Jane Hutt
Minister for Health and Social Services
|
| JH/05697/03 |
The Rt Hon Lord Richard QC
Richard Commission
Caradog House
1-6 St Andrews Place
Cardiff
CF10 3BE |
|
16 July 2003
|
| Dear Lord Richard |
| Thank you for your letter dated 23 May inviting me to
give further evidence to your Commission. Whilst I am
grateful to be given this opportunity, I do not wish at
present to add to the evidence I have provided. |
| You asked for information on two specific items: the
implications of NHS Foundation Trusts in England, and
achieving our manifesto policy of free prescriptions in
Wales. |
| In Wales, we intend to pursue many of the benefits of
the proposed NHS Foundation Trusts in other ways more
fitting to our circumstances and policy direction. The
legislation for Foundation Trusts, in the Health and Social
Care (Communities and Standards) Bill, therefore refers
to England only. The approach we are taking in Wales is
not dependent on further primary legislation, although
it has been facilitated by the creation of Local Health
Boards established through earlier legislation. These
provide local focus in the commissioning of services,
whilst the Welsh Assembly Government will set national
standards and the new regional offices will enhance performance
management and performance improvements based round a
"balanced scorecard" approach that allows flexibility
at local level in terms of the way in which national strategy
is implemented. This will also allow for a greater devolution
of power responsibility to clinicians and managers responsible
for the provision of care. In addition, we are pursuing
a rigorous 'Agenda for Change' programme to allow
for the more flexible deployment of a modern workforce
in Wales. These elements are all achievable within existing
legislation, so there is no need for the Health and Social
Care Bill to take them into account. |
| The Bill does, however, contain Welsh-only clauses which
will establish a Health Inspectorate to carry out inspections
of health organisations in Wales |
| in a manner analogous to the Care Standards Inspectorate
Wales and Social Services Inspectorate Wales. |
| I understand that, subsequent to your letter, your office
has requested information on the concerns raised over
cross-border. implications for Wales of Foundation Trust
legislation. There are two basic concerns which have been
raised, both about operational issues if trusts close
to the border achieve Foundation status. |
| The first is that the degree of financial freedom Foundation
Trusts will have may allow them to increase salaries or
provide incentives to attract key staff from other regions,
including Wales. At this stage, it is not certain that
Foundation Trusts will actually raise salaries but, if
they do, this is one more pressure on the already significant
issue of recruitment and retention faced by organisations
across the UK. The Welsh Assembly Government has developed
a national strategy for recruitment and retention - reflected
in local strategies in all Welsh NHS trusts - and is addressing
the issue in other ways such as a new contract for consultants
in Wales currently under negotiation (without the need
for primary legislation). |
| The second concern has been that Foundation Trusts would
not provide services to Welsh patients. This concern has
been cleared up within the Health and Social Care Bill
with Amendment 148, which states that every Foundation
trust must be authorised to provide healthcare services
to NHS patients from other parts of the UK. This will
allow Welsh patients who live on the border with England
to be treated in an English hospital, if that is most
convenient. As importantly, it allows for NHS patients
from any part of the UK to receive care in national specialist
facilities in England. |
| You also asked how the manifesto policy on free prescriptions
would be achieved within the devolved powers. A number
of options are being considered for taking forward this
policy, but the challenges are practical rather than legislative.
As far as legislation is concerned, the main change is
to amend the NHS (Charges for Drugs and Appliances) (Wales)
Regulations 2001 so a patient for whom drugs or medicines
have been prescribed in Wales will be entitled to an exemption
from prescription charges. The policy can therefore be
pursued through changes to secondary legislation in Wales,
without the need for primary legislative changes. |
| I hope this answers your queries and that you find this
information helpful. |
|
Jane Hutt AM
Minister for Health and Social Services |
|
|
