Health and Care Bill (Ninth sitting)

Debate between Hywel Williams and Alex Norris

Committee stage
Tuesday 21st September 2021 Public Bill Committees

[Hywel Williams (Arfon) (PC)]

I beg to move amendment 85, in clause 33, page 40, line 11, at end insert—

‘(3) The Secretary of State must consult the Welsh Ministers before the functions in this section are exercised.”

This amendment would require the Secretary of State for Health and Social Care to consult the Welsh Government before the functions on workforce assessments in this clause are exercised.

I will be brief, given that much of what I would otherwise have said has been covered in the debate on the previous group of amendments. I will just say to those on the Front Benches, in their discussion of the genesis of the NHS, that success has many parents. Aneurin Bevan of Tredegar was the father of the NHS, based on his experience of the provision of health in that area, but it was also based on the foundation that was set up by my predecessor but three as Member for Caernarfon, David Lloyd George.

Having got that out of way, the amendment would place a duty to consult the Welsh Government on workforce assessments. Although the amendment is a probing one, I am concerned that the devolution settlement remains somewhat complicated and sometimes unclear, even in its current iteration. As a piece of history and a reference to how that settlement can cloud matters, I will mention a question I asked a former Labour Secretary of State for Health, Mr Alan Milburn, some years ago about nurses’ pay. His response, which I committed to my memory, was “It is one of the abiding joys of my life that I have no responsibility for things Welsh.” Unfortunately for both Wales and him, he actually had responsibility for nurses’ pay at that time. Even Secretaries of State are not perfect, let alone Ministers of State and others. That situation has now been resolved.

The danger is always that the remaining integration of parts of the Welsh health service and health service in England might be overlooked. I referred to that earlier in respect of services and people from Wales—and people from England, for that matter—accessing health services on the other side of the border. People in north Wales specifically will recognise the names of individual hospitals in England. I refer briefly to Alder Hey on the Wirral, which provides services to children with severe conditions. There is the Royal Liverpool; the Christie in Manchester, which provides specialist cancer treatment; and the hospital in Gobowen, which has for a long time provided orthopaedic services. Recently, severe casualties and people who have suffered road traffic accidents have been helicoptered to Stoke for specialist treatment. As I said the other day, around 13,500 Welsh people access GP services in England, and 21,000 or so people from England access GP services in Wales. Those are the 2019 figures.

The workforce-training and education aspects of cross-border arrangements must be considered because staff are mobile. People from Wales access training in England and then return to Wales, and it works the other way around as well. In my own constituency specifically, the school of nursing at Bangor University has for a number of years trained nurses from all over the UK and elsewhere. We are now establishing a medical school that will certainly be training doctors who will return to Scotland, England or Northern Ireland.

The other positive opportunity that proper workforce planning would present the health service throughout the UK is in the specialisms that we hope to develop in Wales—particularly in my area of north Wales. Those specialisms include, for example, treating injuries arising from accidents on our coasts and mountains, for which we already have some specialism. There are also particular issues around mental health and multilingualism, particularly in talking therapies and work with children and older people.

There are opportunities for people who might be trained in Wales before going over to England, and vice versa. For the reasons that I have outlined, I think it essential that those matters be taken into consideration in workforce planning.

[Alex Norris]

It is a pleasure to serve with you in the Chair once again, Mrs Murray, and to follow the thoughtful contribution by the hon. Member for Arfon.

The hon. Gentleman’s points about interdependency are important. Of course, we cherish and build on the devolved settlement, but we understand that we still have important relationships, not least at our borders. I thought that his point about specialised care was a thoughtful one, too: we know that as conditions or treatments become complex, there will be specialisations, and we would never want artificial barriers to get in the way of people accessing specialised care. His point about training was also good and jumped out to me.

Yesterday, I spoke to a surgeon in my community who took great pride in working in the hospital where he was born. In between, he had gone away; I am told that there are parts of the world other than Nottingham—I dispute that fact—and he wanted to go and see some of them. That will inevitably involve crossing borders, and it is important that that is reflected in the Bill. That will happen from nation to nation, but in the future it will happen from integrated care system to integrated care system. Where there is divergence, we need to be thoughtful of it.

The statement of values relating to cross-border care said:

“no treatment will be refused or delayed due to uncertainty or ambiguity as to which body is responsible for funding an individual’s healthcare provision.”

That is an important principle because it sets out that it is the job of the system rather than the individual to understand and navigate the separation between different bodies that may diverge but which work together in common purpose. That is easy to say, but hard to do at times. As I say, that is something that we will see between integrated care systems in time, too. That is true for patients, but also for staff, whether those staff work in Wales but live in England or vice versa, and for the important interrelationships between border integrated care systems on the Welsh border and the NHS in Wales.

There will be devolved and separate competencies between those bodies, but the human beings who make those systems go live side by side in communities, sometimes even next door to each other. A decision taken in one place, of course, impacts on everybody; we see that a lot in social care. Local authorities are under so much pressure at the moment, both in the resources that they have to fund social care and finding individuals to staff that care. There could be price wars at the borders that mean that individuals move between organisations more frequently than they would in a system that was better planned. We have to be mindful of that.

During the evidence sessions, we heard about the safe staffing legislation for nurses in Wales. That is the sort of thing that would already impact on border CCGs, and will do on integrated care systems in due course. That will only grow as the considerable workforce pressures that we discussed in the previous debate bite down even harder. Again, we must be mindful of that. It is crucial that there is a collective approach—a minimum approach—where the NHSs in neighbouring nations have due regard to each other. If the workforce becomes a zero-sum game, we will all lose in the long term.

I was heartened in those proceedings to hear about the contact between the Minister and his colleagues in Wales. I know that he takes matters seriously in Wales and across the United Kingdom, which is good. We might hear more about how that works with regard to the work- force. In the meantime, we support the inclusion of this measure in the Bill and the fact that it will be a priority.