Health Bill

The short answer to the last question is that I would need to look at that, although my officials may come up with an answer if I speak long enough. On the issues that the noble Earl raised and, first, on the subject of guidance and training, further guidance was issued to the NHS. It was published on 9 May and is called Going Further Faster. It was developed to help trusts implement Saving Lives, a delivery programme to reduce healthcare-associated infection, including MRSA. This guidance will help to ensure that trusts have a clear strategy for reducing infections that is understood by all staff and implemented consistently. It also reinforces that reducing infection is central to the trust’s business and key to the effective use of resources. The other thing that I would say to the noble Earl is that a number of things are in play that are relevant to ensuring that change takes place. I shall come in a moment to his point about standards and why we need Clause 14, but it is worth bearing in mind that we have integrated this code into the rating system as well. It is a fact of life that we have a performance-assessment system with individual trusts rated. I also draw his attention to the ““choice”” leaflet, which has been available since 1 January, by which people can exercise choice on local hospitals, which is soon to be extended nationally. There is information about hospital performance on some key indicators, one of which is MRSA rates, so people themselves can make judgments. We know from survey information that in exercising choice, the two issues that are most crucial are the length of time to wait for an operation and cleanliness and healthcare-acquired infections. These are important indicators for people exercising their choice over elective surgery, in particular. What we have are some market mechanisms that cover this territory, which point in the same direction of getting people to take seriously the issues around healthcare-acquired infection. The noble Earl asked why we had not relied just on the 2003 Act. He may want to cast his mind back to the long hours, way into the night, during which we discussed that Act. The point about the standards issue, which we took very seriously, was that the standards should be a manageable number of items. In the standards that we produced after the 2003 Act was published, we tried to take seriously the point that was consistently made to us that there were lots of things that had the label ““standards”” that were knocking around in the NHS. We tried to bring those standards together into a manageable number of domains and standards that could represent a credible system for assessing performance in a consistent way throughout the NHS. That is where we have come to rest. There is already provision in there for cleanliness and hygiene, in a general way, but when we came to devise the policy, given legitimate public concerns over healthcare-acquired infections, we felt that we needed something more specific about this area. We thought long and hard about this before coming to the conclusion that the code linked to enforcement by the inspection body—the Healthcare Commission—was the way forward. I have listened to debates on this issue for a long time, from before the Bill was published, and nobody came up with a better way in which to link enforceable guidance about what one needs to do to tackle this on a multifaceted basis at local level. That is what the code does, but with a link to enforceability alongside these other mechanisms, such as ““choice”” and the ratings system. Alongside that, we have kept the surveillance system under review, so that it will change over time as new infections are put into it on the basis of expert advice. That is the context into which we have tried to place this code and the reasons for taking it forward. I have now managed to speak long enough to answer the question of the noble Baroness, Lady Masham. Of course, I should have realised that strategic health authorities are not direct providers of healthcare, so it would be difficult for them to have a healthcare-acquired infection. I dare say they do have some, possibly around and on them, but they are not in direct contact with patients.