Select Committee on Welsh Affairs Appendices to the Minutes of Evidence


Memorandum submitted by the Welsh Institute for Health and Social Care, University of Glamorgan


  I have discussed the above Bill with colleagues here at the Institute and we wish to provide the following observations to the Welsh Affairs Committee.

1.   The development of Community Health Councils in Wales

  The Bill provides the Assembly with a welcome opportunity to address some of the structural barriers which have arguably impeded the effective operation of CHCs in the past—such as the total number of Councils, their relationship with the independent contractors in primary care, and their public profile (through change of nomenclature, etc). These measures should go some way towards meeting the avowed aim of ``giving patients and the public more say in the running of the NHS''.

  There are two remaining substantive issues, however, upon which the Bill is either silent or vague. The first concerns resources—in the past, CHCs were substantially under-resourced for the tasks they were expected to perform—but presumably this will be addressed when the Bill becomes law.

  More importantly, the Bill is vague on the issue of the accountability of CHCs. In the past, there was considerable variation in the standards of performance of CHCs that could not entirely be explained by issues of resourcing. The intention (in Schedule 7A, paragraph 4) to create a body to advise Councils may represent the beginnings of a regime of greater accountability, but clearly an ``advisory'' body is just that—it will have no statutory means of ensuring that CHCs provide a uniformly high quality of service to the public and patients. Such issues of accountability are difficult to resolve—how can CHCs on the one hand maintain a degree of independence from both the NHS and the Assembly, and yet on the other be effectively held accountable for their performance? Organisational models could be devised which would achieve these twin aims, but they are not present in the Bill.

2.   The establishment of the Wales Centre for Health (WCH)

  Discussions within the Public Health Review Task and Finish Group showed strong support for the development of a Wales Centre for Health; and a key element focussed upon by the membership was that of independence.

  Both the Explanatory Notes (cm 5527-II, paragraph 8) and the Press Release (17 May, 2002) described the WCH as an independent body or organisation. However, neither the Bill nor Schedule 2 use the word ``independent'' in describing the role of the WCH.

  Indeed, it is the NAW that may, by regulation, make provision as:

    —  to whom information and advice are to be given by the Centre;

    —  to which reports are to be published by the Centre.

  Further, Section 3(3) allows for an order of transfer to the Assembly of the Centre's functions and Section 3(4) allows the WCH to be abolished by the Assembly. Neither the Schedule nor the Explanatory notes indicate the scrutiny that would be exercised over such decisions.

  Finally, Schedule 2 (4)-(7) give rise to questioning the need for a Board if the NAW is to have such hands-on control by virtue of is ability to exercise such a range of specific and general directions.

  In summary: the public, from the outset, will not be guaranteed that the WCH can offer independent views; the NAW will not be well served in its continuing quest for transparency; and the WCH will be unmanageable. It is necessary to determine whether the Centre is to be a political organisation or a technical organisation in support of the political process: the Public Health Review membership believed it should be the latter.

3.   The Establishment of Health Professions Wales

  The creation of a new body to oversee health care professions should be resilient to future changes in the nature of education and training. Page 5 of the draft Bill sets out various provisions descended as Schedule 1. Paragraph 3 of this Schedule listed eight organisations that are required to allow members of the Council to enter or inspect premises. It is not clear that all potential providers of education and training are fully covered in (a)-(h); in particular the premises owned by independent contraction, private companies, and universities may deserve separate mention.

  The use of the abbreviation "LP" is not helpful when issuing a draft for wide public comment unless this is readily explained.

  The use of HPW as an abbreviation risks confusion with the former body of Health Promotion Wales.

Professor Morton Warner

19 June 2001

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