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Health and Social Care Bill

moved Amendment No. 21: 21: Clause 16, page 8, line 16, leave out from ““for”” to end of line 21 and insert ““— (a) the prevention and control of health care associated infections; (b) the safeguarding of individuals (whether receiving health or social care or otherwise) from the risk of any increased risk of being exposed to health care associated infections or of being made susceptible or more susceptible to them; (c) the displaying, in a place accessible to the public on the premises of the service provider, information relating to the incidence of health care associated infections, subject to the following provisions— (i) that the display of such information be in a location agreed by the Commission; (ii) that the information be made available in a form prescribed by regulations; (iii) that the information made available relates to each and every outbreak of such infection on the premises of the service provider in the previous six month period; (iv) that the information on health care associated infections provided under this paragraph shall be confined to those infections required to be published by the Secretary of State.”” The noble Lord said: My Lords, I have been very brief on my last three interventions but will be longer on this one. This is the first of a series of amendments that fall under the general heading of transparency. I am hoping to move a number of similarly themed amendments on a number of other Bills. Some may appear controversial, but I am increasingly convinced that transparency plays a vital role in the exercise of influence over conduct in both public and private sectors. In overview, transparency is a powerful tool to be used in securing greater economy, efficiency, effectiveness and accountability in the control of enterprise and in the provision of public services. It conditions conduct. I believe that we have not even begun to consider the scale on which it can be applied and what are the consequences. That principle underscores my amendments to the Bill. Amendment No. 21 is based on my own observations over the years, both as a patient and as a visitor, of what happens in many hospitals. It also stems from my experience as an MP in the late 1990s in trying to extract information from my local area health authority on the incidence of MRSA in individual hospitals in Cumbria—not statistics on death but statistics on infection. The only statistics it was prepared to provide me with were trust-wide statistics, and the only way you could secure information about the incidence of infection in any particular institution at that time, or even ward, was through unofficial personal contacts, but of course that rendered the information gained as unusable. I am more than conscious of the many programmes that have been put in place to help reduce the incidence of hospital-acquired infections—the use of hand-washing facilities and gels, the deep clean programme, the designation of responsible officers, the wearing of disposable garments, pre-admission screening, and hospital-based uniform laundering services. I am equally aware of the Winchester approach and arrangements in Holland. The Winchester and Eastleigh healthcare NHS trust has been very successful in its campaign to eradicate MRSA. Its use of pre-assessment screening techniques; the requirement that the use of cannula be prescribed and then monitored daily; additional care over the use of catheters; and the emphasis on stricter standards of ward cleanliness have all contributed to the collapse in the incidence of MRSA in the hospital. There has been only one case in the past six months, and that was community-acquired. Contrast that with the sloppy conditions that remain in some hospitals and the casual approach that some hospital staff have to the need to secure the highest possible standards of cleanliness. For example, some hospital toilets and even bathroom facilities are filthy, even today. Some hospital ward floors are not kept constantly clean. Some nursing staff, thankfully a minority, allow standards of personal hygiene to slip. Some ward managers run a highly intensive use of hospital beds, resulting in an increased risk of contamination. Some consultants believe that they are somehow beyond the rules and do not always apply them to themselves and are rarely challenged by ward staff. Some hospitals are unable to enforce contractual agreements on cleaning due to managerial inadequacy. Some hospitals suffer from failure due to ward politics and personality conflict. I argue that applying principles of transparency could make a difference in the attitude of some staff and break down barriers to hygiene programme reforms where they exist. If you make a ward publicly accountable for its hospital-acquired infections by making statistics available in a public place, it will have a marked effect on attitudes to hygiene control within the ward. Wards would not want to be identified as at risk and ward managers, whether they be admin staff, matrons, sisters or whoever, would demand the highest possible standards and would challenge any activity which they felt would prejudice the inspection control integrity of their ward. Yes, it would cause ructions within hospital management structures. Yes, it would irritate a lot of people. Yes, it might even lead to ward boycott on occasions. But it would concentrate the mind of everyone involved in hospital care on the need to drive out infections. It would have a knock-on effect right up the line through to the national allocation of resources for this area of inspection control. It would unleash that backlash of public opinion which is often needed when major change is necessary and it would focus the minds of not only the movers and shakers in healthcare but the wider community on the need to stamp out this menace which now frightens millions of people in this country. I close by reminding noble Lords of the European tables on hospital-acquired infection, particularly as regards MRSA. I shall not go through them in detail but they show that the UK has the highest incidence. I believe that if my amendment became law and were implemented by the new commission, it would have a marked effect on the whole incidence of hospital-acquired infections. I beg to move.