The Welsh NHS Confederation response to the Fourth Assembly Health and Social Care Committee’s Legacy Consultation


Nesta Lloyd – Jones, Policy and Public Affairs Officer, the Welsh NHS Confederation.

Date created:

25 September 2015



1.       The Welsh NHS Confederation, on behalf of its members, wholeheartedly welcomes the opportunity to respond to the Fourth Assembly Health and Social Care Committee’s Legacy Consultation. The Welsh NHS Confederation, and our members, continue to liaise with and support the work of the Health and Social Care Committee to ensure that the views of the NHS in Wales are considered and that the Committee can understand the complexities of the policies and processes of the health service.


2.       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.


3.       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.


4.       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

5.       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. Prior to Committee inquiries and oral evidence sessions, the Welsh NHS Confederation liaises with the clerks to ensure that the most suitable representatives from across the NHS in Wales provide evidence to the Committee. On behalf of our members we discuss with the clerks the key areas that the Committee is considering, the possible issues that will be discussed on the day and liaise with the clerks after the session when draft session transcripts are sent to representatives from the NHS. We hope this relationship 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.


6.       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 the Committee. 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 the Committee;

·         Organising pre-meetings to discuss some of the potential areas of questioning the 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 Committee 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.



Question 1

To what extent has the Health and Social Care Committee had an impact on health and social care in Wales?

7.       Overall our members think it is difficult to assess the extent to which the Health and Social Care Committee has had an impact on health and social care in Wales. While the Committee has probably had an indirect impact on health and social care through its scrutiny of policy and its legislative function, it is difficult to clearly evidence this.


8.       The 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 the Committee evidence sessions it has increased the profile and focus on some areas, for example unpaid and family carers, medical technologies and new psychoactive substances. Furthermore, the Committee has successfully sought views from a range of agencies and the public on the Social Services and Well-being Act, the Human Transplantation (Wales) Act and recently with the Public Health (Wales) Bill and the Safe Nurse Staffing Levels (Wales) Bill.


9.       In addition to representatives from the NHS and professional bodies providing evidence to the Committee, it has provided the opportunity to ensure there has been significant and relevant user representation when scrutinising legislation as it has been developed. The Committee has achieved balance in its recommendations by taking account of public lobbying without being disproportionately influenced by it during its scrutiny process.


10.   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.


11.   Given the breadth of subjects the Committee has considered - ranging from substance misuse, nurse staffing levels and stillbirths - 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. We would recommend that more time is provided in some key oral evidence sessions in the future 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 has been the Committee’s biggest achievement?

12.   The Committee has had a number of achievements during the Fourth Assembly, especially in relation to examining and scrutinising legislation. Our members have highlighted the overseeing scrutinising of the development of the Social Services and Well-being (Wales) Act 2014 as a positive example of the Committee’s work.


13.   In addition to legislation, the Committee has a valuable role in ensuring that the work of the Welsh Government is open and transparent. In particular, by engaging directly with operational and clinical staff working in the NHS, it brings people closer to the machinery of Government, enabling them to make a contribution and influence policy as well as understand the process involved in legislation, policy development and scrutiny in more detail.


If the Committee could have done one thing differently, what would it be, and why?

14.   It is important that the Committee, and the National Assembly for Wales in general, raises further awareness of its role and the impact its work has on holding the Welsh Government to account and on improving services. While there have been significant improvements around the Committee’s communication with the public, through social media and the Assembly outreach team, there could be further awareness of the Committee’s work among members of the public. It is unclear whether the public are aware of the role and the impact that the Committee has on health and social care services and also how the Committee works with other National Assembly Committees, particularly the Finance Committee and the Petitions Committee.


15.   The Committee has undertaken a significant number of inquiries in the Fourth Assembly and has produced numerous reports. However 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 Committee’s 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 the Committee and also encourage people to follow up and take account of the detailed reports where appropriate.


16.   As well as increasing the communication around its work, the Committee could have done more to recommend and facilitate an integrated approach to health and social care issues through considering areas that impact on a number of public bodies or other Assembly Committees’ work - for example, tackling health inequalities, considering the impact welfare reform is having on people’s health, integration between health and social care, holding an inquiry on all Welsh Government Delivery Plans -  instead of individual inquiries on specific Delivery Plans because the issues highlighted around the implementation of one Delivery Plan will be the same for the other Delivery Plans e.g. early identification, assessment and care planning, having a key worker and providing information.


17.   While the Committee’s work is clear in relation to examining legislation and holding the Welsh Government to account by scrutinising expenditure, administration and policy matters, it would be beneficial for the Committee to be more transparent and provide more feedback on how issues brought to their attention during the evidence sessions are considered and why the recommendations have been put forward.


Has the Committee’s work struck the right balance between scrutiny of policy, finances and legislation?

18.   The Committee appears to have struck a reasonable balance, but we are unsure whether any, or sufficient, consideration has been given to quality of service and outcomes for patients.


19.   The scale of the legislative programme being undertaken, and the weighty nature of the areas being addressed, 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.


20.   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 six month period they provided evidence to National Assembly Committees four times, which impacts on their day-to-day work.



Question 2

Looking ahead to the next five years, in your view what will be the three biggest challenges for health and social care in Wales?

21.   The Welsh NHS Confederation has recently undertaken a survey with our members in preparation for the work that we are doing around the National Assembly Elections. The survey was sent to Chairs, Vice Chairs, Chief Executives and Directors within Local Health Boards and Trusts and we had a 42% response rate to the survey. We asked our members to consider the top three challenges facing NHS Wales in the next five years. The key challenges highlighted included:


·         Recruitment and retention of the NHS workforce;                                           42%

·         Financial challenges;                                                                                                       37%

·         Ageing population;                                                                                                          30%

·         Reducing unhealthy behaviours                ;                                                                               28%

·         Raising numbers of people with chronic & complex conditions;                  26%

·         Integration of health and social care.                                                                      26%


22.   The comments that we received from our members in relation to this consultation supports the survey results. The key areas that our members highlighted included:

·         Meeting the increasing demand for services and the ability of services to respond to this increase. We must ensure that the costs of health and social care are recognised and identified alongside the policy intent, together with understanding and articulating the cost to the individual. The challenging population demographics, for example, of an older population and their demands on health and social care, will intensify at a time of increasing financial austerity and a diminishing workforce. The Committee will need to do more to support how the NHS delivers health and social care in the future.

·         Implementing the significant whole system and cultural changes needed as a result of key legislation, for example the Social Services and Well-being (Wales) Act 2014 and the Well-being of Future Generations (Wales) Act 2015. Delivering genuinely integrated services and holding public services to account will be challenging.

·         Making integration work between health and social care services. Ensuring the delivery of integrated primary and community services which are appropriately resourced to meet the growing demands of an ageing population, and supports the development of new models of care that are out of hospitals. We will have to work in a more integrated way and develop community resilience to deliver services differently. To meet this challenge we will need;

o   Availability of a skilled workforce that maximises the benefit of multidisciplinary teams, and the use of the non-registered workforce, to support safe and effective care;

o   Infrastructure in order to utilise advances in technology and prescribing and informatics; and

o   More creative use of estate across agencies to deliver local healthcare.

·         Ensuring consistent, high quality standards across health and social care and rationalising the plethora of different performance management and outcome frameworks across pubic bodies.

·         Recruitment and training of the right numbers of health professionals to staff the future services required in Wales. Recruitment and training should be throughout all specialisms, but also importantly in primary care.

·         Increased focus on primary prevention and public health to ensure that we move from a ‘treating illness service’ to a public health and prevention orientated service.

·         Communication and co-production with patients, the public, third and independent sectors will be required with more support in influencing the public message regarding co-production and self-management. Without support across all sectors for these messages, it will not succeed.  

·         Striking the right balance for unpaid and family carers as part of the new Social Services and Well-being (Wales) Act 2014 to maintain their profile across Wales.


23.   As highlighted previously, we would recommend that the Committee undertakes more strategic inquiries and not condition specific. For example instead of individual inquiries on specific Delivery Plans the Committee should look at whether the Delivery Plans are being implemented consistently across Wales, the cross cutting barriers and issues and whether patient experience/ outcomes have improved.




24.   The Welsh NHS Confederation supports the work that the Health and Social Care Committee has undertaken in the Fourth Assembly. We look forward to liaising with and supporting the Committee in the Fifth Assembly.