The next group of amendments is group 7, which relates to the duty to secure quality in health services and a review of statement of standards. Amendment 36 is the lead amendment in this group, and I call on Angela Burns to move that amendment and to speak to the other amendments in the group. Angela Burns. 

Amendment 36 (Angela Burns) moved.

Diolch, Llywydd. I formally move the amendments tabled in my name. These amendments consider the Minister's concerns at Stage 2 about the implications of extending safe staffing levels to all clinical staff. This is despite the Chair of the Health, Social Care and Sport Committee stating that, in the committee's view,

'it is impossible to separate out the issue of quality from the provision of appropriate staffing levels—they are inextricably linked.'

And we still firmly believe that is the case. The Minister has instead relied on the health and care standards on workforce levels, and, at Stage 3, the Minister promised to update them. To that end, amendments 36 and 37 are intended to place that promise on the face of the Bill. 

Amendment 36 places a duty on Welsh Ministers to carry out a detailed review of the standards at least once every term, meaning that we will have an opportunity to, first of all, analyse how effective the standards are at ensuring safe staffing levels. I cannot impress upon the Minister enough how important it is that we have this commitment across all clinical staff since the Mid Staffs report's findings. Indeed, the Royal College of Physicians UK said that, in 2018, more than one in five of their census respondents reported that gaps in trainee rotas occurred so frequently as to cause significant problems in patient safety. It is therefore essential that workforce planning is undertaken across the board. As such, health boards need to ensure workforce levels are planned and accounted for, and not to just rely on safe staffing for nurses. Secondly, we need to be fully aware of evolving changes to NHS pressures in population age, which will increase incidences of comorbidity and complex conditions. And we also have to recognise the technological advances, which may have a further impact on staffing levels. It cannot therefore be left for five years between updates and reviews to this important document. 

Amendment 37 ensures that Ministers must have regard to the views of stakeholders when updating and reviewing these standards. I do note, Minister, and you've already mentioned it tonight, that you've invited the British Medical Association Cymru and the Royal College of Nursing Wales to reviewing and updating the health care standards in the first instance. However, we believe this should be an ongoing duty, so that healthcare professionals are taken seriously throughout the review process. 

It is extremely heartening, Llywydd, to see such a wide range of Welsh healthcare representatives bodies, including BMA Cymru, RCN Wales, the Royal College of GPs Wales, the Association of Medical Research Charities Wales, the RCP Wales, the Royal College of Surgeons of Edinburgh, the Royal College of Surgeons, and the Royal College of Midwives Wales, calling on the National Assembly to support amendments that ensure the duty of quality in the Bill is underpinned by guidance that includes reference to workforce planning, and that health and care standards are appropriately and regularly reviewed, and that reporting by NHS bodies of the steps taken to comply with the duty of quality includes workforce planning. I therefore urge all Members to support these amendments. 

In all seriousness, we will be supporting these amendments. This is our insurance policy after failing to have our amendments passed in group 2. I reminded you earlier that I was concerned that there were a number of standards that I'd like to see on the face of the Bill that are not there, and that that is in the context of guidance that is five years old by now. If the guidelines are going to be valuable, then we have to ensure that those guidelines are contemporary and up to date. And, in failing to have that strengthened on the face of the Bill, then, certainly, we want to see the commitment to have standards that are up to date and meet requirements that constantly change in our health and care services. 

I call the Minister to reply to the debate—Vaughan Gething.

I don't support the amendments, as I believe they're unnecessary. The existing legislation requires the standards to be kept under review. That means they are already subject to regular review, and updated standards are published. There is clear evidence to demonstrate that that has happened. The first set of standards, under the Health and Social Care (Community Health and Standards) Act 2003, were published in 2005. They were updated in 2010 and 2015, and of course a review of the current framework is already under way in 2020. So, as you can see, the standards are already reviewed and updated each five years. The NHS does not stand still, so it stands to reason the standards must be kept under review and updated as necessary.

With regard to amendment 37, there is already a duty to consult before publishing or revising the standards. Wide stakeholder engagement and consultation has therefore been, and will remain, a fundamental part of future reviews of the standards, as is required by the Act. Part of consulting is to take the views of consultees into account. A consultation cannot be effective without doing so. The proposed change adds nothing to what is already required by legislation and a well-established process, and I ask Members not to support the amendments.

Angela Burns to reply to the debate.

Thank you, Presiding Officer. All I will say is I totally disagree with the Minister. As I outlined, there's so much that's going on in the NHS, there are so many advances, there are so many changes in the patient profile, we need our standards to be operated on a very, very regular basis. And, once again, I will remind everyone that we're always talking about listening to the clinicians, doing what they think is the best, taking on their advice. And I read out at the end of my first contribution a list of organisations that support this amendment, and I suggest that all Members should listen to them.

The question is that amendment 36 be agreed to. Does any Member object? [Objection.] We therefore proceed to a vote on amendment 36. Open the vote. Close the vote. In favour 22, no abstentions, 28 against. Therefore, the amendment is not agreed.

Amendment 36: For: 22, Against: 28, Abstain: 0

Amendment has been rejected

Amendment 37, Angela Burns.

Amendment 37 (Angela Burns, supported by Caroline Jones) moved.

Formally, Llywydd.

The question is that amendment 37 be agreed to. Does any Member object? [Objection.] We therefore proceed to a vote on amendment 37. Open the vote. Close the vote. In favour 22, no abstentions, 28 against. Therefore, the amendment is not agreed.

Amendment 37: For: 22, Against: 28, Abstain: 0

Amendment has been rejected