Thank you, Llywydd. I have listened to the rationale for laying the amendments tabled in this group, both at Stage 2 and again today. In relation to amendment 39, which, for reasons that I'll explain again, I don't agree with, the purpose and the effect is quite clear: any failure by an NHS body to comply with the duty of candour procedure regulations, or with the provisions is sections 5 to 10 in the Bill, must be dealt with under NHS Wales's escalation and intervention arrangements. Now, there is a recognition that there are those arrangements in place already. But there's a technical point, though, about the fact that the escalation and intervention arrangements and their use in primary legislation means there's a mixture of legislative and non-legislative measures available to the Welsh Ministers.

However, those very much, as I say, work within a wider governance and accountability framework within the NHS at individual body and system level, through quality and safety committees, on health boards and trusts, quality and delivery meetings, and joint executive meetings. Those are all opportunities for scrutiny and appropriate and timely action and learning.

Should serious concerns emerge from those mechanisms, they would, where needed, inform any discussions and potential action under our existing escalation and intervention arrangements. However, it is my expectation that every opportunity should be taken to address concerns as they emerge and that a body should take immediate corrective action. I don't believe it's necessary to include a provision on the face of the Bill that essentially says failures by an NHS body to comply with the duty must be dealt with under the measures that already exist.

I've listened again to the intended purpose and effect of amendments 73 and 74 and their requirement for Welsh Ministers to set out the procedure in regulations that NHS bodies must follow if they fail to follow the duty of candour procedure or comply with the reporting and other arrangements set out in sections 5 to 10 of the Bill. So, that means there would be a procedure for failure to comply with the procedure, and a duty to make statements and issue a report where the NHS has failed to comply with their reporting requirements. Now, that sounds really quite bureaucratic to me and adds unnecessary layers of complexity to the operation of the duty, which is not desirable. I also have real concerns about how this would work, or rather wouldn't work, in practice.

The requirement in subsection (4) of amendment 73 for Welsh Ministers to make a statement on serious breaches of the duty of candour procedure could result in information that enables patients to be identified being disclosed. The definition of a serious breach is not clear, and it's certainly not defined in the amendment. Requiring Welsh Ministers to report on the number of the breaches of the duty of candour that are reported to them is, again, unnecessary. In terms of monitoring compliance with the duty, I expect regular updates to be provided in public safety and quality committee meetings so independent members, as a first port of call, can seek assurance that the duty is being discharged and learning being taken forward.

Now, that will be discussed at quality and delivery group meetings between Welsh Government, individual bodies, joint executive team meetings, and of course between the chief executive of NHS Wales and the chief executives of boards and trusts, as well as my appraisals with chairs and vice-chairs. The Welsh Government will also monitor the content of those reports alongside other sources of information to help us try and get at the application of the duty with, for example, consideration of serious incident reports. The reports will also be considered by Health Inspectorate Wales as part of their wider reviews of services. Where concerns come to light through these mechanisms, they would undoubtedly inform the tripartite discussions and any subsequent advice to Ministers on escalation and intervention.

But I do need to return back to a point that was made both at Stage 2 and in the previous two contributions: the key intention of the duty is to promote an ethos of learning and improving and the promotion of an open and honest culture to be owned at an organisational level. When comments are made about how there's already been an act of dishonesty or lying if the duty is breached, I don't think that sets the right tone at all. It would be possible for an oversight or a mistake to lead to a breach of the duty, not an act of deliberate dishonesty, necessarily. And that runs wholly against our aim to foster that open culture, where people can hold their hand up when something goes wrong, rather than looking to say, 'How can I explain this away or avoid responsibility?'

The approach that is being urged on us in these amendments is, in my view, entirely the wrong approach to take. And in any event, the powers to intervene already exist. I don't believe that these overly bureaucratic amendments would facilitate the creation of the open and honest ethos that we're aiming to create. More concerning, though, is that they really could drive a much more punitive culture and a fear of reporting. I ask Members to reject the amendments in this group.