Cynulliad Cenedlaethol Cymru

Can I welcome Members to this morning's meeting of the Public Accounts Committee? I welcome our witnesses as well. We've received no apologies and no substitutions. Do any Members have any declarations of interest they'd like to make at the start of the meeting? No. Okay. Well, usual housekeeping rules apply. 

Today we continue with the evidence gathering as part of our inquiry into the barriers to the successful implementation of the Well-being of Future Generations (Wales) Act 2015. The summary of stakeholder event findings and consultation responses is the background information for this briefing. You should have received that. The committee received this summary in the meeting pack for 14 December. The same summary will also be used as the background information for the next two meetings with public bodies. Would our witnesses like to give their name and position for the Record of Proceedings?

Yes. Thanks, Nick. I'll go first. I'm Carl James. I work for Velindre University NHS Trust, and I'm director of transformation, planning and digital, and I'm the executive officer with the responsibility for sustainability. I'll pass across to Huw.

Good morning. My name's Huw Llewellyn. I'm director of commercial and strategic partnerships at Velindre, and I support Carl in transforming cancer services, wider trust activity and also implementing the sustainability agenda.

Good morning. My name's Alan Prosser. I'm currently the interim director of the Welsh Blood Service, which is a division of Velindre NHS trust.

Great. Thanks for being with us today and we do appreciate, with the developments in the pandemic, that this is a very busy time for you. So, thanks for finding the time to come to answer some of our questions about this important area, moving forward. We've got a number of questions for you, so I'll kick off with the first couple and, briefly, as an outline at the start, what has been the biggest challenge for your organisations in implementing the Act?

Okay. Shall I pick that up? What we'll try to do for the committee is that I pick them up and then I'll co-ordinate between the three of us, if that's helpful. I think it's probably useful to start with just recognising how much we welcome the Act. I think we all agree that it's a groundbreaking piece of legislation for Wales and for the globe because it's got a huge amount of attention over the last five years. So, it's a really, really important thing for Wales to do. And it's already starting to frame a different type of conversation, particularly in the health service, about outputs versus outcomes, and also the broader intention then about social value. So, how do we do good across the world as opposed to how we just do what we do in our part of the organisation? So, that's the opening sense from ourselves.

And I guess the second part, then, perhaps would be that, as opposed to the biggest challenge, we're looking at it in a slightly different way in terms of trying to best understand the conditions that would make it successful, or more successful than it already might be, and I guess there's a couple of obvious things that we've been working through. The first, I guess, is a key long-term strategic approach from Government and from policy, because if we do understand where we're trying to get to over a five, 10, 15, 20-year period, it does enable us, then, to put in place a set of arrangements that give us the best chance of being successful. So, we've got a real clear direction of travel—and I believe we have—from Government. If you take the Act, over the last five years, but also in terms of health policy, if you go right the way back to 'Designed for Life' and all the way through to 'A Healthier Wales', they do stick with a very clear, strategic direction of travel about outcomes, patient involvement, people involvement, citizen participation, long-term partnerships. All those things are broadly there, and I think they're still there; I think they could be a bit more nuanced.

The second one for us, really, is the understanding of the Act, and I think that would really need to pick up, both in terms of our organisation so that we have a good understanding of the Act at a board level and a senior level, and, I guess, as you go down the organisation, we need to get far more information and education support to all the people, to really enable them to grasp the Act, and not just theoretically understand the Act, but, actually, how you implement it to make a tangible difference to things we do on a daily basis. So, it just becomes part of the culture—you know, the way we do things around here—rather than have to think about how we take an Act and implement it.

The next bit, really, would be around, I suspect, support and guidance. And, again, this is really, really starting to pick up with our work with the commissioner's office and other colleagues in the healthcare system—how do we get far more practical support from people like the commissioner's office, people around Wales, around the world, to actually take good ideas and implement them in practice? So, I think that's another area where there are clear challenges. Resources—we can always, always do with some more resource, but particularly, I guess, in the initial phase, when we're starting to really grapple with what the Act means and translate that into practice on the ground. So, whilst we do have some resource within our organisation and also available to us from the commissioner's office and other partner organisations, it would be really helpful if we could get additional resource both in terms of people, whilst we're in the pioneer stage, but also, then, into physical online resources that we can use—'how-to' guides, good benchmarking clubs, good practice, knowledge of practice, communities of practice, and so on and so forth.

Then, I guess, finally, I think it would be how we measure success. I think it's also fair to say that there are a number of ways we measure success across public services, NHS Wales, local authorities, so it would be really helpful if we did have a smaller number of shared outcome measures that actually start to take us towards what 'good' looks like and how we really track success over the long term. I work in the NHS, and, clearly, there are some important things we need to also track—so, waiting times, unscheduled care—and we'd all probably agree that that can sometimes distort our sense of priority and focus to a more immediate short term. So, I think anything that is tracked over 10, 15, 20 years does give us a real opportunity to understand what's working well, what we need to change, and then we can actually measure, over a good period of time, how much benefit and value we are giving to the people of Wales.

So, that would be my initial sense. So, in answer to the question, I think the challenges are also opportunities, and I would say that, but we fully believe they are, because we do believe that we're partially making progress in all those areas I've outlined, and I believe that there's a little bit more to be done to really take the good start to date and translate that into real success over the next 10 or 15 years.

And, Carl, what about the impact of the pandemic? Clearly, that's all consuming at the moment. Has that hindered the implementation of the Act, or has the Act been helpful in that regard?

Well, I want to say a couple of words, and I'll pass across to Huw and Alan then. I guess there are pros and cons, to be honest. Essentially, if I just think about what we're trying to achieve here, we're trying to achieve cultural change over the long term, aren't we? So, whatever we do is just the way we do things. So, yes, there have been huge impacts of COVID, but if we just take the opportunities it's sprung up, for example, it's accelerated many of our strategic intentions and our plans. So, I can give you a couple of examples. Innovation is a good example under 'A Prosperous Wales'. Well, just for cancer patients, we've managed to introduce hypofractionation. So, fewer fractions for a cancer patient of radiotherapy, which improves the outcome, improves the quality, reduces the amount of times they have to come to the centre, and also, then, gives a benefit of reduced travel, reduced carbon dioxide emissions. Another one is around participation—cancer patients in decision making. And another one is around the blood service. Clearly, we've been able to make huge progress on convalescent plasma. So, the amount of innovation that is thrown up as a result of the pandemic has been game changing. Our ability to take people away from unnecessary travel. So, we've got—I don't know the exact number—a high majority of our staff who are back-office staff now working from home. So, we had an intent to reduce our footprint but we've been able to bring that directly into action as a result of the acceleration of the pandemic.

And then, I guess, the other thing, around some of our concerns around what perhaps hasn't happened, will be this cultural view that everything's got to pause with regard to the well-being of future generations Act. And I think that's the nutshell, isn't it: if we can get to the point where this Act is fully embedded and we live the values every day, we wouldn't be pausing around pausing things; it's just the way we work. That aside, there are some things that, I think, have been slightly reduced by the pandemic. So, for example, our time. So, people like myself, Huw and Alan have not been able to fully focus on some of the things we wish to take forward in terms of our sustainability agenda because we've had to focus on the pandemic. We've also got some issues we've discussed with the board. So, for example, the supply chain. When we need lots of PPE very quickly, we start really pushing hard on the supply chain about the ethical supply chain and so on and so forth. That does raise some questions to be answered by all organisations across the world about how we get that important PPE. And then also, I guess, there's climate change. Once we're going across all sorts of continents to get this kit, what is that doing for our carbon footprint, the finite resources we're using to overproduce the PPE? And also, then, I guess, the waste. What's happening to the waste generated from PPE?

So, I think there's probably a range of pros and cons in terms of the immediate understanding of the pandemic to date, but I've just picked up a couple there for the committee.

Thanks for that, Carl. Can I just welcome Eryl Powell as well, from Aneurin Bevan University Health Board? I know you had a couple of broadband issues earlier, but thanks for being flexible today, and for being able to join us.

I just asked a basic opening, introductory question about the biggest challenges for organisations with the implementation of the Act, and also in the light of the pandemic as well. So, thanks, Carl, for that. Did any other witnesses want to add any comments before we move on? Alan.

Just to reinforce some of—. I concur with everything Carl says, and not to lengthen the debate, but, for me, I think, for our service, which is fairly small and niche within Wales, the interconnectivity in the health system has speeded up through the pandemic. We've had to talk to a lot more organisations at a public sector level to deliver services, and I think that's been hugely beneficial in this space. And the digital support that's been gained has been really transformative in terms of working this way and working from home. Those are my comments in that space.

Good. Anyone else, before we move on to some other questions? 

If I could, Chair. If I could switch my video off, as I've got broadband issues myself, so hopefully you can hear me if I do. I don't know if anybody can hear me here. I'm trying to speak, but—. In terms of the barriers, for me, the main barrier to the implementation of the Act is actually the scope and depth of the Act itself. So, because it's such a holistic piece of legislation, touching social, environmental, cultural and economic matters, it requires organisations or public sector organisations to fully review their whole way of functioning, and also the whole way they recruit, train, educate and orient their workforce. So, I think the challenge in implementing the Act is actually the scale and ambition of the Act, and that is something we're all working very hard to address and to deal with. 

In terms of the COVID situation, I would say—it's an obvious thing to say—it's required us to focus on the here and now. But the opportunities that have arisen, they've made us aware of interconnections, really, the interconnectedness of public sector bodies and what it means to be a citizen when you're trying to access—[Inaudible.]

I think—

—but it's also given us a sense of how we can do things quickly when we need to. Obviously, the digital response of our organisation in NHS Wales is an example of how we can respond when there's a need and resources to change. So, there are some observations from me, panel.

Great, okay. We've got a fair number of questions for you, so I propose we move on now and you'll all have a chance to dip in then with some answers. Rhianon Passmore.

Thank you, Chair, and thank you to our witnesses for being here this morning. How well is the Act understood throughout the organisations that you represent and could you outline briefly the work that you've undertaken to develop that understanding at all levels throughout the organisation? I don't know who wants to go first.

I don't know if Eryl wanted to come in first, before us. Eryl.

I'm checking that I'm unmuted. Yes, thank you, happy to come in first. Good morning, all. So, in terms of Aneurin Bevan University Health Board, we've had an embedding programme for the well-being of future generations Act for a number of years, and that has been designed to embed the principles of the Act, the ways of working and the cultural change that we need very much from a bottom-up approach within the organisation, so, looking, really, at operational level up to strategic level. If I talk just very briefly about some of the ways in which we've done that, we have a well-being of future generations programme board, and on that programme board we have cross-divisional representation from all of our operational divisions within the health board, and those representatives are effectively our well-being of future generations champions within the organisation.

We have organised community-of-practice sessions that focus on specific practical support for embedding the behavioural change that we need around the Act. So, the future generations commissioner's office supported us to have a session with respect to thinking long term and embedding long-term ways of working into the Act, just as an example.

Our embedding programme also has a self-assessment process built into it, so those champions are self-assessing themselves against those ways of working, looking at it from a perspective of maturity, so recognising that there's no final point here, really, this is about how we mature as an organisation with those five ways of working, and we've set up the sorts of things that you would expect to see to support that operationalisation, so web-based resources, taking the tools and resources and the information that the future generations commissioner's office has provided us with and making those available to those champions across the organisation. So, it's very much a distributed leadership model that we've had within Aneurin Bevan to support that practice. 

Eryl, can I just stop you there? That sounds absolutely excellent, but in regard to the points that were made earlier, and I don't know whether Carl and Alan can address this as well, for you, I can understand the processes and the mechanisms and you're working with the clay that you've got there, but would you say that you knew what 'good' looked like? And also in terms of those longer term endpoints, bearing in mind that there is no endpoint, in the fact that this is still regarded by some as more nebulous, how do you do that? I mean, do you know what 'good' looks like as far as Aneurin Bevan is concerned?

Yes, and we've looked at our ambition statements. We've looked at our ambition with respect to our clinical futures programme, so we've really looked at how we embed the Act into our strategic vision for the organisation, so I'd say that at an executive or strategic level, there is a clear sense of what 'good' looks like, and then I think that then gets translated across the organisation into the divisions, and I think, if we're honest, some of our divisions are more mature in terms of understanding that vision than others. It does take time to embed it consistently across a very broad organisation, but I think one of the things that is really important with this Act is how you make it relevant and how you make it work with the strategic direction and the operationalised links to that strategic vision within the organisation. So, I think, yes, we have got a good sense of that.  

Okay. Are there any further comments on that part of this question from Velindre?

I think Eryl has described broadly what we've got in place as well—slightly different language, but yes, we've got a strategic board. We've got a load of champions. The one thing that is probably of note for us is, as Eryl just suggested, we are currently just about finalising a refresh of our strategic direction of travel up to 2030. So, as an example, I think the 2015 Act and the learning subsequently, we have—. One of our strategic aims for 2030 is actually being a globally responsible organisation. So, playing our part in the bigger picture. And what we're able to describe, then, is taking the Act and what does it mean for us and what does it mean for others. And actually, your point, really: it's to actually describe what 'good' looks like and how we measure that, so we do know where we're trying to get to. Now, you never get to it, we also know that, because things move, but at least we get a clear sense of direction, a clear set of either measures or proxy measures and we can then coalesce around that to make sure the resources are prioritised to achieve the key ambition. So, I think we are far more knowledgeable than we were, say, three or four years ago about what we're trying to achieve, rather than this sort of nebulous concept, as you've described. 

Okay, and I'm sure others will pick up issues around shared outcomes, et cetera. So, my next question, around the same theme, really, is: in terms of the Act, we've talked about organisational understanding; how well do you think service users understand the Act? What have you done to engage with them? I think we've touched a little bit on that. And, I think importantly, is it necessary for the general public to understand the Act for it to be implemented successfully? I don't know who would like to take that first. Yes, Alan. 

Thanks. I think at the moment it's something, certainly within my own remit within the service, I'm quite conscious of. The blood service has had a fairly fundamental service review and improvement programme over the past three years, where we've looked at taking blood from the donor to infusing blood to the patient. So, we've unlocked everything in that supply chain to see where we can improve. And we mapped the seven themes of this Act against that to see where we've improved over that three-year programme. We're just about to take that information out to the service so that we have aligned ourselves to it and demonstrate where we've improved in that space. And I think the big challenge for me and the thing that I'm musing over at the moment is how we also take that message out to the donors. So, I have a donor base of around 60,000 of the population of Wales, and I think it's extremely important to describe the journey that our service is on in this space.

At a feedback level, within our service, within clinics, I am starting to receive feedback and comments that reflect on the Act, whether they're about improvements in the service or the amount of plastic they see within our service, et cetera. But I think it's really important that we start to take the public on the journey, and I think I have a responsibility to bring the donors on that journey. So, I'm certainly putting a narrative together and a message from February onwards, using our social media channels and our contact points with our donors. So, I think we're not there yet, but I think it's a direction of travel I'm keen to focus on. 

Carl.

Just building on Alan's point, really, and answering your question directly—does the public need to have an understanding—I think it would be helpful, for a couple of reasons, really. The more informed we are as a nation, the better the discussion and the more challenging it is. So, I think that's really, really important. I think the other thing, in realistic terms, as part of Wales, change happens in groups of five to eight, it doesn't happen by didactic, top-down policy. That's where we get real change: what does it mean for me in my locality, in my community, and how can it make a little bit of a difference? So, there is no magic bullet with this Act, there's not intended to be. So, I think the more people involved in that discussion day to day, week to week, the better the level of discussion and the more change we'll get over the long term, so I think that's one of the areas where we could collectively really seek to up our game: how do we enable people at all levels—not just people like ourselves, but schoolchildren, the school curriculum, all those things—how do we start early to get a different conversation about a different broad range of areas that isn't just about the things we've always talked about? Because that's what we're looking for; this is about future generations, so 10, 20, 30, 50 years hence, how do we have a better society that starts today? So, I think it is important, but I do think that's one area where we could really spend a bit of time to understand how we actually properly inform and enable people to get involved in that discussion.

Okay. Thank you for that, and I can't see Eryl, but if she wants to comment, then obviously she will. Going on, then, in terms of the differing roles of the senior players within this in terms of the future generations commissioner, in terms of Welsh Government, Audit Wales, how should they be improving awareness and understanding of the Act further to what is already happening? It all seems slightly incongruent in the middle of a health pandemic to talk about these really important issues, but it is actually really, really important that we do that. So, what do you see as their roles in this particular area?

So, I think it's interesting. I think the first thing to say is there's a role for all. Our relationship with the commissioner's office is excellent. I think they're hugely knowledgeable, very enthusiastic, supportive, and similar for Wales Audit Office, not just on the Act, but on our broader business where they're able to actually give us a view on how we're doing, how we're spending public money, but more importantly, pointing us to good practice and other areas we may wish to explore. I guess the bit for us; if I wanted more from each, what might that be? And then, do they come into conflict? So, what I want more from the commissioner's office: I want more time. I think they're excellent. There are too few of them, and they're trying to do an awful lot with a very small resource, so what I can see, for example, if we just—simple maths, there's about 50 sort of statutory organisations, and some RPBs who need to really drive the Act. So, if we had one relationship person embedded in each organisation, that would be 50; what's that? Two million pounds in salary—I don't know—across billions of pounds in Wales, so that might be something positive. I'd want them to be far more facilitative, more products, with tools, learning on the ground. So, it's almost, can they be the more facilitative side? And then Wales Audit Office would be holding us to account: how are we doing, are our plans robust, is there a real culture of ambition?

No, that is their role—to interrupt you, Carl—but how do you see their role in terms of awareness? I think Angela wants to come in in a minute, but it's really: what more could these be doing? You mentioned, in terms of capacity, around the future generations commissioner's office, which has been a theme to date, so I think that's more what I'm trying to get at in terms of—.

Sorry, I do apologise. I think there needs to be clearer separation; that was going to be my point. They seem to encroach upon each other's territory a little bit. The commissioner's there to facilitate but also to hold to account. So, I think clarity would be far more helpful, because we could then work directly with the commissioners as the facilitative part of the system and then be held to account by a very clear body that is doing that job. At the minute, from my perspective, it seems to be a little bit entwined.

Okay, that's a really important—

Angela, did you want to come in?

But it wasn't on that, so I don't know if Rhianon wants to finish her—

I don't know if anybody else wants to comment on that before Angela comes in with her supplementary.

I think Huw's got some thoughts.

I think Angela wanted to come in on a different point, Rhianon, so have you finished with your questions?

Just a further follow-up, then. Finally from myself, then, in terms of the evidence we have received, and it goes very well to the point that Carl has just underscored in terms of a perceived disconnect between the key partners—the auditor general, the Welsh Government and the commissioner—and that's an interesting debating point, illustrated by the lack of a unified message, and going back to the beginning, an approach to expectations. So, do you feel, any of you, that there is a disconnect, and if so, how can that perception be addressed?

Huw, you've got some thoughts on this, haven't you? Do you want to come in? 

I will just step in. Firstly, I don't think there is a disconnect. I think the Act is clear. I think, for me, it's about how it's playing out in practice. I mean, clearly, we've mentioned the resources, so I won't repeat that, but it is a fundamental issue—

Okay. I think he's frozen.

[Inaudible.]—generations commissioner, given the scale of public spend, public bodies, that they're hoping to facilitate and enable. I think this separation of support and enablement from the future generations commissioner—[Inaudible.]

I think we're having troubles with the broadband with Huw. Are you there, Huw?

I think he's there, but I think he's in space. 

He's frozen completely.

[Inaudible]—but, as time goes forward, I'm sure they'll increase their knowledge and expertise and challenge to us, which we would welcome. 

Just a final point on awareness: I think, clearly, what would help public bodies is a wider understanding among the public and citizens of sustainability and the importance of it to all our lives. And clearly, that's beyond the public sector—that is in a more holistic way, as citizens of Wales. So, I think anything that the future generations commissioner could be supported or enabled to do to promote those messages, politically or culturally, through other media to enable the public to more readily embrace what we are promoting as public sector organisations would be very helpful, I think, to the agenda in Wales.  

Thank you, Huw. Thanks very much. 

Okay. Angela, did you want to come in? 

Yes, it was just on Rhianon talking about the awareness of the Act and understanding and so on within organisations and within the general public. One of the comments I picked up when I read the evidence was that some people were suggesting that there was confusion over the definition of well-being, and that there was a slight tension between the definition of well-being in the future generations Act and the definition of well-being in the social services and well-being Act, and I just wanted your view on that. 

Is that one perhaps for Eryl in terms of the LHBs? I can say a word but—. Eryl, I don't want to put you on the spot there. 

No, I'm happy to come in on that one. I think that there's been quite a bit of discussion about the fit between the PSBs and the RPB, and I certainly feel for us within Gwent that there's a very good understanding of the different definitions of well-being that apply to those areas of legislation. So, the well-being definition for PSBs is very much that broad definition of well-being that encompasses the breadth of what we want for our population and for the place within Gwent. And then, with respect to the definition of well-being that's outlined within the social services and well-being legislation, that's specifically about certain population groups, sub-population groups, that have specific needs that fit underneath that population approach. So, I think there is a hierarchy of legislation here, and those definitions are different according to that hierarchy. So, certainly from our experience within Aneurin Bevan health board and, I think, partners within Gwent, there is clarity on those well-being definitions. 

Thanks for that, Eryl. Did you have anything further, Angela, before I bring in Jenny? 

No, I just wanted to clarify that, because it was brought up in the evidence, so thank you.

Okay, thanks. Jenny Rathbone.

Good morning and thank you very much for coming along today in the middle of a really challenging situation. We've had at least 20 years of the NHS being urged to reshape services to better meet people's needs, and yet we still have a lot of public bodies, including some health boards, arguing that they're struggling to implement the Act because they haven't got dedicated resources, because they haven't got the skills and the expertise. I wonder what we can do to persuade some of our colleagues or your colleagues that these five ways of working are what they should have been doing anyway. I take it as read that the organisations of our witnesses today are all implementing the Act effectively, but clearly there is a lot of resistance out there. So, what do we need to do to change the discourse, particularly in the middle of a pandemic, where such arguments look pretty thin?

Who wants to take that?

Shall I give you Velindre's perspective about this? It's a really important question from Jenny, and it's a broad question, isn't it, so I'll just try to bring it back a touch. I guess I'd agree with everything you've said. So, day to day, well before 2015, the services we provide and the people who work for us do think long term. They do involve people and participate with others. They do integrate across both health but also social care and third sector. Let's not forget that the third sector and voluntary sector in Wales provide a huge range of services, which are equally important as those provided by the public service. They also look to prevent—and our organisation is an interesting one, and I'll come back to that—and we collaborate. So, I think we absolutely do that.

I think what the Act is asking us to do is to go further faster and actually think more consciously about the decisions we make on a day-to-day basis, rather than having a couple of examples that we can roll out to committees such as this to demonstrate that we're ticking the box. I'm speaking very bluntly here, because, as I said at the start, we are trying to think strategically about what does Wales need to look like in 10, 15 or 20 years, and also, really, it's the point about changing culture. So, how do we do that? Well, we do provide education, information, and inform.

I think the other thing we need to think about is making it easier to do than to do the other thing. Because if it's more difficult to do—if there's lots of paperwork and bureaucracy—people will obviously default to the thing that is most easy to do. And the last thing I think we need to do, like any business or service, is show that it's made a difference—and I mean a positive, tangible difference—to the people who need services from us and the people who work in them. So, I suspect it's just about making it simple, less bureaucratic, clear line of sight, not change tack in two years or five years—it's got to be long term—and actually just make sure that we have systems in place that do then show tangible difference. In our organisation we are able to demonstrate to people that what they've done has made a big difference to the people that we are working with, but also it's made their lives a little bit easier as well.

So, I think that's the broad message we are trying to get across in our organisation: doing the right thing is better for the people we serve and easier for you in your day-to-day job. And we've got many examples where we've been able to use that, then, in terms of our education and training sessions, and others, to get more people on board.

Thank you. Huw.

To build on Carl, I think for us the challenge of the Act is not just about applying the five ways of working, promoting a healthier Wales as a goal; it's about how we can apply the five ways of working to promote all seven goals. So, we spend a lot of money, we invest a lot in infrastructure, we control a lot of the workforce, a lot of the workforce are citizens with families. So, the opportunity for us, as we see it, is how we can lever our full resource as an organisation, obviously to apply in health—that's our prime remit—but also to lever progress across all the goals. So, as an example, we're very focused around how we can lever our skills and resources around research and development and innovation, in partnership with academia and other bodies in the public sector, to promote, obviously, Wales as a centre to attract inward investment. So, that's an example where, clearly, it's got a health dimension, but it has a wider dimension to it around economic growth and employment. And we also see opportunity, for example, as we tackle digital challenges in health, in terms of digital inclusion. We also understand that, if we work with other partners, when you include a patient digitally, you also include them as a citizen to participate in education and wider social engagement and possibly in an economic manner. So, we do understand that we have a contribution to all seven goals, and it's those partnerships with other bodies outside of health that are as important to us as developing the relationships with health boards and other health organisations. So, that's just the point I wanted to make, really, about the broad nature of the Act and how we're trying to address it as one NHS organisation.

Okay. Eryl, did you want to come in at this point, or—?

Yes. So, I'll add just briefly, really. One of the things that we found very helpful within Aneurin Bevan University Health Board with respect to the breadth of our responsibilities under this Act is to really think about our responsibilities that we have collectively as a public sector organisation that really we can only achieve through collaboration with our other partners. So, if you're thinking about population-level change and systemic change and a well-being objective around, for example, the best start in life, as a public sector organisation, we cannot do that by ourselves, but we can look at how we can achieve it through collaboration with our PSB partners. And I think what we've found helpful, in terms of approaching this and organising our approach to this, is being very clear about which of our well-being objectives we can only fulfil through that collaboration and which of them are individual duties for us as an organisation that we can do on our own. And I think getting that perspective is very important when we're trying to look at systemic population and environmental change.

Very good. Alan, did you want to add anything or are you happy to come in on the next question?

I'm happy coming in on the next question. I think Carl has wrapped it up.

Fine. I just wanted to move on to—. One of the levers of Government in influencing change is obviously the way we allocate budgets and I just wondered if you have any insight into how we could improve the allocations to different public bodies to make the ways of working and the aims of the Well-being of Future Generations (Wales) Act 2015 more—you know, forcing people to drive their attention more towards the objectives of the Act. Obviously, there's one obvious difference where health boards currently get three-year funding, whereas local authorities get one-year funding. But, on the other hand, Welsh Government never knows in advance what the UK Government's going to provide until, often, the very last minute. So, you can see the tensions there. Are there any obvious things that you think that we could do better that we could advise the Government to do?

Who wants to take that?

Huw.

I'll pick it up. I think it's a difficult one. I think you've, in a sense, if I could say, answered yourself with the comment you made about being constrained by UK Government funding allocations and the allocation process. Because the process itself is very focused on that short term, it's very difficult I think for organisations or the Welsh Government to operate in a different time cycle. And what people find when they put down longer term plans, which they need to do, is often they are made redundant by the fact that the funding cycle, or a crisis nationally through economic issues, renders those plans maybe un-implementable. So, I think we have to—. To me, I think we're just acknowledging that we are working in that time frame that's set by broader policy.

For me, a lot of the work to encourage collaboration is to continue the drive, which Welsh Government have done, to encourage people to integrate and to operate pooled arrangements, potentially, to identify resources that can be shared in a structured way. And those structured arrangements, if they can be put in place, can have a life of many, many years—potentially decades. And I think it's that micro approach to pooling and collaboration that could be one of the tools we use, given that I don't think we have the ability to influence the macro environment around funding allocation from UK level. So, that's just a thought, really, about using those micro tools about pooling and integration that are available to us and I know the Welsh Government has encouraged, but possibly we could use them more. And obviously Welsh Government then being in a position to support that way of operating, because it does raise some governance issues from an audit perspective when you move into shared governance arrangements through pooling.

Carl.

I'll just add a couple of points to Huw's thoughts. I think your original statements around the difference between the period of time for health and social care funding is an obvious place to go, isn't it? So, we've got one or two partners who are running a different sort of budget and financial strategy. So, could we align those? That's the first obvious question. The second is: could we try and seek more long-term funding? So, could we move to five, seven, 10 years? I don't know if that's even possible, but anything that is longer term does give you the ability to put stronger foundations in place and more strategic plans to deliver. I guess the other one I keep mentioning, but going back to the start, is what's the strategic intention in Wales, and can we coalesce our finance and funding priorities around five or 10 key outcomes for Wales as a nation?

And then there are some things we could do that are exemplar. So, if you start to think about how we fund infrastructure. We could ensure there's a real drive and incentive that all infrastructure is green and carbon neutral. Those things are happening, but could we go further and faster? And also then, where we get the money from. So, there's quite a strategic intention in the certification B companies in the commercial sector to really look at green infrastructure funding mechanisms. So, really start to put our money where our mouth is, so to speak, and not do business with anybody who's not really in the green sustainability business, in terms of future funding and financing. So, there are some things there we can both make a practical difference, but also a really symbolic and big message difference to future partners.

Fine. Thank you. And, obviously, just to point out that no Government can bind a future Government, so we are in a five-year cycle, whether you like that or not.

Jenny, I think—. Eryl, did you want to come in there, briefly, before Jenny went on?

Sorry. I beg your pardon, Eryl, I didn't see you. Go ahead.

No problem. So, I agree with all the comments that have been made with respect to the alignment of planning and financial cycles for different organisations.

I think, for me, I can see that within Gwent we have had some examples of some very good collaborative work that has come from what is in effect a very small amount of money that Welsh Government have made available year on year to the Gwent strategic action group to support collaboration across Gwent with respect to well-being priorities. That pot of money is in the region of about £70,000 a year, but it has led to what I think are some very forward-looking programmes of work, particularly around sustainability and green infrastructure—so, looking at a Gwent green grid programme, looking at electric vehicle charging points. And I think that has, in its own way, and it's a very small way, certainly encouraged different ways of working that align to the principles of the Act.

And then the final thing that I just wanted to say is that, similar to that, I think some of the challenge funds that have been made available to encourage collaboration around specific challenges that we have are a very different way of getting some novel solutions and some different partners to lean in to some of our more systemic challenging problems. So, I just wanted to add that in terms of maybe different ways of approaching resource and funding as we move forward.

Thank you. Rhianon, you wanted to come in.

Thank you. In regard to that £70,000, you're obviously using that to its absolute maximum in terms of the green grid. Is that happening across Wales? And would you be able to do it—? This is a bit of a daft question, but if that money were more, would you be able to do more, because we often hear that it's not all about money? What's your response, briefly, to that?

So, I think what's happened with that money is it's essentially pump-priming, it's encouraged partners to come together, and organisations, through their involvement, have put more resource into those programmes than what's been provided through Welsh Government. I think it's potential to look at that sort of green grid approach in other areas of Wales too. I think that the work that's happened with respect to the healthy travel charter, for example, that started off in Cardiff and Vale, Gwent has now extended that and we've got in the region of 20 public sector bodies that have signed up to that, and there's certainly potential for that sort of programme to be scaled up across Wales.

Thank you. I just, finally, want to look at something where we can put the Welsh Government's feet to the fire, which is around how public bodies are performance managed. Obviously, many of the performance management tools are based on very short-term targets—things like waiting lists and numbers of people who've been treated, et cetera. How do you think that we could—? I mean, obviously, I would like to see all organisations being judged on the ability to change the obesity agenda and the air pollution agenda, but these are very long-term issues. How would we have longer performance management targets without losing some of the bite that goes with shorter term targets?

Who wants to take that?

Shall I kick off? This is a well-trodden path, isn't it, about how you essentially understand how well we're all doing. I guess the one thing I would probably start off by saying is that we probably need fewer not more performance measures, but we need the right ones. And I think we've probably got, actually—. Most of the measures are largely in place, whether that be front-line service delivery, because, let's not forget, things like waiting-time targets are very important. If you're waiting for a treatment, it's extremely important to you. And also, then, picking up Huw's earlier point, the sooner we get people treated, if they require treatment, rehabilitated and back into work, they become economically productive, their children thrive. So, these are part of the same conversation.

I think the key bit for me, if colleagues have been familiar with the balanced scorecard or the strategic tactical operational pyramid, we've got all the measures we need. I think, at the minute, though, they can often be in conflict with each other. I think that the bit for me would be actually making sure all those things are lined up and are actually supporting each other. Sorry, have I lost colleagues?

No, I can hear you. Keep going.

You've all frozen. And, actually, are supportive. So, if we do understand 10 or 15-year outcome measures, what are the key drivers, how do they all relate? So, if we go down the area of getting involved in five-year survival for cancer that does relate to screening, it does then relate to what people eat and the exercise they take, and so on and so forth. So, for me, I think it's probably a stock take, a pause, no more new measures right now, understand what we've got, making them align better and then actually making them work. Because I do think if you just take maternity, public health, mental health, cancer, obesity, Flying Start, each portfolio in Welsh Government has a good set of measures. At the minute, they're often played off against—. It can only be waiting times versus mental health, versus cardiac, versus cancer, versus obesity. What we need to try and ensure is that the sense of order is such that they all get done, because having a child with good parenting, who gets a good education, then does not go on to get cancer. So, that's the long-term bit we need to try to plan into our performance management systems. At the minute, they can often be seen as competing.

Thank you. Eryl, you're nodding your head. Anything you want to add to that?

I don't think there's much more to add to it. It is absolutely, I think, about the simplification of the performance measures and I think it's about stronger integration as well, so that we're not getting what I call parallel universes of performance. So, you have your well-being objectives that may be separate to your organisational strategic objectives. What's needed is, I think, much stronger integration of those and then the organisation of them, so that we're very clear about the relationships between those long-term well-being objectives, the medium-term objectives and the more day-to-day performance measures.

Okay. Huw, you're nodding too. Is there anything you want to add or disagree with?

Only a comment about this golden thread, which has been referred to in the written evidence, I suppose: a strategy around the well-being of future generations needs to be embedded right throughout the organisational strategies, at its heart. That needs to be translated, then integrated through the plans, and clearly the performance management, which you touched on, needs to be integrated. I think you need both short and longer term measures being performance managed, because that's life, you just have to keep your eye on the longer term, but you have to manage the here and now, so you need both. And I think organisations, and I think we do, but we were trying to enhance this, need to develop different parts of the organisation with the capacity to keep both agendas moving at the same time. So, you need certain people who are constantly driving the longer term whilst other colleagues, naturally, are being drawn to immediate pressures. And what you try and avoid is when you have a crisis like we have now, or we will have in the future, that all the organisation's resources are being pulled to the short term, and some of the organisation's resources need to be held and keep the longer term agenda moving. And that's quite an important organisational development issue: how you keep that balance in play over time.

Okay. And just finally, do you think that the integrated medium-term plans are the best vehicle for doing this, for driving this forward?

I think the plan, at its heart, what it says, it's medium term, it's integrated. I think the issue being for the well-being of future generations Act is the Act isn't seen as some additional compliance that needs to be added on. It's integral, it's fundamental, it's almost the core purpose of being for an organisation. So, if the Act is taken as the central, organising principle, and then all other activity drives around it, the plan works. If the plan is there and then somebody looks to add on around the edges the well-being of future generations Act, then it fails. So, I think it's about embracing it at the core—it's key. It's not easy, but what we're trying to do is to actually bring it to the heart of what we're trying to do.

Thank you. Alan, you're the only person who hasn't spoken in this, did you want to add anything?

Just to concur, really. I think it's about it being front and centre in everything that we do. And, again, it's a cultural journey. I explained the journey that we're on; we're not there yet. I think the commissioner describes it as an expedition. This is something that has to be front and centre in everything that you're thinking about—integrated. And the performance measures—long term, short term—should come with it if you've got it right.

Thank you very much. Thank you.

Thanks, Jenny. Vikki Howells.

Thank you, Chair. Good morning. I've got some practical questions for you about how each of your organisations interact with the future generations commissioner. So, if you could just give us a little information about that, as well as anything that you think could improve your interaction with her office in the future. I don't know who wants to start.

Who wants to take that? Carl?

I'll pick it up if that's okay. So, as Carl has already said, we've got an excellent relationship with the commissioner's office. We tried to develop that in a number of ways. So, I've personally spent time working in her office in the past, and I found it extremely informative and helpful, in building up relationships but also my knowledge. I think colleagues within Velindre have also been developing relationships with key members of the commissioner's office, and also the commissioner has a very supportive but challenging relationship with the board and the chair, and that's been very important to us as we've moved on.

I think, moving forward, clearly, we use the materials and we're in constant dialogue in that regard, but we're looking to identify commitments and actions that meet the seven goals, or at least a large number of them, that we can take best practice from the commissioner's office, use the commissioner's office to form relationships with other organisations that can be mutually beneficial to delivery. So, for example, we've done something on sustainability and design and building that Welsh—. In terms of what we're looking to do, the future generations office has made a connection for us with another Welsh organisation that has a lot of skills and knowledge, and that's really helped us move our agenda forward, but also helped them use us to drive their sustainability agenda. So, making connections has been important, and I think will be increasingly important as we go forward.

And if the future generations commissioner's office had greater resources, I think we would seek to maybe encourage secondments between public sector bodies and the future generations office. We've got an excellent sustainability manager doing a Master's in sustainability in Cardiff University, and we would like to be in a position where we could second her, possibly to the future generations office, and we receive, again, a colleague in return, and improve that ongoing relationship and clarity of working. So, they're some of the types of things, Vikki, that we're doing that hopefully will answer or—[Inaudible.]—answer your question.

Thank you. Any other comments from any of the other witnesses? Alan.

Yes, thank you. So, one of the things that my service is trying to do at the moment, and we touched on infrastructure being a key component, is that we have one testing, processing and distribution centre for Wales. It's a good-looking building, but it's 25 years old. We've put a sustainability business case together to Welsh Government for scrutiny where the well-being of future generations Act is front and centre as part of that case. So, I would certainly be looking for regular touch points with that office, and engagement, because I think, for me, we have huge ambitions, but, actually, it's about that long-term decision making and that expertise alongside you with some of the decisions you might take forward for that building. But I think it's a huge opportunity to refurbish a public sector building for the future and move towards some of those challenging targets that are there as well. So, I think the future touch points are absolutely going to be critical.

Thank you. Carl.

Thanks, Vikki. I just really want to emphasise the point that Huw's made. In an ideal world—I think we've got a very good relationship, as Huw's described. It goes back to the earlier conversation about clarity of role, because, ultimately, what I'd like is more of their time, because they're excellent, but they're a very finite resource. So, I could see the future generations commissioner's office working in our organisation with us as change makers. Could we have 20 or 30 people across Wales? Not doing it, because you can't have an individual changing the way in which we operate in Wales, but it's those boots on the ground with the knowledge, the passion, the experience and the time, just to start to get us really, really motoring. So, I would really push hard for additional resource, not just for the commissioner, but to be based in organisations and across organisations.

The point was made earlier around the RPBs and the PSBs, and speaking on our behalf as a trust, we find that difficult territory to get involved in, because we've got a national service, blood and transplant, and a regional service, cancer. So, the RPBs are for health and social care, the PSBs are for well-being—I'm still not sure what the difference is, actually, because isn't it all the same? But, more importantly then, we'd have to have huge numbers of people to manage a national relationship as well as a regional one. So, the organisation infrastructure should be tweaked a bit, with the help of the commissioner's office, to really get some stronger partnerships at a local level, but also then at a regional and national level. That's what I would really start to think about—if we could get real traction.

Thank you. Eryl, is there anything you'd like to add?

Sorry, I lost connection earlier, but I think I've got the gist of what the question was. We've found that the support and the input that we've had to date from the future generations commissioner's office has been very, very helpful. I mentioned earlier that we were fortunate to have one of the officers come and deliver a session for us with respect to longer term decision making. Colleagues within the health board found that expertise and that input very useful indeed, and they were able to see how that applied to their day-to-day work. We've also had support with respect to our 'Building a Healthier Gwent' strategy, and key collaboration with the office on that.

I think more outreach support like that would absolutely be beneficial, and I think it is an issue, really, of capacity for that office, but it's probably an area really worth investing in if public services are to maximise what they can get from this piece of legislation. I think there's something about supporting organisations to see what's possible when they work differently and to bring examples of best practice where things have worked well by a different approach to the attention of public bodies and then enable them, with a little bit of upfront support and boots on the ground, to start to put that into practice in their own organisation. So, comments very similar, really, to what colleagues have made.

Thank you. My next question was going to be to ask you all what barriers you think the commissioner and her office face as they discharge their responsibilities under the Act, and I think three of the four of you have already alluded to resource issues and capacity issues. So, firstly, if I could just ask Alan whether he would agree with that, and then if any of you who've already alluded to those things were to come in with anything else that you think is a barrier, then that would be great. Alan.

Yes, I think capacity is an issue, and bandwidth, either on the ground within services or, I dare say, within the commissioner's office. I'm not sure how many staff they're currently sitting on, but I'm sure capacity is an issue for them, going forward. 

Thank you. 

Jenny, did you want to come in? I think Jenny wanted to come in with a supplementary. 

I just want to challenge that, because surely this is all about doing things differently and stopping doing things that aren't effective in order to be able to do more of the things that are effective. 

Yes, but with every service there are hugely competing priorities within the service, I suppose, and it's about finding bandwidth within services. As I described earlier, I'm in a position where keeping the wheels on the bus currently is quite hard within a COVID environment, and then bringing people into a conversation about future well-being in the middle of a pandemic is difficult to do. But that's not to say we shouldn't do it and we shouldn't raise ourselves to the challenge. That's the leadership challenge, but it is a journey, and I think, for me, a lot of the stuff we've done is by nudging and bringing people along in the conversation. We need to have a deeper conversation with the staff. It's not saying that it's not a priority within the service and we don't need to do things differently, it's just the pace at which we do things and to take account of the amount of work that's going on in services at the moment and—

I agree that some things are impractical at the moment—

Yes, at a practical level is what I was trying to—

—but you can see how, in the medium term, as we come out of the pandemic, there's going to be even more pressure on us to do things more effectively and eliminate duplication, and all that sort of thing. 

Yes, I agree. 

Carl.

Pulling that together, really, if I was in the commissioner's office, what would I want Government or others to do more of? I think the question, for me, has been picked up, really. It's about continuity and consistency of direction of travel. That, then, translates into policy. So, making sure policy supports. And also then about alignment. We've talked a little bit about that there are lots of things going on; how do we consolidate and have that golden thread? So, that would make my job easier, if I were in the commissioner's office, and also easier if I was in an organisation trying to work with them to implement the Act. So, just long term, golden thread, bringing together. The simpler the better, I think, is the message, both in terms of the policy approach but also the way in which we organise our services beneath that. We talked about various RPBs, PSBs, and there are lots of other things; how can we consolidate and improve, and focus on, rather than grow more? I think that's, if I was in the commissioner's office, what I'd be seeking from other partners to help me to be successful. 

And my final question builds on what Jenny has asked and what Carl has answered there. So, just any further comments, feel free—you don't need to repeat yourselves, but any further comments from anyone about how you think the role of the commissioner needs to change, moving forward, and why that would be. 

I think Huw Llewellyn wanted to come in. 

We made the point about resources, and I think hopefully that's—I won't go there. I think as well as supporting the public sector organisations under the Act as to how they could evolve in the future, if they had more resources I think they could play an even greater role in engaging the Welsh public—not on the Act per se, as it's a complex piece of legislation, but on this issue of sustainability, future generations, the importance of the climate emergency and how it relates to social justice. And I think it's this conversation, really, combining social justice and environmental justice, that the commissioner could lead with the Welsh public, because ultimately we will have to make choices, and they have political implications, and it's important, I believe, that the Welsh public have the opportunity to have a conversation around those issues, whilst we go around the mechanics of organising our public bodies to respond to the Act. So I think that is something, with an outstanding commissioner, we could well take advantage of, if they had the resources to do such a thing. 

Okay. And Carl. 

If we're being really ambitious, I'll chuck another one in. I guess it's not only public service organisations that live and operate in Wales, it's private and commercial entities. So, if we look at the broader global ambition around B corporation certification, how do we get other private partners into that space around social value? A good example and one of the better ones is Unilever, where their mission is social good rather than profit. So, if we're going to really be world breaking, ground shattering, that's what we need to be—everyone who lives in Wales, no matter where they work. So, how can we get the commissioner's office to influence, support, educate, inform, and bring along other partners other than just those who work in public services? Because they have such an influential impact, good and indifferent, on the things we wish to do in Wales.

Okay. Vikki, are you done with your questions?

That's all from me. Thank you, Chair.

Okay. I'll bring in Delyth Jewell.

Diolch, Gadeirydd. I've got some questions about the leadership role of the Welsh Government. Huw was talking earlier about how the Act needs to be central rather than being thought of as an add-on, and it's already come up in the conversation this morning in terms of the interaction between this Act and other pieces of legislation. In addition to what's already been said, particularly about the points that Angela raised about different interpretations of the phrase 'well-being'—although I take the point that not all of you think that that is true of your organisations—how well do you think that the principles and the requirements of this particular Act align with other pieces of legislation, and are there other areas of concern with this that you'd like to raise in addition to what you've already said? But again, please don't feel that you need to repeat points you've already made. Who wants to go first with this? Huw first and then Eryl. 

I was just going to use the example of the socioeconomic duty, just to reference this. Clearly, when that's been communicated and developed, Welsh Government have shown in the information how it relates to the well-being of future generations Act, and how it aligns with the more equal Wales, and also about developing integrated communities. So, in some respects for us, that type of communication, when legislation comes out that actually enhances the Act, in a sense, because it gives more detail and granularity, showing at policy level how it relates to the Act, is very helpful to us, and allows us then to keep that golden thread running. So, I use that as an example of something that clearly is what we would like to see.

Obviously, there's so much legislation around, and also legislation that was in place prior to the well-being of future generations Act, so I do think it's a challenge for them. But from a public body's point of view, the more that is done going forward, with all legislation that appears—because ultimately, it's hard to imagine any legislation that wouldn't come under or reference or relate to the Act, given its nature—constantly showing that relationship I think is important, because it keeps the well-being of future generations Act central to our whole mandate as public sector bodies.

Thank you, Huw. Eryl, you wanted to come in as well, didn't you?

Yes. I suppose it's just building on that point, really. I think for us, it's very helpful where we can see that the relationships between other pieces of legislation and the well-being of future generations Act are clearly mapped out, and that helps to ensure the relevance of the legislation. I think probably more could be done with that; I think we can go further. Sometimes, there's a sense that the relationships are shown at the start of a policy, and they're mapped out in the introduction in the policy section, but then, when it comes to the follow-through on that and the implementation and the monitoring, the positioning of the Act becomes weaker. I think this is about, I suppose, maximising the integration of the well-being of future generations legislation into other legislation, and going beyond just the mentioning of it in that policy background section. So, it's certainly that follow-through, and that certainly enables us as public bodies to be able to demonstrate the relevance. We've talked about the importance of simplification, and I suppose a much clearer kind of policy landscape, and I think just, I suppose, deeper consideration of those five ways of working, the national goals, in other legislation, not just in terms of mapping out the relationships, but what it means in terms of implementation, what it means in terms of monitoring, and also, if we're honest, sometimes what it means in terms of the tensions that will exist. So, I just wanted to add that. Thank you. 

Thank you, Eryl. I know that Carl and Alan may well want to come in on this as well, but we often talk in the Senedd about the need to consolidate Welsh law. I suppose this is also looking at consolidating the policy landscape, not just in terms of the high-level requirements but what it means in practice and ironing out some of the unintentionally combative elements that obviously weren't drafted in any way in order to be difficult, but it's an unintended consequence of these different bits of legislation overlapping. Carl wants to come in, I think. 

Yes, thanks for that. I think you've hit the nail on the head, really. So, I'll declare a previous interest—I used to work in Welsh Government some time ago. So, these things are sometimes unintended consequences. We've got really good legislation, good policy makers who are trying to do the right thing, and I guess your point, really. At a practical level, it goes back to our earlier conversation around planning, funding and managing performance. Sometimes, the unintended consequences of having almost silo based approaches are that everybody wants to plan on this bit, but we know that a person who goes across all of the Act is a person who is actually in a community service, might want to speak the Welsh language, might then bump into 'A Healthier Wales', might bump into socioeconomic duty. And I guess that's the tricky bit, isn't it—making sense of that really complex landscape, so it's simple and easy to understand, we get the right service for the right person and we measure the right things. And if it was easy, we would have done it by now, so I'm not underestimating it. I think Government, in fairness to them, are getting much better at it and I think we're getting far clearer policy. 

And there's definitely an integration. I see that—I'll talk about health. The integrated medium-term plan is a good example. When I was in Government, I used to set the targets around the operating framework, and it was a bit silo based. You can definitely see the progress of those strategic themes, very thematic—you know, older people, younger people. So, I think there is real progress being made; we've just got to continue to build on that progress. 

Thanks, Carl. Alan, did you want to come in on this point? If not, if you just agree, that's fine. 

I think I concur. 

Okay, great. Thank you, Alan. Do any of you think that—and I know this is something that has already been touched on—? Eryl was talking about the need to follow through and the need to provide, presumably, resource in order to help organisations follow through on the requirements of the Act. Do you think that one of the main areas of tension could be the fact that discrepancies in terms of funding allocations—. Some pieces of legislation have funding behind them, whereas, again, unintentionally, overlapping areas that have been brought in by this Act do not have the same resource behind them. So, again, do you think that because of that, some organisations will end up getting the impression that the legislation with the funding behind it needs to take precedence? 

Who wants to take that?

Shall I start? I guess, for me, funding is a second-order question for the minute. I think it's really understanding what are we all trying to do, and I don't mean that in a flippant way but, actually, as Huw said, it's such an all-consuming intention that we often—. I'm not going to argue myself out of funding, because everybody wants more money, but I guess my first question would be, 'Do we know what we're trying to do and are we spending all the money we have available on this particular endeavour as we might?'. So, there's the first question. The second question for me, then, is: 'How do we engage more people, because, actually, a lot of this doesn't cost money?' Some of it does, there's no way two ways about that—you need people to educate and so on and so forth. A lot of it is just getting good conversations going, because many of the problems we are trying to seek to solve, largely, people know the answers on the shop floor and/or the people who receive the service. So, I think there's a huge area of opportunity there that the NHS and other colleagues are seeking to explore. 

When you go up a level into the more medium-term strategic intentions, you do really need a very clear sense of direction, a clear plan that is integrated with other organisations and partners, and I think that's where we get into the real, proper conversation about long-term sustainable funding. So, I haven't directly answered your question. There is no number I could write. If somebody said to me today, about my organisation, 'Give me a number and I'll give you a blank cheque', I don't know what the number is, because there isn't one. So, I don't think, in the primary instance, it's a funding issue, other than to get some of these good things further embedded and accelerated whilst we then actually really come up with a long-term view of what are the areas we need to focus on first, second, third and fourth. I know Huw wants to come in, because Huw and I have this conversation fairly often in our organisation.

Well, the first thing to say is I'm an accountant by background, so I'm always interested in having money, so I declare my hand. To give an example specifically here that we find a challenge, I mentioned earlier on we're working with the Digital Inclusion Alliance. We've got a commitment to connect every patient with cancer digitally, to support them in their care, and there are a whole range of issues associated with that. Clearly, in undertaking that action, any investment that we make is not solely for the benefit of health, because when we connect those people in that way, there will be benefits to other policy areas and other public sector bodies.

I think the challenge we have is that when we're looking to promote such a—I would suggest it's an ambitious commitment to make—that we're only effectively speaking to our funding body health department, and at that point we will then compete against other health priorities, where this one might clearly not be as important. But if you looked at it across the benefits that that initiative could bring to the citizen, actually it could trigger multiple benefits that could escalate it up, but we're not in the position to speak to those funding channels in a regular way. So, it's a challenge for us and we're actively working out how we navigate our way through that, because we passionately believe that that could—. Coming back to Jenny Rathbone's point about doing things radically different and starting to change the landscape, digital connectivity for us is one of the two main issues we believe is going to radically change our engagement with the citizen and move some of this agenda forward for a range of reasons, but it's not just an NHS issue, it's a Welsh public sector issue, and therefore how we navigate those funding pathways is a challenge.

Thank you, Huw. Before I move on to my final question, Eryl or Alan, did you want to add anything to that? No. Alan? Eryl? Yes.

Yes, so if I come in from a PSB perspective. I mentioned earlier the relatively small amount of money that has not come directly to PSBs but has come to a Gwent collaboration to support implementation of the Act, and that's been very helpful. One of the things that I suppose I would reflect hasn't happened maybe to the extent that one would want is thinking about how all of the existing resource that's tied up within public bodies is used differently. So, we tend to think about the additional moneys or new moneys, when in fact there's a considerable amount that's already invested within, and I suppose the question is why haven't we maybe maximised the opportunities to maybe stop doing certain things in order to do things that would be more effective, or why haven't we got into the space of really thinking about how we use the existing resource differently. So, I suppose the opportunities to have the flexibility to do that or to be incentivised to do that will be important as we move forward. It will be so important for public services to really look at how they work differently. They will be more needed and more important than ever before, and I suppose there does need to be some challenge, some support, some incentive, around looking at that resource quite differently as we move forward.

Thank you. I think Carl wanted to come in on that as well.

Yes. Thank you, Delyth. Just one final point, then, in terms of NHS. Obviously, we're a provider organisation and Eryl and colleagues in Aneurin Bevan are commissioners, so three main commissioners, and I think that does present another potential barrier for us, because clearly, there's a finite resource, lots of need, an ageing population—all the things we already know about. So, I guess, in terms of our conversations as a region, what do we first prioritise, then, in terms of the commissioning plan that generally, understandably, goes to front-line services around blood, cancers and so on and so forth, to those invisible sort of back-office things around Acts such as this? It can be quite a difficult discussion to really identify for provider organisations how we do seek additional funding, given sometimes the longer term return on the investment. So, it's another thing we just need to work through, how do we break that quite difficult—not difficult between us as organisations, but it goes back to the earlier conversation about how we effectively invest in the future, rather than fund the now.

Yes. Thank you, Carl. Finally, from me, Chair, do I have time for a final question—I'm very aware of time—or is it better if we write with the final question?

Yes. As long as our witnesses are okay with the time. How are you fixed? Obviously, we were going to have two evidence sessions originally, but it's all been combined into one. How are you fixed for time?

[Inaudible.]—by 11 o'clock.

Yes, okay. If you could ask a quick question then, Delyth, and then we'll move on and bring it to a close.

Okay. The final question, Carl had mentioned earlier that there is some confusion, or at least overlap, between different layers of strategic partnership boards or groups that have been set up by different—again, unintentionally competing bits of legislation. Do you all see that that is something that needs to be addressed? Do you think that that can hamper the implementation of this particular Act? Carl, did you want to go—? I think Rhianon will want to ask something on the back of that. Rhianon, did you want to ask something specifically about the question before anyone answers?

It is relevant, but I don't know if you want to take it now. My question was briefly to follow this up with regard to the point that Eryl made, which is that public services are never going to be more needed in the future in terms of investment in that and with regard to the points that everybody's made about strategic alignment and the need to be as efficient and optimally achieving as organisations as possible. How much more efficient would we be if those systems were aligned as you've just spoken of? That might sound a little bit nebulous as a question, but it does really go to the heart of what Eryl says.

Thanks, Rhianon. If you want to respond to the two of those together.

Could I make a general comment to start? In terms of delivering the Well-being of Future Generations (Wales) Act 2015, or even the health agenda, collaboration and integration needs to take place at a whole range of levels. For example, Alan is managing the national service, Velindre cancer operates across the region, so that's three, and into Powys, four health boards. You've then clearly got the activities for partnership around health board boundaries and then you've got the activity around service boards around local authority boundaries. I think the issue for me, rather than just saying, 'Well, one size fits all', it's being very clear on what is the role of the different levels of collaboration. So, if I took regional collaboration for cancer, which I'm involved in, there is a regional body that's set up to attempt to drive the Act across the region through cancer services, and that sits above the two bodies that we're talking about. So, my comment would be that it is helpful to have clarity, but I don't think that one group or one level of organisation can deal with the variety of collaborations needed to embrace the Act, given the types of services that we provide. 

Okay. That's helpful, thank you, Huw. I think we may have lost Eryl again, but Carl, I know that you're unmuted, was there anything that you wanted to say?

Huw's answered spot on. I mean, service delivery is complex, let's not kid ourselves. I'm not going to go back around it, but the one thing I would perhaps comment on is your second question, really, around efficiency. I think there's always a bit more efficiency that you can squeeze out of nearly everything. I think that's important, but not the aim or the main thing. The main thing is about effectiveness, so how can it be far more effective to deliver on-the-ground change? And that, by default, would deliver the efficiency. So, I think that's the key for us is looking for those things that have clear clarity of purpose, shared goals and all those sorts of things, but—Huw's point, really—operate at a variety of levels. I think we are making our way towards that as well. I give two examples as a provider trust where we see things and we've got involvement, but it's more difficult. But it does operate at a number of levels. So, it's not just a case of aligning the RPB and the PSB—that's a symbolic gesture and may or may not be correct. I think it's far more complicated than that, and good progress is being made across a whole range of areas within Wales. Eryl's back with us now, actually. Oh, and Alan.

Welcome back, Eryl. We need to make some progress, if that's okay, Delyth. I'd like to bring Gareth Bennett in now, and, as I say, we'll bring things to a conclusion. Gareth.

Yes. Thanks, Chair, and thanks to the witnesses for the session today. There are a couple of questions, Chair, about the roles of the auditor general and the future generations commissioner. I think we might have largely covered that, and, given the lack of time, I'll skip them. How do you involve the general public in your work related to the future generations Act? I don't know who wants to go first.

Alan.

Thanks. Yes, I was just musing on the previous question, and I'm glad this question has come up, actually. So, for the blood service, as I've described, we're fairly niche. The other thing we're niche in is we deal with the healthy part of the population. We don't deal with patients; we deal with donors, and we deal with an altruistic nature, as I'm sure you're aware. So, for me, our national engagement is certainly at a community health council level. I've been starting to have national discussions, as well as regional discussions where we can, about involving people in changes, opportunities, and, again, I think that's the forum that we sit within currently. As I described earlier, I'm keen to describe the journey our service has taken with both the staff and with our donor base currently. So, that's just something I'm trying to play through and just think about how best we do that, and then evolve a conversation—I think that's going to be really critical in that space. So, I think that would be the Welsh Blood Service's practical level of trying to engage in this space.

Thanks. Did anyone else want to give a response to that question?

Eryl, did you want to come in?

Yes. So, you'll be aware that as part of developing the well-being plans for public services boards there's quite an extensive engagement programme on the draft well-being objectives that the local authority engagement teams undertake, and that's really about checking in. We use the data that's available to us to really understand what the emerging needs and issues are, but also what the strengths are, what the assets are, within any community. But I think it's really important—and this is what's done through the development of those plans—to reflect those back to the communities to ensure that the right sort of issues are emerging as priorities, as either assets or areas for development. So, at a high-level local authority geography, that's the sort of process that's undertaken to support citizen engagement, and then as a health board we've looked at how we can further strengthen our approach to engagement.

Just one example that I'll give where I think the future generations Act has made a difference is when we set up a new children and young people's weight management service two years ago. We used the tools, the project planning tools, that the future generations office had pulled together, and within them is a very specific set of criteria and prompts around engagement that the service manager for Connect used to ensure that the service was being shaped along the lines that children and young people themselves and their families would find appropriate. I think some of the learning from using that tool was that the young people themselves had a much broader scope of the sort of support that they wanted, so they were thinking much more about the support in their communities, the access to leisure services, and the connection between what an NHS-provided—albeit in the community—service would offer, and then how any improvements that had been made by those young people through the service would be subsequently sustained at the end of their programme. So, I think some of the learning really was that, by engaging young people and their families themselves, they had a much broader range of support that they would like to enable them to maintain that weight loss at the end of the programme. So, I just use that as an example of how we shaped that service differently as a consequence of that engagement.

Yes, that's good. Thanks for that, Eryl. Just thinking about the PSBs, are there any ways in which they could operate more effectively in terms of that public engagement?

I think we'd all acknowledge that that needs to be part of an ongoing conversation, doesn't it? So, yes, it's helpful to have engagement once the plan has been developed and there's an annual report against those well-being plans, but I suppose what we'd like to see is much more ongoing engagement and much more opportunity for citizens themselves to be involved in the governance of those plans. So, I think it's looking at how that approach can mature into something that's sustained throughout the well-being plan and not just an exercise where we engage at the start and then we report back at the end on delivery.

Okay, thanks. Thanks, Chair.

Great, Gareth. And finally, Angela Burns.

Yes. Thank you for that. I just want to ask you about your wish list, but, before I get there, I'm just going to very quickly ask your opinions on whether or not you believe that the future generations Act is a golden thread within the Welsh Government policy and decision making at present. Our evidence has contrary views, but of course, for this to be successful, it has to be the golden thread that runs through all decisions taken, because from the Welsh Government flow all the other organisations and non-governmental organisations. So, first of all, if you could let me know if you believe that it's currently there and, if not, what would be the key movers or the key levers that we would need to put in place to ensure that that happens. 

Secondly, just for speed of time, because a lot of the questions I was going to ask have already been answered, if you each could have maybe one or two changes that you would like to see that you think would really help to underpin the delivery of this Act and to get over the barriers that you currently face—what would be the one that you or your organisation would like to see the most.

Who wants to take that first?

I'll start with you, Carl, because you sighed. [Laughter.]

Well, it's a really good question, that's why. It's such an opportunity, I guess—where do you start? That was my sigh. In answer to your question, my answer is 'yes'. I do think absolutely, 100 per cent, Government are very committed to this being, as you described earlier, the framework under which everything else sits. I think that's really, really important. It is the central organising principle—

Sorry, can I just clarify my question there, Carl? Because I agree with you, I think the Government are committed to it, but there's a big difference between the Government up here being committed and the policies that are stemming out, made by all the people in the organisation—do you think it's a golden thread there?

So, I was going to move on to that, Angela. It's emerging. Is it complete? No. But I do think—. My ask of others would be policy alignment. We've talked a lot about that today, but, just essentially, making sure that there's no new policy unless it's absolutely required and we focus on bringing the existing policy together in a coherent, simple way. That would be my first ask. My second ask would be to tidy up the existing organisational arrangements and structures, so you get a clear line of sight, a clear set of arrangements and we then really, really make sure that our plans for the next three to five years deliver the requirements and then we support that with funding, both in terms of education and training of the public organisations, supporting the resource within the commissioner's office and also then incentivising colleagues to do the right things. That's what I would ask for. Then there is a broader, really high level, population-based Wales, big education awareness-raising, marketing campaign about getting people sighted on the Act at a local level. Those are the two or three things I would be really seeking to do.

Yes. Yes. Thank you. That's really clear, actually, and I think it encapsulates much of what has been said during the course of this morning's evidence session. Huw or Alan or Eryl, do you—? Huw, yes.

If I could just add to what Carl said, in terms of your golden thread issue at Welsh Government, I'll use the example of what we are trying to do locally. We've got a central corporate team that look to make sure that all aspects of the organisation's plans and performance have the Act front and centre, incorporate it. So, I understand that the Welsh Government have a futures team. It may have changed, but they used to have a futures team, and I suppose, possibly, again, they may be acting, or they could act, in a similar way to make sure that Welsh Government policy and legislation is aligned as it flows out of the Welsh Government—act as the central body, the guardians, of the well-being of future generations Act, if I could say. So, that could be something, just as a thought, that we are doing that may be useful further upstairs.

In terms of the things that we would like, a small number for me. Cross-sector relationships: any mechanism that can drive the relationships between sectors—so, health, local authority, third sector, academia—very powerful. We have got an academic partnership board—very powerful in driving behaviours between academia and health. I think, if we are going to be more holistic in our policy responses, we need to form relationships at senior and middle management and beyond in order to enact those.

Digital is pivotal to me. I think we really need to have a drive with digital across the public sector, as a response to enable a lot of the goals of the Act. A small example: we're looking to establish a collaborative centre for leadership, technology and innovation, which will be regional, cross-sector and include patients and citizens. So, that's an example of where we are trying to transcend the sectors and transcend the areas.  

Education, training and development, as Carl has said, is fundamental, and I think it needs heavy resourcing, with very good quality resources. I think we need to make relationships with people within Wales, and outside of Wales, who are leading sustainability management. There are very, very good organisations outside of Wales that we could learn from and network with. I think that's something important for us to do. 

Finally, the one that we've talked about a lot is that the future generations office gets recognised with the resources they need to deliver the task, which is—[Inaudible.] Thank you.

Thank you, Huw. I think that you've finished. Sorry, we lost you very slightly just there. And Alan.

So, I can't really add anything to the golden thread that my colleagues have actually said. In terms of my wish list, it was training, education and population awareness, which is high on my agenda for the donor base, certainly. But I think that the other one for me that I would add in there, given what I'm going into, is some expertise touch points, some real experts in the space that we're going to to make sure that decisions are the right decisions for the long-term future. I think that we can get into medium-term and short-term decisions, but I want expertise that really leaves something for the next 25 to 30 years downstream. That's key for me and my service, going forward.  

Thank you. Eryl, did you want to add anything?

So, I suppose I'm already starting to think about what recovery looks like for us, and what public services will look like as we move forward throughout this year and into the next. I think we've talked quite a bit about the importance of on-the-ground support for public bodies to implement the ways of working to support the cultural change that's needed, and I think, if we're honest, to really rise to the challenges that we're likely to have ahead of us, both from a people point of view, in terms of the citizens that we serve, but also in terms of place and the environmental challenges. So, I think it will be critically important for public bodies to have some on-the-ground support, some capacity, some expertise, to enable them to look for, I think, some very different solutions to our challenges and to facilitate that cross-organisational working. So, that's the one thing for me.

The second thing for me, I think, pivotal to that, is support, whether that's through a citizens panel or some other mechanism, for much stronger citizen awareness of this Act and engagement with public bodies in terms of how we develop different solutions. I think we will need to look much more strongly at the assets that people and communities have themselves, and be looking to build upon those, as we look at what the future holds for Wales. So, I think it's those two things—the support for public bodies with respect to the legislation and how the future generations commissioner's office can do that, but also on the other side ensuring that we really are identifying and working on the things that are most important to people within Wales, as to the sort of Wales that they want in the future and looking ahead, but the needs they have in the here and now as well. 

Thank you. Thanks, Chair.  

Okay. Thank you, Angela, and thank you, Eryl, for that. We are completely out of time and some more. Can I thank our witnesses for being with us today? And I appreciate that we've overrun, but we did combine two sessions into one, as you know. Can I particularly thank Eryl Powell for being able to make herself available at very short notice for the first session today? It did help us all. I appreciate you've taken a lot of time out from dealing with the pandemic, so you're all free to go and to get on with your day job. We'll send you a transcript of today's proceedings for you to check before anything is issued or is factored into the report. 

Excellent. Thank you for the opportunity. Thank you.  

Thank you. Good day. 

Thank you to our witnesses.  

With that, I move Standing Order 17.42 to meet in private for the next item.