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27 Nov 2002 : Column 411—continued

Lembit Öpik: My personal experience of Gobowen hospital has always been positive and just as the hon. Gentleman describes. Does he agree that we may want to explore the important matter that he raises in Committee? There will unquestionably be issues on jurisdiction to deal with and it may be the case that the CHC will need to have the authority to act on a non-statutory basis across the border.

Ian Lucas: I agree. The issue has not been raised sufficiently. Most hon. Members who have contributed to the debate do not have the same cross-border services as those of us who work in north-east Wales.

Huw Irranca-Davies: Does my hon. Friend also agree that because the issue is long standing, the Bill gives us the opportunity to address it? One way or another, we have to ensure that we satisfy the requirement for accountability on cross-border issues.

Ian Lucas: My hon. Friend is also correct. We must be conscious of the fact that we are in an era in which health care and the experts are becoming more specialised. It is simply not the case that every district hospital can provide expertise of the highest quality. Although the mantra XWelsh solutions for Welsh problems" is appealing, when my constituents come to me for good quality health care, they do not mind whether that is supplied in Chester or Wrexham. What they want is a decent service and a good standard of care.

Mr. Evans: Would not the hon. Gentleman prefer it if the CHCs in his area were in discussions with the sister organisation in Chester, for instance, so that it could investigate the problem? After all, part of the problem is that his Government abolished CHCs in England and we are trying to preserve them for Wales. Does he not have faith in the sister organisations in England?

Ian Lucas: I know from close discussions with health professionals, health consumers and patients in

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north-east Wales that there are close working relationships of all types between people who work on different sides of the border. Indeed, many health professionals are employed by more than one hospital spending, for example, 50 per cent. of their time in Chester and 50 per cent. in Wrexham. Areas such as north-east Wales recognise that the services must be provided on both sides of the border. The care needs to be of a high quality. I am sure that good relationships will be developed in due course.

Another aspect that I greatly welcome is the extension of the CHCs' powers on primary care and the inspection of private facilities that offer NHS services. Will that inspection extend to voluntary organisations that provide health care? I have in mind the Nightingale House hospice in Wrexham. It provides an excellent standard of care and would have nothing to fear from an inspection regime. Will CHCs be able to inspect hospices?

For once I take issue with my hon. Friend the Member for Caerphilly (Mr. David). There are excellent nursing homes in the private sector that provide high-quality care. I have inspected the Pendine Park nursing home in my constituency. It is a high-quality home that provides an excellent service. Private nursing homes have nothing to fear from the system of assessment, but it is good that the CHCs have that additional power.

I welcome the Bill. The substance is good, but the procedure by which we reached this point could be improved. The Bill is positive for Wales, and although it may need some refinement in Committee, I am sure that it will be a good step in the right direction for my constituents in Wrexham and I am pleased to support it.

9.30 pm

Chris Grayling (Epsom and Ewell): This has been an interesting and wide-ranging debate—sometimes a little too wide-ranging for the Chair. In some ways, however, it has not been as wide-ranging as it might have been because, as some hon. Members have said, this is not quite the Bill that was anticipated, so much of the Government's planned reforms for Wales having already been handled in the National Health Service Reform and Health Care Professions Act 2002.

The debate began with the Secretary of State making a strong defence of the Bill and of the NHS in Wales. However, he failed to explain why such high levels of spending per head of population have not led to better health outcomes, and he admitted that not all was well with waiting lists. During his speech there was a noteworthy intervention by the hon. Member for Blaenau Gwent (Llew Smith), who basically asked, XWhatever happened to our bonfire of quangos?" I got the impression from the Secretary of State's response that he believed that the only problem in the past was that we had the wrong kind of quango.

My hon. Friend the Member for Ribble Valley (Mr. Evans) made a telling attack on the failures of the current Administration to deliver improvement. He warned that the Bill risked putting too much control into the hands of politicians. He also pointed out that it delivers more change to a service that is already struggling with very considerable change.

We have had numerous contributions, including many from members of the Select Committee. Those speeches addressed the measure itself but they also

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strayed—as I said, sometimes rather too far for the comfort of the Chair—on to wider Welsh health issues ranging from the health benefits of free bus passes to a call for free eye tests, and even, in the case of the hon. Member for Aberavon (Dr. Francis), making a foray into the labour wards.

The Bill is not directly about the treatment of patients, but it is about the creation of new organisations designed to improve the quality of health care in Wales. The key question that needs to be asked tonight and in Committee is, XWill these changes ultimately make a difference to patients in Wales?" That is the criterion by which any change of this kind must be judged.

Conservative Members do not take issue with the overall nature of the organisations, but we think that important modifications need to be made to the detail of the Government's plans. The Bill concentrates too many powers in the hands of the Assembly and too few in the hands of communities and health care professionals. In Committee, we will want to put forward different ideas about how the organisations should operate. We also question whether the Bill risks creating unnecessary duplication at a time when the NHS in Wales has many other pressing priorities.

At the heart of the Bill are the community health councils. The Bill marks an astonishing U-turn by Ministers, who are tonight heading in a direction diametrically opposed to the one that they took in the House only a few months ago. We Conservatives have always supported the role of the CHCs in providing a proper link between local communities and the NHS and in monitoring the effectiveness of the service that it provides, and until recently so did the Prime Minister. In 2000, his office wrote to his local CHC, praising its work and that of its counterparts. The letter said:

Only two years after that letter, CHCs have been abolished in England.

We opposed the changes put forward by the Government earlier this year in the same way that we support tonight the retention of CHCs in Wales. Earlier this year, however, the Government told us that we were wrong. Indeed, we were lectured by the Parliamentary Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), who said on 15 January:

How is it necessary to push forward the boundaries in England and not in Wales? The Secretary of State for Health put it even more strongly, telling the House:

Have Ministers had a vision on the road to Damascus? Here they are, a matter of months later, telling us that CHCs are the right way forward for Wales. Ten months ago, the Under-Secretary of State for Wales voted against Conservative amendments to

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the National Health Service Reform and Health Care Professions Bill that would have retained community health councils in England. Tonight, he will vote in favour of community health councils. He cannot have it both ways—either CHCs are a good idea or they are not; they cannot be both.

We welcome the U-turn and the plan to retain CHCs in Wales. Our concerns about the Bill centre on the provisions that allow the Assembly extensive controls over Welsh CHCs.

Huw Irranca-Davies: Does the hon. Gentleman recognise that he has just paid a magnificent back-handed tribute to the good common sense of Welsh elected representatives? Furthermore, he might like to realise that we now have devolution.

Chris Grayling: If the hon. Gentleman believes so strongly in CHCs, why have he and his colleagues deprived English patients of the right of representation by CHCs?

To be effective, CHCs must be independent—that telling point was made by my hon. Friend the Member for Leominster (Mr. Wiggin). CHCs must be free to represent the interests of the communities and patients in the areas they cover. They do not exist to be controlled by politicians. The Government should not put as many powers into the hands of the Assembly as they are giving it in the Bill. The Assembly cannot be both provider and monitor of services—it cannot be both poacher and gamekeeper. During debates on these measures, our Conservative colleagues in the Assembly argued for a strong, independent organisation to co-ordinate the work of CHCs and to remove some of the prescriptive powers that the Bill would give to the Assembly.

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