National Assembly for Wales

Bore da. Croeso, pawb. I'd like to welcome Members to the Health and Social Care Committee this morning. I move to item 1. This meeting is a fully virtual meeting this morning, so it's being conducted via video-conference, but Standing Orders remain in place as they normally would. This is a bilingual meeting, so Welsh is also translated into English, and we've previously agreed that Mike Hedges will stand in should something happen to my connection to the meeting this morning. So, thank you, Mike. We have one apology this morning, from Gareth Davies, and if there are any declarations of interest, please say now. No, there are not.

In that case, eitem 2, item 2, this morning, is an opportunity for members of the Health and Social Care Committee to question the Government's preferred candidate for the role of chair of the Citizen Voice Body. So, I would like to welcome this morning our only witness today, Professor Medwin Hughes, who is the Welsh Government's preferred candidate for the said body. So, good morning, Professor Hughes, and good to see you this morning, and good that you're attending committee. Can I thank you as well for providing us your curriculum vitae and application for the role? We very much appreciate it. Professor Hughes, if I could perhaps just ask a very general question—by all means if you want to expand on anything else briefly as an opening comment, then please do—can I ask why are you suitable, do you think, for the role at the said body?

I think there's a real opportunity in the context of establishing this body to make a difference to secure the voice of the citizens of Wales in health and social care. There is a clear focus here on setting up a new national institution. My experience over the years has been in bringing institutions together and creating new national institutions, and I'd hope that that experience would support in the context of creating the infrastructure, and making sure that it is responsive and engaging in the context of policy linked to health and social care.

Thank you, Professor Hughes, and I can see from your CV that you've got a great depth of experience in supporting public bodies and setting them up. You've touched on it a little bit, but I wonder if you could perhaps expand a bit further on how your experience in other roles will benefit this role, if you move forward as the chair of this new body.

I think the evidence I presented in the context of my application shows significant experience over the years in building up new institutions, and also on several occasions of bringing different parts of institutions together, and I think that's going to be key in the context of establishing this particular body.

I think we should be celebrating what has been achieved over the years in the context of the community health councils, and also clearly building anew. There is a real opportunity, focusing on the Government's policy of putting the citizen, person-centred care at the heart of a health and social care strategy of making sure that the experiences of building the new building blocks of this Citizen Voice Body is adhered to best practice of bringing people together, building coalitions, and making sure that there's good governance and good structures, and hopefully the work I've done over the 20 years of leading institutions will help in setting the right framework and making sure that the right governance and cultural values are related to this new national institution.

Thank you, Professor Hughes. In terms of, perhaps, experience you may have gained within the health and social care sector, perhaps you could talk a little bit to any experience you've got in those fields and how that would bring added benefit to you as the chair of this new body.

I was fortunate, through some of my charity work over the years, to be involved with some organisations across Wales. One particular charity that I really valued the opportunity of serving was Kaleidoscope. Some of you will know of the excellent work that they do across Wales in the context of helping individuals with issues of substance misuse and educational support and infrastructure. I had the chance to be a trustee and to be a chair of Kaleidoscope, and in the context when we were—again similar to this particular body—building relationships across Wales, making sure that the voice of individuals was heard in refining and developing an appropriate service, and building, hopefully, a quality structure. I'm very pleased with the work that Kaleidoscope have done through the excellent leadership of individuals like Martin Blakebrough over the years. I think it's safe to say now that over 10,000 clients are supported by this charity. And again, my work in that context, hopefully, would help. I have also, in the context of my work as vice-chancellor of the University of Wales Trinity Saint David, been involved in developing partnership work with aspects of Government in digital healthcare infrastructure. All of that, hopefully, would support in the establishment of a new body to serve Wales.

Diolch yn fawr. Mike Hedges.

Diolch, Cadeirydd. My first question is: what do you think the strategic direction of the Citizen Voice Body should be, and what are its main aims and objectives, especially the short-term aims and objectives when you start it up?

If I can refer you to the focus of the Act and the very clear statements of the Act, and what is required of this body, it clearly stipulates to represent the interests of the people of Wales in the context of health and social care, and a parity of representation for health and social care; it's extremely important. It's there, therefore, to seek the views; it's also there to make sure there's appropriate face-to-face engagement, and that is across Wales, representing the different communities, and also if I may say, the different voices of Wales. And that is so important in the context of setting up the infrastructure for this particular body.

You'll also know that there's a key direction there to focus upon public awareness and also to secure advocacy, and where appropriate, to engage in a meaningful dialogue with relevant bodies to make sure that the strategy for Wales for health and social care is fit for purpose.

You specifically ask about the short-term objectives. Clearly in the context of the infrastructure, it will be a key requirement over the first 12 months to set up the body and to engage in a meaningful way with those partners that are already involved right across this area in Wales, and I refer in particular to the community health councils. I think we should also pay tribute to the good work that has happened over 40 years. So, we build upon a tradition, a strong tradition of advocacy, and we secure consistency.

There's also, I think, a need to make sure that there is appropriate information for the people of Wales on how important their voice is in a seamless person-centred strategy. So, again, I would see in setting up the structure for creating good governance, good frameworks, people are aware that there are opportunities, that their voice can make a difference, as we look to person-centred care and developing a healthier and more resilient Wales.

Thank you. Community health councils have both strengths and weaknesses and there are some things they did very well, some things they did, perhaps the term 'less well' might be appropriate. What I'm asking is, though: how are you going to ensure that what had been the good that was carried out by community health councils in the past continues?

And how are you going to get the feeling of one organisation? You've seen mergers; you've been involved in mergers; it's very difficult sometimes to get people to actually believe the merger's taken place and they continue in their old life as if what's happened there does not affect them. How are you going to ensure, first, that the mergers actually appear to take place in the minds of the people working there, most of whom worked previously for other community health councils, and secondly, and perhaps more importantly, how are you going to make sure the good is not lost?

I think the key thing one must do is to start from a process of celebrating and acknowledging the work that has been achieved in the context of the community councils. It takes time to build trust. I always say in the context of building new institutions that you have to gain the trust of people, you have to work through systems, and you have to engage and identify common values and common strategies. The Act has been clear in what is required of a new corporate body, but to achieve that, it takes good people to work together and to build coalitions of people that will see the common value of working across Wales. So, certainly, an important part of my role is to engage, to engage with the key stakeholders, to listen to their views in the context of the process and to bring people together on that journey.

I think when you look to the evidence over the last several reports that have been presented to Government over a period of four or five years—and I'd refer you to the Longley review; I'd also refer to the Marks review and the Organisation for Economic Co-operation and Development review—I think they did show that there were some good examples of excellent advocacy work, some really good work in the context of identifying thematic areas of concern. What we need to do is to build upon that and to secure consistency, and also, if I can suggest, to maximise the opportunities that this new body is digitally connected right across Wales.

It mentions the citizen voice, but I've said before: it is the voices of Wales, and they are very different voices in our communities. How can we, if we firmly believe in an inclusive, healthier Wales, make sure that those communities are heard? And I think it is so important to go back to the work that the community health councils have done to build the trust, and also make sure that the best of that is taken forward. And also, to finish the point, the importance of social care. This is a real opportunity, of course, to bring parity in the context of health and also social care, across our communities.

Thank you.

I was just making sure that I wasn't on mute there. Rhun ap Iorwerth.

Diolch, Rhun. Jack Sargeant.

Diolch yn fawr, Cadeirydd, and bore da, Professor. Great to have you here. If I can just maybe follow on from the last question there and the reflection of communities across Wales, to do that, it's really important when we're developing this—[Inaudible.]

I think, Jack, you've just frozen for a moment. I'm not quite sure. We'll just pause for a moment and just make sure that it's just on a temporary pause. Sorry.

—from the start.

Jack, sorry, can I interrupt? Just at the start of your question, you froze, so you might have to ask the question again.

Okay. My connection, Chair, has just come up as 'unstable', but I will try and continue.

We can hear you now, Jack. Go ahead.

Okay. Apologies for that, Professor. Just in terms of reflection of communities, which you mentioned, back to Rhun ap Iorwerth's question there, it's crucial that we do have the right board to grow the Citizen Voice Body, isn't it, and can I ask you, therefore, how you'll bring together, if appointed as chair of the body, a board that has the required skills, that will work together efficiently and effectively, and perform to that level of standard that we would seek to achieve, as citizens of Wales? And perhaps you could go on a little bit more and tell us what exactly the skill sets and experiences of people who will join your board are—[Inaudible.]

You've just frozen again, Jack.

—to reflect those communities across Wales.

There we are. I think we heard nearly all of that. It was just a little bit at the end. I think Professor Hughes can fill in the gaps on that last point. Thank you, Professor Hughes.

If I could focus, first of all, on the importance of securing that the diverse voices of Wales are heard, in the context of this board infrastructure, that's absolutely key in the context of developing a resilient board that reflects a cohesive Wales and a cohesive Wales that is diverse in its sociocultural context and in its representations linked to health and to social care. That has to be set in place right from the start. How would one secure that that is appropriate in the context of the board? Clearly, the skill set of board members has been articulated and set in what has already gone out by the Welsh Government, and individuals will have shown their interest in the context of their engagement to the board. Should I be appointed to the role, clearly I would want to engage immediately, to make sure that we have due representation, cultural representation and appropriate representation that reflects, I think, the mosaic of the citizens of Wales.

As we move that forward, what will be key, in considering the values of the health system that have been identified in 'A Healthier Wales', is to make sure that the board does consider what are the cultural issues, how those are considered in all the areas of policy that relate to health and social care. And I think that when you reflect on the values that the Government have set in their health system, I think what comes over to me very clearly is how important it is to have co-ordination and cultural voices as we reflect, ongoing, on the values of system care and the term 'prudent care'. Well, prudent healthcare focuses upon listening very carefully to the diverse languages and the diverse themes of culture that show and are seen across Wales, and that certainly would be the role of the chair and also of the board, and answerable, of course, to the Senedd.

Diolch yn fawr, Professor. Can I go on to ask about the role of the board and that strong relationship between the board and the chief executive that is clearly needed, but one that needs to be constructive and also challenging? Can I ask your views, therefore, on what you see the role to be for the board and how you would develop that strong working relationship between the staff of the Citizen Voice Body, but also whilst challenging the changes that may be needed, monitoring that performance and also supporting the wider goals of the organisation?

I think, over the years, I've learned very clearly the importance of the difference between the role of governance and of the executive that undertake the work, and there is a very fine line, but it's a very important line, for the chief executive and also for members of a board, and that's something I'm acutely aware of, and, hopefully, I will have demonstrated in my work as a vice-chancellor of the University of Wales that importance. I think the role of the chair and of the board is to set the direction. The Act has been clear on what is expected of this body. How that happens, the functioning of that, is through the chief executive and the staff. The chair and the board are critical friends—there to support, there to engage, to encourage, but also to offer critical advice, and if we consider, in the context, things are not appropriate, clearly we are responsible in the context of the core objectives of that board.

It's very important, as we develop a new partnership, that there is a good working relationship between the board members and the office of the chief executive. My role, should I be appointed to the board, is to support, to help colleagues to frame, to create the scaffolding and to build this. This is about a partnership, a coalition. If we have the same values, if we have the same objectives, we can deliver and deliver so that the voice of the citizens is heard and that it makes a difference.

Diolch yn fawr. One final question from me, Chair. It's unfortunate for the committee, but we've heard quite a lot during a recent inquiry about the, perhaps, poor communication within the health service, within the actual services delivered, whether that be between organisations, between Government and service providers, or directly to patients. Now, the body and the board clearly have to be independent of the Welsh Government, but it is going to require some strong communication, lengthy communication and regular communication with the Minister of the Welsh Government. The example I'm picking on here, perhaps, is from the start of the year, with Public Health Wales making announcements around cervical screening. Whilst that directly communicated with Members of the Senedd, perhaps, or the Welsh Government—. In short, was it good enough? I don't think it was, and there's work to do there. So, can I ask how you will provide that strong communication to the Minister, and not just to the Minister, though, but wider, to Members of the Senedd too, who represent the Welsh public, whilst also remaining independent of the Welsh Government?

The board, as structured—[Inaudible.]—is independent. It has been created in the context of an independent body, but clearly it relates the citizen's voice to Government policy, and, in that context, it'll be extremely important that there is an excellent working relationship in the context of the Government, focusing with Ministers, and also in the context of the Senedd as a whole. We are talking of the citizens of Wales and, therefore, making sure there is appropriate parity of engagement across the Senedd is important, but I would certainly see, in the context of my work and of the board in working with the Government, making sure that the strategy is delivered. At the heart of that 'A Healthier Wales' strategy is the focus on a seamless health and social care system. For us to do that well, it means honesty in dialogue, standing back, independence, critically engaging together. I focus on the word 'co-curation'. If co-curation works well, it allows us to build, I think, anew, and build systems together, and that is about clarity, clear objectives, clear accountability and an honesty in communication, be that with the Government and also with the Senedd as a total body.

Diolch, Professor Hughes. Chair, if you don't mind—that's my final question—I'm going to turn my camera off to hopefully hear the rest of the professor's answers to this session. 

Not at all a problem, Jack, thank you. Diolch yn fawr. Joyce Watson. 

[Inaudible.]—Professor. I'm going to ask questions around equality, diversity and the Welsh language. Unfortunately, I'm going to ask my questions in English, and you will, obviously, answer them in the language you choose.

So, I want to know about the skills and experience that you're going to draw on to promote equality, diversity and inclusion, and I'm going to point to an area that's been clearly highlighted as a consequence of the pandemic, and that was the disparity in the health opportunities of certain diverse groups in Wales and the way that they receive and access healthcare.

You refer to two parts, one in the context of making sure that appropriate representation and appropriate consideration is given to cultural diversity, and then you refer in the context of bilingualism. If I focus initially in the context of bilingualism.

There is no reason as this board is established—. We mentioned bilingualism, but, if we are really going to focus upon the diversity of cultural entities in Wales—I refer to the mosaic of culture in Wales—we should also make sure that individuals can relate to their issues of health and social care through their preferred languages, because what we do know in the context of the diverse cultures of Wales is that it's so important, as we create the system, that there is an opportunity for them to engage in their appropriate language, and that's something I would be really keen to focus on, because what we do know, when people need support, in issues of health and social care, they will find it difficult, sometimes, if they cannot relate through their own language. And, clearly, the infrastructure, from the bilingual context, has to be in place from day one. But also we should be reflective on how do we bring the diversity of cultures, and that has to be reflected in the board, in membership, in our processes, in our values, and in our ongoing critical reflection right across Wales. Absolutely key if we really are going to create a Wales of cohesive communities, where there is respect for the cultural mosaic and cultural values.

There are, of course, areas where people live in Wales but don't receive their care, necessarily, in Wales, and their voices will have to be heard. We're about to have a report from Shropshire and Telford where women would have received the most appalling lack of care in maternity settings, but those women will reside in Wales, although their care was elsewhere, and then we've got issues in the north as well. So, in terms of your voice, the citizen's voice, which is about healthcare for the people of Wales, how are you going to manage? Do you see it as your role, even, to manage looking after the healthcare of people who live in Wales, but don't necessarily have their care in Wales?

The board will have been structured to have regard to the core objectives of the Act, and in that it is called upon to represent citizens. Should it be required to make representations, and, clearly, to engage, it should have the confidence to do so, either in the context of Wales or, where appropriate, to make those representations known in other contexts. So, my own view would be—and clearly this is for the board to consider and to come to a measured, collective view on—if our task is to listen, to construct and to create a narrative that health and social care issues are presented, then we should be doing that across different domains. That means in Wales and also to consider the implications further afield. 

Thank you, because that might be one of the first challenges that comes your way should you end up being chair. Thank you. Diolch.

Thank you, Joyce. Professor Hughes, in your response to Joyce Watson there you did focus a lot on ethnic diversity, but I wonder if you could perhaps talk a little bit about broader diversity such as age or disability or sex or gender, perhaps, in the context of your role.

I think, again, if we are creating an inclusive board, we have to have regard to all of those distinctive features that you note, and I think that's going to be absolutely key in setting the core values of the board, and that has to take place as we set up the board. So, again, there would be a very clear statement of that inclusivity based upon, I think, the best values, and the highest cultural values, that we will maintain as a board, and the service we will offer to the diverse communities. That is at the heart of setting up the infrastructure of this new national body.

And, perhaps, how do you do that?

Well, first of all, you have to listen and engage. You have to clearly demonstrate respect and making sure there is meaningful engagement, not in the context of just words, but actual engagement with communities, and therefore there is trust, and building that relationship right across the diverse communities that you have identified. That is key, and that starts in setting up the board, setting up the infrastructure across the different communities so those voices, those representations, not only are heard, but are engaged in the process of systemic change for a better Wales that focuses upon respect for different cultural traditions. 

Thank you, Professor Hughes. I'll perhaps have a series of last questions to you, but this is the last set of questions, I think, as we come to a close, so I'd like to give you the opportunity, really, to tell us anything and draw anything from you that you feel has not been drawn out from you during questions today, if there's anything you think that's important to impart to us as we come to the conclusion of this session. But particularly I'd like to think about—. You talked a lot about your priorities for the first year; is there anything you've not said that you think is an important priority for your first year? And should you be appointed the chair, at some point in the future, how would you like to look back and think about what you've achieved in your role as chair and what the new body has achieved? And how do you think that could be measured as well, and should be measured? How is your success measured at some point in the future?

I think you ask a number of key questions there that link to scaffolding. How do we now focus upon building this new entity? What excites me in this role is there is a real chance to bring parity in the context of citizenship voice for health and social care. It gives us the chance to create an inclusive infrastructure, building upon the good work that we've noted, and Rhun ap Iorwerth has noted very clearly we shouldn't lose the value of very strong representation across some of the boards already.

But I think it's also a chance to create something that is digitally connected. I'm a fan of seeing, where we can, linking in different policy opportunities for Government, and there's a real opportunity here, I think, with the digital agenda, to develop an exciting body. The priorities have to be, clearly, in the context of legislation, of setting up the corporate board, setting the systems, the processes, as you would expect from a legal entity, but there's also significant work of building relationships, of building trust, of building, I think, that common understanding between the significant players that are already engaged in this context and, if I may say so also, showing from day one the parity of health and social care.

Should I be successful and should one reflect in the context of four or five years' time, in the context of the life of this Senedd, what would success look like, it would be to have created an infrastructure that is responsive, that is clear in its representation to the different cultures and different traditions of Wales. It would be an institution that has set a framework and isn't afraid, through meaningful, honest conversation, to play a part in developing, I think, the healthcare system. How is that measured? The board has to set very clearly targets and structures and also how it can be called to account, clearly by the Senedd, and also, over the fullness of time, to show it makes a difference. This is an opportunity where the voice of the citizen is heard, is acted upon, and all of that, then, hopefully will deliver in the context of the citizen values of Wales, linked to the clear statement that has been noted by the Government in the document of health and social care. 

Thank you, Professor Hughes. I think you answered all of the questions I had very ably there, but I suppose, perhaps, just how do you think your role—you mentioned four or five years into the future—how is your role as the chair going to be measured, perhaps, by us as a committee?

I would have thought that the first question you'd want to ask is: has the chair managed to bring a coalition of board members to create a corporate board that will stand the test of time? We're fortunate; we've had community health councils for over 40 years. One would hope that, whatever board is created, it'll be fit for purpose and it is a question you would ask: has the chair managed to support that? A chair never works alone, he works or she works in a context of a partnership of individuals. The accountability, of course, is with the chair, and you will expect any chair you appoint to create the right structure, to create the right culture and, hopefully, to deliver the right values for the benefit of Wales and its citizens. 

Thank you, Professor Hughes. I'm looking at Members to see if there are any—. Yes, I can see Rhun ap Iorwerth. 

Diolch yn fawr. Thank you, Professor Hughes. So, can I thank you for your time in committee this morning? Diolch yn fawr iawn. Thank you ever so much. We'll send you a copy of the transcript of proceedings and, over the next day or so, we will publish our report and obviously share that with you as well. And of course, if you are successfully appointed, we would then look forward to working closely with you as the Health and Social Care Committee over the term of this Senedd. So, thank you, Professor Hughes, for being with us this morning. We're very grateful for your time. Diolch yn fawr iawn. 

Thank you. Diolch. Goodbye. 

Goodbye. 

There we are. So, I move to item 3 and, under Standing Order 17.42, can I resolve that we exclude the public from the remainder of today's meeting. Are Members content with that? Thank you. In that case, we will now proceed to private session.