Ministerial Statement

 

Today, I want to update Members on developments which have taken place over the summer.

 

Let me deal, firstly, with the National Board. While consultation respondents were firmly in support of the principle of a National Board, a variety of views were expressed about its exact composition and governance arrangements.

 

A majority of respondents favoured a Special Health Authority model. They did so largely because of a belief that such an arrangement would create an arms-length relationship between the Minister and the NHS.

 

I disagree. In a devolved Wales it is both impracticable, and undesirable to attempt to create such a distance between political responsibility and service delivery. My own conclusion is therefore that a National Advisory Board will be established, with a small but independent membership.

 

Amongst its independent members will be individuals whose background and experience provide particular expertise in the fields of local government, the voluntary sector and my social partners. They will be joined by others who have experience in relevant fields, such as legal services and finance.

 

I will take the chair of the Board, and it will meet in public. In coming to this conclusion, I have been most influenced by those arguments which revolve around issues of accountability and answerability. The presence of a National Assembly argues powerfully for arrangements in which Ministers remain, in an uncluttered way, answerable to the public and to elected Members.

 

 The Chief Executive of NHS Wales will be a member, and will, separately, chair a Delivery Group responsible to me as Minister for the operational performance of NHS organisations.

 

It is my intention that these arrangements should be in place by April 2009. A further consultation paper will be issued later in the autumn which will, amongst other things, deal with the more technical details of function and membership.  There will be no further consultation on the model of the National Board per se.

 

Turning now to the new health delivery bodies, in my statement in July, I set out the arguments which had convinced me to accept the case for seven unified delivery bodies. The abolition of boundaries between LHBs and Trusts, between in-hospital and out-of-hospital care and between primary, community and acute services will, I am confident, create seven strong integrated organisations. There are three refinements of that model which I wish to bring to Members’ attention this afternoon.

 

Firstly, I want to be clear that, in a period of considerable change, I intend that Boards of these bodies will be constructed, and act, according to governance arrangements which are already familiar within the Welsh NHS. There will be executive members, and independent members appointed through public appointment procedures. These independent voices will mirror those deployed at the National Board, with individuals recruited on the basis of their experience in the fields of local government, the voluntary sector and the social partners. As Minister, I will lead the appointment of both the Chairs and Vice chairs of these organisations. These will, of course, also be carried out under normal public appointment procedures.

 

Secondly, I remain determined to pursue a health service led by preventative, primary and community services. Accordingly, a Ministerially appointed vice chair, in each body, will be made responsible for primary, community and mental health services in a practical demonstration of the importance which, as an Assembly Government, we attach to the future of these services. In order to underpin that work, I have asked Dr Chris Jones, chair of the RCT LHB to lead a group charged with development of a new primary and community health care strategy.

 

Thirdly, I want to make it clear that, future, the local bodies will be organised in ways which make cooperation between them easier to achieve and which helps eliminate the last outcrops of the competitive market ethos inherited from Conservative Party policies. In order to strengthen these horizontal, cooperative relationships between the new bodies I am determined that the seven organisations will operate in ways which conform far more closely to a national pattern, so that the local health service arrangements in one part of Wales are recognisably the same in other Welsh locations.

 

Presiding Officer, in considering the pace of change in the Wales NHS, I am very mindful of the advice I received from Members in this chamber last week.   The detail of the legal personality of the seven bodies, the mechanisms needed to manage financial flows through the system, the ways in which members of the new Boards are to be recruited – all these issues have been subject of detailed work over the summer, but now need a wider airing with those most directly affected. A consultation document will be published for that purpose later in the autumn. I also agree with Members’ who said in last week’s discussion here that, for change on this scale, it is better to concentrate on getting things right, rather than simply on getting them done quickly. I shall be giving further careful consideration to this advice.

 

Change can sometimes distract busy people from their responsibilities.  To overcome any such risk I have agreed that formal local project arrangements should be put in place, to ensure that the delivery of services is unaffected during this transition period. This is primarily an administrative matter for the Chief Executive of NHS Wales to put in place, but I will issue a statement to Members once these have been finalised. 

 

Today’s announcements in relation to the National Advisory Board, and the seven delivery organisations, have implications for other important strands in the NHS. Yesterday, I published a written Cabinet statement, setting out my conclusions in relation to mental health. Today, I can inform Members that I have received and accepted advice to form a Unified Public Health Service for Wales. Arrangements will include public health executive members at each of the seven delivery organisations as well as a strengthened public health presence within local government.

 

The future of Health Commission Wales is affected by what I have said today. Professor Mansel Aylward’s report confirms that significant structural change is needed in present HCW arrangements. I have asked Professor Alyward to advise me further on which of the organisation’s responsibilities might, in future, be allocated to the seven delivery bodies and the implications which this would have for the governance of the organisation itself. I will keep Members informed of the outcome.

 

The future of Velindre Trust is secure but I have asked Ian Kelsall, as the current Chair of that Trust, to advise on the future role and responsibility of the organisation once the NPHS and the screening services have become part of the Unified Public Health Service. In the same context, the future arrangements for shared services and All-Wales bodies need to be the subject of further consideration.  I have asked David Galligan, Staff Side Secretary of the Welsh Partnership Forum, to lead a piece of work looking at the future of these services for the NHS in Wales.

 

Finally, and briefly, I would wish to say something about local engagement. Presiding Officer, I hope I have made it clear that I do not believe that accountability to public and patients is simply a matter for the local level. I have already said that I intend the National Advisory Board to hold meetings in public. I can also inform Members this afternoon of my intention to institute a series of annual accountability meetings with the chair and chief executive of each of the seven new delivery bodies. These meetings will also be held in public and will be an opportunity for me, as Minister, to ensure that the decisions of the National Advisory Board are being reflected in activity on the ground. It will also be an opportunity for the population served by the seven organisations to attend these meetings and make their influence felt.

 

At the same time, in July I also indicated my intention to strengthen Community Health Councils in Wales, making them coterminous with local authority boundaries. Later in the autumn I will consult on proposals for reform of CHCs more generally, in order to make them even more effectively the voice of local patients in the Welsh NHS. In a further statement I will then have more to say on the subject of local engagement more generally.

 

Presiding Officer, that concludes my statement this afternoon.

 

Edwina Hart