New citizens’ health watchdog should be appointed by the Senedd, not the government

(Title Image: Wales Online)

Health & Social Care Committee
Stage 1 Report: Health & Social Care Quality Bill (pdf)
Published: 15th November 2019

1. AMs should support the general principles of the Bill, but the duty of candour should be strengthened

The Bill has several key aims, namely to introduce a duty of candour to health and social care and to overhaul the way the views of patients are taken into account by replacing Community Health Councils with a single Citizen Voice Body.

The aims of the Bill were broadly welcomed, but some witnesses believed it could go further. There were calls for the new Citizens Body to have proper “teeth” and also consideration being given to the use of sanctions for failures.

However, the Health Minister, Vaughan Gething (Lab, Cardiff S. & Penarth), said the Bill’s provisions as they currently could well have made a very real difference in Cwm Taf maternity scandal where both a duty of candour and duty of quality were absent.

2. It’s unclear how the quality of services would be judged

The report says a common theme in the evidence was a lack of clarity on how the new duty of quality of care will be judged and measured. A quality duty already exists, but the NHS Confederation said there was no clear definition of what “quality” means.

BMA Cymru and other NHS bodies called for amendments to the Bill to set out a clear definition of quality and the standards to which it would be measured. The Committee recommended that amendments be tabled to provide for statutory guidance on the duty of quality.

The Minister told the Committee there are at least six measures of health care quality based on internationally-accepted definitions which include safety, effectiveness, being patient-centred, timeliness, efficiency and equitable treatment.

There was some disappointment from witnesses that there’s no proposal for a single health and social care inspectorate – with responsibilities currently divided between Social Care Wales and Healthcare Inspectorate Wales.

There were further calls for a system of sanctions too, but the Minister rejected that:

3. The new Citizens Voice Body has to be completely independent

There was an overwhelming view from witnesses that the replacement for Community Health Councils should be at some distance from the Welsh Govenrment – with some suggestions it should be directly accountable to the Senedd and also retain some element of local representation.

As things stand, the new Body would be fully appointed by the Welsh Government. The Public Services Ombudsman and BMA Cymru oppose this, while the NHS Confederation were concerned the new body would lack public trust from the start.

The new body will also lack the right to access health and care settings to hear directly from people being cared for via both announced and unannounced visits.

The Minister believes the new body will be more independent than the Community Health Councils and appointments by the Welsh Government were well-established and subject to “open and fair competition” based on the merit of the applicants. He didn’t think it was appropriate for the new body to have a blanket right of entry either.

Nevertheless, the Committee recommended that members of the new body are appointed by the Senedd and not the government. They also recommended the Bill is amended to introduce a qualified right of access to speak to service users and carry out checks on care, as well as an internal local structure.

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