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Lord Graham of Edmonton: My Lords, my noble friend Lord Williams of Elvel has asked me to say that he does not wish to oppose the orders and that he recognises the manner in which the Minister has been fair enough to indicate that the orders are to put right matters which ought perhaps to have been taken care of at an earlier stage. That is understood and accepted.

Perhaps the Minister can help me on two points. He referred to the global, almost amorphous, nature of the bodies covered. He then went through a list of other bodies that were perhaps waiting in the pipeline. I take it that that was an exhaustive list of all the other comparable bodies that would receive comparable treatment. I should be glad to know whether that is the case in order to get an idea of the future legislation.

Looking at the orders and looking at the proceedings in another place, it needs someone who is specialised in understanding these matters. Algebra was not one of my strong suits at school, so that excludes me. Am I right in understanding that the basis, ratification and validity of these matters as being fair have been the product of professional bodies who understand the philosophy of rating and who, in effect, have assisted the Government in producing, in these exceptional circumstances, the basis on which a rate is arrived at?

The last point is this. Just as one deals with rates in a personal capacity, there is an appeals procedure for objections. Can the Minister help the House very quickly by saying whether, if these orders go through, that will be the end of the matter, or can some elements of the industry or even individuals who may believe that they are advantaged or disadvantaged by the size of the rate which is levied, have recourse to appeal? Industry will want to pay as little as possible and if it does so then the rest of the population will have to pay a little more. Is there a protest or objection mechanism which is easily understood and available? I do not intend to speak again and the Minister need not spend much time giving me a reply tonight. He may feel that a written reply, which would be appreciated by my noble friend Lord Williams, may be the answer.

Viscount Ullswater: My Lords, I shall do my best to seek to answer the questions that the noble Lord, Lord Graham of Edmonton, has put to me. First, I explained during the course of my remarks that some of the industries I mentioned will be conventionally assessed for the first time in 1995. We are dealing with public sector or ex-public sector industries. Others will have to remain in the prescribed assessment. These are the electricity supply companies, the water supply companies, British Gas and the national rail network including London Underground. They are bodies which I do not believe I mentioned. Also included are the larger ports.

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Industries moving towards conventional assessment in 1995 which were the subject of previous orders, are telecommunications, canals, Tyne and Wear Metro, the Docklands Light Railway and the medium-sized ports. Therefore, the noble Lord is quite right in that we are moving from the prescribed assessment to what one might call the more conventional form of assessment over a period of time. I indicated that there were some problems with the valuation of these large industries and that we would need to make a progression.

The noble Lord then asked me whether the Government had professional assistance in arriving at the valuations. It is done with the Valuation Office Agency and also with the Scottish Assessors' Association. I believe that gives the professional side of it. I have to say that it is done in agreement with the parties so that there is some consultation with them.

The noble Lord then asked me whether there was some form of appeal and objection to the assessments made. The answer to that is no. There is no appeal available to these industries once the matter has been set by Parliament. As I said before, there is the opportunity to discuss the rateable value with the department. As I indicated, that is done with the agreement of the parties. These orders are brought forward with their agreement. In that instance there is not the requirement for an appeal mechanism. All other industries which are not on the prescribed list procedure have a right of appeal, but in this particular instance they do not.

On Question, Motion agreed to.

Railtrack PLC (Rateable Values) (Scotland) Order 1995

8.25 p.m.

Viscount Ullswater: My Lords, I beg to move.

Moved, That the draft order laid before the House on 8th March be approved [13th Report from the Joint Committee]. —(Viscount Ullswater.)

On Question, Motion agreed to.

British Railways Board (Rateable Values) (Scotland) Order 1995

Viscount Ullswater: My Lords, I beg to move.

Moved, That the draft order laid before the House on 8th March be approved [13th Report from the Joint Committee]. —(Viscount Ullswater.)

On Question, Motion agreed to.

Non-Domestic Rating (Chargeable Amounts) (Amendment) Regulations 1995

Viscount Ullswater: My Lords, I beg to move.

Moved, That the draft regulations laid before the House on 21st March be approved [14th Report from the Joint Committee].—(Viscount Ullswater.)

On Question, Motion agreed to.

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Lord Lucas: My Lords, I beg to move that the House do now adjourn during pleasure until 8.30 p.m.

Moved accordingly, and, on Question, Motion agreed to.

[The sitting was suspended from 8.26 to 8.30 p.m.]

Health Authorities Bill

House again in Committee.

Clause 2 [Related amendments]:

Lord Prys-Davies moved Amendment No. 12:

Page 2, line 19, at end insert ("; and—
(c) the Special Health Authority for Wales.").

The noble Lord said: In moving Amendment No. 12, I should like to speak also to Amendment No. 32. Both amendments stand in my name and in those of my noble friends Lady Jay and Lord Carter. The aim of the two amendments is to guarantee the continued existence of the Welsh Health Common Services Authority, as we know it. That is the authority which provides specialist services, often of considerable complexity, and requiring specialised equipment, highly qualified staff and economic operation throughout Wales.

The authority currently employs about 1,750 people. It has been tested in the hot fires of experience and it has passed the test with flying colours. Perhaps I may mention some of its successes. In 1992-93, 93 per cent. of artificial limbs were delivered early or on time. Indeed, the Artificial Limbs and Appliances Service was recently awarded a Chartermark by John Major. The authority checks about 33.7 million prescriptions per annum, with a value of £244 million per annum, and has achieved a high level of accuracy. Then there is Breast Test Screening, a service nearly of life and death significance. That is on course to achieve a 25 per cent. reduction in mortality by the year 2000. The authority's Estate Care Group has received many awards. Its design group is recognised as the leading hospital design unit in the UK. Furthermore, its procurement group, which was formed only recently on the reorganisation of supply functions in Wales, is doing well.

Therefore, it is fair to say that by common consent the authority's record has been good. However, I am sorry to say that the present Secretary of State for Wales, without the benefit of any independent investigation of the facts, is now intent on "untying"—that is the Welsh Office's word for the old word "destruction"—the services and that bank of skills, practical knowledge and experience which the authority has in abundance. The Secretary of State is intent on "untying" the organisation by April 1997. That radical departure in policy is the cause of worry in Wales as the potential damage is enormous.

I would not dream of wearying the Committee this evening by going through Amendment No. 32 line by line although my colleagues and I would be delighted to deal with each provision with the Minister if the Welsh Office were to say in reply to the debate that it is prepared to reconsider its decision. I must acknowledge that paragraph (d) implies the merger of the organisation with Health Promotion Wales.

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The Welsh Health Common Services Authority owes its genesis to the NHS reforms of 1974. In fact, it was the creation of the noble Lord, Lord Thomas of Gwydir, when he was Secretary of State for Wales. Since then, there have been five Secretaries of State for Wales, four of whom have been Conservatives. From time to time since 1974, each Secretary of State has enhanced the role of that special authority. However, as I said earlier, the present Secretary of State has taken up a very different position.

In April of last year, the Secretary of State announced that three clinical services managed by the authority; namely, Artificial Limb Service, Breast Test Wales and National Blood Transfusion, would be moved (in his words)

    "closer to the mainstream NHS"

as if the authority was far removed from the NHS. In fact, it is an integral part of the NHS in Wales. As for the remaining services, in a speech in the other place in June of last year, the Secretary of State announced—pretty arrogantly, many of us thought—that the staff were to take themselves into the private sector where they can compete against others. Since then he has imposed a recruitment freeze on the authority's administrative and clerical services. The Secretary of State can do that without the authority of Parliament.

There are at least three substantial grounds for concern about the Secretary of State's decision. The first is the fact that the special health authority is to be virtually disbanded without any evidence that that is necessary or that better standards of provision will be achieved. Surely a change of that order of magnitude ought to be soundly justified. We have been looking in vain for a justification.

The second ground for concern is the speed with which the decision has been taken and is being implemented when there is no need for urgency. There is no need for it to be given priority. In a letter from the Welsh Office dated 24th January this year, which is signed by a senior civil servant, Mr. R. C. Williams, the head of the Health Services Division of the Welsh Office, there is clear evidence that the decision has been rushed. In paragraph 2 of his letter, Mr. Williams states that the implications of the transfer of those major services from the special authority have been evaluated:

    "So far as was practicable in the time available, the options, criteria and weightings were tested with relevant interests in the field".

We are disturbed by that sentence. What is suggested is that there has been a model, or an hypothesis, which has been tested properly by known methods for undertaking that process, but nowhere in that letter, or in any other letter, are we told what were the criteria and the weightings.

Moreover, the pattern and context of the consultation have not been disclosed. Thus, we do not know whether the "relevant interests" include the people who are dependent upon the services or donors to the blood transfusion service. Indeed, I have been told that the testing amounted to little more than that certain ideas about how the services might be organised were put to a selected few who went along with the ideas.

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The fact remains that the so-called testing was limited "so far as was practicable in the time available". I want to pay tribute to Mr. Williams the author of that letter, for his integrity. He has at least brought his reservation to the surface. I wonder whether I might ask the Minister to place in the Library, before Report, full particulars of the options that were tested; the criteria which were applied; and the weightings that were calculated. May we have the names of the parties who were consulted? In what capacity they were consulted? Over what period of time were they consulted? With that information to hand, we can ask more questions and be satisfied whether justice has been done or denied. Or are we in Parliament asking too much of a department in requesting that that information be deposited in the Library?

Paragraphs 5, 6 and 7 of the letter of 24th January deal inadequately with the funding and management of these essential services which are to be transferred to the private sector or which are to be decentralised. The first sentence of paragraph 5 refers to the funds that are "being repatriated". That is a pretty novel use of the word "repatriated" in this context, because those services have not been performed at a local level; they have been centralised at the Welsh level.

The implicit risks emerge in the second sentence. There may be a flaw in the English here but I have checked it and it reads:

    "The intention is to maintain steady state and avoid destabilisation of these services as new management arrangements come into force".

Then in the third sentence we are told that the funding is to be ring-fenced for 1995-96 and 1996-97. We stress that if the continuity of those services is considered by the Welsh Office to be important—it is important—then expenditure on them should not be liable to local discretion at the end of 1996-97. Surely the ring-fencing should stretch far beyond 1996-97.

Finally, Mr. Williams speaks of the need for authorities to adopt consortium or lead purchaser arrangements for the artificial limb service as it is, in Mr. Williams's words, "a complex operation".

I come to the third point of our serious disquiet. Just as one feels that inadequate attention has been paid to patients and potential patients, so one feels also that the staff of the special authority are being treated as if they were objects to be moved about like puppets on a string at the whim of the Secretary of State for Wales. I can assure the Committee that there is immense uncertainty among the 1,750 people employed by the special authority. There will be redundancies. There may be early retirements. For married staff, there is concern also about the position of their families: 12 months from now will they be in work or unemployed? Will they be able to live in or about Cardiff or will they have to move elsewhere in Wales? If they have to move elsewhere in Wales, will they be able to sell their homes? Will that upset the children's education? Do those considerations matter to the Secretary of State?

In our view, it is inexcusable for the Secretary of State to have refused to meet a deputation from UNISON, whose members will be directly affected by the Minister's decision. Can that decision be

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reconsidered? It appears to us that the present Welsh Secretary's prime objective in his dealings with the Welsh health service is merely to encourage competition. It is our submission that his goals are much too narrow, and prohibit us from thinking in a creative way towards a better health system for Wales. I beg to move.

8.45 p.m.

Lord Elis-Thomas: I support the noble Lord, Lord Prys-Davies. He did not spell out his credentials for speaking on the amendment. I remember him, of course, as a leading member of the old Welsh Hospital Board before reorganisation in 1974. I instanced that because it is important to emphasise that the need for an all-Wales structure in health service provision dates back to those days. A regional health authority was not created for Wales; the Welsh Office carried out that function and in order to do so it had to establish specialist agencies which delivered those services on an all-Wales basis.

That is what our debate tonight is really all about: whether we should have a special health authority covering those specialist services, which were mentioned in detail by the noble Lord, or whether we should entrust the delivery of those services to patients and the users of health services in Wales to the market testing proposals announced by the Secretary of State, to the transfer of clinical services to the so-called mainstream NHS services, and to the market testing of non-clinical services.

It seems that the Government are not clear about the health service objectives of their proposals. In Committee in another place the Minister, Mr. Rod Richards, emphasised that when the market testing exercise had been completed the department would be able to form a view on the functions that still needed to be carried out at the all-Wales level.

That is a complete reversal of how one should approach the whole question of the delivery of services. If we have a way of operating the specialist services which are already functioning effectively on an all-Wales level, to market test, and then, as it were, look for residual services that need to be provided at that level demonstrates a failure to understand the complexity of health service delivery, particularly in an area such as Wales.

I am concerned also about two other aspects of the proposals. A detail has been drawn to my attention by the trade union (UNISON) which is involved with the authority and by certain GPs; namely, the linguistic implications of the changes. At the moment, it is possible for a family practitioner to write a prescription in the Welsh language if the local pharmacist can take that prescription, and to know that there are arrangements within the present prescription pricing mechanism which enable that to be dealt with. If that service were to be contractorised, it is not clear whether that would still be the case. Within the terms of the Welsh Language Act, with which I have a certain affiliation, it seems clear that if the policy is to be fulfilled it is essential that that should still be the case. If contractorisation removes that service outside Wales,

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it may well be difficult for that need to be met. That is a specific service which is currently available. I should like the department's view, either directly from the Minister or later from the Welsh Office.

There is another aspect which concerns me; namely, the role of the Health Promotion Authority for Wales. The authority has had a long record of partial success in tackling very difficult issues of national ill-health within the Principality. I speak as someone who was an admirer of the earlier initiatives of Sir John Catford, who is obviously no longer in favour with the Government. Heartbeat Wales and other initiatives affected the lifestyles of people within Wales and certainly affected the high level of heart disease risk as a result of diet, lack of exercise and lifestyle which was unfortunately part of our historical baggage.

My concern is that although health promotion is being transferred to DHAs which have a health promotion role, that role will reduce the national profile of health promotion. I believe that Heartbeat Wales and the Health Promotion Authority for Wales initiatives were able to provide an all-Wales profile as regards lifestyle issues relating to preventive health care. For all those reasons, together with those set out by the noble Lord, Lord Prys-Davies, I believe that the present proposals of the Welsh Office are a step backwards. I do not see the healthcare justification for the proposals and, as the noble Lord said, the communications from the department indicate an internal tension among the department's officials who care about the delivery of services and who have a long record of delivering the services under different governments and Secretaries of State, which may be more relevant in this discussion. In the official communications, one can detect an ambiguity and a tension.

Therefore, I hope that the Government and the Welsh Office will take a further look at the matter. If they cannot meet our request for special treatment for the national agencies which already exist, at least they should ensure that there will be no reduction in the level either of health promotion for health protection or the delivery of those services which have been made available previously on a national level for all parts of Wales.

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