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27 Nov 2002 : Column 377—continued
Hywel Williams (Caernarfon): Would the hon. Gentleman have welcomed a provision banning smoking in public places?
Huw Irranca-Davies: I certainly think the issue should be tackled. I was going to mention a report that came out recently, of which the hon. Gentleman may know. It examines the regularity of drug use by youngsters, comparing that with the way in which alcohol has already entrenched itself in our societies.
My hon. Friend the Member for Vale of Clwyd (Chris Ruane) mentioned research on a ward-by-ward basis. The WCH should consider that. I am thinking of the way in which the Xcommunities first" analysis was carried out, and the way in which we have looked at communities in terms of multiple deprivation. We should consider wards as well as the bigger county, borough and health authority areas. We need to pinpoint the evidence that will enable us to tackle some of the problems.
Julie Morgan (Cardiff, North): Is my hon. Friend aware of the Townsend report, produced by the Welsh Assembly? It gives details of inequalities in health authority areas.
Huw Irranca-Davies: I know of the report, and I think that we should adopt the same approach. It is no good simply looking at one area. My constituency contains areas of relative prosperity and good health, but the picture is different when it is broken down into not just individual towns and villages, but parts of those towns and villages. The contrasts are stark. I hope the WCH will extend the Townsend approach.
Brynawel house, an institution funded by charitable donations, is the only residential completely Xdry" house in Wales that will tackle drug and alcohol abuse. It is the only institution with a policy forbidding any consumption of alcohol or drugs, and it is in my constituency. I suspect that the WCH will also increasingly consider that approach. How can Welsh solutions deal with such problems?
I have mentioned lifestyle problems. We should adopt a more innovative attitude to issues such as GP referrals and exercise on prescription. Not everyone wants to trot along to the leisure centre rather than being prescribed a bottle of pills, but exercise is not only good for physical health; time and again, it has been shown to have an impact on mental health. I have quoted some worrying figures in that context. We should end reliance on drugs, and turn to prescriptions that tackle lifestyle issues.
We need to get the balance right between repair and prevention. The Assembly is already starting to lead the way in devoting resources and talents to the prevention of illness rather than NHS repair costs.
Health Professions Wales should be broadly welcomed. I expect it to have an impact on standards of nursing, midwifery and radiography. I should declare an interest: my wife works as a radiographer. I see colleagues representing mid-Wales constituencies on the Opposition Benches. They will have their own constituency problems relating to midwifery provision in remote rural communities that are some distance from district general hospitals. Unique circumstances require different solutions.
I want to ask some questions. I am concerned about overall standards, particularly in regard to recruitment from overseas. I was pleased with what I took to be an Opposition welcome for the current recruitment, and a wish for the problems to be eased along with maintaining the appropriate standards. HPW could have a major input. I recently went to Madrid with a number of colleagues, and observed some very good schemes enabling British hospitals to recruit well-trained Spanish nurses directly. The problem is ensuring that they meet our standards and deal with our problems as quickly as possible. One of our problems, of course, is the number of vacancies that we cannot fill. As an Opposition Member pointed out in the Welsh Grand Committee, that reflects the investment that we are making; but we must fill those vacancies.
Mr. Evans: I welcomed the fact that the vacancies were being filled, but was alarmed by the fact that there were still 750 in Wales.
Perhaps HPW should also consider the problem of retaining nurses. When I discussed it with the Royal College of Nursing, I was disturbed to learn that so many people, after three years of training, ended up earning £15,000 a year as staff nurses when they could earn more as managers in McDonalds.
Huw Irranca-Davies: I do not think that the long-term solution to the staff shortages that exist in many areas is recruitment from overseas, although it may be part of the solution. You are right: we need to develop in-house training, and the Spanish example I gave is relevant here. Those people were experiencing the reverse of our circumstances. They invested for a long time, and now have a glut of staff. Oh that we were in that position! Anyway, you are right. We must look at retention, training—
Mr. Deputy Speaker: Order. May I remind the hon. Gentleman to use the correct parliamentary language?
Huw Irranca-Davies: Thank you, Mr. Deputy Speaker. I am still learning on my feet, as it were.
The same approach by HPW might help us to deal with the shortages of NHS dentists, and, amazingly, with the shortages of GPs. In Pencoed in my constituency, which has a large population, it is impossible to recruit more than one GP per surgery rather than the four who are needed. That seems absurd, given that the area is part of the M4 corridor. HPW could play a pivotal role in pinpointing shortages and trying to deal with them.
Let me say something about community health councils. I am glad that local patients and other local people are to be given a democratic voice. I do not agree that the proposals will lead to confusion; I strongly suspect that people will know exactly where to turn.
My hon. Friend the Member for Clwyd, South (Mr. Jones) mentioned time off for public bodies. I hope that the Government will clarify that in their response to the Committee. They have already said
- XFurther consideration will be given to approaching the relevant Secretary of State to make an order"
I acknowledge the extension of powers allowing CHCs to inspect local authority premises, primary care premises and, to a degree, nursing homes, but I want to know why that does not apply to prisons and young offenders' units. As I said in the Committee, that would not replace lay visits, but it would constitute a welcome extension of medical expertise and of patients' rights.
I want to say a little about cross-border co-operation—crossing Offa's dyke, if you will. The Government have said that no review is necessary and have given their opinion, but are they adamant that their proposals will work? I am not in the same position as the hon. Member for Montgomeryshire (Lembit Öpik) and his neighbour in Powys, the hon. Member for Vale of Clwyd, but constituents of mine certainly travel not to Bristol but all the way to Hammersmith for cardiac surgery. So it is a matter of concern, and I seek the Government's reassurance that what they said in response to the Committee's recommendations will work.
Mr. Roger Williams: The hon. Gentleman raises the interesting point of people accessing district general hospitals outside their CHC area. We have experienced differential waiting lists, with people in Wales having to wait longer for treatment for the same condition than people in England. We believe that CHCs could play a vital part in resolving that problem.
Huw Irranca-Davies: I welcome those comments. I am sure that the Minister is listening avidly and hope that he will give a suitable response that reassures the hon. Gentleman.
I welcome the schedule 7A changes on CHCs which allow the National Assembly for Wales to determine the membership regulations. I do not agree that that will mean that the CHCs are hidebound by what the
Assembly tells them. The Assembly is setting the rules by which they work, but the CHCs have great independence within those: they will make their own representations and investigations; they will represent the views of their patients and committee, as opposed to saying what the Assembly tells them to say. There have to be some rules and regulations, but the CHCs still have a great deal of independence.In conclusion, I welcome the Bill, not only in terms of the beneficial impact that it will have for health provision in Wales but for the precedent that it sets for co-operative working between the Assembly, Westminster and other partners.
7.11 pm
Mr. Bill Wiggin (Leominster): I begin by paying tribute to the Chairman of the Welsh Affairs Committee who has guided us through the proceedings on the Bill so far with great skill and diplomacy.
I am sorry that the Government's response to the Committee's proposals have been less positive about the CHCs than other issues. On time off, for example, the Government stated that it could be done by order—which is not in dispute—but that does not mean that it can be done only by order, as might happen under the Bill. The Government's reply on coterminosity seemed to address the case against exact coterminosity, which the Committee did not recommend. Instead, it recommended a statutory duty to have regard to the local health board and other boundaries that could readily be achieved.
The Government's reply regarding other bodies states simply that the current proposals strike the right balance. The Committee did not suggest that they did not, but that the National Assembly for Wales should be empowered to extend CHC remits if it wished to in the future rather than have to return to Westminster to seek such powers.
The Government agreed to the Committee's recommendations on clarity—what it called the
- Xarcane language in sub-paragraphs (g) and (h)".
The Committee wanted to ensure that the National Assembly would be free to allow CHCs to commission others to carry out the independent advocacy services. The Government's reply does not make it clear whether the Bill allows that, or whether they wish it to do so. The Government agreed to review the terms of the schedule to ensure that the Association of Welsh Community Health Councils provided a system for CHCs to report to the AWCHC, but not to limit the functions that the Assembly could give the AWCHC. Again, nothing seems to have changed.
The Government accepted the principal point that the independence of the Wales Centre for Health should be more apparent on the face of the Bill, although no equivalent to the Food Standards Agency was suggested. The bald power of the Assembly to direct the WCH has been replaced in paragraphs 6 and 7 of schedule 2, which allows the National Assembly to give directions where it believes that there has been a serious failure by the WCH to perform any function that it considers should have been performed. That presumably applies to things that have not been done rather than those that have been done, but the distinction may be unclear.
Finally, the Government seem to have accepted the thrust of the Committee's concern that the ambit of Health Professions Wales should not be allowed to spread. However, clause 4(2) and (3) does not make it clear whether the functions to be confirmed by the Assembly order are to be restricted to health care staff. I will come to possible amendments at the appropriate stage. By and large, the Bill is benign, but one or two amendments on these subjects in line with the Committee's recommendations might be helpful.
The Bill could have addressed the excessive bureaucracy involved in the reform of the NHS in Wales. I have heard it said that Wales will have the most bureaucratic health service in western Europe. In addition, an NHS Confederation survey found that 80 per cent. of NHS managers did not believe that the Government's reforms of the Welsh health system would work. Nick Bourne, the leader of the Conservative party in the Welsh Assembly, in his speech entitled XMaking Life Better in Wales" said that we should be reducing the unnecessary layers of bureaucracy building up in our health service.
To some extent, the Bill defeats the purpose of the national health service, which is supposed to be a nationwide public service. For example, Amicus, a manufacturing trade union, is of the firm belief that
- Xprofessional standards should be centrally determined to ensure that the standard of healthcare provision is of the same quality across the whole of the UK."
In the Queen's Speech of June 2001, allusions were made to legislation that would decentralise power and direct resources to NHS staff. Such National Assembly authoritarianism centralises powers and allows for measures of uncertainty and unpredictability in the Welsh health system. In addition, questions have been raised about the degree of independence from the National Assembly enjoyed by the Wales Centre for Health and Health Professions Wales. The Royal College of Nursing questions HPW's independence from the Assembly. We believe that the National Assembly should restrict itself to setting strategic objectives for the NHS, which would be more helpful.
The Bill further illustrates the authoritarian and centralised powers of the Assembly with regard to its powers over the CHCs. Proposed schedule 7A gives the Assembly powers to make regulations concerning CHCs' proceedings, staff, premises, expenses, the discharge of functions of a council by a committee and the appointment of persons who are not members of the council to such committees.
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