The next group is the fourth group of amendments, which relates to non-compliance with the duty to secure quality in health services. Amendment 35 is the only amendment in this group, and I call on Angela Burns to move the amendment.

Amendment 35 (Angela Burns, supported by Caroline Jones) moved.

Thank you, Presiding Officer. I formally move amendment 35, tabled in my name. Members, I want teeth, not for me but for the NHS, and amendment 35 is tabled in support of committee recommendation 6, which asks the Minister to make a specific provision for the consequences of non-compliance with the duty of quality. I've re-tabled this from Stage 2 because, actually, I think it's vitally important that if we have legislation, it must have checks and balances built within it and the whole point of this is to give the Government, give the whole system, those very, very important teeth.

It's not intended to have a detrimental impact on the financial position of health boards, trusts or special authorities, but it could be dealt with through the NHS escalation and intervention arrangements by the health Minister. During evidence sessions and the committee's consultation, it was clear that many stakeholders wanted to introduce consequences for the non-compliance in relation to both the duties of quality and candour. The British Medical Association noted that this needed to be addressed, stating,

'Unless some form of sanction or corrective action is triggered, we believe that the proposed duty would run the risk of lacking effectiveness, and at worst would become a mere box-ticking exercise.'

The Royal College of Nursing noted that there

'has to be a consequence to doing it or not doing it, otherwise there's no incentive to do it, in a sense, at the most basic level.'

Minister, your response at Stage 2 didn't give me any reassurance in the slightest. You said, again, in your commentary from Stage 1, that there were existing mechanisms, including escalation measures, that would underpin the failure to adhere to that duty of quality. Furthermore, you went on to say that these arrangements were part of wider governance and accountability within the NHS, and you believe that it provided opportunities for scrutiny and appropriate, timely action and learning.

Well, I'm sorry, Minister, but I don't believe we are using these mechanisms and I don't believe they've provided opportunities for timely action and learning. I don't see health boards acting really quickly or learning their lessons. So, for example, we're still dealing with the fallout from some of our worst situations: Tawel Fan, where Betsi Cadwaladr is still in special measures four and a half years later, meaning that special measures and direct Government intervention haven't had much effect on the board's governance arrangements. An independent review of its psychological therapy services—you know, mental health services—highlighted that it is still failing in many areas. So, you would have thought that, after Tawel Fan, they would have actually looked at that quality in that element of the health services.

I don't really want to dwell too much on Cwm Taf Morgannwg's maternity services, but we've got to say it here. This is the truth: despite numerous reports between 2010 and 2018 stating that the board's maternity services at Prince Charles Hospital and Royal Glamorgan Hospital were in trouble, including a damning internal report by a consultant midwife, who said there were systemic failings, they were ignored by senior management. So, where's that duty to secure quality in health services? This is a direct mirror of what we've seen at Betsi.

So, Minister, members of the governing party, I really want you to think about this. This could be a really useful piece of legislation to drive quality, to drive candour through the NHS, but it has to have some teeth, and this whole amendment is about giving those teeth to the whole Act in order to ensure that we do get that real compliance. We can't afford for our NHS to carry on in a way where we cannot hold people to account and actually make sure that there are improvements. Duty to secure quality, non-compliance, give us teeth.

Very briefly, just to endorse that. Any legislation needs to have teeth and we need to ensure that the legislation does have force, as Angela Burns has said. We will be supporting this amendment, and we will be arguing that it would be meaningless to pass legislation unless there are implications when someone contravenes that legislation. 

I will clearly expect all NHS bodies to demonstrate how they comply with the new quality duty in an open and transparent way. The new annual report will be a key vehicle for evidencing this. The amendments that we have just passed, 16, 17 and 18, will set that requirement out very clearly. This, along with other mechanisms, such as integrated medium-term plans, provides that range of opportunities to assess how the duty is being discharged. 

Our existing NHS escalation and intervention arrangements should be seen within a wider governance and accountability framework within the NHS at both individual body and system levels through the quality and safety committees, the quality and delivery meetings, and joint executive meetings between the chief executive of NHS Wales and the chief executives of health boards and trusts and their senior teams. These all provide opportunities for scrutiny and appropriate timely action and learning.

I also expect HIW to take a close interest in how an organisation is discharging its duty as part of its inspection and review work. I've already stated, and am happy to state again for the record, that there are a range of levers that may be used where a body is not exercising its functions properly and these include the escalation and intervention arrangements.

The amendment provides that Welsh Ministers 'may' issue an intervention order if an NHS body has failed to exercise its functions in accordance with the duty of quality. The circumstances in which the Welsh Ministers may issue an intervention order are already set out within the National Health Service (Wales) Act 2006. This includes where an NHS body is not performing one or more of its functions adequately. It is therefore unnecessary to add the provisions in these amendments to the face of the Bill, and I ask Members to oppose them.

Angela Burns i ymateb.

Thank you, Llywydd. Failure to comply with the duty to secure quality in health services—you're absolutely right; it does say that

'sections 12A, 20A and 24A, they may make an intervention order in respect of the body.'

However, you've made escalation orders across our health boards because of failures in quality of care: Tawel Fan, Cwm Taf to name but two; there are other— smaller, thankfully—instances. The whole point of this is about giving a driver, it's about putting the focus on it, it's about ensuring that, when people are under pressure, they really realise, with absolute clarity, what—

Would you take an intervention, Angela?

Absolutely. Of course I will.

I'm very grateful to you. Do you agree with me that, if we persist in passing laws in this place where there are no clear consequences on the face of the law for the people who break the law, we risk bringing the whole democratic institution into disrepute? I, for one, am sick and tired of being asked to vote for legislation where nothing happens to somebody who breaks those laws.

I don't think I need to say any more, Llywydd, because I think Helen Mary has absolutely encapsulated my entire feeling on it, which is why we brought this amendment. We've got to up our game. The whole point of this legislation is about us upping our game, and making sure that those who run our health boards, the management teams, really make sure that providing quality care to our NHS citizens, the people who use our NHS, is actually one of their primary jobs, not an also-ran. Members, I really ask you to think about this hard and to support our amendment.

The question is that amendment 35 be agreed to. Does any Member object? [Objection.] Therefore, we proceed to a vote on amendment 35. Open the vote. Close the vote. In favour 23, no abstentions and 28 against. Therefore, the amendment is not agreed.

Amendment 35: For: 23, Against: 28, Abstain: 0

Amendment has been rejected