Draft National Health Service (Wales) Bill

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Julie Morgan (Cardiff, North): Thank you for calling me to speak, Mr. Griffiths. I am a member of the Welsh Affairs Committee. Its Chairman and my hon. Friend the Member for Gower have detailed most of its recommendations, and I shall not repeat them. The process was a valuable way of considering draft legislation. The Bill is short and is not very contentious. That meant that there were no fiery discussions. However, it was an important way of carefully examining how the health service would work in Wales.

Some of us sat in on a sitting of the Health and Social Services Committee of the Assembly, which I found an interesting experience. Although we could not contribute, it was the first time that I had seen how Assembly Committees work. The hon. Member for Meirionnydd Nant Conwy (Mr. Llwyd) has left the Room, but it was interesting to hear his party passionately argue for coterminosity for community health council boundaries, which he obviously—[Interruption.] There was no consultation, shall we say.

It was also interesting to watch all parties attempt to include in the Bill other aspects of health promotion that we all passionately support. It has not been possible to include those wider-ranging issues, as they do not fall under the scope of the Bill, which we wanted to succeed. It was therefore not possible to include some causes about which I am sure that hon. Members from all parties on the Welsh Affairs Committee agreed, especially the smoking issue.

It has been an interesting process, and it is probably the way in which to approach the matter. The Grand Committee is too big for the sort of discussions that we were able to have on the smaller Welsh Affairs Committee, where party issues sink into the background and we try to work as a group, which would produce better legislation. I hope that that is an example of what will happen a lot in future.

I shall focus my remarks on CHCs as they are the main point of the Bill, although the other two bodies that it will create are important. The Assembly's regulation of health support workers is an important step forward. As my hon. Friend the Member for Gower said, some concern was expressed about Wales leading the way in the matter and about whether there would be a code of conduct, but we generally felt that it would be good for Wales to lead the way. Involving health support workers is important. The Wales Centre for Health is a good aspect to which our proposals to ensure its independence would add.

The meat of the Bill relates to how CHCs develop. We have talked a lot about divergence, and it is good that Wales has looked at what the people want and has kept CHCs. Devolution means going different ways in different parts of the UK. The fact that Wales recognised public feeling on the importance of CHCs means that the proposals have been universally

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welcomed, certainly by all those who gave evidence to us. We did not hear a dissenting voice over keeping and strengthening the CHCs. It was good to be in on that debate.

I have had good experience of the community health council in Cardiff, which has provided an advocacy service. I have been personally involved in a number of the cases that it has taken up. My constituency contains the University of Wales hospital, Velindre hospital and Whitchurch hospital, so has a huge concentration of health resources. I have been very involved in many health issues. The hon. Member for Caernarfon mentioned the buildings in which some of our services are provided, and I too have such buildings in my constituency. Whitchurch hospital is a very old, Victorian building and, basically, not fit for people with mental health problems to stay in.

We are tackling such issues through the health service in Wales, but it is very important that bodies such as CHCs are strengthened and that their representatives can go into buildings such as Whitchurch and say strongly that the conditions are not fit. There are parts of Whitchurch hospital about which the staff and management have enormous concerns. We are moving towards building a new mental health facility in Whitchurch to replace that hospital. It is in such matters that I see CHCs playing a very strong role—looking at that sort of accommodation and making their views strongly known.

The importance of the advocacy service provided by CHCs is that, in many cases, it will speak for the most vulnerable patients who use the health service. There is no doubt in my mind that those vulnerable people include the mentally ill and those suffering mental health problems. I am very concerned that that aspect of advocacy is not lost.

Mr. Evans: I think that everyone knows that some 47 per cent. of NHS premises in Wales are deficient in some way, shape or form. Does the hon. Lady envisage giving the CHCs extra powers so that instead of only saying that properties are less good than they should be, they perhaps have the power to direct money towards improving the facilities available?

Julie Morgan: No; I see the CHCs as having the power to highlight the conditions that people are living in and in that way to put pressure on the authorities to change those conditions. They have done that in several cases. As I said, there is a plan for a new 200-bed hospital in my constituency to replace the accommodation in poor condition at Whitchurch hospital. The visits that receive publicity that CHCs make to see how the health service is operating are very important, as is the fact that they are sometimes unannounced. We all know, as many Members have said today, that health service workers do a good job and work hard, but circumstances mean that there are inevitably things that are not right. That is inevitable in any system. CHCs play an important role in highlighting that.

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It is important that CHCs use existing expertise to work with mentally ill patients, for example, and that their advocacy services are carried out in close conjunction with the bodies that have that expertise.

Mr. Edwards: My hon. Friend will recall visiting women in prison in Gloucestershire. An issue raised during that visit, to which my hon. Friend the Member for Gower alluded, was the mental health problems suffered by many prisoners. Would she welcome a widening of community health councils' remit so that they could act as advocates on behalf of such women prisoners outside Wales?

Julie Morgan: Our Committee discussed widening CHCs' remit, and I believe that we enabled that to happen without saying that it was something that CHCs must do at the moment—CHCs were concerned about taking on too much with too limited resources. It is possible for their remit to be widened in future if the recommendations of the Welsh Affairs Committee are taken on board without being returned to Westminster for further legislation, as is enshrined in the Committee's recommendations.

It is important that women such as those to whom my hon. Friend has referred have access to CHCs, which should look at people who are in prison. The point has been made about prisoners many times today because there is a good deal of concern about the health service in prisons and in particular, as my hon. Friend the Member for Gower mentioned, the psychiatric service. The psychiatric service is desperately needed in prison because a large percentage of people who are committed to prison have psychiatric problems, and we must recognise that. When we conducted the young offenders inquiry and visited young offenders from Wales who were living in prisons outside Wales, the staff told us that one of their greatest frustrations was not being able to access skilled psychiatric help in order to help young people in their care, which is very important.

Mr. Simon Thomas: I agree with the hon. Lady's point, but surely the difficulty is the artificial organisation of the prison health service and the need for all prisoners with psychiatric problems to come directly under the NHS without any separation. Is it not the case that most prisoners currently get a second-class health service? We need to bring the health service directly into prisons and allow the CHCs to follow that.

Julie Morgan: Yes, that is an important point.

Psychiatric services form one of the big issues. It is certainly difficult to get psychiatric care in the community for adolescents because not many psychiatrists work in that field, and it is even more difficult in the Prison Service. There is a huge opportunity for the CHCs to work with experts in the mental health service, and they should be able to make a difference with their extended remit.

The other group that it is important to mention is children. There is no doubt that to act as an advocate for a child one has to have expert knowledge and training relating to children. One mistake that many of us have probably made as constituency MPs is to question a child and expect them to respond. In taking

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on issues involving children, one has to know ways in which to get a child to respond. Much work has been done on art with children, playing with children or taking children out and working with them in order for them to express their deep feelings about something that may have happened to them in the health system. It is important that the CHCs work very closely with children's advocacy services, which will have worked for many years on communicating with children and the presentation of services.

It is therefore good that the advocacy service of the CHCs will, as a result of the Bill and the recommendations of the Welsh Affairs Committee, this Committee and the Assembly, provide a more uniform service throughout Wales. At the moment advocacy services are patchy. In Cardiff, for example,

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we have been able to use the advocacy service, and in the north some local authorities pay for an advocacy worker to be attached to the CHCs, but as a whole one cannot guarantee that the CHCs will provide an advocacy service. It will be possible to improve the service that the CHCs give, and advocacy is one of the most important roles that they will deliver.

Several hon. Members rose—

The Chairman: Order. It would not be fair for me to call another Member to speak because there is less than one minute left. If we need an extra minute at 6 o'clock, I will provide it.

It being One o'clock, The Chairman adjourned the Committee without Question put, pursuant to the Standing Order.

Adjourned till this day at Four o'clock.

The following Members attended the Committee:
Griffiths, Mr. Win (Chairman)
Ainger, Mr.
Brennan, Kevin
Caton, Mr.
Clwyd, Ann
David, Mr.
Davies, Denzil
Edwards, Mr.
Evans, Mr.
Flynn, Paul
Francis, Dr.
Havard, Mr.
Howarth, Alan
Irranca-Davies, Huw
Jones, Mr. Jon Owen
Jones, Mr. Martyn
Lawrence, Mrs.
Llwyd, Mr.
Lucas, Ian
Morgan, Julie
Murphy, Mr. Paul
O¨pik, Lembit
Owen, Albert
Price, Adam
Ruane, Chris
Tami, Mark
Thomas, Gareth
Thomas, Mr. Simon
Touhig, Mr.
Williams, Hywel
Williams, Mr. Roger

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Prepared 16 July 2002