Health and Social Care Bill

We all recognise the importance and the difficulty of dealing with healthcare-associated infections, both in our hospitals and care homes and in the provision of care in other settings. In 2006 we passed legislation approving the introduction of a code of practice on healthcare-associated infections. Under this legislation the registration requirements and new code of practice will apply to all regulated care activities and health and adult social care, and not only to those carried out in the NHS. There is international agreement that nursing homes are a reservoir of healthcare-related infections and data on HCAIs in nursing homes are limited. However, a report from the Health Protection Agency covering data collected by the mandatory surveillance scheme between April 2006 and March 2007 indicated that 18 per cent of patients who had their MRSA bacteraemia detected within two days of admission to a trust had been admitted from a nursing home. Improving hygiene measures in care homes would reduce the risk of infections to individuals, both in the home and if they are admitted into hospital. It would reduce the prevalence of infection and, consequently, prevent infections in both hospitals and care homes. The commission will have a whole range of functions and, as an independent body, it ought to decide on how to allocate its resources in order to deliver those functions efficiently and effectively. I understand the concerns, which many noble Lords have already expressed, that social care and the monitoring of the implementation of the Mental Health Act may be marginalised in the new body and that these lie behind the intention of the proposal in Amendment No. 54A to provide separate funding for functions relating to healthcare-associated infections. I recognise that some noble Lords are concerned that if healthcare-associated infections are the top priority for the new commission with respect to the NHS, then, with a reduced operating budget, other areas could suffer. I should point out that an extra £5 million funding has been allocated to the new commission to fund specialist inspections and to monitor compliance with the HCAI code of practice. In rolling out the registration system to bring in NHS providers for the first time, the Care Quality Commission will give priority to healthcare-associated infections. The Healthcare Commission is already undertaking annual inspections of hospitals to ensure compliance with the code of practice, so this expertise and resource can be carried forward to continue monitoring compliance under the new system. Both social care and private and voluntary healthcare will continue to be regulated under the Care Standards Act, where sanction and enforcement powers already exist. They will continue to have to comply with the relevant regulations relating to infection control until the new registration system is up and running. As others have pointed out, many of the required savings have already been made by CSCI and the Healthcare Commission. Further savings in operating costs of the new body will come from rationalising back-office functions and from increasing integrated and efficient working practices. As already discussed, the commission will need to carry out all of its functions in order to meet its statutory obligations, not least its social care and mental health functions. I hope this provides some reassurance that there is no intention to sideline the regulation of social care as a result of the importance placed on healthcare-associated infections and indeed the intention is absolutely that this focus will benefit those receiving social care as well as healthcare. To ensure this is the case, I agree with noble Lords that proper consultation must be carried out before a code of practice is issued. This is why the Bill makes provision for the Secretary of State to consult those he considers appropriate and I would, of course, expect this to include the people who use health and social care services, service providers and local authorities, as well as the NHS. This is our intention, and so I do not believe that this amendment is necessary. In addition, the consultation, as it was for the 2006 code of practice, will be an open consultation to which anyone can contribute, and I encourage all those who are concerned to do so when the time comes, which we hope will be later this year. Given the importance we attach to getting this right, the public will want to be reassured that the commission is taking appropriate action where providers fail to meet requirements on tackling healthcare-associated infections, as the noble Earl and noble Baroness are suggesting. This is the intention behind Clause 85 as drafted, enabling the Secretary of State to make regulations, which either allow or require the commission to publish information about the enforcement action it has taken. This will enable the commission to demonstrate the action it is taking when carrying out its functions and to reassure patients and service users that services which persistently fail will not be able to continue to provide services. The public will be able to access information about service providers where enforcement action has been taken. It should also be an additional incentive for providers to comply with requirements and avoid enforcement action. Publishing details of its enforcement action will also show that the commission is open and transparent in the way it carries out its functions. I therefore believe that Clause 85 as drafted already allows for the provisions set out in Amendment No. 110 and can achieve the transparency sought by that amendment. I hope that I have provided sufficient reassurance on these counts to allow noble Lords to withdraw these amendments.