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27 Nov 2002 : Column 374continued
On other key points, we need to understand exactly the role of the community health councils. That is fairly clearly laid out in the document but there is a side issue about boundaries and co-terminosity. Kirsty Williams, the Welsh Liberal Democrat Assembly Member, who has done a lot of work to help to construct a modern health service in Wales, has pointed out that, although we should respect natural boundaries for local authorities, there may be occasions when having more than one community health council will be effective in the Wales environment. Being parochial for a moment, Powys, for example, has two community health councils; one would be unmanageably big and it probably would not be reasonable to expect one individual community health council to do the work.
Many of the figures cited have come from independent advocacy services. A rough figure of £500,000 has been mentioned, but we must be careful to recognise that the costs are estimates and while those estimates sound okay, it would be a great shame if the intention of the Bill were thwarted by the fact that the community health councils did not have the necessary resources. Even £1 million is not a huge proportion of the Welsh health budget. We back the principles in the Bill, based on an acceptance of flexibility. We should work reasonably with the Assembly, ensuring that it does not end up in an impossible position by trying to fund something from its existing budget that is unfundable, given that it is primarily a Welsh Assembly responsibility.
It may sound like a detail but it was suggested by the Select Committee on Welsh Affairs that prisons be transferred into the ambit of the Bill. Hon. Members will correct me if I am wrong, but I do not believe that that has been done. I think that it is unfinished business. It would be strategically more sensible to do that now, rather than to return to it in future.
The next steps are fairly clear. We will need a constructive Committee stage but, as has been noted, it is likely that our proceedings will be relatively uncontroversial, as many big issues have been resolved. However, various amendments will have to be tabled.
The Welsh Liberal Democrats in particular will want to deal with matters that might fall outside the Bill. We have talked about free, long-term personal care for many reasons. Lloyd George said that the measure of a civilised society is how it treats its elderly. My hon. Friend the Member for Sutton and Cheam (Mr. Burstow) has worked in that sector, and has suggested that tomorrow's debate on community care might be a better opportunity to discuss legislation to achieve that goal. However, I raise the point now as these matters are interrelated.
Lembit Öpik: I apologise, Mr. Deputy Speaker, if I was deviating. I recognise that, to include provision such as free dental and eye tests, the long title of the Bill would have to be changed. That is unlikely to happen in Standing Committee, but it is ironic that the matters to which I have referred could come back to the Floor of the House for discussion, given the advice that I imagine that the Wales Centre for Health will come up with once it is established.
The constructive debate tonight has been encouraging, and I think that the Standing Committee deliberations will be constructive too. I hope to hear the useful and ever friendly criticisms from Tory Members.
Mr. Evans: Earlier, the hon. Gentleman mentioned orthopaedics, for which waiting lists are way above the 72-week target. Does the hon. Gentleman consider that a useful role for CHCs could be the production of annual reports detailing the views of patients in each area? That would highlight where the real problems are, and thus enable a focus on solutions to reduce waiting lists.
Lembit Öpik: That sounds like the sensible sort of role envisaged in the Bill. I am concerned about tying CHCs into too much repeating bureaucracy, as I believe that they will operate best on an ongoing and proactive basis. They should identify and deal with local issues, without having to go through an eternal cycle of preparing reports. However, that is an important matter for consideration in Committee.
Another such matter is whether CHCs should be authorised to go into private health providers, even when there are no NHS patients in them. There is no point in rehearsing the various principles at stake, but I hope that we can discuss the possibility. More encouraging is the way in which the CHCs will have pretty wide powers to investigate the general quality of provision. If we work on the basis of success rather than failure, the CHCs could be critical friends for the institutions that they inspect.
I hope that a reasoned debate in Committee will help build relations between Westminster and Cardiff. After a slow start, that relationship is fast improving. It could also help create a healthier health service. If that leads to a healthier Wales, it would be a credit to the Bill and all those involved in it.
Huw Irranca-Davies (Ogmore): I am pleased to contribute to this debate, as I was when the Bill was discussed in the Welsh Grand Committee in the summer. I have read the extensive work done by the Select Committee on Welsh Affairs on the Bill, and I pay tribute to that.
The Bill is a modest but important step towards increasing joint scrutiny of draft legislation by the National Assembly for Wales and this House. Such parallel scrutiny sets a good precedent, and I am glad that the Government are committed to ensuring that more Bills are handled in that way.
The diversity to which devolution has led is relevant to the Bill. For those who, like me, are powerful supporters of devolution, it is a recognition that different solutions may apply in England and Wales, and that there may be learning experiences to be derived from both. That is to be celebrated, not scorned. We are aiming to secure good health care provision for all communities on either side of the border. If a different approach is adopted in Wales, so be it: results are what matter.
The Bill will establish the Wales Centre for Health, which will gather and disseminate information on health provision in Wales. That is a vital and long overdue function. The Assembly has made great strides in that direction already, especially in recognising the problems of prevention as well as repair when it comes to health. A great tragedy of many Welsh communitiesespecially where there are high indices of multiple deprivationis that chronic and long-term health problems are exacerbated by poor housing, low aspirations and so on. That is something to which the Wales Centre for Health can turn its attention and for which it can work proactively to find solutions.
I also welcome the proposed centre's ability to undertake and commission research. It is right that, under the devolution settlement, that research should be passed down to the Wales Centre for Health. The centre will look at where research is needed, seek solutions and put forward proposals, instead of everything being steered by Westminster. That shows a level of trust in the Assembly and the process of joint scrutiny. The centre will also provide Welsh solutions in matters such as the development and provision of training in the health sector, and that is to be greatly welcomed.
The Welsh Centre for Health will face great challenges. In many of our communities, health problems are huge, long-term and entrenched. In Bro Morgannwyg, for example, heart disease affects more than 20 per cent. of the community. The figures for respiratory diseases, asthma and arthritis are 25 per cent., 12 per cent. and 26 per cent., respectively. Mental illness, the constant Cinderella of health care, affects 13.7 per cent. of the people in my area.
Huw Irranca-Davies: The hon. Gentleman makes a good point. That is exactly the sort of problem that the Welsh Centre for Health can tackle. However, we must be realistic. As has been noted already, once a problem has been identified, the necessary resources must be made available to ensure that it is rectified. We are committed to putting in the necessary resources. I share the hon. Gentleman's anxiety about the problem that he identified. It needs to be tackled, but that can happen only when effective resources are made available.
There are major lifestyle problems in Wales. It would be a failure not to accept that. In Bro Morgannwyg, 32 per cent. of the population are heavy smokers, and 21.3 per cent. consume more than the recommended levels of alcohol. Only a quarter of the population undertake regular exercise, and 53.8 per cent. of people are overweight or obese. Those are staggering figures. This Bill, which has been worked out jointly, gives us a chance to identify and tackle the problems involved.