Select Committee on Welsh Affairs Appendices to the Minutes of Evidence


Letter from Daniel Smith, Welsh Food Alliance to the clerk of the Committee


  The evidence to Welsh Members is presented in two parts. Firstly, proposed amendments. Second, a response to the ATM Review/Report on the future of CHCs (Annex 2). Please find enclosed recent newsletters providing relevant information about our work (not printed).

  Members will observe that we have addressed these issues from a public health perspective, in the spirit set out in the Wanless Report. We welcome specific questions on our evidence since they are based on the practical work of our members who firmly support a long-term view in securing our future health in Wales.

10 June 2002

Memorandum submitted by the Welsh Food Alliance


  Briefing from the Welsh Food Alliance, to be read in conjunction with Hilda Smith's response (see Annex 2) to the ATM report. Suggested amendments in italics.


  The Bill requires LHB and other NHS bodies to consult CHCs on matters relating to health services. This essential change needs to extend beyond NHS bodies, and include health-related services. (The difficulty in using paragraphs 18 and 19 of the 1996 regulations is that it excludes a wide range of organisations needed to consult with CHCs in their new role).

  We need to extend beyond the current illness service, and properly include health promotion and preventative health aspects, as recommended by the Wanless Report—"Securing our Future Health: Taking a Long Term View" (April 2002). Our amendments are designed to achieve this objective. (See our comments about the need to integrate health and well being at Annex 1.)

  Policy and strategy across health and local authorities needs to be strengthened to support the public health function, which is currently lacking, has been emphasised by others (see the article by Kevin Morgan and Gareth Williams, W Mail 11 June 2002, and the attached Alliance newsletter reference to a Food and Health Policy Council and North Karelia (not printed here). It is noted that we still await a public consultation on Stage One of the NHS Public Health Review, promised earlier this year.


 (3)   Wales Centre for Health

  (1)  Functions of the Centre (page 2)

  Insert new (b)

    " (b)  assess policy and evaluate integrated working in Wales" at line 16

  New (c)

    " (c) develop and share expertise in promoting and sustaining public participation" at line 17

  New (d)

    "Appointment of one/two pay members able to represent a public interest point of view. "

  Old line 18

  (renumber old (c) and (d))

 (4)   Health Professions in Wales (page 3)

  (2)  add new "(d) by the appointment of appropriate lay representation" at line 9

 (4)   Health Professions Wales

  (1)  add new "(c) other specified health and well-being professionals" line 40

  (2)  add new "(d) promote and sustain the professional standards of training, testing, certification, and retraining in relation to health and well-being in Wales. Line 42

  (5)  amend after care at line 38, by adding "and health and well-being"

  (6)  amend after care at line 39, by adding "and health and well-being"

  Note: Changing situations demand different solutions therefore we need to look imaginatively and with vision about what the future may require, without having to seek further parliamentary time. We have identified the need for a new multi disciplinary profession termed a "Community Food Adviser". Therefore we are seeking a generic term to cover such a new profession. This aspect requires further consideration and clarification.

Schedule 1 Draft NHS (Wales) Bill

  Clause 1 (a) after health service insert " (including health promotion and health prevention services) " line 8

  Note: this enables the term "Health Services" to reflect a health and well being agenda as far as one can within the NHS Act 1977.

  2(a)  Insert after NHS Trust "local authorities, and other bodies (including health-related elements of local bodies partnerships) " at line 20-21

  Note: this amendment seeks to include elements such as drugs and alcohol abuse, and food security, where the lead could be from non NHS bodies, such as the police, probation, or local authorities.

  2.  New Sub Clause after (d)

  " (e) the co-operation between Health Authorities, Local Health Boards, Strategic Health Authorities, Local Authorities, Primary Care Trusts, NHS Trusts and other Bodies, and (Community Health) Councils with respect to such matters, and on such occasions, as may be prescribed; " at line 22 onwards.

  Note: the term co-operation implies a duty to work with CHCs, whereas the term consultation is weaker in terms of the public having a role in participative policy formulation as set out by the Health and Social Services Minister in her preamble to the "Improving Health in Wales" 2001 public consultation.

  Renumber (e) now new (f)

  Second line, after "health," delete service and insert "and related services" line 23

  Old (f) line 28 should be amended to read "Health Authorities. Local Health Boards, and other bodies" for reasons explained above.


Wales Centre for Health

  Regulation 7(a) refers to the appointment of Centre members. We strongly recommend that one or two appropriate people be appointed who have sufficient knowledge and expertise of health and related services who are able to represent a public point of view in appropriately shaping the Centre's work. The voluntary sector public health representation would seem to be an appropriate place to identify such person(s). We see this as a necessary check and balance, in a publicly accountable and funded body.

General Powers (page 9) at line 4 onwards

  16(2)  That includes, in particular—

   (a)(i)   Co-operating with other public authorities, and other bodies in the provision of information, about matters related to the protection and improvement of health in Wales;

  Add "and the assessment of policy and evaluating integrated working in Wales"

  Add new sub clause (a) (ii)

  " (a)(ii)  developing and sharing expertise in promoting and sustaining public participation related to the protection and improvement of health in Wales. "

David Smith

Food Policy Adviser

Welsh Food Alliance

10 June 2002

Annex 1


 (Strengthening partnerships between the voluntary sector and the NHS on Wales)

  We have commented that this document is restricted to partnership working between the Voluntary Sector and the NHS. The local health partnerships will be key vehicles of work to sustain health and well-being. This is particularly important in addressing, for example, food security issues* (access, affordability, availability) to which we see no reference in any WAG/NafW document. Voluntary sectors also interface with Unitary Authorities, for example, helping to sustain people in their homes. This area of joint working is little mentioned yet vitally important. (*In April we wrote to every Welsh MP concerning the EDM 607—Food Poverty Eradication Bill.)

Annex 2

Alternative Review of the Structure and Staffing Arrangements for CHCs in Wales—to be read in conjunction with comments on the NHS (Wales) Bill

  1.  After reading (a) the Wanless Report on preventive health and the integration of health and social care, the CMO's Report "Health in Wales," and "Targetting health improvements for all"; (b) drawing upon my own experience of serving on CHCs, Regional and District Health and local authorities; (c) community development expertise; and (d) in preparing evidence for "Better Health—Better Wales" Mark 2;

  1 have come to the following conclusions:


  2.  In my view the main recommendation is streamlined line management via the Association and large Federations. This flies in the face of the evidence provided by Health Authorities, Local Health Groups and Hospital Trusts. This review has an emphasis on the importance of line management issues, rather than ways of encouraging public involvement and representation, which in my view is essential.

  3.  A locally based and focused CHC is in a much better position to become a vital part of local community life and to interact effectively with primary and community care providers, health service commissioners and local Health Alliances. At a time of decentralisation of most Health Authority functions to local Health Boards it appears contradictory to further centralise CHCs. It is at the local level where co-terminosity is most important, but this requires higher level strategy and policy to support the public health function, which is currently lacking.

  4.  Therefore this review ignores the fundamental function of CHCs which is to represent and reflect the interests and concerns of individuals and local communities. Has any evidence been sought from individuals or communities that have used CHC services, of from relevant voluntary and community organisations?

  5.  The reason why CHCs vary so widely in the range and quality of services they provide is not the absence of centralised line management, as it is suggested, but the absence of guidelines and performance monitoring arrangements. The Association should be developed to provide these services—and to undertake research into user and community involvement—rather than as indicated in the central control of staff.

  6.  Have any surveys been conducted into general public knowledge and perception of CHCs, and the important work they should be doing for the local community?

  7.  It is essential that CHC staff be answerable to their local members, not to remote Federations, or to Association officials. For example, in Newport I suggest that a local CHC officer with a remit and overall responsibility for Newport, would be more effective in developing relationships, both statutory and voluntary, and a cohesive integrated approach to participative policy development that is required.


  8.  The report recommends that all members should be "selected by and open and local appointment process." This is very imprecise, for what body would be responsible for making the appointments, which must be open and accountable? Any appointment process should be arms length from the CHC itself, and appointed according to Nolan principles, and properly supervised by the National Assembly Public Appointments Unit. We should aim to have every sector of the community represented, including the disabled and the immune compromised. There should be no age discrimination. This will ensure a wide coverage of major issues of concern to both health and local authority functions, and be a means of integration, which will be of increasing importance.

  9.  An alternative would be to organise public elections, but this could possibly politicise CHCs and would not ensure a cross-section of people with different experience and interests. However it would give the public the opportunity to participate fully in electing their representatives, and taking a keener interest in health related issues in their community.

  10.  Membership should include people who have a commitment to public health and preventive measures. In terms of joint working this is important. What is required is to make public health more integral of the CHC and the local authority, which will fit into the pattern desired by the National Assembly for Wales. This will make the CHC link with local Health Alliances more effective. The CHC should also be required to submit reports to the local authority led local Health Alliance.


  11.  This can be beneficial as members often have considerable knowledge and experience in their selected field. However, it is essential that they be locally based, and locally represented, with an understanding of the importance of health related issues.


  12.  There is an advantage in maintaining two members appointed by the National Assembly for Wales. That is not reflected in the NHS Wales Bill. This will help ensure that local CHCs are appraised of national issues which local members should be aware of in the dynamic environment within which health and social care now operate. They should be selected from lists of people responding to advertisements. All NafW members should meet on a twice-yearly basis with the Minister to report progress but also to be appraised on the national issues that the NafW felt should be taken on board by local CHCs. This could help ensure that we develop integrated local policies that reflect not only needs of patients and users of local services, through tracking the considerable increase in public expenditure on health and social care, but are in line with overall Welsh Assembly Government policy, which also has an emphasis upon prevention ands public health, as part of a long term strategy.


  13.  It is essential that CHCs should be co-terminous with LHG/LHBs. They must be given adequate resources and guidance, and their resources should be monitored and evaluated to include the wider public health agenda.

  14.  CHCs should be required to liase at NHS Trust level to monitor the provision of hospital and specialist services, and at the Association level to agree guidance and monitoring procedures, and a co-ordinated response to national policy issues.

  15.  CHC staff should be accountable to CHC members via the chairperson. Employment functions for CHC staff—but not general line management responsibilities—should be the function of an independent body funded for the purpose by the National Assembly for Wales.

  16.  All meetings of the CHC, including Association and Federation Executive meetings should be open to members of the public, and should be held where they are accessible by public transport, with adequate publicity to encourage wider public involvement.


  Staff and their continuous professional development are important aspects of an efficient and effective CHC. Equal attention should be given to CHC members as valuable human resources. This report does not address the wider aspect of how CHC's operate in a new environment of co-terminosity, which will be of increasing importance in ensuring that all members are accountable and function in their local area.

  It is in this way that CHCs in future will be acknowledged for their effectiveness in improving local health and well being. They will have the important role as a check and balance which all systems require. This will also require effective communication and participation of local people if we are to realise the promise set out by the First Secretary and the Health Minister in the report "Improving Health in Wales."

  It will also ensure the most effective use of large amounts of public expenditure on CHCs, that we live up to the faith and expectations of the Minister in keeping CHC structures in Wales, and that the considerable increases in public expenditure are spent efficiently and effectively in improving health and well being in Wales, with increased public participation.

  Note: Our report should be read in conjunction with the ATM consultants report, the Ministers letter of 28 March 2002, and a second forthcoming consultation on the NHS (Wales) Bill, on additional CHC functions and other matters. (not printed)

Hilda Smith

Welsh and Food Alliance

10 June 2002

Annex 3

NHS Wales Bill, and the future role and effectiveness of CHCs


  1.1  Today the Press Release, and the Patient Consultation Report, including 350 comments from members of the public in the Castleton/ Marshfield Areas (Newport) arising from the proposed withdrawal of services deserves studying. Not only about the lack of primary care services and relating this to inadequate public transport, population growth, but of the lack of an effective service, brought to the attention of the CHC only by the threat of closure of temporary GP services.

1.2  Questions

  Shortcomings now revealed by this survey:

    (1)  Why did the Newport CHC, as a CECEwatchdog11, not know of the poor primary care position earlier? What of other areas?

    (2)  Are the public aware of, and therefore able to make the their views known to this CECEwatchdog11?

    (3)  From this report, services at St Mellon's (Cardiff) appear less than adequate. Is there a poverty of expectation is some areas?

    (4)  Significantly, in a changed system next year, without a good surveillance, and clinical governance system, how are we to ensure that the checks and balances within the system that the CHC provides will be effective?

    (5)  What can we learn from the Castleton Report that will help us to reform the work of CHCs? What changes will be required to have an effective surveillance system with CHCs empowered to have a wider role and an effective membership? With the dearth of people to work in a voluntary capacity (for example, school governors), and with increased duties as proposed, how will we be able to obtain the quality and number required? If we fail in this then the whole policy of keeping CHCs in Wales will fail.


  2.1  I can make available representations made by the Family Planning Association (FPA) in 1974, that was agreed by the incoming Health Minister of the new Labour government. This changed policy so that the new government accepted the necessity of CHC independence if they were to command public confidence. An important issue is raised at paragraph 22 of the FPA document, where it states "they should be in accommodation which is separate from any of the offices or hospitals of the AHA in order to ensure that they are not only independent but seen to be so".

  2.2  We are not now adhering to this in Gwent, for example. The checks and balances I believe are impaired where there is a public perception, whether true or otherwise, that CHCs are controlled and part of the Health Authority. For the sake of our impartial role, we should continue to strictly adhere to this principle.

  2.3  It will be even more important in future when GPs as independent contractors, are part of delegated LHB arrangements, with enormous control over budgets for health and community services that will be integrated at the local authority level. CHC members should have voting rights, and with the voluntary sector, take the lead in public involvement and consultation matters.


  3.1  How can we reduce the onerous duties placed upon voluntary CHC members? One apparently obligatory duty is hospital visiting. Is this essential for all members? A small team could take this responsibility. There are other ways of collecting information from patients. A slip of paper put into a locked CHC box on departure, and collected, analysed, and reported upon by CHC member to a subsequent meeting should be sufficient.

  3.2  NHS managers should effectively control standards of cleanliness and repair in NHS wards, toilets and showering areas, with appropriate quality control systems in place. This is not rocket science, and occurs in Motorway Service Stations, where the contractor is obliged to promote and maintain standards.

  3.3  Psychologically it is wrong to be put in a situation of having to speak with patients about possible complaints with a senior staff member present. Often all that is achieved is feed back from staff and there ought to more adequate ways of achieving this through the system.

  3.4  Some CHC members may not, through disability, be able to visit medical wards. More people now have immune deficiency, and should not be prevented from serving on CHCs if we are to have an inclusive equalities policy.


  I hope Committee members find this submission helpful.

Hilda Smith

20th June 2002

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