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Aelodau’r pwyllgor yn
bresennol
Committee members in
attendance
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Peter Black
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Democratiaid Rhyddfrydol Cymru (yn dirprwyo ar
ran Kirsty
Williams)
Welsh Liberal Democrats (substitute for
Kirsty Williams)
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Alun Davies
|
Llafur
Labour
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|
John Griffiths
|
Llafur
Labour
|
|
Altaf Hussain
|
Ceidwadwyr Cymreig
Welsh
Conservatives
|
|
Elin Jones
|
Plaid Cymru
The Party of Wales
|
|
Darren Millar
|
Ceidwadwyr Cymreig
Welsh
Conservatives
|
|
Lynne Neagle
|
Llafur
Labour
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|
Gwyn R. Price
|
Llafur
Labour
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|
David Rees
|
Llafur (Cadeirydd y Pwyllgor)
Labour (Committee Chair)
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Lindsay Whittle
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Plaid Cymru
The Party of Wales
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Eraill yn bresennol
Others in
attendance
|
|
Mark Drakeford
|
Aelod Cynulliad, Llafur (y Gweinidog
Iechyd a Gwasanaethau Cymdeithasol)
Assembly Member, Labour (the Minister for Health and Social
Services)
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|
Helen Whyley
|
Swyddog Nyrsio, Llywodraeth
Cymru
Nursing Officer, Welsh Government
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Kirsty Williams
|
Aelod Cynulliad, Democratiaid
Rhyddfrydol Cymru (yr Aelod sy’n Gyfrifol am y Bil Lefelau
Diogel Staff Nyrsio (Cymru))
Assembly Member, Welsh
Liberal Democrats (Member in charge of the Safe Nurse Staffing
Levels (Wales) Bill)
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|
Rhian Williams
|
Cyfreithiwr, Llywodraeth
Cymru
Lawyer, Welsh Government
|
|
Swyddogion Cynulliad Cenedlaethol Cymru yn
bresennol
National Assembly for Wales officials
in attendance
|
|
Sian Giddins
|
Dirprwy Glerc
Deputy Clerk
|
|
Gwyn Griffiths
|
Uwch-gynghorydd
Cyfreithiol
Senior Legal Adviser
|
|
Llinos Madeley
|
Clerc
Clerk
|
|
Lisa Salkeld
|
Cynghorydd
Cyfreithiol
Legal Adviser
|
|
Philippa Watkins
|
Y Gwasanaeth Ymchwil
Research Service
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Dechreuodd y cyfarfod am 08:59.
The meeting began at
08:59.
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Cyflwyniadau, Ymddiheuriadau a Dirprwyon
Introductions, Apologies and Substitutions
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[1]
David Rees: Good morning, and can I welcome Members of the
committee and the public to this today’s session of the
Health and Social Care Committee? Before we start our proceedings
today, can I just do a few of the housekeeping rules? Can I please
remind Members that it is bilingual, and if you require translation
from Welsh to English, the headphones are available for the
simultaneous translation on channel 1? If you require
amplification, amplification is available on channel 2. There is no
scheduled fire alarm this morning. So, if one does occur, please
follow the directions of the ushers to leave the building safely.
Can I remind all Members and witnesses to switch off your mobile
phones or put them on silent—thinking about that; I better do
it myself—to ensure that they don’t interfere with our
broadcasting equipment? Can I also welcome Peter Black to this
morning’s committee, who’s substituting for Kirsty
Williams, who’s actually the Member in charge of this
particular Bill?
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09:00
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Bil Lefelau Diogel Staff Nyrsio
(Cymru): Cyfnod 2—Trafod Gwelliannau
Safe Nurse Staffing Levels (Wales) Bill: Stage
2—Consideration of Amendments
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|
Mae gwelliannau a nodir ag [R] yn dynodi bod yr Aelod wedi
datgan buddiant cofrestradwy o dan Reol Sefydlog 2 neu fuddiant
perthnasol o dan Reolau Sefydlog 13 neu 17 wrth gyflwyno’r
gwelliant.
Amendments marked [R] mean
that the Member has declared either a registrable interest under
Standing Order 2 or relevant interest under Standing Orders 13 or
17 when tabling the amendment.
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[2]
David Rees: Okay. Then we go into item 2 of today’s
business, which is Stage 2 consideration of amendments to the Safe
Nurse Staffing Levels (Wales) Bill. Can I welcome the Member in
charge, Kirsty Williams, and her team, Philippa Watkins and Lisa
Salkeld? Can I also welcome the Minister, Mark Drakeford, and his
team, Helen Whyley and Rhian Williams?
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[3]
Can I just go through a few of the procedural issues? As the
committee agreed on 19 November, the order of consideration will be
sections 2 to 5 of the Bill, section 1 of the Bill, and then the
long title. The amendments have been grouped to facilitate debate,
and each group of amendments will be debated in turn, but the order
in which amendments will be called and moved for decision will be
dictated by the marshalled list, which all Members should have.
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[4]
Due to the nature of amendment 29, and a number of other amendments
tabled to this Bill, group 1 is very large. So, to facilitate
debate on group 1, it’s the intention to structure the debate
thematically, and details of the sub-themes are set out under group
1 on the groupings list. The note outlining the structure of the
sub-themed debate is given on pages three and four. We’ll
provide more details when we go into group 1.
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|
[5]
On groups 2 to 4, I will first call the proposer of the lead
amendment in the group to move and speak to that amendment, and any
other amendments in the group. I will then call on Members who wish
to speak. If the Minister does not have a lead amendment, once all
committee members have spoken I will call him to speak. Kirsty
Williams will then be called as the penultimate speaker, in her
capacity as Member in charge of the Bill, and the proposer of the
lead amendment will then be asked to close the debate in that
group.
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[6]
Following each group, I will ask the Member who moved the lead
amendments whether they wish to move to a vote on the amendment. If
not, the Member may seek the agreement of the committee to
withdraw. If the amendment is not withdrawn, I will put the
question on the lead amendment and ask whether any Member objects
to the amendment being agreed. If there is no objection, the
amendment will be deemed to be agreed in accordance with Standing
Order 17.34. If any member of the committee objects, I will call
for a vote by a show of hands. The vote will be recorded in the
minutes, so please keep your hand raised until the clerks have
recorded a vote. In accordance with Standing Order 17.37 and 6.20,
if there’s a tied vote, as Chair, I will exercise my vote
against the amendment.
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[7]
I will call on the proposers of other amendments in each group to
move their amendments at the appropriate time, in accordance with
the marshalled list. If you do not wish to move the amendment, you
should say so clearly when your amendment is called. For the
record, only committee members can move amendments. Therefore, in
accordance with the convention agreed by the Business Committee, as
Chair, I will move the amendments on behalf of the Minister. For
expediency, I will assume the Minister wishes me to move all the
amendments in his name, unless he actually indicates otherwise. I
do not intend to use the words ‘formally moved’ on each
occasion, but Members may take my putting the question as an
indication of each amendment being moved formally. Minister, if you
do not wish a particular amendment to be moved, please indicate at
the relevant time.
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[8]
As is the usual practice, advisers to the committee, to the Member
in charge and to the Minister are not expected to provide advice on
the record. If Members need to seek legal advice during
proceedings, please do so either by passing a note to the relevant
adviser, or by requesting an adjournment to the proceedings to have
that advice. Are there any questions? Sorry for the long spiel, but
I think it’s important we clarify the position, particularly
for the public as well. Okay, in that case, let’s move on to
the business of the day.
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Grŵp 1:
Dyletswydd i gynnal Lefelau Diogel o Staff Nyrsio (28, 29A,
29B, 29C, 29D, 29E, 29F, 29G, 29H, 29I, 29J, 29Z, 29AA, 29AB, 29AC,
29AD, 29K, 29L, 29M, 29N, 29O, 29P,
29Q, 29R, 29S, 29T, 29U, 29V, 29W, 29X, 29Y, 29AE, 29, 1, 20, 2,
21, 3, 4, 22, 23, 24, 5, 6, 7, 8, 9, 10, 11, 12, 25, 30A,
30B, 30, 13, 14, 31A, 31, 15, 16, 36, 37, 32, 17, 18)
Group 1: Duty to maintain Safe
Nurse Staffing Levels (28, 29A, 29B, 29C, 29D, 29E, 29F, 29G, 29H,
29I, 29J, 29Z, 29AA, 29AB, 29AC, 29AD, 29K, 29L, 29M, 29N, 29O, 29P, 29Q, 29R, 29S, 29T, 29U, 29V,
29W, 29X, 29Y, 29AE, 29, 1, 20, 2, 21, 3, 4, 22, 23, 24, 5,
6, 7, 8, 9, 10, 11, 12, 25, 30A, 30B, 30, 13, 14, 31A, 31, 15, 16,
36, 37, 32, 17, 18)
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[9]
David Rees: The first grouping of amendments to consider is
in relation to the duty to maintain safe nurse staffing levels. As
noted in the groupings list, in order to facilitate debate on this
large group, the structure of the discussion is in sub-themes. In
the first instance, I will call the Minister to speak to his
amendments 28 and 29. I will then call on committee members, the
Member in charge, and the Minister, to discuss each sub-theme in
turn. Once all sub-themes have been debated, I will call on the
committee members, the Member in charge, and the Minister, to make
any final remarks—in that order. We will then vote on the
amendments, at the end of the group, in accordance with the order
in which they appear on the marshalled list. The lead amendment in
this group is amendment 28.
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|
Cynigiwyd
gwelliant 28 (Mark
Drakeford).
Amendment 28 (Mark Drakeford) moved.
|
|
[10]
David Rees: I formally move amendment 28, in the name of the
Minister, and I call on the Minister to speak to the lead amendment
in this group—amendment 28—and to make any introductory
comments on amendment 29. Minister.
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|
[11]
The Minister for Health and Social Services (Mark
Drakeford): Thank you very much, Chair. What I intend to do, as
you said, is to make some introductory remarks in relation to
amendments 28 and 29, and then reserve any more detailed
contribution as we get to each sub-theme.
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|
[12]
So, in introducing this part of the discussion, I just want to
remind Members that, when the Member in charge introduced this
Bill, in December 2014, I said then that I agreed with the purpose
behind the Bill, and wanted to try to support the legislation, by
working with the Member in charge to achieve its aims. The
amendments tabled by the Government this morning reflect the
discussion that we have had as a result of that decision. I
don’t expect, Chair, that I will always have persuaded the
Member in charge to share my view; I hope, however, that, by the
end of the morning, we might have achieved sufficient common ground
to find ways that will allow the Bill to proceed and on to the
statue book. I say that because the Government amendments are
consistent with the objectives set out by the Member in charge on
introduction: to ensure that we have the right number of nurses in
place to meet the particular circumstances of a particular adult
acute medical or surgical in-patient ward in Wales.
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|
[13]
The essence of the Government amendments, proposed at Stage 2, are
about practicalities. They are about the means by which we decide
upon the required level of nurse staffing, and how we account for
the operation of the system. The Government amendments focus on the
‘how’ rather than the ‘what’ of the Bill,
aiming to secure its intended outcomes in ways that avoid the
unintended consequences warned of in this committee’s Stage 1
proceedings.
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|
[14]
At this point, Chair, I hope it would be helpful if I just briefly
set out the two principal duties in the Bill, as amended by
amendment 29, and what the Bill would then achieve.
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|
[15]
Firstly, it’s important to know that local health boards are
already under a duty, in relation to their areas, to provide
nursing services to such an extent as they consider necessary to
meet all reasonable requirements. NHS trusts in Wales that provide
nursing services must also provide those services to such an extent
as they consider necessary to meet all reasonable requirements.
Now, the new section 25A, introduced by the Government amendments,
would extend the existing duty to require local health boards, and
NHS trusts that provide nursing services, to have regard to the
importance of providing sufficient nurses to allow nurses time to
care for patients sensitively.
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[16]
Secondly, the new section 25B would place a duty upon local health
boards and NHS trusts in Wales to designate a person to calculate
the nurse-staffing level for acute adult medical in-patient wards
and adult acute surgical in-patient wards. There are linked duties
under new section 25B to take all reasonable steps to maintain the
nurse-staffing level and to make arrangements to inform patients of
the nurse-staffing level. There is a regulation-making power that
allows the Welsh Ministers to make regulations that extend the
scope of the duty to calculate nurse-staffing levels to other NHS
settings.
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[17]
The new section 25C prescribes how the designated person must
calculate the nurse-staffing level using the triangulated method,
to which we will return, I’m sure, in one of the later
groups. New section 25D places a duty upon the Welsh Ministers to
issue guidance about the duties under sections 25B and 25C. And,
finally, new section 25E sets out the reporting arrangements for
health boards and NHS trusts, where applicable to trusts. I will be
asking Members to vote in favour of Government amendments 28 and 29
because, in that practical way, they give effect to the original
intention of the Bill, but do so in a way that is both
proportionate and practical.
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Is-thema o fewn Grŵp 1: (a) Y Disgrifiad o
Lefelau Staff Nyrsio (Gwelliannau 29A, 29B, 29E, 29F, 29G, 29H,
29I, 29K, 29L, 29M, 29N, 29O, 29R, 29S, 29V, 31A (28, 29))
Sub-theme within Group 1: (a) The Description of Nurse Staffing
Levels (Amendments 29A, 29B, 29E, 29F, 29G, 29H, 29I, 29K, 29L,
29M, 29N, 29O, 29R, 29S, 29V, 31A (28, 29))
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[18]
David Rees: Thank you, Minister. We will now move to debate
the sub-themes within group 1, and, as I indicated earlier, we will
not vote on any amendments within group 1 until all sub-themes have
been debated and all final comments and debates on group 1 have
been provided.
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[19]
So, sub-theme A is the description of nurse staffing levels and the
first sub-theme amendment is led by amendment 29A. I call on Darren
Millar to move amendment 29A and to speak to the amendments in this
sub-theme.
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[20]
Darren Millar: Thank you, Chair, and can I first of all say,
in opening my remarks on this particular sub-theme, how much I
welcome the fact that we’ve been debating this Bill in the
Assembly? I think that it is a timely Bill and I want to pay
tribute to Kirsty Williams, the lead Member on this issue, and the
Royal College of Nursing in Wales for the work that they have done
in preparing the ground amongst Assembly Members and, indeed, with
the Government, to ensure that this Bill gets on the statute
books.
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[21]
I have to say that, when I saw amendment 29 in particular, I was
surprised to see the extent of the amendment. I think that
everybody accepts that it’s effectively a complete re-write
of the original Bill, as drafted, but I do accept that it does seek
to secure some very similar aims to the original intention of the
Bill.
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[22]
I want to speak now, if I can, to amendments 29A, 29B, 29E, 29F,
29G, 29H, 29I, 29K, 29L, 29M, 29N, 29O, 29R, 29S, 29V and amendment
31A in this particular sub-theme. This group of amendments,
effectively, places the word ‘safe’ or
‘safely’ throughout amendment 29 and into amendment 31
in order to protect what I believe is the integrity of this Bill.
The National Assembly for Wales, when it gave permission for this
Bill to proceed, supported the principle of a safe nurse staffing
Bill, not just a nurse staffing Bill, which would be the effect of
the amendments that the Government has tabled. I am disappointed
that there’s no reference to the word ‘safe’. The
word ‘safe’ is not included within the Minister’s
amendment at all. There’s widespread agreement in this
committee—there certainly was at Stage 1—on the need to
develop safe staffing legislation and I think that amendment 29
undermines this principle.
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[23]
The health Minister’s amendment goes against the
recommendation of the Health and Social Care Committee’s
report on the Bill. In that report, we concluded that there needed
to be more evidence of the word ‘safe’ throughout the
legislation and what the health Minister has done is secure its
removal, or is seeking to secure its removal. So, all the
amendments in this group support the aims of the chief nursing
officer’s non-statutory guidance to health boards in Wales,
which, of course, are the all-Wales nurse staffing principles,
which have been in place since, or were published in, April 2012.
Her guidance regularly refers to and uses the word
‘safe’ to describe the sort of staffing levels that she
is recommending for the national health service in Wales and I can
see no reason, if she is able to use that word ‘safe’
and it is able to be interpreted by health boards, why this Bill
should not include that word and use the same term.
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[24]
We also know, of course, that third-party organisations have
questioned how effectively health boards in Wales are complying
with the existing guidance, with the Royal College of Nursing,
UNISON and Professor Dame June Clark all pointing to the fact that
the guidance to date had failed to make sufficient impact. The
Minister referred to existing duties, which are already out there
for health boards to comply with, but I’ll be dealing with
some of the issues later in some of the other sub-themes in terms
of how I believe that these new duties need to be policed. So,
effectively, all of my amendments in this sub-group will put back
on to the face of the Bill the word ‘safe’ in all of
the appropriate places to ensure that the fundamental principle of
this Bill is not undermined by the Minister’s amendment.
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[25]
David Rees: Are there any other Members who wish to speak?
Elin.
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[26]
Elin Jones: Diolch, Gadeirydd. Rwy hefyd eisiau diolch
i’r Aelod sydd yn gyfrifol am y Mesur yma am gyflwyno Mesur
sydd wedi caniatáu inni gael trafodaeth adeiladol iawn ar yr
angen i ddiogelu lefelau
staffio nyrsio, a’r ffaith ein bod ni’n gwneud hynny
drwy ddeddfwriaeth, yn egwyddor yr wyf yn ei chefnogi.
|
Elin Jones: Thank you, Chair. I too
want to thank the Member in charge of this Bill for introducing a
Bill that has allowed us to have a very constructive debate on the
need to safeguard nurse staffing levels, and the fact that
we’re doing that through legislation, is a principle that I
support.
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09:15
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[27]
Os caf i wneud un pwynt wrth siarad
i’r gwelliannau yma ar y broses, mae’n rhaid dweud fy
mod i’n ffeindio’r broses o ddeddfu yn y modd yma yn
annigonol iawn. Rwy’n credu bod y ffaith bod un gwelliant
o’n blaen ni heddiw sydd i bob pwrpas yn ailysgrifennu 80 y
cant o’r Mesur y buom ni fel pwyllgor yn ei sgriwtineiddio yn
drylwyr iawn o dan Gyfnod 1—nid yw hynny’n adlewyrchiad
da ar y prosesau sydd yn eu lle. Rwy’n derbyn bod popeth mewn
trefn, ond rwy’n gobeithio, efallai, y gwnaiff y pwyllgor,
pan ŷm ni’n edrych ar ein legacy report ni, yn
adlewyrchu ar y profiad o fod wedi sgriwtineiddio Mesur sydd wedi
cael ei gyflwyno gan Aelod unigol yn y ffordd yma ond sydd, i bob
pwrpas, wedi cael ei ailgyflwyno yng Nghyfnod 2 gan y Llywodraeth
drwy welliant sy’n ailysgrifennu popeth drwy un gwelliant,
neu 80 y cant o’r Mesur, ac wedyn yn ailysgrifennu bron
popeth arall, yr 20 y cant sy’n weddill, drwy welliannau
eraill, gan gynnwys teitl y Mesur. Felly, o ran proses—i chi,
Gadeirydd—rwy’n gobeithio y cawn ni ddod yn ôl i
adlewyrchu ar y broses yma sydd ddim wedi bod yn gwbl effeithiol,
yn fy marn i.
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If I could make one point in speaking to these
amendments on the process, I have to say that I find the process of
legislating in this way to be very inadequate. I think the fact
that we have one amendment before us this morning that to all
intents and purposes redrafts 80 per cent of the Bill that we as a
committee scrutinised in great detail at Stage 1—that
doesn’t reflect well on the processes in place. I accept that
everything is in order, but I do hope, perhaps, that the committee,
when we come to consider our legacy report, can reflect on the
experience of having scrutinised a Bill that has been brought
forward by an individual Member in this way, but which, to all
intents and purposes, has been reintroduced at Stage 2 by the
Government through an amendment that virtually redrafts the whole
of the Bill in one amendment, or 80 per cent of it at least, and
then redrafts almost everything else, the remaining 20 per cent,
through other amendments, including the title of the Bill. So, in
terms of process—for you, Chair—I hope that we can
return to reflect upon this process, which hasn’t been
entirely effective, in my view.
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[28]
Beth bynnag, o ran y gwelliannau yr
ŷm ni’n eu trafod fan hyn, byddaf i’n
cefnogi’r gwelliannau yn enw Darren Millar. Yn y drafodaeth a
gawsom ni yn ystod Cyfnod 1, fe ddaeth hi’n rhan ganolog
o’n trafodaethau ni, a chael ei adlewyrchu yn argymhelliad 3
o’n hadroddiad ni, ein bod ni eisiau eglurder fod yr hyn sydd
yn cael ei gyflawni drwy’r Mesur yma yn sicrhau lefelau
diogel o staff—safe nursing staff levels—ac fe
oedd yn glir inni fel pwyllgor, ac yn sicr i mi, fod y defnydd
o’r term ‘diogel’ yna, ‘safe’,
yn gwbl allweddol i’r hyn yr oedd y Mesur yma’n ceisio
ei gyflawni, ac nad oedd unrhyw gyfeiriad at y term
‘gofynnol’, ‘minimum’, yn
adlewyrchu’r hyn yr oedd mwyafrif o’r tystion yn ei
gyflwyno i ni, na’r hyn yr oedd y Mesur cychwynnol yn ceisio
ei gyflawni hefyd, i rwy raddau. Felly, rwy’n credu ein bod
ni fel pwyllgor wedi sefydlu’r egwyddor yna yn argymhelliad 3
ein bod ni eisiau gweld uchelgais y Mesur yma yn cael ei adlewyrchu
drwy ofyniad statudol am lefel ddiogel o staffio, ac felly
rwy’n cefnogi’r gwelliannau sy’n ceisio
diogelu’r egwyddor bwysig yna.
|
Anyway, in terms of the amendments that
we’re discussing here, I will be supporting the amendments in
the name of Darren Millar. In the debate that we had during Stage 1
proceedings, it became a central part of our discussions, and it
was reflected in recommendation 3 of our report, that we wanted
clarity that what is achieved through this Bill does secure safe
nursing staff levels—and it was clear to us as a committee,
and certainly to me as an individual, that the use of the word
‘safe’ was entirely crucial to what this Bill was
seeking to achieve, and that any reference to the term
‘minimum’ didn’t reflect what the majority of the
witnesses were putting forward to us, or what the initial Bill was
trying to achieve, to a certain extent. So, I believe that, as a
committee, we’ve established that principle in recommendation
3 that we want to see the ambition in this Bill reflected through a
statutory requirement for a safe nursing staff level, and I
therefore support the amendments that seek to safeguard that
important principle.
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[29]
David Rees: Thank you, Elin. Do any other Members wish to
speak? No? Then I call on the Minister to speak on this
sub-theme.
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[30]
Mark Drakeford: Thank you, Chair. Well, as Members have
heard, this sub-theme is all about a series of amendments aimed at
putting the term ‘safe’ or ‘safely’ back
into the Government’s amendment 29. Amendment 29 is drafted
in the way it is because the unambiguous advice I have received
from those with expertise to draft the law is that it should be
drafted in the way that it is, and that these amendments should be
resisted. Of course the term ‘safe’ is used in other
contexts, where its general meaning is intended without needing to
define in a legal sense what that term means. Here, we are drafting
the law—not guidance, not a press release, but the
law—and, in that context, ‘safe’ or
‘safely’ would have to be defined as being a reduction
in harm, rather than absence of harm, because no clinical setting
can ever be completely free from danger. The nature of clinical
services and the interventions provided will always carry a certain
degree of risk. Trying to establish a legally secure definition of
‘safe’ or ‘safely’ in such terms would be
impossible, I believe, as the concept would have to be relative to
the setting in which it was being used. If, for example, a patient
with acute pancreatitis is at serious risk of multi-organ failure,
as someone suffering from that condition is very likely to be, then
no matter how many nursing staff are on duty in a ward, that
patient could not be regarded as being safe from the potential
ravages of the illness that afflicts them. If we use the word
‘safe’ it will be necessary to identify not only who
was made safe by the nurse staffing level, but in what sense and
from what. Not only would this be difficult to demarcate, but also
the extent to which the nursing care a patient receives contributes
to the safety of that patient will inevitably vary greatly
depending on that person’s condition and other circumstances
of their care, including the clinical contribution of all others
members of the team responsible for that care.
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[31]
Acute medical and surgical wards are staffed by clinically
qualified and competent people trying to make the best and the
right decision in the situations that they face in front of them.
The significance of this Bill is that, if it is amended by
amendment 29, then the use of a triangulated approach to set
staffing will be embodied within the law. The method is what makes
the difference to the outcome, not the use of an adjective or an
adverb. The method we set out allows professionals to exercise
their judgment and use validated tools and indicators to support
those decisions. The method gives back the power over staffing
decisions to those who are there and on the spot and with the
ability to make them. It is not a formulaic method for establishing
a number above or below which patients would necessarily be unsafe,
or, in other words, in danger.
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[32]
There are circumstances on a busy ward where, for operational
reasons, the nurse staffing level could fall below or exceed the
level that has been calculated using the triangulated approach, but
where patients might not be at risk of harm and therefore not
actually be unsafe. Furthermore, not only would a nurse staffing
level that fell below or exceeded the calculated safe level be
unsafe within the terms of the Bill, using ‘safe’ in
this way would call into question the safety of a nurse staffing
level determined by any other means.
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[33]
The use of the term in its general and natural meaning, in
non-legal contexts, is absolutely unproblematic. Transpose that
term into a very specific and legal context and you end up with all
the unintended consequences that I have rehearsed this morning. For
that reason, I ask Members to reject all the amendments in this
sub-group tabled in the names of both Darren Millar and Elin
Jones.
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|
[34]
David Rees: Thank you, Minister.
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|
[35]
David Rees: I call on the Member in charge, Kirsty Williams,
to speak to the sub-theme.
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|
[36]
Kirsty Williams: Thank you very much, Chair. May I take this
opportunity to place on record my thanks to Assembly Commission
staff who have helped me through this long and drawn-out process
for their professionalism and expertise? Can I thank colleagues of
the health committee that have dedicated so much of their time to
scrutinising the proposals when I know that we have a very busy
schedule, and they have done so with great diligence? Can I also
thank the Minister and his officials for the courtesy shown to me
during the passage of this Bill? I’m grateful to Mark for the
approach he has taken.
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[37]
But as the Minister indicated in his opening remarks, whilst those
discussions have been numerous and lengthy, there still remain
areas of disagreement before us. I’m disappointed with the
content of amendments 28 and 29, in particular the removal of the
term ‘safe’. However, I’m also conscious that if
amendments 28 and 29 were to pass, I believe that there is still
significant merit to this legislation and this legislation should
be passed. Critically, for me, it would still achieve the general
principles that informed the development of this private
Member’s Bill. It will ensure that local health boards have
regard to the importance of providing sufficient nurses to allow
those nurses to care for their patients. It will also enshrine a
duty to use the triangulated approach to calculate and take action
to maintain nurse staffing levels. Indeed, this has been a journey
of discovery and greater understanding for me.
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[38]
When I first started this process, it seemed to me that a single
number would achieve my goals. It was quite clear from discussions
with people who do this job on a regular basis that a simple number
itself would not be good enough. And therefore, even with
amendments 28 and 29, the use of the triangulated approach will
make a significant difference. I don’t just believe that; the
healthcare professionals I’ve spoken to—they also
believe that, even with these amendments, this Bill will make a
real concrete difference to patients and nurses on the front line.
Such a duty has never existed before, and it will enable all
nurses—not just the designated nurses—working on a ward
and patients to challenge a health authority that has failed to
have regard to this legislation.
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[39]
Quite simply, I believe the practical benefits can be realised from
this legislation, and I would agree with the Minister that it is
not a word in itself that will make the difference to staff and
patients. Given the constraints of the process I find myself in, I
don’t want the perfect to become the enemy of the good.
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[40]
Nevertheless, I do support the proposed amendment by Darren Millar
in this regard that would put the concepts of ‘safe’
and ‘safety’ back into the Bill. The term
‘safe’ is a concept that is used frequently in the
context of healthcare legislation. Indeed, the Health and Social
Care (Safety and Quality) Act of 2015 describes itself as an Act to
make provision about the safety of health and social care services
in England. Closer to home, the term ‘safe’ has also
been used in numerous Measures and Acts in the National Assembly
for Wales—the Children and Families (Wales) Measure of 2010,
the Learner Travel (Wales) Measure of 2008, the Active Travel
(Wales) Act of 2013, and the Well-being of Future Generations
(Wales) Act 2015. Safety is also a concept that is well understood
by health professionals. They’re well versed in it and they
have to make decisions about safety day in, day out, and
that’s reflected in the National Institute for Health and
Care Excellence’s safe staffing guidance. It’s also a
concept that I believe is readily understood by the public. The
concept of ‘safe’ was emphasised and has been referred
to by other Members during the passage of this Bill and the
consultation exercise that was carried out.
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[41]
The Minister may correct me, but I don’t believe that the
intention of the Minister’s amendment is to result in unsafe
staffing levels. In practical terms, I therefore believe that the
Bill, subject to the Government amendments, will still result in
actions that support the delivery of safe staffing levels, but I
think that the removal of the term ‘safe’ from the face
of the Bill is a missed opportunity to symbolically set out clearly
what the intention of the Bill is.
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|
[42]
David Rees: Thank you. I call on Darren Millar to reply to
the debate.
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|
[43]
Darren Millar: Thank you, Chair, and thank you, Members, for
your contributions. I have to just put on record also my sympathy
with the view expressed by Elin Jones about the processes within
the Assembly to manage such an extensive rewrite of a piece of
legislation. I do think that some consideration needs to be given
to that, but I’m grateful for her support and, indeed, the
support of the Member in charge in relation to the amendments that
I have tabled in this particular sub-theme. I do believe that the
examples that have been cited by Kirsty Williams—and there
are other examples as well of course at UK legislation level in
health and safety law, for example—clearly demonstrate that
the words ‘safe’, ‘safety’ and
‘safely’ are all terms that are used regularly in
legislation both here in Wales and in other parts of the UK.
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|
[44]
I referred earlier on to the chief nursing officer’s existing
guidance to local health boards, which uses also the same term,
‘safe’, throughout it, and I cannot understand why the
Minister feels so resistant to ensuring the inclusion of this
particular word on the face of the Bill. The Minister’s own
amendment uses words like ‘sufficient’,
‘sensitively’, ‘efficiently’ and
‘effectively’, all of which are open to interpretation
and will require definitions—particularly the word
‘sensitively’; I don’t think I’ve seen that
anywhere else in other pieces of legislation, although I may well
be mistaken. So, I do want to move later on to a vote on these
particular amendments. I think it’s really important that, as
a committee, we follow through on our commitment at Stage 1 to want
to see this word throughout this Bill on the face of the
legislation, and I urge Members to support this batch of
amendments.
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|
[45]
David Rees: Thank you, Darren. I just wish to reiterate that
we won’t be voting on the amendments until the end of group
1.
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|
[46]
Darren Millar: I appreciate that.
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|
09:30
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|
Is-thema o fewn
Grŵp 1: (b) Lleoliadau y Byddai’r Ddyletswydd yn Gymwys
Iddynt (Gwelliannau 29C, 29J, 29Z, 29AA, 29AB, 29AC, 29AD, 20, 2,
21, 3, 4, 22, 23, 24, 30, 31, 15, 16, 36, 37 (28, 29))
Sub-theme within Group 1: (b) Settings to Which the Duty Would
Apply (Amendments 29C, 29J, 29Z, 29AA, 29AB, 29AC, 29AD, 20, 2, 21,
3, 4, 22, 23, 24, 30, 31, 15, 16, 36, 37 (28, 29))
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[47]
David Rees: Therefore, I move on to the second sub-theme
amendments, which we will consider in relation to the settings to
which the duty would apply. The first amendment in the sub-theme is
amendment 29C. I call on Darren Millar to move amendment 29C and to
speak to the amendments in this sub-theme.
|
|
[48]
Darren Millar: I move amendments 29C and 29J, and I want to
speak to amendments 2, 3, 4, 15, 16, 36 and 37—all in this
sub-theme, Chair.
|
|
[49]
This group of amendments looks at extending the remit of the Bill
to the independent sector as well as increasing its provision to
beyond adult acute wards in order to encompass children’s and
mental health services, for example. Amendment 29C extends the
scope of the Bill to include the independent sector in the
provision of safe staffing levels. We all know that the independent
sector, when it came before this committee, felt very clearly that
the scope of the Bill did not go far enough and that the duties
included within it should also apply to their activities within the
health sector. For example, Care Forum Wales expressed concern that
its members may be adversely affected if the Bill’s provision
did not apply to nursing homes. It argued that the Bill could
restrict their ability to recruit and retain nurses, aggravating an
already difficult situation across the country because of poor
workforce planning in the national health service and wider
education sector. This view was supported, of course, by the Welsh
Independent Healthcare Association, which said that if the
Bill’s provisions were extended to include the independent
sector, then it should include all care delivered by this sector,
not just NHS-funded care. It argued that the inclusion of private
care in the Bill would allow the independent sector to reflect its
support for safe staffing for all the patients whom it cares
for.
|
|
[50]
Amendment 29J would ensure that the Bill, in terms of safe nursing
staffing levels, extends to all wards in both acute and community
hospitals. At present, the Bill applies just to acute medical
in-patients and surgical in-patient wards, if amendment 29 is to
proceed, but children’s wards, maternity wards and mental
health wards would all be excluded. I believe that this presents a
real risk that staff would be taken from these settings in order
for the staffing requirements to be met elsewhere in our hospitals.
Indeed, many witnesses alluded to this when they came to give
evidence to the committee.
|
|
[51]
It’s for this reason that I also will be supporting amendment
29AC in the name of Elin Jones in this sub-theme, which seeks to
extend the scope of the Bill to community nursing as well, which we
know is going to become an increasing feature of NHS services as
our services move away from secondary and tertiary care, out into
the community and into primary care.
|
|
[52]
My amendment 2 would have a similar effect, but on the Bill as
introduced, should amendment 29 not proceed.
|
|
[53]
There’s also a risk that the Bill as it stands and amendment
29 could be subject to challenge, I believe, as discriminatory
under the Equality Act 2010, and that Ministers may fall foul of
their own obligations in failing to have regard to the UN
principles on the rights of the child should my amendments not
proceed.
|
|
[54]
My amendments 3 and 4 would extend the scope of the Bill to include
commissioned services, whether from NHS providers beyond Wales or
the independent sector. These are commissioned services that are
funded by the Welsh NHS, and we know that, given the development of
community partnerships in the delivery of healthcare in Wales,
including the private sector and third sector partners, this
amendment therefore would require independent providers of
healthcare services to adhere to the same staffing levels as local
health boards and ensure that Welsh patients cared for in settings
other than NHS settings in Wales are not disadvantaged as a
result.
|
|
[55]
We also support the independent sector and the role that it plays
in delivering commissioned health and social care services.
|
|
[56]
The Royal College of Nursing, of course, agreed that staffing
levels for children, subject to care from independent providers
should,
|
|
[57]
‘equate to those recommended for the equivalent NHS
service’.
|
|
[58]
I believe that these amendments would achieve just that.
|
|
[59]
I should say also that, should my amendments to amendment 29 not be
agreed, we will be supporting amendments 29Z, 29AA, 29AB, 29AC and
29AD, which have all been tabled in the name of Elin Jones, which
seek to make similar amendments to amendment 29.
|
|
[60]
If I can just speak very briefly to the Government’s
amendment 31, although I feel that this could be improved by my
amendment 31A, I will be supporting that particular amendment and
speaking to 31A later during the course of the morning.
|
|
[61]
Amendments 36 and 37 seek to ensure that the Bill’s
provisions require the registered person in care home settings to
have due regard to any guidance that is issued in relation to the
Bill. Of course, it is absolutely necessary for those amendments to
proceed should the other amendments in this sub-theme that
I’ve tabled proceed and be agreed by the committee.
Similarly, my amendment 2 has the same effect, but on the Bill as
introduced. I understand that the Government’s amendment 30
is a technical amendment in terms of its nature, but perhaps I can
hear the debate on that in a few moments. Thank you.
|
|
[62]
David Rees: Thank you, Darren. Elin, do you wish to
speak?
|
|
[63]
Elin Jones: Yes. I’ll speak to the amendments in my
name in this group, which serve to add hospital and NHS settings to
the face of the Bill. Amendments 29Z to 29AD, if the Government
amendment 29 passes, will add community hospital wards, mental
health in-patient wards, children’s in-patient wards in acute
hospitals, community nursing and maternity services to the settings
covered by the Bill at this point. In the committee’s work,
we took evidence and we formed views that the current settings, as
proposed in the Member’s Bill, were insufficient to meet some
of the concerns that we had as to the unintended consequences of
the legislation that could see local health boards meet their
statutory requirements under this Bill by relocating nurses. In
particular, we focused on mental health in-patient wards where a
number of issues have arisen in Wales that have related to staffing
on such wards. I have a particular concern that mental health
in-patient wards should be included on the face of this Bill, and
29AA seeks to do that.
|
|
[64]
Also, in terms of non-acute hospital settings—both community
hospital wards and community nursing—it would be very
unfortunate, if, as a consequence of legislating for acute medical
and acute surgical wards only, the unintended consequence is that
local health boards move nurses from community settings to meet the
statutory requirement, because all of public policy is now towards
increasing support in community settings, whether that is in a
community hospital setting, or certainly in community nursing. So,
my amendments under this theme seek to ensure that none of these
unintended consequences materialise as a result of passing this
legislation in the form originally intended by the Member, now
intended, possibly, by the Minister’s amendment 29.
|
|
[65]
David Rees: Thank you, Elin. Lynne.
|
|
[66]
Lynne Neagle: Thanks, Chair. Could I first of all place on
record my thanks to Kirsty for bringing forward this piece of
legislation? As she knows, I’ve been supportive of it from
the beginning. I think if it gets on to the statute book, it will
be a very useful tool to empower not just nurses, but patients and
their families, as well, so, I’m pleased that we’ve
reached this point today. My main reservation, when we were
scrutinising the Bill, was about the possibility of staff being
drawn from wards that weren’t covered by this piece of
legislation. I still have some concerns about that, so I have some
sympathy with these amendments today.
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|
[67]
I just wanted to say a few words, particularly about Elin
Jones’s amendment 29AA, because my concern is foremost as it
relates to adult mental health wards. I do want to declare an
interest, as I have a close family member who is living on one of
those wards at the moment. But I just wanted to say that I am very
sympathetic to this amendment. We know that there have been
problems with these wards in Wales, as Elin has highlighted, but in
my experience also, some of the patients who are on those wards
have few or no visitors, so they are, to all intents and purposes,
voiceless. So, while I understand that the legislation has to start
somewhere, I won’t be supporting that amendment today, and I
hope that the Minister will use the powers that he will have to
regulate quickly to bring these wards within the scope of the
legislation. I hope that he will be able to say something to us
about that here today.
|
|
[68]
David Rees: Thank you. Does any other Member wish to speak?
No. Minister.
|
|
[69]
Mark Drakeford: Thank you, Chair. On the first sub-group of
amendments we discussed this morning, the changes, if they were to
go through, would be, as the Member in charge has said, essentially
symbolic. In this sub-group of amendments, however, the amendments
sought are substantive, and the risks that they run should they
reach the statute book are real. I’ll be asking Members to
resist them for reasons I will now outline.
|
|
[70]
Deciding nurse staffing levels is a complex area and, as the
committee has explored it, we have found that other countries that
have already begun to introduce such laws struggle to implement
them. NHS England has decided to stand down the work that NICE has
been doing in this area. The approach that we have developed is to
use the triangulated approach, using professional judgment, the
acuity tool and nurse-sensitive indicators in conjunction with one
another. A considerable amount of work has been done on this
approach for adult acute medical and surgical wards, and work is
ongoing here in Wales to develop similar approaches in other
clinical settings. The thing that distinguishes the wards that are
already proposed to be within the ambit of the triangulated method
are issues of evidence and issues of timing. The acuity tool, which
is a pivotal part of a triangulated approach, needs to be developed
specifically for each clinical setting. The acuity tool used for
medical and surgical wards cannot simply be applied in the same
way, for example, to children’s wards or mental health wards.
In the Bill, we apply the triangulated approach to adult in-patient
acute settings because we know that this is where the evidence
exists to support its application. That is why I am confident we
are protected from the Equality Act compliance issues that Darren
Millar raised. We have a rationale for applying the approach in
these settings, and the rationale is that there is an evidence base
on which to base clinical practice.
|
|
[71]
The conclusion that there is robust evidence that the triangulated
approach works in adult acute in-patient settings was confirmed by
witnesses who gave evidence to this committee in January and
February, and I think all the witnesses you heard from agreed on
this point, including the RCN and NICE itself. It is simply the
case that there is not yet any equally strong evidence about the
most effective approach to use in other clinical settings. A great
deal of work, however, is going on in Wales to validate
evidence-based tools in other clinical settings. A national pilot
scheme for an acuity tool for adult mental health in-patients is
currently being tested at ward level here in Wales. Staff at
Cardiff and Vale health board are currently evaluating an acuity
tool for paediatric wards developed by staff at the Great Ormond
Street Hospital. So, I am very happy to assure the committee that I
do have an active intention to use the potential to extend the
scope of the Bill as amended, should it be amended, under the
regulation powers that it provides. But that will have to be done
at the point where there is clear evidence of the most effective
approaches to be applied in those different clinical settings. Now
is not the time to do so because that evidence is not firmly enough
established. That’s the basis on which I will ask the
committee to reject amendments 2, 20, 21, 22, 23, 24 and amendments
29J, 29Z, 29AA, 29AB, 29AC and 29AD, all of which seek to extend
the settings on the face of the Bill, for which, as I’ve
indicated, the evidence does not exist at the current time.
|
|
09:45
|
|
[72]
Chair, can I now turn to
commissioned or funded care, which is the subject of amendments 3,
4 and 29C? Darren Millar’s amendment 3 seeks to add a new
duty for health service bodies to have regard to the degree to
which providers of commissioned or funded care achieve the duties
in 10A(1)(a). His amendment 4 would provide that the duty
introduced by amendment 3 applies whether the services are
commissioned in Wales, or not. My advice is that amendment 4 is
unnecessary, as amendment 3 does not limit the duty to have regard
to services that are commissioned or funded in Wales. In any case,
I ask the committee to reject the amendments, as they are both
unnecessary and unworkable. They are unnecessary because
commissioning contracts already contain requirements for quality
services, including quality of care and patient outcomes. They are
unworkable in practical terms, as they would place duties upon
health service bodies to have regard to the extent to which persons
for whom they commission or fund care comply with section 10A(1)(b)
of the Bill as introduced. Local health boards will be
commissioning from providers outside Wales, or the independent
sector, where fixed ratios would not apply. They are not within the
scope of this Bill.
|
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[73]
Turning now to amendment 29C, this amendment amends section 25B as
introduced by Government amendment 29. The effect of this amendment
would be to place a duty upon local health boards and NHS trusts,
whenever they commission or fund services to which section 25B
applies, to designate a person to calculate nurse staffing levels
to take all reasonable steps to maintain the level and to make
arrangements for informing patients of the level. Here, however,
more impracticality and undesirability intrudes. It places, for
example, requirements on local health boards and trusts in Wales
when they commission services from outside Wales, or from an
independent provider, to designate a person within that
organisation to calculate the nurse staffing levels in accordance
with the guidance to be published by the Welsh Ministers. At least
it’s theoretically possible that a health board or NHS trust
could make compliance with the duty a requirement when it tenders
for commissioned care. The risk would be that, in making that a
requirement of care provided outside Wales or in the independent
sector, the potential bidders would simply decide not to bid for
contracts on those terms, thus reducing choice for NHS Wales
patients. I think that that risk would be particularly acute along
our border, where a great deal of care that is required for Welsh
patients does indeed take place outside Wales.
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|
[74]
Turning, Chair, to amendments 15, 16, 36 and 37, which aim to
extend the duties to have regard to the care home and independent
healthcare sector, the effect of these amendments is to require the
registrant of an independent care home or an independent healthcare
establishment to have regard to the duties in section 10A of the
Bill as introduced, or sections 25A to 25D of the Bill as it would
be amended by Government amendment 29. I ask the committee to
reject these amendments as neither the Bill as introduced, nor as
it would be amended by the Government amendments, place duties upon
establishments in the independent sector. There are already
requirements in place dealing with staffing in the independent
healthcare sector through the registration requirements with the
Care and Social Services Inspectorate Wales. The cost of extending
the duties under the Bill in this way has not been ascertained and
could be unsustainable. I ask you to reject those amendments.
|
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[75]
I turn now, finally, to the Government amendments. Amendment 30, I
think, is slightly more than technical. It would make the exercise
of the Welsh Ministers’ regulation-making powers, under
subsection 25B(3)(c) of the Bill, subject to the affirmative
procedure. In that way, it answers a commitment I gave at Stage 1
to consult the National Assembly fully before issuing guidance or
making regulations under this Bill’s provisions, and putting
a requirement to use the affirmative procedure for regulations onto
the face of the Bill will enshrine that commitment in law, and
ensure scrutiny of them by the National Assembly.
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[76]
I’m grateful to Darren Millar for his indication of support
should amendment 31 be the amendment we finally have in front of us
in defining nurse staffing levels. Amendment 31 adds a definition
of nurse staffing levels to the National Health Service (Wales) Act
2006. Both this committee and the Constitutional and Legislative
Affairs Committee noted the lack of definitions on the face of the
Bill, and this amendment goes some way, I hope, to addressing those
concerns.
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[77]
David Rees: Thank you, Minister. I call on the Member in
charge, Kirsty Williams, to speak to these sub-themes.
|
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[78]
Kirsty Williams: Thank you very much, Chair. I think, at the
start of this debate about the settings to which the duty would
apply, it’s really important to note that even if amendment
29 is successful, this Bill still enshrines an overarching duty
that local health boards and NHS trusts must have regard to the
importance of providing sufficient nurses to allow the nurses time
to care in all settings. The overarching duty remains, and boards
will have due regard to that in all settings.
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[79]
It’s also important to note that this overarching duty will
apply when health service bodies in Wales are deciding whether and
how to use hospitals in England, and commissioning services on
behalf of Welsh patients. I agree with the Minister and, as such, I
do not consider it necessary to include the additional requirement
with regard to commissioning as set out in amendments 3 and
4.
|
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[80]
Like the Minister, I remain convinced that a specific duty for
adult acute medical and surgical wards at this point in time is the
most sensible approach, as that is where the evidence currently
lies. And I have tried at all points during this process to follow
the evidence. As the Minister said, the acuity tools evidence base
is there, allowing us to move forward at this point in time.
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[81]
I therefore do not support amendments 29J, 29Z, 29AA, 29AB, 29AC,
29AD, 2, 20 and 21 to expand this duty to other settings at this
current time. But the Bill does include provision to extend
specific duties to additional ward settings within Wales as the
evidence base in this area develops. The Minister has given very
clear examples of how that is currently being undertaken in Wales
with regard to paediatrics. I know in my own local health board of
Powys that a great deal of work is going on to look at the issue of
what is a manageable caseload for a nurse working in the
community.
|
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[82]
I’m also very grateful to hear from the Minister of his
specific intentions to use the powers within the Bill to extend the
duty to additional settings as and when that evidence becomes
appropriate. And that’s why I have some sympathy with
Elin’s amendments 22, 23 and 24. The examples that she lists
in those amendments are exactly the kinds of settings that I hope
in which we can develop the evidence base and use the provisions in
this Bill to be able to incorporate those settings at a later
date.
|
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[83]
Like Lynne Neagle, I do have concerns specifically about those
people receiving care on mental health wards, as covered by
amendment 29AA. None of us that could have witnessed the events at
Tawel Fan in north Wales can be immune to the problems that can
arise in acute mental health wards, and we need to be mindful that
these are some of our most vulnerable patients. They are often, as
Lynne Neagle correctly identified, patients who do not have people
to watch out for them or to speak up for them. And I’m very
grateful to hear from the Minister that it is his intention to
develop work in this area so that we can address those
concerns.
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[84]
Can I just make a point with regard to this fear about nurses being
removed from one setting into an adult acute ward or surgical ward
to address the issues of the Bill? What is really important to
recognise, Chair, is that nursing isn’t a blanket profession.
Each nurse will have a very specific skill set. Indeed, when people
enter the profession, they follow different routes of training.
They choose at very early stages within their career whether
they’re going to train as an adult nurse, as a
children’s nurse, nursing in the mental health field or
nursing in the learning disability field. They are very different
skill sets. Just because someone has skills in nursing children
does not mean they will have the requisite skills to nurse on an
adult ward. Just because somebody is currently employed as a mental
health nurse, with those very specific training and skills in
mental health, does not mean that those skills would be applicable
to an adult ward covered by this Bill.
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[85]
So, this Bill looks at a triangulated approach—it includes
the ability of the nurses to do the job. So, therefore, Members
should have some reassurance that it is simply not as easy for our
local health boards to transfer nurses from one setting to another,
because they’ve not been trained to nurse on an adult ward.
And, therefore, I would argue the LHB would not be fulfilling its
obligations under the Act if it was to do that. So, I think a
combination of recognising the skill sets of specific nurses, as
well as the overarching duty, will mitigate some of these concerns,
as well as a very welcome commitment by the Government to look to
extend the duties of this legislation to other settings as and when
that evidence arises and is developed.
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[86]
If I could turn to the issue of the private sector, it has never
been my intention to include the private sector in this
legislation. It has always been my duty to try and provide
protection for the majority of nurses and the majority of patients.
I don’t support amendments 15, 16, 36 and 37 to the Bill,
which would amend the regulations that provide the framework for
the regulation of care homes and the independent healthcare sector.
These amendments provide that the care provider must have regard to
the provisions of the new duties and any guidance issued by Welsh
Ministers when they’re operating within their own regulatory
framework. Whilst these amendments do not go so far as to amend the
Bill to make these sectors expressly subject to the duty, the
existing Bill is presently predicated on the application of public
law principles, such as the availability of judicial review. It
also relies on the Welsh Ministers’ existing powers of
intervention under the National Health Service Act 2006. In order
for the duty to be imposed on, and enforceable against private
healthcare providers, we would need an entirely different mechanism
for the imposition and enforcements of duty on a private healthcare
provider.
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[87]
With regard to the issue of care homes, the chief nursing officer
has said that the current acuity tool that has been developed is
not designated for the care home sector, as, often, the nature of
patients’ needs within that sector is very different from an
acute medical or surgical ward within a district general hospital,
and therefore, it simply would not be applicable to apply this tool
to that setting. Therefore, I do not support amendments to include
that setting under the auspices of this Bill.
|
|
[88]
David Rees: Thank you. Can I call on Darren Millar to
reply to the debate?
|
|
[89]
Darren Millar: Thank you, Chair. I’ve listened very
carefully to what has been said, and I welcome the commitment that
the Minister has given to consider other settings in the future.
But, nevertheless, I do think it is important that some of the
concerns that Members identified during the course of Stage 1,
particularly regarding mental health wards and, indeed,
children’s wards—. Children are also voiceless in many
respects and need somebody to be able to advocate for them. I take
on board the point that Kirsty Williams made about specialisms in
nursing. I completely understand and appreciate that, but, of
course, this Bill doesn’t just cover nurses; it covers the
nursing profession more widely, including healthcare support
workers, who regularly shift between one ward and another, or one
part of a hospital and another, or, indeed, one hospital and
another, as part of their work, in order to cover shifts. And, we
all know also that bank staff and agency staff are regularly called
in to work in departments that they may be unfamiliar with, too.
So, I think it is really important. These are real risks. The
Minister referred to risks and said that these amendments posed a
risk to the Bill. The reality is that there are risks to those
other care settings if this Bill proceeds and simply looks at acute
medical wards and surgical wards alone. But, notwithstanding the
commitment that the Minister has given, I think it is important
that he’s minded to consider these other settings in the
future. But I will be seeking to push Members to a vote later on on
these issues.
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|
[90]
Elin Jones quite rightly spoke about the innovation in the
healthcare sector, which is pushing more and more work into the
community nursing part of the business, as it were, and it is
important that that too is absolutely captured somehow through the
provisions of this Bill, in order that that can be sure of ensuring
that there are sufficient staffing levels.
|
|
10:00
|
|
[91]
But I do want to just touch again on the independent sector and
commissioned care. I think it is very, very important that patients
are not disadvantaged, if their care is funded by the NHS, simply
by being placed in a different care setting other than a hospital,
whether that’s a private provider, a third sector provider or
indeed a provider over the border. I listened very carefully to
what was said about commissioned care and some of these wider
duties being applicable to even the care that has been
commissioned, but I don’t accept fully that that will deal
with my concerns or the concerns of the independent sector. The
number of nursing beds in the independent sector is higher than the
number of nursing beds in the NHS these days, and it is continuing
to grow apace as a result of changes in the way in which care is
commissioned and the ageing demographics of our society. So,
it’s important somehow to ensure that NHS-commissioned care
in the independent sector—not just the private sector, but
the third sector as well—is adequate in terms of those
staffing levels and that patients cared for in such settings are
not disadvantaged.
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[92]
The Minister is quite right that many people in north Wales and in
mid Wales who receive care in hospital settings over the border
will want to be reassured that that care is also going to be of the
same standard, with the similar or better staffing levels than are
going to be achieved as a result of this Bill here in Wales. There
are no safeguards for that at all on the face of the Bill at the
moment, and that’s why I’ll be encouraging Members
still to support my amendments.
|
|
[93]
Can I welcome amendment 30 and the clarification on amendment 30?
I’ll certainly be supporting that given that it’s in
relation to affirmative procedures on regulations. Thank you.
|
|
Is-thema o fewn Grŵp 1: (c) Cymwysterau,
Hyfforddiant, a Recriwtio Nyrsys (Gwelliannau 29D, 29AE, 1, 25 (28,
29)
Sub-theme within Group 1: (c) Qualifications, Training, and
Recruitment of Nurses (Amendments 29D, 29AE, 1, 25 (28, 29)
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|
[94]
David Rees: We now move on to the third sub-theme of
amendments in group 1 to consider. They’re in relation to
qualifications, training and recruitment of nurses. The first
amendment in this sub-theme is amendment 29D, and I call on Darren
Millar to move amendment 29D and speak to the amendments in the
sub-theme.
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|
[95]
Darren Millar: I move amendment 29D and want to speak to
amendment 1, also in my name. Amendment 29D seeks to ensure that
NHS providers, in addition to deploying nurses in sufficient
numbers, must also ensure that staff have the necessary mix of
qualifications and experience to enable the provision of safe
nursing care. I believe that this amendment will provide the people
of Wales with the confidence that health service bodies were
legally bound to ensure that their staffing levels are sufficiently
bolstered with nurses that have the necessary skills to provide the
very best standards of care that the NHS can fund.
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|
[96]
This has long been advocated, of course, by the RCN. It was first
implemented at their 2011 congress, where nurses voted to legally
enforce deploying nurses in sufficient numbers, motivated by
initial findings of the Mid Staffs inquiry, in which low staffing
levels and skills were cited as contributory factors in the
failings in that trust. Of course, we all know that it’s not
just about numbers, but also about making sure that people, as
Kirsty Williams has said, have the right skills for the wards that
they’re working on and have the right skills for the acuity
of the patients as well. At the moment, the Bill makes no reference
on the face of it to this. Amendment 1, of course, would seek to
have a similar effect, but to the Bill was introduced.
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[97]
I also want to speak in support of amendment 29AE and amendment 25
tabled in the name of Elin Jones, which seek to ensure that
workforce planning reflects the provisions in this Bill and the
need to look ahead at the skills that the NHS is going to require.
There’s very little point in having this Bill if there is an
insufficient supply of suitably qualified and experienced nursing
staff, and that’s what these amendments seek to achieve.
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|
[98]
David Rees: Thank you, Darren. Elin, do you wish to
speak?
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[99]
Elin Jones: Ydw, dim ond i siarad i’r gwelliannau yn
fy enw i, sef gwelliannau 25 a 29AE. Pwrpas y gwelliant yma yw
sicrhau bod y mesur yma a’r ddeddfwriaeth yma’n cael eu
cysylltu gyda’r angen hefyd i sicrhau bod cynllunio’r
gweithlu nyrsio yn digwydd, mewn ffordd sydd yn ofynnol o dan y
ddeddfwriaeth, er mwyn sicrhau cyflenwad digonol o nyrsys i’w
recriwtio a hefyd i’w hyfforddi. Mae wedi bod yn thema yn ystod y dystiolaeth rŷm
ni wedi ei chasglu fod yr angen i ddiogelu ac i sicrhau y cyflenwad
o nyrsys yna i gwrdd â beth fydd uchelgais y ddeddfwriaeth yma
yn gweithio law yn llaw â’r egwyddorion o dan y
ddeddfwriaeth yma, achos yr hyn nad ydym ni eisiau iddo ddigwydd
fel canlyniad i’r ddeddfwriaeth yma yw fod yna ddibyniaeth
gynyddol ar nyrsys of fewn y
system bancio ac agency, sydd yn mynd i roi pwysau ariannol
ychwanegol ar y byrddau iechyd. Felly, mae rhoi gofyniad penodol ar
y byrddau iechyd, ac ar Weinidogion y Llywodraeth, i sicrhau bod
yna broses o gynllunio’r gweithlu yn digwydd, law yn llaw
â’r ddeddfwriaeth yma ac ar wyneb y ddeddfwriaeth yma,
yn cael ei amlinellu yn y gwelliant rwy’n ei
gyflwyno—bod y ddau beth yn rhedeg law yn llaw er mwyn
gwireddu beth yw gwir amcan y ddeddfwriaeth.
|
Elin Jones: Yes, just to speak to the
amendments in my name, namely amendments 25 and 29AE. The purpose
of this amendment is to ensure that this measure and this
legislation is linked with the need to ensure that the planning of
the nursing workforce, as required under the legislation, secures
an adequate supply of nurses for recruitment and for training. It
has been a theme during our evidence gathering that the need to
safeguard and secure that supply of nurses to meet the ambitions of
this legislation goes hand in hand with the principles of this
legislation, because what we don’t want to see happening as a
result of this legislation is an increasing reliance on nurses
within the nurse bank and agency system, which will place
additional financial pressures on the health boards. It places a
specific requirement on the health boards, and on Government
Ministers, to ensure that there is a workforce planning process in
place, along with this legislation and that that is included on the
face of this legislation, and that is what is outlined in my
amendment—that both things should go hand in hand in order to
achieve the real objectives of this legislation.
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|
[100]
David Rees: Thank you, Elin. Do any other Members wish to
speak? No. Then, I call on the Minister to speak to the
sub-theme.
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|
[101]
Mark Drakeford: Chair, in this sub theme, there’s no
difference between what the Government would wish to achieve and
what the Members who’ve already spoken have as their aims.
Our difference is simply one of how we achieve them rather than
wanting to achieve them. We entirely agree about the need to make
sure that there’s a proper mix of qualifications and
experience of registered nursing. I believe that the Government
amendment 29 as drafted is preferable to Darren’s amendment
29D, because I think amendment 29 goes further. The Government
amendment provides that professional judgment should be exercised
when calculating nurse staffing levels. Section 25D also provides
for guidance to be issued that sets out a number of elements that
should be taken into account in the application of that judgment.
This will include not only the qualifications and experience, it
will go beyond that to take into account the competencies and the
skills of the nurses providing care. I think that these things are
best covered in guidance, given their complexity, and therefore are
already provided for under my amendment 29.
|
|
[102]
Turning to Elin’s amendments 25 and 29AE, I am persuaded by
what she has said, and by some of the arguments I anticipate will
be made by Darren in relation to his amendment 29P in a subsequent
group, that workforce planning arrangements should be reflected on
the face of the Bill. For today, I would just need to say to Elin
that I think that there are some drafting issues in relation to
amendment 29AE, which means that, if it’s put to a vote,
I’ll have to ask Members not to support it today. The duty as
drafted, for example, could be interpreted as requiring an approach
where, when vacancies exist, they must all be filled with new
graduates. Now, we understand that there are other ways of filling
nurse vacancies, where retention and retaining people in the
workforce who are already qualified can be just as important as new
graduates coming into the profession.
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|
[103]
If Elin were to decide not to move amendment 29AE today, then
I’m very happy to extend an offer to work with her, through
my officials and hers, to come up with an amendment at Stage 3 that
would achieve her intentions in a way that we think would be more
robust. I’ll make the same offer to Darren later, in relation
to amendment 29P. If the amendment is put to the vote today,
I’ll have to ask Members to vote against it. But the same
offer of working to a Stage 3 amendment would apply in those
circumstances too.
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|
[104]
David Rees: Thank you, Minister. I call on the Member in
charge, Kirsty Williams, to speak to this sub-theme.
|
|
[105]
Kirsty Williams: Thank you. Can I begin by saying that I
absolutely recognise that the Minister’s amendment 29 will
provide that, when calculating a nurse staffing level, a designated
person should exercise professional judgment by taking
nurses’ qualifications and skills et cetera into account?
That, I believe, is appropriate, welcome and important. However, I
have a slightly different interpretation than the Minister does
with regard to Darren’s amendments 1 and 29D. I believe that
these will strengthen the provision by making it explicit that
staffing levels should include an appropriate mix of qualifications
and experience, and I would support those amendments going
forward.
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|
[106]
On the issue of recruitment, I think it’s important to note
that, by placing safe nurse staffing on a statutory footing, the
Bill aims to strengthen accountability for the safety, quality and
efficiency of workforce planning and management, and I believe it
continues to meet these aims. I believe that those aims would be
strengthened by Elin’s amendments 25 and 29AE, which would
assist in ensuring that Welsh Ministers also have a role to play in
ensuring appropriate nurse staffing levels. I’m very pleased
to hear the Minister’s acknowledgement of the importance of
this principle, and I believe it would be a welcome amendment to
the Bill, whether that is achieved either by Elin’s amendment
today or by subsequent amendments that the Minister, myself and the
Member would be able to work on, because I think it’s a
valuable addition to the legislation before us. I’m grateful
that the Minister shares that belief.
|
|
[107]
David Rees: Thank you. I call on Darren Millar to reply to
the debate on this sub-theme.
|
|
[108]
Darren Millar: While I’m pleased to hear the consensus
from everyone who’s spoken in this sub-theme debate around
the issues that have been identified by the amendments, and I
welcome the Minister’s commitment to the same aims and,
indeed, the Member in charge’s commitment to the same aims
and certainly her support for my amendments, I think it is
important that we test the committee today, if you like, by putting
these issues to a vote. I’ll be encouraging people to support
those amendments. I think there’s always an opportunity,
should the drafting, Minister, not quite be as adequate as it could
be, for that to be further amended then at Stage 3, but let’s
show a demonstration of support for these two principles today, I
think, in supporting all of the amendments in the group, because I
do think they add value to the Bill. I think that, yes, whilst I
accept that anybody who’s calculating safe nurse staffing
levels, if they’re using their professional judgment, will
take issues such as the skill mix and the experience and
qualifications into account, putting it on the face of the Bill
just allows a belt-and-braces approach to make sure that those
things are adequately considered by whoever is making those
professional judgments. I’ll touch a little bit more on
workforce planning in the next sub-theme as well, but the principle
that Elin Jones is making here about the importance of workforce
planning is completely understood, and I would urge people to
support her amendments also.
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|
[109]
David Rees: Thank you, Darren.
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|
Is-thema o fewn Grŵp 1: (d) Canllawiau
(Gwelliannau 29P, 29Q, 5, 6, 7 (28, 29))
Sub-theme within Group 1: (d) Guidance
(Amendments 29P, 29Q, 5, 6, 7 (28, 29))
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|
[110]
David Rees: We now move on to the fourth sub-theme of
amendments in group 1, and these are in relation to guidance. The
first amendment under this sub-theme is amendment 29P, and I call
on Darren Millar to move 29P and to speak to the amendments in this
sub-theme.
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|
[111]
Darren Millar: I move amendments 29P and 29Q and amendments
5, 6 and 7, all tabled in my name. This group of amendments is
focused on the guidance in relation to workforce planning
arrangements. Amendment 29P, which the Minister referred to just a
few moments ago, requires Ministers to issue guidance to NHS
organisations with duties under the Bill on their workforce
planning arrangements. As I said earlier, and as other Members have
alluded to, there is very little point in having legislation on
staffing levels if there is an insufficient supply of suitably
qualified nursing staff. So, this amendment simply seeks to ensure
a consistent approach to workforce planning
arrangements—[Inaudible.]—issued by the Welsh
Government to our health boards.
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|
[112]
Amendment 6 seeks to have a similar effect but, of course, to the
Bill as introduced. My amendment 29Q broadens the scope of the Bill
to include within that guidance the need to consult with the
independent healthcare and care home sectors when planning for the
workforce in Wales. It was very clear in the evidence that we
received that, all too often, they feel overlooked in the workforce
planning arrangements. That was one of the reasons that they felt
that there is an inadequate supply of nursing staff throughout the
UK, not just in Wales, as is the case at present. There was a
willingness, a very keen willingness, for the independent sector to
become more involved in workforce planning arrangements for the
healthcare workforce and the nursing care workforce here in Wales.
So, I think it is important to acknowledge these issues. The
Minister’s already suggested, and the Member in charge has
already suggested, that these are important issues, and I believe
that my amendments will facilitate improved workforce planning
arrangements for the nursing care workforce here in Wales. So, I
urge Members to support the amendments.
|
|
[113]
David Rees: Thank you, Darren. Are there any other Members
who wish to speak? No. Then I’ll call the Minister to speak
on this sub-theme.
|
|
10:15
|
|
[114]
Mark Drakeford: Thank you, Chair. We are picking up where we
left off under the last group and, in this group too, there is no
great difference of principle that separates the Government’s
approach and the one that Darren Millar’s just outlined.
Guidance is already available to health boards on the matter
covered by amendments 6 and 29P, but, having heard the debate, my
view is that those amendments could further support existing
arrangements and could bring into sharper focus the requirements on
health boards and trusts to plan the nursing workforce for the
future. What prevents me from accepting them today is simply their
reference to ‘health service bodies’. One consequence
of amendment 29, tabled by the Government, is to replace such
references with ‘local health boards and trusts’. To
accept amendment 29P as it is today would therefore introduce the
possibility of having varying definitions on the face of the
legislation should amendment 29 be passed, which, of course, I hope
it will be.
|
|
[115]
I’ll make the same offer identically to Darren as I did to
Elin. If this amendment isn’t put to the vote today I’d
be very happy to work with him, the Member in charge, and with
Elin, to bring back an amendment on workforce planning at Stage 3.
Even if it is tested through the vote today, that offer, of course,
still stands.
|
|
[116]
Turning to amendments 7 and 29Q, both of those relate to a
requirement for the independent healthcare and care home sectors to
be consulted in the development of guidance. We would always seek
to consult with a wide range of stakeholders in the development of
guidance, but amendment 29Q strengthens that requirement in
relation to these key sectors. If it’s passed, it would help
us to further explore and to move to resolve issues around care
homes where they have difficulty in securing and retaining the
number of nurses they need. I certainly recognise that the
independent and care home sectors are essential to the delivery of
integrated health and social care, and to our aim of caring for
more people closer to home.
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|
[117]
Now, Chair, I’m advised that, if amendment 29Q were to be
passed this morning, a further amendment would be needed at Stage 3
to add some additional definitional clarity to the terms used in
amendment 29Q. If Darren, in replying, is willing to commit to that
this morning, in the way that we worked with Lindsay in a similar
sense in the Regulation and Inspection of Social Care (Wales) Bill,
where we accepted an amendment at Stage 2 and then brought greater
definitional clarity to it at Stage 3—. If Darren is happy
with that approach, then I’m also happy to support amendment
29Q this morning.
|
|
[118]
David Rees: Thank you, Minister. I call on the Member in
charge, Kirsty Williams, to speak on this sub-theme.
|
|
[119]
Kirsty Williams: Thank you, Chair. I think it’s
important to note that the Bill, if it were to be amended by the
Minister’s amendment 29, would still ensure that Welsh
Ministers must issue guidance, and health boards and trusts must
have regard to such. It sets out a non-exhaustive list of matters
that may be included in the guidance, including the extent to which
nurses providing care are required to undertake supervisory or
administrative functions. The Welsh Ministers would also be
required to consult with relevant organisations and persons before
issuing guidance, which I consider to be appropriate.
|
|
[120]
But I do support Darren’s amendments 29P and 6 to provide
that the guidance must include specific provisions about the
workforce planning, and those arguments have just been rehearsed in
the previous sub-theme debate. I believe that such amendments would
strengthen longer term workforce planning to ensure a sufficient
supply of nurses, and it should be noted that this committee
recommended that I do consider including reference to arrangements
for comprehensive workforce planning on the face of the Bill to
ensure that the numbers of trained nurses are available across both
the public and the independent sectors.
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[121]
I also support amendments 29Q and 7 that would require Welsh
Ministers to consult the independent healthcare and care home
sectors before issuing guidance. Clearly, there is nothing in the
Bill that would prevent a Welsh Minister from consulting such
bodies, but, like the Minister has just stated, I believe that
including them on the face of the Bill would be of value and allay
concerns about this legislation having unintended consequences for
such organisations. I hope that we’re able to reach a stage
where an amendment is supported that has the definitional clarity
that the Minister is looking for.
|
|
[122]
However, I do not support amendment 5, because the text of the Bill
already provides that the guidance must specify methods that make
provision about the required nursing skill mix, and as such, I do
not believe that that amendment is necessary.
|
|
[123]
David Rees: Thank you. I call on Darren to reply to the
debate.
|
|
[124]
Darren Millar: Can I thank the Minister and the Member in
charge for their comments and the way in which they’ve
approached this set of amendments in the sub-theme? I welcome the
Minister’s commitment, or offer, to work together in order to
secure some definitional clarity to my amendment 29Q, and indeed
the offer to work on a cross-party basis in order to secure some
appropriate amendments on workforce planning. I think everybody
accepts the need to engage with the independent sector and the care
home sector when looking at the workforce planning arrangements,
and I think that this is a useful way to take things forward.
|
|
[125]
As the Minister will expect, I’d obviously like to see the
Bill amended today and then further amended, if necessary, at Stage
3, to accommodate the definitional clarity that both the Member in
charge and the Minister have indicated, but obviously I’ll
put this to the vote later on, Chair. Thank you.
|
|
[126]
David Rees: Thank you, Darren.
|
|
Is-thema o fewn Grŵp 1: (e) Trefniadau Adrodd
(Gwelliannau 29T, 29U, 32, 17, 18 (28, 29))
Sub-theme within Group 1: (e) Reporting Arrangements (Amendments
29T, 29U, 32, 17, 18 (28, 29))
|
|
[127]
David Rees: We move on to the fifth sub-theme of amendments
to consider in group 1, and they’re in relation to reporting
arrangements. The first amendment in the sub-theme is amendment 29T
and, once again, I call on Darren Millar to move 29T and speak to
the amendments in this sub-theme.
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|
[128]
Darren Millar: Chair, I move amendments 29T and 29U, and
amendments 17 and 18 tabled in my name. This group of amendments
focuses on the reporting arrangements for nurses and health service
bodies. Amendments 17, 18 and 29T allow for any review of the
impact of the Act to incorporate the effect of this legislation on
inadequate hydration and nutrition in patients. The Royal College
of Nursing recognises that hydration and nutrition are key
performance indicators in establishing patient welfare, and are a
key indicator in determining whether there’s high-quality
care and safe care being delivered. In fact, these are reflected in
the Welsh Government’s own fundamentals of care, which have
been working in the NHS, now, for some years here in Wales. The
current list of indicators of factors that constitute the
assessment of safe staffing is non-inclusive of these very
important issues and I think that, in measuring the impact of the
Bill, should it proceed and become an Act, it’s really
important that we capture those indicators, which, I believe, will
point to the value that this Bill can add to nursing care in
Wales.
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[129]
Of course, we all know that, unfortunately, the ‘Trusted to
Care’ report made clear reference, as have reports by the
Commissioner for Older People in Wales in the past, to the
importance of hydration and nutrition, and to the shortcomings,
unfortunately, in some hospitals in Wales, which they documented. I
think it’s important that we take this opportunity to include
on the face of the Bill reference to hydration and reference to
nutrition, as some of the key measures that will inform the public
and the NHS of the impact of this Bill on the ground, should it
proceed to become an Act.
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[130]
I’ll obviously be urging Members to reject the Welsh
Government’s amendment 32, which seeks to remove completely
any measures of the impact of the Bill on patient care from the
face of the Bill, and I think that’s very much a backward
step. I do hope that my amendments, rather than taking away from
the Bill, will actually strengthen it, going forward. We know that
concerns have also been raised, I might add, by both the Public
Accounts Committee in the National Assembly and, indeed, the Wales
Audit Office, in some of the work that they have done on patient
nutrition and hydration in Wales, about these important aspects of
care. I think it is important that we reflect on that and
that’s why I’m urging Members to support these
amendments today.
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|
[131]
David Rees: Thank you, Darren. Are there any other Members
who wish to speak? No. Then, I call on the Minister to speak on
this sub-theme. Minister.
|
|
[132]
Mark Drakeford: Thank you, Chair. As Darren Millar just
said, amendment 32 is relevant to this sub-theme, as well as
amendment 29, and I’ll be asking Members to support both of
those Government amendments.
|
|
[133]
My amendments move away from reporting requirements that have only
a weak relationship to staffing levels, and towards three key
evidence based indicators that can properly be reported upon. By
contrast, amendments 17 and 18 from Darren add to the list of
reporting indicators proposed in the Bill as introduced. This has
been a matter that I’ve been concerned about since the very
beginning of the Bill. I said in my evidence paper to this
committee at Stage 1 that I was concerned at the lack of evidence
of a causal relationship between some of the indicators set out in
the original Bill and nurse staffing levels. I tried to explain
these concerns at the Stage 1 committee, citing the fact that there
are many factors that contribute to patient outcomes, and therefore
the indicators used to report on this Bill must have a proper
correlation to the nurse staffing level if they are to be
meaningful. Those concerns apply equally to the addition of
nutrition and hydration as proposed by amendments 17 and 18.
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[134]
It’s important to be clear, Chair, that NICE did not find a
direct link between staffing levels and issues of nutrition or
hydration. They concluded, as I have in my amendment, that the
evidence points to three areas: pressure ulcers, medication errors,
and patient falls. None of this is for a moment to take away from
the very real issues of nutrition and hydration. Those issues are
central to the role of the nurse, and in the post-‘Trusted to
Care’ era we are very seriously focusing on issues of
nutrition and hydration. Our current Water Keeps You Well campaign,
for example, is evidence of that, but there was nothing in what I
heard Darren Millar say, in introducing these amendments, that
could produce a causal link between the number of nurses on a ward
and issues of nutrition and hydration. If we’re going to
measure the impact of a Bill that is about the number of nurses on
the ward, then the way we test the success of the Bill must be
indicators that have that causal relationship. I’m afraid
that those amendments do not.
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[135]
I agreed with the committee recommendation from Stage 1, that the
reporting requirement should be revised so as not to create
additional bureaucracy and be aligned to existing reporting
requirements. That was recommendation 12 of this committee’s
report, and my amendments set out to do just that. That’s
why, in addition to the list of indicators that I believe have that
causal relationship, and therefore should be reported upon, I also
seek to align the reporting requirements to the current three-year
planning cycle, and that’s the effect of my amendments 29 and
32, and I ask Members to support them.
|
|
[136]
David Rees: Thank you, Minister. I call on the Member in
charge, Kirsty Williams, to speak to this sub-theme.
|
|
[137]
Kirsty Williams: Thank you. Obviously, I note that the
Minister’s amendment 29, if passed, would reduce the proposed
list of indicators to just three. As the Minister has just stated,
those include medication errors, falls and pressure ulcers. I am
pleased that these indicators remain, and note that they are
indicators identified, as the Minister has just stated, by
NICE’s safe staffing guidance from July 2014 as being
sensitive to the numbers of available nurses and to nurses’
skill mix. However, I am disappointed that the other indicators
have been removed.
|
|
[138]
The intention of the indicators was not to assess the impact of
staffing levels against a single indicator in isolation, but rather
to provide a consistent set of data against which to monitor the
overall impact of staffing levels. It is this overarching range of
outcomes rather than any one individual indicator that would, I
believe, have enabled a detailed examination of the impact of the
measures within the Bill on outcomes.
|
|
[139]
However, the amendment does helpfully state that these are only
‘for example’. Consequently, health boards could choose
to report on any other relevant indicators, although there is a
risk that this may result in a variable dataset across Wales,
depending on the indicators individual health boards chose, and
reporting bodies may choose to report on those indicators that they
believe will put them in a more positive light. Consequently,
whilst I absolutely understand the importance of hydration and
nutrition and the points made by Darren Millar to include those on
the face of the Bill, I believe it would be legally incongruous to
include them if the other indicators from the original list are
lost as a result of the Government’s amendments.
|
|
10:30
|
|
[140]
I also note that the Minister’s amendment 32 will remove the
requirement for Welsh Ministers to review the operation and
effectiveness of the Act. Again, I believe that this is a missed
opportunity—notably, in evidence to the Constitutional and
Legislative Affairs Committee in its making laws inquiry, the Law
Commission commented that it is commonplace for UK Government
departments to carry out post-legislative reviews of new Acts.
Post-legislative reviews enable a Government to assess the
effectiveness of legislation to determine whether it has met its
objectives and is delivering its intended benefits to citizens. I
believe that’s an essential part of good law making. I
therefore, with regret, will not be able to support amendment 32,
but will not oppose it either, because to do so would endanger the
passing of the legislation as a whole.
|
|
[141]
David Rees: Thank you, Kirsty. I call on Darren Millar to
reply to the debate on this sub-theme.
|
|
[142]
Darren Millar: Thank you, Chair. I’m pleased that both
the Minister and the Member in charge have acknowledged the
importance of patient nutrition and hydration. I’m surprised
to hear that neither of them feel prepared to be able to support my
amendments in this particular sub-theme. Reference has been made to
there being no evidence of any causal effect—I think that was
the phrase that the Minister used—of staffing levels
contributing to poor hydration and nutrition. Well, I beg to
differ, Minister. It’s very clear from the Betsi Cadwaladr
governance work that was done by Healthcare Inspectorate Wales and
the Wales Audit Office that some of these issues have a direct
correlation, and the ‘Trusted to Care’ report was very
clear, too, that low staffing levels were contributing to some of
the challenges there in relation to care, including poor patient
hydration on that particular ward.
|
|
[143]
I’m pleased to note the reference to the three other
indicators, which, quite rightly, have been picked up on the back
of the NICE piece of work in relation to pressure sores, medication
errors and patient falls, but I do think that the addition of these
other two further measures of success, or otherwise, would be an
important addition to the Bill, which would actually strengthen it.
Like Kirsty Williams, I will be encouraging Members to vote against
amendment 32, because I do think it is important that there’s
a review post legislation, and there should be a requirement to
report back on the impact of legislation, and I think that
there’s a missed opportunity should that amendment be
agreed.
|
|
[144]
David Rees: Thank you, Darren.
|
|
Is-thema o fewn Grŵp 1: (f) Cydymffurfio
a’r Ddyletswydd (Gwelliannau 29W, 29X, 29Y, 8, 9, 10, 11, 12,
30A, 30B, 13, 14 (28, 29))
Sub-theme within Group 1: (f) Compliance with the Duty (Amendments
29W, 29X, 29Y, 8, 9, 10, 11, 12, 30A, 30B, 13, 14 (28, 29))
|
|
[145]
David Rees: The sixth and final sub-theme of amendments in
group 1 to consider is in relation to compliance with the duty. The
first amendment in the sub-theme is amendment 29W, and I call on
Darren Millar to move amendment 29W and speak to the amendments in
the sub-theme.
|
|
[146]
Darren Millar: I move amendments 29W, 29X and 29Y, 30A, 30B,
and amendments 8 through to 14, which are all tabled in my name.
Regrettably, the Bill as it stands has no teeth, and this group of
amendments focuses on enforcement and policing arrangements of the
staffing levels in the Bill and seeks to give the Bill the bite
that it needs to make sure that the NHS actually delivers on the
very important staffing levels and the safe staffing levels that we
all want to see.
|
|
[147]
Amendment 29W would require compliance with duties under the Bill
to be subject to independent inspection. Members will be aware that
almost all health boards, in providing evidence to the committee,
suggested that nurse staffing levels were already safe in their
hospitals, but we only have their word to rely on, as there was
absolutely no independent examination of the assertions that had
been made. Whilst I don’t want to question the integrity of
the NHS, I do feel that any new arrangements should be subject to
independent and regular inspection, rather than simply the
assertion of a health board nurse director. And I do believe that
my amendment would allow for an impartial view by the healthcare
inspectorate on whether health service bodies—by the
healthcare inspectorate, or perhaps CHCs—have fulfilled their
obligations under the Bill.
|
|
[148]
My amendment 29X provides for financial penalties for those who do
not comply with their duties under the Bill. The Royal College of
Physicians said that the Bill, and I quote:
|
|
[149]
‘must be properly enforced to ensure it is
effective’.
|
|
[150]
The Board of Community Health Councils in Wales also suggested that
there needed to be clear sanctions on failure to meet the staffing
requirements that the Bill would progress. And I think that my
amendment, in facilitating the imposition of penalties on health
boards, which are not punitive, and simply says that the penalties
must not exceed the cost that it would have incurred had it been
meeting the nurse staffing Bill requirements, is appropriate.
Unison also, of course, have stated that serious consideration
needed to be given to the available sanctions for non-compliance
within the Bill.
|
|
[151]
Amendment 29Y inserts a new section into the Bill on
whistleblowing. It requires health board employees to blow the
whistle if a health board is in breach of its duties and provides
protection for those employees to avoid discrimination against them
for being brave enough to do so. We all know that there are cases
here in Wales of nursing staff doing the right thing in the
NHS—reporting incidents, reporting concerns—and then,
unfortunately, facing consequences sometimes from managers as a
result.
|
|
[152]
Amendments 30A and 30B are consequential to amendments 29W, 29X and
29Y, and amendments 8 through to 14 would have a similar effect to
the amendments I’ve just been referring to in this sub-group,
but on the face of the Bill as introduced. I urge Members to
support.
|
|
[153]
David Rees: Thank you, Darren. Are there any other Members
who wish to speak? No. Then I call on the Minister to speak to this
sub-theme. Minister.
|
|
[154]
Mark Drakeford: Chair, Darren described his amendments 8 and
29W as ‘giving bite’ to the Bill through the creation
of a new inspection regime. My fear is that it would be costly,
bureaucratic, untested and unnecessary. The committee rightly
warned at Stage 1 that the proper objectives of the Bill could
spiral out of control if a huge superstructure of reporting and
inspecting were to be constructed on its base, and amendment 8
ignores that advice. Compliance with the duties imposed by the Bill
will be pursued, but they will be pursued through existing
healthcare standard requirements. One of the challenges of this
Bill has always been to achieve proportionality—to secure its
aims without the costs turning out to be greater than its
rewards. Amendment 8 takes us backwards in that regard, and I
ask you to reject it.
|
|
[155]
Amendments 9 and 10 set up a regime of financial penalties for
health service bodies in the Bill as introduced, and 29X has a
similar effect if amendment 29 is accepted. The imposition of
financial penalties was not supported when the principle was
discussed by this committee during Stage 1, and I reject the
approach again today. It would turn the Bill into an
accountant’s charter and introduce another set of unwelcome
distractions from its core purpose. If LHBs are in breach of the
statutory duties that the Bill places upon them, then Welsh
Ministers already have powers of direction through sections 12 and
19, and powers of intervention through section 26 of the National
Health Service (Wales) Act 2006. Moreover, nothing in this Bill, as
Kirsty Williams pointed out earlier, would prevent an individual
from bringing a legal challenge against local health boards and
trusts if such an individual were to believe that those bodies were
in breach of their statutory duties as created under the
Bill.
|
|
[156]
Amendments 11, 12 and 29Y seek to place an obligation upon
employees to disclose to management if they are of the view that
the body for which they work is not complying with their duties
under this Bill. Darren said that his amendments were designed to
bring teeth to this section, but these amendments are completely
unenforceable. There is simply no sanction in the amendments
proposed by the Member for a person if they did not make a required
disclosure. Furthermore, in the context of the Bill, it’s
worth pointing out that the duty of candour for nurses issued by
the Nursing and Midwifery Council already requires practitioners
and organisations to report on adverse incidents. And the NMC code
also has clauses that require registrants to report to persons of
authority environments where care is not satisfactory. And on that
basis, I don’t support these amendments either.
|
|
[157]
Amendments 13 and 14 are technical amendments that arise only if
amendments 8 and 9 are accepted, but I ask Members to reject those
amendments. Amendments 30A and 30B are also technical amendments
and relevant only if amendment 29X is agreed, but I ask Members to
reject that amendment also.
|
|
[158]
David Rees: Thank you, Minister. I call the Member in
charge, Kirsty Williams, to speak to the sub-theme.
|
|
[159]
Kirsty Williams: Thank you. I do not support amendments 29W,
30A, 8 and 13, which, as previously stated, would introduce a
requirement for Welsh Ministers to set out a process for
independent inspection of compliance with the new duties by health
service bodies. Health Inspectorate Wales has stated that its
inspections explicitly consider staffing levels, and my intention
in developing the Bill was always to use existing processes and
mechanisms wherever possible to avoid creating any new additional
bureaucracy in the system.
|
|
[160]
I do not believe that the Bill should be amended either by
amendments 29X, 30B, 9, 10 and 14 to introduce a power for Welsh
Ministers to bring forward affirmative regulations that would
provide for financial penalties to be levied on health bodies that
fail to comply with the new duties. I did consider that option for
financial penalties when originally developing the Bill. However,
there was insufficient evidence or consensus in responses to my
consultation for me to conclude that this would be of benefit. A
specific concern was also raised that money could be diverted away
from patient care if fines were introduced, and I have come to the
conclusion that financial penalties would help no-one.
|
|
[161]
I am receptive to the rationale behind amendments 29Y, 11 and 12,
which would place an expressed requirement on employees of health
service bodies, who have reasonable cause to suspect that the body
is in breach of the duties, to inform management of the fact. When
problems arise in NHS settings, whistleblowers have a vital role to
play and should be applauded and supported for coming forward, a
fact that was highlighted in this Assembly by the Public Accounts
Committee’s report on grants management. However, I do not
believe it’s appropriate to include a provision on this
matter on the face of the Bill, because it potentially raises
issues of legislative competence around its interaction with
employment law and regulation of healthcare professionals, which is
an exception to the Assembly’s competence. Any sanctions that
flowed from a failure to report could be argued to relate to
employment law for the purposes of Schedule 7 to the Government of
Wales Act 2006 or could be considered to be a listed exception to
our competence. Moreover, even without these proposed amendments,
nurses would remain under a professional obligation to report any
breaches.
|
|
[162]
David Rees: Thank you, Kirsty. I call on Darren Millar to
reply to the debate.
|
|
[163]
Darren Millar: Thank you, Chair. The Minister, in his
opening remarks to the debate on this sub-theme, said that my
amendments would be costly, bureaucratic, untested and unnecessary.
And yet we’ve already heard from Kirsty Williams that HIW are
already inspecting on some of these things. So, I cannot understand
why those assertions are being made. I simply want that to be a
regular feature of their inspection work, not something that may be
done, but something, rather, that must be done and must be reported
against. The Minister said that he has existing opportunities,
through existing regulation and legislation, to be able to deal
with non-compliance, but, of course, we all know that ministerial
guidance is often not actually being fulfilled by health boards,
and yet things are not currently working. Ministers set targets for
health boards, performance targets, on a regular basis that
aren’t being met, and yet the existing arrangements for
policing those targets and performance measures simply don’t
work.
|
|
[164]
So, the Minister’s bite at present is a rather gummy bite; it
doesn’t have any teeth to it. I’m simply trying to give
you a decent set of gnashers, really, Minister, when it comes to
being able to deal with compliance in respect of this Bill, should
it proceed to be an Act. He described it as an
‘accountant’s charter’, the suggestion that there
should be financial penalties for those health boards. I
don’t accept that fines will be something that will divert
cash from patient care. They could be kept within the NHS as a
whole, and invested in further NHS care, and, at the end of the
day, these are designed to act as a disincentive for health boards
to breach their duties under the Act. So, I will be pushing for
those teeth to be given to the Minister to be able to deal with
non-compliance.
|
|
10:45
|
|
[165]
If I could just touch on the whistleblowing issue, I fully accept
the principle of support for whistleblowers, which has been
expressed by the Minister and the Member in charge. There is a duty
of candour, but it’s not legislated for, if you like, here in
Wales, and I want to see it on the face of this Bill so that
nursing staff themselves can see the direct relationship between
this legislation and the nurse staffing levels that they are
working with in the care environments where they are placed, so
that they can see a definite relationship between them being able
to blow the whistle on compliance matters, where staffing levels
aren’t being met, and to be able to see clearly in
legislation that they have proper protection from people who may
want to discriminate against them in the workplace because
they’ve chosen to be able to do that.
|
|
[166]
We cannot rely on self-reporting and we cannot rely on the existing
arrangements. We know the existing arrangements aren’t
working because we regularly get members of the nursing profession
and of the wider healthcare workforce contacting Assembly Members
on a regular basis, saying that they’ve blown the whistle on
some poor practice or on some non-compliance and that they’ve
lost their jobs as a result. We can’t allow that to go on and
I believe that ensuring that these provisions are on the face of
the Bill, in respect of whistleblowing, will give the protections
and send a clear message to the nursing profession that we back
them in wanting to deliver high standards of quality care.
|
|
[167]
David Rees: Thank you, Darren. We’ve now completed our
debate on all sub-themes within group 1. Finally, before we move to
the vote, I will invite Members to make any final additional
comments that they wish to make on the amendments in group 1, and
then I’ll ask the Member in charge to make any final comments
and then the Minister to close group 1. Do any Members wish to
speak? No. Does the Member in charge wish to make any final
comments on group 1?
|
|
[168]
Kirsty Williams: Just briefly. In my opening remarks on this
group, I indicated that although I’m disappointed by some of
the Minister’s amendments, I believe fundamentally that what
will result, even if they are passed, is a Bill that makes a
meaningful difference to Welsh nurses and Welsh patients. Of
course, I would like my Bill to be exactly as I had intended, but
this isn’t about me, it’s about legislation that makes
a meaningful difference to the citizens of Wales. The relationship
between nurse staffing levels and safe, effective patient care is
in no doubt. Only last week the health service journal highlighted
in an article that more than nine out of 10 acute hospitals in
England are failing to meet their own targets for the number of
nurses working on wards. And in May this year the Welsh
Government’s own research into nurse staffing levels in Wales
highlighted that although much advice is circulated regarding
nurse-to-patient staffing ratios, such as that circulated by the
Chief Nursing Officer for Wales and the National Institute for
Health and Care Excellence—NICE—different organisations
may well be operating within different understandings of what that
advice means.
|
|
[169]
This Bill, and the guidance to be issued under it, will help bring
clarity and transparency around the staffing levels and bring NHS
Wales in line with improvements in nurse staffing reporting in
other parts of the world. I believe that this legislation, even
when amended, is legislation needed to guarantee results and
safeguard patient outcomes. As such, whilst I do not support the
Minister’s amendments, neither do I urge Members to vote
against them.
|
|
[170]
David Rees: Thank you. Minister, do you want to reply to the
debate on group 1?
|
|
[171]
Mark Drakeford: Thank you, Chair. I thank all Members and
the Member in charge for the very detailed and engaged discussion
that I think we’ve had on these amendments this morning.
There have been a number of sub-themes on which we’ve not
been very far apart at all and even when we have disagreed, the
concerns raised have all been important ones.
|
|
[172]
Throughout the process of this Bill, my aim has been to help
achieve a piece of legislation that strengthens the ability of our
systems to secure the right number of nurses on acute adult medical
and surgical wards here in Wales to make a meaningful difference,
as Kirsty Williams has said, without the dangers that were clearly
identified in this committee’s Stage 1 report. That’s
what the Government amendments in this group set out to achieve. I
hope Members here will be able to support them and, other than in
those instances where I’ve indicated areas of agreement, to
resist the other amendments in front of you this morning.
|
|
[173]
David Rees: Thank you, Minister. We’ll now dispose of
all the amendments in group 1. The question is that amendment 28 be
agreed to. Does any Member object? [Objection.] I have an
objection, therefore I’ll take a vote by a show of hands. Can
those in favour of amendment 28 please show? Can those against
amendment 28 please show? Abstentions. Therefore, in relation to
amendment 28, there voted seven in favour, two against, and one
abstention. The amendment is therefore agreed.
|
|
Gwelliant 28: O blaid 7,
Yn erbyn 2, Ymatal 1.
Amendment 28: For 7, Against 2, Abstain 1.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Alun Davies
John Griffiths
Altaf Hussain
Darren Millar
Lynne Neagle
Gwyn R. Price
David Rees
|
Elin Jones
Lindsay Whittle
|
Peter Black
|
|
Derbyniwyd gwelliant 28.
Amendment 28 agreed.
|
|
[174]
David Rees: Darren, would you like to move amendment
29A?
|
|
Cynigiwyd gwelliant 29A (Darren Millar, gyda chefnogaeth Elin
Jones).
Amendment 29A (Darren Millar, supported by Elin Jones) moved.
|
|
[175]
Darren Millar: Moved.
|
|
[176]
David Rees: The question is that amendment 29A be agreed to.
Does any Member object? [Objection.] I have an objection;
therefore I'll take the vote by a show of hands. Can those in
favour of amendment 29A please raise their hands? Can those against
please raise their hands? As there is a tied vote, I use my casting
vote in the negative, against the amendment, in accordance with
Standing Order 6.20(ii), and therefore amendment 29A is not
agreed.
|
|
Gwelliant 29A: O blaid 5,
Yn erbyn 5, Ymatal 0.
Amendment 29A: For 5, Against 5, Abstain 0.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Peter Black
Altaf Hussain
Elin Jones
Darren Millar
Lindsay Whittle
|
Alun Davies
John Griffiths
Lynne Neagle
Gwyn R. Price
David Rees
|
|
|
Gan fod nifer y pleidleisiau yn gyfartal, defnyddiodd
y Cadeirydd ei bleidlais fwrw yn unol â Rheol Sefydlog
6.20(ii).
As there was an equality of votes, the Chair used his casting vote
in accordance with Standing Order 6.20(ii).
|
|
Gwrthodwyd gwelliant 29A.
Amendment 29A not agreed.
|
|
[177]
David Rees: Darren, amendment 29B.
|
|
Cynigiwyd gwelliant 29B (Darren Millar, gyda chefnogaeth Elin
Jones).
Amendment 29B (Darren Millar, supported by Elin Jones) moved.
|
|
[178]
Darren Millar: Moved.
|
|
[179]
David Rees: The question is that amendment 29B be agreed to.
Does any Member object? [Objection.] I have an objection;
therefore I'll take a show of hands for the vote. Can those in
favour of amendment 29B please raise their hands? Can those against
please raise their hands? As there’s a tied vote, I use my
casting vote in the negative, against the amendment, in accordance
with Standing Order 6.20(ii), and therefore amendment 29B is not
agreed.
|
|
Gwelliant 29B: O blaid 5,
Yn erbyn 5, Ymatal 0.
Amendment 29B: For 5, Against 5, Abstain 0.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Peter Black
Altaf Hussain
Elin Jones
Darren Millar
Lindsay Whittle
|
Alun Davies
John Griffiths
Lynne Neagle
Gwyn R. Price
David Rees
|
|
|
Gan fod nifer y pleidleisiau yn gyfartal, defnyddiodd
y Cadeirydd ei bleidlais fwrw yn unol â Rheol Sefydlog
6.20(ii).
As there was an equality of votes, the Chair used his casting vote
in accordance with Standing Order 6.20(ii).
|
|
Gwrthodwyd gwelliant 29B.
Amendment 29B not agreed.
|
|
[180]
David Rees: Darren, would you like to move amendment
29C?
|
|
Cynigiwyd gwelliant 29C (Darren Millar).
Amendment 29C (Darren Millar) moved.
|
|
[181]
Darren Millar: Moved.
|
|
[182]
David Rees: The question is that amendment 29C be agreed to.
Does any Member object? [Objection.] I have an objection;
therefore we'll take a vote by a show of hands. Can those in favour
of amendment 29C please raise their hands? Can those against
amendment 29C please raise their hands? In relation to amendment
29C, there voted two in favour and eight against. Therefore,
amendment 29C is not agreed.
|
|
Gwelliant 29C: O blaid 2,
Yn erbyn 8, Ymatal 0.
Amendment 29C: For 2, Against 8, Abstain 0.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Altaf Hussain
Darren Millar
|
Peter Black
Alun Davies
John Griffiths
Elin Jones
Lynne Neagle
Gwyn R. Price
David Rees
Lindsay Whittle
|
|
|
Gwrthodwyd gwelliant 29C.
Amendment 29C not agreed.
|
|
[183]
David Rees: Darren, 29D.
|
|
Cynigiwyd gwelliant 29D (Darren Millar).
Amendment 29D (Darren Millar) moved.
|
|
[184]
Darren Millar: Moved.
|
|
[185]
David Rees: The question is that amendment 29D be agreed to.
Does any Member object? [Objection.] I have an objection;
therefore I'll take a vote by a show of hands. Can those in favour
of amendment 29D please raise their hands? Thank you. Those
against, please raise your hands. Thank you. As there’s a
tied vote, I use my casting vote in the negative, against the
amendment, in accordance with Standing Order 6.20(ii). Therefore,
amendment 29D is not agreed.
|
|
Gwelliant 29D: O blaid 5,
Yn erbyn 5, Ymatal 0.
Amendment 29D: For 5, Against 5, Abstain 0.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Peter Black
Altaf Hussain
Elin Jones
Darren Millar
Lindsay Whittle
|
Alun Davies
John Griffiths
Lynne Neagle
Gwyn R. Price
David Rees
|
|
|
Gan fod nifer y pleidleisiau yn gyfartal, defnyddiodd
y Cadeirydd ei bleidlais fwrw yn unol â Rheol Sefydlog
6.20(ii).
As there was an equality of votes, the Chair used his casting vote
in accordance with Standing Order 6.20(ii).
|
|
Gwrthodwyd gwelliant 29D.
Amendment 29D not agreed.
|
|
[186]
David Rees: I propose that amendments 29E to 29I, which
appear consecutively in the marshalled list, are disposed of en
bloc, given their nature. Does any Member object to voting being
grouped? No. Okay. Darren, would you like to move amendments 29E to
29I?
|
|
Cynigiwyd
gwelliannau 29E, 29F, 29G, 29H, a 29I (Darren Millar gyda
chefnogaeth Elin Jones).
Amendments 29E, 29F, 29G, 29H, and 29I (Darren Millar, supported by
Elin Jones) moved.
|
|
[187]
Darren Millar: Moved.
|
|
[188]
David Rees: The question is that amendments 29E, 29F, 29G,
29H, and 29I be agreed to. Does any Member object?
[Objection.] I have an objection. Therefore, the question is
that those amendments be agreed. Those in favour of amendments 29E,
29F, 29G, 29H, and 29I, please raise your hands. Thank you. Can
those against please raise their hands? Thank you. As there’s
a tied vote, I use my casting vote in the negative, against those
amendments, in accordance with Standing Order 6.20. Therefore, they
are not agreed.
|
|
Gwelliannau 29E,
29F, 29G, 29H, a 29I: O blaid 5, Yn erbyn 5, Ymatal 0.
Amendments 29E, 29F, 29G, 29H, and 29I: For 5, Against 5,
Abstain 0.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Peter Black
Altaf Hussain
Elin Jones
Darren Millar
Lindsay Whittle
|
Alun Davies
John Griffiths
Lynne Neagle
Gwyn R. Price
David Rees
|
|
|
Gan fod nifer y pleidleisiau yn gyfartal, defnyddiodd
y Cadeirydd ei bleidlais fwrw yn unol â Rheol Sefydlog
6.20(ii).
As there was an equality of votes, the Chair used his casting vote
in accordance with Standing Order 6.20(ii).
|
|
Gwrthodwyd
gwelliannau 29E, 29F, 29G, 29H, a 29I.
Amendments 29E, 29F, 29G, 29H, and 29I not agreed.
|
|
[189]
David Rees: Darren, would you like to move amendment
29J?
|
|
Cynigiwyd gwelliant 29J (Darren Millar).
Amendment 29J (Darren Millar) moved.
|
|
[190]
Darren Millar: Moved.
|
|
[191]
David Rees: The question is that amendment 29J be agreed to.
Does any Member object? [Objection.] I have an objection. I
will therefore take a vote by a show of hands. Can those in favour
of amendment 29J please raise their hands? Thank you. Can those
against please raise their hands? Thank you. In relation to
amendment 29J, there voted four in favour and six against.
Therefore, amendment 29J is not agreed.
|
|
Gwelliannau 29J: O blaid 4, Yn erbyn 6, Ymatal 0.
Amendments 29J: For 4, Against 6, Abstain 0.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Altaf Hussain
Elin Jones
Darren Millar
Lindsay Whittle
|
Peter Black
Alun Davies
John Griffiths
Lynne Neagle
Gwyn R. Price
David Rees
|
|
|
Gwrthodwyd
gwelliant 29J.
Amendment 29J not agreed.
|
|
[192]
David Rees: Elin, would you like to move amendment 29Z?
|
|
Cynigiwyd gwelliant 29Z (Elin Jones).
Amendment 29Z (Elin Jones) moved.
|
|
[193]
Elin Jones: Symud.
|
Elin Jones:
Move.
|
|
[194]
David Rees: Thank you. The question is that amendment 29Z be
agreed to. Does any Member object? [Objection.] I have an
objection. I will therefore take a vote by show of hands. Can those
in favour of amendment 29Z please raise their hands? Thank you. Can
those against please raise their hands? Thank you. In relation to
29Z, there voted four in favour and six against, and therefore
amendment 29Z is not agreed.
|
|
Gwelliant 29Z: O blaid 4, Yn erbyn 6, Ymatal 0.
Amendment 29Z: For 4, Against 6, Abstain 0.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Altaf Hussain
Elin Jones
Darren Millar
Lindsay Whittle
|
Peter Black
Alun Davies
John Griffiths
Lynne Neagle
Gwyn R. Price
David Rees
|
|
|
Gwrthodwyd gwelliant 29Z.
Amendment 29Z not agreed.
|
|
[195]
David Rees: Elin, 29AA.
|
|
Cynigiwyd gwelliant 29AA (Elin Jones).
Amendment 29AA (Elin Jones) moved.
|
|
[196]
Elin Jones: Symud.
|
Elin Jones: Move.
|
|
[197]
David Rees: Thank you. The question is that amendment 29AA
be agreed. Does any Member object? [Objection.] I have an
objection. We will therefore take a vote by a show of hands. Can
those in favour of amendment 29AA please raise their hands? Thank
you. Can those against please raise their hands? Thank you.
Therefore, in relation to amendment 29AA, there voted four in
favour and six against, and therefore amendment 29AA is not
agreed.
|
|
Gwelliannau 29AA: O blaid 4, Yn erbyn 6, Ymatal
0.
Amendments 29AA: For 4, Against 6, Abstain 0.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Altaf Hussain
Elin Jones
Darren Millar
Lindsay Whittle
|
Peter Black
Alun Davies
John Griffiths
Lynne Neagle
Gwyn R. Price
David Rees
|
|
|
Gwrthodwyd
gwelliant 29AA.
Amendment 29AA not agreed.
|
|
[198]
David Rees: Elin, 29AB.
|
|
Cynigiwyd gwelliant 29AB (Elin Jones).
Amendment 29AB (Elin Jones) moved.
|
|
[199]
Elin Jones: Symud.
|
Elin Jones: Move.
|
|
[200]
David Rees: The question is that amendment 29AB be agreed.
Does any Member object? [Objection.] We have an objection. I
will therefore take a vote by a show of hands. Can those in favour
of amendment 29AB please raise your hands? Thank you. Can those
against please raise your hands? Thank you. In relation to
amendment 29AB, there voted in favour four and against six.
Therefore, amendment 29AB is not agreed.
|
|
Gwelliant 29AB: O blaid 4,
Yn erbyn 6, Ymatal 0.
Amendment 29AB: For 4, Against 6, Abstain 0.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Altaf, Hussain
Jones, Elin
Millar, Darren
Whittle, Lindsay
|
Black, Peter
Davies, Alun
Griffiths, John
Neagle, Lynne
Price, Gwyn R.
Rees, David
|
|
|
Gwrthodwyd gwelliant 29AB.
Amendment 29AB not agreed.
|
|
[201]
David Rees: Elin, amendment 29AC.
|
|
Cynigiwyd gwelliant 29AC (Elin Jones).
Amendment 29AC (Elin Jones) moved.
|
|
[202]
Elin Jones: Symud.
|
Elin Jones:
Move.
|
|
[203]
David Rees: The question is that amendment 29AC be agreed
to. Does any Member object? [Objection.] I have an
objection. Therefore, I will take a vote by a show of hands. The
question is that amendment 29AC be agreed to. Can those in favour
please raise your hands? Thank you. Can those against please raise
your hands? Thank you. In relation to amendment 29AC, there voted
four in favour and six against. Therefore, amendment 29AC is not
agreed.
|
|
Gwelliant 29AC: O blaid 4,
Yn erbyn 6, Ymatal 0.
Amendment 29AC: For 4, Against 6, Abstain 0.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Altaf, Hussain
Jones, Elin
Millar, Darren
Whittle, Lindsay
|
Black, Peter
Davies, Alun
Griffiths, John
Neagle, Lynne
Price, Gwyn R.
Rees, David
|
|
|
Gwrthodwyd gwelliant 29AC.
Amendment 29AC not agreed.
|
|
[204]
David Rees: Elin, amendment 29AD.
|
|
Cynigiwyd gwelliant 29AD (Elin Jones).
Amendment 29AD (Elin Jones) moved.
|
|
[205]
Elin Jones: Symud.
|
Elin Jones: Move.
|
|
[206]
David Rees: The question is that amendment 29AD be agreed
to. Does any Member object? [Objection.] I have an
objection. Therefore, I will take a vote by a show of hands. Can
those in favour of amendment 29AD please raise your hands? Thank
you. Can those against please raise your hands? Thank you. In
relation to amendment 29AD, there voted in favour four; against,
six. Therefore, amendment 29AD is not agreed.
|
|
Gwelliant 29AD: O blaid 4,
Yn erbyn 6, Ymatal 0.
Amendment 29AD: For 4, Against 6, Abstain 0.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Altaf, Hussain
Jones, Elin
Millar, Darren
Whittle, Lindsay
|
Black, Peter
Davies, Alun
Griffiths, John
Neagle, Lynne
Price, Gwyn R.
Rees, David
|
|
|
Gwrthodwyd gwelliant 29AD.
Amendment 29AD not agreed.
|
|
[207]
David Rees: I propose that amendments 29K to 29O, which
appear consecutively in the marshalled list, are disposed of en
bloc, given their nature. Does any Member object to the votes being
grouped? No, okay. Darren, would you like to move amendments 29K to
29O?
|
|
Cynigiwyd
gwelliannau 29K, 29L, 29M, 29N a 29O (Darren Millar, gyda
chefnogaeth Elin Jones).
Amendments 29K, 29L, 29M, 29N and 29O (Darren Millar,
supported by Elin Jones) moved.
|
|
[208]
Darren Millar: Move.
|
|
[209]
David Rees: The question is that amendments 29K, 29L, 29M,
29N and 29O be agreed to. Does any Member object?
[Objection.] I have an objection. I will therefore take a
vote by a show of hands. Can those in favour of amendments 29K,
29L, 29M, 29N and 29O please raise your hands? Thank you. Can those
against please raise your hands? Thank you. As there is a tied
vote, I use my casting vote in the negative against the amendments,
in accordance with Standing Order 6.20(ii). Therefore, those
amendments are not agreed.
|
|
Gwelliannau 29K, 29L, 29M,
29N a 29O: O blaid 5, Yn erbyn 5, Ymatal 0.
Amendments 29K, 29L, 29M, 29N and 29O: For 5, Against 5, Abstain
0.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Altaf, Hussain
Black, Peter
Jones, Elin
Millar, Darren
Whittle, Lindsay
|
Davies, Alun
Griffiths, John
Neagle, Lynne
Price, Gwyn R.
Rees, David
|
|
|
Gan fod nifer y pleidleisiau yn gyfartal, defnyddiodd y Cadeirydd
ei bleidlais fwrw yn unol â Rheol Sefydlog 6.20(ii).
As there was an equality of votes, the Chair used his casting vote
in accordance with Standing Order 6.20(ii).
|
|
Gwrthodwyd
gwelliannau 29K, 29L, 29M, 29N a 29O.
Amendments 29K, 29L, 29M, 29N and 29O not agreed.
|
|
[210]
David Rees: Darren, do you wish to move amendment 29P?
|
|
Cynigiwyd gwelliant 29P (Darren Millar).
Amendment 29P (Darren Millar) moved.
|
|
[211]
Darren Millar: Move.
|
|
[212]
David Rees: The question is that amendment 29P be agreed to.
Does any Member object? [Objection.] I have an objection. I
will therefore take a vote by a show of hands. Can those in favour
of amendment 29P please raise your hands? Thank you. Can those
against please raise your hands? Thank you. As there is a tied
vote, I use my casting vote in the negative against the amendment,
in accordance with Standing Order 6.20(ii). Therefore, amendment
29P is not agreed.
|
|
Gwelliant 29P: O blaid 5,
Yn erbyn 5, Ymatal 0.
Amendment 29P: For 5, Against 5, Abstain 0.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Altaf, Hussain
Black, Peter
Jones, Elin
Millar, Darren
Whittle, Lindsay
|
Davies, Alun
Griffiths, John
Neagle, Lynne
Price, Gwyn R.
Rees, David
|
|
|
Gan fod nifer y pleidleisiau yn gyfartal, defnyddiodd y Cadeirydd
ei bleidlais fwrw yn unol â Rheol Sefydlog 6.20(ii).
As there was an equality of votes, the Chair used his casting vote
in accordance with Standing Order 6.20(ii).
|
|
Gwrthodwyd
gwelliant 29P.
Amendment 29P not
agreed.
|
|
[213]
David Rees: Darren, would you like to move amendment
29Q?
|
|
Cynigiwyd gwelliant 29Q (Darren Millar).
Amendment 29Q (Darren Millar) moved.
|
|
[214]
Darren Millar: Move.
|
|
[215]
David Rees: The question is that amendment 29Q be agreed to.
Does any Member object? There are no objections. Therefore,
amendment 29Q is agreed.
|
|
Derbyniwyd gwelliant 29Q yn unol â
Rheol Sefydlog 17.34.
Amendment 29Q agreed in accordance with Standing
Order 17.34.
|
|
[216]
David Rees: Darren, would you like to move amendment
29R?
|
|
Cynigiwyd gwelliant 29R (Darren Millar, gyda chefnogaeth Elin
Jones).
Amendment 29R (Darren Millar, supported by Elin Jones) moved.
|
|
[217]
Darren Millar: Move.
|
|
[218]
David Rees: The question is that amendment 29R be agreed to.
Does any Member object? [Objection.] I have an objection.
Therefore, I will take a vote by a show of hands. Can those in
favour of amendment 29R please raise your hands? Thank you. Can
those against please raise your hands? Thank you. As there is a
tied vote, I use my casting vote in the negative against the
amendment, in accordance with Standing Order 6.20(ii). Therefore,
amendment 29R is not agreed.
|
|
Gwelliant 29R: O blaid 5,
Yn erbyn 5, Ymatal 0.
Amendment 29R: For 5 Against 5, Abstain 0.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Altaf, Hussain
Black, Peter
Jones, Elin
Millar, Darren
Whittle, Lindsay
|
Davies, Alun
Griffiths, John
Neagle, Lynne
Price, Gwyn R.
Rees, David
|
|
|
Gan fod nifer y pleidleisiau yn gyfartal, defnyddiodd y Cadeirydd
ei bleidlais fwrw yn unol â Rheol Sefydlog 6.20(ii).
As there was an equality of votes, the Chair used his casting vote
in accordance with Standing Order 6.20(ii).
|
|
Gwrthodwyd
gwelliant 29R.
Amendment 29R not
agreed.
|
|
[219]
David Rees: Darren, amendment 29S.
|
|
Cynigiwyd gwelliant 29S (Darren Millar, gyda chefnogaeth Elin
Jones).
Amendment 29S (Darren Millar, supported by Elin Jones) moved.
|
|
[220]
Darren Millar: Move.
|
|
[221]
David Rees: The question is that amendment 29S be agreed to.
Does any Member object? [Objection.] I have an objection. I
will therefore ask for a vote by a show of hands. Can those in
favour of amendment 29S please raise your hands? Thank you. Can
those against please raise your hands? Thank you. As there is a
tied vote, I use my casting vote in the negative against the
amendment, in accordance with Standing Order 6.20(ii). Therefore,
amendment 29S is not agreed.
|
|
Gwelliant 29S: O blaid 5,
Yn erbyn 5, Ymatal 0.
Amendment 29S: For 5 Against 5, Abstain 0.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Altaf, Hussain
Black, Peter
Jones, Elin
Millar, Darren
Whittle, Lindsay
|
Davies, Alun
Griffiths, John
Neagle, Lynne
Price, Gwyn R.
Rees, David
|
|
|
Gan fod nifer y pleidleisiau yn gyfartal, defnyddiodd y Cadeirydd
ei bleidlais fwrw yn unol â Rheol Sefydlog 6.20(ii).
As there was an equality of votes, the Chair used his casting vote
in accordance with Standing Order 6.20(ii).
|
|
Gwrthodwyd
gwelliant 29S.
Amendment 29S not
agreed.
|
|
[222]
David Rees: Darren, would you like to move amendment
29T?
|
|
Cynigiwyd gwelliant 29T (Darren Millar, gyda chefnogaeth Elin
Jones).
Amendment 29T (Darren Millar, supported by Elin Jones) moved.
|
|
[223]
Darren Millar: Move.
|
|
[224]
David Rees: The question is that amendment 29T be agreed to.
Does any Member object? [Objection.] I have an objection. I
will take a vote by a show of hands. Can those in favour of
amendment 29T please raise your hands? Thank you. Can those against
29T please raise your hands? Thank you. Therefore, in relation to
amendment 29T, there voted four in favour and six against.
Therefore, amendment 29T is not agreed.
|
|
Gwelliant 29T: O blaid 4,
Yn erbyn 6, Ymatal 0.
Amendment 29T: For 4, Against 6, Abstain 0.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Altaf, Hussain
Jones, Elin
Millar, Darren
Whittle, Lindsay
|
Black, Peter
Davies, Alun
Griffiths, John
Neagle, Lynne
Price, Gwyn R.
Rees, David
|
|
|
Gwrthodwyd gwelliant 29T.
Amendment 29T not agreed.
|
|
[225]
David Rees: Darren, would you like to move amendment
29U?
|
|
Cynigiwyd gwelliant 29U (Darren Millar, gyda chefnogaeth Elin
Jones). Amendment 29U (Darren Millar, supported by Elin Jones)
moved.
|
|
[226]
Darren Millar: Move.
|
|
11:00
|
|
[227]
David Rees: The question is that amendment 29U be agreed to.
Does any Member object? [Objection.] I have an objection.
Therefore, I will take a vote by a show of hands. Can those in
favour of amendment 29U please raise your hands? Thank you. Those
against amendment 29U, please raise your hands. Thank you. In
relation to amendment 29U, there voted four in favour and six
against. Therefore, amendment 29U is not agreed.
|
|
Gwelliant 29U: O blaid 4,
Yn erbyn 6, Ymatal 0.
Amendment 29U: For 4, Against 6, Abstain 0.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Hussain, Altaf
Jones, Elin
Millar, Darren
Whittle, Lindsay
|
Black, Peter
Davies, Alun
Griffiths, John
Neagle, Lynne
Price, Gwyn. R
Rees, David
|
|
|
Gwrthodwyd gwelliant 29U.
Amendment 29U not agreed.
|
|
[228]
David Rees:
Darren, amendment 29V.
|
|
Cynigiwyd gwelliant 29V (Darren Millar, gyda
chefnogaeth Elin Jones).
Amendment 29V (Darren
Millar, supported by Elin Jones) moved.
|
|
[229]
Darren Millar:
Move.
|
|
[230]
David Rees: The question is that amendment 29V be agreed to.
Does any Member object? [Objection.] I have an objection.
Therefore, I will take a vote by a show of hands. Can those in
favour of amendment 29V please raise your hands? Thank you. Can
those against please raise your hands? Thank you. There’s a
tied vote. Therefore, I will use my casting vote in the negative
against the amendment in accordance with Standing Order 6.20(ii),
and amendment 29V is not agreed.
|
|
Gwelliant 29V: O blaid 5,
Yn erbyn 5, Ymatal 0.
Amendment 29V: For 5, Against 5, Abstain 0.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Black, Peter
Hussain, Altaf
Jones, Elin
Millar, Darren
Whittle, Lindsay
|
Davies, Alun
Griffiths, John
Neagle, Lynne
Price, Gwyn R.
Rees, David
|
|
|
Gan fod nifer y pleidleisiau yn
gyfartal, defnyddiodd y Cadeirydd ei bleidlais fwrw yn unol â
Rheol Sefydlog 6.20(ii).
As there was an equality of votes, the Chair used his
casting vote in accordance with Standing Order
6.20(ii).
|
|
Gwrthodwyd gwelliant 29V.
Amendment 29V not agreed.
|
|
[231]
David Rees:
Darren, would you like to move
amendment 29W?
|
|
Cynigiwyd
gwelliant 29W (Darren
Millar).
Amendment 29W (Darren Millar)
moved.
|
|
[232]
Darren Millar: Move.
|
|
[233]
David Rees: Before we vote on 29W, Members should be aware
that, if amendment 29W is not agreed, then amendment 30A will fall.
The question is that amendment 29W be agreed. Does any Member
object? [Objection.] I have an objection. I will therefore
ask for a vote by show of hands. Can those in favour of amendment
29W please raise your hands? Thank you. Can those against please
raise your hands? Thank you. In relation to amendment 29W, there
voted two in favour and eight against, and therefore amendment 29W
is not agreed.
|
|
Gwelliant 29W: O blaid 2,
Yn erbyn 8, Ymatal 0.
Amendment 29W: For 2, Against 8, Abstain 0.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Hussain, Altaf
Millar, Darren
|
Black, Peter
Davies, Alun
Griffiths, John
Jones, Elin
Neagle, Lynne
Price, Gwyn R.
Rees, David
Whittle, Lindsay
|
|
|
Gwrthodwyd gwelliant 29W.
Amendment 29W not agreed.
|
|
Methodd gwelliant 30A.
Amendment 30A fell.
|
|
[234]
David Rees: Darren, amendment 29X.
|
|
Cynigiwyd
gwelliant 29X (Darren
Millar).
Amendment 29X (Darren Millar)
moved.
|
|
[235]
Darren Millar: Move.
|
|
[236]
David Rees: Before we move to a vote on amendment 29X, we
should be aware that, if amendment 29X is not agreed, then
amendment 30B will fall. The question, therefore, is that amendment
29X be agreed. Does any Member object? [Objection.] I have
an objection. Therefore, I will take a vote by show of hands. Can
those in favour of amendment 29X please raise your hands? Thank
you. Can those against please raise your hands? Thank you. In
relation to amendment 29X, there voted four in favour and six
against. Therefore, amendment 29X is not agreed.
|
|
Gwelliant 29X: O blaid 4,
Yn erbyn 6, Ymatal 0.
Amendment 29X: For 4, Against 6, Abstain 0.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Hussain, Altaf
Jones, Elin
Millar, Darren
Whittle, Lindsay
|
Black, Peter
Davies, Alun
Griffiths, John
Neagle, Lynne
Price, Gwyn. R
Rees, David
|
|
|
Gwrthodwyd gwelliant 29X.
Amendment 29X not agreed.
|
|
Methodd gwelliant 30B.
Amendment 30B fell.
|
|
[237]
David Rees:
Darren, would you like to move
amendment 29Y?
|
|
Cynigiwyd
gwelliant 29Y (Darren
Millar).
Amendment 29Y (Darren Millar)
moved.
|
|
[238]
Darren Millar: Move.
|
|
[239]
David Rees: The question is that amendment 29Y be agreed to.
Does any Member object? [Objection.] I have an objection.
Therefore, I will take a vote by show of hands. Can those in favour
of amendment 29Y please raise your hands? Thank you. Can those
against please raise your hands? Thank you. Therefore, in relation
to amendment 29Y, there voted for four and against six, and
therefore amendment 29Y is not agreed.
|
|
Gwelliant 29Y: O blaid 4,
Yn erbyn 6, Ymatal 0.
Amendment 29Y: For 4, Against 6, Abstain 0.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Hussain, Altaf
Jones, Elin
Millar, Darren
Whittle, Lindsay
|
Black, Peter
Davies, Alun
Griffiths, John
Neagle, Lynne
Price, Gwyn. R
Rees, David
|
|
|
Gwrthodwyd gwelliant 29Y.
Amendment 29Y not agreed.
|
|
[240]
David Rees:
Elin, would you like to move
amendment 29AE?
|
|
[241]
Elin Jones:
No, I won’t move 29AE in light
of the Minister’s commitment to work with me on an amendment
for Stage 3 on workforce planning.
|
|
[242]
David Rees:
Thank you, Elin. Before we move on,
does any other Member wish to move amendment 29AE? No. Then 29AE is
not considered.
|
|
Ni chynigiwyd gwelliant 29AE (Elin
Jones).
Amendment 29AE (Elin Jones) not
moved.
|
|
[243]
David Rees: Before we move on to a vote on amendment 29,
Members will wish to be aware that, if amendment 29 is agreed, then
amendments 1, 20, 2, 21, 3, 4, 22, 23, 24, 5, 6, 7, 8, 9, 10, 11,
12, 25, 13, 14, 15 and 16 will fall. And, as amendments 29W and 29X
were not agreed, amendments 30A and 30B have fallen. If amendment
29 is not agreed, then amendments 30, 31A, 31, 36 and 37 will also
fall. Okay, is that clear? The question is that amendment 29 be
agreed to? [Objection.] I have an objection. Therefore, I
will take a vote by show of hands. Can those in favour of amendment
29 please raise your hands? Thank you. Can those against amendment
29 please raise your hands? Thank you. Can those abstaining—?
Thank you. In relation to amendment 29, there voted in favour five,
against four, and there was one abstention. The amendment is
therefore agreed.
|
|
Gwelliant 29: O blaid 5,
Yn erbyn 4, Ymatal 1.
Amendment 29: For 5, Against 4, Abstain 1.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Davies, Alun
Griffiths, John
Neagle, Lynne
Price, Gwyn. R
Rees, David
|
Hussain, Altaf
Jones, Elin
Millar, Darren
Whittle, Lindsay
|
Black,
Peter
|
|
Derbyniwyd gwelliant 29.
Amendment 29 agreed.
|
|
Methodd
gwelliannau 1, 20, 2, 21, 3, 4, 22, 23, 24, 5, 6, 7, 8, 9, 10, 11,
12, 25, 13, 14, 15 a 16.
Amendments 1, 20, 2, 21, 3, 4, 22, 23, 24, 5, 6, 7, 8, 9, 10, 11,
12, 25, 13, 14, 15 and 16 fell.
|
|
[244]
David Rees: I suggest that we take a 10-minute break
because, obviously, Members have talked quite a lot this morning so
it will give us a rest. So, can we reconvene at 11.15 a.m. to
finish the groups, please?
|
|
Gohiriwyd y cyfarfod rhwng 11:04 a
11:14.
The meeting adjourned between 11:04 and 11:14.
|
|
[245]
David Rees: Can I welcome Members back to this
morning’s session? Just to clarify, previously to the break,
amendment 29 was agreed. Therefore, amendments 1, 20, 2, 21, 3, 4,
22, 23, 24, 5, 6, 7, 8, 9, 10, 11, 12, 25, 13, 14, 15 and 16 have
fallen. Okay?
|
|
[246]
As amendments 29W and 29X were not agreed, amendments 30A and 30B
have fallen. So, we now move straight to amendment 30.
|
|
Cynigiwyd gwelliant 30 (Mark
Drakeford).
Amendment 30 (Mark Drakeford)
moved.
|
|
[247]
David Rees: The question is that amendment 30 be agreed.
Does any Member object? There are no objections. Therefore,
amendment 30 is agreed.
|
|
Derbyniwyd gwelliant 30 yn unol â Rheol Sefydlog
17.34.
Amendment 30 agreed in accordance with
Standing Order 17.34.
|
|
[248]
David Rees: We move on to amendment 31A. Darren, would you
like to move amendment 31A?
|
|
Cynigiwyd gwelliant 31A (Darren Millar, gyda
chefnogaeth Elin Jones).
Amendment 31A (Darren
Millar, supported by Elin Jones) moved.
|
|
[249]
Darren Millar: I move.
|
|
[250]
David Rees: The question is that amendment 31A be agreed.
Does any Member object? [Objection.] I have an objection.
Therefore, I will take a vote by a show of hands. Can those in
favour of amendment 31A please raise your hands? Thank you. Can
those against please raise your hands? Thank you. As there’s
a tied vote, I use my casting vote in the negative against the
amendment, in accordance with Standing Order 6.20(ii). Therefore,
amendment 31A is not agreed.
|
|
Gwelliant 31A: O blaid 5, Yn erbyn 5, Ymatal
0.
Amendment 31A: For 5, Against 5, Abstain
0.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Black, Peter
Hussain, Altaf
Jones, Elin
Millar, Darren
Whittle, Lindsay
|
Davies, Alun
Griffiths, John
Neagle, Lynne
Price, Gwyn R.
Rees, David
|
|
|
Gan fod nifer y pleidleisiau yn gyfartal, defnyddiodd
y Cadeirydd ei bleidlais fwrw yn unol â Rheol Sefydlog
6.20(ii).
As there was an equality of votes, the Chair used his casting vote
in accordance with Standing Order 6.20(ii).
|
|
Gwrthodwyd gwelliant 31A.
Amendment 31A not agreed.
|
|
Cynigiwyd gwelliant 31 (Mark
Drakeford).
Amendment 31 (Mark Drakeford)
moved.
|
|
[251]
David Rees: The question is that amendment 31 be agreed to.
Does any Member object? There is no objection. Therefore, amendment
31 is agreed.
|
|
Derbyniwyd gwelliant 31 yn unol â Rheol Sefydlog
17.34.
Amendment 31 agreed in accordance with
Standing Order 17.34.
|
|
[252]
David Rees: Darren, would you like to move amendment 36?
|
|
Cynigiwyd gwelliant 36 (Darren
Millar).
Amendment 36 (Darren Millar)
moved.
|
|
[253]
Darren Millar: I move.
|
|
[254]
David Rees: The question is that amendment 36 be agreed to.
Does any Member object? There is an objection. Therefore, I will
take a vote by a show of hands. Can those in favour of amendment 36
please raise your hands? Thank you. Can those against amendment 36
please raise your hands? Thank you. In relation to amendment 36,
there voted in favour two, against eight. Therefore, amendment 36
is not agreed.
|
|
Gwelliant 36: O blaid 2, Yn erbyn 8, Ymatal
0.
Amendment 36: For 2, Against 8, Abstain
0.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Hussain, Altaf
Millar, Darren
|
Black, Peter
Davies, Alun
Griffiths, John
Jones, Elin
Neagle, Lynne
Price, Gwyn R.
Rees, David
Whittle, Lindsay
|
|
|
Gwrthodwyd gwelliant 36.
Amendment 36 not agreed.
|
|
[255]
David Rees: Darren, would you like to move amendment 37?
|
|
Cynigiwyd gwelliant 37 (Darren
Millar).
Amendment 37 (Darren Millar)
moved.
|
|
[256]
Darren Millar: I move.
|
|
[257]
David Rees: The question is that amendment 37 be agreed to.
Does any Member object? [Objection.] I have an objection.
Therefore, I will take a vote by a show of hands. The question is
that amendment 37 be agreed. Can those in favour please raise your
hands? Thank you. Can those against please raise your hands? Thank
you. In relation to amendment 37, there voted in favour two,
against eight. Therefore, amendment 37 is not agreed.
|
|
Gwelliant 37: O blaid 2, Yn erbyn 8, Ymatal
0.
Amendment 37: For 2, Against 8, Abstain
0.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Hussain, Altaf
Millar, Darren
|
Black, Peter
Davies, Alun
Griffiths, John
Jones, Elin
Neagle, Lynne
Price, Gwyn R.
Rees, David
Whittle, Lindsay
|
|
|
Gwrthodwyd gwelliant 37.
Amendment 37 not agreed.
|
|
Cynigiwyd gwelliant 32 (Mark
Drakeford).
Amendment 32 (Mark Drakeford)
moved.
|
|
[258]
David Rees: Before we move to a vote on amendment 32,
Members should be aware that if amendment 32 is agreed, amendments
17 and 18 will fall. The question is that amendment 32 be agreed.
Does any Member object? [Objection.] I have an objection.
Therefore, I’ll take a vote by a show of hands. Can those in
favour of amendment 32 please raise your hands? Can those against
amendment 32 please raise your hands? Any abstentions, please raise
your hands. Thank you. In relation to amendment 32, there voted
five in favour, four against, and one abstention. Therefore,
amendment 32 is agreed.
|
|
Gwelliant 32: O blaid 5, Yn erbyn 4, Ymatal
1.
Amendment 32: For 5, Against 4, Abstain
1.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Davies, Alun
Griffiths, John
Neagle, Lynne
Price, Gwyn R.
Rees, David
|
Hussain, Altaf
Jones, Elin
Millar, Darren
Whittle, Lindsay
|
Black, Peter
|
|
Derbyniwyd gwelliant 32.
Amendment 32 agreed.
|
|
[259]
David Rees: As amendment 32 was agreed, amendments 17 and 18
have fallen.
|
|
Methodd gwelliannau 17 a 18.
Amendments 17 and 18 fell.
|
|
Grŵp 2: Cychwyn
(Gwelliannau 19, 33 a 34)
Group 2: Commencement (Amendments 19, 33 and 34)
|
|
[260]
David Rees: We now move on to group 2. The second grouping
of amendments to consider is in relation to commencement. The lead
amendment in the group is amendment 19, and I call on Darren Millar
to move amendment 19 and to speak to the amendments in this group.
Darren.
|
|
[261]
Darren Millar: I move—in fact, I don’t move
amendment 19. Having considered the Minister’s amendments in
this group—amendments 33 and 34—I’m satisfied
that they would achieve the aims of my amendment 19 and that they
deal appropriately with commencement issues.
|
|
[262]
David Rees: Thank you, Darren. In that case, the
Minister’s amendment becomes the lead amendment in this
group.
|
|
Cynigiwyd gwelliant 33 (Mark
Drakeford).
Amendment 33 (Mark Drakeford)
moved.
|
|
[263]
David Rees: I move amendment 33 on behalf of the Minister
and ask the Minister to speak to the amendments in this group.
Minister.
|
|
[264]
Mark Drakeford: Thank you, Chair. I’m very grateful to
Darren Millar for his recognition that amendments 33 and 34 are, in
impact, identical to his amendment 19. Amendment 33 clarifies the
Bill. It comes into force, apart from section 2, when it receives
Royal Assent. Section 2 will be brought into force by commencement
Order, and amendment 34 means that different parts of section 2 can
be commenced at different times and for different purposes. Both of
these amendments aim to satisfy both this committee’s and the
Constitutional and Legislative Affairs Committee’s
recommendation that the commencement section in the Bill, as
introduced, be amended to allow time for guidance to be developed
and issued, and for recruitment and retention issues to be
addressed. I believe that my amendments meet those requirements and
I ask Members to support them.
|
|
[265]
David Rees: Thank you, Minister. Does any other Member wish
to speak on this group? No. Then I call on the Member in charge,
Kirsty Williams, to speak to this group of amendments.
|
|
[266]
Kirsty Williams: Just briefly, Chair, to say that I support
the Government amendments with regard to commencement. It is
important that the guidance is available at the appropriate time
and, therefore, commencement should happen when that guidance is
there. Therefore, I support it.
|
|
[267]
David Rees: Thank you, Kirsty. Therefore, I call on the
Minister to reply to the debate.
|
|
[268]
Mark Drakeford: I have nothing further to say.
|
|
[269]
David Rees: Thank you very much. Darren, given that
you’ve indicated that you do not wish to move amendment 19.
Does any other Member wish to move amendment 19? No.
|
|
Ni chynigiwyd gwelliant 19 (Darren
Millar).
Amendment 19 (Darren Millar) not
moved.
|
|
[270]
David Rees: Then we move on to amendment 33. The question is
that amendment 33 be agreed to. Does any Member object? No
objections. Therefore, amendment 33 is agreed.
|
|
Derbyniwyd gwelliant 33 yn unol â Rheol Sefydlog 17.34.
Amendment 33 agreed in accordance with Standing Order 17.34.
|
|
Cynigiwyd
gwelliant 34 (Mark
Drakeford).
Amendment 34 (Mark Drakeford)
moved.
|
|
[271]
David Rees: I move amendment 34 on behalf of the Minister.
The question is that amendment 34 be agreed. Does any Member
object? No objections. Therefore, amendment 34 is agreed.
|
|
Derbyniwyd gwelliant 34 yn unol â Rheol Sefydlog 17.34.
Amendment 34 agreed in accordance with Standing Order 17.34.
|
|
Grŵp 3: Enw Byr ac Enw Hir y Bil (Gwelliannau
35, 38, 39)
Group 3: Short and Long Titles of the Bill (Amendments 35, 38,
39)
|
|
[272]
David Rees: The third group of amendments is in relation to
the short and long titles of the Bill. The lead amendment in the
group is amendment 35.
|
|
Cynigiwyd
gwelliant 35 (Mark
Drakeford).
Amendment 35 (Mark Drakeford)
moved.
|
|
[273]
David Rees: I formally move amendment 35 in the name of the
Minister and I call on the Minister to speak to the amendments in
this group.
|
|
[274]
Mark Drakeford: These amendments simply give effect, in both
the short and long titles of the Bill, to the arguments that
I’ve made earlier in relation to the use of the word
‘safe’ in a legal context. I won’t repeat all
those arguments again because Members are very familiar with them
by now. I move these amendments on the basis of the arguments with
which you are now familiar.
|
|
[275]
David Rees: Thank you, Minister. Are there any other Members
who wish to speak to this group? No. Then I call on the Member in
charge, Kirsty Williams, to speak to this group of amendments.
|
|
[276]
Kirsty Williams: As the committee will anticipate, I’m
disappointed with the Government amendments to remove the word
‘safe’ from the long and short title. As the Minister
says, those arguments have been well rehearsed here this morning
and I believe it’s a missed opportunity. I believe that the
effect of the Bill will be to deliver safe staffing levels and it
is a shame that that cannot be reflected in the long and short
titles.
|
|
[277]
David Rees: Thank you, Kirsty. Minister, do you wish to
reply to the debate?
|
|
[278]
Mark Drakeford: Just to agree with the Member in charge that
the impact of the Bill and the effect of the Bill are not affected
by the use of a single word. We differ on whether it should
be included or not, but we are of the same mind in relation to the
impact that the Bill will have.
|
|
[279]
David Rees: Okay, thank you, Minister. I move now to a vote
on amendment 35. The question is that amendment 35 be agreed to.
Does any Member object? [Objection.]I have an objection.
Therefore, I’ll take a vote by a show of hands. Can those in
favour of amendment 35 please raise your hands? Can those against
please raise your hands? Thank you. Are there any abstentions?
Thank you.
|
|
Gwelliant 35: O blaid 5,
Yn erbyn 4, Ymatal 1.
Amendment 35: For 5, Against 4, Abstain 1.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Davies, Alun
Griffiths, John
Neagle, Lynne
Price, Gwyn R.
Rees, David
|
Hussain, Altaf
Jones, Elin
Millar, Darren
Whittle, Lindsay
|
Black,
Peter
|
|
Derbyniwyd gwelliant 35.
Amendment 35 agreed.
|
|
[280]
David Rees: In accordance with the marshalled list,
we’ll return to vote on the remaining amendments in this
group later in the proceedings.
|
|
Grŵp 4: Diben y Bil (Gwelliant 27)
Group 4: Purpose of the Bill (Amendment 27)
|
|
[281]
David Rees: We now move on to group 4. The fourth grouping
of amendments to consider is in relation to the purpose of the
Bill. The lead and only amendment in this group is amendment
27.
|
|
Cynigiwyd
gwelliant 27 (Mark
Drakeford).
Amendment 27 (Mark Drakeford)
moved.
|
|
[282]
David Rees: I formally move amendment 27 in the name of the
Minister and I call on the Minister to speak to the amendment in
this group.
|
|
[283]
Mark Drakeford: Thank you, Chair. Section 1 of the Bill, as
originally introduced, was essentially descriptive in nature.
However, it contains a series of phrases—improved working
conditions, strengthening accountability, equality, safety and
efficiency of workforce and planning and management—all of
which are open to interpretation and challenge. As the section does
not contain any substantive provisions, I believe that its
continued inclusion opens up a plethora of opportunities for
lawyers rather than for nurses. I believe that its potential
ambiguities are best addressed by elimination and that, through
elimination, no harm at all is done to the impact that the Bill
will achieve. Furthermore, this is a short Bill. The aim of a
‘purpose’ section is generally to provide an overview
of the Bill and is commonly used in a longer and more complex
Bills. An overview, I think, is unnecessary in a Bill of this
length and I ask Members to agree to my amendment 27, which would
simply remove section 1 from the Bill as introduced.
|
|
[284]
David Rees: Thank you, Minister. Are there any other Members
who wish to speak to this amendment? No. Then I call on the Member
in charge, Kirsty Williams, to speak to theis amendment in this
group.
|
|
[285]
Kirsty Williams: Chair, I’m disappointed by the
Minister’s amendment 27 because, as he states, it would
remove the purpose clause of this Bill. Not for the first time, I
think this is a missed opportunity, because the purpose clause used
language that would be readily understood within the healthcare
sector and with the general public, and set out a clear message as
to the Bill’s intentions. However, regardless of whether it
is stated or not in the Bill, the essential purpose of this
legislation remains the same: to provide nurses with the time to
provide compassionate care. That remains the purpose of the Bill
and, I believe, will be the effect of the Bill regardless of
whether the purpose of the Bill remains or is amended, as suggested
by the Government.
|
|
[286]
David Rees: Thank you. Minister, do you with to reply to the
debate?
|
|
[287]
Mark Drakeford: Chair, can I thank the Member in
charge—this is the last time I will speak this
morning—for all the efforts that she has made throughout the
discussions that we’ve had to engage with the
Government’s essential argument, which has been to find ways
in which we can successfully retain and, I think, strengthen the
key purpose of the Bill, while eliminating some aspects of
it—and I understand why she would be disappointed at the loss
of section 1, if it is lost—that don’t add to that key
purpose and run some dangers of distracting attention from it. I
continue to ask Members to agree to my amendment 27.
|
|
[288]
David Rees: Thank you, Minister. We therefore move to a vote
on amendment 27. The question is that amendment 27 be agreed. Does
any Member object? [Objection.] I have an objection,
therefore I will take a vote by a show of hands. Can all those in
favour of amendment 27 please raise your hands? Thank you. Can
those against please raise your hands? Thank you. Any abstentions?
Thank you. Therefore, in relation to amendment 27, there voted five
in favour, four against and there was one abstention. The amendment
is therefore agreed.
|
|
Gwelliant 27: O blaid 5,
Yn erbyn 4, Ymatal 1.
Amendment 27: For 5, Against 4, Abstain 1.
|
|
O blaid:
For:
|
Yn erbyn:
Against:
|
Ymatal:
Abstain:
|
|
Alun Davies
John Griffiths
Lynne Neagle
Gwyn R. Price
David Rees
|
Altaf Hussain
Elin Jones
Darren Millar
Lindsay Whittle
|
Peter Black
|
|
Derbyniwyd gwelliant 27.
Amendment 27 agreed.
|
|
Cynigiwyd gwelliant 38 (Mark
Drakeford).
Amendment 38 (Mark Drakeford)
moved.
|
|
[289]
David Rees:
Before we move on to a vote on
amendment 38, Members will wish to be aware that if amendment 38 is
agreed, amendment 39 will fall. The question is that amendment 38
be agreed to. Does any Member object? There are no objections,
therefore amendment 38 is agreed. As amendment 38 was agreed,
amendment 39 has fallen.
|
|
Derbyniwyd gwelliant 38 yn unol
â Rheol Sefydlog 17.34.
Amendment 38 agreed in accordance with Standing Order
17.34.
|
|
Methodd gwelliant 39.
Amendment 39 fell.
|
|
[290]
David Rees:
All sections of the Bill have now
been deemed agreed by the committee.
|
|
Barnwyd y
cytunwyd ar bob adran o’r Bil.
All sections of the Bill deemed agreed.
|
|
[291]
David Rees:
As Stage 2 has been completed today,
Stage 3 begins tomorrow. Members will be notified of the tabling
deadlines in due course. Before we finish, Members will wish to be
aware that the Member in charge will bring forward a revised
explanatory memorandum ahead of Stage 3 proceedings, in accordance
with Standing Order 26.27. Therefore, can I thank everybody this
morning? I also add my wishes to the Member in charge, who has, I
think, demonstrated a strong passion for the Bill throughout our
stages of proceedings. I am sure that that passion will be
continued in the further stages of the Bill’s progress. Thank
you very much.
|
|
11:28
|
|
Cynnig
o dan Reol Sefydlog 17.42(vi) i Benderfynu Gwahardd y Cyhoedd o
Weddill y Cyfarfod
Motion under Standing Order 17.42(vi) to Resolve to Exclude the
Public from the Remainder of the Meeting
|
|
Cynnig:
|
Motion:
|
|
bod y pwyllgor yn penderfynu gwahardd y cyhoedd o
weddill y cyfarfod yn unol â Rheol Sefydlog
17.42(vi).
|
that the committee
resolves to exclude the public from the remainder of the meeting in
accordance with Standing Order 17.42(vi).
|
|
Cynigiwyd y cynnig.
Motion moved.
|
|
[292]
David Rees:
I would like to propose that we have
a short break and reconvene in five minutes while we undertake some
changes for the next part of our meeting.
|
|
Derbyniwyd y cynnig.
Motion agreed.
|
|
Daeth rhan gyhoeddus y cyfarfod i ben am
11:28.
The public part of the meeting ended at
11:28.
|
|
|
|
|
|
|
|