§ The Secretary of State for Wales (Mr. Nicholas Edwards)
With permission, I should like to make a statement on changes in the organisation and management of the National Health Service in Wales.
I have today published a statement "The Structure and Management of the National Health Service in Wales" which sets out my preliminary conclusions following the consultations on "Patients First". I emphasise that these are preliminary conclusions, and, in effect, this is a consultative document.
It reaffirms my intention that responsibility for managing the Service should be delegated as close as possible to the point at which patient services are provided by creating a new system of strong health management units at local level. I confirm also that community health councils are to be retained, as are the existing arrangements for administering family practitioner services. There has not been general support for the view that it is not necessary for Wales, in its particular circumstances, to suffer the upheaval of breaking up the existing eight area health authorities in order to get the benefits of good management. It is evident, however, that many people have not understood the full implications of the proposal to delegate management authority to health units. I have therefore concluded that before I make final decisions there should be further opportunity for comment in the light of the explanations in the statement and of local consultations about the pattern of health units. I am also inviting further comment on the arrangements at an all-Wales level, where I propose to set up an advisory Welsh health council comprising representatives of the health authorities, the professions and the Welsh National School of Medicine. My intention is that the council should meet in public, thus facilitating public awareness of debates on major health issues. I also propose to promote further co-operative working between health authorities.
I wish to minimise continuing uncertainties, particularly for NHS staff, so I am asking that further comments be submitted to me by 31 December, and I would then hope to publish final decisions early in 1981.
§ Mr. Alec Jones
First, I hope that the Secretary of State has learnt a valuable lession this afternoon that, in the discussion of matters as important as this, it is not on to try to get away with it by dealing with it in a planted written question by an hon. Member who is not even present in the House. This is seen by Opposition Members as a matter of some considerable discourtesy, because my hon. Friends have still not been able to obtain a copy of the parliamentary answer that the Secretary of State read out so eloquently, or a copy of the statement to which his answer refers.
Certainly, the Opposition welcome the decision to retain the community health councils in Wales, but we still suspect that these councils will have insufficient teeth. I notice that in his statement the Secretary of State for Social Services indicated that a consultation paper would be issued about the community health councils, their powers, their role and their membership. I would hope that there would be a similar consultation paper for Wales.
What consideration was given more fully to integrate the family practitioner committees into the area health authorities? I recall that when the NHS was reorganised in its present structure this matter demanded some attention.
I believe that the decision to set up an advisory Welsh health council is at least a step in the right direction, but I wonder why the Secretary of State has decided not to have an all-Wales health authority. Why not give the Welsh health council the powers that regional health authorities exercise in England?
Finally, I understand that the Secretary of State's statement indicates that there will be further discussion before the pattern of the health units is decided. All the arguments put forward this afternoon by the Secretary of State for Social Services apply equally in England as they do in Wales. If England is to have locally based district health authorities, why should this not apply to Wales as well? We would like a much fuller explanation of that point.
The English statement referred to the present NHS structure as "unduly complicated". We do not want such a structure for Wales, but I am not convinced that the right hon. Gentleman's statement does much to ensure that we do not get it.
§ Mr. Edwards
I assure the House that I was not attempting to get away with anything in not making a statement in the House. Genuine problems occur when there are three different Ministers responsible for similar subjects. We do not want to overload the House. The reason why I had not intended to make a statement is that we are issuing a new consultative document and there will be plenty of opportunity for hon. Members to make representations and debate the issues. I did not think that it was the best way forward to deal with the issues that are handled in this document simply by a quick exchange across the Floor of the House. I am not announcing any final decisions about the structure of the NHS in Wales this afternoon.
The right hon. Gentleman referred to community health councils having insufficient teeth. We propose, in at least one major respect, that they should be given an important new role. We are suggesting that in Wales they should establish sub-committees to work very closely with the new health units at local level so that we can inject into the management of the health units at local level a real participation by local people through the community health councils. This is an interesting development. We are putting forward suggestions and we shall welcome people's views. This is a real step forward and a major new role for CHCs in Wales.
On the question of family practitioner services, I do not believe that we received significant representations on this point in the round that we have had so far.
On the question of the regional body, there is a real difference between the situations in Wales and England. The relationship of the Minister with 14 different regions is clearly very different from that of the Secretary of State who has overall responsibility for the Health Service generally. He cannot step aside from the situation in Wales and his responsibility covers precisely the same area as the regions. There is the problem of avoiding unnecessary duplication of these two roles. The view has been held in the past that it would be a duplication of services and an unnecessary complication to set up a full-blown regional health authority. None the less, wide representations were made to us about 529 the fact that the strategic role of the Welsh Office was insufficiently understood and appreciated, and there was insufficient opportunity for public debate of strategic decisions for Wales as a whole. We are trying to meet this difficulty by producing a committee that will come up from the health services underneath, so that the main constituent members of it will be the chairmen of the area health authorities. Others will be involved as well, including the medical profession. The committee will meet in public and will provide a forum for advice and debate that will be very valuable. This is a new proposal. We did not touch on it in our previous proposals and there will be every opportunity for consultation on it.
On the question of the pattern of health units and the structure of the NHS in Wales, we propose a precisely similar pattern at the lower level to that in England. We are not attempting to duplicate the districts, but the Welsh areas that we propose will be similar in size and role to the new districts in England. We propose exactly the same structure of powerful units between them, with the same management responsibilities and the same involvement in budgetary and administrative control at local level. We seek to achieve exactly the same ends in Wales as we hope to achieve in England.
I plead guilty to one mistake which has led to some of the misunderstandings. We did not publish a full document originally. By including a short passage in "Patients First" we have brought about some misunderstanding of our objectives, and that is precisely why we want to set the position out clearly and give the opportunity for a further round of consultation.
§ Mr. Garel-Jones
I welcome my right hon. Friend's statement. However, does he not agree that the discussions hold out a real hope, not only for Wales but for the rest of the United Kingdom, of an improvement in standards of service to patients? In particular, I welcome the suggestion of my right hon. Friend that community health councils should work in close contact with the new units.
I do not wish to raise the temperature, but does not my right hon. Friend feel that it is, perhaps, unfortunate that the 530 Opposition should have chosen to create such an incident of the way in which this statement was made? I ask that particularly because the Labour Party has just published a draft manifesto which scarcely contains a reference to Wales at all.
§ Mr. Edwards
My hon. Friend's credentials entitling him to speak on Welsh affairs are unchallenged. I believe that the relationship that we propose between the community health councils and the new units offers an opportunity for local participation in the running of hospital, medical and related services. That is an important step forward.
§ Mr. Rowlands
Is the right hon. Gentleman aware that one of the reasons why we feel strongly that discourtesy has been displayed to us is that the consultative document referred to has not been placed even in the Vote Office? We are entitled to at least the same rights as people outside the House.
Turning to the contents of the statement, we feel that the advisory Welsh health council should have a strong and significant lay representation. Representation should not be confined to chairmanships of area health authorities. There should, possibly, be representatives on that advisory body from the community health councils. The AHCs represent the patient at the most obvious local level.
After the Secretary of State's statement, and his subsequent answers, we are confused about the exact relationship that will exist between area health authorities, whose powers we understand will be totally untouched, and the district health teams and structure. Has not the right hon. Gentleman received considerable representations to the effect that the district structure is closest to the needs, wishes and feelings of the local community and that power should be devolved from the powerful area health authorities to district authorities and that, as has happened in the past, the responsibilities of district authorities should not be whittled away?
I hope that the Secretary of State intends to make clear exactly what the relationship between area and district will be.
§ Mr. Edwards
The council that we propose, and about which we are inviting 531 representations, would include representatives of all the health authorities, the main professions and the Welsh National School of Medicine. The council will advise on strategic decisions and we think that it is right that its prime constituents should come from area health authorities which have responsibility in their parts of Wales.
On the matter of the relationship between area health authorities, districts and units, we believe that the proper way forward is to replace the existing district by strong management units. We contemplate that there will probably be about 50 such units in Wales which will be truly local and be related to the main hospital facilities of an area.
Such bodies would have a strong management role, with overall responsibility to the area authorities. But there will be real delegation of power and responsibility to the unit. Given that situation, with strong units, it is not self-evident that one could easily fit in an intervening round of districts. There are many parts of Wales where, if we did that, the obvious unit would be the existing district. In my own constituency I think it likely that the natural unit would be based on Withybush hospital and the facilities in South Pembrokeshire and Preseli. Therefore, we would have a direct overlap between the district and the unit, which does not seem to make sense. We are putting forward proposals based on the existing structure of area health authorities, but with strong delegaton of powers to units.
However, to enable people to understand and assess the situation properly, we are asking the area health authorities to begin consultation now so that they can publish their plans for units in their areas. Thus, people will be able to make judgments about the area and district structure against the background of a known, planned pattern of units. I think that that is the sensible way forward, but I emphasise that we attach great importance to unit management.
§ Mr. Best
I thank my right hon. Friend for giving such a full reply to what was, essentially, my written question to him. That question prompted this discussion. May I draw the attention of my right hon. Friend to two matters in the document? I think that hon. Members on both sides of the House will agree that we must 532 study it in closer detail before making any full comment on it.
§ Mr. Ray Powell
On a point of order, Mr. Deputy Speaker. The hon. Member for Anglesey (Mr. Best) is referring to a document which some Opposition Members have not seen. Is it in order for the hon. Member to refer to a document that we have not had the opportunity of examining?
§ Mr. Powell
Further to that point of order, Mr. Deputy Speaker. I left the board scarcely a minute before the Secretary of State rose. There was no copy of that document on the board for me.
§ Mr. Deputy Speaker (Mr. Bernard Weatherill)
I regret that I have no knowledge of the document to which the hon. Member for Anglesey (Mr. Best) is referring, or even whether it refers to the Secretary of State's statement.
§ Mr. Best
If my use of the document causes difficulty I shall not refer to it. I turn to the issue of lay involvement. As I understand my right hon. Friend, he is saying that he wishes to see community health councils taking a greater role at unit management level. I understand that he contemplates, subject to consultation, appointing additional lay members to area health authorities. Will my right hon. Friend confirm that that is the case? If it is, I certainly welcome the proposal. I am sure that many other hon. Members will welcome a greater lay involvement in the management of the NHS in Wales. On many occasions, lay people feel that they are kept away from the management of the Health Service.
§ Mr. Edwards
In relation to the points of order just raised, it was intended to provide information by a written answer. Papers; were sent out to go on the board 533 at 4 pm and I am sorry if hon. Members have not had the chance to collect their copies. We intended to get copies into the hands of right hon. and hon. Gentlemen at the earliest opportunity. It is precisely because this is a major consultative document that people will wish to consider it carefully. For that reason, we thought that the best way forward was to issue the document and allow people to think about it before we became involved in a series of exchanges.
We do not propose to make major changes in the membership of the area health authorities, although there may be some room for adjustment in size. I think that there is room for an interesting experiment in the involvement of community health councils in local management. By involving the community health councils in the affairs of their local units, I believe that lay participation will thus be brought into the Health Service at its most sensitive point. That is the point nearest to the patients.
§ Mr. Alan Williams
On a point of order, Mr. Deputy Speaker. I have been out to check the board. It appears that a wedge of envelopes arrived there but there was no indication that they were urgent or immediate. Therefore, they have been put into the post. That is not the fault of the attendants. There was no indication as to the urgency of the material. How is it that one Back Bench member has a copy when the copies intended for the rest of us are lost in the post? Will you investigate that, Mr. Deputy Speaker?
§ Mr. Deputy Speaker
It is an unfortunate matter, but it is not one of order for the Chair. The document is not essential. I am sorry that it is not available, but it is not for me to make documents of this nature available. The Secretary of State said that it was a consultative document. There is a heavy programme of business before the House and therefore I suggest that short answers and short questions will help.
§ Mr. Ioan Evans
We understand that the question was planted and that, since the hon. Member for Anglesey (Mr. Best) planted it, he should receive a planted answer—
§ Mr. Best
On a point of order, Mr. Deputy-Speaker. Is it within the rules of order for one hon. Member to accuse another of acting as some sort of Government lackey—[Hon. Members: "Yes."]—The hon. Member for Aberdare (Mr. Evans) may have been an unfortunate recipient of that treatment at some time in the past, but I hope that he will not accuse me of such action now.
§ Mr. Deputy Speaker
I have heard the phrase "planted question", but I do not really know what it is.
§ Mr. Evans
If I have accused the hon. Member for Anglesey of being approached by the Welsh Office or someone in it to table a question and that has not happened. I am prepared to withdraw the accusation. I should prefer that he rose to deny the allegation before I withdrew it, however.
I realise that the Secretary of State has made an ad hoc statement. Welsh Members have a right, when the Secretary of State for Social Services makes a statement in respect of England, to have a statement dealing with Wales.
Since this is an interim statement, will the Secretary of State for Wales, when he has preperaed his final recommendations, make that statement to the House? Why did the Secretary of State for Social Services make an eight-page statement when the Secretary of State for Wales has made one only half a page long? Is the Secretary of State for Wales covering the same topics as his right hon. Friend?
Since there is strong support for the community health councils, in reaching his conclusions will the Secretary of State for Wales ensure that they are retained in the new structure? The earlier statement contained a reference to the possibility of a change in this respect in the long term.
Will the right hon. Gentleman ensure that if management costs are reduced the money that is allocated to the Health Service will be maintained at existing levels? If the advisory health council for Wales is set up will it replace any existing bodies? Is it to be a Government quango? If it is to be an advisory body, will those serving on it be drawn from existing bodies in the NHS in Wales?
§ Mr. Edwards
I can give the undertaking that when we reach firm conclusions to put before the House about the pattern of the Health Service I shall make a statement to the House about them. We had not intended to do so today, only because we were issuing a consultative document. That is also why my statement is different from that of my right hon. Friend the Secretary of State for Social Services who has announced a lot of firm conclusions for the Health Service in England. If the hon. Member for Aberdare (Mr. Evans) wants to compare the size of statements, he should bear in mind that I have issued a consultative document, the English language version of which runs to 23 pages. We can double that figure if we include the Welsh language version. The hon. Member cannot complain, therefore, about the amount that he is getting.
We have made it clear that we intend to retain the community health councils. That is firm, not provisional. Their role is being strengthened at unit level.
It is clearly to the advantage of the Health Service if it can reduce its administrative costs in every way. That will leave more money to be spent on patient care, and we all ought to be in favour of that. The all-Wales body will basically be composed of representatives of the area health authorities and of the professions, but that is a matter about which we are consulting in the document.
§ Mr. Ray Powell
Is the right hon. Gentleman aware that he has abused the House by not presenting a proper statement? It is impossible for us to examine the booklet today or to go through his statement in detail. If the closing date for consultation is to be 31 December, and if the bodies that he is to consult will be similar to those he consulted in respect of his first consultative document, when will he be able to inform the House or the Welsh Grand Committee of his final proposals?
§ Mr. Edwards
It is because there are difficulties in issuing a long and major consultative document that there is something to be said for simply issuing it and letting people consider it before we embark upon question and answer across the Floor of the House. I shall always come to the House when I have firm 536 conclusions on which to be questioned. I sometimes wonder whether it is not to the benefit of the House, with consultative documents, for hon. Members to be given time to consider them and then to have the chance to debate them in the Welsh Grand Committee or somewhere else.
We shall complete our consultation by 31 December and announce our decisions early in the new year.
§ Dr. Roger Thomas
I am sure that Welsh Office Ministers will not be surprised that there is resentment in Wales that in the document "Patients First" Wales was dismissed in two comparatively short and complex paragraphs. As the only Welsh Member to sit on the Standing Committee examining the Health Services Bill, which is now being discussed in another place, I received a deluge of communications from all parts of Wales. The theme of those communications was a desire to get rid of area health authorities, just as they are being abolished in England. I cannot understand why the Minister says that we in Wales should still have to tolerate these authorities, representing as they do an extra tier of administration.
§ Mr. Edwards
I have already acknowledged that I think that we made a mistake in not issuing a separate consultative document at the first round, which is why I have decided to issue one now. We have received for the first time a whole range of representation—the hon. Member for Carmarthen (Dr. Thomas) was involved in this—about the all-Wales area. This is a totally new area, on which we wish to take opinions.
I think that it was precisely because we failed to make clear the strength and pattern of the units and their possible duplication with the district pattern that some of the representations were made on that aspect. I want to consult people on the basis of a unit pattern so that they put forward their views with a clear understanding of exactly what is proposed and what that will involve in their districts. We received many more representations from Dyfed than from the rest of Wales put together, and the hon. Member for Carmarthen will understand that. In our document we particularly asked for further views about the position in Dyfed.