Health (Wales) Bill

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Mr. Wiggin: In her evidence to the Select Committee, Jane Hutt discussed whether coterminosity should depend on patient flow or geographical boundaries. She expressed the belief that patient flow was more important. Has the Minister had a chance to discuss that with her?

Mr. Touhig: No, I have not. I am aware of the points that the Assembly Minister made, but it is important that, at this stage, the Administration of the Assembly does not believe it to be appropriate to make any changes to the boundaries. If it becomes necessary to make any such changes, the Assembly will consult all the relevant councils and key stakeholders before it does so to ensure that it is acceptable. I should make it clear that the Assembly's consultation system is open and transparent. It runs for about 12 weeks and is based on Cabinet guidelines on the principles of consultation. It is a model, and I have no doubt that there would be widespread and extensive consultation should any change be proposed.

Amendment No. 15 relates to coterminosity. It is interesting, because the Opposition want to amend the Bill to read,

    ''In making an order the Assembly must ensure . . . that due regard is paid to the boundaries of those health authorities which a Council is to scrutinise.''

In effect, if the amendment were accepted and the Assembly made any proposals, it would be the end of the story if it said that it had given due regard to the boundaries of the health authorities that the council is expected to scrutinise. The amendment is unnecessary, because the Bill will ensure that the Assembly gives due regard to any changes by making them part of the consultation.

Most CHCs are already coterminous with NHS organisations and they are already working in federal structures, which have proved beneficial in many parts of Wales. The federation structure allows CHCs to exert more leverage at all levels of the NHS as well as linking them more effectively with local authorities. Further arrangements will develop to ensure that CHCs engage effectively with the new NHS structures coming into play next year. Although the Assembly does not wish to make further boundary changes in the foreseeable future, should the Assembly and the CHCs decide that it is appropriate to do so, the Bill will allow maximum flexibility to make the changes. The amendments take us no further towards improving the quality of the Bill. I understand the hon. Gentleman's points and it is right to explore them, but the amendments will not move us further forward.

The hon. Member for Brecon and Radnorshire was surprised that the Government tabled no amendments, but I am surprised that he was surprised. It shows how little the Liberal Democrats understand how this place operates. All Governments seek to avoid amending their legislation once it has been published.

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I noticed that the hon. Member for Caernarfon made no response to my hon. Friend the Member for Cardiff, Central (Mr. Jones) on the matter of bed blocking. It is a question of one voice in Wales and another voice in London; precisely what we have come to expect from the nationalist party over the years. I urge the Committee to reject the amendments.

Mr. Evans: I am deeply saddened that, although the Minister recognises the importance of debating the issues fully to improve legislation, he fails to see the merit in these particular amendments. I should like to refer to some of the points raised in the debate.

The hon. Member for Brecon and Radnorshire sees the merit in consulting CHCs, but does not believe that they should be in the driving seat when it comes to name changes. My hon. Friend the Member for Epsom and Ewell may have distracted him from reading the Western Mail today—

Mr. Roger Williams rose—

Mr. Evans: Let me finish and then I shall allow the hon. Member for Brecon and Radnorshire his Christmas present; an intervention. It is argued that we should accept devolution and the Assembly. Of course we accept them and we shall fight the elections next year. I hope that we shall bring more common sense to the Assembly; controlling it would be the best solution to delivering better services. However, we are referring to real devolution. The hon. Gentleman has the fanciful idea that devolving power from this institution to another institution is what devolution is all about—

Mr. Roger Williams: Will the hon. Gentleman give way?

Mr. Evans: In a second. The hon. Gentleman needs to understand that real devolution is giving power from this place—or, indeed, from the Welsh Assembly—to a body such as community health councils, which can then drive the change.

Mr. Roger Williams: Nothing in the Bill stops CHCs from requesting a change of name, but surely the point is whether a change could happen without their request. That is the key issue.

Mr. Evans: I am grateful for that intervention, but we want to see change happening. The hon. Member for Caernarfon intimated that his own CHC is already gearing up to name itself it after him or some other name that people will easily recognise; they at least will be in the driving seat.

Mr. Touhig: That is the most amazing defence of devolution. If the hon. Gentleman were a Catholic, he would have to go to confession. He refers to an article in this morning's edition of the Western Mail. In it, a leading Conservative Assembly member, Glyn Davies, said that the Conservatives must

    ''end their grudging acceptance of devolution''.

However, he went on to say:

    ''We can all agree that devolution is a dangerous and unpredictable process''.

I am not clear where the hon. Gentleman and his party stand on devolution.

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Mr. Evans: I shall tell the Committee where we stand on the Bill. We want to ensure that power resides at the most appropriate level. In this case, we are ensuring that the power to change the names will reside with the bodies that act as the patients' champions. They have a particular remit, which is to improve the health service behalf of the patients. There is no reason, therefore, why a CHC would want to obs—

Chris Grayling: Obfuscate.

Mr. Evans: Obfuscate. I should go to the same dentist as the hon. Member for Caernarfon, if we could find one in Wales.

Those bodies would want as many people as possible to know who they are and what they do. The Welsh Assembly, which is presiding over the health service in Wales, may not have the same reasoning. We already know that Jane Hutt is irritated when she opens her newspaper to see that people find fault with the national health service. She finds it irritating because people criticise the way in which the NHS is turning out. She tries to say that she has no responsibility for it and that people should not criticise her for it, but the fact is that she should be ensuring that the money goes into the right areas. Frankly, that is not the case; people should be criticising her if there are problems and deficiencies. That is one of the key roles of the CHCs, and that is why I would wish to put them in the driving seat.

Mr. Touhig: In his earlier remarks, the hon. Gentleman suggested that if a community health council became difficult, Assembly Ministers might want to use their powers to get rid of it. That is not how we do things. We all remember a certain Baroness Thatcher abolishing the GLC because it was a constant thorn in her side. We do not do that. It may be the Tory way, but it is not the Labour way.

Mr. Evans: It may not be the third way that the hon. Gentleman and his party used to stand for. Instead, the London Assembly is now up and running, and I am sure that we are all looking forward to the congestion charge that will be introduced in February—

The Chairman: Order. We are straying a little from Wales.

Mr. Evans: Congestion charging, Mr. Griffiths, is most certainly straying from Wales. Perhaps the Welsh Assembly's answer to too many patients seeking service from the NHS in Wales would be to introduce a congestion change. The whole point is to put the CHCs into the driving seat.

The hon. Member for Brecon and Radnorshire observed that there are no Government amendments. I have sat on many Committees when some of the more independent thinkers have read a Bill and thought that they would try to improve it. It may be a bit of an irritant to the Government that their Back Benchers should think that there are still ways to improve the Bill even after the scrutiny that it has already received, so they table amendments. They may not press them to a vote, and I can understand why. It would be a career-limiting move in many respects, I suggest.

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At least we would debate the amendments, and it is possible that an appropriate amendment could be tabled in the Government's name in another place. Progress could be made and improvements to the legislation may result. I am slightly disappointed, but the day may yet come when one or two of the more independent minded Labour Members may look at a Bill and decide that it could be improved with one or two amendments that we could debate. We shall see.

We wish the hon. Member for Caernarfon well later on in his dental appointment. Again, there is a real problem. I remember the hon. Member for Monmouth (Mr. Edwards) had problems finding an NHS dentist; such problems exist. That area could be resolved through the independence of the CHCs, which the Minister mentioned. The hon. Member for Caernarfon talked about his CHC looking at ways to change its name and to make it more relevant to the people in the area. As the Minister intimated, CHCs have a branding that people recognise. That should be retained.

Real devolution would be the CHC in Caernarfon suggesting a better name that would be more recognisable in the area. Under the Bill, they could write to Jane Hutt and say, ''This is a jolly good idea. What do you think?'' She might say, ''It is an interesting idea, but we believe that devolution ends at the Welsh Assembly. We make these decisions on behalf of the people of Caernarfon, not the CHC in Caernarfon.'' Surely if we believe in devolution and we devolve the power to the CHCs—they want to be the driving force and they want the name to be changed—they should have more of a say. I am worried about the reverse. The Welsh Assembly could decide that it wanted the name to be changed. Even though there had been consultation, it could announce that it would change the CHC name in Caernarfon to something that was less recognisable. That is the problem and that is why we have tabled the amendments.

The Minister referred to the independence of the CHCs—this is what the clause is all about—and we believe in that, too. As CHCs have a unique role in championing patients in Wales, we believe that they should be independent, too. We have tabled the amendments in order to give them greater independence from the Welsh Assembly. The Minister says that of course the Welsh Assembly will consult. During the passage of the devolution legislation, whenever we said that certain things would happen, we were told that we were just being negative and that once the Welsh Assembly was up and running it would be the answer to all Wales's ills. As generous as one may wish to be towards the Welsh Assembly, no one can argue that that is the case. Indeed, let us take the example of the building. We were told that it would cost between £12 million and £17 million—

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Prepared 10 December 2002