Thank you, Presiding Officer. I formally table the amendments here in my name. I would like to, at the outset, Minister, say that these are by way of probing amendments. You do have the opportunity, by your response, to ensure that we don't have to spend time in voting from 21 to 34. 

These amendments have been retabled by us from Stage 2. They were previously tabled as a mix from Helen Mary Jones and from me, and they are in support of committee recommendation 4, because I think it is necessary to remember the Royal College of Nursing's comments on the Bill at Stage 1, saying that this Bill is an ideal opportunity for the Welsh Government to progress with the principles of the Nurse Staffing Levels (Wales) Act 2016 and to broaden its applicability. It's particularly relevant to section 25D of this Act, which is about making sure that local health boards and NHS trusts may undertake these provisions in order to enable them to comply with their duties under this Act.

Now, surely this chimes with what the Minister also said at Stage 1, when he said that the duty of quality is more than just a cultural change, and I agree with him. To have a cultural change, all clinical staffing groups should be part of sufficient workforce planning. Amendment 33 outlines that the Welsh Government must take reasonable steps to ensure that there are a sufficient number of specific healthcare staff, including nurses, midwives and medical practitioners. As I noted at Stage 2, it was heartbreakingly clear in the case of Cwm Taf that a number of factors, including an insufficient level of midwives, caused the catastrophic collapse in the provision of safe care that we saw there.

So, we believe it's the Welsh Government's duty to ensure that it's not repeated again, and we think that this Bill is a very good vehicle to do that through. There is no routine reporting of midwifery vacancies, and Healthcare Inspectorate Wales's national review of maternity services in Wales won't be published until later this summer. So, without this key data on an ongoing basis, rather than a one-off review, we're not aware of whether there are enough maternity staff in every health board in Wales.

The first part of amendment 34, a duty to ensure appropriate staffing, is intended to hold the Welsh Government to the same standards and expectations as an NHS body. It does require the Minister to demonstrate what action has been taken to achieve this. Now, let me be clear, with the cases that we're now seeing of COVID-19 appearing in Wales, and noting the potential pressures on staffing that a full outbreak will have, now is the time to monitor pressures within the health system, so that we know whether our health boards are able to deliver those safe levels of care.

The second part of our amendment, the duty to have a real-time staffing assessment in place, will ensure that staffing levels are regularly monitored so that NHS bodies and Ministers actually respond to issues as they happen in real time, instead of only responding to agreed procedures from months or years before. As I noted at Stage 2, there are already issues with safe nursing levels, as the Royal College of Nursing is still concerned that neither the Welsh Government nor NHS Wales publish national figures for nursing vacancies using an agreed definition of what constitutes a vacancy. And annual data published by the Welsh Government on nursing levels does not adequately reflect patient need or service development, including comorbidities and an ageing population. 

The third and final part of the amendment, the duty to have a risk escalation process in place, will give every single member of staff a clear mechanism to raise concerns if they are working in settings where they feel the levels of available staffing are not conducive to safety. 

At Stage 2, it was noted by the Minister that he would not support these amendments—so, I understand that at the moment—as the Bill would not be the appropriate mechanism for enacting a change of this magnitude, and that applying any principles of the nurse staffing levels Act to all other clinical staffing groups in Wales without the same degree of consideration and scrutiny would be inappropriate and inconsistent. Yet, as we have so often said before with Welsh Government legislation, the Bill's provisions on the duty of quality are overly broad. It therefore risks becoming an aim rather than a duty, without specific mechanisms for health boards to undertake the necessary action to ensure it is upheld and monitored routinely. 

I do also, Minister, dispute your concerns about the financial considerations, as having appropriate staffing levels in place will cost NHS bodies and Welsh Government less money in the long term due to less sickness and stress-related illnesses, as well as improved mental health for all staff. The amendments also recognise that the onus is not solely placed on NHS bodies, and that Welsh Government have a role to play in the long-term secure future of staffing levels for NHS bodies.

I do note the points that you raised in Stage 2 in your letter to the Chair of the Health, Social Care and Sport Committee on 26 February, in which you said that Schedule 3 to the Bill amends subsection 47 of the Health and Social Care (Community Health and Standards) Act 2003 to require NHS bodies to take into account the healthcare standards. However, as will be outlined in my amendments in group 7, these standards have not been updated since 2015. Since then we've had a rapidly ageing population, as well as advances in technology that mean they are fast becoming obsolete. Therefore, I would be grateful if the Minister could outline a timeline on the refreshed standards, as well as placing on record his commitment to a clear mechanism to review these standards regularly.

Minister, should you be prepared to answer these questions on the health and care standards, as well as commit to supporting amendments 36 and 37, I would be prepared to withdraw these amendments.