I beg to move amendment No. 1, in page 2, line 21, at end insert—
'provided that it shall not use media channels widely accessible in any area outside Wales for the communication of such information unless that information is communicated jointly with those public information bodies responsible for the communication of health information in that area;'.
Obviously, I am disappointed that we did not win the vote on amendment No. 2. I must wholly disagree with the comment of my hon. Friend Chris Grayling that the Minister was not at his best during the wind-up to the debate: we have never seen the Minister at his best, so I do not understand how my hon. Friend could arrive at that judgment. However, we shall move on.
Amendment No. 1 is straightforward; it relates to the promotional activities with which the Wales centre for health will be involved. We are not dealing at this stage with its role in research or the development of training.
Clause 3 provides that:
XThe Wales Centre for Health must...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."
Our amendment would add the words
Xprovided that it shall not use media channels widely accessible in any area outside Wales for the communication of such information unless that information is communicated jointly with those public information bodies responsible for the communication of health information in that area".
That is a common-sense amendment.
In many ways, the amendment builds on the Minister's earlier suggestion that, in practice, the WCH will work with several other organisations, even though that is not specified in the Bill. The Minister will remember that, in Committee, we tried to include a provision that would force the centre to work with similar bodies elsewhere in some of its campaigns. The amendment would do that, in another guise, inasmuch as we recognise that once the WCH is properly and fully established, it may embark on television campaigns that impinge on people outside Wales.
As we know, a considerable number of people in Wales—north and south—turn their aerials away from Welsh television stations for all sorts of reasons. People living in north Wales who were born in England may be more interested in what Granada has to offer, or people in parts of south Wales may point their aerials in the direction of Westcountry television, which is owned by Carlton, rather than watching domestic Welsh services.
The Wales centre for health might embark on a campaign of precautions and warnings against smoking—something that we would all welcome. We know that obesity is a problem, so the centre might launch a campaign for better eating habits, perhaps coupled with the promotion of health exercise. Again, we would support that, especially if the campaign was targeted on people who were vulnerable to those problems.
I do not think that there would be a great problem if such advertisements were broadcast on HTV Wales and also seen by people in Bristol who can receive that channel. However, there might be other campaigns where we should want the centre to collaborate with other bodies and co-ordinate its work with them. That is only common sense.
In Swansea, for example, there is a problem in getting mums and dads to take up the MMR inoculation for their children. Several GPs are so worried about that lack of take-up that they fear that there will be an outbreak of disease. The centre could set up a campaign targeted on the Swansea area, or even nationally throughout Wales. There might be no problem in doing that, but it might run counter to messages coming from England.
One of the beauties or strengths of devolution—so we are told—is that there can be policy differentiation between Wales and England if that is what Wales wants. For example, England already has a diabetes strategy, but Wales is still waiting for one. I am bewildered by that decision and hope that the Government will get on with a proper diabetes strategy for the whole United Kingdom and that all organisations will work together to ensure that it is sensible.
However, the situation could be reversed: Wales might have a strategy on something while England did not. If there was an advertising campaign in Wales on the issue, some English residents might think that it was also English health policy. Such differentiation in policy might not be a strength—it could cause confusion.
Confusion can also arise when we hear references to the XHealth Minister", because, as hon. Members know, the title XSecretary" in the National Assembly for Wales has been replaced by that of XMinister". When that job title is mentioned people do not know whether it means the UK Minister or the Welsh or Scottish one.
Surely, the diabetes strategy is an example of devolution working well. It was not an English initiative but a Scottish one. England took it up and Wales will do so later on.
I do not dispute the fact that the strategy started in Scotland and that it followed in England. The question that I want to stress is why Wales is last. People in Wales who suffer from diabetes have been pushing hard for such a strategy; indeed, even in England we waited too long for its implementation.
There is huge confusion even about simple things, such as the roles of county councillors, MPs and MEPS. We do not know who does what. We are trying to bring back some sanity and coherence. That is what the amendment is about.
There is a problem with flu jabs, for example. Due to the recent cold snap, one hospital in Wales stopped all non-emergency operations until February to tackle the problem. Although we would endorse a campaign to encourage more people to take up flu jabs, we also know that in some areas doctors have run out of vaccine in the past. A campaign might be initiated in one part of the country but seen on television in another area where no vaccine was available. That would be a gross waste of time and extremely inefficient.
Does my hon. Friend agree that it would cause huge frustration if people saw on television that they are supposed to get themselves inoculated against flu but when they turned up at their local GP surgery they found that there was no vaccine? There are already far too many attacks on people who work in the health service. Such campaigns could increase frustration with NHS staff, even though they were incapable of carrying out inoculations due to the lack of vaccine. The amendment would prevent such dilemmas.
I am grateful to my hon. Friend for that point. The frustration would be worse if people were told in a television campaign to go to their surgery, only to find when they did so that there was no vaccine. That has happened in the past, so we are not even talking about a worst-case scenario.
If we can get everyone to work together on such matters it would be not only efficient, but would also save money. As we have said in the past, the duplication of television campaigns can be hugely expensive. Of course, I can almost read the Minister's mind as he sits on the Treasury Bench. He thinks that everything will be wonderful and that everyone will work together in their best interests. We have heard it all before, but we want such things to be stated in the Bill to ensure good practice, for goodness' sake. Much of the Bill is common sense in many ways—for example, some of the requirements that the Wales centre for health will be asked to meet—but we still think that it should be stated in the Bill none the less. That is what we are trying to do with the amendment.
The hon. Gentleman quotes only part of the amendment, which goes on to say that the proposal should apply unless the centre is in dialogue with its sister bodies in England. We are trying to make that dialogue the norm, so that such problems would not arise.
There are various ways in which the centre should try to get its message across. For example, it could use regional newspapers. There are several very good daily morning and evening newspapers and even weekly newspapers in Wales, and they get their message across. Using the South Wales Evening Post would be a perfect way to get the message on MMR across, especially in areas that face the problem, such as Swansea. There would be no problem in doing that, and I suspect that it would be far more cost-efficient.
The use of television is the main problem because it does not respect boundaries, as has been rightly said. Many people could receive pictures from elsewhere. Of course, with digital television, people living in England can receive Welsh television, and vice versa. Satellite television, the internet and e-mails could be used, and I am sure that there is even a role for texting on telephones. All those things have to be considered.
We feel very strong about this issue. Although we failed in Committee when we tried to get those bodies to work together to achieve coherence and joined-up thinking, the campaigning aspect for the Wales centre for health will be vital. I can imagine that Members of Parliament will get in touch with the centre, saying XThis is a particular health problem in my area. Please will you look into it, and do some research and campaigning on it?" That would be a perfect and appropriate role for Members of Parliament, but, surely, given the limited amount of money that the Wales centre for health will have at its disposal, we want to ensure that it at least talks properly to similar organisations elsewhere.
We want to ensure that the campaigns are properly costed, work together and are rolled out where appropriate, so that we can save money and be far more efficient than if we leave things as they are and simply pray that the bodies will talk to one another and work together. Why do we leave that to chance? Let us include such things in the Bill and ensure coherence.
I would not want to disappoint Mr. Evans, but I also believe in co-operation between health promotion bodies in Wales and those in England. After all, disease does not respect national boundaries, or any other boundary for that matter. However, I wish to point out some of the problems to which he has already alluded, as well as those that arise from the fact that the amendment uses the words,
Xshall not use media channels widely available accessible...unless that information is communicated jointly".
Let us consider the media channels available. The hon. Gentleman has already referred to television. However, I contend that the amendment would constrain the Wales centre for health unreasonably because all the media channels that may be used would have to be agreed with bodies over the border. Any message that the centre wanted to broadcast in Wales would probably have to be communicated jointly with those bodies.
I shall list the media that might be used and comment very briefly on them. First, Sianel Pedwar Cymru—S4C, the Welsh television channel—is widely available as the hon. Gentleman has already said. I occasionally watch it when in London, and I understand that it is also available on the internet and can be watched all over the place. Radio Cymru and Radio Wales—the two national radio channels—are widely available in the west and north-west of England and in the midlands, as is witnessed by the phone-ins that they broadcast. People in many places listen to programmes on Radio Wales, so anything broadcast on those two media would then have to be communicated jointly with bodies in England.
Of course the internet is available universally. It is available to people in Caernarfon in my constituency and to those in Caernarfon in New South Wales; to Bangor in the constituency of the hon. Member for Conwy and to Bangor, Maine. We are talking about only England and Wales, of course, but information that the Wales centre for health might produce would be widely accessible in many areas outside Wales, and any such decision would be a matter of practicality.
Certainly not; people would be very interested in co-operating, but the question is whether such things should be stated in the Bill and whether the centre should be constrained not to use media unless it agrees to communicate jointly. That question applies not only to broadcast media and the internet, but to newspapers because, as many hon. Members will know, the vast majority of people in Wales read morning and some evening newspapers that are produced in Fleet street in England, and 80 per cent. readership for the Daily Post and the Western Mail is fairly modest.
The hon. Gentleman will also recognise that, for example, the Daily Mirror produces an edition for Wales called the Welsh Mirror, which predominantly carries Welsh articles on certain pages, where advertisements could be placed that would not infringe the provision.
Yes, indeed. I agree with the hon. Gentleman; that is a matter of fact. I am sure that hon. Members would be very pleased if the print media in Wales were developed so that we could have dedicated Welsh newspapers. However, that it not the case at present, so the amendment would constrain the Wales centre for health if it wanted to use, for example, The Sun, which has a wide circulation in Wales, or, at the other end of the scale, the Shropshire Star, which is now sold in Barmouth, Harlech and various other places on the west coast.
Those are the practical points that I want to make. I am entirely in favour of co-operation in health promotion; it is a vital function of the centre. I cannot see how the amendment would add anything to its operation. In fact, it would constrain it considerably.
I am concerned about the amendment's practicality. During a short holiday in France, I had the great joy of watching S4C by some technical wizardry that enabled the owner of the property to watch club rugby while enjoying the finest wines available in the area. I do not know whether we would need the co-operation of various organisations in France to carry out the amendment's requirements.
The Wales centre for health will have lots of organisations with which it can carry out its information campaigns, including the Brecon and Radnor Express—an excellent newspaper that is widely read throughout my constituency. However, Mr. Wiggin took things a little far when he said that the amendment would produce a reduction in surgery rage and hospital rage. I am not sure about the cost effectiveness of all the work that would have to be done.
I would obviously want to see a reduction in any rage in surgeries and hospitals, but I am suggesting that the amendment would have a minimal effect in achieving such a reduction.
A number of my constituents face another problem. They do not turn their receivers towards England. The problem is that they cannot receive Welsh television, so the Wales centre for health would have a problem in communicating to those in that sector of Wales, which runs up and down the English border, who are unable to have access to television—the strongest and most important media in the country.
In addition, I thought that the driving force of the amendment may have been to inform people in England of a special circumstance in Wales. For instance, were there an outbreak in Wales of a communicable disease such as mumps, rubella or chickenpox, it would be unwise for children from England who were not vaccinated to visit the area affected. That information might be required to be put out to people living in England. In those circumstances, it would be in the interests of everyone if the health authorities in England were informed of that. Once again, that is something that can be achieved in practice rather than in legislation, and I look forward to the Minister's comments.
Chris Grayling felt that I was not at my best in the last debate. He was not persuaded by my argument or my oratory. I am sure that he will forgive me, however, if I point out that 300 people were, and they followed me into the Lobby, while barely 70 followed him.
They were all listening or watching on the monitor.
I also note the point of Mr. Williams about communications and how he was watching club rugby and drinking good French wine. I did exactly the same in the Dordogne last year. Long may those methods of communication, and French wine, continue.
The previous debate centred on the links between the health protection agency and the Wales centre for health. What is extraordinary about the amendment is that it will put a complete block on a key area of collaboration and communication between the health protection agency and the Wales centre for health. The amendment would impose unjustified restrictions on the Wales centre for health's ability to make information available to the public in Wales. It will prevent the centre from publishing information in any way that might lead to it reaching people anywhere outside Wales, without first getting the specific agreement of those public health information bodies responsible for the communication of health information in that area, as the amendment states.
The amendment raises two issues: the role of the Wales centre for health in communicating with the public; and the need for the centre to collaborate with other bodies. On the first issue of the role of the Wales centre for health, there may be some misunderstanding. Let me clarify the matter. The role of the centre is to assess evidence and provide information and advice on public health issues to the public, to the Assembly and to other public sector organisations in Wales, including the new national public health service. It will also monitor trends and undertake surveillance, identify gaps in information and data and encourage action to fill those gaps, build partnerships with other bodies in the public, voluntary and academic sectors, and develop the skills and knowledge base that underpin public health practice.
What the centre will not do, however, is conduct health promotion programmes, as it appeared that Mr. Evans was suggesting when he spoke a moment or two ago. That will remain the responsibility of the Assembly together with the national public health service in Wales, which will take over the health promotion work done by the health authorities when they are abolished later this year. There are already several campaigns in Wales addressing such issues as smoking, HIV and sexually transmitted infections in accordance with the Assembly's national health promotion strategy, XPromoting health and well-being". There has been no need to impose restrictions on those campaigns in terms of the media used, nor do they cause cross-border problems. There can be no justification for imposing such severe restrictions on the freedom of the Wales centre for health to provide information to the public, if it wished to use such media.
The amendment refers to
Xmedia channels widely accessible in any area outside Wales".
That would include publications such as newspapers and magazines, including medical and professional journals, radio and television channels and the Wales centre for health's website. Many of those can be readily received in areas outside Wales. The amendment would therefore prevent publication through numerous media popular within Wales simply because they are, or could be, accessible in England, as Hywel Williams pointed out.
I made it clear at column 58 in the second sitting of the Committee that the centre will have its own website, which will provide an important means by which it provides information across the planet. The amendment would prevent the centre from being able to post valuable information on its website simply because it would be accessible to people outside Wales. It could only overcome that embargo if it could secure joint publication with public health providers in the rest of the world. It is hard to see what form of communication would be accessible to the centre. Even locally distributed leaflets could stray across national boundaries: a wind might blow them across the border into England, and the centre would be in trouble. That shows the quality of the amendments being tabled by the Conservative party.
At a time when communications have never been more fluid, nor information more accessible, the amendment would impose unacceptable and unreasonable restrictions on the Wales centre for health. It would restrict the free flow of information across Wales' borders—information that could benefit the rest of the United Kingdom.
On the second issue of collaboration with other bodies, on which part of the debate on the previous group of amendments focused, I can confirm that the centre, in its shadow form, is already taking steps to co-ordinate its work with other bodies. For instance, it is to seek partner status with the public health observatories in England, and it is in contact with the Public Health Institute of Scotland and the Institute of Public Health in Ireland. It will work closely with the Health Development Agency in its development of a public health evidence base.
Paragraph 20 of schedule 2 gives the centre the power to co-operate with other public authorities. The Assembly intends that it should do so with other bodies in Wales and in other parts of the United Kingdom and with other countries in the world. The centre will co-operate with other bodies in providing evidence and information. The amendment, however, would place severe restrictions on the means available for the centre to do so. It would also restrict the means by which public bodies outside Wales could learn of the information provided by the centre.
The amendment is too prescriptive and is unworkable. The Bill requires the centre to make information about matters related to the protection and improvement of health in Wales available to the public in Wales. It must be up to the centre to decide how it intends to make that information available within Wales. I can only suggest that the author of the amendment must have been somebody related to comrade Ceaucescu.
I did not realise that S4C was so widely viewed in France. I am sure that it will be delighted to learn that its viewing figures, at certain peak times, may be larger in France than they are in Wales. Perhaps the French are tuning in to look at the quality of club rugby in Wales so that they can improve their game.
The amendment is clearly designed to get everyone working together. The Minister tells us to accept with blind faith that organisations are doing what the amendment suggests and that they will do that in the future. However, when we try to make the position clear in the Bill, we are told that we are handcuffing organisations and that it would be dreadful to force them to do what we are told they are doing anyway. That argument does not wash with me.
I have heard more red herrings than are in Billingsgate about what might happen if the amendment were accepted. The Minister talked about leaflets straying in the wind. Leafleting is possibly one of the most effective tools for communicating a message if the leaflets are targeted and delivered and are not thrown up on the borders in the hope that the wind is blowing in the right direction. That would be ridiculous.
The vast majority of local newspapers would not fall foul of the provisions in the amendment. They are most widely read in the area in which they are distributed. I am sure that people from England and other parts of the world subscribe to the newspaper circulated in the constituency of Mr. Williams. However, it is most widely read in its own patch, as is the case with most local newspapers.
I am not convinced by the Minister's argument. He was not at his best in the previous debate and he certainly has not been at his best in this one. He has not convinced me, so we shall press the amendment to a Division.
I beg to move, That the Bill be now read the Third time.
The Bill has been considered in Standing Committee and on Report. It exemplifies the partnership that exists between the Labour Government and the Labour-led National Assembly for Wales and is a practical example of the benefits of devolution. Although Westminster and Cardiff have already achieved a great deal by working together, the Bill proves that that partnership has the potential to deliver much more for the people of Wales. The Bill helps to fill in the detail of the strategic framework established in the last Session by the NHS Reform and Health Care Professions Act 2002. It will deliver some of the key elements of the Assembly's 10-year plan to improve the health and well-being of the people of Wales. By bringing patients closer to the centre of the stage, the Bill will give them a stronger voice in the improvement, development and running of the health service in Wales. The newly reformed community health councils will be the main vehicle for giving patients a greater say.
The Bill retains and reforms CHCs in Wales and provides an independent NHS complaints and advocacy service, which will strengthen public and patient involvement in health service planning and delivery. It establishes the Wales centre for health to provide independent training, advice and research in health care, which will make an important contribution to arrangements for protecting and improving health. It also establishes Health Professions Wales to provide education and training of health care professionals. That will increase the equality, effectiveness and efficiency of the health care system.
The Bill is important not just for its content, but for the process by which it has come before us. It is the first all-Wales Bill to have been subject to the rigours of pre-legislative scrutiny. It is no exaggeration to say that it is regarded as the model for the way in which that should be carried out. As such, it comes to us not only improved in its contents by pre-legislative scrutiny, but as an ambassador for the process. It underlines how the House can change and reform its processes to improve legislation making. The Government are rightly proud of that innovation and gratified by the reaction to it. We consequently intend to make more use of that form of scrutiny. However, it is right to pay tribute to the four Opposition parties and their leaders in Wales and the House who welcomed and embraced the pre-legislative process. They helped to underpin its legitimacy. Rather than merely having a political party express its will, hopes and aspirations in Parliament, they expressed the will of the House in Parliament.
The Bill was first published in draft as the NHS (Wales) Bill in May last year. Some 87 organisations and individuals representing the profession and other bodies that would be affected by it were sent copies and explanatory notes on which they were invited to comment. Some 27 did so. To facilitate the widest possible public involvement, the draft Bill was also published on the Wales Office website. Some 15 people responded to that including, as I said on Second Reading, a Mr. Lei Leiu in China, who sent an e-mail offering to sell us an excellent forging hammer. It is clear that something was lost in translation. That aspect of scrutiny produced 25 recommendations for changes to the draft Bill.
The Welsh Affairs Committee considered the draft Bill in this House. I want to pay tribute to my hon. Friend Mr. Jones, who chairs that Committee, and Committee members for their work in scrutinising the Bill. The Committee also consulted stakeholders widely. Both the Assembly Health and Social Services Minister, Jane Hutt, and I gave evidence before the Committee, which produced a carefully considered report with 17 recommendations for change. The Welsh Grand Committee had a full day's debate on the report. The National Assembly for Wales also debated it in Cardiff in committee and in its plenary session. The Health and Social Services Minister and I also accepted an invitation to appear before an all-party group in the other place. The Assembly asked for a number of changes to the Bill to which we were able to accede in most cases.
Publication in draft has allowed for a lengthy, thorough and open consideration of the Bill and the policies that it contains. It says much for the effort put into the original draft, including discussion with stakeholders by the Assembly, that the draft Bill received warm and widespread welcome across Wales. Indeed, none of the pre-legislative scrutiny revealed any concerns with the principle of what was proposed. The pre-legislative scrutiny produced 45 recommendations for changes to the draft Bill. Some of those duplicated recommendations and some suggested extending the Bill to include, for example, a ban on smoking in public places, which, as I explained on Second Reading and in Committee would be outside the Bill's scope.
The Bill adopts the principles behind 16 of the recommended amendments. The revised Bill was considered by the Standing Committee and agreed without amendment. It remains unchanged. All amendments to the draft Bill could be categorised as minor or technical—even the change to the long and short title. It is worth reflecting on some of the more significant changes because they provide a context for the issues raised in Standing Committee. The Bill is essentially enabling by nature. It quite properly devolves responsibility for determining the detail of the function of the bodies established by the Bill—the reformed community health councils, the Wales centre for health and Health Professions Wales—to the Assembly. It would fly in the face of devolution to do otherwise.
Questions were raised during consultation about the extent to which this approach might be seen to constrain the freedom or independence of the bodies. The policy intention was that they should enjoy considerable autonomy. On reflection, we concluded that the Bill would be improved if we made that clearer, so we amended the draft Bill to give more powers to CHCs to require information, and to impose on them a clearer duty to report on their activities. We also restricted the Assembly's powers to direct the activities of the Wales centre for health and removed the Assembly's power to issue directions about the functions of Health Professions Wales.
When we came to Second Reading, several hon. Members dwelt on those issues. Mr. Evans asserted that the Assembly's powers over CHCs were too wide. My hon. Friend Mr. Jones called for greater independence for CHCs, and Chris Grayling extended that to call for more independence for CHCs, the Wales centre for health and Health Professions Wales.
In the Standing Committee, we were privileged to work under the guidance of my hon. Friend Mr. Griffiths. I am sure that hon. Members on both sides of the House want me to pay tribute to his wise and skilful chairmanship and to say that we will miss him when he stands down at the next election. We wish him well for the future. He made a major contribution to the Bill's passage through the Committee. Opposition Members tabled several amendments, and some, where the Bill's intentions may not have been clear enough, were of a probing nature. I hope that we satisfied all hon. Members on those matters. Other amendments continued the theme of the Second Reading debate and sought to strengthen the position of the CHCs, the Wales centre for health and Health Professions Wales.
The intention behind those amendments was summarised by the hon. Member for Epsom and Ewell at the Committee's third sitting, when he said:
XBroadly speaking, the Committee is agreed that the Bill is a decent set of steps, sensible, based on consultation and welcomed by health care professionals in Wales."
In fairness to him, I point out that he went on to say:
XIts main weakness is that in several different ways it hands excessive power to the politicians of the Assembly".—[Official Report, Standing Committee B,
I wholeheartedly concur with his first point, but I disagree with him totally on the second. Giving power to the Assembly within a carefully constructed legislative framework, and making those powers subject to the Assembly's arrangements for democratic determination, so that there can be detailed, open and transparent consultation, can hardly be deemed excessive when considered in the context of the devolution settlement.
The independence that Opposition Members seek to enshrine in the Bill is already assured. We took careful note of the views expressed by stakeholders during pre-legislative scrutiny. We amended the draft Bill in 16 areas to address the concerns expressed and, as I was able to remind the Standing Committee, amendments were made to provide greater autonomy and to clarify the independence of CHCs, the Wales centre for health and Health Professions Wales.
I was also able to assure the Standing Committee that the Assembly's freedom to impinge on the autonomy of those bodies was itself constrained by its own consultation arrangements, which I further explained in a subsequent letter sent to all members of the Committee.
This is a short Bill—short in content and short on controversy—but it is important. It breaks new ground in pre-legislative scrutiny and it is important for the future of health care in Wales. It is a key part of the reform agenda of the Government and the Assembly. It had a thorough airing before introduction. It reflected the views of stakeholders when introduced, and its intentions have been further clarified in Standing Committee and in the House today. I therefore have no hesitation in commending the Bill to the House and asking hon. Members to give it a Third Reading.
We have heard a lot about the strengths of devolution, and in all honesty I cannot say that the NHS in Wales is a prime example of it. However, I heard the Secretary of State for Wales on the Frost programme on Sunday trying to entice Sir David Frost with the news that, thanks to devolution, he can look forward soon to receiving a concessionary bus pass. There was a look of bemusement on Sir David's face at the prospect of catching the No. 13 bus from Swansea to Townhill. I am not sure what he thought the Secretary of State was saying.
The Minister has just spoken about the procedure that the Bill followed, which we certainly welcome. Pre-legislative scrutiny is important, particularly as, time and again, we find our opportunities for detailed consideration of Bills further constrained. Perhaps the Minister should have bought the forge hammer from Mr. Lei Leiu of China so that he could have knocked the Bill into better shape. However, we know that the Bill has a further journey to make. Judging by its consideration in Committee and in the House today, the Government should not be so obsessed with timetabling. There is a great deal of good will on this side of the House towards Bills that genuinely deserve support.
I echo the Minister's comments about Mr. Griffiths, who chaired the Standing Committee well. Of course, he takes a great interest in this area of the NHS in Wales, and has much experience of it. We wish him well for his retirement at the end of this Parliament.
We know that the Government intended the Bill to be much bigger, but parts of it were hived off to the NHS Reform and Health Care Professions Bill. Problems will arise from that Bill, not this one. I have huge reservations about that new bureaucratic system, with five health authorities being replaced by 22 local health boards and other bodies.
We know that the former Secretary of State for Education and Skills said yesterday in an interview that politicians should be more credible and admit when they have made mistakes. This is one area in which Welsh politicians and UK politicians could achieve more credibility with the public by admitting that they have made a big mistake with those reforms. A report out this week says that #8.5 million of savings must be made in the NHS in Wales if the reforms are to be cost-neutral, and that is without the #15 million of transitional cost in setting up the new bodies, so there will be problems with that bureaucracy.
Returning to the Bill before the House, we support the retention of CHCs in Wales. We supported their retention in England as well, and we would have welcomed that measure if Labour Members had voted for it. We tried in our amendments to give CHCs more independence. The issue is not whether we should trust the Welsh Assembly to retain power over CHCs but whether we should ensure that CHCs, which are the whistleblowers, watchdogs and champions of patients, will be given independence. They would not then need to worry that the Welsh Assembly could change their name, savage them or even abolish them, which the Bill gives the Assembly the power to do.
We know that CHCs will be hugely busy. Headlines randomly selected from newspapers make that clear. One says XHutt again fails to meet targets" and another, from the South Wales Evening Post, says XWoman, 82, stranded in hospital". Another headline is, XHealth wait deadline passes"—a reference to people who had to wait more than 18 months for orthopaedic surgery. I know that the Minister said that the Welsh Assembly had made advances in that key area, but I am afraid that in some parts of Wales the waits are still huge. Other headlines are, XHealth board shake-up costs 'rise'"—a reference to the fact that an imperceptible improvement in the service will cost a lot—and, XNursing vacancies plague Welsh NHS".
Those are important headlines. One can hardly open a newspaper in Wales without reading a story about the dire problems faced by the NHS. In Wales, more money is spent per head of population than in England—#822 in Wales compared with #740 in England, although waiting lists in England are lower than in Wales. Since 1997, the number of beds in Wales has been reduced, and both in-patient and out-patient waiting lists have gone up. Total activity has gone down, as has elective activity. I referred earlier to University hospital of Wales, which has stopped non-emergency operations until February because of winter problems. I have talked about orthopaedic surgery. In Gwent, 1,200 patients have waited more than three years to see a consultant for the first time, which is not acceptable or humane. Waiting lists are also rising in several other key areas.
At the same time, bed blocking is a problem in Wales, and we have not heard any solution to the issue. Local authority care homes are closing, which will add even further to the problems of the NHS in Wales. We know that the health service is scouring the world for nurses and that more patients are being sent abroad or to England for their operations, which is causing a huge problem for trusts' budgets in England. As I said, trusts are spending more in Wales than in England. It is terrible that the NHS in Wales faces all those dire problems, and I feel sorry for the dedicated staff who are dogged by politicians, whether from Westminster or Wales. They are being prevented from getting on with the job that they sincerely want to do and which was their reason for going into the NHS in the first place.
I do not believe that the Government woke up one day and said, XLet's see how we can wreck the NHS," but that is exactly what has happened since they came to power in 1997. As for the Bill, we wish it well. We hope that when it goes to the other place, peers will look at some of our suggestions and table their own amendments. Indeed, I hope that the Government in a quieter moment will reflect on our suggestions and amend the Bill in the other place themselves. However, we wish the Bill well, and I do not wish to delay its progress any further.
We welcome the Bill as well. During an earlier discussion of the Bill, my hon. Friend Lembit Opik spoke about the stress he suffered as a result of the Conservatives' delay in announcing whether they would support the Bill. I am pleased to say that he has recovered and is now doing his bit in Committee.
I congratulate everyone who has contributed to the progress of the Bill, particularly Mr. Jones on his work with the Select Committee. The good relationship that has developed between the Assembly and Welsh Members will stand the legislative system in Wales in good stead, and will give us a huge advantage when we come to consider other Bills. We all recognise the problems that Wales faces, and the Bill represents a step forward in improving the NHS there. To a large extent, the poor state of the health of the Welsh nation is an historic problem. Any audit would point out that many people suffer health problems such as pneumoconiosis and silicosis as a result of their employment in the mining and slate industries. In the farming industry, people suffer from farmer's lung, an illness that attacks the lungs.
Those chronic illnesses are not cured easily, if at all, but we should ensure that people's quality of life is improved so that they can have a longer and more enjoyable life. People whose jobs involve heavy lifting can suffer from orthopaedic conditions. As I walk around farmers' markets in my area, I see many farmers hobbling away, waiting for their hip replacement, an operation that can provide many with comfort and relief.
Is the hon. Gentleman disturbed by the increasing number of people who have to use their life savings and, indeed, borrow money to go private because of the wait, often in great pain, that they have to endure before getting a hip replacement on the NHS?
I agree. Many of us have dealt in our surgeries with people waiting for hip replacements who are forced to use the private sector. To some extent, that is an historic problem that cannot be solved at the stroke of a pen; it will take time.
Ill health in Wales is due not only to employment, but to high unemployment. The closure of the steel industry and the coal mines has brought relative poverty to many areas. There is a close relationship between poverty and ill health. Through a cycle of ill health and deprivation, families that have suffered from ill health for many years go on to produce another generation whose lifestyle and quality of life make it more prone to long periods of ill health. Youth unemployment has decreased over recent years, but many people have difficulty in finding gainful employment, and drug abuse has dragged them into ill health and exclusion from the health service.
The Bill is, as the Minister said, an enabling Bill. I welcome that. It gives powers to the Assembly to organise the structure and workings of the three organisations in a way that is suitable for Wales. In Committee, I was critical of some of the Tory amendments—
I shall in a moment. I was glad to see Tory amendments, as we would have had a very short Committee stage without them. I was critical of them because they showed a misunderstanding of the devolution principle and settlement. It is not in the interests of devolution for the primary legislation to contain such fixed requirements that they give the Assembly no discretion to use its powers to make the organisations responsive to the needs of the people of Wales. I was happier with the tone of today's Tory amendments, which reflected a sense of partnership and working together. I am sure that that can be achieved, not necessarily by being written into the Bill, but through the working partnerships that will grow up between people working in different areas of Britain who are concerned to improve the health of the nation.
We are pleased that community health councils are to be retained in Wales and their role enhanced and extended. If that is to be achieved, we must ensure that the their membership is of suitable calibre and sufficiently representative of the people who live in Wales. I have mentioned on several occasions the amount of training that CHC members will have to undertake to carry out their responsibilities. I am pleased that the Assembly will be able to arrange appointments to the CHCs.
Although local authority members have for a long time made a huge contribution to the work of the CHCs, too many of them on such a council will not enhance its work. Many local authority members give much time and effort to that work, while some see it as an extension of their local authority work. They put more emphasis on the local authority work, and less time and effort into their CHC work. I have spoken to local authority members about the provision. They are happy about it. If they want to obtain or retain membership of a CHC, they can put their name forward and go through the process. The Nolan principles for the system of appointment are well established in Wales and widely respected. Gone are the times when all three members for the Brecon Beacons national park went to the same church, which was the church that the Secretary of State attended.
Since the Standing Committee proceedings finished, I have received representations about the name of CHCs. We discussed whether they had a good brand name and whether it should be retained on the basis that everybody knows where to go. However, certain members of CHCs believe that they could be renamed with a term that makes them more accessible and is more descriptive of their job and their advocacy work on patients' behalf.
The Wales centre for health will undoubtedly do much good work that will be valuable in addressing the endemic problems that affect the Welsh nation in relation to health. A huge amount of work certainly needs to be done on research and to roll out some specific results on Welsh conditions and medical problems.
I do not think that Health Professions Wales will act as a bar to prevent people from coming to Wales to work in nursing or any of the other health professions. It will be an enabling body that will encourage people to come to Wales to work. It will also produce an environment in which people can enter their chosen profession and look to it to give them a good quality of life and experiences. The body could also be influential in improving the qualifications to which health professionals can aspire and perhaps increasing their number. Qualifications might be introduced in relation to skills or duties that would be useful in a specifically Welsh context.
I am sure that everybody will want the Bill successfully to complete its passage.
The Bill will, sensibly, retain CHCs for Wales. It is a disgrace that English CHCs have not been preserved in the same way. While I am happy to work in the House for what is best for the Welsh people, it is fair to point out that Labour Members have a responsibility to look after the whole of the UK and that the Bill will therefore stand in the statute book as a monument to new Labour's double standards.
What is good for the goose is good for the gander—and my entry in the Register of Members' Interests shows that I have some expertise on geese. We know that CHCs are a good thing, as does the National Assembly for Wales. What a shame that nobody told the Executive of this Government, as was shown when my hon. Friend Mr. Hawkins asked the Prime Minister this question:
XFollowing the Government's humiliating defeat in another place last night, will the Prime Minister finally agree with the views of medical charities, the British Medical Association and the Opposition and withdraw his mad plans to abolish community health councils?"
The Prime Minister replied:
XNo, we will not, because the replacement of community health councils by patient forums and patient councils is, we believe, and as the College of Health made clear earlier, a better way to make sure that patients' interests are represented. There has been a debate about community health councils for many years, but patient forums"—[Hansard, 25 April 2002; Vol. 376, c. 305.]—
Order. We are debating on Third Reading the contents of the Bill that is before the House. The hon. Gentleman cannot remain in order while making such comparisons with matters outside the Bill. He must speak about the contents of the Bill that is before the House.
I can allow the hon. Gentleman to allude to the fact that a different policy is being pursued in England, but that is outwith the scope of the Bill. On Third Reading, a much more restrictive approach is taken than on Second Reading, when hon. Members can speak about what they would like a Bill to deal with and make complaints in that regard. On Third Reading, it is not in order to talk about matters that lie outside the Bill.
I hope that you will not feel that that is necessary, Mr. Deputy Speaker.
Let me deal with the aspects of the Bill that cover the National Assembly. Until your recent intervention, Mr. Deputy Speaker, I had not witnessed such pathological delight by Labour Members as that shown in their eagerness to hand over opportunities to the National Assembly to exercise powers such as those in the Bill. I am worried about the autonomy of Health Professions Wales and the Wales centre for health as well as Welsh CHCs when the National Assembly can exercise almost unlimited power over them.
I am also worried about the Bill's ambiguity on the co-ordination of the activities of the Wales centre for health and Health Professions Wales with those in rest of the United Kingdom. For example, there is the bureaucracy involving Welsh patients who seek medical treatment in England or vice versa. I support the Conservative view that a strong, independent body separate from the Welsh Assembly needs to be created to support CHCs. We were dismayed that none of the amendments that we tabled in Committee in favour of the independence of Welsh CHCs was accepted.
Let me give an example of imbalance. The Bill gives highly centralised powers to the National Assembly for Wales to abolish or alter the CHCs, to abolish or assume the functions of the Wales centre for health as well as to appoint its members and chairman, and to abolish Health Professions Wales. Although I am sure that it is possible for the Government to know and agree with the intentions of the current Welsh Assembly Administration, it is impossible to know the type of Administration that will exist in future.
I have always believed that, when making law, we should take the longer-term view and attempt to prevent as many unknown eventualities as possible, thus ensuring that the powers in the Bill will not have to be redistributed yet again. I am not against its concepts, but I am increasingly saddened by the short-term approach that it exemplifies.
Foundation hospitals constitute another missed opportunity. We have all expressed anxiety that there are no plans to create foundation hospitals in Wales. An article in the Daily Post on
Although I appreciate that some may describe Rhodri Morgan as a dinosaur with extreme socialist views who is stuck in a prehistoric shell and refuses to accept that we have moved on from the 1940s, the First Minister is more than entitled to his views. However, the Secretary of State deserves criticism for endorsing those seriously outdated views. Despite criticising the two-tier health service, the Government are trying to construct a similar division.
The Secretary of State made it clear in his comments that we are a partnership. The Government here and the Government in the Assembly have the same objectives, which we shall follow by different routes. However, the objectives are the same, and the Secretary of State emphasised that.
I am also worried about the excessive bureaucracy that the Bill will add to the already horrific amount in the NHS in Wales. Health spending in Wales is significantly higher than in England, yet Wales has worse health outcomes. The Labour-Liberal Democrat Welsh Assembly Government have failed to meet their targets for waiting lists, which continue to increase. Welsh consultants rejected the Government's offer of a new contract because they were worried that the waiting list targets distorted clinical priorities.
The shortage of funding for Welsh patients who seek treatment in England has threatened the principle of treating patients according to clinical priority. Shortages of care home places and delayed discharge are also significant problems in Wales. There are also many GP vacancies. A truly Welsh health Bill would deal with those matters and strengthen the excellent work of the staff, doctors, nurses and managers who work in Wales. A Welsh health Bill of which we could all be proud would put patients first.
I am sure that hon. Members will be gratified to learn that I intend to be brief. [Hon. Members: XSit down, then!"] I shall in a moment, if hon. Members contain themselves.
I welcome this, the first all-Wales Bill since devolution. It is the product of extensive preparation and discussion. The proposals that have been fashioned are extremely appropriate for Wales and do not preclude co-operation between the health service in Wales and that in England, Scotland or any other country. The Bill contains valuable proposals for the Wales centre for health, which will have a vital job in promoting public health. I also welcome the establishment of Health Professions Wales, and the strengthening of the CHCs, including, I hope, their all-Wales body.
I would like to look at the process by which we have reached this point. It has involved an extensive process of consultation, consideration and discussion involving the National Assembly for Wales and its committees, the public, the Welsh Affairs Committee, the Welsh Grand Committee, followed by the Bill's Second Reading, the Standing Committee, Report and Third Reading—nine steps, so far. The interpretation of this process will, no doubt, be varied and could form the subject of much discussion in Wales in political and academic circles. I look forward to that discussion, as I think that we need to develop our understanding of Welsh political processes through as wide a discussion as possible. Bearing in mind those nine steps, however, I conclude by commending to hon. Members—and, incidentally, to Lord Richard—the good business principle of cutting out the middle man.
With the leave of the House, Mr. Deputy Speaker, I should like to say that we have had another good debate on the Health (Wales) Bill this afternoon, and we have again explored in fine detail some of its provisions. The outcome has confirmed that the pre-legislative scrutiny that preceded the Bill's introduction was successful, and proceedings in the Standing Committee and here today have further assisted in providing a thorough understanding and appreciation of the Bill and the policies that it seeks to implement.
Mr. Evans gave the Bill a welcome but then, as usual, dwelt on some of the problems that we have had with the health service in Wales. We recognise that there are problems, but I hope that he will also recognise that the legacy of his party's time in government was closed hospitals, fewer doctors and nurses, and fewer hospital beds. One wonders where the Conservatives' present proposal for a 20 per cent. cut in public expenditure would leave the health service in Wales, if ever they were in power and able to do anything so drastic and insane.
Mr. Williams welcomed the Bill. He referred to some of the problems that we face in Wales, in terms of the legacy of ill-health and inequality. He also touched on the worries about orthopaedics. I can tell him that, in Gwent, where there has been a problem with the delivery of orthopaedic services, the health expert Professor Brian Edwards will carry out a review of orthopaedics in the area of the Gwent NHS trust, and produce a report on ways in which waiting times can be reduced. We all look forward to that.
Mr. Wiggin highlighted the different approaches in Wales and England, so far as giving patients a clear voice is concerned. That is devolution, and this Labour Government, working in partnership with the Labour-led Assembly, share the same objectives, although we may well follow different routes to achieve them. That is perfectly valid within the context of the devolution settlement in Britain. He also mentioned waiting lists. As I said earlier, there have been significant improvements in reducing waiting lists in Wales. Money is being put in to tackle the problem, reforms are being put in place, and the taskforce headed by the Assembly's deputy Health Minister is now monitoring progress to see how quickly we can reduce waiting lists across a range of areas in Wales.
Hywel Williams welcomed the Bill, but also spoke about the processes by which we brought it here. No doubt we shall continue to evaluate how successful they have been. I am sure that there will be Wales-only legislation further down the line and that we shall examine how we should consult, in a pre-legislative sense, before it comes before the House.
The Bill contains three key elements that have been extensively considered and welcomed. The first is the retention and reform of community health councils, which has been widely welcomed. The second is the welcome from stakeholders for the establishment of the Wales centre for health, which was conceived back in 1998 in the days of the old Welsh Office before devolution and taken on as a result of the commitment of the Cardiff Assembly. That means that we shall strengthen public health capability and capacity in Wales. The third is the creation of Health Professions Wales—a body to perform the functions of the former Welsh National Board for Nursing, Midwifery and Health Visiting and to support post-registration education and training of health care professionals.
Proceedings in Standing Committee improved Members' understanding and knowledge of the Bill, which have also been enhanced this afternoon. I am grateful for all contributions made by Members throughout the pre-legislative process and in Committee as well as on Report and Third Reading. We have done a good job of work between us and I am very pleased. I have every confidence in commending the Bill to the House.
Question put and agreed to.
Bill accordingly read the Third time, and passed.