HC Deb 19 July 2004 vol 424 cc41-61

  1. '(1) For the purpose of the exercise of its functions under section 2(1)(a) and (b) the Agency may prepare and publish statements of standards.
  2. (2) The Agency must keep such standards under review and may publish amended standards whenever it considers it appropriate.
  3. (3) The Agency must consult the appropriate authority and such other persons as the Agency considers appropriate—
    1. (a) before publishing a statement under this section;
    2. (b) before publishing an amended statement under this section which in the opinion of the Agency effects a substantial change in the standards.
  4. (4) The standards set out in statements under this section are to be taken into account by every English NHS body, Welsh NHS body and cross-border SHA in discharging its duty under section 45 (quality in health care) of the Health and Social Care (Comunity Health and Standards) Act 2003 (c.43).
  5. (5) This section does not extend to Scotland and Northern Ireland.'.—[Mr. Lansley.]

Brought up, and read the First time.

4.41 pm
Mr. Andrew Lansley (South Cambridgeshire) (Con)

I beg to move, That the clause be read a Second time.

The Bill has not been the subject of detail or aggressive controversy. We are all working towards one objective, which is to reach a point at which patients in the NHS, and the public generally, are protected to the maximum possible extent. A key part of that objective is securing good-quality infection control, not least in the NHS.

It will not have escaped the House's notice that since the Committee stage there have been further developments in the control of hospital-acquired infection in particular—developments that have led Conservative Members to believe that one further change is required before the Bill completes its passage.

The Health Protection Agency's function under the Bill is to promote measures to prevent the spread and promote the control of infectious diseases both in the community and in the NHS. New clause 1 provides that when standards are published for NHS bodies, the agency—as an independent body—would have power to publish those standards. English and Welsh NHS bodies would then have legal responsibility to have regard to them in the pursuit of their duties, and they would become part of the framework of health care standards that is intended to be the subject of inspections by the Healthcare Commission in due course.

We would not have been minded to do this but for the particular nature of the Government's failure in regard to the publication and pursuit of standards relating to hospital-acquired infection. Last week the National Audit Office published its progress report on reducing the risk of hospital-acquired infection. Appendix 1 includes details of developments in the surveillance of hospital-acquired infection since its report on 2000. A number of actions had been taken before then, which are not described in the report but include the publication of work by the working party consisting of, among others, the Infection Control Nurses Association, the British Society for Antimicrobial Chemotherapy and the Hospital Infection Society. Those bodies worked together to produce guidelines for the control of MRSA infection, originally back in 1998.

In 1999, controls assurance standards were issued, the first of which dealt with hospital-acquired infection. Given that standards against which NHS bodies were supposed to assess their performance were already in place, the regularity with which Ministers and their agencies have published guidance is astonishing. In February 2000, they published a programme of action. In May 2000, NHS Estates published standards for environmental cleanliness. In June 2000, "An organisation with a memory: report of an expert group on learning from adverse events in the NHS" was published dealing with inspection control.

Guidelines on preventing health care-associated infections were commissioned by the Department of Health and published in the Journal of Hospital Infection in January 2001. In April 2001, national standards of cleanliness for the NHS were published by NHS Estates, and the requirement for mandatory surveillance of rates for methicillin-resistant Staphylococcus aureus was issued. "Building a safer NHS for patients" was published in July 2001 as a follow-up to "An organisation with a memory". In the same month, the Government responded to a report from the House of Lords Science and Technology Committee, and in January 2002, the chief medical officer published "Getting Ahead of The Curve", in which he first recommended the establishment of the Health Protection Agency. In March 2002, national standards of cleanliness for the NHS were published by NHS Estates.

4.45 pm
Mr. Paul Burstow (Sutton and Cheam) (LD)

The hon. Gentleman is rightly listing a wide range of reports, guidance and other documents published by the Government since the last NAO report. Does he share my puzzlement and disappointment that throughout those few years they have not undertaken the necessary auditing to ascertain whether any of their guidance has been applied on the ground? We therefore have a sense of déjà vu, as the Government continue to re-announce proposals.

Mr. Lansley

The hon. Gentleman is right—the publication of those documents is not the same as achieving enforcement or implementation. I shall, however, complete my argument.

In August 2002, the National Patient Safety Agency initiated the "clean your hands" hygiene project, to which I shall return in due course. The chief medical officer announced a number of additional requirements on surveillance in June 2003, and revised standards of cleanliness were published by NHS Estates in August 2003. In December 2003, "Winning Ways: working together to reduce healthcare associated infection in England" was published by the chief medical officer. In March 2004, NHS Estates published "The NHS Health Care Cleaning Manual".

The Secretary of State published a document entitled "Towards cleaner hospitals and lower rates of infection" last Monday, although it was not listed by the NAO, because it was not told about it until it had sent its report to the printers. The Healthcare Commission, following the consultation on health care standards, is due to publish detailed criteria later this year. As the hon. Member for Sutton and Cheam (Mr. Burstow) said, one must consider why the issue has been revisited, but the NAO is to be congratulated on the thoroughness with which it has investigated those initiatives and reported to the House. It said that the NHS still lacks sufficient information on the extent and cost of hospital acquired infection".

The balanced score card that is used to assess the performance of NHS bodies refers to measures on cleanliness and infection control but they are no more than procedures. The question appears to be whether the requirements of "Winning Ways" have been met, not whether infection rates have been reduced, and the consequences for patient care. For example, the NAO report states that there has been a focus on structures and processes, and a limited emphasis on evaluating changes in patient care".

Let us consider some of the things that the Government said would be achieved, compared with what has actually happened. The NAO states: Seventy-one per cent. of trusts are still operating with bed occupancy levels higher than the 82 per cent. target that the Department told the Committee"— the Public Accounts Committee— it hoped to achieve by 2003–04. Fifty-six per cent. of trusts undertook risk assessment in respect of isolation facilities, but only a quarter had secured the required facilities. The NAO states that it is impossible to quantify with any certainty if there have been any changes in NHS Trusts' infection rates. By that I assume that it means infection rates generally, as distinct from the very specific MRSA hospital-wide data that were published as a result of mandatory surveillance. The NAO went on to say: There has been no progress in introducing a national post-discharge surveillance scheme as recommended by the Committee".

There is clearly a substantial difference of opinion between the NAO and the Government on the question of the production of information and the way in which it is to be used. The NAO further states: Feedback of specific local infection rates to clinical staff is vital".

In its summary, which I shall quote at rather greater length as it includes several specific points, the NAO states: The new mandatory national surveillance schemes do not currently enable clinicians to identify and reduce risks within their own specialty. In the absence of ownership and access to such data, hospital acquired infection is still perceived as a problem for the infection control team to deal with"— so those in the NHS with clinical responsibility do not regard such infection as their own problem— and consequently many of the issues identified as barriers to effective infection control practice in our original report still apply. Considerable improvements could therefore still be made in: the coverage of education and training in infection control to all groups of staff, particularly doctors; compliance with guidance on issues such as hand hygiene, catheter care and aseptic technique; antibiotic prescribing in hospitals; hospital cleanliness; and consultation with the infection control team on wider trust activities such as new build projects.

Given that the Secretary of State doubtless had access to the NAO's findings, one might have thought that his purpose in publishing the new document last Monday was to demonstrate that—even though the chief medical officer had published previous recommendations in detail—he was taking personal responsibility to ensure that what the NAO said had not been done would be done. However, that is not what happened. That new document, entitled "Towards cleaner hospitals and lower rates of infection", begins with patient environment action teams' assertions about cleanliness in hospitals. It states that these teams have been assessing hospital cleanliness from a patient perspective since 2000 and have found consistent improvement".

That is the position from which the Secretary of State begins, but how is that to be reconciled with the views of the Healthcare Commission? Two weeks ago, it said that

there is only weak agreement between cleanliness scores produced by official inspections of NHS Trusts and patient survey results on the cleanliness of the in-patient facilities of those Trusts".

The National Audit Office also looked into the same issue and its report states that only a third of infection control teams believe that standards have improved", where cleanliness is concerned, in over half of the clinical areas in their trust over the last two years". There is no certainty, as the Secretary of State appears to believe that there is, about improvements in cleanliness.

It is curious that the Secretary of State's document seems to be designed around the proposition that increased cleanliness necessarily leads to improved infection control. I do not think that any of us believes that poor cleanliness is consistent with good infection control—we view cleanliness and such control as complementary—but I do not think that anyone has any evidence to suggest that good or improved standards of cleanliness are a sufficient condition for good-quality infection control. If we examine the professional advice given to hospitals, it is perfectly clear that there is a requirement for a range of special measures associated with infection control that go beyond any patient's individual perception of what constitutes a clean hospital for this purpose.

It is disappointing that the Secretary of State appears not to believe what the Department told him in the departmental report—effectively that common sense tells us that cleanliness and infection rates are related to one another, but that there is no hard evidence to show that that is the case. That is what the departmental report said only about three months ago. The Secretary of State, however, has clearly decided that, if he can convince the public that they will have clean hospitals, he can also convince them that they will also have, by extension, low-infection hospitals. Clean hospitals are very important and it is necessary that we secure them, but the Secretary of State has started to push cleanliness and infection control together as if they were entirely the same thing.

Let us examine the weight that the Secretary of State places in his latest document on the empowerment of patients and, in particular, on the hand hygiene project launched by the National Patient Safety Agency. It is mentioned on page 38 of the National Audit Office report that the project began at the John Radcliffe hospital, Oxford and that a range of pilot sites developed from that while the "clean your hands" project was being evaluated. It is due for national rollout this year.

The John Radcliffe had 92 cases of methicillin-resistant Staphylococcus aureus between April 2001 and 2002; 114 from April 2002 to March 2003; and 127 from April 2003 to March 2004. Let us compare that record with some of the other pilot sites for the "clean your hands" project. At the Queens Medical Centre, such cases have increased from 58 to 77 over the last year; at the Royal Devon and Exeter from 36 to 50; and at St. George's Health Care NHS Trust from 75 to 93. No one would argue that there is no merit in the "clean your hands" campaign. Everything that it says is right and should be followed, but it is not sufficient. The Secretary of State appears to be treating it as if the process of trying to ensure cleanliness in hospitals is sufficient for infection control purposes. It is not.

I was deeply disturbed by the way in which the Department, presumably for presentational reasons, set out just over a week ago to try to convince the public that the Secretary of State regarded this matter as a new issue and that he would take a hands-on approach and try to resolve it. He then publishes this document, but there are aspects of "Towards cleaner hospitals and Lower Rates of Infection" that make life even worse from the NHS point of view. Previously, it had the chief medical officer's document "Winning Ways", but things have been left out of the new document—and the NAO report referred to some of them, such as the importance of reduced use of catheters in intravenous drips and invasive procedures. That is in "Winning Ways" and is referred to by the NAO, but it does not get a mention in "Towards cleaner hospitals". The prudent use of antibiotics is also important and was mentioned in "Winning Ways". The importance of emphasising infection control in undergraduate and postgraduate curricula for doctors, nurses and other NHS professionals is in "Winning Ways" but is not referred to in "Towards cleaner hospitals".

5 pm

One might be forgiven for thinking that the Secretary of State, or others acting on his behalf, had cobbled together the document at a few days' notice—including a number of things that were due to happen anyway, such as the publication of standards, the roll-out of national surveillance and the National Patient Safety Agency's "clean your hands" campaign—and published it a couple of days before the National Audit Office report to try to offset the range, depth and seriousness of its criticism of the Government's failure to achieve reduced rates of infection control.

Mr. Burstow

The hon. Gentleman may be interested to know that both versions of the original PDF version of the document—it was placed on the Government's website, and I also had a copy emailed to my office—had blank pages where there were meant to be new initiatives.

Mr. Lansley

That is very interesting. The hon. Gentleman may be able to speculate a bit more about that when he makes his contribution. My proposition may well be reinforced by that thought.

I want to give others, albeit perhaps not that many, the opportunity to speak, so let me return to the failure of the 20 or so documents that the Government have published in one form or other. If it were possible to achieve improvements in performance in the NHS by publishing documents, that would have happened already, but it has not. Why not? It will not happen simply because somebody publishes a statement of standards. But it will happen—on this point, at least, the Secretary of State has belatedly accepted one of our propositions—if NHS institutions are increasingly required to respond to the demands of patient choice and are provided with the information necessary to enable patients to exercise that choice and incentivise their hospitals to respond.

Unfortunately, it is not clear whether the information provided will be sufficient for that purpose. I am forcefully reminded by some of those who work in hospitals that the current hospital-wide MRSA data do not distinguish between infections brought into a hospital and those acquired in it. Now, that is not easy to do. As the best guidelines appear to suggest, there is sufficient screening in some clinical specialities to demonstrate the prevalence of infection in a hospital, but it would be a major task to achieve pre-admission screening across hospitals generally. But it can be achieved in some circumstances, and the National Audit Office report notes the successful impact of pre-admission screening at University College hospital in London.

We agree with the Government that it is important quickly to reach the point—indeed, it should be done more quickly than they propose—at which data are introduced in a form that allows the relative importance of cleanliness and infection control to be demonstrated to patients so that it can form part of their decisions. However, the Government do not propose the kind of independent system that we need to back that up. At every point, one continues to see, for example, the imposition of Government targets, and they will, of course, have a new target for MRSA. However, as we learned from the National Audit Office report, Many of the survey responses from trust senior management identified difficulties reconciling the management of hospital acquired infection with the fulfilment of government performance targets.

Indeed, 50 per cent. of those responses singled out compliance with waiting times and, I suspect, bed occupancy rates and the like.

It should be for patients and hospitals to determine the balance between bed occupancy rates, waiting times and patient choice. Where patients regard a hospital as good, efficient, clean and with minimal infection rates, they will be able to make a trade-off between that and the waiting times with which they may have to comply to enter that hospital rather than another one. We shall arrive at that situation only when there is independence in the NHS system.

Over the past few days, we have been driven to conclude that, through his latest intervention, the Secretary of State has only further demonstrated the Government's desire to interfere with the NHS for presentational reasons and to confuse the already confused picture concerning guidance. We are already to have a new set of criteria from the Commission for Health Improvement, in response to the new health care standards.

The Secretary of State's document does not appear to build appropriately on "Winning Ways", published by the chief medical officer. Under the Bill, the Government propose to set up a body geared to the control of the spread of infectious diseases, yet the Public Health Laboratory Service, in the past, and the Health Protection Agency special health authority more recently have demonstrated their competence to understand the control of infectious diseases in a health care context, and have published guidance for that purpose. After reading the working party guidelines, I was far more informed about how a hospital would, in reality, manage infection control than by reading anything that the Department of Health has produced recently.

If there are to be such standards for the NHS to respond to, everything points to their being produced by a more independent body, with the necessary competence. Such a body would be more likely to command support across the NHS in publishing standards that were not only practical but also evidence-based and peer-reviewed. They should form the basis for the NHS response.

The Health Protection Agency needs a legal basis on which to publish a statement of standards relating to its responsibilities for infection—something that is part of the legal structure that NHS bodies must observe. New clause 1 would give the agency that responsibility and take it away from Ministers who have so transparently failed to tackle infection control in the NHS and have recently made the situation worse.

I commend the new clause to the House.

Mr. Burstow

I support the new clause; it is useful and would improve the Bill. It also enables us to explore a little further some of the issues discussed outside this place last week, in conversations on the GMTV sofa and following the publication of the NAO report.

In my intervention on the hon. Member for South Cambridgeshire (Mr. Lansley), I referred to "Towards cleaner hospitals", because it struck me as symbolic of the true content of the document that neither of the two copies sent electronically to my office could be opened, so one could not see what was new about the Government's announcements. I fear that as we examine that document in greater detail we shall find that there is almost nothing—if anything—new and that it was merely a ragbag of recycled announcements brought together to provide some cover in a particularly embarrassing week, before the publication of the NAO report last Thursday and, subsequently, of the latest MRSA figures. The figures were brought forward so that they could be published on the same day as the NAO report, thereby conflating them with it and obscuring their importance. I am, therefore, sceptical about what the Government proposed on Monday.

My scepticism was reinforced by the fact that I understand that the hon. Member for South Cambridgeshire quite properly sought to secure an urgent question to enable the matter to be discussed, but that his request was declined for various reasons. Indeed, no written statement was made to the House. My understanding of the conventions—I may be wrong; if I am, I am sure I will be put right—is that new policy and substantive changes in Government policy must be announced first in the House, not on the sofa of GMTV. Therefore, one can only conclude charitably that the Secretary of State for Health has not announced a new policy to deal with the threat of hospital-acquired infections. The hon. Member for South Cambridgeshire gently discussed the reasoning and rationale behind the publication of the document on Monday, but its publication was very much about managing the fallout from a very negative report that examined the Government's progress since 2000, when the NAO first considered the issue in detail and made its comprehensive set of recommendations to the Government.

I want to explore one or two of the issues in the report that fit very nicely with the standard-setting responsibilities that the new clause would give the Health Protection Agency. It is right that a body with a deal of independence from Government has the responsibility of becoming almost the critical friend when it comes to such issues. Only a couple of weeks ago the Health Protection Agency set out the scientific basis for some of its concerns and what it saw as the links between bed occupancy rates and hospital-acquired infections—something that is reiterated and borne out in the NAO report.

The new clause picks up on an issue that I raised in Committee during debates on amendment No. 5, which I tabled and which said: The Agency shall draw up and consult on a protocol with the Commission for Healthcare Audit and Inspection to collect and publish information concerning the performance of NHS organisations in controlling healthcare-acquired infections. The Minister said that that was unnecessary because it would be covered in the star ratings. The criticism in the NAO report, which relates to the Government's attempted rebuttal of my amendment in Committee, seems to be that the star-rating system is much more focused on process than on outcomes. In other words, people can tick all the boxes, adhere to all the guidelines and have wonderful policies lining the shelves of the infection control team's office, but whether or not people still pick up infections and get sicker in hospital would not count in awarding the star ratings. Surely that must be the litmus test of whether the NHS is getting to grips with the problem of hospital-acquired infections, irrespective of whether those involved have ticked all the boxes and have all the manuals in place.

The report "Winning Ways", which was published last December, shows that, according to currently available data, the Government have achieved only a small improvement. I hope that the Minister will be able to explain that and say what will be done, in concrete terms, to change it. That small improvement was mentioned not only in "Winning Ways", the chief medical officer's report, but in the Commission for Health Improvement's findings. In its annual report, published in May 2003, the commission concluded that it had seen few examples of notable practice in infection control; good policies did not always exist and, even when they did, they were often not followed sufficiently well to make them effective. The new clause proposes a mechanism to ensure that the standards are grounded in good practice across the NHS.

The NAO refers at paragraph 2.21 of its report to the fact that it undertook a survey in February to evaluate the implementation of a number of aspects of the Government's policies. It found that trusts expressed concern that, for example, the only people who could undertake the role of the new director of infection control in hospitals were the existing infection control doctors. There still seems to be a great deal of uncertainty and lack of clarity on the ground about the precise remit of infection control directors. I hope that the Minister will be able to shed some light on that.

5.15 pm

One of the most worrying findings was contained in paragraph 2.25 of the report. Almost one in four NHS trusts—24 per cent.—said that they had cut their budgets for infection control since the NAO last looked at the issue in 2000. That is an extraordinary finding, and I hope that the Government were sufficiently disturbed by it to make their own inquiries through the strategic health authorities and so forth.

Another figure struck me when I read the NAO report, and its significance was reinforced by representations that I received last week from the Infection Control Nurses Association, which feels rather shut out from the Government's latest set of announcements about how to take forward the fight against infection. Paragraph 2.32 of the NAO report states: Twelve per cent. of infection control teams reported that their recommendation to close a ward or hospital to admissions for the purpose of outbreak control was refused or discouraged by their chief executive. Two per cent. of teams also reported that their strategic health authority had refused or discouraged their recommendation.

One of the points that the Infection Control Nurses Association strongly put to me was that it feels quite insulted by the idea that the best way to solve the crisis of infection within the NHS is to fly in experts from abroad when there are experts in our country who are not being adequately used, sufficiently consulted or given the authority on the ground to do the job. It is strange that, four years on, the NAO is yet again having to recommend in its report that it should be mandatory that infection control teams are consulted on the letting of a range of contracts from cleaning and laundry to catering. It is disturbing that, when it comes to their judgment being applied with regard to the risk of infection and outbreaks, those teams are being turned down, presumably because of concerns about hitting targets.

The hon. Member for South Cambridgeshire mentioned the NAO report's remarks on chief executives. It said: Almost 50 per cent. reported that waiting times for inpatient treatment had caused conflicts, one third that trolley waits in accident and emergency departments caused conflicts, and one in ten experienced difficulties in reconciling the management and control of hospital acquired infection with other targets.

The truth is that the Government's obsession with targets—the targets and tick boxes that they have so many of nationally—gets in the way of, and conflicts with, the objectives of trying to contain and prevent infection. That is not my view; it is the view of NHS managers and staff articulated through the NAO report. It is no wonder that on Monday the Government were keen to do all that they could to cast a shadow over that report so as to obscure its findings.

The report's findings on bed occupancy are also worth commenting on, and I hope that the Minister will address them. When the Government responded to the NAO report and the Public Accounts Committee on this matter in 2000–01, they basically said, "Don't worry; it will be sorted out because we will make a massive investment in the NHS so there will be more beds, more staff and bed occupancy rates will come down." However, we now know from paragraph 2.34 of the NAO report that the reverse has happened: bed occupancy rates have gone up. In answer to a parliamentary question that I asked, I learned that, according to the Department of Health's hospital activity statistics, whereas bed occupancy rates were 80.8 per cent. in 1996–97, they rose to 86.5 per cent. by 2002–03. That is a significant increase, well above that which the Health Protection Agency seems to think would be appropriate and certainly well above that which the NAO recommends in response to the representations that it has received.

On the Bill's Second Reading, I raised some questions about surveillance, which go to the heart of how to ensure that standards really are bedding down and having traction on the problem. I asked the Under-Secretary of State for Health, the hon. Member for South Thanet (Dr. Ladyman), to outline the timetable for the roll-out of the surveillance of other types of hospital-acquired infection, because I understand that MRSA accounts for only 44 per cent. of such infections. Subsequent to that, the NAO report makes interesting reading, because paragraph 3.5 states: Instead of developing mandatory specialty specific surveillance of bloodstream, surgical site and urinary tract infections whose information would be fed back to clinicians to improve practice, the Department focussed on trust wide surveillance of MRSA bacteraemias and other specific organisms, together with plans for mandatory reporting of orthopaedic surgical site infection.

Although the hon. Member for South Cambridgeshire is right to say that it would be an engine for choice if people had information and a clearer idea of the worst hospitals for infection, surely the key is to provide clinicians with information in such a way that they may identify how mistakes are made so that practice can be changed. The current system does not do that. Indeed, the scariest statistic from the report is that 18 per cent. of infection control teams fail to carry out any surveillance activities other than the mandatory MRSA bacterium surveillance. No other activity is going on in many of our trusts to find out which parts of hospitals are experiencing the worst rates of infection so that real feedback may be given to clinicians to enable them to change practice and save lives.

I hope that the Minister will tell us how the Government, at long last, are ensuring that the succession of initiatives and announcements—recycled, re-announced and so on—are beginning to have a real effect on the NHS. Will she also tell us when the Infection Control Nurses Association will have the opportunity to meet Ministers to discuss its worries about Monday's announcement and the NAO's findings, and talk about how it may help the Government to crack the problem of infection?

Mr. John Redwood (Wokingham) (Con)

I rise to support the new clause moved by my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) because it is desperately important to tackle the problem as vigorously and objectively as possible. As my hon. Friend pointed out, we have had seven years of initiatives—well-intentioned ones, I am sure—from Secretaries of State and Ministers in the Department of Health that have failed to deliver. Seven years on, and many circulars and directives later, we still have unacceptably high rates of infection in our hospitals. As we have heard, infection rates have risen dangerously in some hospitals over recent years, and there have often been no positive responses to the exhortations from the centre.

I support new clause 1 because, like many right hon. and hon. Members, I have constituents who have paid a high price for the failure of a local hospital to control infection. I recently received a letter from one of my constituents who went to the local district general hospital for an operation at the end of last year. My constituent was told that a full recovery from the wounds that the surgeon had to inflict was very likely and that their quality of life would be much improved after the operation had been successfully carried out. Seven months later, my constituent is in more pain than that experienced before going to hospital to get the original problem sorted out. My constituent contracted a dangerous infection in the wound as a result of the hospital operation, and had to be readmitted twice so that the wound could be reopened and cleansed under hospital conditions. On each occasion, the process was not only painful but failed to overcome the obstinate infection that had got into the wound, presumably when the original operation was performed. My constituent had to spend a couple of months on antibiotics, but that has still not solved the problem.

In a macabre way, I suppose that my constituent was lucky because they did not die—we know that all too many hundreds of people die as a result of severe infections contracted in hospital by one means or another. This Government are all too ready to tackle the problems of death and serious injury on the roads, when perhaps as many as one in eight of all accidents are caused partly or wholly by speed. The Government are always dramatic in their moves to try to control speed on the roads, yet far more people die in our hospitals as a result of mistakes and infections contracted in our hospitals, where there is not the same sense of urgency.

One of my objections to the way the Government legislate and respond is that if the problem lies in the private sector, the answer is regulation and legislation, often with criminal charges, penalties and prosecutions attached, but if the problem is in the public sector, the answer is exhortation and another quango, and not the same sense of urgency or seriousness. I see the Minister objecting, but she must see the justice of what I am saying. My constituents are very angry that there is still so much infection and danger in our hospitals.

Of course, elective surgery has always been a risky process. It entails first wounding the patient in order to bring about a much better life for them in due course. It is worth taking the risk of having the skin and muscle cut through if the surgeon is skilful, as they often are, and if, as a result of surgery, a part of the body that will not work properly can be removed or a part of the body can be repaired. Many fine things are done by many brilliant surgeons around the country and many of us are grateful for their work. We hope we will not need it, but we will be very grateful should we need it ourselves.

If the risk of a serious infection while the process is under way becomes too great, the entire question of what we are doing in hospitals is opened up with an entirely different balance of risk. If someone is told that they will probably have a substantial improvement in their quality of life if a non-threatening condition is tackled, they will say, "Well, I don't mind the pain for a few weeks from a flesh wound that will repair." But if they are told, "By the way, there is a danger that while you are going through that process, you might contract something that causes you permanent pain or that was even life-threatening in itself," that will lead people to ask, "Is that really what I want? Is this what we should be doing?"

I agree with the hon. Member for Sutton and Cheam (Mr. Burstow) that one of the issues that need to be tackled in the new clause and in the Bill is bed utilisation. Bed utilisation in the Royal Berkshire hospital in Reading, my local district general, is undoubtedly too high. I am someone who likes to use public money wisely and usually I favour great productivity, but there are limits. There must be enough time between one user of a hospital bed and another to ensure thorough cleaning and preparation of the bed and the ward or the room, so that the new patient is not likely to be at risk as a result of over-utilisation of the bed and perhaps some rushing of the procedures that should be undertaken to prepare the bed and the area for the new patient.

I quite understand how managers and senior doctors in hospitals, faced day after day with the terrible problem that there are not enough beds and there are people in the corridors, people queuing and people needing treatment, say, "Let's just clear the bed and get on with it," but we must take some of the strain off them by offering enough beds in our hospitals and enough facilities so that we can have a more civilised regime, so that there are not queues at the doors and so that there is adequate time between patients to make sure that all the right procedures are followed.

As my hon. Friend said, the Secretary of State intruded into the debate in recent days, without the courtesy of a statement to the House of Commons, to say that he would be hands-on and would solve the problem of cleanliness in hospitals. I do not think that that will work. I do not believe it is possible for any man or woman, however talented and energetic, to be personally responsible for the cleanliness of every hospital and every surgery throughout the country, or simply by the magnetism or lack of magnetism of their personality to ensure that every one of the million-plus staff follows all the right procedures all the time to guarantee that conditions are clean enough.

It may be, as my hon. Friend said, that the Secretary of State was going to be hands-on by way of washing his hands of responsibility. We certainly hope he will wash his hands thoroughly before taking responsibility and before intruding in this sensitive area. He seems to think that hand-washing is one of the most important routines that has not been properly observed in recent years.

I will support my hon. Friend, as the new clause is a valiant attempt to bring about improvement and change in an important area. I hope the Minister understands how desperately important that is to many constituents contemplating operations or who have recently had operations, who want the reassurance from someone within such a mighty organisation that everything is being done to get on top of the problem and, more importantly, that infection rates are falling rapidly and not continuing to rise, as they have done in many places in recent years. Patients and constituents expect no less. They expect clean hospitals but, above all, they expect to have hospitals in which infection control is taken seriously and successfully implemented. It cannot be beyond the NHS, with all the money now at its disposal and all the people whom the Government say they are now recruiting, to control infection better. We owe it to our constituents, and I hope that the Minister will accept my hon. Friend's new clause in that spirit.

5.30 pm
The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson)

I shall try to address all the issues that have been raised, but I shall try also to relate my comments to the new clause, as Opposition Members have made little effort to do so.

The hon. Member for South Cambridgeshire (Mr. Lansley) raised the question of standards and the work that is going on. I draw his attention to the fact that his proposals would lead to the HPA having power to set standards, but no responsibility to resource them. The reason why we do not support such proposals is that they would divorce responsibilities for standards from those for money. Under the new clause that he advocates, the agency would be able to set standards, but would have no responsibility to meet the bill. I do not think that it would take him much effort to work out why any Government of any political persuasion would think that that might not be a desirable situation. That is one of our three basic objections to his proposals.

On the question of standards generally and what we are doing about them, we have already issued standards, and I am glad that the hon. Gentleman was confident that we had issued so many and that we had regularly issued guidance. I was not sure whether he made those points as a criticism. They seemed to me to be a compliment, and I chose to take them as such. However, the issue of health care-acquired infections is a question not of dealing with only one component, but of bringing together a set of components. Indeed, I thought that that was the point that a number of hon. Members made in their contributions. That is why we need a multi-pronged approach that brings together the sort of issues to do with standards that need to be brought together, as well as the guidance that goes with them.

Of course, we are following up the publications that the hon. Gentleman mentioned. We do so through National Care Standards Commission work, through PEAT—patient environment action team—inspections and through the Commission for Health Improvement and its successor body, the new CHI. We follow up all those things.

.Mr. Lansley

We are supposed to call it the Healthcare Commission.

Miss Johnson

We are indeed. To help the hon. Gentleman, I shall be absolutely correct in these matters.

We do not believe that there is any room for complacency. The nub of the issue has been mentioned by a number of hon. Members, although they have not been as up-front as they should be about acknowledging it. The crux of the issue is implementing the standards. The overall guidance includes standards, and work continues to make sure that the standards are right. We must ensure that we get them right, which requires the compliance of all NHS staff. The guidance covers everything from estates to consultants and back again, and people must get standards right throughout the NHS.

Mr. Burstow

Will the Minister give way?

Miss Johnson

Yes, provided that the hon. Gentleman does not raise a point that he made earlier.

Mr. Burstow

Heaven forbid. I agree with the Minister about the importance of compliance. In a written answer some months ago, she indicated that the Government were not minded to undertake and publish an audit of compliance with the published guidance to date. Do the Government still take the view that an audit to see whether compliance is being achieved on the ground is not necessary?

Miss Johnson

We are making sure that the outcomes improve.

The other day, the Secretary of State for Health made an announcement, and I am sorry the hon. Member for South Cambridgeshire was not included on the sofa at the television station—he obviously took it badly, and I regret that he did not get that opportunity. Had the Secretary of State's announcement raised any problems in relation to the powers and prerogatives of this House, I am sure that they would have been raised and that the House would have opined accordingly.

The proposals cover six main areas, many of which are based on the notion that we must improve compliance and implementation. Measures such as being open, displaying information about infection levels, involving patients, making sure that matrons control cleaners, including housekeeping buttons on patients' bedside phones and cleanliness inspections, the results of which will be made public, are all important in improving compliance and dealing with health care-acquired infection and methicillin-resistant Staphylococcus aureus in particular.

Mr. Redwood

Given that the most serious threat occurs in situations such as the one that I described, where the infection took place in the operating theatre when the wound was open, how will those procedures help cleanliness in operating theatres, where nurses and surgeons work, or in the preparation of patients before operations?

Miss Johnson

It depends. All of us sympathise with any patient who experiences the same difficulties as the right hon. Gentleman's constituent. The risk depends on the procedures and the type of surgery. If one undergoes surgery to the stomach or gut, the risk of acquiring an infection is substantially greater than that in orthopaedics, where special provisions are made tightly to control infection and where those parts of the body are not directly involved. Different parts of hospitals clearly face different issues, and it would be wrong to make a blanket statement.

A second area of difficulty is contained in new clause 1. We have consulted on key standards across a wide range of areas and are currently collating our response. Those standards will be linked to decisions on priorities and resources. That brings me back to what I said earlier about the importance of linking the two.

As a service provider, the agency needs to consider how it can work with the primary care trusts and other NHS bodies as equal partners. That relationship would be undermined if, as envisaged in new clause 1, the agency had the unilateral power to specify standards for PCTs. Awkward tensions could arise between the agency and NHS bodies that it works alongside to support. The new clause would not bring about a desirable change.

The hon. Member for Sutton and Cheam (Mr. Burstow) asked about innovation in relation to infection control. On the whole, there are no amazing discoveries to be made about the subject—it is not rocket science. He criticised what we are doing in respect of cleaner hospitals for its lack of innovation. On that, and on star ratings, we are trying to encourage compliance in terms of audit outcomes. The hon. Gentleman suggested, as did the hon. Member for South Cambridgeshire, that the star ratings are not important. That is an odd complaint, because they relate to whether certain processes are carried out. The hon. Gentleman nodded when I mentioned compliance; I think that he recognises that that is the core issue on which we need to achieve improvement. That is why much of the Secretary of State's recent announcement featured compliance and related issues.

Mr. Burstow

The Minister talks about auditing outcomes in terms of compliance. Will she undertake to start to collect and publish the outcomes of those audits so that the public, clinicians and others can see whether compliance is really being delivered?

Miss Johnson

We are certainly saying, in relation to published information—[interruption.] The hon. Gentleman shrugs, but the audits carried out at a local level by patient forums, in line with guidance set by infection control experts, will be published quarterly. Such information is the best indicator of whether we are making the improvements that we should.

As regards the director of infection prevention and control, of course people other than doctors can carry out that role. Some post holders may be senior nurses, who are extremely well qualified for the job. Indeed, the Bristol trust's director of infection prevention and control chairs the Infection Control Nurses Association.

I agree with the hon. Gentleman on staffing and expertise in the health service. The press notice that accompanied the Secretary of State's announcement made it clear that we are consulting our own experts as well as experts from abroad. Many individuals are leading substantial work to improve infection control in their trusts. Recent publicity in the media in the past couple of weeks has covered that. It is vital to use our expertise, which we greatly value, as well as considering what we can learn from abroad if we are to get the right control mechanisms to achieve the outcomes that we want on health care-acquired infections generally and MRSA in particular.

5.45 pm

I want to consider bed occupancy because we need to strike a balance between bed management and the risks of health care-acquired infection. "Winning Ways" covers that and the matter is being progressed. Although we need to ensure that the balance is right, we must also make sure that we use beds efficiently. I am glad that the right hon. Member for Wokingham (Mr. Redwood) continues to support efficiency because we should not ignore it. It is clear that we need to avoid risk to patients by ensuring that one patient is kept separate from another so that infection is not passed between them.

Such passing on of infection may happen because the patients are in the same part of the hospital or because a health care professional passes from one patient to another. We need to ensure that, apart from the environment, the processes that involve individual members of staff who deal with patients are correct. For example, it is important that members of staff wash their hands. That might seem a small thing but we all acknowledge its importance. That is why so much emphasis was placed on it today and in the Secretary of State's earlier announcement.

The new clause would not be helpful for all the reasons that I have outlined. I therefore hope that hon. Members will not support it. The Health Protection Agency can, should and will make a big contribution to raising health protection standards. We want the agency to be an authoritative source of advice, information and support on infectious disease and other health protection matters. The Bill provides for that.

However, the Secretary of State remains responsible for policy on health and health protection. That applies to the National Assembly for Wales for matters that are devolved to Wales. The policy therefore needs to take account not only of health protection issues about which the agency is well placed to advise but other matters, including judgments about affordability and competing priorities for the NHS and more generally.

The current agency is an authoritative source of advice, which contributes to the policies of both the Secretary of State and the National Assembly. As I said earlier, a range of other bodies, including the Food Standards Agency, which I did not mention, the Healthcare Commission and the National Institute for Clinical Excellence also want to have an input into the advice and the work. They are well placed to help to put many policies into practice, for example, through their support for health protection services locally. I hope that I have answered the points and I commend the Bill as it stands.

Mr. Lansley

I am grateful to the hon. Member for Sutton and Cheam (Mr. Burstow) and to my right hon. Friend the Member for Wokingham (Mr. Redwood) for their contributions. I want to correct one point that I made earlier. When I referred to the National Audit Office, I used an example from University college hospital London. However, that was to do with post-discharge surveillance. The example of screening patients for elective surgery was from the Princess Royal hospital in Brighton.

The Under-Secretary said that she had three objections to the new clause, but we heard only two. Neither were the ones that I expected and I believe that they are damaging suggestions. She said that standard setting would be divorced from resources. That is rather curious, because when we look at the consultation document on the setting of standards, we see that the detailed criteria will be set out by the new Healthcare Commission. The document states:

This relationship between the proposed standards and the independent Commission represents a significant step change between the approach to quality improvement in the future and the approach adopted to date". The Government are proposing that the criteria for standards should be published by an independent body that is not itself responsible for the provision of resources, so argument No. 1 from the Minister simply falls to one side.

Argument No. 2 was that decisions on standards had to be linked to priorities. We know, however, that although the National Audit Office cannot be too specific, it has stated that the evidence is that effective infection control is a cost-effective measure that is likely to reduce the call on resources. No one is attempting to dispute that. However, the Minister appears to be arguing that the Health Protection Agency, the body that the Government are establishing to be responsible for the control of infectious diseases and for the prevention of the spread of those diseases, will not be able to set standards, even though it has that responsibility, because it will not be able to take account of affordability and competing priorities. The core standards that the chief medical officer published included, under the heading "Safety", the requirement that the risk of infection to patients, staff and visitors is minimised".

There is nothing in the standards document to suggest that the achievement of a minimised infection environment for patients—which ought to be an absolute priority—should to be compromised by reference to affordability or competing priorities. It is clearly cost effective when the NHS achieves it, and the Health Protection Agency—as distinct from the Healthcare Commission—will have the expertise to specify the criteria involved, and it ought to be the responsibility of the agency to do so.

The Minister has offered no argument against the new clause and, on that basis, I invite my colleagues to support it.

Question put, That the clause be read a Second time:—

The House divided: Ayes 163, Noes 297.

Division No. 230] [5:52 pm
AYES
Ainsworth, Peter (E Surrey) Curry, rh David
Allan, Richard Davey, Edward (Kingston)
Amess, David Davies, Quentin (Grantham & Stamford)
Ancram, rh Michael
Arbuthnot, rh James Djanogly, Jonathan
Atkinson, David (Bour'mth E) Dodds, Nigel
Atkinson, Peter (Hexham) Dorrell, rh Stephen
Bacon, Richard Doughty, Sue
Baker, Norman Duncan, Alan (Rutland)
Baldry, Tony Evans, Nigel
Barker, Gregory Fallon, Michael
Baron, John (Billericay) Field, Mark (Cities of London & Westminster)
Barrett, John
Bellingham, Henry Flight Howard
Bercow, John Forth, rh Eric
Beresford, Sir Paul Foster, Don (Bath)
Boswell, Tim Gale, Roger (N Thanet)
Bottomley, Peter (Worthing W) Garnier, Edward
Bottomley, rh Virginia (SW Surrey) Gillan, Mrs Cheryl
Goodman, Paul
Brady, Graham Gray, James (N Wilts)
Brazier, Julian Grayling, Chris
Brooke, Mrs Annette L. Green, Damian (Ashford)
Browning, Mrs Angela Green, Matthew (Ludlow)
Bruce, Malcolm Greenway, John
Burns, Simon Grieve, Dominic
Burnside, David Gummer, rh John
Burstow, Paul Hague, rh William
Burt, Alistair Hammond, Philip
Butterfill, Sir John Hancock, Mike
Cable, Dr. Vincent Heald, Oliver
Calton, Mrs Patsy Heath, David
Cameron, David Heathcoat-Amory, rh David
Campbell, rh Sir Menzies (NE Fife) Hoban, Mark (Fareham)
Hogg, rh Douglas
Carmichael, Alistair Holmes, Paul
Chapman, Sir Sydney (Chipping Barnet) Horam, John (Orpington)
Howard, rh Michael
Chidgey, David Jack, rh Michael
Clappison, James Jenkin, Bernard
Clarke, rh Kenneth (Rushcliffe) Kennedy, rh Charles (Ross Skye & Inverness)
Collins, Tim
Cormack, Sir Patrick Key, Robert (Salisbury)
Cotter, Brian Kirkbride, Miss Julie
Lait, Mrs Jacqui Sayeed, Jonathan
Lamb, Norman Selous, Andrew
Lansley, Andrew Shephard, rh Mrs Gillian
Letwin, rh Oliver Shepherd, Richard
Lewis, Dr. Julian (New Forest E) Simmonds, Mark
Liddell-Grainger, Ian Smith, Sir Robert (W Ab'd'ns & Kincardine)
Lidington, David
Lilley, rh Peter Soames, Nicholas
Loughton, Tim Spelman, Mrs Caroline
Luff, Peter (M-Worcs) Spink, Bob (Castle Point)
McIntosh, Miss Anne Spring, Richard
Mackay, rh Andrew Stanley, rh Sir John
McLoughlin, Patrick Steen, Anthony
Malins, Humfrey Streeter, Gary
Maples, John Stunell, Andrew
Mawhinney, rh Sir Brian Swayne, Desmond
May, Mrs Theresa Swire, Hugo (E Devon)
Mercer, Patrick Syms, Robert
Mitchell, Andrew (Sutton Coldfield) Tapsell, Sir Peter
Taylor, Ian (Esher)
Moss, Malcolm Taylor, John (Solihull)
Murrison, Dr. Andrew Taylor, Matthew (Truro)
O'Brien, Stephen (Eddisbury) Taylor, Dr. Richard (Wyre F)
Öpik, Lembit Taylor, Sir Teddy
Osborne, George (Tatton) Teather, Sarah
Ottaway, Richard Thurso, John
Page, Richard Tyler, Paul (N Cornwall)
Paice, James Tyrie, Andrew
Paterson, Owen Walter, Robert
Pickles, Eric Waterson, Nigel
Portillo, rh Michael Watkinson, Angela
Price, Adam (E Carmarthen & Dinefwr) Webb, Steve (Northavon)
Whittingdale, John
Prisk, Mark (Hertford) Willetts, David
Randall, John Williams, Roger (Brecon)
Redwood, rh John Willis, Phil
Rendel, David Winterton, Ann (Congleton)
Robathan, Andrew Winterton, Sir Nicholas (Macclesfield)
Robertson, Laurence (Tewk'b'ry) Yeo, Tim (S Suffolk)
Roe, Dame Marion Young, rh Sir George
Rosindell, Andrew
Ruffley, David Tellers for the Ayes:
Russell, Bob (Colchester) Hugh Robertson and
Sanders, Adrian Mr. Geoffrey Clifton-Brown
NOES
Abbott, Ms Diane Brown, Russell (Dumfries)
Ainger, Nick Browne, Desmond
Ainsworth, Bob (Cov'try NE) Buck, Ms Karen
Alexander, Douglas Burden, Richard
Allen, Graham Burgon, Colin
Anderson, rh Donald (Swansea E) Burnham, Andy
Anderson, Janet (Rossendale Darwen) Byers, rh Stephen
Cairns, David
Armstrong, rh Ms Hilary Campbell, Alan (Tynemouth)
Atherton, Ms Candy Campbell, Mrs Anne (C'bridge)
Austin, John Campbell, Ronnie (Blyth V)
Bailey, Adrian Caplin, Ivor
Baird, Vera Caton, Martin
Barnes, Harry Cawsey, Ian (Brigg)
Barron, rh Kevin Challen, Colin
Bayley, Hugh Clapham, Michael
Begg, Miss Anne Clark, Mrs Helen (Peterborough)
Bennett, Andrew Clark, Dr. Lynda (Edinburgh Pentlands)
Benton, Joe (Bootle)
Berry, Roger Clark, Paul (Gillingham)
Best, Harold Clarke, rh Tom (Coatbridge & Chryston)
Betts, Clive
Blackman, Liz Clelland, David
Blears, Ms Hazel Clwyd, Ann (Cynon V)
Borrow, David Coaker, Vernon
Bradley, Peter (The Wrekin) Coffey, Ms Ann
Brennan, Kevin Cohen, Harry
Brown, rh Nicholas (Newcastle E Wallsend) Cook, rh Robin (Livingston)
Corston, Jean
Cousins, Jim Ingram, rh Adam
Cox, Tom (Tooting) Irranca-Davies, Huw
Crausby, David Jackson, Glenda (Hampstead & Highgate)
Cruddas, Jon
Cryer, John (Hornchurch) Jackson, Helen (Hillsborough)
Cummings, John Jamieson, David
Cunningham, Jim (Coventry S) Jenkins, Brian
Cunningham, Tony (Workington) Johnson, Alan (Hull W)
Dalyell, Tam Johnson, Miss Melanie (Welwyn Hatfield)
Darling, rh Alistair
Davey, Valerie (Bristol W) Jones, Helen (Warrington N)
David, Wayne Jones, Jon Owen (Cardiff C)
Davidson, Ian Jones, Kevan (N Durham)
Davies, rh Denzil (Llanelli) Jones, Lynne (Selly Oak)
Davies, Geraint (Croydon C) Jowell, rh Tessa
Dean, Mrs Janet Joyce, Eric (Falkirk W)
Dhanda, Parmjit Keeble, Ms Sally
Dismore, Andrew Keen, Ann (Brentford)
Dobbin, Jim (Heywood) Kemp, Fraser
Dobson, rh Frank Kennedy, Jane (Wavertree)
Dowd, Jim (Lewisham W) Khabra, Piara S.
Dunwoody, Mrs Gwyneth Kidney, David
Eagle, Angela (Wallasey) Kilfoyle, Peter
Eagle, Maria (L'pool Garston) King, Andy (Rugby)
Efford, Clive Knight, Jim (S Dorset)
Ellman, Mrs Louise Kumar, Dr. Ashok
Etherington, Bill Ladyman, Dr. Stephen
Field, rh Frank (Birkenhead) Lammy, David
Fisher, Mark Laxton, Bob (Derby N)
Fitzpatrick, Jim Lazarowicz, Mark
Fitzsimons, Mrs Lorna Lepper, David
Flynn, Paul (Newport W) Leslie, Christopher
Follett, Barbara Levitt, Tom (High Peak)
Foster, Michael (Worcester) Lewis, Ivan (Bury S)
Foster, Michael Jabez (Hastings & Rye) Lewis, Terry (Worsley)
Linton, Martin
Gapes, Mike (Ilford S) Lloyd, Tony (Manchester C)
George, rh Bruce (Walsall S) Love, Andrew
Gerrard, Neil Lucas, Ian (Wrexham)
Gibson, Dr. Ian Luke, Iain (Dundee E)
Gilroy, Linda Lyons, John (Strathkelvin)
Goggins, Paul McAvoy, Thomas
Griffiths, Win (Bridgend) McCabe, Stephen
Grogan, John McCafferty, Chris
Hall, Mike (Weaver Vale) McDonagh, Siobhain
Hall, Patrick (Bedford) MacDonald, Calum
Hamilton, David (Midlothian) McDonnell, John
Hamilton, Fabian (Leeds NE) MacDougall, John
Hanson, David McFall, rh John
Havard, Dai (Merthyr Tydfil & McGuire, Mrs Anne
Rhymney) McIsaac, Shona
Healey, John McKechin, Ann
Henderson, Ivan (Harwich) McNamara, Kevin
Hendrick, Mark MacShane, Denis
Hepburn, Stephen Mactaggart, Fiona
Hesford, Stephen McWalter, Tony
Hewitt, rh Ms Patricia McWilliam, John
Heyes, David Mahmood, Khalid
Hill, Keith (Streatham) Mahon, Mrs Alice
Hinchliffe, David Mallaber, Judy
Hodge, Margaret Mandelson, rh Peter
Hoey, Kate (Vauxhall) Mann, John (Bassetlaw)
Hoon, rh Geoffrey Marris, Rob (Wolverh'ton SW)
Hope, Phil (Corby) Marsden, Gordon (Blackpool S)
Hopkins, Kelvin Marshall-Andrews, Robert
Howarth, rh Alan (Newport E) Martlew, Eric
Howarth, George (Knowsley N & Meacher, rh Michael
Sefton E) Meale, Alan (Mansfield)
Howells, Dr. Kim Merron, Gillian
Hoyle, Lindsay Miliband, David
Hughes, Beverley (Stretford & Miller, Andrew
Urmston) Moffatt, Laura
Hughes, Kevin (Doncaster N) Mole, Chris
Hutton, rh John Morley, Elliot
Iddon, Dr. Brian Morris, rh Estelle
Illsley, Eric Mountford, Kali
Mudie, George Singh, Marsha
Mullin, Chris Skinner, Dennis
Munn, Ms Meg Smith, rh Andrew (Oxford E)
Murphy, Denis (Wansbeck) Smith, Angela (Basildon)
Murphy, Jim (Eastwood) Smith, rh Chris (Islington S &
Naysmith, Dr. Doug Finsbury)
O'Brien, Bill (Normanton) Smith, Geraldine (Morecambe &
O'Hara, Edward Lunesdale)
Olner, Bill Smith, John (Glamorgan)
O'Neill, Martin Soley, Clive
Organ, Diana Spellar, rh John
Perham, Linda Squire, Rachel
Picking, Anne Stewart, David (Inverness E &
Pickthall, Colin Lochaber)
Pike, Peter (Burnley) Stewart, Ian (Eccles)
Plaskitt, James Stoate, Dr. Howard
Pollard, Kerry Strang, rh Dr. Gavin
Pond, Chris (Gravesham) Straw, rh Jack
Pope, Greg (Hyndburn) Stringer, Graham
Prentice, Ms Bridget (Lewisham Stuart, Ms Gisela
E) Sutcliffe, Gerry
Prentice, Gordon (Pendle) Taylor, rh Ann (Dewsbury)
Prescott, rh John Taylor, Dari (Stockton S)
Primarolo, rh Dawn Taylor, David (NW Leics)
Prosser, Gwyn Thomas, Gareth (Clwyd W)
Purchase, Ken Tipping, Paddy
Purnell, James Todd, Mark (S Derbyshire)
Quin, rh Joyce Touhig, Don (Islwyn)
Quinn, Lawrie Trickett, Jon
Rammell, Bill Truswell, Paul
Rapson, Syd (Portsmouth N) Turner, Dennis (Wolverh'ton SE)
Raynsford, rh Nick Turner, Dr. Desmond (Brighton
Reed, Andy (Loughborough) Kemptown)
Reid, rh Dr. John (Hamilton N & Twigg, Derek (Halton)
Bellshill) Twigg, Stephen (Enfield)
Robertson, John (Glasgow Vaz, Keith (Leicester E)
Anniesland) Vis, Dr. Rudi
Robinson, Geoffrey (Coventry Ward, Claire
NW) Wareing, Robert N.
Roche, Mrs Barbara Watson, Tom (W Bromwich E)
Rooney, Terry Watts, David
Ross, Ernie (Dundee W) White, Brian
Roy, Frank (Motherwell) Whitehead, Dr. Alan
Ruane, Chris Williams, Betty (Conwy)
Ruddock, Joan Winnick, David
Russell, Ms Christine (City of Winterton, Ms Rosie (Doncaster
Chester) C)
Ryan, Joan (Enfield N) Woodward, Shaun
Salter, Martin Worthington, Tony
Sarwar, Mohammad Wright, Anthony D. (Gt
Savidge, Malcolm Yarmouth)
Sawford, Phil Wright, Tony (Cannock)
Sedgemore, Brian
Sheridan, Jim Tellers for the Noes:
Short, rh Clare Charlotte Atkins and
Simpson, Alan (Nottingham S) Mr. John Heppell

Question accordingly negatived.

Forward to