The next item, therefore, is the statement by the Minister for Health and Social Services on the National Health Service (Indemnities) (Wales) Bill. And I call on the Minister to make his statement—Vaughan Gething.

Thank you, Llywydd. Yesterday I laid the National Health Service (Indemnities) (Wales) Bill, together with the explanatory memorandum and regulatory impact assessment, before the National Assembly for Wales. I'm pleased to have this opportunity to make a brief statement about the Bill.

The Bill builds on the general medical practice indemnity scheme that introduced state-backed clinical negligence indemnity cover for providers of general practitioner services in Wales on 1 April this year. This scheme, known as the future liability scheme, covers clinical negligence claims arising from 1 April. The future liability scheme has embedded successfully since its introduction and is supported strongly by GPs across Wales. I made a commitment in November 2018 to expand the state-backed indemnity arrangements to cover the liabilities of GPs for clinical negligence claims that have been reported, or incurred but not reported, before 1 April 2019, subject to the completion of legal and financial due diligence and satisfactory negotiations with the medical defence organisations.

The Deputy Presiding Officer took the Chair.

The draft Bill amends section 30 of the NHS (Wales) Act 2006 in relation to schemes for meeting losses and liabilities of certain health service bodies, by inserting new provisions into section 30, enabling Welsh Ministers to make regulations to establish direct indemnity schemes, whilst also expanding the bodies who may be indemnified by the Welsh Ministers under schemes established pursuant to section 30. These powers will enable Welsh Ministers to make regulations to establish a direct indemnity scheme to indemnify GPs for any historic clinical negligence claims reported, or incurred but not yet reported, prior to 1 April 2019. That is the existing liabilities scheme, or ELS.

The Bill will ensure that GPs in Wales are not treated at a disadvantage relative to their counterparts in England where similar state-backed existing liability scheme arrangements are being introduced. This in turn will help to ensure that there is no negative impact on future GP recruitment and retention. The Bill and the subsequent existing liability scheme regulations will also ensure that Wales and England cross-border activity will not be adversely affected by different schemes operating in England and Wales.

In conclusion, the proposed Bill will: futureproof the powers of the Welsh Ministers for any effects, market shocks and stresses of possible future events relating to clinical negligence cover for providers of primary medical services in Wales; it will strengthen the resilience of general medical services; and it will provide assurance for patients in relation to pre-April 2019 clinical negligence claims for redress. I am pleased to introduce this Bill to the Assembly for scrutiny and look forward to working with the Assembly and its scrutiny committees over the coming months.

Thank you. Janet Finch-Saunders.

Thank you. I am pleased to have the opportunity to respond to this statement on behalf of the Welsh Conservatives group. I'm grateful to have received advanced view of the statement, and I know that my colleague Angela Burns AM was grateful for the technical briefing that you arranged recently. 

Can I start by welcoming the statement? It is an essential Bill and it is important that it has been brought before us today, ahead of a busy couple of weeks, to get the Bill enshrined in law before the new financial year in April. GPs have been crying out for this legislation to be brought forward, and it is essential that Wales is on a similar footing to England to enable us here in Wales to compete on a level playing field when it comes to recruiting and retaining GPs. I would, however, like to pick out a couple of areas of concern that we have and to seek some clarification on a few issues. 

Minister, the statement claims that the implementation of this Bill will cost around £30,000. I would like to understand more about how this figure has been reached and what assurances can be provided that this budget will not be exceeded. Can you provide this reassurance?

Minister, you mention a post-implementation review will be carried out, but this is not detailed in the Bill. This was a political objective for your Government, as set out in the Executive memorandum. At the moment, there does not appear to be any reporting or review function in front of the Assembly, which means the policy objective of monitoring of the operation of the scheme is not set in stone. Can you clarify why this review is not included in this Bill?

Minister, I'm also interested in why you are using negative procedure, given that countless committees have recommended affirmative regulation-making powers. It raises questions about the ability that this Assembly has to scrutinise the Welsh Government proposals effectively. 

My colleague Angela Burns commented during the progression of the minimum price for alcohol Bill that the use of negative procedure could lead to a future Assembly judging you harshly if you do not collect credible, consistent, outcome-focused evidence that would enable proper scrutiny and sound judgment. Can you therefore explain why you have opted to follow the negative procedure route?

And, finally, I do have a concern over the timetabling of this Bill. We do seem to be rushing things. And whilst I accept the urgency to have this Bill receive Royal Assent, to have such a short time frame for evidence to be produced and scrutinised is in fact a worry. Can I receive reassurances that this process will allow a decent amount of time to enable a full and transparent scrutiny process? And why wasn't it brought forward earlier to avoid what is now an unseemly rush? Thank you.

Thank you for the comments and points. There were essentially five points. The first on timing: of course, Business Committee have agreed to the timescale. I think there's going to be enough time for all the relevant stakeholders to get involved. They're pretty well informed of the policy intent, the purpose, and the scheme and the regulations. It's also helpful that it's a pretty short Bill. It's inserting an amendment onto the face of the National Health Service (Wales) Act 2006. So, we're not going to get knee deep into a long, technical, difficult Bill. But I think there will be adequate time for every stakeholder to have their say and for Members to ask questions and have answers. 

In terms of your point about the Bill and the time frame for it, it is important to have the regulations in place to allow the scheme to be in place for the start of April, to maintain continuity with England and make sure that we see cross-border activity being properly undertaken for both sides of the border, as well as making sure that Welsh GPs are not disadvantaged by having a scheme come into effect later than in England. 

In terms of your point about the negative as opposed to positive procedure, this is something we regularly go through with each and every Bill and I'm sure we'll be able to go through it in scrutiny in front of both the Constitutional and Legislative Affairs Committee, who regularly have comments, as indeed do the health committee. But we're talking about something to make changes to regulations that are largely going to be technical in nature, regardless of the impact of them. But I'm more than happy to engage with Members through the scrutiny process.

On that, that is part of the point, of course, of having scrutiny of the Bill. In terms of your point about post-scrutiny on the face of the Bill, I don't think that's appropriate, because we're talking about amending the face of a piece of primary legislation to insert an additional section to give Welsh Ministers regulation-making powers. It would be pretty unusual, on the face of the Bill, to also insert a requirement for post-legislative scrutiny, but I appreciate that Members will want additional assurances and comments made on the record by me to give some reassurance about that post-legislative scrutiny taking place. 

On the point about the costs, I don't really have anything to add to the costs paragraph—paragraph 3.7 of the explanatory memorandum. The £30,000 is simply about the costs in terms of the external legal support required to utilise the new indemnity scheme. And I think that is a fair and accurate assessment of the costs we've arrived at. 

Can I warmly welcome this statement, and also the National Health Service (Indemnities) (Wales) Bill? I'll declare my usual interest as a GP who has been known to pay his medical indemnity for many years, otherwise I wouldn't be allowed to practice being a GP at all.

Now, this Bill brings GPs into line with what has always happened with hospital doctors and hospital consultants, in that the state has always paid their huge medical indemnity fees, and now we're going to be doing the same for GPs—long overdue, many people would say, because medical indemnity insurance at the moment can run up to about £15,000 per year, on a sliding scale, depending on where you work—out-of-hours, A&E, riskier times in the middle of the night. But it's a huge personal cost that obviously has been highlighted in recent years as a reason for GPs deciding not to be GPs, particularly part-time or those towards the end of their careers—actually, it costs them more in medical indemnity than they would actually earn doing a lesser amount of work. So, the rising cost of medical indemnity is what has driven this welcome piece of legislation. 

Just a couple of points: obviously, future liabilities, that part has already kicked in since April this year. What we are passing now is a technical improvement, if you like, of that. And obviously we're scrutinising that in the health committee and in CLAC. It's about existing liabilities—in other words, things that have happened prior to April 2019. And, just as a point of fact, obviously, medical negligence, so called, or claims, can start a very long time ago and only come to surface, or to note—or somebody decides to put in a claim—many years after they've happened. I know of examples of a 20-year gap and more between the actual incident and that incident being complained about. Now, if we're going to say now this existing liability scheme covers everything prior to April 2019, can you just state how you feel that would operate, in fact? Are you going to go back 20 years or so, because I would have that worry then about Welsh Government and how Welsh Government is protecting itself, as it were, from the potentially huge liabilities incurred.

Because there's no getting away—and this is my final point, now—from the fact that there are huge costs involved, not in the actual running of the Bill, obviously, but in the huge legal costs. That's why we have to have medical indemnity insurance in the first place, because there's a very adversarial system at the moment: patients and their families have to prove that a doctor or nurse has been negligent—that's a very complicated situation—as opposed to, in some countries, we just accept the possibility of mistakes and medical mishaps and people have a sliding scale of compensation, called 'no fault' compensation, where you don't have to prove fault, you just get the money a lot sooner than you do in the current adversarial legal system that we go through in this country. So, while welcoming this Bill and obviously taking GPs and putting them on the same level as hospital doctors and consultants who already have Crown immunity, in terms of expanding the thought processes for the future, what consideration also has the Minister given to a system of 'no fault' compensation, as exists in other countries, like New Zealand? Thank you. 

I'll deal with your last point first, and that is: we're trying to resolve issues that exist in the here and now, or will exist from the start of April, with this piece of legislation. I'm happy to have a fuller conversation with him about the significant shift he outlined in 'no fault' compensation. I recall you raising it previously in the Chamber in the past, and I think it is something that we should talk about properly, rather than trying to give a one-off and for-all-time answer now, but it would require a significant shift in culture in the way that we deal with these matters already, not just in Wales but across the UK.

On your point about the costs, of course, the reason why we're doing this is we've recognised for some time that the rising costs of indemnity cover have been a significant deterrent to people entering and remaining within general practice, whether that's, if you like, the regular general practitioner working in a surgery, people who work part-time hours—there's a variety of different reasons why people want to work part-time hours, from people at different points in their career, men and women with caring responsibilities, as well as people who want to come back and reduce their sessions at different points in their careers, and, indeed, out-of-hours as well. We've put moneys into the contract but, actually, we weren't getting to what was going to be sustainable, so that's why we've taken this particular point of view. And it is, you're right—the technical term, I think, is a 'current-based cover', so it's about when something has occurred, and, as long as someone has been a member with proper professional indemnity cover with a participating medical defence organisation, then we will stand behind them. 

In terms of the costs, that comes from—funding will be from an asset transfer negotiation with MDOs and Welsh Government funding, as, obviously, the state stands behind this to give people the assurance that moneys will be paid. I'm sure we'll go through this in more detail as we go through the Bill, but I hope that provides some assurance about the costs, how they're going to be dealt with in terms of the Welsh Government and our assessment of the liabilities, but also to make sure that there is proper cover for GPs and the wider public.

Thank you for your statement, Minister. I welcome the introduction of this Bill and I feel that it is long overdue, as many GPs have been put off following their career path, and this large amount of money for insurance can only be seen as a positive regarding recruitment and retention of GPs. Something had to be done in this area, and this is a very good start towards recruitment and retention. So, ensuring also parity with the NHS in England is essential, and, if we are to improve recruitment and retention, again, of medical practitioners in Wales, this parity is extremely important.

The fact that indemnity cover for GPs has been skyrocketing has had an impact on the profession, which is why I supported the introduction of the future liabilities scheme. It's sad that the UK is becoming more litigious, and the explosion of medical negligence claims firms in recent times has undoubtedly led to the massive increase in indemnity costs.

I support also the extension of the indemnity scheme to cover existing liabilities. Minister, one of the criticisms of the future liabilities scheme has been the need for a locum register, separate from the medical performers list, in order to provide cover for sessional doctors. So, will you consider, Minister, using this Bill to reform the future liabilities scheme and the existing liabilities scheme to remove the need for a separate locum register? Minister, are you working with the NHS in England to ensure doctors in cross-border areas have equity of cover? Finally, Minister, how will the scheme operate in relation to prison doctors, given the many differing arrangements for prison healthcare in Wales?

I look forward to conducting detailed scrutiny of this Bill during its passage through the Assembly, but also working with you to ensure medical practitioners in Wales have affordable indemnity cover. Diolch yn fawr.

Thank you. I'll deal with the three specific questions and then a point about the rise in costs.

On your last point, I'm not sure that's particularly relevant to the Bill in the sense of people working in the prison sector. We have two different schemes; the future liabilities scheme is already in place. This is about existing liabilities and, actually, as I've said in response to Dai Lloyd, as long as someone has a pre-existing membership of a medical defence organisation, then they'll be covered. The purpose of the amendment is the existing liabilities that may have been reported, but not incurred, as I set out in my statement.  

In terms of the point about cross-border activity, again, part of the point and purpose of having this Bill and the shorter scrutiny period that the Business Committee have agreed is to ensure that we have these regulations and the scheme in place. One of the express things it will do is to make sure not just about the comparison between doctors working in general practice in England and in Wales, but also that cross-border flow in activity that goes in both directions—so, make sure that there are comparable schemes. I'm not, though, going to use this Bill to remove the locum register. If Members want to bring forward amendments, they're welcome to do so, but I want to state that is not the policy purpose and intention of the Bill, and I'm just going to be honest that I'm not seeking to do that in this piece of very tightly focused legislation dealing with a specific issue.

I do want to come back to the point about the issue about the rising costs, because the rise in GP indemnity costs came from a number of different factors, but I don't think it's right to say that it's about an explosion in claims. Actually, one of the biggest issues that led to action being taken across the UK was the decision by the Lord Chancellor to change the personal injury discount rate. Now, this really matters because it significantly increased the costs and the challenge about cover, and, actually, the move from 2.5 per cent to a -0.75 per cent discount rate on future losses meant that GP subscription costs could have increased by up to 25 per cent, and that really was a significant driver that meant that the current scheme, which was already under pressure—. When I became the deputy health Minister over five years ago now, for my sins, it was an issue then, at that point in time, about the costs of indemnity cover. The steps we took in putting money into the GP contract enabled some of that to be covered and dealt with, but it was still a pressure. But the change in the discount rate was really the issue that forced us to look at something that is radically different, and that's why we're here now. 

Thank you very much, Minister.