§ [Relevant documents: The Third Report from the Welsh Affairs Committee, Session 2001/02, on The draft National Health Service (Wales) Bill, HC 959, and the Government's Response thereto, HC 1215, Session 2001/02.] Order for Second Reading read.5.14 pm
§ The Secretary of State for Wales (Peter Hain)
I beg to move, That the Bill be now read a Second time.
May I say what a pleasure it is having you in the Chair, Madam Deputy Speaker, as you are a Welsh girl yourself?
The Health (Wales) Bill builds on the reforms introduced in the Government's National Health Service Reform and Health Care Professions Act 2002. In bringing it forward, the Government are supporting the efforts made by the Welsh Assembly to improve the health and well-being of the people of Wales and to strengthen patient power in the health service. It is the first Wales-only Bill to be brought before this House, fresh from and improved by the process of pre-legislative scrutiny carried out not just by Members of this House but by Welsh Assembly Members, as well as by health professionals and patients. As such, it is an historic measure that marks another chapter in the process of constitutional change initiated by the Government with the establishment of the National Assembly for Wales.
The Bill achieves three purposes—
§ Llew Smith (Blaenau Gwent)
May I refer to a general issue that is not in the Bill but relates to the Secretary of State's comment that this is all about patient power? Is he willing to think back to the time when he and others were heading the referendum campaign for a Welsh Assembly? They were saying that, in order to have patient power, they would have a bonfire of the quangos. Can he tell me when that bonfire will happen, as I have not noticed it yet?
§ Peter Hain
My hon. Friend feels very strongly on these matters, as we all do. As he knows, a number of quangos have been abolished—
§ Peter Hain
I will give way in a minute, but I want to answer my hon. Friend's point by explaining how the Bill achieves the purposes that I set out—including a reference to independent public bodies—with which I do not think he would disagree.
Let us consider, for example, the proposals, first, to establish an independent Wales Centre for Health to disseminate research and provide multi-disciplinary advice and evidence to support decision making, and, secondly to establish Health Professions Wales, a body to quality-assure the training and education of health care professionals. I am sure that my hon. Friend does not think that those two bodies should not be established. I am sure that he supports an independent 349 Wales Centre for Health providing the necessary research into health needs in his constituency and mine. I am sure that he also agrees with Health Professions Wales, and that he does not think that quality assurance of the training and education of health care professionals should be conducted by a body other than one that has the confidence of those professionals.
§ Llew Smith
The Secretary of State referred to the abolition of many quangos. Will he accept that there are as many quangos in Wales now as there were when the Welsh Assembly was first set up? Will he also accept that, under the new proposals, there will be even more quangos in the health service than previously?
§ Peter Hain
I think that my hon. Friend will recall that, when there was tremendous public opposition to quangos in Wales, it was partly because—I would argue that it was exclusively because—they were packed with Conservative place people. Because of that, they were not accountable in any way.
Two independent institutions will be established by the Bill. My hon. Friend has not told me yet whether he agrees with the establishment of a Wales Centre for Health or Health Professions Wales. I am sure that the whole House agrees with that, as all the pre-legislative procedures have endorsed precisely those new independent agencies, because they strengthen the health service in Wales and provide us with a platform for creating a genuinely world-class health service in Wales.
The third purpose—other than establishing an independent Wales Centre for Health, and the Health Professions Wales body—is to reform and strengthen community health councils in Wales and establish a statutory association that will support community health councils and have a performance management role. I am pleased to say that the Bill implements a commitment made in our Welsh manifesto last year to reform the CHCs in Wales to strengthen their role as community watchdogs.
§ Mr. John Bercow (Buckingham)
I congratulate the right hon. Gentleman on his appointment, and I have placed a bet on him to become a future leader of his party—but that is enough niceness for one day. Can he tell the House what is the total number of public service agreement targets set for the health service in Wales; how many have been met; how many have been missed; and what is he doing about the latter?
§ Peter Hain
I welcome the hon. Gentleman to the debate on Wales. He is an articulate parliamentary performer.
§ Peter Hain
Indeed, he is on my campaign team. However, his bet is not very welcome, as I am happy doing this job and will do any other job that my right hon. Friend the Prime Minister would like me to do. The hon. Gentleman is a talented youngster, and it is a shame that the Conservative Front-Bench team is all the less talented for his absence. The Bill does not cover the specific matter that he raised.
350 In our manifesto, we also pledged to build on the already successful legislative partnership with the Assembly and to continue to enact specific legislation for Wales where appropriate. That is precisely what the Bill does. It is yet another example of a Labour Government working in partnership with a Labour-led Assembly to deliver the means by which the national health service in Wales can be modernised and improved for the benefit of the people of Wales.
§ Mr. Simon Thomas (Ceredigion)
The Secretary of State visited the National Assembly on Monday or Tuesday and he heard the complaints from all parties about the narrow gap for Welsh legislation. He has just talked about partnership, but why can we get through only one Welsh Bill a Session? This Bill is the one for this Session. Will the right hon. Gentleman work harder to see whether he can widen the gap and will he work with institutions in this Parliament, such as the Welsh Grand Committee, so that we can fast-track legislation and create an even better partnership between the National Assembly and the House of Commons?
§ Peter Hain
We do not need to measure the extent of Welsh legislation by the number of Welsh-only Bills in the Queen's Speech. A whole number of pieces of legislation have Wales-specific clauses in them—on planning, local government and several other matters. I am sure that the hon. Gentleman will welcome the Licensing Bill, which deals with the costly and mischievous referendums that are called even though Sunday drinking and Sunday licensing are widely supported across Wales. He is a diligent Back Bencher, so I urge him to look at the clauses in all the Bills that have been drafted at the request of the Assembly. With the support of my right hon. Friend the Secretary of State for Northern Ireland, who was the previous holder of my post, and the excellent assistance of my hon. Friend the Parliamentary Under-Secretary of State for Wales, they design into a raft of Bills coming before Parliament this Session provisions that cover the need that Wales has for Welsh-only clauses in general Bills that also apply to England. In this case, we have a Welsh-only Bill. I ask him to consider the facts rather than stick to the dogma.
When we came to office, the health service was crying out for a programme of sustained investment. The hospital-building programme had almost ground to a halt, and nursing shortages had resulted from cuts in training in the mid-1990s. The budget recently published by the Assembly, which draws on resources made available by the outcome of the Government's spending review and confirmed by my right hon. Friend the Chancellor of the Exchequer this afternoon, will see the health budget in Wales rise next year to £3.8 billion. That is nearly £1,300 for every man, woman and child in Wales, and an increase of more than 70 per cent. since we came to power in 1997.
The number of staff employed by NHS Wales has risen by more than 12 per cent. since 1997, and the Assembly has announced plans for 6,000 extra nurses, 700 more consultants and GPs and 2,000 more health care professionals over the corning years. During the last five years, the number of medical students in training has increased from about 970 to 1,104. By 2004—in a couple of years' time—the number will have increased to 351 1,385. They are all important increases in staffing in the health service in Wales and compare with the background of Conservative rule when there were cuts, after cuts, after cuts.
§ Mr. Jon Owen Jones (Cardiff, Central)
Will my right hon. Friend acknowledge that, given the impressive list of inputs in the health service that he has mentioned, it is all the more important that we have a rigorous and independent audit structure so that we measure outputs and ensure that they are commensurate with the input that the management of our economy under a Labour Government has managed to provide for the health service?
§ Peter Hain
I very much agree, and the proposals provide for an independent inspection audit. I acknowledge my hon. Friend's contribution towards creating the foundations of the success on which the Assembly is now building when he was Minister for health in the then Welsh Office, succeeding another good Welsh health Minister, my hon. Friend the Member for Bridgend (Mr. Griffiths).
The recent opening of the Swansea clinical school, the proposal for clinical schools in north Wales and at the Royal Gwent hospital, together with a graduate entry scheme to medicine also planned for Swansea, are significant stages in the Assembly's plans to increase the number of doctors in Wales. There are 700 specialist registrar training posts in Wales and there will be 60 extra posts by next year, with particular emphasis being placed on areas with shortages. We have also pioneered innovative ideas to improve services for the public. That includes NHS Direct Wales, a 24-hour helpline staffed by nurses which is available throughout Wales. It took nearly 239,000 calls in the 12 months to September 2002, an increase of more than 40 per cent. on the previous 12 months.
The NHS in Wales is treating more patients than ever before, and I salute the dedication of NHS staff in Wales—doctors, nurses and many others—as they cope with the ever-increasing demand for treatment and care. After decades of underinvestment, there can be no quick fixes on waiting times. Significant progress has been made, however. The target to reduce waits for cardiac surgery to a maximum of 12 months has been met in full and the challenging target of reducing waits for orthopaedic surgery to a maximum of 18 months has been broadly met. The latter target is especially important for those of us who represent constituencies in Wales with a long legacy of industrial disease. The waiting lists for people who need hip or knee operations, for instance, are coming down, and they are on target to reduce even further.
§ Peter Hain
I do not gloss over the fact that the waiting list situation in Wales is not as good as it should be. The hon. Gentleman is right to draw attention 352 to that. Two factors primarily account for the difference. The first is the increased demand for the use of the NHS in Wales. That is a sign of increasing excellence in our hospitals and health services in Wales. The second factor is best demonstrated by the example of turning an oil tanker around. That tanker was going in wrong direction under his Government, and it takes time to change its direction.
Waiting lists for orthopaedics fell by more than 36 per cent. last month. That is good news for patients because most trusts in Wales now have no one waiting for more than 18 months for orthopaedic operations. Progress has also been made on cataract waiting times, with the number of people waiting for more than four months falling by more than 10 per cent. The waiting time target for cardiac surgery has been sustained with no patients waiting more than 12 months.
The hon. Gentleman made an important point. One of the greatest health challenges facing the Assembly is the length of time that many patients have to wait to receive treatment or to see a consultant. We all recognise that too many people have to wait far too long. There are no quick fixes. The reasons behind that are complex. They relate to the legacy that we inherited from the hon. Gentleman's Government and to increasing demands on the system. There is no doubt, however, that substantial progress has been made, especially in the priority areas targeted by the Assembly. We are on target to improve the quality of health care in respect of waiting times and other matters.
§ Mr. Bill Wiggin (Leominster)
Does the Secretary of State agree that the level of funding for the NHS in Wales is already at a European level, where there are no waiting lists, and that the over-18-month waiting list has increased by more than 1,800 people since the pledge was made when the Assembly was established?
§ Peter Hain
I have partly answered that point. I do not think that we have yet reached European average levels. Getting there will take time, and the money to achieve that objective is being made available. Turning the NHS around from its state when we inherited it a little over five and a half years ago will be a long job.
The difference between us is that we are willing to put in the investment while the Conservative party would cut that investment. Indeed, its Front-Bench spokesmen have repeatedly said that they oppose our public spending plans, and they have confirmed that this afternoon. We are able to maintain public investment at record levels and, in the health service, to increase it every year until 2008. Those are long-term plans enabling hospital managers, consultants, doctors and nurses to plan ahead. The quality of care, with the NHS treating more people all the time, is steadily going up.
The NHS in Wales is treating more patients than ever before, and I salute the dedication of all its staff. In contrast to the Conservatives, who closed 17 hospitals between 1979 and 1997, we promised in our general election manifesto last year to open 10 new hospitals in Wales over 10 years. The latest steps in the capital programme were announced in the Assembly budget last month and include a replacement for the cottage hospital in Tenby and new community hospitals in Merthyr and in Ebbw Vale, in the constituency of my 353 hon. Friend the Member for Blaenau Gwent (Llew Smith). I am sure that he endorses that decision by the Assembly, if few others.
Both the Government at Westminster and the Welsh Assembly Government in Cardiff believe that the future of the health service in Wales depends on a process of investment and reform. That is why the Bill builds on the measures in the National Health Service Reform and Health Care Professions Act 2002 which remove an unnecessary tier of bureaucracy in the health service in Wales and introduce greater local accountability, placing local decision making in the hands of local communities, health professionals and patients. The proposals build on earlier restructuring by the Welsh Office, which reduced the number of NHS trusts—they might be described as quangos—from 26 to 15.
The Assembly has been working hard to increase the responsiveness of the NHS to patients and the public and to strengthen the public's influence over the running of the health service. Proposals in the Bill will involve the people of Wales in their health service more fully than ever before. Already, strong relationships are being built between health and social care, and the Assembly has been at the forefront of bringing the patient's voice into decision making. The strengthening of that voice through the enhanced community health council structure, which is largely co-terminous with the local authority and local health board structures, will give the people of Wales an unparalleled, strong and meaningful local structure that will deliver for them, provided that the investment continues as we intend it should.
§ Alan Howarth (Newport, East)
Does my right hon. Friend agree that the continuing existence of community health councils in Wales will be of great assistance to the new health boards, enabling them to fulfil their remit of developing health, social care and well-being strategies for their communities, thereby enabling Wales to make progress in preventive health care strategies? It will also enable the health service to play the part that it ought to play with the crime and disorder reduction partnerships. In those respects, Wales will be leading the United Kingdom.
§ Peter Hain
And not for the first time. I agree with my right hon. Friend that the retention of community health councils in Wales provides the bedrock for community involvement. Wales is leading England in that matter just as it is leading England by introducing free bus passes for pensioners and disabled people and by introducing Assembly learning grants, and so on.
Further evidence of the importance of the reform process in Wales and of our commitment to ensure that the extra resources allocated to health in Wales are spent in the most effective way came with the welcome recent announcement by the Assembly Finance Minister, Edwina Hart, that Derek Wanless, who advised the Chancellor on the funding of the NHS at a UK level, has agreed to act as an advisor to a review of health and social care in Wales.
§ Mr. Simon Thomas
I thank the right hon. Gentleman for his generosity in giving way. He will recall that the Wanless report stated clearly that public investment in health care was the best and most effective and efficient way forward, and I am sure that he, like me, supports 354 that. Will he therefore take this opportunity to support all those in the National Assembly who want to rule out the introduction of foundation hospitals in Wales?
§ Peter Hain
I welcome the hon. Gentleman's support for the stance adopted by Derek Wanless. It was on the back of his report to the Chancellor that we as a Government made a clear decision earlier this year that we would go for increased publicly funded health investment—
§ Peter Hain
It is good to know that, for once, the nationalists voted for a socialist measure. The more that happens, the better for us—if not for them.
Returning to the Wanless report and the application to Wales of foundation hospitals, the National Assembly has made it clear that it sees Wales' needs as being completely different from those elsewhere in the United Kingdom; therefore it will not introduce foundation hospitals. I support the National Assembly in that decision. That is precisely what devolution is about—it was so that different decisions could be made according to different circumstances and different needs that we established the National Assembly for Wales, and a far better model for decision making it is than an independent Wales, which the hon. Gentleman's party supports. An independent Wales under the nationalists—Mr. Speaker, IL will not go too far down this road—would be stricken with poverty, and there would be health service cuts as well as all the other difficulties that the nationalists would bring to Wales.
The Wanless report that the Assembly will commission will both help to guide the reform and modernisation agenda for the NHS in Wales, and provide valuable evidence in allocating resources beyond the end of the next financial year. There are now clear dividing lines between the Government and the Opposition, between Labour and the Conservatives, on health. Labour stands for investment and reform, the Conservatives for cuts and privatisation. Earlier this year the Opposition voted against the Budget that released the extra resources that the Assembly is now investing in the health service in Wales. They toured the world in search of a policy on the health service, only to come up with the same old Conservative nostrums of privatisation, making patients pay for their own health care, and subsiding those who are able to pay for treatment.
As for Plaid Cymru, it would not introduce the necessary reform and it could not afford the necessary investment. I make no apology for again asking the question that Plaid Cymru Members never want to answer: in an independent or self-governing Wales, how would they finance the record levels of public investment in the national health service that we are delivering? The answer is they would not, because an independent Wales could not.
§ Mrs. Jackie Lawrence (Preseli Pembrokeshire)
Does my right hon. Friend agree that the nationalists have never satisfactorily answered this question about separatism: where would the money come from, bearing in mind that there is a significant difference between 355 taxes raised in Wales and public spending in Wales—a difference that could mean a 30 per cent. cut in public services, or a 50 per cent. tax increase?
§ Peter Hain
My hon. Friend makes a valid and wholly convincing argument. If the nationalists ever got their way, health services in Wales would be cut and hospitals would be closed, because they do not have the ability to finance the health investment that we are providing in record amounts, which the Bill is designed to underpin.
Part of the Bill can be traced back to the policy document "Better Health—Better Wales" issued by the Welsh Office in 1998, under the leadership of the then Welsh health Minister, my hon. Friend the Member for 13ridgend (Mr. Griffiths), and to the Assembly's ambitious and wide-ranging national plan "Improving Health in Wales—A Plan for the NHS with its partners", which was issued in 2001 and which set out a 10-year programme of renewal.
Last year, we announced our intention to introduce legislation to reform the provision of health services in Wales by establishing local health boards, strategic health partnerships, the Wales Centre for Health and Health Professions Wales. I am pleased that we have been able to establish local health boards and strategic partnerships through the National Health Service Reform and Health Care Professions Act 2002, which went on the statute book on 25 June this year. That Act is important, as it provides the Assembly with a foundation on which to begin delivering the reform agenda that it and the Government want to carry through.
However, we still needed to reform and strengthen community health councils and establish the Wales Centre for Health and Health Professions Wales. We therefore published the draft National Health Service (Wales) Bill—now called the Health (Wales) Bill, which we are considering this evening—on 17 May this year, to include those remaining three elements. Publication of the draft Bill signalled the beginning of an intense three-part scrutiny—by Parliament, the National Assembly for Wales and the public and those with a direct professional interest in the Bill. Pre-legislative scrutiny is an innovation introduced by the Government to elevate the quality of draft Bills, obtain greater involvement by people likely to be affected by proposed legislation, and improve the planning of the legislative process. The Health (Wales) Bill is one of the first measures to benefit from that innovation, and has been much improved and refined by the valuable contributions of a range of institutions, professional bodies and individuals. I pay special tribute to the Select Committee on Welsh Affairs and its Chairman, my hon. Friend the Member for Clwyd, South (Mr. Jones), for their contribution, and to hon. Members from all parties, but especially my own, representing Welsh constituencies.
§ Peter Hain
I am not sure that the hon. Gentleman made a valuable contribution, but as I am a generous soul, I will take it on trust.
356 So thorough was the process of refinement that not even the title of the Bill remained untouched. We therefore have before us today not the National Health Service (Wales) Bill but the Health (Wales) Bill. Pre-legislative scrutiny involved three parallel activities. Parliamentary scrutiny in the House was conducted by the Welsh Affairs Committee, and its report was debated by the Welsh Grand Committee. In the other place, Members were briefed on the Bill by both Government and Assembly Ministers and invited to register any concerns. The Assembly's Health and Social Services Committee undertook scrutiny of the draft Bill on behalf of the Assembly and there was also a public consultation.
It is a testament to the robustness of the original policy that the draft Bill attracted widespread support. Indeed, the process of pre-legislative scrutiny revealed no significant concerns about the policy. In all, 45 recommendations for change to the draft Bill were made—some to remedy omissions, some to clarify the powers both of bodies dealt with in the Bill and the Welsh Assembly, and others to extend its scope. We decided to consider 17 recommendations further. In only one instance did we find that there were legal or technical reasons why it was not necessary or possible to amend the Bill as suggested. In the remaining 16 instances, it was appropriate to amend the draft Bill to achieve what was intended, and we did so.
The changes have definitely improved the Bill. Some acknowledged omissions have been rectified and the powers and independence of community health councils, to which my right hon. Friend the Member for Newport, East (Alan Howarth) referred, the Wales Centre for Health and Health Professions Wales have been clarified. By retaining CHCs and making their membership a better reflection of the people whom they represent, by providing complaints advocacy services independent of the NHS in Wales, and by giving CHCs powers to inspect premises providing NHS services, we will build on the strong local relationships, which already exist within the health service in Wales. By establishing a statutory association of Welsh CHCs that will not only advise and assist CHCs but have a performance management role, we will guarantee the people of Wales a consistent service of the highest standard across Wales.
By establishing the Wales Centre for Health as an independent body, we shall ensure that the people of Wales have the best multidisciplinary advice on health hazards, that risks to health are properly assessed and that research and other evidence is made available to support effective policy making and decision taking. By establishing Health Professions Wales as an Assembly-sponsored public body, we shall provide quality assurance for the training and education of those in the health care professions in Wales. Its remit will be extended to cover not just nurses, midwives and health visitors, but allied health professionals and clinical scientists.
By 2004, there will be more than 4,300 nurses in training in Wales. That is more than double the number in 1997, when 2,029 were in training. The annual allied health professions training intake has been increased from 494 in 1999–2000 to 649 in 2001–02, and will have been increased by a further 681 by 2003–04. Among the increases in recent years, the occupational therapy 357 intake has risen from 161 when we came to office in 1997 to 219 this year. In physiotherapy, there has been a rise from 168 in 1997, when the Conservatives left office, to 288 this year.
§ Mr. Elfyn Llwyd (Meirionnydd Nant Conwy)
The right hon. Gentleman is right to say that there has been an increase in the number of occupational therapists, but unfortunately, it is not sufficient. Will he please look again at the provision of bilingual occupational therapists, which is important in relation to speech therapy and so on? Furthermore, what will the Bill do about the dental crisis in Wales?
§ Peter Hain
I shall certainly look at the hon. Gentleman's question, because I agree that that is an important aspect of providing a high-quality health service for all the people of Wales.
The Bill is designed to improve the health care targets and areas that it is explicitly set up to deal with. Health Professions Wales will set clear standards at an all-Wales level for the continuing personal and professional development of all sectors of the work force. The Bill will give the body a proper statutory footing. It is an enabling Bill that devolves powers to the Assembly to determine through its own secondary legislation the detail of the new arrangements. That is another example of the truism that the Assembly is a powerful body. It has enormous powers to influence and shape policies as it determines they should be for the needs of Wales.
That is as it should be. The devolved Assembly will work in partnership with the health service in Wales and the people of Wales to determine what is right for Wales. That demonstrates once again that, through the devolution settlement, we can deliver policies adapted to the particular needs of Wales. The Bill follows previous legislation such as the Learning and Skills Act 2000, the Children's Commissioner for Wales Act 2001 and the National Health Service Reform and Health Care Professions Act 2002, all of which had specific Welsh clauses. It represents devolution in action and progress through partnership.
§ Mr. Bercow
I am grateful to the Secretary of State for generously giving way again. Given that health inequalities are often income related—to put it bluntly, poorer people are more likely to become and remain ill—will he point to what provision there is in the Bill or will appear subsequently in secondary legislation to tackle that disturbing phenomenon?
§ Peter Hain
The hon. Gentleman is absolutely right that income inequalities are a tremendous source of health inequality and are a particular problem in Wales. In valley constituencies such as those that I and the Under-Secretary, my hon. Friend the Member for Islwyn (Mr. Touhig), represent, that is a curse and a legacy of our industrial history. On the help provided by the Bill, the Wales Centre for Health will ensure that those inequalities are monitored and that the policies that are designed by the Assembly and, where necessary, implemented through primary legislation here are tailored to deal with them. Health Professions Wales will also ensure that the professions in Wales are trained to a standard that is sufficiently high to address those inequalities.
358 Before I gave way to the hon. Member for Buckingham (Mr. Bercow), I was about to say that I commend the Bill to the House.
§ Mr. Nigel Evans (Ribble Valley)
The debate is important because it gives hon. Members an opportunity to discuss issues that relate to the national health service in Wales. Post-devolution, the ability to ask questions on health is somewhat constrained. That is a pity. Members of Parliament with an interest in Welsh affairs must be aghast at what the NHS has become for far too many people in Wales.
I welcome the fact that the Bill was published in draft. As the Secretary of State said, many observations and comments were received before it appeared in its current form. I believe that we have fewer opportunities to debate issues fully now than when I was first elected 10 short years ago. Most of that change has occurred in the past five long years.
The Bill is another stepping stone in the troubled waters of the NHS that leads to yet more change.The National Health Service is safe in our hands.You only have 24 hours to save the national health service.Those statements must ring loud and hollow in Wales. I have used the NHS in Wales. I lived in Swansea for 33 years; my brother worked as an electrician on Singleton hospital when it was built, and my other brother, Anthony, had an operation for cancer at that hospital in January 1998. I cannot pay great enough tribute to the staff at every level who gave my brother back his health. I pay tribute generally to the hardworking staff of the NHS. They work under enormous pressure and constant change.
Our health service has genuine problems, despite the extra revenue that has been earmarked for the service and that the Secretary of State mentioned. Sadly, for far too many people, the extra expenditure is not reaching the right parts to ensure an improved service. Some of the biggest complainers about that miserable fact are those who work in the NHS.
I want to make several points about improving the service for our patients. The retained community health councils, which the Bill covers, will want to consider many deficiencies. Do hon. Members remember the following pledges:By the end of a Labour Assembly's first term no one will wait more than 18 months for inpatient treatment";By the end of a Labour Assembly's first term no one will wait more than 6 months for outpatient treatment"?What has gone wrong?
The Labour party could state that the Administration in Cardiff are not technically Labour; they are a Lib-Lab Administration. Technically, that would be correct. The Labour party could therefore try to blame the Liberal Democrats for the awful state of waiting lists in the NHS in Wales. Much as I dislike the Liberal Democrats, that would be dishonest. Although they will have to take their fair share of the blame, the Labour party would not have behaved differently if it had been able to muster sufficient votes to avoid having to rely on the Liberal Democrats to retain power.
Let us consider the size of the problem: 4,335 people have been on the in-patient waiting list for more than 18 months—1,810 more than when the pledge was 359 made. In 1999, when the pledge on out-patients was made, 25,676 people were on the waiting list. Today, the figure is 83,443. When we left office in 1997, the figure was 5,956. What would Labour Members say if we had presided over that appalling state of affairs? It is a scandal.
§ Mark Tami (Alyn and Deeside)
Does the hon. Gentleman agree that the 18 years of total under-investment in the health service led to the current waiting lists? We do not have sufficient doctors and consultants because it takes time to train them, and the Conservative Government were not prepared to do that.
§ Madam Deputy Speaker (Sylvia Heal)
Order. I remind hon. Members that we are not holding a general debate on the health service in Wales; we are discussing the Bill. It would be appropriate if hon. Members confined their remarks to that.
§ Mr. Evans
I am answering the Secretary of State's points. I listened to him carefully. The CHCs, which the Bill will retain, will also consider aspects of his speech.
For how many more years must we listen to excuses? The hon. Member for Alyn and Deeside (Mark Tami) has to accept that the Labour party has been in power for more than five years. The statements that the Labour party made during the 1997 and 2001 general election campaigns—
§ Madam Deputy Speaker
Order. Again, I remind the hon. Gentleman of the parameters of the debate. We are considering the Health (Wales) Bill.
§ Huw Irranca-Davies (Ogmore)
The hon. Gentleman mentioned five years. How long does it take to train a consultant?
§ Mr. Evans
Part of the problem is retention after training. I have spoken to the Royal College of Nursing, which states that there are 30,000 registered nurses, but that more than 8,000 do not stay in the NHS The hon. Gentleman also knows that the Government have scoured the world for extra nurses and consultants, yet shortages remain. They must accept that there is a problem.
§ Mr. Wiggin
My hon. Friend knows that consultants, especially in Wales, have not agreed a settlement with the Government. There is no point in Labour Members shouting abuse when the Government have failed to agree a deal with consultants on funding.
§ Mr. Evans
My hon. Friend is right. The statistics that we use in today's debate have a genuine impact on patients in Wales. People are suffering because of the deficiencies. That is the real problem.
360 When I mentioned waiting lists to the Secretary of State earlier, he compared the NHS with an oil tanker and said that it had to be turned around. The right hon. Member for Holborn and St. Pancras (Mr. Dobson) once described the NHS as an oil tanker when he was Secretary of State for Health. Many Secretaries of State have passed under the bridge since then. The NHS now resembles the Spanish oil tanker that has sadly run aground and is currently spilling oil. Something must be done about the waiting list problem in Wales for the sake of all the patients in Wales.
§ The Parliamentary Under-Secretary of State for Wales (Mr. Don Touhig)
The hon. Gentleman must acknowledge the distance that we have had to travel in rebuilding the health service. Does he recall that under the Conservative Administration, 70 hospitals were closed, 8,000 general beds were removed from use and there was a 25 per cent. cut in nursing and midwifery training? We have had to travel that distance to start putting things right.
§ Madam Deputy Speaker
Order. Again, I remind hon. Members that we are discussing the Health (Wales) Bill, not the national health service in Wales.
§ Mr. Evans
No. I have given way often, and I want to move on.
Community health councils will want to consider in detail the issues that we are discussing and expose some of the problems. I therefore believe that we should examine carefully CHCs' independence from the Assembly.
I spoke about the professions that the Bill covers, including GPs. Let us consider some of the comments of Dr. John Chisolm, chairman of the BMA practitioner committee, who published a book entitled "Crisis in Care: A GP dossier". I heartily recommend it to all hon. Members who are present. They should examine the Welsh sections if nothing else. It is a harrowing read. He comments on some of the GPs who work in Wales and will be covered by the CHCs. One is Andrew Dearden, a doctor from Cardiff. He says that some people wait as long as six years for hip replacement operations.
He states:I have many patients who are crippled by arthritis and need hip replacements. The word 'crippled' is not an exaggeration for many of them—some are completely housebound and do not go out of the house except to attend hospital appointments. They are often on multiple painkillers, none of which are controlling most of the pain.While we debate the Bill today, let us keep in mind the people to whom it relates: the patients facing lengthy waiting lists with GPs. The GPs are hugely frustrated by that.
§ Gareth Thomas
Can the hon. Gentleman tell us whether his party supports the Bill? Does he agree that rather than embarking on a regurgitated rant, he would do the House a greater service if he told us whether he supports the technicalities of the Bill—yes or no—and why?
§ Mr. Evans
The hon. Gentleman will have to be a little more patient. We support some aspects of the Bill, and we will wish to improve some aspects of it when it reaches Committee. I hope that the hon. Gentleman will serve on that Committee. No doubt we will then be able to debate at length improvements to the Bill. The hon. Gentleman may be surprised to find that amendments are tabled even by his hon. Friends.
The Secretary of State said that the Opposition did not want a national health service, and that under the Conservatives only the rich would get treatment and those who were poor would not. It is a chilling fact that 250,000 people last year used their own money to have operations. That is the figure for the whole of the United Kingdom, and some of those cases would have been in Wales. People withdrew their life savings or borrowed money because they were in pain and the waiting lists were far too long.
We must focus carefully on what the Bill is about. We all want an improvement to the service provided to the people of Wales. That is why we want to ensure that the Bill is improved in Committee.
§ Mr. Bercow
Is my hon. Friend aware that a cursory study of the Bill suggests that it contains no fewer than 18 references to orders and regulations, rendering it something of a parliamentary eunuch? Does he agree that it is therefore essential that we are told tonight by the Government whether the regulations will be subject to the negative or to the affirmative procedure, and that the National Assembly for Wales publishes draft intentions of what it plans to introduce?
§ Mr. Evans
I agree with my hon. Friend. That would be an informed position for the Assembly to take. As we see from the Bill, many powers are to be devolved to the Assembly. I want to know what consultation the Assembly will have with various bodies before it introduces regulations that will impact on the whole of Wales.
I read the second report of the so-called First Minister, Rhodri Morgan, for 2001–02. I wanted to see what he had to say about the NHS, because it is devolved through secondary legislation. Only three of the 35 pages are devoted to the NHS. The First Minister sets out some of the targets. One of those strangely and boldly states:In the main, the maximum waiting times for orthopaedics have been reduced to 18 months.I do not know what is meant by "in the main". I do not see that as a target, but there we go. I then looked at the statistics made available by the NHS in relation to orthopaedics. It is clear that in most of the health authority areas, the waiting time for orthopaedics is more than 18 months—that is, more than 72 weeks.
§ Mr. Evans
I agree that investment is needed in the health service, but it must be investment in the right 362 areas. Clearly, the investment is not going into the right areas at present. I hope that with his interest in the health service in Wales, the hon. Gentleman would want to ensure that the extra national insurance—the extra taxation—that everyone is paying goes into the right areas. When people are taxed to the hilt and receive the sort of service that we are discussing, they feel aggrieved.
§ Lembit Öpik (Montgomeryshire)
Which areas of the health service would the hon. Gentleman not invest in? Out of which areas would he take money?
§ Mr. Evans
The hon. Gentleman, as a Liberal Democrat, is part of the coalition, or the official irritation, as I prefer to call it. His party is just a poodle for the Labour party in the Assembly, and Labour's little helpers at Westminster. When there are more managers than nurses in the NHS, we must refocus on where the money should go.
§ Mr. Evans
No. I must make progress.
Will the Secretary of State please look again at the waiting lists for orthopaedics and see how many people have been waiting for way over 18 months? That is a real problem, which must receive the proper attention. It is pointless having targets if they are not likely to be met. Why does the Assembly promise what it cannot deliver, and why does it claim credit for what it cannot achieve?
Why did Rhodri's second report, if it was to be honest and transparent, not give us all the figures for waiting times so that everyone could judge what the Administration had promised and what they had achieved? The document is spin. Unless the Administration are fully truthful about the position next year, I suggest that they do not bother to produce a report next year, and instead put the money saved towards employing an extra nurse. I suggest an extra nurse because, despite all that the Secretary of State said earlier, there are still 700 vacancies in the NHS for nurses, even though there are 1,000 Filipino nurses working in the health service in Wales. Thank goodness for the job they are doing, but there are still almost 750 vacancies.
§ Mr. Roger Williams (Brecon and Radnorshire)
Has the hon. Gentleman's party estimated how much money would be saved by cutting the administration of the NHS in Wales?
§ Mr. Evans
The hon. Gentleman should know that we would at least examine the areas in which the bureaucracy has grown, where the number of managers has grown and where there are inefficiencies, instead of making excuses all the time to explain why more money has to be pumped in while services are deteriorating. The sad thing for him and his constituents is that they are getting a worse service at the same time as they are paying extra taxes.
§ Mr. Evans
No. I must make a little more progress. I know that other hon. Members want to take part in the debate.
363 Part of the Bill deals with Health Professions Wales and the directions that the Assembly may give to health workers, including nurses. Part of its function must be to ascertain that newly qualified nurses earning £15,000 feel properly valued in their roles. How can we retain them when they are qualified, and how can we encourage more of the newly qualified nurses to go into nursing? Pay is vital, and we all await the outcome of the Agenda for Change at the end of the year, and the impact of Health Professions Wales in ensuring training for our nurses, and ensuring that the training will come to something. It must be a matter of deep concern that so many of those who are trained do not go intro nursing at the end of their training.
All of us who read the Western Mail today saw with great delight that £14,000 has just been spent on a new logo for the Welsh Assembly—£14,000 on a new dragon. What a waste of money. The patients waiting for operations could not care a jot about such expensive trivia. If a new logo costs £14,000, and a nurse costs £15,000 a year, on what would hon. Members prefer the money to be spent?
We all want an improved national health service in Wales. Will the Bill deliver that? It contains no reference to foundation hospitals, which were mentioned by Plaid Cymru Members earlier. The Government believe that foundation hospitals are the answer for England, but not a mention of them for Wales. I wonder why. The retention of community health councils is to be welcomed, as are their enhanced powers, but the power given to the Assembly to decide whether they could be abolished in the future—indeed, the very name could be changed by the whim of the Assembly—is over the top and unacceptable.
Yes, it is right to ensure that the whole of Wales is covered by CHCs, but we need to examine ways of giving the CHCs greater autonomy, away from the Welsh Assembly. They could fall foul of the Assembly by exposing many of the deficiencies in the health service in Wales, some of which I have highlighted. The CHCs could then face the bullet; they could be abolished, just as has happened in England. Many hon. Members here today helped to bring that about by not supporting the retention of English CHCs. Only one Member from a Welsh constituency voted against their abolition.
Part of the CHCs' remit is to be the patients' champion. When the newly reformed national health service in Wales gets off the ground in April of next year, we know that it is going to be hugely bureaucratic. We also know that it is going to be expensive. Even a former Welsh Office Minister has termed it "unworkable". A leaked report presented to Rhodri Morgan, Jane Hutt and the Secretary of State for Wales by the senior civil servant, Bryan Mitchell—the man overseeing the reform—stated that there were major risks involved in the reorganisation. We were told that it was going to be cost-neutral; we now know that it is going to cost £15 million. The Secretary of State for Wales assured me in the Welsh Grand Committee that this was a one-off payment. We will compare the costs after the 22 local health boards are up and running, to see whether the change has been cost-neutral. People should have this kind of information before they vote these measures through. There are also a number of other concerns 364 relating to the reforms. Let us suppose that the CHCs blow the whistle on all this, when the new organisations are up and running. What protection will there be for them?
We know that Jane Hutt receives a lot of criticism—all of it fair, in my book, yet she hates it. She has stated that
people don't want to hear the media bashing politicians. They want to know about us driving waiting lists down".Well, there is not much chance of that, is there? What she fails to recognise is that the reason she is being bashed is that she is signally failing to do as she promised. No doubt the Assembly would like to have the same powers over the media as they are being given over the CHCs. In the Bill, it can decide the membership of the councils, the means by which the chairman is elected, the proceedings of the councils, and the discharge of any function of the councils by a committee of the councils. The Assembly will also be able to decide who consults the councils, the payment of councils, the preparation and publication of reports by councils, matters to be included in any report, what the councils may receive from health authorities, local health boards, strategic health authorities, primary care trusts or NHS trusts, what sort of information they can give out to other people or other councils, and anything else that takes its fancy.
Gosh! If only the Assembly had such powers over the media! It could appoint editors and journalists, decide what goes into the newspapers, what information the public could and could not read, and who that information went to. What sort of far-reaching, searching publication would that produce? Well, it would be a bit like Rhodri Morgan's report to the Welsh Assembly and the people of Wales: wholly spun, wholly disinfected, wholly engineered and wholly useless. Anyone who believes that the Assembly would not use its powers unreasonably should remember that it abused its powers by delaying the local elections from 2003 to 2004 so that they did not coincide with the Assembly elections. That was a complete disgrace, but it is going to happen.
We need much more protection and independence for the CHCs. If we want them to be a whistleblower and a champion for the people of Wales, let us give them some independence from the body that might well be on the receiving end of some of their criticism. I want the CHCs to be empowered to check on all the organisations giving health services to patients in Wales, but I want them also to liaise with other bodies in England, Scotland and Northern Ireland, so that complaints may be taken up from any patients receiving care in facilities in Wales. I would like similar rights to be afforded to Welsh patients receiving care in institutions in other parts of the United Kingdom.
I also wish the CHCs to be consulted and involved in any name changes, abolitions or mergers. More autonomy and independence for CHCs will be important. It is also important that CHCs should consult the people of Wales and issue an annual report on the people's views on the service that they are receiving. Those views will be positive in many regards relating to the people working in the NHS, but I receive letters on a regular basis about the state of health provision in my own area, and it is not always so 365 positive. Only if we encourage this sort of publication will we all learn about any deficiencies, and I am sure that best practice would lead to fundamental changes being made throughout the whole of the NHS.
The Wales Centre for Health has been widely welcomed, and we will be looking for ways in which it can engage in a constructive dialogue with comparable bodies elsewhere in the UK. One of its remits is to keep people in Wales informed on matters that affect their health. That is right, but much of the information gathering and research could well be carried out elsewhere. Furthermore, it could be pioneering an area of health concern and be way ahead of what someone else is doing—on certain aspects of drug abuse, for example—and, in such circumstances, it would only be right for the information involved to be shared and for collaboration to take place, to give any information campaigns the greatest effect.
I see that the Assembly is to give itself the power to appoint the chairman of the Wales Centre for Health. I hope that that will be done in an open and transparent way, and we will look for ways of ensuring that that is the case. Evaluation of the centre's work will also be important, in terms of assessing how effective it is in getting positive health messages across. We will examine how that can best be achieved. I see that the Auditor General for Wales has responsibility for this provision in the Bill. There will be budgetary implications for this body.
Today's report that parents in Neath, Port Talbot and Swansea are shunning the measles, mumps and rubella jab in increasing numbers must be of concern to the Government. More than 25 per cent. of children have no immunisation at all, and the fear is that this could lead to an outbreak of measles, mumps and rubella. The Wales Centre for Health may well be involved in research into the fears of a growing number of parents about autism. Indeed, it may wish to make recommendations on single jabs being made available.
Health Professions Wales will work closely in liaison with a number of other bodies. We will wish to see that it works closely in consultation with the bodies and professions that it covers, especially nurses. I have a concern about the training and qualifications necessary to work in the Welsh health service, and I would like to see training and regulations there that are very similar to those that exist in the rest of the UK. Wales is a small country, and nurses might find themselves unavailable for work in Wales if they had been trained in England or, for example, if they were agency nurses who could not get work in Wales if they lived in Bristol, because a wholly different system was operating in Wales. Given the nursing shortage to which I referred earlier, I would have thought that flexibility and ease of working in Wales would be the byword, as opposed to seeing how different from England or Scotland we can make the system.
I wish to see a world-class health service in Wales, with our dedicated staff receiving the best support and our patients receiving the best care. I am angry that this is not happening after more than five years of a Labour Government and three years of a Welsh Assembly. The number of promises was high. The criticism of the NHS under the previous Conservative Government was constant, but I do not remember Labour Members ever 366 rebuking themselves in those days for talking down the NHS by making constant criticisms or by pointing out where things were going wrong.
The Government are embarking on further change, on top of other changes, and this constant change cannot be good for the system. After all the changes that have been made—and with the differences from other parts of the country—it will not be a case of not knowing where the buck stops for most people; it will be impossible to work out where it starts. We have massive fears about the changes contained in the recent health reform legislation, as it affects Wales. I believe that they are going to cost a fortune and will be unworkable. Mergers will be almost inevitable as local health boards find that they have to join up with others to make a go of the new provisions. The changes mentioned in the Health (Wales) Bill could lead to progress, so long as we can ensure that these bodies have some independence from the Assembly and are given teeth.
We want to see a better health service. The people of Wales were promised that, and they do not deserve what they currently have. Jane Hutt, the Health Minister in the Welsh Assembly, is drinking at the last chance saloon, and—even with the prospect of licensing reform and the possibility of 24-hour drinking—the bell for last orders should be ringing long and loud in her ears.
§ Mr. Martyn Jones (Clwyd, South)
I would be grateful if I could take some time to discuss the background of the Bill, before considering the principle that we are discussing on Second Reading. I would like to do so because it was the Welsh Affairs Committee, of which I am proud to be Chair, that was charged with the responsibility of providing the main pre-legislative scrutiny on behalf of the House. Likewise, the mirrored responsibility from the perspective of the devolved National Assembly for Wales fell to the Health and Social Services Committee of the Assembly in Cardiff.
There was, of course, an input to the draft Bill process from the Welsh Grand Committee, under the excellent stewardship of my hon. Friend the Member for Bridgend (Mr. Griffiths), and that provided a useful Third Reading-style stage of the pre-legislative process, throughout which, I believe, only one voice expressed concern that the scrutiny by the Welsh Affairs Committee was somehow a bad precedent to set. The reason given was that not all members of the Committee represent Welsh constituencies. That is a fact, but it is hardly the fault of the House that the Welsh people do not elect a single Welsh Conservative Member. In any case, that is no excuse for precluding the Welsh Affairs Committee from repeating its scrutiny role and the process would be fundamentally flawed if the official Opposition were effectively excluded.
§ Mr. Jon Owen Jones
Although I was not named, I must speak in my defence. I believe that we have set a bad precedent, because in the event of another Government—possibly a Tory Government—being elected, the Select Committee could have a majority of members from outside Wales. We have set a poor precedent, because it will be used against us when we have another Government. I do not believe that the Labour party will be in power constantly.
§ Mr. Martyn Jones
I am shocked by that suggestion, but I must point out to my hon. Friend that, in any case, 367 the Standing Orders of the House say that every Committee of the House will have a Government majority. Whatever Committee considered such a matter, it would, dare I say it, have a Tory majority were the Tories to be elected.
§ Mr. Jon Owen Jones
I am thankful to be allowed a second go. To correct my hon. Friend, Standing Order No. 86, which we must set aside at the end of the debate, allows Bills exclusively about Wales to be debated by a Committee whose members are all Welsh Members. That is in the existing Standing Orders.
§ Mr. Martyn Jones
A Government who are not a Labour Government could change that Standing Order overnight, as my hon. Friend is well aware. Yes, that Standing Order exists, but if a new Select Committee were set up to discuss Welsh business it would have a majority from another party should such circumstances arise. I am sorry, but that has to be the case, as no Government will ever set up a Committee with a majority of Opposition Members.
By the way, my hon. Friend may not be aware that another Member made such a suggestion in the debate, so the cap that he takes up may not fit him. He may recall that a Member on the other side of the House said something along similar lines about the Welsh Grand Committee. That said, if the cap fits Members on either side of the House, whoever wants to can wear it. I sincerely believe that the Select Committee represents the best process under the rules of the House.
My hon. Friend may or may not agree with what I shall say next: a better change may be to alter the Standing Orders to allow joint working with Assembly Committees.
§ Mr. Roger Williams
I compliment the hon. Gentleman on his work with the Welsh Affairs Committee. Does he agree that one benefit arising from the process is the enhanced legislative understanding and trust that developed between the Assembly and Westminster?
§ Mr. Martyn Jones
Absolutely. I am sure that the hon. Gentleman, who is a valuable member of my Committee, endorses the process, which I have adopted since becoming Chairman of the Committee and since the Assembly was established, of keeping Assembly Members on board at all stages and at no stage, I hope, treading on their legislative toes. That is a self-denying ordinance, but one on which there is general consensus in our Committee.
The Select Committee greatly welcomed the opportunity to take the lead on the draft Bill, which, from a public consultation perspective, was a huge success. In total, 307 organisations and individuals were consulted and, as the Wales Office website rightly boasts:This is the first piece of Wales-specific legislation to be subject to public consultation in draft form and pre-legislative scrutiny by Parliament and the National Assembly.I can assure the House that the process was extremely successful, and I am therefore delighted that the Queen's Speech contains the pledge that the Government intend 368 to publish even more draft Bills to give Parliament and the wider public a greater opportunity to scrutinise proposals before the more formal legislative process takes place in the House.
I thank the previous Secretary of State and the Under-Secretary for their work and, indeed, the spirit with which they entered into the draft Bill process. I also place on record my sincere appreciation of Jane Hutt, the Minister for Health and Social Services in the Welsh Assembly Government in Cardiff, who provided leadership in making the draft Bill process the success for Wales that it has proved to be. However, I add one general suggestion, which I hope is helpful, on the legislative process in relation to the Bill and, indeed, future draft Bills: why does not the House consider holding truncated debates on Second Reading? Members will probably fill the time allotted tonight, in good old Parkinson tradition. However, given that we have had one crack of the whip, perhaps we should cut down debates on Second and Third Reading.
The Government have accepted most of the technical amendments proposed by the Select Committee and the Welsh Assembly during deliberations on the draft Bill, so we should be discussing only parts of the Bill on which amendments were not accepted. In the light of the Government's promise in the Queen's Speech to present further Bills in draft before the formal legislative process begins, I urge them to re-examine the necessity for full Second Reading debates so as to save valuable time in the House. Briefer consideration in Committee will come naturally, but perhaps debates on Third Reading could also be shorter.
When the draft Bill was published in May, it was a good day not just for health in Wales, but for Wales's democracy and parliamentary accountability. I am proud of the Government's commitment in creating that groundbreaking precedent. The real benefits of presenting the Bill in draft have come to fruition, as it offers legislation for Wales that was consulted on and debated in Wales before the House began its deliberations on the details. This is truly "home-grown" legislation. Importantly, the Bill is also testimony to the fact that devolution in Wales and the relationship between this place and the National Assembly in Cardiff have come of age. The Bill proves, conclusively in my mind, that London and Cardiff can and will work together for the benefit of the people of Wales.
The Bill will deliver huge benefits for patients in Wales by giving them a much stronger voice, not only in improving the NHS in Wales, but in running the health service. Patients will be empowered, and I am proud that it took this reforming and imaginative Government to find the way to enable patient power to come into being. They are to be congratulated on that.
The Bill is an important step in the revitalisation of the NHS and it cannot be viewed in isolation from the massive increase in investment that has been injected into the NHS in Wales over recent years. I believe that, today, an extra £1 million has been allocated for the ambulance service in Wales. I hope that the Under-Secretary mentions that in his winding-up speech, as it needs to be put to the public.
When the Government talk of reform, they mean reform, and the Bill is an intrinsic part of that strategy in Wales. It is designed to ensure that the patient's voice 369 is central in the creation of improved services right across the board, and in accepting pre-legislative responsibility the Committee recognised and, I hope, built on that important factor.
Underpinning that empowerment of the patient is the progressive transformation of community health councils across Wales. That crucial strand of reform is to be enhanced by their taking on the new role of being responsible for nursing homes and primary care. CHCs across Wales perform excellent and dedicated work, not just in terms of their quasi-inspectorate role, but through advocacy. The Welsh Affairs Committee wanted CHC members to have a statutory right to take time off work to attend CHC meetings and formal visits. I would like the Government to return to the matter and amend the Employment Rights Act 1996 to include CHCs in the list of approved public bodies.
Another recommendation that the Government did not accept in their response relates to a review in respect of Welsh CHCs not being constrained by the borders of Wales when acting on behalf of Welsh patients who are receiving treatment outside Wales. Wales is in a unique position, particularly the more rural parts of mid and north Wales, where many patients have to travel to Shrewsbury, Oswestry, Telford and even Manchester for treatment. I would have liked to see this uniqueness addressed. Again, I would ask the Government to reconsider this matter in Committee.
The Bill also advances the setting up of a brand new and encompassing health professions body for Wales, which would in future include health specialities such as physiotherapy and speech therapy. Health Professions Wales—HPW—will also replace the functions previously carried out by the Welsh National Board for Nursing Midwifery and Health Visiting, which is to be abolished in the near future.
In evidence sessions, the Select Committee quickly formed the view that the proposal to set up Health Professions Wales has been broadly welcomed. However, the Committee expressed concern about the independence of HPW in relation to staff and funding issues. We are pleased that the Government clarified the extent of the powers in their response to the Committee and in the Bill.
The Bill offers to Wales a bold change of emphasis from just treating disease to looking at the "big picture" of setting out to improve the general health of people in Wales. I believe that that will be greatly helped by the establishment of the Wales Centre for Health, which will offer support training and share advances in cutting-edge medical research throughout Wales. On the independence of the WCH, I am pleased that the Government accepted the Select Committee's recommendation that the Assembly's powers of direction over the WCH should be limited to
the exercise of its administrative or financial functionsand that the Bill is specific on that matter.
In the evidence sessions, the Select Committee highlighted, but did not submit as a specific recommendation, the evidence of some witnesses who wanted the WHC's remit widened to enable it to be more proactive in offering advice and information to the public. Again, we are pleased that the Government recognised the matter and elaborated in the Bill on the WCH's role in relation to that function. The 370 Government also responded positively to the National Audit Office query about the role of the Auditor General for Wales to carry out value-for-money investigations into the WHC's work. That is now included within the Bill.
The Bill, which was brought to the House via the route of pre-legislative scrutiny, has been a resounding success. Not only has that process marked a progressive and organic approach to drafting legislation but, more importantly, as the Bill demonstrates, it has delivered good legislation. In this case, that is good news not just for the NHS in Wales, but for the standing and reputation of this House.
§ Lembit Öpik (Montgomeryshire)
The Secretary of State correctly said that many hon. Members would welcome this Second Reading debate. It is always pleasing to see people from all over the world celebrating our deliberations on what I like to think is, by and large, a Bill arrived at by consensus. As the hon. Member for Clwyd, South (Mr. Jones) said, it is a credit to the pre-legislative scrutiny that so many people have been involved—Members of this House, Members of the Assembly and health professionals. In the past, we have not always realised the importance of working closely with the Assembly. Let us hope that this useful precedent will lead us towards more effective representation of the people of Wales in the future.
The Secretary of State also said that the Bill is about patient power. Actually, I think that it is about patient health. We must make sure that we do not become obsessed with process. All four parties present want to ensure that we maximise the effectiveness and value for money that the public get from the system. In that sense, the consultation process has, one hopes, been all to the good, because it has made stakeholders out of individuals who are on the front line trying to deliver the service.
I was, as ever, entertained by, and delighted to listen to, the hon. Member for Ribble Valley (Mr. Evans). Most Welsh Liberal Democrats were grateful that he did not put all the blame on us for the problems of the health service. He is a very nice man—most Liberal Democrats think that, with the possible exception of Michael Carr. The hon. Gentleman got some considerable heat for the 18 years of underfunding which many believe were instrumental in causing the problems in the run-up to 1997. I noticed the relief on his face when Madam Deputy Speaker intervened to protect him, giving him a lucky escape, lest people were reminded of the 70 closed hospitals and the 8,000 lost beds. I agree that the hon. Gentleman's swingeing attack on the Government had about as much relevance to this debate as improving standards in the Estonian health service. In fact, those improvements are impressive and I would recommend that hon. Members go to Estonia to see how it is dealing with its outstanding health problems.
§ Lembit Öpik
I can honestly say that I am. I think that the health service does a damn good job. I shall return to that matter in a moment. We must all celebrate the 371 fact that the United Kingdom is extremely fortunate that, despite all the issues, we still enjoy some of the highest health standards enjoyed by any society at any time in the history of the planet.
§ Huw Irranca-Davies
I would join the hon. Gentleman in celebrating the standards in the national health service. When my mother was taken into Morriston hospital in an emergency last weekend, the quality of care that she received was first class. She spent two days there and now, thank goodness, she is back home. That was not the first time that she had been taken into hospital; it was the third occasion. Each time, she has been dealt with admirably, so let us not slate health service in the way that it is so often slated.
§ Mr. Deputy Speaker (Sir Michael Lord)
Order. Before the hon. Member for Montgomeryshire (Lembit Öpik) responds to that, may I say that this is not a general debate about the health service in England or Wales, and I should be grateful if hon. Members would confine their remarks specifically to the Bill before the House.
§ Lembit Öpik
I certainly will, Mr. Deputy Speaker, and I apologise for bringing Estonia into the debate as well.
As I listened to the hon. Member for Ribble Valley discussing the Bill, I became increasingly nervous because I simply did not know whether the Conservatives were supporting the Bill tonight. At one point, I almost intervened on a point of order to ask whether it was in order for the hon. Gentleman to expose us to such stress. In waiting for the answer, we may have developed some stress-related disorders.
The hon. Gentleman explained on behalf of the Conservatives where the money should come from to improve the health service. In answer to my question to him, we received only one figure: he would save £14,000 by abandoning the logo project. That would pay for almost a year's worth of nursing—[Interruption.]
§ Lembit Öpik
I believe that my point is almost in order, Mr. Deputy Speaker, so on that basis I shall give way.
§ Mr. Deputy Speaker
Order. I fear that hon. Members are starting to stray again and I must insist that they do not.
§ Lembit Öpik
The point just made by the hon. Member for Ribble Valley brings me right back to the research paper published on 20 November to explain various aspects of the Bill. It says on page 16:The draft Regulatory Impact Assessment, published by the Wales Office to accompany the draft NHS (Wales) Bill, estimated that CHCs' enhanced visiting rights would cost around £100 372 million a year across Wales, while the enhanced advocacy role would cost £480 million per year. The cost of putting the AWCHC on a statutory footing and increasing its responsibility and powers was estimated at £10 million per year in additional rates and rents and £70 million a year in additional staffing.The estimate for the cost of all the measures in the Bill therefore comes to a substantial £660 million a year.
We did some investigation in the House, however, and it transpired that it comes to £660,000 a year, so in one fell swoop the Welsh Liberal Democrats have saved Wales £659,340,000 already, while the Conservatives could come up with only £14,000.
§ Mr. Wayne David (Caerphilly)
Does the hon. Gentleman therefore welcome the fact that the National Assembly Government have already publicly announced an extra allocation of £550,000 for the enhanced role of CHCs in Wales?
§ Lembit Öpik
Indeed, that shows that we are quite close to the estimate within the research document.
The Bill has attracted an encouraging degree of consensus in the Chamber, because much of it has been fashioned on a cross-party basis. Crucially, it has been fashioned with outcomes in mind. The proof of the pudding will be in how it is implemented but in my judgment this is an evolutionary step. Those who were in favour of devolution wanted the Assembly to have greater autonomy in defining how the many different elements of health were provided in Wales.
One of the Bill's crucial elements is the Wales Centre for Health. If it is handled correctly, it could provide a powerful strategic drive to the work and thinking of the Assembly in defining what the Secretary of State said he wanted: a health service specifically tailored to Wales. He mentioned plans for thousands of extra nurses and hundreds of other staff in the health service in Wales, which is to be welcomed. It is a credit to the Welsh Liberal Democrat-led coalition with Labour in the Cardiff Assembly that so much has been achieved.
§ Mr. Jones
If the Liberal Democrats claim so much credit for leading the Welsh Assembly on so much, why is it that the Welsh Assembly intends to renege on a commitment to rebuild Cardiff royal infirmary in my constituency and that of the former deputy leader of the Welsh Assembly, Jenny Randerson? Although Ms Randerson, the Member for Cardiff, Central in the Assembly, has condemned that decision, she apparently is powerless to do anything about it. The Liberal Democrats cannot have it both ways.
§ Lembit Öpik
I shall save you the bother, Mr. Deputy Speaker, of ruling me out of order for attempting to reply to that intervention. I will be happy to discuss that matter with the hon. Gentleman later. I assure him that, as the Secretary of State said—I think that it was a sincerely held point, made in the spirit of the debate—there are still lots of problems in the health service in Wales.
373 To be a little more serious about the coalition, what is interesting is that the Welsh Liberal Democrat-Labour coalition is working hard to achieve the consensus out of which this Bill has been born. What is even more interesting is that there has been constructive input on the Bill from four parties. As I have said—I will not dwell on it particularly—the kind of new politics that we promised a few years ago when we were campaigning for a Welsh Assembly has probably led to a Bill of this sort coming before us now. I am greatly encouraged by that.
There is one risk associated with the Wales Centre for Health. If, in working and offering guidance to the Welsh Assembly, it becomes the strategic driving force that I believe it can be, it is likely that there will be increasing divergence between what happens in Westminster for the English health service and what happens in Wales. That would be a healthy development for Wales but I imagine that it could cause strains between what we discuss here for England and what is discussed in the Assembly for Wales. I hope that the potential resistance of the Government in Westminster, who could be uncomfortable about the guidance given by the centre, will not come about.
For that part of the Bill to work, there must be some tolerance in terms of the divergence, which could put a strain on other health-related debates here. There must be an acceptance that we are trying to find, to use the sort of language that the Secretary of State used before he left the Chamber, Welsh solutions to Welsh health issues.
If the Wales Centre for Health does its job well enough, current best practice could be imported from Wales to England. Again, it requires a new kind of politics, enabling Ministers to take the opportunity, without loss of face, to look at the devolved institutions and to say that the Westminster Government can learn something useful from what has happened elsewhere.
The issue of foundation hospitals and whether they should have been included in the Bill is a good example of divergence. I am not convinced by some of the statements by the Government for England with regard to health provision. I agree with what the hon. Member for Ribble Valley said about divergence.
The Government's language on the health service now seems to include creeping terminology about failing institutions. That sort of psychology has done a lot of damage in the education sector. The Bill may help to protect us from the same danger creeping into Wales.
Certain specific points relate to cardiac and orthopaedic services. While I am very happy with the service that I and my mother, who has had various health problems, have received, again, the strategic approach that the Wales Centre for Health and the community health councils could provide across Wales could deal with the issues that we are all concerned about. Waiting lists concern me—I think that they concern us all—but by working together we can perhaps get those down.
I was heartened by the fact that the Conservatives have travelled around various parts of Europe to see best practice. It is ironic that they are so pro Europe in that respect but not quite so keen on other aspects of harmonisation.
On the question whether the Bill can save money, we need to be honest. It is very difficult to save money in the health service because, ultimately, when people feel 374 better, they live longer. The quality of life improves but the health bill does not reduce. The NHS was originally set up in the belief that it would save money for the Government by reducing illness. It has improved life expectancy and the quality of life of individuals but that has come with a large price tag, not least because technology costs a lot more. Often, technology costs increase at a higher rate than the underlying inflation rate in the health service. This is not the place to discuss that but we should not pretend to anyone that by supporting and passing the Bill anyone will save a significant amount of money in the health service.
The hon. Member for Cardiff, Central (Mr. Jones) said, with insight, that he did not believe Labour would always be in power. How right he is. He knows that the Liberal Democrat Government are just round the corner and already operating effectively in Wales.
§ Lembit Öpik
That was quite good.
Since we intend to govern responsibly, we need to pave the way now so that we do not have to pick up problems.
On other key points, we need to understand exactly the role of the community health councils. That is fairly clearly laid out in the document but there is a side issue about boundaries and co-terminosity. Kirsty Williams, the Welsh Liberal Democrat Assembly Member, who has done a lot of work to help to construct a modern health service in Wales, has pointed out that, although we should respect natural boundaries for local authorities, there may be occasions when having more than one community health council will be effective in the Wales environment. Being parochial for a moment, Powys, for example, has two community health councils; one would be unmanageably big and it probably would not be reasonable to expect one individual community health council to do the work.
Many of the figures cited have come from independent advocacy services. A rough figure of £500,000 has been mentioned, but we must be careful to recognise that the costs are estimates and while those estimates sound okay, it would be a great shame if the intention of the Bill were thwarted by the fact that the community health councils did not have the necessary resources. Even £1 million is not a huge proportion of the Welsh health budget. We back the principles in the Bill, based on an acceptance of flexibility. We should work reasonably with the Assembly, ensuring that it does not end up in an impossible position by trying to fund something from its existing budget that is unfundable, given that it is primarily a Welsh Assembly responsibility.
It may sound like a detail but it was suggested by the Select Committee on Welsh Affairs that prisons be transferred into the ambit of the Bill. Hon. Members will correct me if I am wrong, but I do not believe that that has been done. I think that it is unfinished business. It would be strategically more sensible to do that now, rather than to return to it in future.
The next steps are fairly clear. We will need a constructive Committee stage but, as has been noted, it is likely that our proceedings will be relatively uncontroversial, as many big issues have been resolved. However, various amendments will have to be tabled.
375 The Welsh Liberal Democrats in particular will want to deal with matters that might fall outside the Bill. We have talked about free, long-term personal care for many reasons. Lloyd George said that the measure of a civilised society is how it treats its elderly. My hon. Friend the Member for Sutton and Cheam (Mr. Burstow) has worked in that sector, and has suggested that tomorrow's debate on community care might be a better opportunity to discuss legislation to achieve that goal. However, I raise the point now as these matters are interrelated.
Much research suggests that the introduction of free dental and eye tests—
§ Lembit Öpik
I apologise, Mr. Deputy Speaker, if I was deviating. I recognise that, to include provision such as free dental and eye tests, the long title of the Bill would have to be changed. That is unlikely to happen in Standing Committee, but it is ironic that the matters to which I have referred could come back to the Floor of the House for discussion, given the advice that I imagine that the Wales Centre for Health will come up with once it is established.
The constructive debate tonight has been encouraging, and I think that the Standing Committee deliberations will be constructive too. I hope to hear the useful and ever friendly criticisms from Tory Members.
§ Mr. Evans
Earlier, the hon. Gentleman mentioned orthopaedics, for which waiting lists are way above the 72-week target. Does the hon. Gentleman consider that a useful role for CHCs could be the production of annual reports detailing the views of patients in each area? That would highlight where the real problems are, and thus enable a focus on solutions to reduce waiting lists.
§ Lembit Öpik
That sounds like the sensible sort of role envisaged in the Bill. I am concerned about tying CHCs into too much repeating bureaucracy, as I believe that they will operate best on an ongoing and proactive basis. They should identify and deal with local issues, without having to go through an eternal cycle of preparing reports. However, that is an important matter for consideration in Committee.
Another such matter is whether CHCs should be authorised to go into private health providers, even when there are no NHS patients in them. There is no point in rehearsing the various principles at stake, but I hope that we can discuss the possibility. More encouraging is the way in which the CHCs will have pretty wide powers to investigate the general quality of provision. If we work on the basis of success rather than failure, the CHCs could be critical friends for the institutions that they inspect.
I hope that a reasoned debate in Committee will help build relations between Westminster and Cardiff. After a slow start, that relationship is fast improving. It could also help create a healthier health service. If that leads to a healthier Wales, it would be a credit to the Bill and all those involved in it.
§ Huw Irranca-Davies (Ogmore)
I am pleased to contribute to this debate, as I was when the Bill was discussed in the Welsh Grand Committee in the summer. I have read the extensive work done by the Select Committee on Welsh Affairs on the Bill, and I pay tribute to that.
The Bill is a modest but important step towards increasing joint scrutiny of draft legislation by the National Assembly for Wales and this House. Such parallel scrutiny sets a good precedent, and I am glad that the Government are committed to ensuring that more Bills are handled in that way.
The diversity to which devolution has led is relevant to the Bill. For those who, like me, are powerful supporters of devolution, it is a recognition that different solutions may apply in England and Wales, and that there may be learning experiences to be derived from both. That is to be celebrated, not scorned. We are aiming to secure good health care provision for all communities on either side of the border. If a different approach is adopted in Wales, so be it: results are what matter.
The Bill will establish the Wales Centre for Health, which will gather and disseminate information on health provision in Wales. That is a vital and long overdue function. The Assembly has made great strides in that direction already, especially in recognising the problems of prevention as well as repair when it comes to health. A great tragedy of many Welsh communities—especially where there are high indices of multiple deprivation—is that chronic and long-term health problems are exacerbated by poor housing, low aspirations and so on. That is something to which the Wales Centre for Health can turn its attention and for which it can work proactively to find solutions.
I also welcome the proposed centre's ability to undertake and commission research. It is right that, under the devolution settlement, that research should be passed down to the Wales Centre for Health. The centre will look at where research is needed, seek solutions and put forward proposals, instead of everything being steered by Westminster. That shows a level of trust in the Assembly and the process of joint scrutiny. The centre will also provide Welsh solutions in matters such as the development and provision of training in the health sector, and that is to be greatly welcomed.
The Welsh Centre for Health will face great challenges. In many of our communities, health problems are huge, long-term and entrenched. In Bro Morgannwyg, for example, heart disease affects more than 20 per cent. of the community. The figures for respiratory diseases, asthma and arthritis are 25 per cent., 12 per cent. and 26 per cent., respectively. Mental illness, the constant Cinderella of health care, affects 13.7 per cent. of the people in my area.
The Welsh focus that a Welsh Centre for Health will provide can really tackle such problems, by developing research and making good proposals that tackle local needs.
The hon. Gentleman makes a good point. That is exactly the sort of problem that the Welsh Centre for Health can tackle. However, we must be realistic. As has been noted already, once a problem has been identified, the necessary resources must be made available to ensure that it is rectified. We are committed to putting in the necessary resources. I share the hon. Gentleman's anxiety about the problem that he identified. It needs to be tackled, but that can happen only when effective resources are made available.
There are major lifestyle problems in Wales. It would be a failure not to accept that. In Bro Morgannwyg, 32 per cent. of the population are heavy smokers, and 21.3 per cent. consume more than the recommended levels of alcohol. Only a quarter of the population undertake regular exercise, and 53.8 per cent. of people are overweight or obese. Those are staggering figures. This Bill, which has been worked out jointly, gives us a chance to identify and tackle the problems involved.
§ Hywel Williams (Caernarfon)
Would the hon. Gentleman have welcomed a provision banning smoking in public places?
§ Huw Irranca-Davies
I certainly think the issue should be tackled. I was going to mention a report that came out recently, of which the hon. Gentleman may know. It examines the regularity of drug use by youngsters, comparing that with the way in which alcohol has already entrenched itself in our societies.
My hon. Friend the Member for Vale of Clwyd (Chris Ruane) mentioned research on a ward-by-ward basis. The WCH should consider that. I am thinking of the way in which the "communities first" analysis was carried out, and the way in which we have looked at communities in terms of multiple deprivation. We should consider wards as well as the bigger county, borough and health authority areas. We need to pinpoint the evidence that will enable us to tackle some of the problems.
§ Julie Morgan (Cardiff, North)
Is my hon. Friend aware of the Townsend report, produced by the Welsh Assembly? It gives details of inequalities in health authority areas.
§ Huw Irranca-Davies
I know of the report, and I think that we should adopt the same approach. It is no good simply looking at one area. My constituency contains areas of relative prosperity and good health, but the picture is different when it is broken down into not just individual towns and villages, but parts of those towns and villages. The contrasts are stark. I hope the WCH will extend the Townsend approach.
Brynawel house, an institution funded by charitable donations, is the only residential completely "dry" house in Wales that will tackle drug and alcohol abuse. It is the only institution with a policy forbidding any consumption of alcohol or drugs, and it is in my constituency. I suspect that the WCH will also increasingly consider that approach. How can Welsh solutions deal with such problems?
378 I have mentioned lifestyle problems. We should adopt a more innovative attitude to issues such as GP referrals and exercise on prescription. Not everyone wants to trot along to the leisure centre rather than being prescribed a bottle of pills, but exercise is not only good for physical health; time and again, it has been shown to have an impact on mental health. I have quoted some worrying figures in that context. We should end reliance on drugs, and turn to prescriptions that tackle lifestyle issues.
We need to get the balance right between repair and prevention. The Assembly is already starting to lead the way in devoting resources and talents to the prevention of illness rather than NHS repair costs.
Health Professions Wales should be broadly welcomed. I expect it to have an impact on standards of nursing, midwifery and radiography. I should declare an interest: my wife works as a radiographer. I see colleagues representing mid-Wales constituencies on the Opposition Benches. They will have their own constituency problems relating to midwifery provision in remote rural communities that are some distance from district general hospitals. Unique circumstances require different solutions.
I want to ask some questions. I am concerned about overall standards, particularly in regard to recruitment from overseas. I was pleased with what I took to be an Opposition welcome for the current recruitment, and a wish for the problems to be eased along with maintaining the appropriate standards. HPW could have a major input. I recently went to Madrid with a number of colleagues, and observed some very good schemes enabling British hospitals to recruit well-trained Spanish nurses directly. The problem is ensuring that they meet our standards and deal with our problems as quickly as possible. One of our problems, of course, is the number of vacancies that we cannot fill. As an Opposition Member pointed out in the Welsh Grand Committee, that reflects the investment that we are making; but we must fill those vacancies.
§ Mr. Evans
I welcomed the fact that the vacancies were being filled, but was alarmed by the fact that there were still 750 in Wales.
Perhaps HPW should also consider the problem of retaining nurses. When I discussed it with the Royal College of Nursing, I was disturbed to learn that so many people, after three years of training, ended up earning £15.000 a year as staff nurses when they could earn more as managers in McDonalds.
§ Huw Irranca-Davies
I do not think that the long-term solution to the staff shortages that exist in many areas is recruitment from overseas, although it may be part of the solution. You are right: we need to develop in-house training, and the Spanish example I gave is relevant here. Those people were experiencing the reverse of our circumstances. They invested for a long time, and now have a glut of staff. Oh that we were in that position! Anyway, you are right. We must look at retention, training—
§ Mr. Deputy Speaker
Order. May I remind the hon. Gentleman to use the correct parliamentary language?
§ Huw Irranca-Davies
Thank you, Mr. Deputy Speaker. I am still learning on my feet, as it were.
379 The same approach by HPW might help us to deal with the shortages of NHS dentists, and, amazingly, with the shortages of GPs. In Pencoed in my constituency, which has a large population, it is impossible to recruit more than one GP per surgery rather than the four who are needed. That seems absurd, given that the area is part of the M4 corridor. HPW could play a pivotal role in pinpointing shortages and trying to deal with them.
Let me say something about community health councils. I am glad that local patients and other local people are to be given a democratic voice. I do not agree that the proposals will lead to confusion; I strongly suspect that people will know exactly where to turn.
My hon. Friend the Member for Clwyd, South (Mr. Jones) mentioned time off for public bodies. I hope that the Government will clarify that in their response to the Committee. They have already saidFurther consideration will be given to approaching the relevant Secretary of State to make an orderwhich would extend the power, but I should like more clarification. We must not discourage people from becoming members of CHCs by failing to give them enough time off. I think that the Government have a will to make the system work.
I acknowledge the extension of powers allowing CHCs to inspect local authority premises, primary care premises and, to a degree, nursing homes, but I want to know why that does not apply to prisons and young offenders' units. As I said in the Committee, that would not replace lay visits, but it would constitute a welcome extension of medical expertise and of patients' rights.
I want to say a little about cross-border co-operation—crossing Offa's dyke, if you will. The Government have said that no review is necessary and have given their opinion, but are they adamant that their proposals will work? I am not in the same position as the hon. Member for Montgomeryshire (Lembit Öpik) and his neighbour in Powys, the hon. Member for Vale of Clwyd, but constituents of mine certainly travel not to Bristol but all the way to Hammersmith for cardiac surgery. So it is a matter of concern, and I seek the Government's reassurance that what they said in response to the Committee's recommendations will work.
§ Mr. Roger Williams
The hon. Gentleman raises the interesting point of people accessing district general hospitals outside their CHC area. We have experienced differential waiting lists, with people in Wales having to wait longer for treatment for the same condition than people in England. We believe that CHCs could play a vital part in resolving that problem.
§ Huw Irranca-Davies
I welcome those comments. I am sure that the Minister is listening avidly and hope that he will give a suitable response that reassures the hon. Gentleman.
I welcome the schedule 7A changes on CHCs which allow the National Assembly for Wales to determine the membership regulations. I do not agree that that will mean that the CHCs are hidebound by what the 380 Assembly tells them. The Assembly is setting the rules by which they work, but the CHCs have great independence within those: they will make their own representations and investigations; they will represent the views of their patients and committee, as opposed to saying what the Assembly tells them to say. There have to be some rules and regulations, but the CHCs still have a great deal of independence.
In conclusion, I welcome the Bill, not only in terms of the beneficial impact that it will have for health provision in Wales but for the precedent that it sets for co-operative working between the Assembly, Westminster and other partners.
§ Mr. Bill Wiggin (Leominster)
I begin by paying tribute to the Chairman of the Welsh Affairs Committee who has guided us through the proceedings on the Bill so far with great skill and diplomacy.
I am sorry that the Government's response to the Committee's proposals have been less positive about the CHCs than other issues. On time off, for example, the Government stated that it could be done by order—which is not in dispute—but that does not mean that it can be done only by order, as might happen under the Bill. The Government's reply on coterminosity seemed to address the case against exact coterminosity, which the Committee did not recommend. Instead, it recommended a statutory duty to have regard to the local health board and other boundaries that could readily be achieved.
The Government's reply regarding other bodies states simply that the current proposals strike the right balance. The Committee did not suggest that they did not, but that the National Assembly for Wales should he empowered to extend CHC remits if it wished to in the future rather than have to return to Westminster to seek such powers.
The Government agreed to the Committee's recommendations on clarity—what it called thearcane language in sub-paragraphs (g) and (h)".However, that remains.
The Committee wanted to ensure that the National Assembly would be free to allow CHCs to commission others to carry out the independent advocacy services. The Government's reply does not make it clear whether the Bill allows that, or whether they wish it to do so. The Government agreed to review the terms of the schedule to ensure that the Association of Welsh Community Health Councils provided a system for CHCs to report to the AWCHC, but not to limit the functions that the Assembly could give the AWCHC. Again, nothing seems to have changed.
The Government accepted the principal point that the independence of the Wales Centre for Health should be more apparent on the face of the Bill, although no equivalent to the Food Standards Agency was suggested. The bald power of the Assembly to direct the WCH has been replaced in paragraphs 6 and 7 of schedule 2, which allows the National Assembly to give directions where it believes that there has been a serious failure by the WCH to perform any function that it considers should have been performed. That presumably applies to things that have not been done rather than those that have been done, but the distinction may be unclear.
381 Finally, the Government seem to have accepted the thrust of the Committee's concern that the ambit of Health Professions Wales should not be allowed to spread. However, clause 4(2) and (3) does not make it clear whether the functions to be confirmed by the Assembly order are to be restricted to health care staff. I will come to possible amendments at the appropriate stage. By and large, the Bill is benign, but one or two amendments on these subjects in line with the Committee's recommendations might be helpful.
The Bill could have addressed the excessive bureaucracy involved in the reform of the NHS in Wales. I have heard it said that Wales will have the most bureaucratic health service in western Europe. In addition, an NHS Confederation survey found that 80 per cent. of NHS managers did not believe that the Government's reforms of the Welsh health system would work. Nick Bourne, the leader of the Conservative party in the Welsh Assembly, in his speech entitled "Making Life Better in Wales" said that we should be reducing the unnecessary layers of bureaucracy building up in our health service.
To some extent, the Bill defeats the purpose of the national health service, which is supposed to be a nationwide public service. For example, Amicus, a manufacturing trade union, is of the firm belief thatprofessional standards should be centrally determined to ensure that the standard of healthcare provision is of the same quality across the whole of the UK.The Bill gives authoritarian and highly centralised powers to the National Assembly for Wales to abolish or alter the CHCs, to abolish or assume the functions of the Wales Centre for Health as well as to appoint its members and chairman, and to abolish Health Professions Wales. That is a great shame.
In the Queen's Speech of June 2001, allusions were made to legislation that would decentralise power and direct resources to NHS staff. Such National Assembly authoritarianism centralises powers and allows for measures of uncertainty and unpredictability in the Welsh health system. In addition, questions have been raised about the degree of independence from the National Assembly enjoyed by the Wales Centre for Health and Health Professions Wales. The Royal College of Nursing questions HPW's independence from the Assembly. We believe that the National Assembly should restrict itself to setting strategic objectives for the NHS, which would be more helpful.
The Bill further illustrates the authoritarian and centralised powers of the Assembly with regard to its powers over the CHCs. Proposed schedule 7A gives the Assembly powers to make regulations concerning CHCs' proceedings, staff, premises, expenses, the discharge of functions of a council by a committee and the appointment of persons who are not members of the council to such committees.
§ Lembit Öpik
Does the hon. Gentleman accept that that is less centralised than having all those decisions made at Westminster in the sense that the Assembly is closer to the people being served by the health service in Wales, which is one of the Bill's intentions?
§ Mr. Wiggin
The hon. Gentleman makes a useful point, but the Bill's wording does not achieve that.
382 I should like to welcome the retention of the CHCs and the close link between the public and health service, but some of the Bill's wording is more authoritarian than it need be.
It is regrettable that the Bill does not make provision for the creation of foundation hospitals. Another opportunity missed is that there is no provision for the creation or construction of a much needed children's hospital in Wales. I am sure that right hon. and hon. Members on both sides of the House would like to see that.
§ Julie Morgan
Is the hon. Gentleman aware that a children's hospital is going ahead in the University Hospital of Wales in my constituency and that the Assembly has given it considerable funding?
§ Mr. Wiggin
I was not aware of that—[Interruption.] I think that I heard one hon. Member say "Obviously not" from a sedentary position. I am delighted to hear that progress is being made, however, and perhaps at a later date the hon. Lady might fill me in on why all the money has not been forthcoming.
We would have liked the Bill to include more powers for CHCs to provide patient support services, perhaps by making patient support officers employees of the CHCs. Another of my concerns is the representation of Welsh patients receiving treatment in England, which the hon. Member for Ogmore (Huw Irranca-Davies) mentioned. In Hereford hospital, next to my constituency, at least 10 per cent., and sometimes as many as 15 per cent. of the patients are Welsh. As there are shortages of funding for Welsh patients seeking treatment in England, and as waiting lists are so long in Wales, it may be necessary for Welsh patients to keep crossing the border to be treated in England, so funding must be provided.
The Bill contains no provision for the use of the private or independent sector in reforming the NHS in Wales, or for the use of the private finance initiative, for example. Private and independent sector involvement might be used—and might be needed—to address such problems as the funding of Welsh patients seeking care in England, reducing waiting lists, dealing with the care home crisis, the problem of delayed discharges and reducing GP shortages.
Another major criticism of the Bill is that it fails to address the real crises and issues in the Welsh health service that affect ordinary patients. Assembly Member David Melding said on 18 July 2002 thatthe draft Bill is substantially different to that anticipated in June 2001 and much reduced in scope.Among the problems that the Bill fails to address are waiting lists for both in-patients and out-patients, which increased dramatically between 31 March 1997 and 30 September 2002: in-patients by 7.1 per cent. and outpatients by 135.1 per cent. In that regard, the Government may have broken their manifesto pledge. Before the 1999 Welsh Assembly elections, they said that no one would wait more than 18 months for inpatient treatment. Given that 4,335 people have been on that waiting list for more than 18 months—1,810 people more than when the original pledge was made—it sounds as if they have broken that pledge.
383 Another promise that has been broken is that regarding out-patient waiting lists. The Labour party said that, by the end of its first term in the Assembly, no one would wait more than six months for out-patient treatment. However, more than 83,443 people are now waiting six months or more for out-patient treatment, compared with 25,676 in May 1999. Indeed, the South Wales Evening Post ran a story on unacceptable waiting lists for patients with regard to ear, nose and throat treatment. Adults needing nasal surgery will have to wait for between nine and 70 weeks—
§ Mr. Deputy Speaker
Order. The hon. Gentleman is straying a little from the Bill. I know that he is talking about what is not in the Bill, but he should address his remarks specifically to the Bill.
§ Mr. Wiggin
Rather than focusing on reforming bureaucratic elements of the Welsh health service, the Bill will perhaps have less direct benefit to patients than I would have hoped. It is true that we are not overtly critical of the substance of the Bill, but it would have been better had some of the failures—on which I should have liked to continue—in relation to some of the promises made by the Government to patients in Wales been aired.
§ Huw Irranca-Davies
Does the hon. Gentleman agree that one aspect of the Bill might not only look at the failures but at things that have worked, to promote best practice, in which CHCs would have a role? For instance, in Bro Morgannwg, the number of nursing and dental staff has increased and administration has been reduced.
§ Mr. Wiggin
That sounds very positive, and I agree with the hon. Gentleman. By and large, we all want the same thing from the Bill—better care for patients. We have to identify the best way of going forward. Some of the proposals are exceptionally positive. Having sat through the Select Committee's review of what the Bill was going to contain, the hon. Gentleman will know that I have been very supportive. It would have been better, however, had one or two of the items on which I touched in my speech been included. A Conservative Assembly Member argued that for devolution to be meaningful, major reform in the public services for Wales should be achieved in Wales-only Bills. Much of the content of this Bill should therefore have been included in the National Health Service Reform and Health Care Professions Act 2002 applying to Wales. The extra part of the Bill should not have been necessary.
The Bill's intention is to reform patient services in the Welsh health service, but it fails to address some of the most important issues to patients in Wales, such as GP shortages and massive waiting lists. By and large, however, the Bill is well-intentioned, and I am grateful that I was able to sit on the Welsh Affairs Committee.
§ Mr. Jon Owen Jones (Cardiff, Central)
The Bill has already been described as benign, modest and consensual. I agree with all those adjectives, which is why I must disagree with the conclusions of the Select Committee Chairman, who has unfortunately just left his place. Early in his speech, he suggested that the Second Reading debate on this Bill, and on other Bills, could be curtailed. It is dangerous to generalise from the particular. It is probably true that this Bill could be speeded through the House, as could any consensual Bill, but it does not follow that simply because this Bill is one with which we largely agree, any Bill introduced through this procedure would command similar levels of agreement. I would therefore caution against the Government taking the Select Committee Chairman's word that the House agrees with rushing through all such Wales Bills.
The philosophy that appears to be emerging in the provision of health care in Wales, as compared with the provision of health care in England, seems something of a diversion in terms of how patient empowerment is to take place. I am sure that all Members will say that they want patients to be given more power over their health care needs. It does not follow, however, that that goal can be achieved in only one way.
This Bill and other proposals made in the Welsh Assembly attempt to empower patients by creating committees—in this case, community health councils—that are as representative as possible to give patients greater power. I interpret what is happening in England as an attempt to give patients more power to choose their health care by giving hospitals greater independence, and by giving patients greater opportunity to choose where they seek their health care. There are arguments to be made in favour of both systems—I put it no more strongly than that, as I am being loyal—but we must try to make sure that both systems work as well as possible.
I am in favour of community health councils being made as independent as possible in Wales, because their role in Wales will be extremely important in ensuring that patients are given health care that is adequate to their needs and what they desire, and because it should be seen to be independent of the role of Government. I therefore approve of the measures in the Bill, and I might wish to strengthen them to give independence to the community health councils.
I would like the CHCs to be given possibly greater powers than those provided in the Bill. We need to do more than simply look forward to the role that they should have in relation to what used to be available. Tomorrow, the House will debate a Bill for England and Wales that deals with delayed discharges and the problem of bed blocking. CHCs exist in Wales, but not in England, and they could be given an important role in determining what constitutes bed blocking and whether beds have unnecessarily been taken up by people who should be discharged from acute hospitals. They could also determine at what point charges should be laid on local government to pay for the beds that are being occupied.
That issue is extremely important in Wales, and more important there than it is in England. On any one day in England, 5,000 beds are taken up inappropriately because social care cannot, for one reason or another, 385 be provided. On any one day in Wales, 806 beds are taken up. I calculate that, per capita, the problem is at least two to three times worse in Wales than in it is England. That fact alone explains in large part why waiting lists figures in Wales are so much worse than they are in England.
§ Lembit Öpik
Does the hon. Gentleman agree that CHCs will be able to make a positive impact on the difficulties that he has rightly described if, and only if, there is a degree of homogenisation and shared responsibility between local authority budgets and health budgets?
§ Mr. Jones
In effect, the Bill dealing with delayed discharges will do that. When people are lying in bed in a hospital, their care is being paid for from the health service budget. When they are lying in bed in a nursing home or a community home, their care is being paid for by the local authority budget. There is a vested interest—I put it no higher than that—for local authorities to be not too quick in moving someone out of a bed for which they do not pay and into one for which they pay. The delayed discharges Bill will allow the budget to be transferred if the bed is used for social service rather than acute health care reasons.
§ Julie Morgan
Does my hon. Friend agree that the mechanisms for dealing with this problem have already been set up by the Welsh Assembly in the partnership arrangement that has been created between local authorities and health bodies, which looks to solving the problem jointly rather than to considering penalties on one or other of the bodies?
§ Mr. Jones
I do not agree. I hope that that might happen, but we must accept that, if the partnership agreement had been effective, it would already hopefully have had some effect. I have already explained that the position in Wales is two to three times worse than in England—so it appears that, so far at least, partnership has not delivered. It may deliver in the future, but the legislation for England and Wales will enable provision to be made on both sides of the Severn.
§ Julie Morgan
I agree with my hon. Friend that the Bill coming before the House tomorrow will enable the Welsh Assembly to take advantage of what exists. However, the Assembly and local authorities have not been working in partnership for long enough to enable us to judge whether we should penalise local authorities when beds are blocked. Enough time has not yet been spent on the partnership solution.
§ Mr. Jones
I agree that we should all live in hope to some extent. The provisions will be there in case hope is 386 insufficient, but they are important. The CHCs will also have a valuable role, especially if my hon. Friend the Member for Cardiff, North (Julie Morgan), who may be well informed about the view of the Welsh Assembly, is correct. If Wales and England take a different view of delayed discharges and if delayed discharges are not penalised in Wales, the CHCs will have a particular role to play. I can imagine the interesting and difficult issues that will need to be sorted out if the Welsh Assembly chooses not to invoke the procedure. An English hospital, such as that in Shrewsbury, which treats many patients from mid-Wales, will be able to charge local authorities in Powys and Montgomeryshire, while a Welsh hospital such as the Royal Gwent will be unable to charge English local authorities such as Gloucestershire for delayed discharge. CHCs will have much explaining to do to their patients about why such a position has arisen.
I welcome the role that the CHCs will play. I look to them to be as independent as possible and to take on new powers as they become available in the legislative programme before us for the rest of this Session. I hope that the CHCs will be able to ensure that there is the patient empowerment that we all want and that they will do such a good job that Welsh patients will not feel the need for choices that may be available in England but not in Wales.
§ Hywel Williams (Caernarfon)
We are having an interesting and constructive debate. I commend the remarks of the hon. Member for Cardiff, Central (Mr. Jones) and his support for the CHCs. I also commend the remarks of the hon. Member for Ogmore (Huw Irranca-Davies) about the effect of mental ill health and the relative neglect that that subject has received.
Referring to the Bill in his press release for the Queen's Speech, the Secretary of State said:Patient power will be our watchword in the future.Patient power—or rather patient power, carer power and community power—has for many years been the watchword of the most progressive elements in the health service, but they have often been frustrated by the centralisation and hierarchical structure of the system and by the strongly hierarchical nature of medical power.
There is a glaring and long-standing need to reduce health inequalities in Wales. As page 9 of the recent Welsh Assembly document "Well Being in Wales" notes:Average life expectancy in some parts of Wales is five years less than in others".That is a startling geographical difference. The document goes on to state that there are marked differences between different social groups. We have known about those class differences for many years and they have often been neglected. Discussion about them has sometimes been thwarted, as notoriously happened under the tenure of the right hon. Member for Wokingham (Mr. Redwood) when he served in the Conservative Government.
A cross-cutting approach is sorely needed in Wales. It needs to consider poverty, housing and other issues, such as smoking and the consumption of alcohol. I hope 387 that the Bill will help to expose those differences and to keep them in the minds of people who make and implement policy, irrespective of the long waiting lists and the lack of dental treatment that other hon. Members have mentioned.
It has been said that the Bill is largely uncontroversial. Even the House of Commons Library research paper says that. Some hon. Members will recall King Vidor's 1938 film "The Citadel". I am sure the previous Secretary of State will. In that film, part of the answer to a public health problem was the selective use of high explosives. The Bill may be largely uncontroversial, but the proper implementation of patient, carer and community power is the metaphorical high explosive we need to attack the historical inequalities of health in our country and to provide Wales with the world-class health service that the Secretary of State says it is his ambition to achieve.
Patient power has to be enabled. We will look for a practical demonstration of the growth of that following the implementation of the Bill and other measures. We welcome the provisions that will extend the roles of CHCs to the primary sector and nursing homes. That will provide a statutory basis for the patient advocacy service and will establish a Welsh body for CHCs. We welcome the intention to create the Wales Centre for Health, which will provide public health advice, research and training support, and Health Professions Wales, which will discharge the Assembly's functions on the education and training of health care professionals and health care support workers. We also welcome the education and training functions of the Nursing and Midwifery Council and the Health Professions Council in Wales. All that is to the good.
We hoped that the Bill would contain other proposals, such as the banning of smoking in public places, which would have made a substantial contribution to the improvement of public health. I was glad to hear the hon. Member for Ogmore agree with that. We were also keen for the Bill to contain provisions on free personal care for older people, which would create a simpler and more coherent structure, to say the least.
However, we welcome the Bill as a specific Welsh Bill, with its process of discussion and scrutiny in both Cardiff and the Welsh Affairs Committee. We look to the fulfilment of the Assembly's pledge to provide draft regulations by the Standing Committee stage. We trust that that entire process will demonstrate clearly that the representatives of the people of Wales are well able to handle the legislative affairs of our country.
On the particular proposals for CHCs, we are very supportive of the retention and strengthening of CHCs in Wales. We are glad that that course has been taken for our country—as glad as some hon. Members from England are envious of us and unhappy about the course set for their CHCs. The CHCs will hopefully be independent of vested interests, which relates to a point made by the hon. Member for Cardiff, Central (Mr. Jones). That is essential. We trust that the independence will not be diluted by the proposed changes in the organisation of CHC membership.
388 I know from the case of my own CHC in North Gwynedd that the local authority representatives are wholly committed and valuable members. Perhaps they will join the CHC by other means. However, in rural and dispersed areas there is a limited number of such individuals. We cannot afford to ignore those public-spirited and committed people. The hon. Member for Clwyd, South (Mr. Jones) referred to the importance of taking time off work. I agree entirely.
The extension of CHCs' role to the primary sector and to nursing homes is welcome. Clearly, CHC visits to NHS premises where care is being provided will be a valuable addition to the important professional inspection. We will look with interest at the draft regulations produced by the Welsh Assembly Government for the Report Stage on matters such as unannounced visits, but obviously those are to be welcomed as a development of patient and carer power. I do not share the concern expressed by the hon. Member for Ribble Valley (Mr. Evans) on the Assembly's power to draft the regulations and the powers given to it throughout the Bill. Irrespective of the value or virtue—or otherwise—of the Labour-Liberal pact in Cardiff, we are happy for those decisions to be taken in Wales.
Hon. Members have mentioned the fact that some Welsh patients receive their care in England. The names Gobowen, Christie, Alder Hey and Clatterbridge are familiar to patients from north Wales and their carers, who are also familiar with the high standard of care provided by those institutions and the difficulties that arise from accessing care in them. Only the other day I was made aware of a case in which a referral of a child from a specialist unit at Alder Hey to a local hospital for occupational therapy was refused because the list was closed, not because it was long. CHCs should have information about care from establishments over the border so that they can perform their duties well.
A particular concern is the availability in English establishments of people who can speak Welsh, especially in cases that involve children, people with chronic conditions or brain injury, and the terminally ill. We particularly welcome the proposed statutory basis for the role of CHCs as patient advocates. Some CHCs already have a discrete patient advocacy service, but others do not. The welcome extra funding announced the other day will be used in my area to employ a patient advocate for the first time. I hope that that will lead to a substantial improvement in the service provided.
I particularly look to the work that I expect the CHCs to undertake as part of patient advocacy to push for the extension and development of services through the medium of Welsh—and, for that matter, through the medium of languages other than Welsh and English—in our locality and throughout Wales. The establishment of proper and good communication between the patient and the health care worker is essential, and that means that communication needs to take place in all the languages used widely in Wales.
If patient power is to mean just that, there must be a sustained effort over an extended period to recruit people with the appropriate language skills. Being able to converse with patients in the language that they find most congenial is a core skill for some staff in some areas and for the majority of staff in others, especially if the patient is young or elderly or has suffered a stroke or 389 brain injury. I know that some hon. Members have family experiences of the health service's deficiencies in that respect, and I trust that they will support the CHCs in pressing for change, as I sincerely hope the CHCs will do.
The establishment of a national body for CHCs has been welcomed by the CHC representatives whom I consulted before the debate. The relationship with individual CHCs in respect of the performance management function will have to be approached in a supportive manner, and I understand that that is the standpoint of the new body. I note from the research brief that the Welsh Affairs Committee called for greater clarity as to how the new body's powers would be strengthened, and that the Government agreed that the wording of the schedule would be reviewed, but no change has resulted. Clearly the House may turn to that topic on Report.
On a lighter note, I understand that the body is to be known as the Association of Welsh Community Health Councils, or AWCHC, an acronym already used by an hon. Member on these Benches. The health world is blessed with many and varied acronyms, which exclude and sometimes confuse even those who are used to them, let alone the patients. I had a brief look at the back of the report by the Welsh Affairs Committee, and saw the WCCPH, or Welsh Combined Centres for Public Health, the WCH, or Wales Centre for Health, and the ATM, After Today Management. I always thought that ATM stood for automated transaction machine.
May I suggest, therefore, that the Welsh title of the new body is to be preferred, in acronym form at least, in that it yields an acronym that combines accuracy with at least a suggestion of the function of the new body? Welsh-speaking Members will realise that Cymdeithas Cynghorau Iechyd Cymuned Cymru becomes CCICC, or CIC—an essential attribute for a patient advocate. I hope that the CHCs, and the national body, will have CIC.
On the Wales Centre for Health, we welcome the establishment of a Welsh body to act as a multidisciplinary advice forum. Hopefully it will draw attention to the many causes of ill health and the many ways of tackling issues of health, poverty and housing. The body will also disseminate research, particularly Welsh data, the lack of which has, for many years, been a problem to many people working in health and social services. It will support training in sustainable health and liaise with UK and international professional groups. We have much to learn from professional groups over the border and in other European countries. Sometimes we look with too narrow a focus for comparators. In addition, as we develop Welsh models of health provision and for the prevention of ill health, we will have much to teach the world.
We are glad that the centre's independence is assured and that it will take an active role. It will be a virtual as well as an actual centre. Some years ago, I had the experience of setting up a national centre for training and education in social work. I regret that we invested so much in bricks and mortar and much less in the networks of people throughout Wales that would have supported that centre in the future. Unfortunately, the money went into the building.
390 Equally, we welcome the establishment of Health Professions Wales, which is an ambitious move. The body will carry out the functions of the Health Professions Council in Wales relating to the continuing education and training and the clinical experience of nurses, midwives, health visitors and other health care professionals and support workers. Fears have been expressed about the loss to Wales of having new and different arrangements for the health professions, compared with England. I trust that those will be allayed by the operation of the new body.
As I said, I come from a background of education and training of social workers. In 1985, the body responsible for that, the Central Council for Education and Training in Social Work, consisted in Wales of one person coming over from Bristol to work half a day a week, sitting by the phone waiting for a call. As Members can imagine, he had very little business. The CCETSW developed into a fully fledged body, and when it was wound up, it had its own policy documents and publication programme. It also had professional staff and a training agenda complementary to that in the UK. That agenda covered all aspects of training, including, importantly, Welsh-medium training. After 17 years we see the value of that sustained development for the CCETSW, because we have a Welsh body for social care that is a fully fledged, separate entity. That was a process—a long one—and not an event. I therefore value the role of Health Professions Wales in developing high-quality training, Welsh careers information and senior practitioner posts.
On the retention of staff, we have to make sure that we recruit people who fully understand the profession, and we should be careful to promote work-based learning. I note from the research document provided by the Library that the acting chief executive of HPW sets out, as a function to be developed, advice on work-based learning. That is essential if we are to foster a climate in favour of training. People must be able to take up training while they are working. That will be important for the retention of staff.
The use of Welsh practice as a model for developments throughout the UK is also important. I referred earlier to developing medium and practice in Welsh and other languages. We have a great deal to teach other parts of the UK and the world. We have an opportunity to experiment and to develop proper practice to give the user of the service the power to choose the language. We should be confident that we can do the research and development work and that we have something to boast about.
I spoke earlier about the metaphorical high explosive that we need in order to attack the historical inequalities in health in our country and to provide Wales with the world-class health service that it needs. That will be hugely difficult and, no doubt, controversial. I also mentioned the widely held view that the Bill is uncontroversial. If it leads only to uncontroversial change, it will not have contributed sufficiently to the change that is needed if we are to achieve a healthier future for all the people of Wales.
§ Julie Morgan (Cardiff, North)
I am pleased to be given the opportunity to speak on this Second Reading. I am pleased that there is a Wales-only Bill in the 391 Queen's Speech, following the Children's Commissioner for Wales Bill in an earlier Queen's Speech. Taking into account the Welsh clauses in other Bills, we can see that the devolution settlement is working, as many hon. Members have said tonight.
It is interesting that the Bill, along with the Welsh clauses introducing reform of the health authorities and the creation of local health boards in an earlier Bill for England and Wales, is helping to develop a distinctive way forward for the NHS in Wales. The first parts of both the Wales-only Bills, on the children's commissioner and on health, were initially included in legislation for England and Wales.
The children's commissioner began in the Welsh clauses of the Care Standards Bill, and the reform of the health service began in the National Health Service Reform and Health Care Professionals Bill. In both cases, that allowed the proposals for Wales to start moving. The children's commissioner was able to begin work before the full powers were finally conferred on the post by the Wales-only Bill, and the health boards were included in earlier legislation so that they could be set up and staffed by April 2003. I understand that they are on course to achieve that.
The Health (Wales) Bill has already had pre-legislative scrutiny by the Welsh Affairs Committee—the first time that that has happened—and by the Health and Social Services Committee of the National Assembly. I attended a sitting of the Health and Social Services Committee, which I found an interesting and unique experience. In that sitting, members of the Committee raised the issue of smoking, saying that a ban on smoking on public places must be part of the Bill. Everyone in the room—every member of the Committee and those who were there observing it—strongly agreed that we all wanted a ban on smoking in public places, but it was also agreed that that did not lie within the scope of the Bill. None the less, I want to register my hope that we will get a ban on smoking in public places and that it will be dealt with as a priority. The emphasis in health should be on prevention, and smoking causes such a huge bill for the health service and such misery in people's lives that we have a duty to do what we can about it. I accept that it is not within the scope of the Bill, but I am glad that we have marked up the fact that we must do something about smoking.
The Bill is short and generally uncontroversial. There has been some controversy in England about the removal of the community health councils, and it is good that we in Wales have avoided that controversy by aiming to strengthen and build on the existing CHCs and increase their advocacy role. The performance of that role has varied throughout Wales. The CHC in Cardiff has played a strong advocacy role—many people who have come to my surgery to discuss problems in the health service have been helped to an enormous extent by the CHC. Cardiff CHC has had special funding to help it in its advocacy and complaints role in respect of individuals, but that does not extend throughout Wales. CHCs in other parts of Wales have not been so well funded for advocacy and complaints functions, so I am pleased that the Bill will ensure more uniform provision for CRCs and that they will be strengthened throughout Wales.
392 It is interesting that England decided not to keep, change and strengthen CHCs. There seems to be a divide between attitudes in England and in Wales to CHCs. In Wales, CHCs have been thinly staffed, but there has always been a good standard of advocacy and their existence has never been questioned. As other hon. Members have said, the difference in this respect between England and Wales shows how devolution produces different outcomes. It is easy to live with the fact of different outcomes—there is no tension about Wales taking one course and England taking another. That is what devolution is and what the Bill emphasises.
CHCs, with patients and local representatives, will work with local health boards and local authorities to create a service in which the primary aim is prevention, and the emphasis is on health, not ill health. That is the message that has been coming from the Assembly in its development of health policy: we are talking not about ill health but about health and how to create a healthy society, and that change of focus is a positive aim. Many people, especially in later life, experience health problems because of their style of living in youth—smoking is a prime example. CHCs and the health boards will play a vital role in spreading information, for example, about healthy living and ways to avoid ill health in later life. The Assembly has already done a lot of work on health promotion. If those efforts are successful, Welsh society as a whole will be healthier, which will help the health service by lessening the drain on health service resources and on the community caused by people who become ill later in life as a result of their lifestyle choices. I do not criticise those choices, but that is what happens and we have to tackle the problem.
It is important that CHCs reflect the society they serve. I was pleased to see in their response to the Welsh Affairs Committee's report on the draft Bill that the Government acknowledge the need to ensure that CHCs appoint members whobring … a wide range of skills and experience, drawn from a variety of backgrounds.Until now, local authority representatives have made up half, and the voluntary sector one third, of the membership of CHCs, with the other members drawn from various sources. Now, it will be up to the Assembly to decide the composition of CHCs. I hope that a strong effort will be made to encourage people from a wide range of backgrounds to come forward, in particular people from less privileged backgrounds, so that we will have input from the whole spectrum of Welsh society. I hope that there will be representation from the black community and other ethnic minority communities.
I strongly believe that young people's voices should also be heard. I do not know precisely how that will be achieved, but we must get young people involved in CHCs and their advocacy role. We have had a huge problem with advocacy services for children in Wales since the loss of the Children's Society and the advocacy services it provided. Somehow, we must find a way to ensure that CHCs can speak for young people and children. The Children's Commissioner can work to determine what young people want from the health service—in fact, the commissioner has already done some work in that respect, by examining what sort of health service provision certain groups of patients want, but I think that the CHCs should take on that role in relation to young people.
393 It is important that work on a CHC be recognised as a public duty. In their response, the Government say thatthe list of public bodies can be amended by Orderto include CHCs, but we could do that here and now, via the Bill, and perhaps we should consider doing so.
As hon. Members have said, in Wales the link between ill health and deprivation is clear for all to see. People in areas of severe deprivation suffer from bad health. In recognition of that, the Townsend report, commissioned by the National Assembly, suggested a funding formula that placed particular emphasis on funding, within as well as between health authorities. It is important to recognise that in a time of growth in health spending, it is possible to redistribute money. The Assembly is implementing the formula changes in the Townsend report—the formula needs some refinement, but the broad thrust of the Townsend report is being implemented. As the health budget grows, every area gets an increase, but the most deprived areas get a bigger increase, and the main beneficiaries are the areas where need is greatest. I applaud the Assembly for taking that step to tackle the health inequalities that are so obvious in Wales.
I hope that the Wales Centre for Health, when it has been set up, will take the Townsend proposals further and work towards ensuring that tackling health inequalities is seen to be the way forward in Wales. The huge differences in the health of the people in different parts of Wales are key issues that must be addressed. The Townsend report addressed the problem, and its recommendations are being implemented, but the creation of the Wales Centre for Health will be of enormous help.
The Townsend report set out two strategies: first, the change in the formula—the redistribution of money; and, secondly, tackling the causes of ill health, which involves all the other services that contribute to the wellbeing of the population. Because health is linked so strongly with poverty and the vital services that local authorities provide, I strongly support the proposals in previous legislation to make the health boards coterminous with local authorities. That is absolutely right. There has been some criticism that the authorities are too small, but if they are, it is because of what the previous Government did when they reorganised local government and that is what we have to work with.
§ Lembit Öpik
In Powys, it is the other way round—the local authority area is too large. While I agree with the sentiment expressed by the hon. Lady, does she agree that we must bear in mind the size of local authorities to try to avoid complicated cross-cutting for community health councils?
§ Julie Morgan
Yes, I agree.
If we look at inequalities which cause ill health, housing and access to leisure facilities have more of an impact on the health of the nation than, for example, the prescribing of drugs. I wonder whether hon. Members read press reports yesterday of a study which showed that pensioners in Japan live longer if they live near parks and tree-lined streets in cities? The study showed that less noise and more natural light in houses were associated with long life. The more active an older person, the longer they tend to live. We should look at 394 those crucial points when we provide health care. A huge benefit of free bus travel for pensioners in Wales is that they will live longer because they are getting out and about—that is a vital impact on the health of people in Wales.
The provision of public parks is important. In Cardiff, we have wonderful parks. Bute park is adjacent to my constituency of Cardiff, North, and the Taff trail passes through it. Those opportunities for leisure and health are as important as the services provided by the NHS. The two issues are closely linked. I am therefore pleased that existing legislation makes provision for local authorities and health boards to work together closely—on the boards themselves, of course, there will be local authority representation. In our pre-legislative examination of CHCs, we discussed whether their boundaries should be strictly coterminous with those of the health boards. The Select Committee's conclusion was that that was best left to regulations by the Assembly, following consultation. There were strong views about not restricting boundaries too much, with which I agree. It is best to consult, as CHCs have already gone through reorganisation and uncertainty, and different issues arise in different parts of the country, as the hon. Member for Montgomeryshire (Lembit Öpik) mentioned. We should not be prescriptive, so I support the view that the Assembly should make a decision and introduce regulations.
The Bill plans to extend the CHCs' remit to primary care nursing homes, which is a good move. The Prison Service issue needs to be looked at again. I am concerned about the provision of health care in prisons, and an overseeing body is needed to look at standards. I support the creation of the Wales Centre for Health and Health Professions Wales. I welcome the fact that Wales will take the lead on the inclusion of health support staff. The Select Committee on Welsh Affairs discussed the way in which such an inclusion would be different from practice in the rest of the UK, and we in Wales should be pleased that we have acknowledged the importance of health support staff.
The Welsh health agenda is preventive and radical. Measures already introduced, such as the freezing of prescription charges and free prescriptions for the under-25s, by the Assembly will result in long-term benefits. We do not know what the long-term effect of such measures will be—perhaps the Wales Centre for Health can analyse the effect of their early introduction. For example, if young people have access to free prescriptions, that may have long-term benefits. I am pleased that the Minister for Health and Social Services in the Assembly has said that there is no intention to go down the route of foundation hospitals, which were included in the Queen's Speech.
One of my concerns about foundation hospitals is the fact that they could choose to pay their staff more. We would get into a situation where one hospital would be out-bidding another, and I fear that health would suffer generally as a result. It would be unfortunate if an auction were to take place between different types of hospitals. I am therefore glad that the NHS in Wales is not going down the route of foundation hospitals.
395 It is important to retain a national pay scheme for nurses in England and Wales—if there was a variation in Wales, we would end up being out-bid. Also—
§ Mr. Deputy Speaker (Sir Alan Haselhurst)
Order. The hon. Lady must resume her seat if I am standing. She is now roving rather wider than the terms of the Bill and must come back to order.
§ Julie Morgan
Thank you, Mr. Deputy Speaker. I am sorry if I roamed from the Bill.
In conclusion, the Bill is a small step towards achieving the Assembly's goals of prevention and a healthy Wales. The pre-legislative scrutiny was a beneficial process, and I look forward to the Bill's remaining stages.
§ Mr. Roger Williams (Brecon and Radnorshire)
It is a great honour to follow the hon. Member for Cardiff, North (Julie Morgan), who has done a great deal of good work on behalf of children in Wales. I noted her remarks about the membership of CHCs and the way in which we could better reflect the needs of children. I shall return to that later.
We support the Bill wholeheartedly. It is a small and devolved step towards a better national health service in Wales. Those of us who want a thoroughly improved NHS in Wales know that that cannot be achieved at a stroke, but step by step, inch by inch. Waiting lists have been mentioned, but they are an inappropriate measure of the success of a health service. The Bill is about patients and patient power, but it does not matter to the patient whether he is first on the list or 10,000th. What matters is when he is going to get his treatment—that is the key issue for individual patients. We are in danger of sinking into a morass of statistics about the NHS and losing sight of the fact that it should provide a personal service—people desperately want to achieve that.
I was going to give another accolade to the hon. Member for Clwyd, South (Mr. Jones) who was in danger of receiving so many that it would be impossible for him to leave the Chamber. However, he has left—probably because he is afraid of having so many accolades. It was a privilege to serve on the Select Committee on Welsh Affairs, which undertook pre-legislative scrutiny of the Bill. Particularly impressive was the way in which the public and health professional in Wales were involved in that process. As a result, many of the Select Committee's recommendations were accepted and the Bill has achieved its Second Reading. The hon. Member for Clwyd, South said that we could have a truncated Second Reading because many issues had been teased out and put to bed. One that springs to mind is the title of the Bill. It started off as the National Health Service (Wales) Bill, but it quickly became apparent that CHCs, the Wales Centre for Health and Health Professions Wales could deal with health care delivered by agencies outside the NHS. Quite rightly, the title has been changed, and the Bill is now the Health (Wales) Bill. That is a minor issue, but it demonstrates the way in which problems were identified at an early stage and rectified.
396 Turning to issues raised by the Bill, I wholeheartedly agree with the hon. Member for Cardiff, North that it is appropriate that the Welsh Assembly should have a say in the way in which members of community health councils should be identified and appointed—that should be a devolved matter. Under the old appointments system, local authorities could nominate members for community health councils. We all know of local authority members who have played leading and very significant parts in the work of community health councils, as well as some who see such work as another part of their overall role and cannot give the amount of time and effort that is needed because of the responsibilities that they have in their local authority. Perhaps the Assembly will take that into consideration when deciding on membership.
I also take on board the point made by the hon. Member for Cardiff, North about including on CHCs people from ethnic minorities and younger people. That is desperately important.
The Bill's extension of the powers and roles of CHCs will also involve the training that members receive. The duties and expertise that they will need in carrying out the inspections and dealing with problems raised by individuals will be much greater than in the previous CHC system. When we look at the amount allocated for setting up the councils, I hope that there will be enough resources to ensure that those involved do not go out on their visits and inspections unprepared for the duties and responsibilities that will be expected of them.
I also value the advocacy role that CHCs have exercised in the past and the greater advocacy that will be expected of them in future. I am especially interested in the work that they have done for people suffering from mental health problems. In rural areas, the importance of mental health issues is especially acute, because people tend to live in isolated locations where they do not get the family and community support that is sometimes available in more densely populated areas. Voluntary bodies are also involved in that advocacy work. Great skill will be needed when the CHCs and voluntary bodies decide between them how such work will be done to best effect for the patient.
Mention has been made of the possible extension of the work of CHCs to prisons and young offenders institutions. That issue has been teased out in this debate and we will perhaps see more of it in future. Schools are another area in which health provision is made. Not only are there emergencies such as accidents or sudden illnesses—lay people are often asked to administer medication to children who may need it during the school day—but children in school are given advice and counselling on health issues, and the quality of that counselling and advice is important in health delivery for young people.
I should like to mention a particular initiative that my local CHC has just undertaken: the setting up of a first responder scheme in which a group of volunteers is trained to attend when somebody has suffered heart failure or a heart attack and to use defibrillators to restart heart activity. As the volunteers are based locally, such action can often be more quickly carried out than by the ambulance service. The initiative has already been set up in one area and is about to be set up in another. It is an example of how CHCs can take initiatives and drive forward service improvements, 397 rather than merely inspect or wait for people to make complaints. Figures show that where first responders are in place, recovery from heart attacks is 10 times more likely than elsewhere. That is a very good example of how CHCs can work.
§ Lembit Öpik
Does my hon. Friend agree that the Bill presents an especially important opportunity in that regard? He and I have both known people such as the late Hugh Taylor, who would have been alive today if such a scheme had been in place and the community health councils had had the power to implement the very important service to which he refers, especially in rural areas.
§ Mr. Williams
I take the point that my hon. Friend makes; we both know the gentleman whom he mentioned. We have an opportunity in Wales to show what the powers and scope of CHCs can be in improving the health and well-being of people in such areas.
I would like us to keep the name "community health councils", as access to these bodies is so important. A change of name merely makes it that much more difficult for somebody to find their way in getting the help and support that they need. We have already a successful organisation and we are going to make it better by introducing the Bill, but we should not make access to it more difficult by changing names.
The Bill is about devolution and getting the right solutions for Wales. My hon. Friend the Member for Montgomeryshire (Lembit Öpik) and I have certain difficulties in respect of community hospitals that have always delivered various medical operations and activities that are now being phased out because royal colleges believe that those hospitals do not have the appropriate facilities. That is happening despite the very good safety record on delivering those services. Indeed, the population to whom the services are delivered are very satisfied with them and hope that they will continue. In the Wales Centre for Health, which could give advice on those matters, and also Health Professions Wales, which could train people to operate in such ways, we will now have the facilities in Wales to reconsider those matters and see whether such services could be delivered locally in community hospitals by doctors who want to provide them and to patients who would benefit greatly.
A local example is Brecon hospital, which had a GP-led maternity service. Not only low-risk, but medium-risk, mothers could be delivered. However, because of advice given by a London-based organisation, that has now changed to a midwife-led maternity service of which only mothers who have been classified as low risk can take advantage. The service was very well thought of by local mothers, many of whom wanted it to be delivered locally. In some cases, however, they now have to travel 20 or 30 miles to get the level of service that they want. I hope that we can have Welsh solutions to Welsh medical issues, and I am sure that the Bill goes a long way towards achieving that.
My hon. Friend the Member for Montgomeryshire mentioned several matters over which we would like the Assembly to have power. The first is free eye tests for everyone in Wales. In 1989, the Conservative Government introduced charges for eye tests, but the 398 current thrust of health policy in Wales is prevention and primary health care. Free eye tests for everyone would mean the early diagnosis of the symptoms of some diseases and therefore the use of preventive medicine.
We also support free dental checks—
§ Mr. Williams
I thank you, Mr. Deputy Speaker, for your advice. Free dental checks are such an important aspiration for us that we sometimes get carried away when we advance it.
The Bill will improve the health service in Wales. We thoroughly support it.
§ Mr. Martin Caton (Gower)
It is a great pleasure to follow the hon. Member for Brecon and Radnorshire (Mr. Williams). Like him, I am a member of the Select Committee on Welsh Affairs, which was involved in the pre-legislative scrutiny of the draft Bill.
It became clear as we took evidence that the Bill is uncontentious and has wide support across the professional and political spectrums. That was confirmed in our debate in the Welsh Grand Committee on 16 July and in the debate in the National Assembly a couple of days later. It received further confirmation this evening, at least when we focused on the Bill.
I do not deny the importance of the Bill's three key objectives, but the different method of dealing with the measure so far and its impact on the Bill's passage is equally important. In the current instance, process may be as significant as the event. I therefore want to consider briefly what the process has achieved and whether we can learn lessons from our approach that will help in future.
It has already been said that this is the first occasion on which a Wales-only Bill has been subject to pre-legislative scrutiny that involved Back-Bench Members in Westminster and our colleagues in the Assembly. The Welsh Affairs Committee was given the job of initially examining the draft Bill on behalf of the Commons.
Some hon. Members, especially Labour Members, have argued that the Select Committee was not the appropriate forum for the task. Perhaps their strongest argument is that although a Select Committee is normally the best body for undertaking pre-legislative scrutiny, the Welsh Affairs Committee is different. Most Select Committees cover specific aspects of policy such as education, health and defence. The members have therefore developed expertise and have a special interest in their subject. It is argued that that does not apply to the Welsh Affairs Committee or any of the other territorial Committees, and that we need to find a different way forward for Bills that apply only to Wales.
Although that argument contains a kernel of validity, Select Committees have greater strengths than a collegiate expertise and experience. The approach and culture that established Select Committees are more important. We proceed through investigation, seek objectivity and try to reach consensus. All Select 399 Committees, even those that cover specific policy matters, look outside to those who give evidence and to special advisers for expertise and special interest.
The Welsh Affairs Committee did a good job in considering the draft Bill. It would be difficult to establish an alternative body on an ad-hoc basis that could do a better job in future. The Welsh Grand Committee is too large and too party political to undertake that function.
I was impressed by the partnership approach that developed between the Government in Whitehall and the Government in Cardiff bay in devising the measure. That was reflected in the joint session when my hon. Friend the Under-Secretary and Assembly Minister Jane Hutt gave evidence together.
We did not achieve the same partnership between our Committee and the Health and Social Services Commit tee in the Assembly in scrutinising the measure. However, we made some progress and, as my hon. Friend the Member for Cardiff, North (Julie Morgan) pointed out, Assembly Members attended some of our Committee's meetings and vice versa. I am sure that we can build on that. Surely we can maintain our separate responsibilities as Members of Parliament and Assembly Members and our separate decision-making processes, but co-operate far more effectively in evidence gathering.
§ Julie Morgan
Does my hon. Friend agree that it would be a good idea to have joint committees comprising Westminster Members and Assembly Members, as the Chairman of the Select Committee suggested?
§ Mr. Caton
I thank my hon. Friend for that suggestion. I think that we are a little way away from that, but it is an objective that I would seek. We could probably do that only in the evidence-gathering stage, as I suggested. For pre-legislative scrutiny, the Assembly needs to come to its own decisions separate from us, whichever forum is used to represent the Commons. Similarly, the Commons, whether in the form of a Select Committee or another body, would have to come to a decision about its recommendations independently. However, in the evidence-gathering stage, there could be much better, more effective co-operation. I hope that we will move towards that.
The pre-legislative scrutiny at both levels of Welsh government has already proved its worth. Even on a short and uncontentious Bill such as this, we have identified scope for real improvement at the draft stage. I congratulate the Government on taking on board many of the proposals. In some cases the Government, in responding to recommendations from various parties, including the Select Committee, made a fair case for sticking to their guns. In one or two other cases, they should be pressed a little further.
I want to return to the concerns that I raised in the Welsh Grand Committee back in July, and look at how they have been addressed in the Bill. I warmly support each of the three purposes of the Bill. I remain convinced that reformed and enhanced community councils will be the right people's watchdogs for the health service in 400 Wales. I am sure that the Wales Centre for Health, with its advice, training and research remit, will provide independent assessment and support that will form a hub for partnership between the various sectors that provide or utilise information or evidence on health issues.
I am equally confident that Health Professions Wales is a step forward, building on the remit of the old Welsh National Board for Nursing, Midwifery and Health Visiting to include care support workers, and allowing the inclusion of other health care professions over time.
In July, we considered various issues that came out of the Select Committee inquiry. I welcome the fact that the short and long titles of the Bill now properly reflect the contents of the Bill. I welcome also the clarification of languages in some clauses and schedules, although I suspect that there is still more scope for improving the plain speaking part of the Bill; the inclusion of the promised reference to the rights of CHCs to receive information from health service providers; and the tightening of the wording to protect the independence and the perceived independence of the Wales Centre for Health, although again there may be further steps that we can take in that regard.
The Government have made a broadly rational case for maintaining their and the Assembly's approach to the co-terminosity of CHC boundaries and local health boards; to some extent on the adequacy of current drafting to enable CHCs to undertake independent advocacy services; and on the powers and functions of the Association of Welsh Community Health Councils.
I now also accept that the National Assembly's powers of direction to Health Professions Wales on functions carried out by that body on behalf of the Health Professions Council or the Nursing and Midwifery Council are already constrained by the agreements that established those functions. A requirement in the Bill for prior consultation, as we suggested, would therefore be superfluous.
Although we in the Welsh Affairs Committee did not address the matter in our report, the National Audit Office rightly drew attention to the lack of provision for the Auditor General for Wales to carry out value-for-money investigations into the work of the Wales Centre for Health. I am delighted that the Government have provided for that in the Bill.
That leaves me with three ongoing worries about the Bill—two that I raised in the Grand Committee, and one that the Royal College of Nursing Wales raised subsequently. First, I still believe that it would be useful if the Bill went even further in empowering the Assembly to extend the remit of community health councils to include the inspection of and the requirement for information from anyone involved in the provision of publicly funded health care.
I still believe that the scope of CHCs should extend to prisons and young offender institutions, as has been mentioned several times today. Medical assessment and care, especially psychiatric assessment and care, in our prisons is a real issue. Although I appreciate that prisons have their own inspection and lay visitor systems, I believe that inspections by a group of informed lay people who could make direct comparison between health provision in prison and outside would be extremely valuable.
401 That brings me to my other on-going concern: the fact that the Bill still does not give CHC members a statutory right of time off work for their public duties. Frankly, this remains an anomaly. Representatives of CHCs across Wales told the Select Committee that provision of this right was probably the best way of getting CHCs better to reflect the communities that they are supposed to represent. At present, younger working people feel unable to participate in the work of CHCs because they cannot get time off work or cannot afford to take that time off.
I was a member of the old Swansea and Lliw Valley community health council for some years, and this was a real issue even then, in particular for hospital and other institutional visits, some of which, sensibly, had to be made in the daytime. During my time on the council, anyone who went to one of our regular monthly meetings in an evening would have seen a body of people who broadly reflected Swansea and Lliw Valley society in terms of gender balance, age range and—to a lesser extent, sadly—ethnic origin. If they went on one of our inspection visits in the daytime, however, they would have got a very different picture. Mostly, it was only retired members who were able to take part. We are now talking about extending the responsibilities of CHCs to deal with private homes and primary care providers as well as hospitals and other institutions, and the problem is likely to get worse if we do not address it. Perhaps the Bill is not the right way to provide a statutory right—it might be more appropriate to use an order—but this change is essential, however we achieve it.
The Royal College of Nursing Wales has raised an issue worth considering, in the briefing that it has sent to us all. It is worried about how major health service reconfigurations proposed by local health boards or the NHS Wales Department will be dealt with in practice. It foresees that, due to the small size of local health boards, big changes—the closure of an accident and emergency department is the example that it cites—could be devised jointly between the local health board and the regional offices of the NHS Wales Department, which is part of the Welsh Assembly Government. In such circumstances, if a CHC exercised its right of appeal against that reconfiguration to the Assembly Health Minister, that Minister would be sitting in judgment on a proposal that had come, at least partly, from her own officials. The RCN believes that this would constitute a conflict of interest, and proposes the creation in the Bill of an independent configuration panel for Wales, to provide independent advice to the Minister. I understand that that is what happens in England. I would be interested to hear the Minister's thoughts on that proposal when he winds up. Perhaps we could return to the matter in Committee.
This was a good draft Bill; it is a better Bill now. Who knows—perhaps it will be better still when it comes back on Third Reading.
§ Dr. Hywel Francis (Aberavon)
I warmly welcome the Bill for several reasons, not least because it makes a major contribution to Welsh constitutional history, Welsh social history and—dare I say it?—Welsh socialist history. Most important of all, it makes a contribution to the future and well-being of the Welsh people. As a fervent campaigner for democratic 402 devolution in Wales, I am proud to say that this is the first Wales-only Bill that has undergone pre-legislative scrutiny by the National Assembly for Wales and by this House, and as a member of the Welsh Affairs Committee, I am very proud to have participated in that process. What better first Wales-only Bill could there be than one that addresses the quality of life of our people and the health of our nation? It is also constitutionally important because it shows the benefits for Wales of the devolved and central Administrations working in partnership rather than engaging in confrontation and conflict.
The Bill is also important because it is the logical consequence of recent social history in Wales. The retention, democratising and strengthening of Welsh community health councils is the logical conclusion of our own recent struggles, particularly in relation to democracy and advocacy. We all know that the national health service was modelled on the democratic, socialist and grass-roots principles of the Tredegar Medical Aid Society by the founder of the NHS, Aneurin Bevan, rooted as it was in all the struggles of all the valleys of south Wales and, indeed, the whole of Wales.
More recently, that advocacy and those democratic principles have been carried forward by such pioneers as the late Dr. Alistair Wilson and his Cynon valley patients committees and by Dr. Julian Tudor Hart of Glyncorrwg in my constituency. Dr. Hart's document "Going for Gold" inspired so much of the thinking behind the Welsh Office document "Better Health, Better Wales", which, like Dr. Hart's publication, addressed improving primary health care, democratising the health service and giving patients a voice.
It is a tribute to the Welsh Assembly Government's Minister for Health and Social Services, Jane Hutt, her deputy, Dr. Brian Gibbons, who was at one time a partner of Dr. Julian Tudor Hart, and my hon. Friend the Under-Secretary that the Bill, which has a consensual and sensible nature, has progressed with wide public support. It addresses the central questions of NHS reform, not only in Wales but more widely. I refer in particular to the nature of local democratic accountability and ensuring that we move from what Dr. Julian Tudor Hart once described as a "body repair service" and a "national disease service" to a genuinely democratic and effective NHS for the 21st century.
I commend two aspects of the Bill, the first of which is the continuation and strengthening of the community health councils in Wales. That welcome development is very much in the social justice tradition of Wales, and it is thoroughly appropriate that the CHCs have a strong democratic element that is achieved through local authority and other representation. That is a major local democratic reaffirmation and a return to the best values of the Tredegar Medical Aid Society and other similar voluntary health organisations of the past.
The CHCs will have a significant additional advocacy role in the complaints process. We do not need a confrontational complaints procedure. The new complaints system can also provide useful feedback to service providers. We know to our cost how stressful some of those procedures can be. For example, a Gower doctor tragically committed suicide after a complaint was lodged against him last year.
403 When matters proceed to a formal complaints stage, patients need assistance through a complex and difficult process that they might go through only once in their lives. I welcome the fact that CHCs will be able to have a remit on nursing and residential homes. May I make a final observation on CHCs? The public do not find that name easy to establish in their thinking as that of an NHS watchdog. No doubt the Welsh Assembly Government will address that matter through their own local consultation processes.
The second aspect that I wish to address is the creation of the Wales Centre for Health, which will promote well-informed public health policies across Wales and from which I am sure the whole UK will benefit. Of course, we need good, reactive health services, particularly for those parts of the UK that suffer disproportionately from serious ill health, such as the south Wales valleys and certain parts of rural Wales. However, we also need informed public health policies that take on board the wider agenda of identifying the causes and determinants of good and bad health, so that people can live healthier lives in the first place.
The A.J. Cronin novel "The Citadel", which is based on a south Wales mining valley, has already been mentioned. Its hero performed an extreme act in taking a public health initiative and blowing up a defective sewer system. A more benign and peaceful, but nevertheless powerful purpose of the new centre is to provide independent public health information to community health groups that are concerned about the health implications of public policy. We have noticed in recent times, for example, the deep concern at Nantygwyddon Tip in the Rhondda and Crymlyn Burrows in my constituency.
I understand that the Welsh Health Minister has pledged that the CHCs will have a statutory right to consult on major local changes in NHS provision and that she will address that matter in regulations. I believe that she is correct in doing that, as those issues should be addressed by the devolved Administration.
The health service is entering a bright new era in Wales. Next Saturday, I shall visit a new hospital in my constituency at Baglan Moors and I am reliably informed that my first visit may coincide with the birth of the first baby at the hospital—Labour delivering once again for Wales.
The two developments within the Bill—the strengthened, democratised CHCs and the new Wales Centre for Health—encapsulate democratic devolution in practice. They are policies made in Wales in partnership with Welsh representatives here in the House. I hope that we have been true to the needs and aspirations of the Welsh people in our deliberations. The representative and advocatory nature of the CHCs and the WCH is very much in accordance with the spirit and aspirations of the Welsh founder of the national health service, Aneurin Bevan.
I end with Aneurin Bevan's prophetic words, quoted in Dai Smith's admirable book, "Aneurin Bevan and the World of South Wales":The first function of a political leader is advocacy. It is he who must make articulate the wants, the frustration and the aspiration of the masses. Their hearts must be moved by his words, and so 404 his words must be attuned to their realities … A representative person is one who will act in a given situation in much the same way as those he represents would act in that same situation. In short, he must be of their kind … Thus a political party which begins to pick its personnel from unrepresentative types is in for trouble. Confidence declines.I believe that that applies equally to public bodies, and for that reason the Bill enhances confidence. That is why I commend it to the House.
§ Mr. Wayne David (Caerphilly)
Like other hon. Members, I welcome the Bill. Although it is short, it is very significant. Unfortunately, some Members—perhaps not those who are here tonight—have been somewhat dismissive of it. I believe that the Bill will make a big difference, because the health service is one of the biggest, if not the biggest, issue in Wales today. My hon. Friend the Member for Aberavon (Dr. Francis) quoted from Aneurin Bevan's "In Place of Fear". If something is to be put in place of fear, it should be a society with a proper health service, so that people do not have to be unduly concerned about their health.
The Bill is important in two very real senses. First, it has constitutional significance: this is the first time that a Wales-only Bill has passed through the process of pre-legislative scrutiny. It is therefore very much a product of a constructive partnership—not just a consensual partnership in this House, but a partnership between this House and the National Assembly for Wales. Others have described the Bill's long gestation process: it was discussed in the National Assembly—the genesis of the idea came from the Assembly; it has been discussed by the Under-Secretary of State for Wales in this House and by the Minister for Health and Social Services in the National Assembly; and it has been deliberated on by Members of both places. It was also discussed in some detail in the Select Committee on Welsh Affairs, which produced an excellent report on it. It was the subject of a major debate in the Welsh Grand Committee, which I am pleased I participated in. If we look back at the process to date, we can honestly say that it has provided a good model. I sincerely hope that its lessons will be learned and similar processes will be put in train.
There is a wider debate to be had about how the House co-operates with the National Assembly for Wales. We must seek and promote greater dialogue between individual Members. We need mechanisms that bring our two institutions together. I pay tribute to my hon. Friend the Member for Wrexham (Ian Lucas) for the suggestions that he has made.
It is worth noting that there has been a debate about co-operation with another institution, namely in the European Scrutiny Committee. The suggestion has been made that there should be a European Grand Committee, which would pull together Members of the European Parliament and hon. Members to debate issues of common interest. Perhaps we should consider inviting Assembly Members to the Welsh Grand Committee, so that they could deliberate on legislation at a pre-legislative stage. That is one of the constitutional debates that must be held and arises from dealing with the Bill.
§ Lembit Öpik
Does the hon. Gentleman agree that the strength of the Bill and the relatively uncontroversial 405 nature of the debate tonight is a direct consequence of stakeholders in the Assembly, together with health professionals, having exactly the opportunity that he describes?
§ Mr. David
There is something in that point of view. However, the material that we are debating is perhaps intrinsically uncontroversial. Nevertheless, if we are concerned about achieving a new form of politics in Wales, as has often been said, it must be done on the basis of partnership. The experience of this Bill has provided a good model to develop in future.
The Bill, which is important for the people of Wales, essentially contains three proposals relating to community health councils, the Wales Centre for Health and Health Professions Wales. Although it is good legislation, it is not always easy to comprehend and certainly during the later stages of the Bill consideration could be given to how it could be simplified and more straightforward language could be employed.
I should like to concentrate on the proposals with regard to community health councils. In my time as the Member of Parliament for Caerphilly over the past year and a half, I have had a positive relationship with my local community health council, Gwent community health council. Some 60 members bring to that CHC a wide range of experience. I have been very impressed with the range and quality of the work that they are engaged in. Extensive consultations are taking place on a range of services, and the CHC frequently takes up individual issues in a sensitive and responsive way for members of the public. My constituency office has developed a good and productive relationship with Gwent community health council.
I am pleased that the Bill recognises the worth of community health councils and points the way forward but significantly the Bill is not so much about defending what we have and maintaining the status quo; it is about looking positively at how we can build on the base that we have already. That is why I warmly welcome the fact that there is scope for making our CHCs more representative than they are already. There is scope to bring a wider still cross-section of society into CHCs to make them more effective. There is a need to extend the powers of CHCs.
I welcome the fact that there will be a more comprehensive advocacy service, covering, I hope, the whole of Wales. That network of CHCs will need to co-operate closely with other advocacy services, not least the Children's Commissioner for Wales, a post that has recently been established and has proven to be a success.
I think, too, that we must welcome the new powers in the Bill to oversee primary care facilities. The National Assembly for Wales will be empowered to introduce regulations to allow inspections of private health premises where NHS services are deployed. I certainly welcome that: it is a small measure in terms of the relationship with the private care sector, but I am very concerned about the standard of private nursing homes in my constituency. I could cite many examples of appalling standards in those homes that would be a disgrace in any civilised society. Modest as it is, the proposed introduction of CHCs into that context will be warmly welcomed by many people.
I share with other hon. Members the view that there remains scope to extend CHCs' role. There is a logical argument that they should be involved in prisons and 406 institutions for young offenders. It is also worth noting that, although the allocation of extra resources of some £550,000 from the National Assembly is welcome, that amount will not be sufficient to secure true democratic accountability and effective CHCs. For that, we will need even more resources in the future, and I urge the Assembly to allocate them.
In conclusion, the Bill is significant, both in constitutional terms and in terms of the development of the NHS in Wales. I hope that my hon. Friend the Minister will respond positively to the constructive points that have been made by hon. Members of all parties, and that the Bill will receive the House's warm endorsement in its later stages.
§ 9.2 pm
§ Mr. Dai Havard (Merthyr Tydfil and Rhymney)
I, too, welcome the Bill. I do not intend to deal with technicalities and cover ground that many hon. Members have covered already, but I am especially interested in the scrutiny process that has taken place. Many useful comments have been made about how the process has increased the number of people able to express a view.
I share the concern about prisons and institutions for young offenders, and think that the involvement of CHCs could be a good idea. A long time ago, in a former life, I was a trade union official representing prison governors. I have seen some consequences of bad health provision in prisons. That provision would certainly benefit from having another pair of eyes look at it from outside.
The cross-border problem associated with the work of CHCs has been mentioned, and I shall return to it later, as it has some important aspects. First, however, I want to say something about investment, process and patient involvement. The latter is the most important element of the Bill.
I have different tests for the Bill. Is it really about patient empowerment? Is it really going to be a way of providing engines of change? What I require in the health service is step change as well as incremental change. There has been massive investment in the health service in Wales. By April 2004, spending on health provision in Wales will be £3.8 billion, 50 per cent. more than when the Assembly was created in 1999.
There has been investment also in people. That is continuing, and the Bill contributes to that growth. I welcome that. Investment is going not simply to clinicians, but to the other professionals in the health team, right the way through to the ancillary workers. That is necessary, because health provision requires a team approach.
Investment is also being made in knowledge and information, and I hope that that will allow the health service to be proactive rather than reactive. I intend to concentrate on the role of CHCs in that context. The structures of health service provision in Wales have been subject to many changes, and that process is continuing. We now have local health boards and strategic partnerships involving local authorities. They are fundamental to a holistic approach to health. I pay tribute to the managers of all those institutions in my area. They even involve themselves in crime and disorder partnerships. I celebrate the development of that strategic holistic view.
407 My local CHCs do a lot of good work, but, as my hon. Friend the Member for Caerphilly (Mr. David) has said, we should do more than defend what we have; we should develop it for the future. Advocacy is important in that context. In the valleys, people often put up with services that the articulate middle classes in other parts of the United Kingdom would not tolerate, because they do not have the right aspirations. I need others to help them identify their requirements. Studies are in progress, although I understand that developing the advocacy role is proving slightly more problematic than was expected. The patient support officer schemes that are being trialled are exactly what we need.
If we are to live up to the standard we have required from the Welsh Assembly—sustainability in all things, but particularly in terms of improving health, and a holistic view—we need helpers. The voluntary sector is very important in my constituency. A charity called Cancer Aid Merthyr provides not only transport but counselling, and other services that would not otherwise be available. Macmillan nurses are also important, and they are to become part of the facilities provided by hospitals—oncological facilities, for example. I hope those voluntary workers will be integrated in the makeup of the institutions that we are creating—or the Welsh Assembly is creating.
Perhaps other parts of the UK can learn from the various ways of managing this process in Wales. My local trust now has public involvement liaison groups. It is a horrible title, but its intentions are good. It has already accepted the principle of extending involvement and bringing in more people—not the "usual suspects", as my research assistant said to me the other day, but people beyond that definition. My hon. Friend the Member for Cardiff, North (Julie Morgan) made a good point about the need to involve younger people and previously disenfranchised groups.
The Minister referred to the new community hospital that we are to have in Merthyr. The principles I have mentioned are being applied in the plans for that hospital. I am also very pleased that it is being financed publicly rather than through the private finance initiative—but that is another story for another day.
I want to say something about patient involvement—not what is planned, but how it could be used. The incidence of cancer in my constituency is very high. Wales already has a cancer champion, a care strategy including a palliative care strategy, investment in specialist centres and a cancer co-ordinator. Many useful things are happening. The problem is the standards being applied, and the major frustrations encountered by those who try to make changes. As I have said, I want to test the ability of the new institutions to make such changes.
My current worry is that cancer patients often suffer badly from fatigue as a result of anaemia, and need blood transfusions. Having investigated, I think they would benefit from alternatives to transfusion. Bed-blocking was mentioned earlier, and it is certainly one of the major problems in the health service. If patients were not having transfusions they would not be taking up hospital beds, and according to my calculations 250,000 hospital beds would be become available.
408 How can I ensure that such standards operate? If change is to happen, there must be ways of seeing that. I need agents to help me. The blood service in Wales is run by the Welsh blood service in the south, while what is known as the national blood service but is actually based in England deals with north Wales. It will be interesting for the CHCs responsible for the area to deal with that problem by considering the remit of those blood service institutions. Another serious issue, as we have heard, is that some patients have to go to Alder Hey or other hospitals in England, and I ask the Minister to give further consideration to that arrangement.
§ Mr. Jon Owen Jones
My hon. Friend makes an interesting point about how effective specialist care could be best managed in different areas. I am sure that community health councils will be able to play a role, but surely the most effective way to develop that is to have a national audit across the United Kingdom comparing best systems and how they work. An independent database helps local people know what is the best available care.
§ Mr. Havard
I share some of my hon. Friend's views on the audit process, but I shall not go into detail about it. He has made the point that he wanted to make.
Setting up the Wales Centre for Health is a very important step. It will have to work alongside and co-operate with many other health institutions, for example, the National Institute for Clinical Excellence, whose remit will still apply in Wales. It will be important to judge how that arrangement works.
I have a problem that I am trying to resolve. I have decided that I may be banging my head against the existing bureaucracy, even though I have the Chancellor of the Exchequer on my side, apparently, in doing so. So, I have turned the problem the other way around and said that what is really important is what the patients understand. I welcome the CHCs and the advocacy services. I want the informed debate that I am told should take place between clinicians and patients regarding what is the standard and the care that they should expect. I hope that these bodies will help empower patients so that they know what to ask for—very often they do not know unless someone tells them what care is available.
I am involved with a free magazine for cancer patients. It is in the Library of the House, and it provides a forum for debate so that patients can understand what could and should be available to them. In that way, they are empowered and can make the health service their health service. If these proposals help that process, I shall be very pleased—if they do not, I shall be less pleased, because those are my tests to measure their success.
I once saw a campaigner wearing a huge badge that said, "Wearing badges is not enough"; nor is changing institutions. We have to have the right intentions; we have to listen to the response when it comes, and act on it. We will confront the issue about money at some point, although it will not be in our gift here at Westminster, of course, because we will have given that opportunity away. It is called devolution. Nevertheless, we will have an important view and there need be no worry that it will be properly put.
409 I welcome the fact that some of the institutions in the Bill will help make change. They will test one or two of the old boys' clubs current in the bureaucracy surrounding the health service. If we say what standards we require, people will say exactly what they want. Wales is the appropriate place for those institutions to carry out the Government's intentions in practice, given that it was the place that designed and achieved the national health service, as my hon. Friend the Member for Aberavon (Dr. Francis) articulated earlier.
§ Ian Lucas (Wrexham)
This has been a long and interesting debate. Right hon. and hon. Members have been almost unanimous in welcoming the Bill. Part of the reason that the Bill has been so widely welcomed is the procedure that has been followed to bring us to this point. The scrutiny that has taken place has ironed out some of the differences between the various parties and the Government have in many respects already addressed the smaller issues that were raised during the process. However, the Bill is largely uncontroversial and I therefore caution against the inference that the procedure that has been followed for this Bill is the best possible when considering legislation for Wales.
I want to say, at the outset, that the onset of draft legislation—a tremendous innovation by the Government—gives us a great opportunity to forge a working relationship with the National Assembly for Wales. Within the context of draft legislation, we can begin to deal with the major constitutional challenges brought by the establishment of the Assembly.
The Government decided that a draft Bill for Wales should first be looked at by the Welsh Affairs Committee. That was a useful experiment, but I am not a member of the Welsh Affairs Committee, and I have an interest in, and experience of, the health field, and I should have liked to contribute to the Bill at an earlier stage than now. The fact that the Welsh Affairs Committee is a territorial Committee is relevant in the context of draft legislation. One of the great benefits of the Select Committee system is that it enables Members to develop specific expertise, which they can bring to bear in consideration of any Bill that relates to the individual topic. The Welsh Affairs Committee does not have the same merits as a departmental Select Committee in that respect.
My view is that a special Committee should be set up to look at draft legislation of this type. As I have said before, I believe that that Committee should be made up of Members of this House and Members of the National Assembly for Wales. I am pleased that, today, the Chairman of the Welsh Affairs Committee has adopted my suggestion and appears to be following the course that I have set out previously. It is important that we follow that course for two main reasons. First, it would mean that a thread would run from the inception of any policy in the Assembly through to the passing of the Bill in the UK Parliament. Assembly Members would be present at the beginning of the Bill when the ideas were brought forward, and, at the onset of draft legislation, they would become members of a Committee with Members of this House and would work together to improve the Bill.
At that stage, once the preliminary consideration of the draft legislation had taken place, the Bill would be shifted up to Westminster, and the Committee members 410 from Westminster who had been looking at the Bill could pass on the information, experience and arguments of Assembly Members to this House. That would ensure a rigorous line of scrutiny from inception of ideas through to passing of legislation. That is a sensible framework that at least deserves to be tried. The test will come when we have a contentious piece of legislation. The Select Committee format is very positive, and as a new Member I have been impressed by the way in which Select Committees operate and relationships develop, even with Members from Opposition parties.
§ Mr. Deputy Speaker
Order. I am not sure that this is the most apt occasion for a constitutional essay. I hope that the hon. Gentleman will come to the Bill in a moment.
§ Ian Lucas
I am obliged, Mr. Deputy Speaker. I am coming to the Bill now.
The issue on which I want to focus is the retention of community health councils. My experience of community health councils comes from a different perspective, which has not been mentioned in the debate so far. Before I came to the House, between 1997 and 2001, I was a non-executive director of the Robert Jones and Agnes Hunt hospital at Gobowen. It is an unusual hospital. It is two miles from the border with Wales and provides a great deal of help, expertise and care to people from north Wales, mid-Wales, Shropshire and the surrounding area.
In my role as a non-executive director, I was also complaints convenor and had much experience of dealing with members of the CHC. It played an extremely valuable role in putting together submissions on behalf of people who would not usually be able to put together submissions themselves. It presented complaints in a NHS procedure that is, in my experience, the most complex one that anyone making a complaint could encounter. The procedure is bedazzling to all those who deal with it, including me as a trained lawyer.
§ Gareth Thomas
I know that my hon. Friend has an interest in this subject. He has not only been involved in health service management but is a lawyer who has experience of clinical negligence claims. He will recall that I chaired a seminar on clinical negligence in the House. Does he think that there is a role for CHCs and the Wales Centre for Health in trying to bring about a more effective complaints system? Such a complaints system would offer the patient a quicker and more transparent explanation of what had gone on in an adverse incident, as it is termed by doctors. It would also have the ability and power to make small awards and compensation without recourse to the long-winded procedure in the courts.
§ Ian Lucas
There is, indeed, an essential role for the CHCs. In my role as a member of the board of a hospital that provided health care to people in north Wales, I knew that the submissions and complaints made by patients were a valuable management tool for the hospital. They helped to improve the standard of care that was delivered. One of the major challenges that the NHS faces is to find a system that responds to the 411 concerns and complaints of patients and does so in an environment that does not threaten the providers of the care—whether they are doctors or nurses. The CHCs need to develop a partnership role with hospitals so that information can be presented in a uniform way as far as possible. That information would then be a valuable management tool for the hospital.
I must confess that another aspect of the Bill causes me concern, and it relates to cross-border care. I represent Wrexham, which is a border town. Health care is supplied to it by the Countess of Chester hospital, Wrexham Maelor hospital and the Robert Jones and Agnes Hunt hospital near Oswestry that I have already mentioned. More specialist care is provided in Liverpool and Manchester. However, the Bill does not appear to be clear on the important question of whether the CHCs in north Wales, which will continue, will have the investigatory powers to examine matters in England. I hope that my hon. Friend the Minister will clarify that point when he winds up. Many of my constituents who see me about health care problems tell me that they have been treated across the border and want to pursue their case just as readily as they could if the hospital were in Wales.
§ Lembit Öpik
My personal experience of Gobowen hospital has always been positive and just as the hon. Gentleman describes. Does he agree that we may want to explore the important matter that he raises in Committee? There will unquestionably be issues on jurisdiction to deal with and it may be the case that the CHC will need to have the authority to act on a non-statutory basis across the border.
§ Huw Irranca-Davies
Does my hon. Friend also agree that because the issue is long standing, the Bill gives us the opportunity to address it? One way or another, we have to ensure that we satisfy the requirement for accountability on cross-border issues.
§ Ian Lucas
My hon. Friend is also correct. We must be conscious of the fact that we are in an era in which health care and the experts are becoming more specialised. It is simply not the case that every district hospital can provide expertise of the highest quality. Although the mantra "Welsh solutions for Welsh problems" is appealing, when my constituents come to me for good quality health care, they do not mind whether that is supplied in Chester or Wrexham. What they want is a decent service and a good standard of care.
§ Mr. Evans
Would not the hon. Gentleman prefer it if the CHCs in his area were in discussions with the sister organisation in Chester, for instance, so that it could investigate the problem? After all, part of the problem is that his Government abolished CHCs in England and we are trying to preserve them for Wales. Does he not have faith in the sister organisations in England?
§ Ian Lucas
I know from close discussions with health professionals, health consumers and patients in 412 north-east Wales that there are close working relationships of all types between people who work on different sides of the border. Indeed, many health professionals are employed by more than one hospital spending, for example, 50 per cent. of their time in Chester and 50 per cent. in Wrexham. Areas such as north-east Wales recognise that the services must be provided on both sides of the border. The care needs to be of a high quality. I am sure that good relationships will be developed in due course.
Another aspect that I greatly welcome is the extension of the CHCs' powers on primary care and the inspection of private facilities that offer NHS services. Will that inspection extend to voluntary organisations that provide health care? I have in mind the Nightingale House hospice in Wrexham. It provides an excellent standard of care and would have nothing to fear from an inspection regime. Will CHCs be able to inspect hospices?
For once I take issue with my hon. Friend the Member for Caerphilly (Mr. David). There are excellent nursing homes in the private sector that provide high-quality care. I have inspected the Pendine Park nursing home in my constituency. It is a high-quality home that provides an excellent service. Private nursing homes have nothing to fear from the system of assessment, but it is good that the CHCs have that additional power.
I welcome the Bill. The substance is good, but the procedure by which we reached this point could be improved. The Bill is positive for Wales, and although it may need some refinement in Committee, I am sure that it will be a good step in the right direction for my constituents in Wrexham and I am pleased to support it.
§ Chris Grayling (Epsom and Ewell)
This has been an interesting and wide-ranging debate—sometimes a little too wide-ranging for the Chair. In some ways, however, it has not been as wide-ranging as it might have been because, as some hon. Members have said, this is not quite the Bill that was anticipated, so much of the Government's planned reforms for Wales having already been handled in the National Health Service Reform and Health Care Professions Act 2002.
The debate began with the Secretary of State making a strong defence of the Bill and of the NHS in Wales. However, he failed to explain why such high levels of spending per head of population have not led to better health outcomes, and he admitted that not all was well with waiting lists. During his speech there was a noteworthy intervention by the hon. Member for Blaenau Gwent (Llew Smith), who basically asked, "Whatever happened to our bon fire of quangos?" I got the impression from the Secretary of State's response that he believed that the only problem in the past was that we had the wrong kind of quango.
My hon. Friend the Member for Ribble Valley (Mr. Evans) made a telling attack on the failures of the current Administration to deliver improvement. He warned that the Bill risked putting too much control into the hands of politicians. He also pointed out that it delivers more change to a service that is already struggling with very considerable change.
We have had numerous contributions, including many from members of the Select Committee. Those speeches addressed the measure itself but they also 413 strayed—as I said, sometimes rather too far for the comfort of the Chair—on to wider Welsh health issues ranging from the health benefits of free bus passes to a call for free eye tests, and even, in the case of the hon. Member for Aberavon (Dr. Francis), making a foray into the labour wards.
The Bill is not directly about the treatment of patients, but it is about the creation of new organisations designed to improve the quality of health care in Wales. The key question that needs to be asked tonight and in Committee is, "Will these changes ultimately make a difference to patients in Wales?" That is the criterion by which any change of this kind must be judged.
Conservative Members do not take issue with the overall nature of the organisations, but we think that important modifications need to be made to the detail of the Government's plans. The Bill concentrates too many powers in the hands of the Assembly and too few in the hands of communities and health care professionals. In Committee, we will want to put forward different ideas about how the organisations should operate. We also question whether the Bill risks creating unnecessary duplication at a time when the NHS in Wales has many other pressing priorities.
At the heart of the Bill are the community health councils. The Bill marks an astonishing U-turn by Ministers, who are tonight heading in a direction diametrically opposed to the one that they took in the House only a few months ago. We Conservatives have always supported the role of the CHCs in providing a proper link between Focal communities and the NHS and in monitoring the effectiveness of the service that it provides, and until recently so did the Prime Minister. In 2000, his office wrote to his local CHC, praising its work and that of its counterparts. The letter said:Tony would certainly like to add his congratulations to the work the CHCs have done over the last 25 years, and wishes them every success in the future.Only two years after that letter, CHCs have been abolished in England.
We opposed the changes put forward by the Government earlier this year in the same way that we support tonight the retention of CHCs in Wales. Earlier this year, however, the Government told us that we were wrong. Indeed, we were lectured by the Parliamentary Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), who said on 15 January:We are all tempted to stick with what we know because it is comfortable and we have seen it in practice, but we must now push forward the boundaries and consider new ways of working to empower the public, too."—[Official Report, 15 January 2002; Vol. 378, c. 226.]How is it necessary to push forward the boundaries in England and not in Wales? The Secretary of State for Health put it even more strongly, telling the House:No organisation has a God-given right to exist. Governments do not have a God-given right to exist. Community health councils do not have a God-given right to exist. MPs do not have a God-given right to exist."—[Official Report, 10 January 2001; Vol. 360, c. 1089.]
Have Ministers had a vision on the road to Damascus? Here they are, a matter of months later, telling us that CHCs are the right way forward for Wales. Ten months ago, the Under-Secretary of State for Wales voted against Conservative amendments to 414 the National Health Service Reform and Health Care Professions Bill that would have retained community health councils in England. Tonight, he will vote in favour of community health councils. He cannot have it both ways—either CHCs are a good idea or they are not; they cannot be both.
We welcome the U-turn and the plan to retain CHCs in Wales. Our concerns about the Bill centre on the provisions that allow the Assembly extensive controls over Welsh CHCs.
§ Huw Irranca-Davies
Does the hon. Gentleman recognise that he has just paid a magnificent back-handed tribute to the good common sense of Welsh elected representatives? Furthermore, he might like to realise that we now have devolution.
§ Chris Grayling
If the hon. Gentleman believes so strongly in CHCs, why have he and his colleagues deprived English patients of the right of representation by CHCs?
To be effective, CHCs must be independent—that telling point was made by my hon. Friend the Member for Leominster (Mr. Wiggin). CHCs must be free to represent the interests of the communities and patients in the areas they cover. They do not exist to be controlled by politicians. The Government should not put as many powers into the hands of the Assembly as they are giving it in the Bill. The Assembly cannot be both provider and monitor of services—it cannot be both poacher and gamekeeper. During debates on these measures, our Conservative colleagues in the Assembly argued for a strong, independent organisation to co-ordinate the work of CHCs and to remove some of the prescriptive powers that the Bill would give to the Assembly.
§ Lembit Öpik
Surely politics is different. Politicians who do not do a good job will lose their seats. We are talking not about trying to sell a service to the public but about being judged on the outcomes, so the poacher-gamekeeper analogy is not entirely valid.
§ Chris Grayling
The Conservatives believe that the role of CHCs is to challenge what is happening within the NHS, and that, by definition, means challenging decisions taken by politicians who control the NHS. That is why it is so important that CHCs are a truly independent voice, not subject to undue controls placed on them by central Government.
We need to ensure that Welsh CHCs are properly independent of political manipulation, which was mentioned by the hon. Member for Cardiff, Central (Mr. Jones). In Committee, we will table amendments to strengthen the role of CHCs and their independence from politicians. In an intervention, the hon. Gentleman called for better auditing of the outputs of the NHS in Wales. Given its poor performance, his words are especially important. They go to the nub of why we must ensure that CHCs have a powerful voice in the communities they seek to represent.
Any assessment of NHS performance in Wales today does not make happy reading. The Secretary of State is right to say that spending per head in Wales has been much higher than the national average in recent years, 415 and the Wanless report highlighted the fact that Wales has more doctors per head of population than England, as well as shorter GP lists and higher prescribing rates. Despite that, by any objective judgment, the NHS in Wales is not delivering for patients what it should be delivering. That must be a priority for CHCs as they examine what is happening within the service. That is why it is important that the Bill gives them the freedom to do so.
In reality, things are getting worse. In the past three years, waiting lists have been rising by 1,000 people a month. In the past five years, the number of people waiting more than 12 months for in-patient treatment has increased by 82 per cent. The number of people waiting more than 12 months for out-patient treatment has increased from just 378 five years ago to more than 36,000 today. In 1997, no one waited more than 18 months for such treatment; today, more than 16,000 people are waiting. That is nothing short of a scandal. Having heard the comments of the hon. Member for Brecon and Radnorshire (Mr. Williams), I say to him that those are real figures about real people waiting for real treatments, and those people deserve better. I would tell the hon. Member for Montgomeryshire (Lembit Öpik) that no hon. Member should feel proud of that situation, still less one who represents a party that is part of the Administration in Cardiff. We want CHCs to address those issues. As the hon. Member for Caernarfon (Hywel Williams) pointed out, they need to serve as metaphorical high explosive to make sure that there is real change for the benefit of patients.
§ Lembit Öpik
I am sorry to interrupt the hon. Gentleman a second time, but I hope he agrees with other hon. Members that we are lucky to have a national health service at all. For all the difficulties that people experience in the NHS, surely he is not suggesting that we are not privileged in our standard of living and health provision.
§ Chris Grayling
I find it distressing that at a time when more and more money is being spent on the service it is getting worse. None of us should be proud of that.
Turning to the implementation of the proposals, we are concerned about the ability of the NHS in Wales to tackle a further round of organisational change when clinical targets are not being met and organisational plans appear to be in chaos, despite the fact that the NHS has been hiring administrators three times faster than doctors. In Committee, we must ensure that we do not add to the burdens that NHS management are already facing. My hon. Friend the Member for Ribble Valley (Mr. Evans) spoke about the problems caused by the latest set of Government reforms in Wales, the establishment of 22 health boards and the document leaked to the BBC a month ago questioning whether they would work at all. We are told that the cost of the changeover and the future operation of the system is still unknown; that the changeover may not happen on time; that the NHS in Wales cannot find enough applicants to fill key posts in organisations; and that there are real fears that the system for funding health care in Wales after April will be launched in chaos. All that will make the implementation of the Bill more difficult, so the 416 changes outlined and discussed tonight must be seen against the background of a system that is not working for patients and the dedicated staff who work long hours. That is the true priority for Welsh health Ministers.
Turning briefly to other bodies covered by the Bill, we are concerned about possible duplication between the new Welsh bodies set up by the Bill and existing organisations elsewhere in the United Kingdom. For example, we are uncertain about the provision for the Wales Centre for Health to commission research into health matters in its own right. It would be foolish in the extreme to have a service commissioning research that is duplicated elsewhere in the United Kingdom.
§ Mr. John Smith (Vale of Glamorgan)
Will the hon. Gentleman please recognise that some health issues are of greater concern in Wales than in other parts of the country? One group in Wales that will welcome the creation of the centre consists of the victims and families of victims of flight-related deep vein thrombosis. A higher proportion of people die and develop serious injury from that disease in Wales than anywhere else in the United Kingdom.
§ Chris Grayling
The hon. Gentleman should realise that that condition affects people throughout the UK, which is precisely why we should ensure that resources in different parts of Britain are pooled for the maximum benefit of patients.
We are also concerned about possible duplication between Health Professions Wales and organisations that the Government have established for the UK as a whole. Ministers need to ensure that those organisations work together effectively. In particular, they should not create different training and registration criteria for our health care professionals, thus making it difficult for them to work in one part of the UK after working in another. I hope very much that Ministers will exercise great caution on that score.
The Bill is not controversial in itself, but it comes at a time when the NHS in Wales is in turmoil. It is failing to meet its clinical goals and, far from getting better, it is getting worse. It is tangled up in a major reform process that is also in turmoil, and huge amounts of work remain to be done if the transition next April is to occur without causing real problems to the people who work in the service. Welcome as some of the Bill's provisions are, welcome as the retention of CHCs is, the Bill will not help to tackle those problems. Too much of its detail leaves power in the hands of politicians, not communities and professionals. Conservative Members have argued for years that the reason why the NHS is not delivering the first-rate health care that patients deserve is that it is too centralised and prescriptive. Too many of the provisions before the House fall into the same trap and we will work to change them as the Bill continues its passage.
The Government simply do not seem to understand that that centralised approach will not deliver the improvements that people want and need. Wales is the living example of what is wrong with their health policies. Spending in Wales is already much higher than the national average, but the NHS in Wales is heading backwards, and until the Government take on board the 417 real lessons from this situation, nothing that we discuss in the House will make the difference that people in Wales and elsewhere in the United Kingdom are hoping for.
§ The Parliamentary Under-Secretary of State for Wales (Mr. Don Touhig)
We have had a very good and constructive debate on the Bill.
In summary, the Bill has three key elements: it provides a new role for reformed community health councils as the main vehicle for giving patients a greater say; it establishes the Wales Centre for Health to provide independent training, advice and research in health care; and it establishes Health Professions Wales to provide education and training to the health care professions.
We have heard in the debate that the pre-legislative scrutiny process in which we have been involved has been very successful. Publication of the Bill in draft, including on our Wales Office website, has allowed thorough consideration in all policy areas. Here in the Commons, the Bill was considered by the Select Committee on Welsh Affairs and debated in the Welsh Grand Committee. In another place, peers met the Assembly's Minister for Health and Social Services, Jane Hutt, and me, and in the Assembly, the Bill was discussed in the Health and Social Services Committee and in plenary session. The extensive public consultation on the draft Bill has ensured that the most important people—the people who will be affected by the legislation; the people of Wales—have had an opportunity to contribute.
Eighty-seven groups and organisations were invited to comment on the Bill, which was extensively scrutinised. We also published the Bill on the Wales Office website, which produced 15 responses, including an e-mail from a Mr. Liu Lieu, who runs a company in China and offered to sell us an excellent forging hammer. I think that something was lost in the translation.
In total, that process produced 45 recommendations for changes to the draft Bill. It says much for the effort that was put into the original drafting that the Bill received widespread support from stakeholders and that none of the pre-legislative scrutiny revealed any major concerns about the principles of what was proposed. The amendments made to the Bill following the pre-legislative scrutiny were all minor and of a technical nature.
The Bill has been in preparation for a long time in the sense that the proposals for reforming and retaining community health councils were first mooted by my hon. Friend the Member for Bridgend (Mr. Griffiths) in his first week after being appointed Minister with responsibility for health in Wales following the 1997 election of a Labour Government. Our reform agenda has been to reinvigorate and change community health councils in Wales. Thai has been universally accepted throughout the country, and the Welsh Affairs Committee helpfully contributed to that debate and expressed its support.
What the Bill proposes for community health councils in Wales is an essential element for the Assembly's wider strategy of involving the public in health service planning and delivery and listening to their views and 418 concerns. The independence of community health councils in Wales is rightly cherished and we will ensure through the mechanisms in the Bill that they are independent and can deliver the services required by their communities.
The establishment of the Wales Centre for Health originated in the "Better Health—Better Wales" document produced by the Wales Office in 1998. The foundations for creating the Wales Centre for Health were laid before devolution. The Government are now carrying them forward in partnership with the Assembly. In addition, the creation of the body that will oversee training and so on, Health Professions Wales, has been well-received and widely welcomed and will make an important contribution.
The Government were unable to take on board some aspects of the recommendations. As hon. Members have referred to a couple of those issues, I think that I should also mention them. The seventh recommendation of the Welsh Affairs Committee was that the Bill be amended to allow community health council members a statutory right to time off work for public duties. Other respondents made the same comment. While the Government strongly sympathise and understand and fully support people's opportunity to serve on community health councils, after having reflected, we did not consider that the Bill was the appropriate measure or vehicle in that regard. The Employment Rights Act 1996 contains a list of bodies whose membership attracts statutory time off. It could be amended by order and we will give further consideration to approaching the relevant Secretary of State with that in mind.
A ban on smoking in public places was a further suggestion from the Welsh Affairs Committee that we could not accept. After considering the proposal, we decided that such a measure was beyond the scope of the Bill and would entail creating a new public offence. A health Bill is not the proper vehicle for that.
I want to comment briefly on the remarks made by as many hon. Members as possible. The hon. Member for Ribble Valley (Mr. Evans), who led for the official Opposition, welcomed the draft Bill but provided his usual litany of all the woes that he perceives in the NHS in Wales. He quoted two statements:You have 24 hours to save the national health service",andThe National Health Service is safe in our hands".I accept ownership of the first on behalf of my party. We said that to the people of Britain, and they elected a Labour Government. However, the second statement was originally made by Baroness Thatcher when she was Prime Minister. She said that the NHS was safe in Tory hands. My right hon. Friend the Member for Oldham, West and Royton (Mr. Meacher) responded by saying that that was as encouraging as putting King Herod on the board of Mothercare.
The hon. Gentleman also referred to the National Assembly's powers to make regulations. They will be exercised in the way prescribed by Assembly Standing Orders. Public consultation will take place before any regulations are made and I shall be happy to convey the Assembly's intention on each of the orders when we discuss the Bill in Committee, if that is helpful.
419 The hon. Gentleman spoke with some passion about nurse training. The Conservative Government cut the number of nurses and midwives in training by 25 per cent. in the mid-1990s and I am therefore not surprised that he is passionate about the matter. Those cuts led directly to the shortage of nurses that we inherited.
I thank my hon. Friend the Member for Clwyd, South (Mr. Jones) for all the work that he and Welsh Affairs Committee undertook on pre-legislative scrutiny. He welcomed the Bill as a progressive measure and spoke about the opportunities that it would provide through its CHC provisions to respond to patients' voices in the health service.
The hon. Member for Montgomeryshire (Lembit Őpik) said that the pre-legislative consultation had been successful. I thank him for correcting some of the points in the research paper that was produced in the House on the costs of the proposed reorganisation. He was worried about co-terminosity with regard to CHCs. There is provision for CHCs to work in federations. However, I understand that that would not work in his large constituency. The Bill and the Assembly's regulation-making powers have sufficient flexibility to deal with those points.
My hon. Friend the Member for Ogmore (Huw lrranca-Davies) asked several questions to which I shall try to respond. He asked whether Health Professions Wales would have an input into the standards on overseas recruitment to ease assimilation. It may adopt functions from the Nursing and Midwifery Council only with the agreement of that body. That is a matter for Health Professions Wales when it is established.
My hon. Friend also asked about extending the role of CHCs to examining health provision in prisons. The National Health Service Reform and Health Care Professions Act 2002 requires the Prison Service and prescribed NHS bodies to co-operate with the view of improving health care in prisons. We do not believe that CHCs have a role in that and the Bill does not make such provision.
My hon. Friend and several other hon. Members raised matters about CHCs' cross-border operation. Powers for CHCs, including those to require information and undertake inspections, will be the same for CHCs in Wales as those that we gave patient forums in England in the National Health Service Reform and Health Care Professions Act 2002. The Bill's language will mirror that of the 2002 Act. That reciprocal arrangement is sensible and will work beneficially for all of us.
The hon. Member for Leominster (Mr. Wiggin) said that he was disappointed that the Government had not responded more positively to the Welsh Affairs Committee report. It was debated thoroughly in the Welsh Grand Committee. We carefully considered the comments of the Welsh Affairs Committee and adopted several although not all their proposals. There was widespread consultation and the hon. Gentleman and anyone else who felt strongly about our responses could have contributed at the pre-legislative scrutiny stage.
My hon. Friend the Member for Cardiff, Central (Mr. Jones), a former Wales Office Minister with responsibility for health, made important points about 420 choice, which underpins the aims of our NHS reforms. I share my hon. Friend's views about the independence of CHCs. Any monitoring, appraisal and inspection of the health service must be open and transparent and must be seen to be fully transparent.
My hon. Friend referred to delayed discharges and bed blocking. I shall leave that to my colleagues who are dealing with the Community Care (Delayed Discharges etc.) Bill tomorrow. In response to the question whether the Bill could be amended to enable community health councils to investigate delayed discharges, I can tell my hon. Friend that I believe that the powers in the Bill are sufficient. Under paragraph 1(a) of schedule 7A, it is the duty of a CHCto represent the interests in the health service of the public in its district".The powers that we will confer on CHCs will cover the point that my hon. Friend raised.
The hon. Member for Caernarfon (Hywel Williams) said that patient power must be enabling. I agree. The thrust of our CHC reforms is intended to enable patients to exercise more power and influence on the health service. We must make sure that that works.
My hon. Friend the Member for Cardiff, North (Julie Morgan) spoke about the developing roles of community health councils and put forward some interesting perspectives. I do not know whether she will serve on the Committee, but we can explore there the perspectives that she outlined in her comments this evening.
The hon. Member for Brecon and Radnorshire (Mr. Williams) gave his wholehearted support to the Bill. I welcome that. The fact that he was able to do so stems from the fact that we had wide-ranging pre-legislative scrutiny, which enabled members of all political parties or of none to make a contribution to the way in which the reform should be structured. That is reflected in the Bill.
My hon. Friend the Member for Gower (Mr. Caton) believed that the Welsh Affairs Committee did a good job on the pre-legislative scrutiny, and I agree. The Committee did an excellent job, which is a model for future pre-legislative scrutiny. He welcomed the partnership approach between the Government and the National Assembly for Wales. I have had the closest working partnership with my colleague Jane Hutt, the Assembly Minister for Health and Social Services. We have had the closest collaboration between my officials and hers, which is reflected in the strong support that we received throughout the pre-legislative scrutiny. This is how we are trying to take the agenda forward in Wales: the Government working in partnership with the Labour-led Assembly—the hon. Member for Montgomeryshire might care to note that—the Labour-led Assembly. That is proving beneficial for the people of Wales.
My hon. Friend the Member for Aberavon (Dr. Francis) also welcomed the reforms to CHCs and gave some interesting and important historical 421 perspectives on how we had developed a democratic and a socialist health service as a result of the work of Aneurin Bevan.
§ Mr. Roger Williams
The hon. Member for Aberavon (Dr. Francis) waxed lyrical about the support that the NHS was given by socialists, but does the Minister agree that it was conceived by a Liberal—Beveridge?
§ Mr. Touhig
Nye Bevan was certainly no Liberal, and he was the architect of the national health service. We share that honour with no one.
My hon. Friend the Member for Caerphilly (Mr. David) said that although the Bill was short, it was important and it would make a difference. I certainly agree. My hon. Friend the Member for Merthyr Tydfil and Rhymney (Mr. Havard) said CHCs in his area did good work and he wished to see their role develop, especially the advocacy role. We will see that develop, following the introduction of the Bill. My hon. Friend the Member for Wrexham (Ian Lucas) welcomed the pre-legislative scrutiny procedure and wondered whether it could he improved. I am sure that we will return to the matter later in our discussions. CHCs will have the power to inspect hospices, where they are delivering primary care. That is an important point to make.
I thank all hon. Members who have taken part in the debate. I thank those who took part in the pre-legislative scrutiny, those in the Welsh Affairs Committee, the Welsh Grand Committee and colleagues in the National Assembly, who made an important contribution to our discussions in formulating the policy. As a result of the pre-legislative scrutiny, we have a better Bill now than we would otherwise have had, and that is a lesson for all of us. I remember a time when I had a private Member's Bill soon after coming to the House. If we had had pre-legislative scrutiny at that time, that piece of legislation might well have been improved.
The Bill builds on the strategic framework put in place by the NHS Reform and Health Care Professions Act 2002, which was passed in the last Session. It gives patients in Wales a stronger role and a voice in the improvement, development and running of the health service in Wales, to which we are all committed, and changes the emphasis from treating disease to improving health in Wales. It supports the Welsh Assembly's drive to improve the health and well-being of people of Wales and delivers key elements of the Assembly's 10-year plan for the health service in Wales.
This is an excellent example of the partnership that exists between the Government and the National Assembly. We have already achieved a great deal by working together, and I commend the Bill to the House and ask hon. Members to support its being given a Second Reading.
§ Question put and agreed to.
§ Bill read a Second time.