Community Health Councils in Wales: proposed changes

Welsh Government

Consultation Document

Date of issue: 10 November 2014Action required: Responses by 9 January 2015

Number: WG23717

OverviewThis consultation is to gather views on amendments to the current Regulations and Establishment Order which underpin the operation of Community Health Councils (CHCs) in Wales. The changes are being proposed principally as a result of recommendations made by Professor Marcus Longley in his 2012 report Moving Towards World Class?: A Review of Community Health Councils in Wales. However, they also reflect recommendations on the functions of CHCs made in other reports received during 2014. These are referred to in the consultation document as appropriate.

How to respond Please respond by completing the questionnaire at the back of this document and sending it to:

HQDMailbox@wales.gsi.gov.uk

or by post to: Patricia Vernon Healthcare Quality Division Department of Health and Social Services Cathays Park Cardiff CF10 3NQ

Further information and related documentsLarge print, Braille and alternate language versions of this document are available on request.

Data protection How the views and information you give us will be used

Any response you send us will be seen in full by Welsh Government staff dealing with the issues which this consultation is about. It may also be seen by other Welsh Government staff to help them plan future consultations.

The Welsh Government intends to publish a summary of the responses to this document. We may also publish responses in full. Normally, the name and address (or part of the address) of the person or organisation who sent the response are published with the response. This helps to show that the consultation was carried out properly. If you do not want your name or address published, please tell us this in writing when you send your response. We will then blank them out.

Names or addresses we blank out might still get published later, though we do not think this would happen very often. The Freedom of Information Act 2000 and the Environmental Information Regulations 2004 allow the public to ask to see information held by many public bodies, including the Welsh Government. This includes information which has not been published. However, the law also allows us to withhold information in some circumstances. If anyone asks to see information we have withheld, we will have to decide whether to release it or not. If someone has asked for their name and address not to be published, that is an important fact we would take into account. However, there might sometimes be important reasons why we would have to reveal someone’s name and address, even though they have asked for them not to be published. We would get in touch with the person and ask their views before we finally decided to reveal the information.

© Crown Copyright 2014

Contents Page  

Introduction and background...................................................................................... 2 

Legislative background....................................................................................................................2 

Current Regulations and Establishment Order............................................................................3 

Reviews and recommendations relating to CHCs ......................................................................3 

Changes to the Regulations ....................................................................................... 6 

The leadership role of the CHC Board..........................................................................................6 

The Chair of the CHC Board and Non-Executive Directors.......................................................8 

CHC Board Director .........................................................................................................................9 

Performance Management of CHCs and Members....................................................................9 

Indemnity .........................................................................................................................................10 

Appointment of members by local authorities to ease burden on councillors.......................11 

Co-opted members ........................................................................................................................11 

Staff issues ......................................................................................................................................11 

Changes to the Establishment Order ....................................................................... 13 

Creation of a single CHC for Powys............................................................................................13 

Other issues not requiring changes to the legislation............................................... 14 

Local committees and number of members ...............................................................................14 

CHC Board and CHC accountability and reporting lines .........................................................14 

Arrangements for Human Resources and Financial support ..................................................15 

Financial Planning ..........................................................................................................................15 

CHC names.....................................................................................................................................16 

Consultation Response Form................................................................................... 17 

Appendix 1: Draft Amendment Regulations and how they appear in full................. 20 

Appendix 2: Draft Establishment Order .................................................................... 21 

Appendix 3: Reports and their recommendations relating to CHCs ......................... 22 

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Introduction and background  

1. Community Health Councils (CHCs) have an important job to do in representing independently and without bias, the interests of patients and the public in the way health services are planned and provided in Wales. They are amongst the longest-surviving organisations in the NHS today. However, although CHCs have gone through some changes over their long history, including the setting up of the Board of Community Health Councils in Wales (the CHC Board) in 2003, it is generally agreed that more needs to be done to help CHCs to represent patients more effectively within today’s fast-paced health service.

2. The purpose of this consultation is to seek your views on changes to the Regulations which will:

• Strengthen the leadership role of the CHC Board

• Make the appointment of the Chair of the CHC Board subject to the

principles laid down by the Commissioner for Public Appointments.

• Create two new non-executive roles for the CHC Board

• Promote more consistency and effectiveness in the way CHCs carry out their work

• Provide a clearer framework for the performance of CHCs and their members

• Provide more flexibility for the administrative arrangements and management of CHCs.

Legislative background 3. CHCs were established by Act of Parliament in 1974 to represent the interests of

patients and the public in the National Health Service, independently and without bias. Made up of members appointed by Welsh Ministers, local authorities and the voluntary sector, as well as a number of permanent support staff, they have several specific functions and duties connected to the scrutiny and monitoring of health services on behalf of local communities.

4. CHCs were abolished in England in 2003 but continued to operate in Wales by virtue of the Health (Wales) Act 2003 (the 2003 Act). The 2003 Act also set up the CHC Board in Wales. The provisions of the 2003 Act were repealed and replaced by section 182 and Schedule 10 of the National Health Service (Wales) Act 2006 (the 2006 Act) which is still in force.

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5. Section 182 of the 2006 Act creates order-making powers for the Welsh Ministers

to change the name or area of CHCs, abolish CHCs or create new CHCs. Schedule 10 of that Act sets out the functions of CHCs and contains a number of regulation making powers for Welsh Ministers to make provision about the constitution, role and administration of CHCs and for the establishment of a body (the CHC Board) to advise and assist CHCs in the performance of their functions.

Current Regulations and Establishment Order  

6. The Community Health Councils (Constitution, Membership and Procedures) (Wales) Regulations 2010 (the 2010 Regulations) completely replaced the previous regulations. The 2010 Regulations set out all the main details about how CHCs are made up and about their functions. The 2010 Regulations also set out revised provisions for the CHC Board.

7. The Community Health Councils (Establishment, Transfer of Functions and Abolition) (Wales) Order 2010 (the Order) established six CHCs in Wales from 2010, allowed for the continuation of two CHCs for the Powys area and abolished 17 former CHCs.

8. The 2010 Regulations and Order marked a significant change in the numbers and structure of CHCs in Wales reducing them from 19 to 8. As a result, the then Minister for Health and Social Services announced that the arrangements would be reviewed after two years in order to ensure they were working as intended.

Reviews and recommendations relating to CHCs 9. A number of recent reviews and reports have made recommendations relating to

CHC effectiveness.

10. The principle report1 was commissioned from Professor Marcus Longley in fulfilment of the Ministerial commitment to review CHC arrangements after two years, as mentioned above. Professor Longley’s report made a number of detailed recommendations relating to the structure, functions and membership of CHCs and the role of the CHC Board with a view to clarifying and strengthening the existing arrangements, including an unambiguous line of accountability between CHCs and the Board of CHCs. The Welsh Government accepted the majority of the recommendations and indicated that many could be achieved through better ways of working within CHCs whilst others would require changes to the legislation.

 1 Moving Towards World Class?: A Review of Community Health Councils in Wales (Professor Marcus Longley, Welsh Institute for Health and Social Care), June 2012  

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11. Other reports received this year have subsequently made additional, but often similar, recommendations relating to:

• better planning, prioritisation and focus for CHCs and clearer governance

arrangements2;

• the effectiveness of CHCs in the prevention of service failings and as a vehicle for raising issues of concern or for highlighting trends and strategic priorities to Local Health Boards as well as acting as a partner for quality assurance3 and;

• more clarity on the role of CHCs in the complaints process both in the visibility of CHCs service the public as complaints advocates, as well as the ability of CHCs to seek out and anticipate problems which can then be reported to Health Boards for appropriate action4 5;

12. In addition, two further reports are expected to make recommendations in

relation to: • CHCs’ role in the process of service change and consultation with the

public6 and • how CHCs should work more closely with Healthcare Inspectorate Wales

(HIW)7.

13. The above reports create a considerable amount of expectation in relation to how CHCs may be reformed in order to be fit for purpose now and into the future. We go on to describe the changes we are proposing to make to the Regulations and the Establishment Order now and what we think they will achieve in the very near future. The changes address several of the recommendations made in the above reports and we believe they will have the effect of strengthening the arrangements around the performance and operation of CHCs in Wales.

14. The Regulations set out the changes we know we would like to make now and the consultation period is set at eight weeks rather than the usual 12, as these issues have already been subject to considerable discussion.

 2 Commission on Public Services Governance and Delivery (Chaired by Sir Paul Williams OBE), January 2014  3 Trusted to Care (Professor June Andrews and Mark Butler), May 2014  4 Using the Gift of Complaints (Keith Evans), June 2014  5 National Assembly for Wales Health and Social Care Committee’s Inquiry into the NHS Complaints Process, August 2014   6 Lessons Learned Independent Review into Recent Consultation Exercises (Ann Lloyd CBE), October 2014  7 Review of Healthcare Inspectorate Wales (Ruth Marks), expected autumn 2014 

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15. We would also wish to highlight that there will be a phased “coming into force” for the Amendment Regulations, with some of the Amendment Regulations designed to come into force to coincide with the establishment of a new Powys CHC from 1 April 2015.

16. Finally, we will consider the review reports from Ann Lloyd (which has been

published today) and Ruth Marks in due course and decide what further actions may be required in light of any recommendations made.

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Changes to the Regulations 17. The Amendment Regulations will make the following amendments to the

Community Health Councils (Constitution, Membership and Procedures) (Wales) Regulations 2010 (please note the Regulations referred to below in bold type are those which are being amended).

The leadership role of the CHC Board 18. As was highlighted in Professor Longley’s report, the effective leadership of the

CHC Board is the key to achieving more consistency and better performance amongst the CHCs in Wales. Whilst local CHCs should be able to act independently in representing the interests of the public and patients within their own areas, they would achieve this a great deal more effectively by working in a planned and co-ordinated way. The CHC Board is necessarily able to take a wider view of matters given its all-Wales perspective, and CHCs should work within this context. It should also be the case that wherever possible, CHCs should follow the same standards and procedures, for example in the provision of complaints advocacy services, where a national approach would provide better value for money, more visibility and avoid inconsistency in the service.

19. We are therefore proposing to amend Regulation 32 (and make other consequential amendments as appropriate) to give the CHC Board the ability to set standards for, in particular:

• complaints advocacy;

• the scrutiny of the operation of the health service, including the entry and

inspection of premises; • the process of engagement; and • the referral by individual CHCs of matters to Welsh Ministers in connection

with service changes.

20. Indicating these areas “in particular” means that the CHC Board will set standards for these areas, but may also set standards for other activities, as it deems appropriate, for example, in terms of how CHCs conduct their financial planning, or in their dealings with the media. CHCs would be expected to follow these standards in carrying out their work and would need to demonstrate reasonable and rational arguments for choosing to depart from them.

21. By way of illustration, in terms of complaints advocacy, the standards set by the CHC Board may cover (this list may not be exhaustive):

• the professional operation of the service;

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• visibility;

• timeliness;

• accessibility to service users;

• management and organisation of the service;

• reporting emerging concerns to health boards and

• sharing of information and themes with Healthcare Inspectorate Wales

22. In addition, the CHC Board may underpin the standard with a set of guidance for CHCs, both at a national and local level. We believe this would address many of the recommendations made in the reports referred to above about the current problems with the CHC advocacy service.

23. With regards to monitoring service provision and entry and inspection, currently CHCs can choose what aspects of service provision to look at locally. This can be useful in picking up local concerns and in identifying problems and issues which should then be reported back to health boards and potentially also Healthcare Inspectorate Wales. However, there are concerns about the level of impact of CHC monitoring visits and a view that there is no overall plan. There is also potential for considerable duplication of activity with the health and social care inspectorates which is inconvenient for NHS staff and organisations and potentially a waste of resources. The standards set by the CHC Board may cover (this list may not be exhaustive):

• planning of what is to be monitored in terms of service provision;

• prioritisation of activity, for example into national/local priorities;

• professionalising the approach towards inspections, working with HIW and CSSIW on training and deployment of CHC members and

• adopting the same rationale as the inspectorates, but from a specific lay perspective.

24. In particular, working jointly with the inspectorates would give added weight to the role of CHCs and could help solve some long-standing issues such as entry into nursing homes where NHS care is provided.

25. In terms of how public engagement is carried on locally, the CHC Board should be able set standards on what is expected of CHCs, this may cover f meeting members of the public and ascertaining their views and engaging with LHBs and NHS Trusts on a continuous basis in order to feed back those views. The CHC Board may also consider including within the standards, the systematic sharing of the public’s view with Healthcare Inspectorate Wales. In order to ensure the best use of resources, a clearer idea of the rules of engagement with LHBs and better prioritisation and focus of effort, the CHC Board may underpin the standard with guidance within which CHCs would be expected to work.

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26. With regards the referral of matters to Ministers in relation to service changes, the CHC Board should be able to set standards that may require such referrals to be of good quality, constructive, objective and carried out in accordance with legislation and the guidance issued by Welsh Ministers. In future, CHCs could be expected to consult more widely with local stakeholder groups before a decision is made to refer any issue to Welsh Ministers. This would ensure a more rounded, community-wide view is obtained on the issues of concern. It is also envisaged that proposed referrals to the Minister would go to the Board for quality assurance purposes. The purpose of the Board’s intervention at this stage is not for it to change the properly taken decision of a CHC but to satisfy itself that all appropriate actions have been taken prior to the referral processing to the Ministers and that the referral appears to be sound. By this we mean the CHC Board may check for:

• Clarity of grounds for referral;

• Evidence that efforts have been made to discuss and resolve matters locally, with local stakeholder groups, and that CHCs have been afforded assistance by the LHB, particularly in terms of alternative proposals;

• Any defamatory or other statements which could cause damage to the

CHC’s reputation or standing.

27. In order not to prolong uncertainty for health bodies and the public, and to enable CHCs to manage this additional requirement without overly extending the existing process, the CHC Board will need to turn round referrals in a timely manner. This means that they should have knowledge of the CHC’s position at the earliest possible opportunity, i.e. once it becomes clear that local resolution has not resolved the issue. At that stage any guidance issued by the Board should be considered by the CHC and the Board should offer them reasonable support in considering whether a referral should be made to the Minister.

28. In supplementary guidance on the process of referral issued by Welsh Government in February 2013, a period of six weeks is allowed for CHCs to refer a matter to the Minister. We would suggest this time scale is extended to eight weeks in order for the additional consideration of the referral by the CHC Board to take place.

The Chair of the CHC Board and Non-Executive Directors

29. Professor Longley’s report made a firm recommendation that in order to provide the level of leadership required internally, as well as a credible and influential voice externally, that the Chair of the CHC Board should be appointed through the Public Appointments process rather than through the system of election from within the CHC membership which currently exists. The appointment will not be remunerated. Regulation 34 now provides that the arrangements for the

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appointment of Chair must take into account the principles laid down by the Commissioner for Public Appointments.

30. Professor Longley also recommended the appointment of two external non-executive directors to provide sufficient challenge to the CHC Board and to CHCs. The role of the non-executive director is described in a factsheet from the Institute of Directors as someone who provides “a creative contribution to the Board by providing objective criticism”. They should bring “independent judgment to bear on issues of strategy, performance and resources including….standards of conduct”. They will focus on Board matters and not stray into matters of day to day running. The appointments will not be remunerated. Regulation 34 has therefore also been amended to make this change. The arrangements for the appointment of non-executive directors must also take into account the principles laid down by the Commissioner for Public Appointments.

CHC Board Director  

31. It is the Welsh Government’s view that the post of Director of the CHC Board has been undervalued in relation to the responsibilities carried by the role and this needs to be addressed. The title “Director” is no longer sufficient to describe the various strategic challenges inherent in this position, and we propose that this should be changed to “Chief Executive”. Although the post does not carry the same weight of responsibility as the Chief Executive of an LHB or NHS Trust, in terms of public visibility, complexity of relationships and political sensitivity, the role is significant. An amendment to Regulation 36 has therefore been made to effect this change.

Performance Management of CHCs and Members

32. Linked to the strengthening of the CHC Board’s leadership of CHCs in Wales, we propose amending Regulation 32 to allow for the CHC Board to monitor and manage the performance of CHCs and their members. This does not mean that the CHC Board would overly intervene in local CHC decisions or seek to “micro-manage” CHC members, but it provides a stronger role for the Board in ensuring consistency of performance of CHCs and their members and would allow for actions, such as performance improvement plans, to be put in place.

33. All members will be required to sign a Code of Conduct on appointment and reappointment. The arrangements for the appointment and reappointment of members will ensure that standards of competence and conduct (including previous observance of the Code of Conduct) will be taken into account and only those candidates who are able to meet the requisite standards are appointed. The Code of Conduct is now covered at Regulations 9 and 10A.

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34. The CHC Board will also have a new duty under Regulation 32 to advise Welsh Ministers of inadequate performance of CHCs or members. This ability to refer matters of concern to the Minister would provide the Board with additional strength to hold whole CHCs to account if it is felt that the overall culture and approach at a local CHC is of concern. The expectation would be that concerns would only be referred to the Minister exceptionally and that every step would be taken by the CHC Board to resolve matters locally in the first instance.

35. If an issue is referred to the Minister, then he could decide to take a number of actions, from issuing letters of warning up to and including, if felt necessary, appointing external co-opted members to sit on a CHC committee. If external co-opted members are brought in, then this would be for a maximum of two years and they would have the same voting rights as full members. The existing members would remain in place during the period and would retain their voting rights. This change is provided for in Regulation 3A.

36. The Minister may terminate the appointment of a CHC member before the end of their term of office, if there are good reasons for doing so. A new stipulation in Regulation 13 means that the Minister will only accept a recommendation from the CHC Board as to the termination of a member’s appointment before the end of their term of office. The CHC Board should, before making such a recommendation to the Minister, consult the appointing authority if it is a local authority or voluntary sector organisation.

Indemnity  

37. Whilst not a matter mentioned in any of the recent reports or recommendations, we would wish to take the opportunity to clarify the matter of indemnity for CHCs. The current arrangements for indemnity of the decisions of CHCs are not covered in the existing Regulations but there have been circumstances where the Welsh Ministers, in exercise of their general powers, have indemnified CHCs in relation to legal costs of defending actions against them, however because the terms of the indemnity are not currently set out clearly, there has been uncertainty as to when it may or may not apply. It is therefore proposed that the power to grant indemnities will now be included in the Regulations rather than relying on general powers. Welsh Ministers may provide indemnity, so long as the CHCs’ or CHC Board’s decisions have been properly taken and their functions reasonably and rationally exercised. Members and staff of CHCs and the Board of CHCs act in the name of those bodies and it is therefore considered sufficient to provide the indemnity to each CHC and the CHC Board and not to individual members or officers personally. It is not proposed that the Welsh Ministers will indemnify individual members or officers acting outside the decisions or functions of the CHCs or the CHC Board.

38. The terms of any indemnity will be a matter for the Ministers and this will sit outside the Regulations. The terms will be described in detail and the Regulations will enable the Ministers to review and amend those terms as

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appropriate. As a result, a new Regulation 41A has been inserted to cover indemnity.

Appointment of members by local authorities to ease burden on councillors  

39. Although also not a matter which was raised in any recent reports or recommendations, we have listened to the concerns of CHCs and local authorities in relation to the burdens the current Regulations are placing on serving councillors. The requirement in the Regulations for all local authority appointees to be members of their authorities (i.e. local councillors) has led to difficulties in identifying members who have enough time to devote to a CHC role. As a result, local authorities have either not appointed enough members or if they have, those members’ attendance has been patchy. We have therefore made an amendment to Regulation 6 to return to the earlier arrangements whereby at least one of the people appointed by the local authority should be a member of that authority and the others can be persons of the local authority’s choosing. Local authorities (as well as voluntary sector bodies) will make their appointments in accordance with their own procedures, constitutions, governance arrangements and the legislation applicable to them.

Co-opted members

40. We also wish to take the opportunity to make some changes relating to co-opted members. We have made an amendment to Regulation 10 to make it clear that the maximum term of eight years which can be served by any CHC member does not include any period spent as a co-opted member. There has been some interpretation of the 2010 Regulations by the CHCs in the last few years which has sought to include the terms of office of co-opted members within the eight year maximum. However it should only be terms served as a full member, appointed by Welsh Ministers, Local Authorities or the Voluntary Sector, which count towards the eight year maximum.

41. In addition, in order to ensure a better turnover of co-opted members, and a spur to increasing the diversity of those members, the maximum term for a co-opted member will be two years, after which time they cannot be reappointed in that role. They would not, however, be prevented from seeing full CHC membership. An amendment has therefore been made to Regulation 5 to make this change.

Staff issues

42. Currently the lead officer in each CHC is known as the “Chief Officer”. This has, as far as we are aware, always been the terminology used, however, if we are to change the Director of the CHC Board to the Chief Executive of the CHC Board,

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then the use of the term “Chief” in other situations will need to be addressed in order to avoid confusion.

43. We should be clear that there is no intention to “downgrade” the standing of the lead officer role within CHCs, but rather to reflect a more federated structure and the relationship with the CHC Board and its Chief Executive. The person acting locally must have sufficient standing both with their own members and with the NHS organisations and officers with whom they deal and so this will need to be reflected in any new terminology which should denote the appropriate level of authority and autonomy. We propose the use of the term “Executive Director” to replace the Chief Officer role descriptor and various amendments have been made to the Regulations, for example in Regulation 23 and other sections, to make this change.

44. In addition, it would be useful to have the flexibility for one Executive Director to

manage more than one CHC or for staff to work across more than one CHC, if this is felt to operational advantageous and the Regulations now allow for this also through an amendment to Regulation 23.

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Changes to the Establishment Order 45. We are proposing to make the following amendments to the Community Health

Councils (Establishment, Transfer of Functions and Abolition) (Wales) Order 2010.

Creation of a single CHC for Powys 46. Moving to one unified CHC for Powys is one of the recommendations in

Professor Marcus Longley’s review. Currently there are two CHCs within the single local authority area of Powys – Brecknock and Radnor CHC and Montgomeryshire CHC. It was suggested by the CHC Board previously that the existing members of the two CHCs should simply transfer across to the new CHC. However, we propose that there should be a new membership. The newly formed CHC may have a different focus to the two separate CHCs and members should be sought with the requisite skills and interests to take forward the new agenda. There is of course nothing to prevent members of the existing CHCs applying for membership of the new Powys CHC, so long as they have not served the maximum term of 8 years.

47. We are therefore proposing to amend the Establishment Order to abolish the existing Brecknock and Radnor CHC and Montgomeryshire CHC and create a new CHC for the county council area of Powys, to be known as Powys Community Health Council. All member appointments will cease on abolition of the old CHCs and new appointments will be made. We would propose the old CHCs are abolished on 31 March 2015 and the new CHC is established from 1 April 2015 to allow for time to carry out the membership appointments.

48. A number of minor consequential amendments to the Regulations have also

been made to reflect this change.

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Other issues not requiring changes to the legislation

Local committees and number of members 49. Professor Longley’s review highlights that the CHC local committee structure as

set out in Regulation 17 has become bureaucratic and superfluous in some areas, particularly those where the geographical boundaries of the local authorities are small and there is considerable community of interest between local committees. The local committees were meant to provide a link between the local authority areas within the CHC boundaries and to ensure an equitable representation of members and views from those areas within a larger CHC structure. They were not meant to give rise to more meetings, paperwork and bureaucracy.

50. There has been some suggestion that whether or not to have local committees should be an optional matter for CHCs and that this should be reflected in the Regulations. We have considered this, however, we have concluded that removing the local committee from the structure or making them optional could cause unintended consequences, in particular in the distribution of the membership which is fixed to the local committee structure in Schedule 2 of the 2010 Regulations.

51. Instead we have looked at what the current Regulations allow and are of the view

that each Executive Committee of a CHC can already, by virtue of Regulation 17, vary the standing orders of the local committees. This means that CHCs can already choose when to hold meetings of local committees and how those committees conduct their business in accordance with local needs. We would not propose to make any further changes on this issue.

52. Professor Longley’s report also looked at, but made no recommendation on, the

number of members at each CHC since there has been a long standing concern about capacity. We have considered this further but for the moment, have decided not to propose changes to membership numbers. In particular, should new patterns of local government emerge in Wales over the next few years, as envisaged in the report of the Commission on Public Services Governance Delivery, this may well have repercussions on the structure of CHCs in the future and on the number of members. For this reason we are not proposing any structural changes to CHCs (apart from in Powys) or any alteration to the size of the membership at this stage.

CHC Board and CHC accountability and reporting lines 53. In terms of accountability, the arrangements for CHCs are not straightforward

and require further clarification. This is echoed in the recommendations of the report of the Commission on Public Services Governance Delivery. CHC officers

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are employed through an arrangement with Powys LHB under NHS terms and conditions. However, there has always been a perceived conflict between this arrangement and the CHC’s role in scrutinising health service provision. In addition, Welsh Ministers have a legitimate interest in ensuring the public voice is heard and that CHCs are performing their functions effectively in this regard but should not prescribe in detail how CHCs should carry on their role.

54. We have considered the Memorandum of Understanding (MOU) in place between the Welsh Ministers and the Chief Inspector of the Care and Social Services Inspectorate for Wales (CSSIW) and the Chief Executive of Healthcare Inspectorate Wales (HIW). It appears to be a suitable model on which to base a future similar MOU with the CHC Board and we will seek to take this forward administratively.

55. Whilst not directly a matter for the Regulations, we envisage that the Chief

Executive of the CHC Board would in most practical regards be accountable to his or her Chair, who will be appointed by the Welsh Ministers in the way described above and who would meet the Minister at certain intervals. The Chief Executive would be accountable in an employment sense to the organisation which employs him or her, currently Powys LHB. Additionally, in practice the Chief Executive would also have a working relationship with the appropriate Director within the Department for Health and Social Services with whom they would discuss an annual set of high level objectives for the Board. This is not meant to imply a relationship of direction between the Welsh Government and the CHC Board but rather an opportunity to share views with the Chief Executive and for him or her to be aware of any concerns the Minister may have. This relationship would be similar to the one in place for HIW. CHCs remain independent entities in their own right but have a clearer line of accountability to the CHC Board through the standards set by the Board and by virtue of the Board’s responsibility for monitoring and managing the performance of CHCs.

Arrangements for Human Resources and Financial support  

56. Professor Longley recommended that the current “hosting” arrangements with Powys LHB should be reviewed to ensure the arrangements are a better fit for the future. CHCs are not corporate bodies in their own right and this cannot be changed without an amendment to the primary legislation, therefore a third party arrangement such as that with Powys LHB is still required to provide employment and financial support. However, although not something we can seek to change in the Regulations, officials are working with the CHC Board to review the current arrangements and to make any necessary changes.

 

Financial Planning 57. In terms of reviewing the financial allocation and budgetary management

arrangements, which was another of Professor Longley’s recommendations, we

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considered whether to provide for some standard-setting for financial matters to allow the CHC Board to carry out financial and budgetary planning across all CHCs. However we have concluded that there is already a robust provision within Regulation 40 which, if exercised properly, would result in better planning and financial management.

CHC names 58. At present, given the considerable challenges facing CHCs in Wales, we do not

consider a change in name to be a priority. However, we remain open-minded on the issue and welcome comments.

Consultation Response Form 

Responses to this consultation will be collated and published as appropriate. Welsh Government officials and lawyers will look and the responses and make any appropriate changes to the draft regulations as a result.

There are no specific consultation questions, but we would appreciate comments on the content and clarity of the Regulations. Please order your comments according to the sections in the Consultation Report, as laid out in the response form below.

Name

E-mail

Telephone

Address

Postcode

Organisation (if applicable

Returning this form

The closing date for replies is 9th January 2015

Please send this completed form to us by post to

Pat Vernon

Healthcare Quality Division, Department for Health and Social Services

Welsh Government, Cathays Park, Cardiff, CF10 3NQ

or by email to: HQDMailbox@wales.gsi.gov.uk

If you are sending your response by e-mail, please mark the subject of your email: Consultation on Community Health Councils Amendment Regulations and Establishment Order.

Publication of responses

Responses to consultations are likely to be made public, on the internet or in a report. If you would prefer your response to remain anonymous, please tick here.  

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Consultation response form – page 2

Your comments are invited on:

Clarity of CHC Board standard setting power

The appointment of the CHC Board Chair and non-executive directors

Change of title for CHC Board Director and CHC Chief Officers

Performance Management arrangements for CHCs and CHC Members

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Consultation response form – page 3

Indemnity

Creation of a single CHC for Powys

Any other comments on another aspect of the consultation

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Appendix 1: Draft Amendment Regulations and how they appear in full

See separate documents

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Appendix 2: Draft Establishment Order

See separate documents

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Appendix 3: Reports and their recommendations relating to CHCs  

Key to reports from which recommendations arise

1. Moving Towards Word Class?: A Review of Community Health Councils in Wales (Professor Marcus Longley, Welsh Institute for Health and Social Care), June 2012

2. Commission on Public Services Governance and Delivery (Chaired by Sir Paul Williams OBE), January 2014

3. Trusted to Care (Professor June Andrews and Mark Butler), May 2014 4. Using the Gift of Complaints (Keith Evans), June 2014 5. National Assembly for Wales Health and Social Care Committee’s Inquiry into

the NHS Complaints Process, August 2014

Colour-coded key to actions

To be addressed in forthcoming amendments to the CHC Regulations and CHC Establishment Order (either through the standards the CHC Board will be able to set for CHCs, or via another amendment to the regulations)

To be flagged in the consultation document for the above but taken forward administratively or no action proposed/needed

For review and action by the CHC Board and CHCs, working with Welsh Government officials

May require different actions, e.g. change to the primary legislation; changes to the appointments process; link to complaints policy development, etc

Action Function

The complaints advocacy function within CHCs should be further strengthened and developed (1)

CHCs should prioritise patient advice and advocacy, and reduce waiting times for this service (2)

Lack of evidence that CHCs are using the intelligence they gather through complaints advocacy to highlight concerns to the LHB (3)

Advocacy

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The specific and ongoing role of CHCs in raising general patient complaints and community concerns, based on them acting as the eyes and ears of the local population, should also be restated and communicated in the context of the overall complaints and concerns system. CHCs should be supported to continue to have statutory functions alongside any specific complaints role in discharging their statutory role to act as the patient voice, assess the local quality and service environment and facilitate local discussions on service change (4)

CHC Boards have to fully realise their balance of responsibility and in particular the necessary responsibility to search out and speak out about poor experience and practice of any sort in the care environment. There is a need to consider the training levels for CHC boards and members in particular in the discharge of the duties as eyes and ears for the NHS. It is recommended that the recent CHC review recommendations led by Professor Marcus Longley are therefore reinforced and fully implemented with pace and urgency (4)

The lack of visibility of CHC complaints advocacy service needs to be addressed (3)

There is a need to increase the general awareness amongst the public and patients of the role of the CHC Independent Advocacy Service that is generally seen to offer good patient support mechanism, but there have been some reflections on limited knowledge of its availability. Working with Welsh Government and Health Boards and Trusts, there needs to be some proper assessment of CHCs in respect of their ability to give full individual support within their current infrastructure (4) There has been a recent internal CHC review of the Independent Advocacy Service. It is recommended that these recommendations, which are now in the public domain, be fully implemented to further strengthen the deliberate role of the CHC in the complaints advocacy process (4)

The Welsh Government should extend the remit of CHCs’ advice and advocacy roles to provide seamless support to those who use both health and residential social care services (2)

There is a need to specifically describe and reclarify the role of the CHCs in Wales in respect of complaints and concerns

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management. This should fit with an overall description of the complaints management system and the different roles and functions in place across NHS Wales to support patients (4) It would be better for the regulator to be separate from current organisations with regulation roles, e.g. HIW, CHC, Ombudsman etc. However, an appropriate step may be to allow the role to be located within the CHCs in the interim, as part of a clarification of their roles. The regulator should chair a routine quarterly meeting of Chairs and Chief Executives to investigate the monthly and cumulative results of PTR to ensure that Health Boards and Trusts are correctly implementing the scheme (4)

There is a need to clarify the role of CHCs in the complaints process (5)

The Board of CHCs should resolve the position regarding visiting Nursing Homes, and CHCs start such visits as a matter of urgency (1)

CHCs should be more focused in their scrutiny of the quality and safety of patient services by planning and co-ordinating their work with the Healthcare Inspectorate Wales, the Care and Social Services Inspectorate for Wales, the Public Service Ombudsman for Wales and local authorities (2)

Visiting and monitoring

CHCs should scrutinise proposals for health service change constructively and objectively (2)

Service change

The leadership role of the CHC Board should be re-affirmed and endorsed by CHCs (1)

The CHC Board should adopt a more transparent and outcome-focused approach to the performance management of individual CHCs, using SMART metrics and an effective process to ensure that performance is acceptable (1)

The CHC Board should be more proactive in identifying and sharing good practice between CHCs, and in facilitating learning amongst staff and Members (1)

The CHC Board should ensure that CHCs use their business planning processes to identify and prioritise themes and issues to be explored proactively, on both a local and national basis, so that a higher proportion of their total workload is

CHC Board

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determined in such a fashion (1)

Welsh Government should appoint the Chair and non-executive members of the Board of CHCs (1)

The CHC Board should review the overall balance of CHC activity (1)

Reform of the CHC Board – to achieve improvement in quality of patient focus and public involvement and collection of systematic data (6) Clarify the role and function of CHCs and explore options for joint working with LHBs (1) Establish Powys as a unified CHC (1) Minimise the bureaucratic burdens of separate Local Committees (1) The agency arrangement for financial, HR and other support, and the division of administrative responsibilities for CHC, should be reviewed (1) Review CHC financial allocations and budgetary management arrangements (1) Consider changing CHCs’ names (1) Welsh Government should continue to reinforce the independence of the CHCs by changing their reporting line so that it is outside the remit of the Directorate of Health and Social Services (2) CHCs should make much greater use of electronic communications technology (1) Undertake an inclusive process of deliberation to define what would constitute ‘world class’ in this context (our ‘aspiration’), and then to bring forward specific organisational recommendations to help bring it about (1) The diversity of CHC membership needs to be improved(1)

Other