|Draft National Health Service (Wales) Bill
Adam Price (East Carmarthen and Dinefwr): ''Historic'' has been the most overused word in today's debate. I add to the historic nature of the proceedings by resisting my usual tendency to launch into a 12 or 15-minute tirade castigating the Government for all their inadequacies. That may be
Column Number: 067evidence of the civilising effect of being a member of the Welsh Affairs Committee.
Mr. Llwyd: Character building.
Adam Price: Indeed.
As has been said, the Bill is short and uncontentious, but that has not prevented hon. Members from finding something to disagree about, sometimes on the thinnest of premises. It is fair to say that, in terms of the Bill's contents, only a few cigarette papers separate Opposition and Labour Members. Our complaint relates to what is not in the Bill: my hon. Friend the Member for Caernarfon raised several issues. We should have liked a reference to a separate health audit body, which may come in due course with the audit Bill that may feature in the Queen's Speech following our return.
On the process, I pay tribute to the skill of the Chair of the Welsh Affairs Committee and the staff in navigating us through a tight time scale. It has been a good-humoured and assiduous process—Parliament at its best. Unfortunately, much of it took place behind closed doors, but the Committee added a lot of value to the pre-legislative process.
There was confusion, a lack of clarity and frustration among some stakeholders. For instance, the Society of Chiropodists and Podiatrists said that it was disappointed that the draft Bill did not explicitly mention the professional bodies covered by the legislation. It felt that there had been a disappointing lack of consultation with some professional bodies, and it felt slightly marginalised. The Welsh board of the British Psychological Society said that it was unclear about the role of Health Professions Wales in relation to itself.
There are lessons to be learned. The Wales Office could learn from the Welsh Affairs Committee, whose consultation involved a wide range of bodies.
The Secretary of State was right to say that the Welsh Affairs Committee made some interesting proposals. In response to the point made by the hon. Member for Clwyd, South, the Plaid Cymru parliamentary group is happy to endorse the recommendations, with the one qualifying statement made by the hon. Member for Brecon and Radnorshire. Clearly it is a matter for our Assembly colleagues to respond to in their own time and in due course in the plenary debate in the National Assembly. However, some positive proposals have been made, and I shall touch on one or two of them.
The issue of the membership of community health councils was first raised by the hon. Member for Gower and was subsequently mentioned by several hon. Members, including the hon. Member for Vale of Clwyd (Chris Ruane). The issue of the extent to which community health councils are representative has been raised consistently in the past. It was mentioned in the evidence to the Committee given by the Community Practitioners' and Health Visitors' Association, who hoped that as a result of the Bill CHCs would become more representative of the communities that they
Column Number: 068represent, and would put mechanisms in place to ensure that currently excluded groups were included in the membership. I consider that the Committee is right to stress maximum discretion for the National Assembly in implementing the legislation. The recommendation of allowing statutory time off for members almost had cross-party support—perhaps we can tempt the hon. Member for Ribble Valley in due course. I would be interested if the Minister gave some indication of the Government's view at this early stage.
The issue of coterminosity was mentioned by several hon. Members. It has been Plaid Cymru policy since 1994 that CHCs should be coterminous with local health boards. Clearly, we have always operated a policy of subsidiarity. Where there are pressing local concerns, hon. Members may take their own view. Under current arrangements, most CHCs are coterminous, but there are several exceptions, and that has the potential to cause confusion and a lack of clarity, particularly in parts of the Glamorgan valleys, and in my constituency. We are entering into an era of greater coterminosity, but some hon. Members were right to stress the need for flexibility, particularly with a view to counties with large land masses such as Powys and Gwynedd. In the case of Carmarthenshire, I feel that the benefits of transparency and coterminosity outweigh any disbenefits. The Committee has got the balance right in seeking to ensure that the Administration and the Assembly give proper regard to the advantages of coterminosity without unduly constraining them from taking into account particular local circumstances.
The Committee referred to the need to give the National Assembly for Wales the power to extend the scope of community health councils' powers to inspect premises. Other hon. Members also focused on the issue of prisons where the NHS is providing services locally. Unfortunately, as the Bill is currently drafted, the power to scrutinise will not be extended. I should be grateful if the Minister would explain why the power to extend that to prisons could not be included in the legislation.
The accountability of community health councils was raised by several hon. Members. It is a fine line to tread to ensure the independence of CHCs while ensuring some sort of framework for performance management across the whole of Wales. In his evidence, Professor Warner expressed concern that the designation of the Association of Welsh Community Health Councils as an advisory body could frustrate ambitions to create a more seamless level of service throughout Wales.
We had several interesting contributions from Members from Cardiff constituencies. It is widely accepted that the community health council in Cardiff is something of a beacon and an exemplar of best practice in Wales. Why do we then see this variation in the level of engagement between CHCs in Wales, and how can we ensure some kind of accountability mechanism to spread best practice throughout Wales? The Committee has made some tentative recommendations as to how that could be achieved.
The ability of the National Assembly to commission specialist service providers in terms of
Column Number: 069advocacy is raised in the report, and was also raised by several hon. Members. The other issue in terms of independence of CHCs is their independence not from the Assembly, but from the very bodies that they are intended to scrutinise. Some concern has been expressed in the past at the collocation—not coterminosity—with health authorities in some cases, where for technical reasons the staff are actually employed by the health authority. Because of that, there has been some public perception that CHCs are part and parcel of the local health authority structure. Obviously, that must be examined and could possibly be addressed during the passage of the Bill.
Securing and ensuring the independence of the Wales Centre for Health was very much at the forefront of the Committee's deliberations. Much evidence that we received from witnesses stressed that element, in the light of concern in Wales about landfill. In that regard the Secretary of State mentioned Nantygwyddon, where we are bringing over experts from outside Wales at the moment. In future, it would be very positive to have a rigorously independent source of specialist advice in Wales, which the public and communities could approach themselves. We should be grateful for further reassurance and perhaps some guidance on how such independence could be written into the Bill.
On diversity, a positive aspect of the Wales Centre for Health is the fact that written into its objectives will be the aim of looking not only at best practice across the whole United Kingdom, as the hon. Member for Ribble Valley and others stressed, but at best practice globally, and at international multi-professional bodies. The Welsh Food Alliance mentioned the interesting experiments in northern Karelia into the relationship between food and health outcomes. Certainly, we know that diet is an important factor in Wales and there are a wide range of lessons to be drawn on internationally. We look forward in due course to the Wales Centre for Health embarking on such matters.
The Committee expressed some unease about the powers of direction conferred on the National Assembly for Wales in relation to Health Professions Wales. Similarly, the Committee wants, as does my party, to ensure that Health Professions Wales has sufficient independence as a statutory body. My hon. Friend the Member for Caernarfon mentioned Welsh language. I should be grateful if the Minister would reply on that point in due course.
I have resisted raising the dreaded issue of resources. I was almost going to complete an entire speech without mentioning the Barnett formula but, unfortunately, I was provoked by the hon. Member for Ogmore. I say to him that the comprehensive spending review may have been Barnett plus, but it was Wanless double minus in terms of the health settlement for Wales. Once again, we shall see a lower rate of increase in health spending for Wales than for England.
We absolutely support the objectives of the Bill and we look forward to the positive changes that will be wrought.
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Mr. Llwyd: My hon. Friend might be interested to know that I challenged the Secretary of State for Education and Skills this afternoon on the spending allocated to the devolved areas—compared with the increase of 28.5 per cent. during the next three years, there will be only 21.6 per cent. for Wales. Those are Library figures. The right hon. Lady answered:
which means that we are being—[Interruption.]
|©Parliamentary copyright 2002||Prepared 16 July 2002|