The following amendments have been selected: amendment 1 in the name of Jane Hutt and amendment 2 in the name of Rhun ap Iorwerth.

We now move on to the Welsh Conservative debate on community health councils, and I call on Mark Isherwood to move the motion.

Motion NDM6505 Paul Davies

To propose that the National Assembly for Wales:

1. Notes the Welsh Government’s White Paper—’Services fit for the future’—which seeks to abolish Community Health Councils in Wales.

2. Recognises the important role Community Health Councils have played in delivering independent public service accountability and providing a strong voice for patients in Wales.

3. Believes that the White Paper proposals will weaken the voice of patients and communities and reduce scrutiny of the Welsh Government and Health Boards.

4. Calls on the Welsh Government to:

a) extend the consultation period on the White Paper, following its failure to properly engage with Community Health Councils, patients and the Welsh public; and

b) work more constructively with Community Health Councils on future proposals for a new people’s voice body.

Motion moved.

The Welsh Government’s White Paper consultation document, ‘Services fit for the future’, claims to focus on the principles of enabling and empowering organisations, staff and citizens. However, it also proposes to replace our regional community health councils, which are independent and therefore able to challenge and scrutinise the NHS on behalf of patients, with what it describes as a new national citizen voice body, thereby threatening yet further top-down, centralised control.

We therefore view with real concern the Welsh Government’s amendment to this motion, which seeks to delete reference to the widespread and evidence-based concerns raised with us. In consequence of these, our motion recognises the important role that community health councils have played in delivering independent public service accountability and providing a strong voice for patients in Wales, and believes that the White Paper proposals will weaken the voice of patients and communities and reduce scrutiny of the Welsh Government and health boards.

The White Paper states that the new arrangements will be based in some respects on the Scottish Health Council and working across health and social care. However, as today’s Plaid Cymru amendment, which we will be supporting, notes:

‘a single national community health council in Scotland was regarded as not sufficiently independent of government by the Scottish Parliament’s Health and Sport Committee.’

In fact, when the director and the chair of the Scottish Health Council attended the Scottish Parliament’s Health and Sport Committee in January, the committee’s convenor stated, ‘I think you are a toothless hamster. I don’t see where you’re adding value’, and that campaigners feel distant from decision making. The committee collectively found that it was clear the Scottish Health Council does not, in its current guise, present itself as a body independent of Government. Some might say that this is what attracts the Welsh Government to this model. After all, they removed the right for an independent review from the NHS complaints procedure in 2011, leaving complaints to be investigated solely by the body complained against, followed by the right to request a review by the Public Services Ombudsman for Wales, who then reported a 50 per cent increase in complaints about the NHS in Wales over the following five years.

In a positive and pioneering step, community health councils, or CHCs, were established in 1974 under a Conservative Government with a statutory duty to represent the local community’s positive interest, which included acting as patient advocates in complaints involving the NHS. They became a whirlwind of activity and achievement. After 26 years acting as the only statutory NHS patient-led watchdogs, Labour abolished all CHCs in England on 1 December 2003. As Andy Burnham, a subsequent Labour health Secretary in England, stated some years later, ‘The abolition of community health councils was not the Government’s finest moment. It seems we failed to come up with something to replace CHCs that did the job well.’ And, as Lord Justice Francis stated in the Francis report on serious failings in care at Mid Staffordshire NHS Foundation Trust before 2009, quote:

‘Community Health Councils…were almost invariably compared favourably in the evidence with the structures which succeeded them’ in England. It is now quite clear that what replaced them—two attempts at reorganisation in 10 years—failed to produce an improved voice for patients and the public, but achieved the opposite.

Labour replaced CHCs in England with public patient forums and then local involvement networks, which were criticised on the basis that they were constrained by a lack of real power, often criticised for not being representative of their local populations, and hampered by cases of internal disputes and a lack of awareness of their work. A Conservative-led Government replaced this with Healthwatch in 2012, comprising independent social enterprises responsible for representing patients across England and dealing with local concerns. The UK Government bit the bullet after the Mid Staffs scandal and commissioned the independent Keogh report, which resulted in 11 English trusts being put into special measures. But it was the north Wales community health council that then wrote to the previous Welsh Government health Minister after it obtained hospital mortality statistics showing that all three main hospitals in north Wales had higher than expected death rates. After that Minister stated the decisions to close the community hospitals at Flint, Llangollen, Blaenau Ffestiniog and Prestatyn were supported by the community health council, the community health council also wrote to him expressing concerns about the robustness of the information provided by Betsi Cadwaladr university health board, which they had used to inform their decision-making process. Community health councils’ acting independently and inconveniently in this way sets the context for the Welsh Government’s failure now to include them in their proposals.

We’re advised that, two years ago, the Welsh Government directly or indirectly appointed the chief executive of the board of community health councils in Wales who made the CHC submission to the preceding Green Paper, ‘Our Health, Our Health Service’. No doubt the Welsh Government will deny that, but that, nonetheless, is what we’ve been advised. We further understand that the White Paper is basically what he said, that the CHCs themselves never saw the paper until it was submitted, and that this chief executive was subsequently suspended and then dismissed—all matters of public record now.

Up until the night before the White Paper was published, the CHCs themselves were told by the Welsh Government that they would not be affected. Successive reports have criticised a single CHC, Abertawe Bro Morgannwg, which was chaired by the former Labour Merthyr Tydfil council deputy leader. But, gradually, those criticisms were extended—wrongly—to all CHCs across Wales.

Despite an ever-increasing shift of resources to the central board of CHCs in Wales, CHCs themselves have sought to get on with their provision of complaints and advocacy services, visiting and monitoring, scrutiny and challenge, and engagement. In 2015-16, Healthcare Inspectorate Wales conducted just one hospital inspection in Betsi Cadwaladr university health board settings, compared to 600 hospital ward visits by north Wales community health council. Whereas every ward is inspected every six months by north Wales community health council, inspections by Healthcare Inspectorate Wales are, on average, only every seven to 10 years. All this is at risk.

Commenting in late July on the Welsh Government’s consultation, the Consultation Institute stated

‘worryingly, there are unanswered questions about the proposed process for public involvement on service change’, that there are

‘important questions that need to be properly considered’ and that they were therefore organising their own ‘special Roundtable’ in Cardiff.

However, on 1 September, they stated that they had encountered a problem they ‘had never seen before’, with the Welsh Government uniquely stating

‘that to attend such a third-party event would compromise the integrity of the consultation’ and suggesting

‘that it would be wrong for NHS Managers and other public bodies to attend anything that was chargeable.’

In reality, the respected Consultation Institute is an independent, best practice, not-for-profit body.

Facebook posts then revealed that the organisation hired by this Welsh Government to lead on public engagement had only begun their search for venues three weeks before the consultation ends. One post includes the phrase ‘tight turnaround’. In another, the employee seems to suggest the scrapping of CHCs is inevitable, despite the consultation phase still being ongoing. Only yesterday, the organiser issued an e-mail requesting support from its members where events were still low on participant numbers—just nine days before the consultation ends. Further, CHC members and staff are explicitly excluded from attending.

Another e-mail yesterday stated that older people in north Wales obtain help when they need it from the Bangor and Wrexham offices of the CHC, but very often they approach one of the 72 individual CHC members who reside in north Wales. These unpaid, but skilled volunteers, who are the eyes and ears of the public, have also been instrumental in alerting the health board management and Assembly Members to major issues such as the mental health and infection control failings we have experienced. There are 700,000 patients residing in the area served by Betsi Cadwaladr, which translates into just one CHC representative for every 10,000 people.

The White Paper references the Organisation for Economic Co-operation and Development report published last year. The White Paper suggests that CHCs should be closed, but the OECD did not say at any point that CHCs should be closed down. The OECD advised that they should evolve. Professor Marcus Longley, also referenced, did not say in his report that CHCs should close down, but evolve, and based his advice on the presumption that they would continue.

CHCs across Wales agree that a new body is needed with a remit over health and social care, but have expressed serious concerns about these Welsh Government proposals. They have therefore confirmed that they support the calls on the Welsh Government in our motion to extend the consultation period on the White Paper, following its failure to properly engage with community health councils, patients, and the Welsh public, and to work more constructively with community health councils on future proposals for a new people’s voice body. For goodness’ sake, listen to them.

I have selected the two amendments to the motion, and I call on the Cabinet Secretary for Health, Well-being and Sport to move formally amendment 1, tabled in the name of Jane Hutt.

Amendment 1—Jane Hutt

Delete all after ‘Services fit for the future’ and add, ‘which sets out a range of proposals to strengthen quality and governance in health and care services in Wales’.

Amendment 1 moved.

Formally.

Thank you. And I call on Rhun ap Iorwerth to move amendment 2, tabled in his name. Rhun.

Amendment 2—Rhun ap Iorwerth

Add as new point at end of motion:

Notes that a single national community health council in Scotland was regarded as not sufficiently independent of government by the Scottish Parliament’s Health and Sport Committee.

Amendment 2 moved.

Diolch, Dirprwy Lywydd, and Plaid Cymru is pleased to support this motion today. We are not happy with the proposals that the Government is indeed trying to rush through with little scrutiny, it seems, and what could only be described as a sham consultation, and, yes, we too have noticed the scramble to arrange focus groups close to the consultation deadline—indicative, I think, of how this is being handled, with the consultation being regarded almost as an oversight.

Now, last week, that quick appeal was made on a personal Facebook account by an individual who had been charged with running a number of focus groups, we are told, to discuss the matter, admitting that it was, as we heard, a ‘tight turnaround’, and it certainly was. The consultation period is nearly over. Somebody did suggest that CHCs could be invited to those focus groups, but a reply stated that, as the White Paper proposes their abolition, they may not be too keen to take part. Now, individuals, certainly, who sit on community health councils have got in touch with the organisers of these focus groups and have been told, in no uncertain terms, that they are not to represent the views of community health councils in those focus group meetings, and to be there as ordinary citizens and nothing else. This is not the way that consultations should take place, and the Government has been found out. But a flawed consultation isn’t the sole reason for our concerns; we simply don’t agree with the proposals.

The first objection: the proposals to remove the independence of our community health councils. Now, the Scottish Parliament’s Health and Sport Committee noted this was the effect of similar proposals in Scotland. Now, we’re all for learning from Scotland where it fits, and they have, without doubt, got a lot of things right, but learning also involves learning from mistakes. We can look at a whole host of countries and the way that they tackle issues similar to ones that we need to tackle here in Wales. But it’s not just looking at what they’ve done in Scotland or anywhere else that is important, but looking at the effects of actions that have been taken, and I think making such a body like a community health council too close to Government goes against everything that we have known about how to make such bodies effective, and Scotland have found that out after their experience with changes to governance and the oversight of health in Scotland. Hence, our amendments that we urge you to support today, and I’m grateful to the party opposite for indicating that they will be supporting that amendment today.

Another objection: the notion that because Healthcare Inspectorate Wales do inspections we don’t need another body going into hospitals. Dare I remind the Minister that it wasn’t so long ago that HIW was heavily criticised by a committee in this Assembly, and indeed it failed to spot the poor care that was going on in the Princess of Wales Hospital? Having duplication of inspection is a good thing, and adds an additional layer of protection. And, no, CHCs aren’t an inspectorate, but they know, from far more visits to hospitals, it must be said, than are conducted by HIW, what goes on in our hospitals, and crucially there is a different kind of oversight. CHCs offer a particularly important element: they measure the patient experience. And if we are to provide a better experience for our patients, ensuring that hospitals provide for them what they need and deserve and require, then we will not be succeeding in giving Wales the kind of NHS that it needs.

Now, we’re not arguing for the preservation of CHCs as they are. I haven’t heard anybody from any CHC arguing that, forever and a day, community health councils should remain. What we are arguing for is the maintaining of their function in being an effective voice for patients in Wales. What we have in this White Paper are proposals that take away the voice of the patient. These proposals do not give patients in Wales the security, the support and the voice that they need. So, I’m afraid it’s back to the drawing board.

The Welsh Government consultation document entitled ‘Services fit for the future’ set out a number of proposals with the declared aim of strengthening the voice of citizens in health and social care. However, in the view of many people, the proposal regarding community health councils will not provide an effective and independent voice for patients in Wales. The consultation proposes to abolish community health councils in their current form and establish a new body, based, in some respect, on the Scottish Health Council. This all-Wales body would work across health and social care.

Community health councils represent the public’s interest in the way services are planned and provided. There are seven community health councils in Wales—one in each of the local health board areas, and responsible to the same local population. The role is to listen to what individuals and the community have to say about health services with regards to the quality, quantity, access to and appropriateness of the services provided for them. They then act as the public voice in letting the managers of the health services know what people want and how things can be improved. In my view, abolishing community health councils and setting up an all-Wales body on the Scottish model will seriously weaken accountability and public influence. It will break the vital link between local people having a say over the services provided by their local health boards. Community health councils provide an accessible outlet for patients, service users and the public to engage with their health services. This is particularly important for vulnerable patients. Community health councils are able to represent the interests of such patients when they are unable to do so themselves.

Removing this established and independent avenue for engagement and scrutiny runs the risk of silencing communities’ concerns on the delivery of local services. This is an essential component for the improvement of future services within the NHS in Wales. Abolishing the CHCs is also likely to exacerbate the inability of health boards to settle complaints within the existing 30-working days target. At present, nearly half of the complaints to Aneurin Bevan health board are outstanding after 30 working days. My concerns are in no way alleviated by the example set by the Scottish Health Council, which the Welsh Government seems to think is the model we should follow. The Health and Sport Committee of the Scottish Parliament voiced its concern earlier this year. This committee is chaired by Neil Findlay, a Labour Party Member of the Scottish Parliament. They said they were clear that the Scottish Health Council did not, in its current guise, represent itself as a body independent of Government.

Concerns were also expressed that SHC’s function was not clear to the public or to the health boards. They appeared to lack any formal role on direct engagement with patients and the public who may be impacted by proposed service changes. Indeed, one representative of the Scottish Health Council, when asked about local protests against service changes, told the committee it was not their role to campaign on behalf of local groups. No wonder the committee concluded that the SHC was a ‘toothless hamster’. I believe we must retain community health councils with increased powers and responsibilities as the best way of meeting the Welsh Government’s aims set out in this consultation. Deputy Presiding Officer, this Government in Wales are not very happy to make changes to the NHS, but they are quite happy to make changes to the NHS’s eyes and ears of the public, and want to change it, which is not acceptable. Thank you very much.

Can I welcome the White Paper, which addresses the issue of how we should engage better with citizens in terms of service delivery? I think it’s clear that the more we work with service users, the more likely it is that we are going to get a better and successful model of service delivery. The recent experience, for example, of the Gellinudd Recovery Centre, where patients have a say in everything from policy to the decorations, has led to not just a better service, but also to predicted savings of £300,000 to the NHS. So, one of the areas that’s being suggested in this White Paper that is ripe for reform is that body of community health councils, which are embedded in local communities around Wales. That’s clearly where we have all focused our attention today.

I think the community health councils themselves would be the first to put up their hands and agree that there is a need for reform. An obvious point is the fact that, at the moment, they have the right to speak on behalf of the public in relation to health but not in relation to social care. It’s clear that we want to see better integration, and so there’s an example of where something needs to change. I think if we are honest, we would have to admit that, in general and certainly in some areas, members of the public have no idea that community health councils exist to speak on their behalf. I had not heard of them before I was elected to this Chamber last year. So, if we are going to have a patient voice organisation—

That’s a lack of curiosity.

I don’t think it’s a lack of curiosity. I have been an elected politician for a very long time, and I have got to tell you that I had never heard of them. So, I don’t think that I am atypical. I think that you guys are the atypical people. I think that what’s important—[Interruption.] Well, go and do a straw poll of the people just walking down the street, and I can tell you that I would be very surprised—. I held a meeting recently with about 150 people who were pretty angry with what was going on in their local community, and they had no idea that the community health councils exist. I’m not saying that this is about—. I’m saying that they need resources, sometimes, to allow them to get out there and to speak to the public. So, they do need help in terms of communicating with the public. I don’t think that their transparency and their accountability to the public, and their ability to stand up for the public in relation to the health service, is as clear as it perhaps could be. I think they should be properly resourced, so that the public are aware of them, and that it’s a channel for them to have their say.

In principle, I think that we do need a forum for local patients’ voice and an independent complaints advocacy service. My fear is that if we don’t have a mechanism to file complaints, I believe that in this day and age, what we are likely to see is a free-for-all on social media, where patients could be whipped into a frenzy and where individual health workers could be vilified. That’s the situation that I think we have got to avoid at all costs. But, I think there are elements of the work that CHCs currently undertake that, in a new structure—or in an enhanced role for community health councils—should be made with the designs and needs of Welsh patients in mind. I think the formal relationship with local health boards is something that must be built on, and it’s difficult to envisage how a national approach to a citizens’ voice advocacy service could work locally. I have examples where CHCs in my area are co-designing services with the health board, supporting service change, and working with people through communicating changes to service delivery.

The ability of CHCs to intervene as people are receiving their treatment is also invaluable, and I think it makes sense that we’ve got to try and change services for the better, even while patients are undergoing treatment, and a retrospective approach, whilst valuable, is likely to undermine individual patient confidence. Just because Government and health boards think geographically, in terms of lines on maps, it doesn’t mean that patients do, and we must take the stress of understanding health configurations away from patients, and that’s particularly important when we’re talking about sharing services with England.

I think it’s extremely useful for CHCs, if they are dissatisfied with the response of the health board, to be able to refer that decision to Welsh Government Ministers, and I think we’ve all learned by now that it is not possible, or correct, for us to duck and avoid political responsibility. I think this is simply a part of a genuine consultation process—I certainly hope that it is. My understanding is that CHCs are not looking for more time to consult on this issue, and whilst we should look to other parts of the UK for best practice, it’s important to note that the Scottish model, as Rhun referred to, has also received criticism. So, I hope that by working together, the Welsh Government, the individual health boards and the existing CHCs can design an organisation that supports patients and the delivery of excellent health and care services that the people of Wales can and should expect.

I’ve got to say, Eluned Morgan, I listen closely to your arguments, and you have very many sensible things to say, but that wasn’t one of them. I’m a bit concerned about your argument that just because people aren’t aware of community health councils, they shouldn’t exist. If you use—

I didn’t say that.

Well, you said something that could be confused as saying that.

I actually said they should be better resourced.

Are you taking an intervention from the Member?

No, not yet. I’m not.

No, sorry; you can’t shout out.

You actually said that you hadn’t heard of community health councils and that was an argument for them not to be there. Well, on those grounds, I think many of my constituents have never heard of the Welsh Assembly, but I don’t use that as an argument to abolish myself—well, not yet, anyway, but I suppose there’s still time.

Look, no-one—well, very few people at any rate are saying that the current community health council structure is perfect or that it shouldn’t be changed. Far from it; it should be changed. I think we all accept that. Community health councils, as Eluned Morgan did say later, accept that as well, but they need to be changed for the better. I just don’t think there’s been a full appreciation on the part of the Government of the value-added the CHCs have brought to the NHS in Wales since their inception. Nor has there been an adequate consultation process with members of CHCs on the relative merits and disadvantages of their abolition. Now, as has been said, they have the statutory rights under law to hold health boards to account. Crucially, of course, volunteers visit and monitor hospital services and speak to patients and staff in hospitals. Yes, in many cases, volunteers, not experts, to be sure, but volunteers who bring enthusiasm, dedication, a fresh viewpoint, and who can peel back the layers of the bureaucratic onion and see to the core of issues that bureaucrats often won’t see.

Now, there is no doubt at all that the new model, whatever form that takes, should without doubt retain all that is good about the current structure. The organisation should have teeth—many Assembly Members here today have spoken about the need for that. It should be independent. It should be able to hold a health board to account. It should be non-political as far as possible, transparent, and ensure that people can be heard.

What are we in danger of losing? Well, I would say nothing less than the day-to-day oversight of the NHS from a patient’s point of view, and the importance of that should not be underestimated. How many times do we stand on this Chamber and grandstand, for want of a better word, about the importance of the citizen being at the centre of the decision-making process, whether that be in relation to the health service or the care system, as has also been mentioned in today’s debate, schools, or whatever sphere it may be? Co-production, which is one of Mark Isherwood’s buzzwords and a current buzzword across the political spectrum—yes, it seems to me that the key tenets of co-production are being cast aside, shredded, when it comes to devising this new system of monitoring the NHS and holding it to account locally.

I recently met with Aneurin Bevan community health council, my local health council, who explained to me some of the areas that they get involved in. Often, these areas, I would concede, are in many ways secondary in the wider scheme of things—secondary, at least, to the managers’ concerns, who are busy overseeing at the top layer, and with managing some major budgets. But they’re areas that, to patients, are extremely important, and actually can be resolved pretty easily with a bit of organisation, once a clear focus is brought to bear on them. For instance, the Aneurin Bevan CHC visits to local wards highlighted that there seemed to be a problem with low linen pillow supplies, particularly on weekends and bank holidays. This was actually pretty easily sorted out, but without CHCs there, there would have been no patient voice, no clear focus on that issue. Patients could still be lying in beds on weekends or bank holidays without the sheets that they wanted, and yet it was sorted out, thanks to the intervention of the community health council.

Now, I accept that the UK Parliament’s solution in England has had some serious problems, and probably should itself be left well alone. But it is quite frankly bizarre that the Welsh Government should be contemplating moving to the Scottish model of patient representation at the very time—the very time—that that model is coming under such heavy criticism north of the border. Many AMs have referred to the description of it as a toothless hamster. If the Welsh Government doesn’t want to listen to this Assembly on the issue of CHCs, then at least listen to the experience of the Scottish Government, which is now learning the lessons of rushing into a change that was not appropriate and is not fit for purpose.

So, in conclusion, Deputy Presiding Officer, as we contemplate the twentieth anniversary of devolution to Wales, and the creation of this place, surely the greatest benefit of this process—not the event, as was originally alluded to, but this process—surely should be the ability to take our own local decisions over key areas of peoples’ lives, and that should allow us, even at this late stage, to reconsider the proposed changes to community health councils in Wales and come up with an alternative that, yes, embraces change, but at the same time retains the core principle that lay behind the establishment of those CHCs in the first place—putting the patient truly at the centre of the process and at the centre of the NHS. Not bureaucrats, not health boards, not dogmatic ways of thinking—let’s put the patient at the centre.

I’m pleased to contribute to this debate because I do think that the community health councils do important work. I have spoken to both in my region, Hywel Dda and Powys, and part of Betsi is also within the region that I represent. I hope to express in this debate some sort of development on the community health councils, which builds upon the good things that they do: the ability to oversee, and the reliance on volunteers, which is both a strength and a weakness simultaneously in the current regime. But I also want to reflect on the fact that the community health councils have been in place since 1974 and haven’t developed a great deal since then. There are some very old-fashioned aspects to the way that they work. There has to be improvement and they have to be modernised.

I do want to focus on one thing specifically, which is a weakness in the Government’s paper at the moment, particularly in speaking to the residents of Powys—. There is no mention and no consideration given to the cross-border issues, with patients from Powys serviced in English hospitals, but can be overseen by the community health council in Powys. Therefore I want to ensure, and I hope that the Minister, in replying to the debate, can give an assurance, that the Government does wish to retain that patient voice in health services that are located in England but which provide services for patients from Wales.

As I discussed these issues with community health councils, I have seen a desire from them to develop, and they are developing an alternative model. They have responded to this consultation with their own ideas, and I very much hope that the Government will listen to them. There has been some discussion today on the basis that the consultation and the proposals of the consultation are to be implemented as they stand. I hope that this will be a true consultation and that the Government will listen to what the community health councils themselves have to say, because they do have an alternative model.

Now, placing health and social care together is something that is to be welcomed. Ensuring a patient voice is something that we should welcome. The question is: how do we achieve that?

First of all, any new pattern has to be entirely independent of Government—that is something that we should all stand firm on. And being independent does mean being independent in terms of structure, in terms of legal status, and in terms of appointments to the councils or to any new body that is established to replace them.

I don’t sense that the councils themselves are opposed to the concept of a national body. They haven’t told me that. What they have said is that what’s important is that the local voice and regional representation is maintained. So, there is a possibility here to have a national body that could merge some aspects, which may bring forward savings, if you like, in terms of bureaucracy, employment and staffing and so on, but also ensure that the community health councils’ structures are in place to reflect local needs and the local voice. Now, that’s not exactly what the Government is proposing, of course. That is some sort of compromise and a discussion that needs to happen. But I am open to listening to such ideas and to see what happens.

I do think, whatever does happen, it’s exceptionally important that local people have the right to go onto wards, to undertake visits where health and care is provided, and that that is strengthened, that there is sufficient support for laypeople to understand that situation, because I do think that it’s important that their status is enhanced when they visit wards or placements, and that they are treated with respect by professionals, and that support and training is available for them.

The final thing I want to say is that we must take this opportunity to enhance the membership of community health councils. Eluned says that she wasn’t aware of them and I accept her comments, of course, but I have been aware of them for some decades now, I have to be honest. Some of the people I was aware of 20 years ago are still on the local community health council, and I’m not quite sure if that is necessarily how these should develop in order to be entirely representative of the communities that they represent and representative of the people who now use our health and care services.

Thanks to the Conservatives for bringing today’s debate forward on an important subject. We’ve heard a lot already about the flaws in the Welsh Government’s consultation process, so I won’t dwell on that, but rather on the changes that they propose in their White Paper.

Now, ‘Services fit for the future’, the White Paper, recognises the need for what it calls a strong citizen voice in how health and social care is planned and provided. They also want to improve the legal framework for the inspection and regulation of health services and they want to establish a new independent body for patient voice and regulation and inspection.

Unfortunately, this so-called citizen voice is not described in any detail in the White Paper. There is nothing about how the members will be recruited. There is nothing about resourcing of the new organisation. The only thing we can see clearly is that citizen voice is designed to replace the existing system built around community health councils, or CHCs.

The White Paper uses the current buzz phrase of co-production. However, it doesn’t really go into much detail regarding what this so-called co-production will actually consist of. If we go back to the Welsh Government’s own social services Act of 2014, the codes of practice in this Act do actually give us detailed guidance as to how to achieve co-produced well-being. This includes promoting user-led organisations that add social value. Well, the CHCs with their membership containing a strong element of volunteers surely represent a good example of a user-led organisation. The notion of co-production should surely be encompassing bodies like the CHCs, rather than being used as a vague form of words that is utilised to help get rid of them.

So, why does the Welsh Government want to ditch the CHCs? Well, Co-operatives and Mutuals Wales, an important third sector organisation, believe that the Welsh Government has a problem with the extent to which the health boards propose sometimes substantial changes, which are then challenged by the CHCs. Although the proposed Government changes are somewhat vague, it is widely believed that under the new system the new body would crucially lose many of the powers of the CHCs. It is not clear if the new organisation would have any rights at health board meetings, for instance. It is also widely suspected that it would not have the power enjoyed by the CHCs, which we’ve been told about today, to enter and inspect premises for spot checks. These powers are crucial in gaining an understanding of how the NHS actually works in one local area. Any new body, if it is to have a meaningful role, must be allowed to visit and inspect NHS premises, speak to patients there, and afterwards be able to contact the patients and former patients once again in order to help establish whether improvements have been made as a result of that body’s intervention.

We need to remember that the model of community health councils scrutinising the work of the NHS came in after the Ely Hospital scandal in Cardiff in the early 1970s. The system adopted throughout the UK at that time came about after a scandal, in other words, which afflicted our own local area. If we are to avoid future scandals—and let’s not forget we’re still in the throes of recovering from the Tawel Fan scandal—then we need to stick to certain clear principles of operation and scrutiny.

Decisions should be taken as close to the people who use the services as possible. Local priorities should be established according to local needs. There should be clear lines of accountability, and volunteers need to be the lifeblood of the scrutiny organisation. Volunteers will have different skills and contribute in different ways. Any new body must be free to determine how it recruits its own volunteers. We are left entirely in the dark from the Welsh Government’s White Paper as to how far these principles are going to be upheld in the new model. We, therefore, in UKIP support the Conservative motion today and urge the Welsh Government to consult further, and more openly, before adopting any new model. We also support Plaid Cymru’s amendment.

A worrying aspect of devolution is that we now have four separate models of user scrutiny of the NHS in the four different regions of the UK. Although enthusiasts for devolution might argue that this is a welcome expression of different regions going their own way, I would argue to the contrary that we have a national health service, not a regional one, and that it should operate broadly in the same way across the UK. The way in which patients are treated and the way in which users can scrutinise the work of the NHS should not differ markedly across the different regions, or we will gradually lose any sense of it being a national service at all. Thank you.

I’m pleased to have the opportunity to contribute to this debate.

Rwy’n falch o gymryd rhan yn y ddadl y prynhawn yma. Rwy’n mynd i ganolbwyntio fy sylwadau ar y rôl bwysig y mae cynghorau iechyd cymuned yn ei chwarae, ond rwy’n awyddus iawn i siarad am CIC Powys yn arbennig. Mae’n rhaid i mi ddweud, fel AC etholaeth, fy mod i mewn cysylltiad rheolaidd â chadeirydd fy nghyngor iechyd cymuned lleol, ac roedd yn dda cael cyfarfod hefyd â llawer o aelodau’r CIC yn sioe Aberriw y mis diwethaf lle cawsom drafodaeth dda am y Papur Gwyn. Nawr, yn ystod cwestiynau i’r Prif Weinidog ddoe, nodais y pryder nad oedd y Papur Gwyn yn cynnwys unrhyw gydnabyddiaeth o gymhlethdodau penodol gwasanaethau trawsffiniol, ar wahân, wrth gwrs, i’r materion eraill yn ymwneud â’r rôl graffu bwysig y mae CICau yn ei chwarae. Nawr, oni bai bod y newidiadau hyn yn cael eu hadlewyrchu, mae yna ofn gwirioneddol y bydd llais y claf a chraffu ar wasanaethau iechyd ar gyfer pobl Powys—nad anghofier eu bod i raddau helaeth, wrth gwrs, yn defnyddio gwasanaethau o dros y ffin yn Lloegr—yn gwanhau’n ddifrifol.

Ddoe, roeddwn yn falch fod y Prif Weinidog wedi cadarnhau y byddai Llywodraeth Cymru yn edrych yn ofalus ar yr ymatebion i’r ymgynghoriad gan gyngor iechyd cymuned Powys ac yn sicrhau y byddai consensws yn cael ei gyrraedd. Roedd hynny i’w groesawu. Ond mae’n hanfodol, yn sicr yn fy marn i, ein bod yn cynnal sefyllfa lle mae gan gynghorau iechyd cymuned hawliau statudol i weithredu fel eiriolwyr effeithiol ac annibynnol ar ran cleifion mewn lleoliadau trawsffiniol yn arbennig. Mae hyn yn bwysicach byth i fy etholwyr oherwydd y newidiadau sy’n digwydd yn Swydd Amwythig mewn perthynas â rhaglen Future Fit y GIG. Rwy’n gobeithio bod Ysgrifennydd y Cabinet yn gwrando ar y pwynt nesaf hwn, fod cyngor iechyd cymuned Powys yn cynrychioli llygaid a chlustiau cleifion o dros 60 o fyrddau a phwyllgorau darparwyr gwasanaeth sy’n darparu gwasanaethau iechyd gwerth cyfanswm o dros £120 miliwn, gan gynnwys £22 miliwn gan Ymddiriedolaeth GIG Ysbytai Amwythig a Thelford yn unig. Ar hyn o bryd, nid oes unrhyw eglurder yn y Papur Gwyn ynglŷn â phwy fuasai’n cyflawni’r rôl graffu bwysig ar ran cleifion yn absenoldeb cynghorau iechyd cymuned.

Mae eraill wedi crybwyll profiad model yr Alban ar gyfer cynrychioli cleifion yno, felly nid af i mewn i hynny a siarad am fochdewion diddannedd ac yn y blaen, ond oni bai bod cynghorau iechyd cymuned yn cael rôl statudol, mae yna ofn na fydd ganddynt unrhyw ddannedd i fod yn eiriolwyr cryf dros gleifion, gan adael cleifion i weiddi o’r cyrion, wrth gwrs, yn hytrach na bod yn rhan annatod o’r broses o wneud penderfyniadau. Wrth gwrs, fe wrandewais ar Eluned Morgan. Yr hyn y buaswn yn ei ddweud yw bod llawer o fy etholwyr yn gwybod am y cynghorau iechyd cymuned am eu bod wedi’u cyfeirio; mae fy swyddfa’n derbyn atgyfeiriadau gan CICau ar gyfer mathau penodol o waith achos. Ac yn aml, mae fy swyddfa yn cyfeirio etholwyr at y cyngor iechyd cymuned, felly os nad ydynt yn ymwybodol o’r CIC, fe fyddant yn fuan erbyn iddynt adael fy swyddfa.

Y pwynt olaf y buaswn yn ei wneud yw ein bod yn aml—mae pawb ohonom yn gwybod hyn fel ACau—yn aml iawn pan fydd sefydliad yn wynebu cael ei ddiddymu, fod y sefydliad hwnnw’n ymgyrchu’n drwm tuag atom ni. Ond yr hyn y buaswn yn ei ddweud, wrth siarad am fy nghyngor iechyd cymuned fy hun, yw mai’r hyn y maent yn ei ddweud yw eu bod yn derbyn newid. Mae hynny wedi’i dderbyn ac wedi’i ddeall, ac nid oes unrhyw deimlad na ddylai fod unrhyw newid yn digwydd o gwbl. Felly, buaswn yn dweud heddiw fy mod wedi fy nghalonogi fod Aelodau o nifer o bleidiau gwleidyddol yn cefnogi cynnig y Ceidwadwyr heddiw. Rwy’n gobeithio y bydd pob Aelod yn gwneud hynny, gan fy mod yn credu ei bod yn bwysig i lais y dinesydd gael ei gryfhau yn hytrach na’i wanhau.

Thank you, and I call on the Cabinet Secretary for Health, Well-being and Sport, Vaughan Gething.

I’d like to thank Members for their contributions and the opportunity to respond to today’s debate. It’s worth reflecting that the White Paper that is mentioned in passing actually sets out a series of wide-ranging proposals to take forward health and care services in Wales, because we do aim to put people at the centre of all that we do, and to enable organisations to work better together across boundaries.

We had some of this conversation yesterday, of course, in the parliamentary review debate. This is a consistent part of this Government’s approach: the citizen, the person is at the centre of the way that health and care services work, are planned and delivered. There is wide agreement that health and care systems here in Wales need to work differently to deliver those services and the kinds of outcomes that people across Wales all want to see. That’s why the White Paper looks at a whole system approach and proposes a package of measures to support closer integration. They include proposals on the composition of health boards, which is a crucial factor in the way organisations are run and how decisions are made; important new ideas of quality and candour to underpin a culture of planning, collaboration, openness and transparency; areas where health and social care could align much more effectively, such as in setting high-level common standards in complaints handling—something that the ombudsman has called for in the past; continuous engagement and decision making on service change, not as a one-off event but as a continual process to engage the public; and, of course, regulation and inspection, including the alignment and independence of the existing inspectorate. And importantly, of course, measures to strengthen the citizen voice are an essential element in achieving this. That is what the Government wants to do—to strengthen, not weaken, the voice of the citizen.

As with all things, we need to look at what to build on, what has worked well and to understand what has not worked well, and learn from experiences elsewhere. As Members will be aware, there’s been a long history of calls to reform community health councils. References have been made to Professor Marcus Longley’s review in 2012, and that made recommendations to improve our current system, as well as highlighting the need to think differently about the future. It not just recommended that, but we have implemented as far as possible what we can do from the Longley review within our current system.

The interim report of the parliamentary review, published in July, that we debated yesterday, indicated that the voice of the public in Wales could be strengthened by reforming the current arrangements. And again, that is what the Government proposes to do, and it’s interesting that the debate is positing that the Government simply wants to remove organisations and remove the citizen’s voice, which is exactly what we’re not proposing to do; we propose a different way and a reform of the process. Members in every part have said that they recognise a case for reform is made, because much has changed since CHCs were introduced in the 1970s and we should not pretend that we can continue to run with the same system as we recognise the changes that we all wish to see made across health and care.

Increasingly, of course, health and care services are being integrated. So, any body in place to represent the voice of the citizen should be set up to recognise and respond to that change. We can’t have a new citizen voice going across health and social care without having primary legislation to achieve that. So, there is a need to fundamentally reform the way that the citizen voice body works. That’s why the White Paper’s underlying aims are to develop proposals that are fit for the future and to genuinely take account of that increasing integration we see now and we expect to see in the future.

The CHC reform proposals are part of a package that I’ve described, which I believe, if enacted, will improve quality and place the citizen at the centre of health and social care planning and delivery.

Will you take an intervention?

I will, yes.

I just want to talk about the fit for the future paper in its generality. You talk about the fact that it’s bringing together everything and it’s going to bring forward a new method of governance, et cetera. So, can you tell me, Cabinet Secretary, why does it make only, I think, one mention of the regional partnership boards and why is there absolutely no mention of how GP clusters should be governed?

Because on regional partnership boards we have an architecture that we’re developing and working with. They’re part of the remit of bringing together our larger public services with partners to deliver across the health and social—well, the social care and well-being Act. In terms of the governance around clusters, there are opportunities to consider that as we go through this, because we haven’t got a fixed view on how to resolve some of the governance challenges.

This is an opportunity to take up the debate started within the Green Paper in 2015. There are clear links between the reform of CHCs and delivering service reform across health and social care, and these proposals aim to rely on the assistance of regulation and inspection. They’re being developed together to maximise benefits for the wider public. That’s why the White Paper sets out proposals for a new national and independent body to replace CHCs. And actually there’s a point there, I think: in lots of the debate today there’s been a suggestion this body will no longer be independent and, again, that is simply not what the Government proposes in the White Paper consultation. And the new body will engage at a national, regional and local level across health and social care. The proposals are high level because I have to strike a balance in terms of this being a consultation on White Paper proposals rather than being detailed legislation.

The consultation has, of course, generated lots of debate—over 700 consultation responses already received ahead of the closure of the consultation on 29 September. And, again, I do take issue with the comments that were made that this is somehow a sham and that this is being rushed through. This is a genuine consultation. I did not have a fixed view on what a new national body should look like, sound like, or how it should be organised, but I do think we need to continue the debate started in 2015. As with any consultation, next steps will take stock of the constructive ideas generated through the consultation and, importantly, we’ll work in partnership with stakeholders to do so.

I don’t recognise the accusations that have been made that we’ve somehow excluded CHCs or that they weren’t told what would happen within the White Paper, or that although they were given an assurance they would take no part in it. That simply isn’t true. But I am pleased to see that CHCs themselves have given consideration to the White Paper and they set that out in their own paper, ‘A new people’s voice body for health and social care: Our proposals’. I understand that’s been shared with all Members. And, importantly, CHCs do not ask for an extended consultation period. They also recognise that the inspection of premises should change. They have a call to ensure they have the opportunity to visit places where care takes place, but they do not want to undertake an inspection function. They themselves recognise that should be undertaken by an independent expert body, and they certainly don’t make the call for deliberate duplication that we heard from one Member in the Chamber today. I’m pleased to say that I think their proposals are generally constructive. They don’t all align with what’s set out in the White Paper; that’s the point about having a consultation. So, there’s much common ground between us and I look forward to working through with them those proposals in the future. They themselves recognise the opportunity presented by the White Paper to reform and deliver positive change.

The Llywydd took the Chair.

So, a new people’s voice body for health and care requires primary legislation. I really think, though, that it will be independent, it will have a complaints advocacy as part of its central functions as the White Paper sets out, and, of course, I expect that local and regional participation in the new body and, yes, it will be able to deal with cross-border issues. And I note what the chair of the—[Interruption.] I won’t have time, I need to finish. The open letter sent to party leaders by the chair of the CHC board sets out what they consider the public would like to see in a citizen voice body, and I agree with her statement that the end of the consultation should be the beginning of this process, and not the end. I know that people can be fearful of change, and I realise that some concerns have been expressed, but I’m clear that an effective mechanism to ensure the citizen voice is represented is a key part, and a part of the success of the overall new arrangements that we are proposing. We will, of course, look to build on experiences in England, Scotland and other places in deciding how to move forward. But there is no suggestion, and there never has been, that we would simply replicate the Scottish Health Council model. We do want to think about what is working and what is not working in other parts of the UK and to generally learn from that and to build on good practice. So, the White Paper should be seen for what it is: an opportunity to strengthen the voice of citizens across a progressively integrating health and social care service, and to develop a model that works for Wales in the here and now and in the future.

I call on Angela Burns to reply to the debate.

Diolch, Llywydd. I’m not frightened of change and, to be fair, all the people who took part in this debate, I think without exception, weren’t particularly frightened of change. I think everyone acknowledged the fact that CHCs do need to change in some way or other. However, Cabinet Secretary, your carefully well-modulated platitudes do not reassure me, because let’s be very clear, this fit for the future documentation has been rushed through. I think Rhun ap Iorwerth used a wonderful way when he talked about it being a, I think it was, ‘scramble’. And it certainly has been scrambled.

Let’s just start at the very, very beginning. Yesterday, we met here to talk about the interim report on the parliamentary review, and we all talked in that about how one of the key themes that they are bringing forward is the engagement of the citizen, is about making all of us step up to the plate, take ownership of our health, stop being so demanding on the health service, accept our own responsibilities and shape, influence and become part of the solution to the problems we currently have. And yet, this fit for the future paper, which you’ve brought forward whilst we’re still doing the interim report and the full report on the parliamentary review—so, for me, there’s the first contradiction. Why do this now? Why not wait until that final report, because it’s so integral to the way we go forward with our NHS? So, we’ve got the parliamentary review, we’ve got this consultation coming out, we’re talking about the citizen being at the heart of it, and yet this fit for the future does row back a bit.

I appreciate the CHCs need to change. I appreciate they should have a wider and better remit. I appreciate they should be better resourced, and not just better resourced, because most of the people on the CHCs are passionate, caring local volunteers, and I think Mohammad Asghar made a very good point when he talked at length about that locality, because with the best will in the world HIW are not based in, you know, my little bit of Pembrokeshire, my little bit of Carmarthenshire, your bit of Ynys Môn. They are a central body. We want to have local people who can hold our local health boards to account, and not just to account, but to influence, to help change, to make those suggestions—Nick Ramsay brought forward the commentary about how issues over linen supply were solved because of the involvement of the CHC. So, here we are, saying we want to have the patient, the citizen, the voice of people really integrated, and yet you’re closing that door. So, that’s my first complaint.

My second complaint, though, and even more is that this Government does enough consultations every year, so you should be really good at them by now. This is a totally rubbish consultation. It is too fast, it’s been left to the last minute, there are not all the places, the meetings or the promised focus groups and all the rest of it. You very proudly say you’ve had 700 responses, but, actually, ordinary people, the people who Eluned Morgan says don’t know anything about CHCs, where’s their voice in this? Why haven’t they been asked about it? This is really, really important. Mark Isherwood very clearly said that the CHCs are saying that they would like a bit more time.

Nobody here is frightened of change. Let’s have some change, but let it be the right change, and, above all, let us actually come true. Minister—Cabinet Secretary, forgive me. You talk the talk, you’ve got to walk the walk. Engage with the people of Wales and make them the heart of this. The CHC doesn’t belong to you. It doesn’t belong to the health board. It belongs to the people of the area it represents. It is their one and only really good voice that belongs to them. It, at the moment, has an opportunity to be loud, strong, and forceful, and you, if you do not have courage and you do not really buy into it, you’re going to make it a tiny, weeny, weak voice and the people who will suffer—the people we’re all supposed to represent.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] I will defer voting, therefore, under this item until voting time.

Voting deferred until voting time.