3. Will the Cabinet Secretary outline progress on plans to change community health councils in Wales? OAQ51680

We are giving detailed consideration to the many consultation responses to the proposals in our recent White Paper, in which changes to community health councils are one. Officials and I remain in discussion with representatives of the CHC board regarding their constructive response to the White Paper. A consultation summary report will be issued in due course. 

Well, of course, Cabinet Secretary, I think that if we're going to have the grown-up debate that you want us to have on the future of the health service, we need to have a community health council sector that is able to respond effectively to that call as well as the politicians. I believe that community health councils are crucial, but I have some reservations from my own patch about how they've reacted to previous problems with regard to Princess of Wales Hospital and, more recently, with regard to the Kris Wade scandal. But that doesn't take away from my fundamental belief that I do not believe that a Wales-wide body will solve this problem. For me, it's about trying to give community health councils guidance, to give them standards, to standardise practices across community health councils and make sure that they are visible. In fact, the former community health council chair of Abertawe Bro Morgannwg University Local Health Board actually told me that it was the best-kept secret in Wales, and I think that's quite a shocking statement to come from a chair of a community health council. So, what are you doing in relation to this concept of a Wales-wide community health council? Are you still going to go ahead with it, despite those reservations?

As I've said, we are gathering together the consultation responses, and we do continue to have a very constructive dialogue about how to take forward proposals, but I think all of us want to see a new citizen-voiced body that is able to properly cover the fields of health and social care, and you can't do that without replacing CHCs, because their current remit set out in primary legislation just doesn't stretch into the social care field. So, that's really important for us to achieve. Actually, there are some people who take your view that a national body shouldn't be the answer, but actually we already have a national body with the CHC board. It's about making it work and ensuring that we can deal with some of the concerns that people do have about a national body being set up in one remote location—whether it's Cardiff, Aberystwyth or Bangor—and that wouldn't then have the local status and the local organisation to have a presence within local communities. So, those concerns are being taken seriously, and as we both have the consultation responses and we've moved forward to then having what I hope will be proposals for a Bill, these are obviously matters that will want to set out in detail, how we propose to deal with those, but those conversations are not complete.

Cabinet Secretary, I think that Bethan Jenkins has made some very good points, and they're points that have been made to many others as Assembly Members from across Wales. I met with my own local community health council last year, and they were concerned about some of the possible proposals to come forward from the Welsh Government in this area. They're not averse to change and they understand that the system, the sector, does have to change. In terms of the structure—whether it's a national body or a local body—that's ultimately for you to decide, but will you, however, ensure that you do listen to patients, ensure that there is a patients' voice as part of this system, whatever structure that may be? Let's not lose that vital aspect of the current CHC system, which sees volunteers going into hospitals, seeing on the ground with spot checks problems that are happening, problems that patients are facing. These are what we really need to hear fed back to the system; we don't just want a bureaucracy that doesn't have the patient's voice at the centre of it.

This has been part of the very sensible and constructive conversation that we've had: how do we make sure that there is a genuine patient voice, a citizen voice, across health and social care? How is that organised in a practical way to take on board the parts that have been successful within our system and to deal with some of the challenges that no-one suggests have worked well? Part of the focus has been on the ability for a community health council or its successor to be able to actually undertake visits, and there's a challenge there about doing that in a way so it doesn't disrupt patient care but actually makes sure that there is access and the ability to undertake some unannounced visits as well, but not confusing the mission with a citizen voice body and the work of the formal inspectorates—Care Inspectorate Wales and also Healthcare Inspectorate Wales. And, actually, there is a tension there to be resolved, because at the time the CHCs were created we didn't have those other formalised inspectorate organisations. So, it's about making sure that there's clarity in the mission that doesn't stop those important visits to understand and to hear directly from citizens as they're receiving and taking part in care themselves. So, I recognise the issues and of course they'll be part of our consideration going forward.

Cabinet Secretary, the White Paper suggested that there was a duplication of inspection roles with community health councils and Healthcare Inspectorate Wales, but the community health council inspections are, in many ways, quite different. They are unannounced and can occur at any time, they include patients and relatives and they also involve follow-up visits. So, it seems to me that there's an important element there that is vital that we don't actually lose.

There was one further function, which, again, was part of the submission that I put in after various consultations, and that is the role of community health councils in the planning process. I've raised this with GP practices, but the fact is that where we have, for example, large housing developments, there is a lack of engagement, properly, with the health boards and with the local GP practices on the impact of such developments, and, also, there's the important role that community health councils could, perhaps, play within that context. It's essential that that role really is beefed up and it is an important one that we really need to develop that doesn't exist at the moment, but could be one of the very important functions that community health councils do play in the future.

Dealing with your second point first about the broader planning process, of course it's a conversation across the Government about our planning system, and the way in which, when new residential properties in particular are created, there's an impact on wider services, such as the health service, which is an obvious one, and with schools being another one and transport being obvious parts that are affected. So, there is a need to look at how different parts of not just the health service, but those actors around it, are able to take part in the process and have a proper say and a conversation with the reality of the impact of future development. So, I recognise the broad point that you make.

On the point about the difference between a CHC visit and a formal inspectorate visit, the CHCs themselves recognise that there is potential for duplication, which is unhelpful. They actually try to have a protocol between themselves and HIW in particular to try and demarcate the different roles that they have and how they should complement each other. Part of what we'll want to do in taking forward the White Paper is to make that clear so that it makes sense to the citizen, but also to the inspectorate and the people who are looking to undertake that work, because I recognise that there is real value in it.