Overall, we broadly welcome the proposals in the Bill and believe it represents an important step towards greater transparency and accountability across health and social services in Wales. Therefore, the committee recommends that the Assembly should agree the general principles of the Bill. That’s recommendation 1.

However, we have considered the evidence from stakeholders and made a number of recommendations to the Welsh Government for amendments to the Bill. I hear the words that the Minister has said about that and I would urge the Minister to give his full consideration to these recommendations as the Bill proceeds.

First of all, the duty of quality. The Bill introduces a new broad duty to require Welsh Ministers and NHS bodies to exercise their functions in relation to health with a view to securing improvement in the quality of health services. Quality includes, but is not limited to, the effectiveness of health services; the safety of health services; and the experience of individuals to whom health services are provided.

Many respondents told us that, while they welcome the aim of the Bill and recognise the need to improve quality, there should be clarification and strengthening of the duty of quality, that there was a need to define the quality more explicitly on the face of the Bill, and that there should be provision for sanctions for non-compliance.

As a committee, we are fully supportive of any measures that seek to improve the quality of services provided by the NHS to its patients. To this end, we support the shift in focus, proposed by the Welsh Government via this Bill, to a system-wide way of working that will require Welsh Ministers and NHS bodies to exercise all of their functions with a view to securing improvement in the quality of health services.

We were, therefore, disappointed to hear from stakeholders, particularly NHS bodies, that the Bill was not strong enough in setting out how quality in service provision would be assessed, how an organisation would demonstrate an improved outcome, and how a failure to deliver improvements in service quality would be addressed. These are matters that must be dealt with by the Welsh Government. To this end, we note the Minister’s intention to issue guidance about the duty of quality to support and assist NHS bodies in the implementation of this duty, and that he has provided a draft outline of that guidance. We accept his argument that guidance is the most appropriate vehicle for the level of detail he intends to provide on this matter.

However, we believe that the guidance to accompany the duty of quality provisions in the Bill is central to the success of these provisions and, as such, they should have statutory authority. Currently, there is no provision in the Bill for the Welsh Government to issue guidance specifically on the duty of quality. Again, I hear the Minister’s words today.

We therefore recommend that the Bill be amended to make provision for the issuing of statutory guidance and I welcome what the Minister said relating to the duty of quality. This guidance should clearly set out how the duty of quality in service provision will be assessed and how an organisation would demonstrate an improved outcome. It should also include details of how innovations and improvements designed in one area will be spread and scaled across the whole of Wales. That’s recommendation 2.

We heard strong evidence about the need for a clear link between service quality and the workforce. We support this. In our view, it’s impossible to separate out the issue of quality from the provision of appropriate staffing levels—they are inextricably linked. In order to deliver quality in service provision, we must have the requisite staffing. Therefore, the Bill should be amended to make specific provision for appropriate staffing levels and workforce planning as part of the duty of quality. That’s recommendation 4.

Further, we believe that there is an inextricable link between improving service quality and reducing health inequalities, and that this link must be more clearly provided for on the face of the Bill. That’s recommendation 5.

In relation to sanctions, we heard strong evidence of the need for a clearer indication of how to address failure to deliver service improvements. To this end, we believe there should be clear consequences for non-compliance with the duty of quality, and that this should be provided for on the face of the Bill. Such sanctions should not have a detrimental impact on the financial position of the organisation. We agree with the Minister that the NHS escalation and intervention arrangements are an appropriate mechanism.

I move on now to the duty of candour. We fully support the policy objective of a duty of candour, and the cultural shift towards greater openness and transparency within the health service that should flow from it. When things go wrong in health settings, patients and their families should be able to expect to be dealt with in an open and honest way. Equally important is that organisations have a culture in place that encourages and supports the principle of learning from mistakes and that creates the right conditions for this to happen.

Although the Bill sets out the conditions to be met to trigger the duty of candour, so much of the detail about the practical operation of this will be a matter for regulations and guidance. The regulations will set out the process to be followed once the duty has been triggered. As such, we welcome the commitment from the Minister to hold a public consultation on the regulations and to provide supporting statutory guidance. 

As with the duty of quality, we heard strong evidence of the need for sanctions for non-compliance with the duty of candour. We heard very real concerns from stakeholders about barriers to disclosure and legitimate fears for health service staff about speaking out. It is vital in delivering the sort of cultural change promoted by this Bill that staff have a safe environment to be open and transparent, without fear of recrimination. Whilst we support these actions, we are not fully persuaded that they are sufficient. We believe there is merit in further exploring a support system for staff that is more independent and robust and that enables them to feel safe in raising concerns and whistleblowing.

In relation to the citizen voice body, there are a number of challenges with the existing statutory framework. As such, reform is needed in this area and therefore we support the proposal to replace the community health councils with a new citizen voice body that will cover both health and social services. However, we must acknowledge the invaluable role that community health councils have played over the past 45 years in reflecting the views and representing the interests of their local communities in the delivery of health services in Wales. We must not lose the strengths of the CHCs, including their ability to represent the voice of local people, in any new structure, but we must built upon and develop them. A number of witnesses suggested that the appointment of members of the citizen voice body should be entirely independent of the Welsh Government. As a committee, we agree with that.  

We also heard concerns about the ability of the citizen voice body to undertake announced and unannounced visits, and we support that. This has been a very valuable and inexpensive way of checking on service quality and provision. We recognise that there are issues around access where people are receiving services at home, especially where this is in a residential care setting. However, we are not proposing unfettered access to people’s private rooms, rather reasonable and proportionate checks should be possible to do. 

Drawing to a close, and thank you for your patience, even though we agree that it would be unlikely that Welsh Ministers would ignore the representations of the citizen voice body, establishing the right to respond in legislation would ensure that the body has sufficient powers so that the public can be confident that it can make a difference. In that, we recommend that it should be included in the Bill. 

There are a number of other recommendations and comments that I would like to make but, of course, time is against me. To conclude, I hear what the Minister has said today. There are a number of amendments necessary to this Bill. I have listened to what the Minister has said, that he is to introduce certain amendments and I would suggest that he should listen to all the remarks made this afternoon. I welcome the Minister's intention to bring forward some amendments, but we do need amendments that do respond to the health committee's report to ensure that this is a Bill that is fit for purpose. Thank you very much.