Health Bill [HL]

Perhaps I may speak very briefly to that point and also say one or two other things. Not only are cleanliness and the cleaning of loos addressed in the code of conduct; it is also to do with the accountability and authority within the organisation. Accountability should be clearly spelt out at the delivery end. As an NHS trust chairman, I had a battle when I found that the loos were absolutely filthy. I asked the chief executive whether he had been into a male toilet in a Little Chef. He said, ““I hope you haven’t””. I said that I had not, but I had been into some of their ladies’ loos and there was a checklist in each one. It took me six months to get checklists into every loo in that trust. We have them here, too. So there has been movement. Some trusts probably have not moved forward, but it is not beyond the wit of man to do so. It comes back to the issue of accountability and the authority that comes from the board down to the first level. That brings me to the list, which the noble Earl, Lord Howe, mentioned, from the Royal College of Nursing. I am aware that much work has been done to develop the metrics for measuring some of the quality issues that the Royal College of Nursing has raised. I agree that some things are more difficult to measure. That comes back to the dignity, care and compassion that are absolutely fundamental to the quality of care. I spoke to this at Second Reading. We must be aware of the danger of this becoming a tick-box system that does not take account of accountability at ward level or in the delivery of care in the community right the way through to the authority at board level. What was the problem at Stoke Mandeville and at Tunbridge Wells and Maidstone? The eye was off the ball. The accountability was there, but the authority had not been taken through. That issue is not recognised in the statement. I take the point made by my noble friend Lord Walton of Detchant about education and training. I know that you can read here that education and training universities are contracted and commissioned through the PCTs, but I have considerable worries about the isolation of the universities. We only have to look back two to three years to the cutbacks in finance and the fall in the workforce. The education and training universities are set apart, and we need them to be in the Bill as very much part of the exercise in quality.