3. Statement by the Minister for Health and Social Services: The Health and Social Care (Quality and Engagement) (Wales) Bill

Part of the debate – in the Senedd at 3:58 pm on 18 June 2019.

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Photo of Vaughan Gething Vaughan Gething Labour 3:58, 18 June 2019

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.