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Mr. Simon Thomas (Ceredigion): I am afraid that I cannot give the Bill such a warm welcome. It is decent enough in parts, but it is not quite good enough for my party, which is why we have tabled a reasoned amendment. Our main complaint is that it does not fully address the recommendations of the royal commission on long-term care for the elderly. In particular, it makes no allowance for the full recommendations to be applied in Wales if the National Assembly for Wales wanted to do that.
Much of the Bill is progressive so far as Wales is concerned. For example, we are exempt from the requirement to abolish community health councils, which have been discussed in detail this evening. That aspect of the Bill is, therefore, less injurious to the people of Wales. The social care proposals are also progressive. However, there is concern in Wales that the full impact of the royal commission's recommendations will not be felt. That is a gaping flaw.
Hon. Members will have noticed that most of the detail relates to English needs and England's national plan. There is no national plan for Wales. The national plan that was trumpeted and launched by the Prime Minister and advanced by the Secretary of State is a plan for England only. The Bill will implement the needs of England in the context of the national plan. I accept that parts of the national plan do affect Wales--long-term care of the elderly being the obvious example. However, the Bill needs tweaking so that it can fully respond to the needs and opinions of Wales and the consultation that is taking place there.
There are two issues of concern--health and social care. Last year, the National Assembly encountered difficulties when it tried to extend the provision of free prescriptions and free eye tests in Wales by introducing a wider range of categories for free prescriptions. It would have been useful if the Government had taken those problems into account, and the Bill does not address them. We should reconsider how we can give the National Assembly greater power to determine the provision of prescriptions in Wales.
I am pleased that the hon. Member for Erith and Thamesmead (Mr. Austin), who is no longer in the Chamber, was also careful to explain that the requirement to abolish CHCs does not apply to Wales. An enabling clause allows the National Assembly to decide whether it wishes to abolish them. At least 3 million people in England and Wales are taking part in a fairly in-depth consultation exercise on the future of CHCs in Wales. I have not been alerted to any serious problems with them. Some hon.
I hope that the National Assembly will decide to retain CHCs. Perhaps the Minister will comment on the enabling provisions in clause 15. Bearing in mind that we are consulting in Wales, the National Assembly might decide that, although it wants to retain CHCs, it would like to reconfigure and enhance them, perhaps to take account of the valid points that the Secretary of State made about independence and the role of an advocate for patients, which might not be fully developed in CHCs. I wonder whether the clause is strong enough to allow the National Assembly not only to decide whether to keep or abolish CHCs, but to reform them and give them a wider role. That is what the majority of people in Wales want, and it would be a good example for the people of England.
Private medicine has been mentioned. A recent problem in my health authority, Dyfed Powys, has brought to light a practice that should be outlawed. Tenby cottage hospital, a small hospital with only 14 beds, is threatened with closure. One reason given for closing it is that beds can be found within the private care sector locally--but that is not what the public-private partnership is about. I think that that is an alarming prospect for the NHS in Wales. I have no problem with using private beds to meet NHS needs, but I do not want NHS hospitals closed and NHS money used for private beds in the locality. That is a poor way to develop the health service in Wales.
On social care, my party welcomes in principle the establishment of care trusts, although the details need to be worked out. Plaid Cymru, the Party of Wales, went into the 1997 general election with a policy of establishing elected health and social care authorities. The creation of care trusts shows that the Government are willing to dip the tip of a toe into the water. There should be benefits in bringing together social services and health services. In rural areas such as my constituency and that of my hon. Friend the Member for Meirionnydd Nant Conwy (Mr. Llwyd), services are stretched and people who are dependent on social services and health services are often visited by several different people who cater for different needs. There must be a way to put that care into one package, but we need to address the funding, so care trusts are a useful way forward.
However, the question of democratic accountability is involved--it was succinctly put by the right hon. Member for North-West Hampshire (Sir G. Young)--and that is why I would prefer local authorities to be responsible for health. I have some sympathy with the remarks made on that subject by the hon. Member for Wakefield (Mr. Hinchliffe).
A curious position could arise. The National Assembly for Wales has legislative powers in this respect, although it has not used them. The Assembly could introduce in Wales provision different from that in England. For example, it could adopt some of the royal commission's recommendations--on benefit, for example--and could also vary the proposed means test disregards for three months, although it could not fully introduce the recommendation on personal care. Therefore, there is no difference of principle over the idea of arrangements being different in Wales and England. The situation in Scotland is already different, and I understand that the Scottish Executive are considering introducing personal care provision, albeit wrapped up in a different care package.
The cost of introducing the royal commission recommendations in full in Wales would be between £40 million and £60 million, which is a considerable sum, and the Secretary of State rejected it as reasonable expenditure in England. That is fine for England, if that is what the national plan for England says and such expenditure is not a priority for England. All well and good. However, why cannot provision be made to enable the Assembly to introduce the recommendations in full in Wales if it so wishes?
The Assembly may consider the cost and say, "No, we have other priorities as well." None the less, for the long-term future, and to set the right relationship between the House and the Assembly, and between the health service in England and in Wales, we should consider whether we could give those enabling powers to the Assembly. It decides priorities for the health service in Wales, which on heart surgery, cancer and adolescent mental health are different from those in England.
The royal commission recommendations for the long-term care of the elderly could also be implemented differently in Wales. The Assembly does not yet have the power fully to introduce the recommendation on personal care, but it can already vary elements of social care, and we should consider that. Surely there is no stumbling block on principle here, because there is already variation.
In response to an intervention, the Secretary of State said that the NHS had suffered too much restructuring in recent years. There is a lot of sympathy for that view, but when I consider the NHS in Wales and the plethora of bureaucracy that is still in place, I despair. We have GP fundholding, local health groups, NHS trusts and authorities. Now we are to have care trusts. We are dealing with a situation created, to a greater or lesser extent, by previous Conservative Governments. No wonder the poor patient needs a community health council to understand these issues. Members of Parliament often have difficulty understanding who is responsible for what, and who has made the decision that means that Mrs. Jones will not have her operation in the morning, and the Bill has missed an opportunity to get to the heart of the problem and sort out some of the mess in the NHS.
There was a misguided introduction of competition into the NHS many years ago under another Government. That competition is still present; it does not work because it is neither one thing nor the other, and the health service is neither fish nor fowl. Until we eradicate that competition, the health service in Wales will remain a long way from the original socialist vision.