The Health and Social Care (Community Health and Standards) Act 2003

The Health and Social Care (Community Health and Standards) Act 2003 received Royal Assent on 20 November 2003. Introduced into Parliament in March 2003, it was a complex Bill, with over 200 clauses and schedules, 37 of which applied wholly or largely to Wales. The Act provides the Assembly with a vital tool for ensuring improved quality of healthcare in Wales. It provides the power to prepare and publish a statement of standards that will have to be taken into account by every Welsh NHS body in discharging its duty of monitoring and improving quality in healthcare. The standards will be formulated in the light of advice from bodies such as the National Institute for Clinical Excellence, the royal colleges, and the National Patient Safety Association, and will take account of national service frameworks. We will consult fully before publishing the standards.

The first meeting of the Wales quality forum, which was held in January, underlined the continuing commitment that exists for joint working to improve the quality of patient care across the breadth of the NHS in Wales and England. We intend to establish an advisory board for healthcare standards in Wales, which will be set up to manage the process of affirming standards to be included in the statement of standards, and to provide professional advice and support to the Assembly. The power to set standards is linked to an accompanying power to monitor and review performance against those standards. The Act therefore gives the Assembly the ability to undertake reviews of, and investigations into, the provision of healthcare by Welsh NHS bodies. We will set up a new inspectorate—the Healthcare Inspectorate Wales—to undertake those functions that were previously exercised across England and Wales by the Commission for Health Improvement.

The independent integrity of Healthcare Inspectorate Wales’s inspection functions will be assured through formal delegations and protocols. By placing these powers and responsibilities with the Assembly, the Act ensures that we can address and monitor health priorities specific to Wales. The Act also establishes a new commission for healthcare audit and inspection, which will have England and Wales functions. In the same way that the National Assembly will undertake reviews and investigations of healthcare provided by or for Welsh NHS bodies, the Commission for Healthcare Audit and Inspection will undertake reviews and investigations of healthcare by or for English NHS bodies. In addition, CHAI will also undertake national England and Wales studies of particular kinds of healthcare in England and Wales. Dr Sharon Hopkins, who is currently south-east Regional Director of the National Public Health Service, has been appointed as the CHAI commissioner with responsibility for Welsh interests.

Turning to social services, the Assembly is given new powers under the Act to ensure the effective evaluation, review and monitoring of these services in Wales. It is important that we have a comprehensive picture of the services that local authorities are providing, and how well they are discharging their statutory functions. These powers will be exercised on the Assembly’s behalf by the Social Services Inspectorate for Wales. As with Healthcare Inspectorate Wales, the independent integrity of the inspection functions of Social Services Inspectorate for Wales will be assured through formal delegations and protocols.

The new powers will support the further improvement of our evidence-based approach to performance management and the continuous improvement of social services. The review and inspection arrangements in Wales share a set of core principles with the new English inspectorate—the Commission for Social Care Inspection. Both will be founded on the same principles of safeguarding vulnerable people, supporting independent living, and promoting social inclusion.

The Act also enables the Assembly to make its own regulations about complaints procedures, in respect of both healthcare and social services. We intend to make it easier for the NHS and social services to work together on complaints of common concern and, unlike in England, unresolved complaints will be reviewed by an independent panel, with further recourse then possible to the health service ombudsman or local government ombudsman.

The Act introduces changes to the general medical services contract that will benefit general practioners, other primary care professionals, and patients. There will be unprecedented investment in primary care. New contracts between local health boards and practices, rather than GPs, will give practices greater flexibility; and there will be new measures to ensure that patients have more choice, access to a wider range of high-quality services, and more community-based treatment. In October, I announced a £7 million package of measures to improve primary healthcare across the country, including the first step towards ensuring access to a member of the primary care team within 24 hours. The measures, called enhanced services, marked the start of the implementation of the new GP contract, which will deliver higher quality primary care services for Wales.

Other changes will help the reform of primary dental care services in Wales. We are working together to improve these services through ‘Routes to Reform: A Strategy for Primary Dental Care in Wales’, while assessing the potential impact on practitioners, the needs of patients, affordability, and the effects of more locally determined arrangements.

The Act makes provision for an expansion of the scheme to recover NHS charges. It is estimated that this will double the revenue currently generated by the scheme. That revenue will be ploughed back directly into the NHS in Wales. The Act also introduces changes to the welfare food scheme, which will allow the Assembly to prescribe the foods that are covered by the scheme, in line with our nutrition strategy ‘Food and Well Being’.

In summary, this Act equips the Assembly with important new powers to further its objective of improving the overall standards of health and social care in Wales. I believe that these new arrangements will complement the new performance management and improvement systems that are already in place in Wales. It will provide a robust base for the improvement of the health and wellbeing of the people of Wales.