Which brings us to the next statement, a statement by the Minister for Health and Social Services on Health and Social Care (Quality and Engagement) (Wales) Bill. I call on the health Minister to make the statement—Vaughan Gething.

Thank you, Llywydd. Yesterday, I laid the Health and Social Care (Quality and Engagement) (Wales) Bill, together with the explanatory memorandum, before the National Assembly for Wales. I am pleased to have this opportunity to make a statement about the Bill. The promotion of quality has long been a central and integral part of the NHS Wales. This was recognised in the report published in 2016 by the highly respected Organisation for Economic Co-operation and Development—otherwise known, of course, as the OECD. The provisions in this Bill build on the arrangements already in place to ensure a quality-driven national health service. This is currently underpinned by the existing duty of quality in the 2003 health and social care Act. But we cannot stand still. There is always scope to learn and do more to deliver continuous improvement.

Suzy Davies took the Chair.

The parliamentary review of health and social care in Wales highlighted the need to continually improve the experience and quality of care, to ensure we have a health and social care system that is always learning and where the voice of the citizen is central and clearly heard. I published the Welsh Government’s response, our long-term plan for health and social care, 'A Healthier Wales' in June last year. It outlines how quality will be key to making the health and social care system in Wales fit for the future—a health and social care system that achieves good outcomes, good experience for people and the best value. Our plan sets out the ambitions of this Government to bring together health and social care services so that they are designed and delivered around the needs and preferences of people. Our plan emphasises the importance of continuous improvement and engagement with citizens that values and enables people to contribute their knowledge, experience and, of course, preferences.

The Bill represents a next step forward in the journey of ever-improving quality in health and social care. The Bill builds on the assets that we already have in Wales, to strengthen and futureproof our health and social care services, facilitating a stronger citizen voice, improving the accountability of services to deliver improved experience, better quality of care and better outcomes for people in Wales. The Bill introduces changes that will strengthen the existing duty of quality on NHS bodies and extend this to Welsh Ministers in relation to health service functions; establish an organisational duty of candour on providers of NHS services, requiring them to be open and honest with patients and service users when things go wrong; strengthen the voice of citizens, by replacing community health councils with a new all-Wales citizen voice body that will represent the interests of people across health and social care; and enable the appointment of vice-chairs for NHS trusts, bringing them into line with health boards.

The existing duty of quality in the 2003 Act has succeeded in providing some focus on improvement in quality and the development of an infrastructure. However, it has been interpreted in a relatively narrow way and led to attention on quality assurance rather than proactively planning and improving quality. Quality needs to be more extensive than this. I want quality to become a system-wide way of working, to enable safe, effective, person-centred, timely, efficient and equitable services. That must include the promotion of a learning culture. The Bill replaces the 2003 duty with a broader duty of quality, more in keeping with how we want our NHS bodies to work together. It will strengthen actions and decision making to drive improvements in quality across our system. And the duty of quality will be placed on NHS bodies and Welsh Ministers. It will ensure impact on the quality of services in its broadest sense. It will be the first consideration when making decisions about health services.

Inevitably, in a system as wide and complex as the NHS, things will occasionally go wrong. The duty of candour will help to ensure that when this happens, providers of NHS services are open and honest with people affected. Recent events in the former Cwm Taf area have shown us the importance of this. The Bill will help ensure that individuals are supported, that organisations do the right thing and use such events to learn and improve.

There is growing evidence that high-performing health and social care systems have people at their heart, and the starting point of any decision should be centred on what is best for the person. Delivering on our ambitions for improving quality means listening to and valuing the voice of people in Wales. Creating a new all-Wales citizen voice body will strengthen that voice across health and social services on national, regional and local levels. Strengthening public engagement, and supporting a stronger citizen voice, will amplify the influence of people. When triangulated with the work of the two inspectorates—Healthcare Inspectorate Wales and Care Inspectorate Wales—it will support the drive for higher-quality services.

Finally, the provisions on vice-chairs for NHS trusts will strengthen their governance arrangements and bring them into line with local health boards. This Bill is just one aspect of a suite of measures we are taking in our relentless drive towards increased quality in health and social care. We will, for instance, be taking forward separately further work around how service change decisions are made in the NHS and consider how the composition of health boards can be used to strengthen governance arrangements. We are also moving forward with work to strengthen regulation and inspection, including work to consider HIW’s legislative underpinning. In the short term, we have invested extra money to incrementally develop HIW sustainability and be ready to respond to any future new legislative framework.

It is my pleasure to introduce this Bill for scrutiny. I look forward to engaging with the Assembly and its committees over the coming months on a Bill that I believe will deliver positive benefits for the people of Wales. The Bill will help to realise our shared ambitions for a health and social care system with quality at its heart—a health and social care system that is open and honest, and where the voice of the citizen is heard loud and clear.

Minister, I'd like to thank you for your statement this morning—or this afternoon—and for bringing forward the further detail on this Bill that you laid yesterday.

I think I need to start by asking you whether or not you can explain to us why you believe we need this legislation. Because, of course, we would all want to support greater quality in our public services, especially with the NHS, because that has such an immediate impact on an individual. And we would all wish to support the principle of candour. However, those two very good aims are of course hiding the dagger that is the eradication of the community health council. The Welsh Conservatives would need to have a very long conversation with you over these coming weeks and months as to whether or not that really would be of benefit to the patient and would really help to reinforce the patient voice.

It's been nine years since 'Together for Health' and it's been four years since our longest-serving health board has been in special measures, yet it's only now that the Welsh Government is bringing forward any form of legislation or thought on how to improve those quality services. And if you say—as you have said in your statement—that the current focus is too narrow, well, Minister, you and your Government have had the best part of a decade to put that right. So why do you think that legislating for it will make the difference, rather than actually the culture change, which is what we really, really need?

In terms of the duty of candour, again, I think that's a very interesting principle. Again, I would want to support that in all walks of life. I have a degree of concern about the establishment of a working group to develop guidance to determine what level of harm must be suffered before the duty is triggered. Where will the patient's voice be on that working group? Because, to be frank, if there's any level of harm, that should be the trigger. And I have a concern from what you've said, from your statement, and from the analysis of the explanatory memorandum, that there's going to be a threshold, there's going to be a bar. Where is that bar, and how high will it be?

I of course now come to community health councils, which is probably the area that gives me the greatest concern. It gives me the greatest concern because everything that you have said as a Government over these last couple of years has been about parliamentary review, has been about the vision for health, has been about empowering the patient. And yet this proposal is basically going to eradicate all of the local community health councils—the boots on the ground, the people who can walk into ward 2 at Glangwili hospital, ward 10 at Withybush Hospital, go into Bronglais, go into any hospital in Wales, and actually have a look. This is going to eradicate the local people who can actually listen to a concern raised by a local resident about the services that they receive. It's going to pop it all into a national, universal organisation—and wahey, that sounds great—but, unfortunately, we have seen this time and time again with Welsh Government, where these national bodies, stretched across the length and the breadth of Wales, simply do not perform what we need them to do. And of all of the things that the Welsh NHS should do, it should be listening to the voice of the patient, because it is a people business and it's about those patients.

So, I have real concern about the comment in your statement about triangulating this with Healthcare Inspectorate Wales, because we know, don't we, that Healthcare Inspectorate Wales has been underfunded. It's still underfunded. It's received less funding than any other Welsh inspectorate—for example £3.5 million compared with £13 million for Care Inspectorate Wales and £11.3 million for Estyn. It is also the only inspectorate body of its kind in the UK that is not fully independent from the Government that it is there to monitor. That's borne out by looking at the Marks review in 2014, where again the Marks review talked about the lack of focus, the focus being too tight and, of course, all these wonderful reports that are reactively produced just disappearing into the ether. And I think that is a real key point, Minister, because, of course, organisations like HIW react to an event. They come in afterwards and start the mopping up. CHCs are very often on the front line and are able to get in there right at the very beginning when a problem first emerges.

So, I'd really like to understand how you see the very weak HIW with very few teeth being able to support your new national body, because opposition stems from the belief that if we lose our independent CHCs we lose the ability to hold our health services to account. And to be frank, the more than obsequious press release that was popped out this morning by the NHS Confederation told me, if nothing else did, that the health boards are jumping up and down with joy, because this is the silencing of a voice. This isn't a re-empowering of a voice.

I do not understand—and I would love it if you could explain to us—why you didn't take the decision to broaden the remit of the current CHCs so that they included social care as well as healthcare, and why you didn't fund them properly, even if you put them in a structure that had more strength given to that umbrella organisation. Because they have done a very good job. I know that throughout Wales it isn't consistent. So, I do buy in to the consistency argument. But when you remember there was a CHC, not very long ago, that was threatened with court for holding its health board to account over a consultation exercise, then that speaks to me of where the power in this really lies. I would like to know—and I have caught your eye, acting Presiding Officer—I would like to know how you are going to ensure that that voice really is independent—independent of you, the Government, independent of you, the Minister, independent of the health boards, and serves the patient. Because that's their one and only job, and we do see these national bodies not doing that and they're subsumed into regional partnerships. 

Thank you for the series of questions and comments. There is broad support for the duty of quality and the duty of candour. Both the Green Paper and the White Paper consultations showed there was widespread support. You'll know about the broader issue of quality; there are a lot of commentators who think it's the right thing to do. I referred in my statement to the OECD's advice and, indeed, that's validated by the parliamentary review and duty of candour that you know came from the Francis inquiry into Mid Staffs.

Those things are, of course, worthwhile doing, and we are at this point because we've had proper consultations at the end of the last Assembly term. The Green Paper and our White Paper are now ready to come forward with legislative proposals. I reject any suggestion, inference or otherwise, that this has been deliberately held up or, indeed, that this is simply hiding the dagger about a desire to get rid of patient voice and patient representation. Far from it. And when Members go through the detail of the Bill and the policy intent, I hope that some of the statements and accusations made and the suspicions that have been regularly repeated will actually give way to some of the facts and the reality of what we are seeking to do in strengthening the voice of citizens across health and social care. 

I'll deal with your question about the level of harm before the duty of candour kicks in before I deal with the point about HIW and then the citizen voice body.

Whilst we're setting a threshold, we're talking about more than minimal harm before the duty of candour is engaged. So we're actually looking at a relatively low level and then to understand how you would describe that range of circumstances and deliver some guidance around that. That should involve a range of stakeholders, including of course patient representatives and patient voices as well. There's certainly no suggestion that we'll go into a room full of lawyers who will try to protect the NHS from any kind of complaint and to make sure that the duty of candour is meaningless. There would be no point in legislating for it and in talking about 'more than minimal harm' triggering the duty, if we then decided that actually we'd find a way of completely turning that around and making sure that it wasn't effective at all. And I hope, again, when we get to the detail of the scrutiny—and I appreciate that you won't have read through all of the Bill in all of the detail you would want to and the explanatory memorandum—we may get beyond the starting point. 

On HIW, I do regularly have to remind any Conservative politician when they talk about funding: you can't avoid the consequences of austerity. I know people groan and moan about it on Conservative seats in this place when we talk about austerity, but the real impact of the choices that we have made ensures—. [Interruption.] There are incredibly difficult choices in every single public service of value. And as a health Minister, I don't set the budget for HIW, because of course it would be entirely wrong for me to do that, because then you could quite fairly say, 'You're deliberately taking money out of Healthcare Inspectorate Wales to avoid them being able to do their job effectively.' I actually took steps in the last budget round to take money from health into the local government budget specifically for HIW, to make sure it is properly equipped to do the job that we want it to do. So, whilst I may have some sympathy with some of the points you made, I have zero symphathy with any Conservative speaker who complains about the underfunding of any particular public service. 

And I think there's a mis-description of the function of HIW in the remarks, as well, and I hope that, during scrutiny again in the Bill, there's a clearer understanding of the role and responsibilities that HIW have. They are not a toothless organisation—far from it. And I think, when we get through the other steps we're seeking to take about the way HIW organises and undertakes its functions, you'll again see we're looking to make sure they're properly equipped to do the role we want them to do and to tidy up how they undertake their work. And that will include, of course, where it sits within and outside Government. 

I'll turn, now, to the citizen voice body, which I expect we'll hear some more about today, and just to deal with the outline of what we are deliberately seeking to do, which is to give a firmer footing for a citizen voice body across health and social care. The primary legislative framework for community health councils means they can only act within the health field. As we deliberately set out to integrate health and social care, we can't have a new citizen voice body that actually spans across health and social care without changing the legislation. We're going to replace community health councils with a new citizen voice body across health and social care, and there will not be a new citizen voice body that comes into place unless and until it is ready to do so, and at that point the CHCs will go and be replaced. We're not going to have a hiatus where there are several years of no citizen voice body existing within the health field.

And, as we move forward with that body, it's important to recognise where CHCs are now. Lots of comments have been made about the independence being lost, but actually, if you look at independence now, one of the problems we have is that community health councils are hosted by Powys Teaching Health Board. They're hosted by an NHS organisation. They can't employ people directly themselves; they're employees, technically, of Powys Teaching Health Board and that causes significant problems. They can't have their own contracts in their own name, because of their arrangements. If we don't take them out and create them as a separate body, as this Bill proposes to do, we will not be able to resolve that issue. And equally, I currently, as a Minister, appoint half of the members to community health councils. I'm directly appointing half of them. That in itself doesn't make sense. We're looking to have a proper organisation, where there'll be a public appointments process for the board, and they will then determine who they employ and how they set themselves up on a local and a regional basis. That will be a process properly overseen by the public appointments commissioner, in exactly the same way that we have appointments for the chair of the board of community health councils now. Not someone that I've ever met at any point in my life before, but someone who has come through as the person who came out on top of that recruitment process. That's what we expect to see in the future for the new citizen voice body.

And in terms of our ability to make sure that there won't be any loss of boots on the ground either, there'll be a deliberate conversation about how we make sure we don't lose what CHCs currently do and the value that is placed on them, particularly in advocacy and in complaints, but in understanding how their role will be expanded across our health and social care sector fields. So, there won't be a loss of staff, a loss of resources; there are more resources going into the new body and, actually, the new body compares very well with alternative bodies across the UK on funding per head.

And I do believe that if people engage openly with what we're trying to do, then they'll see that there is honesty when I set out the policy intent about what we are trying to do to resolve the issues that we currently have, and that must mean reform, because nobody in the Green Paper or the White Paper process made a serious argument that no change was the answer. And I do hope that Members, when we go through scrutiny, will take some more comfort from the concerns that I recognise people generally do have about the new citizen voice body. 

I'm grateful to the Minister for his statement and for the documents that he's made available to us. Our party will not be able to support the legislation as it stands, but we do appreciate some of the principles behind it, and will look through the scrutiny process to strengthen it where we can because that would of course be our preference, rather than to oppose. 

A brief comment to begin with with regard to a couple of aspects that we can clearly support. The expansion of the patient voice body to cover care as well as health makes a great deal of sense to us; of course, it begs the question as to why one can't give that to the regional community health councils, but I'll come back to that in a moment. And it clearly makes absolute sense that the Minister should be able to appoint the vice-chairs of the trusts in the same way as he appoints the vice-chairs of the local health boards. That could, as the Minister said, help to improve scrutiny. 

If I can turn now, acting Presiding Officer, to our concerns, I'll begin with the issue of legislating for quality. This has always struck me as slightly odd, in that you would assume that we would not have any public services in Wales where we were not intending that the services that were to be provided were of the highest possible quality. And we wouldn't on these benches be, in principle, opposed to that legislation, but in my view legislation has to have teeth. So, I'd like to ask the Minister today: will this legislation for quality introduce a system where there are consequences for individual managers when the failure to deliver quality occurs?

He is, of course, right when he says in his statement that with any organisation the size of the national health service, occasionally things will go wrong. We know that when things go wrong, doctors and nurses can be held accountable and, indeed, dismissed if they fail to deliver the quality of service and the safety of service that their patients have a right to expect. So, will this legislation give more teeth to the Minister to deal with managers when they fail to deliver? We still believe on this side of the house that we need a register for national health service managers, and that there needs to be a way to strike them off just as we can strike off doctors and nurses if they fail to perform. So, I'd be interested to hear from the Minister today whether there is potential capacity within this legislation around legislating for quality to ensure that that individual accountability is introduced.

To turn now to the citizen voice body, I just want to, if the acting Presiding Officer will indulge me for a moment, quote from a patients group, commenting on this legislation.

'Disbanding the community health councils flies in the face of logic. In the case of Tawel Fan, the community health councils were often the only support source of independent help and support—a role they undertook without fear or favour. Taking away the right to make unannounced visits really means removing impartial scrutiny.'

Now, wherever we go with this legislation, I hope that the Minister today will reconsider that clause that would take away the right to make unannounced visits. Whether it is a national body, whether we continue with more local community health councils, it is absolutely essential that those who are responsible for raising the patient voice can turn up at the very point when nobody wants them to. Otherwise, they do risk becoming pointless, and I hope the Minister will give consideration, as the legislation goes through, to changing that.

The Minister will understand, I'm sure, the concerns that people are expressing that this new national body would become remote from the communities that it served. I don't think that's inevitable; I think there may be ways in which that could be addressed, but I wonder if the Minister can tell us today: does he appreciate that that is a meaningful concern, and what consideration has he given already to how that could be addressed? It will, of course, be true, he said in his response to Angela Burns, that there will still be boots on the ground, but the generals directing those boots will be a very, very long way away from the front line if it is a national body. And we will take some convincing that this is the right way to proceed.

The Minister referred in his response to Angela Burns to the appointment process, and I wonder if he can give us further reassurance as to how that will be not only independent but perceived to be independent. At the moment, of course, the Minister appoints half the members directly, but local authorities have an input, third sector organisations have an input, and that means that people have some reassurance that the current community health councils are independent. Nobody, of course, is saying that they're perfect. There are issues around, for example, having enough capacity to be able to employ the best quality legal advice. We believe that that could be addressed by sharing services rather than by creating one new body, but I hope the Minister will acknowledge today that those concerns about independence are genuine and that he will look to address those through the process of the Bill.

I'll turn briefly to Healthcare Inspectorate Wales. I've heard what he said to Angela Burns. We do welcome the work considering giving a different legislative underpinning to Healthcare Inspectorate Wales, but can the Minister tell us today a little bit about what the timescale is for that work? Because it is clear—and we'll set aside for now the issues about resourcing, though those are important, but it is clear that there is a need for Healthcare Inspectorate Wales to be more clearly independent and to be legislatively stronger. I wonder if the Minister can tell us how long he thinks it will take for that piece of work he mentions in his statement to conclude.

Finally, to turn to the duty of candour, now, again, nobody would dispute that that will be a step forward and that that will be an improvement, but I would submit, acting Presiding Officer, that just placing that responsibility on bodies is not sufficient. The Minister in his statement refers to the situation in Cwm Taf. Well, to place on that body a duty of candour would spectacularly be shutting the stable door after the horse has long bolted. We know that, in that situation, either the management of Cwm Taf did not know what was going on, in which case they were incompetent, or they did know and chose not to publish it, in which case they were venal and corrupt. In either case, I cannot see how placing a legal duty of candour upon them would make the blindest bit of difference as to whether they operate properly or not. There are many other things that need to be done. We believe that there is a need to place a duty of candour on staff, to empower whistleblowers. If they have a legal duty and they can say to their manager, 'I have to report what I have seen because I have a legal duty of candour', that could support the legal duty of candour on the health bodies, which we wouldn't disagree with but which we don't feel is sufficient.

To conclude my comments, acting Presiding Officer—I can see that you're looking at me, and probably quite rightly—the intention behind this legislation is clearly good, but as one of my school teachers used to say to me when I was young, 'The road to hell can be paved with good intentions.' We will need to scrutinise this in great detail. And the Minister has already said, and I'm grateful to him for this, that he will welcome that scrutiny. As things stand, there are weaknesses around the duty of candour, I don't know quite what we're going to achieve with legislating for quality if we don't do the other things we need to do, and I'm far from convinced that one national body should take the place of community health councils, which, undoubtedly, do need to be strengthened.

Again, thank you for the comments and questions. I won't be able to set out the answer you've asked for today on future legislation for HIW and the timescale, because I'm not in a position to announce the Government's future legislative programme, but the work is ongoing to make sure we have a firmer footing—some of that we don't need primary legislation for as well. So, I'm looking to make best use of the powers that we already have, which is part of our challenge, and I won't get drawn too far into talking about the way that Brexit has affected our ability as a Government to do a range of other things, but resources are deliberately being drawn into the legislation required to get ready for a potential 'no deal' Brexit, and you'll see more of that work happening in the run-up to October. I have spent many, many hours sat down at a desk looking at statutory instruments that have to be ready and prepared, and that is time that our drafters, our legal services, are not spending on delivering other areas of important work, and it's the time of Ministers that is taken up doing that. When I say many hours, I mean many days—many, many days of time—and there is no way of avoiding that. It is the reality that the most significant growth area in the civil service over the last year or two has been our lawyers, and I don't think that is the right priority, and I say that as a lawyer in recovery.

I'll deal with your points about quality and candour, and then I'll try to deal with the points you made about the citizen voice body. On the duty of quality, I think that when you look at the detail that's in the legislation, you will see a deliberate reframing to make it a more all-encompassing duty, because with the duties of quality and candour we're seeking to effect some cultural change. There are some harder points in there about reporting, for example, about, for example, health bodies needing to make an annual report—so to replace a current quality statement with a more expanded one, to expand the range of health bodies with the duty to make that report, and, equally, for Welsh Ministers. So, Welsh Ministers will have to lay before the Assembly every year a report on the duty of quality to demonstrate how to then factor that into Cabinet decisions and whether there's been any change in outcomes as a result of that as well. So, I think we'll have a more rounded conversation to make sure it's properly driven into our planning process, not just our quality-assurance and quality-improvement programmes as well. And this does come from updating the advice we had around the parliamentary review, with the Organisation for Economic Co-operation and Development review as well, to actually doing what we currently understand is the right thing to do, and I hope that, as we go through the scrutiny process, the Member and others will look at what's being proposed and the evidence around it too.

On your point about the duty of candour—again, significant support in the Green Paper and White Paper consultations, and, again, this is about driving some cultural change to have a duty on organisations that complements the professional duties that many of our staff have. Because, actually, we found that if you look at where healthcare has gone wrong, and there's a cultural, systemic challenge in it, it's often because our professional staff have made reports, raised concerns, and they haven't been acted on. And they haven't been acted on at an organisational level, and that's the challenge that we are actually seeing in a significant part of what's happened in the former Cwm Taf area. Now, the requirement to have a duty of candour in an organisation should reinforce the seriousness of the concerns that are made and the duty to respond and deal with them, and, equally, it should definitely have an impact at the head of an organisation, around the boards, as well, themselves. When they have to run through the duty of candour to understand, again in an annual report, how and when that's been engaged, it will rehighlight the number of areas where that should have taken place. And this is part of a cultural change that we're actually seeking to introduce and actually see the citizen voice body as part of that cultural change as well. Knowing that there is both a duty of quality and candour I think should help them in their work to make sure they understand what is happening in each of our organisations and to make sure they are properly representing and advocating for the voice of the citizen.

I'll come back now to the concerns about how independent, really, the citizen voice body will be. Well, as I say, it will be a board, through a proper public appointments process, overseen by the Commissioner for Public Appointments, and that will then have responsibility for the whole organisation across the country, including their local and regional structures. Rather than the Government setting out in a prescriptive manner, 'Here is the structure you must have', it will have to set that out. It will have duties to set out in its annual work plan how it proposes to actually undertake its duties. It will then actually provide an annual report and then a plan for the year ahead as well. So, there will be real clarity and scrutiny of the ability to scrutinise that body to see where we've undertaken this action, how it meets its mission across the country, rather than a Government Minister in the legislation prescribing the organisational structure that it must have. But I would certainly expect that body to have a proper local and regional locus as well. But it's a matter for it to determine.

And in terms of visits—look, this is a challenge about the line between a citizen voice body and where the inspectorate undertakes proper inspections, but the visits, which we understand that community health councils value and how those are properly undertaken—. And I do expect to be able to deliver guidance on that to set out powers and functions, but part of this is—as we expect to deliver a new system, as we expect to have a more integrated approach to health and social care, much of the work that we observe will be in people's homes. Because there can't be a straightforward power to demand access to wherever care is taking place, because if I'm sat in my living room, whether it's health or social care, a third party should not be able to say, 'I require entry to your home', whether that home is a terraced house or whether that home is a residential care home. So, there is a challenge about making sure that we have duties and responsibilities that recognise how care is being delivered. I want to find an answer to that, and I will be genuinely interested in the comments that Members have to make and the evidence given in Stage 1, to think about how we make sure and inform a useful way to make sure that the duty exists and to make sure that CHCs and the new citizen voice body can undertake their function and can support the citizen to make sure the citizen voice is genuinely heard and respected.

Thank you for your statement, Minister, as well as your written statement accompanying the Bill released yesterday. I must admit, 24 hours was not a long time to absorb the explanatory memorandum, but I have sufficient detail to get the gist of the debate.

Minister, as I've said to you in the past, I accept that everything wasn't rosy with the community health councils, however, I feel there needs to be reform and not wholesale annihilation. Whilst some community health councils were not working as intended, other, particularly in north Wales, community health councils truly were the patients' champion. And I accept that not every health council operated like this, often just acting as a rubber stamp for the local health board decisions, but this was a capacity and independence issue.

With some structural changes and reform into a national body with regional committees, we could have strengthened the patient's voice. And this is the object of the exercise, isn't it? Improving the patient's voice and enhancing it. Instead, we have the Health and Social Care (Quality and Engagement) (Wales) Bill that stifles the patient's voice.

Minister, can you explain why you removed the ability for the new citizen voice body to make inspection visits to hospital wards and to challenge service changes? This new body will only be as strong as the people serving on it. Minister, your EM to the Bill talks about encouraging a more diverse volunteer base. So, what processes will you put in place to ensure that these volunteers receive adequate training to enable them to challenge authority, to stand up as a strong, truly independent and politically neutral voice for patients? In that vein, I note the inclusion of vice-chairs for hospital trusts. What steps are you taking to ensure that these vice-chairs are clinical rather than political appointments?

Although I have serious concerns with much of this Bill, I do welcome the duty of candour; it's long overdue. It has been around five years since the Evans review called for a no-blame culture. However, as the NHS Confederation points out, more clarity is needed on what this duty actually means and how it will fit in with existing policies. What role will Health Education and Improvement Wales and Social Care Wales play in developing the duty and rolling out training to all staff?

Thank you once again, Minister. I look forward to the detailed scrutiny. I will work with Members across this Chamber to improve this Bill. Diolch yn fawr.

On your last point, there will of course be a need for training across the services and the system to make sure that people are used to the new system we're looking to introduce, and to be properly ready for it to deliver the benefit we want for both staff and people.

On your point about vice-chairs, I thought I heard you say that you wanted assurance that vice-chairs won't be political appointments but will be clinical appointments. Vice-chairs are not political appointments; they go through a proper public appointments process already, and that will be the same for NHS trust vice-chairs. And they are not clinical appointments either; there's a governance and leadership role that vice-chairs undertake, and we're looking to regularise that with health boards, as opposed to adding additional responsibilities on to current trust vice-chairs. That isn't a satisfactory way to move forward and, actually, there's been widespread support for wanting to do that.

On your point about service change: community health councils themselves and the national board of community health councils didn't argue for the retention of a power to refer in service change proposals. They're actually interested in the point about continuous engagement, to make sure this isn't suddenly something that is sprung on people with a few weeks' notice, but there is much deeper and broader engagement, through time, as proposals are developed. Because our health service and our social care system can't stand still; there has to be a constant evolution and reform that must take place. I'm expecting to revise the guidance on the service change, and I would still expect consultation and engagement with the new citizen voice body around service change proposals, and I hope that in revising that guidance we can reiterate that and make that clear, and I expect that I'll be asked a similar question through committee scrutiny, so I'll be happy to reiterate that broader point.

And just to go back again—the new citizen voice body is not going to be an inspectorate. Community health councils aren't looking to be an alternative to the inspectorate function. It's how we make sure that the voice of the citizen is properly given a platform, and how people are given support as part of that in terms of advocacy across our health and social care system, but it is more than advocacy. And in the Bill, you'll see duties where the citizen voice body requests information from a health or social care provider, then a reasonable request must be responded to by whoever the provider is across social care or health. So, there are powers in the Bill to ensure that the new body can undertake its functions, because I am genuinely looking at reform not annihilation.

I really do hope, as we go through this Bill, that Members, again, will look at what is being proposed and not simply default into, 'This must be a bad thing, and let's fight it tooth and nail', because, actually, we can't simply extend out the powers of community health councils. We do need to have a proper body across health and social care. We should take the opportunity to make sure it has a proper independent footing to allow it to do its job.

But I would gently say to the Member that in describing the current activities of community health councils in different parts of Wales, I don't know of a single one of them that would be happy to be described as a rubber stamp for the local health board. There are different relationships, and when they come to give evidence, I'd ask the Member to think again about—I think I understand some of the point she's trying to make—the manner in which that is actually done.

Finally, Joyce Watson.

Diolch, acting Chair. Anyway, I'm really pleased and I welcome seeing this Bill coming forward. I like the idea of the emphasis being on quality and candour, and broadening the definitions that an all-Wales citizen voice body will be able to work across. I want to also make it very clear that the community health councils have done remarkable work, and they've done it to the best of their ability in most cases, and I, for one, have valued their work and their advice and guidance in the past. I just wanted to put that on the record, because I'm sure that others feel the same.

I think it's right that we look at proactive planning and safe, effective and person-centred services going forward, but I think what really is necessary, and it's being delivered here, is the joining up of health and social care services, and underpinning that structure—as well as being national, it's regional and local level. Because one of the weaknesses that have been identified and talked about here already today has been that weakness in the social care sector, where CHCs clearly couldn't go in.

What I'm hoping will come out here is this clear separation of who is the inspectorate and who is the body that is monitoring some progress, and I'm sure all these details will come out as we go further through examining these proposals. I think the problem that we have at the moment, if we're moving back to candour—very often, litigation gets in the way of candour at the moment, and that is fairly obvious. That can't be a good thing in every case, so I'm hoping that, somehow, we can move forward into, perhaps, a less cautious response because of the threat of litigation and an open and clear determination in the way that I have just described—that we get safe, effective and person-centred improvement in services. Because there is no doubt that—and I'm old enough to remember—when you would have a little bit more candour because you didn't have the ultimate threat of litigation—. I think that if we can move back to that, we could make some progress, perhaps, in some cases, a little bit quicker, and that is in both the social care now, which it's expanding, and the health sectors. So, I look forward, like many others here, to seeing the progress of this coming forward, and, if it is the case, the improvements—if they are needed—in those discussions that we will have, not just us here amongst each other, but with those people that we're hoping these improvements will make the difference to.

Thank you for the questions and comments, and I think it's important—it's the point you were making, Joyce Watson, about making sure this is genuinely across health and social care. And it's interesting that we've worked together with the WLGA and voices across local government about the proposal, including the new citizen voice body, where, of course, there are elected representatives who do take up matters within local government for their constituents, and understanding how they'll work alongside each other in genuinely listening to and engaging with the voice of the citizen. But the duties imposed to supply information to the new citizen voice body, as I say, extend across health and local government. So, we're genuinely and deliberately drawing together the two sectors in the way that we're drawing together care across those two sectors as well.

It's worth also pointing out that the national board of the community health council have been broadly positive about the Bill that we're bringing. So, perhaps some members in this room who have been more critical should look at the way in which we have genuinely worked in advance of the statement, the way in which there will be conversations that are ongoing between officials in my department and the board of the community health council to make sure we do get the legislation right to meet the shared purpose we have, and that does include clarity between the role of inspectorates and the role of the citizen voice body. I don't think there is a desire within the community health council movement to have that sort of deliberate fuzzy overlap between inspectorates and community health councils. There's an opportunity to get that right not just within the legislation but within the guidance and what will understandably be built on in terms of the memorandum of understanding that already exists between community health councils and our inspectorates now.

But I think it's an important point that Joyce Watson made about the impact between litigation and the duty of candour, and the engagement of the duty of candour does not equal an admission of negligence. It's an acknowledgement that there is a need to have an open conversation with the citizen about what has happened in healthcare, and more than minimal harm can be caused in the normal risks that we all know take place within the delivery of health and care— but to be open about the fact that something has happened as opposed to saying, 'I can't talk to you because I'm worried that you'll go to a lawyer.' That's part of the challenge we have in a more closed culture that is more defensive. This is deliberately part of engagement to have a much more open culture that's focused on improvements, so candour and quality have to be seen together, and I hope that, as Members go through scrutiny, they'll see that it's not just an honest attempt, but, broadly, we've got the approach in the right place to deliver that in reality.

Thank you very much, Minister and Members.