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9 Jan 2003 : Column 365—continued

3.24 pm

Mr. Evans: We have heard a lot about the strengths of devolution, and in all honesty I cannot say that the NHS in Wales is a prime example of it. However, I heard the Secretary of State for Wales on the Frost programme on Sunday trying to entice Sir David Frost with the news that, thanks to devolution, he can look forward soon to receiving a concessionary bus pass. There was a look of bemusement on Sir David's face at the prospect of catching the No. 13 bus from Swansea to Townhill. I am not sure what he thought the Secretary of State was saying.

The Minister has just spoken about the procedure that the Bill followed, which we certainly welcome. Pre-legislative scrutiny is important, particularly as, time and again, we find our opportunities for detailed consideration of Bills further constrained. Perhaps the Minister should have bought the forge hammer from Mr. Lei Leiu of China so that he could have knocked the Bill into better shape. However, we know that the Bill has a further journey to make. Judging by its consideration in Committee and in the House today, the Government should not be so obsessed with timetabling. There is a great deal of good will on this side of the House towards Bills that genuinely deserve support.

I echo the Minister's comments about the hon. Member for Bridgend (Mr. Griffiths), who chaired the Standing Committee well. Of course, he takes a great interest in this area of the NHS in Wales, and has much experience of it. We wish him well for his retirement at the end of this Parliament.

We know that the Government intended the Bill to be much bigger, but parts of it were hived off to the NHS Reform and Health Care Professions Bill. Problems will arise from that Bill, not this one. I have huge reservations about that new bureaucratic system, with five health authorities being replaced by 22 local health boards and other bodies.

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We know that the former Secretary of State for Education and Skills said yesterday in an interview that politicians should be more credible and admit when they have made mistakes. This is one area in which Welsh politicians and UK politicians could achieve more credibility with the public by admitting that they have made a big mistake with those reforms. A report out this week says that #8.5 million of savings must be made in the NHS in Wales if the reforms are to be cost-neutral, and that is without the #15 million of transitional cost in setting up the new bodies, so there will be problems with that bureaucracy.

Returning to the Bill before the House, we support the retention of CHCs in Wales. We supported their retention in England as well, and we would have welcomed that measure if Labour Members had voted for it. We tried in our amendments to give CHCs more independence. The issue is not whether we should trust the Welsh Assembly to retain power over CHCs but whether we should ensure that CHCs, which are the whistleblowers, watchdogs and champions of patients, will be given independence. They would not then need to worry that the Welsh Assembly could change their name, savage them or even abolish them, which the Bill gives the Assembly the power to do.

We know that CHCs will be hugely busy. Headlines randomly selected from newspapers make that clear. One says XHutt again fails to meet targets" and another, from the South Wales Evening Post, says XWoman, 82, stranded in hospital". Another headline is, XHealth wait deadline passes"—a reference to people who had to wait more than 18 months for orthopaedic surgery. I know that the Minister said that the Welsh Assembly had made advances in that key area, but I am afraid that in some parts of Wales the waits are still huge. Other headlines are, XHealth board shake-up costs 'rise'"—a reference to the fact that an imperceptible improvement in the service will cost a lot—and, XNursing vacancies plague Welsh NHS".

Those are important headlines. One can hardly open a newspaper in Wales without reading a story about the dire problems faced by the NHS. In Wales, more money is spent per head of population than in England—#822 in Wales compared with #740 in England, although waiting lists in England are lower than in Wales. Since 1997, the number of beds in Wales has been reduced, and both in-patient and out-patient waiting lists have gone up. Total activity has gone down, as has elective activity. I referred earlier to University hospital of Wales, which has stopped non-emergency operations until February because of winter problems. I have talked about orthopaedic surgery. In Gwent, 1,200 patients have waited more than three years to see a consultant for the first time, which is not acceptable or humane. Waiting lists are also rising in several other key areas.

At the same time, bed blocking is a problem in Wales, and we have not heard any solution to the issue. Local authority care homes are closing, which will add even further to the problems of the NHS in Wales. We know that the health service is scouring the world for nurses and that more patients are being sent abroad or to England for their operations, which is causing a huge problem for trusts' budgets in England. As I said, trusts are spending more in Wales than in England. It is terrible that the NHS in Wales faces all those dire

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problems, and I feel sorry for the dedicated staff who are dogged by politicians, whether from Westminster or Wales. They are being prevented from getting on with the job that they sincerely want to do and which was their reason for going into the NHS in the first place.

I do not believe that the Government woke up one day and said, XLet's see how we can wreck the NHS," but that is exactly what has happened since they came to power in 1997. As for the Bill, we wish it well. We hope that when it goes to the other place, peers will look at some of our suggestions and table their own amendments. Indeed, I hope that the Government in a quieter moment will reflect on our suggestions and amend the Bill in the other place themselves. However, we wish the Bill well, and I do not wish to delay its progress any further.

3.31 pm

Mr. Roger Williams: We welcome the Bill as well. During an earlier discussion of the Bill, my hon. Friend the Member for Montgomeryshire (Lembit Opik) spoke about the stress he suffered as a result of the Conservatives' delay in announcing whether they would support the Bill. I am pleased to say that he has recovered and is now doing his bit in Committee.

I congratulate everyone who has contributed to the progress of the Bill, particularly the hon. Member for Clwyd, South (Mr. Jones) on his work with the Select Committee. The good relationship that has developed between the Assembly and Welsh Members will stand the legislative system in Wales in good stead, and will give us a huge advantage when we come to consider other Bills. We all recognise the problems that Wales faces, and the Bill represents a step forward in improving the NHS there. To a large extent, the poor state of the health of the Welsh nation is an historic problem. Any audit would point out that many people suffer health problems such as pneumoconiosis and silicosis as a result of their employment in the mining and slate industries. In the farming industry, people suffer from farmer's lung, an illness that attacks the lungs.

Those chronic illnesses are not cured easily, if at all, but we should ensure that people's quality of life is improved so that they can have a longer and more enjoyable life. People whose jobs involve heavy lifting can suffer from orthopaedic conditions. As I walk around farmers' markets in my area, I see many farmers hobbling away, waiting for their hip replacement, an operation that can provide many with comfort and relief.

Mr. Evans: Is the hon. Gentleman disturbed by the increasing number of people who have to use their life savings and, indeed, borrow money to go private because of the wait, often in great pain, that they have to endure before getting a hip replacement on the NHS?

Mr. Williams: I agree. Many of us have dealt in our surgeries with people waiting for hip replacements who are forced to use the private sector. To some extent, that is an historic problem that cannot be solved at the stroke of a pen; it will take time.

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Ill health in Wales is due not only to employment, but to high unemployment. The closure of the steel industry and the coal mines has brought relative poverty to many areas. There is a close relationship between poverty and ill health. Through a cycle of ill health and deprivation, families that have suffered from ill health for many years go on to produce another generation whose lifestyle and quality of life make it more prone to long periods of ill health. Youth unemployment has decreased over recent years, but many people have difficulty in finding gainful employment, and drug abuse has dragged them into ill health and exclusion from the health service.

The Bill is, as the Minister said, an enabling Bill. I welcome that. It gives powers to the Assembly to organise the structure and workings of the three organisations in a way that is suitable for Wales. In Committee, I was critical of some of the Tory amendments—

Chris Grayling: Tell us about yours.

Mr. Williams: I shall in a moment. I was glad to see Tory amendments, as we would have had a very short Committee stage without them. I was critical of them because they showed a misunderstanding of the devolution principle and settlement. It is not in the interests of devolution for the primary legislation to contain such fixed requirements that they give the Assembly no discretion to use its powers to make the organisations responsive to the needs of the people of Wales. I was happier with the tone of today's Tory amendments, which reflected a sense of partnership and working together. I am sure that that can be achieved, not necessarily by being written into the Bill, but through the working partnerships that will grow up between people working in different areas of Britain who are concerned to improve the health of the nation.

We are pleased that community health councils are to be retained in Wales and their role enhanced and extended. If that is to be achieved, we must ensure that the their membership is of suitable calibre and sufficiently representative of the people who live in Wales. I have mentioned on several occasions the amount of training that CHC members will have to undertake to carry out their responsibilities. I am pleased that the Assembly will be able to arrange appointments to the CHCs.

Although local authority members have for a long time made a huge contribution to the work of the CHCs, too many of them on such a council will not enhance its work. Many local authority members give much time and effort to that work, while some see it as an extension of their local authority work. They put more emphasis on the local authority work, and less time and effort into their CHC work. I have spoken to local authority members about the provision. They are happy about it. If they want to obtain or retain membership of a CHC, they can put their name forward and go through the process. The Nolan principles for the system of appointment are well established in Wales and widely respected. Gone are the times when all three members for the Brecon Beacons national park went to the same church, which was the church that the Secretary of State attended.

Since the Standing Committee proceedings finished, I have received representations about the name of CHCs. We discussed whether they had a good brand name and

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whether it should be retained on the basis that everybody knows where to go. However, certain members of CHCs believe that they could be renamed with a term that makes them more accessible and is more descriptive of their job and their advocacy work on patients' behalf.

The Wales centre for health will undoubtedly do much good work that will be valuable in addressing the endemic problems that affect the Welsh nation in relation to health. A huge amount of work certainly needs to be done on research and to roll out some specific results on Welsh conditions and medical problems.

I do not think that Health Professions Wales will act as a bar to prevent people from coming to Wales to work in nursing or any of the other health professions. It will be an enabling body that will encourage people to come to Wales to work. It will also produce an environment in which people can enter their chosen profession and look to it to give them a good quality of life and experiences. The body could also be influential in improving the qualifications to which health professionals can aspire and perhaps increasing their number. Qualifications might be introduced in relation to skills or duties that would be useful in a specifically Welsh context.

I am sure that everybody will want the Bill successfully to complete its passage.

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