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Session 2001- 02
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Standing Committee Debates
NHS Reform and Health Care Professions Bill

NHS Reform and Health Care Professions Bill

Column Number: 125

Standing Committee A

Thursday 29 November 2001


[Mr. Alan Hurst in the Chair]

NHS Reform and Health Care Professions Bill

2.30 pm


    That the Order of the Committee of 27th November 2001 have effect as if for the second sitting on Thursday 29th November the order in the second column of the Table in which proceedings shall be taken shall be: Clause 6, Schedules 4 and 5, Clause 22, Clause 9, Clause 5, Schedule 2, Clauses 3 and 4, Schedule 3, Clause 10. —[Mr. Hutton.]

The Chairman: I draw hon. Members' attention to the fact that the resolution to which we have just agreed means that we shall start on page 135 of the amendment paper. When we have completed clause 9, we will then turn to clause 5 on page 134. Finally, we will turn to page 128.

Clause 6

Local Health boards

The Parliamentary Under-Secretary for Wales (Mr. Don Touhig): I beg to move amendment No. 93, in page 8, line 10, at end insert—

    '( ) Section 1 of the National Health Service (Private Finance) Act 1997 (c.56) (powers to enter into externally financed development agreements) applies to Local Health Boards as it applies to National Health Service trusts.'.

This is a technical amendment. It simply allows local health boards to enter into private finance arrangements in the same way that local health trusts are able to do.

Amendment agreed to.

Question proposed, That the clause, as amended, stand part of the Bill.

Mr. Touhig: Clause 6 will insert three new sections into the National Health Service Act 1977. New section 16BA will enable the National Assembly for Wales, by order, to establish statutory bodies to be known as local health boards and for those boards to exercise functions directed by the Assembly. Each board will be established in an area of Wales specified in the establishment order.

New section 16BB will empower the Assembly to direct local health boards to carry out specified functions that are currently carried out by health authorities. New section 16BC will enable the Assembly to direct local health board functions to be exercised on its behalf by, or jointly with, a number of other health bodies.

The clause will enable the Assembly to take a major step towards improving the national health service in Wales. It will help to develop the local health model

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and pave the way for achieving the reforms outlined in the NHS plan for Wales. The strengthening of local health groups, allied with a new sense of leadership and direction by the National Assembly, will deliver a key part of the NHS plan for Wales and follows from the Assembly's decision to abolish health authorities on 31 March 2003.

The establishment of local health boards is an essential part of the structural reform—

Mr. Simon Burns (West Chelmsford): Will the Minister confirm that health authorities in Wales will be abolished on 31 March 2003? If that is so, why does a different time scale apply in Wales from that which applies in England for the introduction of strategic health authorities?

Mr. Touhig: That is the way devolution works. The Assembly has set its own timetable for reform of the health service, and has already agreed, under the powers given to it in the Government of Wales Act 1998, to abolish health authorities in March 2003.

Mr. Burns: I understand what the Minister says, but does he have any knowledge of the reason behind the Assembly's decision? Did it not want to rush the introduction of the new structure into the health service in Wales?

Mr. Touhig: No. The Assembly made it clear that it wanted a new structure to run the health service in Wales, hence the clause, which will create the local health boards and do away with the five current health authorities. The Assembly has decided on the structure that it wants, following consultation. In the Queen's Speech, we highlighted the fact that a Bill on the NHS in Wales will follow in draft before too long, to add a lot of extra work that we want to ensure that we deliver to reform the health service in Wales. The clause appears in the Bill because it is time sensitive. It is designed so that the Assembly can meet its deadline of abolishing the health authorities on 31 March 2003. I hope that that satisfies the hon. Gentleman.

The local health boards are an essential part of the reform structure in Wales. They will have a stronger democratic voice and be more accountable for their actions. The arrangements that will result from the clause, and from clauses 9 and 22, will build on the valuable experience gained by local health groups during the past two years. From my constituency, I know that they have been extremely successful. They will open up new opportunities for doctors, nurses, other health professionals, local authorities, NHS trusts, the voluntary sector, carers and older people so that they can work together to assess the health needs of their communities and secure the services necessary to meet those needs.

The local health board model was developed in partnership with the key stakeholders as part of an implementation process to improve the health service in Wales. It was subject to wide public consultation, the findings of which reaffirmed the view that the local aspect of health care in Wales should be strengthened. Local health boards are the means to that end. The boards will be formed with local people and

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professionals who know their communities. They will be accountable to the local population to do all in their power to improve health and well-being.

The new level of accountability will be further underpinned by the statutory status of the boards, which will require them to demonstrate the highest standards of management, financial control and public probity. Local health boards will retain an important feature of local health groups, as they will be coterminous with local authority areas. That will allow them to develop new and better ways of working with local government and other stakeholders to improve the health service in Wales.

The development of local health boards and the well-being strategies that will follow from it are a key element in the reform of the NHS in Wales, and I commend the clause to the Committee.

Mr. Burns: I am grateful to the Minister for his explanation of the precise nature of the clause. Unless I am much mistaken, it lists the Welsh side of the reforms, and its effect and outlook are in many ways similar to what will happen in England.

As I mentioned, I was interested in the abolition of health authorities in Wales and the fact that the introduction of the local health boards in Wales will not happen until 31 March 2003. I find that fascinating, if only for the simple reason that Conservative Members have said consistently that SHAs in England should not come into effect until the day afterwards—1 April 2003—to avoid any haste. Unless the Minister can correct me, it seems as though that advice has been heeded in Wales, in effect, as one structure will not be abolished and replaced with another there until 18 months from now. The Welsh Assembly presumably feels that that is a longer and more responsible time scale on which to introduce such fundamental changes.

I would appreciate it if the Minister would elaborate on the precise reasoning and mechanics that the Welsh Assembly has gone through to reach this decision, so that it is out of sync by about six months.

I would also be grateful for some more information from the Minister about the mechanics of the matter. I see from subsection (1) and the Minister's explanatory note that when the boards are set up, the chair and the vice-chair will be appointed by the Assembly. I am interested in why it is felt that the Assembly rather than the local community or local structures within the NHS should take that decision.

The Minister also said, rightly, that the new system coming in in 2003 would mean that accountability to local communities would increase. It would be difficult to argue with the philosophy behind that. However, I would appreciate it if the Minister would flesh out what he means by greater accountability within the local community. Who will hold the bodies to account and establish this greater accountability? How much will the accountability be vested in local communities, as the Minister said, and what sort of accountability will there be to the Welsh Assembly?

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What will the Assembly's powers be—I assume that the powers will be vested in the Assembly rather than in Ministers in the Wales Office—if there are problems with a health authority and intervention is needed to rectify any problems or any fall in standards of service provision? I make such comments in a probing and information-seeking spirit. I am not trying to open a keg of worms and cause problems. I am simply interested in how the system, which in many ways is similar to the English one, but in others is fundamentally different, will work.

Mr. Touhig: It is important to recognise that, as a result of the devolution settlement, the devolved Administrations will go down a different road from that taken by the Government in Westminster with regard to any reorganisation, particularly within the health service. That is no great problem. We have accepted the devolution settlement and we accept that the Assembly will go down its own road in respect of the powers that it has been given.

Mr. John Baron (Billericay): We do not disagree with the Welsh Assembly. We are not bringing the matter into the spotlight in order to ask why it should be different from us. We are suggesting that the fact that the Assembly has decided to delay the implementation of the reorganisation until April 2003 should suggest to the Government that the Assembly has grave doubts about bringing forward the reorganisation as we are doing in England. We are not disagreeing with the Welsh Assembly's right to make such a decision; we are saying that there is an implication that we, in England, are rushing through the reforms. That has been the thrust of our arguments on the Bill.


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