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Lord Stoddart of Swindon: Although I cannot speak with the same authority and expertise as my noble friend Lord Prys-Davies or the noble Lord, Lord Elis-Thomas, I give them my support as, I suppose, an exiled Welshman. It is shocking that an authority which, as my noble friend pointed out, has given such outstanding service over such a long period of time should be now under threat of destruction within two short years. Surely that cannot be right.

My noble friend mentioned the services which have been administered by that body. There is no need for me to elaborate because he dealt with it so well. However, I know that it is dangerous to interfere with something which has worked so well and so smoothly over such a long period of time. The problem with this Government, not only in relation to the health service but in every other aspect of public life, is that they are market-testing mad. We never really know whether their market-testing

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madness is doing well or doing badly. My guess is that in very many cases it is doing extremely badly indeed. But, with services like these, we really cannot afford to take the risk of market-testing when we know that the present administration has been doing the job well over a period of time.

The present Secretary of State, who represents Wokingham—I live very near there—is an intelligent man. Let us make no mistake about it; he is an extremely intelligent gentleman. I cannot understand why he has embarked on this particular route and why he is ignoring Welsh opinion, particularly bearing in mind the sensitivity of the Welsh people regarding his occupation of the post of Welsh Secretary without having any background in the Principality. One would have thought that he would tread very, very carefully indeed. But no, so far as I can see he is riding roughshod over local opinion. I believe that he will regret that.

As my noble friend pointed out, there has been a lack of consultation in a country where people become very involved and are very concerned about their public services. They do not see them at arm's length. They like to involve themselves in their services because they know, through bitter experience, that it is those services which keep them afloat when times are bad. I lived in the Rhondda Valley when times were very bad indeed. It was the protection of the public services and the Co-op, I might say, which kept us going through those very bad times.

That fact was brought home to me last year when I had the honour to be the chief guest of the mayor at the Rhondda centenary celebrations. The people have not changed since I was there. They still value their public services and still believe that they should be carried out, not in some sort of competitive way, but by people who are dedicated to the task. Now they see that the authority which has been doing the job so well for so long is to be wound up.

As my noble friend pointed out, the staff of the authority must be very unsettled and concerned about their future. I believe that there are about 1,700 of them. In Wales, which is a comparatively small country, that is a significant number of people. They are entitled to receive assurances about their future. One of the reasons they are worried about their future is the failure of the Government to agree to consult them about what is going on in spite of the fact that my noble friend and I have requested that such consultation should go ahead. It is little wonder that they have very little confidence in what is being done. I should like the assurances for which my noble friend has asked this evening. If they are not given this evening, they should be given at some time in the future. The staff will expect to be consulted and to be given assurances about their future within any organisation which may replace the present authority. When she replies, I hope that the Minister will show that she understands and appreciates the strength of feeling that there is over the issue and that she will perhaps help us by giving us some decent information.

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9 p.m.

Baroness Cumberlege: I should say, with trepidation, that I recognise the fact that I am now entering into foreign territory. However, I should tell Members of the Committee that I spent a very happy day on Friday in the Brecon Beacons. As a former chairman of the national association, I remember conversations that I used to have with my Welsh colleagues and how much I used to marvel at their luxury of not having a regional tier. Of course, they have not had a regional tier since 1974, but the amendments would go a long way to reintroducing one and imposing additional bureaucracy.

Members of the Committee will also be aware that the Welsh Health Common Services Authority and the Health Promotion Authority for Wales are both established by secondary legislation. Nothing presently in the Bill would prevent their continuance for as long as they are needed. The common services authority was the subject of a review last year, following which my right honourable friend the Secretary of State for Wales announced that clinical services would be returned to the mainstream NHS and non-clinical services would be market tested.

The noble Lord, Lord Stoddart, asked for the criteria as regards whether market testing had been successful. There are a number of criteria that one could use but perhaps one of them might be the savings. We know that savings have been made through market testing now reaching £1 billion. That money has been reinvested directly into patient services. I see that the noble Lord wishes to intervene. I give way.

Lord Stoddart of Swindon: I am much obliged. The Minister mentioned a figure of £1 billion. Does that refer to Wales or to the whole of the National Health Service?

Baroness Cumberlege: I believe that that applies to England and Wales.

Whatever the eventual outcomes of the present exercise for the many different parts of the Welsh Health Common Services Authority—the achievements of which, I have to say, I happily acknowledge—it is the needs of the organisations, and the patients who rely upon them, that will be the driving force for the change. The very processes being followed will ensure that. I cannot believe that they will necessarily have to remain part of one single organisation.

The noble Lord, Lord Prys-Davies, was very concerned that decisions are being rushed through at present. However, there has been very careful discussion with service users and consultation with the NHS. Those responses are being considered at the moment. As regards the details of the options previously considered, perhaps I may ask my Welsh colleagues to write to the noble Lord. I shall do the same in respect of the detailed issues raised by the noble Lord, Lord Elis-Thomas.

Several noble Lords mentioned the need for a central services authority which dates back to the 1970 reforms. I recognise that the common services authority was expanded over the years. Again, I should like to pay tribute to its many successes. However, I should also

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like Members of the Committee to recognise that the NHS reforms fundamentally changed its position. Trusts need freedom now to introduce different mechanisms and services to support them.

Our aim is that the NHS in Wales should be able to assess the many support services it needs by the most cost-effective means. Our overriding interest is that NHS trusts should provide more and better patient care for the same money. It is no longer tenable to have a large central organisation. When the current exercise is completed, we shall be able to form a view as to which functions will still need to be carried out at the all-Wales level.

I turn now to the employees of the WHCSA. I do not speak Welsh, but I believe that that acronym is pronounced "Weksa". The employees have made a valuable and much appreciated contribution to the NHS in Wales. I well understand that the uncertainty they face is very difficult for them. However, the process itself provides for consultation with staff. I hope that they will come to see it as an opportunity to improve the services that they provide. Handling the process is a matter for WHCSA's own management. That is why Welsh Ministers have declined to meet staff-side representatives whose interests are best served by the proper working through of the process itself.

The role of the Health Promotion Authority for Wales has changed in recent years, as the health promotion role of district health authorities and family health services authorities has grown in importance. The Parliamentary Under-Secretary of State for Wales, Mr. Richards, is currently reviewing the delivery of health promotion in Wales, including the future role of the authority. The results of his review are expected shortly.

In both reviews, the focus should be on responding flexibly to the evolving needs of the health service and, more importantly, to its patients. However, the proposed new clause would require all flexibility to be forfeited. It prejudges how all those services should be provided and allows no means, short of new primary legislation, for revising that judgment. It also asks us to take a leap of faith in abolishing both WHCSA and the Health Promotion Authority for Wales, transferring their functions to a new body with a new management. It would also make the new body responsible for processing health complaints.

As I said earlier, the Government have published their proposals on the subject in the past few days. They constitute a welcome streamlining of present arrangements, and are far superior to the proposal implicit in the suggested new clause for a new, centralised, bureaucratic and wholly rigid management in Wales.

The Artificial Limb and Appliance Service, Breast Test Wales, and the National Blood Transfusion Service, Wales, have recently reviewed the options for the future management of the services that they provide. Having considered their conclusions, my right honourable friend the Secretary of State for Wales has recently consulted on the propositions that management arrangements for the National Blood Transfusion Service, Wales, should not change for the time being; that management of the screening programme of Breast

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Test Wales should transfer to a single trust; and that the Artificial Limb and Appliance Service should, in general, be managed by the hospitals where they are based but some specialist services might best be provided from a single point.

I do not wish to prejudge my right honourable friend's consideration of the responses to his consultation. However, I should like to point out that the proposed amendments would not only anticipate a reasoned judgment of the best way forward in the light of those responses, but would also require that one particular set of administrative arrangements should be set in legislative concrete. In the light of what I have said, I ask the noble Lord to consider withdrawing the amendment.


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