Agenda item

Context:

To scrutinise the White Paper: Services fit for the future – Quality and Governance in health and care in Wales.

Key Issues:

The Select Committee received a presentation by representatives of Welsh Government regarding the White Paper: Services fit for the future – Quality and Governance in health and care in Wales.  All Members of the Council were invited to attend the Select Committee meeting to undertake scrutiny in respect of this issue.

Member Scrutiny:

Following the presentation, a question and answer session ensued. In doing so, the following points were noted:

·         The Health Board had raised concerns regarding how new duties might be enforced.

·         There is no intention for the NHS to become the dominant partner. The White Paper is looking to build on what is already legislation, i.e., partners equally working together. It is about facilitating the culture in order for health boards to work more closely with social services and local authorities.

·         Local Health Boards already have duties for citizens’ engagement but the White Paper wants to future proof these arrangements by making them more effective.

·         Any legislative changes that might result from the White Paper will result in all costs being set out and when the bill is introduced, that document will be laid with it. Engagement with key partners will be undertaken regarding this matter at the appropriate time.

·         Transparency already exists with open meetings of Health Boards.  However, it was acknowledged that there is still some way to go to improve this.  A system has been in place since 2011 entitled ‘Putting things right’ which seeks to resolve issues fairly and openly.

·         There is a requirement for local Authority representation on health boards and this will continue, going forward. The current representation consists of an elected Member and Director of Social Services on the health board.

·         One of the key challenges is to strengthen the citizens’ voice but at the same time, not lose local representation and local links.  The proposals in the White Paper seek to invest statutory function in the national body but give it a significant amount of freedom to decide how to operate locally.  Depending on the results of the consultation, Welsh Government will have to look at whether this is right and whether something important might be lost.

·         The Organisation for Economic Co-operation and Development (OECD) report looked at all four UK nations and the quality of the health services. No one service is performing better than the others.  All services have their good points, as well as having their weaknesses.  The Wales service is very well placed to take advantage of the building blocks already in place in integrated health boards to make a difference in outcomes for the population of Wales. However, there is a balance that needs to be adhered to in terms of the centralised powers that exist, as opposed to local powers that exist.

·         Currently, the duty of candour does not exist in Wales. However, there exists a form of duty of candour which refers to the concerns, complaints and redress regulations which has significantly helped in being more open when things go wrong.  However, the White Paper will be wider, providing a cultural openness and transparency that will be imbedded across the whole of the service.

·         Broadly, the English health boards are composed in the same way as in Wales.  In Wales, we are currently doing something different in which the English health boards are not currently looking at.

·         A definitive time for the legislation is not currently available as the First Minister has taken a decision to only announce one year of the legislative programme at a time.  This is partly due to Brexit.

·         There is nothing in the White Paper which will have a major impact on cross border issues. Community Health Councils (CHCs) have their own patients in Wales, which is the same in England. However, the border is an issue, as the two different systems come together and they are not always synchronised. A protocol has existed for dealing with cross border arrangements for a number of years which is in the process of being revised due to arrangements in England necessitating that.

·         In response to concerns raised regarding the CHCs, it was noted that in terms of independence and patients concerns being heard locally, this will continue to be undertaken.  The intention of the White Paper is to strengthen the process and the views expressed by the public will need to be taken into account. CHC Members have already written to the Welsh Government regarding the White Paper which will be considered as part of the consultation process.

·         It was noted that there is a need for patient participation groups to be included in the White Paper, which are standard in England.

·         The Citizen’s Voice would be an independent body and the Scottish Health Council is a model that could be examined. By changing the CHCs to a new model, this would help strengthen the existing process. Independent scrutiny is a vital part of this role.