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27 Nov 2002 : Column 390—continued

7.57 pm

Julie Morgan (Cardiff, North): I am pleased to be given the opportunity to speak on this Second Reading. I am pleased that there is a Wales-only Bill in the

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Queen's Speech, following the Children's Commissioner for Wales Bill in an earlier Queen's Speech. Taking into account the Welsh clauses in other Bills, we can see that the devolution settlement is working, as many hon. Members have said tonight.

It is interesting that the Bill, along with the Welsh clauses introducing reform of the health authorities and the creation of local health boards in an earlier Bill for England and Wales, is helping to develop a distinctive way forward for the NHS in Wales. The first parts of both the Wales-only Bills, on the children's commissioner and on health, were initially included in legislation for England and Wales.

The children's commissioner began in the Welsh clauses of the Care Standards Bill, and the reform of the health service began in the National Health Service Reform and Health Care Professionals Bill. In both cases, that allowed the proposals for Wales to start moving. The children's commissioner was able to begin work before the full powers were finally conferred on the post by the Wales-only Bill, and the health boards were included in earlier legislation so that they could be set up and staffed by April 2003. I understand that they are on course to achieve that.

The Health (Wales) Bill has already had pre-legislative scrutiny by the Welsh Affairs Committee—the first time that that has happened—and by the Health and Social Services Committee of the National Assembly. I attended a sitting of the Health and Social Services Committee, which I found an interesting and unique experience. In that sitting, members of the Committee raised the issue of smoking, saying that a ban on smoking on public places must be part of the Bill. Everyone in the room—every member of the Committee and those who were there observing it—strongly agreed that we all wanted a ban on smoking in public places, but it was also agreed that that did not lie within the scope of the Bill. None the less, I want to register my hope that we will get a ban on smoking in public places and that it will be dealt with as a priority. The emphasis in health should be on prevention, and smoking causes such a huge bill for the health service and such misery in people's lives that we have a duty to do what we can about it. I accept that it is not within the scope of the Bill, but I am glad that we have marked up the fact that we must do something about smoking.

The Bill is short and generally uncontroversial. There has been some controversy in England about the removal of the community health councils, and it is good that we in Wales have avoided that controversy by aiming to strengthen and build on the existing CHCs and increase their advocacy role. The performance of that role has varied throughout Wales. The CHC in Cardiff has played a strong advocacy role—many people who have come to my surgery to discuss problems in the health service have been helped to an enormous extent by the CHC. Cardiff CHC has had special funding to help it in its advocacy and complaints role in respect of individuals, but that does not extend throughout Wales. CHCs in other parts of Wales have not been so well funded for advocacy and complaints functions, so I am pleased that the Bill will ensure more uniform provision for CHCs and that they will be strengthened throughout Wales.

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It is interesting that England decided not to keep, change and strengthen CHCs. There seems to be a divide between attitudes in England and in Wales to CHCs. In Wales, CHCs have been thinly staffed, but there has always been a good standard of advocacy and their existence has never been questioned. As other hon. Members have said, the difference in this respect between England and Wales shows how devolution produces different outcomes. It is easy to live with the fact of different outcomes—there is no tension about Wales taking one course and England taking another. That is what devolution is and what the Bill emphasises.

CHCs, with patients and local representatives, will work with local health boards and local authorities to create a service in which the primary aim is prevention, and the emphasis is on health, not ill health. That is the message that has been coming from the Assembly in its development of health policy: we are talking not about ill health but about health and how to create a healthy society, and that change of focus is a positive aim. Many people, especially in later life, experience health problems because of their style of living in youth—smoking is a prime example. CHCs and the health boards will play a vital role in spreading information, for example, about healthy living and ways to avoid ill health in later life. The Assembly has already done a lot of work on health promotion. If those efforts are successful, Welsh society as a whole will be healthier, which will help the health service by lessening the drain on health service resources and on the community caused by people who become ill later in life as a result of their lifestyle choices. I do not criticise those choices, but that is what happens and we have to tackle the problem.

It is important that CHCs reflect the society they serve. I was pleased to see in their response to the Welsh Affairs Committee's report on the draft Bill that the Government acknowledge the need to ensure that CHCs appoint members who


Until now, local authority representatives have made up half, and the voluntary sector one third, of the membership of CHCs, with the other members drawn from various sources. Now, it will be up to the Assembly to decide the composition of CHCs. I hope that a strong effort will be made to encourage people from a wide range of backgrounds to come forward, in particular people from less privileged backgrounds, so that we will have input from the whole spectrum of Welsh society. I hope that there will be representation from the black community and other ethnic minority communities.

I strongly believe that young people's voices should also be heard. I do not know precisely how that will be achieved, but we must get young people involved in CHCs and their advocacy role. We have had a huge problem with advocacy services for children in Wales since the loss of the Children's Society and the advocacy services it provided. Somehow, we must find a way to ensure that CHCs can speak for young people and children. The Children's Commissioner can work to determine what young people want from the health service—in fact, the commissioner has already done some work in that respect, by examining what sort of health service provision certain groups of patients want, but I think that the CHCs should take on that role in relation to young people.

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It is important that work on a CHC be recognised as a public duty. In their response, the Government say that


to include CHCs, but we could do that here and now, via the Bill, and perhaps we should consider doing so.

As hon. Members have said, in Wales the link between ill health and deprivation is clear for all to see. People in areas of severe deprivation suffer from bad health. In recognition of that, the Townsend report, commissioned by the National Assembly, suggested a funding formula that placed particular emphasis on funding, within as well as between health authorities. It is important to recognise that in a time of growth in health spending, it is possible to redistribute money. The Assembly is implementing the formula changes in the Townsend report—the formula needs some refinement, but the broad thrust of the Townsend report is being implemented. As the health budget grows, every area gets an increase, but the most deprived areas get a bigger increase, and the main beneficiaries are the areas where need is greatest. I applaud the Assembly for taking that step to tackle the health inequalities that are so obvious in Wales.

I hope that the Wales Centre for Health, when it has been set up, will take the Townsend proposals further and work towards ensuring that tackling health inequalities is seen to be the way forward in Wales. The huge differences in the health of the people in different parts of Wales are key issues that must be addressed. The Townsend report addressed the problem, and its recommendations are being implemented, but the creation of the Wales Centre for Health will be of enormous help.

The Townsend report set out two strategies: first, the change in the formula—the redistribution of money; and, secondly, tackling the causes of ill health, which involves all the other services that contribute to the well-being of the population. Because health is linked so strongly with poverty and the vital services that local authorities provide, I strongly support the proposals in previous legislation to make the health boards coterminous with local authorities. That is absolutely right. There has been some criticism that the authorities are too small, but if they are, it is because of what the previous Government did when they reorganised local government and that is what we have to work with.

Lembit Öpik: In Powys, it is the other way round—the local authority area is too large. While I agree with the sentiment expressed by the hon. Lady, does she agree that we must bear in mind the size of local authorities to try to avoid complicated cross-cutting for community health councils?


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