Grand Committee Report of 26 February 2003

Official Report of the Grand Committee on the

  Health (Wales) Bill
  (First Day)
  Wednesday, 26th February 2003.
  The Committee met at half past three of the clock.
  [The Deputy Chairman of Committees (Lord Ampthill) in the Chair.]
  The Deputy Chairman of Committees (Lord Ampthill): Before I put the Question that the Title be postponed, it may be helpful to remind your Lordships of the procedure for today's Committee stage. Except in one important respect, our proceedings will be exactly as in a normal Committee of the Whole House. We shall go through the Bill clause by clause; noble Lords will speak standing; all noble Lords are free to attend and participate; and the proceedings will be recorded in Hansard. The one difference is that the House has agreed that there shall be no Divisions in the Grand Committee. Any issue on which agreement cannot be reached should be considered again at the Report stage when, if necessary, a Division may be called. Unless, therefore, an amendment is likely to be agreed to, it should he withdrawn.
  I should explain that in the unlikely event of a Division in the Chamber while we are sitting, the Committee will adjourn as soon as the Division Bells are rung and will resume after 10 minutes.
  Title postponed.
  Clause 1 [Community Health Councils in Wales]:
  Lord Roberts of Conwy Lord Roberts of Conwy moved Amendment No. 1:
  Page 1. line 8. at end insert ", following consultation with the Councils affected"
  The noble Lord said: For my part, I shall try to deal as briefly as possible with the majority of the amendments tabled in my name and that of my noble friend Lord Luke, with a view to completing the Committee stage today. The Bill has undergone pre-legislative scrutiny in another place and has been discussed extensively not only there but in the National Assembly for Wales. The amendments, or similar ones, have also been discussed in another place. We know the Government's view. Nevertheless, each amendment contains a point worth making.
  Amendment No. 1 relates to a council's name change. I assume that it is the name of an individual council or councils, rather than the whole genre of community health councils, that the Government have in mind. If that is the case, we think that it would be courteous, to say the least, for the Assembly to consult councils affected. It would also be helpful to the Assembly to get a local view of the proposed name
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  change. As Members of the Committee who know Wales are aware, a name change can be a very sensitive issue.
  Amendment No. 2 requires consultation with those affected in the event of the abolition of a council, a change of the district covered or the establishment of a new council. It is a sensible requirement for a variety of reasons. As we know, local loyalties are very strong in Wales. Care must be taken that any changes affecting local institutions are fully justified in local terms. I know that only too well from my experience of past changes in local government boundaries and so on. The Minister may argue that it is inconceivable that changes such as those envisaged would be made without consultation. But it can happen and can cause a rumpus when it does. The amendment does not inhibit changes; it simply helps to ensure that such changes are effected as smoothly as possible. I beg to move.
  The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath): In responding to the noble Lord, Lord Roberts, I hope for the same brevity as he seeks in moving his amendments. He is right to suggest that both the Bill and some of the issues raised in the amendments have been discussed extensively in the National Assembly for Wales and in another place.
  I shall deal first with name changes. Apparently, many CHCs have long advocated a name change to one more easily recognised by the public. As I read it, the clause that the noble Lord seeks to amend would provide both for a change of the name of individual CHCs and the genre. The debate that took place in Wales focused more on whether the term "community health council" was appropriate and recognisable. I do not know the statistics for Wales, but in surveys carried out in England in which the public were asked whether they knew what a community health council was, and what its purpose was, few recognised the name. There is a view in Wales in particular that changing the name to one more easily recognised by the public might end current confusion over the role of community health councils. For instance, the word "council" may have confused some.
  On consultation, the Assembly has already asked CHCs to start thinking about name changes. Some have made suggestions, including the Patients' Voice and Health Council Wales. Sadly, I do not think that anyone has suggested the Patients' Forum yet, but one never knows. So the position on consultation is already clear. The Assembly already has a statutory obligation to consult before legislating in many cases. Section 65 of the Government of Wales Act 1998 and the Assembly's Standing Orders require that a regulatory appraisal be undertaken before any subordinate legislation is made. They further require that, if the appraisal indicates that the costs of complying with the legislation will be significant, the persons or bodies affected must be consulted. Regardless of whether the costs of a name change will be significant, there is no doubt that the Assembly will consult CHCs and the wider community before making any changes.

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  The same response applies to Amendment No. 2, which relates to the creation or abolition of CHCs, or changes to them. My understanding is that there is no intention to change the boundaries of CHCs in Wales in the short term, although it might be required at some future date. If it becomes necessary, the Assembly will consult closely with relevant councils and other key stakeholders to seek changes that are acceptable to them. I referred to Section 65 of the Government of Wales Act and the Assembly's Standing Orders. I also refer the noble Lord to the note produced by the National Assembly for Wales, Procedures for Consultation, which sets out guidance to the Assembly on how local organisations and bodies should be consulted. I have read it and think that it is very comprehensive. I have no doubt that consultation would take place on possible changes to the name of individual or all CHCs and on changes to their boundaries.
  I hope that I have reassured the noble Lord that the points he made will be fully reflected in how the National Assembly for Wales will discharge its responsibilities relating to community health councils.
  Lord Roberts of Conwy: I am grateful to the Minister for his comments. I am glad to learn that the Assembly must consult and will consult, certainly in relation to the matter covered by Amendment No. 2. I am also grateful to him for the clarification. On reading the Bill it was not clear to me whether an individual council or the genre would have its name changed. The Minister has made it clear that it could be both. I shall not venture to suggest to the Assembly an alternative to the community health council title, but the Minister's suggestion of a patients' forum takes a lot of beating. I beg leave to withdraw the amendment.
  Amendment by leave withdrawn.
  [Amendment No. 2 not moved.]
  Lord Roberts of Conwy Lord Roberts of Conwy moved Amendment No. 3:
  Page 1, line 15, at end insert—
  "( ) that due regard is paid to the boundaries of health authorities with a view to such authorities and councils being coterminous"
  The noble Lord said: Amendment No. 3 seeks to deal with the coterminosity issue. I refer to it as such because it appears always to have been an issue. There is a general desire that health area boundaries should coincide with local authority boundaries and other boundaries because of the close connection between health, social services, housing, education and other aspects of local government.
  As I understand it, at present we have 20 CHCs in Wales and 22 local health boards proposed. Local health boards are coterminous with the 22 local authorities. It seems odd to me that the community health councils are not coterminous either with the local authorities or with the local health boards. If they are not coterminous, clearly some CHCs will deal with more than one board which, I would have thought, would significantly increase their workload. The boards will be coterminous with the local authorities
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  and I believe that to operate effectively it is incontrovertible that the CHCs should have similar boundaries.
  I understand the Welsh Executive's reluctance to become involved in adjusting CHC boundaries while they are still establishing the main framework for the NHS in Wales. However, they will have to examine the CHC structure sooner or later and in doing that they must bear in mind the desirability of coterminosity. What is proposed currently and what is about to be imposed does not make sense at all if the 20 CHCs are not—as they cannot be—coterminous with the 22 health boards. I beg to move.
  3.45 p.m.
  Lord Hunt of Kings Heath: The noble Lord raises an important point. I accept the general principle suggested by him that, all things being equal, coterminosity is desirable. The scheme that Wales will implement of 22 health boards coterminous with the local authorities is an excellent scheme. In terms of the planning of services across health and local authority boundaries there is much to be gained from coterminosity. With the need for more services to be integrated no doubt that will prove to be a major advantage.
  The noble Lord is right in the sense that currently there are 20 community health councils in Wales. They are largely coterminous with the NHS arrangements but clearly not completely. That is because they have reflected variations across Wales and because decisions that were taken in the past were seen to be sensible at the time in view of the way in which patient flows operated.
  My understanding is that the intention of the Assembly is two-fold: on the one hand, it wishes to achieve closer coterminosity in the future between CHCs and health bodies but, on the other hand, it does not wish to impose further changes at this stage. We must respect that wise decision. Many CHCs are working in what are called "federation structures", which enable a number of CHCs to work together. That is one way to overcome some of the problems raised by the noble Lord about one CHC having to deal with more than one local authority concerned with patients that are served by the CHC. The federation structure has much to commend it in terms of enabling CHCs to pool their resources.
  Essentially, as I said, the Assembly does not want to make further boundary changes in the foreseeable future, but the proposal in the Bill allows it maximum flexibility to make changes should it and CHCs wish to do so. I also believe that the Assembly has a clear intent, demonstrated by the re-organisation of health boards into coterminous boundaries with local authorities and by the clear recognition that ideally in future there will be greater coterminosity between CHCs, local authorities and local health boards. In that respect the flexibility in the Bill is to be welcomed.
  Lord Roberts of Conwy: I am grateful to the noble Lord for his reply. I am glad to hear that the Assembly intends to achieve coterminosity in due course. I also

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  understand, as I believe that I showed in my opening remarks, why it does not anticipate further changes at present. Once again, I am glad that the Minister, like ourselves, stresses the importance of coterminosity, particularly when there is coterminosity between the local health boards and the local authority. It seems to me inevitable that there will be coterminosity in due course with the CHCs. It is an important goal to achieve. With those assurances I beg leave to withdraw the amendment.
  Amendment by leave withdrawn.
  Lord Roberts of Conwy Lord Roberts of Conwy moved Amendment No. 4:
  Page 1, line 18, leave out subsection (2).
  The noble Lord said: Clause 1(2) gives a wide-sweeping power to the Assembly to change what after all is primary legislation by order or regulation. The Parliamentary Under-Secretary of State, Mr Don Touhig MP, wrote to the noble Lord, Lord Evans of Temple Guiting, on this matter and he sent me—and am sure others—a copy of that letter. The letter pointed out that similar powers have been conferred on Whitehall departments. It states:
  "This case is no different".
  and,
  "follows a well established precedent".
  But it is different in that it devolves a power to change primary legislation to an Assembly that does not have such power. Furthermore, the Assembly is not directly accountable—as Whitehall departments are through their Ministers—to this Parliament. Therefore, there is a difference.
  Of course, the power is confined to the Bill and specifically to Clause 1 and the schedule referring to CHCs. But it is an extensive power. I question whether it is necessary. It may be useful, but is it necessary? Will the Minister give an incidence, or two, where the power would be necessary and where an order or regulation would change primary legislation in this area to its advantage? I believe that Ministers have argued that it is absolutely necessary in order to implement the Bill.
  I know that the Assembly's presiding officer, the noble Lord, Lord Elis-Thomas, would like this kind of power because he said as much to the commission headed by the noble Lord, Lord Richard. However, we should not be in the business of passing primary legislation in order for others to override it at will. That spells trouble for the future and lays us open to blame if wrong changes are made. I shall be interested in the Minister's reply. I beg to move.
  Lord Thomas of Gresford: There will be trouble in future in the nature of the unsatisfactory position of the devolution settlement. The Committee will not be surprised that I express that point of view. But, the settlement being as it is and dealing with the realities of the moment, I support the provisions in the Bill and oppose the amendment. It is necessary to have a degree
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  of flexibility to ensure that in working practice the provisions of the Bill are carried out properly. Until the great dawn of the future, this is a necessary power.
  Lord Prys-Davies: I listened to the noble Lord, Lord Roberts of Conway, but this is a case where we can support the Henry VIII clause. I am conscious that it, quite rightly, has attracted a great deal of criticism. But in these circumstances, the criticism levelled at the Henry VIII clause is inappropriate. The fact that this power will be exercised by another democratic body, and that the decision will be taken nearer to the people who will be affected by the exercise of the power, mitigates the criticism. Therefore, it is appropriate for the Henry VIII clause to be inserted in the Bill. In this case it can play a positive role in the absence of the Assembly being able to exercise primary legislative power.
  Baroness Finlay of Llandaff: I am not a constitutional lawyer, but it is important that the Assembly is able to expand or alter the role of community health councils as it sees fit and as the health service evolves. I am most grateful to the noble Lord, Lord Evans of Temple Guiting, for his letter explaining some of the aspects of community health councils. He stated that they will be given a right to enter and inspect premises where family health care is provided. That will include doctors' and dentists' surgeries and private nursing homes in which NHS funded care is being provided.
  Given that there is devolution in Wales, it is important to allow as much scope as possible for its health service to evolve. Therefore, I am unable to support the amendment. However, I seek clarification as to how NHS-funded care is provided. There are many places in Wales where there is part-payment by the NHS for care received by patients in institutions not managed directly by the NHS.
  Lord Hunt of Kings Heath: It is always tempting to have constitutional debates on the settlement. It is also tempting to say that we all await the work of the noble Lord, Lord Richard, with a great deal of interest. Taking a proportionate, balanced approach suggests that the Bill, as drafted, gives sufficient flexibility to the Welsh Assembly in what is actually a small area as regards the provisions. It is restricted to incidental, consequential and similar amendments, which it would have been impractical to anticipate within the Bill.
  Both provisions constrain the devolved powers to:
  "Supplementary, incidental, consequential, transitory, transitional or saving provisions".
  It is also worth making the point that exercise of the powers must be in connection with any order or regulations under new Section 20A or new Schedule 7A, the parts which relate to community health councils. Therefore, the Assembly may not use this power other than in consequence of a power that it already has under the CHC provisions.
  The main purpose of such a provision is to avoid the necessity of the Assembly, or a Secretary of State, returning to Parliament to ask for further legislation to

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  overcome some minor unforeseen obstacle or in order to achieve some consequential matter that was not specifically catered for in the powers granted.
  The Assembly's legislative procedures mean that the use of a Henry VIII power would be scrutinised carefully by a legislation committee of Assembly Members, possibly a subject committee as well and, in any event, passed by a vote in plenary session. In addition, the Assembly must secure the approval of parliamentary counsel to any change in primary legislation.
  That proposal was considered by your Lordships' Delegated Powers and Regulatory Reform Committee. It considered the delegated powers in the Bill in its seventh report. The report notes that delegated powers are conferred on the National Assembly and that they are subject to the subordinate legislation procedure under the Government of Wales Act 1998.
  It further noted that these powers can be exercised only as an extension of the exercise of some other powers under the Bill. The committee accepted that the powers may be required and considered them sufficiently circumscribed.
  The committee considered the general principle of Henry VIII powers. It reported:
  "We have no doubt, however, that there are occasions when Henry VIII powers to make incidental, consequential and similar provisions are justified".
  The noble Lord, Lord Roberts of Conwy, asked me to give some examples of why the powers might be used.
  I shall quote one example used recently in the Assembly's health and wellbeing regulations 2003, made under Section 24 of the NHS Reform and Health Care Professions Act 2002. The regulations aim to promote closer working between health and social care providers by installing an overarching partnership strategy. There are already certain strategies in place covering specific areas such as children and young person's plans and health improvement plans. These exist under separate pieces of legislation and would have led to duplication of resources and potentially inconsistent and piecemeal approaches being taken by the bodies concerned.
  The Assembly used its Henry VIII powers in the 2003 regulations not to abolish the existing plans and strategies but to harmonise them with the overarching partnership strategy between health and social care providers. That is a good example of how the Henry VIII powers have been used to avoid duplication and confusion.
  One could speculate that in the future there may be name changes within the structure of the NHS in Wales which would necessitate some consequential changes in various pieces of legislation. I believe that that would be a sensible and proportionate use of the power in the Bill. I hope that the noble Lord, Lord Roberts, will recognise that the Assembly's powers in this matter are severely constrained but that having them will enable it to tidy up matters which cannot be foreseen while the Bill is progressing
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  through Parliament. It is a practical measure to enable sensible improvements and change to be made in the future.
  4 p.m.
  Lord Roberts of Conwy: I am grateful to the noble Lord for his comments. It was the constitutional point that intrigued me, in particular the comment that I believe was made in Committee in another place; namely, that the granting of the Henry VIII power in the case we are discussing was similar to other cases where it was granted to Whitehall departments. There is a considerable difference between Whitehall departments and the National Assembly for Wales.
  The Minister's comments provided considerable clarification. One realises only too well that the power is limited to supplementary, incidental and consequential provisions. The example that the Minister gave was perfectly clear. I am also impressed by the fact that the Delegated Powers Committee said that the granting of the power was justified. I beg leave to withdraw the amendment.
  Amendment, by leave, withdrawn.
  Clause 1 agreed to.
  Lord Roberts of Conwy Lord Roberts of Conwy moved Amendment No. 5:
  After Clause I, insert the following new clause
  "MEMBERSHIP OF COMMUNITY HEALTH COUNCILS
  After section 20 of the National Health Service Act 1977 (c. 49) (Community Health Councils) insert—
  "20B MEMBERSHIP OF COMMUNITY HEALTH COUNCILS
  The membership of Community Health Councils shall be constituted as follows—

  (a) at least one member of the Council shall be appointed by each local authority of which the area or part of it is included in the Council's district. and at least half of the members of the Council shall consist of persons appointed by those local authorities;

  (b) at least one third of the members shall be appointed in a prescribed manner by bodies (other than public or local authorities) whose activities are carried on otherwise than for profit;

  (c) the other members of the Council shall be appointed by such bodies, and in such manner and after such consultations, as may be prescribed: and

  (d) no member of the Council shall also be a member of a Health Authority, a Local Health Board, a Strategic Health Authority, a Primary Care Trust or an NHS trust.""

  The noble Lord said: With all the changes proposed in the Bill to the 1977 Act, I am not at all sure where we stand with regard to the composition and membership of CHCs. Is a change proposed?
  I suggest in the new clause that half the members be drawn from local authorities within the council's district, a third from voluntary organisations with an interest in health matters and the remainder as prescribed.
  I listened carefully to what the noble and learned Lord, Lord Morris of Aberavon, had to say at Second Reading about his disappointment with local authority nominations for appointment to CHCs and

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  I am bound to say that my experience as a Minister was similar to his. I think that was because the local authorities had not fully appreciated the importance of CHCs. They should certainly do so now.
  As was said earlier, local authorities have an important role to play in health. It is a growing role. We recognise the close relationship between health and housing and other areas of local government responsibility. The new unitary authorities in Wales, established by my noble friend Lord Hunt of Wirral, are responsible for social services, housing and education. Local authorities must, therefore, be well represented. Whether it should be half the membership is open to question, but certainly each local authority in the community health council's district should be represented in order to ensure smooth working. The voluntary organisations with an interest in health matters—disability groups and so on—also have a claim to membership although they cannot all be represented as they are too numerous.
  I am equally clear in my own mind that those bodies responsible for the delivery of healthcare should not be represented. I should hope that there is general agreement on that point. The CHCs are guardians of the public interest in the health service and must be independent of the providers and seen to be so. I beg to move.
  Lord Thomas of Gresford: I noted that the noble Lord, Lord Roberts of Conwy, was rather attracted by the name "patients' forum". That being the case, I am rather surprised that he wishes to place such an emphasis on local authority representation when both he and the noble and learned Lord, Lord Morris, have reservations about the interest that local authority representatives have taken in community health councils in the past. We should leave it to the good sense of the National Assembly to decide how these councils are made up. We in this House should not be prescriptive.
  Baroness Finlay of Llandaff: I also have difficulty with the notion of prescription. Although guidance should be given on the way in which people are appointed to CHCs, it is important that no CHC is locked into a set number of members appointed by a set number of people. I hope that community health council appointees will he even further removed from the providers of healthcare than is suggested in the amendment, even if the amendment is considered in terms of guidance rather than as a directive. To he able to represent patients adequately, appointees must be as independent as possible of any conflict of interest.
  There are many voluntary bodies in Wales. I declare an interest, having been employed by Marie Curie in Wales. I am concerned that voluntary bodies also need to be inspected where they are contributing to the provision of healthcare. It may be difficult for them to be inspected by someone with whom they are competing for funds. CHC appointees need to be able to stand back from the whole system. Therefore, I oppose the amendment.
  Lord Hunt of Kings Heath: I say to the noble Lord, Lord Roberts, that high calibre local authority appointees or nominees are to be welcomed in assisting in decision-making in the health service, whether on local health boards, the boards of hospitals or community health councils. Certainly as far as England is concerned, while splendid members have been appointed from a local authority background, that is not uniform. There has been a rather patchy response from local government.
  The substantive point of the debate is whether this Committee should determine the composition of CHCs in Wales or whether it is best left to the National Assembly. I am convinced that it should be left to the National Assembly, the members of which are better placed than noble Lords to determine the kind of community health councils that they wish to see in the future. My problem with the noble Lord's amendment is that it goes too far in seeking to constrain the National Assembly.
  I make it clear that currently CHC membership is made up of one half local authority nominations, one third voluntary organisation nominations and the remainder are appointed by the Assembly. The Assembly recognises the importance of local authority nominees. It wants to retain the experience of local authority nominees. It also wants to create opportunities for people—in particular those from under-represented groups in the community—to serve on community health councils. I understand that the proportions, which it currently has in mind, are that the councils should initially consist of one quarter local authority nominees and one quarter voluntary organisation nominees, with one half left for open competition.
  The National Assembly wants gradually to move to more open methods of member recruitment and to ensure that CHCs have members that are more representative of their communities. CHC members will be recruited in accordance with the Assembly's published code of practice for ministerial appointments to public bodies. Vacancies are advertised in the media, both locally and nationally. Interviews are held by the Assembly's public appointments branch in accordance with Nolan principles.
  It is clear that the National Assembly has thought considerably about the issues. It has a clear view regarding its direction. It wants to see more open competition for some of the places. It also recognises the importance of local-authority nominees. The Chamber should have confidence in the Assembly's ability to sort this matter out properly.
  On a couple of occasions the noble Baroness, Lady Finlay, has raised the issue of the right of CHCs to enter premises. I understand that for the first time CHCs will be given the right to enter any premises where NHS-funded services are provided. That will include doctors' and dentists' surgeries and private nursing homes. It is a crucial definition and returns us to the Community Care (Delayed Discharges etc.) 13ill, on which we had a similar debate. It depends on the

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  provision being NHS funded. Obviously the details will follow, and the National Assembly will need to work the matter through with community health councils. The key is that it is an NHS funded service.
  Baroness Finlay of Llandaff: I thank the noble Lord for giving way. Can he confirm that that situation relates to the situation where there is NHS funding towards the service, but that it is not restricted to a set quota of patients? Therefore, where a service is part funded by voluntary donation and part funded by the NHS, will the patients receiving care within that service and not paying for it he able to make representations to the CHC or whoever represents them if there are matters of concern about the quality of their care and what is happening to them?
  Lord Hunt of Kings Heath: We must be very careful. I am prepared to go away and reflect on the matter and write further to the noble Baroness. Essentially, my understanding is that it depends whether the patients are funded by the NHS. That is the key. Whether they are being treated in the independent sector, the charitable sector or the NHS itself does not matter: they must be NHS patients.
  As regards the question of whether a private or a voluntary establishment is properly regulated, of course we have legislation to cover those institutions as institutions. The question of the CHC rights must rest ultimately in the status of the individual being treated. Clearly, they must be NHS patients.
  Baroness Finlay of Llandaff: I am grateful to the Minister for giving way. Perhaps we can discuss this matter outside the Committee. It would not be helpful to delay us now. I think that there are complexities in funding a service. In Wales we have achieved excellent integration of the voluntary sector with the NHS to the point that it is truly seamless. The patients perceive themselves to be fully NHS funded even when part of their care is paid for by the voluntary sector. It is terribly important that that integration is not undermined because it would be to the detriment of the seamless care that patients receive.
  4.15 p.m.
  Lord Hunt of Kings Heath: Of course I should be very happy to have further discussions with the noble Baroness. However, I enter a note of caution. We must be cautious about the rights of community health councils to inspect premises of independent organisations where the patients are not NHS patients. Ultimately, it must be a question of whether or not a patient is an NHS patient. Otherwise, there are problems for community health councils and their relationship with bodies that are outwith the NHS when that kind of responsibility ought to lie with regulatory bodies. Perhaps we could leave the matter there. I am happy to discuss it further with the noble Baroness.
  Lord Roberts of Conwy: I was delighted to hear the trend in the Assembly's thinking about the
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  composition of the CHCs. It is quite clear that there must be representatives, preferably of the highest calibre, from local authorities and voluntary organisations. The proposed quarter membership for each is about right. Similarly, I think there is scope for the competitive element. When I had some responsibility for health in Wales, I remember that we advertised. The response was astonishing. Some very good people came as a result of the advertising. I am sure that good people will put themselves forward for the community health councils.
  I do not wish to be unnecessarily prescriptive, but someone has to be at the end of the day. I am quite happy to leave the matter to the Assembly. I beg leave to withdraw the amendment.
  Amendment, by leave, withdrawn.
  Schedule 1 [Schedule 7A to he inserted in the National Health Service Act 1977]:
  Lord Roberts of Conwy Lord Roberts of Conwy moved Amendment No. 6:
  Page 6, line 10, at end insert—
  "( ) to publish an annual report on the level and quality of the health services in its area"
  The noble Lord said: Amendment No. 6 concerns CHCs publishing an annual report. I think we would all agree that the public have a right to know what is being done by a CHC responsible for their area. It can be argued that its meetings are normally open to the public and the media and that that is sufficient to discharge its corresponding duty to inform the public of its proceedings. I do not think that that is adequate.
  Paragraph 1 of the schedule spells out the CHC's dual duty. First, to represent the interests of the local public in the NHS; and, Secondly, to perform such functions as may be conferred from among those listed in paragraph 2. Paragraphs 2(h) and 2(i) include:
  "(h) the preparation and publication of reports by Councils",
  under regulations by the Assembly as to,
  "(i) the matters to be included in any such report".
  The succeeding paragraphs appear to be more inhibitive than permissive and I question whether under the provisions of the Bill we, the public, will ever get a true account of the state of the NHS in a council's area and as its members perceive it. CHCs will be creatures of regulation, centrally controlled and with very little freedom. I may be mistaken. I hope that I am. One can understand why such bodies must be regulated to an extent, but CHCs which will have a role representing the interest of the public must surely have a corresponding duty to give an account of themselves to their public—and where better than in an annual report? The amendment prescribes the duty to report alongside the duty to represent the public interest, with the same self-standing independence.
  I regard this as an important amendment, as I hope do other Members of the Committee. I hope that the Committee will support it. I beg to move.
  Lord Prys-Davies: I fully understand the concerns voiced by the noble Lord, Lord Roberts. It seems to me that an annual report is almost a standard informational output of any statutory body. No doubt

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  my noble friend Lord Hunt will correct me on that, but that is my impression. Such a report should be publicly available. That is one way in which a citizen can mark the progress that has been achieved during the preceding year and the obstacles that must be surmounted.
  I have a great deal of sympathy with the amendment and can understand the reasons for it. Nevertheless, I do not support the amendment because, as a devolutionist, I believe that, ordinarily, it is not for us to encroach on the provisions of a Bill that has been agreed by the two Administrations. I shall be content if the Health Minister and the committee at the Assembly pay due regard to the worries voiced on behalf of the official Opposition.
  Baroness Finlay of Llandaff: I have great sympathy with the spirit of the amendment, as it seems obvious that a public body must report, at least annually, on what it is doing. However, I have some concern about the wording of the amendment, because other agencies exist that will be examining,
  "the level and quality of the health services in its area".
  I am worried that, as the amendment is currently worded, it might create a conflict with the roles of other inspectorate bodies.
  The Commission for Health Improvement has been active in Wales in considering the quality of health services, and such inspections will continue. It is important that the CHCs work with, not in competition with, those bodies responsible for determining the level and quality of health services in the area. That includes the local health board, which will commission services. For that reason, I must express concern over the wording of the amendment.
  Lord Hunt of Kings Heath: I am grateful to the noble Lord, Lord Roberts, for raising this question. I very much agree with my noble friend Lord Prys-Davies. No one would argue with the idea that a public body should regularly report on the discharge of its responsibilities. It should be in the minds of the members of those bodies that they have a public responsibility and that they need to be transparent about what they do and what their successes and concerns are. However, my noble friend is right to suggest that the National Assembly should deal with this matter.
  I have looked again at the part of the schedule to which the noble Lord, Lord Roberts, referred. I read it in a very different way from him: he regards it as constraining, whereas I believe that it provides CHCs with a great deal of discretion and responsibility in their future functions. For example, sub-paragraph (f) refers to the,
  "consultation of Councils by Health Authorities, Local Health Boards",
  and so on. Sub-paragraph (g) refers to the,
  "consideration by Councils of matters relating to the operation of the health service within their districts".
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  Sub-paragraph (h), meanwhile, refers to,
  "the preparation and publication of reports by Councils'",
  and sub-paragraph (j) to,
  "the furnishing and publication by"—
  NHS bodies—
  "of comments on reports of Councils".
  Sub-paragraph (k) refers to,
  "the provision of information … to Councils by",
  NHS bodies. Sub-paragraph (1) refers to,
  "the provision of information … by Councils to other persons".
  The schedule provides a satisfactory structure for the National Assembly to make provisions about the job that CHCs are to do in the future in Wales. I have no doubt that the ability is there for CHCs to report on the stewardship of their work and responsibilities.
  I agree with the noble Baroness, Lady Finlay, that the wording of the amendment presents a problem. Other bodies are charged with reporting on the quality and standard of services that are being provided. One such inspection body is the Commission for Health Improvement. We must not duplicate functions. The role of a CHC is clear; it is its duty,
  "to represent the interests in the health service of thy public in its district".
  On the general point, I have no doubt that the National Assembly will charge CHCs to ensure that their activities are properly reported. At the end of the day, however, it is best left to the Assembly to make its own decisions in that regard.
  Lord Roberts of Conwy: I detect a slight note of discord between us, because I believe that the amendment is important.
  CHCs have a dual duty:
  "(a) to represent the interests in the health service of the public in its district: and
  (b) to perform such other functions as may be conferred on it by regulations under paragraph 2".
  I want to add, as a third requirement, the duty to present an annual report.
  There seems a general agreement that bodies of this kind should report, especially when they represent a public interest, as these bodies clearly do. I should have thought that they would wish to report, in any case. If we look at the schedule, we see that the,
  "National Assembly for Wales may by regulations make provision about"—
  and there follow sub-paragraphs all the way from (a to (n), containing a long list of activities of CHCs that will be subject to regulation.
  The Minister's performance is normally impeccable, but I could not fail to notice that he leapt over sub-paragraph (i). He referred to sub-paragraph (h), which mentions,
  "the preparation and publication of reports by Councils",
  but he skipped sub-paragraph (i), which states that there can be regulations regarding,
  "matters to be included in any such report".

  GC 15
  The CHCs may produce reports, but they are regulated reports. They will be told by regulation by the Assembly—very clearly, I should imagine—exactly what can be put into such reports and what shape those reports can have.
  The noble Baroness, Lady Finlay, said that other bodies would have an interest in providing health services. However, the CHCs are particularly responsible for representing,
  "the interests in the health service of the public",
  and that is what they will report on. They will not necessarily report on the level of the service, but the public interest in the service. I do not necessarily see a clash of interests between the providers of health services and the CHCs. Of course there can be a clash if the CHCs think that the providers are defective or lacking, but it is just as well that the public should know. I fear that the CHCs will be too constrained by regulation and the public's knowledge of how they are discharging their duties will be limited.
  I shall withdraw the amendment in a moment, although we may wish to come back to the issue on Report.
  4.30 p.m.
  Lord Hunt of Kings Heath: The noble Lord should not attribute too much significance to the fact that I did not mention sub-paragraph (i). It could be argued that his amendment would constrain the ability of a CHC to report, because it would set out in primary legislation what CHCs should report on. However, leaving that aside, his question goes wider. He is talking about the independence of community health councils. I agree that that is important. My understanding is that the Assembly has no desire to compromise the independence of CHCs and fully intends to safeguard that independence. That will be reflected in the way the Assembly responds to its power in the schedule to make regulations. The Assembly will seek to strike a balance between setting out in detail the requirements and duties to be placed on CHCs and the need to ensure that CHCs represent patients consistently across Wales. That is important. The experience so far is that the performance of CHCs has been patchy. Good CHCs can be marvellous, but the interests of those who live in an area where the CHC is poor are not properly served. I suspect that the point of sub-paragraph (i) is to try to encourage greater consistency across community health councils. I am assured that in striking a balance between setting out—potentially in too much detail—the requirements and duties on CHCs and the need to ensure that they represent patients consistently, the National Assembly for Wales clearly feels that it is very important to preserve the independence of CHCs.
  Lord Roberts of Conwy: I am grateful to the Minister for those reassurances, particularly about the independence of CHCs. However, CHCs must demonstrate that independence. Laying a duty on them to produce an annual report on how they have
  GC 16
  discharged their duties would make that independence abundantly clear, not only to them but to the public whom they serve. I hope that the Minister's assurances about the views of the Assembly are correct and will be implemented in practice. I shall give the issue further consideration and may return to it on Report. I beg leave to withdraw the amendment.
  Amendment, by leave, withdrawn.
  Lord Roberts of Conwy Lord Roberts of Conwy moved Amendment No. 7:
  Page 7, line 45, at end insert ", which shall present an annual report on its activities to the Assembly"
  The noble Lord said: This amendment also relates to the production of an annual report. The background is that, under paragraph 4, the Assembly will establish a national body to advise and assist CHCs in the performance of their functions. It will probably be akin to the association of CHCs, but it will be established by the Assembly. There is some ground for concern about its independence. From the Assembly government's point of view, there is everything to be said for having all these bodies well and truly buttoned up, if not straitjacketed, so that they cannot cause embarrassment, such as the revelation a fortnight ago that some health authority chief executives in Wales were drawing scandalously high salaries, well in excess of £100,000 a year. In a democracy such as ours, the truth usually emerges one way or another.
  One way of safeguarding the integrity of an institution or body, such as the one proposed to advise and assist CHCs, is to impose a duty on it to produce an annual report on its activities so that the public can read about them. I would have thought that the Assembly, as well as the public, would welcome that, because such an account would help in the constant process of assessment of the value of the body.
  Most bodies established by statute are obliged to produce an annual report, which is laid before Parliament. There should be a similar obligation on the body proposed here to report annually to the Assembly and, in so doing, to report to the public. I beg to move.
  Lord Hunt of Kings Heath: In some ways, this is a rerun of our previous debate. My main response is that the Bill gives the Assembly sufficient discretion to ensure that if it so wishes the new body can make an annual report to the Assembly on its activities. Of course I accept the principle that such bodies ought to report on their activities. I am sure that we all agree with that, but it is for the Assembly to decide. My understanding is that the intended establishment of a statutory all-Wales body for CHCs is seen as a way of increasing the standard and quality of work of community health councils and ensuring consistency of service provision. The Assembly sees the body as a powerful strategic influence for patient representation at an all-Wales level.
  The role and responsibilities of the body are currently the subject of consultation with CHCs, but it is likely that its duties will include supporting and advising individual CHCs, providing support for personnel and training, payroll and financial support,

  GC 17
  budget allocation and distribution, the maintenance and review of CHC standards and, importantly, performance monitoring, advice and support.
  I mention performance monitoring because one of the great weaknesses of CHCs over the past 25 years is that there has been very little external monitoring of how well they work. That is why we have seen such a variation in performance between excellent CHCs and very poor ones. The new body will have a key role in helping each CHC to improve its work.
  The noble Lord also raised the issue of independence. The other major function envisaged for the new body is to provide an all-Wales voice for patient and public representation. I understand that the current association of Welsh CHCs undertakes that role, but it is not considered to be adequately resourced. In placing the association's successor body on a statutory footing, the Assembly is turning it from an informal support organisation into one that will have a much greater ability to monitor performance, set standards, develop best practice and provide an all-Wales voice for patient and public representation. That is to be commended. The Bill gives the Assembly plenty of discretion to require such a body, when it is established, to report as it thinks fit. We should have confidence in the Assembly on that.
  Lord Roberts of Conwy: I am very grateful to the Minister again. I am delighted to hear what he has said. The Assembly is right to establish the body on a statutory basis. I am glad to hear that it will have a performance monitoring role. The old CHC association was an informal support organisation and had defects. There is no doubt that the proposal is a considerable improvement, which I hope will raise standards and ensure consistency of performance among CHCs.
  However, it will be a statutory body. In common with other statutory bodies, it should be incumbent on this body to produce an annual report so that the public can see how it is discharging its duties.
  I do not want to sound suspicious, but there is a clear danger that if such a body does not report to the public on the performance of its functions, there will be a considerable danger that it will become introspective and may not perform its functions as well as we all wish. I beg leave to withdraw the amendment.
  Amendment, by leave, withdrawn.
  Schedule I agreed to.
  Clause 2 [Wales Centre for Health]:
  Lord Roberts of Conwy Lord Roberts of Conwy moved Amendment No. 8:
  Page 2, line 12, at end insert "; but must not exceed 15"
  The noble Lord said: We all have high hopes of the Wales Centre for Health—the new independent training, advisory and research body. It will be a body corporate with statutory functions, as set out in the Bill. As the Bill stands, the Assembly may appoint any number of members. I suspect that there is a danger of too many rather than too few members being appointed. I f there are too many, the Wales Centre for Health may not be as effective as we all hope it will be.
  GC 18
  It would therefore be wise to set an upper limit, as is customary in statutes establishing such bodies. The amendment would set such a limit.
  We shall probably be urged to leave all such issues to the Assembly, as has so often been the case with other legislation. However, as we pass these issues back to the Assembly, I wonder whether we are deliberately creating additional work for Assembly Members. They might be grateful if we at least gave an indication of where we think the boundaries should he drawn. I beg to move.
  4.45 p.m.
  Lord Thomas of Gresford: This is a classic issue for the Assembly. As matters proceed, it will decide the suitable number of members for the Wales Centre for Health. It may start with a few and need more or it may start with more and need fewer, but that is a matter for the Assembly.
  Baroness Andrews: The amendment would reduce the power of the Assembly to determine the number of members of the Wales Centre for Health. I entirely agree that we have high hopes for the centre. It is nice to see the first bit of Welsh in the Bill—Canolfan Iechyd Cymru. I think that acronym will be easier to say than WCH. We very much look forward to it becoming more than an acronym in due course.
  The Assembly will be responsible for funding the WCH and monitoring its effectiveness. The noble Lord, Lord Thomas, is right that the Assembly is best placed to take these decisions, although we take the point about having an upper limit and the tendency of public bodies to add ever more people.
  The noble Lord, Lord Roberts of Conwy, has the gift of foresight. I understand that the Assembly intends that the centre should consist of a chair arid no more than 14 members. The noble Lord has happily come up with the right number. All his years in Parliament and public life have made his judgment very sound.
  With that assurance, I hope that the noble Lord is able to withdraw the amendment.
  Lord Roberts of Conwy: I am delighted to have had the chance to anticipate the best thoughts of the Assembly. I am glad that it has a limit of 15 in mind. That is an adequate number. In view of that assurance, I beg leave to withdraw the amendment.
  Amendment, by leave, withdrawn.
  Clause 2 agreed to.
  Schedule 2 [Wales Centre for Health: further provision]:
  Lord Roberts of Conwy Lord Roberts of Conwy moved Amendment No. 9:
  Page 8, line 13, after "authorised" insert "in writing"
  The noble Lord said: I should have spoken to this with Amendment No. 8. I apologise. Paragraph 8 of the schedule specifies that the Assembly has to give its direction to the Wales Centre for Health in writing. The centre would be well advised to give authorisation to those acting in its name in writing as well. That is the

  GC 19
  point of the amendment. Members and staff will be so authorised by the terms of their appointment, but others are to be authorised too. Paragraph 3 mentions committees and sub-committees. For the avoidance of doubt and with the interests of good management at heart, authorisation should be in writing so that all who act for the centre should know the extent of their powers. I beg to move.
  Baroness Andrews: We appreciate the intention behind the amendment. The noble Lord has spoken of good management. He clearly has in mind accountability and the importance of keeping good written records. We can hardly disagree with that.
  However, the amendment would oblige the centre to provide a written authorisation for any member of staff or any committee or sub-committee of the centre. There are some merits in that, but we believe that the virtue of a small research-based centre that we envisage will lie in its capacity to act quickly and be responsive. It will have to identify and reflect on some of the key issues of medical need of the day. It will be very important not to overload the centre with bureaucracy and paperwork that is not strictly necessary. It would be easy to inhibit the centre's capacity to be effective if it had to respond in writing to every conceivable function placed on every member of staff.
  Paragraph 2 places a duty on the centre to,
  "carry out its functions effectively, economically and efficiently".
  In fulfilling that requirement, the centre will be expected to ensure that its members and the staff of committees and sub-committees know and understand how they contribute to carrying out the functions of the centre. That will be a matter of good practice and much of it will be in writing. That is a simple and important tool of good management.
  Paragraph 3 simply ensures that anything authorised or required by the centre can be done by the member of staff or committees of sub-committees, thereby putting beyond doubt the capacity of the centre to act. No doubt a lot of that will have to be in writing, but we are reluctant to inhibit the centre's ability to move fast and effectively. There will he necessary safeguards and the amendment is unnecessary.
  Lord Roberts of Conwy: I am grateful to the noble Baroness. She will appreciate that I was prompted to table the amendment by the contrast between the powers of the centre and the Assembly's directions to it, which have to be in writing. However, I am content to highlight that point. I trust that what the noble Baroness has said about the conduct of the centre will materialise. I beg leave to withdraw the amendment.
  Amendment, by leave, withdrawn.
  Schedule 2 agreed to.
  Clause 3 [Functions of the centre]:
  Baroness Finlay of Llandaff Baroness Finlay of Llandaff moved Amendment No. 10:
  Page 2. line 23, at beginning insert "facilitate and"
  The noble Baroness said: I shall speak also to Amendment No. 11, because the two are linked. I shall be brief, because I received a very helpful letter in which the noble Lord, Lord Evans of Temple Guiting, clarified the issue. I have also had a very helpful conversation this morning with the Chief Medical Officer for Wales, Dr Ruth Hall, which further clarified the issues. I do not intend to press the amendments.
  The amendments were tabled because the Wales Centre for Health is an exciting and important body. It should be able to act and influence health in Wales on as broad a platform as possible. My concern was that if education was not specified, the centre may have little influence at undergraduate level, limiting its input to postgraduate level where training is occurring. Undergraduates need to be aware of the deficit in health in Wales and the enormous problems that exist, as well as the importance of public health in altering the mortality and morbidity of the population.
  I have had reassurances that the centre will work with education providers on the education, training and supply of public health practitioners and specialists and that it will assist in public health education on the broader platform. I understand that input at undergraduate level was not specified in the Bill to avoid any possible conflict over who was responsible for providing undergraduate education. That responsibility rests firmly with the universities in Wales to train the healthcare staff to meet the needs of the health service in Wales and to welcome healthcare professionals from outside Wales to supplement the workforce when required.
  Having received the reassurances that I have sought, I do not wish to move the amendments.
  The Deputy Chairman of Committees (Lord Lyell): As the noble Baroness has spoken at length, I wonder if it might be in order for me to offer others the opportunity to comment on what she has said. She can then wind up afterwards.
  Baroness Finlay of Llandaff: In that case, I beg to move.
  Lord Roberts of Conwy: I am grateful to the Deputy Chairman of Committees for allowing us to say a few words. I am particularly interested to hear what the Minister has to say about the amendments.
  Subsection ( 1) relates entirely to,
  "matters related to the protection and improvement of health in Wales".
  Those are the matters on which the Wales Centre for Health must make information available to the public. It must also research those issues and provide training in them. I am not sure how wide a scope the clause provides for the WCH. I should like to hear the Minister's views.

  GC 21
  The noble Baroness, Lady Finlay, would like to include education as well as training and would like the WCH to be able to facilitate as well as contribute to the provision of education and training. Again, I should like to hear how the WCH intends to fulfil that function.
  I support the amendment, because training alone spells something less than education—covering short courses and the like that may be run by anyone, anywhere. Education is a more respectable description for these serious and important matters.
  5 p.m.
  Baroness Andrews: I am sure that the Committee appreciates that it is always a relief to me when the noble Baroness, Lady Finlay, decides not to press her amendments. We know from long experience that she has challenged the Government on medical matters to great effect.
  The function of the Wales Centre for Health is to help to tackle the legacy of ill health that has been specific to Wales and has set it apart from the rest of the United Kingdom. It will do so by providing independent health advice and supporting and initiating research, by providing and developing training programmes and identifying gaps in information and by focusing on the strategic development of public health skills. That covers a range of issues for which we have not had the capacity to date. Even though the centre will focus on research and development, it is bound to have training and education implications. I shall explain. However, we would have had difficulty in accepting that it was necessary to include the term "facilitate" in the Bill because we believe that the WCH's public health training functions are clear.
  In response to the noble Lord's question, I shall enumerate some of those functions. The current wording of the Bill is intended to enable the centre to carry out a wide range of training activity. It includes: working with other parts of the UK to develop new national standards for public health; specifying competencies for public health practitioners; scoping the current training and development programmes among senior professionals in the NHS, local authorities and the voluntary sector; developing and implementing a national programme of training for public health practitioners in Wales; providing fellowships for non-medical people to become accredited public health specialists; developing inter-professional and multi-professional training in health protection for the NHS and local government; developing training for local authority members; and providing awareness training for health professionals about immunisation and vaccination programmes or potential biological or chemical threats.
  The shadow body has already begun to scope some of those functions and has been working with the Velindre Trust. We are already beginning to see developments. Clause 3 encompasses all those
  GC 22
  activities, and we believe that they imply the term "facilitate". So it is an unnecessary addition to the Bill. Schedule 2(20) gives the centre general powers to,
  "do anything which it considers necessary or expedient for the purpose of, or in connection with, the exercise of its functions".
  So the centre has the scope to develop those areas of its work as it sees appropriate.
  The intention behind Clause 3 is to give the centre a role in developing education and training in public health skills for public health practitioners and specialists, in particular by encouraging joint training between different professional groups. The Bill was framed deliberately with the intention of not giving the centre a duty to contribute to basic professional training. The noble Baroness, Lady Finlay, said that she spoke to professionals in the field who explained that the inclusion of the term in the Bill would have created a problem. Responsibility for the level of competence demanded by basic education is a matter for professional and regulatory bodies. If we gave the centre a duty to contribute, it would cut across those responsibilities. Obviously the amendment would have resulted in a conflict of interests with, for example, the medical committee of the GMC, which has a statutory responsibility for medical education, and the Nursing and Midwifery Council, which has a similar responsibility under the Medical Act 1983.
  In any case, consultation with education providers would be essential before imposing a duty. If the Assembly had contemplated placing that duty on the centre, it would have had to consult the bodies first. We are sensitive to the important issues raised.
  I hope that I can reassure the noble Baroness, Lady Finlay, and the noble Lord, Lord Roberts of Conwy, that their concerns can be met in other effective ways. There is no reason why the centre should not advise education providers on the public health element of basic professional education. I hope that the outcomes of research and development will be fed into the postgraduate and undergraduate syllabuses in due course as we learn more about the epidemiology of Wales and the proper way to respond through public health. If we are serious about making a link between research and policy, that is exactly what we would want to see happen. We would want it to feed into not just the policy-making process but also into the intellectual capital of medical education.
  It is hoped that we shall see a broader platform as the centre works with education providers on public health training. The centre's existence will raise the profile of public health in Wales, which is an extremely important function. It will encourage the identification of issues; it will be a source of information on public health issues, and it will also be a source of evidence, whether working alone or in partnership with other bodies—academic, voluntary and so on.
  The current provision in the Bill is sufficient to cover advising on public health education to any education provider that may need or want such advice. If the Assembly wished to make that more explicit, it could also do so through its powers under Clause 3(3) to

  GC 23
  confer additional functions on the WCH. But, in view of the implications that that could have for other bodies in Wales, it would not be advisable to impose on the WCH the duty proposed in the amendment. I am grateful to the noble Baroness for agreeing to withdraw her amendment.
  Baroness Finlay of Llandaff: I am grateful to the Minister for explaining to the Committee what was explained to me privately outside. I apologise for having been so keen to accept the reassurances that I nearly denied the Committee the benefit of hearing the information. I am grateful to the noble Lord, Lord Roberts, for his support for the spirit in which the amendments were tabled. With the reassurances that have been shared with the whole Committee, and which I received privately, I beg leave to withdraw the amendment.
  Amendment, by leave, withdrawn.
  [Amendment No. 11 not moved.]
  Lord Roberts of Conwy Lord Roberts of Conwy moved Amendment No. 12:
  Page 2, line 24, at end insert—
  "( ) liaise with other bodies in Wales and elsewhere in the United Kingdom having similar functions"
  The noble Lord said: The amendment would ensure that there is liaison between the Wales Centre for Health and other bodies with similar functions, especially in the United Kingdom, to avoid costly duplication of effort and to secure a high quality of service. Although Wales certainly has distinctive health problems, as we all know, it also shares many such problems with other countries and the rest of the UK. Liaison and knowing what is going on world-wide is all-important in the medical field, as most experts would agree. I know from my presidency of the University of Wales College of Medicine and other sources how important international medical knowledge and research are, and how important it is for teachers and practitioners to be familiar with the latest developments in their particular area of expertise.
  With the new centre coming on-stream, it is important that its members should be aware of what is going on in Wales, its two universities and colleges. I apologise to the noble Lord, Lord Morgan, for leaving out at Second Reading Aberystwyth from my catalogue of colleges active in the health field. It simply proves the point that there is a need for constant awareness of what is going on—that applies to the private sector also.
  So I make no apology for seeking to include this amendment, which would impose a duty on the new centre to liaise with other bodies engaged in similar areas of public health research and training. Incidentally, the centre seems to be still in the developmental stage. That is an additional reason why it should have a constant reminder of the need to look outside itself. I beg to move.
  Baroness Andrews: Now that I know that Aberystwyth was left out, my feelings on this
  GC 24
  amendment have hardened considerably. It would place a statutory duty on the centre to liaise with other unspecified bodies in Wales. I accept entirely the motivation behind the amendment: that is, to encourage and enable the centre to liaise with the international research community. But the problem is that the term "liaise" is indefinite. The dictionary definition is,
  "to work closely with more than one group in order to communicate information between them".
  Problems would arise because we do not entirely know the purpose of such communication or the work that could be involved. It is not entirely clear what additional benefit such a duty to liaise would bring in those terms.
  But the more significant difficulty is that in Wales we seem to have created something unique yet again. There are no equivalent or similar bodies to the Wales Centre for Health in Wales or elsewhere in the UK. Many bodies carry out some of the functions of the centre but there is no equivalent duty on them to liaise with it. Whereas a responsibility to liaise would lie with the centre, there would be no equivalent responsibility or reciprocal requirement on other bodies to liaise back. So we feel that to enforce such a duty would impose an unreasonable burden on the centre. It might affect its efficiency and effectiveness in carrying out its work. It would add to its responsibilities in a way that might not add to its value. It would be serious if the amendment constrained the centre's freedom of action, its ability to act on its own initiative, or its scope.
  I hope that I can reassure the noble Lord, Lord Roberts, that Schedule 2(20) gives the centre the power to co-operate with other public authorities. That means that it will have the power to co-operate with local authorities, health authorities, the research community and voluntary organisations. If it determines that in its work co-operation and communication are important and necessary, we fully expect it to do so.
  In its very short life, the shadow body has already collaborated with the Agency for Toxic Substances and Disease Registry of the USA in its public event on the health effects of the Nant y Gwyddon landfill in south Wales. So it has already sprung into action. By definition, it is to have a close working relationship with the new national public health service. It will establish links with the two nearest equivalent bodies in England—the Health Development Agency and the public health laboratories. It will also establish contact with the public health institutes in Scotland and Ireland. So, as part of its public health agenda, it will be properly joined up with other bodies.
  Concern was raised that the centre should be able to access information and contribute to the academic community's growing body of knowledge in general. It would be a poor centre if it did not do that of its own volition. As regards the quality of its own work, we fully expect centre staff as good academics and medical researchers to be in tune with, and in contact with, their peer groups wherever work relevant to their understanding of a project is being done. We must

  GC 25
  leave it to the centre to make those links. A duty to liaise with everyone with similar functions would probably be unachievable. I hope that I have reassured the noble Lord in that respect.
  Lord Roberts of Conwy: I am grateful to the noble Baroness for her words. In particular, I was delighted to learn that the body set up in shadow form was already liaising—although that may he an adequate word—with other bodies in which it was interested, and whose interests it shared. My sole point in moving the amendment is to seek to avoid costly duplication of efforts. Although we have very specific health problems in Wales, we share other health problems with other parts of the United Kingdom and the world. I beg leave to withdraw the amendment.
  Amendment, by leave, withdrawn.
  Lord Roberts of Conwy Lord Roberts of Conwy had given notice of his intention to move Amendment No. 13:
  Page 2, line 35, leave out subsection (4).
  The noble Lord said: I have no intention of moving the amendment, except by the Committee's request. No such request is made, and I am not depriving anyone of an opportunity to speak on this group. Their substance was discussed in another place, and we understand their purpose. Therefore, I shall not move the amendment.
  [Amendment No. 13 not moved.]
  [[Amendments Nos. 14 and 15 not moved.]
  Clause 3 agreed to.
  5.15 p.m.
  Clause 4 [Health Professions Wales]:
  Lord Roberts of Conwy Lord Roberts of Conwy moved Amendment No. 16:
  Page 3, line 20, leave out subsection (3).
  The noble Lord said: These are probing amendments to find out what functions the Government have in mind to he carried out by Health Professions Wales on behalf of the Assembly other than those specified in subsection (4). Perhaps the Minister can help us on this matter.
  Amendment No. 17 would make the nature of the functions specific to healthcare professions and workers. Without that, it would seem that the Assembly could burden HPW with almost any function within the scope of health legislation. Amendment No. 18 has a serious intent in that it seeks to protect standards and to ensure that any training arrangements entered into are not below the standards required by the UK councils for which HPW will be acting in Wales. I beg to move.
  The Deputy Chairman of Committees: I have to advise the Committee that if this amendment were to be accepted I would not he able to call Amendment No. 17.
  Lord Evans of Temple Guiting: I am most grateful to the noble Lord, Lord Roberts, for raising these interesting points. Amendments Nos. 16 and 17 would prevent the Assembly from directing HPW to carry
  GC 26
  out functions that are not specifically mentioned on the face of the Bill. Amendment No. 18 would prevent HPW from entering into any arrangement with any other body that would lead to the creation of professional and educational standards that differ from those set by the Nursing and Midwifery Council and the Health Professions Council.
  Amendment No. 16 would remove the power for the Assembly to request HPW to carry out any function not included in the Bill, while Amendment No. 17 would prevent the Assembly from directing FIPW to carry out functions on its behalf unless they were directly related to healthcare professions and healthcare support workers. Both would constrain HPW in its aim of ensuring a fully competent and flexible workforce for the NHS in Wales by restricting the type of services that it could be asked to provide.
  The Assembly has wide powers and duties in relation to the provision of a comprehensive health service. Those functions do not relate solely to the healthcare professions and support workers, but will have implications for them. The intent of subsection (3) as it stands is to allow the Assembly the necessary flexibility to devolve such of its functions as it deems appropriate to be exercised by HPW in relation to health professions and support workers as provided by subsection (2).
  Amendment No. 18 would restrict HPW from entering into any arrangement with other bodies that could lead to the creation of professional and educational standards that differ from those set by the Nursing and Midwifery Council and the Health Professions Council. While it seeks to ensure that training standards for healthcare professionals arc uniform across the UK, I hope that the noble Lord will not mind me saying that it is an unnecessary amendment. It misunderstands the nature of the arrangements that HPW may enter into. Such arrangements will be entered into by agreement with the standard-setting bodies. HPW will not be empowered under such arrangements—I hope this reassures the noble Lord—to act in any way that is not acceptable to those bodies. HPW may undertake functions on behalf of the standard-setting bodies and in doing so will apply their standards. HPW will not be involved directly in setting standards; its role will be to ensure that UK-wide standards are applied in Wales.
  The regulatory bodies are responsible for the monitoring of educational standards in the UK. Currently, the Nursing and Midwifery Council has a service level agreement with HPW to carry out quality assurance activities in Wales on its behalf. There is also a similar provision in the Health Professions Council order. HPW should be able to assess the need and to support the development of post-registration education and training of professions according to the workforce planning initiatives and the health policy development in Wales.
  It will be important that there are effective communication channels between HPW and the Nursing and Midwifery Council and the Health Professions Council to ensure that rules and processes

  GC 27
  required by the regulatory bodies are understood and implemented in Wales, and that the policies and priorities in Wales health provision are known to the regulatory bodies. It is not the intention of the Assembly to direct HPW to direct any educational standards that differ from those set by the statutory regulatory bodies.
  The amendments would frustrate one of the main policy intentions behind setting up HPW and would seriously limit the work that HPW can undertake in the development and improvement of learning opportunities and the continuing professional development activities available to health professionals working in Wales.
  I hope that I have convinced the noble Lord that the Assembly needs such flexibility to use the knowledge and expertise that HPW will have in order to support and to develop the workforce of the NHS in Wales and that the amendments would serve only to restrict such flexibility.
  Lord Roberts of Conwy: I am grateful to the Minister. As I said, these are probing amendments. He has risen to the probe—if that is the correct phrase—extremely well. We are much enlightened by what he has said and we are greatly reassured that the operating standards in Wales will not be below United
  GC 28
  Kingdom standards. That depends on the statutory regulatory bodies. Having received those assurances, I beg leave to withdraw the amendment.
  Amendment by leave withdrawn.
  [Amendments Nos. 17 and 18 not moved.]
  Clause 4 agreed to.
  Clause 5 [Further provision about HPW]:
  Lord Roberts of Conwy Lord Roberts of Conwy had given notice of his intention to move Amendment No. 19:
  Page 4, line 24, leave out subsection (8).
  The noble Lord said: This group of amendments deals with the power of the Assembly to abolish Health Professions Wales if the need arises and to make consequential provisions. I believe that the matter has been dealt with fully in Committee in another place. Unless I am encouraged otherwise by Members of the Committee, I shall not move the amendments. Perhaps I may take this opportunity to thank you, Lord Chairman, and all Ministers who have participated in this Committee stage.
  [Amendment No. 19 not moved.]
  [Amendments Nos. 20 and 21 not moved.]
  Clause 5 agreed to.
  Remaining clauses and schedules agreed to.
  Bill reported without amendment.
  The Committee adjourned at twenty-five minutes past five o'clock.