§ Lord Evans of Temple Guiting
My Lords, I beg to move that this Bill be now read a second time. I am delighted to introduce the Health (Wales) Bill to the House. This is a small but important example of the sort of partnership approach that the Government wish to promote. This is the first Wales-only Bill to have been the subject of full pre-legislative scrutiny. As a result, it comes before us improved in many respects by amendments made to reflect comments put forward during that scrutiny.
It takes the reforms introduced in the National Health Service Reform and Health Care Professions Act 2002—to establish local health boards and require the production of health and well-being strategies in Wales—and takes the next step in bringing to fruition the Assembly's plans to improve the health and well-being of the people of Wales, and give more power to patients.
It is therefore no exaggeration to describe this as an historic Bill. It is appropriate to observe that it takes the process of constitutional change pioneered by this Government—with the establishment of the National Assembly for Wales—another step forward.
I should like to say a little more about the policy-thinking behind the Bill. It has its roots in the policy document Better Health Better Wales, issued by the Welsh Office in 1998, and in the Assembly's 10-year plan, Improving Health in Wales, issued in 2001. In that same year, the Government announced their intentions to reform health services in Wales by establishing local health boards, strategic health partnerships, a Wales Centre for Health and, finally, Health Professions Wales.
The National Health Service Reform and Health Care Professions Act 2002 established local health boards in strategic partnerships. This provided the 324 foundation for the delivery of the reform agenda to which the Government and the Assembly are committed. However, we still needed to reform and strengthen community health councils and establish the Wales Centre for Health and Health Professions Wales.
So we published the draft National Health Service (Wales) Bill and the accompanying Explanatory Notes on 17th May last year, containing those remaining three elements. Publication signalled the beginning of the pre-legislative scrutiny of the Bill. The Health (Wales) Bill has emerged a better and more widely understood and supported Bill as a direct consequence. Eighty-seven organisations and individuals representing the professional and other bodies that would be affected by it were sent copies of the draft Bill and Explanatory Notes and 27 of them replied.
We published the draft Bill on the Wales Office web-site and 15 people responded. Public consultation generated 25 recommendations for changes to the draft Bill. In another place, the Welsh Affairs Committee considered the draft Bill, taking evidence from stakeholders and Assembly and Government Ministers. The Committee's report recommended 17 changes to the Bill. Also in another place, the Welsh Grand Committee spent a whole day debating the report of the Welsh Affairs Committee. Noble Lords were invited to attend a briefing meeting with the Parliamentary Under-Secretary and the Assembly Health Minister.
At the National Assembly for Wales, the Bill was scrutinised by the Health and Social Services Committee and discussed at plenary. As a result, the Assembly asked for three changes to be made to the Bill. It says much for the effort that was put into the original draft that the draft Bill received a warm and widespread welcome from those whom it affected. Indeed, none of the pre-legislative scrutiny revealed any concerns with the principles of what was proposed. This scrutiny produced in total 45 recommendations for changes to the draft Bill. Some were to remedy omissions and some were to clarify or limit the powers of the bodies that it dealt v4ith or the Welsh Assembly.
Before presenting the Bill, the Government decided to consider further the principles behind 17 of the 45 recommendations for changes. In 16 instances, it was possible to amend the Bill in the way suggested and that was done. The changes made to the Bill have improved it. Some acknowledged omissions have been rectified and the powers and independence of community health councils, the Wales Centre for Health and Health Professions Wales have been clarified. This revised Bill has now passed all its stages in another place and comes before us unchanged.
The Bill is intended to achieve three purposes. The first is to reform and strengthen community health councils in Wales and establish a statutory association which will support community health councils and also have a performance management role. The second is to establish an independent Wales Centre for Health to disseminate research and provide multi-disciplinary 325 advice and evidence to support decision-taking. The third is to establish Health Professions Wales, a body to quality-assure the continuing training and education of healthcare professionals.
By retaining CHCs and making their membership better reflect the people they represent, by providing complaints advocacy services independent of the NHS in Wales and powers for CHCs to inspect premises providing National Health Service services, we shall build on the strong local relationship which already exists within the health service in Wales.
Noble Lords will wish to be assured that when patients resident in Wales receive NHS services in England their local CHC will be able to act as their champion in investigating complaints. I am happy to give that assurance and to confirm that CHCs in Wales will have exactly the same powers as patients forums in England to inspect premises where NHS services are being delivered for patients resident in Wales, whether such premises are in Wales or in England.
By establishing a statutory association of Welsh CHCs, which will not only advise and assist CHCs but also have a performance management role, we shall guarantee the people of Wales a service of the highest standard, consistently, across Wales.
By establishing the Wales Centre for Health, we shall provide the people of Wales with an independent body working in partnership across all sectors to develop the skills and the tools necessary to take forward the drive to improve health. The centre will be a focus for multi-disciplinary advice on, and risk assessments of, hazards to health. It will ensure that research and other evidence is made available to support effective policy making and decision taking.
As to the third element of the Bill, by establishing Health Professions Wales as an Assembly-sponsored public body, we shall set on a proper statutory footing a body to provide quality assurance for the continuing personal and professional development of all sectors of healthcare. Its remit will be extended to cover not only nurses, midwives and health visitors but allied health professionals and clinical scientists.
This is primarily an enabling Bill, devolving powers to the Assembly to determine, through its own secondary legislation, the detail of the new arrangements. That is as it should be, with the devolved Assembly working in partnership with the health services in Wales and the people of Wales to determine what is right for Wales.
During pre-legislative scrutiny and the Bill's passage through another place, the nature and extent of the powers that the Bill grants to the Assembly, and the way in which they might be exercised, generated some debate. Six of the changes made to the Bill before it was introduced reflected recommendations made during pre-legislative scrutiny that the powers of the Assembly over WCH and HPW appeared too wide and could be felt to impinge on the perceived independence of these bodies. So the Government have already responded to those concerns.
326 Perhaps I can also give an assurance to those noble Lords who I know take an interest in the exercise of devolved subordinate powers: in this case, powers which would be exercised by the Secretary of State if this were an England Bill will be exercised by the Assembly.
Your Lordships' Select Committee on Delegated Powers and Regulatory Reform considered the Bill in its 7th report, published on 15th January 2003. It concluded that the extent of the delegation was consistent with existing provisions relating to the National Health Service and was appropriate.
The Select Committee also considered the powers in the Bill allowing the Assembly, through the exercise of subordinate powers known as Henry VIII powers, to amend existing primary legislation. Those powers were questioned in another place, both in Committee and on Report. In the committee's view, those powers were sufficiently circumscribed. The conclusion of the committee was that there was nothing in the delegated powers in the Bill that it wished to draw to your Lordships' attention.
The Bill demonstrates once again that, through the devolution settlement, we are able to deliver policies adapted to the particular needs of Wales. It follows previous legislation such as the Learning and Skills Act 2000, the Children's Commissioner for Wales Act 2001 and the NHS Reform and Health Care Professions Act 2002. It represents devolution in action and, as I said earlier, progress through partnership.
The Government pledged in their manifesto for Wales to build on the already successful legislative partnership with the Assembly and to continue to enact specific legislation for Wales where appropriate. That is precisely what the Bill does. It is yet another example of government working in partnership with the Assembly to deliver a modernised, improved and more responsive NHS for the benefit of the people of Wales.
The Assembly has been working hard in partnership with interested parties to increase the responsiveness of the NHS to patients and the public and to strengthen the public's influence over the way in which the NHS is run. The Bill will ensure that the people of Wales have an even stronger voice in the planning and delivery of health services in Wales. I commend the Bill to the House.
Moved, That the Bill be now read a second time.— (Lord Evans of Temple Guiting.)
§ 11.19 a.m.
§ Lord Roberts of Conwy
My Lords, I welcome the noble Lord, Lord Evans of Temple Guiting, to his new role in Welsh affairs. In doing so, I thank the noble Baroness, Lady Farrington, for the work she has done in this area in the past. I also welcome the noble Lord, Lord Hunt of Kings Heath, into the devolved area, which is comparatively new to him. I am sure that he will prove his expertise in this area of health as in all others. Perhaps I may also apologise in advance for my 327 own fragile state of health in the aftermath of one of those vicious viral attacks that have affected many noble Lords over recent weeks.
This is a small Bill as Bills go, with just 10 clauses and four schedules. As the noble Lord said, it has been heavily and thoroughly scrutinised, not only here in Parliament but also in the National Assembly for Wales, where it began as the draft National Health Service (Wales) Bill. As this was the first Bill relating only to Wales to be produced in draft and made available for pre-legislative scrutiny, I raised the question of whether it should have pre-legislative scrutiny here in your Lordships' House in a letter sent last summer to our noble and learned Leader, Lord Williams of Mostyn. In his reply dated 31st July last, he laid down what amounts to a general principle:This scrutiny will be conducted by either a committee of the House of Commons. the House of Lords or a Joint Committee of both Houses. Which of these types of committee conduct the work will be determined on a case by case basis".So that is where matters stand so far as concerns pre-legislative scrutiny.
The Bill itself, with its three major aims, should be relatively uncontroversial, as Ministers have suggested. However, it is the background and condition of the health service in Wales that is fraught with controversy. From 1979 to 1983 I had ministerial responsibility for the health service in Wales and as a Minister in the Welsh Office I was fully aware of the extensive developments in the service over the period up to 1997. A number of major new hospitals were planned, built and opened, new strategies were implemented and new treatments established during that time, as I am sure my noble friend Lord Walker of Worcester, the Secretary of State for Wales for some of those years, would confirm. During that time the NHS in Wales seldom lacked resources and I do not think that the present Secretary of State for Wales, the right honourable Peter Hain, is right when he blames the current failures on years of underfunding, as he did in his speech on the Second Reading of the Bill in the other place. I believe that the causes of the current ills lie in part in the misapplication of resources. The general impression is that there is far too much bureaucracy in the NHS in Wales.
Of course we cannot consider the Bill's proposals to reform and strengthen the 20 community health councils in Wales, which we on this side of the House are glad to see preserved, without taking account of the 22 local health boards that are shortly to take over the responsibilities of the existing live health authorities. There are also 15 hospital trusts to be added to that local dimension. The immediate question is whether the local structure is not bottom heavy and grossly bureaucratic. It is all very well to sloganise about "patient power", but the patient's first need is treatment. That is where the NHS in Wales has been failing, if we judge by the horrendous growth in waiting lists over the past five years.
I take no pleasure in telling noble Lords that the number of people waiting more than 12 months for inpatient treatment has increased by 82 per cent. The number waiting more than 12 months for outpatient 328 treatment has risen from 378 five years ago to 36,000 today. That is a distressing outcome when more and more money is being spent on the service, especially on its administration. One is bound to ask whether the money is going to the right place and to the right kind of people—doctors and nurses rather than administrators—and whether the thinking behind the proposed reforms in the Bill is right and based on realities rather than a twisted kind of political correctness and wishful thinking.
It is my guess, although perhaps I am being pessimistic, that the United Kingdom will face hard times and that public spending will come under severe scrutiny over the next few weeks and months. Already the reorganisation of the NHS in Wales arising from the National Health Service Reform and Health Care Professions Act 2002 is proving more costly than had been anticipated. Originally it was thought to be cost-neutral. Then the costs were estimated at £15.5 million and now the National Audit Office has stated that a further £8.5 million of savings will be required. Those savings will have to come from somewhere.
In view of that experience, how realistic are the costs of implementing the Bill now before the House? More pertinently, will those costs/savings adversely affect patient care? That is a key question. The draft regulatory impact assessment published by the Wales Office to accompany the draft Bill estimated that the enhanced visiting and advocacy role of the community health councils would cost £580 million a year in all, and that the new association of Welsh CHCs would cost an extra £80 million in rent, rates and staffing. Are those firm figures? What are the anticipated costs of the other new bodies? In the Explanatory Notes a figure of £0.6 million has been given for the new centre for health, but nothing has been estimated for Health Professions Wales. Of course the allocation of funds is a matter for the Assembly, but the money is voted by this Parliament. Given that, I think that we and the public are entitled to know.
At Second Reading in the other place the Secretary of State for Wales stated that:The NHS in Wales is treating more patients than ever before".—[Official Report, Commons, 27/1102; col. 351.]He said that there are no quick fixes to the waiting list problem. Nevertheless, he went on to talk about the Government's plans to open 10 new hospitals over 10 years and to project increases in nurses and members of the health professions in training. All that is good news, if it materialises.
The key issue with regard to Health Professions Wales is the relationship between that body and the United Kingdom Central Council for Nursing and Midwifery and the Health Professions Council, each of which has a UK-wide regulatory remit. Is the new Welsh body to take over responsibilities from them? I understand that that is to be the position. There is a hint of functional overlap between that body and the other major body referred to in the Bill, the Wales Centre for Health, which is also to have a role in training. Obviously we shall be able to examine the 329 proposals in more depth in Committee, but care must be taken to ensure that any overlap which may exist is productive rather than counter-productive.
The Wales Centre for Health is prima facie an attractive proposal. Wales has been plagued by higher morbidity rates than many other regions. In the past, this was attributed largely to the concentration of heavy industry—coal and steel—in many of our communities. But the balance of the Welsh economy has now changed in favour of healthier work in manufacturing and in the service sector. Yet some of the old unhealthy lifestyles and practices remain, and there are new threats to public health. There is ample scope for research into these issues and the need for sound advice, effectively disseminated.
I am not the first to express the hope that the centre will not be focused on a bricks and mortar establishment, but that it will begin by building upon the work already being done within the NHS and within the colleges of the University of Wales. I declare an interest as president of the University of Wales College of Medicine, which lies literally at the heart of the University Hospital in Cardiff and is closely connected to the NHS throughout Wales. There are other colleges—notably in Cardiff, Swansea and Bangor, and in north-east Wales—with medical and health professional training facilities. Some of those who teach at these institutions are world leaders in their field—a fact not always appreciated in Wales. The new centre would be wise to anchor their efforts in this expertise, which is well represented in this House by the noble Baroness, Lady Finlay of Llandaff, who is a medical professor in her own right.
The Bill covers three pillars of the NHS in Wales. We are still unclear about the rest of the edifice, which reaches its pinnacle in the National Assembly, with its Health and Social Services Committee and its Health and Social Services Minister, Jane Hutt. Some of us have been briefed on the contents of the Bill by the Minister and by the Parliamentary Under-Secretary of State, Mr Don Touhig, MP. I want to record my thanks to them for that briefing and for their generally helpful attitude. We on this side of the House shall not stand in the way of the Bill but will assist its passage and improve it if we can.
§ 11.32 a.m.
§ Lord Thomas of Gresford
My Lords, we welcome the Bill. I congratulate the Minister, not only on his appointment but on his presentation of the Bill. I add my personal thanks to the noble Baroness, Lady Farrington, for the sensitive and helpful way in which she has conducted Welsh affairs over the past few years.
My welcome is tempered by some slight disappointment. I had applied, through the usual channels, to address your Lordships from the Government Benches in token of our happy marriage in the National Assembly for Wales and in the belief that this is as much a Liberal Democrat Bill as it is a 330 government Bill. Unfortunately, the fervent reformers of the House of Lords on the Benches opposite were unwilling to give up their seats.
The Welsh Office report, Better Health—Better Wales, published in May 1998, highlighted the need for priority to be given by the National Assembly to health issues. The report summarised the position in this way:Within Wales, a significant proportion of the population remain deeply disadvantaged in terms of expectation of life and health-related quality of life, and there are wide variations between those with the poorest health and those with the best".Compared with England, the mortality gap in Wales had increased in the previous decade from 5 per cent to 9 per cent—that is, life expectancy in Wales was shorter, and increasingly so. The rate of cancer registrations in Wales was among the highest in the European Union, 50 per cent higher than in some countries. There was consistent poor health in the South Wales valleys: for example, in Blaenau Gwent, deaths from heart disease among people under 65 were at twice the rate of those in Ceredigion, while deaths from lung cancer, among men under 75, were at twice the rate of those in Powys. The report pointed out that 12.5 per cent of people of working age report a limiting long-term illness, compared with 8.5 per cent for Great Britain as a whole.
Clearly, there are serious problems to be tackled. Despite the angst of those who still oppose devolution, such as Mr Llew Smith in another place—and with the greatest respect to the noble Lord, Lord Roberts of Conwy, and distinguished former Secretaries of State for Wales who are in their place today—it was during Westminster's period of responsibility that the health service got into that situation. It is not likely—it is in fact impossible—that a Westminster government could have focused upon the problems with the energy now devoted to them. I pay tribute to the leadership of the Minister for Health and Social Services in the National Assembly, Jane Hutt, and to the backing she receives from the cross-party Health and Social Services Committee, chaired by the Liberal Democrat, Kirsty Williams.
It is not surprising that a key point in the partnership agreement between Labour and the Liberal Democrats in October 2000 dealt with health matters. It set out the following principles:We believe that access to high quality health care is the right of all the people of Wales as set out in 'A Healthier Future for Wales'. We will tackle the causes of poor health, such as poverty and bad housing. In partnership with local government and other agencies, we will put a greater emphasis on prevention of ill health and improving nutrition.We will implement distinctly Welsh solutions to improve our National Health Service and to tackle the problems of understaffing and bed shortages which have led to longer waiting times for consultations and treatment".Among the initiatives agreed were substantial spending on health over a three-year period to improve the NHS and to cut waiting times, tackling inequalities in health provision, additional funding targeted at groups in greatest social and health need, and free prescription charges for those in need. In response to the last point, prescription charges were frozen and, 331 for the under-25s, abolished. In the National Assembly, on Tuesday, Kirsty Williams moved that persons suffering from a life-long condition should also be exempt. The Minister agreed to set up a review group to identify the relevant conditions. The Motion was supported by all parties, save for the Conservatives, who abstained. Kirsty Williams pointed out the stark fact that 88 per cent of patients in Wales already receive free prescriptions. She said:That so many people are currently exempt gives a stark picture of the kind of country in which we live".I repeat: 88 per cent of people in Wales are exempt from prescription charges.
A further initiative that formed part of the partnership agreement—free eye tests and dental checks—remains to be tackled. In another place, the Liberal Democrats attempted to move an amendment to the Bill to introduce a power for the Assembly to bring such provisions into force. It was held not to be within the ambit of this particular Bill.
In January 2001, the Welsh NHS Plan, Improving Health in Wales, and the subsequent partnership government document set out the policy aims of the partnership government in a 10-year programme. These included increasing life expectancy and reducing death rates from major and long-term illness, especially in our most deprived communities. The programme also aims to bring infant mortality and five-year survival rates for serious cardiac disease and cancers far closer to the best in Europe and to transform the NHS, resulting in a service better attuned to the needs of the people. It is not surprising, with the problems that we face in Wales and the initiatives that the partnership government, through the National Assembly, is seeking, that solutions to our problems should be developed which are different from those pursued in England.
These aims and initiatives have been tackled with vigour, first, through the establishment of local health boards and strategic health partnerships on the back of the 2002 Act, and now by this first all-Wales Bill.
We welcome the strengthening of community health councils and the increased allocation of £550,000 for them for future years. I hope that in addition to their independent advocacy role, the councils will be foremost in tackling how best to promote a healthy society in their communities. The aim should be not simply to deal with illness but to promote health. For that purpose, it is important that the range of organisations whose premises the councils will now be entitled to inspect has been increased, as a result of consultation, to include local authorities, NHS trusts and GPs.
We also welcome the powers given to the Welsh Assembly to decide the composition of those councils. They should be broad, representative, and open, there should be transparency about how they are selected and who sits on them. I hope that their powers will include carrying out public consultation on significant changes in local health services.
The Wales Centre for Health is, in my view, crucial. There are huge challenges in meeting the problems I have described. Clause 3 sets out the functions of the 332 Wales Centre for Health. First and foremost, it will undertake research and then provide information to the public to protect and improve health in Wales. It will also provide and develop training. These are all crucial functions. I welcome its independence. It has to be independent. It may be necessary for the Wales Centre for Health to criticise the provision of services by the National Assembly and the funding that is provided for the National Assembly to carry out its functions. Therefore, it is essential that the centre be independent. I believe that the way in which it is set up will make it an authoritative body which will approach these endemic problems and, one hopes, cure them.
In his letter of May 2002, Mr David Ravey, acting chief executive of Health Professions Wales—the third area of the Bill—set out its role. He said that it would support high quality education and training for the NHS workforce, call for future functions to be developed— including agreeing standards for education—and develop best practice benchmarks for staff development. I hope that that will lead the way in developing standards for healthcare support workers which will be followed throughout the United Kingdom. This body has the opportunity of leading the way for all.
The noble Lords, Lord Roberts and Lord Evans, recalled how the Bill had been brought forward. The noble Lord, Lord Evans, described it as historic, and it truly is. The draft Bill for pre-legislative scrutiny was sent out for consultation. There was considerable input by consultees, discussion by the cross-party committee chaired by Kirsty Williams and a plenary debate on the floor of the National Assembly. But, very importantly, the matter came to the Welsh Affairs Committee of another place and was debated by the Welsh Grand Committee. As a result of their input, very important changes were incorporated in the Bill when it was finally published. All the information was gathered together and the Bill came forward, as we have it, with important amendments. I am grateful that the Minister for Health and Social Services, Jane Hutt, came to Westminster to discuss the matter with your Lordships.
What, then, is our role in putting the Bill through the House? I am pleased to see the noble Lord, Lord Richard, in his place. The Second Reading debate in the House of Commons took some live hours, and, frankly, makes depressing reading. For much of the time, it was simply the usual party name-calling without anything constructive being said to assist in the promotion of the Bill. The work had been done in the committee where Members of another place had worked very hard and responsibly. The Second Reading debate was disappointing.
One and a half days in Committee added nothing. All that was discussed were footling amendments as to how many councillors should sit on the community health councils and matters of that sort—no use at all. So why are we putting through all the panoply of primary legislation in Westminster? Surely it would have been far more sensible if the National Assembly for Wales had had the power to make the ultimate decision in Cardiff, following consultation through something like the Welsh Grand Committee or a Joint 333 Committee of both Houses, which would act as a revising and scrutinising body for one stage of the Bill's consideration. On behalf of my party, I would think it entirely wrong to attempt to move amendments altering the policy behind the Bill, which is essentially to be determined in Cardiff. We are taking the Bill but it is in Cardiff where scrutiny is required. Our role is otiose. Plenary powers for primary legislation of this sort should be given to the National Assembly.
I wish I had been saying this from the Government Front Bench, but, as I said, that position has been denied to me.
§ 11.48 a.m.
§ Baroness Finlay of Llandaff
My Lords, I, too, pay tribute to Jane Hutt and Kirsty Williams in the National Assembly for Wales. They have consulted widely and demonstrated, as the noble Lord, Lord Evans of Temple Guiting, said so well in his introduction, that they have been in touch with the root and branch of the NHS in Wales. I declare an interest, as someone who works in the NHS in Wales.
The Bill is very important for several reasons. First, it is a Wales-only Bill and, as such, it recognises the unique and different nature of the NHS in Wales. The NHS in Wales is on a different direction of travel from the NHS in England. This is a comparative study in action and warrants research rigour applied to monitoring this natural experiment. As the noble Lord, Lord Thomas of Gresford, has said so well, we are indeed living with our heritage in Wales of social and economic deprivation.
We have social services strongly represented on the local health boards. The health authorities are being abolished but no regional or all-Wales body has come in to replace them. The local health groups are excited about their emerging role, but there is widespread concern that they are not yet ready and able to take on the complexities of commissioning from secondary care, nor is it clear how they will in practice retain and strengthen the governance functions over primary care.
The clinical service networks are beginning to work across Wales. They are bridging boundaries in the secondary care sector. They will be essential in service stability, so local health boards will have to consult with networks. Just as there is a serious recruitment and retention crisis in primary care, a similar shortage exists in secondary care. Support services are suffering from a manpower crisis. Pathology is so short-staffed that in some parts of Wales it has taken months for non-urgent histo-pathology reports to come through. I know of one instance in which a malignancy was then reported.
Five consultant posts in psychiatry that are currently advertised are unlikely to be filled. It has been estimated that £15 million is needed to bring community mental health teams up to the standards that have been agreed for the NHS in Wales. Physiotherapists and occupational therapists are not out there to fill the vacancies. The list goes on.
334 However, I am glad to say that many thousands of healthcare professionals across Wales remain deeply committed to providing the best patient care they can in the face of repeated and exhausting management reorganisation. The healthcare professionals need increased secretarial and IT support to be able to work effectively.
The second important point about this Bill is that it sensibly preserves and strengthens community health councils. They are a point of stability in a changing service. They are a constant for patients and have an important role in advocacy. They can and should have an important role in the handling of complaints. There are some recent examples of excellent practice. In BroTaf, the community health council has recently steered and supported a family through a very complex complaint that involved several trusts, keeping all parties focused on the real issues of concern. They have shown that they can function across from Wales into England as well.
The community health councils have, by and large, a mature understanding of the workings of the NHS in Wales and will be an excellent safeguard for patients and staff. When things go wrong, the patients and their families deserve the best support in seeking redress. When complaints are inappropriate or unsubstantiated, the staff need to be protected from inordinate time taken in dealing with a complaint. That time takes them away from patients and may even result in them leaving the service. Sadly, we have had an example of suicide being precipitated by such a complaint.
The community health councils need to know exactly who to relate to for each issue. They may be the first to see where the fault lines lie in the new commissioning processes. I hope that community health councils will broaden their remit into primary care, as the independent contractors are relatively autonomous and could greatly benefit from the overview and experience of the community health councils in working with patients and their carers.
The community health councils could also help to steer the service away from fallacious targets to ensure that need is met. Currently, waiting list initiatives provide appointments, at great public expense, to those who have been waiting over three years. About 50 per cent of the patients offered appointments in rheumatology do not attend. Among those coming to these evening clinics, many no longer suffer from the original complaint, but present with something completely different. Meanwhile, urgent rheumatology referrals pile up on the routine waiting lists while money is available for long-term waiters only.
The third issue relates to the Wales Centre for Health. Health promotion is essential. The public must be informed about issues for health protection and improvement and this must be evidence-based. The recognition of research on the face of the Bill is a great step forward. There is perilously little research underpinning the reorganisations in healthcare provision that are happening. The research base on all aspects of human behaviour and service utilisation in 335 Wales must be established for its decisions to be informed and appropriate to the needs of the population.
Health protection and promotion is the job of everyone in the NHS and beyond. The centre must have a specific duty to educate as well as to train. Staff need ongoing training, but first they must be educated in the topic. At undergraduate and postgraduate level, health protection and health improvement need to be embedded in curricula. Education and training are linked, but are different. I propose to table an amendment to the Bill to that effect.
The centre can then support and work with the established sectors in education and make the sectors more responsive to the evidence base. It will not compete with the educators in Wales, but it must not be able to opt out of supporting education.
The Wales Centre for Health is a new body. It demonstrates the way that devolution is working to research and act directly on the problems affecting the health of people in Wales.
The fourth and final very important area is the creation of the health professions council in Wales and the ability of the Assembly to abolish it. Within the UK, the regulation of healthcare professions is probably better undertaken at national level with national registers. A regional office of the health professions council may turn out to be the way forward for economies of scale and cost efficiency. However, it may be that that council in Wales will protect the professions from interference by Whitehall in professional regulation.
The role of Health Professions Wales in education and training may in the future require partnership working or handover of some personal development skills escalator functions to the NHSU. I gather that is not the NHS University, so I shall use the initials only.
The Bill is to be welcomed. It has been the subject of wide consultation in Wales and it deserves an easy passage. The comments from the service have been listened to and the draft Bill modified accordingly.
§ 11.56 a.m.
Lord Morris of Aberavon
My Lords, I congratulate my noble friend the Minister on the careful way in which he explained the Bill to us. It is good to follow the noble Baroness, Lady Finlay of Llandaff, who has an intimate knowledge of what is happening on the ground in the health service in Wales.
Now that the existence of the National Assembly for Wales has lost most of its controversial nature, 11 have one or two procedural points to make. The fact that we can legislate to allow divergence in administration between Whitehall and Cardiff goes to the heart of devolution. The Bill is an example of how a Whitehall government can legislate to allow things to be done differently in one part of the country. After the power has been given to the Assembly—as my noble friend has just told us, this is an enabling Bill—it is up to the Assembly to implement it by secondary legislation. That is none of our business. The noble Lord, Lord Thomas. put his finger on our role.
336 Since the National Assembly for Wales was formed, we have adopted two mechanisms to provide the necessary primary powers for it to govern. The first is inserting Wales-only clauses in Bills affecting both England and Wales. I have criticised Ministers in the past for totally ignoring the substantial number of Wales-only clauses in such a Bill in their Second Reading speech. After receiving a fulsome apology from the then Secretary of State for Education and Skills and with the assistance of the Leader of another place, I do not expect this to happen again. However, that episode indicated a cavalier attitude of a centralist department.
The second means is by a Wales-only Bill that has been seen in draft. My noble friend was right to say that this is an historic Bill. I have spent many a long summer afternoon in the legislative committee of Cabinet, seeing so many favourite children of Bill-sponsoring Ministers being slaughtered. The Secretary of State and the First Minister deserve real congratulation on winning a place in the always congested legislative timetable.
What would be the situation if different parties were in government in Cardiff and in Westminster? What would be the chances of getting primary legislation? That is the fundamental point arising from the present division of powers. That is for the Richard commission to examine—and how opportune that it should do so now.
Secondly, the Bill is the result of massive consultation with the Assembly, the Grand Committee and the Select Committee, proceedings in another place and in this House, plus massive and substantial public consultation. A great deal of that happened on the draft Bill, and I very much welcome the fact that we had a draft Bill. We are told that 45 recommendations arose from the consultation, of which 16 were accepted. I understand that nothing of significance was rejected, unless it was more appropriate that it should be catered for elsewhere. I welcome that, too. However, will my noble friend assure the House that nothing of significance desired by the Assembly was rejected by the Government in presenting the Bill?
In short, given the devolution agreement, it might be said that we are facilitators for the Assembly. Are Members of the Assembly wholly happy bunnies in the context of the Bill? The very fact of Parliament finding time to enact the Assembly's Bill is a considerable sign that at the moment devolution is working, procedurally.
My third question reflects on the strengths of the above conclusion. Are there sponsors of Bills in the Assembly who are straining at the leash because no time can be found for their legislation? They would not be unique, if that were the case. From my experience, many Westminster functional Ministers have their disappointments, too. We would like to know the general picture.
I turn to the Bill itself. As Secretary of State, it was my privilege to develop the Welsh Office supervision of the health service in Wales between 1974 and 1979.
337 I appointed the first memberships of the community health councils. Various bodies, including local authorities and voluntary organisations, made nominations. The Secretary of State—myself—made nominations too. We had great hopes for the CHCs, which were seen as a vital part of the health service in Wales.
Years earlier, I had enshrined in statute the need to publicise the role of the Transport Users' Consultative Committee. I came from that stable. I was a supporter of such a role for representatives—if I can use that term—of community. However, in my time in Wales the CHCs were a disappointment. I say that as a supporter and as the one who set them up. The CHCs did not come up to expectations.
There were two reasons for that disappointment— and I plead guilty on this matter. First, it was due to the quality of the nominees. Sometimes, dare I say, local authorities did not put up their best people. Secondly, but equally importantly, it was due to our failure as a government department to give them adequate resources. There has always been a tension involved in allocating scarce resources to CHCs at the expense of other needs of the health service. After all, there is a finite amount in the pot.
I can say frankly that, in their old form, I would have been happy to abolish CHCs. However, I come from the stable of wanting public consultation and participation, and I earnestly hope that with the relaunch of CHCs there will come a new role, a new vision and a new membership. I welcome their role in patient advocacy, which is part of their remit, and the £500,000 of extra resources. I hope that it will do the trick, because there is a need to monitor and involve the public—especially patients. I hope that the relaunched CHCs will provide for that real need, and do somewhat better than when CHCs were under my supervision.
I also welcome the introduction of the Wales Centre for Health. How I wish that I had had the benefit of such collective wisdom in Wales when I was Secretary of State. I shall give one instance.
My noble friend Lord Prys-Davies was my special adviser and a former distinguished chairman of the Welsh Hospital Board under another administration. He campaigned long and hard to convince me of the real need for a chair of geriatric medicine in the Welsh School of Medicine in Cardiff. He told me, time after time, that many if not most parts of the country had such a chair, but that we did not have one in Wales. Would the medical profession have it, however? In fact, the medical profession was split right down the middle. Individual medical disciplines, such as orthopaedic surgeons, would not accept that there was a role for a general medical practitioner who would necessarily adopt a more holistic approach. There was a division of opinion.
The only way to break the logjam was for me to seek a private meeting with a provost of the School of Medicine, with no advisers present from either side. It was a very successful meeting. I went away on holiday 338 and told my Civil Service advisers that on my return I would make a speech announcing the new chair. That concentrated the mind wonderfully, and some outstanding creative work was done to devise a scheme for my endowing a chair. I handed over the cheque to the president of the school—the distinguished predecessor, no longer with us, of the noble Lord, Lord Roberts. I handed it over with the blessing, albeit with varying degrees of reluctance, of both the Welsh Office and the Treasury. The Treasury was prepared for the chair to go ahead because I endowed it with a one-off cheque, so the Treasury did not have a continuing liability.
The prevarication and the forcing of one's will on a divided medical profession would not have arisen if we had had the benefit of an informed view of a body such as the Wales Centre for Health. It worried me a great deal, as Secretary of State, that I was imposing my will in that way. I believed that it was right to do so, but I would have been extremely grateful to have a much wider source of advice when the medical profession was so divided. I look forward to the work that will be done by that body.
The Bill exemplifies the kind of work that can be done in a small country that is able to feed well thought-out material into the legislative process. I wish the Bill well.
§ 12.9 p.m.
§ Baroness Gale
My Lords, the Health (Wales) Bill has, as other noble Lords have said, probably received more scrutiny than any other Bill and is consequently uncontroversial. By now, one hopes that all the concerns have been ironed out, making the passage of the Bill run smoother than it might have done.
The pre-legislative scrutiny of draft Bills is a great innovation, but I was disappointed that the House of Commons undertook the scrutiny rather than a Joint Committee of both Houses. I believe that this Bill would have been an ideal opportunity for a Joint Committee. Members of your Lordships' House could have made a useful contribution if only they had had the chance. Perhaps that possibility will be considered in regard to future Bills, and perhaps a Joint Committee will become the norm when appropriate. Nevertheless, like other noble Lords, I know of the good work that has been done and that pre-legislative scrutiny is a good thing.
The partnership between the Assembly and Westminster has worked well on this Bill. Other noble Lords have mentioned the meeting with Jane Hutt, the Minister for Health in Wales. With the Under-Secretary of State, Don Touhig, she recently met Peers who have an interest in Welsh matters for a briefing on the Bill. All agreed that this type of meeting is very useful, enabling a free exchange of views and an opportunity for Peers to speak directly to Ministers from the Assembly and from Westminster. It was a good example of how well the partnership and devolution are working. I am speaking of the partnership between Westminster and the Assembly rather than the good partnership which is currently 339 working in the Assembly. Westminster and the Assembly are working together for the good of the people in Wales.
The case for retaining the community health councils in Wales has been made. My noble and learned friend Lord Morris spoke with great experience on community health councils. The councils have in the main worked well. In the community of Wales, people understand them and know how they work. It is good to see that the Bill seeks to strengthen their powers, which has been welcomed by many organisations. There has also been a discussion on the change of name. I am aware of the importance of the CHCs in this respect and of the need to consult with them. There may be a case for finding a better and more user-friendly name. My view is that the name is well understood in Wales, but of course a better one might be found. Is the Minister aware of any conclusions at this early stage?
The Bill describes the functions of the Wales Centre for Health: to develop and maintain arrangements for making information about matters related to the protection and improvement of health in Wales available to the public in Wales; and to undertake and commission research on such matters. In the Bill's consultation period, the National Asthma Campaign welcomed the formation of the WCH. The campaign envisaged that the WCH would bring together much needed advice on a wide range of hazards. It also believes that passive smoking is a hazard for asthma sufferers. In its submission, it said:Cigarette smoke is a highly common trigger of asthma attacks causing difficulties for up to 80 per cent of people with asthma. Other people's smoke prevents people with asthma from enjoying their lives to the full, and the impact of cigarette smoke extends even further and can harm unborn children. It is therefore a hazard and there is an opportunity for advice and risk assessments of threats of death to be conducted which we hope will in turn lead to a ban on smoking in public places".Can the Minister say whether that is a matter which the WCH could and should investigate? I am bearing in mind the recent discussions in the Welsh Assembly on the possibility of a ban on smoking in public places.
I am pleased to note that the shadow WCH has already undertaken work in the Rhondda, where I live, on the controversial Nantygwyddon tip. Local residents have been campaigning for many years against the tip as they fear its effects are causing ill health in the locality. If that is an example of the type of work the WCH will be undertaking—investigating local health-related issues—it will be greatly welcomed.
There are many good things in the Bill which we hope will, when implemented, bring about a healthier Wales. That is something that we all want to see. I welcome the Bill and look forward to its progress though the House.
§ 12.15 p.m.
§ Lord Prys-Davies
My Lords, I, too, warmly welcome and support this modest but important. Bill. It has been promoted by the UK Government at the request of the executive of the National Assembly for 340 Wales, the two administrations, as I understand it, having reached a common position as to what should be in it. We should therefore be careful before we interfere with the provisions of the Bill. I think that the Bill is further evidence that the NHS in Wales is now moving in a markedly different direction from the NHS in England; a conclusion which has been drawn by the Constitution Unit. Our hope, indeed our belief, is that the new structure will make it easier for doctors, clinicians, nurses and other workers in the health service to give a higher standard of care to the patient. But I am a fair man and will acknowledge that time alone will tell whether that will come about.
Like the previous speakers, I pay warm tribute to the work of the Welsh Affairs Select Committee. The committee sought out evidence. It received thoughtful evidence. It subjected the draft Bill to detailed and constructive scrutiny. The legislation was much improved in the light of some of the recommendations of the committee. I shall return to the issue of scrutiny before I sit down.
The Bill has been rightly described from the Front Bench as an enabling Bill. It devolves marry regulation-making powers to the Welsh Assembly. I think it should be borne in mind—it is well worth bearing in mind—that the Assembly's standing orders require widespread public consultation on proposed regulations and their scrutiny by the relevant permanent subject committee of the Assembly. Of course, the draft regulations are amendable by the subject committee and by the Assembly in plenary session. So the regulations enacted by the Welsh Assembly rest on a very firm democratic mandate in Wales.
I have great appreciation of the contribution of Jane Hutt, the Health Minister of the 'Welsh Assembly. However, I was a bit worried by a couple of sentences in her oral evidence to the Select Committee on Welsh Affairs on 25th June 2002. The Welsh Assembly Minister had this to say about consultation with the select committee on the draft Assembly regulations:I think this is something where we need to then see how you could be engaged in that process … Maybe this is an area where two committees could agree to work together on the draft Regulations".I read the reference to "two committees" to mean the Welsh Affairs Select Committee of the House of Commons and the National Assembly's Health and Social Services Committee. I am not clear what is meant by the words "work together".
I am sure that the Assembly Minister was trying her best to be helpful, but we do not want to end up with joint responsibility for Welsh Assembly regulations. There should be no shadow of doubt that the National Assembly is solely responsible for the legislation which it enacts and is accountable to the Welsh electorate for that legislation. That principle should not be compromised.
I should like to comment briefly on two specific matters which have not been touched upon. As we have been told, the Bill places a duty on CHCs to provide independent advocacy services to patients on behalf of the National Assembly. There are 20 CHCs 341 and there will be 22 local health boards. In that situation I submit that it is important that patients' complaints at whatever level in the structure and from whatever part of Wales they originate should be treated in a similar fashion. I hope that the Assembly regulations will not be silent on that point.
I warmly welcome the intention to set up a Wales Centre for Health. That is described by the noble Lord, Lord Thomas of Gresford, as being of crucial significance and I agree with that. It seems to me that there are more problems than ever facing the health service in Wales, perhaps more so than in England, although many of them are not new. I am sure that my noble friend Lord Morgan will confirm that historically the main justification for setting up the office of Secretary of State was to tackle the problems of ill health in Wales. It is estimated that the centre will have a staff of about 20 and a budget of about £600,000 per annum. I should very much like to know more about the work on which those somewhat modest resources will be engaged. There have been various interpretations of the centre's possible remit.
There is evidence that the NHS is losing the battle in improving public health and enhancing its profile. The evidence for that—I think that my noble friend on the Front Bench will be aware of this—is to be found in a recent Fabian Society publication. If the proposed Wales Centre for Health could improve public health and enhance its status, that would be a signal contribution towards health improvement in Wales.
It would be unusual to have a Bill brought before us which has not left out some deserving candidates. It seems to me, having read the debate in the Assembly, that at least two candidates stand out. The first is the submission that members of CHCs who are in full-time employment should be allowed to take time off work to attend to CHC business in the same way as do members of other health authorities and local authorities. It has been pointed out that all that is required is an amendment to Section 50 of the Employment Rights Act 1996. I am sure that the Minister will confirm that that is what is required. But will he also confirm that the Secretary of State intends to introduce an order to extend the scope of Section 50 to include CHCs? The relevant power is contained in subsection (10) of that section.
The second candidate is the proposal that CHCs should be empowered to inspect healthcare provision in prisons and young offender institutions. This candidate emerges from the Select Committee's scrutiny of the Bill and from the earlier report of the Select Committee's inquiry into young people from Wales in prison. The reports of the Chief Inspector of Prisons have also highlighted the shortcomings. I am fully aware of the response of the Home Office which usually has the last word in this field. Nevertheless, I hope that a way can be found to involve CHCs in this important area when the resources become available.
There is a third possible candidate which has already been mentioned; namely, that the Bill should empower the National Assembly to ban smoking in public places. An amendment in those terms was debated in 342 the Assembly on 18th July. It was lost. But I see from the official record of the debate that the Assembly health Minister, who supported the principle of the amendment, indicated that if such an amendment were passed by the Assembly it could mean that the entire Bill would be lost. With the greatest respect, I believe that that is a misunderstanding.
A ban on smoking in public places raises a crucial issue in England as well as in Wales. Of course there are reasons for caution. The problem of enforcement has to be resolved. As far as I can see, unless I have missed a paragraph or two, that was not addressed in the Assembly debate. But I hope that all is not lost and that my noble friend the Minister will be able to give an assurance that the issue is being urgently addressed by the Government. If it is not, pressure will grow for the issue to be tackled.
I now turn briefly to my final point which has been raised by a number of speakers. What should be the role of this House in the pre-legislative scrutiny of all-Wales legislation? Noble Lords with an interest in Welsh affairs were given an opportunity to discuss the Bill and the draft Bill on which it is based with a Welsh Office Minister. We were grateful for that opportunity. The meetings were helpful. But I do not think that we would claim to have scrutinised the legislation during those meetings, each of which lasted about an hour.
We have heard throughout this week that one of the strengths of this House is that it benefits enormously from contributions from noble Lords who are experts in various fields of national life. I accept, as I am bound to do, that it is for the other place to determine its own procedures. But I should like to support the suggestion made by a number of previous speakers that wherever possible the two Houses should set up joint ad hoc committees, or joint special standing committees, or whatever one wishes to call them, consisting of Welsh Members to undertake the pre-legislative scrutiny of all-Wales draft legislation. That would be an opportunity to innovate in order to improve the quality of Welsh legislation.
§ 12.30 p.m.
§ Lord Morgan
My Lords, I am privileged to follow my noble friend Lord Prys-Davies, although I share none of his enormous expertise in public health. I do not intend to speak for very long, not least because it is the hour before dinner, which J.B. Priestley said was a time of anxiety in England.
I take an interest in the Bill as a welcome outcome of the processes of devolution. We considered its theme in the Constitution Committee, of which I am privileged to be a member. We noted the effects of devolution, in which I took particular interest as the only Welsh person serving on the committee. It is the second measure of primary legislation to come from the Welsh Assembly, the first being that on the Children's Commissioner in 2001.
The process of the Bill on that matter showed some of the difficulties and complications of the present devolution settlement in Wales. That Bill shed light on 343 the powers of the Welsh Assembly, currently being investigated by the commission headed by my noble friend Lord Richard. It had an interesting passage before this House finally showed its effectiveness, and the role of the Children's Commissioner was greatly enhanced and is now valuable.
The Health (Wales) Bill has made a very different kind of progress in Wales and Westminster. The draft Bill was published and there was extensive pre-legislative scrutiny and public consultation. Peers had the valuable and helpful meeting with Jane Hutt, so the process is not one of scrutiny, as my noble friend rightly said. That process has produced a Bill that will strengthen and reinforce the National Health Service in Wales, which was after all the creation of a famous Welshman—a great Briton in reality, although apparently not so from the BBC poll bearing that name.
As we have heard from my noble and learned friend Lord Morris and others, the Bill still reflects the difficulties of framing Welsh legislation. It goes side by side with earlier Bills, including the then National Health Service Reform and Health Care Professions Bill. In that Bill, a variety of Welsh provisions were dotted about somewhat haphazardly, but this Bill is specific to Wales. It raises many aspects of the role of the Assembly, and its relation to other bodies within Wales and to Parliament.
Earlier speakers raised a number of issues that focused on the fact that subordinate legislation and regulation is the domain of the Welsh Assembly, but many aspects of it have come here. That is in contrast to, and possibly in conflict with, the Government of Wales Act that set up devolution in the first place. That is all grist to the mill of the Richard commission. However, in both the Welsh Grand Committee and when the Bill was in Committee in another place, I noticed that there was a tendency to tilt the power in the direction of the Assembly in certain areas. To me, that seems all to the good.
The Bill is not controversial, and we should all welcome it. It is an enabling Bill. It gives new powers and additional finance to the community health councils, which have been abolished in England but flourish in Wales. That is appropriate, as it reflects a long-held tradition of communitarian involvement in Wales. Aneurin Bevan himself began his interest in such matters through his involvement in the Tredegar Medical Aid Society back in the 1920s.
It has been suggested several times, including by the noble Lord, Lord Thomas of Gresford, that the roles of the councils might be looked at, particularly their powers of inspection, which are increased. That matter will no doubt he considered. Others have welcomed the centre for health, which will be an important body. The noble Lord, Lord Roberts, mentioned a number of institutions within the University of Wales with which it might collaborate. To my dismay he did not mention, perhaps rightly, the Centre for Welsh Health Informatics, which was set up in my time in Aberystwyth. I hope that his silence does not mean that it has subsequently disappeared, but in its time it certainly did valuable work in the area.
344 The noble Lord, Lord Thomas, raised the issue of the independence of the new centre. That is a matter of political and social judgment, a balance to be struck between a centre that should be independent and the power of the National Assembly to set up its own priorities for Wales. That seems the kind of issue that frequently comes up in framing policies, and it is not an extreme of one thing or another. That is to say that one could have research inquiries within a broader national framework.
The Bill has been discussed by Members of this House far more knowledgeable than I am on the matter. I shall raise only one question, which relates again to the national university. I presume that the various healthcare professionals and their training and monitoring will be related to work in the University of Wales, through a number of colleges that will train them including the national college of medicine. I am not quite sure how the monitoring provision will relate to the quality assurance provision that already exists within the higher and further education system. If there could be an exegesis of that, I would be grateful.
We welcome the measure. It raises constitutional questions about considerable elements of ambiguity in the devolution settlement for Wales. If the Bill were amended in the course of its passage—its brief passage, I trust—it would not be possible for the Welsh Assembly to have control over those changes. It would be as powerless as, oddly enough, the Scottish Parliament is when it considers measures that move to the Houses of Parliament under the Sewel conventions. Even Scotland loses control at that point, and it seems in conflict with the principle of devolution that that should happen on the Bill.
Another question that I suppose arises from devolution is how necessary variety and diversity in provision is related to the maintenance of overall standards. On the health and social care reforms, that arose in connection with the proposal for a separate health inspectorate for Wales, and whether that would have been of the same quality and competence as what was monitored under the Wanless reforms in the NHS in England.
Broadly, the Bill is a landmark in constitutional history and the history of health in Wales. It deserves broad support, and like other noble Lords I wish it Godspeed.
§ 12.38 p.m.
§ Lord Hooson
My Lords, the first thing that I would like to say is how I much I welcome the noble Lord, Lord Evans, to the Government Front Bench. No one has yet touched on his Welsh connection. The export of the Welsh family of Evans from Wales to East Anglia was of great benefit to East Anglia. His father, George Ewart Evans, was a famous oral historian who wrote almost exclusively about rural areas in England. I think that he published no fewer than eight volumes, was a frequent visitor to Wales and is a greatly respected figure there. I am very glad to see his son representing Wales on the Government Front Bench.
345 I want to make a very brief contribution, as I entirely agree with what was said by my noble friend Lord Thomas of Gresford and do not intend to repeat any of it.
I have listened to this debate and noted the comments of the noble Lord, Lord Roberts. The Bill has been heavily and thoroughly scrutinised, in a manner that is quite unnecessary, if one thinks it out. One of the most important noble Lords who attended this debate—he has now left the Chamber—is the noble Lord, Lord Richard, who will consider and report on the workings of devolution.
Of all matters, surely the subject matter of the Bill should have been devolved to Wales, which should have powers of primary legislation in that regard. The National Health Service is very important in Wales. I venture to suggest that there are probably fewer subscribers per head of population to private medical insurance in Wales than in any other part of the country. Wales is heavily dependent on the National Health Service and there is great interest in it.
I congratulate the Government and all parties on the fact that everything has been done to facilitate the Bill's progress. It will give effect to what Welsh Assembly Members wish to achieve. Why was it necessary to go through this whole palaver? Fears have been expressed that we might be drawn into joint committees with the National Assembly. Such a situation should not be allowed to continue.
It is obvious that there should have been devolution of legislative power in certain spheres in this regard. We are learning as we go along. I was a great admirer of the then Secretary of State for Wales when he introduced the Bill for devolution. He worked hard to achieve it but there were so many compromises along the way that in the end it did not produce an effective means of achieving what is best for Wales.
I was so glad that the noble Lord, Lord Richard, was in his place. He must have considered, as the process continued, the length of time spent discussing the matter in the National Assembly and through the consultation process, although that would have been necessary anyway. However, the House of Commons also considered the matter—it dotted the "i"s and crossed the "t"s—and we have had a debate in this House. All of that was entirely unnecessary. If anything was needed to demonstrate the need for greater legislative devolution to Wales, it is the process of the consideration of the Bill.
§ 12.43 p.m.
§ Lord Walker of Worcester
My Lords, I add my congratulations and good wishes to the noble Lord, Lord Evans, on his new role and wish him every possible success. I, too, hope that the Bill results in an improved service to the people of Wales and that the new organisations will be successful. Wales has a ghastly inheritance of bad health. The coal and steel industries have inflicted much bad health on Wales. I was always advised by the chief medical officer in 346 Wales that drinking and smoking and eating Welsh cakes did not improve the health of the people of Wales. There are enormous problems to tackle.
I hope that Cardiff will do much better than Whitehall in dealing with one issue in particular; that is, hospices. In Wales, as everywhere else, the hospice movement has made an enormous contribution in terms of meeting the problems of the dying and their families. It is sad to reflect that we had a debate in this House two years ago in which every speaker from every party expressed dismay at the declining support for the hospice movement. Although the Minister said how moved he had been by the debate, the decline continues in England and Wales.
When the Labour Government came to power, 41 per cent of all expenditure on hospices was met by the National Health Service. In England, that has now declined to 29 per cent and in Wales to 20 per cent. I was delighted that Jane Hutt, the Minister for Health and Social Services in the Welsh Assembly, last month made a statement saying that 10 million would be allocated for palliative care in Wales and that an announcement would be made on Valentine's Day, 14th February. I hope that it will be a good and specific announcement; it is very much needed. I am afraid that the statement contained the sorts of phrases that Whitehall has been using for years: that the arrangement must be "part of a partnership" with the National Health Service and that the plans must be "carefully considered". Such phrases have excused government in Whitehall from doing anything about the decline in the financing of the hospice movement. The money is allocated to the National Health Service, which decides locally that it will not give it to hospices but will use it for many of the projects for which it wishes to secure funding. The money never reaches the hospices.
Currently in Wales, 4,892 patients are being looked after in hospices, which employ 146 full-time nurses. The impressive fact is that the hospices also have 1,828 volunteers. It is a tragedy when a movement has attracted that number of volunteers and is willing to finance 50 per cent or 60 per cent of all expenditure, but year by year government support declines. It would be useful if all those in favour of devolution to Wales—noble Lords will know that I was not one of its most enthusiastic supporters—pointed out over the next few months that, so far as the hospice movement is concerned, action can be taken in Wales that Whitehall has failed to take for five years.
§ 12.46 p.m.
§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, this has been a good debate and some distinguished noble Lords from the Principality have spoken with a great deal of expertise and experience on the devolution settlement and on the condition of the National Health Service in Wales. On behalf of my noble friends Lord Evans and Lady Farrington, I thank those noble Lords for their kind words.
347 Sadly, unlike my noble friend Lord Evans, I cannot claim Welsh ancestry but I do claim a great deal of interest in the health service in Wales and in what noble Lords described in one way or another as the interesting divergence in the different health services in different parts of the UK. That divergence can be to the good only so long as we maintain the integrity, philosophy and principles of the National Health Service and ensure that people can cross borders as patients or staff and that none the less there is close collaboration and co-operation.
A number of noble Lords discussed the scrutiny of the Bill. For a relatively short Bill, it involves considerable scrutiny. I doubt whether noble Lords will follow the stricture of the noble Lord, Lord Thomas, and propose no amendments in Grand Committee. I have observed the comments on whether future pre-legislative scrutiny concerning Welsh Bills should be undertaken by a Joint Committee of both Houses. It is not for me to respond to that but I assure the House that I shall bring those thoughts to the attention of the appropriate authorities in both Houses.
The noble Lord, Lord Thomas, felt that another place had not done itself justice in relation to the Bill. Many Members of another place do not believe that this House should exist. Perhaps the noble Lord is proposing a Motion to abolish another place, in the spirit of co-operation that we are currently observing in relation to Lords reform.
§ Lord Thomas of Gresford
My Lords, my criticism was in relation to the Second Reading debate and the committees that followed that. It certainly did not involve the Welsh Affairs Committee, which I thought gave excellent consideration to the Bill and showed that there is a real role for Members of another place from Wales.
§ Lord Hunt of Kings Heath
My Lords, that I fully understand. My noble and learned friend Lord Morris of Aberavon raised the question of the legislative proposals that come from Wales. He asked a number of questions and raised an interesting point concerning the chances of a similar Bill being given fair wind if different parties were to be in government in Westminster and Cardiff. Of course, such a question is purely speculative and, so far as concerns the Westminster Government, I hope that it will be many years before it has to be tested. However, I suppose that that is the kind of issue that would be embraced within the Richard commission. I say to my noble friend that I have found a great deal of constructive working in the relationship between Ministers of the Westminster Government, the Welsh Assembly and officials. That is to be commended.
The noble Lord, Lord Hooson, raised more substantive issues about the extent of devolution. He questioned whether a Bill such as this should be decided by this Parliament or whether it should be delegated and devolved to the Welsh Assembly. Again, I believe that that is a matter for the Richard commission. Noble Lords will know that the 348 commission is expected to draw its conclusions in September this year and to publish its report in December.
My noble and learned friend Lord Morris asked whether Members of the Welsh Assembly were "happy bunnies", as he put it, in relation to the Bill. I do not think that I could go so far as to say that they are happy bunnies. But my understanding is that they are content with the Bill as it now stands and wish to see it supported and passed through your Lordships' House.
As to the question of the number of Bills that the National Assembly for Wales would like this Parliament to consider, my noble friend will know that there are always pressures on the legislative timetable. I suspect that those pressures are as much a concern for my department—the Department of Health—as they are for the National Assembly.
As I said earlier, a different approach is being taken within the Bill, which continues the trend of the approach towards the NHS in Wales. My noble friend Lord Prys-Davies said that time alone will tell the outcome of that change. But it seems to me that there has always been a degree of diversity between the four countries of the UK in relation to the way in which the NHS has been managed. I believe it is positive for that diversity to continue, for us to learn from each other, to learn what works well and to share problems and experiences. That must surely be the culture and philosophy that we wish to develop together.
The noble Lord, Lord Roberts, spoke of the number of challenges that face the NHS in Wales. The noble Baroness, Lady Finlay, also raised issues of concern, particularly in relation to the recruitment and retention of key staff. It is not for me either to proselytise or to defend the conduct of the National Assembly in its management of Welsh health affairs. But it may be appropriate for me to comment that, although it would be wrong to say that there are no problems or challenges in relation to the Welsh health service, it is right to point out the achievements and progress taking place in the Principality. For example, the NHS in Wales is now receiving unprecedented levels of investment; more patients are being treated than ever before; the number of staff working in the NHS in Wales has increased; and some additional hospital beds have been funded.
The issue raised by the noble Baroness, Lady Finlay, about the shortage of doctors and nurses is well taken. We face the same issue throughout the United Kingdom. Just as in England, the National Assembly for Wales has taken important actions designed to ensure an increase in staff numbers. A workforce planning mechanism is in place which will enable the National Assembly to come to conclusions about the number of staff and training places that will be needed in the future. But it is good to report that the commission's figures for student numbers in Wales show a considerable increase over the past four to five years. For example, since 1998, there has been a 63 per cent increase in the number of training places commissioned for nurses. There has been an increase 349 of 39 per cent for midwives, and 87 per cent for the allied health professions. I consider that to be very good progress.
The question of waiting times will always be important for those who are concerned about the National Health Service. I say to the noble Baroness, Lady Finlay, that I know that some doctors feel that we should not go down that path in relation to waiting times generally. But when patients are asked their major concerns with regard to healthcare, waiting always comes near the top of the list. I also say to the noble Baroness that my experience of 25 years in the health service is that, unless there are targets for waiting, I am afraid that the NHS lets them slip.
It is important that clinical priorities are always to the fore and that the patients who most need treatment receive treatment first. Equally, it is important that we cut waiting-list times as much as possible. I know that the National Assembly is as determined as we are to ensure that that happens.
The noble Lord, Lord Roberts, raised the question of bureaucracy. He suggested that the new structure coming into operation in Wales on 1st April might be bottom heavy and grossly bureaucratic. I accept that we must always ensure that any structural changes in healthcare are non-bureaucratic. But I believe that there are real advantages in making changes which align the health service to local government. I consider that the development of 22 local health boards, coterminous with unitary local authorities in Wales, offers many advantages in terms of collaboration and in ensuring that health, social services and other local government services are integrated.
Costs are important. I understand that the Assembly budget for transition costs of structural change ranges from £12.5 million to £15.5 million. So far as concerns the report of the Comptroller and Auditor General, I am advised that it is the view of the National Assembly that, once the transition has been made, the new structures will cost no more to run than the existing ones.
I now turn to the question of community health councils. My noble and learned friend Lord Morris was responsible for the establishment of CHCs in Wales. He expressed disappointment. Putting on my hat for a moment as a Department of Health Minister, I share that point. I believe that English CHCs have had a very patchy record—they have disappointed. But, in Wales, the National Assembly has decided that CHCs are an effective mechanism to build upon to ensure effective patient involvement and representation in the future.
I had a shock when the noble Lord, Lord Roberts, quoted the figures for the cost of running community health councils in Wales. My understanding is that there was a mistake in the House of Commons research paper. I am glad to tell the noble Lord that the figures are nowhere near those that he suggested.
350 So far as concerns the question of CHCs and their future performance, I agree with the noble Lord, Lord Thomas, that inspection, and its proposed extension, is indeed crucial.
I agree with the noble Baroness, Lady Finlay, about the importance of ensuring that community health councils make stronger links with primary care. My noble friend Lord Prys-Davies is surely right when he talks of the need for consistency in the handling of complaints. As regards time off work for CHC activities, the noble Lord is right to raise the question of the Employment Rights Act 1996. This is not a matter for my department, but I understand that officials from the Assembly are liaising with their counterparts at the DTI further to discuss this matter.
The HPW fulfils and is intended to fulfil an important role in relation to the health professions in Wales. It will complement, not conflict with or duplicate, the activities of other bodies concerned with professional practice and regulation. I believe it will fulfil an important role. Perhaps I may say to my noble friend Lord Morgan that pre- registration education will be monitored in the same way as all university education. Health Professions Wales has no remit for monitoring pre-registration education. However, I am sure that it will wish to collaborate with higher education institutions and other relevant bodies in Wales.
I sympathise with the point made by the noble Lord, Lord Thomas, concerning health care support workers. He may be interested to know that that is a matter the Department of Health is currently considering in terms of regulation. There is no doubt that healthcare workers play a crucial role. It is important that they are given appropriate training and support to take on great responsibilities. Alas, I believe that the decision made some years ago to phase out state-enrolled nurses was a grave error.
My noble friend Lord Prys-Davies asked about prisons. That question has been considered in relation to CHCs. It is felt that the current proposals strike the right balance. There are no plans to extend their remit to other areas such as prisons. As regards the Wales Centre for Health, a number of noble Lords raised the issue of inequalities in health in Wales. I believe they were right to do so. The figures are striking. Anyone looking at those figures and seeing the incidence of ill health in Wales would be concerned to ensure that a focus of future endeavour is strategies and implementation of programmes to tackle the root causes of ill health. The Wales Centre for Health will have an important role to play. It will be an independent body which will provide information and impartial advice on public health in Wales. I believe it will be a great source of support to everyone concerned with tackling inequalities. It will act as an advocate for public health at national level; I agree with the noble Baroness, Lady Finlay. I believe that it will cost £1.3 million per year, although I shall provide further information in relation to that. I correct myself. That figure is for Health Professions Wales. Perhaps I may confirm that figure in writing.
351 Other issues raised concerning public health relate to smoking. I note with interest the comments of my noble friends Lady Gale and Lord Prys-Davies. It is true that on 22nd January the Assembly voted in favour of calling on the UK Government to bring forward a Bill to give the Assembly power to prohibit smoking in public places. The Assembly has been concerned about that issue. We shall most carefully consider the Assembly's position. However, we have previously concluded that compulsion in that area is not the answer.
My noble friend Lady Gale raised the important question of asthma and smoking. I believe that the WCH will have a crucial role to play in terms of research and advice on tackling what is an increasingly worrying and important area of concern.
The noble Lord, Lord Walker, raised the question of hospices. I am glad that he recognised the progress being made within Wales. I well remember the debate. My department is concerned to ensure that the resources we wish to see spent within palliative care are indeed spent in that area. My colleague Ministers concerned with this matter frequently meet with representatives of the palliative movement to try to ensure that the NHS and the voluntary palliative care sector work together and to ensure stability in funding contributions from the National Health Service. It is not just a question of the size of the contribution but of the period of time that hospices are given in terms of a grant being made. Stability is important.
I hope I have endeavoured to answer most of the points raised.
§ Baroness Finlay of Llandaff
My Lords, I rise briefly to reinforce the statement made by the Minister. The consultation over provision of money to palliative care services has been extremely extensive and has tried to involve health care professionals in all walks of palliative care services. For that we are all grateful.
§ Lord Hunt of Kings Heath
My Lords, I am grateful to the noble Baroness for that comment. In conclusion, I believe that the Bill commands general support. It will help the National Assembly to make significant changes to the organisation of the health service in Wales.
§ On Question, Bill read a second time.
§ Lord Hunt of Kings Heath
My Lords, I beg to move that this Bill be committed to a Grand Committee.
On Question, Bill committed to a Grand Committee.