Health and Social Care Committee

Bore da. I’m Alex Slade. I’m the group director of strategy and director of primary care and mental health. Thank you.

Bore da. Mari Williams from legal services.

Diolch. Thank you for joining us this morning. Members have a number of questions to put to you related to this. We’ll make a start with the first question from Safa Elhassan.

Bore da, Minister. Could you outline the Welsh Government’s overall position on the Health Bill and the key issues that remain to be resolved before you make a recommendation to the Senedd on legislative consent?

Thank you very much for that, Safa. Thank you for the invitation and welcome to come here to discuss this proposed LCM. I think it's important to begin by emphasising that this is a Bill that is being brought forward in Westminster for the needs of the health service in England. You will have heard me previously criticising LCM processes where governments in the past have sought to use them to introduce policies in Wales. That's not the case here. This is an LCM to do with a Bill in England, which looks to get rid of NHS England and to transfer powers to a new system. It is their intention to back up the 10-year plan for health by doing this and to introduce a new patient record system in England.

However, there are elements of this Bill that do have an impact on issues or matters that have been devolved and we have expressed concern about elements relating to transfer plans, plans that are to do with taxation issues, and looking at how they will collect data and who will manage that data and share it through their SPR, namely the single patient record. So, those were our concerns, but our officials have been in constant touch with the officials in the UK Government and have been discussing these issues, and we have literally just had a response from the Department of Health and Social Care of the UK Government that tackles some of those points. I understand, although I haven't had time to fully assess the response, that they will be introducing amendments to the Bill during its progress through the House of Lords, based on our concerns. So, those concerns will be allayed.

Brilliant. Thank you. Now, some questions from Matthew Jones.

Thank you. You've mentioned your view with regard to legislative consent motions, but could you tell us about how these have been dealt with by the Welsh Government in the field of health in the past? What discussions has the Welsh Government had with the UK Government during the development of the Bill, and how have those discussions changed the Bill to date?

Thank you. That's an important point, because there's sometimes a concern that a piece of legislation that affects Wales can have an adverse impact on people here and on patients and services. I'm glad to say that since the Government here became aware of this Bill and the proposed legislation, officials have been in constant touch with officials in the UK Government. They have shared their concerns, they have discussed and explained why we were afraid of some of these clauses—around transfer, for instance, how that could possibly have an impact on Wales, and, as I mentioned, the taxation issue. They identified those problems early and, as I said, we've just had a response now, which has been very positive, according to what I've seen. I've just got the copy I've received here. And it looks as though the Westminster Government will be introducing amendments in accordance with our requirements.

Excellent. I think you've responded to my second question with those comments, but could you detail what the concerns are in terms of the single patient record, taxation and transfer arrangements?

If we look specifically at the taxation issues, they've made it clear that the Bill looks at taxation issues that are reserved, not devolved, so it will not impact on the taxes that we can levy or adapt in Wales. So, it doesn't affect the devolved area there. When it comes to the single patient record, then that is to do with managing the data; they've given us an assurance that they will not interfere in the Welsh sphere there. So, we have been reassured that that matter will be resolved as the Bill goes through the House of Lords. But I'll turn over to the officials to expand a little further on this.

Just to touch on the transfer schemes, which is one of the main concerns that we had, presently the Bill would enable property rights and liabilities to be transferred from NHS England to a Welsh body. Whilst the UK Government had assured us that that wasn't their intention and that it was included more as a safeguard in the Bill, they have now confirmed to the Minister that they will bring forward an amendment that will make it clear that, before any transfer is made, they will need to seek the consent of the Welsh Ministers. So, that's what we asked for and they've agreed to table an amendment.

Similarly, in relation to the single patient record, their policy intent was always that it would enable data from patients being treated in England to be accessed as part of one record, but clearly, there are instances where patients are treated in Wales, and vice versa, so our concern was the potential that Welsh health bodies could be required to share data or access data. They've recognised those concerns and are going to look to bring forward a suitable amendment to ensure that the policy is achieved that this is an English record. That's what we've been assured of in the correspondence this morning.

Are you content that the House of Lords will pass this? Are you sure that there is that assurance there?

I am confident that the UK Government has given us a written commitment to introduce amendments. As this is a UK Government Bill, then it will pass according to their wishes.

Thanks.

Brilliant, diolch. Questions now from Nigel Williams. Nigel.

Obviously, you're aware I represent the Fflint Wrecsam constituency, and cross-border healthcare and border communities form a substantial part of healthcare in the area. I'm going to ask questions about the duties of integrated care boards and the impact of commissioning decisions on people living in the whole of Wales, really. So, will that provide meaningful protection in practice, and how will any adverse impacts on Welsh patients be identified through the process and how will they be addressed?

Thanks, Nigel. As you know, there are currently established governance arrangements for commissioned services from England, and those are made through the JCC, the joint commissioning committee. The JCC has already got a duty of quality, and they have to prove through that duty of quality and demonstrate how the decisions that they make improve the quality and outcomes of services for patients here in Wales. So, that's not going to change. The Bill, as I understand it currently, will update that statutory framework, and the intent, therefore, is to ensure that there's a smooth transition from the existing commissioning framework to the new body that will carry out those duties, but, essentially, nothing will change in that relationship on how the governance arrangements work.

Except for the people working in healthcare, perhaps. Because, as you know, I worked in healthcare, and one of the biggest moans all the time was the constant change ongoing within healthcare. So, do the reforms provide an opportunity to strengthen and formalise cross-border healthcare arrangements, and what improvements from the Welsh Government would you like to see that actually make it a smooth transition, if you like, into this new process?

As I said earlier, this Bill isn't a vehicle for us to change policy in Wales; it's about changing the provision of services in England, so it won't change that cross-border element. We can be sure that the legal frameworks that we've got in place at the moment around how patients are treated in England when services are commissioned, how any complaints that they may have are dealt with, will essentially remain the same, so we've got no real concerns.

I think my question as well was about the actual people working, the clinicians, the people working in accident and emergency or wherever. Will they see any change? Is that sort of—?

No, they won't see any change at all. That's not our understanding of the Bill. Again, this is to do with establishing a new body in England to replace NHS England, rather than changing the working conditions.

So, you're saying it essentially provides adequate protection for everyone all round, yes? The Bill.

No change from current structures.

None at all?

No. That's not our understanding.

Can we go back, sorry, just around the question that Nigel asked about the integrated care boards? I'm wondering if that new duty on those integrated care boards to consider the impact of commissioning decisions on people living in Wales is likely to provide meaningful protection in practice and how those adverse impacts on Welsh patients identified through that process would be addressed. Do you think that new duty on integrated care bodies will—? How will that impact be considered?

The new integrated care bodies in England will be a matter for the new body that replaces NHS England, so it won't impact on Wales is my understanding. It won't impact on patients from Wales, and when patients from Wales go for services in England because of commissioned services, they will be governed by the current frameworks that we have, which JCC commission from Wales, so it shouldn't impact on Welsh patients. I will just seek legal input there.

Just to say, it's not a new duty, in a sense, so that duty is already on NHS England. What is happening is because NHS England is being abolished, that new duty will now rest on the ICBs, so the new bodies. So, as the Minister said, whilst there may be changes of bodies on the English side of the border, those relationships, the underpinning legal structures that govern those don't change. From a Welsh perspective, there has always been a duty on NHS England to have regard to the needs of Welsh patients with regard to commissioning. That duty is now just being transferred to the ICB, which will now be undertaking that role instead of NHS England.

Can I just ask one more question?

Absolutely, Nigel. Sorry, I didn't want to—. I just wanted to clarify.

No, it's all right, it's just about commissioning decisions by the integrated care boards. Who directs that? Is it the Secretary of State? Is it directly from the Secretary of State, or are they making independent decisions? How are those decisions made? I don't understand that myself.

For the integrated care boards—

Yes, absolutely, yes.

—that's a matter for the UK Government and how they commission their work. It doesn't impact on Welsh patients or our duties here.

OK, thank you. Appreciate that.

Brilliant, thank you. And just as well, whether the Bill provides adequate protection for all Welsh patients who rely on specialised and tertiary NHS services in England, given that the duty on those integrated care boards to consider impact applies only to patients living in border areas.

We heard, or I read the transcript of the evidence from Powys and Betsi Cadwaladr about concerns on that element and the cross-border, and my understanding is that Welsh Ministers and local health boards here will continue to be able to secure those services in England and enter the cross-border commissioning and joint working, so that shouldn't impact on the potential of Welsh patients to receive services provided and commissioned from England. We've already got the established cross-border pathways in place. The framework that governs those cross-border pathways won't change. It won't impact, therefore, in any material way on Welsh patients' access to those commissioned services from England if they can't be commissioned in Wales.

If I may—

Yes, absolutely.

It's a legal not an operational capacity change in terms of what's being undertaken here. From the focus of NHS Wales and Welsh Ministers, that focuses on ensuring Welsh patients are treated fairly and appropriately, so they're not disadvantaged by any of the changes, but that's been a principle that we've had for a long time in terms of any cross-border commissioning.

Brilliant, diolch, thank you. Questions now online from Becca Martin.

Diolch. We've just sort of touched on this in terms of the cross-border care and the commissioning and what have you. I'm just wondering if you've got any particular services or patient groups that you have concerns about in terms of accessing that specialised care.

No, I can't say I've got any particular groups that I'm concerned about. Again, just to reiterate the point that if services can't be commissioned from Wales—. So, JCC, when they can, they'll commission services from Wales, but if they can't and those services can only be commissioned from over the border, then they will continue to do so in the interests of patients from Wales. Welsh patients shouldn't lose out as a consequence of this. Just to re-emphasise the point: this is an English internal restructuring Bill that shouldn't impact on the frameworks that we have in place on cross-border commissioning and services between England and Wales.

Thank you, Mabon. Just sort of on that again, just in terms of the really highly specialised things and things like organ transplant pathways and then things like mental health and in-patient care, are there any concerns around that really highly specific stuff?

Yes, that's an interesting question and probably another line of inquiry for this committee at another time. This committee did touch on the mental health issue in the last term. So, we've got the Mental Health Act 2025 in force in the UK at the moment. It's an England and Wales or a UK piece of legislation that looks at and includes matters of reserved and devolved areas, and that UK Mental Health Act provides the same assurances and the same rights and safeguards across the UK—or, in fact, across England and Wales. So, patients in Wales and England should expect the same treatment when it comes to that Mental Health Act, so that won't be impacted.

I mentioned earlier the JCC. They commission services from England and when it comes to high secure mental health in-patient care, then the high secure places are exclusively from NHS England. In Wales, there are two units in the medium category, which are commissioned, but they'll also commission some places from England. I'm aware that the JCC are reviewing the secure services currently, reviewing those secure placements. There might be a different inquiry you might want to look at on mental health placements. That's a different question from today. But as things stand, I am content that this proposed Bill will not impact on that part of people's mental health expectations.

Thank you, Mabon. And just in terms of the transplantation pathways, do you have any concerns around those?

Again, no. The Bill as it stands shouldn't be impacting on any commissioning services or the ability to commission from England. But I'll just confirm with legal and—.

Again, it's an operational matter. As the Minister describes, there's no particular reason why we'd have specific concerns over the commissioning of those services, whether it's a liver transplant, retinoblastoma, et cetera. They are very specialised, which takes considerable focus and oversight from the JCC in terms of their role there. But the legal amendments being made through the Bill and the impact on Welsh patients don't give rise to concern; it is one of those day-to-day operational management responsibilities.

Thank you very much. Thank you, Mabon.

Brilliant. Diolch, Becca. Just to clarify, I appreciate that this is restructuring in England, but the JCC, when we heard from them last week, were concerned about having to deal with a number of different bodies now rather than just NHS England. So, that obviously means a lot of new relationships that they have to build. So, I just wanted to get your view on that.

Yes, we'll have to wait to see how this Bill, as it moves through the system, develops and what the actual final outcome will be on how many bodies will be in place, and what that means materially for organisations in Wales. So, officials will keep assessing that and then we will have to ensure that we've got structures in place so that accountability and responses are made in due time.

Great. What arrangements will ensure that NHS Wales is consulted before an English commissioning body changes a specialised service used by Welsh patients? I think that's another concern, really, isn't it? And how will the effects on access in terms of waiting times, travel and continuity of care be properly assessed?

Yes, so these are all considerations that will have to be kept in mind as the Bill progresses. As things stand, again, just to re-emphasise my understanding, we've got no real concerns about the agreements that we currently have between the JCC, as the commissioning body, and organisations in England and how they will impact on service and delivery of service for patients. This Bill shouldn't really impact on that. However, as it does progress, we'll keep tabs on it, making sure that it doesn't impact us. Officials will keep in touch with officials in England, making sure that these considerations are taken on board. But as things stand, it's not a concern. Again, I'll seek assurance from officials.

Yes, thank you, diolch, Minister. There's no reason that the Bill gives rise to concerns about the pathway. But clearly, as the committee knows, for those specialist pathways, the route of treatment, speed of treatment, availability of medicines, could all change at any given time, but that has no relationship to the Bill. Whether the National Institute for Health and Care Excellence make a recommendation on new medicines for specialist cancers, for which we commission across the border, would be a day-to-day operational matter that we'd need to handle and would need to be consulted on in terms of those changes, but all done through an evidence base, and not triggered by the Bill progressing through the UK Parliament.

Okay, thank you. Natasha Asghar.

Thank you very much, Chair. Good morning. I'd like to ask: what role will NHS organisations have in the development and governance of the single patient record? And what steps are the Welsh Government and Digital Health and Care Wales going to be taking to prepare for the—? I do apologise. What steps are they going to be taking to prepare for and influence implementation long term?

Okay, so when it comes to the single patient record, the main area of concern for us in Welsh Government has been on understanding the cross-border element of the information-sharing implications for Wales.

So, we've had some assurances from the UK Government in the response today. Again, I haven't read that response in detail, but I understand that we've been provided with assurances. I'll ask Mari to come in in a minute, because Mari has read it in great detail. But as things stand, it's no longer a real concern for us that it will impact on Welsh patients.

Yes, thank you. Just to reiterate the point on the single patient record, some of the concern we'd raised was that the purpose of it, as we'd been assured by UK Government, was to enable English bodies to access the record, but they had drafted it with flexibility in mind, to ensure that where patients received care in Wales, the record of that care could be accessed as part of the record. So, clearly we raised some concerns about any provision that would mandate health bodies in Wales to have to share data. I think the UK Government wanted the record to be flexible, to ensure that if patients were treated then that data could be included in the record, but they have made it clear that they will bring forward an amendment to ensure that any sharing of data would be voluntary and there would be no mandating or requiring of health bodies to share data into that record. So, as the Minister said, we've had confirmation from UK Government that they will bring forward an appropriate amendment. We haven't seen that, but we will assess that to ensure that it meets the objectives that they've set out.

Have they given you a time frame as to when that will be?

They believe that the amendments—. Apologies, I have the letter on screen. As the Minister says, I think they're bringing them forward end of the month, beginning of next month, but we would hope that they would share those amendments with us in advance so that we would be able to comment on those before they're formally tabled.

Okay, fine.

Can I just ask, at this point, would you share the UK Government letter with us, or at least set out the relevant bits of information from that? That would be helpful.

I don't know what the protocol is around that. Certainly, we can share highlights of the letters so that you're aware of some of the promises made, but—

That would be helpful. Diolch, Mabon. Sorry, Natasha.

No, that's okay. In relation to Schedule 7 and the Bill's wider data sharing and information provisions for healthcare and adult social care services in Wales—I know you just touched upon that in your response—I just wanted to know, with regard to your engagement to the UK Government—. I know you've said that there's not going to be much change et cetera, but I just wanted to know, particularly with relation to the Schedule: are there going to be any progressive movements happening, particularly in relation to the Schedule, or not?

We did have some serious reservations about the proposed changes with Schedule 7, as was promoted, which was going to amend the 2012 Act, but officials shared those concerns with the UK Gov officials, expressed those concerns, and as Mari has eloquently described, those concerns were taken on board by UK Gov. We have had assurance that amendments will be placed. We haven't seen a draft of those amendments yet, so we'll need to assess how the wording is in place, but as things stand, they've committed to amending it and have listened to us.

If I could just come in—just to say, Schedule 7 is slightly different. These are health and social care information systems, and they can be established by the Secretary of State. There is currently an ability for the Secretary of State to establish such systems for the Welsh Ministers if we request them to do so. The change in the Bill was that they could do it of their own volition without a request from us, which was, again, of concern to us, so we'd raised those and they've acknowledged that that is not the intention, so, again, they're proposing to bring forward an amendment to ensure that any time there is a system set up, it would only be if the Welsh Ministers asked them to do that, or with the Welsh Ministers' consent. So, as the Minister says, we're hoping to see those amendments, and if they do what they say, then they would alleviate the concerns that we'd identified.

Okay. Thank you so much for your answer. In relation to safeguarding, because obviously we're going to be talking about patient confidentiality, we're talking about public confidence, and also the appropriate use of data in relation to Schedule 7, which I just touched upon, I just wanted to know, in relation to the collection, processing, publication and sharing of data, what safeguards are you going to be making sure are in place for this.

Again, we've received assurances from the UK Government that those amendments will be placed, so we have to wait and see that, but that gives us the security that they've listened to our concerns around it.

So, as it stands, there aren't any particular safeguarding options that you're pushing forward for to be a part of this Bill?

Once we see the draft of the wording, then we'll be content as that moves forward.

Thank you.

If I may add to that, as the Minister describes, safeguarding provisions towards patients would remain the same and wouldn't be amended. The point that Mari is making—and it applies to all of the requests we've made—is not to preclude the intent of the Bill, but actually to ensure that Welsh Ministers' powers aren't overridden by the Secretary of State, so that a consent clause is in place, so that then, on a case-by-case basis, we'd make the assessment should they want to enact a patient record or transfer scheme. So, it doesn't preclude it from happening, it just enables Welsh Ministers to make the choice at the time, based on that evidence of whether we'd want it to proceed. But that's a safeguard for Welsh patient data at a macro level. The individual safeguarding issues for individuals engaging in care would still remain in place as they do at the moment.

I remember when we first saw this when it came on my desk, that was one of the major concerns I had, and one of the questions I asked was, 'How can we allow this to happen, whereby the UK Government would be allowed to overrule the Welsh Government in this respect?' So, that's why those concerns were expressed and relayed to the UK Government, and, thankfully, they've listened.

Okay, great. Thank you so much.

Diolch. How will the single patient record interoperate with NHS Wales systems, so that patients' details and diagnosis treatments made in England are available promptly to inform GPs, hospitals and community teams?

Again, in the response we've had today, I've just scanned it, but there's a part there saying that the UK Government are willing to work with us, if we want, as a Welsh Government, to look at how they can allow that provision of interoperability between the systems in Wales and the systems in England, so that, should we want, we can have that patient-sharing information. But that's something that we will be looking at.

I think it's important that we have interoperable systems in place, where possible, but, again, this isn't a vehicle for us to put forward policy for the benefit of Wales, this is an English NHS issue that they're trying to resolve. But there might be abilities there to share information in the future, should we want that to happen.

Because, obviously, that's really important in terms of that interoperability, isn't it—

Yes.

—that Welsh patients aren't disadvantaged by anything?

And especially as we have so many patients from Wales being treated in England. And there are services that we can provide here. So, moving forward to the future, it's certainly something we need to look at.

Diolch. Questions now from Claire Archibald.

Thank you, Chair, and that was one of my questions. Hi, Mabon. So, if a change in England harms access for Welsh patients, who has the responsibility and the power to correct it, or put it right?

So, once again, there are frameworks in place already, ensuring that patients from Wales can escalate concerns and have access to advocacy. So, we've got Llais in Wales already, and they will still have the ability to represent patients in Wales, even though they might be treated in England. So, that framework, which is a cross-border framework, still exists post implementing this Bill.

Thank you. If those discussions do not resolve the problem, do you have any other mechanisms that would ensure that Welsh patients retain their treatment?

Sorry, in what sense?

If the discussions with Llais, or anything like that, didn't cure the issue involved, would you have any other reason—? Would you step in then to help the patients receiving that treatment if there was a problem?

Well, I can't step in to help the patient—

Not you, but—

—as things stand. But the system that—. Let's say there's a patient from Wales receiving treatment in Wales, and something goes wrong, then there are escalation frameworks in place, where they're allowed to go through, as I said, Llais. There are systems in place—listening to people, the NHS Wales complaints procedure, the incidents and redress process. These systems are in place in Wales and they will apply to patients receiving treatment in England as well.

Yes. The only reason I ask is because, obviously, with the JCC, like the Chair said, last week saying that there were so many bodies now that they might have to—. That was the only reason I was asking.

The same systems would apply.

Thank you.

Brilliant. Thanks, Claire. Questions now from Sara Crowley.

Thank you. I'm going to ask my questions in Welsh, if that's okay. Perhaps some of the questions will touch on issues that we've already discussed. But may I ask, in terms of accountability and patient voice, how will the Welsh Government ensure that the views and experiences of Welsh patients—and also, I make a point of asking about people from all ages, including children and young people, where appropriate—who receive care in England are gathered often, and are reflected in terms of service planning, quality assurance and decision making?

This does touch on Claire's previous question, and I think this is a very fair series of questions, because this is what patients in Wales will want to know. They'll want to have that assurance that whatever new arrangements come into place in England, they will not affect them, and to give that reassurance to you as a committee and also people on the outside that there will be no changes to the legal framework, when it comes to accountability around Welsh patients—the same system will apply as exists at present. At present, if a patient in Wales, for example, has to go to Broadgreen in Liverpool for treatment, and something doesn't quite go right, then there is an accountability system that applies. The same system or arrangements will apply in the new system, because this Bill is about creating new arrangements in England; it won't change the framework between Wales and England as to patient rights.

Thank you. Perhaps we've also touched on this matter, but I want to be clear on it, because I think it's important: who will be accountable when a patient from Wales—once again, a patient of any age—receives care in England, but when there is a serious failure? What safeguarding measures are in place to ensure that patients don't fall between the cracks in terms of those responsibilities, because we see that being a difficulty between health boards, so how would we see that working across the border as well, just to elaborate on that?

So, I will be repeating myself, because it's that assurance that you and patients are seeking. I know Alex wants to come in, and he has a depth of understanding of this.

Thank you. Diolch. The Minister describes the statutory framework. Patient safety incidents are ordinarily investigated by the English NHS provider, so you would start with the source of the care provision. However, there are regulations from 2011, the National Health Service (Concerns, Complaints and Redress Arrangements) (Wales) Regulations, which expressly address care that is commissioned by a Welsh NHS body but delivered in England, and those services are included within the regulations. So, it provides the statutory mechanism for cross-border investigation, information sharing and redress mechanisms, should that be needed for the issue that's arisen. Clearly, the point on accountability would be case-by-case specific, but the statutory basis enables—. It doesn't disadvantage Welsh patients receiving care in England because they're given the same statutory basis as if they received the care in a Welsh NHS body, and then, as the Minister described, there are other mechanisms in terms of Llais et cetera. So, all of the safeguards are maintained in place and aren't changed by the Bill.

And do you feel that patients would understand that and that they would know that that is something they would be part of? Is that clear for them?

Yes, there is a role in that patients need to be made aware of their rights in engaging with the NHS wherever that is, so we need to maintain that, but actually it's ensuring that the JCC are also making sure that those patients who are commissioned across the border are protected and that those rights are known to them so that they can enact those, should they find themselves in an unfortunate situation.

On that, that's a fair question, but there's a broader question linked to that around the current system, isn't there, as to whether people are aware of the accountability system that is in place. Now, perhaps that is something you would wish to look at in future. As a Government, what we certainly want to do is to ensure that Llais is strengthened as a body, but I'm not entirely confident at present that the people of Wales fully understand the accountability system here. We've seen that over recent weeks, that people are insisting all sorts of things from the Minister that the Minister cannot do, so there's another question there, isn't there, that lies beyond this inquiry.

And just a final question—. And I agree with what you said there, as somebody who's worked for 10 years in the NHS, people don't understand what is around them that they can turn to and access. So, yes, perhaps doing further work there will be a big help over the coming years.

But in terms of Llais, what role do you foresee that Llais will have in representing Welsh patients who receive care in England, particularly when there is a need to raise concerns? And also if I can just touch on this—I think I'm right in saying that Healthwatch has a similar function to Llais in England, and that that is going. So, are there problems there? What role will that function play, and how, once again, will people know that that still exists in Wales—

—if I've got that right?

Yes. That's a fair point. Once again, Llais will continue to be a body that represents and advocates for Welsh patients. What they're doing with Healthwatch in England is an issue for England; it won't affect patients in Wales. Again, perhaps there is a broader question there as to whether the press will look at this and run stories and whether people will understand the difference in terms of devolution. Will people feel as if they're losing out because of the change to Healthwatch? Well, that is a problem we regularly face in Wales because of the understanding of devolution, but the change to Healthwatch won't affect patients here. So, we all have a role here to ensure that people understand what the role of Llais is and that Llais is going to continue to be there to represent the patients of Wales.

Great. Thank you. Thank you, Chair.

Diolch, Sara. And just to clarify, just—. Given that nothing will change, and, you know, some of the things that you’ve been saying earlier, when a person in Wales receives specialist care in England but has ongoing care and monitoring in Wales, which organisation will be accountable for the whole pathway?

That's a very good question. I think that as things currently stand—.

Sorry. I'll answer in English. I’m so sorry, Jayne. When the commissioning body or the organisation that commissions the service asks for that service to be provided, then they're in charge of the patient; that will continue, and responsibility will lie with the local health board or the body that's asked for that piece of work. But I'll just seek assurance from my colleagues here.

Yes, from a legal perspective, it's the commissioning body. So, if it was a health board in Wales that commissioned the service, then, ultimately, legally, they would remain responsible. And as the Minister said, there are arrangements under the 'Listening to People' guidance, the regulations that underpin that, which make provision clear around responsibilities when things do go wrong, if they go wrong. But, ultimately, from a legal perspective, the commissioning body is, ultimately, responsible for care.

Brilliant. Thank you for clarifying that as well. We'll move back to Claire for a few questions.

What contingency plans are being put in place if the transfer from NHS England—well, to their new system—disrupts access to specialist treatment for Welsh patients?

Yes, so—. Thanks, Claire. We've got to monitor the Bill as it progresses now, making sure that it doesn't impact on Welsh patients. We'll continue to assess any of the implications that might arise from abolishing NHS England and any consequential service change that might arise from that. But officials will continue to work with counterparts in England and successor bodies there.

Thank you. How will you ensure the expertise that we obviously rely on is retained, rather than our having to build those relationships all over again? Will that be—?

So, as I said, as the Bill progresses, officials keep in contact with officials in England so there's an understanding and a continuity there.

Thank you. Diolch.

Great. We'll go back to some final questions from Nigel.

You mentioned, actually, that people don't understand who's accountable for what and where; I want to ask some questions about funding and financial accountability for cross-border healthcare. So, what are the financial implications for the Bill in Wales, including any potential costs, savings or financial risks that arise from the reforms?

So, assessments have been made of any potential financial implications and we don't foresee any financial implications for the NHS in Wales or Welsh Government.

That's a nice answer. Good. I'm glad to hear that, actually. So, will the current cross-border funding arrangements remain fit for purpose following the abolition of NHS England?

That's our hope, yes. There's nothing to suggest at the moment that it won't be fit for purpose. The legal frameworks that we have are pretty solid at the moment, they've worked well over the last number of years, although there might be political questions around that, of course, and, again, that's for a different inquiry, potentially. But, as things stand, we're confident that things won't materially change for patients from Wales because this is an internal organisation restructuring in England.

And because it does involve cross-border in England and Wales, in terms of transparency, how transparent will all this be to people out there looking from the outside at this process?

In what respect?

Well, in regard to the changes that will take place. How will people know across Wales, as an example, in terms of financial implications?

Well, again, for people in Wales, just to give that assurance and confidence, this won't impact on outcomes or on ability to receive treatment or on the commissioning. It's an internal organisational issue for England that won't change things for people in Wales, so they can be confident that they'll have the same outcomes as they currently do. The legal frameworks aren't changing on the cross-border issues. So, for us, in Wales, I'm confident that things won't deteriorate as a consequence of this, but we will continue to monitor it as the Bill progresses. If we see that any future amendments might impact on us or might touch on devolved issues, then, clearly, we'll be in contact with them, and we'll make our voices heard. We've got good relationships already. As we've said, they've listened to us so far on our concerns, so I hope that good relationship will continue.

Lovely. Thank you very much.

I did say final question. We've got another question from Matthew Jones. You've obviously sparked more interest.

My question relates to something that was raised by one of the witnesses who gave evidence to us. I'd like to ask about the impact on patients from England who come to Wales for any health services. We've heard that many patients along the border are registered with GPs in Wales. I just wanted to ask whether any kind of assessment has been made of any additional requirements that are, perhaps, being placed on the health service in Wales as a result of the changes in England. Are there any additional pressures on services in Wales? Are there any additional requirements?

As I've said, as it stands, I don't think there's an expectation that there will be additional pressures on the provision of services from Wales to patients coming from England. That doesn't look as if it will be a consequence of this Bill. If we do see, as I say—. These are still relatively early days for the Bill; there's quite some time to go yet. There'll be an opportunity for us to see further amendments put forward in the House of Lords, for instance. Now, if we see that amendments are introduced that will have a material impact on us here, then we will assess those. There are discussions with officials of the UK Government to ensure that we can express our views. But, as things stand, it doesn't look as if it's going to have an impact. But I will ask for an assurance from officials in regard to that.

Diolch. Thank you. Again, it's similar one, where it's outside the scope of the Bill. There's no reason to believe that the Bill gives rise to an issue there. It is an operational matter, and arrangements such as the funding flows agreement protocol, that is a discussion that we have regularly with the Department of Health and Social Care colleagues in terms of, I suppose, who's the net beneficiary in terms of those English to Welsh or Welsh to English patient flows. But the Bill doesn't actually give rise to any reason for concern in that regard, as the Minister described.

Thanks. I should have said as well, we have received a copy of the letter that you sent in response to the legislation committee and their questions. We have got that information. But we do know that the Welsh Government, obviously, hasn't given a view on this LCM yet. When do you think you'll be in a position to do so?

There's a reason why not, because we didn't receive this letter at that point. Now we've got the response from the Department of Health and Social Care to our concerns, we'll be able to assess that fully and then—. All I can say at the moment is 'in due course', but it won't be too long. Maybe my officials will be—

I like the 'in due—'. Well, I'm not that keen on the 'in due course'. We'll get to 'the autumn' and the—

There's a lot of work.

No, no, I understand the words, but, yes, just if—

I think we would need to see the amendments. Whilst the Minister says we've had an indication of what they intend to do to alleviate the concerns, we would need to assess those to ensure that, then, in practice, they do. So, I'm hopeful that they will share those with us in good time before they're tabled, and then we can consider and see whether they alleviate the concerns the Minister's identified.

Great. Because, obviously, we will be taking a very keen interest in this. So, anything that you'll be able to keep the committee updated on, we'd very much appreciate.

We will do that. As soon as we get information and we're in a position to do so, then absolutely we will.

And if there are parts of the letter—. If you can't share the letter fully, if you can share points of that letter that you've received this morning with the committee, that would be really helpful as well. But, yes, just to say 'thank you', diolch yn fawr, for coming in this morning on this particular matter. We do appreciate it. You will receive a copy of the transcript just to check for factual accuracy as well. So, diolch yn fawr, thank you for coming in this morning.

Diolch.