Health Bill

My Lords, I thank the noble Lord, Lord Warner, for explaining this Bill so clearly. When the Health Bill appeared in the Printed Paper Office just before the half-term break, I thought, as I suspect others did too, ““Not more changes to the National Health Service””. But some of the additions in this Bill, such as restrictions on smoking, will be of great benefit to many people. Changes of membership of bodies and appointments to bodies, however, always seem to take the concentration away from direct patient care. Part 4 of the Bill deals with pharmaceutical services and makes changes to enable PCTs to consider, in their assessment of applications from pharmacists to provide NHS services over the counter, medicines and other healthcare products. It is the other healthcare products that I query. There is great concern that the Department of Health, having conducted a consultation exercise, is considering options for changing Part IX of the Drug Tariff. There are concerns about the proposals for change in the consultation on arrangements for the provisions of dressings, incontinence appliances, stoma appliances, chemical reagents and other appliances to primary and secondary care. The Patients Industry Professional Forum consists of medical professionals, patients and patient representative groups. Representatives from industry have been in touch with me. They say the consultation fails to acknowledge the demand for, and the necessity of, the essential services currently provided for patients by companies in this sector. Such services include the home delivery of appliances required by stoma and continence patients and the provision of specialist stoma care nurses, who care for patients by providing bespoke services such as the measuring and fitting of their appliances. The thrust of the Government’s approach appears to be based on the opinion that the payment received by member companies that provide such essential services—known as dispensing appliance contractors, or DACs—should be the same as that received by high-street pharmacists, who do not provide such services. The members of the Patients Industry Professional Forum recognise that within the patient population will be many patients who wish to obtain their necessary prescriptions over the counter. However, for a large number of patients, such a service is impractical and inappropriate. Unfortunately, my husband is one such patient. The services provided by member companies in this area bring significant benefit to a sensitive part of healthcare, which much of the population does not understand and still finds embarrassing to talk about. New patients are recovering from the mental stress involved in facing up to serious illness, as well as the physical stress involved in recovering from major surgery. The support given by the specialist nurses is invaluable to carers, too. The Continence Foundation has also been in touch with me. It says that it hears that some PCTs are trying to make significant savings to the budget for continence products and that they are trying to withdraw delivery to people’s homes and care homes. In a rural area, that would be totally impractical. On Friday, 17 February 2006, the headline of The Times read:"““Thousands threatened by oxygen shortage. Woman dies as ‘chaos’ follows privatisation of vital NHS supplies””." Surely we cannot continue with the Government telling us that it is up to individual PCTs. The public are worried about the fragmentation of these vital services. Do the Government and the Minister not want to protect these most vulnerable patients? We need some amendments to protect them and to make PCTs realise that they have a duty of care to provide these vital services. I am delighted with the progress in this Health Bill in making many premises smoke-free. All my life, I seem to have been trying to dodge smokers. For years, I have served on the board of visitors of a young offender institution. I have always felt that not enough has been done in health promotion in the Prison Service, especially with regard to the dangers of smoking. I ask the Minister to clarify the exemptions to smoke-free premises in Chapter 1, Clause 3. Will the Secretary of State for Health be able to make some specified areas in prisons and other institutions smoke-free? If prisoners who are non-smokers are banged up in a cell with a heavy smoker for long periods, that must be totally wrong now that the health evidence is so clear. Would it not be possible to make smoke-free wings in prisons and ban smoking in all eating areas and also in visiting areas, where there are often children and where staff are always on duty? I often interviewed young people who were non-smokers. Those who are trying to stop smoking should be given as much encouragement as possible. I hope that the Secretary of State will make appropriate regulations. I hope, too, that in care homes people who do not smoke are given a smoke-free environment to eat and socialise in if they so wish. Part 2 of the Bill introduces new provisions on prevention and control of health care associated infections. I am pleased that this important part of health care is in this Bill. On 4 November 1996, I had an Unstarred Question debate on MRSA and infections that were resistant to antibiotics. The late Lord Fitt, who had recently lost his wife from MRSA caught in the Chelsea and Westminster hospital, spoke movingly, and the debate was well reported by the press. Since then, there have been several Select Committees and debates in both Houses of Parliament, and conferences throughout the country on infection control. Infection control is now firmly on the health agenda, and I am pleased that the Bill incorporates the issue. It is important to cover it by legislation. There are many different clever bugs—not just MRSA—not only in hospitals and other health facilities, but in the community. The public are now critical of dirty hospitals, and I am glad to say that the hand-cleaning campaign has now taken off, but not without a lot of hard work from many people working in the area of infection control, including the Royal College of Nursing with its Wipe it Out campaign. The Secretary of State will have the power to issue a code of practice, which I hope will include some basic needs. Only on Sunday evening, I was telephoned by a carer of a very disabled man. She said that his wife would not be given gloves that had been supplied to the carer for cleaning up the patient. He has 24-hour care, and has had MRSA twice. He has a peg in his stomach to feed him. To stop supplying such aids used for the prevention of infection seems unwise. I was told by a GP receptionist a few days ago that the NHS did not supply sterile swabs. Knowing that to be untrue, I told her that the NHS might be short of money but it had not yet reached that desperate state. GP practice receptionists should not be giving out false information. Otherwise people will not realise the importance of sterile procedures for vulnerable patients. There must be more training on infection control for everyone. I give those examples to illustrate what can happen at the grass roots. There are several areas in the draft code of practice requiring much greater clarification and definition. They include hospital design, staff to patient ratios, bed occupancy rates, isolation facilities, the timely management of patient care, clean air environment, hand-washing, and the correct clothing for medical and nursing staff—no rings, no ties—cleanliness of wards, beds, trolleys, curtains, door handles, and so on, and adequate laundry services. Clinical waste must be disposed of effectively and appropriately. Often there is a problem in the community. Infections can set in on a Friday or at the weekend. Doctors have to give a wide spectrum antibiotic instead of the most sensitive one for the infection, but the problem is that GP surgeries close on a Friday evening. If there were more testing facilities for infections of all sorts, with quick test results, fewer infections would become resistant to antibiotics. I am pleased that the Bill is trying to address the horror of Shipman, but with the increase in the number of elderly patients, there will be plenty for the accountable officer to do. There have been some disturbing cases in the north, with nurses abusing vulnerable patients with controlled drugs. The recent report on care homes and abuse through administering incorrect medication needs urgent attention. With so many demands and an increasing amount of patients of all sorts, I hope that the Government will not rob the most severely disabled people of their vital services. I hope that the Government will not forget that some patients need looking even though the current message coming down from on high is that people should be capable of looking after themselves. There are some very concerned patients and carers who need reassuring. I hope that the Minister can give them that today.