The next group of amendments is the group that relates to the duty to secure quality in health services and the meaning of quality. The lead amendment in this group is amendment 60, and I call on Rhun ap Iorwerth to move and speak to the lead amendment and to speak to the other amendments in the group. Rhun ap Iorwerth.

Amendment 60 (Rhun ap Iorwerth) moved.

Thank you, Llywydd. I would assume that these amendments are quite central to what we're discussing here today. This is a Bill that relates to quality within health and social care, and these are amendments defining exactly what we mean by quality and what we mean by the standards that we expect within our services here in Wales. There are amendments here related to prevention of ill health, there are amendments related to reducing health inequalities, and also amendments on the need to provide accessible health services through the medium of Welsh, because we believe, in those three areas, we do need very real quality, and we need high standards in what we should expect. I expect the Minister to reply to this debate by saying that standards in health and care already take account of these issues. So, let's look at some of those.

Standard 1.1, first of all, refers to preventative behaviour and deals with health inequalities, and it states that:

'People are empowered and supported to take responsibility for their own health and wellbeing and carers of individuals who are unable to manage their own health and wellbeing are supported. Health services work in partnership with others to protect and improve the health and wellbeing of people and reduce health inequalities.'

Now, I don't feel that that, in and of itself, is always delivered. We may need to go further than that.

When it comes to the Welsh language, there is no particular section related to the Welsh language. What we have is a mention of the Welsh language in other parts of the standards. Standard 2.7, for example, is related to the safeguarding of children and adults at risk, and it says this:

'Priority is given to providing services that enable children and vulnerable adults to express themselves and to be cared for through the medium of the Welsh language because their care and treatment can suffer when they are not treated in their own language.'

There is also reference to the Welsh language in the standards as a means of providing equal access to everyone to services, stating that people should see that respect is shown to their cultural identity, and that they should be able to access Welsh language services without any barriers, although not everyone responsible for providing the care would be able to converse through the medium of Welsh.

But these are standards that have been in place since 2015, and I don't think that anyone could argue that every NHS institution is delivering those kinds of standards and that quality of service. I think failing to include a section specifically on the Welsh language suggests that it's not really thought of as particularly important in terms of quality, of the standards that should be expected by people. It feels like something that has been bolted on at the end.

So, we reject the notion that the current standards are sufficient and we would consider all of those three categories that I've mentioned—prevention, reduction of inequalities, and the Welsh language—to be important enough to place on the face of the Bill. The Minister has already conceded that safety, effectiveness and the experience should be on the face of the Bill as part of what quality supposedly means, despite the health and care standards also referencing those too. He has defined some new things he wants to emphasise by bringing them on to the face of the Bill. Why not prevention, reduction of inequalities, and the Welsh language? We see no reason why other important factors in the quality of a service shouldn't also be on the face of the Bill. It allows for a clearer signal to be sent about what the Welsh Government considers important.

The other question to ask is that if all these important indicators of quality are already part of the health and care standards then why the need for this legislation at all? Isn't quality already part of legislation underpinning the NHS? If the answer to that is that the standards are inadequate for the Minister to enforce on health boards, then what we need is either the strengthening of the current guidance on standards, or for standards perceived to be important and not currently being met to be put on the face of the Bill. So, either the standards are sufficient, in which case there's no need for the Bill, or they're not, and we need this Bill. If they're not, then this Bill needs to have a far stronger section on defining what quality is. So, I ask you to support these amendments. Diolch yn fawr iawn.

The Welsh Conservatives support all of these amendments, and Rhun ap Iorwerth very neatly took my words, which were: if we don't have a definition of what quality is on the Bill in all the areas, then what is the point of the legislation? If they're already doing it, if the health boards are already doing it, then we don't need the legislation.

With the previous set of amendments that I tabled a little bit earlier, that's the whole point: health boards should be doing it. If they're not doing it—. We should be achieving this level of quality in our NHS; we're not achieving this level of quality in our NHS in all of these areas that you raise—three very important areas: the Welsh language, prevention of inequalities, and the prevention work—and it is absolutely key that we do just that. So, we support your amendments and thank you for tabling them.

The elements of quality set out in the Bill are non-exhaustive and deliberately broad, as I said in the debate on the first group. It is intended that quality will align with the internationally recognised definition of quality. And, again, that is intentional, given the broad-ranging functions of NHS bodies, and I do not want to risk diluting that approach or making it cross-purposes. And it's worth remembering that equity is one of the six domains recognised in the internationally accepted definition of quality, and therefore needs to be an important component of any decisions taken to secure improvement. I therefore won't be supporting the amendments brought forward in this group.

Importantly, as Members know, the Bill already makes a significant, and in this context very relevant, amendment to section 47 of the Health and Social Care (Community Health and Standards) Act 2003. That does mean that health and care standards must be taken into account by NHS bodies when discharging their quality improvement duty, and as I've already said those standards are being updated.

The health and care standards are comprehensive and mean that NHS bodies will have to consider matters relating to workforce, improving population health, equity, and the Welsh language in discharging their duty, because these are all covered in our current standards, and will be covered in the revised ones. These will be reinforced and set out in the statutory guidance that I've already referred to.

So, whilst I understand the sentiments behind the amendments, I don't believe they're required as the Bill, because of the alignment with the standards, will ensure that those requirements are covered in a manner in which they have statutory force, but also in a manner in which they can be revised, as indeed we have done at five-yearly intervals for some time. The amendments to expand the elements of quality are therefore, in my view, unnecessary, as they are already provided for.

To summarise, in my view, all three of the areas highlighted are catered for in the health and care standards that underpin the duty of quality, and the guidance can further reinforce this. There will also be important considerations for Welsh Ministers when taking decisions with a view to securing improvement in the quality of services. I therefore ask Members to oppose the amendments in this group. 

Rhun ap Iorwerth to respond to the debate.

Diolch yn fawr iawn, Llywydd. I'm grateful for the signalling of support from Angela Burns and the group opposite; disappointed, but not surprised, in not gaining the support of Welsh Government and Labour Members. To me, it's clear enough that the statutory guidance that we have now isn't delivering the quality that we want as strongly as we could. It strikes me that if we're not seeking to actually enhance the quality of services through a health quality Bill, well, what on earth is the point of having a quality Bill? A cynic would suggest that this is a Bill that is meant to achieve something else, which is to get rid of the community health councils and their ability to be a thorn in the side of Welsh Government, and that it needed to be padded out with other things. But I'll leave it there.

The question is that amendment 60 be agreed to. Does any Member object? [Objection.] We therefore proceed to a vote on amendment 60, in the name of Rhun ap Iorwerth. Open the vote. Close the vote. In favour 21, one abstention, 29 against. Therefore, amendment 60 is not agreed.

Amendment 60: For: 21, Against: 29, Abstain: 1

Amendment has been rejected

Is amendment 61 being moved? Rhun ap Iorwerth.

Amendment 61 (Rhun ap Iorwerth) moved.

Yes, move.

The question is that amendment 61 be agreed to. Does any Member object? [Objection.] We therefore proceed to a vote on amendment 61, in the name of Rhun ap Iorwerth. Open the vote. Close the vote. In favour 21, one abstention, 29 against. Therefore, amendment 61 is not agreed.

Amendment 61: For: 21, Against: 29, Abstain: 1

Amendment has been rejected

Amendment 62, Rhun ap Iorwerth.

Amendment 62 (Rhun ap Iorwerth) moved.

Formally.

The question is that amendment 62 be agreed to. Does any Member object? [Objection.] We therefore proceed to a vote on amendment 62. Open the vote. Close the vote. In favour 21, one abstention, 28 against. And therefore, amendment 62 is not agreed.

Amendment 62: For: 21, Against: 28, Abstain: 1

Amendment has been rejected

Amendment 23 in the name of Angela Burns is the next amendment. Is the amendment moved? 

Amendment 23 (Angela Burns, supported by Caroline Jones) moved.

Move.

Yes, it is. Is there any objection to amendment 23? [Objection.] We therefore move to a vote on amendment 23, in the name of Angela Burns. Open the vote. Close the vote. In favour, 23, no abstentions, 27 against. Therefore, amendment 23 is not agreed.

Amendment 23: For: 23, Against: 27, Abstain: 0

Amendment has been rejected

The next amendment is 24. Angela Burns.

Amendment 24 (Angela Burns, supported by Caroline Jones) moved.

Formally.

The question is that amendment 24 be agreed to. Does any Member object? [Objection.] We therefore proceed to a vote on amendment 24. Open the vote. Close the vote. In favour 22, no abstentions, 28 against. Therefore, amendment 24 is not agreed.

Amendment 24: For: 22, Against: 28, Abstain: 0

Amendment has been rejected

Amendment 25 is the next amendment. Angela Burns.

Amendment 25 (Angela Burns, supported by Caroline Jones) moved.

Formally.

The question is that amendment 25 be agreed to. Does any Member object? [Objection.] We therefore proceed to a vote on amendment 25. Open the vote. Close the vote. In favour 23, no abstentions, 27 against. Therefore, amendment 25 is not agreed.

Amendment 25: For: 23, Against: 27, Abstain: 0

Amendment has been rejected

Amendment 63, in the name of Rhun ap Iorwerth, is the next amendment. Is it moved?

Amendment 63 (Rhun ap Iorwerth) moved.

Formally.

The question is that amendment 63 be agreed to. Does any Member object? [Objection.] We move to a vote, therefore, on amendment 63. Open the vote. Close the vote. In favour 21, no abstentions, 30 against. Therefore, the amendment is not agreed.

Amendment 63: For: 21, Against: 30, Abstain: 0

Amendment has been rejected

Amendment 64, Rhun ap Iorwerth.

Amendment 64 (Rhun ap Iorwerth) moved.

Formally.

The question is that amendment 64 be agreed to. Does any Member object? [Objection.] We therefore proceed to a vote on amendment 64. Open the vote. Close the vote. In favour 21, no abstentions, 29 against. Therefore the amendment is not agreed.

Amendment 64: For: 21, Against: 29, Abstain: 0

Amendment has been rejected

The next amendment is amendment 65, Rhun ap Iorwerth.

Amendment 65 (Rhun ap Iorwerth) moved.

Formally.

The question is that amendment 65 be agreed to. Is there any objection? [Objection.] We therefore move to a vote on amendment 65. Open the vote. Close the vote. In favour 21, no abstentions, 29 against. Therefore, the amendment is not agreed.

Amendment 65: For: 21, Against: 29, Abstain: 0

Amendment has been rejected

Amendment 26 is the next amendment, Angela Burns.

Amendment 26 (Angela Burns, supported by Caroline Jones) moved.

Formally.

The question is that amendment 26 be agreed to. Does any Member object? [Objection.] We therefore proceed to a vote on amendment 26, in the name of Angela Burns. Open the vote. Close the vote. In favour 23, no abstentions, 28 against. Therefore, that amendment is not agreed.

Amendment 26: For: 23, Against: 28, Abstain: 0

Amendment has been rejected