NHS Reform and Health Care Professions Bill

[back to previous text]

Mr. Touhig: I reassure the hon. Gentleman that that is not the case. The local health boards will be shadowing the other bodies before they actually take over their new responsibilities. The problem with the Welsh dimension is that there are many other reforms to the health service that the Assembly would like carried out. In the early discussions among the Wales Office, the Assembly and the Department of Health, the Assembly had a shopping list of items that it wanted included in this Bill and was prepared to consider a different time scale, if necessary. As I pointed out in response to an intervention from the hon. Member for West Chelmsford (Mr. Burns), the Government are committed to publishing a draft NHS Bill for Wales, which is not yet ready—we are still in discussions with the Assembly and the Department of Health on that. The Assembly has an extended time scale because many of the reforms that it would like carried out cannot be implemented until Parliament enacts that Bill.

Mr. Burns: What proportion of the reforms to which the Minister referred and that are needed in a draft Bill are actually beyond the scope of this legislation as it applies to Wales?

Mr. Touhig: I cannot directly answer the hon. Gentleman, because we are still in discussion about what should be included in the draft Bill. The

Column Number: 129

Assembly suggested a range of things that it would like to do but that we have not been able to include in this legislation. Clauses 6, which establishes the local health boards, and clause 22, which establishes the statutory partnerships requiring local authorities, health boards and trusts to work in partnership, are time sensitive. We are dealing with them now so that the shadow local health boards can be up and running and ready to take on their responsibilities by 2003. I cannot honestly say what will be included in the draft Bill.

2.45 pm

The hon. Gentleman made the point about the appointment of the chair and vice-chair of the local health board by the Assembly. The chairman will be independent in the sense that he will not be the person representing the Assembly in the health board, and the post will be advertised in the Nolan way. The appointment will be totally independent.

The hon. Gentleman also referred to the way in which boards will be accountable for their actions, and the greater degree of accountability in the community. The structure of local health boards will include representatives of health professionals. Only this week, during a debate in the Assembly, the secretary responsible for health agreed with an amendment moved by a representative of his party that determined that carers should also be represented on local health boards. Other health professionals and the local authority can also be represented, and it is believed that that will give the health service greater accountability, profile and visibility, which we welcome.

Each health board will be required to produce an annual report of its activities, and the Assembly, as we will see in clauses yet to be discussed, will have powers over the funding of the boards to ensure that they meet the Assembly's general strategy for health delivery. Obviously, the Assembly will be able to bring pressure to bear on the boards, as we will discuss in later clauses, to achieve the overall strategy and outcomes for reform of the health service.

This is an important reform of the health service for Wales. The local health groups have had an important influence on articulating local interests, hopes and desires for the reform and delivery of the health service. I am pleased about that because, in my constituency, in 1993, an ad hoc group produced the Islwyn local health plan, which identified the problems that we saw within the health service in my area. If some mechanism had been in place for delivering the solutions that were recommended, there would have been a great improvement in the health service in my constituency. I hope that local health boards will work after that kind of model, be responsive to the demands and hopes of the local communities and work in partnerships with the trusts to ensure that what people want is delivered.

Mr. Burns: Although the boards are called simply local health boards, will their primary function be strategic, similar to the SHAs that are being established in England?

Column Number: 130

Mr. Touhig: No, the local health boards will have responsibility for commissioning and delivering services.

Mr. Burns: So who or what body in Wales will have the function of strategically considering each aspect for the future of health care in that area?

Mr. Touhig: A director within the NHS will be responsible to the Assembly for ensuring that its strategic policies for health delivery in Wales are delivered.

Mr. Burns: I can understand that, but why were the Government not persuaded that the English model, which is one step divorced from this House and even from ministerial control, was not suitable in Wales? The sort of strategic planning that is emanating from the Welsh Assembly could be compared with the Department of Health taking over a strategic role in each region of the country—or whatever sub-geographical division one wanted to create. Would it not be better if strategic planning were undertaken one step lower, and closer to the area that would benefit—or otherwise—from its decisions on the provision of health care?

Mr. Touhig: Under the devolution settlement, it is the responsibility of the Assembly to make proposals for the reform of the health service in Wales in dialogue with the Department of Health. That formula has been agreed to be appropriate to deliver the improved health service that we seek in Wales.

Mr. Burns: I understand that, but I do not understand why it is thought better for SHAs in England to be independent of the Department of Health but not in Wales. It seems odd; if strategic health authorities are such a good idea for England, why are they not equally good for Wales?

Mr. Touhig: I can only reiterate that the Assembly takes the view that that is the most effective way of delivering the health service in Wales. It is a small country, with 3 million people and about dozen health trusts. We want to push down as much of the decision-making process as we can to the local health boards. Those boards will represent the interests of the whole community in order to deliver the hopes and aspirations for the health service in that community. It is a formula and a model that we believe will work in Wales.

Dr. Andrew Murrison (Westbury): Have the Government taken a view on which of the two different models that we have discussed they prefer? Which do they believe will deliver the best outcome? The differences have only just dawned on me. On the one hand there is the strategic health authority, which is effectively an ectopic part of the Department of Health sitting in the Welsh Assembly, and on the other the numerous strategic health authorities in the rest of England. It seems to me that they will work quite differently and I should be interested to know what the Govt think. We understand what the Welsh Assembly thinks but I want to know what the Government

Column Number: 131

believe is the best model. If they think that the Welsh model is best, the natural corollary is to transpose it to England.

Mr. Touhig: The Government believe that both will be appropriate, because the devolution settlement allows the Assembly to define and decide its preferred route. It is as simple as that. Perhaps the hon. Gentleman has a problem coming to terms with the devolution settlement.

Mr. Dai Havard (Merthyr Tydfil and Rhymney): As a Member of Parliament in Wales, and until recently a trade union official dealing with people in the health service, including nursing groups and some of the professionals, I know of the great welcome that has been expressed on the involvement of local health boards. We are trying to get across the message that it will become a primary led service.

The local authority will have the legislative responsibility of producing a community strategy. That area will be coterminous with that of the health board, which has to produce a health and well-being strategy, and the two must work together. That is the power of the local connection, and of local people being involved in deciding what is important for their communities. The local authorities and boards will then co-operate with the local trust, of which there are only 12, and will commission the services from them for hospitals and so on. That level provides another strategic view. The NSH in Wales has not been organised as it is in the UK—

The Chairman: Order. The intervention is too long, but the hon. Gentleman will have a further opportunity to speak in the debate if he wishes.

Mr. Touhig: If I may help the Committee, primary care trusts exist in England, but not Wales. We are setting up local health boards, which will be the Welsh equivalent. People in England can already see the value of primary care trusts, and England is ahead of Wales in that regard. However, both approaches are perfectly valid given the devolution settlement in the United Kingdom.

Mr. Havard: I was trying to say that there will be a strategic vision, but it will be described differently.

Dr. Richard Taylor (Wyre Forest): Two days ago, we went over the difference between geographic boundaries and boundaries in size. If 3 million people is the right figure for Wales, I shall accept it because there are differences in size and concentration of population.

Mr. Touhig: Let me explain a little further what the NHS directorate will do. The Assembly views the strengthened directorate as part of the new relationship that will be developed with the NHS. It will ensure that a concerted effort is made at national and local level to deliver local services that provide national standards of care. That is the primary point that I want to get across to members of the Committee.

Column Number: 132

We have had a useful debate. I have sought to answer hon. Members' questions properly, and I hope that they will support the clause.

Question put and agreed to.

Clause 6, as amended, ordered to stand part of the Bill.

Schedule 4

Local health boards

Question proposed, That this schedule be the Fourth schedule to the Bill.

Previous Contents Continue

House of Commons home page Parliament home page House of Lords home page search page enquiries ordering index

©Parliamentary copyright 2001
Prepared 29 November 2001