The next item is the Welsh Language Standards (No. 7) Regulations 2018. I call on the Minister for Welsh Language and Lifelong Learning to move the motion. Eluned Morgan.

Motion NDM6693 Julie James

To propose that the National Assembly for Wales, in accordance with Standing Order 27.5

1. Approves that the draft Welsh Language Standards (No. 7) Regulations 2018 are made in accordance with the draft laid in the Table Office on 27 February 2018.

Motion moved.

Thank you. It’s a great pleasure to open this discussion on the Welsh Language Standards (No. 7) Regulations 2018. The regulations allow the Welsh Language Commissioner to place standards on health boards, health trusts, community health councils and the Board of Community Health Councils in Wales. These are organisations that provide crucial services to the public and are among the leading employers of Wales. These standards will build upon 'More than just words', the Welsh Government’s strategic framework for Welsh language services in health, social services and social care.

The framework introduces the principle of the active offer, that one should be offered a Welsh language service without having to request it. 'More than just words' recognises that care and language go hand in hand with the importance of ensuring the dignity and respect of Welsh speakers. It is more than complying with legal requirements and maintaining professional standards. It relates to providing quality public services that focus on the individual.

The regulations build on the firm foundations that the language schemes and 'More than just words' have created within the sector. The most important thing about the policy of creating standards and extending it to new organisations and bodies is to ensure that more bodies provide Welsh language services for their users and their staff. But there's a great deal of capacity-building work to be done, and these standards reflect that.

Everyone uses health services at some point or another, and therefore I'm pleased to be able to introduce these standards, which have the potential of improving the experiences of Welsh speakers as they access these services.

In preparing the regulations, we have been aware that some of these bodies run services 24/7 every day of the year, and I've also considered the broad range of services that they provide in a range of locations, from the commonplace to heart surgery, from emergency care to end-of-life care. Ensuring that the Welsh language is at the heart of all of these services is challenging, and there is an understanding that it won't happen overnight. If we're to succeed, the bodies will have to change the way they work, and we will ensure that the support is available to them to improve Welsh language services.

In preparing these regulations, I have listened and considered the responses received to the consultation, and I accept that the timetable for scrutiny has been tight, but I do think it's important that we make progress. A number of consultations have taken place, and I think it is now time to start this journey. Given the evidence received, I have amended some of the draft standards, and I believe that these standards assist bodies in planning and increasing their capacity to provide Welsh language services. The ultimate aim is that everyone will be able to access services in the language of their choice.

These regulations are part of the jigsaw. If we're to deliver that aim of providing more Welsh language services, it makes sense to support these regulations, which will put foundations in place for actions with other interventions in order to build the capacity required within the sector to provide services through the medium of Welsh. For example, through the Welsh Language in Business project, officials are working with businesses to increase their use of the Welsh language, and we will be running a pilot project with some GP clusters in the Hywel Dda and Aneurin Bevan areas to increase and enhance their use of the Welsh language. There will also be a toolkit developed for independent providers of primary care on how to operate bilingually.

A new pilot scheme has been launched by the Coleg Cymraeg Cenedlaethol in partnership with the universities of Cardiff and Swansea to increase the number of Welsh-speaking students who study medicine. Over 50 year-12 pupils have joined this pilot, and I saw an excellent example at Cardiff School of Medicine of a lecture being presented through the medium of Welsh to a lecture theatre full of students, most of those students listening via headphones. The National Centre for Learning Welsh is developing courses that are specifically designed for the health sector. The regulations before you are a key part of this jigsaw, which will lead to improved services in the health sector over time. 

Thank you. I call on the committee Chair, Bethan Sayed. 

Thank you, Dirprwy Lywydd.

These regulations are clearly a very important part of the Welsh language standards system introduced by the Welsh Language (Wales) Measure 2011. The Culture, Welsh Language and Communications Committee agreed that it was important that the regulations should be scrutinised as carefully as possible, with an opportunity for stakeholders to submit written evidence and for the committee to hear oral evidence.

In the extremely limited time available, the committee was able to invite and receive a range of written evidence, and also to question some of that evidence in a public meeting of the committee. I'd like to put on record the committee’s thanks to all those who took part in our consultation and who provided oral evidence at very short notice. The committee also received a private technical briefing from Welsh Government officials in March, and I’d also like to put on record the committee’s thanks to those officials. All of the evidence we received is attached to our report or is published in the transcript of our meeting on 14 March.

Turning to the committee’s conclusions and time available for scrutiny: well, we had just 21 days on this occasion from the regulations being laid before the Assembly until this debate. While this has allowed us to carry out a very basic written consultation and to arrange some oral evidence sessions, it's only barely sufficient to properly scrutinise regulations as significant as these. For example, there were only five working days available to receive written responses, and only 10 working days between the laying of the regulations and the final date for the committee to consider them. As a result of the requirements of Standing Orders and committee briefings, the time genuinely available was even more restricted.

It doesn't appear that there's any specific reason why this debate couldn't have been held later on to allow time for more comprehensive scrutiny. Even though this could have caused some delay in terms of the preparatory work on implementing the regulations, it would have allowed our committee to consider this issue in more detail. So, the committee would be pleased if the Government could allow more time to scrutinise the regulations in future.

This could be achieved easily by making it clear in the explanatory memorandum that it will not be seeking approval in terms of regulations until a period greater than the minimum of 20 days has elapsed. Forty days would allow reasonable committee scrutiny—including by other committees with an interest—while not holding up work unduly in terms of implementation.

The committee agreed that it has taken too long to bring these regulations before the Assembly—some three years from start to finish. We agreed that there is now a pressing need to put in place robust Welsh language standards for the health service. And, we heard no evidence that standards are not needed to move Welsh language provision in the health service forward.

However, the committee did hear considerable concerns about aspects of the regulations. In many ways, the health service is the most important public service that most people will use. Perhaps the greatest concern we heard was the lack of any right to receive face-to-face clinical healthcare services in Welsh. Of course, for practical reasons, a right to receive these services cannot be absolute. But, the importance of language in diagnosis and care is very clear. Also, the right to receive a service in your language of choice should be an established principle in the public sector in Wales, even if there are occasions when practicalities temper what can be provided. The idea that this basic principle should not also apply to the health service is, in our view, unacceptable. So, we want the Government to consider bringing forward, as soon as practicable, additional regulations to establish clearer rights to receive face-to-face healthcare services in Welsh.

Primary care services are the ones most often used by the public, and the other major area of concern about the regulations is that they do not apply for the most part to primary care service providers. Again, the committee recognises the practicalities, but the absence of any standards at all for independent primary care providers is a clear weakness, in our view. We are not convinced that it is unreasonable to place duties on local health boards to pursue compliance with standards by independent primary care providers. [Interruption.] I think this a statement.

Do you want an intervention?

I can?

Yes, you can do.

I thought it was a statement. Sorry.

No, it is a debate.

It's a debate now.

It's certainly a debate now. The point I wanted to raise, and I know that the committee hasn't had much time to look at this, but there is specific provision in the Measure for that which the Chair has just outlined. It would be possible for the Government to designate, through regulations, anyone to be captured under the Measure who is in receipt of more than £400,000 of public funding. Not all, but most independent primary care providers do receive this sum, and therefore could be encapsulated under this Measure. Was there any consideration given by the committee, or by the Minister, as to why this wasn't adopted?

We did ask those who appeared before the committee about that particular idea, but we haven't had sufficient time to scrutinise that effectively. But I think that is something that we have raised, as something that could be considered.

I have a little bit of time remaining. So, it's a matter for the Government to bring forward standards that can be applied sensibly to primary care and to empower and support local health boards to help primary care service providers to comply with standards and develop services. 

In fact, the Government has said that it does intend to place a small number of Welsh language duties using the primary care contract. But as has already been mentioned, there is a way to do this more widely, and it is not clear to us why the specific duties that will be placed in contracts cannot be specified in standards for local health boards, which would then create a route for complaints to the Welsh Language Commissioner and greater transparency.

Under the system that is being put in place by the Minister, as far as I can understand it, the commissioner won't be answerable to any complaints or any issues. So, the committee concluded that the Government should bring forward revised regulations with clearer standards for developing Welsh language services in the primary care sector.

Finally, and I'm sorry for running over time, a theme running through the evidence we heard was the need to improve the recruitment and relevant skills of Welsh speaking staff in the health services. We do agree that this is a concern. It is important that the Welsh Government ensures that these broader policies are pursued at pace and with ambition to help address some of the practical issues that witnesses have drawn to our attention. Thank you very much.

I have to admit that this has been a difficult decision. I must make that point. On the one hand, we have a system of rights that we’re trying to extend, and, on the other, we have a sector that isn’t ready for meaningful rights, that is, face-to-face communication and provision in the primary care sector. The standards, as they currently exist, do actually contain some unfortunate discrimination between patients that are served by a GP surgery run by the health boards and those going to independent GP surgeries. There are also issues between in-patients and out-patients.

Despite a broad-ranging consultation on the draft version of the regulations, the final version wasn’t subject to a long period of consultation, and it includes a small number of significant changes. The responses to that brief consultation weren't of the same opinion either. Generally speaking, the standards as they currently stand are clear and can be applied in various different areas of Wales, but we cannot ignore the inherent inconsistencies forever.

We have to consider why these weaknesses have appeared in the regulations, and in the past I have said in this Assembly that challenging standards can push stubborn councils to take steps, for example. And, for large parts of the health service, I would say the same thing. They’ve known that standards were in the pipeline since 2010, and they should have been making preparations for them. Certainly, most of these standards as they currently exist could have been foreseen, and that’s why I would like to proceed with these standards now.

We can consider why some of the standards haven’t been included, when, from the point of view of rights, they should have been. Now, what I would ask is: why is it difficult to recruit practitioners of sufficient quality? Why is that more difficult than recruiting staff to councils? Because that’s what’s been happening, unfortunately. With so few key relevant practitioners able to speak Welsh in Wales, the right to a consultation through the medium of Welsh at the moment is something that cannot be enforced, and therefore it shouldn’t be worded as an inherent right. Unlike local authorities, the cohort of doctors and trainee doctors come from all parts of the world, and I don't see this as a question of the health service ignoring the inherent skills of the workforce; it’s a question of ensuring a workforce at all, whatever language they speak.

But we won’t accept this rationale forever. Minister, we will be supporting these regulations today because something needs to be done after so long, and there are over 100 standards that could be applied at once. But we will hold you to standard 110, and we will expect this to be a step towards any new set of standards in the future—the next part of the jigsaw, as you mentioned. We recognise that, although recruitment is still a problem, it's possible securing rights to face-to-face consultations across all disciplines will still be difficult, but we will expect them to be introduced in key areas such as dementia, mental health, children’s services and autism services at least as a result of standard 110, and, if possible, it should be done before the five years is up.

So, that’s why I was content to sign up to the committee’s report, because I am of the view that it’s possible to do something before the end of that five years, and that is to do something as soon as is reasonably practicable. We don’t have to wait for five years if there is a chance to do something sooner. Thank you.

It’s disappointing that the Government is determined to continue with the vote on these important standards that are to be set with regard to the Welsh language in the area of health, namely the Welsh Language Standards (No. 7) Regulations 2018. Plaid Cymru believes that this decision should be postponed to give the Government an opportunity to add to the standards that are before us today. The cross-party Culture, Welsh Language and Communications Committee has said that the Government should consider giving more time to the committee to have more of an opportunity to scrutinise these standards.

The committee has also come to the conclusion that additional standards should be put forward. As things stand, the standards are entirely insufficient and deficient. As there will be a vote today, we in the Plaid Cymru ranks have no choice but to vote against these weak standards. The standards that are before us don't set any standard that acknowledges the need for face-to-face services through the medium of Welsh in our hospitals, nor do they set standards for the vast majority of primary care providers, which are the main link between citizens and the world of health.

Having that face-to-face contact in your mother tongue to discuss aspects of your healthcare is vital for the quality of that service, especially if you are a young child who hasn't yet acquired the English language, or if you suffer issues with memory such as dementia that mean that it's only in your mother tongue that you can communicate, or if you suffer from mental ill health and want to deal with emotions in a meaningful way. The quality of the care, and, in some cases, the safety of the patient, are compromised if there are communication issues. That need is acknowledged very clearly in the innovative Welsh Government strategy 'More than just words', but, unfortunately, the spirit of that strategy isn't reflected in these weak standards that are before us today.

If we can pause for a moment to consider what exactly standards are, the Welsh Language (Wales) Measure 2011 enables Welsh Ministers to set standards, which is a way of setting standards of behaviour with regard to the Welsh language. In the case of the health sector, there are 114 standards set, mainly relating to correspondence, phone calls, staff meetings, signs, job interviews, policy making and so on. But there is no expectation for a health body to jump straight into achieving that overnight. There's a process where the Welsh Language Commissioner will be putting forward a compliance notice on the body in question, but, and this is an important 'but', there's no compulsion on the commissioner to make it a requirement for every body to comply with every standard. Rather, this is a list—it's a menu, if you will—and if it's clear that it is entirely impractical for a body to operate in accordance with any of the standards then that specific standard doesn't have to be in the compliance notice, nor does the standard have to be implemented immediately. There is a great deal of flexibility in the system that would allow the commissioner to set a future implementation date.

What's forgotten as part of this discussion is the voice of the patient. Very rarely is there mention of the rights of patients in hospitals. There's one standard amongst all of the others talking about the need to record a desire to speak Welsh, but, after that, it doesn't mention what to do with that information. Then there's another standard about publishing five-year plans about the steps that are intended to be taken to improve the ability to undertake a clinical consultation in the Welsh language, but, again, there is no specific standard that sets out the right to a Welsh language service, and so even that five-year standard becomes meaningless, because that standard isn't defined clearly as part of these regulations. There's no reference at all to setting standards in the independent primary care sector, which is a clear weakness.

My argument is that these standards should set out rights to a face-to-face service through the medium of Welsh—clear rights. Of course, there are great challenges, we all know that, but there is change afoot as more nurses and doctors receive training through the medium of Welsh. We need to respond creatively to the challenges that face the health service. There is a way to add to these standards without causing major problems, and Plaid Cymru, in Government, would leave no stone unturned to find those creative solutions, and Plaid Cymru, in Government, would have the robust political will to demand that the needs of Welsh speakers are met fully.

It's easy to see these regulations—wrongly—as part of a policy on culture; it's actually a health measure that we're talking about today, and we will be supporting the regulations on the basis that half a loaf is better than no bread. I heard the eloquent plea by Siân Gwenllian today to go further, and I very much sympathise with it. It won't please them to know it, but Cymdeithas yr Iaith Gymraeg have produced some written evidence with which I very largely agree. They say that they recommend a specific stance should be added confirming the rights of both in-patients and out-patients to receive clinical consultation, treatment and care through the medium of Welsh, and Siân Gwenllian has explained why this is very necessary for the very young, for perhaps the very old, and perhaps the not so old, who unfortunately suffer from dementia or related conditions, where the ability to attend a consultation through the language in which you can best express yourself is going to be the language through which you may best be diagnosed and therefore treated. That's a vitally important issue, which needs to be properly recognised.

I fully understand the reasons why the Minister has not felt able to go so far, but I do think that Siân Gwenllian made a good point when she referred to the degree of flexibility that exists within the scheme that has been set up by the 2011 Measure. I do believe that there should be an aim set in legislation for the right to receive face-to-face treatment or diagnosis through the language of your choice, and the explanatory memorandum to these regulations does explain why this would not necessarily come into conflict with the obvious practical difficulties that we have, not having enough professionals able to deal with patients through the medium of Welsh. The evidence that we've seen from the British Medical Association is also an interesting point to add to that: we mustn't have the Welsh language being perceived outside Wales as an impediment to the recruitment of professionals within Wales, and I do believe that that is an important point, which we must always bear in mind. But the explanatory memorandum to these regulations explains, I think, quite clearly, that the scheme that the commissioner is obliged to implement gives her—'her' at the moment, at any rate—the power to be flexible, as Siân Gwenllian said. The commissioner may

'require a body to comply with one standard in some circumstances and another standard in other circumstances',

'the Commissioner may require the body to comply with the standard in some circumstances but not others, or require it to comply with the standard only in some areas.'

Similarly, where there are two or more standards relating to a specific conduct,

'the Commissioner may...require a body to comply with one of those standards only, or with different standards at different times, in different circumstances, or in different areas'.

I think that's a fully comprehensive possibility of introducing flexibility into the scheme. So, I do hope that although we'll support these regulations today—and I know for a fact that the Minister would like to go further and is only inhibited by what she sees as practical difficulties at the current time—that, within a relatively short time, we will be able to go further towards the realisation of this objective. Because I do believe that it's important for people to have the assurance that they can use the health service in a way that is best for them. It is a national health service, and that includes, obviously, Welsh speakers—and, indeed, Welsh monoglot speakers, for that matter—as well as everybody else, and so I think it's important for reasons of inclusivity. It's important for reasons, as we all know, of achieving by the year 2050, if we can, a million Welsh speakers, but it's more important, I think, that we see this as a measure that is going to provide the best possible health service for everybody in our country.

Well, I rather agree with Neil Hamilton on this, in that it's really important that, whatever measures we're introducing, we cannot afford to give the impression that only those who speak Welsh can be working in the Welsh NHS, because that would be a very dangerous path to travel. I welcome the measure; a long time in gestation, but now we need to give birth to this baby. Therefore, I will be voting in favour of the measure. We have to recognise that—. I absolutely agree with Siân Gwenllian that, in some cases, it isn't just a quality issue; it can be a safety issue. If a child is a Welsh speaker and needs to express how they're feeling about the pain or where it is, the quality of the consultation is going to be reliant on being able to understand what that child has to say. So, this is a really important issue in areas where children are being brought up as Welsh speakers. That also applies in relation to where we're discussing mental health issues or dementia is involved, where people may revert to being monoglot as a result of their dementia.

Caution is required in the speed with which we introduce this measure, simply because many of the services, certainly in my area of Cardiff and Vale, are dependent not just on attracting people from other parts of Britain, but on attracting European clinicians for whom we have to make sure that they speak sufficiently good English, never mind Welsh, and it's extremely unlikely they're going to speak Welsh if they're coming from other countries. So, I absolutely support the right and the duty on us to make progress on ensuring that services offer people the choice between Welsh and English, but as with the movement to enable women to see women clinicians, particularly on women's health issues, where somebody's life is at risk, we're clearly not going to be proposing that somebody cannot see a doctor because a woman doctor isn't available. In emergency circumstances, we clearly have to go with the clinician that's in front of them.

So, I support this measure, but I think we need to go cautiously in order not to artificially discourage people from coming to work in the Welsh NHS when, at the moment, we are having considerable difficulty filling vacancies for people who speak either language, never mind both languages.

I call on the Minister to reply to the debate.

Thank you very much, and thank you, first of all, to the committee for the report. I am highly aware that you didn't have a great deal of time to look at this, but we have complied with the 21 days that is usually in place. However, I do accept that perhaps we can look at expanding that, if that's created a problem on this occasion. But that's the way it's always been done. But as a point of principle, I do think that we can extend the time in future.

The Chair of the committee was right in saying that it has taken a long period of time. There was a consultation that went on for a lengthy period of time. It is quite a sophisticated and broad-ranging service, and I was eager to ensure that we did get responses from all sorts of levels within the health sector. But that is why we are eager now to make progress today.

Now, this issue of the face-to-face clinical consultation is a difficult one, partly because of the practical problems. Once you establish rights, at what point do you say, 'Well, actually, you have to have this given treatment or consultation at this particular point'? You don't necessarily want to stop that process of assisting the patient through the system. So, we have to strike that balance correctly, and that's why we have said that we want to start the health boards on this journey of ensuring that, ultimately, they will need to provide services and to move towards providing clinical services to their patients. That is why we've introduced this idea of five-year plans, and that's why they have to demonstrate to us how they're going to respond and that they can change in terms of what they want to do in any given area. So, what might be right for parts of Gwynedd might be very different to what might be required in another part of Betsi Cadwaladr. So, they will have that flexibility to respond to local need.

In terms of primary care—

Will you take an intervention?

Yes.

What we heard from one member of the committee, Siân Gwenllian, was that it was possible to give that flexibility about how that standard would be implemented. So, you could then place a standard on Gwynedd, whereas Blaenau Gwent might take more time to reach that particular standard. If there isn't a standard, then the obligation isn't perhaps as strong—if that standard isn't in place.

What I hope will happen now is that the commissioner will speak to these services and see what is ideal in those areas, and to push them in those areas where we can push people further.

In terms of primary care, of course, care provided directly by health boards will be captured under the standards, but that's an issue of practicalities in terms of how we actually require independent primary care providers to comply with these standards. What is the system to police this? There are over 3,500 of these, and the language commissioner doesn't have the capacity to pursue that many bodies. So, I think it makes more sense to do this through the health boards. That's why there is an agreement in place. It commenced yesterday, and GPs have been given more funding. As part of that contract, they are committed to looking into providing more services through the medium of Welsh. So, we've started on this road. There is some way to go with those contracts, of course, but policing this is important. 

Suzy, the balance of rights is important, I agree. It's very difficult in this area, in terms of what your rights are. Do you have the same rights in Blaenau Gwent as you would have in Gwynedd? It's very difficult when we have this system that looks at what's reasonable and proportionate. So, I do think that the system that we have is quite sophisticated, but it does make sense to respond to what is required locally.

I do think we have to be sensitive, Siân Gwenllian, to the elderly and children particularly, and I do hope that when people bring these ideas forward on their five-year plans that they will look at those as the first points so that they move towards providing a clinical offer in those sectors first of all. I hope that they will consider that. But, I am eager now for the commissioner to proceed with this work. I do understand that recruitment can be problematic in the health sector, and we don't want to convey any messages that people who don't speak Welsh aren't welcome in Wales. It's extremely important that we get this sensitive message right, as Neil Hamilton said. 

Will you take an intervention on that point?

Well, the Minister's out of time—very briefly, then.

Well, just on that point, because we had evidence on the way that prospective students are recruited in our medical schools in Wales—the two that we have. A very low percentage come from Wales in the first instance, and there is no weighting being put on whether you speak Welsh or not. That's why there is pressure to have a medical school in Bangor to overcome this situation.

But the Coleg Cymraeg Cenedlaethol is doing a great deal of work in this area already. So, a great deal of work is already being done. So, we can't discount the other things that are happening. We are dealing just with the standards today, and in my opening remarks, I did say that we must look at these standards in a far broader context. But, I do now hope that we can make progress in this area. I do think that we need to ask the commissioner to start this work, and I am confident that the services available for people in future will improve as a result of these standards.

The proposal is to agree the motion. Does any Member object? [Objection.] I will defer voting under this item until voting time.

Voting deferred until voting time.