Commissioner for Older People (Wales) Bill [HL]

I should like to explore the consequences of accepting Amendment No. 23, which suggests that the commissioner should have the power to enforce his recommendations. In doing so, I shall seek to illustrate the consequences of such an enforcement power. I have recently been taking an interest in the issue of providing physiotherapy facilities for female incontinents, very many of whom are obviously elderly. The pattern of provision and service within the various health trusts shows that some provide such a physiotherapy facility while others do not. If an elderly person suffering from this horrible and debilitating illness should seek such help from her health trust but find that it was not at that stage willing to make such a provision, presumably she could seek the support and advice of the commissioner and gain his or her interest. The commissioner might then explore the clinical system provision of such an arrangement in health trusts throughout Wales. As a consequence, he or she could make a recommendation that such a facility should be provided in every health trust in Wales. I do not think that I am stretching it; that is the kind of thing that could occur, and it could have very significant budgetary implications for health authorities. A similar situation could arise if a recommendation of this kind was made affecting the Assembly department that deals with health. The department could already have worked out its budget in conjunction with the Assembly committee for health; it could have worked out its priorities and might have consciously decided to provide one sort of service to elderly people and not another. If that is the case, are we saying through the amendment that the commissioner would have the power to override those decisions and enforce changes in the budgets of health authorities or the Assembly Government department? I would love him or her to do so—but have I got the right angle on the amendment? If it were passed and the commission had the right to enforce the commissioner’s recommendations, could he or she fundamentally affect the budget of the Assembly department or a health authority or health trust? In that case, are we saying that an appointed commissioner has the power to override the democratically taken decisions on budgetary issues that might have been made by an Assembly Government or an Assembly committee? It has been puzzling me for a while how far we shall give an appointed commissioner such a right; yes, he will be able to recommend, but will he be able to enforce such powers and such changes in budget? Perhaps we may wish to make that provision, but we should not do it without consciously understanding the consequences for the relationship between an appointed commissioner and the democratic decision-making processes that often determines such budgets. I would love and hope that the commissioner would recommend that there were total consistency in the provision for physiotherapy for elderly female incontinent people, for example. Nevertheless, I wonder whether such a power, overriding democratic decision-making, is the right one to give to an appointed commissioner.