Health (Wales) Bill

Public Bill Committee, 10 December 2002.

Standing Committee B

Health (Wales) Bill

Don Touhig (Labour/Co-operative, Islwyn)

I beg to move,

That—

(1) during proceedings on the Health (Wales) Bill the Standing Committee, in addition to its first sitting on Tuesday 10th December at half-past 10 o'clock, do meet on that day at half-past 4 o'clock and on Thursday 12th December at five minutes to 9 o'clock and at half-past 2 o'clock;

(2) the proceedings shall be taken in the following order, namely Clause 1, Schedule 1, Clause 2, Schedule 2, Clauses 3 to 7, Schedules 3 and 4, Clauses 8 to 10, New Clauses and New Schedules;

(3) the proceedings on the Bill (so far as not previously concluded) shall be brought to a conclusion at Five o'clock on Thursday 12th December.

May I say how delighted I am that you are chairing the Committee, Mr. Griffiths? You were a distinguished Minister in the Welsh Office and achieved a great deal for the health service in Wales. I know that you have announced your intention not to seek re-election in the next general election, and that will be met with sadness in your constituency, as it will in this House. Over the years, you have made a major contribution to public life in Wales, as a Member of the European Parliament and of this House.

I know that the subject of this Bill is close to your heart, Mr. Griffiths; as a Wales Office Minister in 1997, one of the first things you did was to reiterate our commitment to reform and change and to the protection of our community health councils. I am indeed pleased to serve under your chairmanship and look forward to your guiding of these proceedings as expeditiously and successfully as possible.

Nigel Evans (Conservative, Ribble Valley)

I do not wish to detain the Committee long on this motion, which was keenly debated yesterday evening and received unanimous support.

I should like to add my and my party's delight that you are chairing the Committee, Mr. Griffiths. When you were a Minister in the Wales Office, improving the quality of the health service for all the people of Wales was at the forefront of your objectives. It was refreshing that you thought—and, sometimes, spoke—the unthinkable, when other colleagues were less frank. We are looking forward to two full days of debate on the Bill and I hope that our discussions will improve it.

Win Griffiths (Labour, Bridgend)

I thank the Parliamentary Under-Secretary of State for Wales, the hon. Member for Islwyn (Mr. Touhig) and the hon. Member for Ribble Valley (Mr. Evans) for their kind words, though they will not affect the conduct of the Committee.

Question put and agreed to.

Win Griffiths (Labour, Bridgend)

I remind the Committee that the Bill has a financial resolution, copies of which are available in this Room. Adequate notice should be given of

amendments and, as a general rule, I do not intend to call starred amendments, including any reached during an afternoon sitting. I also remind everyone to switch off mobile phones.

Clause 1 - Community Health Councils in Wales

Nigel Evans (Conservative, Ribble Valley)

I beg to move amendment No. 1, in

clause 1, page 1, line 8, at end insert 'following a request by the Community Health Council or Councils affected;'.

Win Griffiths (Labour, Bridgend)

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.'.

Nigel Evans (Conservative, Ribble Valley)

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.

Roger Williams (Liberal Democrat, Brecon and Radnorshire)

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).

Nigel Evans (Conservative, Ribble Valley)

I am sure that the hon. Gentleman will concede that his party has tabled only two amendments. If it had not been for the amendments tabled by Her Majesty's official Opposition, it would indeed be a short Committee stage.

Roger Williams (Liberal Democrat, Brecon and Radnorshire)

There is an element of substance to what the hon. Gentleman says in terms of number, but on the matter of quality I entirely disagree with him.

Jon Owen Jones (Labour/Co-operative, Cardiff Central)

I am fascinated by the hon. Gentleman's proposition that is normal or even sensible for the Government to table amendments to their own Bills.

Roger Williams (Liberal Democrat, Brecon and Radnorshire)

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.

Chris Grayling (Conservative, Epsom and Ewell)

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.

Roger Williams (Liberal Democrat, Brecon and Radnorshire)

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.

Nigel Evans (Conservative, Ribble Valley)

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?

Roger Williams (Liberal Democrat, Brecon and Radnorshire)

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.

Nigel Evans (Conservative, Ribble Valley)

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.

Roger Williams (Liberal Democrat, Brecon and Radnorshire)

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.

Bill Wiggin (Conservative, Leominster)

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.

Roger Williams (Liberal Democrat, Brecon and Radnorshire)

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.

Hywel Williams (Plaid Cymru, Caernarfon)

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.

Nigel Evans (Conservative, Ribble Valley)

Did the hon. Gentleman think of going to his CHC to complain about the lack of provision of dental care in Wales?

Hywel Williams (Plaid Cymru, Caernarfon)

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.

Jon Owen Jones (Labour/Co-operative, Cardiff Central)

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?

Hywel Williams (Plaid Cymru, Caernarfon)

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.

Bill Wiggin (Conservative, Leominster)

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.

Win Griffiths (Labour, Bridgend)

I have noted the hon. Gentleman's comments.

Bill Wiggin (Conservative, Leominster)

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.

Don Touhig (Labour/Co-operative, Islwyn)

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.

Chris Grayling (Conservative, Epsom and Ewell)

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?

Don Touhig (Labour/Co-operative, Islwyn)

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.

Nigel Evans (Conservative, Ribble Valley)

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.

Don Touhig (Labour/Co-operative, Islwyn)

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.

Chris Grayling (Conservative, Epsom and Ewell)

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.

Don Touhig (Labour/Co-operative, Islwyn)

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.

Bill Wiggin (Conservative, Leominster)

In her evidence to the Select Committee, Jane Hutt discussed whether coterminosity should depend on patient flow or geographical boundaries. She expressed the belief that patient flow was more important. Has the Minister had a chance to discuss that with her?

Don Touhig (Labour/Co-operative, Islwyn)

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.

Amendment No. 15 relates to coterminosity. It is interesting, because the Opposition want to amend the Bill to read,

''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.

Nigel Evans (Conservative, Ribble Valley)

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—

Nigel Evans (Conservative, Ribble Valley)

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—

Roger Williams (Liberal Democrat, Brecon and Radnorshire)

Will the hon. Gentleman give way?

Nigel Evans (Conservative, Ribble Valley)

In a second. The hon. Gentleman needs to understand that real devolution is giving power from this place—or, indeed, from the Welsh Assembly—to a body such as community health councils, which can then drive the change.

Roger Williams (Liberal Democrat, Brecon and Radnorshire)

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.

Nigel Evans (Conservative, Ribble Valley)

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.

Don Touhig (Labour/Co-operative, Islwyn)

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.

Nigel Evans (Conservative, Ribble Valley)

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—

Chris Grayling (Conservative, Epsom and Ewell)

Obfuscate.

Nigel Evans (Conservative, Ribble Valley)

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.

Don Touhig (Labour/Co-operative, Islwyn)

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.

Nigel Evans (Conservative, Ribble Valley)

It may not be the third way that the hon. Gentleman and his party used to stand for. Instead, the London Assembly is now up and running, and I am sure that we are all looking forward to the congestion charge that will be introduced in February—

Win Griffiths (Labour, Bridgend)

Order. We are straying a little from Wales.

Nigel Evans (Conservative, Ribble Valley)

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—

Win Griffiths (Labour, Bridgend)

Order. This is the Health (Wales) Bill, not a Bill on the building of the Welsh Assembly.

Nigel Evans (Conservative, Ribble Valley)

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.

Don Touhig (Labour/Co-operative, Islwyn)

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.

Nigel Evans (Conservative, Ribble Valley)

Of course I welcome any note from the Minister to assuage my fears about changes that would affect the health of the people of Wales and, indeed, the champions of those people's rights within Wales.

Bill Wiggin (Conservative, Leominster)

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.

Nigel Evans (Conservative, Ribble Valley)

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.

Huw Edwards (Labour, Monmouth)

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?

Nigel Evans (Conservative, Ribble Valley)

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—

Huw Edwards (Labour, Monmouth)

This is very woolly.

Nigel Evans (Conservative, Ribble Valley)

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

Chris Grayling (Conservative, Epsom and Ewell)

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.

Don Touhig (Labour/Co-operative, Islwyn)

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.

Chris Grayling (Conservative, Epsom and Ewell)

Does the Minister believe in the process of legislative scrutiny? Does he believe that if a clause involves a significant transfer of powers, it should at least be discussed and explained by the Government of the day? Does he really believe that such an explanation constitutes a wrecking amendment?

Don Touhig (Labour/Co-operative, Islwyn)

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.

Nigel Evans (Conservative, Ribble Valley)

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?

Don Touhig (Labour/Co-operative, Islwyn)

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.

Bill Wiggin (Conservative, Leominster)

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.

Chris Grayling (Conservative, Epsom and Ewell)

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.

Don Touhig (Labour/Co-operative, Islwyn)

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.

Chris Grayling (Conservative, Epsom and Ewell)

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.

Schedule 1 - Schedule 7a to be inserted in the

Nigel Evans (Conservative, Ribble Valley)

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.

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?

Nigel Evans (Conservative, Ribble Valley)

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.''

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.

Nigel Evans (Conservative, Ribble Valley)

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.

Chris Grayling (Conservative, Epsom and Ewell)

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.

Nigel Evans (Conservative, Ribble Valley)

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.

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.

Nigel Evans (Conservative, Ribble Valley)

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.

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.

Nigel Evans (Conservative, Ribble Valley)

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.

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.

Nigel Evans (Conservative, Ribble Valley)

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.

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.

Nigel Evans (Conservative, Ribble Valley)

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.

Julie Morgan (Labour, Cardiff North)

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

Nigel Evans (Conservative, Ribble Valley)

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''?

Jon Owen Jones (Labour/Co-operative, Cardiff Central)

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

Nigel Evans (Conservative, Ribble Valley)

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.

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.

Nigel Evans (Conservative, Ribble Valley)

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.

Don Touhig (Labour/Co-operative, Islwyn)

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.

Nigel Evans (Conservative, Ribble Valley)

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.

Don Touhig (Labour/Co-operative, Islwyn)

Where are they?

Nigel Evans (Conservative, Ribble Valley)

They have been mentioned.

Don Touhig (Labour/Co-operative, Islwyn)

Is there another amendment coming?

Nigel Evans (Conservative, Ribble Valley)

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.

Don Touhig (Labour/Co-operative, Islwyn)

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.

Nigel Evans (Conservative, Ribble Valley)

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.

Chris Grayling (Conservative, Epsom and Ewell)

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.

Nigel Evans (Conservative, Ribble Valley)

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.

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.]

Nigel Evans (Conservative, Ribble Valley)

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—

Don Touhig (Labour/Co-operative, Islwyn)

Common sense is common sense.

Nigel Evans (Conservative, Ribble Valley)

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?

Dari Taylor (Labour, Stockton South)

Cynical.

Nigel Evans (Conservative, Ribble Valley)

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.

Win Griffiths (Labour, Bridgend)

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

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.

Nigel Evans (Conservative, Ribble Valley)

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.

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—

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.

Julie Morgan (Labour, Cardiff North)

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.

Don Touhig (Labour/Co-operative, Islwyn)

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.

Chris Grayling (Conservative, Epsom and Ewell)

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.

Don Touhig (Labour/Co-operative, Islwyn)

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.

Nigel Evans (Conservative, Ribble Valley)

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.

Chris Grayling (Conservative, Epsom and Ewell)

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.

Nigel Evans (Conservative, Ribble Valley)

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.

Standing Committee B

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

Chris Grayling (Conservative, Epsom and Ewell)

I beg to move amendment No. 17, in

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

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.'

Chris Grayling (Conservative, Epsom and Ewell)

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.

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?

Chris Grayling (Conservative, Epsom and Ewell)

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.

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?

Chris Grayling (Conservative, Epsom and Ewell)

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.

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.

Chris Grayling (Conservative, Epsom and Ewell)

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.

Hywel Williams (Plaid Cymru, Caernarfon)

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.

Chris Grayling (Conservative, Epsom and Ewell)

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.

Nigel Evans (Conservative, Ribble Valley)

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.

Chris Grayling (Conservative, Epsom and Ewell)

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.

Don Touhig (Labour/Co-operative, Islwyn)

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.

Nigel Evans (Conservative, Ribble Valley)

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?

Don Touhig (Labour/Co-operative, Islwyn)

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.

Chris Grayling (Conservative, Epsom and Ewell)

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.

Don Touhig (Labour/Co-operative, Islwyn)

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.

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.

Chris Grayling (Conservative, Epsom and Ewell)

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.

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.

Jon Owen Jones (Labour/Co-operative, Cardiff Central)

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?

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.

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.

Chris Grayling (Conservative, Epsom and Ewell)

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?

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.

Hywel Williams (Plaid Cymru, Caernarfon)

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.

Chris Grayling (Conservative, Epsom and Ewell)

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.

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?

Chris Grayling (Conservative, Epsom and Ewell)

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.

Don Touhig (Labour/Co-operative, Islwyn)

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.

Chris Grayling (Conservative, Epsom and Ewell)

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.

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?

Chris Grayling (Conservative, Epsom and Ewell)

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.]

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.

Chris Grayling (Conservative, Epsom and Ewell)

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

Win Griffiths (Labour, Bridgend)

I realise that the temptation is great.

Chris Grayling (Conservative, Epsom and Ewell)

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?

Don Touhig (Labour/Co-operative, Islwyn)

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.

Chris Grayling (Conservative, Epsom and Ewell)

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.

Clause 2 - Wales Centre for Health

Nigel Evans (Conservative, Ribble Valley)

I beg to move amendment No. 8, in

clause 2, page 2, line 12, at end insert '; but at least one-third of the members shall be appointed only on the nomination of community health councils.'.

I welcome the hon. Member for Caernarfon back to the Committee after the strains and tortures of finding a dentist who was prepared to deal with him. I hope that he is in much better shape now than he was a few hours ago.

The clause and the amendment deal with the Wales Centre for Health, a body that we all welcome. It could be vital in promoting activities to protect and improve health in Wales, and will also be known as Canolfan Iechyd Cymru. I see it as an important body, which is why we seek to amend the Bill in such a way. I should be interested to hear what the Minister has to say on our suggestion, which tries to ensure some independence for the body, and with good reason.

Subsection (2) states:

''The Centre is to consist of such number of members appointed by the National Assembly for Wales as the Assembly may determine''.

That is an extremely wide power, and lets the Assembly appoint exactly whom it likes. The nomination powers may be the same as those that we spoke about on the previous amendment. The Assembly will be able to appoint the chairman or propose further regulations as to how he may be appointed.

One reason why we seek more certainty of independence for a body that champions patients' rights is that it will deal with some important aspects

of health promotion and protection. Prevention of smoking in public places was mentioned on Second Reading. Perhaps the centre will recommend policy guidance on that on behalf of the Welsh Assembly, or on behalf of us in Westminster if we want to take primary powers to try to improve health. Smoking raises the emotions of many people in one way or another, but the subject is controversial.

The body may deal with substance abuse as well, a vital subject that is sometimes overlooked. Ten years ago, I was extremely concerned about glue sniffing, as it was then known. Substance abuse still goes on, involving glue and other substances, and some direction is needed on it. Alcohol abuse is widely recognised in the House; the all-party group on alcohol misuse has an important role in bringing those problems to the fore. CHCs may want to carry out a study so as to start a campaign to promote sensible policy guidance on the subject.

I am a former chairman of the all-party group on drugs misuse, and there may be a campaign on drugs. I would welcome that in the whole community in Wales, especially schools and youth centres. I was saddened to read today that nine pupils had been suspended from a north Wales secondary school after they were allegedly caught with cannabis. The school is in Denbighshire, and the pupils have been suspended for up to 10 days. Disturbingly, the report on the matter stated that it would be the fifth time in 2002 that pupils at schools in north and mid-Wales had been disciplined over drugs.

That must concern all members of the Committee. We must put the message across, whether in relation to cannabis or other drugs, and we must deal with the problems that young people face. We would all welcome a campaign in schools led by the Wales Centre for Health. Again, there are resource implications, but the money would be saved in spades.

Jon Owen Jones (Labour/Co-operative, Cardiff Central)

On a point of order, Mr. Griffiths. Is it in order for the hon. Gentleman to make a speech on a wide variety of drugs without declaring an interest as owner of a tobacconist shop?

Win Griffiths (Labour, Bridgend)

I call the hon. Member for Ribble Valley to declare his interest.

Nigel Evans (Conservative, Ribble Valley)

The interest is in the Register of Members' Interests for everyone to see.

Win Griffiths (Labour, Bridgend)

The hon. Gentleman does not sell cannabis.

Nigel Evans (Conservative, Ribble Valley)

Not to my knowledge, Mr. Griffiths. I suspect that the profits would not be as dire if we did, but I would not recommend that policy for our humble newsagent's shop. We do, however, sell cigarettes, which I sometimes find awkward, as, I suspect, do the tobacco companies because I recommend that people give up smoking. Any campaign that we can encourage in that regard must be welcomed.

The Wales Centre for Health will have much work on its hands. There will be many campaigns. The Assembly will have powers to recommend that the centre examines certain key areas. No doubt, some hon. Members will write to the centre to highlight their areas of concern. As we know, there is the problem of

crime and drugs, not just youth and drugs. Three quarters of crime is drug-related, and if we can tackle the one, surely we can tackle the other. On a more positive note, the centre may want to campaign on healthy lifestyles and on gaining fitness through taking more exercise, such as walking instead of taking the bus or driving the car. We tabled the amendment with the aim of ensuring an independent element within that body.

My hon. Friend the Member for Epsom and Ewell referred to active voluntary groups. They should be allowed to be independent so that they can act on behalf of patients and see at first hand some of the problems with which the health service is faced. I am not sure how active those active groups are, or whether they have one person who is a champion for a particular cause. All hon. Members know people who fall into that category and who write to us regularly. Where would we be without them? Where would we be without the organisations that draw from a much wider pool of people; people who meet regularly to discuss issues such as the Red Cross, death, multiple sclerosis, strokes, or ME, which was commonly referred to as ''yuppie flu''? I suspect that all hon. Members have received letters from people who want the Government to do more about ME, and who doubtless want the Welsh Assembly to recognise it as a real illness, which I do, as well as to place greater emphasis on securing more consultants and specialists to deal with it.

The Assembly may not be so keen to concentrate on one area because of the resource implications. A group of people with their own nominees on CHCs may push the centre to consider key conditions that may not be as high profile as others. People with such conditions should not be denied access to the research that the centre will promote. I hope that when the centre is created, several of its reports will be made as widely available as possible on the internet and elsewhere.

We tabled the amendment because, under the schedule, the Assembly has the powers to appoint anyone to this particular body, to determine how the chairman may be appointed or even to appoint the chairman itself. That gives me cause for concern. The centre could be extremely effective in helping to promote good health in Wales and to prevent illness if it can do its job in the most effective way. I hope that the Committee will accept that there should be an element of independence within that body. I hope that we can gain some support for our amendment.

Don Touhig (Labour/Co-operative, Islwyn)

We have decided that Wales needs an independent body that can provide information and impartial advice on public health issues. There is currently no equivalent body that can provide such independent advice. The status of the Wales Centre for Health will enable it to draw on academic and public sector expertise and different public and professional interests to work together. It will also support professional training in public health, including joint training between different sectors and professional disciplines.

The Assembly has identified the need for a body with suitable standing and expertise, which can act as an advocate for public health at the national level. That has been the aim of health policy in Wales since the issue of ''Better Health, Better Wales'' in 1998. The centre will play an important role in advising the Assembly, as well as public agencies and voluntary organisations. The statutory basis for the Wales Centre for Health will ensure its legal independence and establish its role as an impartial advocate for public health in partnership with all sectors. The restructuring of the NHS underlines the relevance and importance of the part that the centre will play in addressing the long-standing legacy of ill health in Wales. The centre will be a health service body. It will not be a servant or agent of the Crown or the National Assembly for Wales. It will function at local, regional, all-Wales, United Kingdom and international levels. That is the ambition and status we have in mind for it.

The amendment would provide that a number of places would be reserved on this body for nominees of community health councils. Like the previous amendment, it reserves a block of places for a group, which is contrary to the way in which we are trying to develop the openness of the health service in Wales. The amendment would reduce the ability of the Assembly to determine the overall composition and balance of membership of the centre. It is the Assembly's intention that members of the centre should be appointed for their expertise and experience. Surely that ought to be the only criterion. They should be drawn from the statutory, voluntary and academic centres.

Chris Grayling (Conservative, Epsom and Ewell)

One of the great tensions within the NHS at the moment is between the academic view at the centre and the practical needs of communities. An awful lot of major health care issues are being significantly shaped by the royal colleges' textbooks—by the leading members of the profession—without reference to the implications of those decisions for the delivery of local services. Does the Minister not think that having a balance between that top level, with its undoubted expertise, and representatives of the services on the ground would provide an effective means of reconciling those different demands?

Don Touhig (Labour/Co-operative, Islwyn)

The hon. Gentleman makes a fair point. We want the Wales Centre for Health to be as broadly based as possible, but to draw on all possible expertise. I am reluctant to start reserving blocks of places for groups, whether they are broadly described as having some sort of vested interest, albeit an admirable interest so far as CHCs are concerned.

Roger Williams (Liberal Democrat, Brecon and Radnorshire)

Will the Minister explain the role of the centre on a UK and international basis? I understand that it may provide information and knowledge that would helpful to Wales, but does he expect that it will disseminate knowledge on a greater basis than just throughout Wales?

Don Touhig (Labour/Co-operative, Islwyn)

The work of the centre will be posted on its website, so there will be access across the planet to the work and research that it is doing. We need

hope, aspiration and vision that the centre will make a wide contribution across a whole range of issues. The hon. Member for Ribble Valley (Mr. Evans) and my hon. Friend the Member for Cardiff, North spoke of AIDS and so on, and the centre may well do some work on that problem. I do have that hope and ambition for it.

I remind Opposition Members that we undertook extensive public scrutiny on the Bill before we bringing it forward. That does not take away from hon. Members the right to seek to amend it in Committee, but no one who was consulted asked that a block of places should be reserved for a particular group.

Wales Centre for Health members will be recruited by the same process—and under the Nolan principles—that apply to the community health councils, and the process will be open, transparent and accountable. Nothing will be hidden. As part of the recruitment drive, people will be able to look on the Assembly website for guidance on how to become members of the Wales Centre for Health. It is important that we should make the process open, transparent and accessible, so that everyone who feels that they can make a contribution can apply. However, we want to take the proposal forward without setting a number of places aside for a particular group or any vested interest group. We think that that is the best way to push it forward. I hope that the hon. Gentleman will consider withdrawing the amendment.

Nigel Evans (Conservative, Ribble Valley)

I share with the Minister the same hopes and aspirations for the Wales Centre for Health. The hon. Member for Brecon and Radnorshire asked whether it was intended that the centre should consult with other UK bodies, or even more widely. I am reassured to hear that part of its research, perhaps into AIDS, will not be a Wales-only thing, or even a UK-only thing; it should be much wider than that. The implications of AIDS for Africa are huge and immense. We look on aghast at the problems being faced on that continent, which is being ravaged by AIDS. Anything that the Wales Centre for Health can do to help produce programmes that may spread even into Africa would be welcomed by every member of the Committee; indeed, we would be proud of its work.

I asked about the internet and I am reassured by the Minister's answer. He said that the centre would have a website that could be accessed by all interested groups, wherever they happened to be, so long as they had access to the internet. I am grateful for that confirmation.

Like the Minister, we want the centre to be independent. However, we want at least some part of it to be more independent of the Assembly than it would be under the Bill, which is the reason for the amendment. It is a probing amendment to allow us to press the Government on whether there are any means of ensuring that the centre is independent of the Assembly. Although the Minister assured us that the Nolan committee appointments procedure would be followed, that may change. It is not included in the Bill; I cannot see the word ''Nolan'' there. What

assurances do we have that that procedure will always be followed? We in Parliament are placing a huge amount of trust in the Welsh Assembly and its Executive.

Don Touhig (Labour/Co-operative, Islwyn)

I accept and value the hon. Gentleman's comments. I should have stressed earlier that the Assembly has agreed a code of practice for recruitment to all such organisations. That can be changed only by a majority vote in the Assembly. I hope that he will accept that reassurance, because it would require all-party support to make such a change.

Nigel Evans (Conservative, Ribble Valley)

I am grateful to the Minister. I know how much more difficult it is for any one party to have overall control of the Welsh Assembly. Even if a party wished to go down that route, I hope that there would always be an element of independence that would resist such a move. We want the Wales Centre for Health to be manned by people who are appointed for their expertise and experience, as it will be dealing with many wide-ranging areas of health promotion in Wales. However, I am sure that he will not blame us if we look for worst-case scenarios and ways of ensuring that the Bill is as watertight as we can make it. The Minister has given us certain assurances. The suggestions that we have made may be reconsidered in the other place, but I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Clause 2 ordered to stand part of the Bill.

Schedule 2 - Wales centre for health: further provision

Bill Wiggin (Conservative, Leominster)

I beg to move amendment No. 18, in

schedule 2, page 8, leave out lines 27 to 32.

This is very much a probing amendment. At first glance, paragraphs 6 and 7 of the schedule seem reasonable. Paragraph 6 states:

''If it appears to the Assembly that there has been a serious failure by the Centre to perform any function which it considers should have been performed by the Centre, the Assembly may give the Centre such directions as it may consider appropriate for remedying that failure.''

That seems innocent enough. Paragraph 7 states:

''Directions under paragraph 6 must include a statement summarising the reasons for giving them.''

The Minister pointed out a few moments ago that the Wales Centre for Health was not to be regarded as a servant of the Assembly or, indeed, the Crown, yet almost everything about the centre is decided upon by the Assembly. Therefore, this is either a belt-and-braces provision, or unnecessary.

Paragraph 9 states:

''The Centre must comply with any direction given by the Assembly under this Schedule.''

If the Wales Centre for Health is responsible for any type of failure, it will automatically be in default, so paragraphs 6 and 7 are almost completely unnecessary, and the amendment would leave them out of the Bill. If the provisions stay, they will not be to the detriment of the centre, but part of our duty as a

Committee is to ensure that the Bill is as clear and positive as possible.

Chris Grayling (Conservative, Epsom and Ewell)

My hon. Friend is a member of the Select Committee on Welsh Affairs. Am I right in saying that the Committee expressed concerns about this whole block of legislation, particularly the apparently draconian powers that it offers the Assembly over the workings of the Wales Centre for Health? If so, will he enlighten us about the discussion that took place and whether he shares that view?

Bill Wiggin (Conservative, Leominster)

I do, and I am grateful to my hon. Friend for bringing that up. I have a quote from Jane Hutt, who says:

''I am not being prescriptive, but I am saying we need to use regulations not to tie down the Wales Centre for Health, but at least provide the appropriate routes into the Wales Centre for Health and provide more clarity on the routes into the Wales Centre for Health.''

We are trying to clarify the amount of influence that the Welsh Assembly should have over the centre, and whether this aspect of the Bill would allow the centre to be a scapegoat should something go wrong. Removing paragraphs 6 and 7 would tidy up the Bill, so I am curious to hear why the Minister feels it is so important to leave them in.

Don Touhig (Labour/Co-operative, Islwyn)

The amendment would remove the provision that enables the Assembly to give directions to the Wales Centre for Health to remedy a serious failure in the centre's performance. That provision is essential for the Assembly to maintain proper oversight of the centre's work. Surely it would be wrong if the Assembly had no powers to intervene if it were aware of major financial mismanagement or administrative malpractice in the centre.

Bill Wiggin (Conservative, Leominster)

Paragraph 9 says:

''The Centre must comply with any direction given by the Assembly under this Schedule.''

Everything that the Minister has said would still apply if paragraphs 6 and 7 were removed.

Don Touhig (Labour/Co-operative, Islwyn)

I am sure that if I say a few more words about the matter, what I am trying to get at might become clear to the hon. Gentleman. As I said, we want to ensure the independence of the centre. However, we also took account of the concerns that the Select Committee on Welsh Affairs—of which he is a member—expressed at the pre-legislative scrutiny stage. The hon. Member for Epsom and Ewell helpfully reminded the hon. Gentleman of what that Committee said.

I remind hon. Members that when the draft schedule 2 was first published and put out for scrutiny, under ''Assembly directions'', we said:

''In exercising any function, the Centre must comply with any direction given by the Assembly for Wales.''

We have taken account of the concerns that were expressed during pre-legislative scrutiny, and the Bill has been amended accordingly. Now, the Assembly will be able to intervene only when there is a serious failure, and it must give reasons for doing so under

paragraph 7. We believe that that is not only a proper and adequate safeguard against any misuse of power by the Assembly or interference with the centre's work, but a backstop. If there is serious financial or other malpractice, a body must be able to intervene in order to take corrective action. That body is the National Assembly.

Recognising that the amendment is a probing amendment, I hope that the hon. Member for Leominster (Mr. Wiggin) is reassured. We have listened to the comments made during pre-legislative scrutiny. We have removed the all-embracing power to exercise in any function and in any direction. We have made the provisions more specific in relation to the matters that I articulated. I hope that for those reasons the hon. Gentleman will feel able to withdraw his amendment.

Bill Wiggin (Conservative, Leominster)

I would most like to withdraw the amendment. It is unfortunate, however, that the Minister has not yet managed to convince me that everything that he said is different from paragraph 9. That is the sticking point. Under paragraph 9,

''The Centre must comply with any direction given by the Assembly under this Schedule.''

That means that paragraphs 6 and 7 are redundant. I do not understand why such negative provisions are necessary. However, I will happily listen to the Minister again, if he will help me on that point.

Don Touhig (Labour/Co-operative, Islwyn)

If I may help the hon. Gentleman, paragraph 9 relates to the directions as concerns paragraphs 6 and 7, which are specific to any failure by Assembly in the functions that I have illustrated.

Bill Wiggin (Conservative, Leominster)

I am grateful, and I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Schedule 2 agreed to.

Clause 3 - Functions of the Centre

Chris Grayling (Conservative, Epsom and Ewell)

I beg to move amendment No. 3, in

clause 3, page 2, line 24, at end insert—

'Provided that it shall be obliged to coordinate those activities with those carried out by similar bodies elsewhere in the United Kingdom.'.

I view the amendment and the principles in it as perhaps the most important for the Bill. It seeks to enshrine in the Bill a duty of co-operation across borders in the United Kingdom. It is designed to be commonsensical and constructive, and in no way to remove rights and powers from the Wales Centre for Health, but to ensure that it works in partnership, for the good of the United Kingdom, rather than in isolation from the United Kingdom. I say that with genuine passion because, despite all the processes of devolution that have taken place, we are one nation. In all parts of our country, we share issues, in particular health issues. I simply do not believe that there is one single health issue that applies to Wales alone; certainly not the issues that, one could argue, have a significant impact in the Welsh community.

The hon. Member for Vale of Glamorgan (Mr. Smith) intervened on me on Second Reading to refer to his proper concerns about deep vein thrombosis and about the experience of that unfortunate condition in Wales. As I pointed out to him, however, it is not an exclusively Welsh issue. Wales is undoubtedly affected by other issues. Former coalminers face problems after many years in the pits, but so do former coalminers in other parts of the country. The young generation faces health and well-being issues, but those, too, are shared by other parts of the country.

We do not have a Welsh health service or an English health service; we have a national health service, as is right and proper. It is right that we make the best use of the resources available to us as a nation and that we do not commit resources unnecessarily to duplicating effort. At the same time, we must recognise that the localisation of health education and of some aspects of research may meet some local community needs.

It is fundamentally important that the Bill enshrines a spirit of co-operation, without detracting from the Welshness of certain services. As I told the hon. Member for Monmouth in the previous debate, health issues cross boundaries.

Hywel Williams (Plaid Cymru, Caernarfon)

Is the hon. Gentleman aware of the condition that affects slate workers and ex-slate workers in my constituency? It is probably unique to north Wales, as is the fact that the employers went bankrupt. In 1979, that led to the passing of legislation that applied only to those slate workers and nowhere else in the UK, as far as I know. I do not see how there could be co-operation, as the hon. Gentleman called it, with parts of the UK where a condition does not exist and where employers have not gone out of business.

Chris Grayling (Conservative, Epsom and Ewell)

If there is an individual case, I stand to be corrected. I should remind the hon. Gentleman, however, that there has been an established slate mining industry in other parts of the country; most notably in the peak district. It would surprise me, therefore, if his constituents' experience was limited wholly and exclusively to his part of Wales. It may have suffered more than any other part of the UK, and different areas will always be affected differently. However, I should be astonished if any complaint was wholly and exclusively limited to Wales, even though some complaints are more significant there. I fully accept the hon. Gentleman's point about his constituency experience, but when he hears the full details of my argument, he will see that that one case does not prove that I am wrong.

Health services cross borders. I mentioned that the Association of Welsh Community Health Councils had embarked on a project to assess the level of service provided by English health organisations to Welsh patients in the cross-border region. In the areas around Chester and, indeed, right the way up the border, there will inevitably be crossovers involving people who live in Wales and the English health service, as well as people who live in England and the Welsh health service. Several years ago, a significant issue arose right on the border, in the constituency of my hon. Friend the Member for Leominster, where a

hospital closure had undoubted implications for both communities.

Jon Owen Jones (Labour/Co-operative, Cardiff Central)

I have just thought of a crossover problem, and the hon. Gentleman might like to think about whether the amendment would deal it. If, as reported, the Welsh Assembly does not enact the Bill's provisions on bed blocking, but they are enacted in England, English hospitals will presumably be entitled to charge Welsh local authorities for bed blocking, while Welsh hospitals will not be able to charge English local authorities. Would the amendment sort that interesting problem out?

Chris Grayling (Conservative, Epsom and Ewell)

The hon. Gentleman makes an interesting point, although I do not think that my amendment would solve the specific issue. None the less, it is a good point. As funding regimes differ between local authorities, and, potentially, between England and Wales, the whole issue of placements for the elderly in care homes will open up a Pandora's box of problems for the care home sector and for local authorities, such as placing people across the border for financial reasons.

Nigel Evans (Conservative, Ribble Valley)

Perhaps the Wales Centre for Health will look into that, to work out what will happen to elderly people in certain areas who are bed blocking. The hon. Member for Cardiff, Central (Mr. Jones) raises an interesting point. If fines are introduced in England but not in Wales, bed blocking may be eradicated in England but not in Wales. That should interest both the Wales Centre for Health and community health councils.

Chris Grayling (Conservative, Epsom and Ewell)

I thank my hon. Friend for that salient point. My amendment is designed to focus primarily on two areas; medical and health research, and the provision of public information and education on health. I strongly believe that we need to ensure that there is proper collaboration and co-ordination in those two areas. Medical research already crosses boundaries. I have looked to see what research is currently being conducted, and it is obvious that the medical research that is taking place in Wales—either research generated from within Wales or research programmes to which people in Wales are contributing—is international. For example Cancer Research UK has been funding a project involving girls in Wales, England and three other European countries, to investigate links between health issues for girls before puberty and cancer. That is an example of a health problem that crosses many boundaries and a research project that is being carried out in several countries; people are pooling information and working collaboratively for the benefit of everyone in those countries.

Some excellent medical research is taking place in Wales, for example on cancer. The cancer charity Tenovus, based in Wales, is doing excellent work, both in the Principality and internationally, looking for new treatments to combat cancer. Its research is based on work carried out in Wales but it is used in an international arena. The charity is working across the United Kingdom, and has people working in Cardiff, as well as at its research centres in Southampton, Liverpool and Bournemouth. That UK team is doing a first-rate job, developing new

projects to tackle different sorts of cancer. Their work should be applauded.

Among the international community, the UK remains at the leading edge of medical research. We need to use our strengths to benefit everyone, because the health solutions that we discover will provide better outcomes for patients around the world. That is why we must not be provincial in our approach to health research.

Under the legislation, the Wales Centre for Health has a particular remit, to

''undertake and commission research into such matters''.

I appreciate that much of that research may be at a low level or local, but equally it could be at a high level or relate to public health or specific issues of concern. It would, therefore, be a dereliction of duty on the part of that organisation and the health service in Wales if research were simply undertaken in a Welsh context, without examining whether there were similar issues elsewhere in the United Kingdom, without exploring whether similar projects were being considered by bodies elsewhere in the UK and without a degree of partnership between the Wales Centre for Health and its counterparts elsewhere in the UK. That is plain common sense, making the best use of resources in the NHS.

The amendment is designed only to write a duty of care into the Bill and to send a message from the UK Parliament—ultimately responsible for our national health service—that the different component parts of our nation should work together. Where they face common issues, they should make the best use of available resources, pool their expertise and share their best practice. I hope that the Minister will accept that the amendment would enhance the role of the Wales Centre for Health, without detracting from its powers. It would underline the fact that the centre operates within a United Kingdom health framework, of which it should be mindful in undertaking its work.

On public information and education, consistency of message is important. We face several significant health issues. My hon. Friend the Member for Ribble Valley referred to the alarming growth over the past 12 months in the number of people found to be HIV positive. I fear that, as a nation, we have become too complacent about the threat of AIDS.

Fifteen years ago, public information campaigns warned people of all ages, but particularly the young, about the risk of AIDS and the different ways of contracting it. Advice was given about the steps necessary to remain infection-free. The campaign was largely successful. The doom-mongers in this country, who said that AIDS would swamp us within a few years were proved wrong. We have not been swamped; we have remained relatively immune, though it remains tragic for the small minority who are infected.

As we look abroad, we recognise that the threat is far from gone. In parts of the world, AIDS remains a scourge on humanity, perhaps the greatest threat that

humanity faces. Africa has infection rates of 30 to 40 per cent., and both India and China face mounting infection rates. We must recognise how vulnerable we are as a nation to HIV/AIDS, in a world where people travel and cross borders legally and illegally. It is crucial to pick up on the work of 15 years ago and make a new generation of young people aware of the threat of HIV/AIDS. It is just one example of many where our society has a duty to educate people about the health threats that they face, the lifestyle choices that they make and their implications for their future health.

Let us examine the practicalities. When AIDS campaigns were waged in the 1980s, extensive use was made—quite rightly, as it is the most effective means of reaching our population—of television. However, let us reflect on the implications of ITV companies, for example. HTV, viewed in many parts of the west of England, is not an exclusively Welsh organisation; Granada, covering areas beyond Chester and extending into north Wales, is not an exclusively English organisation. BBC programmes have the same problem, as do local radio stations and newspapers. The media does not stop at the boundaries of England and Wales. People in England will hear messages sent out by the Wales Centre for Health and the population of Wales will hear messages sent out by public health bodies in England. Without co-operation and partnership between the bodies, we will be sending conflicting messages to the younger generation over matters such as HIV/AIDS at a time when we simply cannot afford to do so.

Jon Owen Jones (Labour/Co-operative, Cardiff Central)

Conflicting messages can be a benefit because no one has a monopoly on truth and wisdom. For example, when the BSE crisis arose, there was a monopolistic view that eating beef was perfectly safe. However, the then medical adviser in the Wales Office, under a Tory Government, took the opposite view. It turned out that she was correct. Had there been a separate body, both views would have been put into the arena, to the public benefit.

Chris Grayling (Conservative, Epsom and Ewell)

There will always be multiple opinions in the medical and scientific communities. New research comes out one week and we are told that we can eat something. The following week there is another piece of research and we are told not to eat it, only to be advised the week after that that the food is very healthy. One loses touch with what is good for you and what is bad.

Should a young person watching a public information campaign about HIV/AIDS, produced by the Wales Centre for Health and shown on HTV, receive a dramatically different message from that shown a moment or two later on Channel 4 from the public health bodies in London? Would that be prudent? That is why I believe in a partnership campaign and the co-ordination of messages.

Jon Owen Jones (Labour/Co-operative, Cardiff Central)

The proposal would not work in that way; various pressures would be put on agencies. If I may to return to my earlier example, in the case of BSE, the pressures came from the industry not to frighten the consumers. No matter what side of the River Severn we are talking about, if it was believed that someone would publish and be damned in any

case, people would consider the research more carefully and probably come up with a united, and therefore better, view.

Chris Grayling (Conservative, Epsom and Ewell)

The hon. Gentleman is making my case for me. It would be a nonsense if the Wales Centre for Health said that beef was safe, the Food Standards Authority in London said the opposite and public information campaigns in London and Cardiff reflected those diametrically opposite opinions. When messages are crossing borders, it should be beholden on the bodies involved to get together and work out the best message.

Hywel Williams (Plaid Cymru, Caernarfon)

Will the hon. Gentleman explain what ''co-ordinate'' means? I accept that he uses the word for the purpose of argument but he suggests a situation in which the Welsh body might go in one direction and bodies elsewhere in the United Kingdom in another. On the whole, people tend to go in the same direction, with variations. Does ''co-ordinate'' mean that everyone has to be absolutely the same and hold a monolithic view of the issue or is the hon. Gentleman allowing a variation for the Celtic fringe?

Chris Grayling (Conservative, Epsom and Ewell)

The word ''co-ordinate'' means just that. Those running public health information services in the Wales Centre for Health should be in touch with their counterparts in London and know what they are doing, and vice versa. Ideally, the same should be done in Scotland although I appreciate that that is not within the remit of the Bill. We should ensure that the bodies focusing on health issues in different parts of the United Kingdom are in contact with each other and work together. Even if the nature of their campaigns is different, they should at least ensure that there are no absurd conflicts of the kind that could arise if a dialogue does not take place. That is the sole purpose of the amendment.

Roger Williams (Liberal Democrat, Brecon and Radnorshire)

I agree with the hon. Gentleman's argument. However, if science on a particular issue is well established and agreed, there is hardly likely to be a different approach to communicating it to the public.

Chris Grayling (Conservative, Epsom and Ewell)

One would hope that the approach would not be different. Anyone who has been involved in communication—my professional background before I came to this place—knows that organisations are wonderfully good at saying things that contradict one another. A marketing campaign from one department will say one thing, and another campaign from another department will say something diametrically opposite. The company concerned is then in a mess as a result.

That lesson should be taken on board by the public sector, especially the national health service in this arena. It should simply be a duty of care for those responsible for research and for public information and education to ensure that they talk to each other, work together and co-ordinate their work, so that each strengthens what the other does, rather than weakens it by putting out contradictory messages.

The amendment would not remove any powers from the Wales Centre for Health, but would put a duty of care on it, simply to remind the centre that it is part of a health service that is spread across the United

Kingdom and that it will indulge in activities that cross borders. The need for co-ordination and to work together with other parts of the UK is sacrosanct and should be included in the Bill.

Hywel Williams (Plaid Cymru, Caernarfon)

I asked the hon. Gentleman what ''co-ordinate'' means, as the amendment states that the centre is obliged to co-ordinate

''with . . . similar bodies elsewhere in the United Kingdom''.

That is in terms of

''the provision and development of training''

as well as information on

''protection and improvement of health''

and the commissioning of research. My fear is that the amendment would prevent a specific Welsh view being taken of specific Welsh problems.

If I were in the hon. Gentleman's shoes, I would take care when using the word provincial. Some people get rather prissy about its use in terms of Wales, because we see some issues as national.

Perhaps ''co-ordinate'' means allowing certain variation, but would it prevent the Wales Centre for Health from taking a particular course? I recently visited the Fresno centre for ageing in California, where there is an innovative and promising project on the health of older people. It combines several features, such as a public health campaign against abuse of the elderly in co-operation with the sheriff's departments and prosecution departments. I am not aware of a similar venture in the UK. If the Wales Centre for Health wanted to do such work, would it need to co-ordinate that with something that did not exist elsewhere in the UK?

Chris Grayling (Conservative, Epsom and Ewell)

If the Wales Centre for Health were to invest in excellent research such as that, would the hon. Gentleman think it prudent of the centre to tell organisations elsewhere in the UK that it was going to do so, and to offer to share the findings with them?

The rest of the debate is in Hansard.