Item 6 is the debate on the general principles of the National Health Service (Indemnities) (Wales) Bill, and I call on the Minister for Health and Social Services to move that motion—Vaughan Gething.

Motion NDM7189 Vaughan Gething

To propose that the National Assembly for Wales in accordance with Standing Order 26.11:

Agrees to the general principles of the National Health Service (Indemnities) (Wales) Bill.

Motion moved.

Thank you, Deputy Presiding Officer. On 14 November I laid the National Health Service (Indemnities) (Wales) Bill, together with the necessary supporting documents before this Assembly. The Bill amends section 30 of the National Health Service Wales Act 2006 in relation to schemes to meeting losses and liabilities of certain health service bodies. It will confer a new power on the Welsh Ministers to establish direct indemnity schemes. This will provide the enabling power to make regulation to establish an existing liability scheme to cover the liabilities of general practitioners for clinical negligence claims that have been reported, or incurred but not reported, prior to 1 April 2019.

The future liabilities scheme that covers claims arising from 1 April 2019, together with the existing liabilities scheme, will align with the arrangements being put in place for GPs in England. It would ensure that GPs in Wales are not treated less favourably than those in England, and that there is no negative impact on GP recruitment, retention, and no interruption of the cross-border flow of GPs.

The draft Bill was scrutinised by the Health, Social Care and Sport Committee, the Finance Committee, and, of course, the Constitutional and Legislative Affairs Committee. As part of that scrutiny, key stakeholders, including the three medical defence organisations, were invited to give evidence, and I'd like to thank the committees for their work within what was unavoidably a truncated timetable.

I am pleased that the Health, Social Care and Sport Committee supports the Bill and has recommended that the Assembly agrees the general principles today. The scrutiny committees have, however, requested reassurance or clarity on a number of points. Two of the medical defence organisations questioned whether GPs will continue to receive a holistic service from a state-backed provider at the same standard that has been provided to date by the medial defence organisations. They also queried whether the state-backed provider will protect the professional standing of GPs to the same extent, which they feel is integral to the credibility of the scheme.

The Llywydd took the Chair.

Now, the future liability scheme is operated by the NHS Wales Shared Services Partnership's legal and risk services—and I'll now refer to them as NHS Wales SSP for brevity. But appointing NHS Wales SSP builds on their existing experience of dealing with NHS Wales's secondary care indemnity and it has the support of GPs across Wales. The future liability scheme has bedded in well since its introduction. NHS Wales SSP is fully committed to providing GPs in Wales with a high-quality service, commensurate with the level of services GPs have become accustomed to when dealing with the three medical defence organisations. And to this end, NHS Wales SSP has held a number of workshops for local health boards and GP practice managers. This proactive and collaborative approach has enabled GPs to better understand the role of NHS Wales SSP and the interface between them and the continuing role of medical defence organisations. NHS Wales SSP recognises the importance of robustly defending claims where appropriate, and of protecting GPs, their staff and reputations. NHS Wales SSP is also committed to resolving any claim for compensation brought by a patient in relation to the clinical care under the NHS as fairly and as quickly as possible. I'm confident that GPs will continue to receive a high-quality holistic service as a result.

I am pleased to say that existing liability scheme arrangements have been agreed with the Medical Protection Society. This arrangement will help to strengthen the sustainability of general medical services, and discussions with Medical and Dental Defence Union of Scotland are at an advanced stage. My commitment in November last year to expand the state-backed indemnity scheme to cover existing liabilities was made subject to the completion of legal and financial due diligence and satisfactory negotiations with the three medical defence organisations. Discussions with the Medical Defence Union have progressed more slowly than with the other two medical defence organisations. They also still have ongoing judicial review proceedings against both the UK Secretary of State for health and the Welsh Ministers. I can, however, assure Assembly Members that the Welsh Government is continuing our discussions with the Medical Defence Union. We're committed to progressing existing liability scheme arrangements as swiftly and as positively as possible, just as we have done and continue to do with the other two medical defence organisations.

I want to turn, now, to the recommendations from the Constitutional and Legislative Affairs Committee. In response to recommendation 1, in May 2018 I indicated that a state-backed future liability scheme for clinical negligence would be introduced from 1 April 2019. In November 2018 I confirmed that the state-backed provision of indemnity will be extended to cover clinical negligence claims arising before 1 April 2019—that is the existing liability scheme. Following consultation with the medical defence organisations, discussions on the commercial terms of the existing liability scheme commenced in January 2019, and those discussions confirmed in March 2019 that an element of the proposed existing liability scheme agreements was a requirement to underpin the scheme with regulations. Having acted swiftly, confirmation was received in July 2019 that the GP indemnity Bill that we're discussing today at Stage 1 would be included in the First Minister's legislative programme for the current Assembly to give Ministers the powers to make those regulations.

In response to recommendation 2, I would point out that the new subsection 10 does not confer any powers on the Welsh Ministers. The purpose of the new subsection 10 is to clarify that nothing in section 30 limits or affects the Welsh Ministers' general powers in any other legislation. And the new subsection 10 makes clear that the amendments made by the Bill do not limit any powers that already exist. I do, however, disagree with recommendation 3 to apply the affirmative procedure to the first regulations made under the new subsection 38 and then to revert to the negative procedure.

The Bill has had a full, albeit short, Stage 1 scrutiny period, with stakeholders able to provide evidence to committee, either in person or in writing. The Bill's regulatory impact assessment identifies what and who is covered by the existing liability scheme regulations, as does the statement of policy intent. The existing power of Welsh Ministers to make regulations indemnifying health bodies under section 30 is already subject to the negative procedure. This power has already been used to establish the future liability scheme by regulations. The Bill, therefore, maintains a status quo already set by the National Health Service (Wales) Act 2006 for regulations made pursuant to section 30.

In relation to the recommendations made by Finance Committee, I accept recommendation 1. Once all of the ELS arrangements have been agreed, the information will be disclosed, in accordance with commercial confidentiality and audit and reporting requirements. I also accept recommendation 2. The cost of NHS Wales Shared Services Partnership in relation to overseeing ELS claims from April 2021 will not be greater than the cost of MDO-managed claims. The regulatory impact assessment will be amended to reflect this. I welcome Members' comments and I hope for continued support for this necessary Bill.

I now call on the Chair of the Health, Social Care and Sport Committee, Dai Lloyd.

Thank you, Llywydd. At the outset here I should say, as I've already said in the past on a number of occasions, that as a GP I have in the past paid indemnities, but I have no direct interest in this Bill before us today.

Now the Health, Social Care and Sport Committee considered the Bill in its meeting of 23 October of this year. And as part of this, we heard evidence from the Minister, the Medical Defence Union, and the Medical and Dental Defence Union of Scotland. We had no further opportunities to take oral evidence because the timetable for scrutinising the Bill had been curtailed. This timetable also limited the opportunities available to the committee to invite and consider written evidence.

I think it's worth putting on record the committee’s view that the use of a curtailed procedure for legislation does not allow for robust examination of the evidence, not least because it limits the opportunities for meaningful engagement with those affected by the Bill. I hope the Minister will take note of that.  

I now wish to move on to consider the Bill itself. Arrangements are in progress in England to transfer historic clinical negligence liabilities for GPs from private indemnity providers to the state, as we've already heard. As a committee, we felt it was important to ensure that GPs practising in Wales would not be disadvantaged compared to their colleagues in England as a result of this policy decision. We were satisfied that the Bill was necessary in order to guard against this, and for this reason, the committee recommended that the Assembly agrees the general principles of this Bill.

However, we were keen to ensure that any state-backed scheme would not provide less protection or support to GPs than they currently enjoy as part of their membership of a private indemnity provider. We heard from the medical defence organisations that they defend robustly the professional standing of any doctor concerned in a negligence claim, and that they also provide additional support to that doctor during the course of the claim.

We recommended that the Minister gives a commitment today that this level of protection and support will continue to be provided to GPs under any future state-backed scheme, and I do welcome the comments already made by the Minister on the importance of the exact level of commitment required in the future, compared to what medics have enjoyed in the past.

In turning now to the cost of the Bill and asset transfer, as part of our work on the Bill, we considered the costs and liabilities to be assumed by the Welsh Government. The Minister has estimated that the liabilities for the Welsh Government under this Bill will be in the region of £100 million, subject to successful negotiation and agreement with the three medical defence organisations.

We note that the Welsh Government has recently reached agreement on asset transfer with one of the three medical defence organisations—the Medical Protection Society, the MPS—and is close to agreement with one other. But it was very disappointing to hear that there had been no progress with the third organisation, the MDU. In fact, the MDU told us that the Welsh Government had failed to engage in any meaningful discussions with it on this matter.

As a committee, we felt that the effective operation of any state-backed scheme relies on reaching agreement with all three medical defence organisations about the levels of asset transfer. As such, we recommended that the Welsh Government must engage in meaningful discussions with the MDU to reach agreement on asset transfer, and that the level of this transfer must represent a fair and proportionate settlement in terms of indemnifying GPs and delivering value for money. I again listened to the comments made by the Minister on this point and I welcome any progress in discussion with the MDU, and I do urge the Minister to have those discussions in a meaningful manner and to reach agreement with the MDU, MDDUS and MPS as the three main organisations that defend doctors.

In terms of the broader points on wider law reform, briefly, Llywydd, the committee heard evidence of the need for wider reform to the tort laws in place in England and Wales. As in England, the Minister, through this Bill, is attempting to mitigate the impact of the rising costs of clinical negligence and thereby deal with some of the issues around the recruitment and retention of GPs. However, the Bill does not address the root causes of rising negligence costs and the associated pressures on NHS finances. There are a number of factors, such as why use the cost of private treatment in the courts as a basis for compensation to a patient? Does it make sense for the NHS to have an opportunity to provide redress for what went wrong in the first place, as some of our witnesses mentioned? As a committee, we believe that there are benefits to an examination of the law in this area, and this is something the Welsh Government should pursue with its UK counterparts. I look forward to hearing the Minister's response. Thank you.

Next, the Chair of the Finance Committee, Llyr Gruffydd.

Thank you very much, Llywydd. I'm pleased to contribute to this debate to outline the two recommendations that the Finance Committee has made. 

The committee is broadly content with the estimated cost of the Bill of £30,000, which includes, of course, external legal support to implement the Bill using the new direct indemnity scheme regulation-making powers. We accept the Minister’s assurance that external legal support was used as a matter of expediency and that costs would have been similar if the work was undertaken by legal advisers within the Welsh Government.

The committee acknowledges this Bill will bring legislation in Wales in line with England as far as possible to provide a state-backed scheme providing clinical negligence indemnity cover for providers of GP services. We are pleased to hear that this will ensure GPs in Wales are not at a disadvantage and will help to ensure therefore that GP recruitment and cross-border activity will not be adversely affected by different schemes operating in England and in Wales. As part of the state-backed scheme, the Welsh Government will assume responsibility for historical clinical negligence claims that had been reported, or incurred but not reported, prior to 1 April 2019.

During evidence with the Minister, we heard the existing liabilities scheme was subject to the completion of legal and financial due diligence and satisfactory negotiations with the medical defence organisations, which are ongoing. I am pleased to hear the announcement that an agreement has been reached with the Medical Protection Society. I would be grateful if the Minister would keep the Assembly updated when negotiations have concluded with the other two medical defence organisations. 

The committee heard the current estimate of liabilities that would be assumed by Welsh Government, were an existing liabilities scheme agreement to be signed with each medical defence organisation, would be in the region of £100 million before any transfer of assets. Now, the Minister told us this figure would reduce once the transfer of assets is factored in. However, the value of the transfer is currently restricted due to its commercial sensitivity and non-disclosure agreements between the Welsh Government and the medical defence organisations. Whilst we appreciate the Minister isn't currently able to provide this information, we believe it should be made available when feasible and we've recommended that the total value of the asset transfer is identified in the Welsh Government’s consolidated accounts that are laid before the Assembly.

In regard to managing the existing liabilities scheme, handling of claims up until April 2021 will be undertaken by the participating medical defence organisation, and after April 2021 by the NHS Wales Shared Services Partnership Legal and Risk Services. We heard that the Welsh Government believes the NHS Wales Shared Services Partnership Legal and Risk Services can take on management of existing liability claims at no additional cost. The committee recommends that the Welsh Government revises the regulatory impact to reflect that it doesn't anticipate any additional costs for the NHS Wales Shared Services Partnership when it begins managing the existing liabilities scheme from April 2021.

As I said, the committee only had two recommendations, and I'm grateful for the opportunity to express those to the Chamber this afternoon.

The Chair of the Constitutional and Legislative Affairs Committee next—Mick Antoniw.

Diolch, Llywydd. We reported on this Bill on 12 November and made three recommendations. Before discussing those recommendations, I just wish to highlight one broad point. As with our scrutiny of all Bills, the Constitutional and Legislative Affairs Committee considered matters relating to the legislative competence of the Assembly, and this includes compliance with human rights legislation. We have consistently maintained that the Welsh Government should ensure that information relating to legislative competence, which is set out in explanatory memoranda, contains sufficient details to ensure transparency and to enable effective scrutiny of Bills. 

In this report, we have taken the opportunity to reiterate the conclusion we made most recently in our report on the Children (Abolition of Defence of Reasonable Punishment) (Wales) Bill, namely that full explanations of assessments undertaken in relation to human rights are available in explanatory memoranda that accompany Bills laid before this National Assembly. 

As has as already been noted, this Bill has been subject to a curtailed Stage 1 process in the Assembly. Our first recommendation related to this point. The Welsh Government announced the background policy decision for this Bill in May 2018, and the regulations for a future liability scheme were brought forward in March of this year. Therefore, it was not clear to us why the Bill was not brought forward earlier. This would have allowed for more Stage 1 scrutiny and for engagement between stakeholders and committees. For that reason, we ask the Minister to use this debate to clarify the timescales that led to the introduction of the Bill, including confirming the point at which the Minister was aware that primary legislation would be needed. And I note the Minister's comments earlier in clarification on this particular point. 

Moving on to our second recommendation, within the context of the short period of Stage 1 scrutiny, we noted the broad power provided to the Welsh Ministers by section 1(8) of the Bill, which inserted a new subsection (10) into the NHS (Wales) Act 2006. The Minister at the time suggested to us that this provision would help facilitate the prevention of accidental or mistaken impact on the existing powers of Welsh Ministers, and we ask the Minister to use this debate to clarify the rationale behind the power being sought in section 1(8). And I note again the Minister's comments earlier on on this particular matter. 

And then, finally, with regard to the balance between the detail on the face of the Bill and what is left to subordinate legislation, we noted that the Bill provided three powers to the Welsh Ministers to make subordinate legislation. We acknowledge the Minister's explanation regarding the choice to bring forward regulations made under section 1(8) of the Bill using the negative procedure. However, in our view, it is questionable whether it's fair and appropriate to compare the making of regulations that will be bring forward an existing liability scheme to those which brought forward the future liabilities scheme earlier this year. 

Our concerns are based on the fact that this Bill, which provides the primary legislative footing for the regulations, has not been afforded the full opportunity for Stage 1 scrutiny, and nor is it clear at this point who and what will be covered by subsequent regulations. For that reason, our third recommendation was the Bill should be amended so that the affirmative procedure would be applied to the first regulations made under section 1(8) of the Bill, followed by the negative procedure on subsequent occasions. Again, I've noted the comments that the Minister has made on this particular point. Thank you, Llywydd. 

Thank you for bringing forward a statement on the Bill today, Minister. The Welsh Conservatives will be supporting it. I know that it's very much looked forward to by the medical profession—it's a great step forward. I do want to just echo the comments made by the three Chairs who've spoken, as to why we've had to rush this at the last knockings and why it didn't come forward earlier on this year, given that you'd already made that intent and you'd implemented the future liabilities scheme.

In terms of any commentary that I might wish to make on the Bill, I think I would like to reserve most of my commentary for, 'Have you made enough plans for the money?' I was actually, personally, very shocked during the evidence session to find out that, sometimes, a negligence claim can come forward 20 years after the event. So, it must be extremely difficult. I noted from your additional letter that you sent to the Health, Social Care and Sport Committee that you'd commissioned external financial advisers to undertake the financial due diligence and that you had been liaising with actuaries to try to predict it, and I wonder whether, perhaps, in your response you might just give a little bit more information about how confident you feel that this rough £100 million will be enough. Obviously, if we end up with fewer claims than that, then the Welsh Government's a winner. I do take on board your point that you will make sure that there's a transfer of assets that meets it, but because we don't know whether there could be some dreadful claims lurking out there that we're not going to know about for another five or 10 years, how confident do you feel that you've got the number about right when it comes to planning that future, going forward?

I appreciate you can't give us that much of an update on the discussions with the Medical Defence Union, but, again, they're one of the biggest players, and I think that having them on board is absolutely key. If the Medical Defence Union are sitting in their offices watching this by any chance, I'd like to say to them, 'Please can you come to the table to make this happen?' I say to you, Welsh Government, 'Make it happen', because I do think it's vital for the workforce out there in primary care. It will help with every single thing that can help with the retention of workers in primary care—of GPs. It is absolutely vital, and this is a real tool that might persuade people to stay longer or to defray their expenses if they come back on a pro-tem basis to help out.

I'd be very interested to know whether you think that there's going to be any issues with any cross-border effects because of this, because, obviously, we have a very porous border in some parts of Wales. I am pleased that you've come to an agreement with the Medical Protection Society.

Finally, I would like to reiterate—I think they were comments that Dai Lloyd made—our view at the end of this report about the rising cost of clinical negligence. Every time there's a clinical negligence claim, the NHS has to pay it and it comes out of what we need to do—it comes out of beds, nurses, doctors and primary care. So, I would urge you to constantly give us updates and to, perhaps, once a year come back to just let us know about what you've been able to do to encourage the UK Government and all of the other Governments of the devolved nations to really come together to try to address the root cause of how eye-wateringly expensive some of these medical negligence claims are, because that's where the real difference, long term, will be made. Thank you.

I just want to make a few very brief comments—some of the points that I would otherwise have wished to raise have either already been addressed by the Minister or have been raised by other speakers.

With regard to the committee's recommendation 2, I was pleased to hear what the Minister said with regard to the level of support that will be available to staff—to any GP who finds themselves in a situation where they are being acted against. But, the point was made to us in committee—I think it was by the Medical Defence Union—that when GPs are being acted against, or an accusation is made, it's very directly to them personally, and their situation is somewhat different to a medical professional in a hospital setting.

I'd just like to invite the Minister to reiterate and to commit to there being a similar level of personal support available. The Medical Defence Union told us that it was not only about providing the practical and legal advice, and financial support if necessary, but it was also about, because a GP, potentially, is more isolated, a level of personal support there. I'm hoping that the Minister will be able to reassure us today that that level of personal support won't be lost. 

And also—and, again, the Minister may not be able to say very much about this, but it would be helpful to know if the Minister has got an indicative timescale with regard to the judicial review, or is that something that will be solved if he and his officials are able to come to an agreement with the Medical Defence Union? It would be helpful for us to know how long this is all likely to take, though I do appreciate, Llywydd, that this is not in the Minister's hands necessarily, nor in the hands of his officials.

And, just finally, to say we know we have real problems with GP recruitment and retention in Wales; we also know we're not alone in that. I don't think any of us believe that this measure by itself will change that and transform it overnight, but it is an important step forward. And I hope that GPs and potential GPs will be able to see this as a sign of the political community in Wales wanting to offer them support, and wanting to give them the protection that they need. I'm sure that we can all agree to that in principle across parties. Diolch yn fawr.  

I welcome the introduction of the National Health Service (Indemnities) (Wales) Bill. The fact that indemnity cover for GPs has been skyrocketing, and that this has had an impact on the profession, is why I supported the introduction of the future liability scheme. It's sad that the UK is becoming more litigious, and the explosion of medical negligence claims firms in recent times has undoubtedly contributed to the massive increase in indemnity costs we have seen in recent years.

As the explanatory memorandum to the Bill highlights, there has been around a 7 per cent per annum increase in indemnity costs in recent years. The Minister has previously stated that much of this increase can be attributed to the UK Government's decision to change the personal injury discount rate. However, the UK Government were right to ensure that victims with life-changing injuries receive the right level of compensation in order to cover future loss of earnings and ongoing care costs.

The rising cost of indemnity insurance is impacting our GPs and having a negative effect on recruitment and retention, and I don't think any of us here disagree with the intention of this Bill, which will see the extension of the indemnities scheme to cover existing liabilities. However, it is regrettable that this legislation was not introduced earlier, and, as a result, we have a limited time to scrutinise this Bill.

We have to ensure that this Bill results in an indemnities scheme that is as good as, if not better than, the schemes it is replacing. It is vital that the Welsh scheme provides parity with the English scheme. We must ensure doctors in cross-border areas have equity of cover. One of the big criticisms of the future liability scheme has been the need for a locum register, separate from the medical performers list, in order to provide cover for sessional doctors. I will therefore seek to amend the Bill during its passage through the Assembly to remove the need for a locum register.

It is also regrettable that Welsh Government have decided to use the negative procedure for regulations under the Bill. I will seek to work with other parties to amend the Bill so that regulations require the affirmative procedure.

Our GPs need this Bill or, rather, they need the indemnity scheme that this Bill creates. We have to ensure the existing liability scheme is fit for purpose, and I look forward to working with colleagues to improve the Bill and to ensure that the scheme is in place by April. Diolch yn fawr.

The Minister for Health and Social Services to reply to the debate—Vaughan Gething. 

Thank you to Members for the variety of comments, and for the broad support for the point and purpose of the Bill, although I recognise there are some points of both clarification and reassurance and, indeed, some points about potential amendments that Members have signalled they might make.

I do just want to deal at the outset, though, with the point made in a couple of contributions about whether or not we are a more litigious society or not and, indeed, the cost of making medical negligence claims. Look, I don't think it's necessarily a bad thing that people are more likely to complain now than 20 or 30 years ago. We're less deferential, and I actually think that's an expansion in people's access to justice; I don't think that's a bad thing at all. Part of our challenge, though, is, in terms of the cost of medical negligence claims, we are more aware of the significance of the impact of potential negligence, particularly if it happens, as we've seen at the start of this week, to a young person; there is life-long care involved. And I'm always nervous, when people talk about restricting the cost, about whether that means restricting people's access by restricting the cost recovery, and that then means that, essentially, for some people, you could be saying that, if you can't pay for it yourself, you won't get access to justice, or, indeed, about potentially restricting the overall recovery of costs for an individual who has suffered a form of negligence. And, regardless of what field it is in, I don't think it's the right approach to say that we should restrict the level of justice that people can receive. There are difficult challenges about things for us to do, but, actually, that is more about us improving the care that we provide, the quality within the system and the candour. There's different legislation that's trying to make improvements to the quality of care we provide in every part of the United Kingdom as well as the legislation we're piloting through the Assembly at present. But I think that's the area of focus in terms of how we reduce the cost of medical negligence. I don't think the focus should be on having an artificial restriction on people who have a form of complaint to be adjudicated upon.

I'll just reiterate a couple of points I made in my contribution and thank the scrutiny committee chairs for giving me an opportunity to respond to them both in the early part of the debate, but I think I dealt with the points about timing. I put that on record. It wasn't possible to bring this forward in previous legislative statements; that's why it happened in the most recent one. It's also worth pointing out that, in terms of the scheme of regulations, section 30, as I said, in NHS Wales Act, they're all negative procedure regulations and the future liability scheme has been introduced on that basis too.

In terms of the points about resources and asset transfer, I'm happy to confirm what, again, I said in my opening contribution about the scale of that asset transfer and how and when we'll be able to provide an indication of what that is. So, I'm happy to reiterate the acceptance of the recommendation made by the Finance Committee.

In terms of our experience from the running of the risk pool for secondary care, I think this should give people practicing in primary care some confidence, not just of the financially well-run process that exists, but actually the level of direct care and support provided within that, and I don't think that it would be acceptable for me to say that there should be a bargain basement of that, if you like, individual or pastoral support available. So, I'm happy to say that is not the expectation and GPs themselves have a level of confidence about this more broadly.

It's also worth pointing out that, in terms of the way in which the risk pool is run across NHS Wales at present, it is well-regarded within Wales and, indeed, across our border for the efficiency in which it is run. That should, again, give Members some confidence about the financial judgments that have been made, together with the independent advice that we've sought on that point.

And, in terms of the point about not having an impact on cross-border activity, the point I made at the outset is that we will definitely have an impact on cross-border activity if we don't have regulations in place to provide a similar scheme for general practice in Wales when the English scheme comes into force at the start of April next year. I'm happy to restate my commitment to update Members on progress with medical defence organisations. That's both when I hope I'll be in a position to confirm agreement with the Medical and Dental Defence Union of Scotland. Those are constructive negotiations that are taking place—

Would you take an intervention?

I was going to deal shortly with the Medical Defence Union as well, and then I'll take the intervention. 

The point about the Medical Defence Union's judicial review—they've applied for an oral hearing, as is their right, and that is currently listed to be heard on 17 December. I'm not anticipating a lengthy delay, and it, of course, affects the ability to introduce these regulations in both Wales and England as well, but, as soon as we're in a position to have that resolved and what that means, then I will, of course, update Members, and, as I say, at this point in time, the door very much remains open and my officials are continuing to try and engage with the Medical Defence Union to land what I hope will be an agreement that they can live with as well as us. I'll take the intervention before I finish.

I just wondered if, for the record, it might be worth you just rehearsing what effect you think there might be on the whole scheme if the Medical Defence Union choose not to come forward and what effect that might have on general practitioners. 

Well, there's a point here about the number of people who have taken part in the indemnity arrangements with the Medical Defence Union, a potential hole, and a different level of cover and a different actor for people in primary care, and that would be across England and Wales. I don't think that that differential would be helpful, because there's still something about wanting certainty for the future. I think it would be in everybody's interests for us to be able to agree this across England and Wales. It's worth finishing on this point, and it was a point that was raised earlier: there's broad support in this Chamber because there's broad support across the political spectrum. And we heard earlier, and I'm sure we'll hear on many more occasions, the differences between parties in this place and beyond about the future of the national health service, but on this there is a very constructive relationship between Governments across the UK on trying to get the right outcome for general practice and to provide real certainty for the future. I'm committed to seeing that legislation do just that here in Wales.

The proposal is to agree the motion. Does any Member object? The motion is therefore agreed in accordance with Standing Order 12.36.

Motion agreed in accordance with Standing Order 12.36.