I beg to move amendment No. 93, in page 8, line 10, at end insert—
'( ) Section 1 of the National Health Service (Private Finance) Act 1997 (c.56) (powers to enter into externally financed development agreements) applies to Local Health Boards as it applies to National Health Service trusts.'.
This is a technical amendment. It simply allows local health boards to enter into private finance arrangements in the same way that local health trusts are able to do.
Amendment agreed to.
Question proposed, That the clause, as amended, stand part of the Bill.
Clause 6 will insert three new sections into the National Health Service Act 1977. New section 16BA will enable the National Assembly for Wales, by order, to establish statutory bodies to be known as local health boards and for those boards to exercise functions directed by the Assembly. Each board will be established in an area of Wales specified in the establishment order.
New section 16BB will empower the Assembly to direct local health boards to carry out specified functions that are currently carried out by health authorities. New section 16BC will enable the Assembly to direct local health board functions to be exercised on its behalf by, or jointly with, a number of other health bodies.
The clause will enable the Assembly to take a major step towards improving the national health service in Wales. It will help to develop the local health model
and pave the way for achieving the reforms outlined in the NHS plan for Wales. The strengthening of local health groups, allied with a new sense of leadership and direction by the National Assembly, will deliver a key part of the NHS plan for Wales and follows from the Assembly's decision to abolish health authorities on 31 March 2003.
The establishment of local health boards is an essential part of the structural reform—
No. The Assembly made it clear that it wanted a new structure to run the health service in Wales, hence the clause, which will create the local health boards and do away with the five current health authorities. The Assembly has decided on the structure that it wants, following consultation. In the Queen's Speech, we highlighted the fact that a Bill on the NHS in Wales will follow in draft before too long, to add a lot of extra work that we want to ensure that we deliver to reform the health service in Wales. The clause appears in the Bill because it is time sensitive. It is designed so that the Assembly can meet its deadline of abolishing the health authorities on 31 March 2003. I hope that that satisfies the hon. Gentleman.
The local health boards are an essential part of the reform structure in Wales. They will have a stronger democratic voice and be more accountable for their actions. The arrangements that will result from the clause, and from clauses 9 and 22, will build on the valuable experience gained by local health groups during the past two years. From my constituency, I know that they have been extremely successful. They will open up new opportunities for doctors, nurses, other health professionals, local authorities, NHS trusts, the voluntary sector, carers and older people so that they can work together to assess the health needs of their communities and secure the services necessary to meet those needs.
The local health board model was developed in partnership with the key stakeholders as part of an implementation process to improve the health service in Wales. It was subject to wide public consultation, the findings of which reaffirmed the view that the local aspect of health care in Wales should be strengthened. Local health boards are the means to that end. The boards will be formed with local people and
professionals who know their communities. They will be accountable to the local population to do all in their power to improve health and well-being.
The new level of accountability will be further underpinned by the statutory status of the boards, which will require them to demonstrate the highest standards of management, financial control and public probity. Local health boards will retain an important feature of local health groups, as they will be coterminous with local authority areas. That will allow them to develop new and better ways of working with local government and other stakeholders to improve the health service in Wales.
The development of local health boards and the well-being strategies that will follow from it are a key element in the reform of the NHS in Wales, and I commend the clause to the Committee.
I am grateful to the Minister for his explanation of the precise nature of the clause. Unless I am much mistaken, it lists the Welsh side of the reforms, and its effect and outlook are in many ways similar to what will happen in England.
As I mentioned, I was interested in the abolition of health authorities in Wales and the fact that the introduction of the local health boards in Wales will not happen until 31 March 2003. I find that fascinating, if only for the simple reason that Conservative Members have said consistently that SHAs in England should not come into effect until the day afterwards—1 April 2003—to avoid any haste. Unless the Minister can correct me, it seems as though that advice has been heeded in Wales, in effect, as one structure will not be abolished and replaced with another there until 18 months from now. The Welsh Assembly presumably feels that that is a longer and more responsible time scale on which to introduce such fundamental changes.
I would appreciate it if the Minister would elaborate on the precise reasoning and mechanics that the Welsh Assembly has gone through to reach this decision, so that it is out of sync by about six months.
I would also be grateful for some more information from the Minister about the mechanics of the matter. I see from subsection (1) and the Minister's explanatory note that when the boards are set up, the chair and the vice-chair will be appointed by the Assembly. I am interested in why it is felt that the Assembly rather than the local community or local structures within the NHS should take that decision.
The Minister also said, rightly, that the new system coming in in 2003 would mean that accountability to local communities would increase. It would be difficult to argue with the philosophy behind that. However, I would appreciate it if the Minister would flesh out what he means by greater accountability within the local community. Who will hold the bodies to account and establish this greater accountability? How much will the accountability be vested in local communities, as the Minister said, and what sort of accountability will there be to the Welsh Assembly?
What will the Assembly's powers be—I assume that the powers will be vested in the Assembly rather than in Ministers in the Wales Office—if there are problems with a health authority and intervention is needed to rectify any problems or any fall in standards of service provision? I make such comments in a probing and information-seeking spirit. I am not trying to open a keg of worms and cause problems. I am simply interested in how the system, which in many ways is similar to the English one, but in others is fundamentally different, will work.
It is important to recognise that, as a result of the devolution settlement, the devolved Administrations will go down a different road from that taken by the Government in Westminster with regard to any reorganisation, particularly within the health service. That is no great problem. We have accepted the devolution settlement and we accept that the Assembly will go down its own road in respect of the powers that it has been given.
We do not disagree with the Welsh Assembly. We are not bringing the matter into the spotlight in order to ask why it should be different from us. We are suggesting that the fact that the Assembly has decided to delay the implementation of the reorganisation until April 2003 should suggest to the Government that the Assembly has grave doubts about bringing forward the reorganisation as we are doing in England. We are not disagreeing with the Welsh Assembly's right to make such a decision; we are saying that there is an implication that we, in England, are rushing through the reforms. That has been the thrust of our arguments on the Bill.
I reassure the hon. Gentleman that that is not the case. The local health boards will be shadowing the other bodies before they actually take over their new responsibilities. The problem with the Welsh dimension is that there are many other reforms to the health service that the Assembly would like carried out. In the early discussions among the Wales Office, the Assembly and the Department of Health, the Assembly had a shopping list of items that it wanted included in this Bill and was prepared to consider a different time scale, if necessary. As I pointed out in response to an intervention from the hon. Member for West Chelmsford (Mr. Burns), the Government are committed to publishing a draft NHS Bill for Wales, which is not yet ready—we are still in discussions with the Assembly and the Department of Health on that. The Assembly has an extended time scale because many of the reforms that it would like carried out cannot be implemented until Parliament enacts that Bill.
I cannot directly answer the hon. Gentleman, because we are still in discussion about what should be included in the draft Bill. The
Assembly suggested a range of things that it would like to do but that we have not been able to include in this legislation. Clauses 6, which establishes the local health boards, and clause 22, which establishes the statutory partnerships requiring local authorities, health boards and trusts to work in partnership, are time sensitive. We are dealing with them now so that the shadow local health boards can be up and running and ready to take on their responsibilities by 2003. I cannot honestly say what will be included in the draft Bill.
The hon. Gentleman made the point about the appointment of the chair and vice-chair of the local health board by the Assembly. The chairman will be independent in the sense that he will not be the person representing the Assembly in the health board, and the post will be advertised in the Nolan way. The appointment will be totally independent.
The hon. Gentleman also referred to the way in which boards will be accountable for their actions, and the greater degree of accountability in the community. The structure of local health boards will include representatives of health professionals. Only this week, during a debate in the Assembly, the secretary responsible for health agreed with an amendment moved by a representative of his party that determined that carers should also be represented on local health boards. Other health professionals and the local authority can also be represented, and it is believed that that will give the health service greater accountability, profile and visibility, which we welcome.
Each health board will be required to produce an annual report of its activities, and the Assembly, as we will see in clauses yet to be discussed, will have powers over the funding of the boards to ensure that they meet the Assembly's general strategy for health delivery. Obviously, the Assembly will be able to bring pressure to bear on the boards, as we will discuss in later clauses, to achieve the overall strategy and outcomes for reform of the health service.
This is an important reform of the health service for Wales. The local health groups have had an important influence on articulating local interests, hopes and desires for the reform and delivery of the health service. I am pleased about that because, in my constituency, in 1993, an ad hoc group produced the Islwyn local health plan, which identified the problems that we saw within the health service in my area. If some mechanism had been in place for delivering the solutions that were recommended, there would have been a great improvement in the health service in my constituency. I hope that local health boards will work after that kind of model, be responsive to the demands and hopes of the local communities and work in partnerships with the trusts to ensure that what people want is delivered.
No, the local health boards will have responsibility for commissioning and delivering services.
A director within the NHS will be responsible to the Assembly for ensuring that its strategic policies for health delivery in Wales are delivered.
I can understand that, but why were the Government not persuaded that the English model, which is one step divorced from this House and even from ministerial control, was not suitable in Wales? The sort of strategic planning that is emanating from the Welsh Assembly could be compared with the Department of Health taking over a strategic role in each region of the country—or whatever sub-geographical division one wanted to create. Would it not be better if strategic planning were undertaken one step lower, and closer to the area that would benefit—or otherwise—from its decisions on the provision of health care?
Under the devolution settlement, it is the responsibility of the Assembly to make proposals for the reform of the health service in Wales in dialogue with the Department of Health. That formula has been agreed to be appropriate to deliver the improved health service that we seek in Wales.
I understand that, but I do not understand why it is thought better for SHAs in England to be independent of the Department of Health but not in Wales. It seems odd; if strategic health authorities are such a good idea for England, why are they not equally good for Wales?
I can only reiterate that the Assembly takes the view that that is the most effective way of delivering the health service in Wales. It is a small country, with 3 million people and about dozen health trusts. We want to push down as much of the decision-making process as we can to the local health boards. Those boards will represent the interests of the whole community in order to deliver the hopes and aspirations for the health service in that community. It is a formula and a model that we believe will work in Wales.
Have the Government taken a view on which of the two different models that we have discussed they prefer? Which do they believe will deliver the best outcome? The differences have only just dawned on me. On the one hand there is the strategic health authority, which is effectively an ectopic part of the Department of Health sitting in the Welsh Assembly, and on the other the numerous strategic health authorities in the rest of England. It seems to me that they will work quite differently and I should be interested to know what the Govt think. We understand what the Welsh Assembly thinks but I want to know what the Government
believe is the best model. If they think that the Welsh model is best, the natural corollary is to transpose it to England.
The Government believe that both will be appropriate, because the devolution settlement allows the Assembly to define and decide its preferred route. It is as simple as that. Perhaps the hon. Gentleman has a problem coming to terms with the devolution settlement.
As a Member of Parliament in Wales, and until recently a trade union official dealing with people in the health service, including nursing groups and some of the professionals, I know of the great welcome that has been expressed on the involvement of local health boards. We are trying to get across the message that it will become a primary led service.
The local authority will have the legislative responsibility of producing a community strategy. That area will be coterminous with that of the health board, which has to produce a health and well-being strategy, and the two must work together. That is the power of the local connection, and of local people being involved in deciding what is important for their communities. The local authorities and boards will then co-operate with the local trust, of which there are only 12, and will commission the services from them for hospitals and so on. That level provides another strategic view. The NSH in Wales has not been organised as it is in the UK—
If I may help the Committee, primary care trusts exist in England, but not Wales. We are setting up local health boards, which will be the Welsh equivalent. People in England can already see the value of primary care trusts, and England is ahead of Wales in that regard. However, both approaches are perfectly valid given the devolution settlement in the United Kingdom.
Let me explain a little further what the NHS directorate will do. The Assembly views the strengthened directorate as part of the new relationship that will be developed with the NHS. It will ensure that a concerted effort is made at national and local level to deliver local services that provide national standards of care. That is the primary point that I want to get across to members of the Committee.
We have had a useful debate. I have sought to answer hon. Members' questions properly, and I hope that they will support the clause.
Question put and agreed to.
Clause 6, as amended, ordered to stand part of the Bill.