§ 'For all purposes:—
- (a) a health authority shall not be regarded as a servant or agent of the Crown or as enjoying any status, immunity or privilege of the Crown; and
- (b) premises used by a health authority or provided by a health authority for use by health authority staff shall not be regarded as property of or property held on behalf of the Crown.'. —[Mr. Dobson.]
§ Brought up, and read the First time.
3.49 pm§ Mr. Frank Dobson (Holborn and St. Pancras)I beg to move, That the clause be read a Second time.
§ Mr. SpeakerWith this it will be convenient to take the following:
§
New clause 2—Application of Rent Acts to health authority—
'For the purpose of the Rent Acts:—
§
New clause 3—Application of health and safety legislation to health authorities—
'1. — (0 for the purposes of the health and safety legislation:
(2) The appropriate authority may by regulations provide who is to be treatd as the user, occupier or owner of any such premises for any of those purposes; and
(3) The powers to make regulations altered by subsection (2) above shall be exercisable by statutory instrument.
(4) A statutory instrument containing regulations made in the exercise of the power conferred by that subsection shall not be made unless a draft of the instrument has been laid before Parliament and approved by a resolution of each House.
(5) Section 125 of the 1977 Act and section 101 of the 1979 Act shall have no effect in relation to any action, liability, claim or demand arising out of the health and safety legislation.'.
§
New clause 5—Health Authority Premises—
'No. premises, owned or used by health authorities, including residential accommodation used by or tenanted by health authority employees, shall be regarded as the property of or property held on behalf of the Crown.'.
§ Amendment No. 62, in title, line 2, after 'food', insert 'and health and safety.'.
§ Mr. DobsonWhen one looks at any of the learned tomes, one finds that the concept of Crown immunity 27 comes to us, as it is described, from time immemorial. An explanation is offered that laws that were the King's own laws could have no jurisdiction over the King. It is on that basis that Crown immunity still exists. At the time that that concept was formulated we lived in a primitive society. Under this Government many people are reverting to living in a primitive society, but not in the sense that I am talking about.
At the time that the concept of Crown immunity came into operation and became hallowed by use, it was a simple state, which had few functions. Since then the state has taken on a multiplicity of functions, there are a multiplicity of laws, and there are a multiplicity of Government agencies responsible for enforcing those laws. In the more complex and, some would claim, more sophisticated society that we now have, Labour Members claim that the concept of Crown immunity is time expired. It has no place in our current society.
Crown immunity was first substantially undermined —if that is the right word—by the Crown Proceedings Act introduced by the Labour Government in 1947. It was felt necessary to move with the times and at least give individuals the opportunity and right to sue the Crown for damages. However, the Crown Proceedings Act does not permit criminal proceedings against the Crown or any of the agencies presently covered by Crown immunity. As a result, many laws do not apply to Crown property or to Crown institutions.
We find ourselves in the strange position that a health authority can be sued by an injured individual in the civil courts, possibly over being poisoned as a result of something going wrong in a kitchen, but the health authority cannot be prosecuted under the criminal aspects of the food hygiene regulations that the authority was breaking. It is not simply the food hygiene regulations that do not apply to hospitals and Health Service property. The general health and safety legislation does not apply. Recently, the Secretary of State for Social Services made it clear that the Rent Acts do not apply to Crown property, at least as far as the National Health Service is concerned. Who benefits from the existence of Crown immunity? The answer seems to be literally no one, because the existence of Crown immunity leaves hospital more dangerous than they could be and should be for both patients and staff.
If Crown immunity has lasted since time immemorial, should it be kept for that reason alone? We might argue for that in relation to the armed forces or for one or two aspects of Crown activity that have gone on since time immemorial, but in the case of the National Health Service and hospitals, Crown immunity arrived with time immemorialness on 5 July 1948. When hospitals were owned by private charities or municipalities, Crown immunity did not apply. Crown immunity is not even hallowed by time. It is certainly not hallowed by any sense of justice, logic or common sense.
The position is exactly the reverse in the Post Office, which used to be a Government department but became a nationalised industry. On vesting day, when the Post Office became a nationalised industry and ceased to be a Government department, Crown immunity disappeared in a trice. Apparently no one thought that that would be harmful, damaging, expensive or likely to undermine the state.
28 We believe that there is no justification in logic for the maintenance of the concept of Crown immunity in its application to Health Service properties. This Government have rejected that idea time and time again and, to be fair to them, previous Governments had done so as well, but a combination of extremely bad publicity about the conditions prevailing in NHS kitchens and long-term campaigns by the Institution of Environmental Health Officers and by a considerable number of trade unions, supported by the Royal College of Nursing and the British Medical Association, forced the Government to reconsider the position.
The campaigns were strongly supported by the new media, which found that they gained attention for their programmes and papers if they displayed vast piles of rotting refuse in a kitchen or—to use the example of a hospital that is outside my constituency but serves it—made the Royal Free cockroach probably more famous than the Royal Free hospital itself. It reached the stage at which someone wrote in my local newspaper that he or she did not mind the Royal part but would really like it to be the Cockroach Free hospital. Such publicity gradually drove the Government into at least considering abandoning the concept of Crown immunity in relation to hospital kitchens.
The final blow that forced the Government to give way altogether was the incident and then the report of the inquiry into the severe outbreak of food poisoning that led to more than 20 deaths at Stanley Royd hospital in the Wakefield health district. It is worth repeating that the Stanley Royd hospital—in which in the fourth quarter of the 20th century people were attempting to provide a decent service and decent care and meals for patients—was built when Napoleon was alive in 1818 as the West Riding Paupers Lunatic Asylum. It would be useful for the House to bear that fact in mind when discussing this series of new clauses and the other amendments relating to the lifting of Crown immunity. From 1818 to 1948 Stanley Royd hospital was not protected in any way by Crown immunity. That protection has been needed only since 1948, when it became part of the NHS.
As a result of all the publicity, the Government decided —we welcome their decision—to end Crown immunity in so far as it applied to the food regulations. We believe that we should get rid of Crown immunity altogether in relation to all NHS premises, and there are a large number of reasons for advocating that course. In that part of the economy that is outside the Crown, if there are serious offences relating to health and safety, the appropriate people from the Health and Safety Executive issue enforcement notices. If a Crown property is involved—in this case an NHS property — they issue Crown notices. If it is non-Crown property, they can institute legal proceedings against those responsible for health and safety offences being committed. If, having issued a notice, it is not complied with by the deadline set down in the notice, the Health and Safety Executive can prosecute, even if it had not decided to do so at the outset.
A health authority cannot, however, be prosecuted either at the outset or if it fails to take action within the period of time laid down in the Crown notice. It follows, as night follows day, that without that threat there will be less outside regulation by the HSE and its staff and that the people working within the Health Service will not take the concept of health and safety at work as seriously as it 29 is taken by those outside the Health Service and as seriously as they would take it if the notices and investigations could be followed up by court proceedings.
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Substantial delays occur in the implementation of Crown notices. Health authorities are slower than those who are not covered by Crown immunity to do what the HSE thinks is necessary. Again that follows from the fact that health authorities cannot be prosecuted if they do not do it or, or if they are slow to do it. That is damaging. It means that for an HSE inspector to take action over Health Service premises is much more of a bind, much more troublesome and much less immediately productive than his work on premises where the HSE has the necessary statutory powers.
All hon. Members recognise that each human being responds to either incentives or difficulties. If we permit to continue a system that leads to frustration for HSE inspectors when they try to do something about NHS premises, we should not be surprised if they are not so enthusiastic about that work as about their other work.
It is usual for the HSE to make surprise visits to premises that are not covered by Crown immunity. The forewarned visit to premises is a useful technique for getting premises tidied up temporarily, but if premises are to be made permanently safer and healthier the threat of a visit that has not been forewarned is very important. However, the HSE may not make surprise visits to health authority premises without the prior consent of the health authority. That may sound as though the surprise visit is no surprise at all. I do not suggest that the HSE needs to obtain consent on every occasion when it intends to make a surprise visit, but it needs in advance a blanket agreement from the health authority that surprise visits will be permitted. I am told by the staff involved that that consent is not always as readily forthcoming as we might expect from public bodies that are supposed to obey the laws that have been passed by this House.
There is also clear evidence that Crown notices are used less frequently than the notices that are issued to employers who are running other premises. Again the reason is that it is not worthwhile from the point of view of hard-worked HSE inspectors, whose numbers have already been reduced. However, there is an anomaly. Although a health authority which may have failed to provide funds to make a kitchen safe, clean and decent cannot be prosecuted, the individual managers can be prosecuted. If I were a manager, that would be most offensive to me. I should find it most offensive that my gaffers, who had made my life impossible, could get away with it but that I could be gaoled. That is completely unreasonable.
It has another effect. Faced with the possibility of individual prosecution, in the absence of the ability to prosecute the authority as a whole, managers have been observed to try to spread the responsibility among several of them so that none of them is individually responsible for the prevailing circumstances. It is understandable that they should try to camouflage their activities and render themselves less liable to individual prosecution. It is a normal human response, even if we do not welcome it.
If individuals can be held responsible but not the organisation that employs them and fails to supply them with the necessary resources to do their job, it amounts to statutory hypocrisy and we ought to get rid of it. 30 Therefore, the concept of Crown immunity ought to disappear altogether. The Government intend to get rid of it in hospital kitchens, but the Opposition see no reason for getting rid of Crown immunity relating to the food regulations but keeping it for other parts of hospital premises and for other hospital functions. In particular, we are very doubtful about its continued application to health and safety.
Some Conservative Members who served on the Standing Committee will have heard me say, but it is worth emphasising it by saying it again, that hospitals are extremely dangerous places. They are more dangerous than most industrial and commercial premises. Most hospital patients are full of germs, and most hospitals carry out dangerous processes. On the premises of most hospitals there are large amounts of dangerous drugs and substances which, if used carefully, may be beneficial, but which can cause trouble if they are not properly handled, or if there is slack control over what goes on.
Furthermore, most hospitals are full of extremely dangerous and horrible refuse. I refer to clinical waste and to things cut from people, sucked from people or dragged from people. Hospitals are also full of what hospital employees call "sharps"—that is, implements that can cut people. They, too, are very dangerous. There are few premises in this country, including nuclear installations, which in a day-to-day sense, are so intrinsically dangerous to the people who work in them as hospitals. This is a threat to the health and safety of both patients and staff.
When patients go into hospital they assume that they will he made better, that their lives will be saved and that their pain will be eased. Patients are entrusted to the National Health Service on those grounds, but many of our hospitals are breaching that trust. There is a great deal of cross-infection. For example, post-operative infection has increased in the National Health Service since this Government came to power, but it is not listed among the Government's achievements when the Secretary of State for Social Services or the Prime Minister refers on television to the National Health Service. There has been a 14 per cent. increase in post-operative infection since 1979. We all know from what happened at the Stanley Royd hospital that salmonella poisoning is a fairly commonplace complaint in our hospitals. We also know from the incident on which a report was made last week that legionnaire's disease has killed a number of people in our hospitals.
Many hospital buildings are of poor design and many are in a poor state of repair. There are poor standards of cleanliness and hospitals are full of dangers to staff and patients. People can suffer from falls, and heaps of rubbish lying about can lead to fires. Society and Parliament are asking people to do things for us and our constituents, and we owe it to the patients, staff and visitors to make hospitals as safe as possible. We are simply not doing that. One reason for that is that, compared with the need for health and safety at work in other premises, and because of how the law stands, officialdom sees hospitals as different. I am talking about officialdom in the hospitals and officialdom outside. Inspectors see the hospital premises as different, and so do the inspected.
There is an assumption, which history suggests is wholly false, that people running hospitals know about health and safety and about how to keep people in hospitals healthy and safe. All the evidence suggests that outside the specialist fields in which they operate few 31 people in hospitals know how to do that. I can give an example by citing something that occurred in my constituency a year or two ago.
Someone was unfortunate enough to die of smallpox as a result of work carried out at the London School of Hygiene and Tropical Medicine in my constituency. In the course of the inquiry into that outbreak the staff of the environmental health department, or, as the outbreak may have occurred before local government reorganisation it may have been the health department of the London borough of Camden, was closely questioned about why it had permitted certain practices at the London School of Hygiene and Tropical Medicine in dealing with smallpox. The answer given by the staff was that it would have needed official advice on how to advise others. The QC conducting the inquiry asked where the advice would have been sought. The staff replied that it would have been sought from the London School of Hygiene and Tropical Medicine because it was reasonable for the staff to assume that the people at that school knew better than anyone else in Britain how to deal with smallpox. They manifestly did not, because they were not even keeping to their own rules. That is an example of what can happen.
The Rent Acts do not apply to Health Service premises or to premises owned by, or, as far as I can make out, leased by, or run by the health authorities. Crown immunity intervenes in a civil court relationship, and not just in relation to criminal proceedings. The non-application of the Rent Acts to hospital residential premises has become more important because of the Rayner review, which the Government have accepted and which suggests that the Government should get on with disposing of nurses' homes as quickly as they can in order to raise money.
I think that it was on 24 March that the Secretary of State gave me an undertaking that no health authority would take court action to turn a nurse out of accommodation in which the nurse wanted to remain. No caveats or reservations were expressed when that undertaking was given. It was later discovered that in the West Surrey and North-East Hampshire health authority a nurse was being put out of the premises in which she lived and that the health authority was resorting to the county court to get her out. That appeared to be in breach of the undertaking given by the Secretary of State. To add insult to injury, the Secretary of State joined his name to that of the health authority in the court action that the authority was taking against the nurse.
The right hon. Gentleman has since arranged for the Minister to explain to me rather belatedly that what he said in the House related only to property owned by the health authority. He did not say that at the time, and in any case large numbers of health authorities do not own the freehold of nurses homes, especially in central London and in other big cities, where hospitals tend to have long leaseholds.
Are we to understand that the plain undertaking given by the Secretary of State to the House does not apply unless by a quirk of fate the health authority happens to own the freehold of the property in which the nurses are living? That strikes me as a bit odd, because the next stage in the case in West Surrey and North-East Hampshire was that although the health authority did not own the premises from which the nurse was being chucked out, the 32 Secretary of State's plea in the court was to be that the Rent Act did not apply to him because he had Crown immunity. He cannot have it both ways. He cannot say that he will not apply his undertaking to leasehold property and at the same time say that if it comes to a fight in the courts over leasehold property he will plead Crown immunity. There is no need for the Secretary of State or for health authorities to have Crown immunity for nurses' residential homes or for residential property provided by hospitals or health authorities. The Rent Acts, feeble as they are in some ways, should apply to those properties, and that is why we have tabled new clause 2.
4.15 pm
There seems to be no one, other than the Secretary of State and a few of his hon. Friends and a few civil servants who are paid to agree with him, who is in favour of retaining Crown immunity. Trade unions and other staff bodies within the National Health Service have campaigned for years for Crown immunity to be lifted from National Health Service properties. Bodies and organisations representing patients also believe that it would be in the interests of patients for Crown immunity to be lifted. The National Association of Health Authorities in England and Wales, the representative of the authorities that would become liable to prosecution, thinks that Crown immunity should be lifted. Perhaps the case for lifting it is best summarised by the British Medical Association, which said:
We believe the arguments for retaining Crown immunity are no longer tenable. The National Health Service is the largest employer in the country and as such it should not be outside the legislation. Moreover, the passage of time should have given experience of meeting legal requirements in health and safety. The recent introduction of the recommendations of the Griffith inquiry into the management of the National Health Service has clarified management responsibility.No doubt the Minister will tell us wondrous things about the introduction of general managers. The BMA went on to say:A visit to almost any hospital would provide examples of the disregard for the Health and Safety at Work etc. Act 1974, laboratory conditions, storage of materials, collection and disposal of rubbish, fire hazard and ventilation. Whilst these breaches of the Act may be pointed out by the health and safety executive inspectors, there is no compulsion upon health authorities to rectify the conditions.It is a bit disturbing to hear the BMA saying something like that.The BMA compares that situation with the circumstances of general practitioners in the NHS who, if they employ more than five people, are not covered by Crown immunity and are subject to the Health and Safety at Work etc. Act. The bag of sharps or clinical waste in a GP's surgery—extremely unlikely to be as horrible as some of the clinical waste from a hospital—is covered by the Health and Safety at Work etc. Act. Hospitals in the private sector, which I should like to see disappear entirely, are covered. Local authorities are covered. The BMA and, as far as I know, all my hon. Friends believe that it would be right for the NHS to be covered.
Why will the Government not lift Crown immunity altogether? It is right that it should be lifted. The case for doing so is supported by everyone involved, and it has been conceded on food hygiene. There is clearly no principle involved. The question whether some premises, functions or organisations are or are not covered by Crown immunity is just a lottery. It could well be that Parliament decided when the NHS was set up that it did 33 not count as Crown property. It did not make a ha'porth of difference when the Post Office went out of the Crown area and became a nationalised industry.
Labour Members believe that Crown immunity is an idea whose time has passed. It serves no useful purpose. We are convinced that it is positively harmful to patients and staff and that it should go. What explanation Ministers can give for not getting rid of it, I cannot imagine. They will not be able to say that they do not care any more because, following the Tory party conference in Perth, we know that even the Prime Minister apparently cares about things such as the NHS and the patients in it. They may say that it will cost money, but I should not need to tell a Tory that most worthwhile things cost money.
If it is right to have clean hospitals and to spend money to make sure that the operating theatres of a hospital are spotlessly clean, not full of infection, and as a patient who has been in the operating theatre has to go on to a ward and he fed with food produced in a kitchen, to be wheeled about and have tests done on him in pathology laboratories, it follows, as night follows day, that anybody who is serious about cleanliness, standards of hygiene and the care of patients must support the abolition of Crown immunity altogether. That is what Labour Members believe and that is why we are putting forward the four new clauses. I commend them to the House and I defy the Minister to come up with any sensible reason for not accepting them.
§ Mr. Jack Ashley (Stoke-on-Trent, South)I want to begin by recommending support for new clause 1 and the associated new clauses and complimenting my hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson). In Committee he has argued these basic points with the Minister and on any reading of those debates it is obvious, even to the most prejudiced reader on one side or the other, that my hon. Friend won the argument hands down. Moreover, I commend him on the speech that he has just made.
It is disgraceful that we need to put these new clauses forward at all. It is the Government's responsibility to ensure that hospitals are clean and safeguarded, but they are not doing so. All the evidence at our disposal shows clearly that patients and staff are suffering dangerous conditions. It beats me how the Minister can stand up in the House and say that there is a powerful case for abolishing Crown immunity in one part of a hospital— the kitchen—but not elsewhere.
By removing Crown immunity from the kitchens the Government have admitted that Crown immunity is protective of negligent health authorities, but those same health authorities can be just as negligent in other parts of a hospital. Having admitted the principle that Crown immunity is wrong because it prevents the prosecution of negligent health authorities, the Minister should go much further and ensure that health authorities are not protected in their work in other parts of hospitals, particularly with regard to health and safety, as is specified in the new clauses.
The Government are dodging and fudging on this vital issue. It is axiomatic that health and safety legislation is good and necessary. No one seriously disputes that. But the health and safety provisions should apply in the NHS as they apply outside. The Minister for Health is on record as saying that compliance, rather than punishment, should be the objective. Of course, we want compliance, but we 34 shall not get compliance without the threat of punishment. All the evidence shows that the Crown notices, which are the alternative to the abolition of Crown immunity, simply do not work.
In 1984 there were only 32 Crown notices to health authorities, although there were 1,891 hospitals. In that same year there were 15,816 Crown notices in non-Crown premises. The difference is twentyfold. Crown notices in non-NHS premises were meaningful because the right to prosecution was there. The threat of prosecution could be made where there was negligence. Only one twentieth of Crown notices were issued in NHS hospitals simply because they could not be enforced.
The lack of power to prosecute can be seen in the views of environmental health officers, especially those mentioned by my hon. Friend in relation to the Stanley Royd hospital. They see themselves not as enforcement officers but as visitors and that is scandalous. Those people are specially selected, trained and appointed to enforce the law, yet they are unable to do so and they simply see themselves as visitors. Just fancy any policeman seeking to be invited in as a visitor with no right to take action. That is the position for environmental health officers in NHS hospitals. It really is ludicrous.
The consequences of the lack of enforcement should be known to the House of Commons, but nobody knows what the consequences are. I asked the Minister, in a series of parliamentary questions, for a comparison of the figures on industrial disease and accidents in NHS hospitals and those in non-Crown premises. The Minister's answer was that those figures were not available. He does not know what goes on in the hospitals for which he is responsible. He prefers a blindfold and a lack of knowledge. He prefers the House not to know the facts. If he wanted the House to know the facts he would find the figures, hut he is simply telling me, and therefore the House, that the Government do not know that, and that is inexcusable. Ministers should acquaint themselves with the facts and not simply say that they do not know the answer.
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My hon. Friend the Member for Holborn and St. Pancras rightly paid tribute to various organisations. The General, Municipal, Boilermakers and Allied Trades Union started the campaign, along with the environmental health officers, and managed to get some action from the Minister. Now the British Medical Association has added its considerable weight. The BMA speaks authoritatively and tells the Minister that he must remove Crown immunity because of the dangers to patients and staff. The Minister should take those views very seriously.
Some hospitals are full of bacteria and viruses and daily pose a risk to the health of patients and staff. We need to ensure hygiene of the highest order and the safe disposal of rubbish and powerful drugs.
The 1981 survey by the pest control unit showed that 11.6 per cent. of English hospitals were infested with pharoah's ants, which carry disease and 20 organisms. The ants are tiny and move around our hospitals, from germ-infested sluices to wards, beds, operating theatres and even to sterile dressings and hypodermic needles.
What do the Government do about these dangerous conditions? They have a pest advisory service, which consists of two people working part-time on pest control. Pharoah's ants are crawling all over our hospitals and infesting sterile dressings, but the Government have only 35 two part-time workers dealing with pest infestation. It is the merest nod towards the control of disease caused by pests. It is simply not good enough, especially as only 73 of the 1,891 hospitals in England have been surveyed in the past 10 years.
Removing Crown immunity in this area and others would make health authorities far more vigilant and active, because of the fear of prosecution. That fear applies everywhere else and there is no reason why it should not operate in our NHS hospitals. I hope that the Minister will think again and will ensure that patients and staff in our hospitals have the same protection as everyone else.
§ Mr. Willie W. Hamilton (Fife, Central)My hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) was right to emphasise how extremely dangerous hospitals can be. They are places to be avoided if possible, but, because entrance to them by patients, visitors and staff is unavoidable, it behoves hon. Members, health authorities and everyone else to make the premises as safe as possible.
The new clauses emphasise the fact that "premises" should include all premises and not just kitchens and the places where food is provided. The Bill is unacceptably narrow in the view of Labour Members and every interested body.
My hon. Friend the Member for Holborn and St. Pancras made perhaps the most significant point in the debate when he said that the Government go out of their way to say that the Bill will cost nothing. Not a single organisation or individual believes that for an instant. If we are to have safe kitchens, rid of the infestation that we have read about and seen on television, it will cost a lot of money.
If the Minister asks, "Where will the money come from?" I shall remind him, as I have reminded the House, that at the time of the Falklands expedition the Prime Minister said, "We shall see this through, no matter what the cost." She has maintained that view throughout and we have spent, and will continue to spend, thousands of millions of pounds of taxpayers' money on the Falkland islands. However, when we ask for some millions to be spent on hospital services to make hospitals safe for patients, visitors and staff, we are told that the Government cannot find the money or, if they can, that it must come out of another part of hospital authorities' budgets.
I tabled an amendment to extend the Bill to residential accommodation. It has been said many times in the House and outside that the Bill presumes that all the filth that we know about—all the rats, the mice, the cockroaches, the ants, the flies and the other infestations in NHS hospitals — are due to mismanagement. Indeed, the Minister made that point about the recent scandal involving food poisoning at Wakefield. It is suggested that all the problems can be eliminated within existing budgets.
My right hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) has referred to some aspects of the matter and I did not realise how much disgusting filth and danger exist in our hospitals. The smaller the insect, the filthier it seems to be. I have a document from the British Pest Control Association entitled "Hospitals can damage 36 your health". It says of the common house fly, which infests not only kitchens, but often wards and certain residential accommodation,
This is what happens when a fly lands on your food. Flies can't eat solid food, so to soften it up they vomit on it. Then they stamp the vomit in until it is a liquid, usually stamping in a few germs for good measure. Then when it's good and runny they suck it all hack again, probably dropping some excrement at the same time. And then, when they've finished eating, it's your turn.That is happening in our hospitals where people go to get their health improved. While these wretched flies are busy, the bugs, the cockroaches and the ants are all at it as well. The Government say that they will tackle them if these pests happen to be in the kitchen. But cockroaches and flies do not know the difference between kitchens, wards and residential accommodation.It was said that the nuclear accident at Chernobyl knew no national boundaries, but flies, ants and cockroaches do not know national boundaries either. In that regard, the Bill is nonsense. It pretends that if only the problems in the kitchens were solved, everything would be all right. My hon. Friend the Member for Holborn and St. Pancras referred to the activities, over the years, of the trade unions. I am sponsored in the House by the Confederation of Health Service Employees, which has taken a longstanding interest in these matters. Moreover, the General, Municipal, Boilermakers and Allied Trades Union — GMBATU for short — has also taken a long-standing interest in them. The union's report, published in 1985, estimated that one in four of all hospital kitchens would be closed on grounds of hygiene if the NHS did not have immunity from prosecution. I suspect that the same applies to residential accommodation.
For years, hospital doctors and nurses have complained about the state of NHS residential accommodation. My sponsoring union, COHSE, has been in the forefront of that campaign for a long time. In 1985, at the TUC conference, Mr. Hector MacKenzie, the assistant general secretary of that union, said:
It is scandalous that hospital kitchens can become breeding grounds for infection and be equipped with dangerous machinery—and that Crown Immunity allows standards which would lead to the immediate closure of a fast food restaurant in Bloomsbury or Blackpool and the prosecution of its owner.A report of that conference states:COHSE's successful motion stressed that the 'Crown employee' status of one million NHS employees and many other public sector workers means that they arc excluded from the laws designed to protect employees at work.Indeed, my hon. Friend the Member for Holborn and St. Pancras referred to the fact that the health and safety legislation does not apply. The Parliamentary Under-Secretary of State for Scotland knows full well the great difficulties that followed the fire some years ago in the nurses' home at Kirkcaldy's Victoria hospital, partly as a consequence of Crown immunity. But, Mr. MacKenzie continued:Hospital staff live in hospital accommodation which is falling into an incredibly disgraceful state of repair. Because of Crown Immunity the NHS can (and sometimes does) behave like the most unscrupulous of private landlords—and get away with it.The report of the conference then adds:Crown status deprived them of rights of security of tenure and repairs afforded to most private and council tenants.That is the situation in an area to which everyone pays lip service. The Prime Minister says that she cares very much about it, but she does her best to destroy it, and not 37 least in this regard. In 1983, the Nursing Mirror launched a "Homes Fit for Nurses" campaign which excited great national interest and sympathy. Thousands of letters poured in from all over the United Kingdom, describing the disgusting and intolerable living conditions of thousands of the most dedicated workers in our NHS. A lot of the letters came from doctors and nurses, many of whom have no choice but to live in that accommodation which is protected by Crown immunity. After that campaign had reached its crescendo, the Government's response was to introduce this Bill. They did not introduce it immediately after the Nursing Mirrors' campaign of 1983. Only now, after the scandal of Wakefield, have the Government decided on this miserable little Bill.4.45 pm
The Government's response to the problem of accommodation was merely to get rid of it altogether and to sell it off. They decided to tell many of the nurses that they should seek their own accommodation in the private sector as best they could. Successive Ministers have argued in the House that not all of the accommodation is used. I think that the Government quote a figure of about 20 per cent. for the amount of accommodation that is not used, and they argue that it should he disposed of in the interest of value for money. But it is a Catch 22 situation. If the property is neglected and allowed to fall into decay so that nurses and doctors avoid it, it will become untenanted. The Government then use that as an excuse for getting rid of it altogether.
When my hon. Friend the Member for Battersea (Mr. Dubs) raised these issues a few weeks ago in an Adjournment debate on 23 May, he referred to the Rayner report of August 1984, which specifically dealt with the problem of NHS residential accommodation. In that report, Rayner recommended —and the Government accepted — that 73,000 units of accommodation, including houses, flats and bedsits, should be disposed of out of a total of about 112,000 units. I am not sure whether that includes the figures for Scotland, but perhaps the Under-Secretary of State can tell me. However, that would mean getting rid of 65 out of every 100 residential units occupied by NHS doctors and nurses, and the nurses certainly would have to seek accommodation where they could. The Government are now implementing those proposals, and are causing great anxiety and anger in the process.
In his reply to that debate, the Minister played down the issue and implied that my hon. Friend was scaremongering and inaccurate. But there can be no doubt that the Government have gone ahead with that policy without giving much thought to its consequences. In his reply to that debate, the Minister spoke in his bland and soporific way about the more efficient use of public money. Indeed, he is an expert at that sort of thing. He also spoke about the need to cut out waste. We all know the shibboleths that the Government bring out when they are slashing public expenditure on services that they do not much like. He spoke about saving public money, cutting out waste, and becoming more efficient in order to project the image of a caring Government and a tear-jerking Prime Minister. But we all know her, and what she has done to the Health Service, housing and so on.
In column 695 of Hansard, even the Minister had to concede that the health authorities would investigate how the policy would be implemented. I think that he said that 38 a circular would be issued very shortly. Has that circular been published? He must be able to tell me by now whether it has been published and also whether it applies to residential accommodation in Scotland.
A number of questions remain unanswered and I hope that the Minister will reply to them today. A few of them have been asked by myself and my hon. Friends during recent exchanges in the House. On 23 May the Minister said:
Nobody will he required to move from his or her present accommodation without being offered a suitable alternative place to live."—[Official Report, 23 May 1986; Vol. 98, c. 694.]I say nothing about the grammar; I am simply reading Hansard.I have asked the question — and we deserve an answer: who will seek out that accommodation'? Will the onus be on the health authority or the nurse? Who will decide what is suitable accommodation — the NHS manager on a salary of £40,000 to £50,000 a year or the nurse on a salary of £5,000? Who will decide what is a reasonable rent? Who will decide whether accommodation is suitable in terms of its rent, its facilities or its proximity to the hospital? A hospital manager in a rural area might decide that accommodation is convenient even though it might be 10 miles away—but the poor nurse probably does not have a bike and certainly not a car, and the Government have destroyed the bus services. It is no use providing accommodation that is 10 miles away from the hospital in a rural area where there are no buses at weekends. There is a multiplicity of questions that the Government have not even attempted to answer.
This is a mean little Bill that is designed to deceive. It is designed not to solve the problems but to allay a little anxiety within a limited area of the NHS. It does not get to the root of the problem because the Government fear the enormous cost that might be involved in tackling the problems with the seriousness that they deserve.
The Labour party has tabled these amendments to reveal the shortcomings—indeed, the irresponsibility—of the Government in trying to deceive the people into believing that the Bill will solve anything. It will not solve very much because the Government will not spend the money to achieve that.
§ Mrs. Ann Clwyd (Cynon Valley)I can assume only that the Bill's proposals are so limited because Conservative Members know so little about kitchens. They obviously do not realise that kitchens are not surrounded by Berlin walls —they may prefer to think of them in that way, as they do not wish to venture inside them. Certainly, cockroaches know no bounds in kitchens or any other area of public buildings. They use the lifts, fire escapes, drainpipes and even escalators, as do many other nasty creatures that can be found in public buildings which are protected by' Crown immunity. If Conservative Members think that the nasty vermin will somehow be contained within an area called a kitchen, they are in for a bit of a shock.
Perhaps Conservative Members have not had my experiences. For four years I served on the Welsh regional hospital board — a body that was abolished in 1974, much to the dismay of people in Wales where there is now a less democratic Health Service than obtains in other parts of Britain. Responsibility for the Health Service now lies with the Welsh Office, and I am sorry that no one from that Department is present for the debate. 39 I was a member of the catering committee of the Welsh regional hospital board, and one of its interesting tasks was to visit hospitals throughout Wales to inspect kitchens and menus. Some of the things that we saw would beat many of the horror stories that were spelt out in the reports referred to by my hon. Friends. The kitchens, especially those in long-stay hospitals, were dank, damp and dirty. Some of the items on the menus were not fit to feed to the cat. One hospital had coley fish on the menu —something that is rather more acceptable today than it was in the early 1970s. One of my colleagues pointed out that coley fish was food for cats, not for patients, and it disappeared from the menu.
Unfortunately, our visits to those hospitals were, of necessity, fleeting. We could not make the detailed inspections that many of those who prepared the reports were able to carry out. Had we been able to spend some time at the hospitals, I do not doubt that we, too, would have found the pests that were mentioned during the inquiry into the food poisoning outbreak at the Stanley Royd hospital.
The 1977 circular stressed the need to be constantly on the alert to the dangers of food poisoning. It laid down certain basic requirements with which hospitals should comply and it also dealt with inspection. It suggested that health authorities should invite inspection by environmental health authorities to report on all areas within their premises where food was stored, processed or consumed.
One section in the report deserves repeating because I am sure that it applies to many establishments. The report of the Charing Cross environmental health officer shows that bird droppings were found in the jelly, rice coated with bacteria, infestations of mice and cockroaches, sparrows flying around kitchens, dead cockroaches in a food store and slicing machines coated with thick grease. The newly appointed general manager was quoted as saying that conditions were absolutely disgraceful and indefensible.
Another example is the Royal Free hospital, which environmental health officers said would have been prosecuted had it not been for Crown immunity. Chicken and cockroach chasseur was reportedly served to two patients and a nurse. Other named hospitals that have beeen criticised included ———
§ Mr. DobsonIs my hon. Friend aware that no one was reassured by the reassurances given by an official of the Royal Free hospital that, provided the cockroach had dropped in the mixture at the beginning of the cooking process, it would have been all right?
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§ Mrs. ClwydI thank my hon. Friend for that information. If a cockroach is well cooked, that will not make it more palatable to patients nor to anyone else. The fact that cockroaches might be in our food without our knowledge would cause most of us great concern and considerable revulsion.
Three organisations have recently produced reports on this issue. The report of the British Pest Control Association, entitled "Hospitals Can Damage Your Health", contains details of the sort of pests which can cause problems and gives many specific examples of failings as well as making several good recommendations. 40 The association recommends that Crown immunity should be lifted or abolished, which would ensure that hospitals are legally obliged to implement the requirements of environmental health officers. It makes many other recommendations.
The General, Municipal, Boilermakers and Allied Trades Union published the case against Crown immunity in April 1985. Much of that publication was concerned with hospital kitchens, and it contained many proposals for action. It suggested that Crown immunity should be removed from the premises covered by the Health and Safety at Work etc. Act 1974. I am sure that all hon. Members would like to see that happen here. The GMBATU paper said that Crown immunity should be removed from the food hygiene regulations and that food hygiene laws should be amended to include the recommendations presented by the Institution of Environmental Officers in a review of food legislation. It said that EHOs should be given the power to issue enforcement notices under food hygiene legislation — a power which they already have under the Health and Safety at Work etc. Act. It recommends that food hygiene laws should be amended so that employees' representatives receive the same information from enforcement officers as they do under section 28 of the Health and Safety at Work etc. Act.
The Government have always expected health authorities to provide resources for health and safety and hygiene improvements from their existing budgets for patient care. When there are such great demands upon their budgets it is not surprising that they have difficulty in finding the necessary resources. No extra resources have been provided by the Government to help the NHS to meet its new obligations under the Health and Safety at Work etc. Act. The Government must make sufficient resources available to enable the NHS to meet the new burdens imposed upon it by that Act and the food hygiene laws.
I ask the Minister to bear in mind that in 1978 the Health and Safety Commission gave inspectors the power to issue a new form of notice against Crown immunity. Those Crown notices, as they are called, are much the same as the improved prohibition notices, except that they have no force in law. In practice, health authorities ignore the notices because they have no force in law. Their stock answer, when they have failed to comply with the law, is lack of funds. The Health and Safety Executive, and its inspectorate, cannot possibly meet burdens placed upon it without an increase in staff.
We rehearsed this argument during the debate on the privatisation of British Gas when we discussed the burdens that were to be put on the inspectorate. The number of health and safety inspectors has diminished every year since the Government came to office, at both head office executive level and field work level. Does the Minister consider it feasible for the present number of inspectors to carry out the duties that he expects them to undertake? I shall be interested to hear his answer.
§ Mrs. Anna McCurley (Renfrew, West and Inverclyde)The hon. Lady is condemning hospitals universally, but the majority of hospitals have been responsible. They have employed proper pest control associations, and their standard of cleanliness has been acceptable. Does she 41 accept that additional resources are not necessarily required, given the infernal sloppiness of some hospital staff?
Mrs. ClywdIf the hon. Lady is addressing that remark to some of the privatised services working within our hospitals, I am sure that she and I would not disagree. I would not say that her comment applies to NHS staff, who, with few resources, have been able to carry out a proper programme of hygiene within hospitals over the years. I think that the hon. Lady is condemning privatisation within the Health Service. A number of contractors have been dismissed because of their failure to observe proper hygiene standards and to carry out the high standard of work that the Health Service has normally been able to perform.
§ Mr. DobsonDoes my hon. Friend agree that rather more private contractors would have been dismissed had not the Government intervened to say that, even where the health authority was entirely dissatisfied with the standard of service, the contract could not be terminated without prior discussion and the consent of Ministers, partly as result of representations made by Tory Members who had a financial interest in the companies under threat?
§ Mrs. ClwydThat is an extremely relevant intervention. Where private interests are concerned, it seems that the same standards do not apply.
§ Mrs. McCurleyThat is pathetic.
§ Mrs. ClwydThe British Pest Control Association, which has called for the abolition of Crown immunity, which prevents hospitals and other public buildings from being prosecuted, is not exaggerating when it talks about cockroaches, rats, mice and other disease-carrying pests taking over hospitals and putting patients' health and lives at risk.
§ Dr. John Marek (Wrexham)The hon. Member for Renfrew, West and lnverclyde (Mrs. McCurley) described some of the arguments of my hon. Friend the Member for Cynon Valley (Mrs. Clwyd) as pathetic. Does my hon. Friend agree that the primary duty of private contractors, as they sec it. is to make profits for their shareholders and not to uphold standards of care or cleanliness within the Health Service?
§ Mrs. McCurleyThey will not make profits if they do not do their job properly.
§ Dr. MarekI am grateful for the interjection. There is enormous discontent with private contractors in the Health Service. Does my hon. Friend agree that profits is one of the important differences between the attitudes of private contractors in the Health Service and those of NHS staff who look after the health and welfare of patients?
§ Mrs. ClwydThat point is well made by my hon. Friend. If we are being entirely objective, which the Opposition are seeking to be, it is clear that standards of hygiene and patient care have been severely diminished since 1979.
The British Pest Control Association believes that part of the problem lies with priorities. Only one fifth of 1 per cent. of funds, or about £800,000, is spent on pest control. If the Government are serious about wanting to get rid of pests, they must give additional resources to the NHS to enable it to do the job properly.
42 The British Pest Control Association, in its report, asks:
Would anyone with any sense serve a sick patient food that has already been contaminated with organisms that cause food poisoning, boils, abscesses, typhoid, pneumonia, dysentery, worms or jaundice?Would that sensible person bandage a wound with material exposed to contamination from the contents of drains, sinks and sewers? Sensible or not, this is what is happening in hospitals up and down the country.The association also drew attention to a survey of 360 nurses conducted by Nursing Mirror last year,which showed that 88 per cent. had seen cockroaches in their hospitals, 53 per cent. had seen rats or dead mice, and 51 per cent. considered their hospital unclean.That is the evidence of people working in those hospitals. It is clear that hundreds of NHS hospitals fail to meet accepted hygiene standards, and pose serious hazards to patients and staff.The Institution of Environmental Health Officers, in a recent report, found 97 hospitals with hygiene standards
sufficiently serious to warrant prosecutionand 159 hospitals with "significant pest infestations."The Minister thinks that the pests are confined to the kitchens. I should be interested to know about his own experience of kitchens, particularly hospital kitchens. Pictures of a hospital for the mentally ill, where cockroaches scuttle around the kitchen, shocked a conference of English and Welsh health authorities in Cardiff last year. Mr. John Yates, a senior research associate at the university of Birmingham, told the health officials about a hospital, the identity of which he refused to disclose, but which he described as having dripping, dirty and dark corridors
because the authority prefers to save money to spend on patient care".That reinforces the point that I and my hon. Friends have been making, that, if hospitals have to decide on priorities, obviously patient care must come first. Mr. Yates said that the rooms in the hospitalwere empty of moveable objects, and the lavatories had no paper …the rooms were unnecessarily depressing and dark and the lavatories were dampBeds in the wards were only inches apart. A long crack over a window in a day room was stuffed with lavatory paper to keep out water.Worst of all were the cockroaches, a dozen of which had been photographed swarming on tables, around the sink and on the floor".Mr. Yates said:These pictures were taken not 20 years ago but just this month.He argued that the'horror stories' about mental hospitals … were not isolated instances but signs of a system of management and monitoring that did not work.Again, that is evidence that pests are not confined to the kitchens, and that the danger to patients cannot be kept within the kitchens. Lifting Crown immunity there will riot be sufficient to protect the patients.The other day I made a point about air conditioning systems, which the Minister missed. Many diseases can be caught from those systems — not just legionnaire's disease, but humidifier fever. Many doctors now recognise that it has a considerable effect on people's health. Other diseases are also caused by air conditioning systems. I asked the Minister to widen the scope of any inquiry to the operation of air conditioning systems in hospitals and other public buildings. In buildings where there is Crown immunity, it is particularly important that proper inspection of those systems is carried out.
43 I shall mention an experience that I had in the European Parliament. One in three people were sick during the week when we met in Strasbourg. A team of doctors had come over from Britain to look at the air conditioning systems. Unfortunately, the authorities in Strasbourg thought that it was a plot to get the Parliament moved from France to Belgium, and refused to allow the doctors through the front door. It was only when I got them in through the back door that they were allowed to look at the systems.
The doctors found that there were seven different air conditioning and cooling systems within that one building, and bacteria were contaminating many of the tanks that were pumping water into the air conditioning system. Rat poison pellets were found in ducts all round the building, and those ducts were pumping the air conditioning through the building. It is not surprising that one in three people were sick during our visit to Strasbourg.
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The point that I am trying to underline is the necessity for proper investigation of air conditioning equipment used in hospitals and other buildings, which are now protected by Crown immunity. Such equipment can also cause ill health. For that and many other reasons, Crown immunity should be lifted so that the Health and Safety Executive can do its work properly and so that control is applied in areas that were previously protected by Crown immunity. It is not only in the catering areas of hospitals that accidents can occur or where epidemics start.
Anyone who has done the rounds of hospitals, as I have over the years, could provide many examples of disregard for the Health and Safety at Work etc. Act 1974. That is seen in laboratory conditions, the storage of materials, the collection and disposal of rubbish, fire hazards and ventilation. While those breaches can be pointed out to Health and Safety Executive inspectors, there is still no compulsion upon health authorities to rectify the conditions. The best compulsion of all would be for Crown immunity to be completely lifted. I am sure that is what all Opposition Members will be arguing for today.
§ Mr. Charles Kennedy (Ross, Cromarty and Skye)Time is getting on, and, if I may say so in the context of this debate, most of the arguments have been made ad nauseam. [Laughter.] I am glad that the hon. Member for Holborn and St. Pancras (Mr. Dobson), who is almost my hon. Friend, has got the joke.
I repeat the support that I gave on Second Reading and in Committee for the extension of the abolition of Crown immunity beyond what is proposed in the Bill. I pick up the point argued by the hon. Member for Fife, Central (Mr. Hamilton), that one of the reasons why the Government have gone for a Bill of more limited application, and therefore, by implication, more limited objectives, is financial. It goes back to many of the debates that we had on the matter in Committee. In the explanatory and financial memorandum to the Bill the Government stress that it does not have financial implications. Many Opposition Members have said that that strikes us as nonsense. I suspect that, although they have not said so, many Conservative Members would agree with that.
It stands to reason that if there are substandard kitchen premises in hospitals, and if health authorities have to 44 commit expenditure to bring them up to standard, that will have revenue implications. Given the extent of the problem nationally — it must exist to a considerable extent or we would not have the legislation—one can only assume, logically, that the Government realise that, on a national basis, there will be significant financial implications for health authorities from the measure. Despite the fact that the Government argue in the explanatory and financial memorandum to the Bill and in their speeches in support of the Bill that there are no financial implications, the appreciation of the likely financial implications — although the Government do not publicly admit to them—is one reason why they have confined the impact of the legislation to hospital kitchens.
When one considers the background to the Bill, especially the report on the food poisoning outbreak at Stanley Royd hospital, it is fair to say, as the report did, that the absence of Crown immunity would not have prevented the disaster. That is sensible and self-evident. Paragraph 230 of the report states:
Basing our view on the facts proved before our Inquiry, and on these alone, the abolition of Crown immunity would appear unnecessary.The implication is clear: the general application — the report was talking about wider abolition than that which the Government propose—of such legislation would not have prevented what happened at the Stanley Royd hospital. However, the incident was the straw that broke the camel's back and moved the Government to introduce the legislation.After considering that specific case, and the undoubtedly important report, Health Ministers concluded that it would be enough to abolish immunity for hospital kitchens. They are mistaken in that. I cannot understand, for the host of reasons that we have heard during the debate, how the arguments that are advanced in favour of the limited abolition do not logically and forcefully apply equally to NHS premises in general. Neither on Second Reading nor in Committee did the Government give an adequate response to that basic contention.
In reply to the Second Reading debate the Parliamentary Under-Secretary of State for Health and Social Security said that the general repeal of Crown immunity was not necessary because the Crown notice system already works well enough. He conceded that,
although 300 notices have been issued since 1980, in no case was it found necessary to take action." [Official Report, 15 April 1986; Vol. 95, c. 826.]I do not doubt the veracity of the Minister's statement, but if the Government were sufficiently persuaded to introduce this albeit limited measure, which must be an expression of their anxiety on the nationwide problem, how can they set that judgment alongside the arguments deployed by the Under-Secretary of State, who was saying essentially, "There is no problem whatsoever"? That is an argument based on internal absurdity——
§ Mr. AshleyIt is a contradiction.
§ Mr. KennedyI agree with the right hon. Gentleman. It is a fundamental contradiction in terms. The Government have not adequately defended or persuaded the House of their argument.
Even allowing for that, there are difficulties with the Crown notice system in which the Under-Secretary of State placed so much faith. There are delays in implementing some Crown notices because there is no 45 automatic offence for failing to meet the deadline set. Under the Government, the number of Health and Safety Executive inspectors has been cut by 20 per cent. Much of their time is taken up by return visits to Crown premises to persuade employees to comply with their notices. Deadlines are sometimes renegotiated on non-Crown premises, but that is comparatively rare.
The inspectors have less incentive to use Crown notices when there is no prosecution. In 1983, about 13 per cent. as many notices were served per 100,000 people at risk in the manufacturing and service industries as were served in NHS premises. Yet, as was fully and fairly stated by the hon. Member for Holborn and St. Pancras, one cannot say that the risk element or dangers in hospital premises can be reduced or overlooked to the same extent as they could be in some service industries. Hospitals are inherently dangerous places, for the many reasons given by the hon. Gentleman.
§ Mr. Ken Weetch (Ipswich)The hon. Gentleman mentioned the word "prosecution". Does he realise that, although a considerable number of appalling facts were discovered during the inquiry at Stanley Royd hospital, it was subsequently revealed that there was not enough evidence to mount a legal prosecution? Has the hon. Gentleman considered what burden of proof might be necessary to find a way through this?
§ Mr. KennedyIf an incident involving so many tragic deaths does not constitute a sufficient basis for a successful prosecution, something is wrong. I am glad to welcome the hon. Gentleman's intervention, which hit the nail on the head.
The Government argue that the Bill will have no financial implications, whereas we argue that even on this limited basis it will. Time will soon tell whose assessment is correct. Having argued that it will have no financial implications, the Government none the less stop short—I suspect largely for financial reasons—of extending the logic of their case beyond the hospital kitchen door to NHS premises generally. That suggests an acceptance, albeit privately, by Ministers and civil servants that the rhetoric on the Bill is not a fair reflection of the reality with which the Bill deals.
Ministers have argued that the Crown notice system is satisfactory. The Under-Secretary of State laid special emphasis on that, yet there is a fundamental internal inconsistency in presenting that argument at the same time as the Government present the Bill. If they believe that the system is so good, why do they not stand by it? Why is it necessary to legislate?
The hon. Member for Ipswich (Mr. Weetch) mentioned the appalling state of affairs highlighted by the report on the tragedy at Stanley Royd hospital. In part, the report mitigates in favour of the Government's argument, which is that legislation does not attack the root of the problem but rather allows some form of redress if the problem proves tragic. The central weakness of the Government's case is that they deny the existence of financial implications, although the Bill must have some. The Bill is also weaker because it stops short of more general application.
We have welcomed the Government's fairly timid steps, but they do not go far enough. I hope that it is not too late for the Minister to see sense, to be slightly more candid and to accept that the principle of clause 1 should extend beyond NHS kitchens.
§ Mr. Frank Haynes (Ashfield)First, I declare my interest as a vice-president of the Institution of Environmental Health Officers. It is proper to declare that interest because of my interest in their work. I was involved in local government for many years before coming here and it is clear to me that environmental health officers in all local authority areas have done a first-class job on behalf of the community.
My hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) made a first-class speech and mentioned slack control in the NHS. The service seems to have a protective shell. Through our proposed new clauses, we are trying to crack that shell so that the community can find out what is going on inside. I have heard Ministers defend the NHS and Crown immunity, saying that there is no need for its abolition, for long enough. There is great public feeling about the problems with hospital kitchens. I pay tribute to my right hon. Friend the Member for Stoke-on-Trent. South (Mr. Ashley) who has done a marvellous job for many years. He is one of those who have finally got the Government to cave in and abolish Crown immunity for NHS kitchens. There is no doubt that that is a step in the right direction.
I have listened carefully to the debate, especially to what my hon. Friend for Holborn and St. Pancras said. He mentioned cleaning services. I also listened carefully to the intervention made by the hon. Member for Renfrew, West and Inverclyde (Mrs. McCurley). She should not have said what she did. She should have stayed in her seat. She boobed. There is no doubt about it. She talked of private organisations doing certain jobs in the NHS. Private firms are falling down on the job. It is all very well to say that they will not get paid if they do not do the job, but they are not doing the job properly in many respects, yet they are still being paid for what they were supposed to do and paying their workers little. One of the most annoying things about such private organisations, especially those involved in hospital cleaning, is that many Conservative Members are their directors or are associated with them. They should declare their interest.
§ Mrs. McCurleyThe hon. Gentleman is suggesting that all private enterprise is in some way malevolent and inefficient. The majority of health boards employ responsible and effective companies. If I failed to clean my kitchen properly for several weeks, would I expect it to remain hygienic for my family or would I expect mice to start coming in? May I suggest that the matter is not confined to cleaning services and that it matters very much how hospital staff conduct their daily business. Filth occurs when people do not do their work efficiently and properly.
§ Mr. HaynesThat was a fairly long intervention. The understanding in this place is that interventions are short. I must repeat that my experience is that many private organisations in the NHS have not lived up to their responsibilities but have, nevertheless, been paid for the job.
The hon. Lady mentioned her kitchen. We have a kitchen in our bungalow. It is spotlessly clean. I do not pay my wife for doing it. We share what we have. She does a first-class job on my behalf and that of the family. In many hospitals, however, the kitchens are filthy. It is high time that there was some action. The Minister can sit and nod 47 his head and grin every now and again, but he is still not listening. He is supposed to be replying to the debate, but if he does not listen how can he?
I should like to pick up something that my hon. Friend the Member for Holborn and St. Pancras said about the Minister. I should like to know what he knows about the NHS. I have a reason for asking. He is a financial wizard.
§ Mr. WeetchOh? That is news to me.
§ Mr. HaynesOh, yes. He is a financial wizard. He was with the Treasury long enough. I tabled a question to the Minister because I wanted to know how many chairmen of district health authorities had no connection with the Health Service. It emerged that, out of 195 chairmen, 41 had no connection with the NHS. That is how the service is being run—on a financial basis. The Government are not running a service for the people who need what my hon. Friend the Member for Holborn and St. Pancras described.
§ Mr. Allan Rogers (Rhondda)When my hon. Friend next tables that question, will he consider asking the Minister how many friends of Tory Ministers, how many solicitors and professional people employed by Tory Ministers and how many people connected with the Conservative party have been appointed as chairmen of health authorities? [HON. MEMBERS: "How many ex-Labour Members?"]
§ Mr. HaynesCan you hear them, Mr. Deputy Speaker? My hon. Friend has hit on a raw spot and Tory Members are reacting. Most of them are financial wizards from the finance houses and institutions of this land. They can be counted when the House is full. During these debates I have often looked at the Treasury Bench and seen as many as five millionaires on it. All they are bothered about is money. We in the Labour party are concerned with the service of the NHS to our people.
§ Dame Jill Knight (Birmingham, Edgbaston)Will the hon. Gentleman give way?
§ Mr. HaynesNo, the hon. Lady has only just walked into the Chamber. The hon. Lady can make a speech if she wants to, Mr. Deputy Speaker, providing you let her. That is how this place works. I am trying to make an important point about the way in which the Government run the NHS: their motive is profit.
§ Dame Jill Knightrose——
§ Mr. HaynesBecause they run it on the profit motive, they want to protect Crown immunity. That is why we have tabled these new clauses.
§ Dame Jill KnightWill the hon. Gentleman give way?
§ Mr. Deputy Speaker (Mr. Harold Walker)Order. I remind the hon. Lady that if the hon. Gentleman is not prepared to give way she should not persist.
§ Mr. HaynesI am obliged to you, Mr. Deputy Speaker. I always knew that the Chair would protect an hon. Member, and this is genuine protection. As I said earlier. the hon. Lady has only just walked into the Chamber and she does not know what has been said. I suggest that she hangs on a while and listens to some real debate. Only the Opposition are providing that. I wonder what is going on on the Tory Benches. Are they interested in the NHS? 48 [HON. MEMBERS: "No."] Will they listen to the Minister's reply to the debate without hearing it? When it comes to the vote Tory Members will troop through the Tory Lobby without having heard a word.
§ Dame Jill Knightrose——
§ Mr. HaynesTo give the Minister and the Whip their due, at least they are present and have heard the debate.
§ Dame Jill Knightrose——
§ Mr. Deputy SpeakerOrder. If the hon. Lady wishes to participate she should seek to catch my eye. If the hon. Gentleman will not give way to her, she must not persist.
§ Mr. HaynesIt is a bit off. The hon. Lady has been a Member of Parliament for many years and she knows the rules of the House as I do, although I have not been an hon. Member for so long as she has. I respect the Chair and live up to the rules and regulations of the House.
In my visits to different hospitals throughout the country I have found that mentally handicapped people are treated differently from everybody else, and I wonder why. I have seen wards where the beds have been so close together that there is no room for a locker between them, and wards with beds placed before fire doors, so that in an emergency people cannot get out. If anything happens involving a serious loss of life the NHS and Ministers are within the protective shell to which I was referring. That is not good enough. In such an event they should be prosecuted. They should be taken to court and dealt with. Mentally handicapped individuals cannot possibly look after themselves.
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What power does a district fire officer have? In my area he must refer to one of the 41 recently appointed district health authority chairmen, who has a financial interest. The fire officer is reponsible to the chairman or the board, and they take no notice of him, so nothing is done. The shouting and bawling of local people making representations has persuaded health authorities to make alterations, and, indeed, they have. Nothing will be done with this profit motive business and the Government trying to save money here and there. We need much more money in the NHS. People are living longer nowadays and we must provide proper facilities for them. It is shocking that my local authority has not been allowed to build proper housing for elderly people.
There are chiropodists in the NHS, but not enough of them because the Government have cut the funds for them. That means that, because elderly people cannot get the service of a chiropodist, they cannot be discharged and must lie in a hospital bed. I have seen many such cases, and before long the old person dies. The Government should be prosecuted for what they are doing. We have tabled these new clauses to get some sense into the NHS and into the heads of the Secretary of State and his cronies who sit with him. I am talking about not civil servants, but Ministers.
§ Dame Jill KnightOn a point of order, Mr. Deputy Speaker. I have been listening most carefully to the hon. Gentleman and I wonder whether chiropody has anything to do with the new clause before the House.
§ Mr. Deputy SpeakerI too have been listening carefully, and so far I have not heard anything that is out of order.
§ Mr. HaynesI am obliged to you, Mr. Deputy Speaker. Here we go again, with the hon. Lady abusing the Chair. I would never do that. I have had nothing to do with chiropody, and I declared my interest at the beginning of my speech. My connection is with the Institution of Environmental Health Officers which, together with my experience as an ex-chairman of a community health council, is why I have so much experience of the NHS. I know the hon. Lady's connections with the NHS, but I shall not say anything about them. I shall leave that to her.
My hon. Friend the Member for Fife, Central (Mr. Hamilton) made an important point about the appointment of the new chairmen, and my chairman in central Nottinghamshire has no experience of the NHS. I understand my hon. Friend's interest in this area, and in the question of the rent that nurses must pay for their accommodation. We are on a winner with these new clauses. The Government are bumping up nurses' rents because their tiny financial minds tell them that this is another area where they can pull in a bob or two. That is how they think. They do not realise that those nurses are providing a service to the ill. People are in hospital because they are ill and hope to get better, so that they can leave and live healthy lives. The Government are clobbering the people who do a first-class job in the hospital service on behalf of the community, but they continue to make statements on the radio and television as though they were doing a marvellous job. Some of the Ministers should look behind the scenes——
§ Mrs. McCurleyOn a point of order, Mr. Deputy Speaker. Would you try to encourage the hon. Member to refer to new clause 1, because what he is talking about is totally off beam?
§ Mr. Deputy SpeakerOrder. With new clause 1 we are debating new clauses 2, 3 and 5 and amendment No. 62. The hon. Gentleman's latter remarks were addressed to new clause 5 and so seem to me to be in order.
§ Mr. HaynesI am obliged to you, Mr. Deputy Speaker. The hon. Member for Renfrew, West and Inverclyde (Mrs. McCurley) came in late and did not hear the speeches from the Front Bench. My hon. Friend the Member for Holborn and St. Pancras made all the necessary references to the clauses. It seems that one or two hon. Members are bidding for your Chair, Mr. Deputy Speaker. I am having nothing to do with that. They are trying to do your job for you and I object. That is what you are there for, Mr. Deputy Speaker. As I said before——
§ Mr. Deputy SpeakerOrder. I can get by very well without the protection and help of the hon. Gentleman.
§ Mr. HaynesI realise that only too well because I remember the wonderful, exhilarating experience that I had sitting on the Back Benches when you were at the Dispatch Box. I thought it was wonderful, but we lost you because you were appointed to that Chair, when you should have stayed on the Front Bench. I have got that off my chest. No matter where you are, whether at the Dispatch Box or in the Chair, you do a first-class job. There is no doubt that I have been within the rules of order because otherwise you would have pulled me up pretty smartly, because you are pretty keen in your job.
I have said enough. I do not know how long I have been speaking, but I know that there will be other opportunities 50 to speak during the debate. We hope that the Minister is taking in all that we have said. We want the abolition of Crown immunity for the NHS. We want nurses to be looked after properly. We do not want them penalised, because they do a wonderful job on behalf of the community. If the Minister and the Government would accept many of the things that we have said this afternoon, the NHS would run a lot better.
§ Mr. RogersI am pleased to follow my hon. Friend the Member for Ashfield (Mr. Haynes) in his exposition, and to join in his tributes to you, Mr. Deputy Speaker. I hope that during the course of my speech we shall not get interruptions telling you how to do your job.
The new clause is of great importance to those Labour Members who have a special interest in the NHS. I agree with my hon. Friend the Member for Ashfield that it is only Labour Members who take a particular interest in the NHS. It seems that Conservative Members are interested in the NHS only when they want to borrow its equipment for use in private practice. The Labour party has a strong vested interest in the NHS because not only do we have a political and social commitment to it, but we participate in it. These are the only hospitals that our children will use. [Interruption] Does the hon. Member for Aberdeen, South (Mr. Malone) wish to intervene? It is sad that he could but dare not. I realise that the Conservative party is effectively gagged.
§ Dame Jill KnightI am grateful to the hon. Gentleman for giving way. He has always been courteous. Perhaps it is rather a good idea that the private sector occasionally deals with the Health Service in order to provide equipment such as the lithotriptor, which helps to get rid of kidney stone conditions, at St. Thomas's. About 75 per cent. of its use will be for NHS patients. Can this not sometimes be a useful partnership and so help the NHS?
§ Mr. RogersYes, but ——
§ Mr. Deputy SpeakerOrder. I hope that the hon. Gentleman is not persuaded to go down that road, because that will take us away from the new clauses.
§ Mr. RogersI agree with you, Mr. Deputy Speaker. If the hon. Lady wishes to lead us down that road, I shall resist the temptation, except to say one thing. I understand that, under the arrangement to which she referred, private medicine makes a profit out of the lending of the machines. I do not blame it for doing this, because that is what it is in action for. The private sector is not hypocritical about it. It is like the Government, who are taking the country for a ride. However, that is what they are there for. They are there to serve their friends the City of London, for the quick buck, to make a couple of bob and shove everything into their back pockets. That is what the Tory party is about. It is not about serving the interests of the people and those who might need this precious institution, the National Health Service. This is why they have such a cynical attitude to the NHS. They will borrow from the NHS when they need to, but when they need to cheat and to jump to the front of the queue, and when they have special treatment——
§ Mr. Deputy SpeakerOrder. The hon. Gentleman is falling into the fault against which I warned him. I hope that we can return to the subject of the new clauses.
§ Mr. RogersI shall do so, Mr. Deputy Speaker. I am sure that the hon. Member for Birmingham, Edgbaston 51 (Dame J. Knight) will want to intervene again, and if she does I hope that she will not lead me down these side alleys because if I follow her I shall be admonished by you again, Mr. Deputy Speaker.
We are concerned about Crown immunity for hospitals and health authorities because of the appalling conditions that exist in some of our hospitals as a result of cuts in the service, which means that there is not enough money for proper cleaning and maintenance.
I have come to the Chamber from the Public Accounts Committee where we were hearing evidence from the permanent secretary at the Department of the Environment on capital expenditure of local authorities. One fact struck me strongly and is pertinent to the debate. It is that it has been estimated by reliable authorities, and acknowledged as a correct figure by the Department of the Environment, that to enable local authorities to catch up with maintenance and refurbishing, on which they have fallen behind with schools, housing and roads, they would need capital expenditure of £40 billion to £50 billion.
§ Mr. James Couchman (Gillingham)Rubbish.
§ Mr. RogersThe hon. Gentleman says, "Rubbish." If he wants to dispute my figures, perhaps he will correct me. He does not wish to. My figures are correct and will be written into the evidence of the Public Accounts Committee, and they have been published in the Comptroller and Auditor General's report. If the hon. Gentleman is saying that the Comptroller and Auditor General is an idiot and does not know what he is doing, perhaps he will be proved badly wrong. What he has said shows his ignorance of what goes on in local authorities. I am glad that we have been able to put his ignorance on the record.
This problem affects the NHS as well because of the tremendous cuts in spending in this sector. Health authorities, even when run by Tory friends of Ministers, are suffering badly because they do not have enough money to refurbish hospitals to bring them up to standard. That is why the British Pest Control Association said on 11 September last year that cockroaches, rats, mice and other disease-carrying pests were "taking over" hospitals and putting patients' health and lives at risk.
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§ Mrs. McCurleyIs there anything in that report that criticises the Government? If the hon. Gentleman looks at the report more closely he will find no condemnation of the Government, but some condemnation of health authorities which spend more on window cleaning than on hospital kitchen cleaning.
§ Mr. RogersThe hon. Member for Renfrew, West and Inverclyde (Mrs. McCurley) probably has more knowledge of window-dressing authorities than I have. They probably exist in the Conservative areas, one of which she represents.
The British Pest Control Association, in its book "Hospitals Can Damage Your Health", also calls for the abolition of
the anomaly of Crown Immunitywhich prevents hospitals and other Government-owned buildings from being prosecuted. The report has already been sent to the Secretary of State for Social Services.
§ Dr. MarekThis is an important matter in relation to the new clauses. I do not agree that we are talking about only a few authorities here and there. The problem is serious throughout the country and it is caused by lack of funds. Health authorities are so pressed and so much under pressure that pests and cockroaches exist in hospitals. There are countless examples throughout the country.
§ Mr. RogersI thank my hon. Friend. The British Pest Control Association can hardly be called a raving Left-wing group. It has fairly strong connections with the Conservative party. The association says in its damning document:
It is a story of indifference and of apathy bordering on incompetence in the NHS.As the hon. Member for Renfrew, West and Inverclyde said, the problem is not only one of money, but of priorities. Often the problem is created because of the need to choose between refurbishing and providing front-line services for patients. The choice is often between life and death and refurbishing the kitchen.Because of the scandalous way in which the Government have handled the nurses' pay award, money has been taken away from the front-line services to fund that award. The Government have handled the problem shabbily in the last two years. The way in which Ministers have obfuscated and misled the House on the issue is a public scandal. The pay award might amount to £150 million or £300 million——
§ Mr. Deputy SpeakerOrder. The hon. Gentleman is straying again. Will he please get back to the new clauses?
§ Mr. RogersI accept your admonition, Mr. Deputy Speaker, but the real problems in the National Health Service are concerned with priorities and lack of money. We talk about the appalling conditions which lead to our plea for a lifting of Crown immunity from hospitals and health authorities because conditions are such that health authorities have to choose between operating on acutely ill people and refurbishing a kitchen.
§ Mr. Albert McQuarrie (Banff and Buchan)One of the biggest problems is that health authorities have built huge administration towers. If we cut those and put more money into patient care there might be fewer problems in the hospitals.
§ Mr. RogersThat might be right. I am not here to defend bureaucracy. The bureaucrats are the Conservatives' friends. What amazes me about the Government and Conservative Members is that they have been in government for seven years. Any blame for problems in the National Health Service must lie in their laps. Why have they not done something about them?
§ Mr. John Maxton (Glasgow, Cathcart)Does my hon. Friend agree that the Government are responsible for the grossly overpaid general managers——
§ Mr. Deputy SpeakerOrder. We cannot have a general debate about the National Health Service. I hope that we can now return to the new clauses.
§ Mr. RogersYou are right, Mr. Deputy Speaker. I am being constantly led astray from the general thrust of my argument.
I have already mentioned the British Pest Control Association and its remarks about the standard of hygiene in hospitals. I said that it could not be regarded as a raving 53 Left-wing organisation. Another organisation which cannot be said to be hand-in-glove with the Labour party is the Institution of Environmental Health Officers, which states that hundreds of National Health Service hospitals fail to meet accepted hygiene standards and pose serious hazards to patients and staff. It says that almost 100 hospitals would face prosecution or be closed if they were not protected by Crown immunity. That institution has a statutory function to safeguard standards in all aspects of life except in connection with institutions controlled by the Government. The Government hide behind Crown immunity in the face of such damning indictments.
The National Association of Health Authorities and the Royal College of Nursing, which is not what I would call a raving Left-wing, loony organisation, criticise declining standards of hygiene in the National Health Service. The campaign gathered a great deal of support as a result of the outbreak of food poisoning that led to the death of 19 patients at the Stanley Royd hospital in Wakefield during the summer of 1984.
I must tell the hon. Member for Banff and Buchan (Mr. McQuarrie) that that was five years into this Government's administration. In those five long years they could have done something, but instead they spent millions of pounds on a foolish escapade in the south Atlantic and refused to spend money on giving our hospitals decent standards. I sometimes think it is a pity that General Galtieri did not raid the south Wales valleys, because had he done so we might have received some money. However, for that we would have to get him out of the nick first. It would perhaps not be such a bad idea if he were resurrected, because we desperately need the money.
In my area, not only are hospital standards declining, but the number of hospitals is being reduced. Therefore, my area is doubly penalised. Reports that had been published showed that the standards were exceptionally high in hospitals in my area, but now those hospitals are being closed, which is a great tragedy for the people they serve and for those who work in those marvellous facilities that serve the community at large.
The Institution of Environmental Health Officers said recently that 97 hospitals had hygiene standards that were sufficiently serious to warrant prosecution. Reinforcing the report of the British Pest Control Association, it said that 159 hospitals had significant pest infestations.
§ Mrs. McCurleyDoes the hon. Gentleman condemn those examples that we saw on television recently—I believe on "World in Action"—where staff at a hospital in Glasgow put together cooked meats and raw, dripping meat, uncovered, in the same refrigerator? That has nothing to do with the private sector and pest control associations. It has an awful lot to do with environmental health and the day-to-day standards of activity and work in hospitals.
§ Mr. RogersThe hon. Lady is right. I am glad that she supports my argument. If there is no money available for staff training, one cannot expect high standards of hygiene in the kitchen.
§ Mrs. McCurleyIt is basic common sense.
§ Mr. RogersIt is not a matter of basic common sense. Very often, no other facilities are available. I do not condone the rather silly happening to which the hon. Lady referred.
§ Mr. DobsonWhile on the subject of common sense, does my hon. Friend agree that the average spent on a long stay hospital is £40 per patient per day and that as only £25 per patient per day was being spent at Stanley Royd there might be some connection between the figures?
§ Mr. Deputy SpeakerOrder. The House is debating whether the Health Service should continue to enjoy immunity from legal proceedings stemming from various enactments. I hope that the House will stick to that.
§ Mr. RogersI am trying desperately to do so.
§ Mr. Deputy SpeakerOrder. The hon. Member might try a little harder.
§ Mr. RogersI shall indeed. If Crown immunity were abolished, probably half the people involved in controlling it would be put in the nick. The Department of Health has a cynical attitude to those most alarming reports that have been published, such as that by the British Pest Control Association and the Institution of Environmental Health Officers. In response, the Department of Health said:
We have not yet seen the environmental health officers' report but we will be looking at it very closely.Only the Department had not seen the report. At that time, the British Pest Control Association's report had been out for three weeks and the Department of Health, the authority responsible, had not seen it.The DHSS continued:
After the last such report, about eight years ago, we recommended to all health authorities, whose responsibility it is, that free access should be given to these officers, and that note should be taken of their recommendations.With all the notes and all the access in the world, there has been no action that is required by way of investment in the service.When we talk about Crown immunity and the scrutiny of hospital hygiene, we should perhaps consider what Peter Hartley, the chairman of the environment committee of Westminster city council, said. The city council is controlled by the Conservative party. In a letter to The Times dated 24 September last year Mr. Hartley said:
hygienic practices in Government premises—particularly in DHSS hospitals—are all too often below standard.Significantly, the letter did not mention private hospitals. I do not know whether Mr. Hartley is interested in those, but he is an expert on DHSS hospitals. He continued:These hospitals are, of course, through t he active encouragement of the DHSS, subject to monitoring checks by local authority environmental health officers and the conditions there are open to inspection. Other Crown properties are not open to such council inspection and one may be forgiven for wondering what the overall situation really is".Mr. Hartley complained at length especially about the present law regarding Crown immunity. In the last paragraph he said:In the wake of recent disclosures in other Crown premises a positive response from Government is called for.6.15 pmI wonder what the Government have to hide by not being prepared to lift Crown immunity regarding hospitals. On 22 June last year the English and Welsh health authorities met in Cardiff. They were told by Mr. John Yates, a research associate at the university of Birmingham, that at some institutions for the mentally ill cockroaches scuttle around the kitchens and patients beds are inches apart. He said that the conditions were absolutely appalling. He referred to a hospital that had dripping, dirty and dark corridors 55
because the authority prefers to save money to spend on patient care".I think that his conclusion is wrong, because local authorities in my area do not have money to spend on patient care. I think that his conclusion is wrong, because local authorities in my area do not have money to spend on patient care. The Mid-Glamorgan health authority was told recently that it must give back £5.5 million to the Welsh Office, at a time when one of the most deprived areas of Europe is desperately short of hospital beds and hospital facilities.
§ Dr. MarekMy hon. Friend has made a pertinent point. The Government, in the Bill, are making sure that hospitals come under the food Acts, but only the kitchens of hospitals where food is prepared. If my memory serves me correctly —we have it only on the Minister's say so —food will be protected under the food Acts as it goes on its way from the kitchens to the patients. My hon. Friend made a point about corridors and inadequacies in other parts of hospitals, besides kitchens. The Government are not doing anything about that. They ought to he invited to do so, unless they see sense at the last moment and accept the new clauses.
§ Mr. RogersMy hon. Friend is absolutely right. I do not understand why the Government do not agree to the fairly moderate new clause. It is a simple extension of the principle which the Government have accepted. If the principle is good enough to apply to kitchens, it is good enough to apply beyond them, as we are trying to invoke in the new clause. My hon. Friend is absolutely right in saying that in the large institutions—some of our mental hospitals are large institutions—the time between the preparation of food and when it is given to the patients can be fairly long. The food may have travelled a significant distance from the kitchens before it is given to the patients in the wards.
§ Mr. Ray Powell (Ogmore)I ask my hon. Friend to refer to a hospital at east Glamorgan in his constituency. At that hospital, the repairs to the underground passage have been completed but the services have not been finished. In areas where there is raw cement and works, food is transferred from one trolley to another before it is taken to patients' beds. I suggest that the Minister should consider hospitals with conditions that I have outlined in the constituency of east Glamorgan, for which the Mid-Glamorgan health authority is responsible.
§ Mr. RogersI am well aware of the conditions. Fortunately, I have used the hospital only once, hut, in the past three years, my two daughters have had appendix operations there. The hospital has a marvellous record because of the experience, skill and dedication of the nursing and ancillary medical staff. It dedicates itself to a community which is one of the most deprived in Europe. It has to cope with relatively primitive conditions. There is not enough money to refurbish some parts of the building which perhaps should have been knocked down and rebuilt. Even the refurbishment, to which my hon. Friend the Member for Ogmore (Mr. Powell) referred, which is now taking place slowly, is not enough to bring the hospital up to the high standards set by those who work there.
These concerns are felt throughout the profession. It is not just a matter of the Opposition carping and political 56 dogma. The new clause has been tabled because every section of the community, with the exception of the Government and the Conservative party, wants Crown immunity to be removed. In April the British Medical Association wrote to my right hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) supporting his campaign for the substantial expansion of the Government's legislation to end Crown immunity in relation to hospital kitchens. The BMA wanted the legislation to be amended to cover all hospitals, clinics and health centres, and wanted the health and safety at work regulations to apply to all staff. That campaign has been carried on by the Labour Front Bench.
No doubt the Government will respond by saying that there will he severe public expenditure implications if Crown immunity is lifted, but I believe that the implications will not be severe. The Government will again hide behind the response that they make to all reasonable legitimate demands. The Government, having accepted the principle of Crown immunity, should accept its extension to places through which food is transferred. That is a reasonable request, and I do not understand why the Government do not accept the new clause.
§ Mr. Ray PowellI know that you will bring me to order, Mr. Deputy speaker, if I stray from the new clause.
Reference has been made to the appointment of chairmen of area health authorities. I should like the Minister to give full details of the changes since the Conservative party took office seven years ago, because they concern these new clauses. I want him to refer to the attitude of some chairmen to administration and particularly to hygiene and the money spent on certain parts of the NHS. I am concerned especially with the hygiene regulations that should be followed in hospital kitchens.
At one time, the chairman of an area health authority in Wales, Mr. Ron Evans, was the agent of my right hon. Friend the Member for Blaenau Gwent (Mr. Foot). He was replaced by the solicitor and Conservative friend of the then Secretary of State for Wales. I know, Mr. Deputy Speaker, that you will bring me to order, but——
§ Mr. Deputy SpeakerOrder. The hon. Member is right. He is anticipating my comments. He said at the outset that I would call him to order if he strayed from the subject. He is now doing so. I hope that he will return to the subject of Crown immunity.
§ Mr. PowellI was merely prompting you, Mr. Deputy Speaker. I knew that it would not be long before you prompted me. Appointments are important, because the attitudes of chairmen and members appointed to area health authorities affect how finances in the Health Service are directed.
§ Dr. MarekPerhaps I am anticipating my hon. Friend's comments. He might be about to say that the excuse that is always given as to why hospitals have never been made subject to the provisions of the Health and Safety at Work, etc. Act 1974 is that there are no lines of communication, line management, and so on, that consensus decisions are made and that no one is in charge. Now that we have general managers that reason can no longer be used by those who seek to prevent the lifting of Crown immunity in hospitals. Is that not an important argument in support of the relevant new clause?
§ Mr. PowellIt is relevant. My hon. Friend has rightly prompted me to suggest that we should consider lifting Crown immunity because of the declared interests of these managers.
§ Mr. RogersMy hon. Friend the Member for Ogmore (Mr. Powell) has referred to the problem in relation to the appointment of the chairman of the Gwent health authority. Would not my hon. Friend be wise if he pointed out that the gentleman who was ultimately responsible for the services in the area had no previous experience of the Health Service, but was simply the solicitor friend of the then Secretary of State for Wales?
§ Mr. Deputy SpeakerOrder. I hope that the hon. Member will not refer to such matters. They have nothing to do with the subject of the debate.
§ Mr. PowellI respect your ruling, Mr. Deputy Speaker. I appreciate the point that my hon. Friend the Member for Rhondda (Mr. Rogers) is probing. It is essential that the managers appointed to the new set-up of area health authorities should be experienced in the Health Service. That is as important as any of the measures discussed in Committee. If the managers are not experienced in the Health Service, the proposals in the new clauses will not be effectively carried out. I hope that the arguments during the past two and a half hours have convinced the Minister that he should accept the new clause.
My hon. Friend the Member for Rhondda referred at length to articles in the Nursing Mirror about cockroaches, bats, mice and other disease-carrying pests which are taking over hospitals and putting at risk the health and lives of patients. He referred specifically to the British Pest Control Association in a contribution that dealt entirely with the subject matter of the new clause—Crown immunity.
I served on the Mid-Glamorgan area health authority for some years before I became a Member of Parliament. I visited hospitals in Mid-Glamorgan and my job, as a member of one of the committees, was to inspect the kitchens. In addition, my son spent four years in and out of the East Glamorgan and Bridgend hospitals. That gave me a further opportunity to visit hospitals before 1979. Since 1979 I have visited constituents and relatives in the same hospitals. The conditions in those hospitals now are absolutely appalling because of the lack of finance to ensure that they are hygienic. The corridors and passageways are not kept as clean as they should be. The health standards that are required in restaurants, canteens and in the Palace of Westmister are far higher than those that are to be found in the National Health Service.
§ Mr. McQuarrieWhat did the Labour Government do about removing Crown immunity between 1974 and 1979? The hon. Gentleman referred to hospitals generally as being filled with cockroaches and vermin. That may apply to England and Wales, but it does not apply to Scotland. Nurses are trained not only in patient care but in hygiene. I saw a classic example of that only last weekend at the Royal Alexandra infirmary in Paisley. Ward 8 was spotless and the food that arrived from the kitchens was superb. [HON. MEMBERS: "It is a Labour area."]Yes, it is a Labour area.
§ Mr. PowellThe hon. Gentleman is fortunate to have those conditions in Scotland. He referred to the Labour 58 Government. That was indeed the ideal period. During that time I served on the Mid-Glamorgan area health authority. The conditions about which the hon. Gentleman boasts in Scotland were conditions that my constituents and I enjoyed in Mid-Glamorgan, but we are not enjoying them now. During that period the Labour Government introduced many protective measures, including the Health and Safety at Work etc. Act 1974. I should like those measures to apply to hospitals as they apply elsewhere. In this place we pass Acts of Parliament but they do not apply to us. Perhaps that is just as well, because I should not like the conditions that one finds in National Health Service kitchens to apply to the kitchens in the Palace of Westminster.
The Government say that they are spending more money on the National Health Service. I have been invited to the opening on Wednesday of a new hospital in Bridgend. We have fought for that hospital for 18 years. It will replace a number of hospitals in Ogmore and in Mid-Glamorgan. [HON MEMBERS:"Who is opening it?"] The Princess of Wales, and it is to be called the Princess of Wales hospital. However, the new hospital is to replace some of the old hospitals. Many of the old cottage hospitals, which were built with the donations of pennies and threepences a week by the miners, are to be closed. Instead of better facilities, there will be even worse facilities. The small communities will no longer have their cottage hospitals.
I have been round the new hospital and I am not all that enamoured of it. Although some of the cottage hospitals were built a century ago, their hygiene standards are far better than those in the new Cardiff hospitals.
§ Mr. McQuarrieThat is exactly what I was trying to point out to the hon. Gentleman. The standards of hygiene in the older hospitals are far superior to those in the new hospitals. Nurses are trained to ensure that in listed buildings, which were built 100 years or more ago, high standards of nursing and hygiene are maintained.
§ Mr. PowellThen why are the Government closing the old hospitals that we should like to retain? The new hospitals should he used to meet the demand for hospitalisation.
§ Mr. McQuarrieAs I said earlier, the construction and types of wards in listed hospital buildings are unsatisfactory for modern medical practice, but in rural areas in particular the smaller hospitals can be used for geriatric patients. I have many hospitals of this type in my constituency. Instead of being looked after in massive hospitals, patients are cared for in the very kind of hospitals to which the hon. Gentleman referred —nice little hospitals, where people can feel at home in the latter days of their lives. There is a very good case for retaining such hospitals in rural areas.
§ Mr. Deputy SpeakerOrder. I am afraid that once again we are wandering away from Crown immunity. May we return to the new clause?
§ Mr. PowellI am sorry that you intervened, Mr. Deputy Speaker, because I was enjoying the hospitalisation Utopia for which I have been looking and which the hon. Gentleman was describing in Scotland. In Mid-Glamorgan, however, the Government are closing not 59 only the old hospitals but the geriatric hospitals. In Mid-Glamorgan, 14 hospitals, including geriatric units, are being closed. They are old hospitals, but they provide better care for patients than some of the new hospitals.
The new clause ought to be accepted by the Government. It will protect those who have to go into hospital for treatment. It is frightening to read the reports to which my hon. Friend the Member for Rhondda (Mr. Rogers) referred. When patients enter hospital they hope to be cured, but because disease-carrying vermin contaminate their food they leave hospital in a far worse condition than when they went in.
§ Mr. RogersMy hon. Friend referred to my area, which is adjacent to his constituency, and to the problem we face over hospital closures. We feel passionately about this, because of what is happening at the Pentwyn cottage hospital at the top end of the Rhondda where my hon. Friend was born. It is vital that the new clause should be implemented to extend immunity to this hospital for the remaining period of its use. It is about to be closed. Very severely handicapped children and people with ——
§ Mr. Deputy SpeakerOrder. The hon. Gentleman is stretching my patience and, no doubt, the patience of the House.
§ Mr. PowellI will not wander down that road, Mr. Deputy Speaker.
My hon. Friend the Member for Rhondda spoke about an area that is dear to my heart—the Rhondda, where I was born and bred — and the hospital that he spoke about is on my doorstep. That hospital treated many miners when they were taken out of the colliery just half a mile away. Although the colliery no longer exists, many miners and miners' widows still live in the area and would enjoy the facility of such a hospital. I have spoken about Mid-Glamorgan because it has a lot to do with this new clause. A brand new hospital is being built, but it will not offer the same facilities as the old one. That new hospital is being built as a result of pressure in this House from 1979, so that the 700 people on the hospital waiting list in that area can be accommodated. We were promised a new hospital and no closures, but within seven years hospitals with high standards of hygiene and health care are being closed.
When people go into hospital for treatment of any sort, have they any claim against the authorities if they are infected by vermin or suffer from food poisoning? It has been suggested that boils, abscesses, typhoid, pneumonia, dysentery, worms or jaundice can be contracted by people in hospital as a result of inefficient management. Cockroaches and all sorts of vermin are sometimes found in the food that patients eat. How can a patient prove that that is because of neglect by the management?
Recently I was wheeled through one corridor after another in the Bridgend hospital, from one part of the hospital to another, to have an ear operation. I noticed that the walls were not being repaired, and cobwebs and cockroaches and other vermin could be seen in the corridors along which I was being wheeled. That was before I got into the operating theatre. The theatre is supposed to be kept in such a way that a patient cannot catch an infection or disease. I was just having an ear operation, but I could have been having my leg off.
60 After my operation I was wheeled back along the same dirty corridors with the paint peeling off the walls and half the floor coming up. In my room, as I was coming round, I saw six people in pinstripe suits standing at the foot of my bed. I thought they were Members of Parliament. I said, "What on earth are you doing here?" They told me that they had come to look at the room because they were in the process of offering a price. "A price for what?", I said. Unknown to me, because on that day I did not have the Western Mail, there was a front-page article which said that Bridgend cottage hospital was up for sale, was open to offers and could be inspected almost immediately. I understand it has now been sold. There I was in bed recovering from an operation, and six people were measuring the room because they wanted to purchase the hospital. Surely the health authorities could wait until patients have been properly treated and discharged from hospital before they start selling the building under the very noses of people who have just had operations.
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There should be some measure to force health authorities to ensure that the standards of hygiene we expect in areas like Mid-Glamorgan and throughout Britain are maintained.
I do not want to dwell on the hospital service in Wales. I have also been to hospitals near the House of Commons. There is no way that we can get medical treatment in the House. We have to go to the hospitals nearby. If I were to suffer a heart attack now, I would have to wait until somebody could take me to Westminster hospital or to St. Thomas's hospital. That is because there is no sick room or hospital room in the House. There are 650 hon. Members and a staff of 3,000, as well as other people who visit the House. It is deplorable that we have so few medical facilities. If we worked in industry, we would have better facilities than anything that is available in this place.
Some years ago I went to visit a close friend of mine who was in hospital, the late hon. Member for Newcastle upon Tyne, Central, Mr. Harry Cowans. He was in a room on his own, and the conditions were disgraceful. That is all we can expect when we go forward from the House. It is no different from what I expect when I visit some of the hospitals in Mid-Glamorgan and see the treatment that is available there. It is high time that the Government did something to ensure that standards of hygiene are improved. Patients in hospital should not suffer from infection caused by the problems that I have mentioned. The disrepair of hospitals, especially old hospitals, should be remedied.
I hope that the Minister will respond to the speeches on this new clause by accepting it.
§ The Minister for Health (Mr. Barney Hayhoe)This debate has gone on for just over three hours and I suspect that the House would like to see it concluded. The longer the debate has continued the weaker the case in favour of this new clause has become. The general conditions that have been so roundly condemned by Opposition Members existed throughout the lifetime of the last Labour Government. This Government have come forward with the initiative to abolish Crown immunity in relation to hospital food and kitchens. That initiative was warmly and rightly welcomed when it was announced by my right hon. Friend a few months ago. There has been hardly a mention of that in the debate and one can only assume from the speeches of Opposition Members that for them history 61 began with the general election in May 1979. The hon. Member for Holborn and St. Pancras (Mr. Dobson) barely acknowledged responsibility for these matters——
§ Mr. D. N. Campbell-Savours (Workington)On a point of order, Mr. Deputy Speaker. I have just been to the Vote Office to pick up a copy of the report of the Second Reading of this Bill and it was not available. It is unprecedented for us to have a debate of this nature when the report of the debate on Second Reading is not available. What can he done? I am told that we must wait for it to come from the printers. We are now on Report and many hon. Members want that document for reference. This is a genuine point of order. We cannot all go to the Library and photocopy all the proceedings. It is unreasonable that we should be debating the matter when the arrangements and supporting services of the House have broken down in that way. I wonder whether you will be able to do something, even at this late hour.
§ Mr. Deputy SpeakerI understand that the hon. Gentleman is complaining that there is not a copy available in the Vote Office of the official record of the Second Reading debate. I shall have some inquiries made.
§ Mr. HayhoeI was talking of the changing situation which existed for many years under the Labour Government. Those Labour Members who have spoken have hardly acknowledged their party's responsibility in these matters. Indeed the hon. Member for Holborn and St. Pancras acknowledged in about 30 seconds that, with hindsight, he would have preferred matters to have been put right earlier. But the right hon. Member for Stoke-on-Trent, South (Mr. Ashley) was wholly and utterly partisan and selective. His world clearly begins in 1979. He was self-satisfied with his own party's record and unfairly critical of others. That narrow, blinkered approach does him no credit at all.
The tragic affair at Stanley Royd has been prayed in aid by many hon. Members. I should make it clear that the report of the committee of inquiry into the outbreak of food poisoning at Stanley Royd reported that the presence or absence of Crown immunity would have altered nothing at Stanley Royd. Available finance has also been referred to. Again, the official report made it clear that resources were not the cause of the outbreak. The reasons were as follows:
So far as the immediate cause of the outbreak at Stanley Royd is concerned, namely errors and faults in the preparation and handling of food, there are no recommendations which we can make which have not been made before, which do not appear in the numerous publications on catering and hygiene to which we were referred and which were published to everyone concerned … All the rules and principles of good catering practice appear to have been within the knowledge of those concerned in Stanley Royd before the outbreak, including the requirement to keep samples of the food served from the kitchens. The outbreak occurred because those concerned ignored those rules and principles. The failure to follow known rules and principles arose, at least in part, because of the long standing failure of the supervisory grades to supervise adequately. This failure caused venial habits to become bad practices. In turn the failure of the supervisory grades stemmed in part from the failure of management to manage, to check, and to ensure that the staff were constantly reminded of the rules and complied with them.That must be the background to what we are considering today. Indeed, the report of the committee of inquiry is 62 one of the most powerful arguments in support of general management, which did not exist when the outbreak occurred, being introduced.Reference has also been made in the debate—
§ Mr. Kevin Barron (Rother Valley)Will the right hon. Gentleman give way?
§ Mr. HayhoeNo. I shall deal with some of the points that have been raised during the debate. The hon. Gentleman was not here and it is important to respond to the points that have been made during what has been a long debate.
Let me deal with competitive tendering. Labour Members, in their usual prejudiced and dogmatic fashion, sought to say that if something was being done by a private contractor it was necessarily bad, with the implication that if something was being done by a public employee it was necessarily good. I reject such a dogmatic and absurd view of the world. The truth is that good practice occurs in both the private and public sectors, just as bad practice can occur in both. I want to see conditions with general management within the NHS supporting good practice and trying to ensure that the sort of failures that occurred at Stanley Royd never occur again.
We have had something of a re-run of the debate in Committee. The hon. Member for Holborn and St. Pancras repeated the arguments that he put then, as did some of his hon. Friends, and so I must repeat some of mine. There is no exact parallel between Crown immunity as it affects hospital food and kitchens and Crown immunity as it affects health and safety legislation and, indeed, other matters.
The Labour Government treated those matters separately and differently. Most of the representations that we as Members of Parliament have received in recent months also treated these matters separately and differently. The Government have made it clear that the test that they apply to deciding whether Crown immunity should be lifted from a given area of legislation is that the case must be made that the lifting of Crown immunity is the best way to secure arty improvement in standards necessary to protect patients and staff.
The Government believe that that case has been established with regard to the application of food hygiene legislation to health authorities. That is why the Government have brought forward the measures contained in clause 1. The wider matters to which hon. Members have referred at various points in the Bill's progress, and which were referred to specifically by the hon. Member for Holborn and St. Pancras in moving new clause 1, are of clear importance, but in no instance has the case to lift Crown immunity been made with the same strength as was made with respect to food hygiene legislation.
§ Mr. Dobsonrose——
§ Mr. HayhoeLet me deal with some of the points raised during the course of a long debate, in which I listened to every word.
Arrangements were established by the Labour Government when they introduced the Crown notice system which still apply and which are working reasonably well. The hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) referred to comments that my hon. Friend the Under-Secretary, the Member for Wycombe (Mr. 63 Whitney), had made in replying to the Second Reading debate about the fact that 300 notices had been issued between 1978 and 1984. All had been dealt with and none referred to the Secretary of State concerned noncompliance matters. The Crown notice system, as introduced by the previous Labour Government, gave the power to the health and safety inspectors, if they believed that a Crown notice was not being complied with, to refer that matter to the Secretary of State of the Department concerned.
Suggestions have been made by the hon. Gentleman, and I think elsewhere, that there has been, to put it in unpejorative terms, a more relaxed approach by health and safety inspectors when they were dealing with Crown premises compared with the attitude that they adopted when they were dealing with other premises. I am grateful to have a nod of assent from the hon. Gentleman. The Health and Safety Executive is now tightening up its procedures to ensure that requirements for compliance are as stringent for Crown premises as for firms in the private sector. In particular, it is issuing new procedures with instructions to health and safety inspectors, revised to emphasise that a problem found in a Crown body should receive the same priority as it would in a private concern. The time allowed to do remedial work—a point raised by the hon. Gentleman—should be no more generous than it would be for the private employer. In general, a sense of urgency should be instilled into the execution of any required improvements.
Secondly, copies of all Crown notices that have not been complied with in the time allowed and reports of all offences that, but for Crown immunity, would have led to prosecution, must now be sent directly to the headquarters of the Department responsible for the establishment concerned.
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A positive and constructive change is being adopted for health and safety inspectors and I believe that that will go a long way towards reinforcing the existing good working relationship between those inspectors and Health Service personnel.
Reference was made to health authorities restricting the access of inspectors. There is no justification for that. Any inspectors who feel that access is being restricted or that they cannot make random, surprise visits should raise the matter with their superiors. It is intended that such access should be available.
The hon. Member for Holborn and St. Pancras and others mentioned the Rent Acts. The effect of Crown immunity is that NHS tenants are not protected tenants under the Rent Acts. However, council tenants are also not protected tenants under the Rent Acts and, as far as I can see, the hon. Member for Holborn and St. Pancras wants to institute for the NHS a regime that I suspect that he would not be prepared to introduce for local authorities. I may do him an injustice, but he certainly did not refer to that matter.
The hon. Member for Holborn and St. Pancras put the debate into the wider context of the Government's policy on NHS residential accommodation. I dealt with the issue in an Adjournment debate on 23 May and I repeat what I said then. The conditions under which staff occupy NHS accommodation and under which health authorities 64 manage the residential estate require examination, with a view to establishing a code of practice or some similar set of arrangements. My right hon. Friend the Secretary of State has therefore asked the NHS management board to review these matters urgently and to consult health authorities and professional and staff interests. I am sure, from the general tenor of what the hon. Gentleman said, that he will welcome that clear undertaking and I hope that the House will welcome its repetition.
The review will consider Crown immunity and it would be wrong to prejudge or pre-empt the review body's consideration.
The hon. Member for Fife, Central (Mr. Hamilton) asked about the circular that I said on 23 May would be sent out fairly soon. I can tell the hon. Gentleman that the advance copy went to regional general managers on Friday and the printed copies for wider circulation will follow.
The hon. Member for Holborn and St. Pancras referred to the West Surrey case. He knows about the case and his comments today were even more odd than was his original prejudice, which was based on a fairly complete ignorance of the background to the incident. The property concerned was not owned by the NHS; it was leased from a trust company, which sought to increase the rent to £5,000 a year—four or five times the previous level. The notice to quit was served on the health authority, which, in turn, had to take action and did so by offering the nurse alternatives. I understand that after a fair amount of to-ing and fro-ing she has accepted alternative accommodation.
§ Mr. Dobsonrose——
§ Mr. HayhoeThe hon. Member for Holborn and St. Pancras wishes to intervene, but let me ask him a question. He seemed to be saying that the nurse should have an absolute right to remain in that property, come what may. But what if the rent had been going up to £10,000, £20,000 or £100,000? Would he still maintain that Health Service funds should be diverted in that way and that NHS management should not take appropriate action to deal with the situation?
§ Mr. DobsonFor a start, it was the Secretary of State who was stupid enough to give a guarantee without any reservation or caveat. If he had to break his word to do what he thought was sensible, that is his problem.
If the Minister is saying that the Secretary of State's guarantee applies to no leasehold property, why, when the case arose, did the right hon. Gentleman rely on Crown immunity? The Government ought to accept responsibility for people living in NHS property. If they do not, they surely cannot fall back on Crown immunity as a way of getting people slung out.
§ Mr. HayhoeCrown immunity is a side issue in this case. The essential element is that the property was not owned by the NHS and therefore did not form part of the review of the methods of dealing with that property to which my right hon. Friend was referring when he gave the hon. Gentleman that assurance. I am sorry that, despite our correspondence, the hon. Gentleman seeks to place that assurance in a much wider context.
§ Mr. Dobsonrose——
§ My HayhoeI will not give way to the hon. Gentleman, because I think that the House is ready to come to a decision on the new clause.
65 The lurid descriptions of Opposition Members of the state of kitchens and other parts of NHS hospitals could lead one to imagine that things were different when Crown immunity did not apply under the Labour Government. Of course, conditions were precisely the same then. We are improving them, in a limited, constructive and helpful fashion.
Great stress has been laid on unacceptable conditions in many of our hospitals from time to time, but it would be right to end the debate by paying tribute to the staff concerned for maintaining high standards as the normal course. It would be wrong if the critical speeches of Opposition Members sent out a message that was critical of the standards of care and service that the vast majority of NHS personnel give to the Service.
§ Dr. MarekThe Minister has a contorted view if he believes that conditions are the same as they were under the Labour Government. That is not true, because, by and large, conditions in hospitals were considerably better before 1979.
The explanatory and financial memorandum to the Bill says:
Clause 1 has no implications for public expenditure.Yet the Government are seeking in clause 1 to make sure that hospital kitchens come under the food legislation and if there are kitchens that are not up to scratch and in which there are cockroaches, flies, feral cats and other vermin, it will necessarily cost money to bring those premises up to the required standard. The comment that clause 1 has no implications for public expenditure sets the tone of the Bill and tells us what the Government really think of the NHS and its hospitals. They want to make the right noises in public. They will do the minimum necessary, but they will not spend money, because by and large Conservative Members and their friends do not use the NHS.
§ Mr. RogersA letter sent to my hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) by the National Association of Health Authorities in England and Wales says that if more effective management is to enable higher standards to be established, extra money will have to be given.
§ Dr. MarekMy hon. Friend has made the point for me. It is obvious, not only to Labour Members, but to the public, that the Government's hypocrisy has carried them through since 1979. Indeed, they are talking about hanging on until 1988, but the public will not be deceived.
The Government claim that the minimal clause has been introduced because they are dissatisfied with the conditions in hospital kitchens. Of course, that is not true. The credit for the introduction of this Bill must go to the hon. Member for Aldridge-Brownhills (Mr. Shepherd), who was about to have his Bill debated. There was so much concern on both sides of the House about the conditions prevailing in hospitals that the Government had to do something about them. The Government would not have introduced the measure if the hon. Member for Aldridge-Browhills had not been in that situation.
There is no point in introducing a clause that seeks to make only hospital kitchens subject to the food legislation. Food is sent in by outside caterers, has to be prepared, and then travels up and down the corridors. At present we do not know whether the whole area will be subject to the food legislation. After the food has been eaten, the swill and refuse have to be taken away.
66 My hon. Friend the Member for Fife, Central (Mr. Hamilton) said that cockroaches were no respecters of boundaries. They may primarily eat food that they find in hospitals, or they may find a living in rooms where drugs are kept. The legislation will not cover those areas. [Interruption.] The Government are stupid to say that the legislation should cover food but nothing else.
I shall give some examples of letters that I have received about the Bill. This is an important debate. I know that Conservative Members want me to hurry up, but we are discussing a serious issue. I have received a lot of correspondence, and the issue must be given due consideration. The BMA said:
The Association's Annual Representative Meeting"—which is the policy-making body of the BMA—last year passed the following Resolution: — That this Meeting believes that Health and Safety at Work Regulations should be enforced on Crown property.One of the new clauses seeks to do just that.Why should we ask for health and safety at work legislation to be enforced on Crown property in addition to food legislation? The Health and Safety at Work etc. Act was passed by the previous Labour Administration. It has contributed to safety and the maintenance of standards—something for which the Government have shown little regard. The Act makes
further provision for securing the health, safety and welfare of persons at work, for protecting others against risks to health or safety in connection with activities of persons at work, for controlling the keeping and use and preventing the unlawful acquisition, possession and use of dangerous substances.I should have thought that the new clause, which seeks to apply the Health and Safety at Work etc. Act to hospital premises, was unexceptionable in this case. After all, there are plenty of dangerous substances in hospitals. That Act also controls certain emissions into the atmosphere. It makes further provision with respect to theemployment medical advisory services; to amend the law relating to building conditions".The ordinary man in the street would immediately say that we needed all those things and that the Act should apply to NHS hospitals.In 1983 the Health and Safety Commission went so far as to issue a document entitled, "Safety Policies in the National Health Service", which set our guidance for employers in the NHS
to devise and use effective statements of health and safety policy as required by the Health and Safety at Work etc. Act 1974".However, the document was disappointing in that its foreword clearly stated that the guidance document did not have the force of law or of an approved code of practice. The Minister made great play of Crown notices being tightened up and reporting being made much stricter, but there is still a deferential attitude when it comes to applying that Act to the NHS. I do not think that any circulars or ministerial prompting of the Health and Safety Executive will change that.David Basnett, general secretary of the General Municipal, Boilermakers and Allied Trades Union, submitted a document entitled, "The case against Crown Immunity". It cites case No. 2 in which the House may be interested, which concerns an explosion in kitchen equipment. The prosecution of an NHS manager was eventually dropped. I shall briefly go through the case later, but it is a pity that the prosecution was dropped simply because the Health and Safety Executive did not 67 have the necessary powers. It had a deferential attitude towards the NHS and was persuaded not to prosecute. "The case against Crown Immunity" says——
§ Mr. Willie W. HamiltonOn a point of order, Mr. Deputy Speaker. I am trying to listen to my hon. Friend, but these louts down by the Bar of the House are preventing me from doing so. Will you get some kind of order in the place?
§ Mr. Deputy Speaker (Sir Paul Dean)I am also finding it somewhat difficult to hear. I hope that the conversations taking place in various parts of the Chamber and outside it will cease so that we can hear the hon. Member for Wrexham (Dr. Marek), who has the Floor.
§ Dr. MarekThe following was said about that intended prosecution:
An HSE inspector issued a summons against an NHS Area Administrator for a breach of the Health and Safety at Work etc. Act following an explosion in kitchen equipment and other safety defects. (Managers and other employees in Crown premises can be prosecuted as individuals even though the organisation itself is immune). Following intervention by senior HSE Administra-tors the summons was withdrawn and the Inspector was later transferred. The GMB wrote to the Chairman of the HSC to complain and to seek an explanation. In his reply the HSC Chairman said that Crown Immunity had 'complicated the issue' and that the summons had been withdrawn following more than the usual degree of scrutiny by senior HSE administrators who recognised the 'wider implications' of such an action.It is not just a case that involves issuing a Crown notice or having a quiet word with the administrator or general manager. A risk to life and something quite serious was involved, yet the prosecution was dropped because of the deferential attitude shown towards the NHS by the HSE. The description of the case continues:If Crown immunity had not complicated the issue there would have been a prosecution. A similar case involving another large new entrant area, ie employers covered by health and safety legislation or for the first time following the HSW Act 1975, had resulted in the prosecution of a senior local authority employer. The surrounding publicity and shock to senior managers in local authorities galvanised that whole sector of employment into compliance with the health and safety rules. This opportunity has been missed in the NHS due to the deferential attitude towards the NHS by the HSE".I had hoped that the Minister would take on board some of those arguments. There can be nothing wrong with applying the Act to hospital premises, especially as that would mean an arm's length relationship between the HSE and the NHS. If the HSE found something wrong, it would have statutory backing to take appropriate action. However one dresses it up, Crown notices are apologies for not doing the proper thing, which is to have statutory regulations guiding the HSE on how to secure the safety of the nation.The staff in hospitals cannot have the same level of concern about health and safety as they would if there were statutory guidelines. Kitchens are dangerous places, and if the Health and Safety at Work etc. Act were applied there would be a formal system of committees, health and safety officers and inspections. That happens in some hospitals anyway, but there is no statutory backing and the staff cannot demand it. It is another failure in the system.
What possible excuse can the Government give for not allowing the Act's provisions to apply to hospitals'? I 68 answered that question during my opening statement—the Government do not want to spend the money. They do not care one jot about what happens in the NHS. They would prefer that it did not exist. By and large, Members of the Conservative party do not use the NHS, so the Government do not have the interests of NHS patients or NHS employees at heart.
The BMA document makes other points, but I accept that time is becoming short——
§ Mrs. ClwydDoes my hon. Friend agree that the Health and Safety Inspectorate has been run down under this Government and that there are now 15 per cent. fewer inspectors than in 1979? Therefore, the number of visits to factories and hospitals has fallen by 15 per cent. The inspectorate cannot even do the job that it is expected to do. It is no wonder that the Government do not want Crown immunity lifted from hospital kitchens.
§ Dr. MarekMy hon. Friend makes a valid point. The Government are not interested in the health and safety of employees, only in the health and wealth of their supporters — and they do not find their supporters working in the NHS.
The new clause seeks to extend the removal of Crown immunity so that hospitals come under the Health and Safety at Work etc. Act. The BMA points out that one of the appendices to the Health and Safety Executive document "Safety Policies in the Health Service 1983" gives a checklist that identifies matters that should be covered in safety policy. It is only a guideline, but it involves some detail in identifying matters that should be considered in the implementation of safety policy. Questions were posed under headings such as noise and vibration in hospitals, radiation, dust, toxic materials and their availability and storage, various gases, infection risks and disposal of waste and effluent. Those areas are of relevance not only to staff but to patients, and the guidelines provide a cogent argument to show why the new clause should he accepted.
Patients are not well people — they are which is why they are in hospital. They need more than the usual care given by health and safety inspectors at a normal place of work. The House should bend over backwards to ensure that the most stringent conditions apply.
The BMA document further states:
The 1974 Act was to make further provision for securing the health and safety of persons at work and for protecting others against risks to health or safety in connection with the activities of persons at work.I have given the House a fair impression of what the BMA thinks about this matter. It is a great pity that the Government are obdurate in their insistence upon saving money and not giving their blessing to the new clause.The Royal College of Nursing also believes that Crown immunity should be removed. A letter from its general secretary of 12 May, which I suspect has been sent to many hon. Members, states:
The Royal College of Nursing welcomes the Government's plans to amend the law relating to Crown immunity in respect of the Food Act 1984. The RCN would also urge amendments to the Health and Safety at Work etc. Act 1974 to remove the Crown's immunity from prosecution under that Act.Why does it say that? It is the major nursing union in hospitals and has direct experience of what happens. It has given its considered judgment.69 The National Association of Health Authorities in England and Wales has written to express its support for new clause 1. It states that at its annual general meeting the following resolution was passed:
That Crown property should be legally subject to the same rights and requirements as other property in respect of matters of public concern such as environmental health and health and safety at work and that the present immunity should be removed.There are many other paragraphs in that letter, but I shall not read them because that paragraph is sufficient. It is a responsible body that has the NHS very much in its mind. It supports an extension of the removal of Crown immunity along the lines of the new clause.The Consumers Association does not go quite that far, but in a letter it complains about the enormous powers reserved for Ministers and states:
We have one serious reservation about the Government's Bill as it is drafted and this concerns clause 2(b). It seems that this subclause would give Ministers the power to reduce or even eliminate the application of the main principles of the Bill in virtually any way they see fit.The Government have done only the minimum necessary, and the view of that body is that Ministers are being given powers to reduce even what the Government are giving in clause 1.The British Pest Control Association believes that the problem of pest infestation has grown so rapidly that most hospitals are now affected. It is not saying that infestation has been present during the last six years under the Tory Administration at the same levels as under the previous Labour Administration. It says that the problem has grown rapidly and that most hospitals are now affected. That gives the lie to the Government's assertion that the problem existed when the previous Labour Government were in office and that the present Tory Government are taking action.
I am not saying that the problem did not exist under the previous Labour Administration, but I contend that the Government's refusal to spend money on the NHS has led to the problem becoming more severe. The Government talk about expenditure of 24 per cent. in real terms, but that is a gross misrepresentation of the figures. I am grateful to the Minister for not repeating that misrepresentation when he replied to the debate. The real fact is that hospitals have been starved of money and have suffered throughout the past five years. Less money is available to them in real terms than hitherto.
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Hospitals are suffering because of the presence of private contractors in many institutions. That is one reason why the clauses have been tabled. If the House accepts them, it is undeniable that there will be a need for extra finance to be provided by central Government or from some other source so that matters can be put right. I believe that the extra finance must be provided in any event. Infestation is so bad that extra money will be necessary if the law is to be obeyed. If the clauses were passed, our case would be overwhelming and extra money would have to be provided.
Private contractors are not interested primarily in the health and wellbeing of patients; they are interested in providing profits for their shareholders. I hope that the Government will not say outside the House that the Opposition have said that that is their view of the staff and workers of private contractors. I am not saying that. I accept that those people have been up to the mark. 70 Unfortunately, the conditions under which they have to work, the materials with which they are provided, low pay, a consequent lack of morale and inevitable uncertainty have led to the grave situation that is now to be found in our hospitals.
The Opposition believe that the Government have gone a small step towards making life in hospitals for patients and NHS staff slightly better. They have done this only because the hon. Member for Aldridge-Brownhills has a Bill which is about to be debated and voted upon in private Members' time. We do not believe that the Government would have brought forward this measure if that had not been the position. Additionally, we believe that there is a long way to go and that extra provision should be made. Crown immunity should be removed completely and more finance should be provided. This is necessary because the Government have not been providing a real increase in finance for our hospitals. Given the seriousness of the clauses, the Opposition will be asking for separate votes.
§ Question put, That the clause be read a Second time:—
§ The House divided: Ayes 130, Noes 214.
72| Division No. 211] | [7.33 pm |
| AYES | |
| Abse, Leo | Flannery, Martin |
| Adams, Allen (Paisley N) | Foot, Rt Hon Michael |
| Alton, David | Forrester, John |
| Anderson, Donald | Foster, Derek |
| Ashley, Rt Hon Jack | Fraser, J. (Norwood) |
| Ashton, Joe | George, Bruce |
| Atkinson, N. (Tottenham) | Gourlay, Harry |
| Banks, Tony (Newham NW) | Hamilton, James (M'well N) |
| Barron, Kevin | Hamilton, W. W. (Fife Central) |
| Beckett, Mrs Margaret | Hardy, Peter |
| Benn, Rt Hon Tony | Hattersley, Rt Hon Roy |
| Bidwell, Sydney | Heffer, Eric S. |
| Blair, Anthony | Hogg, N. (C'nauld & Kilsyth) |
| Boothroyd, Miss Betty | Howells, Geraint |
| Boyes, Roland | Hoyle, Douglas |
| Brown, N. (N'c'tle-u-Tyne E) | Hughes, Dr Mark (Durham) |
| Brown, R. (N'c'tle-u-Tyne N) | John, Brynmor |
| Bruce, Malcolm | Jones, Barry (Alyn & Deeside) |
| Buchan, Norman | Kaufman, Rt Hon Gerald |
| Caborn, Richard | Kennedy, Charles |
| Callaghan, Jim (Heyw'd & M) | Leadbitter, Ted |
| Campbell-Savours, Dale | Leighton, Ronald |
| Clark, Dr David (S Shields) | Lewis, Ron (Carlisle) |
| Clarke, Thomas | Lewis, Terence (Worsley) |
| Clay, Robert | Livsey, Richard |
| Clwyd, Mrs Ann | McCartney, Hugh |
| Cohen, Harry | McDonald, Dr Oonagh |
| Coleman, Donald | MacKenzie, Rt Hon Gregor |
| Cook, Frank (Stockton North) | Maclennan, Robert |
| Cook, Robin F. (Livingston) | McWilliam, John |
| Corbett, Robin | Madden, Max |
| Corbyn, Jeremy | Marek, Dr John |
| Cox, Thomas (Tooting) | Maxton, John |
| Crowther, Stan | Maynard, Miss Joan |
| Cunliffe, Lawrence | Meacher, Michael |
| Davis, Terry (B'ham, H'ge H'l) | Michie, William |
| Deakins, Eric | Mikardo, Ian |
| Dixon, Donald | Millan, Rt Hon Bruce |
| Dobson, Frank | Miller, Dr M. S. (E Kilbride) |
| Dormand, Jack | Nellist, David |
| Douglas, Dick | Oakes, Rt Hon Gordon |
| Dubs, Alfred | Park, George |
| Eadie, Alex | Patchett, Terry |
| Eastham, Ken | Pendry, Tom |
| Edwards, Bob (W'h'mpt'n SE) | Powell, Raymond (Ogmore) |
| Evans, John (St. Helens N) | Radice, Giles |
| Fatchett, Derek | Raynsford, Nick |
| Faulds, Andrew | Redmond, Martin |
| Field, Frank (Birkenhead) | Richardson, Ms Jo |
| Fields, T. (L'pool Broad Gn) | Roberts, Ernest (Hackney N) |
| Fisher, Mark | Robertson, George |
| Rogers, Allan | Thorne, Stan (Preston) |
| Rooker, J. W. | Tinn, James |
| Sheldon, Rt Hon R. | Wainwright, R. |
| Shore, Rt Hon Peter | Wallace, James |
| Short, Ms Clare (Ladywood) | Wardell, Gareth (Gower) |
| Short, Mrs R.(Whampt'n NE) | Wareing, Robert |
| Skinner, Dennis | Weetch, Ken |
| Smith, C.(Isl'ton S & F'bury) | Welsh, Michael |
| Snape, Peter | Wigley, Dafydd |
| Spearing, Nigel | Williams, Rt Hon A. |
| Steel, Rt Hon David | Wilson, Gordon |
| Stewart, Rt Hon D. (W Isles) | Winnick, David |
| Stott, Roger | |
| Strang, Gavin | Tellers for the Ayes: |
| Thomas, Dafydd (Merioneth) | Mr. Frank Haynes and Mr. Ron Davies. |
| Thomas, Dr R. (Carmarthen) |
| NOES | |
| Alexander, Richard | Emery, Sir Peter |
| Alison, Rt Hon Michael | Evennett, David |
| Amess, David | Eyre, Sir Reginald |
| Arnold, Tom | Fairbairn, Nicholas |
| Ashby, David | Fallon, Michael |
| Aspinwall, Jack | Favell, Anthony |
| Atkins, Robert (South Ribble) | Fenner, Mrs Peggy |
| Atkinson, David (B'm'th E) | Finsberg, Sir Geoffrey |
| Baker, Nicholas (Dorset N) | Fletcher, Alexander |
| Batiste, Spencer | Fookes, Miss Janet |
| Beaumont-Dark, Anthony | Forsyth, Michael (Stirling) |
| Bellingham, Henry | Forth, Eric |
| Bendall, Vivian | Fraser, Peter (Angus East) |
| Best, Keith | Freeman, Roger |
| Biggs-Davison, Sir John | Gale, Roger |
| Blackburn, John | Gardiner, George (Reigate) |
| Blaker, Rt Hon Sir Peter | Gardner, Sir Edward (Fylde) |
| Bonsor, Sir Nicholas | Garel-Jones, Tristan |
| Bottomley, Peter | Goodhart, Sir Philip |
| Bottomley, Mrs Virginia | Goodlad, Alastair |
| Bowden, Gerald (Dulwich) | Gorst, John |
| Braine, Rt Hon Sir Bernard | Gower, Sir Raymond |
| Bright, Graham | Greenway, Harry |
| Brinton, Tim | Gregory, Conal |
| Brittan, Rt Hon Leon | Griffiths, Peter (Portsm'th N) |
| Brown, M. (Brigg & Cl'thpes) | Ground, Patrick |
| Browne, John | Hamilton, Hon A. (Epsom) |
| Bruinvels, Peter | Hamilton, Neil (Tatton) |
| Bryan, Sir Paul | Hampson, Dr Keith |
| Buchanan-Smith, Rt Hon A. | Hargreaves, Kenneth |
| Buck, Sir Antony | Harris, David |
| Budgen, Nick | Hawkins, C. (High Peak) |
| Bulmer, Esmond | Hawkins, Sir Paul (N'folk SW) |
| Burt, Alistair | Hawksley, Warren |
| Butterfill, John | Hayes, J. |
| Carlisle, Kenneth (Lincoln) | Hayhoe, Rt Hon Barney |
| Carlisle, Rt Hon M. (W'ton S) | Hayward, Robert |
| Cash, William | Heathcoat-Amory, David |
| Chapman, Sydney | Heddle, John |
| Chope, Christopher | Henderson, Barry |
| Clark, Hon A. (Plym'th S'n) | Higgins, Rt Hon Terence L. |
| Clark, Sir W. (Croydon S) | Hind, Kenneth |
| Clarke, Rt Hon K. (Rushcliffe) | Hirst, Michael |
| Colvin, Michael | Holt, Richard |
| Conway, Derek | Howard, Michael |
| Coombs, Simon | Howell, Rt Hon D. (G'ldford) |
| Cope, John | Hubbard-Miles, Peter |
| Cormack, Patrick | Hunter, Andrew |
| Corrie, John | Jackson, Robert |
| Couchman, James | Jessel, Toby |
| Cranborne, Viscount | Johnson Smith, Sir Geoffrey |
| Critchley, Julian | Jones, Gwilym (Cardiff N) |
| Crouch, David | Jones, Robert (Herts W) |
| Currie, Mrs Edwina | Joseph, Rt Hon Sir Keith |
| Dickens, Geoffrey | Kellett-Bowman, Mrs Elaine |
| Dicks, Terry | Kershaw, Sir Anthony |
| Douglas-Hamilton, Lord J. | Key, Robert |
| Dover, Den | Knight, Greg (Derby N) |
| Dunn, Robert | Knight, Dame Jill (Edgbaston) |
| Durant, Tony | Knowles, Michael |
| Edwards, Rt Hon N. (P'broke) | Lang, Ian |
| Eggar, Tim | Latham, Michael |
| Lawler, Geoffrey | Pollock, Alexander |
| Lawrence, Ivan | Porter, Barry |
| Lee, John (Pendle) | Portillo, Michael |
| Leigh, Edward (Gainsbor'gh) | Powell, William (Corby) |
| Lester, Jim | Powley, John |
| Lewis, Sir Kenneth (Stamf'd) | Prentice, Rt Hon Reg |
| Lightbown, David | Price, Sir David |
| Lloyd, Ian (Havant) | Proctor, K. Harvey |
| Lloyd, Peter (Fareham) | Raffan, Keith |
| Lord, Michael | Rathbone, Tim |
| Luce, Rt Hon Richard | Rhodes James, Robert |
| Lyell, Nicholas | Rhys Williams, Sir Brandon |
| McCurley, Mrs Anna | Ridley, Rt Hon Nicholas |
| Macfarlane, Neil | Ridsdale, Sir Julian |
| MacKay, Andrew (Berkshire) | Sackville, Hon Thomas |
| MacKay, John (Argyll & Bute) | Sainsbury, Hon Timothy |
| McLoughlin, Patrick | Sayeed, Jonathan |
| McQuarrie, Albert | Shaw, Giles (Pudsey) |
| Major, John | Shaw, Sir Michael (Scarb') |
| Malins, Humfrey | Sims, Roger |
| Malone, Gerald | Skeet, Sir Trevor |
| Maples, John | Smith, Tim (Beaconsfield) |
| Marland, Paul | Soames, Hon Nicholas |
| Marlow, Antony | Spicer, Michael (S Worcs) |
| Marshall, Michael (Arundel) | Squire, Robin |
| Mates, Michael | Stevens, Lewis (Nuneaton) |
| Maxwell-Hyslop, Robin | Stewart, Andrew (Sherwood) |
| Merchant, Piers | Taylor, Teddy (S'end E) |
| Miller, Hal (B'grove) | Thompson, Donald (Calder V) |
| Mills, Iain (Meriden) | Thompson, Patrick (N'ich N) |
| Mills, Sir Peter (West Devon) | Thorne, Neil (Ilford S) |
| Miscampbell, Norman | Thurnham, Peter |
| Mitchell, David (Hants NW) | Townend, John (Bridlington) |
| Moate, Roger | Twinn, Dr Ian |
| Montgomery, Sir Fergus | Viggers, Peter |
| Moore, Rt Hon John | Wakeham, Rt Hon John |
| Morrison. Hon C. (Devizes) | Walden, George |
| Moynihan, Hon C. | Walker, Bill (T'side N) |
| Nelson, Anthony | Waller, Gary |
| Newton, Tony | Watson, John |
| Nicholls, Patrick | Wells, Bowen (Hertford) |
| Norris, Steven | Whitney, Raymond |
| Onslow, Cranley | Wood, Timothy |
| Ottaway, Richard | |
| Page, Richard (Herts SW) | Tellers for the Noes: |
| Pawsey, James | Mr. Mark Lennox-Boyd and Mr. Francis Maude. |
| Percival, Rt Hon Sir Ian |
§ Question accordingly negatived.