Thank you, Llywydd. I want to thank, at the outset, people who have worked on this Bill to date, both the scrutiny we've had through the committee process, as well as officials and all those who engaged in the White Paper stages and wider consultation. We will have various points of disagreement, and some points of agreement, through the passage of this evening. I won't respond to some of the broader comments about the future arrangements to replace community health councils; we'll come to that group later in the Bill.

In terms of staffing, of course, this Government supports the principle of having sufficient staff in our health service: having the right staff in the right place with the right skills.

I want to address the amendments in this group in two parts: firstly, whether the definition of quality should explicitly include staffing levels itself, and, secondly, amending the Bill to include a staffing duty.  

I want to be clear: the duty of quality, as drafted, is deliberately broad. It captures all aspects of the health service and relates to everything the health service has responsibility for. Workforce considerations are clearly a key enabler to meet the duty of quality. No body can ensure it secures services that are, for instance, safe and effective and provide a good experience unless they've given consideration to the types and the numbers of staff needed to achieve that.

And we are deliberately using the internationally recognised definition of quality put forward by the former Institute of Medicine in the states, and the person who went on to lead that institute was Don Berwick, who took part as one of our international experts in the cross-party endorsed parliamentary review. As I have said, having the right staff in the right space with the right skills is, in effect, the resource needed to secure improvements in quality. Staffing in and of itself is not defined as meaning quality. The workforce is there a key and most significant enabler in being able to secure improvements in quality.

Now, as has been said, Schedule 3 to the Bill links the duty of quality to the health and care standards, which have a whole theme, with detail on them, on staff and resources. NHS bodies will therefore need to demonstrate that full consideration has been given to workforce matters in discharging the duty of quality.

As I've indicated previously, and in particular in the useful and constructive discussions we had after Stage 2 with other parties, the standards are kept under regular review, and, in fact, a review is about to take place within this year. The passage or otherwise of this Bill will obviously help to inform the review of those standards and the framework we expect people to respond to.

The statutory guidance will deal with the application of the duty across all functions of the health service, and will undoubtedly highlight the importance of workforce planning, alongside the requirement to consider securing improvements through areas such as prevention, health improvement, and taking action to address inequality in outcomes.

I'm pleased to confirm that the RCN and the BMA have offered to work with us on developing the guidance, and of course I very much welcome that offer. The amendments on staffing levels being included in the definition of quality are not, therefore, in my view required.

Turning to the amendments that seek to extend the staffing duty to Welsh Ministers, I have to say at the outset that I'm firmly of the view that making a change of this magnitude by way of amendments to a Bill is simply not the right approach. The Nurse Staffing Levels (Wales) Act 2016 benefitted from significant planning and considerations of the financial ramifications, and was subject to the full scrutiny that we would all expect for such a landmark piece of legislation. And it was important to ensure that it was done in the right way. Applying any of the principles of that Act to all other clinical staffing groups in Wales without the same degree of care, consultation, consideration and scrutiny would be wholly inappropriate.

The Royal College of Nursing in their own evidence to the health committee acknowledged that a change of this magnitude is not something that they believe is suitable to try and achieve by way of an amendment. When you consider not just the headline measures, but also the process measures as set out in the highly detailed amendments for reporting mechanisms, you would have to do a considerable amount of financial work on the workforce implications as well as the availability of staff and having the tools to calculate staff—the appropriate levels of staff—in different settings.

In the case of inserting a section 25AA, as set out in the amendment put forward by Angela Burns, it would inappropriate and impracticable to level such a duty on Welsh Ministers when it is health boards and trusts who have that operational responsibility for those staffing considerations. The proposed amendment is in essence an extension of section 25A of the Nurse Staffing Levels (Wales) Act 2016 to all clinical staff, and it's very clearly a duty for health boards and trusts.

It is important to recognise that NHS bodies already have arrangements in place for ensuring that managers and senior decision makers are informed of staff shortages where this is likely to present a risk to patient safety. These arrangements include decisions to be taken 'in-hours' and 'out of normal working hours', and that includes arrangements for informing executive board members where appropriate, for them to make choices.

I am therefore unable to support the amendments put forward in this area, and ask Members to oppose them.