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Mr. Nicholas Winterton (Macclesfield): I am very pleased indeed to follow the hon. Member for Dartford (Dr. Stoate), not only because he is a practising general practitioner, but because he speaks a great deal of sense, as he is practically involved at the grass roots of the delivery of health care in this country. I congratulate him on his contribution to the debate.
We have heard some splendid speeches. The right hon. Member for Llanelli (Denzil Davies) spoke with great authority and principle. He is well regarded in this House as a man of independent views and opinions and the House should heed some of what he said. He highlighted the bureaucracy that he believed would result from the Bill. The hon. Member for Romsey (Sandra Gidley) likewise spoke with considerable authority as a pharmacist and I respect very much of what she said. I think that the Secretary of State presented forcefully and transparently the case for the Bill from the Government's viewpoint, and I congratulate him on that. My hon. Friend the Member for Woodspring (Dr. Fox), speaking from the viewpoint of the Conservative and Unionist party, put down markers on what we would seek to do and explained where we believe that faults and problems will result from the Bill.
I fervently believe that all Governments try to do their best for the health service and the health care of the people of this country. There are differences over methods of provision, but I believe that all political parties treat the health service and the health care of our people as a priority.
The contribution of the right hon. Member for Birkenhead (Mr. Field) was impressive not only because his remarks were succinct and brief, but because he speaks from the head as well as the heart. I had the pleasure of serving with him on the Select Committee on Social Services in the 1980s.
The Secretary of State suggested that the Bill was ground breaking. I believe that the health service needs reform like it needs a hole in the head. It needs a period of stability and a Government who are dedicated to improving health care. As the Minister knows, when the health service was set up after the last war, with cross-party support, expectations of it were dramatically different from those of today. The cost of what people want and expect from the health service today has dramatically increased.
I am totally committed to the principle of the health service, which the right hon. Member for Birkenhead mentioned, but I have gradually come to believe that the provision and funding of health care must be tackled differently. For example, the right hon. Member for Llanelli mentioned the huge bureaucracy that would result from the Bill. It is a pity that we are putting more resources into those who administer the health service than into providing health care.
When I first became a Member of Parliament, there was a Macclesfield health board under an administrator. He had the minimum number of staff, but I got quicker responses to any matter that I raised on behalf of a constituent then than I have received since. We went from Macclesfield health board to Cheshire health authority. Different configurations of the health authority followed until we reached today's version, which is the South Cheshire health authority.
I am deeply worried about the Bill's effect on the provision of health care. It could lead to conflict between primary care trusts and acute hospital trusts. I hope that the Minister will respond to that point. The primary care trust will try to do a great deal, much of which is already undertaken by the acute hospital truststhe East Cheshire NHS trust in my constituency. Conflict will ensue.
The Minister knows of my interest in mental health. I have had the privilege and honour of coming to see him about such matters on a number of occasions over the past four-plus years. I am deeply concerned that mental health services will be taken away from East Cheshire NHS trustwhich is an all-purpose trust and highly successful, with the minimum of bureaucracyand put into a separate trust, the Cheshire and Wirral specialist trust. That could be extremely damaging. At present, there is a partnership between community, mental health and acute services in Macclesfield, which provides a high quality of health care for the people whom I represent.
I am also concerned about bed blocking in my area. Co-ordination is needed between social services and the health services. In my constituency, we are losing huge numbers of beds in residential and nursing homes and creating bed blocking in the health service, which causes difficulties for the through-put of patients in my hospital. How can we solve that? I am not sure that the Bill directs any particular proposals at the problem, but it is an important issue.
We live in difficult times. The health service must change. The funding of the health service must change, or people's expectations will not be met. As the Minister knows, I have strongly opposed my own party in the past. I believe that the people of this country are ready for dramatic changes in the way in which the health service is funded. Putting aside party politics, I hope that the Minister and the Labour Government will take the opportunity to explore ways in which the health service can meet the growing expectations so that it will provide medical operations and treatments that were never envisaged when the health service was founded in the years after the war.
I put down a marker. I am concerned that the strategic health authority for my area will not do as good a job as the health authority, which was impartial and allocated funds in accordance with need. I am deeply concerned that mental health services, which have been dealt with so effectively in Macclesfield will be undermined
Mr. Jon Owen Jones (Cardiff, Central): I should have liked to follow on from the interesting comments of the hon. Member for Macclesfield (Mr. Winterton), but if he will forgive me, time is short and I must make my own points.
We are, in effect, debating two Bills. There are a number of Welsh clauses in the Bill, and this will be the first occasion on which the House will debate matters arising from the Welsh Assembly which are truly matters of some controversy. In the debate so far we have heard just two and a half speeches about the Welsh issues, and no comment on them from the Front Bench.
The debate is an opportunity to test whether the present constitutional settlement for Wales provides a means for adequate scrutiny of new Bills. The Welsh Assembly does not have primary legislation powers, but if Parliament simply acts as a rubber stamp for Welsh matters brought to the House, we should dispense with the charade and move towards giving the Welsh Assembly primary legislation powers.
An example of the problems that arise was provided by the spokesman for the Liberal Democrats today. The Liberal Democrats do not seem to understand the settlement or the relevant parliamentary procedures. The Liberal Democrat spokesperson was criticised by my hon. Friends for not discussing his own policies and merely finding fault with those before the House, but, in effect, some of those are Liberal Democrat policies. At least the Liberal Democrats share ownership, because they are in coalition in the Welsh Assembly, yet their spokesperson said that they intend to vote against Second Reading. He argued that that does not mean that they are against the Welsh clauses, but I have news for him: voting down Second Reading means that the Welsh clauses fall. Perhaps he thinks that it does not matter how Liberal Democrats vote.
Interestingly, Plaid Cymru Members have made no contribution to the debate today, but they have contributed in the Welsh Assembly. Their leader, Ieuan Wyn Jones, said today that my hon. Friend the Member for Bridgend (Mr. Griffiths) and I would tear the Welsh clauses to shreds. I do not know whether he anticipated what my right hon. Friend the Member for Llanelli (Denzil Davies) had to say, but I have no intention of tearing the proposals to shreds. That is not to say that I have no reservations.
The Welsh clauses aim to set up a primary care-led health care structure that will enable local commissioning of health care, enhance co-operation between local government and the health services and, in particular, help to ensure joined-up strategies between social care and health care. They aim to foster a local environment that is responsive to local needs and responsible in its commissioning of cost-effective care to meet those needs.
Although I have no difficulty with signing up to all those objectives, I have reservations that seem to be shared by many people in health care in Wales. The consultation process achieved results that are mixed to say the least and a research paper in the Library refers to a survey carried out by the NHS Confederation in Wales which found that 69 per cent. of managers believe that 22 new boards will be difficult to sustain, that 87 per cent. think that accountability will be less clear and that 81 per cent. think that the NHS will find it difficult to manage or understand the structure put before it.
No Member of the House has seen details of the consultation document, and the document itself and those details arrived in the Library only this morninga single copy 500 pages long. There is no summary and no analysis, and I would be interested to hear whether Ministers have read it.
My researcher spent hours undertaking analysis and hon. Members will benefit from hearing some of it, although I apologise for the fact that we were able to take only a 10 per cent. random sample to try to find out what the consultation said. Of the random sample, 21 per cent. expressed concern about how the restructuring will affect recruitment and retention, 42 per cent. expressed concern about how partnerships and consortiums between local health boards will work, 56 per cent. said that local health boards are too small to work effectively and 61 per cent. said that specialist medical practitioners and managers will splinter because of the smallness of local health boards.
My views largely reflect those responses. The boards may well be too small. How will we restrict the bureaucracy that will probably increase as we move from five to 22 commission authorities? However, my main worryI hope that Front Benchers are listeningis that the list of 353 respondents to the consultation exercise did not include the name of a single Member of Parliament. I thought that odd, as I had been assured by my hon. Friend the Member for Bridgend that he had responded and I knew damn well that I had done so. Somehow, MPs' responses had been airbrushed from the consultation document. I do not know the reason for that. Perhaps we shall hear it in one of the winding-up speeches. Let me say honestly to the Government, however, that if they believe that the present constitutional arrangements
My final point is the most important. How do we ensure that, during this period of upheaval, we do not deflect resources and concentration from the important task of improving service delivery? I shall put it simplymy constituents, and those of other hon. Members, will not care too much about the structure; what they will care about is whether the changes will make any difference to the time for which the Mrs. Davieses, the Mrs. Joneses and the Mrs. Williamsesand the Mr. Williamsesmust wait for operations. If they will make a difference, will they increase or reduce the waiting time? That is what we need to be told.