Draft National Health Service (Wales) Bill

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Mr. Jon Owen Jones: Under the devolution settlement, requests for legislation are bound to come from the Assembly. The present arrangements enable the Government to turn down those requests flatly, so it could be that no draft legislation would come about, or that a mechanism would have to be found for that to happen. I have suggested in the past that there should be an automatic requirement for a Committee such as this to consider any proposals that come from the Assembly, to avoid the problem that my hon. Friend just mentioned.

Mr. Martyn Jones: That is a slightly different point, although a related one, and I agree with it. My point was that we would not have the opportunity to look at draft legislation without at the very least enshrining it in Standing Orders. These are early days and this is an

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exciting time for the way in which we deal with legislation. I agree that my hon. Friend's points need to be considered. In conclusion, by any measure this is an historic day for Parliament, and I hope that before the end of the debate all Members will have acknowledged and welcomed it.

11.55 am

Hywel Williams (Caernarfon): I begin by welcoming the first draft Bill for Wales and the opportunity for Welsh Members to scrutinise it; I hope that all Welsh Bills will follow that procedure in future. In answering the hon. Member for Cardiff, Central, the Secretary of State said that this was not the end of the story, and perhaps the Under-Secretary will tell us whether this is a process or an event.

I note that the Secretary of State's press release of 17 May holds off until paragraph 3 before making the points that the Bill demonstrates the benefits of the close working relationship between the United Kingdom Government and the Assembly and that it is a further example of the success of devolution. Irrespective of the Bill's status, I welcome it—as far as it goes—as proof or otherwise of the success of devolution. My hon. Friend the Member for East Carmarthen and Dinefwr (Adam Price) hopes to discuss some of its detail later in the day if he is fortunate enough to catch your eye, Mr. Griffiths.

I shall begin by paying my respects and tributes to the people who work in the NHS in Wales. Before entering the House, I worked closely with NHS staff both in hospitals and out in the community as a social worker for 10 years and as a teacher and trainer for 15 years. During that period I saw heroic attempts to overcome the poor conditions and lack of resources that bedevilled the health service. I worked in huge Victorian mental hospitals in which people were shut up for decades, where I grant that they were cared for with kindness but in conditions that I would not want either for my relatives or for myself, which must be the ultimate test. There are some who speak with less authority because they have opted out of the state system, but be that as it may.

I also worked with people who had left the hospital system and whose only support systems were visits by hard-pressed GPs, nurses or social workers and drug treatments that often had horrible side effects. I played my part in admitting people to hospitals, the names of which evoked terror in those unacquainted with the asylum that they provided, against their will. I saw the effects of the changes in the organisation of health care such as foolish and futile attempts to impose a market structure on a public service, and I heard Members of the Conservative Government at that time claiming that their reforms would provide choice—the choice was merely to dine at the Ritz if one had the wherewithal. I saw the chaos and the criminal waste of scarce resources that those alleged reforms engendered. I am therefore saddened and angered that, despite the commitment and hard work of NHS staff over the past five years, in many ways the service has worsened.

Waiting lists have grown, and we might as well get that over with now because the figures speak for

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themselves. In 1997, 28,401 people waited as out-patients for more than three months compared with 85,546 in 2001. In 1997, 5,956 people waited as out-patients for more than six months compared with 45,756 in 2001, which is an increase of 668 per cent. In 1997, 6,274 people were waiting as in-patients compared with 9,037 in 2001. In 1997, 1,402 people were waiting as in-patients for 18 months compared with 4,045 in 2001. In case one thinks that that is the end of the story, the figures for 2002 confirm that trend. The provisional figures for this year state that the number of people waiting for a first out-patient appointment is 73,362, which is an increase of 2.8 per cent.; the number of people waiting for 12 months to be admitted as in-patients or day cases is 10,497, which is an increase of 1.4 per cent.; the number of those waiting more than 18 months is 4,201, which is an increase of 0.8 per cent. I thank the Committee for bearing with me while I went through those figures.

Can the Secretary of State defend those figures? Will he guarantee that waiting lists will fall as a result of the spending review announced yesterday? Will health be put right, as he said it would earlier? I would be happy to give way to hear such a guarantee from the Secretary of State; perhaps his hon. Friends will reply later.

There are 800 nurse vacancies in Wales because the establishment has grown. However, that is of no comfort to those waiting for an appointment, let alone for treatment. I understand that there are also 130 GP vacancies in Wales.

Spending on health has increased substantially, and it would be ridiculous and churlish not to welcome and acknowledge that. Hon. Members will recall that during the last meeting of the Welsh Grand Committee the Secretary of State was pressed to state the percentage spending increase on the health service in Wales compared with the percentage spending increase in England. The Secretary of State's answer eventually acknowledged that health spending would rise by 6.8 per cent. in Wales, whereas it would be 7.4 per cent. in England, although this morning he said that the figure was 7.5 per cent.

Mr. Jon Owen Jones: The hon. Gentleman is no doubt enthralling the Committee with his many statistics. [Interruption.] If hon. Members will bear with me, I shall get to the point.

The Chairman: Order.

Mr. Jones: Thank you, Mr. Griffiths. My point is that, so far, the hon. Gentleman has complained that not enough money has been spent. He has acknowledged that very large sums of money have been spent, but he has not suggested what he or his party would do to create better delivery apart from simply spending even more money.

Hywel Williams: The hon. Gentleman should contain himself and bate his breath.

As I said, we spend more in Wales than in England. We spend more because we need to. Health is worse in Wales than in England; the need is greater, so we

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spend more. The alternative is to spend the same in Wales as in England, even though the need is different. To defend the fact that spending in Wales is rising at a lower rate than in England because of need is equally ridiculous.

Mr. Simon Thomas (Ceredigion): I hope that my hon. Friend will bear with me, as I am in need of care today because I am not feeling too well. To reflect on the point raised by the hon. Member for Cardiff, Central, does my hon. Friend accept that the important point is not just money, but delivery? The national health service framework for coronary care states that Ceredigion must have a cardiologist consultant in Bronglais, but Jane Hutt of the National Assembly says that we cannot have one because the money is not available. However, that same Assembly is prepared to spend £15 million once again on restructuring the health service and introducing 52 new bodies for that service in Wales. The question is not just about money, but the manner in which services are delivered.

Hywel Williams: I thank my hon. Friend for that point, to which I shall refer later. If I were in the position of spending all this money, I would not spend it on yet another restructuring, which is the sixth in the past 13 years.

The Chairman: Order. May I point out to the Committee that the debate is on the draft National Health Service (Wales) Bill? Although that gives scope to talk about health spending and so on, it must be placed within the context of the Bill.

Hywel Williams: Thank you, Mr. Griffiths, for that help. The Bill is, of course, an essential part of the context in which I wish briefly to compare spending in Wales with that in other countries in the European Community.

The report of the Welsh Affairs Committee referred to the difficulty in getting proper statistics. It stated:

    ''The grave difficulties confronting public health data collection will offer an early challenge to the new Wales Centre for Health.''

That is a relevant point.

The Wales Office report reveals that identifiable spending per head on health and personal social services in Wales was £1,303 in 2001. If we compare that with the health figures released in 2002 by the Organisation for Economic Co-operation and Development for the year 2000, we find that UK spending was $1,763, which was better than in Spain, Portugal and Greece, worse than in Austria, Ireland and Italy and much worse than in the Netherlands, France and Denmark. Denmark spent $2,420 that year. Thankfully, the figures for Germany for the year 2000 are not available, because in 1998 it spent £2,451 per head.

As I said, the identifiable spending per head on health and personal social services in Wales in 2001 was £1,303, or $2,036. We are not comparing the same year, and the different base for counting flatters Wales. Therefore, I feel safe in drawing comparisons with health spending in other European countries. In 2001, Wales spent less than Austria, Belgium, Denmark, France and the Netherlands spent in 2000, less than

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Luxembourg spent in 1999 and less than Germany spent in 1995. The figures that we found for Germany do not go back further than 1995.

The Secretary of State said a moment ago that his aim was to have the best health service in the world. Historically, we have been a long way from that, at least in terms of spending. As the Government say, there is great scope for catch-up.

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Prepared 16 July 2002