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27 Nov 2002 : Column 381—continued

Lembit Öpik: Does the hon. Gentleman accept that that is less centralised than having all those decisions made at Westminster in the sense that the Assembly is closer to the people being served by the health service in Wales, which is one of the Bill's intentions?

Mr. Wiggin: The hon. Gentleman makes a useful point, but the Bill's wording does not achieve that.

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I should like to welcome the retention of the CHCs and the close link between the public and health service, but some of the Bill's wording is more authoritarian than it need be.

It is regrettable that the Bill does not make provision for the creation of foundation hospitals. Another opportunity missed is that there is no provision for the creation or construction of a much needed children's hospital in Wales. I am sure that right hon. and hon. Members on both sides of the House would like to see that.

Julie Morgan: Is the hon. Gentleman aware that a children's hospital is going ahead in the University Hospital of Wales in my constituency and that the Assembly has given it considerable funding?

Mr. Wiggin: I was not aware of that—[Interruption.] I think that I heard one hon. Member say XObviously not" from a sedentary position. I am delighted to hear that progress is being made, however, and perhaps at a later date the hon. Lady might fill me in on why all the money has not been forthcoming.

We would have liked the Bill to include more powers for CHCs to provide patient support services, perhaps by making patient support officers employees of the CHCs. Another of my concerns is the representation of Welsh patients receiving treatment in England, which the hon. Member for Ogmore (Huw Irranca-Davies) mentioned. In Hereford hospital, next to my constituency, at least 10 per cent., and sometimes as many as 15 per cent. of the patients are Welsh. As there are shortages of funding for Welsh patients seeking treatment in England, and as waiting lists are so long in Wales, it may be necessary for Welsh patients to keep crossing the border to be treated in England, so funding must be provided.

The Bill contains no provision for the use of the private or independent sector in reforming the NHS in Wales, or for the use of the private finance initiative, for example. Private and independent sector involvement might be used—and might be needed—to address such problems as the funding of Welsh patients seeking care in England, reducing waiting lists, dealing with the care home crisis, the problem of delayed discharges and reducing GP shortages.

Another major criticism of the Bill is that it fails to address the real crises and issues in the Welsh health service that affect ordinary patients. Assembly Member David Melding said on 18 July 2002 that

Among the problems that the Bill fails to address are waiting lists for both in-patients and out-patients, which increased dramatically between 31 March 1997 and 30 September 2002: in-patients by 7.1 per cent. and out-patients by 135.1 per cent. In that regard, the Government may have broken their manifesto pledge. Before the 1999 Welsh Assembly elections, they said that no one would wait more than 18 months for in-patient treatment. Given that 4,335 people have been on that waiting list for more than 18 months—1,810 people more than when the original pledge was made—it sounds as if they have broken that pledge.

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Another promise that has been broken is that regarding out-patient waiting lists. The Labour party said that, by the end of its first term in the Assembly, no one would wait more than six months for out-patient treatment. However, more than 83,443 people are now waiting six months or more for out-patient treatment, compared with 25,676 in May 1999. Indeed, the South Wales Evening Post ran a story on unacceptable waiting lists for patients with regard to ear, nose and throat treatment. Adults needing nasal surgery will have to wait for between nine and 70 weeks—

Mr. Deputy Speaker: Order. The hon. Gentleman is straying a little from the Bill. I know that he is talking about what is not in the Bill, but he should address his remarks specifically to the Bill.

Mr. Wiggin: I apologise for straying.

Mr. Desmond Swayne (New Forest, West): It is very tempting.

Mr. Wiggin: Indeed.

Rather than focusing on reforming bureaucratic elements of the Welsh health service, the Bill will perhaps have less direct benefit to patients than I would have hoped. It is true that we are not overtly critical of the substance of the Bill, but it would have been better had some of the failures—on which I should have liked to continue—in relation to some of the promises made by the Government to patients in Wales been aired.

Huw Irranca-Davies: Does the hon. Gentleman agree that one aspect of the Bill might not only look at the failures but at things that have worked, to promote best practice, in which CHCs would have a role? For instance, in Bro Morgannwg, the number of nursing and dental staff has increased and administration has been reduced.

Mr. Wiggin: That sounds very positive, and I agree with the hon. Gentleman. By and large, we all want the same thing from the Bill—better care for patients. We have to identify the best way of going forward. Some of the proposals are exceptionally positive. Having sat through the Select Committee's review of what the Bill was going to contain, the hon. Gentleman will know that I have been very supportive. It would have been better, however, had one or two of the items on which I touched in my speech been included. A Conservative Assembly Member argued that for devolution to be meaningful, major reform in the public services for Wales should be achieved in Wales-only Bills. Much of the content of this Bill should therefore have been included in the National Health Service Reform and Health Care Professions Act 2002 applying to Wales. The extra part of the Bill should not have been necessary.

The Bill's intention is to reform patient services in the Welsh health service, but it fails to address some of the most important issues to patients in Wales, such as GP shortages and massive waiting lists. By and large, however, the Bill is well-intentioned, and I am grateful that I was able to sit on the Welsh Affairs Committee.

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7.25 pm

Mr. Jon Owen Jones (Cardiff, Central): The Bill has already been described as benign, modest and consensual. I agree with all those adjectives, which is why I must disagree with the conclusions of the Select Committee Chairman, who has unfortunately just left his place. Early in his speech, he suggested that the Second Reading debate on this Bill, and on other Bills, could be curtailed. It is dangerous to generalise from the particular. It is probably true that this Bill could be speeded through the House, as could any consensual Bill, but it does not follow that simply because this Bill is one with which we largely agree, any Bill introduced through this procedure would command similar levels of agreement. I would therefore caution against the Government taking the Select Committee Chairman's word that the House agrees with rushing through all such Wales Bills.

The philosophy that appears to be emerging in the provision of health care in Wales, as compared with the provision of health care in England, seems something of a diversion in terms of how patient empowerment is to take place. I am sure that all Members will say that they want patients to be given more power over their health care needs. It does not follow, however, that that goal can be achieved in only one way.

This Bill and other proposals made in the Welsh Assembly attempt to empower patients by creating committees—in this case, community health councils—that are as representative as possible to give patients greater power. I interpret what is happening in England as an attempt to give patients more power to choose their health care by giving hospitals greater independence, and by giving patients greater opportunity to choose where they seek their health care. There are arguments to be made in favour of both systems—I put it no more strongly than that, as I am being loyal—but we must try to make sure that both systems work as well as possible.

I am in favour of community health councils being made as independent as possible in Wales, because their role in Wales will be extremely important in ensuring that patients are given health care that is adequate to their needs and what they desire, and because it should be seen to be independent of the role of Government. I therefore approve of the measures in the Bill, and I might wish to strengthen them to give independence to the community health councils.

I would like the CHCs to be given possibly greater powers than those provided in the Bill. We need to do more than simply look forward to the role that they should have in relation to what used to be available. Tomorrow, the House will debate a Bill for England and Wales that deals with delayed discharges and the problem of bed blocking. CHCs exist in Wales, but not in England, and they could be given an important role in determining what constitutes bed blocking and whether beds have unnecessarily been taken up by people who should be discharged from acute hospitals. They could also determine at what point charges should be laid on local government to pay for the beds that are being occupied.

That issue is extremely important in Wales, and more important there than it is in England. On any one day in England, 5,000 beds are taken up inappropriately because social care cannot, for one reason or another,

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be provided. On any one day in Wales, 806 beds are taken up. I calculate that, per capita, the problem is at least two to three times worse in Wales than in it is England. That fact alone explains in large part why waiting lists figures in Wales are so much worse than they are in England.

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