4. WALES CENTRE FOR HEALTH
- In May 1998 the Welsh Office published its consultation document Better Health - "Better Wales", one of a number of papers emanating from the 1998 NHS White Paper Putting Patients First. The consultation document raised the possibility of a collaborative public health network at National Assembly level.
- In October 1998 the Welsh Office published a Strategic Framework, reflecting the responses to the earlier paper, and setting out the aims and priorities for improving health and reducing health inequalities. The document listed 17 areas where action would be taken, including the establishment of a "multi-disciplinary Wales Centre for Health" as a means of "bringing together the best public health surveillance and advice to support decision-making". The establishment of the Centre was one of 15 priorities listed for 1999-2002.
- The document listed the functions of the proposed Centre as including
- providing a forum for multi-disciplinary advice on health hazards;
- risk assessment of threats to health;
- disseminating research and other evidence to support decision-making;
- support for multi-professional training in sustainable health; and
- liaison with national and international multi-professional groups.
- Four years on, the draft Bill now includes two clauses and a long schedule designed to give effect to this proposal. The draft Bill seeks to establish the WCH as a "body corporate", with Members appointed by the NAW, a chief executive and staff. The NAW is given some freedom to regulate the WCH, and can (under paragraph 4 of Schedule 2 ) give directions on the exercise of any of its functions. The Schedule sets out in some detail how it is to pay members and staff, and other administrative matters reflecting the fact that WCH is a new body. Establishing WCH by statute rather than informally is intended to raise its profile, increase its clout in attracting funding from public and other sources, and help establish its independence.
- "A shadow" WCH is in train of formation. The intention is that the Centre will have a "real" existence somewhere, as well as what Ms Hutt called a "semi- virtual" existence with a website, library video-conferencing facilities etc. The Explanatory Notes refer to "about 20 whole time staff (or equivalents)" and an already allocated budget of £600,000. In order to maximise the Centre's access to specialisms, many of the staff may be part-time, working the rest of their time elsewhere in the public health service. Some staff will evidently be drawn from among those already in post in other parts of the Welsh NHS structure: the draft Bill, at paragraph 6 of Schedule 2, provides for the NAW to be able to direct the WCH to employ specified people employed by a NHS Trust.
- It is intended that as a statutory corporate body the WCH should enjoy a greater degree of visible independence from NAW control than other APSBs. Its independence is however to be statutorily constrained by paragraph 4, under which it must comply with any direction given by the NAW, and by the extent to which the Assembly is to control the recruitment and pay of members and the chief executive. Several witnesses expressed concerns that the Bill did not give sufficient guarantees of the Centre's independence. They feared that its potential value in giving the public authoritative and demonstrably independent advice and informationas seen recently, for example, in the controversy over the local public health implications of landfill or incineration sites, or over MMRwould be undermined if it was seen to be unduly influenced by the NAW.
- Both Ministers assured us that they wanted the Centre to be independent of Government and expected it to become increasingly independent as it developed. Mr Touhig suggested that the express determination of Ms Hutt that the Centre should be an independent body should be sufficient assurance. While we do not for one moment doubt their sincerity, such declarations do not have the force of law, and there is unlikely to be another opportunity to enshrine the independence of the WCH in law.
- The attempt to create a body with the necessary degree of visible independence has not been entirely successful. Although the WCH can, under paragraph 16 of the Schedule, do anything necessary to exercise its functions, it is obliged under paragraph 4 to comply with any direction given by the Assembly exercising any function. That could, for example, prevent it from commissioning research, or reporting to the public, on some controversial matter of public health which for whatever reason the NAW did not want it to report on. That cannot be the intention. We recommend a review of the terms in the draft Bill under which the WCH is obliged to comply with any direction of the NAW, with a view to limiting that obligation to the exercise of its administrative or financial functions.
- Paragraph 16 of the Schedule gives three specific examples of things which the Centre can do: co-operating with others in the same field, purchase of land, and entering into contracts. There may be value in listing these activities, although we are surprised that it should be altogether necessary to spell out that a body corporate is free to buy property or make contracts. The provision on co-operation should evidently cover all the Centre's functions and not just the provision of information. It would also be useful to enshrine in statute that the Centre is free to embark on, and publish the results of, research into any topic it considers appropriate, and that it may pursue a public information policy of its own making. We recommend that the terms of paragraph 16(2) of Schedule 2 be revisited with a view to using the sub-paragraph to enshrine the operational independence of the WCH.
- Paragraph 22 of Schedule 2 provides for the WCH to make and publish an annual report to the NAW. There could, in our view, be advantage in the involvement of the principal professional public health bodies, including the relevant Royal Colleges, in the process of annual reporting by the WCH. There may well be other and better ways of providing for the Centre's independence. We recommend further consideration as to how best to provide within this founding statute for the real independence of the WCH.
- Evidence from several witnesses, and the first scrutiny of the Bill by the NAW HSSC, demonstrated some sense that its ambit, as set out in Clause 3, may be unduly modest, and that the WCH should be able to go beyond the provision of "information and advice to the public", to a more proactive and participatory role. Witnesses also expressed some concern that WCH should be funded with "new" money rather than at the expense of services for patients. UNISON, for example, gave the WCH a rather cautious welcome and warned that
"Unless the Centre can be seen to add value, then it will be open to criticism that it is effectively diverting much need [ed] resources from direct patient care".
It is plain that such criticism will continue unless the Centre responds to the expectations raised by its creation.
- It must be for the NAW and the WCH once established to determine the scope of the Centre's work, within the deliberate constraints of the terms of Clause 3. On balance we are satisfied that the basic statutory function of dealing with the protection and improvement of health in Wales is broad enough to allow for the NAW and the Centre itself to develop its work as appropriate; and we are confident that the desire to see the Centre as a genuinely accessible public resource for the people of Wales is well understood within the NAW.
Public health data collection
- Evidence submitted to us by the Welsh Combined Centres for Public Health (WCCPH) addressed in some detail the problems confronting public health bodies seeking to collate and analyse individual medical data as a result of the data protection and human rights legislation. The memorandum noted that "several hospitals in Wales have stopped sending data to databases that are crucial for health surveillance". As a result a number of the Welsh databaseson hospital admissions, cancer, congenital anomalies and accident injurieshave experienced difficulties in obtaining data. WCCPH noted that
"the development of the Wales Centre for Health comes at a time when the quality and accuracy of administrative and clinical databases is dramatically improving and consequently it has the potential to contribute substantially to the health and well-being of the people of Wales. However, unless there is urgent consideration and resolution of the issues raised in this letter, the Wales Centre for Health may not be able to carry out many of the intended functions."
This is not, of course, a new problem; it was, for example, commented upon in March 2002 by the Science and Technology Committee in its Report on Cancer Research in relation to cancer registries. Nor does the draft Bill offer the right vehicle for a solution. The grave difficulties confronting public health data collection will offer an early challenge to the new Wales Centre for Health. Urgent and concerted action by Government, in consultation with all the stakeholders involved, is required to ensure that a proper level of collection of public health medical data can be resumed.
Public health structures
- The June 2002 Department of Health Consultation Document on creating a Health Protection Agency noted that " historically, public health relationships have been different in Wales". With the proposed Wales Centre for Health, another piece of the distinctively Welsh public health jigsaw will fall into place. From April 2003 the newly established National Public Health Service for Wales, based at Velindre, will provide the public health function to local Health Boards.
- Ms Hutt assured us that there was a clear distinction between the service functions of the new Public Health Service for Wales and the advisory and training role of the WCH. There is however some risk of overlap with other existing bodies, in particular over training, as revealed for example in the submission from the Welsh Combined Centres for Public Health. The WCCPH was set up in 1993 to support the public health function through teaching, training and research. They have in recent years created a Masters degree in public health. The WCH is apparently already active in developing an "interprofessional fellowship in public health". The WCCPH warned against excessive duplication in the training role envisaged for the WCH. The University of Wales College of Medicine also drew attention to this general point. The statutory language, obliging the WCH to "contribute to the provision and development of training in such matters [ie the protection and improvement of health in Wales]", is suitably modest.
53 Cm 3922 Back
54 Cm 3841 Back
55 Cm 3922, 6.35-6.36 Back
56 Strategic Framework, October 1998, paras 1.7 and 1.8 Back
57 Q 150 Back
58 Qq 147-8 Back
59 Q 156 Back
60 Qq 157, 161-4 Back
61 Qq 154-5 Back
62 eg Ev 58-9, 61; see Q 159 Back
63 Qq 147-9 Back
64 Amendments 4 and 5 debated in NAW HSCC, 29 May 2002 Back
65 eg Ev 51, 60 Back
66 Ev 23, 3.4 and Qq 94-95 Back
67 Ev 61-63 Back
68 Science and Technology Committee, Cancer Research-A Follow-Up, First Report of Session 2001-02, HC 444, paras 31-37. Back
69 Q 155 Back
70 Qq 156, 158, 160 Back
71 Ev 58, 61, 67 Back