Memorandum submitted by UNISON Cymru Wales
DRAFT NATIONAL HEALTH SERVICE (WALES) BILL 2002
1.1. UNISON CYMRU WALES welcomes the opportunity to provide evidence to the Welsh Affairs Select Committee on the Draft National Health Service (Wales) Bill 2002. It is conscious that this Bill will be the first example of Wales-specific legislation to go through a pre-legislative scrutiny and public consultation process, and this evidences a constructive approach to policy making between UK Government (in the form of Welsh Members of Parliament) and the Assembly.
1.2. The Union's evidence is summarised under the Bill's three main areasmodernising Community Health Councils, creating a Wales Centre for Health, and establishing Health Professions Wales.
2. COMMUNITY HEALTH COUNCILS
2.1. UNISON CYMRU WALES is broadly supportive of the Bill's intention to strengthen and modernise the Community Health Councils (CHC) in Wales, and its commitment to improving the voice of the public and patients in the NHS in Wales. It recognises that it is a "Made in Wales" solution that stands in contrast to the situation in England where abolition has been favoured and replacement bodies known as Patient Advocacy Panels set up.
2.2. The Union understands that new legislative powers are necessary to reform and reconfigure CHC. This will allow in particular:
2.3. The extension of the current remit of CHC to inspect primary care (surgeries, dentists, opticians etc) and nursing homes.
2.4. The change of name of CHC to something that is more appropriate to its responsibilities and is more easily recognised by patients and the public. However, the Union is not convinced that the name "Patients Cymru" necessarily achieves this purpose. The term 'patient' suggests a very narrow focus for a service that needs to embrace the wider views of citizens, service users, carers and so on.
2.5. It will allow the boundaries of CHC to be made coterminous with those of the new Local Health Boards, which is a sensible development to ensure maximum coherence and co-ordination. There is a wider problem, however, concerning the sustainability of 22 Local Health Boards and 22 local authorities. There is a real debate around the need for a future re-organization of these structures given the current and anticipated problems of scale, capacity and competence of existing arrangements.
2.6. It will enable the rules relating to the appointment of members to each CHC to be amended to reflect the composition of particular local communities (age, ethnicity, gender, social groupings etc). The Assembly wishes to have the power to specify through Regulations the proportion of members to be drawn from the local authority and voluntary sectors, and through open advertisement. This appears to be a healthy development in fostering a participatory approach to local governance as opposed to biasing it towards local authority members. In discharging this function, every effort needs to be made to gain representation from groups and communities who are traditionally excluded or disaffected from involvement in public bodies. Perhaps training and capacity building programmes need to be offered to enable people from such groups to participate effectively.
2.7. The new Bill intends to enable CHC to pool their budgets to facilitate cross-boundary working, and to empower CHC to provide an independent advocacy service for patients wishing to complain against the NHS. Both of these provisions are supported by UNISON CYMRU WALES.
2.8. The Bill will enable the Assembly to establish a statutory Association of Community Health Councils in Wales. Again, this is helpful because it provides this sector with a potentially unified voice to inform and influence the nature of health policy at both a local and strategic level. Such an Association will have the legitimacy to speak on behalf of a wide constituency and the information of the effect of particular health policies and practices at a local level. It can be an important source of networking for its membership. It can encourage unified standards and performance frameworks throughout Wales. However, what form this responsibility takes is unclear as are any powers of sanction or coercion?
2.9. The effectiveness of local CHC will depend upon establishing good working relationships with Local Health Boards. There is a potential area of tension between the respective roles of each in relation to promoting and enabling effective public involvement. Indeed, Local Health Boards will have lay members on them whose responsibility it is to reflect the needs of their local communities and patients.
2.10. It will be important, also, for CHC to direct their focus on sectors and organizations, such as local government, who have a huge impact on the wider "health" agenda in terms of determinants of health status, health inequalities and quality of life. CHC need to build effective strategic alliances with these organizations and co-ordinate their activities with the many attempts that are being undertaken to engage with people and communities across the policy spectrum such as Community Strategies, Communities First, Crime and Disorder, Health Alliances and many more. The inter-organizational focus of their business is crucially important in this complex and interdependent area of public policy. Public participation programmes need to be co-ordinated across sectors in Wales to avoid fatigue, confusion and raised expectations.
2.11. It is intended that the Bill will confer on the Assembly the power to control staff and accommodation. It would be helpful to know precisely what arrangements are envisaged to "control" staff. To whom are they responsible? What are the proposed management arrangements, remuneration levels, terms and conditions and so on?
3. WALES CENTRE FOR HEALTH
3.1. The new Bill will enable the creation of a Wales Centre for Health that is intended to be independent and responsible for training, advice and research relating to the protection and improvement of health for the people of Wales. It is envisaged as a Centre that will assemble information and evidence to help inform new policies and be predicated on facilitating partnerships between the Assembly and the public, voluntary and academic sectors.
3.2. On balance, UNISON CYMRU WALES supports the development of such a Centre. Wales needs a single organisation to link with similar units in the UK, liase at a European level and assemble relevant high-level information, statistics and evidence. However, it considers that its success will depend on a clarification of roles and responsibilities between a number of different organisations having an interest in public health matters in Wales. A crucial relationship that needs to be clarified is that between the Centre and the All Wales Public Health Service. It might be argued that there are potential areas of overlap that can only be resolved by a formal link between the two organisations.
3.3. There are also serious questions to be resolved in relation to the co-ordination of research/development and training. There are already in existence a number of organizations that have a valued stake in these functions, and respective roles and responsibilities will need to be clarified to avoid unnecessary competition or overlap.
3.4. The Union is of the opinion that it is crucially important that links are made between the research/evidencebased focus of the Centre and the health service organizations that deliver and implement policy on the ground. Unless the Centre can be seen to add value, then it will be open to criticism that it is effectively diverting much need resources fro m direct patient care. Finally, UNISON CYMRU WALES is aware that there is already a recruitment problem with public health consultants in Wales, and is concerned that the viability of the new Centre might be compromised by its inability to attract high quality staff.
4. HEALTH PROFESSIONS WALES
4.1. Health Professions Wales is the replacement for the Wales National Board for Nursing, Midwifery and Health Visiting. Its remit will involve continuing education, training and clinical experience of nurses, midwives, health visitors and health care professionals.
4.2. UNISON CYMRU WALES considers that the main advantage of such an organisation is that it consolidates the training and development of these staff groups into a single overarching framework. However, it can be argued that it does not go quite far enough by not including doctors, consultants and other medical staff in such an organisation.
4.3. The new organisation reflects public policy's collaborative agenda by promoting joint professional training and it sends a signal to frontline workers that they are as valued as much as the medical and consultant staff groups. The problems of amalgamating a number of professional groupings, with their hitherto distinct forms of training, culture and values into a single organisation, should not be underestimated.
4.4. UNISON CYMRU WALES is concerned that the resource implications of this new body have not been fully developed. The new organisation will want the flexibility to develop various workforce matters and fulfil its new roles and responsibilities. This will inevitably require resources much above that envisaged by the Assembly.
4.5. UNISON CYMRU WALES is particularly pleased to note the proposals to make Health Professions Wales an Assembly Sponsored Public Body (ASPB) as this will demonstrate the independence and respectability of these new arrangements.
Head of Health Wales
10 June 2002