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Address in Reply to Her Majesty’s Most Gracious Speech

My Lords, I join other noble Lords in welcoming the noble Lord, Lord Adonis, and I congratulate him on his wide-ranging maiden speech. I also congratulate the noble Lord, Lord Warner, on his promotion to Minister of State for NHS Delivery. In Her Majesty’s gracious Speech, new Bills were promised on health, including the health improvement and protection Bill, the mental health Bill and the NHS redress Bill, among others. There is once again a danger of the Government introducing more legislation to preoccupy NHS staff and to distract them from their primary function, which is to improve access to services, to improve the standard and quality of healthcare and to improve outcomes of care. I welcome the health improvement and protection Bill, which incorporates legislation on hospital hygiene and smoke-free public places and workplaces. Hospital hygiene has been a focus of the media because of the problem of infections acquired by some seriously ill patients admitted to hospital. Chief among those much-publicised infections has been MRSA. The media opinion and popular opinion that improved hospital hygiene would solve the increasing problem of MRSA is sadly an inaccurate and oversimplified misunderstanding of hospital and healthcare-acquired infections. I have been in discussions with the head of our hospital’s infection control team at Wirral trust, an acute trust providing care for 320,000 people on Merseyside. The consultant microbiologist provided me with the following evidence of MRSA grown from blood samples of ill patients in the past two years. Between 10 per cent and 30 per cent of MRSA grown from blood cultures were from patients who were so ill at home that they required hospital admission. Clearly, those infections were not acquired in hospital; the infections were acquired in the community. An example of such an infection is the tragic case of Richard Campbell-Smith, an 18 year-old Royal Marine who recently died days after he was infected with MRSA acquired from a scratch on a training run. A further 10 per cent of MRSA was grown from the blood of patients who had urinary infections that did not lead to bacteraemia or blood poisoning. Therefore, those isolates were the result of contamination of bacteria on the patient’s skin. Only in 60 per cent of ill patients were severe life-threatening MRSA infections acquired during their stay in hospital. Half of those patients had undergone surgical operations, and the other half had medical conditions such as pneumonia. There is therefore no simple solution to reducing MRSA infections in hospitals in the short term. Infection control in hospital is everyone’s business, from the clinical and cleaning staff to patients’ visitors. Because most people carry bacteria on their skin, scrupulous hand-washing, as has already been mentioned, is essential to prevent and control infections. In hospitals where infection control is being successfully implemented, all staff start their day by carefully washing their hands with plain soap or antiseptic hand-washing liquids, taking at least one minute to rub in between their fingers. After that, whenever clinical staff touch their patients they apply concentrated alcohol—about 70 per cent—in gel to their hands. That procedure kills all bacteria, including MRSA, in a matter of seconds. Visitors are also encouraged to apply concentrated alcohol gel to their hands. Of course, that best practice is nothing new. It has been used with great success in intensive care nurseries for newborn babies for the past 30 years. I therefore support the NHS chief executive’s advice on tackling MRSA published in his report earlier this month. However, will the Minister please ensure that targets for the reduction of MRSA infections in hospital are applied with clinical appreciation and not as a statistical exercise? That should ensure that hospitals making good progress will not be penalised when their more difficult cases take longer to respond to treatment and to prevention of further infection. The news that a Bill will be introduced to make public places and workplaces smoke-free is most welcome. The Minister will no doubt be aware that many parents are ignoring warnings about smoking near their children. The case of five year-old Sol Rickman is a timely warning. Sol developed breathing difficulties, and when   surgeons operated on him they discovered that he had lungs that looked like those of a lifelong smoker. His mother had been smoking 20 cigarettes a day since Sol   was born. Every year, around 17,000 children under the age of five go into hospitals with asthma attacks and other breathing problems, bacterial meningitis, cot death—complaints all caused by the smoke from their parents’ cigarettes. An ICM poll of 500 children found that 39 per cent of teenagers were exposed to cigarette smoke in the home when younger, while 13 per cent were exposed to it in cars. Will the Minister ensure that parents and adults are alerted again to the grave dangers of smoking near children? The next urgent public health concern is binge drinking among young adults, particularly female university students. A recent study on 120 female binge drinkers by Caitriona Byrne and David Clark, professor of psychology at Swansea University, showed that two out of three drank above the Government’s weekly recommended limit. The three most common reasons for drinking alcohol were to get drunk and have fun; to be sociable; and to relax. The average consumption was 20.3 units, and the average amount spent was £25.64 per a week. Therefore, I welcome the scrapping of happy hour promotions by the 32,000 members of the British Beer and Pub Association. However, another one in three public houses have not supported that sensible ban on happy hour drinking, and some of them target female drinkers, inviting them to drink free of charge in some north-west cities. That age group, which is also likely to become pregnant when drunk, will cause damage to their   offspring who will suffer brain dysfunction through the effects of alcohol on the developing foetus. The NHS should alert women to the dangers of alcohol consumption during pregnancy and recommend them to abstain when pregnant. The Government’s alcohol harm reduction strategy for England—Strategy Unit 2004—stated:"““Young people under the age of 16 are drinking twice as much today as they did 10 years ago, and report getting drunk earlier than their European peers””." Will the Minister elaborate on how young people will be included in health action plans? For health protection of patients, the Government should press on with the statutory regulation of complementary and alternative medicine—CAM. Acupuncture is available to a limited extent in the NHS in pain clinics, during childbirth and for musculoskeletal complaints. A register of acupuncture practitioners should include both professionals working in NHS establishments and those who work in the private sector using traditional methods. Practitioners of herbal medicine should also be regulated. There is a need for practitioners of traditional medicine, such as traditional Chinese medicine and Ayurvedic or Indian medicine, to be regulated separately under the proposed CAM council. A final issue in health improvement and protection involves the Government’s plans for handling an outbreak of bird flu. Last week, 178 geese were found dead in Qinghai province in north-west China that had been infected with the H5N1 bird flu virus. That news, together with the deaths of at least 53 people in Vietnam and Thailand in the past 18 months, makes it important to have a report on the progress made by the NHS in preparing for the UK Influenza Pandemic Contingency Plan. Will the Minister indicate how many doses of antivirals have now been added to the 100,000 that we had last year? We should also examine the mental health Bill on providing a new legal framework for treating people with a mental disorder without their consent when they pose a risk to themselves or others. I do so as a non-executive director of my primary care trust with a brief for mental health and also after serving for three years on a mental health trust. The Government have continued, in spite of some stuttering and hesitation, to propose improvements in the healthcare of black and ethnic minority patients with mental illness. A significant catalyst has been the independent report into the death of David Bennett, a 38 year-old black man of Caribbean heritage with 20 years’ history of schizophrenia. I congratulate the Government on producing a document in January this year on improving the mental healthcare of ethnic minority patients and also on answering questions and recommendations posed by the independent inquiry into David Bennett’s death. In the document the Secretary of State for Health summarised the aims for mental health for ethnic minorities as,"““equal access, equal treatment and equal outcomes””." I hope that that ambition will be achieved as soon as possible. I remind the Minister that more black patients enter mental health care through compulsion with the assistance of police officers than by the normal pathway via GP referrals. Therefore, I am concerned that the new mental health Bill, if approved and applied without sensitivity and care to black and mental health ethnic patients may lead to negative opinions among black and minority ethnic communities when a patient being detained without his consent dies in the process. I look forward to the Minister’s response.