Schedule 1 - Schedule 7A to be inserted in the National Health Service Act 1977

Health (Wales) Bill – in a Public Bill Committee at 4:30 pm on 10th December 2002.

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Photo of Chris Grayling Chris Grayling Opposition Whip (Commons), Shadow Minister (Health) 4:30 pm, 10th December 2002

I beg to move amendment No. 17, in

schedule 1, page 6, leave out lines 13 and 14.

Photo of Mr Win Griffiths Mr Win Griffiths Labour, Bridgend

With this it will be convenient to take New Clause 1—Composition of Community Health Councils—

'The membership of Community Health Councils shall be constituted as follows—

(a) one-half of the members shall be nominated by the local authorities within the area of the Community Health Council's operations;

(b) one-third of the members shall be nominated by those voluntary organisations active within the area of the Community Health Council's operations; and

(c) the remainder of the members shall be nominated by the National Assembly for Wales.'

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

I welcome you back to the Chair, Mr. Griffiths. It is a gloomier evening than one might choose.

The amendment and new clause are designed to follow the theme that Opposition Members have pursued throughout the debate so far, which is to try to provide an appropriate balance between the interests of the Welsh Assembly and its role as manager of the Welsh national health service and the need for independent scrutiny of the performance of the Welsh NHS in the hands of communities and professionals and not just politicians. They are part of the jigsaw puzzle of various ideas that I described to the Minister this morning, which we proposed to reflect our concerns and to amend the Bill.

I know that the Minister will say that Opposition Members do not understand devolution or the need to push powers down to the Assembly. In fact, I understand perfectly well the principles of devolution and where it is right to give powers to the Assembly. The Bill grants powers to the Assembly entirely appropriately at many points, but as the debate unfolds, the Minister will understand that we are keen to ensure that there is a balance and that we do not simply hand over to the Assembly—lock, stock and barrel—the right to monitor the performance of the NHS in Wales.

Ultimately, the power to monitor should not be controlled by the same organisation that delivers the strategy and, to a significant degree, the overall management of the service. It is essential to maintain the genuine independence of the community health councils, which the amendment and new clause would ensure. I hope that the Minister will recognise that,

and consider the amendment and the new clause in the spirit in which they have been tabled.

Nominations for membership of CHCs come from three, and often four, separate groups: the local authority; voluntary organisations in the areas served by the CHC; the National Assembly; and, in some cases, co-optees, to represent different parts of the local community that do not fit the formula. That structure provides an excellent balance. It was set up by past legislation, and I can see no good reason why it should change. It may not be the National Assembly's intention to change it, but politicians have a habit of placing their cronies in organisations. All parties have been guilty of that to some degree, but despite its initial public statements, the Labour party has been especially bad in terms of placing people in jobs, especially in recent years. It is important to ensure that no process enables the Assembly simply to control the choice of people who sit on the CHCs. What we have already works.

Photo of Mr Huw Edwards Mr Huw Edwards Labour, Monmouth

The hon. Gentleman claimed that things had got worse under the Government. Does he agree that, under the Government, all quango appointments in the National Assembly must be advertised, and that there is open competition?

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

The hon. Gentleman will find, if he looks across the United Kingdom—including Wales—that there have been significant numbers of appointments to key jobs of people with political links. Even if those jobs are advertised openly, as all such jobs are, that does not necessarily mean that the end appointment is free from political influence. [Interruption.] I will happily stand by that comments. Simply having a process in which a job is advertised does not remove the likelihood and risk of a political appointment.

Our proposals would at least spread out responsibility for nominations to the bodies, and would ensure a truly representative mix of people on those bodies. I do not cast aspersions on the current Administration in Wales. However, by allowing what happens at present to continue, we give current and future politicians the opportunity to shape the membership of those bodies. We should not do that.

Photo of Julie Morgan Julie Morgan Labour, Cardiff North

Does the hon. Gentleman believe that the presently constituted community health councils, admirable as they are, fully represent the range of people and interests in Wales?

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

I thank the hon. Lady for her intervention, as I was coming on to consider a few such examples. For instance, Meirionnydd community health council has a good mix of people and organisations represented on it, such as the local Red Cross, the Wales Council for the Deaf and the Multiple Sclerosis Society. A number of local authority members are on the board of the community health council, and there are representatives of the Stroke Association and the First Minister. The local authority members on the body are spread quite widely across the area. That collection of organisations represents different patient

groups that use the national health service. Different communities are represented through their elected representatives and there is a representative of the First Minister of the National Assembly. That is an eminently sensible mix of people to serve as patient representatives on the community health council for the area.

Photo of Julie Morgan Julie Morgan Labour, Cardiff North

One of the key questions to consider in setting up and strengthening the new community health councils is how to make them representative in a way that has not always been possible. For example, does the hon. Gentleman know whether the representatives from the Stroke Association or the Multiple Sclerosis Society have experienced the disease themselves, or are they carers? Representation of people with such experience—rather than professionals and societies, admirable as their contributions may be—is a key issue in terms of getting genuine representation on bodies such as community health councils.

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

I hear what the hon. Lady says. In my experience—and, I am sure, in hers as well—the people who tend to be most active in voluntary groups of local representatives of those organisations have been motivated to join by their or their families' experience. I am comfortable, in so far as it is possible, that on a local basis those organisations provide good representation of the community interest and the patient interest.

Photo of Hywel Williams Hywel Williams Shadow PC Spokesperson (Work and Pensions), Shadow PC Spokesperson (Health)

The Rowntree Foundation carried out research—some of it in Powys—into the National Health Service and Community Care Act 1990. It identified the problem that in rural areas there is a limited pool of potential members, and that we must have a more active policy of involving people who are excluded—those who are not members of voluntary organisations, admirable as those organisations are. That includes the rural poor and the rural disenfranchised.

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

I entirely agree with the hon. Gentleman, but he highlights a problem that exists for the voluntary organisations. I should be surprised if any voluntary organisation in his constituency said that it had enough people. Not enough people are willing to get involved, and anything that we can do to encourage people to participate—either directly or through voluntary organisations—is entirely to be welcomed, and I fully accept the problems that have been highlighted.

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

Surely new clause 1 takes care of that in any event, and does not prescribe the exact membership of those bodies. I fully accept what the hon. Members for Cardiff, North (Julie Morgan) and for Monmouth (Mr. Edwards) said; they intimated that we should have as wide a representation as possible. However, we are considering nomination powers. There is nothing to stop the Assembly, the local community health councils or the voluntary sector nominating some of the people who fall within the wide remit that they mentioned.

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

Indeed, I agree with my hon. Friend. The purpose of the two new clauses is to ensure that the framing of the groups of people to be represented on those bodies should not be merely a matter of political debate in the Assembly. We already have a framework in place for the membership of community health councils.

I have been looking at the membership of the councils; not only do they have a diverse membership, it is clear that that membership covers a wide range of community representation. It may not be as diverse as we would wish in some rural areas, but that problem is found not only in community health councils. Nevertheless, each council makes it clear that it has a group of people who are representative of the community. For instance, the Vale of Glamorgan has a membership of 20, plus two co-opted members; 10 are appointed by the local authority, eight by voluntary organisations, two by the National Assembly for Wales and two are co-opted. The co-opting of members permits the addition of one or two people of the kind described. However, there is no reason why voluntary organisations should not appoint patient representatives or carers of those in difficulties.

We argue that the appointment process should not be handed over to the organisation that runs the service. We already have a legal framework in place that sets the parameters outlined in new clause 1, and it works; it gets a good mix of people on to the councils. We do not want to see the power to change that framework placed in the hands of the organisation that those people should be scrutinising. That is the key point.

It is not that the Assembly should not have the power to take such decisions; of course it should. If the Assembly is to exist, it clearly needs the power to take those decisions. We argue that there is a conflict of interest; the organisation that runs the service—it takes decisions about the way in which health care operates in Wales, and is accountable for the performance of that service—should not have overall responsibility for establishing the appointment process of the council membership.

I go back to what I said to the Minister this morning. It is not simply a question of what the current Administration what might do or what is happening today. None of us has a crystal ball; none of us knows what political shape the Assembly might take in future, what political motivation it might have or how it might seek to change the public appointment process to serve its own ends. Surely, we should retain a framework in primary legislation that establishes the kind of people who should serve on community health councils.

We are happy to hear the Minister's ideas if he believes that the framework that we have put forward is wrong. He may say that we should do it differently. He may suggest that we should set aside 10 per cent. for patients, or 5 per cent. for carers. He may suggest setting aside a proportion of the membership for serving health professionals in the region concerned. Those might be perfectly coherent ways of approaching the problem, but we adopted the

current framework because there was no evidence to suggest that the system was not working or not delivering. Members of the councils do the job properly and provide effective scrutiny of the national health service in Wales, as others have done previously in the whole of the United Kingdom. However, if the Minister says that he accepts the principle but that it will be achieved in a different way, we will look favourably upon any Government amendment.

The principle is that the National Assembly should not be allowed to be both poacher and gamekeeper. We must not allow politicians control over those whose job it is to scrutinise the performance of the services that they run. I hope that the Minister will think that through and ensure that it is reflected in this measure and in others that are designed to strengthen the Bill, to enhance its quality and to make the organisations more effective. The independence of the CHCs will be strengthened by some of our amendments. I hope that he can accept this amendment in the spirit in which it is proposed.

Photo of Don Touhig Don Touhig Parliamentary Under-Secretary, Welsh Office, The Parliamentary Under-Secretary of State for Wales 4:45 pm, 10th December 2002

All of us want to maintain the independence of CHCs. It is essential to the work that they do that they should be seen to be, as far as possible, at arm's length in terms of their scrutiny and support for the health service. I do not dismiss the Opposition's amendments or the new clause because they have got it wrong; rather, I do not believe that they provide the right track to follow to achieve independence.

Amendment No. 17 would prevent the Assembly from making regulations about the membership of CHCs and would restrict the Assembly in its intention to move gradually to more open membership of CHCs. Those aims are strongly supported by CHCs in Wales, who have pressed for a more open approach to appointments to CHCs. The removal of the sub-paragraph specified in the amendment would prevent the Assembly from securing incremental change in membership to better reflect the needs and aspirations of local communities. That is what the Bill seeks to do.

It is important for the membership of a CHC to reflect the community that it serves; many local authority and voluntary sector members have made a tremendous contribution over the years. I witnessed that when I was a local authority member and the hon. Member for Epsom and Ewell (Chris Grayling) reflected it when he referred to Meirionnydd. They play an important role in CHCs. It would be wrong to lose them—we want to retain their expertise, their background and their knowledge. I assure hon. Members that the Assembly is not seeking to control CHC membership. Because it wants to retain as many such people—where appropriate—as possible, it seeks to move to a more open method of recruitment in order to ensure that the members of CHCs fully represent their communities. He is right that CHC membership is now made up of one half local authority nominations, one third the voluntary sector and the remainder Assembly appointees.

Recruitment of Assembly-nominated members is set out in accordance with the Assembly's published code of practice for ministerial appointments to public bodies. Vacancies are advertised in the media, both locally and nationally. Applicants are interviewed by the Assembly's public appointments branch in accordance with the Nolan principles. It is easy to score party political points, but I am sure that the hon. Member for Epsom and Ewell will agree that that is the right way to do things, rather than to continue as we did in the past, when many appointments were made exclusively by Ministers without any consultation and without the open application that is now preferred by the National Assembly for Wales.

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

Would not it be better for other bodies to have an input in nominating their own people to CHCs, taking some of the power away from the Assembly? Let us consider the worst-case scenario suggested by my hon. Friend the Member for Epsom and Ewell. If the Assembly were controlled by a group of people whom we cannot even envisage at this time, they might try to load CHCs with people from the same mould as themselves. Would not it be far better for other people to have an input into the composition of CHCs?

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

I understand the thrust of what the hon. Gentleman says, but surely nomination could be seen as more susceptible to cronyism if we reserved half the membership of CHCs for local authorities, as is currently the case.

Let me explain why I resist new clause 1. Earlier, the Opposition made a number of perfectly valid points about the desirability of removing control of the bodies from politicians; yet the new clause proposes that elected local politicians should retain power. It would reserve for them half the nominations and therefore half the membership of CHCs. Surely that goes against the grain of what the hon. Member for Epsom and Ewell and his colleagues said earlier.

New clause 1 would restrict the Assembly's intention to move forward to a more open membership, which CHCs themselves have been advocating. It would secure a place on CHCs for local politicians with no scrutiny other than the fact that their local authority nominated them and it was Joe Bloggs' turn, or the turn of someone from another party. That would not be as open, transparent and testing as the method that the Assembly is using of application, interview and appointment.

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

The point about elected local authority representatives is that it is important to secure community representation. I gave the example of Meirionnydd, where there is representation from a number of towns. The local authority route provides a vehicle to ensure balanced representation from the area covered by a CHC. If that is part of the mix, along with people who represent patients' groups and others from the community, it is in no way an invalid approach.

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

Having known local authority representatives over the years, as I am sure the hon. Gentleman has, I accept that many of them have made an important contribution to the work of CHCs.

However, we are trying to move to a system in Wales in which more people from across the board and with or without political links can apply to serve on CHCs. That approach may not be recognised, appreciated or valued in other parts of the United Kingdom. The people will be properly interviewed and a proper appointment made, taking into account what they can contribute as individuals, not the fact that there is a block number of places left on the CHC for the voluntary sector or local authorities.

Placing a membership requirement in the Bill would prevent the incremental change that my colleagues in the Assembly seek. We can even argue that the hon. Gentleman's proposal is virtually unworkable, because although it requires a third of the members to be nominated by voluntary organisations that are ''active'' in the area of the CHC, the word ''active'' is not defined. In those circumstances, an organisation could meet—[Interruption.] It is not up to me to define the word ''active'' or the value or importance of it; it is up to the Opposition, who tabled the new clause.

An organisation that meets in an area might not do terribly much, but it might be said to be ''active'' and could therefore nominate people to serve on CHCs. It is important that the membership of CHCs truly reflects the communities that they serve. Many local authority and voluntary sector groups make an important contribution, which we do not want to lose, but it is important that we open up the opportunities for more people to serve on CHCs. The Assembly's approach of an incremental move to public advertisement, interview and appointment is right. I could say more, but given those remarks, I hope that the hon. Gentleman will reflect on his proposals in amendment No. 17 and new clause 1. We share the same objective, but his solution is more restrictive and prescriptive; it would not allow people to serve on community health councils unless they came from the voluntary sector or the local authority sector. That restricts the opportunity for people in communities to play an important part.

I hope that the changes brought about by the National Health Service Reform and Health Care Professions Bill will mean that when the 22 local health boards take over, decisions about who is to control spending and determine the priorities will be pushed down to be taken by local people, who will consider the needs, aspirations and hopes of their communities. Appointments to the community health councils will open things up and give more people, regardless of their party political affiliation or lack of it, the opportunity to take part in the scrutiny of the national health service and to make an important contribution to the way the health service is run.

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

I agree with those who have spoken in the debate; we are all in favour of having a broader representation on community health councils and a more open way of appointing the members. That will ensure that they reflect the nature and composition of the area they represent in considering the quality of the health service that is provided for local people.

The hon. Member for Epsom and Ewell seems to be embracing the concept of devolution but he has not got there yet. Glyn Davies, the Assembly Member for Mid and West Wales, has been referred to. He said:

''I would like to see more Conservative ideas about how we can improve devolved Government and less looking back towards a more centrally based system of government.''

As those of us who know Glyn are aware, he is not in the best of health, but his ideas are fairly robust.

The amendment would mean that the powers were held centrally, in Westminster. But we should have the faith and confidence to say that these matters should be for regulation by the Assembly. I do not go along with the argument that things are hunky dory at the moment. Recently, I received a letter from a person who has reservations about the Bill, stating:

''Roughly six months ago I had reason to go to my GP's surgery. On one of the notice boards was a list of members of the local CHC with the area they represent . . . we established the political affiliation of the twelve members of this CHC. They were either serving Labour Councillors, former Labour Councillors or, yes you've guessed it, members of the local Labour party.''

I have not said which local CHC the letter referred to because I have not been able to ascertain whether the statement is truthful, but that is people's perception. We must break away from that.

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

The hon. Gentleman must remember that the local authorities are under a statutory duty to allocate places on internal and external bodies in proportion to the membership of their authority. It is possible, although undoubtedly regrettable, that the authority concerned may have been made up entirely of Labour members. If that is the case, it is a disservice to the community but probably not against the law.

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

The hon. Gentleman makes a point about proportional voting for local government, because several local authorities are entirely composed of one party.

We must have courage, and confidence in the Assembly, which would like a much fairer and more open way of appointing people to CHCs. On Second Reading, I said that several local authority members have served with great distinction on CHCs and have given a huge amount of time and effort to ensure that those councils are effective. At the same time, there is a perception that certain local authority members see the membership of the CHC as an adjunct to their local authority work and do not have the time, and cannot make the effort, to make it work and to put in their full whack.

We could consider having fewer local authority members on CHCs because, after April, there will be four local authority representatives on the local health board, too. Most of those local health boards will commission health care but some—particularly the one in Powys, which will take the place of not only the health authority but the trust—will deliver health care, too, such as out-of-hours services for GPs. If local authority people are almost in the majority on the CHCs and there are local authority people on the local health boards, there could be a conflict of interest.

I have confidence that the Assembly will be much more open about this matter. It may take specific measures to include young people, people from ethnic minorities and disabled people and will use the Nolan principles to make the appointments. The amendment does not accord with the Rawlings principles of how legislation should be drafted to ensure that devolution works and to give discretion to the National Assembly for Wales.

Photo of Mr Jon Owen Jones Mr Jon Owen Jones Labour/Co-operative, Cardiff Central 5:00 pm, 10th December 2002

Does the hon. Gentleman believe that having a large representation of local authority members on both CHCs and health boards will, of itself, ensure that the bed blocking problem in Wales can be dealt with without recourse to fining local authorities?

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

Having local authority members on the local health boards will mean that there is some co-ordination between social services and the NHS and so will help to eliminate bed blocking. I do not think that having local authority members on the CHC will contribute to the resolution of that problem.

Photo of Julie Morgan Julie Morgan Labour, Cardiff North

I support what the Minister and the hon. Member for Brecon and Radnorshire (Mr. Williams) have said about moving away from party political patronage. It is essential that we move to a more open, Nolan-style, method of appointment. The move to advertise appointments on public bodies is a tremendous advance. It will open up public bodies to the public, rather than to a narrow range of elected people who then appoint people like themselves. The amendment would take us back to the pre-Nolan era. I hope that the hon. Member will think about this amendment before he considers whether to push it to the vote.

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

Given that we are advocating the status quo, rather than a different approach, can the hon. Lady explain how the work done by the CHCs is disadvantaged by the present structure?

Photo of Julie Morgan Julie Morgan Labour, Cardiff North

I do not wish to denigrate the work done by the CHCs. They do a very good job. However, they could do a much better job. Having their membership selected by open advertisement will bring people on to them who are not local authority members, or members of the Labour, Conservative, or Liberal Democrat parties, or of Plaid Cymru. They will want to be on the CHC and will be prepared to go through the arduous process of responding to advertisements, being interviewed and being appointed. As I understand it, the Assembly appointments are made on a cross-party basis. There is no political patronage in the final appointments to public bodies in Wales.

We should certainly embrace that message on the appointment of CHCs and bring in an open method of advertising. We should not think, however, that people will flock in if we simply advertise. We must make a huge effort to place advertisements where people will see them. As the hon. Member for Brecon and Radnorshire said, black people and young people are under-represented on CHCs. To encourage members from under-represented groups to apply, we must

ensure that advertisements reach them. We must also make every effort to show that they would be welcome on CHCs. The ultimate decision is based on carefully thought out principles of appointment, but it is hard to get members of under-represented groups as far as the final selection process. However, the present proposals are the best means we have of doing that, and we will certainly not overcome under-representation using the methods that the Opposition recommend for appointing people. They have not resulted in representative CHCs, so it is important that we resist the amendment, and go down the open Nolan way of appointing people.

Photo of Hywel Williams Hywel Williams Shadow PC Spokesperson (Work and Pensions), Shadow PC Spokesperson (Health)

I am slightly unclear about the intention of the hon. Member for Epsom and Ewell in tabling the amendment. I thought that he was edging towards advocating apolitical, rather than independent members. Apolitical members are a bit like the unicorn: they are free, wild and beautiful, but essentially mythical. We are looking for independent members. We all have our own views, and joiners tend to join because they have their own views. The trick is properly to regulate those views and ensure that people take an independent stance. The way to do that is to have the very highest standards in public life, and we have taken many large strides in that direction in the past few years.

We must also ensure that members consult and represent their communities more effectively, but that is difficult. The communities first programme has operated in my constituency, and people who would never have taken part in public life have been enabled to join; they might now respond to an advertisement. Getting to that point is quite a task; it is a process, rather than a matter of taking snapshots of the community and selecting prominent people. I fear that setting proportions of people to be nominated for CHCs by other bodies will not achieve our aim.

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

Let me deal with one or two of the points that have been raised. The hon. Member for Cardiff, North talked about the need to progress down the open process route that she described. With respect, however, we are not doing that. We are framing a power that would enable the Assembly to go down that route, and it may indeed choose to do so. Equally, however, it would have the power to make entirely political appointments from its own ranks, should it choose to do so. We are talking not about the nature of the process that the Assembly intends to go through but about framing certain safeguards in law to ensure that bodies have the power to remain in perpetuity independent of the administration of the national health service in Wales.

Photo of Julie Morgan Julie Morgan Labour, Cardiff North

The amendment goes directly against the principles of openness. Does that not contradict what the hon. Gentleman has just said?

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

Let me return to that point in a moment, because I have a thought for the hon. Lady and the Minister. First, I wish to make one or two other points. The Minister referred to the definition of being active in a local area, and organisations may be active to a greater or lesser degree. That is right, but it applies to virtually everyone who is a representative on a CHC. Any organisation that any of us has been

involved with includes some people who are hard working and others who turn up only for an occasional meeting. Nothing that we as legislators—or the Assembly in Cardiff—do will ever change that. The reality is that people who give up time to attend meetings to represent their organisations—whether a local authority, patient group or other community organisation—will do so because they want to play an active role.

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

I refer the hon. Gentleman to new clause 1(b):

''one-third of the members shall be nominated by those voluntary organisations active within the area of the Community Health Council's operations''.

We must define ''active''. Otherwise, even if it were not doing much in the community, any organisation could claim that it had the right to be present and to nominate people to CHCs. It is bad drafting on the part of the Opposition.

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

I shall be happy to listen to the advice of Government draftsmen if the Minister accepts the principle of the amendment. The word ''active'' is fairly comprehensible to most of us; if it needs to be made more legalistic, I shall be delighted to hear the Government's proposals.

The hon. Member for Brecon and Radnorshire, who continues to take advantage of the article in the paper this morning and to revert to the devolution issue, still misses the point. We are not arguing about devolution: we all accept that the NHS in Wales has responsibility for running the NHS in Wales. As legislators, and under our constitution, we have responsibility for primary legislation across England and Wales, so it is important to provide a balance between those holding political and administrative responsibility for the NHS and those with the remit to scrutinise the performance of people in that role. It is not entering a debate on the rights and wrongs of devolution to argue that those responsibilities should be separated, as far as possible, to ensure that scrutiny is genuinely independent and not potentially influenced by party politics or politicians.

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

I would accept that if the Assembly were to use its powers directly to appoint people, but it has adopted the Nolan principle of open selection for public bodies. Does that not overcome the hon. Gentleman's reservations and concerns?

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

Surely the hon. Gentleman accepts that the role of legislators is to provide a framework for the future that deals with all political eventualities. It is easy to say, ''In today's world, that won't happen, so let's not bother about it'', but we can never anticipate what will happen in the future. The role of legislators is, ideally, to frame provisions that cannot be abused later. That is the reason for having checks and balances in our legislative framework that last for the duration, not just the short term. [Interruption.]

Photo of Mr Win Griffiths Mr Win Griffiths Labour, Bridgend

Order. When members of the Committee are speaking, they should address the Chair. Furthermore, I remind hon. Members of the

more technical reason for facing the right way—so that the microphones pick up all that is said.

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

Thank you, Mr. Griffiths, and I apologise for facing the other way.

Photo of Mr Win Griffiths Mr Win Griffiths Labour, Bridgend

I realise that the temptation is great.

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

I return briefly to the intervention made by the hon. Member for Monmouth, who raised an important point about what decisions the Welsh Assembly might be free to take. It is not a Wales-only issue because CHCs have the power to scrutinise services across the border in England. I refer to the current work of the Association of Welsh Community Health Councils, which is

''voicing concerns about the English NHS plan which is weakening the strength of the patient voice in the NHS, and . . . will affect all Welsh patients who receive health services in England''.

The implications of our decisions about the powers of the Assembly are not exclusively Welsh. It may not be a major issue, but we should reflect on it.

I would prefer not to press the issue to a vote, although I am prepared to do so. I accept that some hon. Members will feel that our proposed framework is too rigid. Nevertheless, we stand by the principle that we should set guidelines to prevent the Assembly from taking any power that it wishes with regard to appointments. It might do so by specifying a minimum representation from patient groups, from local authorities and from other groups within the community—we do not want to prescribe exactly how things are done; it is not a question of percentages. However, in order to ensure that the checks and balances that I have described exist, minimum parameters should be set in the legislation. It should state that there must be representatives from local authorities and local groups. If the Minister will accept the principle and will agree to consider whether that element of the Bill can be strengthened in order to ensure that that safeguard exists, we shall be happy to withdraw the amendment. Will he do that?

Photo of Don Touhig Don Touhig Parliamentary Under-Secretary, Welsh Office, The Parliamentary Under-Secretary of State for Wales 5:15 pm, 10th December 2002

I would, but for the fact that the proposals that I have articulated today are supported by the CHCs themselves. They are urging the Assembly to introduce open recruitment. The Government and the Assembly are responding to the requirements of those who run CHCs in Wales.

The Assembly's recruitment process is published, it is subject to a code of practice and it is open, and the Assembly, as a body corporate, has approved the code. The Opposition are right to express fears that, at some time, a different political party might try to change the code for party political ends. However, it would have to put the issue to a vote in the Assembly before a change could be made. I reassure the hon. Gentleman that there is an open and transparent system for recruiting people to serve on CHCs. The Bill seeks to extend that, not to diminish the important roles of the voluntary sector and local authorities. We are responding to a demand from CHCs in Wales, which favour a more open recruitment process.

I do not know what more I can say to satisfy the hon. Gentleman, other than to make it absolutely clear

that we are committed to the process; it is there for everybody to see. Nothing is hidden and anyone can apply. People in my community have asked how they might apply and I have given them the forms and paperwork to send in. When I attend meetings in my constituency, I ask for a show of hands to indicate who serves on the CHC. If no hands go up, I ask people to serve and invite them to apply; I tell them that we need people like them, representing all parts of the community, to participate. That is the process that the Assembly is promoting. I urge the hon. Gentleman to reflect and to withdraw the amendment and new clause 1, and to accept my assurance that the CHC movement throughout Wales supports the increasingly open and transparent recruitment process.

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

I have listened carefully to the Minister. I know that he is a man of principle and I accept his word. Will he at least bear in mind the concerns that have been raised? I know that further steps are to be taken in the establishment of the bodies and I hope that he and his Department will be watchful to ensure that the recruitment process, as it evolves, provides genuine independence. Accepting his word that he is mindful of that, I am happy to beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Schedule 1 ordered to stand part of the Bill.