Group 13 is our next group of amendments, and it relates to structures of and engagement by the CVB. Amendment 40 is the lead amendment and I call on Angela Burns to move the lead amendment and speak to the other amendments in the group. Angela Burns.

Amendment 40 (Angela Burns, supported by Caroline Jones) moved.

Diolch, Llywydd. I'd like to formally move amendments 40, 19 and 20.

This comes to the nub, to the heart, of the citizen voice body. If you talk to the citizen, they want a voice body, they want a representative body that's local to them, understands their local issues, understands their local health board, somebody they can access easily—and, of course, it's not just health boards now, it'll be the local residential home, private or public, it'll be domiciliary care, it'll be across all sorts of settings. There is a fear by significant parts of Wales that we get chopped out of the equation, and that everything is centred here in the south-east. North Wales, in particular, has a very strong sense of that disconnect; west Wales has a very strong sense of that disconnect, and we don't want that to happen. So, this is why we've tabled these amendments, to try to ensure on the face of the Bill that it's not just a promise, but it's actually in writing, that this voice body will represent people on an as-near-to-them-as-possible basis.

Now, I am not, as you all know, an entirely unreasonable person, and I have discussed this matter with the Minister at great length and listened to him in various stages, talking about this. So, I have moderated from saying that I want an absolute replica of the CHCs—one for Pembrokeshire, one for Carmarthenshire, one for Ceredigion—and I'm prepared to go down the regional model, which is why amendment 40, which deals with that structure of regional body is very, very important. It is similar to amendment 59, tabled by the Minister, and amendment 75, tabled by Rhun ap Iorwerth. But we think, having talked to the Minister, and having talked to various people, that if we could build it on a regional basis, perhaps reflecting our regional partnership boards—which are there, which are enshrined, and we've been told that so much of our direction of travel over the next five or 10 years is going to hang on those regional partnership boards—it seemed very obvious to make them the footprint for a regional voice body.

I'm very sad that, despite our conversations, the Minister has remained intransigent about this point. He wants flexibility, and I understand that desire. But I would warn you, Minister, that your quest for flexibility here, as has been the case throughout the Bill, runs a very real risk of leaving too much off the books—too much down to subsequent decisions, subsequent guidelines, subsequent promises and subsequent intent. And above all, what we don't want to see is some body that is centralised in a place where, if the citizen wants to access them, they have to phone into this place, and maybe somebody will come out—maybe somebody will come from Cardiff to Pembrokeshire, maybe somebody will come from Cardiff to Arfon to listen to somebody, hear their problems and try and sort them out. That's not what we want. So, we are very keen to see our amendment, which enshrines the locality, actually put onto the face of the Bill. And if our amendment were to fall, then I would support the Plaid one. Although, my only comment is that the structures that you are suggesting it could be based on could be changed in the new format, if they change local government, if there's, you know—. So, that's why we went for the regional partnership boards, because we think that, whatever happens, they'll probably be the rocks that never, ever move.

And, Minister, I thought about this long and hard, because I thought, 'Well, if our amendment falls and then Plaid Cymru's falls, the next best thing perhaps would be to adopt your amendment, which promises face-to-face consultation wherever possible, however possible', but the more I thought about it, the more I thought, 'No, that's just not right.' This is a body to represent the citizen's voice, wherever they are, not wherever you or the body are—big difference.

There are five amendments in this group. We will be supporting the three that have just been described by the Conservatives.

Amendment 59 is a Government amendment that is a step forward from what we had previously—it talks of the need for the citizen voice body to represent everyone in all parts of Wales. But, do you know what? Those are words, and what we've tried to do through drawing up our amendments for Stage 3 here was to try to put some meat on the bones in order to persuade people that we are serious about creating a new body that will feel close to them, because that is important. Because it's not just the voice of patients—that's not what the CHCs have been; they're also a voice for the communities in which those patients live. And that direct relationship, I think, between the patient voice or the community voice and the communities that they advocate for is something that is truly important to me. And the fear of losing that is one of the main reasons why we cannot why we cannot support this Bill as it currently stands. Because it takes a strong local body with a strong local presence and it will scrap that and put in its place a body that has a structure that we don’t quite yet know what it’ll look like, and a presence at a local level or a regional level, but we have no idea how it will ultimately look.

And let me tell you how this Bill looks from the perspective of north Wales, for example. From the north Wales perspective, it appears here that we have a Bill that is seeking to scrap a very effective community health council in north Wales because it has been very effective in its scrutiny of the Government’s record in running Betsi Cadwaladr. That’s the perception in north Wales. There’s no doubt about that. I’ve referred once already to the excellent work that the north Wales community health council has been doing over the past few weeks and months in engaging with the public across the north-west of Wales on the changes—the disastrous changes, as I see them—to vascular services. And I’ve congratulated them on their work in that area.

Does anyone really believe that a national citizen voice body that is centralised in terms of its ethos could provide that same kind of local scrutiny? I don’t feel that that scrutiny would be in place. Some people would say that it would be focused on south Wales. Now, I don’t want to see a split between north and south. I want an united nation. But I will say that, if you get your way as a Government, establish the CVB and put its HQ in north Wales. That would be positive and would perhaps be a solution to the picture I painted as a scenario just a few moments ago. But that doesn’t resolve problems in other parts of Wales, who would see it as a voice that is overly focused on north Wales. But I have given that invitation now.

But what our amendment and the Conservatives' amendments do is to try and alleviate this problem, to respond to that perception of what is actually happening here by removing that local voice, and what we have done is try to define—. Of course, we’ve been in negotiations with the Government to try and persuade them to provide a definition that can work regionally. We’ve failed, so we’ve brought this forward. And I know that the Government will reject our amendments, and I’m sure they’ll argue that it’ll be very difficult legally to define what is meant by 'regional'. But there are many bodies that work at regional levels, and, to respond to the point made by the Conservatives earlier, we aren’t being prescriptive as to which model to follow here, but we do have many regional bodies—the fire services, the public services boards and so on and so forth—and all the Government would need to do in their policy statement would be to explain what the regional footprint would be.

It could even change over time, and certainly the intention with this amendment is to provide the Government with that flexibility to provide that strong local link whilst continuing from here on in to seek the best model to provide that. We’ve done our very best to meet the Government half way, but we don’t expect the Government to travel with us on that journey, so we will reject the Bill, I fear.

One of the biggest criticisms of the Welsh Government's plans to replace the CHCs was the loss of the local, regional voice. We have given our support to Angela's amendments because, in our view, they will help restore the local links that would be lost by scrapping the CHCs and replacing them with a small national body with an office in Cardiff, for example. If the new body is to truly be the voice of the citizens it has to have representation in all parts of Wales and be accessible to everybody, regardless of where they live in Wales.  

Votes on this Bill thus far, I fear, have further weakened the citizen's voice in Wales, further reduced the accountability of public servants, and further tilted power away from people and places to public bodies. But these amendments provide an opportunity to reverse that trend, where only independent local voices give true challenge locally. This is critically important, as we've heard, particularly in Betsi Cadwaladr university health board area, where the community health council has been particularly effective in providing a citizen's voice, sometimes perhaps to the annoyance of people in public bodies and people in Government, but we need to praise them for doing their job, recognising, as Angela said earlier, that owning a problem, actioning a problem, exposing a problem, addressing a problem, creates positive outcomes, creates reputational gain, creates happy employees and creates happy citizens. The opposite culture creates the opposite of all those things. 

As the board of community health councils and community health councils in Wales have said, the intention that the citizen voice body has a local presence covering all parts of Wales should be set out clearly in the Bill. They say the Bill should clearly reflect the intention that the citizen voice body has a local presence covering all parts of Wales. They say a requirement that the body must demonstrate its accessibility to people in all parts of Wales on a face-to-face basis would help ensure that everyone, including those who may not readily be able to travel or access online services, can confidently share their views and experiences with the citizen voice body. The body must be properly equipped and funded to support and develop its staff and volunteer members through appropriate learning and development, they state. They say people across Wales are clear that a new citizen voice body needs to have teeth if it's to be truly strong, truly independent, a true voice to reflect their views and represent their interests in health and social care at national and local level. Because people will only be confident that the new body has these teeth and is capable of meeting their needs long into the future if this is clearly set out within the statutory framework established for the body.

Please prove me wrong: please show that my initial comments are entirely invalid and that you are listening to what makes things work properly, and that you believe we have to have an effective balance of power between Government and the people so that the people's voice is always respected, always heard and always acted upon. Because, at the moment, it looks as though things are going badly in the wrong direction.

I just wanted to endorse briefly some of the comments Rhun made. Rhun referred to the excellent work that the north Wales community health council has done, particularly on vascular services, but that’s one of very many cases. I can tell you that the CHC has played a crucial role in the work around the newborn intensive care units. You remember that campaign that was ultimately won and the CHC was at the heart of it.

They have been a superb advocate for families and those affected by events at Tawel Fan. That, again, was a very prominent case across north Wales, and the CHC were at the very heart of the work there. We’ve heard about vascular services. There’s the whole agenda around special measures. Once again, it’s the community health council that is the voice of the people. They have been there in all circumstances, fighting and standing shoulder to shoulder with patients and citizens, doing exactly what it says on the tin.

Nobody here should be under any misapprehension: this is seen as the Welsh Government closing down a strong and effective voice and advocate for the people of north Wales. I know that the Minister will argue differently, and he has every right to do so, but that’s the perception.

Now, I don’t know whether some of the CHCs are less effective and that we see the loss of the north Wales CHC because of the failings of others. I don’t know. I’m only aware of the situation in north Wales. I tell you now: the perception is that it’s seen as a way of avoiding the scrutiny and the accountability that the health board and the Government have faced over a period of years.

You could do one thing to send a clear message to the people of north Wales. You could make a decision that this body will be located, as Rhun said, in north Wales. I think that would go some of the way to alleviating some of the concerns of people in north Wales. But, unfortunately, losing the community health council will be a loss and the Government has a great deal of work to do to convince people that there isn’t another agenda being played out here.

I call on the Minister, Vaughan Gething.

Thank you, Llywydd. I have listened again to the debate on these amendments, as, indeed, this has been a significant part of the passage of both the White Paper and, indeed, through Stages 1 and 2. Now, I do, though, recognise that we're broadly at the same starting point, which is how we ensure that the citizen voice body represents the interests of people throughout Wales and is accessible to people in all parts of Wales.

I indicated during Stage 2 scrutiny that I would meet with opposition health spokespeople to listen to their concerns and try to find a common way forward. The meeting was constructive and we did make progress in agreeing how the Bill might be improved. It's unfortunate that we weren't all able to come to agreement on a common position, but it is a positive step that there has been some recognition that the Government amendment represents a step forward. I am, though, pleased to indicate that the Government will support amendments 19 and 20. I agree that, if passed, those amendments will strengthen the Bill. I've always been clear throughout the scrutiny process that the new body, to deliver its interventions effectively, cannot be remote from the people whose voices it needs to represent. Requiring the body to have regard to the importance of face-to-face engagement when they're seeking views and providing complaints assistance, as required by amendments 19 and 20, I believe takes a further significant step forward in that regard.

Amendments 19 and 20 complement the Government amendment 59, which adds further strength in this area, and I am, of course, happy to support them. The Government amendment 59 requires the body to set out in its statement of policy how it proposes to ensure that it can represent the interests of people in all parts of Wales, is accessible to people throughout Wales, and also how it proposes to ensure that its staff and others who act on its behalf, such as volunteers, are able to engage effectively with people throughout Wales. That places clear duties on the citizen voice body relating to its engagement with people throughout Wales. This isn't just a Bill for north, south, east, west or mid Wales; it's a Bill for the whole country, a citizen voice body for the whole country. And it will have to publish a statement explaining its policy in this respect. So, I would ask that Members support Government amendment 59 and the two amendments that I've previously mentioned, 19 and 20.

However, I don't support amendments 40 and 75. I'll deal with amendment 75 first, because I don't believe that it achieves what the mover actually wants it to. When you look at the wording of it, it really isn't clear what a regional level is, and I think it's important to be clear about what's proposed. Similarly, it is not clear in amendment 75 what an 'effective permanent presence' means. It could mean an operational full-time presence, or it could mean something that exists in perpetuity. Now, I remain of the view that not only are there technical challenges there, but also, on amendment 40, requiring the citizen voice body to establish regional bodies along regional partnership board footprints at least has some certainty in our current arrangements.

However, I still believe, and I come back to this point about independence, that, for an independent body—and the new citizen voice body will be significantly more independent than the current arrangements for a hosted body within Powys health board—they, the citizen voice body, should not have their ability restricted in determining what their local structure should be. The body itself will be best placed to judge this, based on what I'm sure will be the changing local needs over coming years, and it will have the knowledge to know how to operate most effectively. Placing constraints is not, I believe, in the best interests of the body nor the public whom it will ultimately serve. I'll take the intervention and then I'll finish.

Thank you for taking the intervention. You've referred a couple of times now to Powys. Speak directly to my constituents and people in the north of Wales—and I explained how I believe this is perceived by them—how do you explain to them that the citizen voice body that you are proposing will be more independent, will be holding you firmer to account, than the community health council and the excellent work that it has been doing in the north of Wales over the past few years?

An arm's-length corporate body, able to enter into its own contracts, its own arrangements, its own leases, is significantly more independent than a body that is hosted by Powys Teaching Health Board. All of the community health councils' staff at present are employees of the national health service through Powys health board. Now, to move those people to an independent, arm's-length corporate body, able to determine their own affairs, is undeniably a more independent way of operating than their current arrangements. Those are the facts of what is being proposed. The challenge here is whether Members are able and willing to describe honestly the difference between that set of arrangements and the ones that currently exist.

The current Bill gives the citizen voice body the power to establish committees, to enable it to establish local or regional committees that are focused on local or regional needs as they, not the Government, see them. It can, as I've mentioned, enter into contracts or leases for premises. Therefore, it can determine where its offices should be based. It won't simply be tied to a location determined by Ministers in Cardiff, as is often supposed to be the case. It will be up to the citizen voice body to determine where it is based, not just its head office, but all of its other regional locations as well. 

The desire not to prescribe the structure is not linked to money. The regulatory impact assessment clearly includes costs for multiple offices. The costs in the impact assessment are based on the current CHC accommodation, which has staff spread across 12 locations within Wales. In developing and preparing its statement of policy, I'd expect the body to engage and involve stakeholders to ensure that its arrangements are actively supported by people across Wales. I believe that strikes the right balance between allowing the body to determine its own local structure, based on its own assessment, whilst placing a requirement on the body to ensure that it is accessible to and able to represent all people across Wales. So, I remain committed to an organisation that has local roots, but where the body itself determines where it is based and how it is organised, and I ask Members to support that approach.

Angela Burns to reply to the debate.

Thank you very much, Presiding Officer. Let me just deal with this by picking out little bits of it. I want to put to bed the 'hosted by Powys' argument, because I think, actually, that's disingenuous; smoke and mirrors, if you like. Powys doesn't have any hospitals—[Interruption.] I haven't finished my sentence, Kirsty Williams, I know that you like to defend Powys at all accounts, I was just going to finish my sentence—of huge note. Thank you. They've operated very well under the Powys umbrella. I actually don't think that, 'They're going to be more independent and, therefore, they'll be better', cuts any mustard, because they've already shown that they can be better, that they can be independent. Llyr Huws Gruffydd made an absolutely stunning case for the north Wales CHC and the outstanding work that they have done over the last few years, especially calling to—

If I can give a specific example—thank you for taking the intervention—on the challenges that the current arrangements provide: when, with the previous chief executive of the community health councils movement, there was a challenge about his conduct, community health councils themselves couldn't take action because he was an employee of the national health service. Powys had to agree a range of actions to take. That's my point: they couldn't undertake a range of measures. They can't enter into their own leases, they can't do their own employment issues, in their current form. This new way of operating that we propose will allow them to do so and give them the distance and the power to control their own destiny.

I did not say, at any point during my contributions, that they should not be independent of Powys. I do not think it is a primary reason for making these changes to the citizen voice body. My personal view is that a lot of the changes to the citizen voice body could be construed—in fact, I do construe it—as a bit of a muzzling exercise: let's get them on board. I want to make sure that that citizen voice body—. It's not my voice body, it's the voice body for my constituents, your constituents, and your constituents, and I want to make sure that they believe that it is their citizen voice body.

I don't think they care at the moment where it is hosted and by whom, but I do take your point that it should be an independent body, and I'm very happy for that to happen. What I'm not happy about is: nowhere in this Bill does it say, 'When you reconstitute yourself, and you regather all your directors, and you regather your staff and your chief executive and your chair, you will, you must, ensure that you have arms and legs, you have soldiers on the streets of Wales in each and every corner and part of Wales.' It doesn't say that.

And I'm very disappointed in your amendment 59. While I'm thrilled that you've accepted 19 and 20, which you and your officials worked on with me, I am disappointed in 59 because our amendment 40 was based on your commentary in the meeting that we had that regional health boards might be the solid rock on which to build it. So, I was prepared to come forward—yes, you did. I came forward and said, 'Okay, I will row away from there being one in Hywel Dda and one in here and one there, I'll build it on a slightly bigger footprint.' Regional boards were seen, partnership boards were seen as the key way of doing it. So, that's why I'm very disappointed in your amendment 59 and why I won't be supporting it.

Because I am desperately worried that, not only are we going to end up with a Bill that doesn't have the appropriate method of being able to say, 'If you fail on your duty of quality, these are what outcomes we expect; if you don't do it, this is what will happen—and for your duty of candour', and there's no real measurement or teeth in the whole thing, but we're now going to end up with a citizen voice body where—and I hear you say that it won't happen—in theory, the new team could say, 'We're going to have just one body and what we'll do is we'll just have representatives over there who'll all be volunteers and they won't be staff.'

Let me tell north Wales that, as somebody who lives in west Wales, I am perfectly happy for the citizen voice body to be based in north Wales, because what I want it to do is I want it to be based in a place where you feel on the edge of things, where you feel marginalised, where you kind of feel actually left out. So, I'm perfectly happy for it to be based there, because I know that, if it is based in a place like north Wales, the people running it will have a really clear understanding of why it is so important that all the corners of Wales, all the edges of Wales, are brought in and represented and given a voice. So, I don't have any problem with that suggestion, and I would like everyone to please support amendments 40, 19 and 20.

The question is that amendment 40 be agreed to. Does any Member object? [Objection.] We therefore proceed to a vote on amendment 40. Open the vote. Close the vote. In favour 21, no abstentions, 27 against. Therefore, the amendment is not agreed.

Amendment 40: For: 21, Against: 27, Abstain: 0

Amendment has been rejected

Amendment 19 is the next amendment. Angela Burns.

Amendment 19 (Angela Burns) moved.

Formally, Llywydd.

The question is that amendment 19 be agreed to. Does any Member object? No. Therefore, amendment 19 is agreed.

Amendment agreed in accordance with Standing Order 12.36.

Amendment 59 is the next amendment. Minister.

Amendment 59 (Vaughan Gething) moved.

Formally.

If amendment 59 is agreed, amendment 75 falls. The question is that amendment 59 be agreed to. Does any Member object? [Objection.] We therefore proceed to a vote on amendment 59. Open the vote. Close the vote. In favour 28, three abstentions, 17 against. Therefore, amendment 59 is agreed. Amendment 75, therefore, falls.

Amendment 59: For: 28, Against: 17, Abstain: 3

Amendment has been agreed

Amendment 75 fell.