The next group of amendments is group 6, which relates to the duty to secure quality in health services and a register of managers. Amendment 72 is the only amendment in this group. I call on Rhun ap Iorwerth to move that amendment.

Amendment 72 (Rhun ap Iorwerth, supported by Caroline Jones) moved.

Thank you very much. I do urge you to support this amendment. Should we be able to expect, or should we hope to have, the clinical staff, the best possible doctors, nurses and so on, within the NHS? I think we should, and there are systems in place to ensure that standards are maintained. Should we expect and hope to have the best possible managers within the NHS? Yes, I would argue that we should, but we don't have the same systems in place to try to maintain those standards.

What this amendment does is to create a register of NHS managers and a body with oversight of that register. We have made some changes since Stage 2 proceedings in order to ensure that that oversight body does have the ability to put competencies in place and to place sanctions on managers who fail to reach certain standards.

In the case of nurses, doctors, midwives and other health professionals, there are regulatory bodies in place that insist on high standards, which have the ability to discipline staff if they fail to attain those standards, to put things right when standards are not attained, where there is negligence, and then it's possible to prosecute in accordance with those regulatory standards. But among managers, we don't have those arrangements in place that would ensure that we should insist on a particular standard. We have excellent managers within our health service in Wales, at all levels. We need to give those managers within the NHS pride. We need to celebrate good management. But if we do that on the one hand, then on the other hand we need to ensure that we have those tools in place and that we have systems that provide a yardstick, where we can say, 'Yes, this is the expected standard.'

As we know, we have had too many experiences within the NHS in Wales over the years where managers have fallen way below the standards that we should expect of them. There are grave implications where managerial errors and mistakes have been made. And very often, we will see a manager moved on and taking another role in a health board without there having been processes followed, either to correct, to penalise or to bring sanctions into play, but mainly in order to improve standards.

I understand that some preparation has been made in terms of the kind of system that we are suggesting here, and that this is something that the Government realises should be addressed, but, for some reason, there is an unwillingness, or there has been an unwillingness, to say, 'Well, that's enough of a throwaway attitude towards standards among managers—let us do something to correct the situation.'

I don't think that we can drive standards up to do more with less, and to use resources far more efficiently, unless we have a mechanism in place to improve management. Although the Government will reject this amendment, I fear, I do truly believe that this is an area where the Government should be focusing on, and that this should have been a core part of the Bill, if the purpose of that Bill was to raise standards within health and care.

Thank you very much to Plaid Cymru for bringing this forward. This element of the Bill is really important. I have a stand at the moment to abstain, and the reason for this is because I want to hear what the Minister is going to say in response to you. I agree, it is vitally important to create a register of managers. It's vitally important to have sanctions and measurability on it to make sure that they are doing the job that they're employed to do properly.

And, of course, the other great thing that can happen is that by having such a register, if you move a duff manager on or out, that person is picked up by the next organisation and trained appropriately and encouraged to develop and then pop back in at the right level. Very important—it's all about not being punitive but about identifying where somebody's doing a job that perhaps could be too big for them, that they get the right training, the right support, and they move on through.

Where I'm slightly unclear is the definition of manager. Now, I've been a manager for a big chunk of my life, and I've been registered as a manager, as a director with the Institute of Directors, with the institute of marketing, the Institute of Sales Management, the institute of general management in business, so I'm just slightly unclear, and I would like to have some clarity. Because if you look through, just briefly, you've got everybody from finance managers to hospital managers, estate managers, health and safety, ward managers. So, that's why I'm just slightly in the mood, at the moment, to abstain. I want to hear what the Minister has to say, but if you want to clarify that, it'd just be really, really helpful, because I think it's such an important point.

I'll certainly clarify in this way: I acknowledge that the NHS is a complex machine within which there are many layers of management. The shame, in a way, is that we are here at Stage 3, having proposed this at Stage 2, and having put this on the table at a point where Welsh Government should, and could, have engaged with it in a way, using the might of the Government machine, they would have been able to identify clearly how to implement this kind of change. But I don't think that that detracts from what we are trying to achieve here. 

I'm backing the amendment in this group, and I agree with Plaid Cymru that there has to be a register for NHS managers. I've said many times in this Chamber that we must ensure health service managers abide by the same obligations as clinical staff. Clinicians are covered by duties of care placed upon them by their royal colleges and the various professional bodies. Managers are an essential part of our modern NHS, and they can often play a role in ensuring the quality of care provided to patients.

And I regret that Helen Mary's proposals for a NHS management Bill was rejected by the Government. I welcome the fact that this amendment seeks to address the issues highlighted by Helen Mary's proposed legislation. Managers will play a vital role in securing both a duty of quality and of candour, and we must ensure they are held to the same high standards as clinical staff. I believe registration to be the way forward and therefore support amendments 72, tabled by Rhun, and hope colleagues will follow suit. Diolch yn fawr.

The Minister to reply to the debate—Vaughan Gething.

As Rhun ap Iorwerth implied, I do not support the amendment that now appears in his name. But I support the aim of ensuring that health service managers are competent and capable and that those who fail cannot just move on to another job elsewhere in the system.

I do not agree that amending this Bill to create a new corporate body and a complex and bureaucratic system of registration is the right way to do that. Of course, that isn't just my view. The health committee, in its Stage 1 report on the Bill, recommended the Government bring forward proposals in the future to address the regulatory imbalance between clinical staff and non-clinical managers, but recognised that this is not a matter for this Bill.

Just as in extending the staffing duties that we discussed earlier at all levels would not be appropriate, that is exactly the same point here. Members may want to consider the actual wording of the amendment they're asked to pass. It starts off by saying that

'Regulations must provide for the creation of a register of clinical and non-clinical managers'.

The next subsection refers to all persons:

'All persons who carry out managerial roles within or on behalf of a Local Health Board, NHS trust or Special Health Authority must be registered on the register of managers.'

And Members should consider the scale of what you're being asked to agree to. So, who is a manager? Well, a band 6 nurse, a deputy ward manager—the clue is in the title. To then say the scale of activity on band 6 upwards right across our service, so that all the clinicians call them that, who have their own professional requirements as well, and all of the non-clinical managers—we have to run a huge undertaking. And I raised this point in the Stage 2 committee debate, that creating a specific and prospective regulatory regime would need detailed financial and policy work to be considered to reflect the diverse nature of the workforce and their roles. We'd need to address the issues about the balance of responsibilities between the employer and the regulator, how any requirements apply to individuals or healthcare professionals and managers, and the mobility of the workforce, which is a key consideration for us in many parts of the national health service in Wales. The care and the thought required is simply not available to us and it is simply not the right way to try and amend this Bill, to introduce such an enormous undertaking.

Additionally, in terms of the value-for-money measures, we of course can't have any idea about what that is now, but we do understand some of the complexity of the level of bureaucracy and the demand. When we established Health Education Improvement Wales, the cost for establishing that was around £2.8 million. I couldn't tell you today what the cost of implementing and agreeing this proposal means just for the implementation stage, never mind the operational stage. It's not just the cost, of course. I've already referred to the challenge we have about the fact that managers and staff do regularly move across borders.

Now, I do want to hear the findings of the working group set up by NHS England to consider the recommendations of the Kark review, an independent review of how effective the system in England is at preventing unsuitable staff from being redeployed. That called for a central database of all NHS directors, but even within England they recognised it's complex, and something they may not be able to achieve on a single-nation basis. Now, they recognised the complexity of issues and they themselves want to have a conversation on a four-nation basis. I am more than happy to participate in a four-nation conversation about the sorts of services that I think are worth pursuing, not just for Members in this room but for the wider public. But as for the amendment before us today, it is not simply the appropriateness of dealing with it, but I think the way it's drafted makes it defective and not something that any Member should support. 

Rhun ap Iorwerth to respond to the debate. 

Diolch yn fawr iawn. Well, the Minister very feistily explains why he won't be supporting this amendment aimed at increasing or improving standards within the NHS in Wales in a pretty fundamental way. I do believe that Government did suggest there that they would be moving their own model of regulating managers within the NHS. I don't know if the Minister wants to confirm that, if that was your intention, Minister, in referring to what was said at Stage 1 of the Bill's journey through the Assembly; possibly not. Well, that's how I read it and I do look forward to the Government addressing this in future.

We heard the Minister say that's in an enormous task. Yes, it is an enormous task. This is a task that is worth doing. It's sometimes worth rolling up your sleeves and taking on a big task because there's a job that needs to be done. He refers to the mobility of the workforce and people working across borders. We shouldn't, should we, expect England substandard staff from Wales? Well, we don't want to take substandard staff from anywhere else, so surely we should be setting our own parameters by which we expect to be able to employ our staff in order to achieve the standards that we want within the NHS. It's the job that needs to be done. I picked up a suggestion from the Minister that it's something that Government will look at in future. I hope that's true, but for the time being we're still going to be supporting our own amendment, and I ask you to too.

The question is that amendment 72 be agreed to. Does any Member object? [Objection.] We therefore proceed to a vote on amendment 72 in the name of Rhun ap Iorwerth. Open the vote. Close the vote. In favour 22, no abstentions, 28 against. Therefore, the amendment is not agreed. 

Amendment 72: For: 22, Against: 28, Abstain: 0

Amendment has been rejected