Draft National Health Service (Wales) Bill

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The Chairman: Order. Adam Price.

Adam Price: I do not want to test your patience further, Mr. Griffiths. It has already been severely tested by hon. Members during this debate. The issue of resources for the Wales Centre for Health and Health Professions Wales has been raised by some of the unions of the health professions, which have asked, for example, whether there will be additional resources to fund the new bodies. That is an important issue. Putting aside the usual, rumbustious debates that we have in the Committee, the Barnett squeeze is as much an issue for Opposition Members as for Labour Members and I hope that we shall be able to have a mature and serious debate about how the Barnett squeeze is impeding our ability to deliver the health outcomes that we all want.

5.40 pm

The Parliamentary Under-Secretary of State for Wales (Mr. Don Touhig): We have had a very good debate. I pay tribute to my hon. Friend the Member for Clwyd, South, Chair of the Welsh Affairs Committee, and his colleagues on the Committee for their work in producing the report that we are considering today. As my right hon. Friend the Secretary of State said when he opened today's debate, this pre-legislative scrutiny is a new process, which we welcome. We have a green light from the Prime Minister and it will probably continue.

The Government consulted widely on the draft Bill. Indeed, 89 organisations and individuals were consulted and we received responses from 12, including local authorities, health professions, community health councils and individuals. We also received an e-mail from Mr. Liu Lei who runs a company in China and offered to sell us an excellent forging hammer.

The draft National Health Service (Wales) Bill originates from our ambition to improve health in Wales. Much of it goes back to the ''Better Health Better Wales'' document that was produced by the Welsh Office. Following that, my right hon. Friend the First Minister and Jane Hutt, the Minister for Health and Social Services, launched a document entitled ''Improving Health in Wales'' in February, which followed in the path of our building blocks.

At the outset, we had an ambitious list of things that we wanted to include in legislation and we were able to accommodate two items in the National Health Service Reform and Health Care Professions Act 2002 and particularly two sections that allow us to create local health boards and require local health and well-being strategies to be put in place. They were time

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sensitive and it was important that the Assembly had decided to abolish health authorities and we were able to do that on time. That is an important tool in working towards the reform agenda that we want for the health service in Wales, with the Government and the Assembly working in partnership. In addition, we had a list of things that we wanted to include in earlier legislation, particularly reform of community health councils and the establishment of the Wales Centre for Health and Health Professions Wales. The draft Bill includes those three remaining elements, so we shall continue the reform process.

The need to reform and strengthen community health councils has been on the agenda in Wales for some time. Hon. Members referred to that earlier today and particularly to work carried out by the patient advisory and support working group, which suggested that there was strong support for community health councils in Wales and for strengthening their role and remit. The Welsh Affairs Committee has been helpful in following that through and giving us its comments and advice.

We propose to make community health councils in Wales an essential element in our wider strategy for involving the public in health service planning and delivery and, as hon. Members have said, of listening to their views and concerns. Many community health councils are close to their local communities and already do much good work in representing them. We want to build on that by giving them new powers and making them even more visible and able to act on behalf of their communities.

The independence that community health councils rightly cherish will be maintained, but we shall also put in place mechanisms to ensure that they deliver the same standards to their communities, wherever they are in Wales. The establishment of the Wales Centre for Health originated from the document ''Better Health Better Wales'', which was produced by the Welsh Office in 1998. The centre forms part of the new structures that will take forward the aims of the Government and the Assembly for improving health and well-being and reducing health inequalities in Wales. It will strengthen public health capability and capacity in Wales.

As the Welsh Affairs Committee recognised, its independence is crucial and its role in advising the Assembly, as well as agencies, voluntary organisations and the public, will be greatly valued. It will work with academics and public sector expertise, support training and encourage collaboration between different sectors and professional disciplines.

The creation of a body to replace the former Welsh National Board for Nursing and Midwifery was a commitment given my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) when he was Secretary of State for Health in the days of the first Labour Government in 1997. Health Professions Wales will perform the functions of the WNB that have not been transferred to the new UK-wide body. That will assist in the ongoing development of a work force that will have the appropriate skills and

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knowledge to deliver a safe and effective service in all parts of Wales. It will also work in partnership with the Care Council for Wales to ensure that there is co-operation and co-ordination on skill requirements where professional groups work across boundaries.

The pre-legislative scrutiny process has been useful, and we are considering all the responses and comments that we have had from a range of organisations and individuals including, of course, the report by the Welsh Affairs Committee, and the debate has been very useful.

If I may, I shall respond to comments made by Members in today's debate. I pay tribute to my hon. Friend the Member for Clwyd, South because he has made an important contribution. His speech at the start of today's debate set the scene for our deliberations, and he took us through the list of individuals and organisations that gave evidence to the Committee. Having touched on a number of the Committee's recommendations, he said that the draft Bill would ensure that patients were in control, which is the objective of the Government and the Assembly for reforms to the health service. He also took the view that draft Bills should be produced like Green Papers with combined objectives and explanatory notes, which is obviously something that we can consider because I emphasise that the pre-legislative scrutiny of draft Bills is a new process. We are gaining experience all the time and the deliberations that we have had in recent weeks will inform our decisions on where we take the Bill in future.

The Welsh Affairs Committee made 22 recommendations, some of which I shall touch on in a moment, including ones made by my hon. Friend on NHS staff taking time off to carry out duties on CHCs.

The hon. Member for Caernarfon welcomed the opportunity to consider legislation in draft form. He expressed his hope that that would be the pattern for the future and spent most of the rest of his time talking about matters totally unrelated to the draft legislation. I do not want to suggest that the matters about which he spoke are unimportant—waiting lists are a very important issue and waiting list figures have been broadly disappointing. However, I have to tell him that the Government—we are working in partnership with our colleagues in the National Assembly—are seeking to put right 18 years of under-investment during which we saw massive cuts in doctors, nurses and hospital beds. I remind him that although he was not here his party was in the House of Commons at that time and sustained the then Tory Government and helped to keep them in office for longer than they should have been.

However, I fully concur with the hon. Gentleman's remarks on NHS staff, whom he praised, because they do a marvellous job. I also share the welcome that he gave to extra spending on the NHS. He was worried about further structural changes that the health service will undergo as a result of the passage of the National Health Service Reform and Health Care Professions Act 2002. I can tell him that the Act will create 22 local health boards, which will replace the 22 existing local health groups. The 15 health trusts that already exist

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will continue to do so, and the proposed 12 partnerships covered in the arrangement in the Bill will employ no staff, have no offices and only affect existing relationships. I had better not stray too far or you will pull me back, Mr. Griffiths, to talk about matters relating to the draft National Health Service (Wales) Bill.

Finally, the hon. Gentleman raised an issue concerning the use of the Welsh language. I share his concern and can tell him that I have asked lawyers to discuss with parliamentary counsel whether it would be appropriate to bring health professions in Wales in line with the other two provisions in the Bill by making express reference to the Welsh Language Act 1993. We shall reflect on his comments on that matter.

My hon. Friend the Member for Gower said that he would have liked more time to consider the draft Bill, and I hope that that can be accommodated if we bring through future legislation. He and others, including my hon. Friend the Member for Cardiff, Central and the hon. Members for East Carmarthen and Dinefwr (Adam Price), for Meirionnydd Nant Conwy (Mr. Llwyd)—he did not make a contribution on that—and for Montgomeryshire (Lembit Öpik) all referred to the coterminosity issue, which clearly divides leading Members of Plaid Cymru, as we have just witnessed. CHCs are largely coterminous and my colleague Jane Hutt, the Assembly Minister with responsibility for health, takes the view that she does not wish to make further changes on the coterminosity issue. I will consult with her when we prepare for the Bill and will ensure that the points that have been made in the debate will form part of our discussion when we consider whether we can do anything else.

My hon. Friend the Member for Gower spoke about extending the role of CHCs, which was also touched on by the hon. Member for East Carmarthen and Dinefwr. Broadly speaking, I am satisfied with the proposals in the draft legislation, but I shall certainly take on board the points in the report and have further wide-ranging discussions before reaching any final conclusions.

My hon. Friend the Member for Gower spoke about the role of the Association of Welsh Community Health Councils. I should make it clear that its role will be supportive and regulatory. It will move from being a support organisation for CHCs to one with a line management role for CHC chief officers. My colleague the Assembly Minister for Health and Social Services is already consulting on those proposals.

The hon. Member for Montgomeryshire said that a great majority of the national health service performed well, but the Bill offered an opportunity to make improvements. I certainly agree with that. He welcomed the evolution of CHCs as proposed in the Bill.

My hon. Friend the Member for Cardiff, North made a considered contribution. Her knowledge and experience of CHCs and children's issues in particular was much in evidence in her remarks. She said that the Bill was short. She is right, but elements of our overall reform package have already been dealt with in the

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National Health Service Reform and Health Care Professions Act 2002.

The hon. Member for Ribble Valley said that this was a historic day as far as pre-legislative scrutiny is concerned, and he was absolutely right. He also explained how Members in another place were more fully involved in pre-legislative scrutiny. We will take that insight on board. The Secretary of State is meeting Members in the other place later this evening, and I am sure that the matter will be discussed. We will consider how that can be improved in the future.

The hon. Member for Ribble Valley and my hon. Friend the Member for Vale of Clwyd (Chris Ruane) mentioned the importance of sharing best practice throughout the United Kingdom. I agree that that is important. Any form of audit or inspection that we eventually carry out must take account of the differences across the UK so that best practice can be taken on board.

My hon. Friend the Member for Vale of Clwyd also raised the issue of costs, particularly of local health boards, which were dealt with in a previous Bill. To help members of the Committee, I shall give some indication of the cost forecast for the changes. Currently, £1.8 million is spent on delivery of CHC services. It is estimated that a further £660,000 will be needed as a result of the changes and restructuring. Of that £660,000, about £480,000 will go on the new advocacy responsibilities, which we all welcome, bringing the total spend to about £2.46 million.

Health Professions Wales will cost about £1.5 million, but that money will come from a budget that is already used by the WNB and that will be transferred to the Assembly, which is temporarily carrying out the responsibility. It will feed through to Health Professions Wales. We guesstimate that the cost of the Wales Centre for Health will be about £600,000, which will come from existing resources that the Assembly has already taken into account.

My hon. Friend mentioned a newspaper article in which a surgeon was quoted on problems in the health service. I entirely agree that there are difficulties, and it is right that we listen to those who work at the coal face. However, many surgeons would make a greater contribution to the health service if they spent more time working in it and less time in private practice. Members of all parties share that view.

My hon. Friend the Member for Cardiff, Central welcomed the greater scrutiny role for CHCs, and I believe that that is good. His very good example of why it is necessary was about a whistleblower in his constituency who has apparently suffered discrimination. I hope that the enhanced powers that CHCs will be given will help overcome such difficulties.

My hon. Friend the Member for Cardiff, West (Kevin Brennan) spoke about the value of pre-legislative scrutiny and made an interesting proposal for a Special Standing Committee, which we might consider in future. The hon. Member for Brecon and Radnorshire spoke warmly about the pre-legislative

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scrutiny process. I thank him for his comments. Indeed, I thank the leaders of all the Opposition parties. We had discussions with them about the process before we undertook it and have had great support from all parties. The hon. Gentleman also felt that we should allow the National Assembly and local people to have more of a say. The legislation will help with that. He referred to the need for CHC members to receive appropriate training, and I agree with him.

I am conscious of the time, Mr. Griffiths. My hon. Friend the Member for Vale of Clwyd paid tribute to the work of the Chairman and members of the Select Committee. My hon. Friend the Member for Caerphilly spoke of the constitutional significance of such pre-legislative scrutiny but reminded us that, in partnership with Assembly colleagues, this place has a very important role to play in respect of legislation. My hon. Friend the Member for Ogmore referred to the pre-legislative process and recognised that such draft legislation was valuable.

My hon. Friend the Member for Monmouth (Mr. Edwards) spoke about his professional background in the national health service and the particular insights that that had given him. The hon. Member for East Carmarthen and Dinefwr said that he should have liked to see a proposal in the draft Bill for a separate Welsh audit body. Discussions are taking place between the Wales Office, the National Assembly and the Department of Health on how to establish an audit of the health service in Wales and the rest of the United Kingdom.

I should like to touch on a few more points in the Bill and on comments from hon. Members. The eleventh recommendation requested

    ''publication in the Bill of provisions on the obligations of providers of health services to supply information to CHCs.''

We recognise that not including those was an oversight, and they will be included in the Bill. In the tenth recommendation, the Committee requested a clear explanation of

    ''paragraph (3) of Schedule 7A, and in particular . . . sub-paragraphs (g) and (h)''.

We will ensure that our position is explained more closely and clearly in the final explanatory notes accompanying the Bill.

In its twentieth recommendation, the Committee suggested that a redrafting of clause 4(1) would ensure that functions were not conferred on Health Professions Wales by direction. We accept that. My colleague, Jane Hutt, the Assembly Minister

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responsible, made it clear that the Assembly would go through a process of full consultation and not direction.

The seventh recommendation is to allow CHC members statutory time off to work for their public duties. We do not consider that the Bill would be the appropriate vehicle for that measure because it would create an offence with criminal connotations, in a health Bill. However, I support the Committee's view, and I shall write to my colleagues in Government to see what can be done to change legislation.

The report makes no recommendations on smoking, but evidence on the subject came up in the Committee's findings. We do not consider that the Bill is appropriate for providing rules on smoking in public places, but we take such comments on board. Any rules will be a matter for wider legislation.

It may help if I say that I shall respond more widely, with the Secretary of State, after we have considered all comments from various organisations and individuals. The majority of the comments from the Committee's evidence will receive considerable deliberation. It would not be appropriate for me to be over-specific in giving a response now because I do not want to pre-judge anyone else's comments; all remarks should be considered in the round.

The Government have valued the experience that the draft Bill has provided. It is the first time that I have been involved as a Minister, or even as Member of the House, in pre-legislative scrutiny. The process will help to produce an effective Bill. When I was an Opposition Member, I introduced a whistleblowers Bill, the Public Interest Disclosure Bill, which was killed off by the Conservative party. I wonder whether that would have benefited from wider scrutiny if it had been available at the time. I hope to embrace the new process as a way of looking ahead to legislation, because when hon. Members from all parties have an opportunity to scrutinise legislation the Executive can produce better Bills.

I am most grateful for the work done by the Welsh Affairs Committee and to colleagues who have taken part in today's discussion. We have made a major contribution to a good piece of legislation, which I hope will be introduced in the next Session. It will benefit Wales, its people and its health service.

Question put and agreed to.


    That the Committee has considered the matter of the draft National Health Service (Wales) Bill.

Committee rose at Six o'clock.

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The following Members attended the Committee:
Griffiths, Mr. Win (Chairman)
Ainger, Mr.
Anderson, Donald
Brennan, Kevin
Caton, Mr.
David, Mr.
Edwards, Mr.
Evans, Mr.
Francis, Dr.
Hanson, Mr.
Irranca-Davies, Huw
Jones, Mr. Jon Owen
Jones, Mr. Martyn

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Llwyd, Mr.
Lucas, Ian
Morgan, Julie
Murphy, Mr. Paul
Owen, Albert
Price, Adam
Ruane, Chris
Tami, Mark
Thomas, Gareth
Touhig, Mr.
Williams, Hywel
Williams, Mr. Roger

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