Health Bill

As someone who used to have policy responsibility in this area, I have a good deal of sympathy with the points made by the noble Earl, Lord Howe, and by the noble Baroness, Lady Barker. Amendments Nos. 53 and 55 would require the Secretary of State to include a provision in the code of practice obliging NHS bodies to record and report all healthcare-associated infections acquired in hospital and setting out how this should be done. Amendment No. 55 would go further; it would require the inclusion of a provision obliging NHS bodies to record all healthcare-associated infections. I understand where the noble Baroness, Lady Barker, is coming from. However, the purpose of surveillance is to identify potential problem areas that should be investigated. That is why our reporting system, which already includes information from all acute trusts, concentrates on infections that cause serious illness. We do not aim to record all cases of healthcare-associated infections, for example, minor skin infections; rather, the measure is there to provide a consistent baseline from which to monitor trends and to assess the impact of interventions to reduce infection rates. The surveillance system proposed in Amendments Nos. 53 and 55 would certainly be contrary to the expert advice that we have that surveillance should be targeted and proportionate. Although the code encourages NHS bodies to carry out surveillance, these amendments would not be appropriate or desirable, as the benefits could be grossly disproportionate to the costs and bureaucratic burden imposed on the NHS. I reassure the Committee that the code will specify that NHS bodies will take part in mandatory surveillance—there will be no ability not to take part in that mandatory surveillance. A new prevalence survey is currently underway looking at a range of these issues in terms of surveillance. The early results will be available in the autumn. That is not to say that the issues that are subject to mandatory surveillance are fixed for all time. Circumstances and conditions change, and diseases change. We recognise that that surveillance system needs to be kept up-to-date but, at the same time, we believe that the surveillance system, which has changed over time, needs to be targeted if it is to be effective. Otherwise, we run the risk of collecting information on much lower risk or possibly very low risk items. That is why we want to be guided by expert advice in this particular area. Amendment No. 54 would make it clear that the Secretary of State is able to include in the code requirements relating to the management of healthcare. The Secretary of State already has this power under the current draft of the Bill. She will be able to include any requirements relating to the prevention and control of healthcare-associated infection in connection with healthcare provided by or for bodies covered by the code. That includes requirements relating to the management of healthcare. The provisions are rather wider than the noble Earl may think from his reading of the Bill. Indeed, the draft code already includes such requirements. The second high level requirement is entitled,"““Duty to establish appropriate management systems for infection prevention and control””." The noble Earl raised some issues about board-level responsibility. He is absolutely right that it is essential that boards take responsibility in this area. That is why we have been working with the NHS to ensure that responsibility lies with individual boards. The code requires directors of infection prevention and control to report to the board. The board will agree an infection control programme, and there is provision in the code requiring appropriate management systems for infection control and it will provide comprehensive coverage of healthcare. Those provisions include the written statement on infection control, the appointment of a director of infection prevention and control, training, and audit of practice. That is pretty comprehensive, and I certainly hope that what I have said will reassure the noble Earl. I am happy to put that on record through a letter setting out what we think is covered by the code, and I am happy to take away some of his ideas to see whether we can improve the layout and the focus of the code. We can look at that. I am grateful for those suggestions. The noble Earl raised the issue of nurses’ uniforms being cleaned or carrying infections. I know from previous experience that this issue generates a lot of public coverage, correspondence and concerns. The available evidence does not indicate that uniforms are a significant source of infection. We would expect nurses and other staff to use disposable aprons, for example, to protect their uniforms from soiling. However, the code will require uniforms to be clean and fit for purpose. In addition, the department is reviewing the guidance on the laundering of linen, which is an important issue which has been raised and has caused some public concerns. Again, I can set out a little more detail on that in a letter to the noble Earl and other Members of the Committee. That is the background against which we believe that this group of amendments is not necessary, but I understand why we are being pressed on these issues by the noble Earl and the noble Baroness.