The next group is group 5, which relates to the duty to secure quality in health services and data. Amendment 38 is the only amendment in the group, and I call on Angela Burns to move and speak to that amendment. Angela Burns.

Amendment 38 (Angela Burns, supported by Caroline Jones) moved.

Thank you, Presiding Officer. I've been an Assembly Member for about 10 years now, and I've sat on a whole variety of committees—finance, health, education, children and young people, as it was—and all the time we talk about 'How do we know?' How do we know that we're performing well? How do we know that we're meeting our targets? How do we know we're delivering the outcomes for the money that we're spending? This amendment, amendment 38, which I formally move, is about getting the data so we have the information so we can make the planning.

It is an amendment that was based on a suggestion by the Royal College of Surgeons in their written evidence to the committee, but it actually runs true throughout the whole of the objective of this Bill. We want to know how well our surgical outcomes data is doing at a unit level. Again, I want to remind Members of another exciting fact: how many times have any of you—and maybe not you, but I'm sure Members of Plaid Cymru and I'm sure Members of the Brexit Party, I know Members of my party and I'm sure some of the independent Members will have put in freedom of information requests to try to drill down to get that information to find out what happened: where; when; how? How many things have been achieved; how many operations have happened; what type of operations; where are the blockages? Because by knowing what is going on, by having that data, you can actually start to have good governance. You can go back, you can challenge and you can scrutinise. This amendment is all about getting good data.

I listened, Minister, to your response at Stage 2. You were very concerned about a prescriptive list of information, and I took that on board. As a result, the amendment here at Stage 3 is broader and it's also with an inclusion that the data is shared with Ministers and Public Health Wales to help inform your future work and planning. This is about helping you and helping your NHS teams to perform better, to do a better job, to know what is going on.

I was very disappointed by your response to the Chair of the Health, Social Care and Sport Committee. It's not good enough to list off the current indicators by which health boards must measure their performance. I do note the work surrounding the Once for Wales concern management system on the recording of incidents, complaints and adverse outcomes in healthcare, as well as the aim to develop a single framework for measurement and benchmarking of quality-related data under the five-year quality and safety plan, but I don't think these are yet sufficient to properly analyse patient outcomes. I think it would be prescient for the National Assembly for Wales to monitor the progress of those programmes closely given the past issues we've had with data collection. I would like to remind Members that it was only recently that we found some of the data at Cwm Taf Morgannwg was completely wrong. They had mislaid I think it was 2,700 operations, appointments and results. We need efficient, good data. This Bill gives us the opportunity to do it. Please, Members, consider that and pass this amendment. 

Rhun ap Iorwerth.

Thank you for the opportunity just to say a couple of words. This is also an area where, if we are going to have a Bill that is worthwhile, we have to look for ways to have an impact through it. We know from experience that a lack of data is holding us back, in terms of our ability to increase quality within our health and care services. We support the amendment. We know that data, and the shortage of data, is a problem within the NHS. It is important, for me, to think that we should be getting LHBs to prove that they are complying with legislation, because, otherwise, all we’ll get is some kind of ambiguous certainty that everything is right, until we end up in a situation similar to Cwm Taf again, where we find that things are not okay. This is an opportunity to respond to that situation.

The Minister to respond, Vaughan Gething. 

Thank you, Llywydd. There are already many systems in place to collect, analyse and publish data across our national health service. Much of this is captured on a Wales and England basis, if not a UK-wide basis, such as the range of national clinical audits. It is what is the done with that data that is, of course, key. Amendments 16, 17 and 18 dealt with the requirement for Welsh Ministers to issue statutory guidance in relation to the quality duty and for that guidance to include the evidence for how an assessment has been made to ensure a stronger focus on using data and for that data to be reliable in enabling a body to make decisions that will ensure improvements in quality outcomes.

And, as Angela Burns knows, there is already considerable work under way to streamline and improve our data and that important things are routinely measured in a consistent and clinically relevant way. Because one size will not necessarily fit all. We have to retain some flexibility to determine and review what data is collected in the best and most effective ways, to keep pace with technology and other evidence-based requirements. For example, the changes in the clinical model adopted by the ambulance service, widely adopted in England and Scotland, have necessitated changes in data collection and the way we hold the system to account for their performance.

The work under way to implement the cancer pathway will also necessitate changes to the type of data we collect to see if we are securing improvements in the quality and delivery of the service. Our intention is to develop cancer data and intelligence in order to support better system planning and delivery. That will involve the collection, use and publication of a more comprehensive set of activity data.

And, as Angela Burns referred to, we're working with the service to finalise a five-year quality and safety plan that describes a range of high-level strategic recommendations, including a specific action around addressing measures, data and analytics.  A collaborative programme of work will be established to take that plan forward, with one of the aims being to develop a national approach to measuring and benchmarking quality-related data. I expect that plan to be published ahead of summer recess within this calendar year.

NHS Wales is also in the process of implementing a new system, as referred to: the Once for Wales concerns management system for how local health boards and NHS trusts record, report, monitor, track, learn and make improvements from incidents, complaints, claims and other adverse outcomes. The aim of this is to achieve consistency of data management and workflow design in these areas, across Wales. It is intended that the new system will be implemented over the coming year.

I understand where this amendment is coming from and agree with the Member about the importance of consistent, streamlined and cohesive available data. As I have explained, work is under way on a number of fronts to achieve just that. As evidenced by some of the work in this area that I have described, I don't agree that we need further legislation to achieve this. Legislation would certainly add to bureaucracy and take away flexibility and has a real potential to slow down and even stifle innovative work in this area. I therefore cannot support the amendment.

Angela Burns to reply to the debate.

Thank you for that. Some of the words that I find the most slippery are words like 'intend' and 'expect', because they don't actually tell you when you're going to do something and how you're going to do it.

So, let me just remind Members: in July 2013—we're now in 2020—so, seven years ago, the Welsh Government said it would work to publish—in fact, you didn't just say it, you announced that you would work to publish surgical outcomes data in Wales at a unit level, with a promise to consider individual outcomes data at a later date. It's not been progressed; it's not been achieved. This amendment is intended to drive your Welsh Government promises forward and to remind the Minister that we've already asked to make this an urgent priority, as has already happened in NHS England.

Why is that important? Because if you knew what was happening, for example, with operations, how many are cancelled and whether that cancellation is for a clinical or non-clinical reason, from the health board and from the patient—. We have a little bit of that data, but simply not enough to understand where the pressures are or what is contributing to long waiting times, what is contributing to the bottle necks, and how we can resolve it. Seven years—still not delivered. I'm not holding my breath. If this doesn't get passed, I'm not holding my breath that we will see that data brought forward in a really timely manner, where it is useful to help us to frame or reframe the way we work in our NHS.

The question is that amendment 38 be agreed to. Does any Member object? [Objection.] We therefore proceed to a vote on amendment 38. Open the vote. Close the vote. In favour 23, no abstentions, 28 against. Therefore, the amendment is not agreed.

Amendment 38: For: 23, Against: 28, Abstain: 0

Amendment has been rejected