Item 8 on the agenda is a debate on Stage 4 of the National Health Service (Indemnities) (Wales) Bill. I have accepted a request from the Minister for Finance and Trefnydd to move immediately to Stage 4 proceedings, in accordance with Standing Order 26.48. So, I call on the Minister for Health and Social Services to move the motion. Vaughan Gething.

Motion

To propose that the National Assembly for Wales in accordance with Standing Order 26.48, approves the National Health Service (Indemnities) (Wales) Bill.

Motion moved.

Thank you, Deputy Presiding Officer. I'm happy to move the motion before the Assembly today for Stage 4 of the National Health Service (Indemnities) (Wales) Bill that I laid on 14 October 2019. Since the Bill was laid, it has progressed successfully through stages in the Senedd's legislation process, albeit on a truncated timetable, we have discussed both at committee and in here. I'm most grateful to Business Committee for agreeing to this, and to the Llywydd for agreeing for Stage 4 to proceed immediately from Stage 3. I want to thank the Chairs, members and the staff of the Finance Committee, Constitutional and Legislative Affairs Committee, and of course the Health, Social Care and Sport Committee for their consideration, scrutiny and reports regarding the Bill and the supporting explanatory memoranda and regulatory impact assessment. I'm grateful to all of our stakeholders who've been able to contribute to this legislative process by providing evidence in person and in writing, in particular to the Health, Social Care and Sport Committee. The positive discussions with Members, including the technical briefing sessions offered, together with public evidence sessions from stakeholders, have ensured that the Bill has had real scrutiny despite the expedited nature of the Bill.

I do of course want to thank Members for agreeing that the Bill does not need to change. The Bill is short and discrete. It amends only section 30 of the NHS (Wales) Act 2006 in relation to schemes for meeting losses and liabilities of certain health service bodies, to confer a new power on Welsh Ministers to establish direct indemnity schemes by regulation. This will provide the enabling power to make regulations establishing an existing liabilities scheme to cover the liabilities of GPs for clinical negligence claims that have been reported or incurred but not reported, before 1 April 2019.

The future liabilities scheme has already been established and is operating successfully. It covers claims for clinical negligence arising from 1 April 2019. Both the future liabilities scheme and the existing liabilities scheme are aligned, wherever possible, with the arrangements introduced in England. This will ensure that GPs in Wales are not disadvantaged in comparison to their colleagues in England, that there is no negative impact on GP recruitment and retention and no interruption of the cross-border flow of GPs.

Members will also be aware that I've agreed to provide, from April 2021, an annual report to go to the Health, Social Care and Sport Committee. That report will cover the technical operation of the future liabilities scheme and the existing liabilities scheme. It will be informed by GPs and other key stakeholders, including medical defence organisations, NHS Wales and the NHS Wales shared services partnership, legal and risk services, which operate the future liabilities scheme and will now take over claims handling of the exiting liabilities scheme in line with the ELS arrangements between the Welsh Government and medical defence organisations. The annual report will also outline the ELS arrangements agreed between Welsh Government and medical defence organisations and the way that that the scheme has been operationalised, together with the financial impact of the ELS arrangements, subject to adhering to any confidentiality agreements.

In the Bill's general principles debate on 19 November, all Members present at the time supported and agreed on the need for this Bill. I hope that across the Chamber, we will continue to provide that same unanimous support to take the Bill to full enactment.

As you will be well aware, at times, consensus is difficult to reach in this place. However, the NHS (Indemnities) (Wales) Bill is a piece of legislation that has earned cross-party approval, and I'm grateful to have the opportunity to speak on behalf of the Welsh Conservatives during the final stage of this Bill. I'd like to extend my thanks to the Minister for the work that he and his department undertook on the existing liabilities scheme, and to all the committee members and staff who took the Bill through the legislative stages in record time.

Following my first amendment during Stage 2, concerning the preparation and publishing of a report on the effect of the Act, I received assurances from the Minister for Health and Social Services that the Welsh Government would review reporting mechanisms on both the existing liabilities scheme, i.e. this Bill before us, and the future liabilities scheme. I would like to thank the Minister for confirming that an annual report will be published on both schemes, thereby enabling appropriate scrutiny by the relevant committees and the Assembly as a whole. This commitment was made in the form of a letter that the Minister sent to the Health, Social Care and Sport Committee on 7 January, and indeed has just been reiterated by the Minister. Because it is important that we get this Bill right to ensure that working as a GP in Wales continues to be an attractive and viable career, and that barriers are not created between GPs working in Wales and other parts of the UK.

Turning to the second amendment that we tabled at Stage 2, the amendment raised significant concerns that the Medical Defence Union had not agreed a position with the Welsh Government on the existing liabilities scheme. However, I was content to withdraw that amendment as the Minister again provided assurances. Since that committee stage, I and several other Assembly Members have been alerted to serious concerns raised in the GP future liabilities scheme as set out in the National Health Service (Clinical Negligence Scheme) (Wales) Regulations 2019. Defence organisations and practitioners wish to seek clarity and reassurance from the Welsh Government on the criteria that may be employed to withhold cover under the scheme.

The legal and risk services department currently provides the claims-handling services for GPs, for instance, that take place after 1 April 2019. Defence organisations have raised concerns that legal and risk services do not fully understand the different dynamics at play when supporting individual GPs through a claim, rather than the claims services to NHS trusts. An example of a different dynamic at play is that GPs could face multiple jeopardy. They may have to deal with a complaint, a claim, a disciplinary investigation, a General Medical Council investigation, potentially an inquest and potentially a criminal investigation. There's very real concern that any expression of liability will negate the acceptance of a claim by legal and risk services. This does not sit well with the duty of candour that the Welsh Government is seeking to bring in through the Health and Social Care (Quality and Engagement) (Wales) Bill.

Therefore, Minister, whilst welcoming the positive step this Bill brings to providing reasonable-cost indemnity to primary care providers, may I also take this opportunity to ask that you consider the following questions: looking at outcomes, how is the Welsh Government going to benchmark the future liabilities scheme? What assurances can GPs get that they will be involved in all stages of the claim and be kept fully informed, including the sharing in advance with GPs drafts of all relevant documentation? What clarity can you provide surrounding the use of GP claims data for purposes other than direct claims handling? And the NHS in England, while having a similar position to yours on future liabilities, have assured their GPs that, and I quote, they will not withhold indemnity under the clinical negligence scheme for general practice because a practitioner has taken action to comply with their ethical, professional or statutory obligations. So, what commitment will the Minister make that this assurance will be replicated in Wales?

I absolutely understand that this is going to come under the regulations. It does not detract from the legislation in front of us, which, as I said, has our full support and is very, very welcome to GPs the length and breadth of Wales. But there is an old adage, Minister, that the devil is in the detail and, whilst we are content to support this Bill despite its rapid progress through the legislative process, there is still work to be done to ensure that general practitioners in Wales receive the same level of service and the same standard of defence from the state-backed existing liabilities scheme as they did before. Diolch yn fawr.

I'd like to associate myself with what Angela Burns and the Minister have already said in thanking all of those who have enabled this important piece of work to be done in a timely manner, which was essential. I suppose the Minister would expect me to say that we don't want to get into the habit of legislating in a rush, but there was a particular reason why it made sense to escalate this legislative process and we on the Plaid Cymru benches have been very happy to support that and to support the idea behind this Bill, which is, of course, to make the GP profession in Wales more attractive to young doctors and, indeed, to retain people in their careers. So, we're very happy to support the legislation today. We're very glad that the Llywydd has allowed the debates to be moved on as quickly from Stage 3 to Stage 4, and we're happy to support that. 

When the Medical Defence Union began to raise some concerns with us, I had a bit of a sense that, perhaps, one wouldn't expect turkeys to be supporting the introduction of Christmas and that there may have been a bit of self-interest as an organisation in some of the queries that they were raising, and we did explore that with them in the committee. But I would associate myself with some of the concerns that Angela Burns has raised around the detail that will follow. The Minister may not be able to give us full answers today, and the reporting process that he set out, of course, will be helpful in that regard.

I won't repeat the concerns that Angela Burns has raised about the admission of liability, because one of the strengths of our medical profession is that they are answerable in a number of ways to a number of bodies when things go wrong or when there's an allegation that things have gone wrong. And we wouldn't want to build anything into this system that would make GPs reluctant to participate honestly. On the point about the duty of candour that is going to be introduced in new legislation, it would be ridiculous, I think, if one part of the Welsh Government was telling doctors, 'You cannot admit when something has gone wrong', let's say to an inquest or to the GMC, at the same time as telling them that we expect them to be candid and that we're placing, at least on public bodies—and some of us would like to see that duty of candour placed more broadly on individuals—. So, I'm sure there's no intention for that, but it would be helpful for the Minister to assure us today that he will be able to give those reassurances, similar to the ones that have already been given to the profession in England.

And the final point that I would want to make, Dirprwy Lywydd, is with regard to the nature of the report. It's extremely positive that the Minister has agreed to report annually in response to the Conservative benches' amendment, but we need to know what we're reporting upon and what we're benchmarking against. The Medical Defence Union have made some suggestions to the committee of some of those things: we might want to look at what the average cost of defending a claim is; we might want to look at the success rate of the claim handling. Now, I'm somewhat ambivalent about that because we wouldn't want to be saying that it's always the right thing for the doctor to be successfully defended, because sometimes the doctor will be at fault and should be found at fault.

But I think it would be helpful—I wouldn't, again, expect the Minister to be able to tell us this today—when the process is in place and the regulations are in place, it would be good for him to share with us what the benchmarks and the report are going to be. He may or may not want to respond to the points made by the Medical Defence Union. To the committee the Minister has generously said he'll be making an annual report too. We can't successfully scrutinise that annual report unless we're clear what's being measured, where we are at the beginning of the process, and what the plan is to improve performance against certain key benchmarks.

So, with that, I would join other speakers, Dirprwy Lywydd, in commending this legislation to the Assembly, thanking again my fellow committee members and members of the other committees who scrutinised this, and all the staff who have so ably, as they always do, supported us in the process.

As Chair of the health committee, obviously, I also rise in support of this NHS indemnities Bill and thank everybody who's been involved in the process thus far. Now, some of the misgivings with the Bill have been well aired both by Helen Mary Jones and by Angela Burns so I won't go down the same path, only to note that how various bits of legislation need thought in how they bed down together. We have the NHS Redress (Wales) Measure 2008, we have the duty of candour, and now we have the NHS indemnity Bill. There has to be some thought as regards how all of those sit together.

And for the record, as I've stated in the health committee deliberations on this Bill, Members perhaps will know that I've been a GP—[Interruption.]—working in a voluntary capacity whenever I'm an AM, but I'm no longer practising and therefore I have no direct personal interest in this NHS indemnities Bill before us today. I was asked for clarification; clarification hopefully provided. The Bill itself is widely welcomed. Diolch yn fawr.

Thank you. Can I now call the Minister for Health and Social Services to reply to the debate? 

Thank you, Deputy Presiding Officer, and thank you to Members for their additional questions and contributions today. I'm delighted to see that, again, the purpose and the point of the Bill still enjoys support across the Chamber.

To deal with the points raised by Helen Mary Jones and Angela Burns, I want to give a proper assurance that, in terms of how to measure success—well, success means more than one thing. It's about the financial underpinning of what's going on, about the cost to the public purse, but it's also about the quality of the service from the person who's providing that professional healthcare service. It's also about what that means for the person that they're seeing, treating and working with as well, so I don't think it's as simple as saying that there is a measure. And to be fair, Helen Mary Jones recognised that in part of her contribution as well.

And I don't see a conflict between the duty of candour that we seek to introduce and the operation of this scheme, because, actually, the duty of candour doesn't change the fact of the reality of liability or otherwise. So, we would still want medical professionals to fully engage with the duty of candour, as indeed their representative bodies want them to as well; there's not been any suggestion that they don't want to do that, or that that should somehow affect the way in which liability decisions are or aren't made. And on that, dealing with the points that Angela Burns raised, no GP in Wales should feel or believe, or have any reasonable cause to believe, that there is going to be a diminution in the quality of service or, indeed, protection, either compared to their colleagues in England or elsewhere. They should draw confidence from the operators of the risk pool and the way that their colleagues in secondary care have been dealt with. This isn't just about protecting NHS trusts, or the fact, as you mentioned, about individuals and their own standing within the profession, the potential for regulatory action, or, indeed, the investigations by law enforcement agents that we've seen. They have all taken place within the context of hospital-based care, and it's part of the confidence that a range of actors have about the choice to be made about who will now go on to operate the scheme, that there is a successful record of understanding the context in which healthcare is delivered, and the different risks and challenges that healthcare professionals face, and in this case in particular, of course, general practitioners.

We'll continue to work with stakeholders, including, of course, the British Medical Association and the Royal College of General Practitioners, not just in their overall support for the Bill or in the draft of regulations, but as we do bring those forward to hopefully be approved and in place. So, I'm happy to give those commitments, to continue to work with stakeholders, and to fully provide all the detail we could and should do to this place for further scrutiny in the future.

Thank you very much. In accordance with Standing Order 26.50C a recorded vote must be taken on Stage 4 motions, and so I defer voting on this motion until voting time. 

Voting deferred until voting time.