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Health and Social Care Bill

Amendment No. 105 is intended to establish regulations to deal with malnutrition. It is drafted in the same terms as clause 16(5), which is on health care-acquired infections—or health care-associated infections, depending on which of the Government's definitions one chooses to take. New clause 15 would provide for a code of practice on malnutrition and is drafted in the same terms as clause 17, which provides for a code of practice relating to health care-acquired infections. The context of the new clause and amendment is necessarily fixed within the area of health care-acquired infection. The Government have put in the Bill the need for regulations about health care-associated infections, as they call them on this occasion, notably methicillin-resistant Staphylococcus aureus and clostridium difficile, and a code of practice on preventing them. While that is laudable, I fear that it will do little to dent the Government's ongoing failure on health care-associated infections unless proper infection control measures are put in place in the code. Although health care-associated infections are falling, the rate is still way off track to meet the Government's 2004 target of halving MRSA rates by March 2008. The Secretary of State for Health has contradicted the Prime Minister's promise of screening for C. difficile; bed occupancy is up; deep cleaning is a gimmick with no new money attached; there is no decent search-and-destroy strategy; and Government promises on isolation wards are still being broken. I am sure, moreover, that the House was pretty disgusted by the Health Secretary's posturing promise that he would prevent a payout to the chief executive of Maidstone and Tunbridge Wells NHS Trust, considering that, on 24 January—just a few days ago—we discovered not only that the Secretary of State never had the power to do that, but that the chief executive received £75,000 of taxpayers' money for her failure. That is the context in which malnutrition is so important. As we know, according to the Government's own figures in ““Clean, safe care: reducing infections and saving lives””, published on 8 January, MRSA affected about 6,000 people in 2006-07 and C. difficile about 56,000. By contrast, in 2006-07 no fewer than 139,127 patients were discharged from hospital in a state of malnourishment. The issue is not just about malnourishment; it is also a human rights—we have just discussed human rights—issue. The Joint Committee on Human Rights, in its recent report, ““The Human Rights of Older People in Healthcare””, noted that malnutrition and dehydration in care settings breached articles 2, 3 and 8 of the European convention on human rights. Figures cited in the Department of Health's own nutrition action plan show that the cost of under-nutrition is estimated at £7.3 billion a year, and a recent British Medical Journal study reported that about 20 per cent. of patients in hospital—one in five—are malnourished. Despite those figures, which reaffirm those provided through BAPEN's screening week—I assume that everybody in the Chamber knows that BAPEN is the British Association for Parenteral and Enteral Nutrition—an initiative that the Minister claimed to support, the Department chose to rubbish them as"““hopelessly out of date or misinterpreted.””" Furthermore, the Government's own figures, provided to me through written parliamentary answers, show that the number of undernourished patients being discharged from hospital has risen by 84 per cent. since 1997. There is little evidence that the Government have either the will or the conviction to tackle the problem. Since the new year, they have failed to take the opportunities afforded by the publication of vital signs indicators for primary care trusts, of responses to the payment by results consultation, and of the Bill to demonstrate their intention to do so. Of the 83 vital signs targets, none relates to malnutrition. It has been pointed out to the Department that the lack of recognition of support services, such as those on nutrition, in PBR acts as a barrier to the commissioning of effective care pathways. Most damning was the voting down in Committee of an amendment that would have put the importance of tackling under-nutrition on the same statutory footing as tackling hospital-acquired infections. Clearly, therefore, the Government see under-nutrition as a peripheral rather than central issue in respect of both health and social care and human rights. The new clause and amendment give the House an opportunity to make a genuine addition and improvement. Given the Government's repeated refusal to make use of opportunities to tackle under-nutrition, such as in the NHS's operational plans and the system of PBR, my view and that of my colleagues is that we simply cannot accept the Minister's feeble assurance—““feeble”” is a strong word, but it is correct in this context—to the Committee that he hoped that malnutrition would be included in the core registration requirements examined by the new Care Quality Commission. He said no more than that he hoped that that would happen. That seems a wholly insufficient and inadequate response to what is patently a major issue, given evidence that was based wholly on the Government's own information and statistics, and which was published in parliamentary answers. Unless we hear from the Minister an important and new voice on the matter, it will be important for us to register our concern. We shall want to pursue the matter at this stage and certainly as the Bill proceeds to another place. When it does, I hope that this time the Government will support such amendments.