Health (Wales) Bill

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Mr. Roger Williams: Does the hon. Gentleman think that the situation of the hon. Member for Monmouth will be improved by the publication of an annual report?

Mr. Evans: I actually think that it would. I hope that there will be regular interim reports on given areas, so that inadequate provision in all types of NHS care can be addressed immediately, and only not once a year. However, the report once a year could at least reflect on some of the other reports that the CHC had produced, and some of campaigns that it had been waging. If problems were not being addressed properly in a given area, the CHC could say, ''This is what needs to be done. We're very unhappy about this. We have asked for certain changes to be made. They haven't listened. There is a real problem, and the lack of provision is going to continue, unless this happens.''

Conversely, a CHC could say in its report, ''We have featured this particular problem in one of our sub-reports. We now mention it again in this annual report to say that our concerns have been taken on board.'' There could be extra provision of dentists in Caernarfon or Monmouth, or in another area. Monmouth is a large constituency. Although there may be good provision of dentists in, say, Chepstow, a lack of provision in the town of Monmouth itself would be a problem. People should not be expected to drive huge distances.

Let us say that a CHC mentioned a problem in one of its sub-reports—for example, that the hon. Member for Monmouth found the lack of provision a difficulty—and that it was then addressed. The CHC could rightly say, ''We're pleased to see that the concerns we raised earlier have been met. There is much better provision and people in a local area have no difficulties whatever in finding an NHS dentist.''

Mr. Wiggin: My hon. Friend will recall that the idea of publishing an annual report was deemed to be so important that the Government did it more than once, until they recognised that the content was counter-productive, in terms of their electoral ambitions. I hope that he will ensure that the Government continue to support the idea of annual reports. The amendment

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will ensure that, unlike the Government, the CHCs will not be able to suspend the reports once they find that the content is not favourable.

Mr. Evans: That is why the amendment is to paragraph 1 of new schedule 7A, as opposed to paragraph 2. The amendment seeks to impose a duty on a council

    ''to publish an annual report on the level and quality of the health services in its area.''

It would override paragraph 2(i), which refers to

    ''matters to be included in any such report''.

That would mean that the Welsh Assembly could decide what would and would not go in the report, because that is the advice in the schedule. With the amendment, even if the Assembly did not think it a priority, CHCs would know that they were required to publish a report; as the patients' champions, I am sure that they would.

I can understand Jane Hutt being irritated by a report that highlights a lack of provision in the NHS over which she presides, and she might not think that a report needs to be produced on why the hon. Members for Caernarfon and for Monmouth are having difficulty in finding an NHS dentist. The amendment, however, would place CHCs under a duty to publish such a report. I hope that those hon. Members will get in touch with their local CHCs and ask them to investigate the lack of dentistry in their areas and include their findings in a report.

The hon. Member for Brecon and Radnorshire asked whether a report would make any difference. I hope that it would. To return to the issue of the monopoly provider, there is increasing private dentistry provision, but I believe that a sizeable proportion of people in Wales want NHS provision. After all, they pay into the NHS through national insurance; they will pay an extra 1 per cent. from April. Indeed, local authorities will pay an extra 1 per cent. for their employees, which will lead to higher council taxes, so people will be paying again. They will ask why they cannot have their teeth done by an NHS dentist. I hope that the Minister agrees that this is a sensible amendment, not a wrecking amendment.

Jane Hutt may not be especially grateful for scrutiny of other areas of the health service, such as waiting lists, for which the amendment would provide. I shall not repeat the speech that I made on Second Reading, when I reflected on several areas in which there are real problems. However, we know that problems arise in certain areas from time to time. We will always find problems in a health service the size of the NHS in the UK. For example, the scarcity of consultants and surgeons in certain areas is a problem. The scarcity of nurses is another problem; that is the reason why we are scouring countries where there are a surplus of nurses and trying to attract them here.

The hon. Member for Cardiff, Central mentioned bed blocking in connection with the Plaid Cymru spokesman on the health service in Wales. It has been mentioned that more than 1,000 patients are blocking NHS beds in Wales, and the approach of fining local authorities for not freeing up beds has been questioned. We will see what happens. Bed blocking

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concerns us all, including CHCs. If fines are used as a tool to free up beds in NHS hospitals in Wales, beds may become more available. Those 1,000 beds could then be used for people who need treatment. One thing we do know, however, is that two people do not share a bed. The Government may be thinking of introducing such a proposal, but that is not yet done and a bed can be used for only person. CHCs may wish to raise that in their annual report and, indeed, in some sub-reports.

Chris Grayling: Does my hon. Friend recognise that, far from being entirely a vehicle for negative scrutiny—as, I fear, Ministers might think—the production of annual reports could be a vehicle to enhance the quality of care by disseminating best practice through the eyes of the people observing it in the different organisations around Wales? It could not only provide a tool to highlight the sort of issues that he is addressing, but strengthen the management of the NHS in Wales.

12.15 pm

Mr. Evans: The amendment is a very positive suggestion, because we are considering the quality of levels of service. Anyone who resides in Wales, even Members of Parliament, uses the national health service. My family reside in Swansea, and none of them has private health care. We should not say how wonderful the NHS is when, clearly, there are problems. When hon. Members or their families have health needs, we are all concerned as to why there are deficiencies and what we can do to improve the level of service in specific areas. That is what the annual report would be all about.

Only two such reports differ from that aim. One was the report that the Government used to bring out generally for the United Kingdom, which said how wonderful services were. It hardly scrutinised deficiencies, and I suspect that that is a reason why it had such poor sales figures and was scrapped. The second was that published by the Secretary of State for Wales; I could add the annual report from the First Minister as well. The Government are hardly critical of themselves where there are deficiencies. Those reports show the mastery of spin over substance.

Julie Morgan (Cardiff, North): Is the hon. Gentleman aware that CHCs already bring out reports that highlight problems and issues in the health service? I see no reason why he thinks that anyone will try to hide deficiencies in the health service.

Mr. Evans: That is why we suggest the amendment to paragraph 1 as opposed to paragraph 2 of proposed new schedule 7A, and why I referred to the fact that under the schedule the Assembly would have responsibility for

    ''the preparation and publication of reports by Councils''


    ''matters to be included in any such report''.

By giving it that independence that the Minister said that he cherished, we put the onus on it to take that action, irrespective of the fact that it is doing so now.

Paragraph 2(i) mentions

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    ''matters to be included in any such report''.

I referred to the fact that Jane Hutt gets irritated when people point out lack of provision. Some may not see that as a priority, but the CHCs might. They do so at present, as is shown by the reports that they publish. If we were to add the provision to the schedule, we would safeguard the interests of patients in future, and the security and independence of the CHCs. They desire that independence.

Julie Morgan: Does the hon. Gentleman agree that some annual reports from bodies are of enormous help and show great detail, but others are not? To put such an emphasis on adding the need for an annual report to the Bill is totally inappropriate. The issue of who decides whether there should be an annual report or not is best left to regulations by the Assembly, as in paragraph 2 of proposed new schedule 7A.

Mr. Evans: I disagree. I agree that some annual reports are wholly useless; I mentioned those that I thought were useless and fitted no great purpose other than to promote their own self-importance and hide deficiencies rather than expose them. I am glad that the Government scrapped their annual report, and I hope that the Wales Office and the First Minister will do likewise.

The CHCs offer a specific service. The hon. Lady asks why we suggest the requirement as part of the Bill. We do so because, according to paragraph 1,

    ''It is the duty of a Council . . . to represent the interests in the health service of the public in its district''.

Some may argue that that is superfluous. It is not. It provides track lines to show what the CHCs are there to do. Because of the provisions in the measure, the Assembly may prevent CHCs from making certain reports or get them to emphasise other areas. The hon. Member for Cardiff, North (Julie Morgan) says that it sounds superfluous and that they would do it anyway, but it would give them independence.

Let us imagine, if it is possible, that the health service deteriorates even further. We would hope that the CHC would expose that in its report. I mentioned bed blocking to the hon. Member for Cardiff, Central. There may be problems with trolleys that are called mobile beds. I have a problem with whichever health trust does that, as it is manipulation. If there is a deficiency, we should know about it. Dressing up trolleys as mobile beds is completely wrong, as is designating corridors as annexes to wards. That has happened and it is unbelievable. We should ensure that an independent CHC, with an onus of duty to the patients in Wales, could produce a report that would expose those problems.

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Prepared 10 December 2002