Health and Social Care (Community Health and Standards) Bill

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Mr. Jon Owen Jones (Cardiff, Central): I oppose the amendment. Although it may make some sense to insert ''must'' instead of ''may'' in clause 42, clauses 41 and 42 are both worded in exactly the same way. Clause 41(1) states:

    ''The Secretary of State may prepare and publish statements''.

Clause 42(1) says:

    ''The Assembly may prepare and publish statements''.

There is an argument that the word ''may'' should have been replaced by the word ''must''. However, if that is to happen, it should be replaced in both clauses rather than in the clause relating to the Assembly and not in the clause relating to the Secretary of State. I

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have some sympathy for the application of common standards wherever possible. However, that will not be achieved by removing clause 42 in its entirety, because we would then need to reword clause 41. If we are to have common standards, it is surely not right for those standards to be imposed on Wales by the Secretary of State in Westminster without consultation.

Chris Grayling: I absolutely agree with the hon. Gentleman. I hope that if we stand against clause 42, it will secure the Under-Secretary's agreement to go away and rewrite both those clauses before Report. In that way we could have what the hon. Member for Cardiff, Central (Mr. Jones) and I both wish to achieve, which is a proper set of national standards with a bit of flexibility to deal with specific local issues such as those that we have discussed in relation to the slate industry.

Mr. Jones: I am glad that the hon. Gentleman has reminded me about the use of the word ''national'', because it has been applied so far to mean England and Wales. One can argue that England and Wales are two separate nations; what cannot be argued is that the combination of England and Wales is a nation. The British state is possibly a nation, in which case we need to be arguing about common standards to be applied in Northern Ireland, Scotland, Wales and England rather than to this greater England that just happens to comprise Wales as well. That is the way that the word ''nation'' has been used in the debate so far.

It concerns me that we may have a wide range of standards, which would be deleterious to effective and efficient health care. I can think of circumstances in which some standards might diverge, but surely we should ensure that, as far as possible, common standards apply. The Bill does not do that in the best way. I do not support the amendments being proposed for the reasons that I have stated, and I do not support the deletion of clause 42, because it would make little sense, given the way in which the rest of the Bill is worded.

Mr. Gary Streeter (South-West Devon): I am listening carefully to the hon. Gentleman's point about common standards. We heard earlier that health care outcomes in Wales seem to have fallen short of those achieved in England. I am simply requesting information: does he have an explanation for that?

Mr. Jones: I do not wish to be tempted too far down the road of explaining different health outcomes. What was referred to was the different waiting times, which are not quite the same thing as health outcomes. In comparing different parts of the country, it is not valid to compare health outcomes across all of England with those across all of Wales. It is more appropriate to compare health outcomes across Wales with those in the north-east of England, because the morbidity and mortality rates are more similar for those two areas. If one does that, the results also raise several questions. However, I do not think that it would be appropriate to debate them in the context of these amendments.

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The Parliamentary Under-Secretary of State for Wales (Mr. Don Touhig): I take this opportunity, Mr. Atkinson, to welcome you to the Chair on my first speaking appearance in the Committee. I look forward to your guidance taking us through these important Welsh clauses this morning.

I also thank colleagues on both sides for their forbearance and understanding of my limited attendance in Committee. Earlier this year, I was on three Standing Committees on three separate Bills at once, which was a bit difficult at times. Perhaps that is an answer to those who say that we have not got enough to do in the Wales Office. I will not take that point any further in case there are further announcements this afternoon. It might amuse the Committee to know that the Lincolnshire Echo arrived in my office yesterday afternoon addressed to the Arab Republic of Egypt at Gwydyr house. I do not know if that is an indication of any changes in the Wales Office.

This is a substantial and important Bill for Wales. About 50 of the Bill's clauses apply wholly or partly to Wales. The Bill will continue the joint programme that the Government are pursuing with their colleagues in the Welsh Assembly further to raise health and social care standards in Wales. For Wales, the main effects of the Bill are the inspection, monitoring and enforcement of standards of health and social care providers. At earlier sittings, my right hon. and hon. Friends outlined proposals for the Commission for Healthcare, Audit and Inspection, the new body that will assess performance and enforce standards across a range of health care providers in England and Wales.

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In addition, the Bill provides for the Welsh Assembly to undertake reviews and to investigate health care provision across a series of NHS bodies in Wales. CHAI will have a wide national remit. I take the point that was made by my hon. Friend the Member for Cardiff, Central (Mr. Jones)—by ''national'' the Bill is referring to England and Wales. However, the Assembly needs the opportunity and ability to monitor and to focus closely on addressing the health priorities that it set for the people of Wales.

The Healthcare Inspection Unit for Wales will undertake the reviews and inspections. It will adopt techniques that have been used successfully to review the social services in Wales and will provide a robust case for the improvement of clinical governance tailored to particular Welsh needs.

The Bill establishes the Commission for Social Care Inspection in England, and it places the responsibility for conducting such inspections in Wales on the Welsh Assembly. Consequently, it provides the same powers to the Assembly as are provided to the Secretary of State in England. Another significant change is that the Assembly will be given similar powers to those of the Secretary of State to prescribe a range of foods that are made available under the welfare food scheme. Those powers will allow the Assembly to broaden the nutritional basis of the scheme with particular regard to Welsh matters.

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The Bill also recognises several other differences in the application and operation of the health service in Wales, which it would not be prudent of me to discuss at length at this stage. However, so that people may understand where I come from, and where the Government come from, I should say that I do not subscribe to tweaking every piece of legislation that comes through this place so that each has a ''made in Wales'' stamp on it. However, I do subscribe to a ''better for Wales'' stamp, whereby a piece of legislation can be improved by doing things slightly differently, as is proposed in this part of the Bill.

The amendments tabled in the name of my hon. Friend the Member for Ealing, North (Mr. Pound) take away the Assembly's discretion in preparing and publishing statements, standards and consultation documents. Under those amendments, it would be an absolute requirement for the Assembly to prepare and publish statements, standards and consultation documents.

The principle of the devolution settlement was the ability of the Assembly to conduct its business in an unrestricted way within the confines of the Government of Wales Act 1998, which was Parliament's intention when it handed over those powers and responsibilities to the Assembly. To impose an absolute requirement to prepare and publish statements, standards and consultation documents will run contrary to the fundamental principle that this place guaranteed when it passed that Act. It is for the Assembly to determine what action it should take on the provision of the health service in Wales, which is its remit through the process of secondary legislation that the Act conferred on the Assembly.

In setting standards, the Assembly consults those persons whom it considers appropriate and takes account of the standards set by bodies in England and Wales; for example, it refers to guidance provided by the National Institute for Clinical Excellence, the royal colleges and so forth. Moreover, amended powers conferred on the Assembly under the National Health Service Act 1977, to give direction to NHS trusts, special health authorities and local health boards, do not place an obligation on the Assembly, but rather permit it to issue such directions as it sees fit.

The hon. Member for Epsom and Ewell (Chris Grayling) made some important points in his useful contribution, as he did when he served on the Standing Committee on the Health (Wales) Bill. He researches well, but—this may surprise him—I disagree with several points that he made this morning. He was concerned about the question of standards, mainly the difference in standards that might apply in Wales and in England.

Standards set in Wales will be as high as those in England. They will be determined by the Assembly, but are likely to include the national clinical standards, the national service frameworks, the NICE guidelines and so on. Moreover, targets and other standards developed and issued by the Assembly will be taken into account in assessments. National standards, such

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as the national service frameworks, underpin many of the standards determined by the Assembly. A clinical standards board for Wales will be set up to act as a mechanism to co-ordinate and monitor Welsh clinical standards.

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