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27 Nov 2002 : Column 404—continued

Lembit Öpik: Does the hon. Gentleman agree that the strength of the Bill and the relatively uncontroversial

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nature of the debate tonight is a direct consequence of stakeholders in the Assembly, together with health professionals, having exactly the opportunity that he describes?

Mr. David: There is something in that point of view. However, the material that we are debating is perhaps intrinsically uncontroversial. Nevertheless, if we are concerned about achieving a new form of politics in Wales, as has often been said, it must be done on the basis of partnership. The experience of this Bill has provided a good model to develop in future.

The Bill, which is important for the people of Wales, essentially contains three proposals relating to community health councils, the Wales Centre for Health and Health Professions Wales. Although it is good legislation, it is not always easy to comprehend and certainly during the later stages of the Bill consideration could be given to how it could be simplified and more straightforward language could be employed.

I should like to concentrate on the proposals with regard to community health councils. In my time as the Member of Parliament for Caerphilly over the past year and a half, I have had a positive relationship with my local community health council, Gwent community health council. Some 60 members bring to that CHC a wide range of experience. I have been very impressed with the range and quality of the work that they are engaged in. Extensive consultations are taking place on a range of services, and the CHC frequently takes up individual issues in a sensitive and responsive way for members of the public. My constituency office has developed a good and productive relationship with Gwent community health council.

I am pleased that the Bill recognises the worth of community health councils and points the way forward but significantly the Bill is not so much about defending what we have and maintaining the status quo; it is about looking positively at how we can build on the base that we have already. That is why I warmly welcome the fact that there is scope for making our CHCs more representative than they are already. There is scope to bring a wider still cross-section of society into CHCs to make them more effective. There is a need to extend the powers of CHCs.

I welcome the fact that there will be a more comprehensive advocacy service, covering, I hope, the whole of Wales. That network of CHCs will need to co-operate closely with other advocacy services, not least the Children's Commissioner for Wales, a post that has recently been established and has proven to be a success.

I think, too, that we must welcome the new powers in the Bill to oversee primary care facilities. The National Assembly for Wales will be empowered to introduce regulations to allow inspections of private health premises where NHS services are deployed. I certainly welcome that: it is a small measure in terms of the relationship with the private care sector, but I am very concerned about the standard of private nursing homes in my constituency. I could cite many examples of appalling standards in those homes that would be a disgrace in any civilised society. Modest as it is, the proposed introduction of CHCs into that context will be warmly welcomed by many people.

I share with other hon. Members the view that there remains scope to extend CHCs' role. There is a logical argument that they should be involved in prisons and

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institutions for young offenders. It is also worth noting that, although the allocation of extra resources of some £550,000 from the National Assembly is welcome, that amount will not be sufficient to secure true democratic accountability and effective CHCs. For that, we will need even more resources in the future, and I urge the Assembly to allocate them.

In conclusion, the Bill is significant, both in constitutional terms and in terms of the development of the NHS in Wales. I hope that my hon. Friend the Minister will respond positively to the constructive points that have been made by hon. Members of all parties, and that the Bill will receive the House's warm endorsement in its later stages.

9.2 pm

Mr. Dai Havard (Merthyr Tydfil and Rhymney): I, too, welcome the Bill. I do not intend to deal with technicalities and cover ground that many hon. Members have covered already, but I am especially interested in the scrutiny process that has taken place. Many useful comments have been made about how the process has increased the number of people able to express a view.

I share the concern about prisons and institutions for young offenders, and think that the involvement of CHCs could be a good idea. A long time ago, in a former life, I was a trade union official representing prison governors. I have seen some consequences of bad health provision in prisons. That provision would certainly benefit from having another pair of eyes look at it from outside.

The cross-border problem associated with the work of CHCs has been mentioned, and I shall return to it later, as it has some important aspects. First, however, I want to say something about investment, process and patient involvement. The latter is the most important element of the Bill.

I have different tests for the Bill. Is it really about patient empowerment? Is it really going to be a way of providing engines of change? What I require in the health service is step change as well as incremental change. There has been massive investment in the health service in Wales. By April 2004, spending on health provision in Wales will be £3.8 billion, 50 per cent. more than when the Assembly was created in 1999.

There has been investment also in people. That is continuing, and the Bill contributes to that growth. I welcome that. Investment is going not simply to clinicians, but to the other professionals in the health team, right the way through to the ancillary workers. That is necessary, because health provision requires a team approach.

Investment is also being made in knowledge and information, and I hope that that will allow the health service to be proactive rather than reactive. I intend to concentrate on the role of CHCs in that context. The structures of health service provision in Wales have been subject to many changes, and that process is continuing. We now have local health boards and strategic partnerships involving local authorities. They are fundamental to a holistic approach to health. I pay tribute to the managers of all those institutions in my area. They even involve themselves in crime and disorder partnerships. I celebrate the development of that strategic holistic view.

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My local CHCs do a lot of good work, but, as my hon. Friend the Member for Caerphilly (Mr. David) has said, we should do more than defend what we have; we should develop it for the future. Advocacy is important in that context. In the valleys, people often put up with services that the articulate middle classes in other parts of the United Kingdom would not tolerate, because they do not have the right aspirations. I need others to help them identify their requirements. Studies are in progress, although I understand that developing the advocacy role is proving slightly more problematic than was expected. The patient support officer schemes that are being trialled are exactly what we need.

If we are to live up to the standard we have required from the Welsh Assembly—sustainability in all things, but particularly in terms of improving health, and a holistic view—we need helpers. The voluntary sector is very important in my constituency. A charity called Cancer Aid Merthyr provides not only transport but counselling, and other services that would not otherwise be available. Macmillan nurses are also important, and they are to become part of the facilities provided by hospitals—oncological facilities, for example. I hope those voluntary workers will be integrated in the make-up of the institutions that we are creating—or the Welsh Assembly is creating.

Perhaps other parts of the UK can learn from the various ways of managing this process in Wales. My local trust now has public involvement liaison groups. It is a horrible title, but its intentions are good. It has already accepted the principle of extending involvement and bringing in more people—not the Xusual suspects", as my research assistant said to me the other day, but people beyond that definition. My hon. Friend the Member for Cardiff, North (Julie Morgan) made a good point about the need to involve younger people and previously disenfranchised groups.

The Minister referred to the new community hospital that we are to have in Merthyr. The principles I have mentioned are being applied in the plans for that hospital. I am also very pleased that it is being financed publicly rather than through the private finance initiative—but that is another story for another day.

I want to say something about patient involvement—not what is planned, but how it could be used. The incidence of cancer in my constituency is very high. Wales already has a cancer champion, a care strategy including a palliative care strategy, investment in specialist centres and a cancer co-ordinator. Many useful things are happening. The problem is the standards being applied, and the major frustrations encountered by those who try to make changes. As I have said, I want to test the ability of the new institutions to make such changes.

My current worry is that cancer patients often suffer badly from fatigue as a result of anaemia, and need blood transfusions. Having investigated, I think they would benefit from alternatives to transfusion. Bed-blocking was mentioned earlier, and it is certainly one of the major problems in the health service. If patients were not having transfusions they would not be taking up hospital beds, and according to my calculations 250,000 hospital beds would be become available.

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How can I ensure that such standards operate? If change is to happen, there must be ways of seeing that. I need agents to help me. The blood service in Wales is run by the Welsh blood service in the south, while what is known as the national blood service but is actually based in England deals with north Wales. It will be interesting for the CHCs responsible for the area to deal with that problem by considering the remit of those blood service institutions. Another serious issue, as we have heard, is that some patients have to go to Alder Hey or other hospitals in England, and I ask the Minister to give further consideration to that arrangement.

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