Part of the debate – in the Senedd at 3:45 pm on 18 June 2019.
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.