Draft National Health Service (Wales) Bill

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Mr. Roger Williams (Brecon and Radnorshire): I, too, believe that the pre-legislative scrutiny is a beneficial part of the legislative process. One of the Committees that I first sat on when I came to the House scrutinised the Animal Health Bill, which had certainly not benefited from pre-legislative scrutiny. If some of its worst excesses had been identified at an early stage and modified, or eliminated altogether, parts of that Bill that could prove very beneficial to the agricultural industry—and Wales—would now be in force, and would be able to ensure that outbreaks such as foot and mouth would be less likely to threaten rural industries. An element of that Bill referred specifically to Wales, and I am sure that the Welsh Affairs Committee could have beneficially considered that as well.

Although pre-legislative scrutiny is a good process, scrutiny of a Bill that refers to a devolved Assembly is tricky in many ways. It involves talking about matters that the Assembly holds very dear. I pay tribute to the Chairman of the Welsh Affairs Committee, the hon. Member for Clwyd, South (Mr. Jones), for so expertly manoeuvring through the maze of tricky decisions, at the end of which the devolved process had been strengthened. The process that we have gone through will help in future cases when pre-legislative scrutiny takes place.

I, too, agree with the setting up of the three bodies proposed in the Bill. I do not think that anyone here has spoken against them. The only reservation that I would have is that the Assembly has to be careful not to produce a duplication of effort or responsibility, but

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that is more to do with the management ability of the Assembly than the legislation that is put in place.

Key to it all are the proposals to retain the CHCs in Wales. I was interested that the hon. Member for Ribble Valley (Mr. Evans) was supportive of that as well. They have undertaken hugely important work in Wales, and in England for that matter. The Bill will build upon that important work, and give them added responsibilities and tasks that will help to ensure that the health of the Welsh nation is improved substantially. It is all part of a process of making the health service in Wales more responsive to local need and more under the control of local people. It was interesting the Plaid Cymru seemed less coterminous about coterminosity than at first. It is important that local health boards and local authorities are conterminous because they are concerned with the delivery of service; it is not so important for CHCs because they are concerned with monitoring and acting as an advocate for patients or groups of patients in a community.

If the Bill is introduced, CHCs will have the power and responsibility to inspect private facilities as well as national health facilities and, for that reason, it has been said that National Health Service (Wales) Bill is not the most appropriate title. That should be considered as the draft Bill proceeds, because it is important and right that the title should incorporate reference to the powers that will be given to CHCs. I welcome the fact that CHCs will be involved in primary health care and dentistry, but it is difficult to know how dentistry will be inspected in areas that I represent where no NHS dentist has practised for several years. That is of great concern. Perhaps the CHCs can do something to highlight that problem and ensure that such facilities be made available in future.

The hon. Member for Ribble Valley made an important point about the role of CHCs in consultation. When the maternity facility of Brecon War Memorial hospital in my constituency was changed from being GP-led to midwife-led, the CHC was allowed to oppose the change only if it could come up with an alternative system for delivering maternity care in the area. I am sure that CHC members and their staff have all sorts of skills, but it should not fall to them to suggest an alternative system for delivering maternity, or any other, health care. They have a right to object to the implications that a decision might have for those living in an area, and to draw them to the attention of those taking the decision.

I am sure that there will be a huge amount of work for those serving on CHCs which will take up a great deal of their time. Some of their time will necessarily be taken up by training. Without the necessary skills to observe, report and reach conclusions, there is little point in staff undertaking work and inspections. Some skills will be present already, and some will need improving and developing.

I, too, should like CHCs to be responsible for health care in prisons and young offender units. However, I should like them also to consider the health care delivered in schools. School dentists,

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doctors and nurses provide an enormous amount of advice and treatment in schools, and unless those are of top quality, children will not have the advantages that they could have, and they may suffer disadvantages.

The hon. Member for Clwyd, South (Mr. Jones) asked whether the Liberal Democrats could support all the recommendations in the Welsh Affairs Committee report. As far as I can ascertain, only one—on page 18—gave the party any difficulty. That recommendation reads:

    ''We recommend that the power which it is proposed to give to NAW''—

the National Assembly for Wales—

    ''to allocate any functions to AWCHC''—

the association of Welsh community health councils—

    ''be constrained by providing that they should be related to its core statutory functions of advice, assistance and support to CHCs.''

A number of people thought that that was rather prescriptive, but the problem lies more in nuance than anything else. If the Assembly were to be restricted to using its core functions, that concern might have substance, but the recommendation is that functions be constrained around the core, so it could easily be sorted out.

It is important that we put in place some of the bricks that will give Wales a responsive health service that is locally controlled and delivered. These are building blocks and there is much more to put in place, but we welcome the draft Bill.

4.45 pm

Chris Ruane (Vale of Clwyd): I start by apologising for my absence at the start of the sitting this morning. I had to take a delegation of 16 young people from the Foyer project in Rhyl around the House. I apologise to you, Mr. Griffiths, and the Committee.

I pay tribute to the Chairman of the Select Committee, my right hon. Friend the Member for Clwyd, South (Mr. Jones)—[Interruption.] Have I let it slip that he feels right and honourable? I pay tribute to his interpersonal skills, especially on the draft Bill. We are on new ground in dealing with the National Assembly for Wales and during the past two or three years he has handled Committee work very well and professionally. He has had to deal with National Assembly civil servants, the First Minister, Kirsty Williams, Chairperson of the Health and Social Services Committee, my right hon. Friend the Secretary of State for Wales and the junior Minister. He has handled that very well to a tight time scale. Tribute should also be paid to the officers supporting the Committee: Tom Healey and David Natzler, the Clerks, and Paul Derrett and Amanda Waller, the officials who look after our visits to Wales. We had some excellent visits to the Assembly. This could be a blueprint for a joint approach to draft Bills affecting Wales, whether they are stand-alone Bills applying specifically to Wales, or clauses that apply to Wales in Bills covering England and Wales.

I draw the Committee's attention to unannounced visits. They are the key to effective CHCs. In Cardiff, we heard evidence from someone involved with CHCs

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about a matter that had been referred to her: a private care home had had no rubber gloves available for two weeks, which posed a danger to those who worked in that care home and to patients. Had a visit been announced, those rubber gloves would have been in place and everything would have been spick and span. That is an excellent example of the necessity for unannounced visits. We should encourage whistleblowers in the private and public sectors. The previous Conservative Government had a down on whistleblowers and saw them as troublemakers. I believe that they should be encouraged and that the information that they provide should be acted on immediately for better health in Wales.

The powers should be extended to prisons, perhaps at a later date. The Select Committee held a short inquiry into young Welsh people in prison and was told that 600 young Welsh people were in prison—300 in Wales and 300 outside Wales—150 of whom were at Ashfield prison in Bristol. Of those in prison, 84 per cent. tested positive for drugs when they went to prison. They have massive health problems and perhaps social problems also. How they are treated outside Wales needs to be monitored carefully to ensure that when they re-integrate into society—hopefully back in Wales—they do so as better people.

In the Select Committee, I asked whether £1.8 million is sufficient to fund the CHCs. The health budget in Wales is currently £3.2 billion and by 2005–06 it will have risen to £5.8 billion. I know that there are other methods of scrutiny and monitoring, but CHCs are important. Is £1.8 million enough to spend on monitoring £5.8 billion? I am aware that the Chairman of the Committee rapped my knuckles and said that the matter did not fall within the Committee's area of responsibility, but it is important to raise it at this stage.

On funding, many members of the Committee felt that the people who sat on the CHCs should come from wider and more varied backgrounds, and that people who were in full-time employment could be debarred from daytime involvement because they would lose out financially. With extra funding we may obtain a wider variety of recruits for the CHCs.

Advocacy is a key role for CHCs, certainly in my constituency. The Clwyd community health council is one of the best CHCs in Wales and has helped me on many occasions during the five years since I was elected in dealing with health issues brought to me as constituency MP. It has helped with both individual and group cases. For example, a number of people from north Wales were receiving treatment at an orthopaedic centre in Rochdale that they felt was effective and from which they were benefiting. The North Wales health authority, however, decided to end that treatment. I contacted the CHCs in Wales and convened a meeting. They gave me their full support in marshalling all the arguments, and those patients were allowed to continue their health care at the orthopaedic centre in Rochdale.

With regard to diversity, it is great that there are health and social services boards in Northern Ireland, patients forums in England, CHCs in Wales and health councils in Scotland. It is a case of vive la

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difference, because those health councils pursue their own agendas for their regions, but it is also important that best practice is swapped between those areas not only on the issue of community health councils but on the issue of health generally in the UK. We often hear the cry of ''Welsh solutions to Welsh problems.'' That is all well and good, but at some point in time there may be an Irish solution to a Welsh problem, a Welsh solution to an Irish problem, or a Scottish solution to a Welsh problem. There is a danger that we may become too insular, too blinkered and too chauvinistic in saying that the only answers that we can find are in Wales. There may be excellent practice outside Wales and there should be a formal mechanism by which best practice from those four countries—and from Europe and around the world—is taken from wherever it occurs and brought home to Wales.

The Wales Centre for Health is an excellent initiative and the dissemination of information should be encouraged. Research is undertaken around the world and we need to make sure that we are on top of it in order to bring home best practice to Wales.

The other issue is the collection of data within Wales. There are areas in Wales in which data used to be collected, but where the practice is now falling by the wayside. All the institutions that deal with health in Wales need to collect data to a very fine degree. Perhaps we could use the example of how North Wales police collect data on crime and disorder. Data is collected on a ward-by-ward basis in 19 brackets under disorder and 10 under crime. I encourage the Wales Centre for Health to operate on similar lines. In fact, data must be broken down not just by wards but by streets and postcodes so that we can plot the patterns of bad and good health in Wales and marshal our resources to best effect in the communities.

All in all, the draft Bill is excellent. I enjoyed serving on the Committee and working with the National Assembly. I hope that the blueprint that we have set out will continue to be followed in future.

4.56 pm

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Prepared 16 July 2002