Health Bill

My Lords, this has been a very good debate, which has generated a good deal of what this House enjoys and is good at: well-informed opinions trenchantly articulated. It has been far from the damp squib that some of us thought it might be a couple of days ago when the list of speakers was extremely short. As all the contributions have demonstrated, the Bill presents us with a variety of disparate themes thrown together inside a single wrapper. There is nothing wrong with that, but in any job of summing up such a debate, seamlessness will not be an attribute much to the fore. My initial comment to the Minister is that the greater part of what the Bill contains is uncontroversial and that a great deal of it deserves a welcome and a fair wind. Those parts that do not fall within those descriptions are perhaps self-evident from speeches today. I wish to start with the positive. All of us were aware, as the details of the Shipman case emerged, that an official inquiry into it would be a near certainty and that recommendations would ensue that probably would require legislative change. I am very pleased to see provisions in Part 3 of the Bill that respond to the concerns expressed in Dame Janet Smith’s fourth report about the use and monitoring of controlled drugs. The measures proposed appear in the round to be sensible and proportionate, even if they are not quite what Dame Janet recommended. I am not sure what led the Government to favour the idea of creating accountable officers ahead of Dame Janet’s concept of an inspectorate. If we were looking at an inspectorate, the most obvious candidate, certainly in the case of community pharmacies, would be the Royal Pharmaceutical Society of Great Britain, which already has an inspectorate. It would be helpful if the Minister commented on this. Setting that matter aside, if we table amendments on this part of the Bill, they are likely to relate to issues of detail and practice, rather than principle. That comment applies in equal measure to the provisions in Part 4, relating to fraud, and to the whole of Parts 5 and 6, which are not contentious. I listened carefully to what the Minister had to say in relation to Clauses 25 to 32, covering medicines and pharmacies. We shall probably wish to probe these issues in Committee, because while we all subscribe, I am sure, to the notion of a wider role for community pharmacists in delivering patient care, it would be wrong to try to achieve this at the expense of patient safety. I should like to be quite confident that allowing drugs to be dispensed by unsupervised pharmacy staff will not open up such risks. We also need to be clear about precisely what activities a pharmacist needs to oversee and how wide his empire of responsibility ought properly to be. The issue boils down to what is entailed by the phrase ““responsible pharmacist”” and exactly how the current rules are to be varied. These are matters to be explored. It is regrettable that so much is to be left to regulations. I listened carefully to the Minister’s explanation of the proposals relating to ophthalmic services. He will know that there is considerable disquiet among optometrists about the implications of these proposals. We have had a system that has worked perfectly well up to now, so why change it? And why change it without consultation and in advance of the review of general ophthalmic services? If we change it, and give PCTs the responsibility for commissioning services, the fear is that budgets will leach away into other patient services where funding is under pressure, that PCTs will be tempted simply to go for the cheapest option and that, as a result, the quality and range of ophthalmic care will diminish, with possibly fewer officially approved practitioners for the public to go to for eye tests. That may not be the Government’s intention, but the fear exists. We shall need to explore the rationale and the practical implications thoroughly. What we all want to see, and what the profession is without doubt capable of delivering—if it is allowed to—is an even better and even more innovative service to the patient. That should be what we aim for here. We have debated on a number of occasions in this House the vexed issue of healthcare-associated infections. I shall not make this an opportunity to bash the Government, but the Minister will know very well the number of initiatives that the Department of Health has already put in place to try to combat this problem during the past few years. I have no objection to the idea of a statutory code, but the question which we have to ask, and which has been asked a number of times today, is whether a statutory code will really make the crucial difference. What matters is that hospital staff should follow the proper procedures. The existence of a code is fine as far as it goes, but it will not affect behaviour; nor, I fear, will the issue of an improvement notice by the Healthcare Commission, which already has extensive powers to audit and criticise hospital practice. It is the extent to which staff—all staff, and not just doctors and nurses—are motivated to do the right thing and are held to account if they do not that will make the difference. Whenever corners are cut in hospital hygiene, it has a lot to do with time pressure, lack of access to washing facilities and high levels of bed occupancy. These are very difficult problems to overcome. Where the Government are right is in making it clear that good hygiene is not, and can never be, an optional extra. It is a top priority. The BMA estimates that about 15 to 30 per cent of healthcare-associated infections are preventable. That figure surprised me, because a lot of hospitals in the NHS have done considerably better than that, but it tends to show that a code of the kind proposed here is not likely to prove to be a magic wand. Once again, we shall wish to test and probe the Government’s intentions in this area in Committee. It would be very good if we could see a final draft of the code before then. I do not know whether that is possible. I have left ’til last the Bill’s most contentious ingredient, on which many noble Lords have focused their remarks today. A legal ban on smoking in the workplace and in all other enclosed public spaces, including bars, clubs and restaurants, is indeed a momentous step for Parliament to take. If the decisions taken in another place are accepted by this House, no government Minister will be entitled to claim credit for them. The Government have been all over the place on this issue. They were elected on a manifesto commitment which amounted to a partial ban on smoking in public places. There were to be exemptions for pubs and bars that did not serve food and for private members’ clubs. After the election, the Government had second thoughts. The Cabinet deliberated whether it would be better to go for a more comprehensive ban. Following weeks of discussion, it was decided to stick with the original policy. The Bill was published. The Secretary of State introduced the Bill in another place and defended the policy. Among other things, she stated her firm belief in the right of private clubs to decide on their own smoking arrangements. Then, all of a sudden, the policy disappeared. It was goodbye to the manifesto commitment and to the Cabinet decision. The whole issue would be subject to a free vote. On Report, the Secretary of State, along with the Prime Minister and the Chancellor of the Exchequer, did something quite unprecedented, which was to vote against their own Bill, against their own manifesto and against the policy that had been thrashed out in Cabinet and so stoutly defended at Second Reading. The Secretary of State did something even more extraordinary, which was, without warning, to vote against an exemption for private clubs, which she had previously declared as being right. One has to ask what kind of leadership that is from a Secretary of State for Health. Whether or not you agree with government policy, you expect there to be a policy on a matter as important as this and you expect a Secretary of State to give a lead in promoting it. The handling of the Bill, on this major issue, has been woeful. Your Lordships face a decision about what to do. My own view, though painful for a number of noble Lords, is that the decision is straightforward. The majorities recorded in the other place, on a free vote, in favour of a complete ban were substantial. For this House to overturn those decisions would not be right. We can, and we should, debate the detail of those decisions and test their practical implications, but I suggest that that is, bearing in mind the role and powers of this House, as far as we should go. I say that with due respect—