The NHS Wales Bill must tackle the long standing health inequalities within the country, argues Hywel Williams MP

more is spent on health in wales than in England. Health spending in Wales is in fact above the European average. Some would go so far as to claim that the NHS is in some way a Welsh idea. And yet health is worse on most counts in Wales than it is in England.

Health inequalities within Wales are long standing and are gross both in terms of social class and in terms of geography. The Welsh Assembly's recent document Well Being in Wales notes that average life expectancy in some parts of Wales is five years less than in others - quite a variation in a small country. Waiting lists have grown under New Labour and the government's own targets have been missed. In this depressing scenario the casual observer might have expected a Health (Wales) Bill to address these issues head-on.

It is fair to note that some of the reform agenda was attended to (not uncontentiously) in other recent England and Wales health legislation. But some readers will recall King Vidor's 1938 film The Citadel in which a public health disaster was solved by the hero with the selective use of high explosives on the sewer infecting the local population. Our casual observer might have expected some metaphorical high explosive in this bill and might have been surprised at the apparently uncontroversial content: strengthening the Community Health Councils, establishing a Wales Centre for Health to provide public health advice, research and training support, and setting up Health Professions Wales, to work on the education and training of health care professionals and health care support workers.

However our shiny new secretary of state, referring to the present bill in his press release for the Queen's Speech, said that: "Patient power will be our watchword in the future." Patient power, carer power and community power might indeed be some of the high explosive needed to shift a system characterised by a centralised and top down health management structure and the hierarchical nature of medical power.

Stronger CHCs with extended powers may empower the community, carers and patients, and if so this will be most welcome. Our experience in Wales (as elsewhere) is that a coarse internal market in health just does not work, particularly in rural areas with dispersed populations. In fact it just promotes and entrenches inequality, and the vision of the empowered health customer buying services with perfect information is no more than sub-Thatcherite wishful thinking. There are better ways of holding service providers to account and stronger CHCs are part of the answer.

This bill provides for a statutory basis for the patient advocacy service and a Welsh umbrella body for CHCs. The CHCs' role will be extended to the primary sector and to nursing homes. This will be a valuable addition to the professional inspection system. And we will look in particular to improvements in care through the medium of Welsh - especially for children, people with chronic conditions or brain injury, and people receiving palliative and terminal care. Good communication between the patient and the health care worker is essential, and that requires that proper communication needs to be enabled in all the languages used widely in Wales - not just in Welsh and English.

We in Plaid Cymru had hoped that the bill would contain other proposals, such as the banning of smoking in public places and free personal care for older people, which would create a simpler and more coherent structure, to say the least. However we welcome the bill as a specific Welsh Bill, with its process of discussion and scrutiny in both Cardiff and by the Welsh Affairs Committee. This process will we believe demonstrate quite clearly that Welsh representatives are well able to handle the legislative affairs of our country.

It has been said that the bill is largely uncontroversial. Even the House of Commons Library research paper says that. However if it leads only to uncontroversial change, it will have failed. The proper implementation of patient, carer and community power is some of the metaphorical high explosive we need to attack the historical inequalities of health in our country and to provide Wales with the world-class health service that the secretary of state says it is his ambition to achieve.