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Andy Burnham (Leigh): A moment ago, the hon. Gentleman told my hon. Friend the Member for North Durham (Mr. Jones) that he would deal with his party's alternative proposals for the NHS. Will he now enlighten the House on what they are and how he proposes to pay for them?
Dr. Harris: I should be delighted to do so, but I am keen to stick mainly to the Bill. However, I direct the hon. Gentleman to the manifesto that we produced at the last election, which made it clear that we would provide significant extra money, funded by fair taxation, which is
Such proposals have gained widespread support, not only from the electorate, but from people who are interested in a health service that is free at the point of delivery and stands for equity, quality and access. I will send the hon. Gentleman details of our proposals if he is desperate, but I suggest that he takes the time to read our manifesto. I suggest that he takes the time properly to scrutinise his own Government, as their proposals on public and patient involvement are worse than those that they previously introduced in the House.
We have an open mind about the exact structures needed for such involvement. We have the same questions as the hon. Member for Wakefield about why community health councils cannot be reformed, as the councils themselves wish. They do not have the power to reform themselves, so the Government should not sweep away parts of the CHCs that are working well, but should give them the power to get involved in primary care, to provide the relevant structures so that their members are independently appointed and to enable them to enjoy formal representation on the boards of local bodies. At some point, the hon. Member for Leigh (Andy Burnham) should scrutinise his own Front-Benchers.
Having said that, I welcome the fact that the Government are prepared to change the position that they set out in their consultation paper. It is wrong for political parties to oppose something, then criticise Governments who appear to listen for making a U-turn. I do not wish to criticise the Minister or the Secretary of State for moving back from the position in their consultation paper, but the Bill's proposals still do not pass the tests of accessibility, accountability, effectiveness, independence and integration. There is no accessibility, as the hon. Member for Wakefield said, because it is not clear to which body members of the public and patients can turn, whether for independent advocacy or for scrutiny of what is going on in the health service.
That is why we believe that there is a role for a body such as a co-ordinated patients council, whether it is called a patients council or a reformed community health council, in providing the cohesiveness and integration that are required. It is not clear how patients forums will be accountable to those who appoint them. We need a wider body at a local or sub-regional level to provide that accountability to the representative groups, including local government, that have stakes in the delivery of health care. It is not clear that the Government's proposals will be effective, as it is not clear whether they will involve a professional secretariat and the experience that it would bring to bear.
On all those tests, the current proposals fail. We look forward to the Government making suggestions, preferably in Committee here, but perhaps in later stages of the Bill's passage in this place or the House of Lords, that meet the tests of effectiveness, accountability, accessibility, independence and integration. We will consider such proposals with an open mind.
In conclusion, it is clear that the Government do not have a coherent plan. They are desperate to avoid getting the blame for their failure to deliver in this Parliament because of their failure to allow the health service space to choose its priorities within the all too limited funds that they have so far allocated. We can see a willingness to decentralise only blame and to centralise praise, and to shift not the balance of power, but the blame.
The proposals have their root in the thinking that was initiated immediately after the Labour party's victory in 1997 and that has been developed consistently since then. Our purpose in Wales was to create an NHS in which all parts and all people worked together to provide quality care and effective services for patients. Apart from co-operation across the NHS in Wales, we also took the decision to develop at NHS trust level an integrated service combining, in the main, acute, community and mental health services. The Velindre trust, specialising in cancer care, and the Wales Ambulance trust were the only two of the 16 trusts not to contain at least two of those sectors, and 11 of the other 14 contained all three.
In considering the development of a positive agenda for health in Wales that went beyond treatment issues, we established a framework to develop partnerships between the NHS and local government. Hence, 22 local health groups were created to establish the principle of co-terminosity: matching NHS trusts and local councils to facilitate partnership and joint working, especially between the health service and social services.
Those principles and foundations for action were laid in the first 14 months of the Labour Government and they have been built on consistently since by successive Secretaries of Statemy right hon. Friends the Members for Cardiff, South and Penarth (Alun Michael) and for Torfaen (Mr. Murphy)and Welsh Office Health Ministersmy hon. Friends the Members for Cardiff, Central (Mr. Jones) and for Delyn (Mr. Hanson). The mantle in the National Assembly for Wales was taken up by Jane Hutt, Assembly Member for Vale of Glamorgan and Minister for Health and Social Services in Wales.
Accordingly, I welcome virtually all that has come out of the consultation on structural change in the NHS in Wales. I submitted a contribution to the Assembly and many, although not all, of my concerns have been tackled. The Welsh clauses in the Bill give the Assembly very substantial and wide-ranging powers to abolish health authorities, create local health boards and strengthen strategic guidance and oversight of the NHS in Wales. That will enable the development of a strong and creative partnership between the NHS and local government, which, in addition to tackling treatment problems at local and trust level, will develop a programme for health improvement. I share Jane Hutt's belief that it is essential to maintain the principle of co-terminosity of health and local government structures to deliver a better health service for people in Wales. I differ, however, on the absolute need for that co-terminosity to be determined by the number of county and county borough councils in Wales, an issue to which I shall return in my concluding remarks.
I welcome the strengthening of the NHS Wales directorate with the creation of a primary care directorate and lead directors for mental health and children's health. The importance of the latter initiative cannot be over- emphasised. I look forward to the establishment of new medical committees based on the old district medical committees, but now including secondary as well as primary care staff, to develop policy and tackle health problems in Wales. The creation of a clearly delineated public health service in the Wales centre for health that is accountable to the chief medical officer and operates at local health board level will provide a new focus for high standards in public health services for personal health and well-being, which are of fundamental importance. The hon. Member for Oxford, West and Abingdon (Dr. Harris) might just have mentioned that in his diatribe on that particular subject.
I look forward to the strengthening of the role of the Specialised Health Services Commission for Wales in commissioning tertiary and highly specialised acute services that could not easily be developed in any one trust or by one local health board acting alone, and in providing guidance and oversight in those sectors. I am pleased that, as a result of the consultation, the proposals to create three so-called health economies containing local health board consortiums and disintegrate compulsorily the recently integrated trusts by removing community health and intermediate care services have been dropped. I am pleased that the latter proposal will proceed only if trusts volunteer for it.
Before concluding on the linchpin issue of the role and number of local health boards, I want to pay tribute to the way in which the role of nurses has been recognised, albeit belatedly, on the local health boards and at other levels of the NHS in Wales. The Royal College of Nursing in Wales has responded very positively to consultation on structural change, although, like me, it has one remaining significant concern about the appropriate number of local health boards.
As a general rule, the best way to achieve co-terminosity and maintain the match of national health service trusts and local councils is to base local health boards on trust areas. The boards will be stronger for that, as well as better able to employ high-quality staff and get able board members who are fully capable of working with the trusts to provide improved health care and develop positive health strategies.
Given that the Bill does not specify the number of local health boards or state that each local health authority must have one, and as the National Assembly for Wales is still developing its plans for the final nature of local health boards with the demise of the five health authorities, I shall not rehearse in detail all my arguments about why I think that the arrangement should, as a general rule, relate to the trusts rather than to the local authorities. However, I look forward to continuing dialogue with the Assembly on the most appropriate number of local health boards to maintain the principle of matching trusts with local councils and develop a health service that will serve the people of Wales well.