Health Bill

My Lords, at this stage of a debate there tends to be some repetition, particularly of statistical evidence. However, I welcome the Bill and the changes that have been made in the other place. The other place has been discussing dentistry this afternoon. Normally, when speaking on a health Bill I can steer it round towards dentistry. The Minister will be delighted to hear that that has not proved possible this evening. Although most smoke-related deaths are caused by passive smoking at home, about 500 each year are due to exposure at work. This exposure is particularly high in the hospitality industry and is likely to affect bar workers and, indeed, musicians. Perhaps I have been lucky, having played my trumpet for more than 40 years in smoke-filled bars, clubs, hotels, and marquees without—as yet—a smoke-related problem. I commend the work of the Roy Castle foundation on this particular issue. Roy died from lung cancer at an early age, and passive smoking was thought to have been the major cause of his disease. Although I dislike any nanny-state regulations and the restriction of freedom of choice, I did think that the provision of smoking areas and smoke extraction could go a long way to lessening the risk. It was a regular subject for discussion during my time as chairman of the Refreshment Department, and the committee tried to accommodate the wishes of all members. I am sure that the matter is still being discussed regularly. However, my medical training and the statistical evidence has convinced me that the introduction of smoke-free policies will improve public health, or generate long-term health improvements and reductions in health social inequality. These benefits must override the issues relating to freedom of choice. I am proud to have been present for one of Sir Richard Doll’s early lectures on the association of lung cancer and smoking many years ago and, like the Minister, I pay tribute to his work on this subject. At one time, I thought that a ban in public places would increase smoking at home, but the evidence now shows that where smoke-free workplaces and enclosed public places are accepted, there tends to be less smoking at home. That is clearly the case following the ban in Ireland. The legislation could lead to a million people quitting smoking. Thousands of lives will be saved and the economy will benefit by about £4 billion. I shall now stress some of the points made by the noble Baroness, Lady Murphy. For many years I have thought that there should be changes in working practices in community pharmacies to allow pharmacists to make best use of their skills and experience for the benefit of the public. I was attached to Boots via the Industry and Parliamentary Trust when it widened its policy to build consultation areas into its pharmaceutical outlets for direct patient advice. Doctors should not have to spend time on minor illnesses and infections when practice nurses and pharmacists are equipped by their qualifications to deal with this important aspect of primary care. The Bill deals with many of the issues of concern relating to supervision and responsibility in a pharmacy. Pharmacists will be allowed more freedom to begin to provide some of the other services set out in the newly negotiated community pharmacy contract. A responsible pharmacist will have professional accountability for all processes in the pharmacy and will be able to carry out other duties, such as visiting patients and meeting local GPs, when pharmacy activities can be delegated to appropriately trained pharmacy technicians. That is to be welcomed. When I first read the Bill, I was concerned that it might affect the regulations currently applied to the way drugs and medicines are stored and dispensed by groups of general practitioners who effectively run small pharmacies within their practices. This issue is not covered by the many pages of briefing notes that I have received, so I assume that there will be no change in the current situation. But will the Minister specifically confirm that the Bill will not affect this vital and essential service, and that suitably trained doctors’ dispensers will continue to dispense without the supervision of a pharmacist? That is particularly important in rural areas, where pharmacies can be many miles from the doctor’s surgery. I ask for confirmation as I am aware that the relationships between community pharmacies and doctors’ dispensing outlets are not always ones of mutual agreement, yet they are essential for the efficient management of many practices. I also welcome the provisions in the Bill relating to healthcare-associated infections. This is a major problem that is not under control, and I am concerned that the final version of the code of practice will be unnecessarily delayed by the decision that it should not be published until the Bill receives Royal Assent. The latest figures for MRSA reveal that the NHS will not achieve its goal of cutting rates by 50 per cent within the next two years. The number of deaths linked to MRSA has risen by 22 per cent. Research has shown that up to 100,000 patients admitted to hospital each year were unknown carriers of MRSA. I should have thought that identification of those carriers should be fairly straightforward and an absolute priority. The need for the code to be relevant to all health care, and its relationship to hospital design, staff-patient ratios, bed occupancy, isolation facilities, and a clean air environment, must be addressed urgently. Finally, a brief comment on the supervision of management and the use of controlled drugs, as that directly affects my own work when I have to order drugs, store them, carry them with me, and prescribe and use them in different situations. I hope that the Minister can confirm that this legislation will not affect the right of healthcare professionals to prescribe these drugs. I welcome the response to the Shipman inquiry and the fact that routine monitoring and inspection of controlled drugs in community pharmacies is likely to become a role undertaken by the pharmacy inspectorate of the Royal Pharmaceutical Society. Clause 19 refers to,"““A constable or an authorised person””," being able to enter premises. Pharmacy bodies have been negotiating on the inspection of controlled drugs in England, but not in Wales or Scotland. Given the preparations for the transfer of this role to the Royal Pharmaceutical Society inspectorate, I know that they are keen to receive clarification on this issue. While welcoming the Bill, I am concerned about the sheer volume of detailed provisions that will be enacted through regulations that will have little scope for amendment once made. I hope that the Minister will be able to set out as much detail as possible in the Bill. I am delighted to be followed by the noble Lord, Lord Walton. The last time he followed me was at the Macmillan concert, when he performed in a Geordie accent, but I shall not tempt him this evening.