'( ) That the Wales Centre for Health shall have a duty to coordinate its activities with the recommendations of the Special Health Authority for England and Wales responsible for the functions of the Health Protection Agency in matters related to communicable disease control in England as well as with similar functions controlled by the NHS in Wales.'.
We have tabled the amendments to highlight an issue that should be a matter of concern for everyone in the House at what is undoubtedly a difficult time in security terms, and also because security matters are not the sole issues involved in the relationship between the health protection agency and the Wales centre for health. There is also the issue of how matters relating to communicable disease are addressed and communicated, and how public information on these matters is provided.
These are probing amendments designed to establish the relationship envisaged by the Minister between the Wales centre for health and the health protection agency. The latter organisation covers England and Wales but does not have the full remit in Wales that it does in England. The former will, if we understand its role correctly, have prime responsibility for the communication of public health information to the people of Wales. The Minister may be able to clarify the degree to which he envisages the Wales centre for health having responsibility for communication in those areas. The Bill states that the centre will be responsible for developing and maintaining
Xarrangements for making information about matters related to the protection and improvement of health in Wales available to the public in Wales".
It will also have responsibility for research and training, both of which could be equally important in the current climate.
This is happening at a time of change for the infrastructure for the establishment of information—and, in part, for the provision of information—about communicable diseases and also, in these difficult times, about biological and chemical threats to this country. These functions were previously carried out by the Public Health Laboratory Service for England and Wales, and are in the process of being radically changed. Over the next few months, we shall see the creation of an entirely new organisation, the health protection agency, which will take over the responsibilities of the PHLS and a number of other bodies. It will be created as a special health authority and, from April, take on responsibility for providing or commissioning most of the NHS functions set out in the Government's consultation paper last year.
The organisation will be responsible in England for PHLS roles, but not, in general, clinical diagnostic microbiology services. However, it will be responsible for microbiological research and take over the national focus for chemical incidents, regional services and the National Poisons Information Service. It will also take over the health protection functions provided by consultants in communicable disease control and other health protection staff. Furthermore, it will have a role in providing advice on emergency functions.
In Wales, the organisation will also have many of those responsibilities, but not all of them. It will not be responsible for certain consultancy work, but it will, none the less, be the body that generates first-base information on major communicable disease risks and major biological and chemical risks.
This week, we have seen the first example of a chemical threat being discovered in this country. The PHLS has been predominantly responsible for providing information to the public indirectly and to the NHS directly on the nature of that threat, on what treatments are available, if any, and on how medical practitioners should try to identify the possible appearance of symptoms that ultimately might represent a chemical or biological attack on or threat to this country.
I support the argument that my hon. Friend is making. Will he accept from me the assurance that terrorist groups always try to think one jump ahead? Given that so much has been said in anticipation of a terrorist attack on London as the capital of the United Kingdom, terrorists thinking one jump ahead may be considering the capitals of Scotland and of the Principality precisely to take us by surprise. Is not that a particular reason for bodies in Scotland and in Wales having the extra representation for which he is arguing?
I thank my hon. Friend for those comments, because he is driving at the nub of the reason for our laying the amendments on the Table for, I hope, the Minister's acceptance. I certainly hope that he addresses the issue and responds with his own thoughts on the different ways in which those organisations will interact. Ultimately, in the eyes of the terrorists who are threatening us, we are one United Kingdom and one nation. Terrorists will not respect administrative or national boundaries within the UK, so we must work effectively together.
We have a concern: in creating those structures through the Bill and in creating the Wales centre for health, we want to ensure that the centre has proper links with the organisations that will provide the rest of the NHS in England with the information, training, support and guidance that it requires to do its job properly.
That is the purpose of the amendments that we have introduced. We want to formalise the relationship between the Wales centre for health and the new body to ensure that there is absolute co-ordination between all those people who are responsible for establishing and communicating information on those important issues. In our view, it is particularly important that those arrangements be dealt with because of the uncertainties surrounding the restructuring of the PHLS, the creation of the HPA and the changes in this area as to the organisations being transferred from the PHLS to the NHS.
The debate takes place as those organisations are going through a huge process of change that is enormously disruptive to them. We must be mindful of the warning given by the PHLS internal risk assessment team on the implications of the changes:
XIt seems inevitable that if the timetable of 1st April 2003 for the HPA is to be delivered, some level of risk will have to be tolerated. Were there to be a severe external challenge over the next few months, such as deliberate release, the situation and expected forward timetable would need rapid reappraisal."
I hope that the Minister's colleagues in the Department of Health are taking on board that warning, which has implications for Wales and for those who are taking over responsibility for some areas that the PHLS covers in the Welsh NHS. Those responsible for the Wales centre for health also need to be mindful of it, given the responsibility that they will undoubtedly have for making information available to the public on health issues that we all could face in the months and years ahead.
That information, which will originate from the HPA and our central scientific teams, must be disseminated effectively and quickly right across the NHS in England and in Wales. Our first amendment is one suggestion as to how we could strengthen and formalise those ties, ensuring that they are clearly in place during the period of transition for all those organisations and that they solidify as they go forward.
The PHLS drives the dissemination of information on communicable diseases and chemical weapons, and the HPA will take that over. Do we not need to ensure that those organisations are interlocked? What better way to achieve that than to offer the HPA a non-executive role on the board of the Wales centre for health, so that there is a genuine voice for our scientists and technical experts in the arena where communication and training will be formulated and delivered?
That is the objective of our first amendment. I hope that the Minister gives it due consideration, but, if he feels unable to adopt such an approach, will he none the less consider the direction in which we are attempting to steer him? Will he also consider how to ensure strong linkage between the two, and ensure that the scientists have a strong voice in the work of the Wales centre for health in shaping communication and training?
Our second amendment is designed to formalise a duty of partnership, especially as organisations will be going through difficult changes. It is all too easy for them to miss out working together and to focus on internal issues rather than ensuring that they work in the partnerships that we all need for the future. Our proposal is designed to ensure that there would be a duty on them to do so. It would provide direction for them and act as a reminder from Parliament that the nation needs them to operate in tandem.
The issue does not simply involve security, although at this time security must be a paramount consideration. If there is a chemical or a biological risk, we must ensure that information and training flows right the way through our health services, quickly and effectively, and on to the public as and when they need it. However, the PHLS has played an active and important role in other areas, which, in future, will be played by the HPA. Examples are disseminating information on the spread of methicillin-resistant staphylococcus aureus in our hospitals—hospital-related infections and how they can be tackled—and providing information on winter vomiting disease, which is at the forefront of consideration in the health world, as well as other diseases that may be isolated, such as Legionnaire's disease. They may, like a flu epidemic, spread much more widely.
The information that the HPA produces will be of paramount importance to medical practitioners and patients alike. We are asking the Minister to create a duty of care on the Wales centre for health that says, XYou're not simply there to serve the people of Wales. You're also there to be part of a partnership within the United Kingdom to ensure that we provide proper and effective information across our borders, throughout our nation and to all our people." We are one United Kingdom. The Bill is creating institutions that will serve the people of Wales. They must do that not in isolation, but in partnership with their counterparts elsewhere in the UK and organisations with a remit for the whole UK. The amendments are designed to suggest simple structures and duties that would enable them to do that—indeed, would ensure that they did it. They are designed to convey a sense of direction to the organisations. I hope that the Minister will give due consideration to our ambitions, and that, if he is not willing to accept the amendments in their present form, he will ensure that the partnership we need—in the context of communicable diseases, but particularly in the context of security issues—between our scientists and our information providers is strong, effective and structured.
I know that amendment No. 2 is a probing amendment, and it raises important issues, but I think both amendments should be resisted, because I feel that requiring a place on the board to be given to the Wales centre for health is too prescriptive at this stage. I feel that the Assembly should have maximum flexibility to decide which organisations should have places.
I thank the hon. Lady for giving way, with typical courtesy. Surely she recognises, however, that a terrorist chemical or biological weapons threat would require a national lead from central Government? Does she not agree that if any subject under the sun requires such a lead, it is that subject?
The hon. Gentleman is making important points sincerely, but I do not think that the Welsh body we are creating should be compelled to liaise with another body. Moreover, as was pointed out by Chris Grayling, the arrangements in Wales differ from those in England. The Assembly will retain some responsibility for emergency planning.
The hon. Lady does not think that the special health authority for England and Wales should have a representative on the board of the Wales centre for health. Does she think that the board of the Wales centre for health should have a specific and designated representative on the special health authority for England and Wales?
I welcome the tone of these Conservative amendments more than that of those tabled in Committee, because they show enthusiasm for working together rather than pulling apart. In my view and that of my party, devolution is not about separation and isolation but about maximising the contribution that each nation—such as Wales or Scotland—and each English region can make to the whole. But the arguments of Chris Grayling in Committee often depended on a worst-case scenario, and I feel that the case he has advanced today for an English appointee does the same.
The hon. Gentleman knows, surely, that the health protection agency will cover England and Wales. There is no reason to assume that the HPA representative on the board must be English, as Welsh people will of course be involved in the organisation. This is much more about solidifying the links between the organisations than about trying to involve England in Wales.
I take the hon. Gentleman's point, but I do not think any of us thought, on first seeing the Bill, that the primary purpose of the Wales centre for health would be to deal with terrorist threats—although of course I accept that terrorism is now a key issue, which we should all address. I feel that using a worst-case scenario as a basis for legislation will so constrain the nature of that legislation that it will be unsympathetic to devolution, and the right of the Welsh people and the Welsh Assembly to look after their own affairs.
Although I welcome the tone of the amendments and accept the points made by the hon. Member for Epsom and Ewell, I do not think the hon. Gentleman's aims will necessarily be achieved by changes in the legislation. They could, I think, be achieved by good practice and the building up of partnerships that would work in actuality rather than on the pages of a Bill.
The special health authority, of course, does not yet exist. We intend to set it up in April 2003, using secondary legislation under section 11 of the National Health Service Act 1977, as an interim step pending the establishment of the health protection agency. We intend it to be a non-departmental public body, although that will depend on the availability of legislative time.
It would be inappropriate to give a body that does not exist, and will in any case cease to exist as soon as the HPA is established, a place on the board of the Wales centre for health, or to require the centre to co-ordinate its activities with those of such a body. Surely giving the centre a duty to co-ordinate its activities with the recommendations of the interim body, or those of the HPA when it is established, would be incompatible with a requirement to ensure its independence.
The outcome of the pre-legislative scrutiny supported our intention that the centre should act independently, as Conservative Members pointed out in Committee. It could not act independently if required to co-ordinate its activities with the recommendations of the HPA. There would be no equivalent requirement for the HPA to co-ordinate its activities with those of the centre. It would also be inconsistent to require the centre to co-ordinate its activities with those of a body outside Wales, in the absence of a similar duty for it to co-ordinate its activities with those of relevant public sector bodies in Wales. And why should the HPA have a right to representation on the board of the Wales centre when bodies in Wales will have no such right?
The Assembly intends members of the centre to be appointed on the basis of their expertise and experience, and to be drawn from the statutory, voluntary and academic sectors in Wales. Amendment No. 2 runs counter to that intention. I agree with my hon. Friend Julie Morgan that it would introduce a prescriptive and inflexible approach to a detailed issue. We intend the Assembly to determine the matter, under schedule 2(10)(a). I can reassure Members, however, that the Wales centre for health will not duplicate the expertise that the HPA will provide in Wales.
I do not think that people are worried about the Welsh body duplicating the work of the national body. What worries them, I think, is the possibility that the Welsh body will not consider the role of the national body sufficiently. It is, surely, a crucial defence role, albeit a civil and domestic defence role. It makes no more sense for the Welsh Assembly to consider the work of a body with a national defence role of that sort than for it to consider other important aspects of defence policy and say, XThese should be a matter for us". Surely the Minister can see that we are discussing an overall national danger, and that national defence measures are therefore required.
I hope that the remarks that I am about to make will reassure the hon. Gentleman so far as that point is concerned. We need to distinguish between the roles of the Wales centre for health and of the health protection agency. The HPA will bring together specialist expertise at a UK level against microbiologicial, chemical and radiological hazards, and terrorist threats. The WCH is in support of public health in Wales, so the two bodies have two distinct roles.
The time to discuss the relationship of the HPA with other bodies, including those in Wales, will come when the proposals for establishing it appear before this House. The functions of the HPA in Wales will be fully explained at that time, but if it helps hon. Members I can say now that we do not intend the functions of the HPA in Wales to include all those that it will have in England. As I said, it is intended that, once established, the HPA will provide services and expertise in areas of microbiological, radiological and chemical hazards. I hope that reassures the hon. Member for Epsom and Ewell in respect of the point that he made in his opening remarks.
I do not think that we want the legislation to prevent the WCH from providing any information to any national body such as the HPA, if that were thought appropriate. I see no reason why the WCH should not do that if it has something to contribute, but we need to understand the two separate roles of the HPA and the WCH.
We are getting to the heart of the matter. The Minister is saying that the WCH would not be prohibited from contributing, but the amendment would ensure that the WCH could contribute, make useful statements and enable important measures to be taken in the event of a terrible attack of this sort. He is not really reassuring us that, without the representation for which the amendment argues, the new body in Wales will be able to take effective action in the event of a terrorist attack.
Perhaps I should again make it clear that the bodies have two separate roles. The HPA will bring together specialist expertise at a UK level against microbiological, chemical and radiological hazards and terrorist threats. The WCH is in support of public health in Wales. I cannot see for the life of me how putting a representative on the board of the WCH would in any way guarantee that any information that WCH wanted to contribute would automatically be contributed. I have no doubt that, if the WCH wanted to make a contribution, it would be able to do so through proper collaboration—which will come—between the two bodies.
As I said, the functions of the HPA in Wales will be fully explained when we present that information to the House. When it is established, it is intended that the HPA will provide services and expertise across the range of hazards that I have described: microbiological, radiological, chemical and so on. This information is currently—
There seems little doubt that my hon. Friend Dr. Lewis and I are inadvertently proving to be pestilential nuisances to the Minister, but I am bound to tell him that that is part of our parliamentary responsibility. In answering my hon. Friend a moment ago, the Minister said that the presence of a representative of the special health authority for England and Wales on the board of the WCH would not change the balance of powers, and that is accepted. However, I put it to him in all fairness that the presence of such a representative might usefully serve the purpose of sensitising the WCH to the importance of its communications responsibilities in circumstances of the kind that my hon. Friend has helpfully outlined.
Perhaps we will discuss communications when we debate the next group of amendments. In fact, the hon. Gentleman's party is trying to prevent such communications in tabling those amendments, so perhaps we should leave that issue until we have that debate.
The work that the HPA will carry out in the areas I have mentioned is currently undertaken by the board of the Public Health Laboratory Service, the National Radiological Protection Board and the national focus for chemical incidents. However, field services that the HPA will provide in England—health protection functions that are provided by consultants in communicable disease control—will be provided by the national public health service in Wales. Emergency planning in Wales will remain the responsibility of the National Assembly. So because the functions of the HPA will be different in Wales, it is essential that arrangements for co-ordination with bodies that provide these services in Wales are sufficiently flexible. The HPA will need arrangements with a range of public health bodies, and as I have already said, it cannot achieve this simply by having a place on the board of the WCH.
The HPA will need to have relationships with the national public health service and the Assembly in order to carry out its functions. Those relationships will be most appropriately set out in agreements, which will come when we introduce proposals for the HPA. Settling these relationships by agreement, rather than introducing inflexible duties in the manner of the amendment, will provide the flexibility to meet changing circumstances and to make organisational arrangements, which will be put in place when necessary.
The hon. Member for Epsom and Ewell said that these are probing amendments, and I hope that I have managed to deal with the points that he and his hon. Friends raised.
I am not at all concerned by the hon. Gentleman's rising; each time, I swat away such contributions like flies.
I have to say that that was not the Minister at his best—I know that he can do better. He has not addressed what is a pretty important issue at the moment, and it is clear that he was reading the brief prepared for him earlier. His response concerned the technical issues, rather than the actual ambition of protecting the people of Wales. He said that the HPA will be formed from
The Minister also talked about the independence of the WCH, but I do not believe that it can act in isolation on this issue. If I am not mistaken, we are still one United Kingdom, facing the threat of terrorism and disease. Wales is not becoming an independent country through devolution; we are working together and we need to work together. This issue needs to be about partnership, and to be frank I found the Minister's reference to not wanting Welsh bodies to have a duty to work with English bodies rather reprehensible.
The key issue behind the amendment—
The Minister specifically said that, if the amendment were accepted, the WCH would be accountable to an English body in a way that it would not to bodies in Wales, but I would argue that that is simply not true. The HPA is an England and Wales body with a duty to protect our people, and to deliver the scientific expertise that will enable our health service better to protect our people, and that will enable people better to prepare for unforeseen eventualities. In that situation, surely the role of the organisation with prime responsibility for training and communication in Wales would not be affected adversely in any way by a concept that would put a scientific expert on to its board. That is all that the first amendment in this group seeks to achieve.
Julie Morgan wants to leave these matters to the Welsh Assembly, but they are not solely Welsh matters. Terrorists will strike, and that will affect us all. We cannot act in isolation. Diseases such as MRSA or tuberculosis will affect the whole country; they will not stop at borders.
I am grateful for that remark. It is all the more disappointing, therefore, that the amendment has not sparked a debate and caused the Minister to suggest different approaches. Instead, we have merely been told that the ideas are not relevant. If the Minister will say how he will structure the relationship covered by the amendment, we will be happy to treat it as a probing amendment, as originally intended. However, our public laboratory system and health protection infrastructure are in a state of flux and the new organisation is being set up at a time of threat and risk. We need to understand now what the Government are planning, not when an incident occurs in the future.
I am trying to make it clear that the HPA will be a national body. It will tackle the threats—from microbiological attack, chemical and radiological weapons and other hazards, such as terrorism and so on—about which the hon. Gentleman is so worried. The WCH will not have that function; its role will be to support public health in Wales. The two bodies will collaborate closely. When the HPA is established, it will set up a series of structures through which it will collaborate with the WCH. I assure the hon. Gentleman that the overall responsibility for meeting the threats that he has described will rest with the HPA—the UK body that will take responsibility for such matters.
The Minister said a moment ago that the WCH could—and probably should—play an active role in telling the people of Wales about risks, and in dealing with those risks. We believe that it should play an active role in helping to train medical practitioners and health service personnel to deal with threats arising from terrorist sources or from outbreaks of communicable disease. The WCH and the HPA should be closely linked. It is logical for the House to ensure that the two groups—scientists, and communicators and trainers—should work together.
The Government intend that the two bodies will work closely together and be complementary. The hon. Gentleman has argued that we all belong to one country, the UK, and that we need a single approach to the threats that we face, from terrorists and elsewhere. Now he suggests that the WCH should have a role in training people to deal with those threats. That role more properly belongs to the HPA, as he will understand when it is established.
Xcontribute to the provision and development of training".
The WCH will therefore be the leader in delivering public health information in Wales. It also will play an active role in providing the necessary support training in relation to that information. Surely it should therefore work hand in glove with the scientists who deliver information about communicable diseases and about security risks? I do not understand why the Minister resists establishing a duty for the WCH to work in partnership with the national HPA. That would be a signal from the House at a time when this country faces real risks.
We are not asking the WCH to do anything specific: we are saying that the national Parliament expects the WCH to work with the national organisation that provides the scientific expertise on which the WCH will base much of its information. That would be its duty. We accept that there will be difficulties as the WCH establishes itself, and as the HPA goes through significant changes, but why is it inappropriate for the House to expect the two bodies to work in partnership?
We want to ensure that the people of Wales are not disadvantaged by the creation of separate bodies outside the structures of the NHS. Wales is not becoming an independent country. In respect of both terrorism and diseases, its people must still receive the same quality of service and remain linked to the national expertise enjoyed by people in England.
I assure Mr. Williams that we are as concerned about the threat from communicable diseases as we are about the threat from terrorists. The hon. Gentleman said that Conservative Members have been inclined to look at the worst case when considering this Bill. However, given that chemicals that can be used as weapons have been discovered in the hands of terrorists in this country, I will take no lectures about not focusing on the worst case. It would be irresponsible of the House not to look at and cater for the worst case. We must make minor improvements to the Bill to strengthen the links between our scientists and the people who have to communicate the scientists' work.
I have been monumentally unimpressed by the Minister's response to the amendment. I hoped that he would say that the amendments were not quite right, but that he would take them in the spirit in which they were tabled and come back with his own ideas to ensure that the WCH and HPA work together. His response was inadequate, and I therefore intend to press the amendment to a Division. We need to make the point that the matter is too important not to be taken seriously.