Item 11 on our agenda this afternoon is a debate on Stage 4 of the Health and Social Care (Quality and Engagement) (Wales) Bill, and I call on the Counsel General and the Minister for European Transition to move the motion. Jeremy Miles.

Motion NDM7306 Vaughan Gething

To propose that the National Assembly for Wales in accordance with Standing Order 26.47:

Approves the Health and Social Care (Quality and Engagement) (Wales) Bill.

Motion moved.

Thank you, Deputy Presiding Officer. I move the motion.

I'm pleased to open this afternoon's debate on the Health and Social Care (Quality and Engagement) (Wales) Bill. The Bill is the product of a great number of contributions, from a wide range of sources. The Bill has been informed by over 330 responses to our 2017 consultation, which provided a sound basis for bringing forward the legislation. And I'm grateful to all of those who have contributed throughout that process, and during scrutiny of the Bill itself, to support the development of the thinking and the approach. As always, the scrutiny process has provided insight, and sharpened our initial proposals. And I'd like to pay tribute to the work of the members and officials of the Health, Social Care and Sport Committee in leading this work. Both the Legislation, Justice and Constitution Committee and the Finance Committee have also examined the provisions thoroughly, and I'm grateful for their work in this area also.

I wish to acknowledge the efforts of stakeholder groups, particularly the board of community health councils, the British Medical Association, the Royal College of Nursing and the Welsh Local Government Association. We are committed to continuing this work together, with engagement from other key partners, including citizens and professional representatives, as we move into the implementation phase, subject to the passage of the Bill today, and of course to Royal Assent being granted. If passed today, and subject to Royal Assent, the Government's intention is that the Bill will be implemented within two years. The provisions within this Bill represent a significant step forward in driving quality and improvement in health and in social care, and I urge Members to support the Bill today.

I'd like to remind everyone that this Bill did move at pace, and I'd like to put on record my thanks to all the committee clerks, to the officials on the Welsh Government side. And I'd like to pay particular tribute to our head of research, Georgina Webb, for all the work that she did on this Bill.

And what a Bill. It started with such promise: to drive duty and candour through our healthcare services. It was a Bill full of opportunity, where we could actually look to our healthcare services and say, 'Now is the time for you to really understand that quality is a key driver within the NHS, candour is a key right within the NHS'. And, of course, it was the opportunity to protect and preserve the voice of the people of Wales, their opportunity to actually put forward what they think to formulate and to shape the direction of travel.

But, to be frank, it's an opportunity that has been squandered. And the Welsh Conservatives will not be sponsoring—or, sorry, supporting—this Bill. Why? Because it is a Bill that has not actually done what it said it would do. Counsel General, when I look at the duty of quality, I feel that part of this Bill still remains hugely weak in detail. As I stated last week during the Stage 3 process, I remain concerned that the Bill's provisions on the duty of quality are overly broad—it risks becoming an aim rather than a duty. Without specific mechanisms for health boards to undertake the necessary action to ensure that it's monitored and upheld, what does duty of quality really mean? How are we going to measure it? And, if you fail in your duty of quality, what are we going to do about it? The Bill says none of that—it's very light on it.

And it's not just me who thinks this. This is across a number of different forums, and I just want to bring forward two. The first is from the British Medical Association, who says that:

'Unless some form of sanction or corrective action is triggered, we believe that the proposed duty would run the risk of lacking effectiveness' and could just become a box-ticking exercise. And, of course, the Royal College of Nursing—these are the professional teams that make the health service run as it does. There has to be a consequence to doing it or not doing it, otherwise there's no incentive to do it at the most basic levels. 

And then we turn to the duty of candour. Now this is really an area that deeply concerns me. I've strong reservations as to how effective this Bill will be when delivering this aim, and I stand by the comments I made in Stage 3—that it's because there's been no clarity over whose responsibility it is for failings. Buck-passing has become absolutely routine, and ignorance should not be a defence. The need for this section of the Bill to work effectively is that honesty, openness and transparency should be the focus and, indeed, the locus of the whole health service and the Government, and I still feel that, without a sea change in the culture that's become prevalent across some of the health service management, it is still not being delivered. 

I understand that this Bill, in and of itself, would not necessarily have prevented some of the scandals that we've seen in places like Cwm Taf and Betsi Cadwaladr, However, it would, with more teeth, have enabled us to strive for an NHS with an honest and open culture—a culture where, when a staff nurse or a midwife does a report that says, 'There are serious failings in maternity services', he or she would feel empowered to be able to flag that up, because that's a duty of candour. Nothing in the current Bill is there that says something that will say, 'You can do that'. In fact, rather it's 'Please be candid' and 'Oh, never mind, if you find you haven't been—. There's not a lot we're going to do about it'. 

And then finally, I just wanted to turn to the citizen voice body. I think that is something that has exercised the hearts and the minds of the public and all the local community health councils. Now, I absolutely appreciate that the CHC board have rightfully said, 'We are where we are. Probably the numbers will indicate that this Bill will pass and we will work with the Government'. And they are happy that you've agreed to engage and consult. But I say to you that if this isn't just some political sort of smoke and mirrors, you must engage with them honestly, deeply and truthfully and really bring them on board. Because I've said it before and I'm going to say it again: we keep talking about the voice of the citizen. The health service is for the people, it's about the people, it's staffed by the people and it is in the heart of our country and we absolutely must give the people a voice. And this Bill, as it currently stands, does not enshrine that voice. And I'm just—

Can you do your winding-up, please?

Oh, I beg your pardon—I'm so sorry. I will, but I just want to say this: the Bill, Deputy Presiding Officer, as it stands is a Bill of rights and not remedies; it's a Bill that hopes for quality and candour, but, in my view, it does not show true leadership on how to achieve it and it is a Bill in which the patient's voice can so easily be lost. And it's for these very reasons that the Welsh Conservatives are unable to support this Bill.

Of course, broader events in the health area have put this Bill in some kind of context, but as a party we’ve always been doubtful about this Bill because we believe that it is the wrong solution to the wrong problem. We can't support abolishing some of the most effective voices for scrutinising health boards, for example—the CHCs—even if some of them are not as effective as the one that we have in north Wales. We can’t see how pressing ahead with this kind of structural change is going to be worth the effort that would go into that.

And do you know what? Following the publication of the Williams report several years ago, I don’t think that anybody would have guessed that the CHCs would be the first set of organisations to face mandatory mergers, and there is more than a suggestion of doubt here that it's because of their effectiveness in terms of scrutinising the health boards, and therefore the Government, that they’re being abolished. And if I could say this: we don’t want to protect the CHCs forever, not those bodies—we don't see them as something sacred—but it’s the functions of those bodies and what they do, their independence, and we have concerns about what's going to happen to that independence and their genuine ability to be a voice for the communities that they represent.

Do you agree with me that the work of the North Wales Community Health Council is a laudable example of why we need this scrutiny to continue? The concern is that, by creating one national body, that local-level scrutiny won’t be able to take place.

I agree with that entirely and that’s been shown, hasn’t it, by the great research that’s been done about the vascular services at present. So, we are very concerned about losing that function and that strength that lies within the CHCs—

Will you take an intervention?

—at present. Of course.

Thanks for that, Rhun. You mentioned the importance of the independence of the community health councils. It's not just a question of independence though, is it? It's also a question of their agility, because they're able to go into those health establishments with very little notice, be a genuine friend and voice to the people who are there, and inspire that sort of confidence. So, it's that ability to go wherever they want to as well, at short notice, which must be protected.

And their in-depth local knowledge as well, which is something that's very important to note, and we tried to introduce amendments to the Bill that would try to enforce an element of regional working in order to keep that local expertise. Sadly, Government wouldn't agree with us on that.

But there is more than just the CHC situation that forms the basis of our concerns. This Bill claims that it provides quality at the heart of making decisions, but doesn’t mention specifically the quality of workforce, preventing ill health, reducing inequalities, the need to ensure that Welsh speakers aren’t treated as second-class citizens— fails to set those standards clearly on the face of the Bill. And even though we do welcome the certainty from the Minister that those things are not being forgotten, we do feel that failing to put that on the face of the Bill is a backward or retrograde step. We all accept the need for workforce levels to be incorporated in legislation when we supported the Nurse Staffing Levels (Wales) Act 2016, and the British Medical Association and the Royal College of Nursing are among the bodies who have emphasised the importance of this. That is an issue we definitely want to return to.

Turning to the duty of candour, simply, we don’t feel that this is strong enough to meet the aspirations of the Francis report and all of the other reports that have recommended this. It is an improvement on the status quo—we recognise that—but it could have gone much further. So, we have to question whether this Bill will genuinely improve the NHS and our care services. That’s the wrong way ahead for us. What we would have liked to have seen was a piece of legislation that had a duty of candour that was much stronger within it, and establishing a professional regulatory body for managers—something that we’ve called consistently for during these discussions—incorporating workforce planning within the legislation, and then protecting the voice of our patients in every part of Wales. So, for those reasons, we are not going to be able to support this Bill. It asks officials to focus on the wrong kind of change and for not enough benefit.   

Can I call on the Counsel General and Minister for European Transition to reply to the debate? Jeremy Miles.

Dirprwy Lywydd, I think it's evident from our debates—both at committee and at Plenary—that a tremendous amount of effort has gone into considering how the Bill, as introduced, could be improved, and, indeed, it has been. The debate at Stage 3, and the contributions today from the Conservative and the Plaid Cymru benches, indicate that we haven’t always been able to reach agreement, and I would echo the arguments which the health Minister made in the debate at Stage 3 responding to some of the points of substance which have been raised today. But, not withstanding that absence of agreement on all those areas, we have a common purpose, I think, in strengthening the duty of quality, the duty of candour, the governance arrangements and the voice of the public, and the Welsh Government is satisfied that the Bill achieves these things.

If the Bill is passed today, as I urge Members to do, I want to reassure you that the detailed consideration given to this Bill and the important advice received from stakeholders will also be taken into account when we move into the implementation phase. I hope Members will support the Bill.

Thank you. In accordance with Standing Order 26.50C, a recorded vote must be taken on Stage 4 motions. So, I defer voting on this motion until voting time.

Voting deferred until voting time.