Presiding Officer, I am grateful for this opportunity to report on the emerging findings, arising from the second period of consultation on NHS reform, which closed on 25th February.

During that period three consultation period events were held across Wales, each attended by over one hundred and twenty stakeholders. At the closing date, four hundred and thirteen (413) responses had been received, all of which have been published in full.

Responses were received from a wide range of organisations and representative bodies with an interest in the Health Service in Wales. I have taken the opportunity to read each of these responses over recent weeks.

As a result, I am able to confirm my intention to proceed, subject to legal orders and regulations, to establish the 6 new LHBs in shadow form from the 1st June 2009, and for these bodies to be fully operational from the 1st October 2009. Powys Teaching LHB is the seventh LHB.

This is not about merging LHBs and Trusts to make a hybrid organisation. These LHBs will be new bodies - ones that have a new purpose.

Therefore, they must have new Boards:

- Boards that are strategic;
- can make decisions;
- innovate;
- act collaboratively;

- and have, at their core, a responsibility to sustain the ethos and values of public service.

Board Members must hold the executive team to account for service planning and delivery, and for local engagement, bringing to the Board their own experiences of a sector which they understand, but do not simply represent.

There is a theme in consultation which will not come as a surprise to Members here. Uniformly, consultees agree that Boards must be kept to a size which allows them to be effective and focused. Yet, many also argued that their own particular interests need greater representation.

Doctors want more doctors; local government wants more places for local government; the voluntary sector wants more representation for voluntary bodies; carers want more places for carers.

But nobody wants Boards to be bigger.

I appreciated that the tensions between inclusiveness and agility in decision-making are real. I have had to conclude that the size of Boards will remain very largely as set out in the consultation document. All the key interests are represented, albeit not at a scale which some would wish for themselves.

As Board Members, those from Trade Unions have a particularly difficult role - to balance their role as a corporate member, where they will be bound by the decisions of the board - against their role representing staff working within these organisations.

A number of important points on the details of the role of the Trade Union Board Member were raised in the consultation. I will discuss these issues further during the next week.

Director of Therapies and Scientific Services

A number of respondents suggested a Director of Therapies and Scientific Services should be included on the LHB Board. Such an appointment would be unique in the UK, reflecting the importance of these professional groups to the delivery of health - both now, and increasingly in the future. This is another issue I am considering in light of the responses.

Of course, Board membership is only one of the ways in which health service interests and partners will be able to make their voice and views known in the new system.

Local government, for example, is directly involved on the National Advisory Board, through the membership of Cllr Meryl Gravelle, leader of Carmarthenshire County Council, and WLGA lead on social services.

Local authorities will also be key members of CHC Boards, as well as major players in Local Service Boards in each locality. The statutory duty for Health, Social Care and Well-being Strategies, and Children and Young People's Plans, will remain, building on existing partnership working and placing the NHS close to citizen and to the community.

Just as the new structure will work closely with local government so, too, the importance of the third sector was regularly emphasised in consultation - and I, also, endorse that again this afternoon.

The third sector contribution is important because it reflects not only the diversity of Wales as a nation, but also the unifying support for the National Health Service, which is so powerfully found in every part of our country.

There are a number of further issues for which, through consultation, a direction of travel has been suggested, or endorsed, but where further detailed work is now needed. Presiding Officer, I thought it might be helpful to Members if I were to identify these areas briefly this afternoon.

First, I can report that there has been support for the suggestion of a Professional Forum. I know that the success of the new organisations will rely on the strongest possible clinical engagement in the services they provide, and the decisions which they will have to take. I see the Professional Forum as central to engaging the health care professions, and there will be real benefit in arrangements that bring the professions within each LHB together in one group.

Of course, the interface between the new Forums and the longer-standing Statutory Advisory Committees must be clear and complementary. I have asked my senior officials to undertake some more detailed work, so that we can move forward with the most effective and workable model. My second issue, that of specialised services, has moved forward through the work of Professor Mansel Aylward who has reported to me on those functions and services currently undertaken by Health Commission Wales, which should, in future, be undertaken by the new LHBs.

There remain those services which can only be provided at a higher population level than local organisations. I agree with the views expressed in consultation that these must be organised collaboratively through the new LHBs. A further consultation paper on such a collaborative future for specialised services will be issued shortly. I want to ensure we arrive at a solution to this complex problem, which will address the concerns which have arisen about such services in recent years - concerns that I have discussed with Members previously.

Thirdly, to make it clear that I share the view, expressed in consultation that duplication must be avoided in the roles of Stakeholder Reference Groups and Community Health Councils.

CHCs have a formal statutory role - they must hold LHBs to account on behalf of the citizen. Stakeholder Reference Groups are non-statutory bodies, intended to provide an added dimension, involving citizens in a broader range of debates and open up Boards to a wide variety of views. Consultation on the future strengthened role of CHCs comes to an end mid April. I will ensure that, in responding to that consultation, further advice will be given to clarify the different contributions with these two groups will make to putting the citizen at the centre of the new, co-producing, democratically renewed, NHS in Wales.

Presiding Officer, I am very grateful to all those who attended the consultation events, and wrote to me with their views. Once again, this exercise has been a great success and a testimony to the spirit of dialogue and engagement which has been at the heart of these reforms. Now, we must press ahead with the action needed to make all this a reality. I intend to begin laying the Legal Orders and Regulations required to make these changes, before you within the next 14 days.

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