Schedule 1 - Schedule 7a to be inserted in the

Health (Wales) Bill – in a Public Bill Committee at 12:00 pm on 10th December 2002.

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Photo of Nigel Evans Nigel Evans Shadow Secretary of State for Wales 12:00 pm, 10th December 2002

I beg to move amendment No. 6, in

schedule 1, page 6, line 10, at end insert—

'(c) to publish an annual report on the level and quality of the health services in its area.'.

In essence, amendment No. 6 imposes an obligation on the CHC in each area to publish an annual report on the level and quality of health services. That is important. New schedule 7A, which forms schedule 1 on page 6 of the Bill, starts by stating what the duties of a community health council should be. That is

''to represent the interests in the health services of the public in its district''.

Some hon. Members might ask why that is there; surely it is common sense that that is what a community health council is there to do. However, the Government have decided to include that in the Bill; rightly, because it reminds CHCs and the patients whom they represent what their remit is. It is not superfluous; it is important that that statement is there. It continues with paragraph 1(b):

''to perform such other functions as my be conferred on it by regulations under paragraph 2.''

Paragraph 2 is extensive. One of its provisions, in sub-paragraph (h), is for

''the preparation and publication of reports by Councils''.

Some hon. Members might argue that that is already covered, but I would say that the National Assembly for Wales might make no such provision by regulations. It might not consider that that is the most important thing that a CHC might do. Sub-paragraph (i) mentions

''matters to be included in any such report''.

The Assembly might decide that certain areas ought not be covered by regulations, for all sorts of reasons.

I have already spoken about Jane Hutt being irritated when people point out where there are deficiencies in the health service. Our amendment is therefore important, in that it ensures that those areas are covered. I am sorry that the hon. Member for Monmouth has gone out because sub-paragraph (j) refers to

''the furnishing and publication by Health Authorities, Local Health Boards and NHS trusts of comments on reports of Councils;''.

The hon. Gentleman had some difficulty in recognising health authorities. That is an important part of an important schedule, and that is why we have tabled the amendment. We have asked that the CHC in each area should make its own report about the level of provision in its area. That was touched on when we discussed the first amendment and the hon. Member for Caernarfon said that he had a problem in finding a dentist who could treat him at a time that was appropriate for him.

Some people may ask, ''What is the NHS there for? Is it for us to serve them, or is it the other way round?'' I would think that it is the other way round; to ensure

that it serves the patients in each area. The hon. Member for Caernarfon has a problem finding an NHS dentist in his area who can treat him at an appropriate time. It is quite right that the annual report published by the CHC in accordance with the amendment should contain the fact that the provision of dentistry in his area is inadequate.

Memorably, the hon. Member for Monmouth, on the front page of his local newspaper, complained that he found it difficult to get himself on the list of an NHS dentist in Monmouth. That is a problem, though it does not solely affect the hon. Gentleman; I understand that there are a number of people who found it equally difficult to find an NHS dentist in Monmouth. People are paying into the national health service, and they expect to be able to get a dentist in their own area, at a reasonable distance from them. I think that we would all expect that.

Photo of Roger Williams Roger Williams Liberal Democrat, Brecon and Radnorshire

Does the hon. Gentleman think that the situation of the hon. Member for Monmouth will be improved by the publication of an annual report?

Photo of Nigel Evans Nigel Evans Shadow Secretary of State for Wales

I actually think that it would. I hope that there will be regular interim reports on given areas, so that inadequate provision in all types of NHS care can be addressed immediately, and only not once a year. However, the report once a year could at least reflect on some of the other reports that the CHC had produced, and some of campaigns that it had been waging. If problems were not being addressed properly in a given area, the CHC could say, ''This is what needs to be done. We're very unhappy about this. We have asked for certain changes to be made. They haven't listened. There is a real problem, and the lack of provision is going to continue, unless this happens.''

Conversely, a CHC could say in its report, ''We have featured this particular problem in one of our sub-reports. We now mention it again in this annual report to say that our concerns have been taken on board.'' There could be extra provision of dentists in Caernarfon or Monmouth, or in another area. Monmouth is a large constituency. Although there may be good provision of dentists in, say, Chepstow, a lack of provision in the town of Monmouth itself would be a problem. People should not be expected to drive huge distances.

Let us say that a CHC mentioned a problem in one of its sub-reports—for example, that the hon. Member for Monmouth found the lack of provision a difficulty—and that it was then addressed. The CHC could rightly say, ''We're pleased to see that the concerns we raised earlier have been met. There is much better provision and people in a local area have no difficulties whatever in finding an NHS dentist.''

Photo of Bill Wiggin Bill Wiggin Conservative, Leominster

My hon. Friend will recall that the idea of publishing an annual report was deemed to be so important that the Government did it more than once, until they recognised that the content was counter-productive, in terms of their electoral ambitions. I hope that he will ensure that the Government continue to support the idea of annual reports. The amendment

will ensure that, unlike the Government, the CHCs will not be able to suspend the reports once they find that the content is not favourable.

Photo of Nigel Evans Nigel Evans Shadow Secretary of State for Wales

That is why the amendment is to paragraph 1 of new schedule 7A, as opposed to paragraph 2. The amendment seeks to impose a duty on a council

''to publish an annual report on the level and quality of the health services in its area.''

It would override paragraph 2(i), which refers to

''matters to be included in any such report''.

That would mean that the Welsh Assembly could decide what would and would not go in the report, because that is the advice in the schedule. With the amendment, even if the Assembly did not think it a priority, CHCs would know that they were required to publish a report; as the patients' champions, I am sure that they would.

I can understand Jane Hutt being irritated by a report that highlights a lack of provision in the NHS over which she presides, and she might not think that a report needs to be produced on why the hon. Members for Caernarfon and for Monmouth are having difficulty in finding an NHS dentist. The amendment, however, would place CHCs under a duty to publish such a report. I hope that those hon. Members will get in touch with their local CHCs and ask them to investigate the lack of dentistry in their areas and include their findings in a report.

The hon. Member for Brecon and Radnorshire asked whether a report would make any difference. I hope that it would. To return to the issue of the monopoly provider, there is increasing private dentistry provision, but I believe that a sizeable proportion of people in Wales want NHS provision. After all, they pay into the NHS through national insurance; they will pay an extra 1 per cent. from April. Indeed, local authorities will pay an extra 1 per cent. for their employees, which will lead to higher council taxes, so people will be paying again. They will ask why they cannot have their teeth done by an NHS dentist. I hope that the Minister agrees that this is a sensible amendment, not a wrecking amendment.

Jane Hutt may not be especially grateful for scrutiny of other areas of the health service, such as waiting lists, for which the amendment would provide. I shall not repeat the speech that I made on Second Reading, when I reflected on several areas in which there are real problems. However, we know that problems arise in certain areas from time to time. We will always find problems in a health service the size of the NHS in the UK. For example, the scarcity of consultants and surgeons in certain areas is a problem. The scarcity of nurses is another problem; that is the reason why we are scouring countries where there are a surplus of nurses and trying to attract them here.

The hon. Member for Cardiff, Central mentioned bed blocking in connection with the Plaid Cymru spokesman on the health service in Wales. It has been mentioned that more than 1,000 patients are blocking NHS beds in Wales, and the approach of fining local authorities for not freeing up beds has been questioned. We will see what happens. Bed blocking

concerns us all, including CHCs. If fines are used as a tool to free up beds in NHS hospitals in Wales, beds may become more available. Those 1,000 beds could then be used for people who need treatment. One thing we do know, however, is that two people do not share a bed. The Government may be thinking of introducing such a proposal, but that is not yet done and a bed can be used for only person. CHCs may wish to raise that in their annual report and, indeed, in some sub-reports.

Photo of Chris Grayling Chris Grayling Opposition Whip (Commons), Shadow Minister (Health) 12:15 pm, 10th December 2002

Does my hon. Friend recognise that, far from being entirely a vehicle for negative scrutiny—as, I fear, Ministers might think—the production of annual reports could be a vehicle to enhance the quality of care by disseminating best practice through the eyes of the people observing it in the different organisations around Wales? It could not only provide a tool to highlight the sort of issues that he is addressing, but strengthen the management of the NHS in Wales.

Photo of Nigel Evans Nigel Evans Shadow Secretary of State for Wales

The amendment is a very positive suggestion, because we are considering the quality of levels of service. Anyone who resides in Wales, even Members of Parliament, uses the national health service. My family reside in Swansea, and none of them has private health care. We should not say how wonderful the NHS is when, clearly, there are problems. When hon. Members or their families have health needs, we are all concerned as to why there are deficiencies and what we can do to improve the level of service in specific areas. That is what the annual report would be all about.

Only two such reports differ from that aim. One was the report that the Government used to bring out generally for the United Kingdom, which said how wonderful services were. It hardly scrutinised deficiencies, and I suspect that that is a reason why it had such poor sales figures and was scrapped. The second was that published by the Secretary of State for Wales; I could add the annual report from the First Minister as well. The Government are hardly critical of themselves where there are deficiencies. Those reports show the mastery of spin over substance.

Photo of Julie Morgan Julie Morgan Labour, Cardiff North

Is the hon. Gentleman aware that CHCs already bring out reports that highlight problems and issues in the health service? I see no reason why he thinks that anyone will try to hide deficiencies in the health service.

Photo of Nigel Evans Nigel Evans Shadow Secretary of State for Wales

That is why we suggest the amendment to paragraph 1 as opposed to paragraph 2 of proposed new schedule 7A, and why I referred to the fact that under the schedule the Assembly would have responsibility for

''the preparation and publication of reports by Councils''

and

''matters to be included in any such report''.

By giving it that independence that the Minister said that he cherished, we put the onus on it to take that action, irrespective of the fact that it is doing so now.

Paragraph 2(i) mentions

''matters to be included in any such report''.

I referred to the fact that Jane Hutt gets irritated when people point out lack of provision. Some may not see that as a priority, but the CHCs might. They do so at present, as is shown by the reports that they publish. If we were to add the provision to the schedule, we would safeguard the interests of patients in future, and the security and independence of the CHCs. They desire that independence.

Photo of Julie Morgan Julie Morgan Labour, Cardiff North

Does the hon. Gentleman agree that some annual reports from bodies are of enormous help and show great detail, but others are not? To put such an emphasis on adding the need for an annual report to the Bill is totally inappropriate. The issue of who decides whether there should be an annual report or not is best left to regulations by the Assembly, as in paragraph 2 of proposed new schedule 7A.

Photo of Nigel Evans Nigel Evans Shadow Secretary of State for Wales

I disagree. I agree that some annual reports are wholly useless; I mentioned those that I thought were useless and fitted no great purpose other than to promote their own self-importance and hide deficiencies rather than expose them. I am glad that the Government scrapped their annual report, and I hope that the Wales Office and the First Minister will do likewise.

The CHCs offer a specific service. The hon. Lady asks why we suggest the requirement as part of the Bill. We do so because, according to paragraph 1,

''It is the duty of a Council . . . to represent the interests in the health service of the public in its district''.

Some may argue that that is superfluous. It is not. It provides track lines to show what the CHCs are there to do. Because of the provisions in the measure, the Assembly may prevent CHCs from making certain reports or get them to emphasise other areas. The hon. Member for Cardiff, North (Julie Morgan) says that it sounds superfluous and that they would do it anyway, but it would give them independence.

Let us imagine, if it is possible, that the health service deteriorates even further. We would hope that the CHC would expose that in its report. I mentioned bed blocking to the hon. Member for Cardiff, Central. There may be problems with trolleys that are called mobile beds. I have a problem with whichever health trust does that, as it is manipulation. If there is a deficiency, we should know about it. Dressing up trolleys as mobile beds is completely wrong, as is designating corridors as annexes to wards. That has happened and it is unbelievable. We should ensure that an independent CHC, with an onus of duty to the patients in Wales, could produce a report that would expose those problems.

Photo of Roger Williams Roger Williams Liberal Democrat, Brecon and Radnorshire

Does the hon. Gentleman agree that a conscientious CHC will bring out these reports? If an under-performing CHC brought out an annual report, it would not be worth the paper it was written on.

Photo of Nigel Evans Nigel Evans Shadow Secretary of State for Wales

In the case of an under-performing CHC, powers in the Bill enable the Assembly itself to say, ''Let us see where it is going.'' If the CHC were not performing, a significant number of people would say, ''Hold on, there is something wrong here.'' That is why we want CHCs to be given independence. We

should like them to be more independent in many ways and later amendments deal with that.

I spoke earlier about the closure of a facility, which might come up in an annual report. A facility that was made generally available in a given area might be closed for reasons of efficiency and streamlining. That is not inconceivable. When I was living in Swansea, the accident and emergency unit at Singleton hospital was threatened with closure because there was a good facility in Morriston hospital. The people of Swansea, West were angry about that. We welcomed the facility at Morriston—I have used it myself—but the closure of a facility somewhere else strikes people hard. A group of NHS administrators might think it a jolly good thing to streamline. Everyone would be forced to go to a centre of excellence, as they are called, and everyone would be happy. But they would not be happy if they had to travel 15 miles on congested roads when they have had an accident and it is an emergency. It would be completely wrong.

Photo of Wayne David Wayne David Labour, Caerphilly

I am listening with interest to the hon. Gentleman. However, I cannot understand the link between what he is saying and the need to have an annual report.

Photo of Nigel Evans Nigel Evans Shadow Secretary of State for Wales

The link is that the independence of the CHCs and the requirement for them to bring out a report, which is put into paragraph 1 as opposed to 2, means that we are giving them the freedom to expose those problems. Perhaps the hon. Gentleman can think of an example in Caerphilly where his constituents are angry about changes that have taken place, which may be to the benefit of the whole area, but not to the benefit of the people in the area where the facility is being removed. They would be angry and would want that to be exposed. We want to give the CHCs the duty to expose that, and the independence to do so.

Photo of Julie Morgan Julie Morgan Labour, Cardiff North

Is the hon. Gentleman not aware that CHCs already expose that?

Photo of Nigel Evans Nigel Evans Shadow Secretary of State for Wales

Of course I am, but because of the extra powers that the Minister is happy to give the Welsh Assembly to do as it wishes, I want to give CHCs independence under the Bill from the requirements of the Assembly. There is nothing wrong in that. It would ensure that an independent CHC always had the necessary freedom. Does any member of the Committee disagree with amendment No. 6 for a council

''to publish an annual report on the level and quality of the health services in its area''?

Photo of Mr Jon Owen Jones Mr Jon Owen Jones Labour/Co-operative, Cardiff Central

I disagree, and once the hon. Gentleman finishes speaking, I shall say why.

Photo of Nigel Evans Nigel Evans Shadow Secretary of State for Wales

It is a huge temptation for me to stop speaking immediately and hear what one of the more independent Government Members has to say. I am sorry that he disagrees with me, but he will have an opportunity to express his concerns shortly. We want to give the bodies freedom from the Welsh Assembly and an opportunity, in a totally independent report, to expose deficiencies. I am talking about the powers under paragraph 2.

The closure of facilities and orthodontics has been mentioned. Waiting lists are also relevant, and plastic surgery was raised quite recently. Some people have had to spend nine years on a waiting list. Clearly, it is absurd for people to wait anything like as long as nine years for plastic surgery. There have been problems with regard to hot reporting on radiology. We know that when people are afraid that there is something wrong with them and they have X-rays taken, the stress and strain of waiting for an accurate report leads in many cases to an illness of its own. People have huge worries about that, so we must ensure that hot reporting is best practice and copied by everyone. I am also talking about basic matters such as the use of wheelchairs, for which there are waiting lists in certain areas. We know that they are expensive, but we need to ensure that an independent report exposes areas where improvements can be made.

One of the great beauties of producing such reports is that the newspapers take them up. Some people may say, ''Well, the newspapers sensationalise things,'' but this is about deficiencies in a health service into which people have paid. They cannot afford to go anywhere else, and they look to the CHC to represent their interests. The amendment would create an obligation to publish an annual report about the level and quality of services in the area, which is important.

Photo of Roger Williams Roger Williams Liberal Democrat, Brecon and Radnorshire

Does the hon. Gentleman agree that he is placing great emphasis on statistics, whereas one of the most important roles of a CHC is advocacy for individual patients? That could not be included in annual reports because of confidentiality.

Photo of Nigel Evans Nigel Evans Shadow Secretary of State for Wales

Even with confidentiality, I see no reason why initials should not be used in an annual report or a line used instead of the name of a person where they have gone through pain or experienced a disadvantage or inequality of service, such as the postcode lottery for drugs. That should be exposed. The hon. Gentleman has hit on an important point. He says that I am mentioning a lot of statistics. In fact, I am not, but in the past I have, and behind each statistic is an individual story. He is absolutely right. Every time that I say that some 200,000 people are waiting for outpatient appointments, that figure goes through people's minds. However, they cannot quite get their heads round the sort of pain that some of those people are experiencing. I hope that an annual report published by the CHC would be able to dig beneath the surface of the statistics.

People can find statistics inane, but they do not fully appreciate them. However, they would appreciate the fact that mother had been waiting four years for a hip replacement operation, that she had been deteriorating over those four years, had been in pain and had been prescribed a huge number of drugs at an enormous cost to the national health service.

I remember not feeling well a couple of years ago. I had a pain in my side, rather than being a pain in other people's sides. I asked in June whether I could see the consultant, and my doctor told me that I could not see one until November. When I said that I was in pain, he said, ''Don't worry Nigel, I'll prescribe some painkillers.'' That was the last thing that I needed; I wanted the problem sorted.

The hon. Member for Brecon and Radnorshire hit on an important point when speaking of the breaking of patients' confidentiality. However, I have to say that one cannot read the Western Mail without finding that people who have received inadequate health service. They do not care about the publicity, nor about confidentiality being broken; they have gone to the reporters to complain of having to wait so long for operations.

The hon. Member for Monmouth was not afraid of confidentiality being broken when he found that he could not sign on for national health service dentistry. He was featured on the front page of his local newspaper saying, ''I want an improvement in service''. He thought that the publicity would gain him that improvement. That is what many of our constituents do; it is the final resort for many people.

With the obligation of an annual report, we may find our constituents and other patients in Wales who have problems writing to the CHC to get them investigated. Those problems would be featured either in sub-reports or in the annual report and publicity would follow from that, because journalists read those reports avidly. I am not sure whether the hon. Member for Brecon and Radnorshire would agree, but I am sure that a lot of patients would be only too happy for confidentiality to be broken if they thought that they would get treatment more quickly and if the level of service for friends and relatives improved.

Photo of Don Touhig Don Touhig Parliamentary Under-Secretary, Welsh Office, The Parliamentary Under-Secretary of State for Wales 12:30 pm, 10th December 2002

As the hon. Gentleman develops his argument, he seems to be suggesting that action on matters of concern about the national health service in any part of Wales should not take place until an annual report has been published. Surely, if difficulties in any part of the health service were investigated by the CHC, we would want action now, not in 12 months' time. The hon. Gentleman seems to be taking us along the track of saying that no action should be taken unless it is mentioned in an annual report. That will get us nowhere.

Photo of Nigel Evans Nigel Evans Shadow Secretary of State for Wales

The Minister's intervention was skilful, as if to say, ''We will not have an annual report,'' or, ''Why do we have to wait for an annual report before getting action?'' That is clearly not the case. That is why I referred to sub-reports and to people writing to CHCs.

Photo of Nigel Evans Nigel Evans Shadow Secretary of State for Wales

I rather hope that the Minister would welcome such an amendment, as it would ensure that we scrutinised the Bill properly.

If those who suffer deficiencies in the NHS write to the CHC, I hope that the CHC will champion their rights. That is when the action would be taken. However, even if the CHC has spoken with the trust concerned, no action might have been taken three or six months down the line. We have even heard of letters not being responded to for months on end. That can be a real problem. One of the functions of the

CHC would be to expose the facts. The CHC is not able to initiate action; it can only report and expose such matters on behalf of patients in Wales. Surely such reports would be very handy in exposing deficiencies, even though they did not ask for action to be taken.

Photo of Don Touhig Don Touhig Parliamentary Under-Secretary, Welsh Office, The Parliamentary Under-Secretary of State for Wales

Does the hon. Gentleman not accept that that happens now? When CHCs find that there is a problem with the delivery of the health service in their areas, and if there is a case for immediate action, they act. If the matter has to be referred to in a report, they produce a report. CHCs address such matters; they do not need to be covered by the Bill.

Photo of Nigel Evans Nigel Evans Shadow Secretary of State for Wales

The Minister says that they do not need to be in the Bill. Why, then, do we need:

''It is the duty of a Council to represent the interests in the health service of the public in its district''

in paragraph 1 of new schedule 7A? He agreed when I drew his attention to it earlier because it was important. We take it for granted; that is what they do now. We could say, ''That is what they do now, so why put it in the Bill?'' It is important for it to be in the Bill because it reminds everybody of the obligation of each CHC.

Photo of Chris Grayling Chris Grayling Opposition Whip (Commons), Shadow Minister (Health)

I have been listening to my hon. Friend's comments, and those of the Minister, with great interest. He will have read paragraphs 2(h) and 2(i) of schedule 7A, which allow the National Assembly to make provision about

''the preparation and publication of reports,''

and the

''matters to be included in any such report''.

Does he share my understanding that the National Assembly ultimately has legislative powers to decide what the CHCs can report on and how they do it? His amendment would provide one element of the reporting process outside the control of the National Assembly, which is, after all, the body being scrutinised.

Photo of Nigel Evans Nigel Evans Shadow Secretary of State for Wales

My hon. Friend has hit the nub of why we tabled the amendment—[Interruption.] Hon. Members say that I have spent 20 minutes talking about it. [Hon. Members: ''Thirty.''] It is just as well that I spent 30 minutes and that I had my hon. Friend the Member for Epsom and Ewell with me to bring some light into the darkness that shrouds the minds of Labour members. Just now, after half an hour of hearing my explanation, the Minister said, ''Why put it in the Bill? It is what the CHCs do anyway.'' As my hon. Friend has reminded the Committee, the provisions in paragraph 2 of new schedule 7A are the problem. Under sub-paragraphs (h) and (i), the Assembly has power to direct and restrict. We are not taking that out; that is important in cases in which the Assembly decides that something should be emphasised and the CHCs are not doing it.

We read in the newspapers that there are many AIDS patients throughout the United Kingdom. The number is increasing, and, no doubt, Wales has its fair percentage of AIDS sufferers. Because AIDS is on the increase—I do not know whether that has to do with immigration into the United Kingdom; that is what

the newspapers are saying—the Assembly might say that it would like a report on the matter. It is important for the Assembly to be able to consider that for a number of reasons, particularly the provision of drugs, which are expensive, and the availability of expertise, and for there to be a report on that.

Photo of Roger Williams Roger Williams Liberal Democrat, Brecon and Radnorshire

Does the hon. Gentleman agree that the effect of the amendment would be to place a duty on CHCs that would take up valuable resources in terms of personnel and money? As they are independent—as the hon. Gentleman keeps emphasising—should they not be able to decide whether to spend their resources on the annual report or on something that they believe would be more productive for the health of the people whom they serve? [Interruption.]

Photo of Nigel Evans Nigel Evans Shadow Secretary of State for Wales

I may have heard the Minister saying, ''Spot on'' to the hon. Member for Brecon and Radnorshire. The Liberal Democrats and the Labour party are hand in hand yet again, working together—

Photo of Nigel Evans Nigel Evans Shadow Secretary of State for Wales

Common sense is common sense, and I just wish that the Minister and the hon. Member for Brecon and Radnorshire had some. It is clear why we have tabled the amendment. We are told that CHCs are ''doing it anyway'', but now the hon. Member for Brecon and Radnorshire says that perhaps they will not want to do it and will want to spend their money on something else. Can the hon. Gentlemen make their minds up, or at least meet before this Committee sits in order to work out a line that they can both follow, so that there is some coherence in their argument?

Photo of Nigel Evans Nigel Evans Shadow Secretary of State for Wales

Cynical with good cause. The nub of our amendment is that we wish to see the provision included in paragraph 1 of new schedule 7A. As my hon. Friend the Member for Epsom and Ewell said, we are placing an obligation on them to reinforce the provision under paragraph 1(a) that requires them to do their job by publishing an annual report, which the hon. Member for Cardiff, North says they do in any event. However, we must ensure that they can carry on doing that with the independence that we want them to have—even if the Assembly says that they should not—and, as the hon. Member for Brecon and Radnorshire says, even if they may be too busy and want to spend their money elsewhere. It is important to concentrate on areas where there are deficiencies and to give the patients' champion body the right to expose deficiencies where they exist; not as part of a blame culture, but to improve the quality of services in a particular CHC area.

Photo of Mr Win Griffiths Mr Win Griffiths Labour, Bridgend

I make a technical point that there are no wrecking amendments on the amendment paper; they are rooted out beforehand.

Photo of Mr Jon Owen Jones Mr Jon Owen Jones Labour/Co-operative, Cardiff Central

I was not going to refer to the amendment as a wrecking amendment. I want briefly—extremely briefly compared with other hon. Members—to argue why the amendment should not

be accepted. CHCs are not adequately resourced to assess the level or quality of health care in their area. They can make a useful contribution to any assessment, but they are not resourced to take objective decisions. The newly strengthened Audit Commission will make those assessments, although the position in Wales is not clear.

I do not want the amendment to be accepted. It is not up to the task, and I do not want to give any comfort to anyone who might argue that there was no need for a proper audit body to make an independent and objective comparison between health care providers in the United Kingdom. I do not want to give anyone the excuse that we do not need such a body because the CHCs will do that job.

Photo of Nigel Evans Nigel Evans Shadow Secretary of State for Wales

I respect the hon. Gentleman's views. He spoke about insufficient resources. Does he agree that it would be far better to ensure that proper resources were made available to those bodies? I understand all the other obligations that are placed on them. If one were to press the matter further, one might say that, under paragraph (2)(h) and (i) of new schedule 7A, they do not have the proper resources even to make the reports that the Assembly may ask them to make. Surely it is better to ensure that they have the resources to fulfil the obligations that we place on them.

Photo of Mr Jon Owen Jones Mr Jon Owen Jones Labour/Co-operative, Cardiff Central

No. There will be 22 committees and 22 health boards. Healthcare resources should be concentrated on delivering patient care, not on duplicating resources for a huge number of committees. That is all I have to say.

Julie Morgan rose—

Photo of Mr Jon Owen Jones Mr Jon Owen Jones Labour/Co-operative, Cardiff Central

I have finished the point that I wanted to make. If others want to make other points, they may do so.

Photo of Julie Morgan Julie Morgan Labour, Cardiff North 12:45 pm, 10th December 2002

I had not intended to speak, but the point that I wanted to make was made by my hon. Friend the Member for Cardiff, Central. However, it would not be practicable for the CHCs to do what the hon. Member for Ribble Valley said and make an overall report on the trend of AIDS or HIV in Wales. They are ill equipped to do that sort of work, and it would not be part of their role. As my hon. Friend the Member for Cardiff, Central said, there are 22 community health bodies, whose role would be completely different from that of examining the overall trends of AIDS or HIV in Wales, where, incidentally, a report has recently been published.

Photo of Don Touhig Don Touhig Parliamentary Under-Secretary, Welsh Office, The Parliamentary Under-Secretary of State for Wales

We have had quite a debate, with a long contribution from the hon. Member for Ribble Valley. I do not chastise him for that, because we should scrutinise legislation as thoroughly as possible. However, I am grateful to the hon. Member for Epsom and Ewell for bringing things to a conclusion a little earlier than might have been the case otherwise. I thought that the winter was going to be shortened, if nothing else.

I understand why the hon. Member for Ribble Valley tabled the amendment, but I hope to persuade him that it is not necessary. If we considered it

appropriate for CHCs to publish an annual report, we would have put that in the Bill ourselves after all the widespread consultation that we had undertaken. The amendment would place in the Bill an additional and unwanted burden for CHCs. Such an ill-defined duty as in the amendment would surely go against giving CHCs the freedom to scrutinise as they saw fit—he talked about such freedoms earlier—by prescribing that they produce an annual report.

Moreover, the amendment would require CHCs to duplicate work already undertaken by national health service organisations that report regularly on the quality and level of services through annual reports, directories and so on. Earlier, my hon. Friend the Member for Cardiff, Central referred to the fact that further legislation would be introduced on inspection of the health service in England and Wales. The Opposition will doubtless want to give that their full support, so that we have the most open and transparent system of monitoring and inspection of the NHS.

The provision of information to patients and the public on how local health care services perform is an essential part of building such services around the needs of the people who want to use them. Placing a requirement on CHCs would duplicate much of the good work that is already done and will be done as a result of future legislation. We would expect CHCs to share information about visits that they conduct and complaints that they have to handle with regard to any of the NHS organisations that they monitor in their areas. That would be in the public domain as a result of any report or activity in which they are engaged.

CHCs already publish annual reports on their activities—visits and other problems that they encounter during a year—and NHS bodies also publish reports annually on the level and quality of services. Were we to accept the amendment, we would put another tier and burden on to CHCs that was not necessary. The work is already well provided for in many other areas.

Photo of Chris Grayling Chris Grayling Opposition Whip (Commons), Shadow Minister (Health)

In framing such provisions, one always has to think about the unexpected as well as the expected. Let us suppose that a strongly nationalist Administration were elected in Wales and chose to use their management of the NHS to propagate an anti-UK separatist agenda. They could use the provisions on the preparation and publication of reports and their content to require CHCs to behave in a way that did not diametrically oppose that agenda. To provide one avenue of reporting that is independent of the Assembly, and of prescription by the Assembly, would at least provide a safeguard against such an extreme and unexpected situation. While that is unlikely, it is surely a consideration when we are trying to guarantee the independence of such bodies.

Photo of Don Touhig Don Touhig Parliamentary Under-Secretary, Welsh Office, The Parliamentary Under-Secretary of State for Wales

I can imagine the nationalists being extreme in every way possible, but not even in my wildest nightmares can I imagine them being in a position to enact some of what the hon. Gentleman suggested.

My hon. Friend the Member for Cardiff, Central referred to the Audit Commission. We have bodies

established in statute, with functions independent of and at arm's length from Government, that can inspect and audit what we do on the delivery of public services. That is the case in the health service, and it will be provided for in legislation that will come before the House before long.

It is important that we bear in mind that the function of the CHCs is surely to scrutinise NHS bodies, not to report explicitly in the way that the amendment would make them do. We all know from our constituency surgeries that when someone comes up against a problem in the health service—a failure to provide them with the service that they expect—they want immediate action. We, as Members of Parliament, write to Ministers to raise the issue, which gets into the Western Mail; God only knows what the hon. Gentleman would do for his lines if he did not have articles in the Western Mail to report.

The Committee should recognise that the amendment would create unnecessary additional work for CHCs. They will not be prevented from raising any matter in an annual report if they think it appropriate, but the amendment is unnecessary. I hope that the hon. Gentleman feels that we have fully debated the amendment and that he has had the opportunity to raise some important points. I hope, however, that I have persuaded him that the amendment is unnecessary because the Bill includes provisions to allow CHCs to report as widely as they need to on the delivery of the health service in Wales.

Photo of Nigel Evans Nigel Evans Shadow Secretary of State for Wales

We have had an important and significant debate on the amendment. I thank the hon. Members for Cardiff, Central and for Cardiff, North for their important contributions. It is important that we get the Bill right before it goes to another place, where I am sure that the words of the Committee will be read with great interest and some amendments may be tabled. Just as the hon. Member for Brecon and Radnorshire was shocked that the Government had tabled no amendments, we may all be shocked and dismayed if the Government do not table some amendments in another place to try to improve their legislation, especially once they have listened to what we have to say and when they have received further representation from bodies and individuals affected by the NHS in Wales.

The hon. Member for Cardiff, Central says that CHCs do not have sufficient resources and that the requirement proposed in the amendment would be expensive. I hope that they will be adequately funded in future so that they can do their jobs properly. It would be wholly wrong if their funding were insufficient for them to carry out the duties that we currently place on them, irrespective of whether the amendment ever reaches the statute book in this form or some other.

The hon. Member for Cardiff, Central mentioned the Audit Commission, which is independent, widely respected and publishes some useful reports. We hope that action will flow from that. He said that it would be expensive for the 22 health boards to produce reports and that the money could be better spent. Money spent on health care is always money well spent, as long as it is effectively spent. Efficient

expenditure is important, and that is where CHCs come in. The Government are spending significant sums of money on the national health service, but we know that there are still real problems. That is why a report from each of the health boards would come in handy and give us an overall picture of the quality of service in Wales.

To pick up the point raised by the hon. Member for Brecon and Radnorshire, a report might include some individual cases that reflect an overall pattern of deficiency or improvements in service. If there are areas of expertise in any of the 22 local health trusts, they may want to shout about those, too. A report could provide an important function in allowing a health trust to set out what it does and help other health trusts to roll out best practice in their areas.

The hon. Member for Cardiff, North made an important point about AIDS. That may not be the best example, but we know that it has huge resource implications for the NHS because of the growing number of people being diagnosed as HIV positive. I do not know whether there may be a significant increase in some areas within the 22 health boards and none in other areas of Wales.

I could imagine that Cardiff would have a larger percentage per head of population affected than any other part of Wales; indeed, I suspect that that would be normal. In certain parts of west Wales, I would not be surprised to learn that the figures are, and have always been, few in comparison with Cardiff and London. However, an annual report in an individual area could highlight deficiencies, perhaps without going into too much specific detail. A CHC might raise an issue in response to a growing number of AIDS patients in Cardiff, for example. Other specialties and services might be shown to be lacking in funds or cut back simply because of the budgetary implications of AIDS.

Photo of Chris Grayling Chris Grayling Opposition Whip (Commons), Shadow Minister (Health)

Does my hon. Friend share my disappointment at the Minister's response, particularly his lack of understanding that the amendments are designed to strengthen the independence of CHCs in a Bill that creates too much linkage between the actions, responsibilities and remits of the CHCs and the ability of the Assembly to take decisions affecting them? The amendment is one part of a jigsaw puzzle aimed at strengthening the hand of the CHCs in scrutinising people who are responsible for the health service and for legislation that might follow.

Photo of Nigel Evans Nigel Evans Shadow Secretary of State for Wales

I am mostly disappointed by any of the Minister's suggestions and I am glad that you,

Mr. Griffiths, clarified that none of the amendments are wrecking amendments. They are designed to improve the Bill, probe the Government and clarify the meaning of the provisions. Some legalese is evident and it is important to tackle what the Bill is about. The whole Committee wants the NHS improved from its current level of provision.

The Minister said in his response to me that the amendment would lead to a duplication of duties. Doubtless the CHCs would draw on other reports for their information to underpin their view that the level of quality in a particular area was either superior or inferior to others. The duplication should not, however, overly worry us as long as the other reports are incorporated in the CHCs' annual reports. They might also incorporate some of reports requested under sub-paragraphs (h) and (i) in paragraph 2 of new schedule 7A.

My hon. Friend the Member for Epsom and Ewell described a worst-case scenario; it is always important to do so when reflecting on proposed legislation. If the nationalists took over, that would be the worst-case scenario that members of this Committee could possibly imagine. The nationalists would promote certain policies within an independent NHS within an independent Wales; that should send shudders down our very spines. In considering such worst-case scenarios, it is right that the Bill ensures that CHCs have the independence of mind to investigate certain topics without fear of what the National Assembly for Wales might say. The Assembly might be irritated by their reports and put pressure on CHCs to stop reporting.

The Minister says that the CHCs are there to scrutinise, not to report. I completely disagree; they are there to scrutinise and report. We have already heard about the many reports that CHCs already produce.

The Minister was gracious in saying that I had made some good points in today's debate. I should like to probe further how best to ensure the independent scrutiny of CHCs and their ability to produce a comprehensive report without fear of direction elsewhere by the Welsh Assembly. I shall not divide the Committee on that today, so I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

It being One o'clock, The Chairman adjourned the Committee without Question put, pursuant to the Standing Order.

Adjourned till this day at half-past Four o'clock.