The next item on our agenda is the topical questions, and the first question comes from Angela Burns.
Will the Cabinet Secretary make a statement on the Welsh Government’s progress in bringing forward a long-term solution to the high cost of medical insurance facing Welsh GPs? (TAQ0053)
I thank the Member for the question. We continue to have a constructive conversation with both the British Medical Association and the Royal College of General Practitioners in Wales about the high cost of indemnity insurance. We have agreed with them to review how the market currently operates in Wales to help inform our options for progress. This Government remains committed to finding an answer that works for GPs in Wales.
Cabinet Secretary, I do not doubt your commitment to finding an answer. The trouble is that you’ve been looking for that answer for over two years, if not longer. You offer no timeline, no end date and no commitment to a state-backed solution and no answers. The issue at hand is that GPs have to pay for two elements of insurance. There’s a relatively stable set rate for professional advice and support and a variable, separate rate for clinical medical negligence cover. Changes to the clinical negligence cover model have made this insurance extremely expensive and precludes many contracted GPs from upping their hours in times of need such as winter pressures or stepping in to help another practice where a GP may have resigned or died or retired. The Welsh risk pool offsets cover for managed practices, locums and out-of-hours GP services. Cabinet Secretary, whilst this is a welcome move, by only doing half the job by tackling half the workforce, you risk destabilising general practice. I accept it is an unintended consequence, but I think this highlights why you need to act swiftly, because it makes becoming a GP in a practice far less attractive. The recent—and welcomed—announcement by the Secretary of State for Health in England that English GPs will be covered by a state-backed solution could further attract GPs away from Wales. Given the disparity in earnings between GPs in Wales and GPs in England, this could be the final straw. So, we have a situation in Wales where you’ve been looking for a solution; you’ve been looking for an awfully long time. Cabinet Secretary, can you please tell us when you’re going to come forward with some kind of proposal, so that we can try to ensure that we do not lose those hard-won GPs that we have? We need to ensure that they will stay with us. We need to get rid of the disparity between being a GP in a practice and a GP that works for a health board, is a locum or does out-of-hours services, and we need to make sure they do not drift across that border. I think that this could undo an awful lot of the good work I know you’ve tried to do in recruiting and retaining GPs to this country.
There are a number of points to respond to there. It’s worth reminding ourselves that indemnity insurance is a general issue across the UK, and it’s been an issue for some time. The need to do something about it has been accelerated by the announcement made by the then Lord Chancellor on the personal injury discount rate. There is a difference between those people that are working directly for health boards and the role of the Welsh risk pool, and those that are working as independent contractors, and we need to recognise that. So, this isn’t something where there’s an easy answer and demanding progress in the here and now will deliver the answer. In committing to a timeline for where we are, we are actually undertaking some proper market analysis. We’ve agreed on the appointment of someone to do that for us. I expect a report to come back into Government by the end of this calendar year, and that will then allow us to have a more detailed conversation about options, moving forward. I know you made the point about not committing to a state-backed solution. That’s because I’m not in a position to do that. The announcement that Jeremy Hunt made on a state-backed solution is one that isn’t fully worked out. The announcement’s been made with 12 to 18 months to work out what that means, and we don’t know what that means for us in Wales or in Scotland or in Northern Ireland, because we haven’t been given the facility to understand what that means in terms of ‘state-backed’; we don’t have the power to do that here. If it’s going to be a state-backed solution that provides resource with the state standing behind GPs in England, we need to make sure that those facilities are available in every devolved nation. And of course, since the initial announcement it’s also been clear that GPs may need to top up their own premiums in any event. So, there isn’t a certain position that exists in England but an uncertain one uniquely here in Wales. I expect us, over the time that we’re working to, to have an answer for what options exist in Wales over the exact same timescale that people will move within England, and it’s important that GPs understand that message. That’s why I’m pleased to reiterate we have been and are continuing to work constructively with both the BMA and the royal college of GPs. I wrote to them at the time of the announcement and I will, of course, come back to inform Members when there is real progress to report. But this is an issue I take seriously, and I recognise the timescales to act.
The announcement last Thursday by the Secretary of State for Health concerning indemnity arrangements for GPs in England presents a potential challenge for Wales. The Secretary of State for Health plans to introduce a state-backed indemnity scheme for general practice in England, and he has also stated that the indemnity arrangements are a devolved matter. Therefore, the Secretary of State for Health has opened up the possibility of there being significantly different indemnity arrangements for GPs in England when compared with Wales. So, in light of the current shortage of GPs, this is concerning news, really. If future GP indemnity arrangements are more attractive in England than in Wales, then GP provision in Wales could face several challenges. One challenge would be that existing GPs practising in Wales may move to practise in England. Would graduates also find practice in England a more attractive proposition? In his statement last Thursday, he stated that his department would continue to liaise with the devolved administrations about GP indemnity provision. So, Cabinet Secretary, will you ensure that this promise is kept, and will you point out the specific challenges that we face in Wales? Furthermore, Cabinet Secretary, will you commit to holding discussions with GP representatives, including both the British Medical Association and the Royal College of General Practitioners, about the specific challenges we face concerning GP indemnity schemes in Wales, the recruitment issue, the retention issue, and in light of the proposed state-backed scheme in England, which I think will exacerbate the issues that we have in Wales? Thank you.
I’m happy to reiterate that of course we’re engaging with the BMA, through their general practitioners committee in Wales, and the Royal College of GPs as well. We have been engaged with them in a meaningful discussion in advance of this announcement. And, of course, there will continue to be conversations with the UK Government. But, with all due respect to the comments that have been made about GPs in England being potentially in a more advantageous position, or the previous questions and comments about there being clarity in England, there isn’t. There absolutely isn’t. This is an announcement about a direction of travel and saying there can be a state-backed scheme. The detail of what it really means has not been worked out and is not clear to GP representatives in England or in any of the devolved nations. And this challenge about what exactly is a state-backed scheme, it really isn’t clear. If the state, the UK, is going to stand behind a scheme in England, but not in the devolved nations, that would be a very big problem, and I don’t believe for one single second that the BMA would sign up to a scheme that uniquely advantaged practitioners in England but not their members in Northern Ireland, Scotland or Wales. There’s a need to have a grown-up conversation about what this means, what our options are here in Wales, how whatever answer we have fits the needs of our practitioners here in Wales and the public they serve, but equally to make sure that the state is not used to particularly advantage one part of the United Kingdom over others. And I would have thought that people in all parties would recognise that that’s the position for us to adopt and expect to hold the UK Government to account—that it is certainly where GPs themselves are in every nation across the UK.
I thank the Cabinet Secretary. The next question comes from Simon Thomas
Will the Cabinet Secretary make a statement on the Care and Social Services Inspectorate Wales’s recent report on safeguarding children in Powys? (TAQ0054)
Safeguarding children must be the highest priority for public bodies. The CSSIW report raised serious concerns, and I have issued a warning notice to Powys County Council. This was laid before the Assembly yesterday, and I have also published a written statement. I expect rapid improvement, or more direct intervention action will be taken.
I thank the Minister for that response and for the opportunity to be able to discuss these issues with her yesterday. Since the statement of yesterday and my questions to the First Minister, a couple of questions have arisen in Powys’s response to this situation. May I firstly ask, specifically, what steps the Welsh Government is taking or will ensure will be taken to ensure that services will be safe over the ensuing 20 days? I know that you expect to see an action plan within 20 days, but what is being done at the moment, given that the report states that children are at risk in Powys? Therefore, what is going to be done over the next 20 days? The second point, if I may just ask: last night, in the media, Powys County Council responded to the situation by saying that the figures that they had as regards the management of the services had possibly been faked and that they’d discussed this with the police. Have you any information or knowledge that you could share with the Assembly to say whether these figures and the data are correct and that they’re based on the services? And what other questions does this raise about other services in Powys? If there’s an allegation that the children’s social services data is being manipulated, what does that say about adult and elderly services? In that context, what steps are you taking as a Minister to ensure the security of the wider social services in Powys? Finally, Powys also publicly declared that addressing this problem would cost them £4 million. Are you happy in your mind that they have adequate resources and funding to do that?
Thank you very much for those questions, and also for the opportunity to bring this issue to the floor of the Assembly today. As you say, safeguarding of vulnerable children has to be the No. 1 priority, and that was certainly my priority when I first was made aware of the situation, and that was through the submission, actually, of a confidential note from the chief inspector of CSSIW, and that really does reflect the seriousness of the inspection report. It’s very unusual, certainly unprecedented in my time in this post, for such an action to be undertaken. So it was certainly a priority then to satisfy myself, even before the report became formally accepted by Powys, that children in Powys were safe, and I required some immediate action to be undertaken. For example, Powys has responded by auditing cases and records and a risk-based assurance programme regarding safeguarding, and they’ve brought in an external company to do that piece of work. They’ve also increased their staff resources and put in place a leadership and behaviours programme, and all cabinet members are now on the corporate parenting committee. So, they have taken some early steps, but at every step I have sought out reassurances from the chief executive and the leader of the council that, in their view, children in Powys are safe, and they have given me those assurances most recently when I met with them on Friday of last week to give them advance notice of the action we would be taking in terms of the warning notice. You mentioned the issue that Powys have referred a matter of potential performance management manipulation to the police. I have to tell you that neither I nor CSSIW have had any previous notice of this matter from Powys County Council, so I was disappointed and surprised to have to learn about that from the media. This is a matter for Powys County Council to consider, and, of course, now it is a matter for the police, so it wouldn’t be appropriate for me to comment any further on that at this time, but I will say, of course, that we are considering the implications for our published statistics and those that we are due to publish following the announcement yesterday that the police are investigating those potential data manipulation issues in Powys. In terms of services more widely, I understand that Estyn does have some concerns about education and that Powys is subject to the case conference process that it has. In view of the concerns that I have about children’s services in Powys, I have asked CSSIW to bring forward its inspection of adult social services. It was due for spring of next year, but I’ve asked them to bring it forward, and Powys will receive six weeks’ notice as to when that will take place. I also understand that Powys County Council have suggested that improvements to children’s services will cost in the region of £4 million, and I do understand that moneys that had previously been taken from the children’s services budget will be restored from the council’s reserves to meet that money.
I would agree with you, Minister, that the CSSIW report on children’s services in Powys is incredibly serious. It’s a damning report and makes uncomfortable reading, and highlights a number of historical failings that have meant that children’s safety and well-being have been jeopardised. The report raises a number of very serious concerns about Powys County Council’s children’s services department, which the report says has placed children at risk of harm. I note you’ve said today that you’ve had assurances from the chief executive and the leadership of the county council yourself that children are now safe, but can I ask: are you yourself satisfied that children are safe at the present time? If families who have experienced dealings with the council’s children’s services department have concerns to raise following the report’s publication yesterday, what course of action would you suggest they take? Should they raise this directly with CSSIW, or with Welsh Government directly, or via Assembly Members, or indeed via Powys County Council? If there is a mechanism to report any issues via Powys County Council, would you agree with me that it wouldn’t be appropriate for them to raise concerns via the children’s service itself? The report doesn’t suggest any funding issues or cuts within the service area as a result of its failings, but I do see the report also today in regard to an extra £4 million of funds that have been made available. Can I ask: is there any commitment that the Welsh Government could make in terms of supporting that particular service financially from Welsh Government? I was also disappointed to hear that the council hadn’t raised with you any discussions it has had with the police. As we’ve seen in reports today, I note that the information reported says that Powys County Council have talked to the police. It doesn’t say that the police are investigating any issue. Can I ask you, Minister, if you would formally make representations to the county council—I shall certainly do it myself as a local Assembly Member, but formally, yourself, as a Minister—to ask the county council what exactly they’re talking to the police about and find out if there is a formal investigation taking place or not? It’s certainly my view that the service should be built up from scratch, and leadership will be crucial in that. Have you any assessment of the experience of the new interim director who has been appointment? Are any arrangements in place to encourage staff who do have concerns to come forward without fear of there being any negative consequence to them? And finally, while the report was very highly critical of the departments of the council’s leadership, it should also be noted that the report has praised the commitment of staff who have shown resilience and professionalism in challenging circumstances—that’s what the report states. Often, comments, of course, are lost when the media report such concerning issues. So, what is your message to those particular staff?
I thank you very much for those questions, and you’re right, the report is very clear that inspectors did note that there was real commitment shown amongst the staff who actually showed some real resilience and professionalism during this period, but serious performance issues did arise and that was, in the view of the report, because of instability in management, poor and confused direction and weak governance. And certainly, when I’ve had discussions with the chief inspector myself, she has been very much at pains to press that point that it was deliberately very clear in the report that, actually, we should be recognising the commitment of the front-line staff who wanted to do a good job, but, however, the structures and the leadership and the governance and so on around them was preventing them from doing the better job that they could have done for the children in Powys. With regard to the police issue, as I say, I found out about it through the media, just like everybody else, so I’ll certainly be pursuing that to get to the bottom of exactly what the issues are and what the police intend to do about it. Obviously, you wouldn’t expect me to comment any further, being in receipt of very little information on it myself. However, I certainly will be getting to the bottom of the issue. The improvement board is going to be crucial in terms of driving forward improvement, as you can imagine, and Powys County Council have already convened that improvement board; that was one of the stipulations in the warning notice. I can tell you that the members of the board include Jack Straw, the former chief executive of Swansea, who retired from the council in the local authority in 2016; Phil Hodgson, the former director of social care at Blaenau Gwent; and Geoff Burrows, who, up until May 2017, was a Conservative member of Monmouthshire County Council. And those, alongside Phil Evans, who is the former director of social services at the Vale of Glamorgan, who is now taking over as the interim director of social services for Powys, will be working as a strong team in order to drive forward improvement. And they’ll be reporting back to Welsh Government on a monthly basis as we go through this period, but, as you can imagine, since the concerns were first raised, Welsh Government and the Welsh Local Government Authority have been in very close and constant contact with Powys on these issues. I understand that those members of that board have already been holding discussions together with CSSIW about the work of the board and what they’ll need to do in terms of moving forward. It really is for Powys County Council to make sure that they provide significant funding to address these issues. As I say, funding had previously been moved out of children’s services, and I understand that money will be found from reserves to reinvest in children’s services to seek to address some of the issues that have been found in the inspection report. Some of these issues don’t require funding, of course. Some of the key issues were a lack of strategic direction and planning and lack of permanence in some of those senior and middle-management roles, a blame culture—. You know, some of these things are about the culture of the workplace and lack of leadership as opposed to necessarily investment and capacity and so on.
I’ve been reading with interest this morning about some of the allegations that have been surrounding the delivery—or the non-delivery, to be exact—of children’s services within Powys. I find it somewhat disconcerting to hear that you, equally, Minister, have found out for the first time by reading things online or listening to the news, in whichever form that arrives. And it seems very clear to me that what has been missing is leadership, management, focus and finance. And unless you have those four constituent elements working together, then nothing is actually going to improve. But there’s one thing that really, really worries me, and that is that you are talking about identified potential vulnerable children in every single case that we are talking about, and you’re talking about case reviews where those children will have been identified, ranging from low, to medium, to high risk. And we are being informed via the newsreels today that there is a possibility that some of those cases, or some of the information, possibly, surrounding those cases, has been misrepresented—in other words, tampered with. Now, I find that the most concerning thing of all. So, my question, clearly, is: they’re in a mess, there seems to be no doubt about that, that they are absolutely in a mess and you’ve got staff there who have been trying really, really hard, to do their best; it seems clear that there wasn’t a transparent or open or trusted whistleblowing process in place, because those staff would have been telling somebody, somewhere about their concerns, and it was either suppressed or they were too afraid to state it—and I’ve seen this elsewhere in another authority where I used to be a county councillor. And if you’ve got a culture that doesn’t allow things to come out in the open, then that culture needs close examination. So, my question to you is this: they’ve got 20 days to put their bits of paper together, but it won’t be 20 days that will change the culture, so I ask you, Minister, if you will look at the culture so that it isn’t a culture that’s inward-looking, with, maybe, infighting, and that’s of a secretive nature that actually puts these children at risk.
I thank you very much for those points that you’ve made, and certainly the implementation board will be looking very closely at the culture within the organisation and taking on board all of the many comments that have been raised in the inspection report as well. I think it’s important that Powys County Council now looks to seek out peer support and looks for good practice amongst other local authorities that have a good and strong record on children’s services, and also I know that the regional safeguarding board for children in the area is also really keen to offer their advice and support, and the chair, Jake Morgan, director of social services in Carmarthen, has already spoken to the chief executive of Powys to offer his support. So, I would expect the local authority to be looking for, and accepting, strong support from those areas that do have a stronger experience of children’s services. In terms of the whistleblowing question you raised, I think that is an extremely important one and it’s one that I will commit to looking to see exactly what happened in Powys and I’ll respond to you by letter with some further observations on that.
I thank the Minister.