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Lord Filkin moved Amendment No. 14:
- Page 79, line 6, leave out third "or"
Lord Filkin: My Lords, I beg to move that this Bill do now pass. In doing so, I should like to thank the Opposition Front Benches for their constructive approach to the Bill. I felt that it worked well in Grand Committee and that the probing enabled us to identify one or two lacunas. I am still smarting from the vicious defeat inflicted on the Government today, so I cannot say that we shall not see the Bill again. Just in case we do not, I should also like to thank my noble and learned friend Lord Goldsmith and my noble friends Lord Bassam and Lord Clinton-Davis, and the officials, who have been assiduous in serving both the Government and co-operating with the House on this legislation.
Moved, That the Bill do now pass.—(Lord Filkin.)
Lord Renton: My Lords, perhaps I may say a few words. I speak as a rusty old lawyer who became a barrister 70 years ago. I am full of admiration for the way in which this massive, rather difficult Bill, which breaks new ground, has been handled by two Members of this House who are not lawyers—the noble Lord, Lord Filkin, speaking on behalf of the Government
and my noble friend Lady Anelay of St Johns for all she has done on behalf of the Opposition. What they have achieved is a very great credit to both of them.
Lord Clinton-Davis: My Lords, I do not always agree with the noble Lord, Lord Renton, but I do on this occasion. My noble friend Lord Filkin and the noble Baroness, Lady Anelay, have cast a ray of light over this complicated Bill. Although I do not always agree with the noble Baroness, she is always very polite. The principal praise I give is to my noble friend Lord Filkin. He has tackled the issue with humanity and understanding. I associate myself with the remarks of the noble Lord, Lord Renton.
On Question, Bill passed, and sent to the Commons.
Health (Wales) Bill
6.38 p.m.
Schedule 1 [Schedule 7A to be inserted in the National Health Service Act 1977]:
Lord Roberts of Conwy moved the amendment:
- Page 6, line 8, after "district;" insert—
The noble Lord said: My Lords, we were all agreed in Committee that this Bill received fair scrutiny. There were few outstanding points of difference. That remains the situation. That is why, perhaps, only one amendment has been tabled. We are also all agreed on the importance of CHCs. We on these Benches welcome their retention in Wales and regret their passing in England. Their duties are spelled out in the first paragraph of Schedule 1 and each has the primary role,
It might be argued that the point may be covered by a regulation made by the National Assembly but there is an advantage in including the requirement to report in primary legislation as a counterpart to the duty to represent the interests of the public. The amendment will give CHCs just the measure of independence that they may require if councils feel that they must be critical of some aspect of the health service in their localities.
We have received firm assurances from Ministers that the Government have every intention of ensuring that CHCs will be independent but it is not difficult to see how that intention can be thwarted—God forbid—
There is plenty of scope currently for criticism of the NHS in Wales and that may be the case in future—although we all wish otherwise. We want to ensure that CHCs are fully and freely able to express their views. Reporting back to those whose interests they represent is the very least that we can ask of them. I beg to move.
Lord Thomas of Gresford: My Lords, I pay tribute to the assiduous way in which the noble Lord, Lord Roberts, addresses the Bill. He is right to do so, from his lengthy experience as a Minister of State in the Welsh Office. However, I have said on a number of occasions that I do not believe that we should seek to second guess the Assembly's desire. I do not think that it is appropriate for the amendment to be passed.
Baroness Finlay of Llandaff: My Lords, I also commend the way in which the noble Lord, Lord Roberts, has examined the Bill and drafted the amendment. Reporting on activities to the public is an important principle. However, I share the reservations expressed by the noble Lord, Lord Thomas, as to tying the Welsh Assembly government to one system. It may find it better to have a report every second year with an interim report annually; or reporting more frequently—such as six-monthly interim reports as the role of CHCs changes. I am concerned that flexibility may be constrained by the amendment.
Lord Hunt of Kings Heath: My Lords, I am grateful to the noble Lord for allowing us to debate again community health councils in Wales. He welcomed their continuance in Wales and regretted their passing in England. I feel a little like the Lord High Executioner in saying that I welcome the Welsh Assembly's decision to continue CHCs but equally welcome my department's view that in England it is appropriate to make changes and develop rather more sophisticated mechanisms for patient and public involvement. One of the great joys of devolution is that we shall see how the two systems work side by side and learn the good and bad points of each. That is the spirit in which we approach this issue.
I agree also with the noble Lord that the matter has been extensively debated here and in another place. There are essentially two aspects to the argument—requiring community health councils to produce annual reports on their activities and the extent to which any annual report by a CHC would encompass not just its activities but the quality of NHS provision in the area.
The Bill gives the Welsh Assembly sufficient power to ensure that annual reports are made and cover important issues of public concern. New Schedule 7A(2)(h) allows the Assembly to place a duty on each CHC to publish an annual report about its activities and performance. That power already exists. Each CHC will be required to send copies of its report to the Assembly, relevant NHS bodies and local authorities and to make its content public. I agree that the public have a right to know what is being done by the CHC responsible for their area and that the publication of an annual report gives the council the opportunity to give an account of itself.
Current CHC reports contain details of visits undertaken, public consultation exercises, issues of concern regarding local health provision, the number of meetings and attendances by individual members, and budget details. Those reports are sent to relevant health bodies, which are required to comment on any issues raised. They are also made known to the public by being sent to citizens advice bureaux and libraries and being published on CHC websites. NHS bodies are expected to comment on those reports and to record any steps taken in consequence of advice given or proposals made by the CHC.
The new regulations will re-state the provision of the Community Health Council Regulations 1996, which require CHCs to produce annual reports and make them widely available to the public. In terms of content, the only difference between the reports is that they will contain details of complaints handled by the new CHC complaints advocates and a summary of visits made to inspect general practitioners' premises and other local family health service practitioners.
The Assembly is right to want evidence that CHCs are performing consistently to a set of agreed standards—but how that will be done is the subject of discussion between the Assembly and CHCs. As to independence, it is my understanding that there is no intention to control the activities of CHCs. But they are public bodies and the Assembly has a duty to ensure that their funding achieves the best value for money. The precise details of the matters to be included in CHC annual reports will be set out by the Assembly in regulations, following consultation and agreement with community health councils.
The other strand of the debate is the duty of CHCs to report on the quality of NHS provision in their areas. Traditionally, annual reports have primarily been about the functions and performance of the council itself, rather than the level and quality of health service provision in the area. NHS organisations have a duty to report regularly on the level, quality and performance of service through their own annual reports, directories of services and patient leaflets. Requiring CHCs to do that would create the danger of undermining the good work done elsewhere. The noble Lord, Lord Roberts, mentioned the new commission in forthcoming legislation for health care audit and inspection. The Bill will include special considerations for Wales. But, at present, CHI is charged with reporting on the quality of local healthcare provision. If CHCs undertook that
The Assembly has already made its intention clear of wanting CHCs to report to the public and to enable information about them to be readily available so that their performance can be judged. The regulation-making power in the Bill gives the Assembly sufficient power by which to order the affairs of CHCs and their appropriate reporting. On those grounds, I ask the noble Lord not to press his amendment.
"(aa) to report annually to the public on the discharge of its duty;"
"to represent the interests in the health service of the public in its district".
I pointed out in Committee that the Bill makes no provision for enabling CHCs to report back to the public on how they have discharged that all-important duty. The amendment seeks to remedy that deficiency by requiring each council to produce an annual report. After all, that is a fairly minimal standard requirement. I tabled another amendment to the same effect in Committee but Amendment No. 1 is an improvement.
6.45 p.m.
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