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Standing Committee E
Thursday 5 June 2003
[Mr. Win Griffiths in the Chair]
Standards set by Secretary of State
Amendment proposed [4 June]: No. 469, in
clause 41, page 14, line 18, leave out 'crossborder' and insert 'Welsh'.—[Chris Grayling.]
Question again proposed, That the amendment be made.
The Chairman: I remind the Committee that with this we are discussing the following amendments: No. 471, in
clause 41, page 14, line 28, leave out 'crossborder' and insert 'Welsh'.
No. 472, in
clause 41, page 14, line 29, at end add—
'(5) The standards set out in statements under this section are to be taken into account by every crossborder SHA.
(6) The standards set out in statements under this section are to be taken into account for Northern Ireland when required.'.
No. 24, in
clause 51, page 18, line 1, after 'English', insert 'and Welsh'.
No. 25, in
clause 51, page 18, line 17, after 'English', insert 'or Welsh'.
No. 26, in
clause 53, page 18, line 38, after 'English', insert 'or Welsh'.
No. 27, in
clause 53, page 18, line 42, after 'English', insert 'or Welsh'.
No. 29, in
clause 53, page 19, line 2, leave out 'Secretary of State' and insert 'appropriate authority'.
No. 28, in
clause 53, page 19, line 4, after 'English', insert 'or Welsh'.
No. 32, in
clause 55, page 20, line 19, after 'English', insert 'or Welsh'.
No. 33, in
clause 56, page 20, line 28, leave out from 'trust' to end of line 29.
No. 38, in
clause 65, page 24, line 22, leave out 'Secretary of State' and insert 'appropriate authority'.
The Parliamentary Under-Secretary of State for Health (Mr. David Lammy): When we adjourned yesterday we were discussing the amendment that deals with the establishment of the healthcare inspection unit for Wales. The hon. Gentleman the Member for Epsom and Ewell (Chris Grayling) was concerned that this would mean unnecessary duplication, and in strong terms questioned why we could not have the Commission for Healthcare Audit and Inspection as an inspectorate for Wales. Much of
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what the hon. Gentleman said surprised me, even though he said it so strongly. The nature of the amendment also surprised me, because these health matters have been devolved to Wales for some time. In a sense, this is a settlement of an argument that Parliament heard about devolution in 1998–99.
Chris Grayling (Epsom and Ewell): If this is a devolved matter and the issue has long been resolved, why are we debating it today and why is it in this Bill?
Mr. Lammy: Let me make some progress and I will explain why.
Broadly, the amendments would extend the Secretary of State's standard-setting role and CHAI's various review and investigation functions to Wales and England, including the annual review, other reviews and investigations, co-ordination of those reviews and the power to require explanations.
The hon. Gentleman has forgotten that the National Assembly for Wales is responsible for health care in Wales. Clause 66 confers similar functions on the Assembly, as it is important for the Assembly's drive to improve the health of the Welsh people by ensuring that health priorities specific to Wales are addressed and monitored locally.
Chris Grayling: Can the Minister give me an example of one of those health priorities that is exclusive to Wales?
Mr. Lammy: As I was going on to explain, the National Assembly for Wales does not have primary legislative powers, only secondary ones. Nevertheless, much of what the hon. Gentleman said pertained to devolution. If I can extend the argument, he will understand why the Assembly has those powers. The Commission for Health Improvement currently undertakes these critical function reviews, but in so doing it has not been able to take fully into account defined Welsh health priorities and other issues specific to Wales.
Chris Grayling: Such as?
Mr. Lammy: The hon. Gentleman will understand that the demography of Wales and the history of the valleys, factors such as the high incidence of smoking and teenage cessation, and the Welsh industrial heritage, mean that Wales has its own characteristic demography and health economy. For those and other reasons the Welsh have chosen—as is their right—to pursue a course of action in the health economy that is specific to their needs. That is why their national service frameworks are specific to the Welsh. The coronary heart disease NSF published in July 2001, the diabetes NSF published in 2002, and the children's NSF published in 2002 are all specific to Wales.
Dr. Andrew Murrison (Westbury): My hon. Friend the Member for Epsom and Ewell asked for specific examples of differences in Wales. The Under-Secretary responded with generalities, and pretty poor ones at that. Will he explain how Welsh diabetes differs from English diabetes?
Mr. Lammy: I must always be careful to defer to the hon. Gentleman's clinical expertise. Having said that, I would have thought it patently obvious that the multicultural heritage of cities such as London,
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Birmingham and Leicester means that the incidence and demography of diabetes is profoundly different from that in much of rural Wales.
Health care in Wales is different for several reasons, which is why the Assembly takes an interest in it. The hon. Member for Epsom and Ewell said yesterday that the Assembly was not the right place for such interest, and he challenged the scrutiny powers of the Assembly. I am sure that Members of the National Assembly for Wales would have been surprised at what was said here about their effectiveness and their powers of scrutiny. As the hon. Gentleman knows, they take scrutiny very seriously and have subject and Select Committees similar to ours.
The reporting process of the National Assembly for Wales ensures transparency and accountability, and the Assembly has set up mechanisms to ensure that the establishment of the HIUW is rigorous, and at a remove from the executive powers of the Assembly. These include the appointment of the head of the inspectorate in Wales through a process outside the Assembly; editorial control for the head of the inspectorate in Wales; simultaneous provision of reports prepared by the inspectorate to the Assembly's Health and Social Services Committee, which is similar to our Select Committee; rights of independent access for the inspectorate to the Minister for Health and Social Services; a separate complaints procedure to ensure independence; and other measures including working protocols and delegated functions.
The National Assembly for Wales takes seriously its responsibilities in this area. The hon. Gentleman's new Conservative colleagues in the Welsh Assembly will surely be surprised, as I am, at how quickly their colleagues in England are pouring scorn on their ability to scrutinise health care. Perhaps the hon. Gentleman will say that his colleagues should resign their posts because there are no differences in the health economy of Wales.
Chris Grayling: I am working on the assumption that the Minister believes that the patient should come first. Returning to the earlier example of the hospital in Chester, let us take the case of a consultant who treats a patient from England at 11 o'clock and a patient from Wales at 11.30. Should that doctor use a different approach to treatment for those two patients who may have an identical condition—one to conform with the NSF in England and another to conform with the NSF in Wales?
Mr. Lammy: The scenario that the hon. Gentleman paints is simply not correct. We are talking about an inspectorate that should pertain to the local demography of Wales. The hon. Gentleman's view is that we do not need that.
Mr. Jon Owen Jones (Cardiff, Central): As I understand the Bill, that problem would not arise. The Chester hospital consultant would be subject to an inspection that reported to the Secretary of State here. He would not be subject to an inspection that reported to the National Assembly.
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Mr. Lammy: That is right. My hon. Friend asked me some important questions about cross-border inspection yesterday, and I hope to come to those shortly.
Chris Grayling: I appreciate that we will debate this issue more fully later, but may I draw the hon. Gentleman's attention to clause 66(1)(b), which says that the Assembly has the power to conduct:
''reviews of, and investigations into, the provision of health care for a Welsh NHS body''.
In other words, provision could be made by an English NHS trust for a Welsh primary care trust in the case of a border hospital. So why would the Assembly not have the power to inspect a hospital just across the border that provided a service to a substantial area in Wales, such as the hospital in Chester?
Mr. Lammy: I wish that the hon. Gentleman would let me make some progress. The Bill clearly includes a duty of co-operation between the inspectorates in England and Wales, and both could inspect work commissioned by Wales.
As to the earlier point, there is no difference between the treatment given in England and the treatment given in Wales; nothing that I have said this morning suggests different standards of treatment. I have concentrated my remarks on differences in demography. We have already had a discussion in this place about devolution, and we have had a settlement, and that pertains to the amendment.
Dr. Murrison: For the Minister's benefit, he must clarify in his mind exactly what the NHS is all about—it is about treatment. If he is saying that there is no difference between treatment in England and treatment in Wales, why on earth is he making these different arrangements for England and Wales?
Mr. Lammy: There are already different arrangements for England and Wales. The old health authorities still operate in Wales. I have explained that the NSFs in Wales are different. The hon. Gentleman makes an interesting point, but he should perhaps have made it a few years ago. Things have moved on, and there are already different arrangements in Wales. That is why the amendment does not get us far at all.
Under clause 43, CHAI will be under a duty to provide information and advice to the appropriate authority about the provision of health care in Wales, as may be requested. The Bill provides that the Assembly and CHAI must co-operate with each other where it seems appropriate to them to do so for the efficient and effective discharge of any relevant function, but it would not be proper for CHAI alone, unless under agreement with the National Assembly for Wales, to undertake those reviews. That is the duty of co-operation that I referred to.
The National Assembly for Wales has already announced its intention to establish a health inspectorate for Wales to exercise the Assembly's functions.
That will ensure that there is a strong focus on defined Welsh health priorities and that performance quality and regulation issues are fully and rigorously addressed. It will be for the Assembly and the Welsh
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inspectorate to best determine the annual inspection regime. Reviews and inspections undertaken by the Welsh inspectorate will be carried out using the joint review for social services model, including the Audit Commission for Wales. Effectively, the two inspectorates will examine two separate health services. That arises as a result of the devolution settlement.
I remind the hon. Member for Epsom and Ewell that, under section 1 of the NHS Act 1977, the Secretary of State has responsibility for providing a comprehensive health service. However, by virtue of section 22 of the Government of Wales Act 1998, by council order the functions for providing a comprehensive health service for Wales pass to the Welsh Assembly. That must be the right place for that.
My hon. Friend the Member for Cardiff, Central (Mr. Jon Owen Jones) raised an important point about cross-border inspections in towns such as Shrewsbury, Chester and others. Welsh people use hospitals and medical services on the English side and vice versa. The duty of co-operation means that the English and Welsh inspectorates may establish protocols and carry out studies of issues that are pertinent to those hospitals. However, the relevant inspectorate must conduct the study and work in co-operation with colleagues across the border.