRSA has, in the vernacular, we would not have seen anything yet and there would be widespread deaths in hospitals. One of the contributory factors to the spread of hospital-acquired infection has been bed over-occupancy. My recent experience when visiting a relative in a private hospital was that every bed was left empty for 24 hours after the patient was discharged and then thoroughly decontaminated. Not so in the NHS, where beds are ““hot beds””, re-occupied while still warm, which means that the waiting list targets are met in the short term, but it builds problems in the longer term. The Government should view the wider picture and relax some of their targets in the interest of safety and good clinical management. I welcome the introduction of a code of practice and the involvement of the Healthcare Commission in its enforcement but I hope that the Minister will take into account the continuing concerns of the RCN as to the scope of the code and give organisations a further opportunity to debate and improve it before the Bill receives Royal Assent. Likewise, the definition of a healthcare-associated infection needs reconsideration. Parts 3 and 4 of the Bill have proved controversial. The Royal Pharmaceutical Society has concerns, as do optometrists. I would like to leave the pharmaceutical issues to Committee stage, but regarding the changes to the General Ophthalmic Services the question is: why do the Government want to change an arrangement which works so well at the moment? I have listened to what the Minister has said, but there is still a strong belief that, if the Government allow primary care trusts the powers to limit the availability of NHS sight tests, there is every likelihood that the service will be put at risk. As the Minister has quoted, during the Commons Committee stages, clear promises were given that regulations would be introduced to effectively stop the Bill damaging the service. But it still begs the question why these clauses are in the Bill at all. They put at risk genuine choice for patients, no waiting lists and an opportunity to increase standards. Alongside the negative aspects of these clauses there is also a positive side. The Bill allows for an expansion of the service to deliver in England what Scottish and Welsh patients can already enjoy, and I really welcome that. Those are not the only aspects of the Bill that I think need consideration; as always, other parts require amendment and improvement. I look forward to a lively Committee, a stringent Report stage and a crunchy Third Reading debate.