Health (Wales) Bill

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Mr. Roger Williams: Does the hon. Gentleman agree that a conscientious CHC will bring out these reports? If an under-performing CHC brought out an annual report, it would not be worth the paper it was written on.

Mr. Evans: In the case of an under-performing CHC, powers in the Bill enable the Assembly itself to say, ''Let us see where it is going.'' If the CHC were not performing, a significant number of people would say, ''Hold on, there is something wrong here.'' That is why we want CHCs to be given independence. We

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should like them to be more independent in many ways and later amendments deal with that.

I spoke earlier about the closure of a facility, which might come up in an annual report. A facility that was made generally available in a given area might be closed for reasons of efficiency and streamlining. That is not inconceivable. When I was living in Swansea, the accident and emergency unit at Singleton hospital was threatened with closure because there was a good facility in Morriston hospital. The people of Swansea, West were angry about that. We welcomed the facility at Morriston—I have used it myself—but the closure of a facility somewhere else strikes people hard. A group of NHS administrators might think it a jolly good thing to streamline. Everyone would be forced to go to a centre of excellence, as they are called, and everyone would be happy. But they would not be happy if they had to travel 15 miles on congested roads when they have had an accident and it is an emergency. It would be completely wrong.

Mr. Wayne David (Caerphilly): I am listening with interest to the hon. Gentleman. However, I cannot understand the link between what he is saying and the need to have an annual report.

Mr. Evans: The link is that the independence of the CHCs and the requirement for them to bring out a report, which is put into paragraph 1 as opposed to 2, means that we are giving them the freedom to expose those problems. Perhaps the hon. Gentleman can think of an example in Caerphilly where his constituents are angry about changes that have taken place, which may be to the benefit of the whole area, but not to the benefit of the people in the area where the facility is being removed. They would be angry and would want that to be exposed. We want to give the CHCs the duty to expose that, and the independence to do so.

Julie Morgan: Is the hon. Gentleman not aware that CHCs already expose that?

Mr. Evans: Of course I am, but because of the extra powers that the Minister is happy to give the Welsh Assembly to do as it wishes, I want to give CHCs independence under the Bill from the requirements of the Assembly. There is nothing wrong in that. It would ensure that an independent CHC always had the necessary freedom. Does any member of the Committee disagree with amendment No. 6 for a council

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

Mr. Jones: I disagree, and once the hon. Gentleman finishes speaking, I shall say why.

Mr. Evans: It is a huge temptation for me to stop speaking immediately and hear what one of the more independent Government Members has to say. I am sorry that he disagrees with me, but he will have an opportunity to express his concerns shortly. We want to give the bodies freedom from the Welsh Assembly and an opportunity, in a totally independent report, to expose deficiencies. I am talking about the powers under paragraph 2.

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The closure of facilities and orthodontics has been mentioned. Waiting lists are also relevant, and plastic surgery was raised quite recently. Some people have had to spend nine years on a waiting list. Clearly, it is absurd for people to wait anything like as long as nine years for plastic surgery. There have been problems with regard to hot reporting on radiology. We know that when people are afraid that there is something wrong with them and they have X-rays taken, the stress and strain of waiting for an accurate report leads in many cases to an illness of its own. People have huge worries about that, so we must ensure that hot reporting is best practice and copied by everyone. I am also talking about basic matters such as the use of wheelchairs, for which there are waiting lists in certain areas. We know that they are expensive, but we need to ensure that an independent report exposes areas where improvements can be made.

One of the great beauties of producing such reports is that the newspapers take them up. Some people may say, ''Well, the newspapers sensationalise things,'' but this is about deficiencies in a health service into which people have paid. They cannot afford to go anywhere else, and they look to the CHC to represent their interests. The amendment would create an obligation to publish an annual report about the level and quality of services in the area, which is important.

Mr. Roger Williams: Does the hon. Gentleman agree that he is placing great emphasis on statistics, whereas one of the most important roles of a CHC is advocacy for individual patients? That could not be included in annual reports because of confidentiality.

Mr. Evans: Even with confidentiality, I see no reason why initials should not be used in an annual report or a line used instead of the name of a person where they have gone through pain or experienced a disadvantage or inequality of service, such as the postcode lottery for drugs. That should be exposed. The hon. Gentleman has hit on an important point. He says that I am mentioning a lot of statistics. In fact, I am not, but in the past I have, and behind each statistic is an individual story. He is absolutely right. Every time that I say that some 200,000 people are waiting for outpatient appointments, that figure goes through people's minds. However, they cannot quite get their heads round the sort of pain that some of those people are experiencing. I hope that an annual report published by the CHC would be able to dig beneath the surface of the statistics.

People can find statistics inane, but they do not fully appreciate them. However, they would appreciate the fact that mother had been waiting four years for a hip replacement operation, that she had been deteriorating over those four years, had been in pain and had been prescribed a huge number of drugs at an enormous cost to the national health service.

I remember not feeling well a couple of years ago. I had a pain in my side, rather than being a pain in other people's sides. I asked in June whether I could see the consultant, and my doctor told me that I could not see one until November. When I said that I was in pain, he said, ''Don't worry Nigel, I'll prescribe some painkillers.'' That was the last thing that I needed; I wanted the problem sorted.

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The hon. Member for Brecon and Radnorshire hit on an important point when speaking of the breaking of patients' confidentiality. However, I have to say that one cannot read the Western Mail without finding that people who have received inadequate health service. They do not care about the publicity, nor about confidentiality being broken; they have gone to the reporters to complain of having to wait so long for operations.

The hon. Member for Monmouth was not afraid of confidentiality being broken when he found that he could not sign on for national health service dentistry. He was featured on the front page of his local newspaper saying, ''I want an improvement in service''. He thought that the publicity would gain him that improvement. That is what many of our constituents do; it is the final resort for many people.

With the obligation of an annual report, we may find our constituents and other patients in Wales who have problems writing to the CHC to get them investigated. Those problems would be featured either in sub-reports or in the annual report and publicity would follow from that, because journalists read those reports avidly. I am not sure whether the hon. Member for Brecon and Radnorshire would agree, but I am sure that a lot of patients would be only too happy for confidentiality to be broken if they thought that they would get treatment more quickly and if the level of service for friends and relatives improved.

12.30 pm

Mr. Touhig: As the hon. Gentleman develops his argument, he seems to be suggesting that action on matters of concern about the national health service in any part of Wales should not take place until an annual report has been published. Surely, if difficulties in any part of the health service were investigated by the CHC, we would want action now, not in 12 months' time. The hon. Gentleman seems to be taking us along the track of saying that no action should be taken unless it is mentioned in an annual report. That will get us nowhere.

Mr. Evans: The Minister's intervention was skilful, as if to say, ''We will not have an annual report,'' or, ''Why do we have to wait for an annual report before getting action?'' That is clearly not the case. That is why I referred to sub-reports and to people writing to CHCs.

Mr. Touhig: Where are they?

Mr. Evans: They have been mentioned.

Mr. Touhig: Is there another amendment coming?

Mr. Evans: I rather hope that the Minister would welcome such an amendment, as it would ensure that we scrutinised the Bill properly.

If those who suffer deficiencies in the NHS write to the CHC, I hope that the CHC will champion their rights. That is when the action would be taken. However, even if the CHC has spoken with the trust concerned, no action might have been taken three or six months down the line. We have even heard of letters not being responded to for months on end. That can be a real problem. One of the functions of the

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CHC would be to expose the facts. The CHC is not able to initiate action; it can only report and expose such matters on behalf of patients in Wales. Surely such reports would be very handy in exposing deficiencies, even though they did not ask for action to be taken.

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Prepared 10 December 2002