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Standing Committee E
Thursday 12 June 2003
[Mr. Peter Atkinson in the Chair]
Standards set by Assembly
Chris Grayling (Epsom and Ewell): I beg to move amendment No. 476, in
clause 42, page 14, line 31, leave out 'may' and insert 'must'.
The Chairman: With this it will be convenient to discuss the following amendments: No. 477, in
No. 478, in
clause 42, page 14, line 35, leave out from 'must' to end of line and insert 'publish proposals for consultation'.
Chris Grayling: I have taken it upon my shoulders to move the amendment, particularly as I want to discuss amendment No. 470.
The Chairman: Order. Amendment No. 470 has not been selected.
Mr. Stephen Pound (Ealing, North): I invite the Under-Secretary to consider the benefits and advantages of the amendment. A fairly minor amendment in many ways, it seeks to progress matters slightly and to underline the significance of clause 42. I am happy to address any issues later.
Chris Grayling: Having moved the hon. Gentleman's amendments, I will pick up his point from a different perspective. We on these Benches are anxious about separate standards for England and Wales. Amendment No. 476 inserts ''must'' as opposed to ''may'', thus compounding the problem. Rather than giving the Assembly discretion over whether Wales has standards separate from those in England, the amendment will place a requirement on the Assembly. That is wrong for two reasons. First, if one believes in devolution and local responsibility, one must allow the local decision-making body—in this case the Assembly—the freedom to decide whether it wants to opt into standards established for the entire United Kingdom, or for England and Wales, or to propose its own set of standards to meet the needs of its own country.
The second reason for our profound anxiety is that having two different sets of standards moves us away from a national health service, which is a development that we should not welcome. That will create issues in cross-border areas and unwanted discrepancies between England and Wales. I am in favour of local accountability, but the natural correlation to setting up two sets of standards—we will discuss that later in
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the debate—is two different inspection regimes, and the result of that would be a lesser amount of good care for patients, duplication of resources and bureaucracy and a waste of public money.
If we bring an iron curtain down along the border between England and Wales, not only will that have an adverse effect on patients in cross-border areas, but we will lose the opportunities for sharing best practice across the border, for clinical treatment flows from one side of the border to the other, and for Wales to learn from experience in England. The end result will be a genuinely local health service. If the Government's policy is to have a Welsh health service and an English health service and to move away from the principle of a national health service, let them say so loud and clear.
Whitehall Ministers may want to get the Welsh health service off their hands. That is understandable, because the Welsh health service is not functioning well and is not responding to the aspirations of central Government.
Some of the statistics are absurd. In Wales there are 71,000 more people waiting more than six months for out-patient treatment than there are in England. There are 46 million more people in England than in Wales, so it is quite an achievement to perform as badly as that.
People in border areas are being disadvantaged by the discrepancies in the standards and frameworks on both sides of the border. A Welsh patient was told by his nearest hospital, which is in Shropshire, that he had to wait six months longer for his hip operation than English patients in the same situation, because he was Welsh. A gentleman from north Wales who had been waiting more than 16 months for vital heart surgery in a Liverpool hospital was informed by the hospital of a Government initiative under which all patients waiting more than five months would have the choice of undergoing surgery elsewhere. He was told that as he lived in Wales he would not be involved in the scheme because Welsh authorities had declined to take part.
Is it fair or appropriate to have an increasingly divergent health care system, with different standards, principles and priorities in border areas, where people may be looking to a local tertiary centre or local hospital for treatment? If we continue to go down the road of having separate systems in both countries, some people in border areas will not have the same access to health care as those who live a mile up the road. It is happening today and it will continue to happen as sure as night follows day.
Proper strategic decisions on a particular population area or a rural community are not being made. Communities that do not divide because there is a border between England and Wales are being treated differently by the health service. Decisions are being made on the basis of the villages that people live in.
It would be madness if the principle of standards meant that the two Administrations—the Secretary of State in Whitehall and the National Assembly for Wales—were telling clinicians to do one thing and not another. That would inevitably distort the services
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available and the treatment that could be received by patients who live in border areas.
Last week, I briefly mentioned that it is perfectly conceivable—I have just illustrated that it happens—that a doctor in a clinic will have to treat his 10 o'clock and his quarter-past 10 appointments differently, even though both patients may have the same condition, because of the differences in the standards framework and the requirements placed on that doctor by the Welsh Assembly. It makes no sense. Ministers must be extremely careful about this matter.
Mr. Pound: I am reluctant to interrupt the hon. Gentleman in mid-flow because he seems to be constructing an exegesis that is comparable to the Schleswig-Holstein question. I appreciate that he has wider points to make; however, the purpose of the amendment is to compel the Welsh Assembly to take those factors into consideration and to drive up standards. How can he possibly have a problem with that? It would deal with the very issue of disparity in service provision about which he so eloquently speaks.
Chris Grayling: What the hon. Gentleman is saying in his amendment, and I do not doubt his honourable intentions, is that inserting the word ''must'' removes discretion from the Welsh Assembly to apply common sense.
Let us suppose that in its wisdom—it would be in its wisdom—the Welsh Assembly decides that it is not in the interests of the Welsh people to have two different sets of standards. Let us suppose that it decides not to pay the money that will be required to the team that will produce a set of standards or the money that will be required to communicate those standards to medical practitioners across Wales, in border areas and in hospitals from Liverpool to Bristol. Let us suppose that it will decide not to pay the money required to set up an inspectorate to inspect those standards.
In its wisdom, the Assembly might judge it better to spend that money on patient care. The effect of the hon. Gentleman's amendment would be to say that it could not take that decision, which must be wrong.
Mr. Pound: Under the circumstances, why does the hon. Gentleman not simply suggest the deletion of subsection (1)?
Chris Grayling: I would be delighted to see clause 42 disappear. I would argue against clause 42 in its entirety, because it is not in the interests of the people in Wales, or those in England who live close to Wales, to have separate standards. That would be a hindrance to them and a waste of public money. In the same way, I shall argue this morning that it is not in the interests of those people to have two separate, parallel inspection processes.
My concern about the amendment is that the word ''must'' creates an obligation. Clause 42(1) would then state:
''The Assembly must prepare and publish statements of standards in relation to the provision of health care by and for Welsh NHS bodies.''
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That would remove from the Assembly the discretion to stick with the national standards that the Government have set out from Whitehall. It might choose to do otherwise. I think that it would be wrong to do so, but under this clause it would not have the ability to do so, and that would be a mistake.
It would be a particular mistake for cross-border areas. At least six trusts truly serve cross-border communities, including the North East Wales NHS trust and the Gwent Healthcare NHS trust. There are also the strategic health authorities on the English side of the border: Cheshire and Merseyside; Shropshire and Staffordshire; Coventry, Warwickshire, Herefordshire and Worcestershire; and Avon, Gloucestershire and Wiltshire. Each of those oversees services for significant numbers of patients from Wales. To ask each of those organisations to handle two different sets of standards would add yet more of a bureaucratic burden both to the managers running those trusts and, more particularly, to the clinicians who must deal with them. I see no benefit in doing that.
The only condition that I am aware of that came out of the debate on the Health (Wales) Bill that could be argued to be peculiar to Wales relates to those who worked in the limestone and slate industries. In a telling intervention last week, my hon. Friend the Member for Westbury (Dr. Murrison) asked the Minister how Welsh diabetes differs from English diabetes. The Minister must realise that after his Government have put the effort into creating a national service framework for diabetes, it would be nonsense if the Welsh tore that up and came up with something different just for them.
We must remember that although Wales has a proud tradition, it is also a geographical area with a population that is not much larger than Surrey and Sussex. Is it really sensible and a prudent use of public funds to have a set of standards devised for that number of people that differs from the standards that apply to their compatriots? That would cause confusion, complication and difficulties to practitioners who straddle both countries.
Therefore, the requirement under the amendment to follow that road would be short-sighted and would compound a problem that exists more broadly in clause 42, which in my view has no place in the proper provision of good health care for the future of England and Wales.