Government of Wales Bill

HL Deb 15 June 1998 vol 590 cc1294-301

3.21 p.m.

The Parliamentary Under-Secretary of State, Home Office (Lord Williams of Mostyn)

My Lords, I beg to move that the House do now again resolve itself into Committee on this Bill.

Moved, That the House do now again resolve itself into Committee.—(Lord Williams of Mostyn.)

On Question, Motion agreed to.

House in Committee accordingly.

[The CHAIRMAN OF COMMITTEES in the Chair.]

Lord Hunt of Kings Heath moved Amendment No. 244:

After Clause 112, insert the following new clause—

("Health Advisory Council for Wales

HEALTH ADVISORY COUNCIL FOR WALES

.—(1) The Assembly shall establish and maintain a body to be known as the Health Advisory Council for Wales or Cyngor Iechyd Ymgynghorol Cymru (but referred to in this Act as the Health Council).

(2) The Health Council shall consist of Assembly members and members of—

1. (a) a health authority for an area in, or consisting of, Wales;
2. (b) a National Health Service Trust all or some of whose hospitals, establishments or other facilities, are situated in Wales;
3. (c) local representative committees in Wales of primary care professionals.

(3) The Health Council may—

1. (a) give advice to the Assembly about matters affecting the exercise of any of the Assembly's functions in relation to the strategic direction of the National Health Service in Wales;
2. (b) make representations to the Assembly about any matters affecting, or of concern to, those employed by or involved in the National Health Service in Wales; and
3. (c) give advice to those employed by or involved in the National Health Service in Wales.

(4) The health subject committee of the Assembly shall consult the Health Council as to any order which it contemplates making affecting health and health services.

(5) The Assembly shall appoint as members of the Health Council—

1. (a) the Assembly members who are members of the health subject committee; and
2. (b) as many members of—

1. (i) a health authority for an area in, or consisting of, Wales,
2. (ii) a National Health Service Trust all or some of whose hospitals, establishments or other facilities are situated in Wales, and
3. (iii) local representative committees of primary care professionals,

as the Assembly considers appropriate.

(6) The Assembly shall appoint one of the members of the Health Council to be its chairman.

(7) The Health Council shall meet at least twice a year.

(8) The Health Council shall lay before the Assembly an annual report on the performance of its functions.").

The noble Lord said: The purpose of this amendment is to establish a health advisory council of the assembly with a membership covering both the special subject committee and the National Health Service in Wales. The purpose of such a council would be to advise the assembly about strategic matters relating to the NHS in Wales, and to advise the NHS in Wales itself.

I am a long-standing admirer of the National Health Service in Wales. Over the 50 years of its operation it has produced a consistently high standard of service both in extreme rural areas and in the large conurbations. It has very high public and staff commitments and a very high standard of teaching and research. I believe that we have seen considerable innovations. I refer in particular to public health issues and to the development of an all-Wales mental health strategy.

I believe that the assembly will enhance the ability of the NHS to improve its services. The assembly starts with wide-ranging responsibilities: the allocation of resources to NHS organisations; holding those bodies to account; ensuring that the health of the people living in Wales improves and that there is a strategy for continuing to improve their health; and ensuring that the health service in Wales has an adequate and well-trained staff.

I am convinced that the assembly offers much opportunity to the NHS in Wales by, for example, allowing it to introduce more innovation without being in the shadow of the Department of Health in England, by ensuring a better appointments process to the non-executive positions on health authorities and trusts, and by allowing for cross-sectoral working. I believe that the various subject committees of the assembly, bringing together those with an interest in health, the environment, transport and housing, present a great opportunity to establish cohesive public health policies which will help to improve the health of many people. Finally, I welcome the ability to tailor resources to specific priorities in a way which I suspect has not been possible previously.

The success of that process depends crucially on the relationships between the relevant assembly secretary, the relevant subject committee and the NHS in Wales. The National Assembly Advisory Group offered much helpful advice on, for example, the checks and balances that need to be in place, the role of the assembly secretary and the role of the subject committee, which will have the job of holding the assembly secretary to account, putting its views on the budget of the NHS in Wales to the executive committee, making recommendations on policy and scrutinising secondary legislation.

All of that represents extremely useful advice, but I suspect that there is always the danger that the subject committee may be tempted to involve itself too greatly in operational management at field level and deal rather less with strategic leadership, proper monitoring and holding the NHS to account. That problem is not exclusive to the work of the new assembly. Indeed, the NHS has been bedevilled over the years by too much operational interference in management at local level by the four departments of health throughout the United Kingdom. We have seen the continual second-guessing of decisions, the slowing down of decision-making and, in many cases, the inhibition of effective management at local level. Perhaps we took Aneurin Bevan's words too literally when he said that when a bedpan drops in a ward in St. Thomas's Hospital, its echo should resound in the Palace of Westminster. I suspect that over the past 50 years rather too many bedpans have been dropped and rather a lot of echoes have been heard in this House and in another place.

That is where an advisory council would come into play. It could help to clarify sensibly the relationship between the assembly and the NHS in Wales. It could ensure that the subject committee has access to advice from people in the field. It could encourage the assembly subject committee to focus on strategic leadership and direction. It would, I am sure, create confidence in the NHS about the activities of the assembly. It could ensure that policy and secondary legislation would be tested by the people who have to operate it at field level. I am sure that it could ensure that the performance management of the NHS would be that much more effective.

The Bill already allows for a partnership council between the assembly and local authorities. It allows for a scheme to promote the interests of voluntary organisations. It allows for consultation with business on the impact of the assembly. It would be a great pity if the Bill did not contain a specific reference to the National Health Service in that regard. After all, the NHS is the largest single employer in Wales, with 68,000 people working directly for it. Another 8,500 GPs and dentists are contracted to the NHS. Its budget in the last financial year was £2.4 billion, some 34 per cent. of the entire Welsh Office budget.

So the performance of the NHS in Wales is crucial to the performance of the assembly. Getting right the relationship between the assembly and the NHS is essential. I am sure that an advisory council would help enormously. I beg to move.

3.30 p.m.

Lord Roberts of Conwy

Members of the Committee will recall that we touched on the health service in Wales when we discussed Clause 28 which gives the assembly powers over health authorities in Wales. I drew attention then to the changes that the Government are already promoting in the NHS in anticipation of the advent of the assembly. The health authorities—already reduced to five—may be reduced still further. The trusts are to be reduced—their number is almost to be halved—from 29 to about 15.

I am not criticising those changes in themselves although many people in Wales do criticise them; but I am critical of the timing. For example, it is unfair that the new configuration of the trusts is due to be in place on 1st April next year, exactly one month before the assembly elections. Much of the future structure of the NHS in Wales will be fixed before the assembly takes over responsibility. In short, the views and consideration of the assembly are being pre-empted to a large extent. Perhaps that is a reason why the Government do not propose a co-operative scheme with the NHS as with the local authorities and voluntary organisations.

The Welsh Office has been the regional tier of the NHS in Wales. I believe that there were 18 regional tiers in England. Therefore, the relationship between the Welsh Office and the NHS traditionally has been very close. It is many years since I had personal ministerial responsibility for the NHS in Wales, but I do not believe that the close, almost intimate, nature of that responsibility has changed a great deal over the years. It is a unique ministerial role. It was one I enjoyed immensely and look back upon with great satisfaction. During that time we built a string of major new hospitals across the north and south of Wales and introduced new developments such as the 10-year strategy for improving the life of the mentally handicapped who are now referred to as people with learning difficulties. That strategy has been referred to by the noble Lord, Lord Hunt of Kings Heath.

I trust that whoever becomes assembly secretary responsible for health will find the job as rewarding as I did. He or she will certainly find the officers and staff of the NHS in Wales wonderful people to work with and for. One possible inspiration for the new clause and the health advisory council that is proposed is the partnership council between the assembly and local authorities to be set up under Clause 113. There are a number of similarities between the proposed health council and partnership council and the assembly and local government. There are also subtle differences. For example, assembly membership of the partnership council is not confined to the committee that deals with local government while membership of the health council is specific on that point. There are 22 unitary authorities in Wales. They are generally in favour of the Government's proposals for devolution, unlike the county councils in 1979 who were against because they viewed a national assembly as a threat to their power and possibly their resources.

The Government are surely right to believe that there must be close understanding and co-operation between the assembly and local authorities; certainly, they cannot be at loggerheads. But at the end of the day the assembly rules. Like the noble Lord, Lord Hunt, I question why the Government have sought this partnership with the local authorities and a scheme with the voluntary bodies but nothing specific to do with the NHS. I suspect that the real reason why there is no such proposal is the close connection between Ministers at the Welsh Office and the NHS, the Welsh Office being the regional tier, and the belief of the Welsh Office that the closeness of the relationship will be transferred from the Secretary of State to the assembly.

I believe that the real inspiration for the health council lies deeper; that is, in the personal professional experience of noble Lords themselves. The noble Lord, Lord Prys-Davies, has been intimately connected with the health service in Wales. Clearly, noble Lords want a national forum for the NHS in Wales with a strong advisory and consultative role. It is interesting that noble Lords do not follow the Government's line in asking the assembly to make a scheme with health authorities and local government and with voluntary organisations as in Clause 114. Noble Lords are to be admired; they do not mess about but come straight to their health council. A very substantial, powerful body is proposed; it comprises members of the assembly's health committee. But one wonders whether it is a mistake to include them in an advisory body when they may very well carry executive responsibility. How could they advise themselves? The mix could prove embarrassing.

If the Government are inclined to accept the new clause, I believe that they should take it away and re-model it between now and Report stage if only to remove the ambiguity whereby members of the assembly's health committee who may very well occupy an executive position are also members of what is basically an advisory body. I look forward to the comments of the noble Lord the Minister in due course.

Lord Prys-Davies

I shall always be grateful to two Secretaries of State, one a Labour Secretary of State, my noble friend Lord Clinton-Davis, and the other a Conservative Secretary of State, the noble Lord, Lord Thomas of Gwydir, who many years ago gave me the opportunity to serve the NHS in Wales for about half a dozen years. I have never lost interest in the NHS.

The statistics cited by my noble friend demonstrate that the assembly's responsibilities for the NHS in Wales will be most important. It may be that the amendment is imperfect. I agree with the noble Lord, Lord Roberts of Conwy, that perhaps there is need to reflect on the precise wording of the amendment. However, I believe that the principle of the amendment recognises the importance of the health service in Wales. I hope that the Committee and the Government will see merit in the assembly having a statutory advisory health council.

The case for the amendment has been made by my noble friend Lord Hunt and there is very little that I can add. However, I should like to emphasise two or three points. First, the advisory council would enable the assembly to draw on the advice of those involved in the NHS in Wales. That advice would be based on their knowledge and experience. If the Government were willing to consider the drafting of the amendment I would feel comfortable with the extension of the membership to those men and women who had an interest and expertise in the health service. I could mention some names to the Committee but I shall not embarrass them.

Secondly, my noble friend may say that it is open to the assembly to establish a sub-committee to advise it on the NHS in Wales, and that I accept. However, there is a distinction. A statutory advisory body would give statutory recognition to the contribution of the NHS staff who work extraordinarily hard on modest salaries. If it were statutory, it would enhance the status of the committee and the NHS in Wales.

The noble Lord, Lord Roberts of Conwy, drew attention to the provisions in the Bill for a local government partnership council and the scheme for the voluntary bodies in Wales. Those are fair points to make. But we can distinguish our case from that of the partnership council, local government and the voluntary scheme. The partnership council will be a partnership between two tiers of democratic government. We shall discuss the voluntary bodies in Wales later. However, in the legal sense a distinction can be drawn between the NHS and the voluntary bodies. The NHS will be an agent of the assembly. That leads to the point raised by the noble Lord, Lord Roberts, but I believe that it could be resolved.

Finally, I believe that the NHS undoubtedly owes a part of its inspiration to the medical aid societies and the miners' hospital committees of the South Wales coalfields in the first half of this century. The best way in Wales this year to respect and celebrate the 50th anniversary of the NHS is by embodying a statutory health advisory body composed of representatives of NHS staff in the highest council of government in Wales in the new century.

I hope that the Government will give careful consideration to the amendment so ably moved by my noble friend Lord Hunt.

3.45 p.m.

Lord Williams of Mostyn

I acknowledge at once that all three speeches in relation to the amendment were extremely informed and constructive. I recognise the reasoning underlying the proposal to have a health advisory council (Cyngor Iechyd Ymgynghorol Cymru). I readily pay tribute to all three noble Lords who spoke. The noble Lord, Lord Roberts of Conwy, is right. There have been extremely close, well developed arrangements in place for effective consultation between the Welsh Office and the National Health Service. I endorse the tributes he paid to the personnel involved over the many years, of which he knows much more than I.

It is right to say that the policies have been developed on the basis of close co-operative dialogue and jointly. We have the Health Policy Board chaired by the Secretary of State with members from the chairmen of health authorities in Wales. There is regular contact between Ministers, as again the noble Lord indicated, with the chairmen and chairwomen of the National Health Service organisations; and there are constant formal and informal contacts on a regular basis, not least through the Trust Executive Advisory Group.

There is no reason to suppose that those relations will not continue between the assembly and the NHS. There is nothing in the Bill to stop the assembly from either preserving inherited mechanisms or—if it wishes to as its own powers develop and experience demonstrates to it—arranging alternative processes for consultation with the NHS as well as the handling of subsequent business. It is entirely open to the assembly as the work beds down to establish a help advisory council for Wales, as now proposed by my noble friend Lord Hunt.

We think it better to leave it to the assembly to see how things will develop. It will inherit various statutory advisory committees covering the health professions, and it will have to have, as the noble Lord, Lord Roberts, again indicated, constant contact with NHS bodies and contractor professions. We are presently producing a corporate plan for the NHS in Wales. It is headed by a senior NHS officer. It is supported by a Welsh Office/National Health Service team. It will provide a clear strategic framework in the plan for supervision and direction of the long-term operation and development of the service in Wales.

We do not think, therefore, that specific provision on the face of the Bill is presently required. There would be some difficulties in areas such as subordinate legislation because one would have to convene the council to pass such measures as orders; and that would slow down matters in a way which would not be necessary. I very much respected the views put forward by my noble friend Lord Hunt during Second Reading. He said, and I agree with him, that there are risks sometimes in an over-prescriptive approach. We think that the best course is to allow the present arrangements to continue and for the assembly to judge on experience as matters eventually transpire. Local government is different because it is directly accountable via the ballot box.

I relate specifically to a few remarks of the noble Lord, Lord Roberts. I can assure the noble Lord that we are not seeking to constrain the assembly's freedom. Quite the opposite. We want the organic relationship between the assembly and the NHS in all its manifestations to develop on an incremental basis on the basis of experience. I stress this again. The noble Lord is right. The assembly will be able to modify and change what it inherits.

It seems to me that the four of us who addressed the Committee share the same purpose. We have equal regard to what the NHS has done and to the needs for improvement and change in the future. I come to the conclusion that we should not be over-prescriptive but should leave it to the assembly, since this is a devolution of powers, to see how it best wishes to maintain or alter arrangements in the future.

Lord Thomas of Gresford

I am sure that we are all grateful to the noble Lords, Lord Hunt of Kings Heath, and Lord Prys-Davies, for bringing this important matter before the Committee. However, we believe that the functions of the assembly should not be fettered. As the noble Lord pointed out when introducing the matter, the National Health Service will be an important part of the work of the assembly consisting, as it does, of such an important percentage of the budget, and involving so many functions that the assembly will have to consider.

We are sure that the present arrangements are satisfactory for the moment. If the assembly finds them unsatisfactory, no doubt it will take the appropriate steps to ensure that the continuing good relationships between Government and the health service continue, and that there is proper communication between all parts of the National Health Service to ensure that the people of Wales are properly served.

Lord Hunt of Kings Heath

I am most grateful to noble Lords and my noble friends for their contribution to the debate. I have great confidence in the NHS in Wales, the people who work there, and the civil servants responsible for administering the NHS from the Welsh Office. I acknowledge the good relationships between the NHS and the Welsh Office. I accept that through the principle of devolution it is for the assembly to decide many of these matters. The legislation before us allows for a partnership council with local government, and for arrangements in respect of voluntary organisations and with business. A statutory advisory council would have been a strong visible sign to all in the NHS in Wales. It would have assured a proper relationship between the NHS and the assembly.

Nevertheless, I have listened with great care to what my noble friend has said. No doubt we may discuss this later on. At this stage, I beg leave to withdraw my amendment.

Amendment, by leave, withdrawn.

Lord Williams of Mostyn moved Amendments Nos. 245 and 246:

Before Schedule 8, insert the following new schedule—