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27 Nov 2002 : Column 360—continued

Madam Deputy Speaker: Order. Again, I remind hon. Members that we are discussing the Health (Wales) Bill, not the national health service in Wales.

Mr. Evans: In that case, I shall respond to the Under-Secretary only briefly. Many people will look back on 1997, when waiting lists were much shorter, and wish that the Conservatives were still in power.

Gareth Thomas (Clwyd, West): Will the hon. Gentleman give way?

Mr. Evans: No. I have given way often, and I want to move on.

Community health councils will want to consider in detail the issues that we are discussing and expose some of the problems. I therefore believe that we should examine carefully CHCs' independence from the Assembly.

I spoke about the professions that the Bill covers, including GPs. Let us consider some of the comments of Dr. John Chisolm, chairman of the BMA practitioner committee, who published a book entitled XCrisis in Care: A GP dossier". I heartily recommend it to all hon. Members who are present. They should examine the Welsh sections if nothing else. It is a harrowing read. He comments on some of the GPs who work in Wales and will be covered by the CHCs. One is Andrew Dearden, a doctor from Cardiff. He says that some people wait as long as six years for hip replacement operations.

He states:

While we debate the Bill today, let us keep in mind the people to whom it relates: the patients facing lengthy waiting lists with GPs. The GPs are hugely frustrated by that.

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Gareth Thomas : Can the hon. Gentleman tell us whether his party supports the Bill? Does he agree that rather than embarking on a regurgitated rant, he would do the House a greater service if he told us whether he supports the technicalities of the Bill—yes or no—and why?

Mr. Evans: The hon. Gentleman will have to be a little more patient. We support some aspects of the Bill, and we will wish to improve some aspects of it when it reaches Committee. I hope that the hon. Gentleman will serve on that Committee. No doubt we will then be able to debate at length improvements to the Bill. The hon. Gentleman may be surprised to find that amendments are tabled even by his hon. Friends.

The Secretary of State said that the Opposition did not want a national health service, and that under the Conservatives only the rich would get treatment and those who were poor would not. It is a chilling fact that 250,000 people last year used their own money to have operations. That is the figure for the whole of the United Kingdom, and some of those cases would have been in Wales. People withdrew their life savings or borrowed money because they were in pain and the waiting lists were far too long.

We must focus carefully on what the Bill is about. We all want an improvement to the service provided to the people of Wales. That is why we want to ensure that the Bill is improved in Committee.

Mr. Bercow: Is my hon. Friend aware that a cursory study of the Bill suggests that it contains no fewer than 18 references to orders and regulations, rendering it something of a parliamentary eunuch? Does he agree that it is therefore essential that we are told tonight by the Government whether the regulations will be subject to the negative or to the affirmative procedure, and that the National Assembly for Wales publishes draft intentions of what it plans to introduce?

Mr. Evans: I agree with my hon. Friend. That would be an informed position for the Assembly to take. As we see from the Bill, many powers are to be devolved to the Assembly. I want to know what consultation the Assembly will have with various bodies before it introduces regulations that will impact on the whole of Wales.

I read the second report of the so-called First Minister, Rhodri Morgan, for 2001–02. I wanted to see what he had to say about the NHS, because it is devolved through secondary legislation. Only three of the 35 pages are devoted to the NHS. The First Minister sets out some of the targets. One of those strangely and boldly states:

I do not know what is meant by Xin the main". I do not see that as a target, but there we go. I then looked at the statistics made available by the NHS in relation to orthopaedics. It is clear that in most of the health authority areas, the waiting time for orthopaedics is more than 18 months—that is, more than 72 weeks.

Mark Tami: Does the hon. Gentleman agree that all his arguments show the need for investment in the health service—investment that his party opposes?

Mr. Evans: I agree that investment is needed in the health service, but it must be investment in the right

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areas. Clearly, the investment is not going into the right areas at present. I hope that with his interest in the health service in Wales, the hon. Gentleman would want to ensure that the extra national insurance—the extra taxation—that everyone is paying goes into the right areas. When people are taxed to the hilt and receive the sort of service that we are discussing, they feel aggrieved.

Lembit Öpik (Montgomeryshire): Which areas of the health service would the hon. Gentleman not invest in? Out of which areas would he take money?

Mr. Evans: The hon. Gentleman, as a Liberal Democrat, is part of the coalition, or the official irritation, as I prefer to call it. His party is just a poodle for the Labour party in the Assembly, and Labour's little helpers at Westminster. When there are more managers than nurses in the NHS, we must refocus on where the money should go.

Huw Irranca-Davies: Will the hon. Gentleman give way?

Mr. Evans: No. I must make progress.

Will the Secretary of State please look again at the waiting lists for orthopaedics and see how many people have been waiting for way over 18 months? That is a real problem, which must receive the proper attention. It is pointless having targets if they are not likely to be met. Why does the Assembly promise what it cannot deliver, and why does it claim credit for what it cannot achieve?

Why did Rhodri's second report, if it was to be honest and transparent, not give us all the figures for waiting times so that everyone could judge what the Administration had promised and what they had achieved? The document is spin. Unless the Administration are fully truthful about the position next year, I suggest that they do not bother to produce a report next year, and instead put the money saved towards employing an extra nurse. I suggest an extra nurse because, despite all that the Secretary of State said earlier, there are still 700 vacancies in the NHS for nurses, even though there are 1,000 Filipino nurses working in the health service in Wales. Thank goodness for the job they are doing, but there are still almost 750 vacancies.

Mr. Roger Williams (Brecon and Radnorshire): Has the hon. Gentleman's party estimated how much money would be saved by cutting the administration of the NHS in Wales?

Mr. Evans: The hon. Gentleman should know that we would at least examine the areas in which the bureaucracy has grown, where the number of managers has grown and where there are inefficiencies, instead of making excuses all the time to explain why more money has to be pumped in while services are deteriorating. The sad thing for him and his constituents is that they are getting a worse service at the same time as they are paying extra taxes.

Huw Irranca-Davies rose—

Mr. Evans: No. I must make a little more progress. I know that other hon. Members want to take part in the debate.

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Part of the Bill deals with Health Professions Wales and the directions that the Assembly may give to health workers, including nurses. Part of its function must be to ascertain that newly qualified nurses earning £15,000 feel properly valued in their roles. How can we retain them when they are qualified, and how can we encourage more of the newly qualified nurses to go into nursing? Pay is vital, and we all await the outcome of the Agenda for Change at the end of the year, and the impact of Health Professions Wales in ensuring training for our nurses, and ensuring that the training will come to something. It must be a matter of deep concern that so many of those who are trained do not go into nursing at the end of their training.

All of us who read the Western Mail today saw with great delight that £14,000 has just been spent on a new logo for the Welsh Assembly—£14,000 on a new dragon. What a waste of money. The patients waiting for operations could not care a jot about such expensive trivia. If a new logo costs £14,000, and a nurse costs £15,000 a year, on what would hon. Members prefer the money to be spent?

We all want an improved national health service in Wales. Will the Bill deliver that? It contains no reference to foundation hospitals, which were mentioned by Plaid Cymru Members earlier. The Government believe that foundation hospitals are the answer for England, but not a mention of them for Wales. I wonder why. The retention of community health councils is to be welcomed, as are their enhanced powers, but the power given to the Assembly to decide whether they could be abolished in the future—indeed, the very name could be changed by the whim of the Assembly—is over the top and unacceptable.

Yes, it is right to ensure that the whole of Wales is covered by CHCs, but we need to examine ways of giving the CHCs greater autonomy, away from the Welsh Assembly. They could fall foul of the Assembly by exposing many of the deficiencies in the health service in Wales, some of which I have highlighted. The CHCs could then face the bullet; they could be abolished, just as has happened in England. Many hon. Members here today helped to bring that about by not supporting the retention of English CHCs. Only one Member from a Welsh constituency voted against their abolition.

Part of the CHCs' remit is to be the patients' champion. When the newly reformed national health service in Wales gets off the ground in April of next year, we know that it is going to be hugely bureaucratic. We also know that it is going to be expensive. Even a former Welsh Office Minister has termed it Xunworkable". A leaked report presented to Rhodri Morgan, Jane Hutt and the Secretary of State for Wales by the senior civil servant, Bryan Mitchell—the man overseeing the reform—stated that there were major risks involved in the reorganisation. We were told that it was going to be cost-neutral; we now know that it is going to cost £15 million. The Secretary of State for Wales assured me in the Welsh Grand Committee that this was a one-off payment. We will compare the costs after the 22 local health boards are up and running, to see whether the change has been cost-neutral. People should have this kind of information before they vote these measures through. There are also a number of other concerns

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relating to the reforms. Let us suppose that the CHCs blow the whistle on all this, when the new organisations are up and running. What protection will there be for them?

We know that Jane Hutt receives a lot of criticism—all of it fair, in my book, yet she hates it. She has stated that

Well, there is not much chance of that, is there? What she fails to recognise is that the reason she is being bashed is that she is signally failing to do as she promised. No doubt the Assembly would like to have the same powers over the media as they are being given over the CHCs. In the Bill, it can decide the membership of the councils, the means by which the chairman is elected, the proceedings of the councils, and the discharge of any function of the councils by a committee of the councils. The Assembly will also be able to decide who consults the councils, the payment of councils, the preparation and publication of reports by councils, matters to be included in any report, what the councils may receive from health authorities, local health boards, strategic health authorities, primary care trusts or NHS trusts, what sort of information they can give out to other people or other councils, and anything else that takes its fancy.

Gosh! If only the Assembly had such powers over the media! It could appoint editors and journalists, decide what goes into the newspapers, what information the public could and could not read, and who that information went to. What sort of far-reaching, searching publication would that produce? Well, it would be a bit like Rhodri Morgan's report to the Welsh Assembly and the people of Wales: wholly spun, wholly disinfected, wholly engineered and wholly useless. Anyone who believes that the Assembly would not use its powers unreasonably should remember that it abused its powers by delaying the local elections from 2003 to 2004 so that they did not coincide with the Assembly elections. That was a complete disgrace, but it is going to happen.

We need much more protection and independence for the CHCs. If we want them to be a whistleblower and a champion for the people of Wales, let us give them some independence from the body that might well be on the receiving end of some of their criticism. I want the CHCs to be empowered to check on all the organisations giving health services to patients in Wales, but I want them also to liaise with other bodies in England, Scotland and Northern Ireland, so that complaints may be taken up from any patients receiving care in facilities in Wales. I would like similar rights to be afforded to Welsh patients receiving care in institutions in other parts of the United Kingdom.

I also wish the CHCs to be consulted and involved in any name changes, abolitions or mergers. More autonomy and independence for CHCs will be important. It is also important that CHCs should consult the people of Wales and issue an annual report on the people's views on the service that they are receiving. Those views will be positive in many regards relating to the people working in the NHS, but I receive letters on a regular basis about the state of health provision in my own area, and it is not always so

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positive. Only if we encourage this sort of publication will we all learn about any deficiencies, and I am sure that best practice would lead to fundamental changes being made throughout the whole of the NHS.

The Wales Centre for Health has been widely welcomed, and we will be looking for ways in which it can engage in a constructive dialogue with comparable bodies elsewhere in the UK. One of its remits is to keep people in Wales informed on matters that affect their health. That is right, but much of the information gathering and research could well be carried out elsewhere. Furthermore, it could be pioneering an area of health concern and be way ahead of what someone else is doing—on certain aspects of drug abuse, for example—and, in such circumstances, it would only be right for the information involved to be shared and for collaboration to take place, to give any information campaigns the greatest effect.

I see that the Assembly is to give itself the power to appoint the chairman of the Wales Centre for Health. I hope that that will be done in an open and transparent way, and we will look for ways of ensuring that that is the case. Evaluation of the centre's work will also be important, in terms of assessing how effective it is in getting positive health messages across. We will examine how that can best be achieved. I see that the Auditor General for Wales has responsibility for this provision in the Bill. There will be budgetary implications for this body.

Today's report that parents in Neath, Port Talbot and Swansea are shunning the measles, mumps and rubella jab in increasing numbers must be of concern to the Government. More than 25 per cent. of children have no immunisation at all, and the fear is that this could lead to an outbreak of measles, mumps and rubella. The Wales Centre for Health may well be involved in research into the fears of a growing number of parents about autism. Indeed, it may wish to make recommendations on single jabs being made available.

Health Professions Wales will work closely in liaison with a number of other bodies. We will wish to see that it works closely in consultation with the bodies and professions that it covers, especially nurses. I have a concern about the training and qualifications necessary to work in the Welsh health service, and I would like to see training and regulations there that are very similar to those that exist in the rest of the UK. Wales is a small country, and nurses might find themselves unavailable for work in Wales if they had been trained in England or, for example, if they were agency nurses who could not get work in Wales if they lived in Bristol, because a wholly different system was operating in Wales. Given the nursing shortage to which I referred earlier, I would have thought that flexibility and ease of working in Wales would be the byword, as opposed to seeing how different from England or Scotland we can make the system.

I wish to see a world-class health service in Wales, with our dedicated staff receiving the best support and our patients receiving the best care. I am angry that this is not happening after more than five years of a Labour Government and three years of a Welsh Assembly. The number of promises was high. The criticism of the NHS under the previous Conservative Government was constant, but I do not remember Labour Members ever

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rebuking themselves in those days for talking down the NHS by making constant criticisms or by pointing out where things were going wrong.

The Government are embarking on further change, on top of other changes, and this constant change cannot be good for the system. After all the changes that have been made—and with the differences from other parts of the country—it will not be a case of not knowing where the buck stops for most people; it will be impossible to work out where it starts. We have massive fears about the changes contained in the recent health reform legislation, as it affects Wales. I believe that they are going to cost a fortune and will be unworkable. Mergers will be almost inevitable as local health boards find that they have to join up with others to make a go of the new provisions. The changes mentioned in the Health (Wales) Bill could lead to progress, so long as we can ensure that these bodies have some independence from the Assembly and are given teeth.

We want to see a better health service. The people of Wales were promised that, and they do not deserve what they currently have. Jane Hutt, the Health Minister in the Welsh Assembly, is drinking at the last chance saloon, and—even with the prospect of licensing reform and the possibility of 24-hour drinking—the bell for last orders should be ringing long and loud in her ears.

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