2. How does the Welsh Government ensure that health boards fully engage in public consultations on future health services? OAQ51671

Health boards are responsible for working together and consulting the public regarding proposed changes to health services in Wales. The Welsh Government promotes good practice in engagement and consultation and supports health boards in working together with the public, their staff and others—including, of course, community health councils—to help ensure the best possible health outcomes and planning.

Thank you for that answer, Cabinet Secretary. I'm sure, as you agree, it's very important that they do engage with the public. AMBU has recently gone through three, or is going through three, public consultations—thoracic surgery prior to Christmas, and it's currently going through the major trauma network consultation and the boundary changes. I'm hearing that, in fact, the take-up by the public in some of these public meetings is very, very small. Surely it's important that health boards, when they recognise that there are not many people attending, become proactive and actually go back out to the people to get the consultation. Otherwise, there's a report saying very little because people haven't been attending. People may not attend because they don't know. Many of my constituents didn't know these consultations were going on. We need to get them out there. They have to get engaged with the people. They have to recognise that, if they're not talking to them, if they're not attending—go back out and start again so that consultation becomes meaningful and not lip service.

I do recognise the points the Member raises. There's something important about the balance in what we have to do. We have to make sure that there is a genuine, proactive attempt to engage the public in consultations through a variety of different means. There's the personal conversation that takes place between people and staff, there's the written media, there are formal notices, there's having community meetings, there's all the online presence as well, and, of course, the community health councils and their role in engaging with the public too.

I'm happy to join in with what Julie James said yesterday in business questions to encourage people who have not yet taken part in the major trauma consultation to do so before that closes next week. But we also have to accept we can't force the public to take part in consultations. It's often the way that, when there's a big and a broad subject, the public aren't as likely to engage, but when there's a more specific and local proposal then, actually, you do tend to find that people engage. A good example is planning law, outside the field of health, deliberately. General conversations about planning tend not to have lots of people engaging, but a specific planning proposal in a locality almost always does. But I'm happy to say that I think that we are genuinely looking to learn and to improve. And of course, on one of the proposals that you refer to—the consultation on thoracic surgery—there was confirmation on Monday that thoracic surgery will be centralised, in accordance with a recommendation from the Royal College of Surgeons, and it will be centralised in Morriston in Swansea.

You're absolutely right, Cabinet Secretary, we can't force people to take part in consultations. But picking up from the point that David Rees made, there are an enormous number of really good ways of engaging people at a grass-roots level and really taking the temperature of proposed changes. Organisations such as INVOLVE, who run consultations in England—they work very hard with local authorities and health boards, they run fun days, there's all sorts of new ways of actually getting to the hard to reach, rather than the very stale paper-based, or if you're lucky and get broadband, computer-based consultations that we have in a very, very small window, almost inevitably run over a Christmas or a summer holiday. I would like to ask you to have a good look at all the alternatives we can to reach them.

But, above all, the central point of my question is: do you think it is still appropriate, given the parliamentary review, that we actually have consultations now run by health boards, or should they be health and social care, given the fact that we're looking for such an integrated and seamless way of going forward? Because anything that health decide to do will have an enormous impact on local authorities, and on the provision of social care, and the provision of housing. And if we're trying to get towards this more holistic way of putting the person at the centre of their health needs, ongoing, then we really should look at it in the round. A lot of these consultations are all about the health side, and don't really bring in the other half of the very important provision that we should be providing.

Well, there is something here about understanding the proposals referred to earlier by David Rees, who talked about thoracic surgery and the major trauma centre. Those really are specialist health service consultations that need to take place. And my concern has always been that, if we avoid dealing with issues, then we'll allow ourselves to get into a position where the debate is more difficult, and the need to change is more urgent. So, I don't think it would be helpful to try and stop the health service from running consultations on the way in which services should change and be reformed. But of course, there are a wide range of those services that are properly about how health and social care work together. So, I expect health boards to have proper relationships and conversations with social care partners.

For example, on the consultation about Bridgend, which is ongoing at present, there is absolutely a conversation, not just with Bridgend local authority, but actually with partners in Swansea, Neath Port Talbot, and of course RCT and Merthyr as well, about the potential impact of those. So, there is a willingness and a recognition that health and social care need to work more closely together. Regional partnership boards and the public service boards are part of that, and when you get to having a consultation, I expect that to be the case as well. But I really don't think there is a case to say we should pause and stop what's being done now; we need to learn and improve, rather than putting a pause button on changing, reforming and improving our health service.

My engagement with my health board is going to be a lot more difficult after the events of the last 24 hours, I have to say, now I know information will be shared willy-nilly with the Government for the purpose of traducing engagement with the health board. So, just to confirm that I hope the Cabinet Secretary can confirm today what other information the Welsh Government has around Assembly Members' own engagement with their health boards. What he has in front of him in his little file there would be useful to know.

But, from the point of view of the public, for them to get engaged in health board consultations, they have to believe that the consultation proposals are credible. Now, one of the proposals in the Hywel Dda health board area, which is likely to be put out in March, is one of a brand new hospital, somewhere in west Wales, to replace Glangwili and Withybush. For that to be a credible proposal, to be taken credibly in a consultation exercise, to be responded to credibly by the public, he has to tell this Chamber here today that the Welsh Government will provide the capital funding if a brand new hospital for west Wales is proposed. Will he do that, so that any consultation has some credibility around it?

I think there are two broad points there. The first is on the points you made about traducing Assembly Members and their efforts to engage in local health boards. I think it's really important that every Assembly Member engages with their local health board around the future of health services. We've just had a parliamentary review that set out again that the current way that services are organised have served us well in the past but they're not fit for our future. So, we need to change them. And that's the national challenge that faces us. I think every Assembly Member should be properly engaged in that conversation. Again, the maturity that led to the parliamentary review needs to continue in that continuing debate. And I think that when it comes to a debate in this place, of course, there will be to and fro in the Chamber. It's not as if Ministers—[Interruption.]

Let's allow the Minister to be heard. Carry on, Cabinet Secretary. 

It's not as if Ministers are completely free from criticism and questioning of motives and integrity in this place. I think it is important that Members are open and honest with the public and this Chamber about what our views are and where we're going. And that's a standard for all of us to reach to as well.

On your point about where we are now, Simon Thomas, with the proposals that may come in the future, I've said in the past, and I'm being as open and honest as I can be yet again, that I can't set out the position about what proposals are or are not going to be discussed and put forward in the spring, as the health board have indicated. I'd encourage everyone to engage before then and afterwards, and if there are real proposals coming forward, then of course we will look sensibly at what those are. But you know that I can't say today that I will find money or resources for a future decision because that would not be an open and honest conversation, and you're asking me to do something before there is actually a proposal for me to respond to.

I'd remind people—[Interruption.] I'd remind people that not only is there a role for Ministers in this, but we're at the point of actually constructing the Grange University Hospital right now. The structure's going up. It's been a conversation that's taken a number of years following a proposal, and following a range of ways to look at the business case, to get capital ready to do so. I made the choice for the capital case to go ahead at the start of this Assembly term. So, there was a decision there, which I made, and that was after the case had been made and agreed, with buy-in from local public and clinicians about what to do to reconfigure the health system in that part of Wales. 

I recognise the invitation to say something completely precipitous at this point, but I won't take up his kind offer to do so.