Janet Finch-Saunders
6. A wnaiff y Prif Weinidog ddatganiad am wasanaethau meddyg teulu yn Aberconwy? OAQ(4)2496(FM)
6. Will the First Minister make a statement on GP services in Aberconwy? OAQ(4)2496(FM)
Carwyn Jones
Yes. The provision of GP services in Aberconwy is the responsibility of Betsi Cadwaladr University Local Health Board. The board is working to ensure that people continue to have access to primary care, including where some contractor GP services have given termination notices.
Janet Finch-Saunders
Thank you, First Minister. The Royal College of General Practitioners has already highlighted that prolonged underinvestment has had a significant impact across Wales. In Aberconwy, we are now down to locum provision only in what was once a very busy GP-led practice, and a partner in another local surgery advises me now of an imminent meltdown facing us as some of our local GPs look to retire in fewer than 12 months. What are you actually doing, as First Minister, with overall responsibility for any service provision in Wales? Or is this just another example of your poor governance and a case of Nero fiddling whilst Rome burns?
Carwyn Jones
Well, first of all, there are more GPs now. Their numbers have risen in the past few years. We know that in some parts of Wales, for example, where the contractor model no longer applies, the health boards have run services perfectly adequately. If we look, for example, at Meddygfa Gyffin, which you will be aware of, a GP practice in Conwy, it has been run by the board since 1 April 2015, and now a provider has been identified to take that practice over, with a start date of 1 February next year, without any effect on the service made available to local people. The difficulty is, of course, that most GP practices are self-employed. They are, effectively, private practices that operate within the NHS, I suppose, if you look at it from that perspective. Quite often, little notice is given by surgeries as to what their intentions are. However, when that notice is given—for example, in Denbighshire, surgeries have worked with the local health board—then services can of course be preserved.
Statement: Alternative Delivery Models in Public Service Delivery: An Action Plan for Consultation
Leighton Andrews The Minister for Public Services
Llywydd, earlier this year, with the Minister for Economy, Science and Transport, I published a report, ‘Is the Feeling Mutual?’, which examined the potential role of co-operatives and mutuals in public service delivery. The written statement, which accompanied the publication of the report, explained that an action plan would be developed to take forward the findings of the report. This oral statement provides an update on progress and signals the start of the consultation on the action plan. Public services in Wales are transforming, and the challenging financial situation will continue to mean that there are hard choices to make about the future of public services. It is important that we develop long-term sustainable approaches to delivering our public services to ensure that vital services are protected and maintained. New models of delivery are being developed and rolled out across Wales, but we need to ensure that these models are appropriate, sustainable, and have the interests of citizens and the workforce at their heart. We are clear that public services delivered by public servants are best, and we advocate co-operative, mutual and related alternative delivery models only as an alternative to ceasing or to privatising services.
In considering alternative delivery models in local government, there are three important preconditions: accountability to local government, protection of employee terms and conditions, and continuation of trade union recognition.
In that context, the purpose of the action plan is to provide a clear national framework within which decisions can be made locally on the appropriateness of alternative delivery models in specific service areas, as well as to set out the practical support available to public service organisations, their workforce, citizens and communities, in making decisions about how services should be designed and delivered.
I’m grateful to Cabinet colleagues for the work they already have under way in this area and for the contribution they’ve made to the action plan. It reflects a shared commitment to supporting sustainable, relevant models of delivery that will protect our services, our workforces, and our communities. There is also a real appetite to engage in this agenda across Wales. There was good engagement around the first phase of the work, which led to the ‘Is the Feeling Mutual?’ report. Since then, our consideration of the way forward has been hugely informed by colleagues in local government sharing their experiences of establishing alternative delivery models, and by important contributions from a range of other interests, including the trade unions.
A series of sector-focused workshops are already under way as part of the follow-up to ‘Is the Feeling Mutual?’ I was pleased to participate in two of these events last week. The purpose of these workshops is to gather further views on establishing a framework for collaborative working in the development of alternative delivery models for public services. The outcomes of these events will inform the final action plan. The action plan contains a number of new actions, as well as bringing together the significant activity already under way. The proposed actions pick up the findings and areas for action identified in the ‘Is the Feeling Mutual?’ report, and the suggestions we have received from local authorities and others.
New actions proposed include the establishment of a simple, flexible funding mechanism to support local authorities in drawing on expert support to inform decisions on alternative delivery models; the development of a national framework for advice and specialist support on alternative delivery models, which public bodies can draw from; and supporting the development of mechanisms to build capacity and capability in this area, including peer-led mentoring networks, and support via Academi Wales’s continuous improvement team.
The precise shape and scope of these new offers will be developed, with partners, during the consultation process, so we can move quickly to put them in place. Other actions focus on testing the legal and financial framework within which alternative delivery models are established, and to see if there is scope to remove unnecessary barriers. Shaping and developing our proposals so that they are as effective as possible will be a key focus of the consultation. I am committed to working in partnership with the third sector, public services, trade unions, and other partners, in developing this agenda.
Janet Finch-Saunders
Thank you, Presiding Officer, and thank you, Minister, for your statement. I think everybody in the Chamber here realises the importance of effective local service delivery, especially given the financial challenges facing our public services.
Obviously, we’re very keen to see you facilitate stronger working relationships between local government, civil society, and the independent sector, so that we can ensure there are more efficient, innovative public services, but, of course, with the citizen and the community at the centre in any public service delivery reform. Minister, your report, ‘Is the Feeling Mutual?’, found that there is a desire in Wales to ensure that future service delivery is both citizen-centred and democratically accountable, though, to local communities, and we haven’t seen a lot of that in recent years. It stated that not-for-profit models are increasingly welcome, but, again, as long as they are accountable to the public. Your ‘Reforming Local Government’ White Paper responses also showed high support for the statement:
‘As part of a future performance regime the setting of minimum performance outcomes or standards should be considered.’
Now, in carrying this recommendation forward, how will you ensure that changes to service delivery models are accountable against these standards, and how will you ensure, going forward, that appropriate monitoring and performance data collection are undertaken really, really well and adequately so that the public can hold local authorities accountable for their performance? You mentioned a strong desire to protect employee terms and conditions and ensure trade union recognition. But this leaves us a little surprised, given your opposition to our committee-recommended amendment to the Local Government (Wales) Bill, which would have ensured that local authorities did comply with the code of practice on workforce matters. What is your position on this in relation to staff working with co-operatives and mutuals?
Finally, Minister, the report stated that there is an overwhelming desire to ensure that reform is truly sustainable at this time. As with reorganisation, let me emphasise that we must take the time to get this right, and I actually do look forward to far more open consultation and engagement with our communities as you move the local government agenda forward. Thank you.
Leighton Andrews
Llywydd, I’m grateful for the overall welcome for the proposals in ‘Is the Feeling Mutual?’ Clearly, the action plan that we have just put out for consultation develops the thinking in that report more significantly. There are a number of different kinds of not-for-profit models. They are already being developed within local government and by local community organisations across Wales, and I don’t think it’s a question of having the time to get this right; I think it is a recognition that the financial conditions facing local government, imposed by the cuts in the Welsh budget from Westminster, mean that there is an increased urgency in looking at some of these solutions. We know that communities themselves are being very creative in the way they are coming forward with alternative models, but we also know there is, in some cases, a lack of expertise or capacity to support the development of these initiatives. In respect of the need to hold these initiatives accountable to local government, well, of course, these are matters for local authorities to undertake themselves. We can provide guidance and we can provide assistance but, at the end of the day, it is for local authorities to observe the principles that we have set down.
In respect of the implementation of the code of practice, of course, most local authorities in Wales have abided by the code of practice. We have discussed the amendment that she has referred to in committee. I always find it somewhat ironic, of course, that it was her conservative colleague in Westminster who got rid of the proposals in England.