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27 Nov 2002 : Column 397—continued
Lembit Öpik: Does my hon. Friend agree that the Bill presents an especially important opportunity in that regard? He and I have both known people such as the late Hugh Taylor, who would have been alive today if such a scheme had been in place and the community health councils had had the power to implement the very important service to which he refers, especially in rural areas.
Mr. Williams: I take the point that my hon. Friend makes; we both know the gentleman whom he mentioned. We have an opportunity in Wales to show what the powers and scope of CHCs can be in improving the health and well-being of people in such areas.
I would like us to keep the name Xcommunity health councils", as access to these bodies is so important. A change of name merely makes it that much more difficult for somebody to find their way in getting the help and support that they need. We have already a successful organisation and we are going to make it better by introducing the Bill, but we should not make access to it more difficult by changing names.
The Bill is about devolution and getting the right solutions for Wales. My hon. Friend the Member for Montgomeryshire (Lembit Öpik) and I have certain difficulties in respect of community hospitals that have always delivered various medical operations and activities that are now being phased out because royal colleges believe that those hospitals do not have the appropriate facilities. That is happening despite the very good safety record on delivering those services. Indeed, the population to whom the services are delivered are very satisfied with them and hope that they will continue. In the Wales Centre for Health, which could give advice on those matters, and also Health Professions Wales, which could train people to operate in such ways, we will now have the facilities in Wales to reconsider those matters and see whether such services could be delivered locally in community hospitals by doctors who want to provide them and to patients who would benefit greatly.
A local example is Brecon hospital, which had a GP-led maternity service. Not only low-risk, but medium-risk, mothers could be delivered. However, because of advice given by a London-based organisation, that has now changed to a midwife-led maternity service of which only mothers who have been classified as low risk can take advantage. The service was very well thought of by local mothers, many of whom wanted it to be delivered locally. In some cases, however, they now have to travel 20 or 30 miles to get the level of service that they want. I hope that we can have Welsh solutions to Welsh medical issues, and I am sure that the Bill goes a long way towards achieving that.
My hon. Friend the Member for Montgomeryshire mentioned several matters over which we would like the Assembly to have power. The first is free eye tests for everyone in Wales. In 1989, the Conservative Government introduced charges for eye tests, but the
current thrust of health policy in Wales is prevention and primary health care. Free eye tests for everyone would mean the early diagnosis of the symptoms of some diseases and therefore the use of preventive medicine.We also support free dental checks—
Mr. Deputy Speaker: Order. The hon. Gentleman is losing sight of the Bill.
Mr. Williams: I thank you, Mr. Deputy Speaker, for your advice. Free dental checks are such an important aspiration for us that we sometimes get carried away when we advance it.
The Bill will improve the health service in Wales. We thoroughly support it.
8.29 pm
Mr. Martin Caton (Gower): It is a great pleasure to follow the hon. Member for Brecon and Radnorshire (Mr. Williams). Like him, I am a member of the Select Committee on Welsh Affairs, which was involved in the pre-legislative scrutiny of the draft Bill.
It became clear as we took evidence that the Bill is uncontentious and has wide support across the professional and political spectrums. That was confirmed in our debate in the Welsh Grand Committee on 16 July and in the debate in the National Assembly a couple of days later. It received further confirmation this evening, at least when we focused on the Bill.
I do not deny the importance of the Bill's three key objectives, but the different method of dealing with the measure so far and its impact on the Bill's passage is equally important. In the current instance, process may be as significant as the event. I therefore want to consider briefly what the process has achieved and whether we can learn lessons from our approach that will help in future.
It has already been said that this is the first occasion on which a Wales-only Bill has been subject to pre-legislative scrutiny that involved Back-Bench Members in Westminster and our colleagues in the Assembly. The Welsh Affairs Committee was given the job of initially examining the draft Bill on behalf of the Commons.
Some hon. Members, especially Labour Members, have argued that the Select Committee was not the appropriate forum for the task. Perhaps their strongest argument is that although a Select Committee is normally the best body for undertaking pre-legislative scrutiny, the Welsh Affairs Committee is different. Most Select Committees cover specific aspects of policy such as education, health and defence. The members have therefore developed expertise and have a special interest in their subject. It is argued that that does not apply to the Welsh Affairs Committee or any of the other territorial Committees, and that we need to find a different way forward for Bills that apply only to Wales.
Although that argument contains a kernel of validity, Select Committees have greater strengths than a collegiate expertise and experience. The approach and culture that established Select Committees are more important. We proceed through investigation, seek objectivity and try to reach consensus. All Select
Committees, even those that cover specific policy matters, look outside to those who give evidence and to special advisers for expertise and special interest.The Welsh Affairs Committee did a good job in considering the draft Bill. It would be difficult to establish an alternative body on an ad-hoc basis that could do a better job in future. The Welsh Grand Committee is too large and too party political to undertake that function.
I was impressed by the partnership approach that developed between the Government in Whitehall and the Government in Cardiff bay in devising the measure. That was reflected in the joint session when my hon. Friend the Under-Secretary and Assembly Minister Jane Hutt gave evidence together.
We did not achieve the same partnership between our Committee and the Health and Social Services Committee in the Assembly in scrutinising the measure. However, we made some progress and, as my hon. Friend the Member for Cardiff, North (Julie Morgan) pointed out, Assembly Members attended some of our Committee's meetings and vice versa. I am sure that we can build on that. Surely we can maintain our separate responsibilities as Members of Parliament and Assembly Members and our separate decision-making processes, but co-operate far more effectively in evidence gathering.
Julie Morgan: Does my hon. Friend agree that it would be a good idea to have joint committees comprising Westminster Members and Assembly Members, as the Chairman of the Select Committee suggested?
Mr. Caton: I thank my hon. Friend for that suggestion. I think that we are a little way away from that, but it is an objective that I would seek. We could probably do that only in the evidence-gathering stage, as I suggested. For pre-legislative scrutiny, the Assembly needs to come to its own decisions separate from us, whichever forum is used to represent the Commons. Similarly, the Commons, whether in the form of a Select Committee or another body, would have to come to a decision about its recommendations independently. However, in the evidence-gathering stage, there could be much better, more effective co-operation. I hope that we will move towards that.
The pre-legislative scrutiny at both levels of Welsh government has already proved its worth. Even on a short and uncontentious Bill such as this, we have identified scope for real improvement at the draft stage. I congratulate the Government on taking on board many of the proposals. In some cases the Government, in responding to recommendations from various parties, including the Select Committee, made a fair case for sticking to their guns. In one or two other cases, they should be pressed a little further.
I want to return to the concerns that I raised in the Welsh Grand Committee back in July, and look at how they have been addressed in the Bill. I warmly support each of the three purposes of the Bill. I remain convinced that reformed and enhanced community councils will be the right people's watchdogs for the health service in
Wales. I am sure that the Wales Centre for Health, with its advice, training and research remit, will provide independent assessment and support that will form a hub for partnership between the various sectors that provide or utilise information or evidence on health issues.I am equally confident that Health Professions Wales is a step forward, building on the remit of the old Welsh National Board for Nursing, Midwifery and Health Visiting to include care support workers, and allowing the inclusion of other health care professions over time.
In July, we considered various issues that came out of the Select Committee inquiry. I welcome the fact that the short and long titles of the Bill now properly reflect the contents of the Bill. I welcome also the clarification of languages in some clauses and schedules, although I suspect that there is still more scope for improving the plain speaking part of the Bill; the inclusion of the promised reference to the rights of CHCs to receive information from health service providers; and the tightening of the wording to protect the independence and the perceived independence of the Wales Centre for Health, although again there may be further steps that we can take in that regard.
The Government have made a broadly rational case for maintaining their and the Assembly's approach to the co-terminosity of CHC boundaries and local health boards; to some extent on the adequacy of current drafting to enable CHCs to undertake independent advocacy services; and on the powers and functions of the Association of Welsh Community Health Councils.
I now also accept that the National Assembly's powers of direction to Health Professions Wales on functions carried out by that body on behalf of the Health Professions Council or the Nursing and Midwifery Council are already constrained by the agreements that established those functions. A requirement in the Bill for prior consultation, as we suggested, would therefore be superfluous.
Although we in the Welsh Affairs Committee did not address the matter in our report, the National Audit Office rightly drew attention to the lack of provision for the Auditor General for Wales to carry out value-for-money investigations into the work of the Wales Centre for Health. I am delighted that the Government have provided for that in the Bill.
That leaves me with three ongoing worries about the Bill—two that I raised in the Grand Committee, and one that the Royal College of Nursing Wales raised subsequently. First, I still believe that it would be useful if the Bill went even further in empowering the Assembly to extend the remit of community health councils to include the inspection of and the requirement for information from anyone involved in the provision of publicly funded health care.
I still believe that the scope of CHCs should extend to prisons and young offender institutions, as has been mentioned several times today. Medical assessment and care, especially psychiatric assessment and care, in our prisons is a real issue. Although I appreciate that prisons have their own inspection and lay visitor systems, I believe that inspections by a group of informed lay people who could make direct comparison between health provision in prison and outside would be extremely valuable.
That brings me to my other on-going concern: the fact that the Bill still does not give CHC members a statutory right of time off work for their public duties. Frankly, this remains an anomaly. Representatives of CHCs across Wales told the Select Committee that provision of this right was probably the best way of getting CHCs better to reflect the communities that they are supposed to represent. At present, younger working people feel unable to participate in the work of CHCs because they cannot get time off work or cannot afford to take that time off.
I was a member of the old Swansea and Lliw Valley community health council for some years, and this was a real issue even then, in particular for hospital and other institutional visits, some of which, sensibly, had to be made in the daytime. During my time on the council, anyone who went to one of our regular monthly meetings in an evening would have seen a body of people who broadly reflected Swansea and Lliw Valley society in terms of gender balance, age range and—to a lesser extent, sadly—ethnic origin. If they went on one of our inspection visits in the daytime, however, they would have got a very different picture. Mostly, it was only retired members who were able to take part. We are now talking about extending the responsibilities of CHCs to deal with private homes and primary care providers as well as hospitals and other institutions, and the problem is likely to get worse if we do not address it. Perhaps the Bill is not the right way to provide a statutory right—it might be more appropriate to use an order—but this change is essential, however we achieve it.
The Royal College of Nursing Wales has raised an issue worth considering, in the briefing that it has sent to us all. It is worried about how major health service reconfigurations proposed by local health boards or the NHS Wales Department will be dealt with in practice. It foresees that, due to the small size of local health boards, big changes—the closure of an accident and emergency department is the example that it cites—could be devised jointly between the local health board and the regional offices of the NHS Wales Department, which is part of the Welsh Assembly Government. In such circumstances, if a CHC exercised its right of appeal against that reconfiguration to the Assembly Health Minister, that Minister would be sitting in judgment on a proposal that had come, at least partly, from her own officials. The RCN believes that this would constitute a conflict of interest, and proposes the creation in the Bill of an independent configuration panel for Wales, to provide independent advice to the Minister. I understand that that is what happens in England. I would be interested to hear the Minister's thoughts on that proposal when he winds up. Perhaps we could return to the matter in Committee.
This was a good draft Bill; it is a better Bill now. Who knows—perhaps it will be better still when it comes back on Third Reading.
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