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Lord Thomas of Gresford: My Lords, my criticism was in relation to the Second Reading debate and the committees that followed that. It certainly did not involve the Welsh Affairs Committee, which I thought gave excellent consideration to the Bill and showed that there is a real role for Members of another place from Wales.
Lord Hunt of Kings Heath: My Lords, that I fully understand. My noble and learned friend Lord Morris of Aberavon raised the question of the legislative proposals that come from Wales. He asked a number of questions and raised an interesting point concerning the chances of a similar Bill being given fair wind if different parties were to be in government in Westminster and Cardiff. Of course, such a question is purely speculative and, so far as concerns the Westminster Government, I hope that it will be many years before it has to be tested. However, I suppose that that is the kind of issue that would be embraced within the Richard commission. I say to my noble friend that I have found a great deal of constructive working in the relationship between Ministers of the Westminster Government, the Welsh Assembly and officials. That is to be commended.
The noble Lord, Lord Hooson, raised more substantive issues about the extent of devolution. He questioned whether a Bill such as this should be decided by this Parliament or whether it should be delegated and devolved to the Welsh Assembly. Again, I believe that that is a matter for the Richard commission. Noble Lords will know that the
commission is expected to draw its conclusions in September this year and to publish its report in December.My noble and learned friend Lord Morris asked whether Members of the Welsh Assembly were "happy bunnies", as he put it, in relation to the Bill. I do not think that I could go so far as to say that they are happy bunnies. But my understanding is that they are content with the Bill as it now stands and wish to see it supported and passed through your Lordships' House.
As to the question of the number of Bills that the National Assembly for Wales would like this Parliament to consider, my noble friend will know that there are always pressures on the legislative timetable. I suspect that those pressures are as much a concern for my department—the Department of Health—as they are for the National Assembly.
As I said earlier, a different approach is being taken within the Bill, which continues the trend of the approach towards the NHS in Wales. My noble friend Lord Prys-Davies said that time alone will tell the outcome of that change. But it seems to me that there has always been a degree of diversity between the four countries of the UK in relation to the way in which the NHS has been managed. I believe it is positive for that diversity to continue, for us to learn from each other, to learn what works well and to share problems and experiences. That must surely be the culture and philosophy that we wish to develop together.
The noble Lord, Lord Roberts, spoke of the number of challenges that face the NHS in Wales. The noble Baroness, Lady Finlay, also raised issues of concern, particularly in relation to the recruitment and retention of key staff. It is not for me either to proselytise or to defend the conduct of the National Assembly in its management of Welsh health affairs. But it may be appropriate for me to comment that, although it would be wrong to say that there are no problems or challenges in relation to the Welsh health service, it is right to point out the achievements and progress taking place in the Principality. For example, the NHS in Wales is now receiving unprecedented levels of investment; more patients are being treated than ever before; the number of staff working in the NHS in Wales has increased; and some additional hospital beds have been funded.
The issue raised by the noble Baroness, Lady Finlay, about the shortage of doctors and nurses is well taken. We face the same issue throughout the United Kingdom. Just as in England, the National Assembly for Wales has taken important actions designed to ensure an increase in staff numbers. A workforce planning mechanism is in place which will enable the National Assembly to come to conclusions about the number of staff and training places that will be needed in the future. But it is good to report that the commission's figures for student numbers in Wales show a considerable increase over the past four to five years. For example, since 1998, there has been a 63 per cent increase in the number of training places commissioned for nurses. There has been an increase
of 39 per cent for midwives, and 87 per cent for the allied health professions. I consider that to be very good progress.The question of waiting times will always be important for those who are concerned about the National Health Service. I say to the noble Baroness, Lady Finlay, that I know that some doctors feel that we should not go down that path in relation to waiting times generally. But when patients are asked their major concerns with regard to healthcare, waiting always comes near the top of the list. I also say to the noble Baroness that my experience of 25 years in the health service is that, unless there are targets for waiting, I am afraid that the NHS lets them slip.
It is important that clinical priorities are always to the fore and that the patients who most need treatment receive treatment first. Equally, it is important that we cut waiting-list times as much as possible. I know that the National Assembly is as determined as we are to ensure that that happens.
The noble Lord, Lord Roberts, raised the question of bureaucracy. He suggested that the new structure coming into operation in Wales on 1st April might be bottom heavy and grossly bureaucratic. I accept that we must always ensure that any structural changes in healthcare are non-bureaucratic. But I believe that there are real advantages in making changes which align the health service to local government. I consider that the development of 22 local health boards, coterminous with unitary local authorities in Wales, offers many advantages in terms of collaboration and in ensuring that health, social services and other local government services are integrated.
Costs are important. I understand that the Assembly budget for transition costs of structural change ranges from £12.5 million to £15.5 million. So far as concerns the report of the Comptroller and Auditor General, I am advised that it is the view of the National Assembly that, once the transition has been made, the new structures will cost no more to run than the existing ones.
I now turn to the question of community health councils. My noble and learned friend Lord Morris was responsible for the establishment of CHCs in Wales. He expressed disappointment. Putting on my hat for a moment as a Department of Health Minister, I share that point. I believe that English CHCs have had a very patchy record—they have disappointed. But, in Wales, the National Assembly has decided that CHCs are an effective mechanism to build upon to ensure effective patient involvement and representation in the future.
I had a shock when the noble Lord, Lord Roberts, quoted the figures for the cost of running community health councils in Wales. My understanding is that there was a mistake in the House of Commons research paper. I am glad to tell the noble Lord that the figures are nowhere near those that he suggested.
So far as concerns the question of CHCs and their future performance, I agree with the noble Lord, Lord Thomas, that inspection, and its proposed extension, is indeed crucial.
I agree with the noble Baroness, Lady Finlay, about the importance of ensuring that community health councils make stronger links with primary care. My noble friend Lord Prys-Davies is surely right when he talks of the need for consistency in the handling of complaints. As regards time off work for CHC activities, the noble Lord is right to raise the question of the Employment Rights Act 1996. This is not a matter for my department, but I understand that officials from the Assembly are liaising with their counterparts at the DTI further to discuss this matter.
The HPW fulfils and is intended to fulfil an important role in relation to the health professions in Wales. It will complement, not conflict with or duplicate, the activities of other bodies concerned with professional practice and regulation. I believe it will fulfil an important role. Perhaps I may say to my noble friend Lord Morgan that pre- registration education will be monitored in the same way as all university education. Health Professions Wales has no remit for monitoring pre-registration education. However, I am sure that it will wish to collaborate with higher education institutions and other relevant bodies in Wales.
I sympathise with the point made by the noble Lord, Lord Thomas, concerning health care support workers. He may be interested to know that that is a matter the Department of Health is currently considering in terms of regulation. There is no doubt that healthcare workers play a crucial role. It is important that they are given appropriate training and support to take on great responsibilities. Alas, I believe that the decision made some years ago to phase out state-enrolled nurses was a grave error.
My noble friend Lord Prys-Davies asked about prisons. That question has been considered in relation to CHCs. It is felt that the current proposals strike the right balance. There are no plans to extend their remit to other areas such as prisons. As regards the Wales Centre for Health, a number of noble Lords raised the issue of inequalities in health in Wales. I believe they were right to do so. The figures are striking. Anyone looking at those figures and seeing the incidence of ill health in Wales would be concerned to ensure that a focus of future endeavour is strategies and implementation of programmes to tackle the root causes of ill health. The Wales Centre for Health will have an important role to play. It will be an independent body which will provide information and impartial advice on public health in Wales. I believe it will be a great source of support to everyone concerned with tackling inequalities. It will act as an advocate for public health at national level; I agree with the noble Baroness, Lady Finlay. I believe that it will cost £1.3 million per year, although I shall provide further information in relation to that. I correct myself. That figure is for Health Professions Wales. Perhaps I may confirm that figure in writing.
Other issues raised concerning public health relate to smoking. I note with interest the comments of my noble friends Lady Gale and Lord Prys-Davies. It is true that on 22nd January the Assembly voted in favour of calling on the UK Government to bring forward a Bill to give the Assembly power to prohibit smoking in public places. The Assembly has been concerned about that issue. We shall most carefully consider the Assembly's position. However, we have previously concluded that compulsion in that area is not the answer.
My noble friend Lady Gale raised the important question of asthma and smoking. I believe that the WCH will have a crucial role to play in terms of research and advice on tackling what is an increasingly worrying and important area of concern.
The noble Lord, Lord Walker, raised the question of hospices. I am glad that he recognised the progress being made within Wales. I well remember the debate. My department is concerned to ensure that the resources we wish to see spent within palliative care are indeed spent in that area. My colleague Ministers concerned with this matter frequently meet with representatives of the palliative movement to try to ensure that the NHS and the voluntary palliative care sector work together and to ensure stability in funding contributions from the National Health Service. It is not just a question of the size of the contribution but of the period of time that hospices are given in terms of a grant being made. Stability is important.
I hope I have endeavoured to answer most of the points raised.
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