Y Pwyllgor Iechyd a Gofal Cymdeithasol

Health and Social Care Committee

28/03/2022

Aelodau'r Pwyllgor a oedd yn bresennol

Committee Members in Attendance

Jack Sargeant AS
Joyce Watson AS
Mike Hedges AS
Russell George AS Cadeirydd y Pwyllgor
Committee Chair
Rhun ap Iorwerth AS

Y rhai eraill a oedd yn bresennol

Others in Attendance

Yr Athro Medwin Hughes Ymgeisydd ar gyfer rôl Cadeirydd Corff Llais y Dinesydd
Candidate for Chair of the Citizen Voice Body

Swyddogion y Senedd a oedd yn bresennol

Senedd Officials in Attendance

Claire Morris Ail Glerc
Second Clerk
Helen Finlayson Clerc
Clerk
Lowri Jones Dirprwy Glerc
Deputy Clerk
Rebekah James Ymchwilydd
Researcher

Cofnodir y trafodion yn yr iaith y llefarwyd hwy ynddi yn y pwyllgor. Yn ogystal, cynhwysir trawsgrifiad o’r cyfieithu ar y pryd. Lle mae cyfranwyr wedi darparu cywiriadau i’w tystiolaeth, nodir y rheini yn y trawsgrifiad.

The proceedings are reported in the language in which they were spoken in the committee. In addition, a transcription of the simultaneous interpretation is included. Where contributors have supplied corrections to their evidence, these are noted in the transcript.

Cyfarfu’r pwyllgor drwy gynhadledd fideo.

Dechreuodd y cyfarfod am 09:29.

The committee met by video-conference.

The meeting began at 09:29.

1. Cyflwyniad, ymddiheuriadau, dirprwyon a datgan buddiannau
1. Introductions, apologies, substitutions and declarations of interest

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

09:30
2. Gwrandawiad cyn penodi gyda Chadeirydd Corff Llais y Dinesydd: sesiwn dystiolaeth gyda'r ymgeisydd a ffafrir gan Lywodraeth Cymru
2. Pre-appointment hearing with the Chair of the Citizen Voice Body: evidence session with the Welsh Government's preferred candidate

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

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

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

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

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

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

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

09:35

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

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

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

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

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

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

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

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

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

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

09:40

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

Diolch yn fawr iawn, Gadeirydd, a bore iawn da iawn i chi; braf eich cael chi efo ni y bore yma. Mae'r cynghorau iechyd cymuned wedi'u gwreiddio yn eu cymunedau. Beth sy'n dod yn eu lle ydy corff cenedlaethol sy'n mynd i fod yn llawer pellach, wrth ddiffiniad, oddi wrth y cymunedau hynny. Sut mae sicrhau bod y lleisiau lleol hynny, a'r ddealltwriaeth leol, sydd wedi bod mor allweddol, er enghraifft, yma yn y gogledd wrth ddal Bwrdd Iechyd Prifysgol Betsi Cadwaladr i gyfrif, yn cael eu cadw dan y drefn newydd?

Thank you very much, Chair, and good morning to you; it's wonderful to have you here with us this morning. The community health councils are rooted in their communities. And what we're having in their place is a national body that is going to be far further, by definition, from those communities. So, how do we ensure that those local voices, and that local understanding, which have been so vital in the north, for example, in holding Betsi Cadwaladr University Health Board to account, are maintained?

Mae'n hollol allweddol. Er bod yna isadeiledd cenedlaethol, mae llwyddiant corff fel hwn yn dibynnu'n llwyr ar greu model lle mae yna barch a lle mae yna isadeiledd priodol i leisiau o fewn cymunedau lleol. A dwi'n credu bod y cyfle ar gael inni wneud hynny. Roeddwn i'n sôn yn barod ynglŷn â'r pwysigrwydd, wrth osod y corff yma i fyny, fod angen inni adeiladu ar yr hyn sydd wedi digwydd yn y cynghorau, ond dwi'n credu bod angen mynd ymhellach.

Un o'r prif themâu yng nghyd-destun strategaeth iechyd y Llywodraeth ydy canolbwyntio ar fodel lle mae clystyrau iechyd, a datblygu strategaethau clystyrau iechyd ar draws Cymru. Os ydy hynny'n mynd i weithio, mae clywed llais unigolion—. A chymerwch chi'r gogledd, y gwahaniaeth lleisiau, o Gaergybi i Lanfair-Mathafarn-Eithaf, wedyn i Ros-y-bol a wedyn i Nefyn, sut ydych chi'n sicrhau bod y cymunedau hynny yn gwireddu ac yn cael cyfle i gynnig eu barn? Sut ydych chi'n gwneud hynny? Sicrhau, o'r dechrau, fod yna gorff cryf o unigolion sydd yn cymryd rhan. Roeddwn i'n sôn, wrth ateb i Mike Hedges, pa mor bwysig ydy cyfathrebu a chreu coalisiwn, os mynnwch chi, o unigolion sydd yn gweld bod ganddyn nhw rôl i'w chwarae, ac mae hynny'n hollol allweddol.

Hoffwn i hefyd ei ystyried yng nghyd-destun y gwasanaethau eraill mae Llywodraeth Cymru'n eu cynnig. Cymerwch chi ein llyfrgelloedd ni, cymerwch yr hybiau cymunedol sydd gennym ni, mae hwn yn gyfle ardderchog i ddod â'r mathau o gyd-destunau polisi at ei gilydd i greu, ar gyfer llais y dinesydd, cyfleoedd agosach at y cymunedau, lle mae'r negeseuon, lle mae'r adfyfyrio'n digwydd, ac yn bwydo nôl. Ond mae yna hefyd gyfrifoldeb o'r canol wedyn, o'r cyd-destun iechyd, i adrodd yn ôl i'r dinasyddion. Nid ffordd unplyg yw hon; mae'n rhaid sicrhau bod yna ddeialog. Dyna ydy'r gwerth: isadeiledd canolog sydd yn gwasanaethu'r cymunedau, ond yn sicrhau bod y canol wedyn yn mynd yn ôl i'r cymunedau ac yn nodi, 'Dyma wnaethoch chi nodi. Dyma rydych chi ei angen. Dyma rydyn ni wedi'i wneud', a chael gonestrwydd a datblygu deialog. Mae hynny'n allweddol bwysig ar gyfer llwyddiant corff fel hwn.

Well, it's vital. Even though there is a national infrastructure, the success of a body such as this one depends entirely on creating a model where there is respect and where there is appropriate infrastructure for voices within local communities. And I think there's an opportunity for us to do that. I've already talked about the importance, in setting up this body, that we need to build on what has taken place in the community health councils, but I think we need to go further.

One of the major themes in the context of the Government's health strategy is to focus on a model where health clusters, and the development of those cluster strategies, is undertaken across Wales. And if that's going to happen, then hearing the voice of individuals—. And if you take the north, for example, the different voices, from Holyhead to Llanfair-Mathafarn-Eithaf, to Rhos-y-bol and then to Nefyn, how do you ensure that those communities achieve and have the opportunity to have their say? How do you do that? Well, ensure, from the beginning, that there is a strong body of individuals taking part. In response to Mike Hedges, I talked about how important communication is and creating a coalition, if you will, of individuals who see that they have a role to play, and that is vital.

I would also like to consider it in the context of the other services that the Welsh Government provides. If you take our libraries, for example, and the community hubs that we have, this is an excellent opportunity to bring the different policy contexts together to create, for the citizen voice, opportunities closer to the communities, where the messages, where that reflection happens, and where there's feedback given. But there's a responsibility on the centre, in the health context, to report back to citizens. This isn't a one-way street; we need to ensure that there is a dialogue. That's the value: a central infrastructure that serves the communities, but ensures that the centre then goes back to the communities, feeds back, and says, 'Well, this is what you raised with us. This is what you need. This is what we've done,' and to have that honest communication in that dialogue. That's vital for the success of a body such as this one.

Mae gwrando ar ddinasyddion a rhoi cyfle i bobl ddweud eu barn, a gwneud eich hun yn agored i bobl, wrth gwrs, yn allweddol, a dwi'n reit siŵr eich bod chi'n benderfynol o fod yn agored yn y ffordd yna. Fel corff, mi fyddwch chi'n llai abl, wrth gwrs, na'r cynghorau iechyd cymuned i weithredu ar ran yr unigolion hynny drwy, er enghraifft, fynd i mewn yn ddirybudd i leoliad—wel, iechyd fyddai fo wedi bod. Ydych chi'n poeni bod gennych chi lai o ddannedd na'r cyrff rydych chi'n cymryd eu lle nhw?

Listening to citizens and giving people an opportunity to have their say, and to be open to people is, of course, vital, and I'm sure that you're determined to be open in that way. As a body, you will be less able than the community health councils to act on behalf of those individuals, for example, by going in without warning to settings—well, health settings, is what they would have been. Are you concerned that you have fewer teeth than the bodies that you are replacing? 

Dwi'n credu y buaswn i'n dadlau bod yna fwy o ddannedd, oherwydd mae yna gyfle i ddechrau i sicrhau cysondeb o safbwynt isadeiledd, ac mae hynny'n bwysig. Os ydyn ni'n mynd i greu, o safbwynt nodau llesiant Cymru, gwlad lle mae yna gysondeb o safbwynt polisi a chysondeb llais, yr hyn sy'n bwysig ydy bod yna gorff statudol sydd yn cymryd y gorolwg yna. Ond i hwnnw lwyddo—a dwi'n edrych â diddordeb i'r hyn sydd wedi digwydd yn yr Alban—mae gennych chi fyddin o unigolion sydd wedi cael eu hapwyntio i weithio ar lawr gwlad. A dyma dwi'n credu fydd yn bwysig iawn yng nghyd-destun y flwyddyn nesaf i bwy bynnag sy'n cael ei apwyntio ac i'r bwrdd, i ddod â byddin o unigolion sydd yn sicrhau bod y pwynt dŷch chi newydd nodi yn parhau i ddigwydd, ond bod yna gysondeb, ac er mwyn, pan fyddwch chi'n edrych ac yn adfyfyrio ar bolisi iechyd a gofal cymdeithasol, i ni, wedyn, allu cymryd cyd-destun gorolwg o'r canol ac yna, gobeithio, yn cynnal deialog gyda'r gwasanaeth iechyd ac yn gwneud gwahaniaeth ar gyfer dinasyddion ar draws Cymru.

I think I would argue that there are more teeth, because there's an opportunity to ensure consistency in terms of infrastructure, and that's vital. If we are to create, in terms of the well-being goals for Wales, a nation where there is consistency in terms of policy and consistency in terms of voice, what's important is that there is a statutory body that takes that overview. But for that to succeed—and I look with great interest to see what's happened in Scotland—you have an army of individuals who have been appointed to work on the ground. And I think that's what will be important in the context of the coming year for whoever is appointed and for the board, to bring that army of individuals who ensure that the point you have just made continues to happen, but that there is consistency so that, when you look and reflect on health and social care policy, we can then take that overview from the centre and then, hopefully, have that dialogue with the health service and make a difference for citizens across Wales.

09:45

Mae deialog gadarnhaol yn bwysig, wrth gwrs, a dwi'n siŵr y byddwch chi eisiau cael perthynas dda efo'r byrddau iechyd, ond weithiau, mae eisiau dangos dannedd mewn perthynas â bwrdd iechyd. Ydych chi'n ffyddiog y bydd corff cenedlaethol yn gallu gwneud hynny ar lefel leol mor effeithiol â'r cynghorau iechyd cymuned sydd wedi dod i adnabod lle mae'r gwendidau, er enghraifft, o fewn byrddau mewn gwahanol rannau o Gymru?

Positive dialogue is important, of course, and I am sure that you will want to have a good relationship with the health boards, but sometimes you do need to show those teeth in relation to a particular health board. Are you confident that a national body will be able to do that on a local level as effectively as the community health councils that have come to know where there are weaknesses, for example, within health boards in different parts of Wales?

Mae gen i ddigon o hyder, unwaith y bydd yr isadeiledd yma wedi cael ei greu, y bydd yna onestrwydd yng nghyd-destun y drafodaeth honno. Does dim pwrpas i chi gael corff sydd ddim yn mynd i mewn a bod yn onest, oherwydd ein prif bwrpas ni i gyd ydy gwella'r system iechyd a gwasanaethau cymdeithasol. A'r unig ffordd i wneud hynny ydy i fod yn glir—gosod y targedau ac adfyfyrio. Ac o safbwynt yr hyn sydd gennym ni'n barod, fel dwi wedi nodi o'r blaen, adeiladu ar y cryfderau a byddwn ni eisiau dathlu hynny, yn sicr, a dwi yn credu bod modd adeiladu a grymuso hynny, ond cael mwy o gysondeb. Un peth a oedd yn dod drosodd mewn sawl adroddiad wrth i'r Mesur yma fynd drwy'r Senedd oedd yr angen am adfyfyrio i gael cysondeb cenedlaethol. Dyna beth mae'r corff yma'n ei roi i chi.

I have sufficient confidence, once this infrastructure will have been created, that there will be honesty in the context of that discussion. There is no purpose for you having a body that isn't going to intervene, to be honest, because the main aim of every one of us is to improve the health system and social services. And the only way to do that is to be clear—to set the targets and to reflect on them. And from the point of view of what we already have, as I've already noted, it's about building on the strengths and we would want to celebrate that, indeed, and I do believe that we can build and empower that work, but have more consistency. One thing that came across in several reports as this Bill went through the Senedd was the need to reflect to achieve that national consistency of approach. That's what that body gives you.

Dwi'n meddwl eich bod chi'n gwneud pwynt da iawn yn y fan yna—bod angen y cysondeb cenedlaethol. A dwi'n meddwl y byddai'n deg i ddweud bod rhai cyrff wedi bod yn gryfach na'i gilydd. Beth dŷch chi ddim eisiau'i wneud, wrth gwrs, ydy dod â sefyllfa ymlaen lle mae'r rhai a fu'n bwerus yn dod yn llai pwerus, tra bod rhai eraill, wrth gwrs, yn cryfhau. Hynny ydy, sut mae sicrhau bod y cyrff sydd wedi bod yn gweithredu'n fwyaf effeithiol ddim yn colli'r edge hwnnw wrth drio creu rhywbeth sydd yn gyson, ie, ond fe allai fo fod yn gyson ac yn llai pendant ei weithredoedd nag ydym ni'n ei gael ar hyn o bryd mewn rhai llefydd?

I think that you make a very good point there—that we need that national consistency. And I think it would be fair to say that some bodies have been stronger than others. What you don't want to do, of course, is bring about a situation where those who were powerful become less powerful, whilst others become stronger.  So, how do we ensure that the bodies that have been working most effectively don't lose that edge in trying to create something that is consistent, because, yes, it could be consistent but less certain in its actions than we currently have in some places?

Ddylid ddim gweld, wrth sefydlu corff fel hwn, unrhyw lastwreiddio yng nghyd-destun yr hyn sydd wedi digwydd. A dyna pam bydd y prosesau, y cytundebau, y cydweithio, y cyfathrebu rhwng y gwahanol gyrff hyn mor bwysig. Ac eto, wrth i'r bwrdd gael ei sefydlu, fe fydd hi'n allweddol sicrhau bod y cyfleodd hynny dŷch chi newydd sôn amdanyn nhw yn parhau. Fe ddylai hwn gynnig gwerth ychwanegol. Fel dwi wedi nodi o'r blaen, yr unigolyn sydd yng nghanol system iechyd a gofal cymdeithasol Cymru. Mae'r strategaeth yn glir o ran y Llywodraeth; beth sydd angen i ni ei wneud ydy sicrhau bod yr adfyfyrio, o safbwynt llais y dinesydd, yn amlwg iawn wrth ddatblygu polisi.

Well, we shouldn't see, from establishing a body like this, any dilution in terms of what's happened and what is being done. And that is why the processes, these co-operation agreements and the communication between these different bodies will be so important. And again, as the body is set up, it will be vital to ensure that those opportunities that you have just talked about continue. This should provide added value. As I have noted already, it's the individual who is at the heart of the health and social care system in Wales. The strategy is clear from the Government's point of view; what we need to ensure is that the reflection, in terms of the voice of the citizen, is very prominent in policy development.

Cwestiwn neu ddau, os caf i, ynglŷn â'r ffaith mai corff iechyd a gofal cymdeithasol ydy hwn ac mai cyrff iechyd ydy'r rhai sydd ar eu ffordd allan. Sut dŷch chi'n mynd i sicrhau'r cydbwysedd yna mewn blaenoriaeth sydd yn cael ei roi i ofal cymdeithasol rŵan, gan fod hwnnw'n wedd newydd i'r corff yma?

I have a couple of questions with regard to the fact that this is a health and social care body and that health bodies are those that are being replaced. How are you going to ensure that that balance is struck in terms of the priority given to social care now, as that is a new aspect of this body's work?

Wel, fe fydd o'n hollol greiddiol o'r dechrau fod cysondeb ac, fel mae'r Saes yn nodi, parity of esteem ar gyfer gofal cymdeithasol ac iechyd. Os ydyn ni'n edrych o safbwynt strategaeth 'Cymru Iachach' y Llywodraeth, yr hyn maen nhw'n nodi'n glir yn fanna, ar sail tystiolaeth, ydy bod yn rhaid inni adeiladu system sydd yn gynaliadwy. Mae cynaliadwyedd y system honno'n dibynnu'n llwyr ar ddangos y parch yna ar gyfer y ddwy elfen. Ac wrth i'r bwrdd gael ei greu, yr hyn fydd yn hollol allweddol fydd sicrhau bod y partneriaethau a'r cyd-destunau’n briodol a'n bod ni'n adeiladu strategaeth addas i sicrhau bod yna gysondeb o safbwynt yr agweddau gwahanol.

Well, it will be crucial from the outset that there is consistency and that parity of esteem is given to social care and health. If we look from the point of view of the Government's 'A Healthier Wales' strategy, what they note clearly there, on the basis of evidence, is that we need to build a system that is sustainable. The sustainability of that system depends entirely on showing that respect and parity of esteem for both elements. And as the board is created, what will be vital is to ensure that the partnerships are in place, that the context is appropriate and that we build an appropriate strategy to ensure that there is that consistency in terms of the different aspects.

Mae'r fyddin dŷch chi wedi sôn am ei chreu, sy'n mynd i fod yn gwneud y gwaith ar draws Cymru, yn mynd i ddod â phrofiad o'r maes iechyd yn bennaf, o ran tynnu staff y cynghorau iechyd cymuned. Faint o her ydych chi'n meddwl fydd hi i greu'r arbenigedd yna yn eich gweithlu chi yn y maes gofal cymdeithasol?

The army that you talked about creating, which is going to be doing this work across Wales, is going to bring experience mainly from the health field, in terms of drawing in staff from the community health councils. So, how much of a challenge do you think it will be to create that expertise within your workforce in the field of social care?

09:50

Dwi'n credu mai beth fydd yn allweddol bwysig, wrth geisio datblygu'r isadeiledd, yw bod yr amser a'r parch a'r sylw dyladwy yn cael eu rhoi i'r arweinyddion, y gwirfoddolwyr niferus sydd ar draws ein cymunedau ni o safbwynt gofal cymdeithasol. Mae'n allweddol bwysig eu bod nhw hefyd yn gweld eu rôl ar gyfer datblygu hyn. A dwi wedi sôn o'r blaen, o safbwynt cymunedau diwylliannol gwahanol Cymru, fod iechyd, gofal cymdeithasol yn dibynnu ar gyd-destunau cymdeithasol. Ac eto, os ydy'r corff yma i lwyddo, o'r dechrau'n deg mae'n rhaid sicrhau ei fod o'n adlewyrchu y cymunedau gwahanol a lleisiau gwahanol yng Nghymru. Ac fe fydd y gwirfoddolwyr hynny yn allweddol, a'r gamp fydd mynd i mewn i'r cymunedau i ddatblygu'n briodol beth ydy'r isadeiledd.

I think what will be vitally important in trying to develop the infrastructure is that the time and respect and due attention are given to the leaders, the numerous volunteers that we have across our communities in terms of social care. It's vital that they, too, see a role for them in developing this. And I've talked about this in terms of different cultural communities across Wales, and how health and social care depend on social contexts. And yet, if this body is to succeed, we need to ensure from the very outset that it reflects the different communities and the different voices of Wales. And those volunteers will be vital in that regard, and the trick will be to go into the communities to develop appropriately the infrastructure.

Dyna ni. Diolch yn fawr iawn. Diolch, Gadeirydd.

Thank you very much. Thank you, Chair.

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


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

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

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

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

—to reflect those communities across Wales.

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

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

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

09:55

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

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

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

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

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

10:00

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

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

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

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

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

Mae angen sicrhau, o'r dechrau, fod y corff hwn yn gorff sydd yn gweithredu'n ddwyieithog a'i fod o'n sicrhau bod lleisiau dinasyddion Cymru yn cael eu clywed, bod yr isadeiledd, bod y strwythur, yn ei le. Hoffwn i feddwl bod gen i beth profiad yn y cyd-destun hwnnw. Mi fues i'n ffodus yng nghyd-destun fy ngwaith dros y blynyddoedd fel is-gadeirydd yr hen fwrdd yr iaith ac yn aelod am bron iawn i 13 blynedd o'r bwrdd. Bues i hefyd, pan oedd gennym ni Gynulliad—cyn hyd yn oed fod y Senedd wedi cael ei chreu o safbwynt enw—yn gyfrifol i greu y rheoliadau a'r isadeiledd i sicrhau bod y Senedd, fel mae hi hefyd heddiw, yn gweithredu'n ddwyieithog, ac mi fyddwn i'n tynnu ar y profiad hwnnw.

Ond byddwn i'n nodi nid yn unig dwyieithogi ond bod lleisiau a diwylliannau gwahanol Cymru yn cael eu clywed.

We need to ensure, from the outset, that this body is a body that operates bilingually and that it ensures that the voices of the citizens of Wales are heard, that the infrastructure and that the structures are in place. I'd like to think that I have some experience in that context. I was fortunate in the context of my work over the years as vice-chair of the previous language board and a member for almost 13 years of the board. When we had the Assembly—before the Senedd was established—I was responsible for creating the regulations and the infrastructure to ensure that the Senedd, as it is today, operates bilingually, and I would be drawing on that experience too.

But I would note not just bilingualism, but that voices and cultures in all their diversity in Wales are heard.

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

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

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

10:05

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

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

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

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

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

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

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

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

10:10

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

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

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

Dim ond un cwestiwn olaf gen i, a chwestiwn cyffredinol iawn—dydyn nhw ddim yn dod yn fwy cyffredinol na hyn. Rydych chi'n ddyn prysur iawn, rydych chi wedi bod yn ymwneud, ac yn dal i ymwneud, â llawer iawn o bethau. Pam penderfynu cymryd yr her fawr yma ymlaen, a sut ydych chi'n ffitio hwn i mewn i'r holl bethau eraill sydd gennych chi ar eich plat?

Just one final question from me, and a very general question. You are a very busy man. You've been involved, and you are still involved, in many different things. So, why decide to take this major challenge on, and how will you fit this into all of the other things that you have on your plate?

Dwi'n ymddeol fel is-ganghellor o Brifysgol Cymru Drindod Dewi Sant. Dwi wedi rhoi sawl blwyddyn yng nghyd-destun adeiladu'r cyd-destun hwnnw. Roeddwn i gyflwyno fy enw i ystyriaeth oherwydd rwy'n credu'n angerddol mewn llais democratiaeth Cymru a phwysigrwydd creu is-adeiledd dinasyddiaeth lle mae iechyd, lle mae gofal, yn greiddiol. A dyna pam roeddwn i wedi cyflwyno fy enw i'w ystyried. Mae'n faes sy'n agos at fy nghalon i. Dwi'n credu bod yna gyfle gwirioneddol. Dwi wedi sôn am dapestri ieithyddol a diwylliannol Cymru. Pan fo gennych chi Ddeddf llesiant sydd mor amlwg yn dathlu amrywiaeth y wlad, mae'n braf meddwl y byddai modd creu isadeiledd lle mae iechyd, lle mae gofal, yn hollol ganolog. Ac wrth inni ddatblygu llais iechyd, mae'n bwysig bod yna gorff addas ac, os gallaf i chwarae rhan fechan yn hynny, mi fuaswn i'n hapus iawn i allu gwneud. 

Well, I'm retiring as vice-chancellor of the University of Wales Trinity Saint David. I've given several years in the context of building that organisation. I put my name forward because I believe in the democratic voice for Wales and the importance of creating a citizenship infrastructure where health, where care, are at the heart of that infrastructure. And that's why I put forward my name for consideration. It's an area that's very close to my heart. I think there's a genuine opportunity here. I've talked about the linguistic and cultural tapestry of Wales. You have a well-being Act that is so clearly celebrating the diversity of this nation, and it's wonderful to think that I could help to create an infrastructure where health, where care, are at the heart of this nation. And as we develop the voice in health, it's important that there is an appropriate body to do that and, if I could play a small part in doing that, I would be very, very happy to do so.  

Diolch yn fawr iawn ichi. Diolch, Gadeirydd. 

Thank you very much. Thank you, Chair. 

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

Thank you. Diolch. Goodbye. 

3. Cynnig o dan Reol Sefydlog 17.42 (ix) i benderfynu gwahardd y cyhoedd o weddill y cyfarfod
3. Motion under Standing Order 17.42 (ix) to resolve to exclude the public from the remainder of this meeting

Cynnig:

bod y pwyllgor yn penderfynu gwahardd y cyhoedd o weddill y cyfarfod yn unol â Rheol Sefydlog 17.42(ix).

Motion:

that the committee resolves to exclude the public from the remainder of the meeting in accordance with Standing Order 17.42(ix).

Cynigiwyd y cynnig.

Motion moved.

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

10:15

Derbyniwyd y cynnig.

Daeth rhan gyhoeddus y cyfarfod i ben am 10:15.

Motion agreed.

The public part of the meeting ended at 10:15.