Health Bill

moved Amendment No. 59:"Page 12, line 32, leave out ““such period as is”” and insert ““a reasonable period, such period to be””" The noble Earl said: I shall speak also to Amendments Nos. 61 and 63. These amendments can be dealt with quite quickly, but they all raise matters of some importance in connection with the issuing of improvement notices by the Healthcare Commission. It is proposed that the Healthcare Commission should issue an improvement notice where, following a review or investigation, it concludes that an NHS body is failing to observe the code of practice on hygiene in any material respect. The circumstances in which an improvement notice may be issued are, as I understand them, where the commission is not of the view that the failings are significant. Significant failings require the commission to make a report to the Secretary of State or the regulator under Sections 53(2) and 53(6). A report under Section 53 is therefore a much more serious step than the issuing of an improvement notice, because a Section 53 report could lead to special measures, such as practical help being drafted in or, indeed, more radical intervention by the Department of Health. As I read the Bill, an improvement notice would be issued where a failure to observe the code was considered to be material, but not of such overriding seriousness as to warrant a report to the Secretary of State or Monitor. Nevertheless, we see in Clause 16(6) that, whenever an improvement notice is issued, the Secretary of State, Monitor and any relevant strategic health authority must be notified. Subsection (3)(c) stipulates that the improvement notice must:"““require the body to remedy the failure to observe the code, and to do so within such period as is specified in the notice””." It has been put to me by the Royal College of Nursing that the wording perhaps needs tightening up. The specified time laid down in the notice is not defined in the clause and, while it would clearly be inappropriate to have a fixed time in the Bill—because each case would be different—there is concern that whatever time is specified in a particular notice should be reasonable in all circumstances. My amendment suggests that we should spell that out. It would serve to ensure, at least by implication, that the timeframe for compliance with the improvement notice would be the subject of consultation with the NHS body, rather than a timeframe imposed without regard to the overall circumstances. Subsection (4) states:"““An improvement notice may (but need not) include a recommendation by the CHAI as to the way in which the failure should be remedied””." This is rather odd. The Healthcare Commission is surely ideally placed to make concrete recommendations about best practice in the control and prevention of infection. For an improvement notice to say, in effect, ““This is what is wrong, but we are not even going to give you a hint about how to put it right”” is singularly unconstructive. Will the Minister think again about this? When a hospital has received an improvement notice it will, in the normal course of things, take appropriate steps to put matters right. The Bill sets out various procedures for the Healthcare Commission to follow in the event that the matter is not put right. But if the matter is put right, the commission will effectively sign off the trust and report to the Secretary of State and/or Monitor that it has done so. The point I am raising in Amendment No. 63 is that, for the good of everyone, that should not be the end of the process. Where a hospital has rectified the problems that gave rise to the improvement notice, it nevertheless makes sense for the commission to continue to monitor the hospital to ensure that the changes it has put in place are maintained and that standards are not allowed to slip. This need not comprise any sort of heavy-handed oversight, but perhaps a check after six months and after another six months that all was well. The BMA suggested this amendment, and it has a good point. I hope that the Minister will be receptive to these amendments in principle, at the very least. I beg to move.