Welsh Grand Committee
Tuesday 16 July 2002
[Mr. Win Griffiths in the Chair]
Draft National Health Service (Wales) Bill
Motion made and Question proposed [this day],
That the Committee has considered the matter of the draft National Health Service Wales) Bill.—[Mr. Paul Murphy.]
Question again proposed.
Mr. Nigel Evans (Ribble Valley): I agree with many members of the Committee that this is an historic day. We are considering provisions before they come in the form of a Bill before Parliament. I welcome such a departure, especially given that, when Bills reach the Floor of the House, they are either timetabled or guillotined. The opportunity to debate measures is not as extensive as it used to be. It is important that the balance is redressed and that we are allowed to comment on a draft Bill. It has been scrutinised by the Welsh Affairs Committee, which has taken evidence on it, and its report is before us today. The process has been very useful. It is a pilot exercise and has the Prime Minister's support. In future, if measures deal exclusively with Wales, or if large chunks of proposals that relate to the United Kingdom as a whole would have an impact on Wales, perhaps the other place could be involved at an early stage. Several peers have expressed great interest in this Bill.
I accept that the Bill is narrow, but it is important to consider it in a proper context. On page 11, the Select Committee report refers to
''Wales is retaining CHCs, with extended powers and responsibilities: Scotland has Health Councils, similar to CHCs but different: England will have Patients Forums, local authority scrutiny and separate advocacy services: Northern Ireland retains its network of regional Health and Social Services Councils . . . Such diversity offers ideal opportunities for discovering what works best where and why.''
Well, I feel sorry for the poor patient who is perhaps trying to understand the structure of the health service and how it is organised, particularly when many Welsh patients are treated in England under a different system. When considering what works best and why, perhaps we could consider achieving best practice throughout the United Kingdom as opposed to only part of it. I do not think that any organisation in the country has gone through as many changes as the national health service. It has had more facelifts than Michael Jackson and, I suspect, to the same sad effect.
The draft Bill will establish three new bodies, so we will have to get used to new acronyms, too. There will be 22 local health boards and other bodies that will be in position above them. We were told originally that such changes would be cost neutral, but the Welsh Assembly now says that they will cost between £12 million and £15 million. We must be cautious
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when changes in bureaucracy cost that amount of money, because they must deliver results. We all want that to happen.
The Bill will be judged by whether people receive better health service treatment. I have many press cuttings with me, but I shall not detain the Committee with details of them because we all know that there is a crisis within the national health service, not only in Wales, but throughout the entire United Kingdom. When headlines in The Western Mail say, ''Why are they treating us this way?'', ''Medical schools running out of teachers'', ''Mid Wales villagers wait three years for a GP'', ''£30m worth of NHS buildings unsold'' and ''Shortages as dentists desert NHS over pay'', we have a real problem.
Huw Irranca-Davies (Ogmore): The hon. Gentleman bandies about words such as ''crisis'', but will he also recognise the excellent work carried out in the NHS and the investment put in by the Government. Three or four years ago, one could not get a job as a radiographer in Morriston hospital for love nor money. In the past two years, five extra have been taken on—the hospital is crying out for them, and their recruitment continues. There may be demand in some areas, but does the hon. Gentleman recognise the great amount of good work that is going on?
Mr. Evans: I was coming to that. Tribute has already been paid to the enormous commitment and dedication of our nurses, doctors and ancillary staff—everyone who helps our national health service to perform miracles on a daily basis. Of course I recognise that. At the same time, we would not be doing a service to the NHS and the people who work in it if we turned a blind eye to the real problems. Health service professionals tell me—as they probably also tell the hon. Gentleman—about the low morale that exists when they want to deliver a first-class service, but, for all sorts of reasons, they are unable to do so. A senior surgeon at the Royal Gwent hospital says that the problem with the NHS
''is the lack of everything—there are no surgeons, insufficient staff in training—there aren't the facilities for them to work in, there aren't the operating theatres, there aren't beds, there aren't enough anaesthetists, the whole of the Heath Service is in such a poor state.''
Those comments are from somebody who works daily in the NHS, not me.
Ian Lucas (Wrexham): Does the hon. Gentleman agree that substantial public investment is required to pay for each and every item of expenditure to which he referred?
Mr. Evans: I accept that there must be substantial investment in the NHS, but I also recognise that more per head of the population is spent in the NHS in Scotland and Wales than in England, yet we have an inferior service. We must therefore find ways whereby the money is most efficiently and effectively spent. I am sure that the Secretary of State and the Minister would agree that we could announce billions of pounds of extra money, but we will have real problems if it is not spent efficiently.
Chris Ruane (Vale of Clwyd): Will the hon. Gentleman tell the Committee how long he thinks that it takes to train a consultant in the NHS and when
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the consultants that we need today should have started their training?
Mr. Evans: No doubt there is an ongoing process during which people come into and leave the profession. However, the hon. Gentleman's party has been in power for more than five years. He must recognise that they are scouring the world for nurses and doctors simply because they have not been able to get them in the United Kingdom. There is a problem with the retention of doctors in the NHS because morale is low. Let us begin to look for solutions whereby the substantial investment that is being made—which I recognise—will be effectively spent. If it were only a matter of money, there would be no problem with the NHS.
The Chairman: Order. This is an interesting and wide-ranging discussion, but I should like the hon. Gentleman to relate it to the propositions in the Bill or those that he thinks are not there and should be.
Mr. Evans: Thank you Mr. Griffiths. I knew that you would find what I had to say interesting. I wanted to describe the context of the problems, and the Bill that the Government believe is part of the solution.
Like the hon. Member for Cardiff, North (Julie Morgan), I also wish to concentrate on the community health councils. I am rather sad that England has not retained them, because they are well respected in the main. I was interested to hear about the experiences of the hon. Member for Gower (Mr. Caton) as a former member of a CHC. Several areas must be examined, primarily the independence of the CHCs. It is difficult to get people to serve on the CHCs. It is bad enough now, but what will it be like when the powers and responsibilities of CFCs are extended? Much more must be done to attract people to serve on those bodies. Their funding must also be examined. With current funding, they will simply not be able to take on wider responsibilities and do the job that they are doing at the moment.
The training of CHC members will also be important. I do not know what training the hon. Member for Gower had before taking his position.
Mr. Caton: None.
Mr. Evans: That does not surprise me. I am not critical of him for having no training, but with the extra responsibility that is now involved, training must be considered to show members what to look for when they exercise their responsibility to scrutinise.
Julie Morgan (Cardiff, North): I am unsure whether the hon. Gentleman is aware that when we held discussions in Cardiff bay with the professionals involved and the CHCs, they estimated that what the Welsh Assembly had put aside was just about right.
Mr. Evans: Yes, but I also read in the report that they wanted there to be more, so that it would be possible for them to perform fully all of their extra responsibilities. They say that what has been put aside is tight to the limit.
This is a new role, and it will be necessary to suck it and see, so to speak, and to listen carefully to what
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those who are appointed to the position have to say when they start rolling out their new responsibilities. As has been mentioned, we would like them to get more involved in the prisons. Some people who are in prison have mental health problems; they are being detained, but they are not getting the proper psychiatric treatment that they deserve within the Prison Service, for all sorts of reasons, such as shortages. We must look carefully at the service that is being given in that area. If the CHCs are to be given these wider responsibilities, they should take on the responsibility of going into the prisons—and anywhere else where health care is being provided. I hope that the Government will listen to the suggestions that have come from their party and mine about the role of the CHCs.
I come now to the CHCs' powers with regard to cross-border areas. Welsh people often have to travel to Bristol, Liverpool and Manchester for specialist treatment. If Welsh CHCs are to have a remit to investigate them, there must be clear lines so that everyone knows what their responsibilities are. In addition, there should not be too much duplication—or, possibly, more than duplication, particularly if Welsh patients are coming in from several different areas of Wales. We might give a CHCs' association some responsibility to go to other parts of the UK to check that standards are up to a particular level, but if we go down that route, I suspect that there will be a huge work load. In the initial period, the CHCs may only want to get involved if there are complaints, and I suspect that they would have to liaise with their English equivalents to try to ascertain information, because it would be worrying if Welsh CHCs and their English equivalents came out with contrary reports about the same hospitals. Therefore, they must form a relationship at an early stage.
There is a recommendation that CHC members should be given time off work. I fully understand what the hon. Member for Clwyd, South (Mr. Jones) said this morning about the way that they would be compensated for the loss of pay. I also recognise that there is a problem in getting people on to such bodies in the first place, and that if people are in a profession where employers are not particularly interested in giving their employees time off, there will be a problem. On that point, I declare an interest, as I employee several people in Swansea. Again, I ask the Government to consult widely on this with the Federation of Small Businesses, the Institute of Directors' small business sections, and other employer organisations, to find out what impact that would have.
If this were to come about, exemptions for small businesses might be put in place, because this does not involve giving someone time off in a way that will always impose no cost on the employer: many firms employ only two or three people, and the person who is given time off might be critical to the well-being of that firm. That could cause real problems. In the future, the work load on CHC members will be high, so I ask the Government to consult widely before making a decision about that.
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When we talked about the CHCs this morning, I intervened on the hon. Member for Cardiff, North to ask whether she would give them more power—more teeth—when they inspect some of these premises. She said that she would not, but that the publicity may be enough in itself. We will see about that, and I hope that she is right. However, many hospital buildings in the country are currently deficient—47 per cent. of them is the proportion that has been mentioned. If the CHCs say that that hospital is deficient, or that we need to see an improvement there, I hope that the structure for bringing up the level of service for the people in those hospitals will be sufficiently flexible and responsive. The CHCs will play an invaluable role in pointing out the areas where improvements can be made. We would need to ensure that their morale is kept as high as possible, and that they are doing a real job that we all value.
CHCs had better get a move on if they are to go around care homes; there may not be any left by the time that they are given responsibility for them. They will be looking into care home provision for the most vulnerable people in the country. CHCs may well come forward with recommendations about the level of fees that local authorities are paying care homes. Although we are not giving CHCs the power to direct local authorities to increase the fees, I hope that they will consider the matter and decide whether there is a real crisis.
Several homes in the private sector are closing simply because they cannot make a go of it, as there is a £30, £40 or £50 a head discrepancy between what the local authorities are giving them and what it costs to deliver that service. The service is expensive, but it is even more expensive not to provide it, as we know from what we said earlier about bed blocking. We need to release the beds in our hospitals. It is pointless to have elderly people who could be better looked after elsewhere clogging up beds in the NHS.
The right to access to information has been mentioned, and is referred to time and again in the report. I look forward to hearing what the Minister has to say about that. From what I can make out, it seems that the Government are fairly flexible on the matter, and that the current situation is an oversight that will be corrected. If we are to give extra powers to CHCs, which will champion the rights of patients, we must ensure that they have much publicity, so that the public know which is their CHC, who is involved in it and how to get in touch with them. That may have funding implications, but we must make sure that patients know their rights and how to communicate well with their CHCs. That is something that we desperately need to do.
Morriston hospital has been mentioned. It is a wonderful hospital; there are no two ways about it. As the hon. Member for Ogmore (Huw Irranca-Davies) will know, the South Wales Evening Post is running a campaign to save the hospital's excellent paediatric neurology service, which has wonderful skilled staff. More than 74,500 people have signed a petition to prevent that service moving to Cardiff. All hon. Members present will know of the road problems in
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south Wales, and will know that Morriston hospital has a helipad, whereas Cardiff does not.