§ Order for Second Reading read.1.49 pm
§ Mr. Richard Shepherd (Hereford)
I beg to move, That the Bill be now read a Second time.
The whole House will be aware of the intent behind the Bill, which is to amend the law in respect of Crown immunity for National Health Service premises. In one sense, we have secured a great triumph in that the Government moved very rapidly yesterday to meet the substance and provisions of the Bill. It is also appropriate for me to say that this opportunity to move the Second Reading of the Bill is due to the generosity of my hon. Friend the Member for Upminster (Sir N. Bonsor) in making way for my Bill, thus enabling us to gather here to consider the Crown Immunity Bill.
I must pay tribute to other colleagues and sponsors who have worked hard to persuade what has turned out to be a most sympathetic Government in this respect.
This is an all-party matter, and I must refer to the right hon. Member for Stoke-on-Trent, South (Mr. Ashley) whose work on many social issues over a number of years, especially in the defence of those most at risk, such as hospital patients, has been an inspiration and example to all of us.
I refer also to my hon. Friend the Member for Stafford (Mr. Cash), who has been anxious over the provision of Crown immunity for hospitals. I have a common interest in a hospital that concerns him directly in Stafford. His hard work to protect patients and his constituents has provided an important thrust for the Bill.
I have not met an organisation or group of individuals outside the House that has offered any opposition to the Bill. I do not want to take too much time on this issue, but the Institute of Environmental Health Officers, especially Clive Wadey, has done a tremendous amount of work in tackling Crown immunity for hospitals. The unions have been diligent in leading a campaign in the same direction. The Association of Metropolitan Authorities, district authorities and other organisations have all been pursuing the aims of the Bill for a long time. All the sponsors and all those who have worked to secure that which the Bill seeks all feel a sense of triumph and of real appreciation to the Government. The Government have completed their own review and are acceding in full measure to our arguments that are directed to National Health Service hospitals.
It was a surprise to many people when they found that the food hygiene regulations did not really apply to Crown premises, such as NHS hospitals. Hospital patients often have to tolerate substandard food hygiene. As the Department of Health and Social Security's guidance on food hygiene observes, they are especially at risk. Catering in hospitals is recognised as being more complex than in other catering areas and the consequences of food poisoning for hospital patients are likely to be more serious than they would be for healthy people. It is clearly not right for the catering area with the highest risk consequences to be exempt from food hygiene laws.
A survey of food poisoning, published by the Central Public Health Laboratory, identified hospitals as the third highest source of food poisoning outbreaks in the public sector. That is a shocking revelation. The Institute of Environmental Health Officers' survey in 1976–77 found 602 that 60 per cent. of the 1,627 hospitals visited had food handling areas that were below the standards of the food hygiene laws and that 8 per cent. of hospitals visited would have been prosecuted but for Crown immunity. A smaller follow up survey of the worst premises in 1978 found that 45 hospitals that would have been prosecuted but for Crown immunity were still in the prosecutable category.
The most recent report of the Institute of Environmental Health Officers of 1985 suggests that 60 per cent. of NHS hospital kitchens currently break food health regulations and that 97 hospitals would be liable for prosecution but for Crown immunity. We all aware of some of the details and consequences of that. There have been 211 outbreaks of food poisoning in hospitals over the past six years affecting nearly 4,000 people, of whom, tragically, 279 have died.
Since 1981 there has been a four-fold increase in cases of bacterial food poisoning. I would at this stage mention the Government's position. However, we are fortunate in having the presence of my right hon. Friend the Minister for Health in the Chamber, and I have no doubt that he will do so. I wish to save time and to give an opportunity to the many hon. Members on both sides of the House who, I know, want to participate in the debate. Therefore, I shall omit that section of my speech.
Undoubtedly, the tragic events at the Stanley Road hospital in Wakefield, where 19 people died and where over half the patients were affected, have focused the growing concern of the general public on the standards of NHS hospital kitchens.
The report of the inquiry catalogues appalling breaches of hygiene regulations and mismanagement, and the description of the kitchen and kitchen practices in paragraph 180 and subsequent paragraphs is a profound indictment on hospital management. I am sure that that report should be mandatory reading for all hospital management teams. It is shocking to think that, even with that background, some hospital authorities have continued in much the same way.
Such an instance was given to me by Mr. Dick Carson, the director of environmental health for Edinburgh, who is an acquaintance of many hon. Members. In February 1985 a full survey of Liberton hospital kitchen was carried out and a report was sent to the authorities. In April 1985—let us remember this in the context of Stanley Royd where there had been deaths—a second visit was made, during which it was found that virtually all the major recommendations contained in the report had not been actioned.
§ Dr. M. S. Miller (East Kilbride)
I, too, know of the communication from Mr. Carson. When the hon. Gentleman had discussions with the Ministers on this, did they say whether Scotland would be included in the Bill?
§ Mr. Shepherd
It will be appreciated that, as an English Member of Parliament, I do not always respond swiftly to the Scottish dimension, but, undoubtedly, the removal of Crown immunity should apply to all sections of the United Kingdom, and that includes Northern Ireland.
After the April 1985 visit, nothing happened until December 1985 — three months ago — when a major outbreak of food poisoning occurred during Christmas week. The cause was attributed to a turkey meal, and 160 patients and staff were affected. Fifty extra nurses had to be drafted in.
603 In December, as a result of the outbreak, a third visit was paid to the hospital, during which it was found that no action had been taken on the major recommendations of the report. That shows the shocking inertia of management. There were totally unacceptable practices, such as suspect oven temperature controls and turkeys defrosting in sinks and cooling on work surfaces that had previously been used for food preparation.
Mr. Carson has said that, as a result of the second visit, when it was discovered that the major recommendations of the report prepared in February 1985 had not been implemented, but for Crown immunity he would have felt obliged to report the hospital to the procurator fiscal's office for possible prosecution.
I am sorry to say, too, that even in my area lack of diligence in certain important areas continues. Last Friday I made a quick inspection of one of our hospitals, although not the one that was being visited by my right hon. Friend the Secretary of State, and there I saw raw meat adjacent to cooked chickens. That would seem to show that, not withstanding a report published a few days before, my district health management was unaware of the urgency of responding to this.
Paragraph 177 of the report on Stanley Royd says:It is well known that the most common source of infection is raw meat and poultry and that contamination is most likely to result from a failure to separate cooked and uncooked foods.I have met senior officials within the administration who seem uncertain of such a basic regulation. What chance have our patients and many of our communities when there is a lack of diligence in such an important area?
The fundamental need for bringing about the removal of Crown immunity is the recognition that there is less self-regulation in hospitals and lack of mandatory force is the essential element. Laws that are applicable and should be enforced are absent. I am delighted that the Government will now introduce this measure before Easter so that it can be enacted in this Session of Parliament.
Crown immunity presently encourages diffusion of managerial responsibility, removes incentives to act and does not provide sanctions for breaches of present food laws. Therefore, against that background I gladly welcome the Government's response to the pressure from all of us and their willingness to move in and to act swiftly. This is a triumph for common sense.
§ Mr. Jack Ashley (Stoke-on-Trent, South)
I thank the hon. Member for Aldridge-Brownhills (Mr. Shepherd) for taking on my Bill and congratulate him on his impressive handling of it. I hope that I do not embarrass him by saying that, if he is not on the Government Front Bench before we kick the Conservatives out in a year or two, I shall be very surprised.
I warmly welcome the Government's decision. When we took a deputation to the Minister for Health, he did not commit himself, but said he would listen and respond. he has listened, and I greatly appreciate the way in which he responded.
I should like to echo what the hon. Member said about the organisations involved. I do not propose to repeat them, although I should like to thank Clive Wadey and John Edmonds of the General, Municipal, Boilermakers and Allied Trades Union, the Royal College of Nursing, 604 the British Pest Control Association, the National Association of Health Authorities and the Association of Metopolitan Authorities, which played a major role in the campaign.
The Government must recognise that, if they are to abolish Crown immunity, extra cash will be required. Many improvements will come from good management, proper supervision and properly trained staff, but Government cannot will the end if they cannot provide the means. It does not make sense to rule out extra cash for the health authorities. The Government have always said that NHS hospitals should not hide behind Crown immunity and that they should maintain food regulation standards. The Government, therefore, have an obligation to provide the cash now that Crown immunity is to be abolished.
Although there is no provision in the Bill for Government buildings, other than hospitals, I intend to press the Government to lift Crown immunity in places such as nurses' homes, many of which are in a shocking condition, defence establishments, such as naval dockyards, and prisons. Crown immunity regarding food regulations should be removed from all premises where it now operates. Prisons are especially important, because prisoners' conditions are not inspected. It is right that people should be imprisoned for crimes, but it is wrong for them to suffer food poisoning in addition to serving their sentences
I shall seek to extend the Bill. I want Crown immunity to be removed from all health and safety legislation because it entails double standards of health and safety for some workers. Crown notices are a poor substitute. They are issued infrequently—13 times less often than non-Crown notices—and lack powers of legal enforcement. I give notice that I shall press for future action to be taken.
This warmly welcomed Government decision signals the end of Dickensian hospital kitchens. It will help to sweep away health hazards and thus vastly increase the safety of hospital patients.
§ 2.4 pm
§ Sir Nicholas Bonsor (Upminster)
I first thought of introducing the Bill, but I was extremely happy to hand it to my hon. Friend the Member for Aldridge-Brownhills (Mr. Shepherd) for two reasons. The first was that I thought it would be in extremely safe hands and that he would run it ably, as, indeed, he has. I endorse everything that the right hon. Member for Stoke-on-Trent, South (Mr. Ashley) said about my hon. Friend. I hope that my hon. Friend will be duly noted in the appropriate place.
It is outrageous that hospitals should have the Dickensian conditions that the right hon. Member has described in their catering facilities, which, mercifully, have been prevented in every other sphere of public life outside Crown buildings.
I am a member of several London clubs, but not the one that was prosecuted for having food which fell below safety standards. I recall one club, which I shall not name, in which some years ago a friend of mine and I were dining. We were there after the staff had retired. We went to the kitchen to obtain some food and there we found about 20 cockroaches. We presented them to the chef with a small compliments slip. The club subsequently entirely renovated its kitchen. It is disgraceful that such conditions have been and still are prevalent in our National Health Service hospitals.
605 A television programme recently showed similar conditions in a hospital kitchen. Cockroaches were shown to be still running around. I welcome the steps that my hon. Friend is taking to ensure that such an outrage is prevented in the future.
I welcome the fact that the Government are prepared to take over the Bill. I believe that my right hon. Friend the Minister for Health will shortly announce that the legislation will be introduced in this Session of Parliament. I warmly welcome the Bill and the Government's successor Bill.
§ 2.6 pm
§ Dr. M. S. Miller (East Kilbride)
I congratulate the hon. Member for Aldridge-Brownhills (Mr. Shepherd) on the way that he comprehensively set out the provisions that he would like to have introduced. He gave the House an impressive array of facts. He seems to have influenced the Government to take action even before he did that.
There is no need for me to repeat the catalogue of events that led to the Bill's introduction. It is a tragic commentary on our medical advances that we should have a slogan such as "Hospitals can damage your health."
It is an indictment of the system that Crown immunity protects management that is incompetent and does not care rather than that which is criminally incompetent. The system puts the elderly and the infirm at risk.
Environmental health officers have no legal right to enter such establishments or even to lay down what regulations or code of conduct should be obeyed. Fortunately, some caterers pay attention to a code of conduct. However, others do not. It is tragic that National Health Service hospitals should be the biggest offenders. Many hundreds of people have died unnecessarily in hospital. Only one hospital in seven has anyone trained in pest control awareness, despite all the publicity associated with inadequate pest control in hospitals over the past few years.
I have a constituency interest to declare. I have two hospitals in my constituency — Hairmyres and Philipshill. I mention them only to declare an interest, not to criticise them. I ask the Minister what I have already asked the hon. Member for Aldridge-Brownhills: will he ensure that the proposals are extended to Scotland?
The Government should take on board the point made by my right hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley). Every Government establishment with Crown immunity should be examined. I have another constituency interest here, because the Inland Revenue department in East Kilbride employs hundreds of people, and the Overseas Development Agency and the National Engineering Laboratory are also situated in my constituency. In addition, of course, there are DHSS premises and places where food is prepared and cooked. There is a potential risk in those kitchens if adequate supervision is not implemented.
I would not exclude from such criticism the place in which we are gathered today. That is no criticism of the staff, or of those, including myself, who are trying to help in this respect. A blind eye is turned to too many things. However, as we say in Scotland, I shall let that flea stick to the wall.
All I ask is that the Government proceed with the Bill with all haste, that it should apply to Scotland and that the 606 Government take on board the possibility of extending the provisions to other premises currently enjoying Crown immunity.
§ Mr. William Cash (Stafford)
I congratulate my hon. Friend the Member for Aldridge-Brownhills (Mr. Shepherd) on introducing the Bill. I also congratulate my right hon. Friends the Secretary of State and the Minister for Health for accepting the principles of the Bill, which recognise the need to accept that the king can do no wrong, but only most of the time.
The highest standards are needed for patients in hospitals. Yesterday the Secretary of State said that the nature of the problems displayed by the Stanley Royd hospital report is such that Crown immunity should be removed so that prosecutions under the criminal law can be taken against the Crown. They can already be taken against private hospitals.
The problem arises not only in connection with food in NHS hospitals, but in other areas and in other public buildings. My constituency found that to its cost when 37 people died at the Stafford general district hospital during the recent legionnaire's disease outbreak.
When the result of the inquiry is known, I ask my right hon. Friend to bear in mind that, as long ago as 1977, the Health and Safety Commission recommended that the Government should remove Crown immunity by legislation, especially as it means that only the Crown is immune from prosecution, not Crown servants. Currently the Crown can claim immunity from prosecution for Government Departments, the Armed Forces, the NHS, the Medical Research Council, and so on, although not for nationalised bodies. I ask that the principle that has been won in this case, and for which the Government deserve the greatest possible credit, should be extended to all those premises. I hope that the Bill will cover these when the report on the legionnaire's disease outbreak in my constituency is published, so that the principle of the removal of Crown immunity will apply to them all.
§ Mr. Frank Dobson (Holborn and St. Pancras)
I welcome the Bill on behalf of the Opposition. I congratulate the hon. Member for Aldridge-Brownhills (Mr. Shepherd) on his generously brief introduction which has allowed several other hon. Members to speak.
I congratulate also those who, for many years, have campaigned on this issue. I think especially of those working within the NHS and the Institute of Environmental Health Officers, who have had a long campaign to try to ensure that we match the care and attention that we give to other parts of the hospitals by giving decent care and attention to the kitchens. It has always been absurd that we should spend tens of millions of ponds on building decent hospitals, then proceed to poison some of the patients by not looking after the kitchens.
I do not think that when the Bill is enacted, people will expect many prosecutions of health authorities or their staff. The object of the change is not to get people into court or gaol, but to change the relationship between environmental health officers and people who work in hospitals. Hitherto, whatever the environmental health people have said, they have not had the authority to force their views on those responsible for the kitchens. That is 607 the vital difference. In future it will not be a matter of a departmental circular saying, "You will have to assess the priorities when deciding what to do about the kitchens." We shall provide a statutory priority to keep kitchens up to the mark.
We hope that that will be an end to scandals such as those at Stanley Royd, or the Charing Cross hospital in Fulham or the Royal Free hospital, which used to be in my constituency. We look forward to the cockroach-free hospital as well. We had the appearance of a famous cockroach in the chicken stew there, and some benighted chap in the health authority tried to tell everyone that it was OK provided that the cockroach had been well cooked. I do not think that anybody found that convincing. We would rather get rid of the cockroaches.
As my right hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) said, the change cannot be made on the cheap. One estimate for doing the Stanley Royd hospital's kitchen was £600,000. There were various other, lower, estimates. I hope that we shall decide that bringing kitchens up to the mark is a statutory priority in the next few months, but the Government will have to find the money to do it. We are talking in terms of tens of thousands on some kitchens, and hundreds of thousands on others. I must emphasise that it is not always the old hospitals that have bad kitchens. The Royal Free hospital kitchen is a shambles, and the hospital has been open for only a little more than a decade.
§ Sir Geoffrey Finsberg (Hampstead and Highgate)
The Royal Free hospital is in my constituency, and I agree with the hon. Gentleman. The problem is that, for a long time, we have had to rely on the good sense of hospital authorities to follow the advice that has been given. It is clear that some have not accepted that advice, so there is a clear need for legislation. I agree with the hon. Gentleman.
§ Mr. Dobson
I hope the hon. Gentleman will also agree that his health authority would probably like the Government to provide the extra £150,000 or £200,000 which it says is necessary to do up the kitchen rather than have to take it from some other aspects of health spending. Some hon. Members have played a prominent part in the campaign, but even those who have played the smallest part owe it to health authorities to back up our request with a request for money to make good what we are asking them to do. I hope that we shall all be consistent on that.
§ Mr. Peter Lilley (St. Albans)
I, too, pay tribute to my hon. Friend the Member for Aldridge-Brownhills (Mr. Shepherd) for the manner in which he introduced the Bill. I congratulate him on his success in getting such a speedy response from the Government, and I congratulate the Government on responding so rapidly.
I was pessimistic when I was first alerted to the problems about the speed with which the change could be introduced. I therefore discussed with constituents who have experience of the Health Service and of environmental health problems and who have drawn the matter to my attention, what could be done in our area to act as if Crown immunity had been removed. I took up their recommendations with the regional health authority and with the North West Hertfordshire health authority.
608 They recommended, first, that it was essential to establish clearly at each level of the authority who is responsible for ensuring that the problems are properly tackled. That happens automatically in the private sector because of the threat of legal action. Secondly, they recommended that environmental health officers should have immediate access to NHS premises, without any need to give prior notice and, thirdly, that expense should not be used as an objection to fulfilling obvious obligations under the law.
I took that up with my regional health authority, and I am happy to say that all three steps have been implemented in our area, which may explain why we have not had the problems that other areas have faced in recent years. There are some exceptions to that, but they are not in my area.
My constituents have also started a study of the catering facilities of every NHS establishment in the area, and that example should be followed more widely. One question will remain after today's debate: why has it taken 40 years of the NHS for the laws which apply to private hospitals and establishments to be applied to the NHS? Have we been so bemused by the myth that mere national ownership removes the commonsense necessity of applying to those who work within the services the normal incentives, disciplines and sanctions that are required to make us all fulfil our obligations and ensure that our services are of the highest standard in other areas? I congratulate the Government on introducing this sanction and incentive for people who provide those services.
§ Mr. Mark Hughes (City of Durham)
I join in the congratulations of the House on the skilful way in which the hon. Member for Aldridge-Brownhills (Mr. Shepherd) has managed the matter. I wish to introduce a constituency problem.
I have two large prisons in my constituency. In Frankland prison, 80 people are serving life imprisonment. If there were an outbreak of salmonella it would affect prisoners and wardens alike, yet there are only 20 beds in the hospital wing. My constituents are considerably disturbed by the thought of category A prisoners being transferred from prison to receive adequate medical care as a result of kitchens not being subject to inspection.
My one regret in the Government's written answer yesterday is that their intention appears to be exclusive to the National Health Service. In many other areas the risk to the public is no less severe. Prisoners in Her Majesty's prisons are as much the concern of the Government as are elderly people in psychiatric hospitals. I deplore the withdrawal of protection from prisoners which the food and drug Acts and Crown immunity should give them.
§ Mr. Gerald Bermingham (St. Helens, South)
Does my hon. Friend agree that the rule of Crown immunity would place workplace equal with workplace, and hygiene regulations equal with hygiene regulations, in every sector of society, and that that is how it should be?
§ Mr. Hughes
Of course. We welcome what the Minister is doing for NHS hospitals, but please could the Government bear in mind that the risks facing hospitals also apply to the Palace of Westminster and prisons?
§ The Minister for Health (Mr. Barney Hayhoe)
I am the ninth Member of Parliament to speak in this short 609 debate. I pay tribute to my hon. Friend the Member for Aldridge-Brownhills (Mr. Shepherd) for the brevity of his speech, and add my warm congratulations to him and his co-sponsors on both sides of the House, and to the many organisations and individuals who have been urging the course which my right hon. Friend the Secretary of State for Social Services yesterday announced that the Government would pursue.
All those concerned have focused public attention on food hygiene in the Health Service. It is immensely important that hospital kitchens maintain high standards. The tragic outbreak at Stanley Royd Hospital in August 1984, which resulted in the deaths of 19 patients, illustrated that only too well. The results of poor standards in hospital kitchens can be horrifying.
As I have made clear on many occasions, the Government have been most concerned at the allegations of poor standards that have been made in recent months. For example, the survey by the Institute of Environmental Health Officers, published last autumn, found that 60 per cent. of 1,000 hospital kitchens that had been inspected were in some way in breach of the food hygiene regulations and that 10 per cent. of those, just under 100, were so bad in the view of the survey that they warranted prosecution.
These examples were worrying, and, as the House will recall, I immediately called for urgent action by the health authorities concerned to take priority remedial action wherever that was needed. I also made it clear to the right hon. Member for Stoke-on-Trent, South (Mr. Ashley), who led an all-party deputation which represented a wide range of interests to see me last autumn, that I was undertaking a review of Crown immunity of hospital kitchens. That was under way, and it was that review, set in hand last year, that led to the Government's statement of intention by my right hon. Friend the Secretary of State yesterday.
My right hon. Friend made it clear that in responding to the problem of poor hygiene there can be no substitute for more effective management and supervision in hospital kitchens generally. As the debate is concentrating on affairs that go wrong, it would be right for me to pay tribute to the majority of staff in NHS hospitals who carry out their duties responsibly and very properly. It would be wrong if the message went out from the House that the difficulties to which the legislation and debate are drawing attention were spread over the entire Health Service.
Because effective management and supervision are the essence of solving the problems, the introduction of 610 general managers, who will be both responsible and accountable for these and other matters, will do much to secure the right parity of managerial responsibility. The Government have concluded that, in addition to the essential tasks of improving managements and supervision, further action is appropriate. We have concluded that stronger safeguards are needed to underpin management efforts, and above all to protect patients.
Therefore, my right hon. Friend the Secretary of State made clear the Government's intention to introduce legislation in the present Session to remove Crown immunity from hospital catering in respect of the food hygiene regulations by making health authorities subject to the provisions of the Food Act. We shall propose that the Food Act 1984 and the Food Hygiene (General) Regulations 1970 should apply fully to health authorities.
We have been asked about Scotland. For Scotland, similar amendments will be proposed by the Bill to the Food and Drugs (Scotland) Act 1956. This will mean that local authority environmental health officers will have rights of access to all hospital premises where food is stored, prepared and consumed. In the past, the officers have been encouraged to go in, but this change of law will give them the right of access to all hospital premises. They will be able to require improvements, and, if need be, they will be able to prosecute and seek closure of kitchens if circumstances are bad enough to justify that.
These changes address themselves directly to the concern of my hon. Friend the Member for Aldridge-Brownhills and of other right hon. and hon. Members. The Government consider that it is right, for an important issue such as this, to introduce a Government Bill. I know that it is the. Government's absolute and firm intention to introduce the legislation before Easter. It is better to deal with the matter by means of a Government Bill and to buttress that action with the action that was made crystal clear in my right hon. Friend the Secretary of State's statement about the Stanley Royd affair. We must take action, which is in hand, to strengthen the guidance to the National Health Service on measures to ensure high food hygiene standards. Nobody must be left under the illusion that merely by dealing with Crown immunity hospital kitchens are made hygienic. The guidance that is necessary—
§ It being half past Two o'clock, the debate stood adjourned.
§ Debate to be resumed upon Friday 14 February.