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27 Nov 2002 : Column 414—continued

Lembit Öpik: Surely politics is different. Politicians who do not do a good job will lose their seats. We are talking not about trying to sell a service to the public but about being judged on the outcomes, so the poacher-gamekeeper analogy is not entirely valid.

Chris Grayling: The Conservatives believe that the role of CHCs is to challenge what is happening within the NHS, and that, by definition, means challenging decisions taken by politicians who control the NHS. That is why it is so important that CHCs are a truly independent voice, not subject to undue controls placed on them by central Government.

We need to ensure that Welsh CHCs are properly independent of political manipulation, which was mentioned by the hon. Member for Cardiff, Central (Mr. Jones). In Committee, we will table amendments to strengthen the role of CHCs and their independence from politicians. In an intervention, the hon. Gentleman called for better auditing of the outputs of the NHS in Wales. Given its poor performance, his words are especially important. They go to the nub of why we must ensure that CHCs have a powerful voice in the communities they seek to represent.

Any assessment of NHS performance in Wales today does not make happy reading. The Secretary of State is right to say that spending per head in Wales has been much higher than the national average in recent years,

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and the Wanless report highlighted the fact that Wales has more doctors per head of population than England, as well as shorter GP lists and higher prescribing rates. Despite that, by any objective judgment, the NHS in Wales is not delivering for patients what it should be delivering. That must be a priority for CHCs as they examine what is happening within the service. That is why it is important that the Bill gives them the freedom to do so.

In reality, things are getting worse. In the past three years, waiting lists have been rising by 1,000 people a month. In the past five years, the number of people waiting more than 12 months for in-patient treatment has increased by 82 per cent. The number of people waiting more than 12 months for out-patient treatment has increased from just 378 five years ago to more than 36,000 today. In 1997, no one waited more than 18 months for such treatment; today, more than 16,000 people are waiting. That is nothing short of a scandal. Having heard the comments of the hon. Member for Brecon and Radnorshire (Mr. Williams), I say to him that those are real figures about real people waiting for real treatments, and those people deserve better. I would tell the hon. Member for Montgomeryshire (Lembit Öpik) that no hon. Member should feel proud of that situation, still less one who represents a party that is part of the Administration in Cardiff. We want CHCs to address those issues. As the hon. Member for Caernarfon (Hywel Williams) pointed out, they need to serve as metaphorical high explosive to make sure that there is real change for the benefit of patients.

Lembit Öpik: I am sorry to interrupt the hon. Gentleman a second time, but I hope he agrees with other hon. Members that we are lucky to have a national health service at all. For all the difficulties that people experience in the NHS, surely he is not suggesting that we are not privileged in our standard of living and health provision.

Chris Grayling: I find it distressing that at a time when more and more money is being spent on the service it is getting worse. None of us should be proud of that.

Turning to the implementation of the proposals, we are concerned about the ability of the NHS in Wales to tackle a further round of organisational change when clinical targets are not being met and organisational plans appear to be in chaos, despite the fact that the NHS has been hiring administrators three times faster than doctors. In Committee, we must ensure that we do not add to the burdens that NHS management are already facing. My hon. Friend the Member for Ribble Valley (Mr. Evans) spoke about the problems caused by the latest set of Government reforms in Wales, the establishment of 22 health boards and the document leaked to the BBC a month ago questioning whether they would work at all. We are told that the cost of the changeover and the future operation of the system is still unknown; that the changeover may not happen on time; that the NHS in Wales cannot find enough applicants to fill key posts in organisations; and that there are real fears that the system for funding health care in Wales after April will be launched in chaos. All that will make the implementation of the Bill more difficult, so the

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changes outlined and discussed tonight must be seen against the background of a system that is not working for patients and the dedicated staff who work long hours. That is the true priority for Welsh health Ministers.

Turning briefly to other bodies covered by the Bill, we are concerned about possible duplication between the new Welsh bodies set up by the Bill and existing organisations elsewhere in the United Kingdom. For example, we are uncertain about the provision for the Wales Centre for Health to commission research into health matters in its own right. It would be foolish in the extreme to have a service commissioning research that is duplicated elsewhere in the United Kingdom.

Mr. John Smith (Vale of Glamorgan): Will the hon. Gentleman please recognise that some health issues are of greater concern in Wales than in other parts of the country? One group in Wales that will welcome the creation of the centre consists of the victims and families of victims of flight-related deep vein thrombosis. A higher proportion of people die and develop serious injury from that disease in Wales than anywhere else in the United Kingdom.

Chris Grayling: The hon. Gentleman should realise that that condition affects people throughout the UK, which is precisely why we should ensure that resources in different parts of Britain are pooled for the maximum benefit of patients.

We are also concerned about possible duplication between Health Professions Wales and organisations that the Government have established for the UK as a whole. Ministers need to ensure that those organisations work together effectively. In particular, they should not create different training and registration criteria for our health care professionals, thus making it difficult for them to work in one part of the UK after working in another. I hope very much that Ministers will exercise great caution on that score.

The Bill is not controversial in itself, but it comes at a time when the NHS in Wales is in turmoil. It is failing to meet its clinical goals and, far from getting better, it is getting worse. It is tangled up in a major reform process that is also in turmoil, and huge amounts of work remain to be done if the transition next April is to occur without causing real problems to the people who work in the service. Welcome as some of the Bill's provisions are, welcome as the retention of CHCs is, the Bill will not help to tackle those problems. Too much of its detail leaves power in the hands of politicians, not communities and professionals. Conservative Members have argued for years that the reason why the NHS is not delivering the first-rate health care that patients deserve is that it is too centralised and prescriptive. Too many of the provisions before the House fall into the same trap and we will work to change them as the Bill continues its passage.

The Government simply do not seem to understand that that centralised approach will not deliver the improvements that people want and need. Wales is the living example of what is wrong with their health policies. Spending in Wales is already much higher than the national average, but the NHS in Wales is heading backwards, and until the Government take on board the

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real lessons from this situation, nothing that we discuss in the House will make the difference that people in Wales and elsewhere in the United Kingdom are hoping for.

9.45 pm

The Parliamentary Under-Secretary of State for Wales (Mr. Don Touhig): We have had a very good and constructive debate on the Bill.

In summary, the Bill has three key elements: it provides a new role for reformed community health councils as the main vehicle for giving patients a greater say; it establishes the Wales Centre for Health to provide independent training, advice and research in health care; and it establishes Health Professions Wales to provide education and training to the health care professions.

We have heard in the debate that the pre-legislative scrutiny process in which we have been involved has been very successful. Publication of the Bill in draft, including on our Wales Office website, has allowed thorough consideration in all policy areas. Here in the Commons, the Bill was considered by the Select Committee on Welsh Affairs and debated in the Welsh Grand Committee. In another place, peers met the Assembly's Minister for Health and Social Services, Jane Hutt, and me, and in the Assembly, the Bill was discussed in the Health and Social Services Committee and in plenary session. The extensive public consultation on the draft Bill has ensured that the most important people—the people who will be affected by the legislation; the people of Wales—have had an opportunity to contribute.

Eighty-seven groups and organisations were invited to comment on the Bill, which was extensively scrutinised. We also published the Bill on the Wales Office website, which produced 15 responses, including an e-mail from a Mr. Liu Lieu, who runs a company in China and offered to sell us an excellent forging hammer. I think that something was lost in the translation.

In total, that process produced 45 recommendations for changes to the draft Bill. It says much for the effort that was put into the original drafting that the Bill received widespread support from stakeholders and that none of the pre-legislative scrutiny revealed any major concerns about the principles of what was proposed. The amendments made to the Bill following the pre-legislative scrutiny were all minor and of a technical nature.

The Bill has been in preparation for a long time in the sense that the proposals for reforming and retaining community health councils were first mooted by my hon. Friend the Member for Bridgend (Mr. Griffiths) in his first week after being appointed Minister with responsibility for health in Wales following the 1997 election of a Labour Government. Our reform agenda has been to reinvigorate and change community health councils in Wales. That has been universally accepted throughout the country, and the Welsh Affairs Committee helpfully contributed to that debate and expressed its support.

What the Bill proposes for community health councils in Wales is an essential element for the Assembly's wider strategy of involving the public in health service planning and delivery and listening to their views and

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concerns. The independence of community health councils in Wales is rightly cherished and we will ensure through the mechanisms in the Bill that they are independent and can deliver the services required by their communities.

The establishment of the Wales Centre for Health originated in the XBetter Health—Better Wales" document produced by the Wales Office in 1998. The foundations for creating the Wales Centre for Health were laid before devolution. The Government are now carrying them forward in partnership with the Assembly. In addition, the creation of the body that will oversee training and so on, Health Professions Wales, has been well-received and widely welcomed and will make an important contribution.

The Government were unable to take on board some aspects of the recommendations. As hon. Members have referred to a couple of those issues, I think that I should also mention them. The seventh recommendation of the Welsh Affairs Committee was that the Bill be amended to allow community health council members a statutory right to time off work for public duties. Other respondents made the same comment. While the Government strongly sympathise and understand and fully support people's opportunity to serve on community health councils, after having reflected, we did not consider that the Bill was the appropriate measure or vehicle in that regard. The Employment Rights Act 1996 contains a list of bodies whose membership attracts statutory time off. It could be amended by order and we will give further consideration to approaching the relevant Secretary of State with that in mind.

A ban on smoking in public places was a further suggestion from the Welsh Affairs Committee that we could not accept. After considering the proposal, we decided that such a measure was beyond the scope of the Bill and would entail creating a new public offence. A health Bill is not the proper vehicle for that.

I want to comment briefly on the remarks made by as many hon. Members as possible. The hon. Member for Ribble Valley (Mr. Evans), who led for the official Opposition, welcomed the draft Bill but provided his usual litany of all the woes that he perceives in the NHS in Wales. He quoted two statements:


I accept ownership of the first on behalf of my party. We said that to the people of Britain, and they elected a Labour Government. However, the second statement was originally made by Baroness Thatcher when she was Prime Minister. She said that the NHS was safe in Tory hands. My right hon. Friend the Member for Oldham, West and Royton (Mr. Meacher) responded by saying that that was as encouraging as putting King Herod on the board of Mothercare.

The hon. Gentleman also referred to the National Assembly's powers to make regulations. They will be exercised in the way prescribed by Assembly Standing Orders. Public consultation will take place before any regulations are made and I shall be happy to convey the Assembly's intention on each of the orders when we discuss the Bill in Committee, if that is helpful.

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The hon. Gentleman spoke with some passion about nurse training. The Conservative Government cut the number of nurses and midwives in training by 25 per cent. in the mid-1990s and I am therefore not surprised that he is passionate about the matter. Those cuts led directly to the shortage of nurses that we inherited.

I thank my hon. Friend the Member for Clwyd, South (Mr. Jones) for all the work that he and Welsh Affairs Committee undertook on pre-legislative scrutiny. He welcomed the Bill as a progressive measure and spoke about the opportunities that it would provide through its CHC provisions to respond to patients' voices in the health service.

The hon. Member for Montgomeryshire (Lembit Öpik) said that the pre-legislative consultation had been successful. I thank him for correcting some of the points in the research paper that was produced in the House on the costs of the proposed reorganisation. He was worried about co-terminosity with regard to CHCs. There is provision for CHCs to work in federations. However, I understand that that would not work in his large constituency. The Bill and the Assembly's regulation-making powers have sufficient flexibility to deal with those points.

My hon. Friend the Member for Ogmore (Huw Irranca-Davies) asked several questions to which I shall try to respond. He asked whether Health Professions Wales would have an input into the standards on overseas recruitment to ease assimilation. It may adopt functions from the Nursing and Midwifery Council only with the agreement of that body. That is a matter for Health Professions Wales when it is established.

My hon. Friend also asked about extending the role of CHCs to examining health provision in prisons. The National Health Service Reform and Health Care Professions Act 2002 requires the Prison Service and prescribed NHS bodies to co-operate with the view of improving health care in prisons. We do not believe that CHCs have a role in that and the Bill does not make such provision.

My hon. Friend and several other hon. Members raised matters about CHCs' cross-border operation. Powers for CHCs, including those to require information and undertake inspections, will be the same for CHCs in Wales as those that we gave patient forums in England in the National Health Service Reform and Health Care Professions Act 2002. The Bill's language will mirror that of the 2002 Act. That reciprocal arrangement is sensible and will work beneficially for all of us.

The hon. Member for Leominster (Mr. Wiggin) said that he was disappointed that the Government had not responded more positively to the Welsh Affairs Committee report. It was debated thoroughly in the Welsh Grand Committee. We carefully considered the comments of the Welsh Affairs Committee and adopted several although not all their proposals. There was widespread consultation and the hon. Gentleman and anyone else who felt strongly about our responses could have contributed at the pre-legislative scrutiny stage.

My hon. Friend the Member for Cardiff, Central (Mr. Jones), a former Wales Office Minister with responsibility for health, made important points about

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choice, which underpins the aims of our NHS reforms. I share my hon. Friend's views about the independence of CHCs. Any monitoring, appraisal and inspection of the health service must be open and transparent and must be seen to be fully transparent.

My hon. Friend referred to delayed discharges and bed blocking. I shall leave that to my colleagues who are dealing with the Community Care (Delayed Discharges etc.) Bill tomorrow. In response to the question whether the Bill could be amended to enable community health councils to investigate delayed discharges, I can tell my hon. Friend that I believe that the powers in the Bill are sufficient. Under paragraph 1(a) of schedule 7A, it is the duty of a CHC

The powers that we will confer on CHCs will cover the point that my hon. Friend raised.

The hon. Member for Caernarfon (Hywel Williams) said that patient power must be enabling. I agree. The thrust of our CHC reforms is intended to enable patients to exercise more power and influence on the health service. We must make sure that that works.

My hon. Friend the Member for Cardiff, North (Julie Morgan) spoke about the developing roles of community health councils and put forward some interesting perspectives. I do not know whether she will serve on the Committee, but we can explore there the perspectives that she outlined in her comments this evening.

The hon. Member for Brecon and Radnorshire (Mr. Williams) gave his wholehearted support to the Bill. I welcome that. The fact that he was able to do so stems from the fact that we had wide–ranging pre-legislative scrutiny, which enabled members of all political parties or of none to make a contribution to the way in which the reform should be structured. That is reflected in the Bill.

My hon. Friend the Member for Gower (Mr. Caton) believed that the Welsh Affairs Committee did a good job on the pre-legislative scrutiny, and I agree. The Committee did an excellent job, which is a model for future pre-legislative scrutiny. He welcomed the partnership approach between the Government and the National Assembly for Wales. I have had the closest working partnership with my colleague Jane Hutt, the Assembly Minister for Health and Social Services. We have had the closest collaboration between my officials and hers, which is reflected in the strong support that we received throughout the pre-legislative scrutiny. This is how we are trying to take the agenda forward in Wales: the Government working in partnership with the Labour-led Assembly—the hon. Member for Montgomeryshire might care to note that—the Labour-led Assembly. That is proving beneficial for the people of Wales.

My hon. Friend the Member for Aberavon (Dr. Francis) also welcomed the reforms to CHCs and gave some interesting and important historical

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perspectives on how we had developed a democratic and a socialist health service as a result of the work of Aneurin Bevan.

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