Part of the debate – in the Senedd at 4:37 pm on 27 February 2018.
Thank you for those questions. I'll try and run through them as briefly as possible, but as directly as possible.
On common standards, I recognise what's been said. There's an impression that in the history of the health service there's been a more paternalistic medical approach, as opposed to a more engaged social model within social care, and actually it's part of the movement within healthcare, in any event, to have a more social model to understand what that really means—seeing that person in their context and that person having a real voice. I recognise that, in the field of social care, more progress has been made on the citizen having more voice and control in those choices. That's actually why co-production matters so much within the healthcare system. It really, really matters for people to be informed, for people to make choices and to say what matters to them. That's where we're trying to get in the way we design our system, as well as they way in which individual interactions take place.
I hope that also helps in terms of the point about health being seen and heard over other voices, especially social care. So, if we're going to have, in a whole range of things, the parliamentary review and others, there's got to be more genuine partnerships, and something that is genuine in the way that health deals with others. If we don't do that, then we recognise we'll just see more pressure coming into the health system in any event. So, this isn't just budget choices, this is the way in which we organise and run our wider system, and there'll be more to talk about with that as we take forward the parliamentary review and a long-term plan for health and care in Wales.
I'll deal with your point about the national bodies. The national body for the citizen voice—it's about having a consistent national body, but one that does have local standing and engagement. This is about not doing away with all the things that work in CHCs. I've been really impressed by the way, from the outset, through the consultation, the CHCs initially engaged in this and told us that they were particularly unhappy with the national board. There have been a number of meetings that have taken place with officials, and then, the ultimate response was when, actually, they recognised there were some things that could and should change, but they want assurance that a new voice for the citizen across health and social care will still have an entitlement to organise its business, which must include—. You know, any sensible national body would want to have a local way of communicating and engaging with its citizens. That's what we would expect to be the case. Now, there's something about what we set out on the face of legislation, should we bring that forward, what should be in secondary legislation, what should be in guidance about how a body should organise, where you can be much more descriptive, frankly, than legislation sometimes allows you to be. But I recognise the challenge that Members on all sides have about making sure you don't lose sight of having a local locus for that national citizen voice body, rather than, if you like, a top-down organisation that's based in Bangor, Cardiff or Aberystwyth, that could be remote from local communities.
On your point about the merger of inspectorates, there was a real divide in opinion. Some people thought that the inspectorates should merge and do so as quickly as possible, others felt it was an incredibly bad idea for a range of different reasons. Some think it's about the sprawling nature and how broad health and social care are in any event. The care standards inspector, of course, rubs up against early years and Estyn, in any event. So, actually, there are links between the three inspectorates that matter as well, and having a new superinspector is something that not everybody thought was the right thing to do. So, we'll develop how we have further joint working between those inspectorates, deal with the legislative underpinning for Healthcare Inspectorate Wales, but it's possible, of course, that a future Government may come back and say, actually, the time is now right to think about having a merged inspectorate, not just an inspectorate that works on a more complementary basis.
And finally, your comment about carrying the can. I think the easiest thing is to call for somebody to go, and as a Minister it's much easier to get rid of someone—although that's sometimes difficult—than to then replace them with someone who will improve the position you find yourself in. And I think there's a real challenge about the culture that we have within health and social care and more broadly across public services. So, we don't simply tolerate failure. There is accountability, but equally, we don't move to the extreme end where people recognise their time is limited and they can expect to have a tap on the shoulder or be shown the door within a brief period of time. I heard Bruce Keogh give his leaving speech, and I think it was interesting. It was his leaving speech to the NHS Confederation conference in Liverpool last summer. He said, 'We must recognise there is something wrong in our system if the average life expectancy of a chief executive within an NHS trust in our system—England—is less than two and a half years.' Two and a half years is not a period of time for a chief executive in a large, complex organisation to understand it, to get on top of the challenges, and to be able to make real and lasting change. Now, that's one end of our spectrum. We need to think about what is appropriate here, how much tolerance we have, our ability to get different and better people if we recognise there is a problem, and also how we work to support organisations that are going through difficulty. So, I want a generally rounded approach—one that has real teeth and real accountability within it.