Health (Wales) Bill

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The Chairman: Order. This is the Health (Wales) Bill, not a Bill on the building of the Welsh Assembly.

11.30 am

Mr. Evans: Yes, and it is a shame. I could table many amendments if it were. I am talking not about the building but about consultation. I am talking

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about a process that the Welsh Assembly might adopt on many matters, including changing the name of a CHC. I used the Welsh Assembly building as an example because if it consulted on that, it would find that the people of Wales said no. But it has decided not to consult the people of Wales, even though the cost has gone way through the roof. When the Minister tells me to be reassured that the Welsh Assembly will consult, I am not reassured in the slightest. I believe that we ought to put safeguards in the Bill to protect the independence that the Minister says he cherishes.

Mr. Touhig: If it will help the hon. Gentleman, I will give him and all members of the Committee a note explaining the Assembly's procedures for consultation. It is very open and transparent. It is based on Cabinet Office guidelines. The Assembly's own standing orders require that it consult as widely as possible for any changes covered by the amendments. I will happily do that to assuage his fears and reassure him that, should there be any change, my colleagues in the Assembly will carry out the widest possible consultation.

Mr. Evans: Of course I welcome any note from the Minister to assuage my fears about changes that would affect the health of the people of Wales and, indeed, the champions of those people's rights within Wales.

Mr. Wiggin: During the Select Committee's evidence gathering, the hon. Member for Conwy (Mrs. Williams) asked

    ''what the main differences are between CHCs in Wales and the Patients' Fora in England?''

Ms Hutt replied:

    ''I think the main difference is the Community Health Councils are going to be independent and they are not going to be part of the Health Service.''

Clearly, we are questioning that independence today. It would be written into the Bill if the Government accepted the amendments. Ms Hutt continued:

    ''The Patients Fora, which is the equivalent in England, is going to come into being. If we look at the different powers they are going to have the same right of entry, for example, as the Patients' Fora; and Community Health Councils are going to have the same right of entry. I think the main issue is that the Patients' Fora are going to be more part of the Health Service in England; whereas the Community Health Councils are going to have more of an independent role in relation to patients and to the Health Service.''

Surely that is what we are trying to achieve with the Bill; it is what Assembly Members want and what we want. I hope that the Government will reconsider their position.

Mr. Evans: I am grateful for the intervention from my hon. Friend the Member for Leominster (Mr. Wiggin), because we want the body to be independent. Both he and the Minister have mentioned patients' forums. We do not wish such bodies to be introduced in England but, with the help of votes from some Welsh Members, there was a vote to get rid of our CHCs and to institute patients' forums. I still find it difficult to remember the name ''patients' forums''. As I have said, the name ''CHCs'' had a bit of a ring and a bit of kudos to it. That is why I would prefer them to stay, but I would recognise patients' forums if community health councils in Caernarfon, for

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instance, wished the name to be changed. It is consultation and consent that are important to a body that exists to scrutinise services. That is why we tabled the amendment.

We have been accused of trying to restrict the change and the Assembly's ability to change what it wants to. That is absolutely right, because we are the primary legislative body for the health service in Wales, irrespective of whether others in the Welsh Assembly like that or not. The fact is that that power resides here, and we have a duty of care to patients in Wales to ensure that we do what we can to improve the health service that they receive. I am therefore happy to plead guilty to the charge of trying to restrict change. We are doing it with the purpose of protecting the independence of CHCs.

The Minister says that we should be reassured that Jane Hutt does not want to change the boundaries—then he adds ''at the moment''. It was at that point, sadly, that I started to feel queasy, because as we know those changes could take place at any time in the future. Indeed, with the reconfiguration of the NHS in Wales and the 22 bodies that will exist, I suspect that there will be mergers in future because they are untenable as constituted. No doubt the CHCs, with due regard to the configurations, will want to represent the new structures in future.

We cannot say what will happen, but an assurance from the Minister that the current health Minister in the Welsh Assembly does not want to change the boundaries at the moment does not fill me with the confidence that he hoped it would. That is why we shall press the amendment to a vote. We want to demonstrate clearly that when we talk about devolution, we are talking about devolution that protects the interests of all the patients of Wales, including the bodies that champion their rights. We believe in devolution that devolves to bodies, not just political institutions that have been created recently.

Mr. Edwards: I am intrigued by the hon. Gentleman's arguments. Amendment No. 15 refers to

    ''due regard . . . to the boundaries of . . . health authorities''.

Is he aware that health authorities are to be abolished in Wales as from next April? Was he referring to those bodies that are to be abolished, and did he, or did he not, vote for that abolition?

Mr. Evans: The hon. Gentleman will fully understand that, when we talk about due regard being paid, as the Minister himself said, to the boundaries of those health authorities that a council is scrutinising, those health boards—[Interruption.] The hon. Member for Monmouth (Mr. Edwards) will know that those—

Mr. Edwards: This is very woolly.

Mr. Evans: I can understand, given the way the hon. Gentleman thinks, why he cannot get his mind round the thrust of the amendments. However, if he were concerned about the best interests of the patients in his area—he already gives as an example a deficiency in NHS dentistry—he, too, would want to ensure that CHCs were independent, that they were fully recognised, and that they covered an area with which

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they were comfortable, rather than allowing the Welsh Assembly the freedom to change, at will, the areas that they cover. That is why we wish to put the amendments to a vote.

While we accept that devolution is healthy—we have always done that, even during the time of the great Baroness Thatcher, whom the Minister mentioned and in whose praise in the United States yesterday the Prime Minister is no doubt revelling—we believe in a devolution that devolves power down to as many groups and organisations as possible. They are important because they fight for the rights of individuals rather than those of politicians and political institutions.

Question put, That the amendment be made:—

The Committee divided: Ayes 4, Noes 11

Division No. 1]

Evans, Mr. Nigel Grayling, Chris
Robertson, Hugh Wiggin, Mr. Bill

Ainger, Mr. Nick David, Mr. Wayne Edwards, Mr. Huw Francis, Dr. Hywel Havard, Mr. Dai Morgan, Julie
Ruane, Chris Taylor, Ms Dari Touhig, Mr. Don Williams, Hywel Williams, Mr. Roger

Question accordingly negatived.

Chris Grayling: I beg to move amendment No. 7, in

    clause 1, page 1, line 18, leave out subsection (2).

This amendment addresses a clause of the type that one is never quite certain about. It is the responsibility of the members of a Committee such as this to be sure what an amendment is about before it is passed. When I read it, I was reminded of an episode in the book ''I, Claudius''. Following a rebellion led by his wife, the emperor discovers that he has already signed her death warrant in a huge pile of papers that was slipped through by one of his team the night before. He calls to meet her, but she is no longer able to see him. This clause might well achieve a similar situation. We are handing over substantial powers without knowing precisely what they are. I think that this is a probing amendment, and I hope that the Minister's response will be sufficient for that to be the case. The Committee would be irresponsible to legislate for sweeping powers without knowing what it was doing.

My hon. Friend the Member for Ribble Valley said in the last debate that it was important that the CHCs were independent. If they are to do a proper job of scrutiny on behalf of the people whom they represent, if they are to be able to criticise the national health service in Wales, unfettered and free of political interference, it is essential that they are independent of those whom they scrutinise. Many of the Bill's provisions will result in their not being truly independent; if the Government get their way, the National Assembly for Wales will retain many controls over the people, the nature and the structure of the CHCs. The Assembly will have the right to intervene and make changes if it so wishes, whether or not they are in the interests of patients.

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11.45 am

The Government have a track record of overruling independent regulators when they choose to do so, and I have no doubt that the Assembly—dominated as it is by a Labour Administration—will be willing to do the same. The Minister may not agree, but I remind him that it is only 12 months since a Secretary of State threatened to introduce legislation to overrule an independent regulator in order to secure his own political wishes. It is conceivable that another Minister will decide to take a similar step. It is fundamental that we understand exactly what this part of the Bill will allow a Minister to do, and the limitations—or lack of them—on that Minister's power.

I ask the Minister to explain what the various elements of the clause mean. For instance, subsection (2) refers to

    ''Supplementary, incidental, consequential, transitory, transitional or saving provision''.

What does that mean? How wide can such a provision go? Will he give us an idea of the different elements that could be encompassed by those broad terms? What changes might it allow?

Will the Minister explain the reference to ''regulations'' in subsection (2)? What might such regulations encompass? What powers does he envisage the Assembly having to make changes to CHCs? Will that allow, at least in theory, the abolition of CHCs? Will it allow the wholesale restructuring of CHCs? Will it allow a change to their remit that removes their independence to scrutinise the workings of the national health service?

Subsection (3) includes the words:

    ''may include provision amending or repealing any provision''.

How wide-ranging is the word ''any''? Does it cover any provision relating to CHCs? Does it mean that the ruling group on the National Assembly will have absolute power to do anything that it pleases to CHCs, without reference to the primary legislative body at Westminster? If it does that—I reiterate what I said about independence—we will be giving rights to the Assembly that allow it to be both poacher and gamekeeper.

The CHCs have an independent scrutineer of their services, with a specific remit to consider what is working and what is not working in the national health service in Wales. However, I wonder whether, if the Assembly so chooses—if it is embarrassed by the work of the CHCs, or frustrated by a steady stream of adverse publicity, or does not like the people who are active in the CHCs—it can simply tear the whole thing up and start again. That would be a dangerous principle for the House to endorse, and I ask the Minister to explain it.

Subsection (2) concludes:

    ''provision made by or under an enactment''.

Will the Minister define that? What does ''enactment'' entail? Are we talking only about enactments of the Welsh Assembly, or of references back to Westminster? If the Assembly wanted to introduce new regulations, would they have to be considered

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here? Will the Minister define exactly what that provision entails?

We need to understand how much control over the independent voice of patients in Wales is being placed in the hands of politicians. One of the things that is holding back the national health service in this country is that the day-to-day political involvement is too great. Health care will be improved only if politicians collectively take a step back and leave greater responsibilities in the hands of healthcare professionals and communities.

As we discussed in a debate on the Floor of the House a couple of weeks ago, community health councils can and will be extremely important in ensuring the de-politicisation of the national health service. In the end, however, that independence may be worth nothing if we leave the destiny of CHCs—how they work and are allowed to work—in the hands of elected politicians to whom we give draconian powers to make changes, and in so doing subject them to the vagaries of electoral change and political personality. I hope that the Minister can explain the clause and reassure us. The clause may be entirely innocuous, but it appears, at first glance, to offer the Assembly draconian powers. The Minister needs to explain in some detail what it actually means and what the consequences might be.

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Prepared 10 December 2002