Health Bill

I will speak to Amendment No. 54, which is grouped with the noble Baroness’s amendments. I start with an apology; the amendment is not quite correct. It should refer to subsection (4)(b) rather than subsection (4) as a whole. Where subsection (4)(b) refers to ““health care””, we must be quite clear what we mean by that term in the context of the code of practice and what the requirements to be imposed on NHS bodies will encompass. Healthcare for the purposes of the code of practice is more than just what the patient in a hospital experiences. It also includes matters of direct relevance to the patient’s treatment, but which are less to do with care and treatment and much more to do with management. Although this may seem a rather pedantic point, it is certainly not meant to be. The code of practice has been issued in draft. Much of it has to do with the treatment of patients: hand hygiene, wound surveillance, isolation, drug prescription and all sorts of other aspects of clinical practice. But, quite properly, much of the code also relates to aspects of the infection control regime that are invisible to the patient and integral to decision-making, not by nurses, doctors and midwives on the ward—the people who dispense healthcare—but by those who perform management duties some considerable distance away from those people. It includes the arrangements and systems underpinning microbiology services, education and arrangements for allocating responsibilities and accountability to staff. All these are hugely important for good healthcare, but they are not synonymous with ““healthcare”” as we normally understand the term. The normal interpretation of ““healthcare”” is reflected in subsection (8), which defines ““health care associated infection””. Exposure to infection occurs where the care is actually provided: on the ward or in the operating theatre, not, I would suggest, in a manager’s office. We clearly want the code to be comprehensive. It aims to be comprehensive but, in its present form, I am not sure that it quite makes it. I have a lot of sympathy with the noble Baroness’s amendments which refer to mandatory reporting. She is quite right about that but, like her, I could not see it in the code. What is more, it is not enough for data to be collected and recorded in aggregate at hospital level. It has to be collated and acted upon at ward or department level and, indeed, at the level of the individual. I agree with what she said on that. There is a section in the code about the need to have proper lines of accountability, but nothing that says explicitly—which it should—that someone at board level should have specific responsibility for infection control issues. Nor is there anything that explicitly covers the added risks associated with locum and agency staff. Agency staff come and go. They can bring poor practice with them, and do not necessarily assimilate the good practice that a particular hospital promulgates among its permanent workforce. The code needs to mention this aspect of management and the importance of devising ways to deal with it. The other area where many people have been critical of infection control practice is uniforms and clothing. Nurses travel to and from home in their uniforms more and more. [The Sitting was suspended for a Division in the House from 6.10 pm to 6.22 pm.]