Memorandum submitted by the Welsh Institute
for Health and Social Care, University of Glamorgan
NHS (WALES) BILL:
I have discussed the above Bill with colleagues
here at the Institute and we wish to provide the following observations
to the Welsh Affairs Committee.
1. The development of Community Health Councils
The Bill provides the Assembly with a welcome
opportunity to address some of the structural barriers which have
arguably impeded the effective operation of CHCs in the pastsuch
as the total number of Councils, their relationship with the independent
contractors in primary care, and their public profile (through
change of nomenclature, etc). These measures should go some way
towards meeting the avowed aim of ``giving patients and the public
more say in the running of the NHS''.
There are two remaining substantive issues,
however, upon which the Bill is either silent or vague. The first
concerns resourcesin the past, CHCs were substantially
under-resourced for the tasks they were expected to performbut
presumably this will be addressed when the Bill becomes law.
More importantly, the Bill is vague on the issue
of the accountability of CHCs. In the past, there was considerable
variation in the standards of performance of CHCs that could not
entirely be explained by issues of resourcing. The intention (in
Schedule 7A, paragraph 4) to create a body to advise Councils
may represent the beginnings of a regime of greater accountability,
but clearly an ``advisory'' body is just thatit will have
no statutory means of ensuring that CHCs provide a uniformly high
quality of service to the public and patients. Such issues of
accountability are difficult to resolvehow can CHCs on
the one hand maintain a degree of independence from both the NHS
and the Assembly, and yet on the other be effectively held accountable
for their performance? Organisational models could be devised
which would achieve these twin aims, but they are not present
in the Bill.
2. The establishment of the Wales Centre
for Health (WCH)
Discussions within the Public Health Review
Task and Finish Group showed strong support for the development
of a Wales Centre for Health; and a key element focussed upon
by the membership was that of independence.
Both the Explanatory Notes (cm 5527-II, paragraph
8) and the Press Release (17 May, 2002) described the WCH as an
independent body or organisation. However, neither the Bill nor
Schedule 2 use the word ``independent'' in describing the role
of the WCH.
Indeed, it is the NAW that may, by regulation,
make provision as:
to whom information and advice are
to be given by the Centre;
to which reports are to be published
by the Centre.
Further, Section 3(3) allows for an order of
transfer to the Assembly of the Centre's functions and Section
3(4) allows the WCH to be abolished by the Assembly. Neither the
Schedule nor the Explanatory notes indicate the scrutiny that
would be exercised over such decisions.
Finally, Schedule 2 (4)-(7) give rise to questioning
the need for a Board if the NAW is to have such hands-on control
by virtue of is ability to exercise such a range of specific and
In summary: the public, from the outset, will
not be guaranteed that the WCH can offer independent views; the
NAW will not be well served in its continuing quest for transparency;
and the WCH will be unmanageable. It is necessary to determine
whether the Centre is to be a political organisation or a technical
organisation in support of the political process: the Public Health
Review membership believed it should be the latter.
3. The Establishment of Health Professions
The creation of a new body to oversee health
care professions should be resilient to future changes in the
nature of education and training. Page 5 of the draft Bill sets
out various provisions descended as Schedule 1. Paragraph 3 of
this Schedule listed eight organisations that are required to
allow members of the Council to enter or inspect premises. It
is not clear that all potential providers of education and training
are fully covered in (a)-(h); in particular the premises owned
by independent contraction, private companies, and universities
may deserve separate mention.
The use of the abbreviation "LP" is
not helpful when issuing a draft for wide public comment unless
this is readily explained.
The use of HPW as an abbreviation risks confusion
with the former body of Health Promotion Wales.
Professor Morton Warner
19 June 2001