LOCAL HEALTH BOARDS (Hansard, 15 January 2002)

§ Mr. Win Griffiths (Bridgend)
I beg to move amendment No. 22, in page 6, line 37, at end insert "but no more than fourteen.'.

§ Mr. Speaker
With this it will be convenient to discuss the following amendments: No. 21, in page 7, leave out lines 29 to 31 and insert— '(c) by both of the following: NHS trusts and Local Health Boards.'. No. 20, in clause 9, page 10, line 30, at end insert 'and (c) sums required, on application by Local Health Boards, to deal with major health emergencies.'. No. 10, in page 10, line 39, at end insert— '(2A) In determining the amount to be allotted to a Health Board, the National Assembly for Wales shall have regard to the health needs of the population served by that Board'. Government amendments Nos. 75, 84 and 85.

§ Mr. Griffiths
I want to devote some time in the Chamber to a brief discussion of the number of health boards that will be needed in Wales to ensure that an effective health service works in co-operation with local government. There is no need to press the amendment to a vote, as the Bill is flexible enough to allow the National Assembly for Wales to decide how many health boards are needed. The maximum number possible is 22, as that is the number of local government units in Wales.
I have no problem with the principle that the units of government for the health service in Wales should be organised in the same way as the units of local government there. Where I differ with the National Assembly is that I believe that we should look at the degree of coterminosity between the health service and local government in Wales from the point of view of the health service, rather than of local government.
Jane Hutt, the Minister for Health and Social Services in Wales, feels that it would be best to have 22 local health boards, which would work alongside the trusts in Wales. I believe that it would be better if the local health boards were to mirror the trusts in Wales, although I accept that in a few places it could be argued that the trusts are too large to have only one local health board.
255 I am looking for flexibility, and I think that 14 local health boards would be enough to maintain the principle of coterminosity, and to deliver an effective health service in Wales. For example, in my Bridgend constituency, the present plans mean that Bridgend and Neath-Port Talbot will have separate local health boards, both of which will be within the boundaries of the Bro Morgannwg national health service trust.
Under my proposal, there would be one local health board within the Bro Morgannwg NHS trust, and it would contain representatives of the two local government units. If that health board wanted to create separate sub-committees for Bridgend and for Neath-Port Talbot, it would be free to do so. I believe that my proposal would lead to the more efficient delivery of health services and to better co-ordination with local government.
I have spoken to all the trusts in Wales that would be affected by the proposals, and two of them feel that they would have to negotiate with 22 local health boards for the delivery of the health services that they provide. I shall not go into the details, but more than two thirds of the trusts believe that their negotiating procedures with local health boards will be more complex than the same procedures with the existing health authorities. Therefore, my plea to the National Assembly is that it should reconsider whether 22 local health boards are needed, and that it should settle for a maximum of 14, or fewer.

§ Julie Morgan (Cardiff, North)
Does not my hon. Friend agree that the advantage of exact coterminosity between health boards and local authorities is that preventive and primary care would be given the highest priority as a result of the authority's involvement with housing, the environment, transport and so on? Those issues are vital to health, and it would be bound to be to the advantage of the health of local people if they were the primary concern of a coterminous local authority.

§ Mr. Griffiths
I beg to disagree with my hon. Friend on this issue. In the Bro Morgannwg trust that covers my local authority area, there are two local authorities. One health board would have representatives of both local authorities. I believe that they would be able to negotiate better on that basis than if there were two separate local health boards. However, that is a matter of opinion. I believe that 14 would provide sufficient flexibility for one or two larger trusts to have more than one local health board.
I hope that these issues will be considered seriously in Cardiff. As the person who had the honour of having responsibility for the health service in Wales immediately after the 1997 election, I created the local health boards—or groups, as they then were—because I wanted coterminosity between local government and the health service in Wales. In terms of their responsibilities, the local health boards will be mini health authorities. We will have much better local health boards if we have to staff 14 rather than 22.
We do not have time to go into all the other arguments that I would like to make—I will put those privately to the Minister for Health and Social Services in Wales. However, I wanted to flag up this issue because it is important in delivering a more effective and efficient health service while still ensuring strong co-operation between the health service and local government in Wales.

§ Mr. Jon Owen Jones (Cardiff, Central)
I shall be very brief because there is hardly any time left. I agree with my hon. Friend the Member for Bridgend (Mr. Griffiths) that the number of health boards proposed is excessive. I believe that they are likely to be expensive and too bureaucratic. There is room in the Bill to reduce the number of boards so that we can maintain the coterminosity that my hon. Friend mentioned, while retaining a degree of efficiency and flexibility in the delivery of the health service in Wales.
The majority of those working in the health service in Wales who were consulted and replied to the consultation also agreed that the number of bodies suggested in the new structure would be unwieldy. Unfortunately, the House has never been given proper access to an analysis of that consultation procedure, perhaps because the results would prove to be opposed to the proposals.
There is sufficient flexibility in the Bill, as my hon. Friend has said. I ask the Welsh Assembly to retain coterminosity but to reduce the number of boards so that we can have an efficient system that delivers health care to people in Wales without tying them down to the over-bureaucratic and wasteful system that 22 boards would create.

§ Mr. Roger Williams (Brecon and Radnorshire)
I should like to comment from a Welsh point of view. I pay tribute to the hon. Members for Bridgend (Mr. Griffiths) and for Cardiff, Central (Mr. Jones) in whose name the amendment stands. They were both responsible for the delivery of health services in the Welsh Office, as it then was, and were very helpful to people in my constituency when we were making representations on health issues.
I was disappointed to see these amendments but rather glad to hear how they were interpreted by the hon. Gentlemen. I felt that the amendments went against the spirit of devolution in trying to tie the Assembly to a specific pattern for the health structure in Wales. That would have been unfortunate.
The coterminosity element is especially important in the delivery of social services. One of the main impediments to that delivery in Wales—as it is in England and Wales—has been the delayed departure of patients from hospital to their homes or to nursing homes. The system will work much better if there is full coterminosity between local health boards and local authorities.
I am pleased that the hon. Gentlemen are not going to press the amendment to a vote because the Assembly will certainly undertake further consultation and will take the results on board. The decisions reached by the Assembly will result in the most appropriate structure for Wales.

§ Mr. Heald
On a point of order, Mr. Speaker. We are not going to reach amendment No. 12 to clause 21. That clause was never discussed in Committee—nor were clauses 8 and 20—owing to lack of time. The timetable motion was hopelessly unrealistic. Would it be possible for you, Mr. Speaker, to consider whether there is some way in which you could use your offices to ensure that on a Bill of this sort we do not end up in the ludicrous position of being unable to debate three of its most important parts?

§ Mr. Speaker
By making a point of order the hon. Gentleman is taking time out of the debate. When I chair the proceedings, I take one amendment at a time. The fact that we shall not reach an amendment is not a matter for me to consider: I consider only what is before the House.

§ Hywel Williams (Caernarfon)
I am glad to hear the hon. Member for Bridgend (Mr. Griffiths) plead for coterminosity. That is an extremely important point. However, the House should bear in mind the points made in an earlier debate by the right hon. Member for Llanelli (Denzil Davies). He pointed out that under the current proposals there are likely to be as many as 52 bodies concerned with the delivery of health in Wales, as well as the Welsh Assembly Government—the WAG—and its Committees. That presents the obvious dangers both of complexity and of the lottery in health care.
The proposal made by the hon. Member for Bridgend might, indeed, reduce the number of local health boards and that might be very useful in terms of critical mass—they might be more effective. It might also mean that we avoid some of the dangers that have become apparent since the reorganisation of local government brought in 22 small local authorities. Some of them cover small populations and are thus quite weak in respect of some of their powers and functions. However, the dangers of complexity and of a local lottery in health care would remain.
I support my party's policy on this matter: to establish an all-Wales commissioning body. That is a coherent policy which would avoid complexity and the threat of a health lottery. It is also plain common sense in a nation of only 3 million people.

§ The Secretary of State for Wales (Mr. Paul Murphy)
In the short time left for the debate, I commend Government amendments Nos. 74, 84 and 85. They are technical amendments that will ensure clarity as regards local health boards.
My hon. Friends the Members for Bridgend (Mr. Griffiths) and for Cardiff, Central (Mr. Jones) were formerly Health Ministers at the Welsh Office. When Jane Hutt, the Minister for Health and Social Services in the National Assembly, reads our proceedings she will note their comments with great interest. I am sure that they and other Members who have spoken in this brief debate will agree that clause 6 refers to the establishment of local health boards by the National Assembly for Wales. It does not refer to a specific number of health boards. In other words, the principle of setting up local health boards is established by the House of Commons and by Parliament, but the Assembly, through the devolution settlement, agrees on the number.
I know that my hon. Friends agree with that principle because it is the principle of devolution. The hon. Members for Brecon and Radnorshire (Mr. Williams) and for Caernarfon (Hywel Williams) also know that the secondary legislation that will implement the setting up of those local health boards has quite properly been devolved.
After lots of consultation and debates in Committee, which my hon. Friend the Under-Secretary of State for 258 Wales attended on behalf of the Government, and in the plenary season of the National Assembly for Wales, it was agreed that it would be sensible to ensure that the local health boards coincided with the local authorities that deliver other services, such as social services, and deal with other public health matters. That makes eminent sense, and in this very short debate we have seen the partnership between Parliament and the assembly work to deliver the best possible health service for the people of Wales. There has been a long consultation process on this issue, which is important to Assembly Members because, at the end of the day, we represent the same people in Wales, irrespective of whether we are Members of Parliament or Assembly Members.

§ Mr. Jon Owen Jones
I agree with the Secretary of State when he says that the Welsh Assembly should take those final decisions, but will he tell the House whether he has been privy to the results of the consultation that has taken place and whether he can make the analysis of those results available to the House? It is very unsatisfactory to debate a Bill on Report when we still do not know the results of the analysis of the consultation on which that Bill was brought about.

§ Mr. Murphy
I am advised that that information has been placed in the Library and in the assembly's library. If that is not the case, I shall be happy to discuss the details of the results of that consultation with my hon. Friend and the Minister for Health and Social Services in Wales, but the point that I make is still valid. The way in which the restructuring will occur is the direct result of working with Members of Parliament and Assembly Members.
Of course, the House will recall that my hon. Friend the Member for Bridgend set up the local health boards when he was Minister with responsibility for health in Wales. So the structure was started some years ago by a Labour Government working under the pre-devolution structures, but the assembly has now decided that this is the way to proceed, and we, in turn, have debated such matters in Committee and on the Floor of the House. That bodes well for the people of Wales, and I commend the Government amendments and hope that my hon. Friend will withdraw the amendment.

§ Mr. Win Griffiths
I have already said that I wanted to place on the record my view that Wales could manage perfectly well with 14 local health boards. The Bill will empower the Minister for Health and Social Security and the assembly to create between one and 22 boards, but I hope that they will listen to the suggestion that there should be 14 of them. On that basis, I am happy to beg to ask leave to withdraw the amendment.