(Title Image: Wales Online)

Health & Social Care (Quality & Engagement) Bill

Introduced by Health Minister, Vaughan Gething (Lab, Cardiff S. & Penarth)

Bill (pdf)

Explanatory Memorandum (pdf)

Why intoduce a Health & Social Care Quality Bill?

There’ve been a number of instances in recent years where health boards have caused harm to patients. This is not only through poor quality of services but also not fully taking responsibility for a problem or even not accepting they have one – the most recent high-profile example being the Cwm Taf maternity scandal.

The explanatory memorandum lists a total of 86,474 incidences of “harm” during 2017-18, 25 of which involved the death of a patient and 289 being categorised as “severe”.

There’ve also been criticisms that the bodies attached to each health board which are supposed to represent patient interests – Community Health Councils (CHCs) – haven’t done enough to do that. Meanwhile, various reviews found a lack of public knowledge about what CHCs do, while there’s no equivalent body for people receiving care.

The Lowdown: 3 Key Proposals in the Health & Care Quality Bill

1. Placing a “duty of candour” on the NHS

The Welsh Government will be able to introduce regulations which will outline when a “duty of candour” applies. In essence, if a patient has been harmed in some way as a direct result of the quality of care they’ve received, the health board in question will have a duty to approach it in an open and honest manner, formally apologise, give a point of contact to the patient (or someone acting on their behalf) and keep appropriate records.

NHS bodies (including primary care providers like GPs, dentists etc.) will have to report annually on how often and under what circumstances the “duty of candour” has been triggered.

2. Community Health Councils will be abolished and replaced with a Citizen Voice Body

A new national “independent” body will be set up to replace CHCs and represent the interests of patients and people receiving care. It’ll be a corporate body not tied to any single health board and able to make its own arrangements for regional or local structures. The Bill also places a duty on health and care providers to give due regard to any representations from the Citizen Voice Body.

It’ll be funded directly by the Welsh Government and will be made up of a Chair and between 7 to 9 members serving a maximum of two 4-year terms. Members will be appointed by the Welsh Government – likely to lead to accusations that it’s not anywhere near as independent as the Bill suggests.

73 staff are expected to transfer from CHCs to the Citizen Voice Body via TUPE.

3. Health Boards will be able to (formally) appoint a Vice Chair

Vice Chairs of health boards already exist unofficially to some extent and often fill in for Chairs and alike – but are usually people who do it alongside another role. The Bill will place them on a full legal footing in their own right with the hope it will improve the quality of health board governance.

How much will the Health & Social Care Quality Bill cost?

Between 2020-21 and 2025-26, the Bill’s provisions are expected to cost between £11million and £11.5million in total, with most of that spent in the first two years.

A majority of the costs fall on the Welsh Government, arising due to the establishment and ongoing funding for the Citizen Voice Body, which is expected to cost £6.1million in total over the first five financial years.

The biggest cost to the NHS relates to the new duty of candour (training, awareness etc.), which will cost just over £3.2million in 2020-2, with the ongoing annual cost falling to an estimated £80,300 a year.

The Bill isn’t expected to save any money, though a proper duty of candour could prevent complaints escalating to court level – which could save marginal legal costs.