Clause 21 — Budgetary procedures

Oral Answers to Questions — Justice – in the House of Commons at 7:30 pm on 6th May 2014.

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Photo of David Davies David Davies Chair, Welsh Affairs Committee 7:30 pm, 6th May 2014

I beg to move amendment 12, page 23, line 4, at end insert—

‘(1A) In Part 1, in paragraph 9 (Health and health services), after “national health service”
insert

“Organisation and funding (expenditure and income) of the provision of health services in England to people registered with a GP in Wales and the provision of such services in Wales to people registered with a GP in England.”.’.

Photo of Roger Gale Roger Gale Parliamentary Assembly of the Council of Europe (Full Member)

With this it will be convenient to discuss amendment 13, page 23, line 17, at end insert—

‘(d) the scrutiny of reductions of, and additions to, the block grant to reflect expenditure and income arising from the provision of certain services in England to people resident or otherwise eligible for such services in Wales and the provision of such services in Wales to people resident or otherwise eligible in England.’.

Amendment 14, page 23, line 24, at end insert—

‘(g) a Welsh Minister responsible for a service falling under section 13(d) (definition of budgetary procedures)’.

Government amendment 29.

Clause stand part.

Amendment 17, in clause 22, page 24, line 46, leave out ‘and’.

Amendment 18, in clause 22, page 24, line 46, at end insert—

‘(ae) an estimate of the costs of providing services in Wales to people resident in England; an estimate of the monies received from HM Treasury to fund such provision; and an assessment of the effectiveness of any relevant agreements in place governing cross-border service provision, and’.

This amendment and amendment 17 to Clause 22 are intended to make the operation of agreements that govern cross-border services, such as the NHS protocol, more transparent to residents of both England and Wales.

Clause stand part.

New clause 1—Review of options for Barnett formula reform

‘(1) The Secretary of State shall make arrangements for a review of options for reforming the Barnett formula in order to meet the objective of calculating the block grant funding for Wales on the basis of need.

(2) The Secretary of State shall lay a copy of the report of the review mentioned in subsection (1) before each House of Parliament within six months of this Act receiving Royal Assent.’.

New clause 3—Cross-border health care

‘After section 1 of the National Health Service (Wales) Act 2006, insert—

“1A Duty to have regard to impact on services in certain areas

In exercising functions relating to the health service, the Welsh Ministers must have regard to the likely impact of those decisions on the provision of health services to persons who reside in an area of England that is close to the border with Wales.”.’.

This New Clause places a duty on Welsh Ministers to consider the impact of their decisions on the provision of health services to people who reside in England, analogous to a duty already placed on the NHS Commissioning Board in England to consider the impact of its decisions on people residing in Wales and Scotland.

New clause 10—Welsh Government Finance Department

‘The Welsh Government may, by resolution of the National Assembly for Wales, rename its finance department and this shall be recognised as its official title in all dealings with the Treasury.’.

Photo of David Davies David Davies Chair, Welsh Affairs Committee

I am grateful for the opportunity to speak to this amendment because I believe in the national health service. I know that I speak for all members of my political party in saying that we believe in having a truly national health service. The changes I am attempting to insert into the Bill would bring back the national health service that we once had but no longer have. At the moment, contrary to what people think, we have a regionalised health service with different systems in Wales, in Scotland, in England, and in Northern Ireland. It is a sad fact that in Wales, under the leadership of members of the Labour party, the Welsh national health service has been failing patients and letting people down. I care about that.

I also care about the patients who come to see in my surgery. They include Mariana Robinson, who has been speaking out in national newspapers over the past few weeks. I did not ask her to go the press; she came to see me to ask how she could tell the story of the scandalous treatment that she has been receiving. She was treated very well in a nearby hospital in England but then told that she could no longer have that treatment because funding was not available and she would have to be treated in Wales.

Only a few weeks ago, I spoke to a patient who had been suffering from cancer. She had been told that she was terminally ill and would not last more than a few months. She believes that she was, in effect, written off by the national health service in Wales. She found out about experimental treatment in England and accessed it. She is still alive. Her cancer appears to be in remission at the moment, and I wish her all the best. She obviously wants to continue to receive this experimental treatment in the same area, Newcastle, yet she too has been told that there will be no further funding for her.

There has always been a problem in getting cross-border funding, but it seems to have got a lot worse in the past 12 months, when a decision was taken somewhere along the line that meant that virtually anyone with an illness in Wales would have to be treated in Wales. I believe that this is part of the whole National Assembly mindset about doing everything in Wales because it feels that it can do it better.

Photo of Mark Williams Mark Williams Liberal Democrat, Ceredigion

Does my hon. Friend agree that we should not characterise this as an issue that affects only the borders of England and Wales? I can think of examples of constituents in Ceredigion who have been unable to access services in Gobowen and Frenchay hospitals for exactly the reasons he suggests.

Photo of David Davies David Davies Chair, Welsh Affairs Committee

The hon. Gentleman is absolutely right. He will have to forgive me. I have been looking at this more from the perspective of a Member of Parliament in a border area where many patients find it much easier and quicker to access hospitals in Hereford—as they have for rheumatology, for example—or in Bristol, but it affects the whole of Wales because health care is becoming a more specialised matter. In an area of 3 million people, we will not have all the specialists we would like, and that means that there will always be those who need to travel in order to get access to the best on offer.

Photo of Albert Owen Albert Owen Labour, Ynys Môn

In his opening remarks, the hon. Gentleman talked about regional differences. Has he carried out in-depth research on the situation in England, where there are issues with different health boards not being able to fund certain operations and services? Many of my constituents get good access to some of the best specialist treatments in the Liverpool and Manchester areas; Gobowen is a third good example of this. I am not quite clear about how he arrived at his earlier conclusions.

Photo of David Davies David Davies Chair, Welsh Affairs Committee

I do not know whether this will surprise the hon. Gentleman, but I have not carried out in-depth research into every single health board in the whole of England. [Interruption.] No sir, I have not. I do not have the time because I am seeing so many constituents who are trying to get these treatments in England having looked over the border and seen much higher standards of service.

In Wales, 42% of patients wait over six weeks for diagnostic tests; in England, only 1.8% of patients do so. One in seven people in Wales is on a waiting list. People wait three months longer for hip or knee replacements in Wales than they do in England. People are twice as likely to die of a hospital infection in Wales as they are in England. That is an absolutely shocking set of statistics. No cancer drug programme is available in Wales, unlike in England. People have to wait longer for ambulances in Wales than they do in England. I do not need to go and research the details of every single health board in England because I already know that the standard of service is far higher in England. It is not just me saying that: it has come out in reports such as those by the National Audit Office and, recently, the Nuffield Trust.

Photo of Owen Smith Owen Smith Shadow Secretary of State for Wales

The hon. Gentleman is giving an interesting though not entirely factual speech. Does he accept that in respect of cancer waiting times, for example, in his area of Monmouthshire there is a more stringent target for patients starting treatment within 62 days, and a higher proportion of patients meet that target than in England? Further, given that he speaks of information in reports, would he care to reflect on the 10-year study by the Nuffield Trust that concluded only a few weeks ago that everything he has said is untrue—that no one country in Britain is steaming ahead and no one country is lagging behind?

Photo of David Davies David Davies Chair, Welsh Affairs Committee

The hon. Gentleman ought to be aware that I was citing the Nuffield Trust when I gave the statistics saying, for example, that 42% of patients in Wales have to wait more than six weeks for diagnostic tests as opposed to 1.8% in England. Of course, diagnostic tests are very important in treating cancer.

When it comes to allocating the blame for this, I do not blame doctors and nurses, and it is something of a fallacy to suggest that any Government Member has done so. I blame the leadership of the NHS in Wales and the decisions that have been taken over a period of years by Ministers in the National Assembly for Wales. If we are going to offer some praise to Labour, I will offer it to the previous Labour Government, who pioneered in England some of the reforms that this coalition Government have built on. That Government were happy to bring the private sector into the health service in England.

I recently spoke to a doctor down in Newport who specialises in conducting tests for bowel cancer. He gets a lot of patients coming to him from England whose treatment is being paid for by the NHS. I suppose that it comes down to specialisation. This is what he does, he is good at it, and it is what he specialises in. He gets people in and out quickly and deals with them efficiently and at a cheaper rate than the NHS would be able to. He gets a lot of patients coming in from England, but none from Wales, because of the dogmatic resistance to any use whatsoever of the private sector.

I am often characterised as being a right-wing Conservative—I suppose I am, and I am quite happy with that—but I do not want a privatised NHS or people having to pay to use the NHS. However, as somebody who has had to use it myself on quite a few occasions, I have no problem whatsoever with whether my treatment comes from somebody employed by the state or by the private sector, as long as I am getting the highest possible standard of treatment. That is a common-sense view that most people would adopt.

Photo of Owen Smith Owen Smith Shadow Secretary of State for Wales

Does the hon. Gentleman think that his constituents should have a lesser standard of cancer care and a lower target, as they do over the border in the neighbouring English constituency, or does he think it is good that in Wales we have a higher standard and a higher set of targets?

Photo of David Davies David Davies Chair, Welsh Affairs Committee

I absolutely think that my constituents deserve the highest standard of care possible. There is a very easy way for them to get that, and that is for them to be able to choose it.

Photo of Alun Cairns Alun Cairns Conservative, Vale of Glamorgan

Does my hon. Friend agree that the shadow Welsh Secretary is being somewhat selective in focusing on one element of cancer care? Once the patient has seen the consultant, there is a regular need for medication, and accessing cancer drugs in Wales is much more difficult than in England because Wales does not have the cancer drugs fund. When we are considering cancer care, we need to look at the whole package rather than just one small element.

Photo of David Davies David Davies Chair, Welsh Affairs Committee

My hon. Friend is absolutely right. Labour Members, or at least their colleagues in the National Assembly for Wales, are incredibly reluctant to deal with the issues and go into the detail in the same way as my hon. Friend. We have seen that in the decision of the Assembly’s Health and Social Care Committee to start taking votes on which witnesses they are prepared to listen to and which they are not. As somebody who has chaired a Select Committee for a number of years, I have heard witnesses give all sorts of evidence. I have often sat through whole inquiries in which I have disagreed with virtually every single word of evidence I have heard, but I never try to prevent people from coming in, because I believe that if people have something to say, we should welcome them, and that if I happen to have a different view, I can put it to them and challenge them on the facts. I have never heard of anything as outrageous as a Select Committee, which is supposed to operate in a non-political fashion, taking votes to bar people from giving evidence. That is absolutely disgraceful behaviour.

That is also reflected in the behaviour of some Assembly Ministers, who, rather than make the arguments Owen Smith is trying to make, decry anyone who criticises the NHS as being anti-Welsh. There is nothing anti-Welsh about Members of Parliament for Welsh constituencies trying to demand the best possible health care for their constituents. I also thoroughly welcome the support I have received from the Prime Minister and the Health Secretary, who have rightly spoken out about this issue because they believe it is wrong and disgraceful that people in one part of the

United Kingdom receive health care that is so much worse than that received by people in another part of the United Kingdom.

Photo of Owen Smith Owen Smith Shadow Secretary of State for Wales

I am grateful to the hon. Gentleman for giving way; he is being very generous with his time. Would he care to disassociate himself from the Prime Minister’s recent ludicrous description of Offa’s Dyke as a

“line between life and death”?

In the light of the Nuffield Trust report, which suggested that that is absolute nonsense, will the hon. Gentleman dissociate himself from those remarks or will he continue to scaremonger, just as the Prime Minister has done?

Photo of David Davies David Davies Chair, Welsh Affairs Committee

When people are twice as likely to die of a hospital infection in Wales than they are in England, I am very happy to associate myself with every single word the Prime Minister says and I hope he will continue to draw attention to the shambolic level of health care we are putting up with in Wales.

Photo of David Davies David Davies Chair, Welsh Affairs Committee

I will give way one more time, because I am not afraid to have the debate, unlike members of the Health and Social Care Committee in the Welsh Assembly.

Photo of Owen Smith Owen Smith Shadow Secretary of State for Wales

Excellent. I am grateful that the hon. Gentleman wants to trade facts. Would he like to commend the National Assembly for Wales on the fact that, on cancer and all the major tumour types, the rate of improvement for one and five-year survival times in Wales has been better than that in England?

Photo of David Davies David Davies Chair, Welsh Affairs Committee

If the shadow Secretary of State is so confident that things are good in Wales, he will have no problem backing my amendment, because it is very simple. It would mean that any patient in Wales would have the right to seek treatment in England, with the cost of their treatment being deducted from the block grant of the National Assembly for Wales. Similarly, any patient from England who fancied waiting twice as long as their neighbours could seek treatment in Wales and the money could be added to the block grant. This is not about taking powers away from the Welsh Assembly; it is about giving the Welsh Assembly an opportunity to show how confident it really is in the standards of national health care it is delivering. If the hon. Gentleman is so convinced that his colleagues in the Assembly are doing a good job, he will have no problem at all supporting my amendment. It would not result in a problem, would it? There would be no cut in the block grant, because in the hon. Gentleman’s world nobody would try to leave Wales in order to seek treatment in England.

We all know that the reality is that hundreds, even thousands, of people who are currently patients in Wales want to be treated in England. Is it not a disgrace that Mark Drakeford, the Health Minister, is trying to skew the facts by saying, “Well, there are hundreds of people in England receiving treatment in Wales”? There are, but they do not want to have their treatment in Wales. They have set up an action group to demand the right to be repatriated to England, and I am sure my hon. Friend Mr Harper will address that.

Photo of David Davies David Davies Chair, Welsh Affairs Committee

I have given way enough times. I look forward to my amendment receiving the support of Labour Members. It is about creating competition between health services and I do not think there is anything wrong with that. It is about delivering patient choice and, most importantly, it is about recreating a national health service. The Conservative and Unionist party will also be the party of the national health service—the truly national British health service—at the next election, and I look forward to the support of Labour Members.

Photo of Elfyn Llwyd Elfyn Llwyd Shadow PC Spokesperson (Wales), Plaid Cymru Westminster Leader, Shadow PC Spokesperson (Constitution), Shadow PC Spokesperson (Foreign Affairs), Shadow PC Spokesperson (Home Affairs), Shadow PC Spokesperson (Justice), Shadow PC Spokesperson (Defence), Shadow PC Spokesperson (Environment, Food and Rural Affairs)

I wish to speak to my new clauses 1 and 10, which are in this group. I was discomfited by what David T. C. Davies said, because, to be honest, he was running Wales down. Thousands and thousands of people who work in the NHS in Wales are doing their level best at every single level, from the orthopaedic surgeons to those who clean the wards. There are problems, but there are problems in England as well. I was treated in Gobowen recently, not because I was given preferential treatment, but because the Bala practice happens to refer people to Gobowen for certain orthopaedic problems. I was dealt with promptly and well, and I have nothing but respect for those on that side of the border, as well as for those on our side of the border, which is the point on which the hon. Gentleman is lacking.

Photo of David Davies David Davies Chair, Welsh Affairs Committee 7:45 pm, 6th May 2014

I made it very clear in my speech that my criticisms are directed entirely at the leadership of the NHS in Wales and the National Assembly for Wales, not at the doctors and nurses who operate that service. I am happy to put that on record again. With all due respect, the right hon. Gentleman’s party has been very critical of the way in which the NHS has been run in Wales. I hope he is not going to fall into the trap—this is, frankly, the attitude of tyrants—of suggesting that any criticism of something is actually an attack on one’s nation. That is not the case at all and it is a dangerous criticism for him to make.

Photo of Elfyn Llwyd Elfyn Llwyd Shadow PC Spokesperson (Wales), Plaid Cymru Westminster Leader, Shadow PC Spokesperson (Constitution), Shadow PC Spokesperson (Foreign Affairs), Shadow PC Spokesperson (Home Affairs), Shadow PC Spokesperson (Justice), Shadow PC Spokesperson (Defence), Shadow PC Spokesperson (Environment, Food and Rural Affairs)

I have not been uncritical; it is just that I was taken aback by the vehemence of the hon. Gentleman’s speech. I thought he was talking Wales down—that is my point. Everything is not perfect and I do not pretend it is—only a fool would say as much—but it is not half as bad as the hon. Gentleman alleges.

Photo of Chris Ruane Chris Ruane Labour, Vale of Clwyd

In stressing the positives for Wales, will the right hon. Gentleman welcome the fact that there are 60 nurses per 10,000 patients in Wales and only 50 nurses per 10,000 patients in England?

Photo of Guto Bebb Guto Bebb Conservative, Aberconwy

I am grateful to the right hon. Gentleman for giving way. Is it not the case that a Member of Parliament has a responsibility to speak up on behalf of their constituents, including people who work in the health service who, time after time, come to me with complaints? They do so quietly and behind the scenes, because they know their positions will be endangered. We have a responsibility to speak up for patients and NHS staff in Wales, who are very aware of the fact that the standard of service is not appropriate.

Photo of Elfyn Llwyd Elfyn Llwyd Shadow PC Spokesperson (Wales), Plaid Cymru Westminster Leader, Shadow PC Spokesperson (Constitution), Shadow PC Spokesperson (Foreign Affairs), Shadow PC Spokesperson (Home Affairs), Shadow PC Spokesperson (Justice), Shadow PC Spokesperson (Defence), Shadow PC Spokesperson (Environment, Food and Rural Affairs)

I take the hon. Gentleman’s point. He may know that I was very critical of the Welsh Government for going down the track of closing smaller hospitals, leaving nothing in their wake and pretending that care in the community was available when it was not. I am not uncritical. We should voice concerns when they need to be voiced.

New clause 1 stands in my name and those of my hon. Friends the Members for Arfon (Hywel Williams) and for Carmarthen East and Dinefwr (Jonathan Edwards). If accepted, it would require the Government to review the options for reforming the Barnett formula in order to ensure that Wales is funded on the basis of need rather than population share, as is currently the case. Of course, it is out of the scope of this Bill to seek to change the Barnett formula and make sure that Wales is funded on the basis of need, but the issue of fair funding has become an integral part of the public and political discourse on the powers it offers and we seek to highlight its importance.

Although the need for fair funding—as reform of the Barnett formula has become known in Wales—was not set as part of the remit of the Commission on Devolution in Wales, the cynical among us might view that as a ploy by the Government to continue to ignore the ongoing loss to Wales of between £300 million and £400 million per annum, which is an incredibly large sum of money for such a small country.

Earlier, we debated the need for borrowing and the £500 million limit. We are actually undersold £400 million per annum already, and we do not seem to be too concerned about that or, at least, nobody has been in any great rush to address it. I venture to suggest that if that were put right, the £400 million could be very useful to the Welsh Government immediately.

The so-called formula was devised in the 1970s by Joel Barnett MP, who is now Lord Barnett in the other place. He was a Treasury Minister at the time, and he saw that a simple stop-gap means of funding Wales would be to do so on the basis of its share of population—about 5% of the UK total. However, since the 1970s, Wales’s GVA has fallen as a percentage of the UK’s, and Wales now has a higher number of disabled and older people as a percentage of the population than our friends in England. The formula was intended to be only temporary, before a longer-term and more equitable solution could be found. Politicians of all parties recognise that it is unjust and needs reform, except those in government—whoever is in government at the time.

As part of our One Wales coalition Government agreement in the last National Assembly, Plaid Cymru demanded that an independent commission be put together to examine the shortfall in the funding which Wales evidently misses out on each year through how the block grant is currently calculated. The Independent Commission on Funding and Finance for Wales, expertly chaired by the widely respected Gerald Holtham, entirely vindicated what we have said for upwards of 30 years—that Wales has been losing out. Indeed, the £300 million to £400 million figure has been endorsed by another Committee, the Constitutional Committee in the other place, which separately came to a similar conclusion.

Plaid Cymru has been campaigning for reform of the Barnett formula and to secure fair funding for Wales on the basis of need for more than three decades. In all my time in the House, which spans more than two decades, we have returned to this continuing injustice time and again. If I may reminisce for a second or two, Mr Crausby, I remember asking successive Labour Secretaries of State for Wales why they would not reform the Barnett formula. I do not seek to embarrass my good friend, Paul Murphy—he had to stick to his brief at the time—but there is now an acknowledgment that we are underfunded, and that therefore needs to be put right. As in any other part of the UK, we need to ensure fair funding in Wales, which is something that no democrat would deny.

Imagine my surprise when it emerged that the Labour party had put a caveat on devolving income tax powers for Wales, by stating that it would not hold a referendum until fair funding had been secured. The fact that it wilfully ignored the problem and even denied that there was one during 13 years in power in Westminster must be the symptom of a grave case of collective amnesia. The cynical among us would call that expedient, to say the least, while others might be tempted to see it as a roadblock in the path of greater devolution for Wales, put in place by the anti-devolution tendency that appears to be in the ascendancy among Labour Members from Wales at Westminster.

Photo of Susan Elan Jones Susan Elan Jones Opposition Whip (Commons)

How does the right hon. Gentleman marry his last comment with our very strongly stated support for reserved powers, an innovation about which I am very pleased?

Photo of Elfyn Llwyd Elfyn Llwyd Shadow PC Spokesperson (Wales), Plaid Cymru Westminster Leader, Shadow PC Spokesperson (Constitution), Shadow PC Spokesperson (Foreign Affairs), Shadow PC Spokesperson (Home Affairs), Shadow PC Spokesperson (Justice), Shadow PC Spokesperson (Defence), Shadow PC Spokesperson (Environment, Food and Rural Affairs)

I am pleased that the Labour party agreed to the reserved powers model, but I am a little concerned and I will develop my argument about the difference of opinion on when the Barnett formula should be addressed. The hon. Lady’s colleagues in Wales have one view, and her colleagues at Westminster have another. As I have said, the caveat may be a roadblock to further devolution. In fact, according to Labour party policy as it now stands, it will be a roadblock to further devolution.

Photo of Chris Ruane Chris Ruane Labour, Vale of Clwyd

While the right hon. Gentleman is handing out plaudits to the Labour party, will he congratulate it on actually bringing devolution about? It included in its 1997 manifesto that devolution would be put to the people of Wales.

Photo of Jonathan Edwards Jonathan Edwards Shadow PC Spokesperson (Treasury), Shadow PC Spokesperson (Business, Innovation and Skills), Shadow PC Spokesperson (Transport), Shadow PC Spokesperson (Communities and Local Government), Shadow PC Spokesperson (Culture, Media and Sport), Shadow PC Spokesperson (Wales)

Is not new clause 1 a credibility test for the Labour party? It has put in place a roadblock on income tax powers, in that their devolution cannot happen until Barnett reform. If it does not support the new clause this evening, that will clearly show that its stipulation is a roadblock to further devolution.

Photo of Elfyn Llwyd Elfyn Llwyd Shadow PC Spokesperson (Wales), Plaid Cymru Westminster Leader, Shadow PC Spokesperson (Constitution), Shadow PC Spokesperson (Foreign Affairs), Shadow PC Spokesperson (Home Affairs), Shadow PC Spokesperson (Justice), Shadow PC Spokesperson (Defence), Shadow PC Spokesperson (Environment, Food and Rural Affairs)

Yes, I agree with my hon. Friend, and not only Plaid Cymru is saying that. In a recent article, Professor Richard Wyn Jones of the Wales governance centre at Cardiff university said that because of the difference of view between Labour colleagues in the National Assembly and those at Westminster, and between Scottish Labour and Scottish Labour Members at Westminster,

“Scottish Labour seem to have no compunction about throwing Wales, one of the poorest parts of the Union, under the bus to shore up their own position… For Wales it is, sadly, a very different story. Yet despite this, the Barnett formula—used to calculate funding for the Scottish and Welsh Governments—operates in a way that ensures per capita levels of public spending is far higher for Scotland than for Wales.”

He develops that theme, referring to the Holtham commission, and continues:

“But what of Welsh Labour? It is surely inconceivable that the Shadow Secretary of State…will have been unaware of the contents of Powers for a Purpose, and its pledge to retain Barnett while rejecting a needs-based replacement. Yet, thus far at least, he has remained resolutely silent in the face of this assault on the long-term interests of Wales.”

And so it goes on: it is a pretty harrowing read, but it underlines that unaligned expert commentators believe that denial of the need to get on with reforming Barnett as soon as possible is undermining the democratic process in Wales and its future.

In our party, at least, we are quite clear. We believe that Wales should be fairly funded on the basis of need, and that the Barnett formula should be recalculated to ensure that Wales does not lose out, potentially on billions of pounds, over the coming decade. We have always maintained that position. However, the thrust of what the Bill offers is, on the whole, a good thing, with greater financial and fiscal powers, despite our disagreement about some of the restrictions and conditions that the Westminster Government have placed on the powers. We are disappointed that they have failed yet again to take the opportunity to address the serious injustice of the lack of fair funding, but the Bill is a means of getting on with the important job of improving the Welsh economy—boosting it and, I hope, creating many jobs in the process through careful investment in infrastructure—because we know that a lot needs to be done.

We know that the Conservative and Lib Dem Government will not commit to reform of the Barnett formula. They have always said that it works, despite the fact that many of their senior figures in Wales have acknowledged that it does not work, but needs reform. This Government can never be trusted to put Wales’s interests first.

Photo of Mark Harper Mark Harper Conservative, Forest of Dean

Just to be clear, it is not right that the Government have said they will never amend the Barnett formula. They have said that the work on dealing with the deficit has to be the priority, before the Barnett formula can be looked at. They do not have a closed mind on that—they have another priority, which is the right one of dealing with the deficit—as the right hon. Gentleman is suggesting.

Photo of Elfyn Llwyd Elfyn Llwyd Shadow PC Spokesperson (Wales), Plaid Cymru Westminster Leader, Shadow PC Spokesperson (Constitution), Shadow PC Spokesperson (Foreign Affairs), Shadow PC Spokesperson (Home Affairs), Shadow PC Spokesperson (Justice), Shadow PC Spokesperson (Defence), Shadow PC Spokesperson (Environment, Food and Rural Affairs)

I appreciate the pressures on the Government caused by the large deficit—that is fairly obvious—but it is not as though the Barnett problem has suddenly come out of the ether. It is a case of jam tomorrow, is it not? We have argued our case for 30 or 35 years, but others who are politically unaligned have now said that we are right. It has been on the table for eight or nine years, with very little movement in any direction and no initiative whatever. However, I accept what the hon. Gentleman says about the deficit.

More intriguing, I think, is the Labour position on Barnett. In the National Assembly for Wales, Labour says, following the Holtham findings, that it is a disgrace that Wales loses between £300 million and £400 million each year. The First Minister says that income tax powers will not be taken up by the Welsh Government, who can only trigger the referendum through the National Assembly if there is Barnett reform. By the way, the adoption of income tax powers will provide access to increased borrowing for investment limits, which, as I stated a few moments ago, could provide jobs and boost the economy. Members will naturally have concluded that if the Labour party in Wales has predicated more powers and a greater ability to boost the economy on Barnett reform, the party would commit to reforming Barnett centrally if in power here in Westminster. Surely Labour would not say one thing in Wales and do another thing here in a Janus-faced manner—yet that is exactly what it is doing.

The First Minister and the shadow Secretary of State for Wales have been through so many contortions that they should probably see a doctor for the bends! First Minister Carwyn Jones welcomed the Silk Commission recommendations, then the draft Wales Bill and then said a Labour Welsh Government would not accept the income tax powers without fair funding. Meanwhile, the shadow Secretary of State has pointed out that Wales has missed out on more than £300 million a year, failed to persuade his masters of the need for reform, and so gone back to defending the indefensible. All the while, his constituents and mine suffer as a result of services that could be improved through increased funding. For all I know, this could have had bearing on what David T. C. Davies said earlier.

The Labour party in Wales says one thing in Wales, while fully knowing that its masters down here would refuse to commit to fair funding if they formed the next UK Government. Of course, the spectre of Scotland haunts them. If they commit to Barnett reform, the independence campaign will rightly say that they intend to take money away from Scotland. They cannot have it both ways. Needless to say, if I were Scottish, I would be campaigning for independence—a situation that would solve the Barnett question once and for all!

I remind Members that all their parties signed up to the Silk Commission’s recommendations via their representation on it. We in Plaid Cymru have sought, through our amendments, to maintain the integrity of the cross-party commission’s original findings and recommendations. The other parties have since either watered them down or placed restrictions on, or roadblocks in the way of, greater financial powers for Wales. I urge hon. Members, particularly Labour Members, to put Wales first and back up what the party in Wales says about Barnett reform.

Photo of Nia Griffith Nia Griffith Shadow Minister (Wales) 8:00 pm, 6th May 2014

The right hon. Gentleman’s new clause deals with Barnett reform, but if it were reformed, what would the position be in Scotland? Is it in his mind that Barnett reform would increase funding for Wales and decrease it for Scotland?

Photo of Elfyn Llwyd Elfyn Llwyd Shadow PC Spokesperson (Wales), Plaid Cymru Westminster Leader, Shadow PC Spokesperson (Constitution), Shadow PC Spokesperson (Foreign Affairs), Shadow PC Spokesperson (Home Affairs), Shadow PC Spokesperson (Justice), Shadow PC Spokesperson (Defence), Shadow PC Spokesperson (Environment, Food and Rural Affairs)

I am in the thankful position of not speaking for Scotland. I have an opinion, however, as I would not like to see our colleagues and friends in Scotland being done down at all. I pose the question of whether we need a proper root-and-branch approach to the problem—something that will properly deliver. Come September, there may be no need for Barnett reform in Scotland.

Photo of Nia Griffith Nia Griffith Shadow Minister (Wales)

Does the right hon. Gentleman agree with the Labour party’s announcement this week that we want to increase the funding for Wales, but not reform the Barnett formula as it affects Scotland?

Photo of Elfyn Llwyd Elfyn Llwyd Shadow PC Spokesperson (Wales), Plaid Cymru Westminster Leader, Shadow PC Spokesperson (Constitution), Shadow PC Spokesperson (Foreign Affairs), Shadow PC Spokesperson (Home Affairs), Shadow PC Spokesperson (Justice), Shadow PC Spokesperson (Defence), Shadow PC Spokesperson (Environment, Food and Rural Affairs)

Asking me to say whether I think it is a good thing to increase funding for Wales is a rather strange question. If that ever happens, it will of course be a good thing, but rather than have piecemeal increases in funding, it would be better to have a lasting and proper formula that everybody could understand and that could stand the test of time—unlike the Barnett formula. Whenever I see the noble Lord Barnett—a wonderful character and a very nice man—he turns away. I hope it is not because it is me, but he always turns away, saying “I’m sorry, I’m sorry; the formula was not meant to be in place now”. He acts as if he thinks I am going to jump on top of him! He realises the point himself, so we really need to get stuck in on this issue. I hope that when the Bill is passed, we can reach an all-party consensus by sitting down and seriously having a go at addressing the Barnett crisis. As I say, rather than have a piecemeal approach to the problem, I would prefer a long-standing approach to which everybody could sign up.

Photo of Chris Ruane Chris Ruane Labour, Vale of Clwyd

I thank the right hon. Gentleman for giving way to me a third time. He talks about how Labour has treated Wales. In 1996, the Welsh block amounted to £6.7 billion; by the time Labour left government in 2010, it was £15 billion. Is that not an achievement?

Photo of Elfyn Llwyd Elfyn Llwyd Shadow PC Spokesperson (Wales), Plaid Cymru Westminster Leader, Shadow PC Spokesperson (Constitution), Shadow PC Spokesperson (Foreign Affairs), Shadow PC Spokesperson (Home Affairs), Shadow PC Spokesperson (Justice), Shadow PC Spokesperson (Defence), Shadow PC Spokesperson (Environment, Food and Rural Affairs)

It was raised in line with inflation—[Interruption.] Let me finish. Other responsibilities came to Cardiff—virtually all the agriculture, the environment and various other things came in. [Interruption.] I would like to know the percentage, but I am not in a position to determine one way or another whether it amounted to a substantial increase. I do not think it was substantial: it was clearly above inflation, but other responsibilities had been devolved to Cardiff by that time.

Without trying your patience, Mr Crausby, I would like briefly to speak to Plaid Cymru’s new clause 10. The Silk Commission’s recommendation 28—a brief one, you will be pleased to hear—states that the Welsh Government should set up a Welsh Treasury to manage the new powers contained within the report. The new clause extends that arrangement to the Bill. It is a simple but important new clause. In the spirit of our other amendments, it seeks to preserve the integrity of the cross-party Silk Commission recommendations.

The commission recommended that if the Welsh Government are to be directly responsible for revenue raised in Wales, as will be the case with the advent of the Bill’s powers, they must develop their finance department into a Welsh Treasury. That is a common-sense approach. If the National Assembly for Wales decides to do this, in accordance with its will, so be it. It would avoid the need for inefficient and perhaps time-wasting tidying-up exercises, such as appear in the first part of the Bill. People in Wales have been referring to “the Welsh Government”—a change of name—so there should be no problem with calling the finance department “the Welsh Treasury”. It is common sense for that to happen. I hope that this simple new clause will be supported by both sides of the Committee.

Photo of Guto Bebb Guto Bebb Conservative, Aberconwy

I shall speak briefly to my amendments 12, 13 and 14, of which I am proud. I associate myself, too, not only with the amendment tabled by the Chairman of the Welsh Affairs Committee, my hon. Friend David T. C. Davies, but with his speech. There was nothing in it that was an attack on Wales. He was simply highlighting a real concern of our constituents that needs to be addressed. I believe that the amendments provide the opportunity of dealing with the fact that we need an NHS that serves the people of Wales.

Photo of Albert Owen Albert Owen Labour, Ynys Môn

I take the hon. Gentleman on his word that he is not attacking the NHS in Wales. He has to acknowledge, however, that both his and my constituents already get some of the best specialist treatment over the border in places such as Liverpool, Manchester and Gobowen. That just happens to be a fact of life.

Photo of Guto Bebb Guto Bebb Conservative, Aberconwy

That is true; the hon. Gentleman makes a statement of the obvious. Before I was elected, I was proud to support the campaign launched by my right hon. Friend the Secretary of State for Wales, who argued strongly that services in Walton rather than services in Swansea should be provided for people in north Wales. What the hon. Gentleman completely misunderstands is the fact that patient choice has been taken away in Wales. People in Wales can be referred to hospitals in England by a GP, but only if the GP makes that referral on the patient’s behalf. The opportunity to make a choice is not available to patients in Wales—very different from the situation that applies to patients in England.

The situation in respect of patient choice in Wales is simple. Some political parties in Wales argue strongly that patients in Wales should have entirely the same right to choose their preferred hospital as patients in England. For some reason, the so-called party of the national health service in Wales is of the view that that right to choose should be declined.

Photo of Guto Bebb Guto Bebb Conservative, Aberconwy

I will give way so that I can understand why the Welsh Labour party takes the view that patients should not have a choice that is freely available to patients in England.

Photo of Nia Griffith Nia Griffith Shadow Minister (Wales)

Does the hon. Gentleman not accept that patients in England need a referral from a GP? The way in which the funding is being reformed in England will make things difficult, because some GPs will have to make desperate choices about whose treatment they will fund.

Photo of Guto Bebb Guto Bebb Conservative, Aberconwy

The hon. Lady is mistaken. The NHS England website poses the question,

“Can I have a GP in Wales if I live in England?”

The answer is:

“Yes you can, but… Patient choice and the NHS Constitution do not apply to the NHS in Wales.”

In other words, patient choice does apply in England, but it does not apply in Wales.

It is important that this issue is debated, because the Government in Cardiff Bay state that the NHS in Wales is as good as the NHS in England. That is exactly the issue that our amendments highlight. They make it very clear that if patients from England elect to use services in Wales, there will be a corresponding change to the funding block, and if patients from Wales elect to use services in England, there will be a corresponding change to the block. If the confidence in the Welsh NHS that Opposition Members express in the media and on television is genuine, they would see no danger in the amendments. The amendments would simply allow patients from Wales who want to be treated in England and patients from England who want to be treated in Wales to have that choice. They are simply trying to ensure that we have an NHS that is national. Why is that so scary to the so-called party of the NHS? That question needs to be answered in this debate.

Secondly, I want to touch on the comments of Mr Llwyd. I was genuinely disappointed to hear the comments of my hon. Friend the Member for Monmouth described as an attack on Wales. It is important in a mature democracy that we are able to highlight areas where service levels in Wales are not as good as they should be, because we should aspire to have the best. Whether we are talking about the NHS or education, we have a duty to highlight places where Wales is underperforming. To try to kill off that debate by arguing that all Members who highlight concerns on behalf of their constituents are in some way attacking NHS staff is unacceptable.

I might be suggesting that there is a motive where none exists, but perhaps the defensiveness that was articulated by the right hon. Gentleman reflects the fact that patient choice in Wales disappeared as a result of the “One Wales” Government. According to the House of Commons Library, the “One Wales” Government “eliminated patient choice”. Those are not my words, but the words of the House of Commons Library. It states clearly:

“Patients registered with a GP in Wales do not have a statutory right to choose at which hospital they receive treatment.”

The “One Wales” Government moved from patient choice to patient voice. That was a good soundbite that appealed to people who like poems that rhyme. However, in the Betsi Cadwaladr trust, patient voice meant that if somebody made a complaint, they might get a response in six months. Patient choice, which is what these amendments propose, means that patients in north Wales who feel that they would be better served by electing to be treated at a hospital in England would have that choice.

Photo of Elfyn Llwyd Elfyn Llwyd Shadow PC Spokesperson (Wales), Plaid Cymru Westminster Leader, Shadow PC Spokesperson (Constitution), Shadow PC Spokesperson (Foreign Affairs), Shadow PC Spokesperson (Home Affairs), Shadow PC Spokesperson (Justice), Shadow PC Spokesperson (Defence), Shadow PC Spokesperson (Environment, Food and Rural Affairs)

Does the hon. Gentleman not accept that I do not have people crowding into my office to say that they were badly treated at the hospitals in Llandudno, Bodelwyddan or Wrexham or at Ysbyty Gwynedd, Bangor? People often come in to say, “If you’re in contact with those hospitals, will you please say that the care was excellent and that I have nothing but praise for them?” I do not recognise the problem that he perceives. I am not sure what I am saying about what he is saying, but I do not recognise the problems that he and the hon. Member for Monmouth have highlighted. I do not see those problems every day. If I did, perhaps I would join them.

Photo of Guto Bebb Guto Bebb Conservative, Aberconwy 8:15 pm, 6th May 2014

The right hon. Gentleman makes an important point. When somebody tells me a good news story about the NHS in Wales at a public meeting or an event in my constituency, I am the first to applaud. It is important that we highlight success and great performance when it happens in the NHS in Wales. Unfortunately, I get complaints about the service that people have received in Wales far too regularly. Only three weeks ago, I heard from an individual who suffered from prostate cancer. He had an assessment in Wales that said that he did not have cancer. He was suspicious and booked a private appointment in London. Within 12 hours, he was operated on. He is of the view that the decision to go private saved his life. Is it not disgraceful that a patient in Wales has to have the means to go private to ensure that they get the correct diagnosis?

Photo of David Davies David Davies Chair, Welsh Affairs Committee

I thank my hon. Friend for giving way and allowing me to put it on the record for the third time that I am criticising not the doctors and nurses in Wales, but the policies of the Labour-run Welsh Assembly Government that are making it difficult for people to see those doctors and nurses quickly enough. That is the problem.

Photo of Guto Bebb Guto Bebb Conservative, Aberconwy

I accept that point.

I will conclude my remarks because I wanted to be brief and my hon. Friend the Member for Monmouth has highlighted the main issues. The key issue is that our amendments in no way threaten the Welsh NHS if it is a beacon of success, as is claimed by the Opposition parties. If the good practice that I see on a regular basis in the health service in north Wales is replicated across Wales, the amendments should not strike fear into anybody.

I come back to the individual I saw on Saturday morning while I was out canvassing. As the right hon. Member for Dwyfor Meirionnydd will be aware, a significant portion of my constituents have retired to north Wales to live. They often have family members in the north-west of England. Is it not unfortunate that somebody who is facing a significant operation cannot choose to be treated at a hospital near their family? Medical records show clearly that being in close proximity to one’s family, having the support of one’s family and having a daily visit are often the difference between a quick recovery and a long, drawn-out recovery. However, that choice is not available to patients in Wales simply because they live in Wales.

The amendments are a vote of confidence in a national health service. All parties who claim to support the national health service should support them.

Photo of Nia Griffith Nia Griffith Shadow Minister (Wales)

The amendments tabled by the hon. Members for Forest of Dean (Mr Harper), for Monmouth (David T. C. Davies) and for Aberconwy (Guto Bebb) claim that a disproportionate number of Welsh patients use NHS services in England. That is totally groundless. In fact, the number of English patients going to Welsh hospitals has increased by 10% since 2010, while the proportion of Welsh patients using English A and E services has fallen in recent years.

Photo of Guto Bebb Guto Bebb Conservative, Aberconwy

The point that the hon. Lady has just made is clearly wrong. I just made it very clear that patients in Wales are not able to choose to use hospitals in England, so it is no surprise that the numbers being treated in England have fallen.

Photo of Nia Griffith Nia Griffith Shadow Minister (Wales)

I am coming on to that. I am talking about patients who live in England and come to have treatment in Wales. The implication is that everybody wants to flee from Wales and nobody wants to go there. That is not true.

The issue of choice is key. We all have constituents who go for specialist treatments in England. We all know of emergency cases that have been taken to special care baby units and to hospitals as far away as London. There are obviously issues of funding. Funding does change hands. Amendment 13 suggests that that should be done through the block fund, but it is done from health board to health board.

The hon. Member for Aberconwy ignores the reforms that are being suggested in England, which will mean that instead of a GP making a referral to the hospital that they consider will provide the best treatment for their patient, they will have to consider the GP surgery’s budget and might not be able to afford the treatment. There are hospital consultants in England who are terrified that their services will not be brought in by certain GP practices because of the immense pressure of trying to provide a huge range of services with a limited budget. That is terrifying. Soon someone will not be able to compare like with like, and there will not be a similar situation in England and Wales—it will be very different. I am afraid that the idea of patient choice will vanish in England. It is nice to think it is there and that it will exist in future, but it simply will not be there.

I have heard of many instances of patients who had a certain degree of choice and were able to go to a slightly different hospital than the one first suggested when they made the case and asked for that change. Frankly, I think this amendment has provided the opportunity for an attack on the Welsh health service.

Photo of Nia Griffith Nia Griffith Shadow Minister (Wales)

Absolutely—not necessarily from the hon. Gentleman, but from other hon. Members there has been a blatant and clear attack. I would be the first to make a fuss—indeed, I do—if somebody cannot get a specific treatment, and we all know that in every area, whether in England or Wales, certain specialties may be difficult to cover in certain periods. We all know that we need to fight for certain things for certain constituents. As was mentioned, however, there is no clear winner or loser; there is no clear leader or laggard in the four UK nations in terms of health provision, as shown in a longitudinal study by the Nuffield Trust over a long period.

Photo of Susan Elan Jones Susan Elan Jones Opposition Whip (Commons)

It is all very well various Conservative Members saying, “We are not making an attack on the NHS”, but the leader of their party went to their Welsh conference and—I have just checked this because it is almost beyond belief that he used this phrase—described Offa’s Dyke as

“the line between life and death”.

I am sorry, but that is offensive. Conservative Members continually play the game, but they are Cameron’s little dogs, nothing else, and they are not prepared to speak up for Wales.

Photo of Nia Griffith Nia Griffith Shadow Minister (Wales)

I fully agree with my hon. Friend. Indeed, many of my constituents, who would be the first to criticise if something were wrong with the national health service, were shocked by those comments and deeply outraged at the insult to the many hard-working staff. I am glad that Conservative Members in the Committee have recognised the hard work done by many of our doctors and nurses in Wales, but there has clearly been an unmitigated and quite unnecessary attack. As has been pointed out, if we look at some of the statistics, the hon. Member for Monmouth would find that waiting times for certain cancer treatments are shorter in his patch than over the border in the Wye valley. It is absurd to state that everybody is hopping across to England. Likewise, the hon. Member for Forest of Dean has tabled one of the amendments, but Gloucestershire Hospitals NHS Trust treats only 82% of its cancer patients within the 62-day limit, whereas in Wales the figure is 91%. Every Welsh trust is outperforming the Gloucestershire Hospitals NHS Trust.

When considering these figures it is easy to pick one number or specialty and to forget that for the vast majority of people in Wales treatment has improved rapidly over the past few years. It is certainly very different to how it was in the 1980s and ’90s, when people waited for extremely long times. The key point to remember is that England too has had a dreadful year for A and E.

Photo of Mark Harper Mark Harper Conservative, Forest of Dean

The hon. Lady is attacking the NHS!

Photo of Nia Griffith Nia Griffith Shadow Minister (Wales)

I am saying that in England it has been the worst year for decades for A and E, with almost 1 million people waiting more than four hours. It has been much harder to get to see a GP in England since the Government scrapped Labour’s 48-hour appointment guarantee. [Interruption.] I am stating the fact that some things have not gone well in the NHS in England, and I am pointing out the criticisms, including shortages of nurses. In Wales we have 60 nurses per 10,000 people;

England has only 50, and shortages in certain departments have been causing particular problems. In Wales, delayed transfers of care and discharges are at an all-time low, whereas in England the number of hospital bed days lost to delayed discharges is at an all-time high. One might ask whether that has something to do with the cuts to local government expenditure that have been experienced in England under this Government.

All in all, the amendment on transferring block funding so that people can shift from England to Wales is, first, not very practical. Secondly, there are already opportunities for people to go across the border where that is the most appropriate treatment. Thirdly, the reform of the system in England will make it extremely difficult for GPs to provide even basic treatment for many of their patients, given the budgets they will be dealing with.

There have already been a number of exchanges on fair funding between Mr Llwyd and me, and my right hon. Friend the Leader of the Labour party made clear this week that we recognise that although the Barnett formula has served the UK well, there is a specific set of issues relating to Wales. As a result, an incoming UK Labour Government would address the issue for Wales without it impacting on Scotland. The right hon. Gentleman refers to not having a piecemeal approach, but I suggest that his amendment is just that and that a more comprehensive look at the issue would be more appropriate.

Photo of Mark Harper Mark Harper Conservative, Forest of Dean

I will try to be relatively brief although I will say one or two things that I had not intended to say because I have been provoked by the previous contribution. First, the double standards are breathtaking. My hon. Friend David T. C. Davies gave a perfectly reasonable speech and made it very clear that he was not attacking doctors and nurses but speaking about senior NHS professionals, yet he was accused of attacking doctors and nurses. Nia Griffith then proceeded to criticise standards of health care in England, yet somehow that is okay because she is just pointing out facts. Absolute nonsense. If we see things wrong in our constituencies it is our duty as elected Members to point them out. My hon. Friend was simply pointing out to the Committee problems in his constituency that had been raised by constituents. [Interruption.] I am not surprised that Labour Members do not want to hear this. The NHS is not performing well in Wales, and I will set out why my constituents in England are concerned about that.

I am happy with the confirmation from the hon. Member for Llanelli that if her party is elected to government it will sort out the Barnett formula for Wales and give it more money without that affecting funding for Scotland. As an English Member, it is quite clear which way the bill will be coming, so I will be pleased to tell my English constituents that another reason for not voting for the Labour party is that they will be facing a large bill to give more of their taxes to be spent by the Welsh Assembly Government, as well as the money they give to Scotland. I am grateful to the hon. Lady for that campaigning opportunity.

Amendments 12, 13 and 14 have been tabled by my hon. Friend the Member for Monmouth—my constituency neighbour—and my hon. Friend Guto Bebb. I listened carefully to their arguments and I am happy to support the amendments as I think the principles they outline are sensible. My hon. Friend the Member for Aberconwy spoke about the Welsh Assembly Government’s policy of voice not choice. That would be fine if, when patients said something with their voice, somebody actually listened to them. The problem is that nobody listens, which is a real issue for my constituents.

Photo of Mark Harper Mark Harper Conservative, Forest of Dean

No, I will not give way; I will make some progress. [Hon. Members: “Go on!”] Oh, go on then.

Photo of Paul Flynn Paul Flynn Labour, Newport West

Why does the hon. Gentleman think the Public Administration Committee, which has a Conservative Chair and majority, gave the health service ombudsman in Wales as the model and exemplar to follow? It said that that was the best service of the four countries, and it also recalled that Wales still has community health councils, which act splendidly as a source of receiving complaints and dealing with them.

Photo of Mark Harper Mark Harper Conservative, Forest of Dean 8:30 pm, 6th May 2014

The hon. Gentleman makes a very good point. Of course, the ombudsman service deals with the things that go wrong, and the points made by my hon. Friends were about the things that go wrong in the health service. It may or may not be true that the ombudsman service is a better system for clearing those things up, but we are trying to avoid them going wrong in the first place. I agree with the hon. Gentleman about community health councils. We used to have them in England and they were abolished by the Labour Government, which was a very bad idea. I suspect that he voted for getting rid of them, and I wish that he had not done so.

On the performance of the NHS in Wales, I shall limit myself to what I said when we debated the issue on Second Reading[Interruption.] The shadow Secretary of State cannot help himself. All I want to do is point out that I referred to mortality statistics in that debate, and I made the point that they were worse in hospitals in Wales. The Hansard reporters then note an interruption, which was the barracking from Opposition Members claiming that I was smearing Wales—[Interruption.] Paul Flynn says it again. Actually, if he read the Hansard report for that debate, he would know that all I was doing was quoting Ann Clwyd, who said:

“The second warning sign, said Francis, is the level of mortality statistics. In fact, they appear to be dangerously high in many hospitals in Wales.”—[Hansard, 5 March 2014; Vol. 576, c. 930.]

All I was doing was putting on the record a fact—the hon. Member for Llanelli said that we are allowed to do that—that was cited by a senior Labour Member, and I am accused of smearing the health service. If that is the level of debate we are going to have, we will not get very far.

Photo of Owen Smith Owen Smith Shadow Secretary of State for Wales

Has the hon. Gentleman reflected, in the period since he made those remarks, on the 10-year longitudinal study carried out by the Nuffield Trust?

It looked at all the indicators applicable across all four health areas of the UK and concluded that no one country is steaming ahead and no one country is lagging behind.

Photo of Mark Harper Mark Harper Conservative, Forest of Dean

No, I have not, because all I did was quote a Labour Member. They were not my words, but I was accused of smearing the NHS in Wales, which I did not do.

I was surprised to note that the hon. Member for Llanelli, after we had had our lengthy debate on day one of consideration of the Bill in Committee, tweeted that I was spending a lot of time on the Wales Bill and she wondered what my constituents would make of it. Well, the thousands of my constituents who are forced to be treated by the NHS in Wales against their wishes—that is not my view or assessment of the NHS in Wales—will, I suspect, be grateful that I am raising these concerns in the House on their behalf with Ministers, so that they can get better health care and a choice of where they are treated.

Amendments 17 and 18 are about improving the transparency of the agreements that govern cross-border services—the cross-border principles that were agreed by Ministers in the Department of Health and in the Welsh Assembly Government, together with the accompanying protocol that was sorted out by officials in NHS England and NHS Wales, supposedly based on those principles. The budgetary protocols will improve the transparency of the system.

New clause 3, also in my name, is an exact copy—with the appropriate changes—of the language that is in the Health and Social Care Act 2012. It puts a legal duty on commissioners in England, when making commissioning decisions, to consider the impact of their decisions on the provision of services to people who reside in Wales—and we have heard several examples from Members of constituents who live in Wales and receive services in England. There is no such reciprocal duty, and new clause 3 would provide that Welsh commissioners had to have regard to the likely impact of their commissioning decisions. If my constituents were receiving services in Wales and Welsh commissioners were making decisions that would have an impact on those services, they would have a legal duty to consider how my constituents would be affected. All I am asking for is parity between commissioners.

Photo of Owen Smith Owen Smith Shadow Secretary of State for Wales

Does the hon. Gentleman accept that one reason that provision was included in the Act was to mitigate the risk that commissioning groups in England would choose to decommission traditional services being provided by other parts of the NHS in England, such as tertiary care, and choose BUPA, Spire or some other private provider that might not be bound by the same protocols and memorandum of understanding to provide those services to Wales—a significant concern to those of us who looked at the Health and Social Care Bill? It remains a significant concern in a privatised NHS in England.

Photo of Mark Harper Mark Harper Conservative, Forest of Dean

I do not share that concern. The hon. Gentleman has all these scare stories about privatising the NHS, which are complete and utter nonsense. Since the provision exists, and commissioners in England have to have regard—rightly—to the impact of their decisions on Welsh residents, all I am asking for is a reciprocal duty on commissioners in Wales if they provide services to residents in England. That is nothing more than common fairness.

Hon. Members may be wondering why my constituents would care about the NHS in Wales. I shall set out briefly why it matters. I have some 6,000 constituents who reside in England in my constituency. The only GP surgeries that are conveniently located for them are branch surgeries whose main practices are located in Wales and registered with the NHS in Wales. So even though my constituents go to a GP surgery in England, they are being treated by GPs who are registered in Wales. Following decisions made by the Welsh Government and commissioners in Wales, my constituents find that their choices about where to have secondary care are increasingly limited. That is becoming a real problem. We have made some progress by liaising with the Aneurin Bevan health board, for example, but I am conscious that it could revert at any time to the previous situation. I want the issue to be sorted out permanently.

The cross-border principles that were agreed by Ministers of both Governments provide that cross-border commissioning should reflect the legal rights of patients in their country of residence. That is all I am asking for. What seems to have happened is that the protocol, the detailed arrangements agreed by NHS England and NHS Wales, did not quite reflect what Ministers in both Governments—to be fair—had agreed. My constituents are asking for nothing more than their legal rights under the NHS constitution and according to the Health and Social Care Act 2012. They want to be able to exercise the choice that my hon. Friends the Members for Aberconwy and for Monmouth set out.

My constituents have the option of being treated in Wales and, given what the shadow Secretary of State has said about the quality of services, they may want to be treated in Wales. But what they do not want is to be forced to be treated in Wales if they wish, for whatever reason—better treatment or any other preference—to be treated in England. They are English residents and they should have that right. That is all my amendments would achieve, and I hope that the Minister will address that.

Photo of Owen Smith Owen Smith Shadow Secretary of State for Wales

Much as we are enjoying the extended audition by the hon. Gentleman for the post of Secretary of State for Wales, can he point us to the evidence showing that thousands of his constituents are so concerned about treatment in Wales, or is this just an anecdote?

Photo of Mark Harper Mark Harper Conservative, Forest of Dean

I do not know where to start with that rather childish intervention. There is no vacancy, because my right hon. Friend is doing an outstandingly good job as Secretary of State for Wales, and I hope he continues in his post for a long time. He is doing an awful lot better than the shadow Secretary of State would do if, God forbid, he were ever to get the job.

I am concerned because my constituents are affected by the not very well thought-through devolution settlement—[Interruption.] The evidence is constituency correspondence, a very well attended public meeting with hundreds of local residents, and a very active local campaigning group. This is a real issue in my constituency and thousands of constituents are affected by it. I am doing my job as their Member of Parliament by setting out their views. I have been very reasonable in my argument and I look forward to the Secretary of State’s response. He is a Secretary of State who listens to and deals with issues brought to him by Members of Parliament—unlike the shadow Secretary of State—and I look forward to his response to the debate.

Photo of Paul Flynn Paul Flynn Labour, Newport West

What is entirely novel in the debate on health, which I have never experienced in my 28 years in this House, is for Wales and the Welsh health service to be used as a political football to kick around to save the skins of Tory MPs and fulfil the ambitions of Lynton Crosby. He is the one who is using the issue not to make legitimate complaints—it is right that hon. Members raise legitimate complaints, as they always have—but for something entirely fresh. At every Prime Minister’s questions, when the attention of the whole nation is on this place, questions are distributed to Welsh Tory MPs, and to non-Welsh MPs who do not know the places they are talking about, that criticise the Welsh health service and create the impression that it is a poor, second-class service. This is a malicious deception: it is not true.

There is a lot wrong with the health service in every part of these islands. There are weaknesses and everyone can provide examples of particular cases, but what is the effect when the impression is given, week after week, example after example, that the Welsh health service is rubbish? What does that do to someone waiting for an operation or treatment to be told, again and again, that the service they are getting is second class? A big part of the healing process is confidence. If confidence is destroyed, that damages the health of the nation on a very deep level. What happens to the people working in the health service who do marvellous but thankless jobs—the jobs we turn up our noses at—when they come home and watch the television at night? There is a hallelujah chorus of Tory MPs saying that the service is bad, not good.

Photo of Paul Flynn Paul Flynn Labour, Newport West

I will not give way. I will speak for only a very short time.

At the Conservative party conference in Wales, the Secretary of State for Wales, Assembly Members, the Secretary of State for Health and the Prime Minister lined up to talk about one subject: undermining the Welsh health service. It is, rightly, called the war on Wales. The damage that that does is enormous, and it is done to the whole reputation of Wales. That is not just happening in Wales; it is happening throughout the United Kingdom. This is how the Tories believe they are going to claw their way back to power, but I have news for them. There are now two Tory parties in Wales: the Joneses and the Farageists. The people will have a choice of which bit of bigotry they want to vote for next time. That will cut the reactionary vote in Wales in half and very few Welsh Tory MPs will be back here. When the Prime Minister says, from his lofty position, that there is a line between life and death at Offa’s Dyke, it will not be forgotten and it will never be forgiven.

Photo of David Jones David Jones The Secretary of State for Wales

It is a pleasure to serve under your chairmanship, Mr Crausby. It has been an interesting and lively debate. I will speak in the first instance to clauses 21 and 22.

Clause 21 confers on the Assembly the legislative competence to decide its own budgetary procedures. The effect of the clause is that the Assembly will be able to legislate to put in place budgetary procedures that take account of the Assembly’s and Welsh Ministers’ new powers under part 2 of the Bill. Clause 22 sets a requirement on the Secretary of State and Welsh Ministers to publish separate reports on the implementation and operation of the new tax and borrowing powers. Reports must first be published within a year of the Act passing and thereafter before each anniversary of the Act being passed. They must continue until a year after the new finance powers have been transferred fully to the Assembly and to the Welsh Ministers.

The Silk Commission recommended, in its first report, that the Assembly should have control of its own budgetary procedures. The Welsh Affairs Committee made a recommendation in similar terms following its pre-legislative scrutiny of the draft Wales Bill. The Government agree with these recommendations and clause 21 devolves legislative competence to the Assembly to decide on its own budgetary procedures. The current arrangements require the Assembly to pass an annual budget motion. Clause 21 will instead enable the Assembly itself to determine the procedure for setting the annual budget. It will allow the Assembly to put in place a scrutiny process that takes account of the new tax and borrowing powers in part 2 of the Bill. Giving the Assembly the power to legislate for its own budgetary procedures means that it could, if it wished, pass an annual finance Act in place of the current budget motion. Such an Act could include a wider range of fiscal and financial matters than the current budget motion, such as the determination of tax rates for devolved taxes, forecasts of income from taxation and variances from those forecasts, and scrutiny of the Welsh Ministers’ borrowing powers.

The Assembly would be free to decide whether, following a yes vote in a referendum on the devolution of a portion of income tax, an Assembly resolution setting a Welsh rate of income tax should be considered in the context of budgetary procedures. The use of the new tax and borrowing powers we are devolving in the Bill should effectively be scrutinised and it is right that the Assembly should be able to decide how its annual budget is best determined.

Government amendment 29 further expands the competence conferred on the Assembly through clause 21. Section 119 of the 2006 Act requires the Secretary of State to lay a statement before the Assembly each year, including estimates of the total payments into the Welsh Consolidated Fund and the amount of payments that will be made to the Welsh Ministers, the First Minister and the Counsel General. The annual financial statement forms part of the Assembly’s annual budgetary procedures. Given that we are devolving legislative competence to the Assembly in relation to those procedures, it seems only sensible to enable the Assembly to modify or repeal section 119 in so far as it relates to those estimated payments. In so doing, it would be open to the Assembly to implement the Silk Commission’s recommendation that the annual financial statement to the National Assembly should be presented by the Welsh Government rather than the UK Government.

The amendment does not, however, enable the Assembly to modify the Secretary of State’s duty to include in the statement how much of the Welsh block grant he proposes to deduct before paying the remainder into the Welsh Consolidated Fund and to include details of how that amount has been arrived at. The amount deducted is, in practice, used to pay the costs of the Wales Office. It is therefore only right that the Secretary of State continues to have responsibility for reporting on this amount to the Assembly and for providing details to support the amount specified. This is a sensible amendment that extends the Assembly’s competence in respect of its budgetary procedures.

New clause 10, tabled by the right hon. and hon. Members from Plaid Cymru, seeks to allow the Welsh Government to change the name of their Finance Department through a resolution passed in the Assembly. The Silk Commission recommended, in its part 1 report, that the Welsh Government should set up a Welsh Treasury to manage the fiscal powers it recommends to be devolved. Hon. Members will be aware that the Welsh Government have already started work to establish a Welsh Treasury responsible for financial and fiscal policy in devolved areas. It is, of course, entirely a matter for the Welsh Government to decide how best to structure their finance responsibilities.

We are a Government who believe in decision-making at the most appropriate level, and in this case we consider that the most appropriate level is the Welsh Government. There is simply no need to legislate on this, or—as Hywel Williams put it—for Westminster to stick its oar in. I urge the hon. Gentleman not to press new clause 10 to a vote.

Photo of David Jones David Jones The Secretary of State for Wales

That, of course, is entirely a matter for the Welsh Government, but, in practice, that is what they are calling it at the moment.

I thank my hon. Friends the Members for Monmouth (David T. C. Davies) and for Aberconwy (Guto Bebb) for their amendments 12, 13 and 14, and my hon. Friend Mr Harper for his amendments 17 and 18 and new clause 3. They raise important issues about the provision of cross-border health services in Wales and England, issues which are, of course, vitally important to anyone who lives close to the border—or even not so close, as was pointed out by my hon. Friend Mr Williams. Indeed, they are important to anyone who wants world-class health services to be delivered throughout the United Kingdom.

Health is one of the most important services—arguably, the most important service—to be delivered by any Government. We all know that people value the delivery of good health care more than almost every other public service. This is, after all, a service on which we are all likely to call at some stage in our lives. It is therefore essential for any Government to deliver health services which are effective and efficient, and which provide good value for money. In England, the Government will have increased spending on health by about £12.7 billion in cash terms over the lifetime of the current Parliament, delivering an NHS that continues to improve and the health care that people want and deserve. However, none of that would be possible without our front-line NHS teams: the doctors, nurses, and other health care professionals.

As we have heard from Members this evening, the sad fact is that the Labour Government in Cardiff are presiding over a health service in Wales which is declining. My hon. Friend the Member for Monmouth gave some illustrations of that decline. In Wales, Labour has cut the health budget by 8%, despite having been given an extra £1.6 billion in the block grant. The result has been a decline in health services in Wales which is evident for all to see, with unacceptably long waiting times.

Photo of David Jones David Jones The Secretary of State for Wales

Actually, it is for every elected representative to express concern when a service as important as health is affected. When the devolved Administration are not delivering an adequate standard of health care, it is entirely appropriate for every elected representative to draw attention to that.

Photo of Owen Smith Owen Smith Shadow Secretary of State for Wales

Does the Secretary of State agree with the Prime Minister that Offa’s Dyke is

“the line between life and death”?

Photo of David Jones David Jones The Secretary of State for Wales

I agree entirely with my right hon. Friend the Prime Minister that in England there is a cancer drugs fund, and in Wales there is not. I can tell the hon. Gentleman—[Interruption.] The hon. Gentleman should listen to this. Constituents of mine have died because they have not had access to cancer drugs, because they live in Wales. If the hon. Gentleman considers that an acceptable state of affairs, shame on him.

There is a significant lack of resources in Wales compared with England. For example, Wales has no cancer drugs fund. As the hon. Gentleman will know, a recent study conducted by Bristol university showed that Welsh patients were seven times less likely to have access to cancer drugs than those in England. There is a litany of failure in relation to Welsh health services. Almost everybody who lives in Wales can give examples of such failures. Only today, the Western Mail reported that complaints to health boards in Wales had increased by more than 40% between 2009-10 and 2012-13.

However, the Labour party is simply not listening. The First Minister and his Cabinet are presiding over what looks increasingly like a shambles. Health care in Wales is moving backwards. That is, quite simply, unacceptable—

Photo of David Jones David Jones The Secretary of State for Wales

No, I will not. The hon. Gentleman can listen.

Crucially, it is also both alarming and worrying for people in Wales who need to use those services.

The Welsh Labour Government in Cardiff are not only failing thousands of patients in Wales, but failing hard-working professionals who are every bit as competent and dedicated as those in any other part of the country. It is in that context that we are debating the amendments tabled by my hon. Friends the Member for Monmouth and for Aberconwy.

Photo of David Davies David Davies Chair, Welsh Affairs Committee

I entirely support what my right hon. Friend has just said. I have just received a long e-mail. I shall forward it to my right hon. Friend, but one sentence says it all:

“I run a local veterinary hospital and I am ashamed to admit that the animals under my care are treated more promptly and effectively than the people in Monmouthshire.”

The lady who sent that e-mail made it quite clear that she was criticising not the doctors or nurses, but the system created by Labour Members.

Photo of David Jones David Jones The Secretary of State for Wales

I am grateful to my hon. Friend for that intervention.

Amendments 12, 13 and 14 seek to shine a light on the organisation and funding of cross-border health services—services provided in England to patients living in Wales and vice versa. I shall not dwell on the intended legislative effects of these amendments, but rather on the intentions behind them. I know this is an issue of real importance to many Members who have spoken this evening, and I would like to reassure the House that I share the concerns about the operation of the current system.

My hon. Friend the Member for Forest of Dean has also spoken to his amendments 17 and 18, which would require both the Secretary of State and the Welsh Ministers to include in their annual reports on the implementation of the Bill’s financial provisions details on the costs and effectiveness of cross-border services. His proposed new clause 3, which reflects concerns he has expressed over many months to me and my right hon. Friend the Secretary of State for Health, would require the Welsh Ministers to consider the impact of their decisions on the provision of health services to people who live in England but who are registered with Welsh GPs.

Current funding arrangements are set out in the protocol for cross-border health care. I entirely agree that there is concern about the practicality and deliverability of these arrangements as they operate on the ground. Everyone should receive the best possible health care regardless of where they live or where their GP is registered. As we have heard, health services in Wales are falling short in many respects of the standards we expect. That is a matter for the Assembly, and in particular the Welsh Government, urgently to address.

The Welsh Government’s policy of referring patients registered with Welsh GPs for treatment in Wales only created more difficulties for English patients, such as the constituents of my hon. Friend, who are registered with Welsh GPs. I am pleased, however, that following discussions between the Wales Office and the Welsh Government some local health boards in Wales have reviewed this policy and have exempted English residents. I know this falls short of patient choice, but it is at least a step in the right direction.

Improving the cross-border protocol is the responsibility of both the Welsh and the United Kingdom Governments and I can assure the House that this Government are determined to tackle the protocol shortcomings and ensure better cross-border health services. It is only right that we ensure that the health care of people living close to the border does not suffer merely because of where they happen to live. It is through this mechanism that the greatest potential for real change lies, and that is why we are reviewing it to ensure it really does meet the needs of people on both sides of the border. Work is under way, led by the—

Photo of Owen Smith Owen Smith Shadow Secretary of State for Wales

On a point of order, Mr Crausby. Is it in order for the Secretary of State—who we have not heard from for, I think, fully 245 minutes—to speak for almost the entirety of his speech today in continuing the war on Wales and the Welsh NHS, none of which is addressed in this Bill, which is meant to be about the financial circumstances post-the Silk commission as they relate to Wales, not the NHS in Wales?

Photo of David Crausby David Crausby Labour, Bolton North East

The Minister is addressing the clauses. It is up to him what he says in his speech.

Photo of David Davies David Davies Chair, Welsh Affairs Committee

Further to that point of order, Mr Crausby. Given that Labour Members of the National Assembly for Wales’s health Committee are refusing to hear this evidence and are refusing to hear from important witnesses, is it not absolutely right that my right hon. Friend the Secretary of State should continue to raise the issue of the scandalous standards of care in the NHS in Wales?

Photo of David Crausby David Crausby Labour, Bolton North East

As long as—[Interruption.] Order. As long as the Minister is talking to the amendments, he can say what he likes.

Photo of David Jones David Jones The Secretary of State for Wales

Thank you, Mr Crausby. It is clear that Owen Smith does not want to hear what we are doing to remedy the problems in the Welsh health service.

Work is under way, led by the Department for Health and the Wales Office, to find practical and durable solutions to the problems which patients living on both sides of the border face on a daily basis. In March, the Secretary of State for Health made a commitment to this House that, by the end of this year at the latest, we would find a solution to the problems faced by English patients who must currently use NHS services in Wales but who would prefer to receive their treatment in England. My right hon. Friend has also asked the chief executive of NHS England to investigate the possibility of the English NHS providing treatment to Welsh patients in areas where the Welsh NHS proves unable to provide the care they need.

In its second report, the Silk commission made recommendations in this area. The Government have been clear that we do not consider this Bill to be an appropriate vehicle for the implementation of Silk 2 recommendations, but we are considering carefully those that could be taken forward without the need for primary legislation, with a view to implementing, in this Parliament, those where a good case is made. It is essential that we consider carefully any proposed solutions to ensure that there are no unintended consequences or new layers of bureaucracy created for patients or medical professionals. Our review of cross-border arrangements, coupled with our consideration of the Silk 2 recommendations, provides the right platform for ensuring better cross-border health provision in future. I would like to thank my hon. Friends for bringing forward their amendments and enabling this Committee—or at least some Members of this Committee—to debate the vital issue of Wales’s health service and the effect on cross-border health care. I do not believe the Wales Bill is a suitable vehicle for addressing the concerns expressed this evening, but I undertake to relay the strength of feeling of Members of this House on the issue of health services in Wales generally, and the organisation and funding of cross-border health services in particular, to the Secretary of State for Health, the First Minister and the Welsh Minister for Health and Social Services. I would welcome this House returning to this issue on Report, to enable me to apprise hon. Members on the progress of the work I have described. On that basis, I ask my hon. Friends not to press their amendments to a vote.

Finally, let me deal with new clause 1, which was tabled by right hon. and hon. Plaid Cymru Members. The Government have been consistently clear that our priority is to reduce the deficit, and so any changes to the Barnett formula must await the stabilisation of the public finances. However, we have been working closely with the Welsh Government on Welsh funding. In particular, the Government recognise that there has been convergence between the levels of funding in Wales and England since devolution, and that is of course a significant concern in Wales. As a result, in October 2012 we agreed a joint process to review the levels of funding in Wales and England in advance of each spending review. If convergence is forecast to occur over the spending review period, there will be a joint discussion of options to address the issue in a fair and affordable manner, based on a shared understanding of the evidence available at that time. In advance of the 2013 spending round, a joint review was therefore undertaken by the two Governments. That review determined that funding levels are not expected to converge during the period to 2015-16—in fact, an element of divergence is forecast to occur. The review also determined that relative funding levels in Wales are within the range recommended by the Holtham commission. The next review is expected to take place in advance of a spending review in 2015.

Photo of Elfyn Llwyd Elfyn Llwyd Shadow PC Spokesperson (Wales), Plaid Cymru Westminster Leader, Shadow PC Spokesperson (Constitution), Shadow PC Spokesperson (Foreign Affairs), Shadow PC Spokesperson (Home Affairs), Shadow PC Spokesperson (Justice), Shadow PC Spokesperson (Defence), Shadow PC Spokesperson (Environment, Food and Rural Affairs) 9:00 pm, 6th May 2014

The right hon. Gentleman is describing the process for the Barnett floor, which has been well known for several months. He says that some urgent work is being undertaken by government on this issue. Therefore, it would not be an imposition to expect a review to be forthcoming within six months of this Act coming into force.

Photo of David Jones David Jones The Secretary of State for Wales

I take it the right hon. Gentleman means a review of the Barnett formula itself.

Photo of David Jones David Jones The Secretary of State for Wales

Well, I can only reiterate the point which I thought the right hon. Gentleman had accepted: that our priority is to address the deficit we inherited from the Labour party at the last election. Nevertheless, the next review is expected to take place in advance of a spending review in 2015 and it is likely to be around the time when this new clause suggests the report should be published. These arrangements ensure that we have a shared understanding of funding levels in Wales, and a process is in place to consider options should further convergence be forecast to resume. It therefore provides a firm basis for proceeding with the new financial powers in the Wales Bill, and I hope that the Plaid Cymru Members will therefore not press new clause 1 to a vote. I also ask hon. Members to support clauses 21 and 22 standing part of the Bill and to support amendment 29.

Photo of David Davies David Davies Chair, Welsh Affairs Committee

Given what I have heard today, I am perfectly happy for now to withdraw the amendment. I look forward to working with the Secretary of State for Wales and the relevant Welsh Assembly Minister in drawing further attention to this issue in Wales and to returning to it on Report. I therefore beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendment made: 29, in clause 21, page 23, line 32, at end insert—

‘() in sub-paragraph (2), after paragraph (a) insert—

“(aa) section 119 in so far as it relates to estimated payments for a financial year into the Welsh Consolidated Fund or to the Welsh Ministers, the First Minister or the Counsel General;”;’.

This amendment ensures that the Assembly is not prevented from modifying section 119 of GOWA 2006 (statement of estimated payments) provided such modification relates to the estimated payments described in the amendment and not to the Secretary of State’s duty in subsection (3) of that section.

(Mr

Jones

.)

Clause 21, as amended, ordered to stand part of the Bill.

Clause 22 ordered to stand part of the Bill.