Cynulliad Cenedlaethol Cymru / National Assembly for Wales


Y Pwyllgor Busnes / Business Committee


Etifeddiaeth y Pedwerydd Cynulliad / Fourth Assembly Legacy


Tystiolaeth gan Conffederasiwn GIG Cymru / Evidence from Welsh NHS Confederation



The Welsh NHS Confederation response to the Fourth Assembly Business Committee Legacy Report


Nesta Lloyd – Jones, Policy and Public Affairs Officer, the Welsh NHS Confederation. Tel:  02920 349857

Date created:

29 October 2015




1.       The Welsh NHS Confederation, on behalf of its members, wholeheartedly welcomes the opportunity to respond to the Fourth Assembly Business Committee Legacy consultation.


2.       The Welsh NHS Confederation, and our members, liaise with and support the work of a number of National Assembly for Wales Committees, including the Health and Social Care Committee, Public Accounts Committee and Finance Committee, to ensure that the views of the NHS in Wales are considered and that the Committees can understand the complexities of the policies and processes of the health service.


3.       By representing the seven Health Boards and three NHS Trusts in Wales, the Welsh NHS Confederation brings together the full range of organisations that make up the modern NHS in Wales. Our aim is to reflect the different perspectives as well as the common views of the organisations we represent.


4.       The Welsh NHS Confederation supports our members to improve health and well-being by working with them to deliver high standards of care for patients and best value for taxpayers’ money. We act as a driving force for positive change through strong representation and our policy, influencing and engagement work. Members’ involvement underpins all our various activities and we are pleased to have all Local Health Boards and NHS Trusts in Wales as our members.


5.       The Welsh NHS Confederation and our members are committed to working with the Welsh Government and its partners to ensure there is a strong NHS which delivers high quality services to the people of Wales.



The role of the Welsh NHS Confederation

6.       As the biggest spender of public money in Wales, it is essential that the NHS is accountable, and Assembly inquiries allow this to happen. The Welsh NHS Confederation has built a strong relationship with the Clerks from the Health and Social Care Committee during the Fourth Assembly. This relationship has been very beneficial for Local Health Boards and Trusts and also for the Health and Social Care Committee Members.


7.       Prior to Committee inquiries and oral evidence sessions, the Welsh NHS Confederation liaises with the Clerks of the Health and Social Care Committee to ensure that the most suitable representatives from across NHS Wales provide evidence to the Committee. On behalf of our members we discuss with the Clerks the key areas that the Committee is considering and liaise with the Clerks after the session when draft session transcripts are sent to NHS representatives. We hope this relationship with the Health and Social Care Committee continues during the Fifth Assembly term to ensure that the Committee hears from experts within the NHS and to ensure that the Committee can fully understand the policies and processes of the NHS.


8.       In addition to liaising with the Clerks, the Welsh NHS Confederation provides significant support to representatives from Local Health Boards and Trusts when they give evidence to Committees. The range of support that we provide includes:

·         Practical information on what to expect on the day – from getting through security, to sitting in front of a Committee;

·         Organising pre-meetings to discuss some of the potential areas of questioning a Committee or Committee Members may focus on;

·         Providing up to date briefings and information on the key statements made by political parties and Committee Members;

·         Producing a profile for each Committee Member, including their background, political interests and relevant statements made;

·         Providing up to date information on the amount and type of media scrutiny the topic has received;

·         Providing support to NHS representatives on the day, including attending the Senedd to answer any last minute questions and providing key messages to put forward to the Committee; and

·         Informing representatives from the NHS why Committee inquiries and sessions are so important. The benefits for NHS representatives attending Committees include providing health professionals with an opportunity to give more detail on the work they do, highlight the positive work being carried out and give an in-depth expert view to help Committee Members understand the NHS. It also provides a personal development opportunity for professionals.


9.       While we have a strong relationship with the Health and Social Care Committee and liaise with them on most inquiries that they conduct, the relationships that we have with other Committees is not as strong. In the past this has caused some issues both for the Committee seeking representatives from the NHS and for the representatives from the NHS. Due to the lack of awareness of the logistical support that the Welsh NHS Confederation can provide Committees, and also the support we provide the NHS, there have been instances where Committees are not sure who is best to contact within the NHS, which leads to information not always being provided in a timely manner, and some Health Boards/ Directors from a Health Board being asked to provide evidence to a number of Committees within a short period of time.


10.   We are fully aware of the continuous engagement work we need to do with the Assembly Committees, and the Clerk of the Health and Social Care Committee has supported us in this work. We hope that we can continue this engagement work in the Fifth Assembly because health and social care impacts on a range of National Assembly and Welsh Government policies and legislative work.




11.   We are only providing responses to the questions that impact on our Members.


How effective has this approach been and how have committees achieved a balance between their policy, financial and legislative scrutiny?

12.   As highlighted, due to the fact that health and social care impacts on a range of Government and Assembly business, the Health and Social Care Committee has undertaken a significant amount of work. The legislative scrutiny programme for the Health and Social Care Committee has been large and therefore they have not always had an opportunity to balance their legislative scrutiny function against their policy and financial scrutiny.


13.   The Health and Social Care Committee has held the NHS - both the Welsh Government Health and Social Care Department and the wider NHS organisations - to account, especially in regards to justification for major service changes, NHS finance and general performance. The reports published by the Committee cover a very broad range of topics and have drawn attention to key issues that affect this important area of Welsh Government responsibility. Through Committee evidence sessions, the profile and focus on some areas has increased, for example unpaid and family carers, medical technologies and new psychoactive substances.


14.   While the Committee has provided a high level of scrutiny and challenge to policy, it is not clear whether this has resulted in any tangible, measurable impact or how far its findings and recommendations have been addressed. It could also be argued that the role of the Committee is to hold the Welsh Government to account, which is not necessarily the same as having an impact on health and social care services in Wales.


15.   Given the breadth of subjects the Health and Social Care Committee has considered - ranging from substance misuse, nurse staffing levels and stillbirths – Committee Members cannot be expected to have a specialist, in-depth knowledge of every area that they are required to consider in the timeframes that they are working to. Taking expert witness evidence will have helped the Committee to develop its understanding and come to a balanced view of an issue to produce recommendations to the Welsh Government and the NHS. However, in practice, it may be difficult to ensure detailed consideration and analysis is sufficient to obtain an accurate, rounded, unbiased picture through written evidence submitted by Local Health Boards and Trusts and a 45 minute / hour-long oral evidence session.


16.   We would recommend that more time is given to the Health and Social Care Committee to scrutinise policy, especially in social care. In addition we would recommend that more time is provided in some key oral evidence sessions to ensure that the Committee has enough time and opportunity to question representatives from the NHS and also that representatives have sufficient time to provide detailed answers to the questions and issues posed by the Committee.


What changes could be made to committee size and structure in future to make them more effective?

17.   The scale of the legislative programme being undertaken and the weighty nature of the areas being addressed by the Health and Social Care Committee have implications for the capacity of Committee Members, the workload of Committee Members and the amount of time/balance that can be given to the various components being scrutinised.


18.   In addition to the capacity of Committee Members, the capacity within the NHS should also be considered. There have been occasions where a number of Committees have asked for a Chief Executive from a Local Health Board to provide evidence and it has been difficult to find representatives at short notice because there are only seven Local Health Board Chief Executives in Wales. In addition, we are aware that one Director has been specifically requested by a number of Committees and in a three month period they provided evidence to National Assembly Committees four times, which impacts on their day-to-day work.




Does the current Assembly timetable, including the structure of the working week and committee/Plenary slots provide the correct balance in terms of the use of the Assembly’s time, allowing it to effectively perform its functions of making laws, representing the people of Wales, and holding the government to account?

19.   We would agree that the current Assembly timetable provides the correct balance in terms of the use of the Assembly’s time. We would recommend that information in relation to agenda items for Plenary and also the Committee timetables are made publically available sooner.



Other comments

Health and Social Care Committee

20.   We would recommend that the Health and Social Care Committee remains in the Fifth Assembly. At present 43% of the Welsh Government budget is spent on health and social services and it is likely that any future Welsh Government work will include a significant amount of legislative and policy development around health and social care.


21.   Furthermore, while health has dominated the Health and Social Care Committee work programme compared to social care it is important that the two areas remain linked due to the integration agenda. Integration of health and social care is a key priority for the majority of the political parties in Wales and the Welsh NHS Confederation wholeheartedly supports the integration agenda to ensure that person-centred holistic care is provided to people in Wales. The benefits of integrated care include improvements in service quality and patient experiences and satisfaction, as well as a reduction in pressure on NHS acute services and residential adult social care.



Raising awareness

22.   It is important that all Committees, and the National Assembly for Wales in general, raise further awareness of their role and the impact their work has on holding the Welsh Government to account and on improving services. While there have been significant improvements around the Committees’ communication with the public, through social media and the Assembly outreach team, there could be further awareness of the Committees’ work among members of the public. It is unclear whether the public are aware of the role and the impact that the Committees have on health and social care services. In addition it is not always clear how, for example, the Health and Social Care Committee works with other National Assembly Committees, particularly the Finance Committee and the Petitions Committee. Many of the petitions considered by the Petitions Committee relate to health and social care and there should be a mechanism for the Health and Social Care Committee to conduct more in-depth inquiries into issues that have been raised by the Petitions Committee, especially when it comes to service redesign.


23.   Furthermore, while a number of Committees have undertaken a significant number of inquiries in the Fourth Assembly and have produced numerous reports, it is unlikely that many staff within the NHS and members of the public are aware of what has been done. The visibility and profile of the Committees’ work, together with the outcomes achieved, need to be communicated more effectively across all stakeholders. Ensuring that an overview, or key messages, are widely publicised and accessible would promote the work of Committees and also encourage people to follow up and take account of the detailed reports where appropriate.