With this it will be convenient to discuss the following:
Amendment No. 2, in
clause 1, page 1, line 15, at end insert—
'(c) that in abolishing a Council, altering the district in Wales for which a Council is established, or providing for the establishment of a new Council, it has the consent of the existing Councils in the area affected.'.
Amendment No. 15, in
clause 1, page 1, line 15, at end insert—
'(c) that due regard is paid to the boundaries of those health authorities which a Council is to scrutinise.'.
I am delighted to move these amendments. The Committee stage is important and, as I said earlier, we hope to improve the Bill, which we did not oppose on Second Reading. We have consulted widely and I greatly welcome the printing of the Bill first in draft form. I hope that that will become normal practice rather than an exception. Some of our amendments are based on the consultation that we carried out.
What is in a name? The Labour party—or new Labour, if it still is new Labour—has been re-branded because it thought that another name would be more consumer friendly. Indeed, that turned out to be the case. That was not wholly the reason why the Labour party achieved such a stunning victory in 1997—there may have been one or two other reasons for it—but the change was important. Plaid Cymru has gone through something of a re-branding in trying to make out that it is the party of Wales, so a name can be vital in projecting the right image.
Community health councils, or CHCs as they are commonly known, have an effective branding and are fairly well known. Indeed, we fought, struggled and lost in an attempt to retain CHCs in England. It was a valiant battle because CHCs were popular with patients and other people in England, but we lost that battle. I hope that in the Bill, which gives the Welsh Assembly power to retain CHCs, we will connect with the membership of CHCs in order to retain their name. Indeed, we could change the name only following consultation with the CHCs that would be affected.
Firms with popular names spend millions of pounds on research and analysis. They use expensive public relations companies and test out their ideas on focus groups. They do not always get it right, as we saw in the case of Consignia. It had a useful name that everyone recognised but after service levels were reduced, the Post Office decided to re-brand itself as Consignia. That failed dismally and after spending
millions of pounds, it has now gone back to calling itself the Royal Mail.
We have seen that happen time and time again; for example in the case of British Airways, which decided to call itself BA, and British Telecom, which decided to call itself BT. Those companies changed their names for specific reasons because they were trying to connect with people globally. Therefore, even ditching the word ''British'' and replacing it with ''B'' was seen as important to the effectiveness of those organisations.
Community health councils are widely recognised throughout Wales. One can imagine that attempting to ditch the name, without consultation or a request from the CHCs involved, will be hugely expensive. That money will be diverted from the health service, which we all want to see improved. Some of the proposed changes may be expensive. They include not only changing notepaper but publishing advertisements and changing boards outside the premises where the councils currently have their offices. Even a publicity campaign will be required to tell patients that CHCs will be known as something else. That could dislocate the current connection between patients and patient groups and the CHCs that represent them.
Given the power to do so, the Welsh Assembly may agree to consult CHCs or to wait until it is asked to consider the matter, perhaps because insufficient people know what CHCs do and it is necessary to give them a more consumer friendly name. We must recognise, however, that CHCs are the patients' champion. They do a specific job on behalf of a group of people who receive services from the NHS. The majority of those people have no choice. They do not have private health care so they cannot go anywhere else, and they may not even be able to travel to neighbouring areas to get the health care that they need. They receive their health service from one monopoly supplier, so the role of the CHC is vital. It is the patients' watchdog and was established to ensure that the service is operating at its highest level for the person who cannot afford to go anywhere else.
I suspect that it is important for the patients who have no other choice about where they go—and vital to those who work in the national health service—for there to be a group of people who champion patients' rights and ensure that the quality of service at a health institution will be the best. If there is a deficiency, it will be exposed. That is not part of a blame culture, but is part of improving services generally.
It is right that CHCs are given the opportunity to enter an institution to find out where the inadequacies are and to make recommendations. As I said, it is not about blaming people for problems, for example, with waiting lists; we know that those problems exist in certain areas. I will not repeat the arguments made on Second Reading. We know that there are deficiencies in the health service in Wales in certain key areas, but it is right that the CHCs expose them.
It is right to allow CHCs to change their name if they, as the people's champion, decide that people do not know what they do and do not recognise them as community health councils. However, that demand should come from the CHCs themselves. I believe that
I will be proved right when I say that CHCs would not seek to change their name if they were given that power, but would want to retain, or even add to, their brand name, so that all patients knew exactly what they did and how to get in touch with them.
One might say that all this talk about names is pedantic, and that what the CHCs do is far more important than what they are called. However, I believe that it is important for people, especially in an ageing population, to know who the patients' champion is and how to contact it. I remember, although not with fondness, our discussions on devolution during which we debated ad nauseam the name of the National Assembly for Wales. The debate continued for some time—it took up most of one sitting in the Chamber—on whether it should be the National Assembly of Wales or the National Assembly for Wales. We decided that we would call it the National Assembly for Wales, as it added a distinctive difference. Members of the Committee know that the vast majority of people in Wales call it the Welsh Assembly or, indeed, the Assembly.
During that debate, the right hon. Member for Swansea, East (Donald Anderson) intervened to say that the people of Wales had their own way of doing things and regularly shortened names; for example, the crematorium is known as ''the crem''. I made that wonderful joke about what the Assembly could be shortened to, which brought some light relief to the proceedings. The fact is that people will call it what they will, but it was important for us to get it right.
We also had great discussions about whether people holding portfolio posts should be called Secretaries or Ministers. In the end, after much discussion, we listened to what the Government had to say. They decided that they should be called Secretaries. One of the first things that the Welsh Assembly did was to change the change the name from Secretary to Minister, which is confusing. I avidly read about the Welsh Assembly every day in the Western Mail; I cannot think of anything better. Often, when they refer to a health Minister, I think of one person when they are talking about another. That is hugely confusing, and the Government are right that they should have been called Secretaries.
The main thrust behind amendment No. 1 is that we should widely consult the community health councils if we are going to give the Welsh Assembly the power to be able to change names, which will be significant. Indeed, I pay tribute to the community health councils themselves.
I turn now to amendments Nos. 2 and 15. One is an extension of the other. We are looking at the boundaries in which the community health councils operate. Amendment No. 2 would insert:
''that in abolishing a Council, altering the district in Wales for which a Council is established, or providing for the establishment of a new Council, it has the consent of the existing Councils in the area affected.''
That is important, too. It goes back to the question of being the people's champion. The CHCs might be something of an irritant to the Welsh Assembly. After
all they are there to ensure that the service is effective. If a CHC is doing its job efficiently, it is bound to find deficiencies and to expose them. However, the Health Secretary might find that irritating and take the criticism personally. The Health Secretary might wish to abolish that CHC, reconfigure it or do all manner of things to denude it of its recognised power in a local authority area.
I do not agree with the changes that have already been passed—they are coming in next year—that we should have 22 of these health boards. The whole thing will be hugely bureaucratic—there are problems already—and will lead to a fracturing of the current health service in Wales. I feel that the whole thing will be a disaster, but we know it will go ahead because it has already been passed. I will not rehearse all the arguments in this Committee, but if these health boards are to replicate local authority areas, let us at least have CHCs that cover each and every one of those areas. There should be coterminosity.
It is already confusing enough when people look to see who is covering them. Where does the buck stop in various levels of government and service? At the European level, we have one geographical boundary. We have five of them in Wales. If the European Parliament (Representation) Bill is passed this evening, we may go down to four. That will lead to another reconfiguration that is not based on the old European regions in Wales. That could easily be very confusing, at least for the people in a local authority area who have already gone through boundary changes. They are now getting used to their county areas. If a CHC replicates that local authority area, it may be easier for those involved to work out exactly what that area it is.
It is important that people know where the buck stops. If they have a problem in their area they will know that at least there is a CHC that covers the area, too. Amendment No. 15 would insert:
''that due regard is paid to the boundaries of those health authorities which a Council is to scrutinise.''
That is the coterminosity aspect, which would ease understanding. People would recognise the term CHC and know what it does. They know the area that it will cover and it will be one with which they are already familiar. The amendment is not a probing and certainly not a wrecking amendment. I am sure that the Minister will concede that all our amendments have the sole intention of improving the Bill. Improving the NHS should not be a party-political matter. We all wish to see the service improved for all the people of Wales.
The Government Whip will doubtless try to persuade Labour Members of the benefits of rejecting some of our amendments simply because they did not invent them. Rather than wasting time and waiting until the Bill goes to the House of Lords before the brilliance of our amendments is recognised—at which time the amendments will be slightly reconfigured before coming back to the House—why not accept them now and see them for
what they are; something that will lead to an improved Bill?
I hope that some Labour Members will be independent, as I know one or two of them to be, and that they can come across with us during the Committee stage. I leave it to hon. Members to judge whether they fall into that category or whether they would prefer to be slavish to the Whip's will. They will know how independent they happen to be, but by speaking up for the CHCs they will be speaking up for all of their constituents. They will ensure that their constituents are properly represented by the CHCs; organisations they know and a name that they understand.
May I, too, say what a great pleasure it is, Mr. Griffiths, to serve under your chairmanship, as it always is? I have no doubt that there will be great disappointment in your constituency as a result of the announcement that you will not seek re-election at the next general election. I know that your loyalty has always been with your constituency, but because your place of birth was in Brecon, the Brecon people also feel that they have another ear in Parliament as well as that of the elected Member for their constituency.
The Bill is widely regarded and supported throughout Wales. It went through a long process of pre-legislative scrutiny and consultation. It is an historic Bill, because it is the first Wales-only Bill since devolution. For those reasons, it has been a privilege to work on it. Indeed, it has given us an opportunity to build good relationships with the National Assembly for Wales.
That is not to say that all the processes of legislation, including the Committee stage, are not important. We have the opportunity to improve the Bill with our amendments and to ensure that the people of Wales get the best structures and bodies to represent them within the national health service in Wales. That must surely be at the top of the agenda for us all. Our Committee proceedings would have been rather short if we had had to rely on Government amendments; or, indeed, if we had had to rely on amendments from by the party represented by the hon. Member for Caernarfon (Hywel Williams).
We have often been told about the independent nature of a number of Labour Back Benchers, but that was not apparent today.
I return to the amendments tabled by the hon. Member for Ribble Valley and the Conservative party. I am concerned about the nature and tenor of their amendments, because many of them show that Opposition Members do not care about, or do not understand, the devolved settlement. Many of them would ensure that power stayed at the centre, rather than being devolved.
I must take issue with that and ask the hon. Gentleman to re-read the amendments carefully, because none is prescriptive. They would all require the Assembly not to act in isolation from the views of the rest of the Welsh healthcare community. That is not anti-devolution; it is common sense.
I do not agree, and when we come to new clause 1, which would determine the membership of CHCs, hon. Members will see that it is prescriptive and against the spirit of the devolution settlement.
Let me return to these amendments. The issue of names has been well rehearsed. It is a strength in the retention of CHCs in Wales that they will, for the time being, still be known by that title, because that will make them more accessible to the people of Wales. People often make use of such services only once in a lifetime, so the fact that the councils are easily recognisable and accessible is important. The amendment would not add an awful lot to the Bill; it might add a little.
The hon. Gentleman has recognised the importance of CHCs and people recognising the name, and we in England are pining because we shall lose them. The Assembly goes down the re-branding road constantly and does not care how much money it spends, as we saw the other day with the useless dragon logo for the Welsh Assembly. Is it not right that it should consult at least the very people who are there to champion patients' rights?
I do not disagree that the CHCs should be consulted, but the amendment says that there must be a request from the CHCs. That is slightly different, as I am sure the hon. Gentleman will agree.
I certainly would, but we should understand what CHCs do. As a group of people, their remit is to fight for patients' rights, so would it not be proper that the request should come from the organisation that is fighting for patients, as opposed to the interests of the Welsh Assembly, for example? I want the patients' rights to come first.
I thank the hon. Gentleman for all his interventions, because they are teasing out the issue. I would much prefer to accept an amendment that made it a statutory requirement for the National Assembly for Wales to consult; however, our experience of the Assembly is that it consults widely on these issues. I have no doubt that if there were any suggestion about changing the name of CHCs, the Assembly would consult widely, not only among CHCs, but among the people who use them.
As we are debating what should be in the Bill, surely the hon. Gentleman will accept that although the track record may be acceptable to him, the amendment would set it in legislative stone. It is not acceptable simply to leave matters on the basis of a historical track record.
I accept that, but one can always envisage circumstances in which the CHCs, for whatever reason, would not request a change of name. Many people could feel that such a change would add some benefit, but we cannot look into the future and know what will change in local government; the request is the issue.
Amendment No. 15 would ensure that the boundaries of the local authorities or districts were taken into account. Coterminosity can be argued for but, in practical terms, particularly in the area that I represent—where, for instance, the new local health board will represent the whole of Powys—a single CHC would be unwieldy. It would greatly discourage people from putting their names forward to serve on such a body if they had to represent an area of about 120 miles from south to north and about 60 miles from east to west. That is why the amendment would add nothing to the Bill. It would not find favour among people who wanted an active and positive CHC to operate in their areas, so we will vote against the amendment if necessary.
I welcome you to the Chair, Mr. Griffiths. I am sure that under your wise and even-handed chairmanship we will make good progress. I apologise for the fact that I have to leave by 12.10 today, as I have finally managed to make a dental appointment. Unfortunately, I could not make such an appointment in Wales before Christmas, so I have to go to a dental surgery here.
I called NHS Direct and various other bodies, and was told that I might be able to make an emergency appointment in Llandudno Junction on a Tuesday evening. Unfortunately, I am detained in this place at that time. If I were offered an appointment in Llandudno Junction on a Thursday evening, I might also be detained in this place. If I were at home, I should have to travel some 40 miles to take advantage of it.
I want to speak briefly on the subject of name changes. I represent the community of Cricieth. Hon. Members will know that there has been a dispute in my constituency since the early 1960s as to how many times the letter ''c'' appears in Cricieth. Some say there are two in the middle; some say that there are two in total; others say that it should be spelled with a k after the c. I therefore have a little experience of the sensitivity over the issue of name changes.
The Welsh Assembly and Government—the fully democratically elected representatives of the Welsh people—would consult. Were they to move on the basis of a request by CHCs, that would only be a
recipe for dispute and disagreement. I will not say that it would be a recipe for mischief, but that crossed my mind.
I consulted widely before attending the Committee, including with the Association of Welsh Community Health Councils. The hon. Member for Ribble Valley will be interested to know that it is already considering changing its name to something a bit more catchy. It even asked me what I thought, which I felt quite honoured about.
When the hon. Gentleman consulted people, did he have the opportunity to consult the person described as Plaid Cymru's shadow Health Minister, Dr. Dai Lloyd, before he made an announcement in the Western Mail about Jane Hutt ruling out any use of legislation on bed blocking? Did that announcement show Plaid Cymru's normal desire to oppose anything that emanates from Westminster, or was it borne out of a desire to show that the Welsh health service was as bad as possible so that Plaid Cymru might benefit?
The hon. Gentleman makes some interesting points. The relevant question for the health service in Wales is on capacity. Should the service address the subject of capacity in acute beds, 800 places would be available more easily. Plaid Cymru intends to pursue the capacity question in the National Assembly.
My final point is on coterminosity. My constituency is part of Gwynedd, and we have another community health council in the constituency represented by my hon. Friend the Member for Meirionnydd Nant Conwy (Mr. Llwyd). That is practically the only way to cope in that large geographical area.
I wish to start my remarks with a point of order, Mr. Griffiths. Four members of the Committee serve on the Select Committee on Welsh Affairs. They have been expected to attend our sitting this morning, as is right and proper. Is it possible to investigate the possibility preventing the clash of important Welsh issues within the House? I should be grateful if you gave that some thought.
It is nice to see the Liberal Democrats torn between crying their normal cries that they are the Opposition and being supine about everything Welsh and waiting to have their tummies tickled by the Government.
On coterminosity, one of the great concerns about community health councils is that people who need to contact them must not be allowed to fall through the cracks between geographical boundaries. There can be nothing more frustrating for patients with serious problems than to be told that they are addressing the wrong CHC and to be moved from pillar to post when what they really need is to get their points across quickly and effectively. I recognise the geographical constraints in Wales—the areas are huge and the infrastructure makes it difficult for people to move
around—but that is a good reason for ensuring that patients do not fall between two community health councils in a geographical sense.
Although I am a critic of the Welsh Assembly, none of the amendments seeks to prevent it from reflecting the feelings and wishes of the Welsh people. However, we should try to have consensus about things that affect patients. I should like to see that reflected in the Bill, so several of the amendments aim to ensure that CHCs consult with one another so that there is no overlap.
The hon. Member for Brecon and Radnorshire (Mr. Williams) made the point that if there were a benefit from some of the proposed changes to names or boundaries, they would proceed without consultation. Surely if there were a benefit to be had, the consultation would take place and it would be agreed. Therefore, his criticism of the amendment was unfair; we all want to see benefits brought out rather than suppressed.
I felt strongly about the wording of subsection (2), which lists a variety of words:
''Supplementary, incidental, consequential, transitory, transitional or saving provision''.
Some of those cause me confusion; not because I do not understand them but because I am sure that others might struggle with them in this part of the Bill. One of the tasks of the Committee is to make legislation easy to understand, rather than more complicated. I hope that the Government will take note and comment at length about why they agree with us on the amendment, which would remove that confusing subsection.
I hope to share much with the Committee, apart from my cold, which I am just getting over. We have had an interesting debate and before responding to the comments that have been made about amendments, I shall touch on the broad thrust of clause 1, which allows us to reform and strengthen community health councils in Wales. It recognises their importance and provides them with a sound legislative foundation to strengthen the voice of the patient and the public.
Community health councils are ideally placed to represent patients, but until now they have not had the opportunity to fulfil their potential. This clause seeks to do that by doing a number of things. It allows for the continued independence of CHCs—to which this House and the Assembly are fully committed—and it encourages movement towards more open membership of CHCs, including the creation of new opportunities for other people, especially groups who are under-represented in Wales, to take part in the work of CHCs.
The clause will allow CHCs to provide, on behalf of the Assembly, an independent advocacy service for people who wish to complain about the national health service. It will give CHCs the right to enter and inspect any premises where NHS care is provided. That includes health bodies, providers of family health services such as GPs, dentists and opticians, and other premises, such as nursing homes, where primary care is provided. It also allows the inspection of premises
situated in England and mirrors the powers of patients' forums in England to inspect premises in Wales.
The Minister talked about the ability of different groups to participate in CHCs, but does he accept that many of the powers of those communities are vested in the Assembly, not directly in CHCs? Does he further accept that several of the amendments are designed to ensure simply that the voice in the creation, structure and operation of CHCs that is vested in communities is not controlled by politicians and can, in some cases, be exercised directly?
No, I do not agree with anything that the hon. Gentleman says. As we shall see when we discuss other clauses, the Conservative party wants to restrict the opportunities of people who are not politicians to become involved in the management of the health service.
The clause allows for the creation of an all-Wales body to support CHCs and sets standards for them to follow. You will remember, Mr. Griffiths, the commitment that you gave to strengthening, reforming and improving the work of CHCs when you were first a Minister in the Wales Office. We are taking forward that agenda.
I shall now deal with the amendment tabled by the hon. Member for Ribble Valley; not one to hide his light under a bushel, he described the amendment as ''brilliant''. I thank him and all the other Opposition parties for their support and co-operation in the extensive pre-legislative scrutiny of the Bill, but it is still important for the Committee to scrutinise the Bill as thoroughly as possible because we should not undermine the duties of Members of Parliament.
Amendment No. 1 would prevent the Assembly from changing the name of CHCs, except in the event that groups or councils asked for such a change. That could have bizarre consequences. The hon. Member for Ribble Valley asked what was in a name; we could, perhaps, foresee that Morgannwg community health council, which covers the great city of Swansea—the hon. Gentleman's home town—might decide to call itself the Nigel Evans Morgannwg community health council. That would be bizarre.
I can understand why it might want to do that. [Laughter.] It is obviously attractive to the Committee that it should be allowed to do so. However, if the council wanted to do that, it would tell the Welsh Assembly, which would see the benefit of the name change and allow it. At least the request would come from the CHC, as opposed to the Welsh Assembly deciding to rename a CHC the Don Touhig CHC.
This gets more attractive every minute, but the hon. Gentleman contradicts what he said earlier. He spoke previously about the effective branding of CHCs but he now seems to be suggesting something else.
The amendment would prevent the Assembly from renaming all CHCs to give them greater visibility and better corporate identity in Wales unless the CHCs
unanimously asked for that change to be made. The Bill provides that the Assembly must seek, by agreement, to discuss any name change with CHCs. However, the amendment would shift the onus for a name change to CHCs, which would then have to instigate the whole process. A single identity and name is important. The Assembly would consult widely on any proposal to change the names of CHCs, and I am sure that hon. Members on both sides of the House are aware that the Assembly has groundbreaking processes for widespread consultation on any changes that it plans to make. I do not share the fear expressed by Opposition Members that the Assembly would not take full account of the views of the wider community and CHCs if it decided to propose a change to the name of CHCs. Members should be reassured.
Does the Minister accept that the fundamental principle underlying this issue is the nature of the CHCs? They are supposed to be an independent scrutineer of the performance of the national health service in Wales, which in turn is administered by the National Assembly. The importance of dividing the two bodies and leaving accountability with the independent body is as much about the relationship that should exist between the two as it is about devolution.
I agree in part with the hon. Gentleman. I know that the hon. Member for Brecon and Radnorshire had some doubts about the Assembly's record on consultation and in defending the independence of bodies like CHCs. Devolution does not end in Cardiff and goes much further; more people should be involved in the taking of decisions that affect their lives. That is why we proposed reforms to the health service in Wales and created local health boards under a Bill in the last Session. It is important to protect that independence, but it is also necessary to give the Assembly powers whereby it can decide, following consultation, that CHCs will be called by another name if it is thought to be more appropriate. That would be done only after the fullest of consultation.
Amendment No. 2 relates to the abolition of CHCs. If it were passed, it would prevent the Assembly from abolishing CHCs, changing the boundary of a community health council or establishing new CHCs. Only if it retains this power will the Assembly be able to ensure that we have a network of strong CHCs throughout Wales, covering the relevant geographical areas and operating standard practice. Allowing the Assembly to make changes to a council or councils only at the consent of the councils concerned would restrict its ability to pursue the changes that it wants to make in the interests of patients.
Throughout Wales, we have seen the benefits of CHCs forming federations. That made sense. The situation was not prescribed; it evolved, and has benefited the operation of CHCs and the people whom we seek to serve. There is no intention of changing the boundaries of CHCs in the short term. The National Assembly Minister for Health and Social Services, Jane Hutt, made it abundantly clear that she does not
believe it to be appropriate to start examining the boundaries of CHCs. That may happen later, but will depend on further discussion between the Assembly and CHCs.
No, I have not. I am aware of the points that the Assembly Minister made, but it is important that, at this stage, the Administration of the Assembly does not believe it to be appropriate to make any changes to the boundaries. If it becomes necessary to make any such changes, the Assembly will consult all the relevant councils and key stakeholders before it does so to ensure that it is acceptable. I should make it clear that the Assembly's consultation system is open and transparent. It runs for about 12 weeks and is based on Cabinet guidelines on the principles of consultation. It is a model, and I have no doubt that there would be widespread and extensive consultation should any change be proposed.
''In making an order the Assembly must ensure . . . that due regard is paid to the boundaries of those health authorities which a Council is to scrutinise.''
In effect, if the amendment were accepted and the Assembly made any proposals, it would be the end of the story if it said that it had given due regard to the boundaries of the health authorities that the council is expected to scrutinise. The amendment is unnecessary, because the Bill will ensure that the Assembly gives due regard to any changes by making them part of the consultation.
Most CHCs are already coterminous with NHS organisations and they are already working in federal structures, which have proved beneficial in many parts of Wales. The federation structure allows CHCs to exert more leverage at all levels of the NHS as well as linking them more effectively with local authorities. Further arrangements will develop to ensure that CHCs engage effectively with the new NHS structures coming into play next year. Although the Assembly does not wish to make further boundary changes in the foreseeable future, should the Assembly and the CHCs decide that it is appropriate to do so, the Bill will allow maximum flexibility to make the changes. The amendments take us no further towards improving the quality of the Bill. I understand the hon. Gentleman's points and it is right to explore them, but the amendments will not move us further forward.
The hon. Member for Brecon and Radnorshire was surprised that the Government tabled no amendments, but I am surprised that he was surprised. It shows how little the Liberal Democrats understand how this place operates. All Governments seek to avoid amending their legislation once it has been published.
I noticed that the hon. Member for Caernarfon made no response to my hon. Friend the Member for Cardiff, Central (Mr. Jones) on the matter of bed blocking. It is a question of one voice in Wales and another voice in London; precisely what we have come to expect from the nationalist party over the years. I urge the Committee to reject the amendments.
I am deeply saddened that, although the Minister recognises the importance of debating the issues fully to improve legislation, he fails to see the merit in these particular amendments. I should like to refer to some of the points raised in the debate.
The hon. Member for Brecon and Radnorshire sees the merit in consulting CHCs, but does not believe that they should be in the driving seat when it comes to name changes. My hon. Friend the Member for Epsom and Ewell may have distracted him from reading the Western Mail today—
Mr. Roger Williams rose—
Let me finish and then I shall allow the hon. Member for Brecon and Radnorshire his Christmas present; an intervention. It is argued that we should accept devolution and the Assembly. Of course we accept them and we shall fight the elections next year. I hope that we shall bring more common sense to the Assembly; controlling it would be the best solution to delivering better services. However, we are referring to real devolution. The hon. Gentleman has the fanciful idea that devolving power from this institution to another institution is what devolution is all about—
Nothing in the Bill stops CHCs from requesting a change of name, but surely the point is whether a change could happen without their request. That is the key issue.
I am grateful for that intervention, but we want to see change happening. The hon. Member for Caernarfon intimated that his own CHC is already gearing up to name itself it after him or some other name that people will easily recognise; they at least will be in the driving seat.
That is the most amazing defence of devolution. If the hon. Gentleman were a Catholic, he would have to go to confession. He refers to an article in this morning's edition of the Western Mail. In it, a leading Conservative Assembly member, Glyn Davies, said that the Conservatives must
''end their grudging acceptance of devolution''.
However, he went on to say:
''We can all agree that devolution is a dangerous and unpredictable process''.
I am not clear where the hon. Gentleman and his party stand on devolution.
I shall tell the Committee where we stand on the Bill. We want to ensure that power resides at the most appropriate level. In this case, we are ensuring that the power to change the names will reside with the bodies that act as the patients' champions. They have a particular remit, which is to improve the health service behalf of the patients. There is no reason, therefore, why a CHC would want to obs—
Obfuscate. I should go to the same dentist as the hon. Member for Caernarfon, if we could find one in Wales.
Those bodies would want as many people as possible to know who they are and what they do. The Welsh Assembly, which is presiding over the health service in Wales, may not have the same reasoning. We already know that Jane Hutt is irritated when she opens her newspaper to see that people find fault with the national health service. She finds it irritating because people criticise the way in which the NHS is turning out. She tries to say that she has no responsibility for it and that people should not criticise her for it, but the fact is that she should be ensuring that the money goes into the right areas. Frankly, that is not the case; people should be criticising her if there are problems and deficiencies. That is one of the key roles of the CHCs, and that is why I would wish to put them in the driving seat.
In his earlier remarks, the hon. Gentleman suggested that if a community health council became difficult, Assembly Ministers might want to use their powers to get rid of it. That is not how we do things. We all remember a certain Baroness Thatcher abolishing the GLC because it was a constant thorn in her side. We do not do that. It may be the Tory way, but it is not the Labour way.
Congestion charging, Mr. Griffiths, is most certainly straying from Wales. Perhaps the Welsh Assembly's answer to too many patients seeking service from the NHS in Wales would be to introduce a congestion change. The whole point is to put the CHCs into the driving seat.
The hon. Member for Brecon and Radnorshire observed that there are no Government amendments. I have sat on many Committees when some of the more independent thinkers have read a Bill and thought that they would try to improve it. It may be a bit of an irritant to the Government that their Back Benchers should think that there are still ways to improve the Bill even after the scrutiny that it has already received, so they table amendments. They may not press them to a vote, and I can understand why. It would be a career-limiting move in many respects, I suggest.
At least we would debate the amendments, and it is possible that an appropriate amendment could be tabled in the Government's name in another place. Progress could be made and improvements to the legislation may result. I am slightly disappointed, but the day may yet come when one or two of the more independent minded Labour Members may look at a Bill and decide that it could be improved with one or two amendments that we could debate. We shall see.
We wish the hon. Member for Caernarfon well later on in his dental appointment. Again, there is a real problem. I remember the hon. Member for Monmouth (Mr. Edwards) had problems finding an NHS dentist; such problems exist. That area could be resolved through the independence of the CHCs, which the Minister mentioned. The hon. Member for Caernarfon talked about his CHC looking at ways to change its name and to make it more relevant to the people in the area. As the Minister intimated, CHCs have a branding that people recognise. That should be retained.
Real devolution would be the CHC in Caernarfon suggesting a better name that would be more recognisable in the area. Under the Bill, they could write to Jane Hutt and say, ''This is a jolly good idea. What do you think?'' She might say, ''It is an interesting idea, but we believe that devolution ends at the Welsh Assembly. We make these decisions on behalf of the people of Caernarfon, not the CHC in Caernarfon.'' Surely if we believe in devolution and we devolve the power to the CHCs—they want to be the driving force and they want the name to be changed—they should have more of a say. I am worried about the reverse. The Welsh Assembly could decide that it wanted the name to be changed. Even though there had been consultation, it could announce that it would change the CHC name in Caernarfon to something that was less recognisable. That is the problem and that is why we have tabled the amendments.
The Minister referred to the independence of the CHCs—this is what the clause is all about—and we believe in that, too. As CHCs have a unique role in championing patients in Wales, we believe that they should be independent, too. We have tabled the amendments in order to give them greater independence from the Welsh Assembly. The Minister says that of course the Welsh Assembly will consult. During the passage of the devolution legislation, whenever we said that certain things would happen, we were told that we were just being negative and that once the Welsh Assembly was up and running it would be the answer to all Wales's ills. As generous as one may wish to be towards the Welsh Assembly, no one can argue that that is the case. Indeed, let us take the example of the building. We were told that it would cost between £12 million and £17 million—
Yes, and it is a shame. I could table many amendments if it were. I am talking not about the building but about consultation. I am talking
about a process that the Welsh Assembly might adopt on many matters, including changing the name of a CHC. I used the Welsh Assembly building as an example because if it consulted on that, it would find that the people of Wales said no. But it has decided not to consult the people of Wales, even though the cost has gone way through the roof. When the Minister tells me to be reassured that the Welsh Assembly will consult, I am not reassured in the slightest. I believe that we ought to put safeguards in the Bill to protect the independence that the Minister says he cherishes.
If it will help the hon. Gentleman, I will give him and all members of the Committee a note explaining the Assembly's procedures for consultation. It is very open and transparent. It is based on Cabinet Office guidelines. The Assembly's own standing orders require that it consult as widely as possible for any changes covered by the amendments. I will happily do that to assuage his fears and reassure him that, should there be any change, my colleagues in the Assembly will carry out the widest possible consultation.
During the Select Committee's evidence gathering, the hon. Member for Conwy (Mrs. Williams) asked
''what the main differences are between CHCs in Wales and the Patients' Fora in England?''
Ms Hutt replied:
''I think the main difference is the Community Health Councils are going to be independent and they are not going to be part of the Health Service.''
Clearly, we are questioning that independence today. It would be written into the Bill if the Government accepted the amendments. Ms Hutt continued:
''The Patients Fora, which is the equivalent in England, is going to come into being. If we look at the different powers they are going to have the same right of entry, for example, as the Patients' Fora; and Community Health Councils are going to have the same right of entry. I think the main issue is that the Patients' Fora are going to be more part of the Health Service in England; whereas the Community Health Councils are going to have more of an independent role in relation to patients and to the Health Service.''
Surely that is what we are trying to achieve with the Bill; it is what Assembly Members want and what we want. I hope that the Government will reconsider their position.
I am grateful for the intervention from my hon. Friend the Member for Leominster (Mr. Wiggin), because we want the body to be independent. Both he and the Minister have mentioned patients' forums. We do not wish such bodies to be introduced in England but, with the help of votes from some Welsh Members, there was a vote to get rid of our CHCs and to institute patients' forums. I still find it difficult to remember the name ''patients' forums''. As I have said, the name ''CHCs'' had a bit of a ring and a bit of kudos to it. That is why I would prefer them to stay, but I would recognise patients' forums if community health councils in Caernarfon, for
instance, wished the name to be changed. It is consultation and consent that are important to a body that exists to scrutinise services. That is why we tabled the amendment.
We have been accused of trying to restrict the change and the Assembly's ability to change what it wants to. That is absolutely right, because we are the primary legislative body for the health service in Wales, irrespective of whether others in the Welsh Assembly like that or not. The fact is that that power resides here, and we have a duty of care to patients in Wales to ensure that we do what we can to improve the health service that they receive. I am therefore happy to plead guilty to the charge of trying to restrict change. We are doing it with the purpose of protecting the independence of CHCs.
The Minister says that we should be reassured that Jane Hutt does not want to change the boundaries—then he adds ''at the moment''. It was at that point, sadly, that I started to feel queasy, because as we know those changes could take place at any time in the future. Indeed, with the reconfiguration of the NHS in Wales and the 22 bodies that will exist, I suspect that there will be mergers in future because they are untenable as constituted. No doubt the CHCs, with due regard to the configurations, will want to represent the new structures in future.
We cannot say what will happen, but an assurance from the Minister that the current health Minister in the Welsh Assembly does not want to change the boundaries at the moment does not fill me with the confidence that he hoped it would. That is why we shall press the amendment to a vote. We want to demonstrate clearly that when we talk about devolution, we are talking about devolution that protects the interests of all the patients of Wales, including the bodies that champion their rights. We believe in devolution that devolves to bodies, not just political institutions that have been created recently.
I am intrigued by the hon. Gentleman's arguments. Amendment No. 15 refers to
''due regard . . . to the boundaries of . . . health authorities''.
Is he aware that health authorities are to be abolished in Wales as from next April? Was he referring to those bodies that are to be abolished, and did he, or did he not, vote for that abolition?
The hon. Gentleman will fully understand that, when we talk about due regard being paid, as the Minister himself said, to the boundaries of those health authorities that a council is scrutinising, those health boards—[Interruption.] The hon. Member for Monmouth (Mr. Edwards) will know that those—
I can understand, given the way the hon. Gentleman thinks, why he cannot get his mind round the thrust of the amendments. However, if he were concerned about the best interests of the patients in his area—he already gives as an example a deficiency in NHS dentistry—he, too, would want to ensure that CHCs were independent, that they were fully recognised, and that they covered an area with which
they were comfortable, rather than allowing the Welsh Assembly the freedom to change, at will, the areas that they cover. That is why we wish to put the amendments to a vote.
While we accept that devolution is healthy—we have always done that, even during the time of the great Baroness Thatcher, whom the Minister mentioned and in whose praise in the United States yesterday the Prime Minister is no doubt revelling—we believe in a devolution that devolves power down to as many groups and organisations as possible. They are important because they fight for the rights of individuals rather than those of politicians and political institutions.
Question put, That the amendment be made:—
The Committee divided: Ayes 4, Noes 11
I beg to move amendment No. 7, in
clause 1, page 1, line 18, leave out subsection (2).
This amendment addresses a clause of the type that one is never quite certain about. It is the responsibility of the members of a Committee such as this to be sure what an amendment is about before it is passed. When I read it, I was reminded of an episode in the book ''I, Claudius''. Following a rebellion led by his wife, the emperor discovers that he has already signed her death warrant in a huge pile of papers that was slipped through by one of his team the night before. He calls to meet her, but she is no longer able to see him. This clause might well achieve a similar situation. We are handing over substantial powers without knowing precisely what they are. I think that this is a probing amendment, and I hope that the Minister's response will be sufficient for that to be the case. The Committee would be irresponsible to legislate for sweeping powers without knowing what it was doing.
My hon. Friend the Member for Ribble Valley said in the last debate that it was important that the CHCs were independent. If they are to do a proper job of scrutiny on behalf of the people whom they represent, if they are to be able to criticise the national health service in Wales, unfettered and free of political interference, it is essential that they are independent of those whom they scrutinise. Many of the Bill's provisions will result in their not being truly independent; if the Government get their way, the National Assembly for Wales will retain many controls over the people, the nature and the structure of the CHCs. The Assembly will have the right to intervene and make changes if it so wishes, whether or not they are in the interests of patients.
The Government have a track record of overruling independent regulators when they choose to do so, and I have no doubt that the Assembly—dominated as it is by a Labour Administration—will be willing to do the same. The Minister may not agree, but I remind him that it is only 12 months since a Secretary of State threatened to introduce legislation to overrule an independent regulator in order to secure his own political wishes. It is conceivable that another Minister will decide to take a similar step. It is fundamental that we understand exactly what this part of the Bill will allow a Minister to do, and the limitations—or lack of them—on that Minister's power.
I ask the Minister to explain what the various elements of the clause mean. For instance, subsection (2) refers to
''Supplementary, incidental, consequential, transitory, transitional or saving provision''.
What does that mean? How wide can such a provision go? Will he give us an idea of the different elements that could be encompassed by those broad terms? What changes might it allow?
Will the Minister explain the reference to ''regulations'' in subsection (2)? What might such regulations encompass? What powers does he envisage the Assembly having to make changes to CHCs? Will that allow, at least in theory, the abolition of CHCs? Will it allow the wholesale restructuring of CHCs? Will it allow a change to their remit that removes their independence to scrutinise the workings of the national health service?
Subsection (3) includes the words:
''may include provision amending or repealing any provision''.
How wide-ranging is the word ''any''? Does it cover any provision relating to CHCs? Does it mean that the ruling group on the National Assembly will have absolute power to do anything that it pleases to CHCs, without reference to the primary legislative body at Westminster? If it does that—I reiterate what I said about independence—we will be giving rights to the Assembly that allow it to be both poacher and gamekeeper.
The CHCs have an independent scrutineer of their services, with a specific remit to consider what is working and what is not working in the national health service in Wales. However, I wonder whether, if the Assembly so chooses—if it is embarrassed by the work of the CHCs, or frustrated by a steady stream of adverse publicity, or does not like the people who are active in the CHCs—it can simply tear the whole thing up and start again. That would be a dangerous principle for the House to endorse, and I ask the Minister to explain it.
Subsection (2) concludes:
''provision made by or under an enactment''.
Will the Minister define that? What does ''enactment'' entail? Are we talking only about enactments of the Welsh Assembly, or of references back to Westminster? If the Assembly wanted to introduce new regulations, would they have to be considered
here? Will the Minister define exactly what that provision entails?
We need to understand how much control over the independent voice of patients in Wales is being placed in the hands of politicians. One of the things that is holding back the national health service in this country is that the day-to-day political involvement is too great. Health care will be improved only if politicians collectively take a step back and leave greater responsibilities in the hands of healthcare professionals and communities.
As we discussed in a debate on the Floor of the House a couple of weeks ago, community health councils can and will be extremely important in ensuring the de-politicisation of the national health service. In the end, however, that independence may be worth nothing if we leave the destiny of CHCs—how they work and are allowed to work—in the hands of elected politicians to whom we give draconian powers to make changes, and in so doing subject them to the vagaries of electoral change and political personality. I hope that the Minister can explain the clause and reassure us. The clause may be entirely innocuous, but it appears, at first glance, to offer the Assembly draconian powers. The Minister needs to explain in some detail what it actually means and what the consequences might be.
The Tory party's love affair with devolution has not lasted long. We now see the true colours of the Tory party; it is opposed to the devolution settlement in Wales. The amendment flies in the face of the devolution settlement, because the Bill gives powers to the Assembly, as other legislation has done, in order to enact secondary legislation as it affects regulations concerning matters that we are putting before the House.
The amendment proposes the deletion of subsection (2), which allows the Assembly to amend or repeal measures in primary and secondary legislation consequent on making secondary legislation under clause 1. We have done that ever since the devolution settlement has existed, and in other legislation where the House has given powers to Ministers in Whitehall Departments to use their powers to make regulations effective in legislation that has gone through the House.
Section 126(4) of the National Health Service Act 1977 extends the powers under that Act to make orders and regulations to include such prescribed supplementary provisions as considered appropriate. Clause 1(2) extends that power when used in connection with orders and regulations made under clause 8 and schedule 1 to include provision for amendments and repeals of primary and secondary legislation. The amendment would remove that power to make such amendments or repeals. The hon. Member for Epsom and Ewell referred to it as a probing amendment. It is, however, a spoiling amendment that seeks fundamentally to undermine the devolution settlement that now successfully operates between the United Kingdom Government and the Assembly.
I have no doubt that Members should consider such a proposal. My point is that, only a few moments ago, the hon. Member for Ribble Valley declared his love for devolution; now we see the hon. Member for Epsom and Ewell rowing back as we go. It goes without saying that the Tories do not support the devolution settlement, and would undermine it at every moment.
Does the Minister accept that the clause is legalistic? We are right to seek its interpretation, as my hon. Friend the Member for Epsom and Ewell intimated. If we did not do so, and we got it wrong, the powers may turn out to be ones that we did not want in the first place. Will the clause allow the Welsh Assembly to alter any provision in schedule 7A so that it can do anything that it wants under schedule 7A?
If accepted, the amendment would prevent the Assembly from making essential, consequential changes to other enactments that must accompany the exercise of the subordinate legislative powers of the Bill. That is perfectly clear; we do it all the time in this place. It is important to strike a balance between setting out in detail the requirements and duties to be placed on community health councils and the preservation of their independence. The Government believe that the Assembly should be given the broadest possible discretion to decide on the detail of regulations and to take the most appropriate action required by the new-look CHCs in Wales.
The amendment is also inconsistent because powers to amend or repeal other enactments feature in most Bills conferring subordinate legislative powers as they pass through the House. The Assembly would be restricted in making regulations about CHCs when identical powers to amend or repeal other enactments are available in respect of the Wales Centre for Health, which we shall come on to later, and of the health professions in Wales under clause 8.
I am surprised that the official Opposition again seek to roll back the devolution settlement by suggesting that a perfectly proper and sensible enactment conferring powers on the Assembly as we have in the past in order to help make the primary legislation work should be stopped. I am amazed that they want to roll back and stop it.
I was hoping that the Minister would be less partisan and more helpful in explaining what the extraordinary feast of words means. We have a duty to produce clear legislation and I am struggling to find the requisite clarity, so will the Minister explain what subsection (4A)—
''Supplementary, incidental, consequential, transitory, transitional or saving provision made by virtue of subsection (4)''—
actually means? [Interruption.] A feast of notes is flowing backwards and forwards. Yes, it would benefit the whole Committee to know what that means. It is
legalese spaghetti and I hope that the Minister will properly explain what he is trying to achieve by it.
The Minister's response was disappointing and unnecessary. He should understand that it is the duty of all Members to scrutinise legislation and understand what the provisions mean. It is all well and good for the Minister to say that it has been done many times before. As the Minister responsible for the Bill, it is his duty to explain the limits and scope of what he is trying to achieve. He did not answer any of my detailed questions, although he allowed one or two snippets through, such as his reference to the ability to modify primary legislation. My understanding is that the primary legislative responsibility for the NHS in Wales rests with this House. If the Assembly will have the right to amend primary legislation, why and to what extent is that so? What aspects of primary legislation could be amended as a result of the clause, or is it limited wholly to CHCs?
I realise that Ministers have busy lives and cannot always be expected to understand the finest detail, but now that the Minister has had an opportunity to give the matter greater thought and study his notes more closely, perhaps he will explain simply what he is trying to achieve. It is not a partisan issue about the extent of devolution or rowing forwards or backwards; it is all about the House of Commons doing its job. Before we pass a clause offering a significant transfer of powers—irrespective of whether it has been done before, or whether it is conventional or consistent with devolution—the Minister must properly explain what is going on. As I said at the outset, this is a probing amendment intended to elicit the Minister's clarification. All I want is for the Minister to answer my questions so that the Committee knows what it is doing.
Good Lord! I shall try to make it simple. It is perfectly obvious. Without the power to amend or remove existing provisions in other enactments, it would be impossible to exercise the powers in schedule 7A. This part of the Bill allows the Assembly powers to make regulations changing other enactments, in order that the provisions of the Bill can be put in place. It is as simple as that. I am not dismissing the matter, as the hon. Member for Epsom and Ewell possibly suspects. We have been through the process a number of times in relation to measures that affect Wales; that is why I was surprised that the Opposition tabled the amendment.
The Minister has answered my question. I am grateful for that clarification, which he could have given in two moments at the start. It is the responsibility of Committee members to ask questions so that we know what we are doing. I am grateful, and I am happy to beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Clause 1 ordered to stand part of the Bill.