Cynulliad Cenedlaethol Cymru
The National Assembly for Wales


Y Pwyllgor Cyfrifon Cyhoeddus
The Public Accounts Committee



Dydd Mawrth, 24 Mehefin 2014

Tuesday, 24 June 2014





Cyflwyniadau, Ymddiheuriadau a Dirprwyon

Introductions, Apologies and Substitutions


Papurau i’w Nodi

Papers to Note


Adroddiad Blynyddol y Bwrdd Cynghori ar Adroddiadau Ariannol 2013-14

Financial Reporting Advisory Board Annual Report 2013-14


Gofal heb ei Drefnu: Trafod yr Ymateb gan Lywodraeth Cymru

Unscheduled Care: Consideration of response from the Welsh Government


Cynnig o dan Reol Sefydlog 17.42 i Benderfynu Gwahardd y Cyhoedd o’r Cyfarfod

Motion under Standing Order 17.42 to Resolve to Exclude the Public from the Meeting


Cofnodir y trafodion yn yr iaith y llefarwyd hwy ynddi yn y pwyllgor. Yn ogystal, cynhwysir trawsgrifiad o’r cyfieithu ar y pryd.


The proceedings are recorded in the language in which they were spoken in the committee. In addition, a transcription of the simultaneous interpretation is included.


Aelodau’r pwyllgor yn bresennol
Committee members in attendance


William Graham

Ceidwadwyr Cymreig
Welsh Conservatives

Mike Hedges


Alun Ffred Jones

Plaid Cymru

The Party of Wales

Sandy Mewies



Darren Millar

Ceidwadwyr Cymreig (Cadeirydd y Pwyllgor)
Welsh Conservatives (Committee Chair)

Julie Morgan


Jenny Rathbone


Aled Roberts

Democratiaid Rhyddfrydol Cymru

Welsh Liberal Democrats


Eraill yn bresennol
Others in attendance


Huw Vaughan Thomas

Archwilydd Cyffredinol Cymru
Auditor General for Wales

Mike Usher

Swyddfa Archwilio Cymru
Wales Audit Office


Swyddogion Cynulliad Cenedlaethol Cymru yn bresennol
National Assembly for Wales officials in attendance


Meriel Singleton


Claire Griffiths

Dirprwy Glerc
Deputy Clerk

Joanest Jackson

Uwch-gynghorydd Cyfreithiol
Senior Legal Adviser


Dechreuodd y cyfarfod am 09:01.
The meeting began at 09:01.


Cyflwyniadau, Ymddiheuriadau a Dirprwyon
Introductions, Apologies and Substitutions


[1]               Darren Millar: Good morning, everybody. Welcome to today’s meeting of the Public Accounts Committee. I would just remind everybody that the meeting is bilingual. Headsets can, of course, be used for simultaneous translation, and Members should feel free to contribute to this meeting in either English or Welsh, as they see fit. I remind everybody to switch their mobile phones to silent mode; we do not have to switch them off anymore, apparently, as they do not interfere with the broadcasting equipment. Just silent mode is perfectly sufficient.


[2]               Sandy Mewies: Now he tells us.


[3]               Darren Millar: Yes. Just to remind you, in the event of a fire alarm, we have to follow the ushers’ instructions. We have not received any apologies for absence; we have a full house, so we shall go straight into item 2.


Papurau i’w Nodi
Papers to Note


[4]               Darren Millar: We have papers to note in terms of the minutes of our meetings on 12 June and on 17 June. I take it that those are noted and we will move straight into item 3.




Adroddiad Blynyddol y Bwrdd Cynghori ar Adroddiadau Ariannol 2013-14
Financial Reporting Advisory Board Annual Report 2013-14


[5]               Darren Millar: This is a report that should come on an annual basis to the Public Accounts Committee, but it has been realised only recently that this has not been happening. So, it is a report that is laid before the UK Parliament, the Scottish Parliament, the Northern Ireland Assembly, and now the National Assembly for Wales. Mike wants to give us a little bit of background on this. Over to you, Mike.


[6]               Mr Usher: Thank you very much, Chair. I am speaking to you as the Wales Audit Office’s technical director and as a member of the Financial Reporting Advisory Board, and I represent the auditors general of Wales, Scotland and Northern Ireland on that board. I am conscious that this is probably one of the driest agenda items that this committee has ever considered, so I will keep my remarks fairly brief.


[7]               The FRAB was created in the late 1990s, when central Government moved over from cash to accruals accounting, and its role is to advise the Treasury on how to apply professional accounting standards to the accounts of public sector bodies—that is across central Government, the NHS, and it oversees local government accounting as well. It seeks to promote both clarity and transparency in public sector financial reporting. The members of FRAB are drawn from across the public and the private sectors—they are listed in annex A of the document, where you will see that the Welsh Government itself also has a representative on the FRAB.


[8]               As the Chair said, this annual report is presented to the legislatures of all four of the UK nations. It is pretty technical in its nature and contents, covering things like the intricacies of accounting for movements in asset valuations, but there is one item of wider interest in there, I think, in part 3, where it refers to the work that is ongoing on the streamlining and simplifying of public sector accounts. This is an exercise that is being led by the Treasury, with participation from Whitehall departments and, indeed, audit offices, looking to work together to identify ways in which the key messages within annual reports and accounts of public bodies can be presented in a clearer way. One aim of this is to cut the clutter, if you like, from many of the notes to accounts. We have identified that the preparers of accounts sometimes tend to throw in the kitchen sink in terms of information, and you really cannot see the wood for the trees quite often in sets of accounts.


[9]               In Wales, looking across local authorities, some authorities will produce accounts of 80 pages for the year, while others are over 200 pages long, although you have bodies doing similar functions. It is that sort of obsessive zeal for putting information in that can make things quite impenetrable. So, that exercise is under way, and the plan is that, for 2015-16, a new format will be introduced for public sector accounting and reporting, both for the accounts themselves and for the annual report that comes at the front of the accounts, along with the governance statement. It is likely that accounts will then look very different, in terms of their presentation. It should also lead to much clearer messages for those who are reading the accounts, and make them much easier to understand. So, that is quite an important development, and we will be working closely with the Welsh Government, the NHS in Wales, and local government in Wales, to see that that is introduced in 2015 in a managed way. I am very happy to take any questions, Chair.


[10]           Darren Millar: Thank you very much. Julie has a question.


[11]           Julie Morgan: It is just for information, actually. In terms of the board, who actually appoints the board?


[12]           Mr Usher: The board is independent of the Treasury. The chair is appointed by the Chief Secretary to the Treasury, I think, but there is then an appointments committee, which is chaired by the chair of the board. Some of the members are ex-officio in terms of what are known as the ‘relevant authorities’, and the Welsh Government is a relevant authority under the legislation. The remainder of board membership looks for a cross-section of representation of views from the public and private sectors, and you will see that auditors are represented there as well.


[13]           Julie Morgan: I was just pleased to see that there were some women on it.


[14]           Mr Usher: Absolutely, yes.


[15]           Julie Morgan: Comparatively speaking, it is a reasonable representation, so I was—.


[16]           Mr Usher: The chair, Kathryn Cearns, is a very impressive individual in terms of her background and experience. She is very good.


[17]           Darren Millar: Are there any further questions from Members? I just have one. Obviously, the board makes recommendations in terms of financial reporting for all public bodies across the UK. Is this a body that could advise on or consider some of the outcomes from our senior management pay review inquiry?


[18]           Mr Usher: The requirements for remuneration disclosures in accounts are developed by the Treasury, but they have to be run past the FRAB for its views. The FRAB is very much aware of the importance of transparency of senior management remuneration disclosures. Those disclosures go a long way beyond the private sector comparison, so I think that that is in quite a good place. Certainly, if the Treasury is planning to revise arrangements for disclosures, it would certainly come to the FRAB for its views and endorsement.


[19]           Darren Millar: Okay. Mike is next.


[20]           Mike Hedges: IFRS 10 and its local authority code allow local authorities to consolidate schools into a single entity financial statement. Why would they not want to do that? Why would it not be beneficial to do that? How would free schools have to sit outside of that?


[21]           Mr Usher: This is one where the application of the standard is relatively straightforward in Wales, because the range of schools that we have is much more limited than in England. The application of this standard for the Department for Education in England is a particular challenge in terms of academies and free schools. At the moment, the Department for Education has to consolidate schools into its own accounts. That is not the case in Wales, where schools are consolidated at local authority level.


[22]           Mike Hedges: I thought that that was the case. So, we are actually doing IFRS 10 in Wales in terms of schools.


[23]           Mr Usher: We are, yes. The issue for the FRAB has been the interpretation of this for schools in England, where it has proven quite problematic.


[24]           Mike Hedges: I thought from my vast reading of local government accounts that it was.


[25]           Mr Usher: Yes, you will see schools in those accounts.


[26]           Mike Hedges: So, that is fine.


[27]           Darren Millar: Jenny, you wanted to come in.


[28]           Jenny Rathbone: Yes, I just wanted to say that I am encouraged that we are accounting for future liabilities; page 11 mentions nuclear decommissioning provision, which I am very glad to see in there, although, obviously, it is not a devolved matter. Public sector pension liability is also something that we will want to worry about. There is an unfortunate typo that Sandy Mewies pointed out in the following paragraph.


[29]           Mr Usher: I have spotted that myself as well.


[30]           Jenny Rathbone: I am sure you will correct that before it goes anywhere else. I could not really see anything else for us to grip on to, other than to ask whether the improvement in the accounting to select committees from the Treasury department is reflected in the way that Welsh Government departments report to our committee.


[31]           Mr Usher: I will take those in turn. First of all, on the decommissioning costs and public sector pension liabilities, the whole of Government accounts were published two weeks ago for 2012-13, and those set out very clearly the scale of those liabilities; they dwarf the assets on the Government balance sheet, but those are all in there.


[32]           In terms of your second point, Jenny, it was about mid-year reporting and things—


[33]           Jenny Rathbone: It was about the way in which the Treasury reports in a more user-friendly manner to select committees. I just wondered whether we have the same.


[34]           Mr Usher: We are having discussions with Welsh Government around the way in which it reports its activities to the Assembly. At the moment, the consolidated resource accounts of the Welsh Government include the accounts and the foreword by the Permanent Secretary and the annual governance statement. That is very much a minimalist level of disclosure, I think. Looking at what is happening in Whitehall in terms of Government departments, it has moved a little bit further than that, I think, in terms of what it reports to Parliament. The annual reports of each Government department, which are all available on the websites, give a rather fuller description of each department’s performance, and the latest innovation, if you like, in Westminster is mid-year reporting. Those are short, 12 to 15-page documents that each department is producing. It is not audited, but it is sent in in terms of a stocktake of how a department is doing mid-year against its performance targets. Those are then being taken by parliamentary select committees, some getting into greater detail than others, but I think that there is a greater level perhaps of transparency and frequency of reporting and volume of information that we are now seeing in Whitehall. So, we are having discussions at a fairly early stage with the Welsh Government at the moment as to ways in which some of the positive aspects of that might be translated into the way in which the Welsh Government itself reports to the Assembly. That, again, I think is probably a two to three-year process, but we are looking at the experience in Whitehall and how that is working. One of the members of the FRAB is Sir Edward Leigh MP, and he is feeding back that parliamentarians are finding that very helpful in terms of what they are getting.


[35]           Jenny Rathbone: We can pursue that perhaps, Chair.


[36]           Darren Millar: Okay. Are Members happy to note the report? Are we required to do anything else, Mike?


[37]           Mr Usher: That is fine, Chair.


[38]           Darren Millar: It is just to note at this stage. Okay. Thank you very much indeed.




Gofal heb ei Drefnu: Trafod yr Ymateb gan Lywodraeth Cymru
Unscheduled Care: Consideration of response from the Welsh Government


[39]           Darren Millar: We have now had the response from the Welsh Government to our report on unscheduled care. We have also received a letter of advice from the Wales Audit Office, from the auditor general, in respect of the Welsh Government’s response. Obviously, our report contained many recommendations, but there are a number that have been partially accepted only, rather than fully accepted. They are recommendations 1, 4 and 11, and, in addition to some discussion on those three recommendations, the auditor general has also picked out recommendations 3, 8 and 12 for comment in his letter. So, if we just have a quick look at the Welsh Government’s responses to those recommendations, and then we can decide whether we want to take any further action. Sandy, did you want to come in?


[40]           Sandy Mewies: Yes, I think that the auditor general makes a valid point, but I also think that we heard—. It is very difficult to say to people, is it not? You cannot say to anyone, ‘You must have an injection’. You just cannot say it and we always have to remember that. So, I do not have a problem in perhaps suggesting that it does set more challenging targets and that we get a programme, but I think that we ought to do it in the context of how difficult it could be. It is not enforceable; it just is not enforceable, and we all know, do we not—. I have a flu vaccination every year and people are always asking me, ‘Did you go down with flu straight away?’ Well, actually, no, I did not. I am afraid there are a lot of myths around; I do not know which are true and which are not; it is all down to personal experience in the end. However, I do not have an objection to our having further information when it is available, but I think that we must do it in the context of there being no way of enforcing this.


[41]           Darren Millar: So, that is in terms of recommendation 1, of course, which was our recommendation to set a more stretching target for NHS staff flu jabs. Are there any comments on recommendation 1 at the moment? William is next; I will come back to you, Julie.


[42]           William Graham: I note in the response the comment that increasing the targets risks demoralising staff. Could we have some evidence from the health boards as to how that could possibly be justified?


[43]           Darren Millar: What I will say is that England seems to be much better at achieving higher levels of influenza jabs, does it not?


[44]           William Graham: Yes.


[45]           Darren Millar: I do not know what the situation is like in Scotland or elsewhere.


[46]           William Graham: I cannot believe that this statement is true, so I would like to see the evidence that supports it. I cannot believe that it demoralises staff to ask them to increase the number of flu vaccinations that they have. I do not believe it.


[47]           Darren Millar: It is a fair comment. Julie is next.


[48]           Julie Morgan: That was the comment I was going to make as well; it just seems unlikely. If you look at the figures for 2011-12, compared to 2013-14, it did go up 11%, which is very good, is it not? That shows that the impetus is there, so I would have thought that this was something to be strongly pushed and encouraged. So, I think that we should push that point.




[49]           Jenny Rathbone: [Inaudible.]


[50]           Darren Millar: Okay. Aled is next.


[51]           Aled Roberts: Mae gennyf un sylw ar argymhelliad 2—


Aled Roberts: I have one comment on recommendation 2—

[52]           Darren Millar: Could we just resolve our discussion on recommendation 1?


[53]           Aled Roberts: Okay, fine.


[54]           Darren Millar: I take it that we all want to just challenge the Welsh Government a little more on how ambitious its target is and encourage it to set it higher, notwithstanding that we acknowledge that there will be some resistance from a very small minority of people to accepting a flu jab.


[55]           William Graham: [Inaudible.]—I find it difficult.


[56]           Darren Millar: Okay. We will do that.


[57]           Aled Roberts: Ar argymhelliad 2, nid wyf yn meddwl ei fod yn dderbyniol. Mae’n dweud ei bod wedi cyflwyno canllawiau clir ar system sgriniau trosglwyddo o’r ambiwlans i’r ysbyty yn 2010 ac y bydd yn adolygu’r canllawiau ac yn gobeithio rhoi rhai newydd mewn lle erbyn mis Awst. Y cwestiwn sy’n codi yw: ble mae wedi bod dros y pedair blynedd diwethaf? Os bydd yn cyflwyno canllawiau newydd ym mis Awst, a fydd rhai ohonom yma yn 2018 yn gofyn beth sydd wedi digwydd efo’r canllawiau newydd, ac yn gweld nad yw’r sefyllfa ar lawr gwlad wedi gwella am ryw wyth mlynedd?


Aled Roberts: On recommendation 2, I do not think that it is acceptable. It says that it introduced clear guidance on the screen system for handovers from the ambulance to hospital in 2010 and that it will review those guidelines and that it hopes to put new guidelines in place by August. The question that arises is: where exactly has it been for the last four years? If it introduces new guidelines in August, will some of us be here in 2018 asking what has happened to the new guidelines, and seeing that the situation on the ground has not improved for some eight years?

[58]           Darren Millar: We can ask, can we not, Aled? I would agree with you; I think it is an odd response.


[59]           Alun Ffred Jones: A gaf ategu at hynny?


Alun Ffred Jones: Could I add to that?


[60]           Darren Millar: Of course.


[61]           Alun Ffred Jones: Nid wyf yn deall sut bod canllawiau clir wedi cael eu cyflwyno yn 2010, ac os felly, pam bod eisiau adolygu nhw? Y dystiolaeth a ddaeth gerbron eich pwyllgor chi oedd bod anghysondebau rhwng ardaloedd.


Alun Ffred Jones: I do not understand how clear guidelines were produced in 2010 and if so, why is there a need to review them? The evidence that came before your committee was that there were inconsistencies between various areas.


[62]           Darren Millar: Okay. We will drop a note just to ask why that is. We will pause at recommendation 3. This is one on which the auditor general has picked up some issues. It has been accepted by the Welsh Government, but the auditor general has suggested that we might ask for some more detail, including some timescales—


[63]           Mr Thomas: Yes, principally, timescales.


[64]           Darren Millar: Principally timescales. Are Members content to ask for some timescales in terms of the problems?


[65]           Jenny Rathbone: It does point out, however, that this is a constantly moving feast, and all of the other UK nations are also tampering with their ways of measuring this. We have to acknowledge that that causes difficulties, because if you want to have comparative figures and you agree that you will move towards where they are and then the other nations have moved away from it, that is a problem.


[66]           Darren Millar: I think that the issue that you were raising, auditor general, was about trying to establish what the timescale for moving to new performance measures will be. Is that right?


[67]           Mr Thomas: Yes. There will always be the issues that are there now, I am afraid, in terms of comparisons between the different countries. However, I did not get a sense of exactly the kind of timescale that it has in mind to try to address some of these issues, recognising, of course, that there is a need for cross-border discussion.


[68]           Darren Millar: So, we will ask for any timescales and perhaps we could also ask what discussions are going on with the other UK nations in terms of being able to compare data and benchmark between the different constituent parts of the UK.


[69]           Jenny Rathbone: May I just go back to recommendation 2 and say that, for me, the key is in the Minister’s or the Government’s second to last paragraph? If the clock start time for the four-hour A&E target is as soon as the ambulance crew say that the patient has arrived, all of the other inconsistencies would fall into place, because at that point they become the responsibility of the hospital.


[70]           Darren Millar: There was a challenge, was there not, in terms of when they actually started the count?


[71]           Jenny Rathbone: Yes, but if that is—


[72]           Darren Millar: But they have given some clarity, have they not?


[73]           Jenny Rathbone: Yes, but the point is that we need to know when that particular benchmark will be enforced, because, clearly, it is not enforced at the moment.


[74]           Darren Millar: Or effectively communicated to everybody.


[75]           Jenny Rathbone: Yes, that too.


[76]           Darren Millar: So, just on recommendation 3, we are going to ask for timescales and what discussions are going on between the Welsh Government and the other UK nations.


[77]           Recommendation 4 is one of the partially accepted recommendations. Of course, we called for an end to this uncertainty over the future of emergency department services. I am not quite sure why the Welsh Government says that it has partially accepted our recommendation, because in its narrative—its response—it sort of suggests that things have already been brought to an end, although we know that that is not quite the case, certainly in north Wales, where there are still some acute services being reviewed, and, of course, there is the uncertainty because of the legal challenge in west Wales.


[78]           Huw, was there a specific question that you wanted to address?


[79]           Mr Thomas: On recommendation 4, basically, I felt that, yes, the Government accepted this, but the narrative did not actually give a clear idea—as you said, Chair—about how, therefore, it is going to end the uncertainty. On the plans, it talked about south Wales, and mid and west Wales, but it is silent on north Wales. However, there is, if you like, an acceptance by the Welsh Government about the need to ensure that there are safe and clinically sustainable medical staffing models in emergency departments, and, yet again, I am not picking up from the narrative a particular set of actions that would deliver this.


[80]           Darren Millar: Shall we request some more information on what specific action the Welsh Government is taking to encourage health boards to resolve any outstanding issues? We could put it in those terms. Sandy.


[81]           Sandy Mewies: I wondered whether it was partially accepted because it is not complete in some areas. In paragraph 3, it accepts that there is a continuing need to work with health boards to ensure that plans are implemented in partnership with local community health councils. That is not complete in every way. So, I just think that we should be asking for clarity, if that is it. I do not know—it might be something else, but we could just ask for clarity on why it has been partially accepted, not wholly accepted. It is semantics, is it not—it is the nuance of what has been said, and I have picked up one thing, but it may not be that. So, I think that we need to be absolutely clear, and perhaps you could write to ask for that.


[82]           Darren Millar: So, we will write to ask for further clarity, saying that we are aware that there is still uncertainty around certain services in some parts of the country, and that we would like to know precisely what steps the Welsh Government is taking to end that. Aled is next.


[83]           Aled Roberts: Rwy’n meddwl hefyd y dylem gynnwys y ffaith ei bod yn dweud ei bod yn parhau i gydweithio â’r byrddau iechyd a’r ddeoniaeth ynglŷn â chynllunio a hyfforddi gweithluoedd yn effeithiol. Heblaw ei bod yn cyrraedd rhyw bwynt efo’r ddeoniaeth ynglŷn â sut mae’r unedau hyn yn cael eu staffio—. Mae problemau yn y gogledd ynglŷn â sut yn union maen nhw’n mynd i staffio’r tri ysbyty.


Aled Roberts: I think also that we should include the fact that it says that it continues to collaborate with the health boards and the deanery about planning and training workforces effectively. Unless it reaches some point with the deanery regarding how these units are staffed—. There are problems in the north about how exactly they are going to staff the three hospitals.


[84]           Darren Millar: It is a fair point, but I think that we should just simply write to request some clarity and information on what steps are being taken specifically in order to resolve any outstanding issues. Mike.


[85]           Mike Hedges: I cannot talk about north Wales—please accept that; my knowledge of north Wales is scant—but in south Wales what we have is a system where people go to one accident and emergency service, and then, if what they have is serious, they get transferred to the Heath or Morriston, in the main, but other main hospitals too. I think that that needs to be included in any discussion on health—certainly in terms of people in west Wales. I mean, the helicopter and the ambulances spend a lot of time travelling from there. People go into an A&E department in, say, Carmarthen, and they then get transferred to Morriston or to the Heath because of the seriousness of their injuries. I think that that needs to be looked at in some way. Every A&E department is not exactly the same—there are certain things that can be dealt with in an A&E in one place, but a lot of the movement is because they have to move, because of that, to a more specialist A&E area.


[86]           Darren Millar: I think that we all accept that Mike, but we are not asking it to spell those things out in any detail, are we? We just want it to clarify precisely what it is doing in order to ensure that these plans now are fully implemented. Bearing in mind this network approach in north Wales, which there has not been much communication about so far, I think that we would just like to know what steps the Welsh Government is taking to make sure that it is very clear about the future, because I do not think that it is completely clear at the moment. Okay, we are going to move on.


[87]           I am going to skip down to recommendation 8, if everyone is happy with that. Recommendation 8 is on penalties and consideration of ‘did not attend’ rates in the Republic of Ireland and Northern Ireland. The auditor general points out that it has not really said that it is going to consider anything in Northern Ireland or elsewhere.


[88]           Mr Thomas: As the response indicates, it is going to do some work on establishing the scale of ‘do not attends’ in primary care. It also talks about sharing best practice. My concern is that you also recommended that it considers initiatives outside Wales, particularly the Irish instances, and that that was not picked up by the Welsh Government.


[89]           Darren Millar: We can ask whether that will include a review of the situation in Northern Ireland and the action being taken there. Julie.


[90]           Julie Morgan: I was just going to say that you could say that saying ‘including sharing best practice’ would take account of Northern Ireland.


[91]           Darren Millar: We will just clarify that it is going to explore the situation in Northern Ireland and perhaps elsewhere. Okay, we are happy with that then.


[92]           We will skip down, unless Members want to talk about anything else, to recommendation 11. It is another partially accepted one on the co-location of GP services. The Welsh Government’s response here rejected the suggestion that we made about walk-in centres. It considered the issue of walk-in centres and whether they were a useful addition to the choices that people have. Are we content with its response?


[93]           Jenny Rathbone: I am.


[94]           Mike Hedges: I am not not content with it, but it lacks the clarity of understanding that we have walk-in centres—they are called A&E departments. When you co-locate, you have a walk-in centre where people walk in and see a GP. So, they are actually in existence. With co-location, you would have a walk-in centre, but it does not seem to have identified that.


[95]           Darren Millar: Fair point.


[96]           Jenny Rathbone: You could use that as a strategy for saying that we will not bother to chase GPs about providing adequate provision for out of hours. Alternatively, it is up to general practice to ensure that it has adequate provision for out of hours. So, the Government response is that the walk-in centres will simply let the out-of-hours provision off the hook; that is how I read it. There clearly is a lot of work to be done on ensuring that out-of-hours services are available and responsive to need, so that people do not turn up at A&E by default.


[97]           Darren Millar: I think that our recommendation was wider than just out-of-hours provision. We were talking about permanently embedding—as is the case, I think, in Morriston—an in-hours GP service as well to ensure that people were streamed appropriately when they turned up at the A&E front door, rather than choking up the A&E system.


[98]           Aled Roberts: I am not sure that we got across—. I know that it is up to local determination, but you have a ridiculous situation in Wrexham where there is co-location but it is two completely different streams. It appears to me to be a complete waste of resources, yet there is nobody that seems to be managing the situation. In our area, there is no GP out-of-hours provision, apart from the out-of-hours provision at the district general hospital.


[99]           Jenny Rathbone: That reinforces the point that I was making. Is that a strategy? I do not know. You would probably answer ‘no’ if you lived further away from Wrexham.


[100]       Darren Millar: However, essentially, it is rejecting the principle of stand-alone, walk-in centres. It is its prerogative to be able to do so and, to be fair, it has given a reason for that, has it not?


[101]       Sandy Mewies: Yes, I am quite happy with this.


[102]       Aled Roberts: I have no problem with the stance it is taking, but it then suggests that the current provision is fine.


[103]       Sandy Mewies: I did not think that.


[104]       Aled Roberts: That is my reading of the situation.


[105]       Mike Hedges: Aled’s point is that Morriston and Wrexham deal with it entirely differently. In Wrexham, you can turn up for an out-of-hours GP and that is where you end up queuing, and if you turn up for A&E, then that is where you end up queening. Whereas, in Morriston, you turn up and you join one queue and they move people between the two, because you are not to know, unless you are medically qualified, which queue you need to be in.


[106]       Darren Millar: What is a little bit disappointing here is that, in its response, it says that this is a matter for local health boards and it should reflect local circumstances. However, if you have a district general hospital, and we are talking about embedding people in a district general hospital, we know that all district general hospitals suffer from being overwhelmed by people who could generally be seen by a GP. That was the point that we were making really, was it not? Sandy, do you want to comment?




[107]       Sandy Mewies: As you say, I think that we need to strip out the walk-in centres. I think that that is a different point. However, it does say:


[108]       ‘We will, through the National Unscheduled Care Steering Board, support Health Boards in the best planning of Urgent and Emergency Services, including the co-location of GP services with emergency departments.’


[109]       So, I do not think that that has been ignored at all. I think that, whether you like it or not, it is rejecting—. When I am thinking of walk-in centres—. It is just rejecting it. It has given its evidence. That is it. I think that that is fair enough.


[110]       Darren Millar: What we were after, I suppose, was more consistency across Wales in terms of that good practice in places like Morriston, was it not?


[111]       Aled Roberts: The point is that co-location does happen in north Wales; it is just that it is not a very good model.


[112]       Sandy Mewies: It is talking about best planning. That is exactly what it is talking about: how do you plan? That is one of the issues, is it not? How do you plan for that consistently across the board? That is what it is saying in the first paragraph. I think that you are conflating two different issues.


[113]       Darren Millar: Do we want, then, just to ask it how it is going to monitor the effectiveness of the different co-location arrangements?


[114]       Sandy Mewies: Yes. That is a different question.


[115]       Darren Millar: Why do we not do that? There are slightly different models in different places. This is to ensure that there is better access in all parts of Wales.


[116]       Sandy Mewies: That will take it forward.


[117]       Darren Millar: Yes, we will do that. Finally, the last one we are going to pause at, unless there are any other comments, is recommendation 12. This is about the GP workforce-related issues. To be fair, I recall that, a few weeks ago, there was cross-party support in a debate in which the Welsh Government indicated that it was going to set out a workforce plan. The auditor general has made a comment that it does not have any specific timescales attached to short-term, medium-term and long-term planning arrangements. Is that right, auditor general?


[118]       Mr Thomas: Yes. I want to pick up on the evidence we heard about different views and interpretations of the problems that exist or do not exist as regards the supply of GPs. I think that we do need to identify that in pretty short order. From that, you can then start planning your strategy to deal with it. While the Government has certainly indicated that, yes, it is going to look at it, I just feel that it would be helpful to have a sense of the timescale.


[119]       Darren Millar: Should we ask it to send us a copy of its short-term, medium-term and long-term plans, as they become available? Should we set a date, say by December this year, for the short-term plan at least?


[120]       Mr Thomas: Well, I think that you could perhaps coincide this one with the fact that the Welsh Government, in recommendation 10, indicated that it is going to update the PAC on progress in out-of-hours work in September. Perhaps you could attach a request for that at the same time.


[121]       Darren Millar: Okay. Are Members content? I see that we are. We will do that. Are there any further comments on any other recommendations? If not, we will move swiftly on.




Cynnig o dan Reol Sefydlog 17.42 i Benderfynu Gwahardd y Cyhoedd o’r Cyfarfod
Motion under Standing Order 17.42 to Resolve to Exclude the Public from the Meeting


[122]       Darren Millar: I move that


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


[123]       I see that the committee is in agreement.


Derbyniwyd y cynnig.
Motion agreed.


Daeth rhan gyhoeddus y cyfarfod i ben am 09:33.
The public part of the meeting ended at 09:33.