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27 Nov 2002 : Column 393continued
If we look at inequalities which cause ill health, housing and access to leisure facilities have more of an impact on the health of the nation than, for example, the prescribing of drugs. I wonder whether hon. Members read press reports yesterday of a study which showed that pensioners in Japan live longer if they live near parks and tree-lined streets in cities? The study showed that less noise and more natural light in houses were associated with long life. The more active an older person, the longer they tend to live. We should look at
The provision of public parks is important. In Cardiff, we have wonderful parks. Bute park is adjacent to my constituency of Cardiff, North, and the Taff trail passes through it. Those opportunities for leisure and health are as important as the services provided by the NHS. The two issues are closely linked. I am therefore pleased that existing legislation makes provision for local authorities and health boards to work together closelyon the boards themselves, of course, there will be local authority representation. In our pre-legislative examination of CHCs, we discussed whether their boundaries should be strictly coterminous with those of the health boards. The Select Committee's conclusion was that that was best left to regulations by the Assembly, following consultation. There were strong views about not restricting boundaries too much, with which I agree. It is best to consult, as CHCs have already gone through reorganisation and uncertainty, and different issues arise in different parts of the country, as the hon. Member for Montgomeryshire (Lembit Öpik) mentioned. We should not be prescriptive, so I support the view that the Assembly should make a decision and introduce regulations.
The Bill plans to extend the CHCs' remit to primary care nursing homes, which is a good move. The Prison Service issue needs to be looked at again. I am concerned about the provision of health care in prisons, and an overseeing body is needed to look at standards. I support the creation of the Wales Centre for Health and Health Professions Wales. I welcome the fact that Wales will take the lead on the inclusion of health support staff. The Select Committee on Welsh Affairs discussed the way in which such an inclusion would be different from practice in the rest of the UK, and we in Wales should be pleased that we have acknowledged the importance of health support staff.
The Welsh health agenda is preventive and radical. Measures already introduced, such as the freezing of prescription charges and free prescriptions for the under-25s, by the Assembly will result in long-term benefits. We do not know what the long-term effect of such measures will beperhaps the Wales Centre for Health can analyse the effect of their early introduction. For example, if young people have access to free prescriptions, that may have long-term benefits. I am pleased that the Minister for Health and Social Services in the Assembly has said that there is no intention to go down the route of foundation hospitals, which were included in the Queen's Speech.
One of my concerns about foundation hospitals is the fact that they could choose to pay their staff more. We would get into a situation where one hospital would be out-bidding another, and I fear that health would suffer generally as a result. It would be unfortunate if an auction were to take place between different types of hospitals. I am therefore glad that the NHS in Wales is not going down the route of foundation hospitals.
In conclusion, the Bill is a small step towards achieving the Assembly's goals of prevention and a healthy Wales. The pre-legislative scrutiny was a beneficial process, and I look forward to the Bill's remaining stages.
Mr. Roger Williams (Brecon and Radnorshire): It is a great honour to follow the hon. Member for Cardiff, North (Julie Morgan), who has done a great deal of good work on behalf of children in Wales. I noted her remarks about the membership of CHCs and the way in which we could better reflect the needs of children. I shall return to that later.
We support the Bill wholeheartedly. It is a small and devolved step towards a better national health service in Wales. Those of us who want a thoroughly improved NHS in Wales know that that cannot be achieved at a stroke, but step by step, inch by inch. Waiting lists have been mentioned, but they are an inappropriate measure of the success of a health service. The Bill is about patients and patient power, but it does not matter to the patient whether he is first on the list or 10,000th. What matters is when he is going to get his treatmentthat is the key issue for individual patients. We are in danger of sinking into a morass of statistics about the NHS and losing sight of the fact that it should provide a personal servicepeople desperately want to achieve that.
I was going to give another accolade to the hon. Member for Clwyd, South (Mr. Jones) who was in danger of receiving so many that it would be impossible for him to leave the Chamber. However, he has leftprobably because he is afraid of having so many accolades. It was a privilege to serve on the Select Committee on Welsh Affairs, which undertook pre-legislative scrutiny of the Bill. Particularly impressive was the way in which the public and health professional in Wales were involved in that process. As a result, many of the Select Committee's recommendations were accepted and the Bill has achieved its Second Reading. The hon. Member for Clwyd, South said that we could have a truncated Second Reading because many issues had been teased out and put to bed. One that springs to mind is the title of the Bill. It started off as the National Health Service (Wales) Bill, but it quickly became apparent that CHCs, the Wales Centre for Health and Health Professions Wales could deal with health care delivered by agencies outside the NHS. Quite rightly, the title has been changed, and the Bill is now the Health (Wales) Bill. That is a minor issue, but it demonstrates the way in which problems were identified at an early stage and rectified.
Turning to issues raised by the Bill, I wholeheartedly agree with the hon. Member for Cardiff, North that it is appropriate that the Welsh Assembly should have a say in the way in which members of community health councils should be identified and appointedthat should be a devolved matter. Under the old appointments system, local authorities could nominate members for community health councils. We all know of local authority members who have played leading and very significant parts in the work of community health councils, as well as some who see such work as another part of their overall role and cannot give the amount of time and effort that is needed because of the responsibilities that they have in their local authority. Perhaps the Assembly will take that into consideration when deciding on membership.
The Bill's extension of the powers and roles of CHCs will also involve the training that members receive. The duties and expertise that they will need in carrying out the inspections and dealing with problems raised by individuals will be much greater than in the previous CHC system. When we look at the amount allocated for setting up the councils, I hope that there will be enough resources to ensure that those involved do not go out on their visits and inspections unprepared for the duties and responsibilities that will be expected of them.
I also value the advocacy role that CHCs have exercised in the past and the greater advocacy that will be expected of them in future. I am especially interested in the work that they have done for people suffering from mental health problems. In rural areas, the importance of mental health issues is especially acute, because people tend to live in isolated locations where they do not get the family and community support that is sometimes available in more densely populated areas. Voluntary bodies are also involved in that advocacy work. Great skill will be needed when the CHCs and voluntary bodies decide between them how such work will be done to best effect for the patient.
Mention has been made of the possible extension of the work of CHCs to prisons and young offenders institutions. That issue has been teased out in this debate and we will perhaps see more of it in future. Schools are another area in which health provision is made. Not only are there emergencies such as accidents or sudden illnesseslay people are often asked to administer medication to children who may need it during the school daybut children in school are given advice and counselling on health issues, and the quality of that counselling and advice is important in health delivery for young people.
I should like to mention a particular initiative that my local CHC has just undertaken: the setting up of a first responder scheme in which a group of volunteers is trained to attend when somebody has suffered heart failure or a heart attack and to use defibrillators to restart heart activity. As the volunteers are based locally, such action can often be more quickly carried out than by the ambulance service. The initiative has already been set up in one area and is about to be set up in another. It is an example of how CHCs can take initiatives and drive forward service improvements,