Health Bill

My Lords, I wish to continue with my speech. Let me respond to some other points that were made about the issues around ventilation. I think that the noble Lord, Lord Clement-Jones, put the points in that area very well. There is a total lack of good evidence that ventilation provides a real solution to the health risks associated with second-hand smoke and we do not want to require expensive and potentially useless ventilation equipment, as that would be burdensome to many of the people involved. A lot of concern has been raised about the impact on the home of the ban on smoking in public places and the workplace. The evidence from New York suggests that 100,000 people have quit smoking since the ban was introduced there; in Ireland, cigarette sales in 2004 are 15 per cent down on 2003 and, after the first six months of the ban, an estimated 7,000 more smokers have quit than would otherwise have been expected to. That evidence is also in the public arena for the sceptics to consider as they wish. Issues have been raised about exemptions. We shall no doubt go into those in considerable detail in Committee, but I should like to clarify one or two points. The noble Baroness, Lady Masham, raised the issue whether exemptions would extend to prisons. Prisons are exempted due to human rights issues, as prisons are a person’s residence. However, I can say to the House—and I shall put this in more detail in writing to noble Lords—that the Prison Service management board has set up a working group with the Department of Health to review all the implications of the smoke-free provisions of the Bill with a view to achieving smoke-free prisons, so that certain safeguards are made for prisoners who do not want to be exposed to the smoke. Residential care homes are also to be exempted on human rights grounds, as they are the residences of those living in them, but we shall issue guidance to homes on how best to provide protection from second-hand smoke for other residents and for staff. It is not intended to exempt student halls of residence as such; however, an individual student’s private rooms would be exempted, as they are the individual student’s residence. The noble Baroness, Lady Cumberlege, raised a number of issues around teenage smoking rates. What I can say to her is that the prevalence of smoking among children aged 11 to 15 steadily increased between 1988 and 1996, from 8 per cent to 13 per cent, but that since 1996 the rate has fallen. In 2004, 9 per cent of pupils aged 11 to 15 were regular smokers. We seem to have peaked, and the percentages are coming down. The issue of smoking in the Houses of Parliament is a matter for the House authorities, not the Government. It is down to the House whether it wishes to set a good example to other people. My noble friend Lady McIntosh raised the issue of the impact on the theatre industry of the smoke-free provisions. We are still considering representations from the theatre industry; we are aware that in those countries that have already brought in smoke-free legislation there are a number of different approaches to smoking on stage. That will be covered in the public consultation on the regulations to be made under the Bill. I turn to some of the issues raised around healthcare-associated infections. I would gently say to the noble Baroness, Lady Cumberlege, and remind the House that MRSA took root in our hospitals between 1993 and 1997. There is good evidence on that and we have put that evidence in the public arena. As a Government, we introduced mandatory surveillance, which has now been extended. I shall give further and better particulars on conditions other than just MRSA. We believe that the code will improve hygiene. The fact that we do not know everything about tackling healthcare-acquired infections does not mean that we should not codify what we do know to improve public safety in this area. We know that there is variation across hospitals in the extent to which they have been able to tackle healthcare-associated infections, and we believe that the code will achieve greater uniformity and help to bring up the standards of the less good to the standards of the best. We do not believe that there is any evidence that targets to improve health services have actually had an adverse impact in that area. The noble Baroness, Lady Barker, asked why the code did not apply to the independent sector—to residential care and nursing homes. Enhanced standards of infection control should in our view apply in all settings in which healthcare is provided. We will accomplish that through the legal framework of the Care Standards Act 2000, which forms the foundation of the regulation of the private and voluntary healthcare sector and care homes. In other words, the relevant elements of the code will be applied to the independent sector under regulations made under the Care Standards Act. The noble Lord, Lord Colwyn, asked whether the healthcare-associated infection code should be delayed until the Bill gains Royal Assent. We obviously want to get this into operation as quickly as possible, but we need to wait until the Bill gains Royal Assent before the new powers given to the Healthcare Commission kick in. But the draft code is already available to all NHS bodies. The noble Baroness, Lady Barker, raised some issues around the social care bursary scheme. The transfer is administrative; there is no more significance in it than that. It was a result of the recommendations of the arm’s-length body review. I turn briefly to a number of issues raised in relation to the Bill’s provisions on pharmacy and other areas. I am happy to give the noble Lord, Lord Colwyn, the assurance that the Bill does not affect the work of dispensing doctors. The noble Baronesses, Lady Barker and Lady Murphy, raised concerns about the extent to which people might be put at risk in circumstances in which a pharmacist had responsibilities extending beyond more than one pharmacy. We are trying to ensure that there will be a responsible pharmacist in charge of every pharmacy, even those open 100 hours a week. That pharmacy is expected to be their main place of work. There will be exceptions to the ““one responsible pharmacist”” rule only in exceptional circumstances. An example already in use in Australia is a pharmacist-controlled vending machine, where the pharmacist safely controls the supply of medicines from another place. It would not be sensible to require a responsible pharmacist in that situation to stand by the vending machine on the registered pharmacy premises. The responsible pharmacist will be required to set down procedures and determine which staff are competent to undertake them safely. There are a number of other specifications that would ensure patient safety in this area, and I am happy to put those in writing to noble Lords after this debate. I can confirm to the noble Lord, Lord Walton, that we will consult widely on the regulations, and will expect to work closely with pharmacy organisations such as the Royal Pharmaceutical Society of Great Britain, with which we have already been working in preparing this legislation. In those regulations we will clearly define the activities that pharmacists must undertake themselves and those that can be delegated to other competent staff. The noble Baroness, Lady Barker, raised the issue of inspection. It is intended that Royal Pharmaceutical Society inspectors will inspect controlled drugs management in community pharmacies as part of their routine inspections of community pharmacies. That will build on their expertise and minimise disruption. I tried to give reassurance in my opening remarks about ophthalmic services. This is not the occasion to go into great detail, but I will try to extend those reassurances in a letter to all noble Lords. The noble Baroness, Lady Masham, raised some concerns about stoma service changes. The consultation on that finished on 23 January. Officials have been meeting with patients’ groups to explain the next stages. No decision will be taken until a robust evaluation has been made of the consultation’s evidence of the impact of any changes on patients. Like her, we are concerned to ensure that changes do not disadvantage patients in this particular area. My noble friend Lord Rosser raised an important set of concerns about support for non-executives and the role they play in the running of NHS bodies. He is quite right to raise those concerns, and I assure him that my right honourable friend Patricia Hewitt and I are pursuing the issue energetically. I have tried to cover many of the points noble Lords have raised. I am sure we will go into considerable detail on some of those issues, and I have no doubt that we will be batting around figures about second-hand smoke in a very happy manner, but tonight is not the time to re-enter that fray. I will be pleased to write to noble Lords on all the points I have not managed to cover.