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27 Nov 2002 : Column 385—continued
Lembit Öpik: Does the hon. Gentleman agree that CHCs will be able to make a positive impact on the difficulties that he has rightly described if, and only if, there is a degree of homogenisation and shared responsibility between local authority budgets and health budgets?
Mr. Jones: In effect, the Bill dealing with delayed discharges will do that. When people are lying in bed in a hospital, their care is being paid for from the health service budget. When they are lying in bed in a nursing home or a community home, their care is being paid for by the local authority budget. There is a vested interest—I put it no higher than that—for local authorities to be not too quick in moving someone out of a bed for which they do not pay and into one for which they pay. The delayed discharges Bill will allow the budget to be transferred if the bed is used for social service rather than acute health care reasons.
Julie Morgan: Does my hon. Friend agree that the mechanisms for dealing with this problem have already been set up by the Welsh Assembly in the partnership arrangement that has been created between local authorities and health bodies, which looks to solving the problem jointly rather than to considering penalties on one or other of the bodies?
Mr. Jones: I do not agree. I hope that that might happen, but we must accept that, if the partnership agreement had been effective, it would already hopefully have had some effect. I have already explained that the position in Wales is two to three times worse than in England—so it appears that, so far at least, partnership has not delivered. It may deliver in the future, but the legislation for England and Wales will enable provision to be made on both sides of the Severn.
Julie Morgan: I agree with my hon. Friend that the Bill coming before the House tomorrow will enable the Welsh Assembly to take advantage of what exists. However, the Assembly and local authorities have not been working in partnership for long enough to enable us to judge whether we should penalise local authorities when beds are blocked. Enough time has not yet been spent on the partnership solution.
Mr. Jones: Local authorities are not automatically penalised. They are penalised only if they do not deliver. If the partnership arrangement works, they will deliver and will not be penalised. Everyone will be happy, and waiting lists will fall considerably.
Ian Lucas (Wrexham): Is not the great hope that local health boards will create a closer working relationship between local authorities and the health service and that that will address the problem that my hon. Friend has so eloquently described?
Mr. Jones: I agree that we should all live in hope to some extent. The provisions will be there in case hope is
insufficient, but they are important. The CHCs will also have a valuable role, especially if my hon. Friend the Member for Cardiff, North (Julie Morgan), who may be well informed about the view of the Welsh Assembly, is correct. If Wales and England take a different view of delayed discharges and if delayed discharges are not penalised in Wales, the CHCs will have a particular role to play. I can imagine the interesting and difficult issues that will need to be sorted out if the Welsh Assembly chooses not to invoke the procedure. An English hospital, such as that in Shrewsbury, which treats many patients from mid-Wales, will be able to charge local authorities in Powys and Montgomeryshire, while a Welsh hospital such as the Royal Gwent will be unable to charge English local authorities such as Gloucestershire for delayed discharge. CHCs will have much explaining to do to their patients about why such a position has arisen.I welcome the role that the CHCs will play. I look to them to be as independent as possible and to take on new powers as they become available in the legislative programme before us for the rest of this Session. I hope that the CHCs will be able to ensure that there is the patient empowerment that we all want and that they will do such a good job that Welsh patients will not feel the need for choices that may be available in England but not in Wales.
7.38 pm
Hywel Williams (Caernarfon): We are having an interesting and constructive debate. I commend the remarks of the hon. Member for Cardiff, Central (Mr. Jones) and his support for the CHCs. I also commend the remarks of the hon. Member for Ogmore (Huw Irranca-Davies) about the effect of mental ill health and the relative neglect that that subject has received.
Referring to the Bill in his press release for the Queen's Speech, the Secretary of State said:
- XPatient power will be our watchword in the future."
There is a glaring and long-standing need to reduce health inequalities in Wales. As page 9 of the recent Welsh Assembly document XWell Being in Wales" notes:
- XAverage life expectancy in some parts of Wales is five years less than in others".
A cross-cutting approach is sorely needed in Wales. It needs to consider poverty, housing and other issues, such as smoking and the consumption of alcohol. I hope
that the Bill will help to expose those differences and to keep them in the minds of people who make and implement policy, irrespective of the long waiting lists and the lack of dental treatment that other hon. Members have mentioned.It has been said that the Bill is largely uncontroversial. Even the House of Commons Library research paper says that. Some hon. Members will recall King Vidor's 1938 film XThe Citadel". I am sure the previous Secretary of State will. In that film, part of the answer to a public health problem was the selective use of high explosives. The Bill may be largely uncontroversial, but the proper implementation of patient, carer and community power is the metaphorical high explosive we need to attack the historical inequalities of health in our country and to provide Wales with the world-class health service that the Secretary of State says it is his ambition to achieve.
Patient power has to be enabled. We will look for a practical demonstration of the growth of that following the implementation of the Bill and other measures. We welcome the provisions that will extend the roles of CHCs to the primary sector and nursing homes. That will provide a statutory basis for the patient advocacy service and will establish a Welsh body for CHCs. We welcome the intention to create the Wales Centre for Health, which will provide public health advice, research and training support, and Health Professions Wales, which will discharge the Assembly's functions on the education and training of health care professionals and health care support workers. We also welcome the education and training functions of the Nursing and Midwifery Council and the Health Professions Council in Wales. All that is to the good.
We hoped that the Bill would contain other proposals, such as the banning of smoking in public places, which would have made a substantial contribution to the improvement of public health. I was glad to hear the hon. Member for Ogmore agree with that. We were also keen for the Bill to contain provisions on free personal care for older people, which would create a simpler and more coherent structure, to say the least.
However, we welcome the Bill as a specific Welsh Bill, with its process of discussion and scrutiny in both Cardiff and the Welsh Affairs Committee. We look to the fulfilment of the Assembly's pledge to provide draft regulations by the Standing Committee stage. We trust that that entire process will demonstrate clearly that the representatives of the people of Wales are well able to handle the legislative affairs of our country.
On the particular proposals for CHCs, we are very supportive of the retention and strengthening of CHCs in Wales. We are glad that that course has been taken for our country—as glad as some hon. Members from England are envious of us and unhappy about the course set for their CHCs. The CHCs will hopefully be independent of vested interests, which relates to a point made by the hon. Member for Cardiff, Central (Mr. Jones). That is essential. We trust that the independence will not be diluted by the proposed changes in the organisation of CHC membership.
I know from the case of my own CHC in North Gwynedd that the local authority representatives are wholly committed and valuable members. Perhaps they will join the CHC by other means. However, in rural and dispersed areas there is a limited number of such individuals. We cannot afford to ignore those public-spirited and committed people. The hon. Member for Clwyd, South (Mr. Jones) referred to the importance of taking time off work. I agree entirely.
The extension of CHCs' role to the primary sector and to nursing homes is welcome. Clearly, CHC visits to NHS premises where care is being provided will be a valuable addition to the important professional inspection. We will look with interest at the draft regulations produced by the Welsh Assembly Government for the Report Stage on matters such as unannounced visits, but obviously those are to be welcomed as a development of patient and carer power. I do not share the concern expressed by the hon. Member for Ribble Valley (Mr. Evans) on the Assembly's power to draft the regulations and the powers given to it throughout the Bill. Irrespective of the value or virtue—or otherwise—of the Labour-Liberal pact in Cardiff, we are happy for those decisions to be taken in Wales.
Hon. Members have mentioned the fact that some Welsh patients receive their care in England. The names Gobowen, Christie, Alder Hey and Clatterbridge are familiar to patients from north Wales and their carers, who are also familiar with the high standard of care provided by those institutions and the difficulties that arise from accessing care in them. Only the other day I was made aware of a case in which a referral of a child from a specialist unit at Alder Hey to a local hospital for occupational therapy was refused because the list was closed, not because it was long. CHCs should have information about care from establishments over the border so that they can perform their duties well.
A particular concern is the availability in English establishments of people who can speak Welsh, especially in cases that involve children, people with chronic conditions or brain injury, and the terminally ill. We particularly welcome the proposed statutory basis for the role of CHCs as patient advocates. Some CHCs already have a discrete patient advocacy service, but others do not. The welcome extra funding announced the other day will be used in my area to employ a patient advocate for the first time. I hope that that will lead to a substantial improvement in the service provided.
I particularly look to the work that I expect the CHCs to undertake as part of patient advocacy to push for the extension and development of services through the medium of Welsh—and, for that matter, through the medium of languages other than Welsh and English—in our locality and throughout Wales. The establishment of proper and good communication between the patient and the health care worker is essential, and that means that communication needs to take place in all the languages used widely in Wales.
If patient power is to mean just that, there must be a sustained effort over an extended period to recruit people with the appropriate language skills. Being able to converse with patients in the language that they find most congenial is a core skill for some staff in some areas and for the majority of staff in others, especially if the patient is young or elderly or has suffered a stroke or
brain injury. I know that some hon. Members have family experiences of the health service's deficiencies in that respect, and I trust that they will support the CHCs in pressing for change, as I sincerely hope the CHCs will do.The establishment of a national body for CHCs has been welcomed by the CHC representatives whom I consulted before the debate. The relationship with individual CHCs in respect of the performance management function will have to be approached in a supportive manner, and I understand that that is the standpoint of the new body. I note from the research brief that the Welsh Affairs Committee called for greater clarity as to how the new body's powers would be strengthened, and that the Government agreed that the wording of the schedule would be reviewed, but no change has resulted. Clearly the House may turn to that topic on Report.
On a lighter note, I understand that the body is to be known as the Association of Welsh Community Health Councils, or AWCHC, an acronym already used by an hon. Member on these Benches. The health world is blessed with many and varied acronyms, which exclude and sometimes confuse even those who are used to them, let alone the patients. I had a brief look at the back of the report by the Welsh Affairs Committee, and saw the WCCPH, or Welsh Combined Centres for Public Health, the WCH, or Wales Centre for Health, and the ATM, After Today Management. I always thought that ATM stood for automated transaction machine.
May I suggest, therefore, that the Welsh title of the new body is to be preferred, in acronym form at least, in that it yields an acronym that combines accuracy with at least a suggestion of the function of the new body? Welsh-speaking Members will realise that Cymdeithas Cynghorau Iechyd Cymuned Cymru becomes CCICC, or CIC—an essential attribute for a patient advocate. I hope that the CHCs, and the national body, will have CIC.
On the Wales Centre for Health, we welcome the establishment of a Welsh body to act as a multi-disciplinary advice forum. Hopefully it will draw attention to the many causes of ill health and the many ways of tackling issues of health, poverty and housing. The body will also disseminate research, particularly Welsh data, the lack of which has, for many years, been a problem to many people working in health and social services. It will support training in sustainable health and liaise with UK and international professional groups. We have much to learn from professional groups over the border and in other European countries. Sometimes we look with too narrow a focus for comparators. In addition, as we develop Welsh models of health provision and for the prevention of ill health, we will have much to teach the world.
We are glad that the centre's independence is assured and that it will take an active role. It will be a virtual as well as an actual centre. Some years ago, I had the experience of setting up a national centre for training and education in social work. I regret that we invested so much in bricks and mortar and much less in the networks of people throughout Wales that would have supported that centre in the future. Unfortunately, the money went into the building.
Equally, we welcome the establishment of Health Professions Wales, which is an ambitious move. The body will carry out the functions of the Health Professions Council in Wales relating to the continuing education and training and the clinical experience of nurses, midwives, health visitors and other health care professionals and support workers. Fears have been expressed about the loss to Wales of having new and different arrangements for the health professions, compared with England. I trust that those will be allayed by the operation of the new body.
As I said, I come from a background of education and training of social workers. In 1985, the body responsible for that, the Central Council for Education and Training in Social Work, consisted in Wales of one person coming over from Bristol to work half a day a week, sitting by the phone waiting for a call. As Members can imagine, he had very little business. The CCETSW developed into a fully fledged body, and when it was wound up, it had its own policy documents and publication programme. It also had professional staff and a training agenda complementary to that in the UK. That agenda covered all aspects of training, including, importantly, Welsh-medium training. After 17 years we see the value of that sustained development for the CCETSW, because we have a Welsh body for social care that is a fully fledged, separate entity. That was a process—a long one—and not an event. I therefore value the role of Health Professions Wales in developing high-quality training, Welsh careers information and senior practitioner posts.
On the retention of staff, we have to make sure that we recruit people who fully understand the profession, and we should be careful to promote work-based learning. I note from the research document provided by the Library that the acting chief executive of HPW sets out, as a function to be developed, advice on work-based learning. That is essential if we are to foster a climate in favour of training. People must be able to take up training while they are working. That will be important for the retention of staff.
The use of Welsh practice as a model for developments throughout the UK is also important. I referred earlier to developing medium and practice in Welsh and other languages. We have a great deal to teach other parts of the UK and the world. We have an opportunity to experiment and to develop proper practice to give the user of the service the power to choose the language. We should be confident that we can do the research and development work and that we have something to boast about.
I spoke earlier about the metaphorical high explosive that we need in order to attack the historical inequalities in health in our country and to provide Wales with the world-class health service that it needs. That will be hugely difficult and, no doubt, controversial. I also mentioned the widely held view that the Bill is uncontroversial. If it leads only to uncontroversial change, it will not have contributed sufficiently to the change that is needed if we are to achieve a healthier future for all the people of Wales.
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