|Gareth Bennett AM|
|Jenny Rathbone AM|
|Mohammad Asghar AM|
|Nick Ramsay AM||Cadeirydd y Pwyllgor|
|Rhianon Passmore AM|
|Vikki Howells AM|
|Adrian Crompton||Archwilydd Cyffredinol Cymru|
|Auditor General for Wales|
|Andrew Griffiths||Cyfarwyddwr Gwasanaeth Gwybodeg GIG Cymru a Phrif Swyddog Gwybodaeth Cymru|
|Director of the NHS Wales Informatics Service, and Chief Information Officer for Wales|
|Becky Favager||Rheolwr Polisi a Dull Rheoleiddio, Cyfoeth Naturiol Cymru|
|Regulation Policy and Approach Manager, Natural Resources Wales|
|Dr Andrew Goodall||Cyfarwyddwr Cyffredinol Iechyd a Gwasanaethau Cymdeithasol, Llywodraeth Cymru, a Phrif Weithredwr GIG Cymru|
|Director General of Health and Social Services, Welsh Government, and Chief Executive NHS Wales|
|Ifan Evans||Cyfarwyddwr, Technoleg, Digidol a Thrawsnewid, Llywodraeth Cymru|
|Director, Technology, Digital and Transformation, Welsh Government|
|John Fry||Cynghorydd Arbenigol Arweiniol, Polisi Gwastraff, Cyfoeth Naturiol Cymru|
|Lead Specialist Advisor, Waste Policy, Natural Resources Wales|
|Mark Jeffs||Swyddfa Archwilio Cymru|
|Wales Audit Office|
|Matthew Mortlock||Swyddfa Archwilio Cymru|
|Wales Audit Office|
|Claire Griffiths||Dirprwy Glerc|
|Meriel Singleton||Ail Glerc|
|1. Cyflwyniad, ymddiheuriadau, dirprwyon a datgan buddiannau||1. Introductions, apologies, substitutions and declarations of interest|
|2. Papurau i'w nodi||2. Papers to note|
|3. Gwasanaethau Gwybodeg GIG Cymru: Sesiwn Dystiolaeth gyda Llywodraeth Cymru||3. NHS Wales Informatics Services: Evidence Session with the Welsh Government|
|4. Rheoli Gwastraff: Sesiwn Dystiolaeth gyda Cyfoeth Naturiol Cymru||4. Waste Management: Evidence Session with Natural Resources Wales|
|5. Cynnig o dan Reol Sefydlog 17.42 i benderfynu gwahardd y cyhoedd o'r cyfarfod||5. 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. Lle mae cyfranwyr wedi darparu cywiriadau i’w tystiolaeth, nodir y rheini yn y trawsgrifiad.
The proceedings are reported in the language in which they were spoken in the committee. In addition, a transcription of the simultaneous interpretation is included. Where contributors have supplied corrections to their evidence, these are noted in the transcript.
Dechreuodd y cyfarfod am 13:00.
The meeting began at 13:00.
Welcome to this afternoon's meeting of the Public Accounts Committee. Can I welcome our witnesses as well? As usual, headsets are available for translation or for sound amplification. Please turn off any phones. In an emergency, follow the ushers. We've received one apology today from Adam Price and no substitutions. Do Members have any declarations of interest they'd like to make at the start of the meeting? No. Okay.
Okay. Item 2, and we've got a few papers to note. First of all, the Welsh Local Government Association have provided some responses to the questions that were not reached during the evidence session on 14 October on waste prevention. Happy to note that letter?
Secondly, with regard to the scrutiny of accounts 2018-19, the Assembly Commission have now responded to the action points from the evidence session on 30 September. If Members are happy to note that letter and we will reflect the letter in the drafting of the report.
Yes, in the private session after this, we'll be looking at it. I've got some of the details here, so we'll look at that.
And, finally, on the papers to note, the Welsh Government have responded to my letter of 4 October, in which further clarification was sought on a number of issues in response to the committee's report. Auditor general, did you have any comments you wanted to make on that? No. Okay. So, if Members are happy to note that letter and agree the suggestion from Dr Goodall that the next update is received at the end of May rather than April 2020, when a full year's validated data will then be available. Good stuff.
Can I welcome our witnesses? Thanks for being with us this afternoon. Would you like to give your name and position for the Record of Proceedings?
I'm Andrew Goodall. I'm the director general for health and social services in Welsh Government.
I'm Ifan Evans, director of technology, digital and transformation in Welsh Government.
Andrew Griffiths, the director of NHS Wales Informatics Services and the chief information officer for Wales.
Great. We've got a fair number of questions for you. I know that time is limited, so, if at any point I'm moving things on, it's just so that we can get to some of the later questions. I'll start with the first few questions for you. Your update says that there's been good progress over the course of this year, but the detail is largely about reviews and announcements. In broad terms, what assurance can you give us that progress is being made to improve the delivery of informatics on the ground and that the frustrations in the service are being heard and acted upon?
Chair, if I could respond to that in a couple of ways, I think to be able to comment first of all about the completion of the review processes that led, ultimately, to the ministerial statement that took place at the end of September. And perhaps if I could just reflect more generally on how we're looking to change the system itself, rather than just the national direction and approach.
Obviously, we have a context of significant reviews and reports from the parliamentary review. We've stated our intentions for digital approaches within 'A Healthier Wales', and have responded and given you updates for the Wales Audit Office and also from your own recommendations. I do think, Chair, that we have made progress against what were pretty significant recommendations, requiring our system to be led and changed in a different way. I hope that you will have seen the Minister's announcement at the end of September; there were some very significant commitments that were provided in that, including a new national organisation with a digital responsibility in Wales with a special health authority status; also commitments that came out of some of our reviews, not least around a chief digital officer. We've also had to maintain a process about still trying to improve the way in which we prioritise within the system. We've allocated additional funding, with ministerial support—£50 million coming in as part of 'A Healthier Wales'—and we've been able to commit some of that spend through this year as well. So, 11 out of the 17 recommendations are green or amber. Those that are, for us, in our own assessment, red at this stage, were really because they had to await the outcome of the architecture review and the governance review, and they themselves needed to take time.
You wanted some reassurance about how we've made sure that we've worked with the support of the system, given that there were tensions that came out, both in evidence sessions and also in terms of the recommendations themselves—
Yes, time: you mentioned time and that's the key issue here, isn't it? We appreciate that there are efforts to correct all of this, but this has been going on for a considerable length of time now.
Indeed and, really, a fundamental shift and change in the way that we've wanted to deliver this, but we have spent a lot of time, therefore, with stakeholders—those who are involved in the reviews—very participative, making sure the clinical voices are around the table as well as the organisations. We've wanted to make sure that there has been much more participation in the room together between local organisations and the national structures as well. And, as those two reviews were completed, we also wanted to make sure that the likely recommendations that would end up being considered by the Minister actually were also done together, rather than just a national decision that was made that would have come through us as Welsh Government, through the Minister, or through other organisations as well. So, I'm sure that, when I provide the next update to you, we'll be able to give you some reassurance on the residual recommendations that haven't quite got over the line to be green or amber, but just to advise you they were formally linked to the two governance reviews, and we did need to wait for the Minister's statement, which was just four weeks or so ago.
Great. Why is it necessary to have four further reviews related to informatics, given that the problems are so widely known, and what exactly will it achieve?
There were two very fundamental reviews that happened, and the digital architecture review took 12 weeks, and we needed 24 weeks to complete the governance review. They were the most significant, I think, in terms of the change to the character of the system, including some of the structures and our approaches as well.
The reviews that we've focused on now, in respect of areas that include workforce and communications on the infrastructure side, and also around commercial developments, I'd rather describe them as reviews not about the analysis, but reviews in terms of what the next solutions look like for those areas. The workforce review itself needed to make sure that it would take account of a focus around digital that is going to be in our workforce strategy for Wales. That's not only about digital skills for those who are the technicians who have that expertise; it's actually about raising the digital literacy of our health and social care system in Wales. So, we needed to make sure that that was aligned.
We're still not going to do all four at the same time—there is a bit of a sequence— but I also think that one of the most significant ones is actually our change around how we deal commercially in the digital space. Given the concerns of the committee about agility and our ability to respond as a system, I think the way in which we have a different set of relationships with those who are innovating and developing, including our commercial contracts, is quite important. I don't know if you want to just highlight, perhaps, a couple of those reviews, Ifan, just at the outset.
Yes. If I could just say to begin with that I think reviews are important, recommendations are important, and, as an incoming director, I've certainly found both the Wales Audit Office and the PAC recommendations in reports very useful in framing my lines of inquiry, I suppose I would say. The breadth of those recommendations is quite intimidating, because they do cover everything, more or less, that we cover in digital health and care, and it's a very large and quite complex arrangement. And, quite early on, inheriting the architecture and the governance reviews, they didn't cover everything that was in the two reports and, had they done so, they would have been quite diffuse. So, I think it's important to have a clear scope. Based on those two reports themselves, the architecture review and the governance review, and also the engagement that we've done with stakeholders afterwards, they've highlighted quite a few things that we need to have a further look at.
We're doing them in sequence, because I think there is a natural order. Doing them all in parallel—they're so interdependent with each other that we need to sequentially lock down some certainty in the system. A lack of clarity and a lack of certainty was—
It will. It will, inevitably, add to the time.
By what date do you think the final one will have been done and we can get on with seeing some changes?
So, we're aiming—. Well, we are seeing changes as we go. I think the architecture review has already introduced several changes. The Minister has confirmed those, but we've been doing quite a lot of engagement around those already. The infrastructure and the workforce review are the two that we're looking at first. They will lead to plans, and we're looking to complete those by the end of March or by early summer next year, to inform the new special health authority. And then the commercial and the communications strategies will follow thereafter. We're in a slightly different place on communications particularly, but also on commercial, and this is highlighted in both the PAC and the WAO recommendations that we need to develop our engagement with the supplier market. There's more change needed there, which is why it's a strategy as opposed to a plan.
But, on the commercial side of things, it's probably worth saying it's not just about how we pause and just wait for support on the solution side of things, we've been doing quite a lot in that space anyway—so, work around digital ecosystems, bringing in innovation from within Wales. In fact, there's an event that's happening next week; there are 100 attendees. That covers commercial partners. So, I just want to reassure you that we're not just waiting for an endpoint; we do need some of that external expertise, as I think was highlighted in the original recommendations.
There is ongoing work, and it brings it to life, actually, in terms of what the final document should say.
Thanks, Chair. Could you expand a bit on your approach to developing an electronic patient record and, in particular, the term you use of an 'open architecture' approach? What does that actually mean? And if you could also mention a bit more about the commercial strategy—how that will work in practice.
First of all, just to open up, I think probably a distinction that we'll bring through now more, linked to 'A Healthier Wales', is using the language of an electronic health record, rather than the patient record. I think the patient record, which is the old label that we used to use, conveys a system that is only really focused on the patient moving through that kind of hospital environment and the NHS on its own. Increasingly, of course, we're talking about a record that is across social care and health, and we're also talking about using patients' health records for supporting well-being; it isn't just about access to treatment, as I said, going through that traditional hospital system.
You will have seen both in our evidence, but also if you've been able to check any of the architecture review information—just about the commitment to open architecture approaches. Ifan, perhaps I could ask you to define that for Assembly Members, and then we can obviously respond to some of your questions on that.
So, you'll see from the architecture review that there's a fairly detailed setting out of what that open architecture is, and we've endorsed the report in its entirety rather than parts of it, in order to be able to communicate more clearly. It was a very well-received review by technically-minded people and by lay people as well across the system. So, it was well presented, we felt. Because of that, we've decided to go with that as, if you like, a full blueprint, which is what the report itself recommends, and there's a programme of engagement that includes the event that Andrew referred to next week, which is supporting understanding of that.
In terms of the general characteristics of open architecture, I think I'd pick out a few things. So, one is about a far more public description of how our systems are designed, and, eventually, some of the code base that underlines those—for the code that we develop ourselves, but obviously not the stuff that we purchase from external vendors and commercial partners; much more modularity and reusability of systems that we have, so that we're not inventing from scratch each time; far greater compliance with standards, more definition of standards—where possible, international standards, so that we can still access the wider market; if not, UK standards, so that we can interact with other parts of the NHS across the UK, which we do routinely and very closely in terms of data, but operationally as well—and a clear process that allows third parties, particularly developers, start-ups, small and medium-sized enterprises and others, to innovate on to that open platform.
It's very much about publishing stuff—allowing other people to see how you're doing things and what you're doing, but it's also about having, by publishing, a degree of certainty and stability around how systems inter-operate with each other so that there are no shortcuts because, over time, shortcuts, although they might get you to where you need to be quite quickly, they add unknown complexity, and then it becomes a situation of having to bug test, a concept that is used in the architecture reviews around the technical debt of doing that sort of thing—so, bringing a lot more defined clarity, I think, across the system.
But, as I say, it is set out very clearly in the architecture review. It talks about the characteristics of an open system. It talks about the components of a system. It talks about how we step sequentially through those different components as architectural building blocks. So, there's a considerable amount of detail there, and, rather than taking the review and reinterpreting it, we're taking the review as it is so that we can move more quickly.
It is. It—
But it will move us away from a reliance on single vendors and single systems. So, it is intended to respond to the recommendations that the committee was making, which is, again, to allow for agility. Having said that, open architecture has to still come with rules, so there have to still be ways in which users, of course, but also the developers, can interface with systems. So, whilst it will give us some agility, there will still have to be clarity on the national specifications.
If I could pick up the second half of the question, which was around the commercial strategy, we have a strong emphasis on procurement, and we have a particular emphasis on the procurement process—how a business case leads up to a procurement process to a full business case and to other things. Increasingly, the Welsh Government is looking at how we can pursue policy goals across multiple portfolios. In the other parts of my role within the Welsh Government, I've done a lot of work with the economy department and with the universities as well about how we can use what we do in health to bring benefits for innovation, particularly for SMEs, for economic growth and economic development. So, as well as what the recommendations in the WAO and PAC reports are raising around the need to understand the market in a more sophisticated manner, and what it says in the architecture review about making Wales an attractive market for suppliers to compete in, it's also important that, as we procure, as we engage commercially with external suppliers, we can do that in ways that encourage or support our own indigenous companies to grow and to work onto an open platform, so that we can have spin-outs from universities, so that we can have a more innovative approach and a stronger and more resilient ecosystem, I suppose, around the digital services that we have. Because they're very, very large. There are many tens of millions that are spent on digital services in Wales, and it would be good to see more of that benefit being shared out to small, agile companies around the NHS.
On that very point. We've got lots of expertise in cyber security in Wales, is this expertise transferrable to the sort of systems development that you want to see for the NHS?
It is, and there's a strand on cyber that is included in the digital priorities fund. There was a review undertaken last year—a review of each of the health boards and of NWIS itself. We also worked with the National Cyber Security Centre on a UK basis to support the way that we're developing there. I'm not sure how much of that is engagement currently with the cyber community around some of the large companies that we have in Wales. There are other initiatives across the public sector, around Thales for example, and other areas where we're developing cyber, and many of the skills in cyber move across multiple sectors. I think that the role of the chief digital officer for health working with the chief digital officer for the local government that was announced last week, and the chief digital officer for the Welsh Government as well, will help us to navigate some of the cyber areas that apply to all public sector bodies in broadly the same ways.
Okay, but do you think there'll be an appetite for local companies to want to bid for these services once you've decided exactly what you want?
Well, I'm from a private sector background originally, so I'm sure there'll be an appetite from the companies. The question is whether the architecture that we have is an open platform that allows them to do that. And at the UK level, Government digital services and others have really emphasised open standards as a mechanism for allowing smaller companies to engage, because the more complex the system that they need to engage with and the less clearly defined and the less published it is, the more that advantages large companies that have got the resources to invest in getting to understand that relationship and that context. So, a published set of standards and a common architecture is something that should help smaller companies to engage more productively with our NHS systems.
On cyber security, I was only just going to make the general point that when we had the WannaCry issue a couple of years ago, one of our advantages in Wales was just simply about the fact that because we had a national infrastructure we were able to respond quickly and patch up at that time. It wasn't really to pursue the individual issue of the companies, but of course we want to create a more flexible environment and we are going to have to have different approaches to our procurement, but also we're going to have to look at different ways of developing our business cases as well to make sure we're able to bring some of the suppliers along with us in that development.
I think I'll incorporate it in my line of questioning later. Thank you.
Thanks for those answers. The review set out a three-year timetable for delivering the target architecture. Given the history of delays, what do you now expect to see on the ground at the end of the three years and how closely is that going to resemble the initial vision for—I was going to say an electronic patient record, but I'll call it what you said—an electronic health record?
Firstly, I don't know whether Members would have had an opportunity to look at the governance review information. There's an overview as well as some more detailed supporting areas, but I think what's quite helpful about it—sorry, the architecture review, not the governance review—is that it actually has not just given an assessment of the current state, it actually allows us to understand what are the steps that we can take over the next three-year period and whether that is achievable or not. I think we would have to allow ourselves to ensure that what the system has done is to respond to some of the concerns that have been expressed and make sure that we're able to live up to the statements around digital that are in 'A Healthier Wales'. I know that's a 10-year vision, but nevertheless there should be some key milestones.
Some of the things that I would expect to perhaps feature more strongly would be, broadly: a more accessible range of services for public, patients and professionals, so that we're able to demonstrate that we're using the digital architecture in Wales; a modern digital platform, which means that we can balance the use of mobile-connected devices that are used by health and care professionals; but also we have focused on other issues like the national data centre and cloud infrastructure—I think that will be quite a significant shift. I think a balance on how we've delivered 'once for Wales'—we've already taken approaches through the commissioning of Office365 for the whole of Wales, with 100,000 users, which is going to be equally cloud-based, as well as our approaches to the national data resource centre to make sure that they are 'once for Wales' issues. But I think it's demonstrating that it's not about single systems and single suppliers, but this use of standards and making sure that we have an interoperability around those standards. I think there's still a closer engagement with users, and also with the public and professionals. We still have to lift our systems up to the ways in which we are interacting with digital in our day-to-day lives, and at the moment, some of the offers that we're making, whilst they work, are not in line with our experiences elsewhere across other sectors at the moment. And I think, also, there's more intelligent use of information and the data that's available. There's a lot of clinical data available, patient-based data and management data at this stage. We are able to provide a level of data, internationally even, that is beyond some of the systems who participate in schemes, but there is always improvement that we need to do.
And my final comment, to respond to your question, is that whatever we do, it has to be about secure and resilient systems. We have to have systems that are able to do all of those above areas that I've highlighted, but we have to do it with confidence like the systems that are in place.
Of course, and thanks for that. Now, I'm going on to timescales—you told us in the past that there was going to be a three-year delivery plan for informatics from the end of 2019-20. Was that plan developed, or has that been superseded by the digital architecture review?
We did produce an informatics plan for 2019 to 2022. This was to continue to build on a much more collective conversation that we had highlighted in previous evidence and attending here around the table, making sure that we were balancing the local organisations as well as the national organisations. We wanted there to be clarity running into the financial year. There also needed to be some reflection that issuing 'A Healthier Wales', a year ago in June, was an important development about our strategy for Wales, which included expectations on the digital side, and we also wanted to make sure that we were able to still continue to prioritise our use of resources as well. So, that is in place.
We’ve also underpinned it by, I think, better assurance processes around plans that come from individual organisations. It's not all about what NWIS do—it's actually about what the individual health organisations in Wales do. So, we now have strategic outline programmes in place; that gives us a pipeline of digital developments in Wales that we own on a national basis. But, inevitably, with the Minister making very significant announcements four weeks or so ago, we obviously will still need to adapt and change. So, whilst I think that was a good start, it has to now reflect the Minister's statement from four weeks ago, and that's where some of the new use of the digital funding in the system is going to be used and applied as well.
You mentioned the need to sometimes balance what you do with local decision making. There has been a view in the past that NWIS has been tasked with doing too much with only limited resources. So, are there specific things that you have stopped doing in order to deal with that situation?
First of all, it's quite clear within the prioritisation process—and again I emphasise that this has been done collectively rather than only via individual organisations—that there are some areas, if we wish to increase the pace of implementation, that do require additional resources or us to drop some areas. Our particular focus, however, was that there was a need, actually, to recognise that rather than try do more and spread it more thinly across an existing resource, we actually had the opportunity to invest more in the digital structures in Wales, both locally and actually through NWIS. And our approach has, therefore, been to have more focus on developing and increasing some of the funding that's available. So, as an example, when we have commissioned the cancer network information system Cymru system in Wales, and to change that to a national information system, we've put more money in to support that development approach in here.
I think that's also come with some good change in the staffing arrangements. So, again, since we initially started to come through the committees to give evidence, NWIS itself as the national organisation has been more than able to fill a whole range of vacancies. I know there will still be some issues about recruiting at the specialist level, but, actually, there are 160 extra informatic staff who are actually within NWIS itself as an organisation. So, again, we've tried to balance, yes, prioritisation, but what we have also done is found additional resources to put into the system, and also protected those resources.
Right, thanks. Now, the review includes an action plan that had four key actions to be delivered within six to nine months. Could you quickly go through those four actions and give us an update on how you're progressing with them?
Okay. Ifan, do you just want to give a personal overview?
Yes. So, I was the senior responsible officer for the architecture review and I had a conversation with the contractors. They undertook their work very, very quickly, within 12 weeks or so, and I had a discussion with them around stretch targets and stretch ambition, and we've gone with them. I approved, I suppose, as an SRO, or endorsed, quite an aggressive timetable, and that was off the back of their description of our current state, which was described by them as relatively robust, but not—crucially—in the position that it needed to be to deliver against all the ambitions in 'A Healthier Wales'. That was the reference point that we'd given them. So, they've come up with a two to three-year plan. There are a whole set of actions in the third annex to the document around implementation options, and as I mentioned previously, we've decided to go with them as a whole. Some of that work, the engagement around understanding of the architecture review has been done over the summer, but the bulk of it has not been done before the Minister has made his decision off the back of the architecture review. The review is recommendations to the Welsh Government. It doesn't in itself have status in the same way as a Welsh Audit Office or a Public Accounts Committee report.
So, we're not six months in, even though the review was completed at the end of March—we're four weeks in. The event next week is part of that work, and the work that the Welsh technical standards board are doing around defining the architecture and some of the framework for the architecture are already in place. There's a work plan there; there's a draft document from the end of September that they've put together. But I wouldn't say that we've made very significant progress in advance of the Minister's decision, but we will be seeking to make as rapid progress as we can over the next four months and six months. There's always a limit on that and there are external factors. Brexit, particularly—I'm very conscious of that because that falls within my director's portfolio. We've got a little bit of headroom at the minute, so we'll see how much we can get set up before Christmas, but there are inevitably pressures. Recruitment is always a challenge. I can reassure the committee that we've been discussing these and working out how we can address them because we want to go quickly, just as I'm sure you want to go quickly, and as the NHS wants to go quickly and NWIS wants to go quickly. But we haven't done it in advance of the Minister's decision, I think, is the key thing that I want to emphasise.
Thank you very much, Chair. Good afternoon, the committee here. Could you explain in more detail the thinking behind the making of the NHS Wales Informatics Service, NWIS, into a special health authority? What are the main benefits and the key risks? Could you also outline the timetable, please?
So, again, 'A Healthier Wales' remains our context for the areas that we want to take forward. That's our strategy for Wales, whether it's through the digital lens or through the development of our other services, but it was very clear, obviously, reviewing the recommendations of both the committee and the Wales Audit Office, that there was a need for a different focus on the governance arrangements, and I think, as we were looking through options—and, ultimately, it was for the Minister to decide what structure he wanted to be in place—actually, the creation of the special health authority was probably the strongest arrangement to allow for the governance to be discharged, I think, in the spirit of the committee's recommendations, and I also accept the commentary from the Wales Audit Office.
The hosted mechanisms for NWIS hadn't worked as intended, and I think that was clear, again, from reflections at the time, maybe because of the construct that was put in place, rather than actually through NWIS as an organisation, because, ultimately, it was a hosted body. And the Minister, in deciding which option he wanted to proceed with, was persuaded that, actually, the creation of the additional organisation for him balanced how he could have an organisation clearly enabling digital across Wales, but he was able to have a better governance approach on there.
So, the advantage that that gives us is better clarity on the accountability line via the chief executive arrangements and how that would report into the system alongside other organisations in Wales. I would argue that whilst you can look at it only through the digital experience, our creation of Health Education and Improvement Wales as a workforce organisation I think had created us some confidence about the capacity that that has brought within the system, and we see the same opportunities here.
And, thirdly, in a small system and for a population of 3 million, and still with about 90 per cent of our systems not defined nationally being brokered through all of the system in Wales, there's still a need to have a clear, national platform, which he was persuaded could be discharged with that kind of arrangement. So, if you think about how we deal with other organisations in Wales, it means that the information and the board meetings are happening in public, it means there's a clarity around the nature of those papers and the decision making, it means that there are independent members in place. There's a chair mechanism that reports directly through to the Minister. The chief executive will have an accountability to me also, as other chief execs in Wales do, and it just seemed the strongest response, and probably it may have been a little bit beyond perhaps what the committee might have anticipated. We possibly could have ended up retaining a different hosting arrangement, but this just seemed to be clearer, even though it will itself come with a challenge about how we establish that very quickly.
And on the timings of it, we're aiming at this stage to look to establish it probably no later than mid year. We are looking to see whether there are options to bring that timetable forward, because we're going to be supporting NWIS as an organisation in that transition. But, again, as Ifan said, there have just been some other factors that have been taking up some of the necessary time, and, ultimately, it's still about being able to follow through on the legislation that would be required for that. So, I'd be aiming for possibly going for October, but seeing whether we could either bring that through properly, because we can finish off all of the legal requirements or maybe just to run a shadow mechanism at that time.
Okay, thank you. The digital governance review seemed to have rejected simply putting NWIS into a new structure and favoured more radically reshaping digital functions across NHS Wales or bringing a wider range of functions into a new single body. Why did you decide not to go with these more far-reaching proposals?
I would actually argue that moving to a mechanism of having a distinct single organisation dealing with digital issues is actually more far-reaching than the proposal to break up the mechanisms that were described in the governance review. What I would also say is that it's where you have to take the balance of the governance review and the digital architecture review together, because there were different sets of recommendations that emerged around some of these areas at this stage. What I can say is that, as we try to see whether we're able to remove the operational business from the digital innovation, there were a lot of concerns within the system about how that would be disruptive in the wrong manner, and actually was not necessarily endorsed as best practice digitally. So, we were worried about following through that recommendation too purely at this stage.
Having said that, I think there is clearly still an issue or a need for us to be able to protect the balance of the day-to-day, normal business alongside innovation, and certainly our approach will be to make sure that that protection is given here. So, again, I know colleagues weren't have all worked their way through the two respective reports, but there were differences between the two reviews, and we ultimately went for this organisation because we actually felt it was stronger on the governance and transparency sides.
Okay. The parliamentary review suggested putting NWIS into a strengthened NHS Wales executive. What were the reasons for not adopting that option?
Well, the parliamentary review actually talked about a higher national profile and suggested that there were advantages of linking through to the NHS executive. It didn't actually talk about hosting it within that, and the distinction that we've given on this is actually importantly to recognise how we want the chief digital officer role to work. That will have a role to take responsibility and oversight of the standards in Wales, but we will be placing the chief digital officer actually within the NHS executive, and there needed to be some separation between that and the delivery side of the organisation, because they're going to have a broader all-Wales role and a responsibility for standards and outcomes.
I was expecting to come in on the governance review. So, if Andrew wants to call me in after the parliamentary review comments, then I'll do that.
-I'll draw colleagues in—that's fine. Hopefully I was answering the Assembly Member's question.
And how will you ensure that turning NWIS into its own organisation doesn't deepen the 'us and them' divide between NWIS and the service that was so apparent from the auditor general’s report?
I would hope, in part, by the way in which we've been handling the arrangements leading up to the Minister's statement, the response to the reviews involving stakeholders, making sure that clinical voices feature very strongly. I think some other approaches that we've taken, though, have been to make sure that we are endorsing a different approach around the expertise associated with our clinical informaticists across Wales. So, some of the development work that we've done to actually appoint nurse informaticians, for example, is important. The way in which we've created a chief clinical information officer network is also an approach here, because we do need to make sure that we're able to reach out and have all of the strengths and advantages of the local organisations, alongside the national as well.
But we've been very careful, and some of the delay that we'll have experienced leading up to the Minister's statement was making sure that, rather than just making a national decision, we were bringing the system with us at that time.
Okay, thank you. And how far have you gone in addressing the culture of self-censorship and denial that this committee identified in NWIS, health boards and the Welsh Government?
Ifan, you might have views on this, but one of the reasons that we've been trying to use the sequence of external reviews at this stage is to make sure that there is additional expertise that we can bring into the system that does give a reflection on whether we are making progress, or how we can best deliver some of the developments that are intended for Wales. If you read the governance review, you'll have seen that some of the information that's been promoted there is actually to try to set Wales in the context of international systems and development and to allow us an understanding of how others have worked their way through some of these existing challenges at this time. But I think what we've tried to do is simply find a straightforward way of working our way through the system and actually responding to the expectations for some quite significant change.
Now, as we create a new special health authority, there'll be a need for particular approaches to reporting that need to be more in the public domain, and we feel that by bringing that into the public domain through public board reporting, that's going to really help. I think we still wanted to track progress across the system. We do have a possibility to make sure that existing systems work at this stage, but the governance review did allow a statement about the extent to which Wales did have foundations in place, and their challenge to us is to say that they believe there could be very radical change over the course of the next two years, because we are building on foundations. I wouldn't want you to feel that's at all being complacent about the need for change in the system, but I think these ongoing external voices are quite important, just to make sure that we're going to continue on track. Ifan, I don't know if you have any personal reflections.
I think I've got reflections on all of those four or maybe five questions, because, as you can imagine, I've been very preoccupied with them over the last five or six months, and have also engaged very extensively with NWIS directors, with digital leads from organisations across the NHS, and the wider stakeholder community, as well as the teams on the governance and the architecture review, and with the Minister and policy teams inside Government, because there are many different views around how digital should have optimally been structured. The parliamentary review does give a stronger national prominence and profile linked to NHS national executive. The governance review, obviously, had a particular take on a shared-services arrangement.
I think the governance review was absolutely right conceptually, in that data and infrastructure, which is what it characterises as the shared-services element, should be separated from applications and services, and that is what the architecture review says as well—that's core to an open architecture, that you're separating the underlying informatics model from the way that people access that. What the governance review did was to translate that into an organisational structure to separate those two things organisationally. So, separate teams—both national teams. One would be a shared-services model, developing all the plumbing, and the pipes and wires, if you like—the business-as-usual services—and then, separately, under a chief digital officer, a national digital innovation service that would consolidate all of the innovation that happens in digital.
Now, personally, I didn't buy that, but neither did many of the people we were engaging with— stakeholders from across the system or others—and I don't think that reflects the way that DevOps, in a digital context, is usually conceived of. There is a very close link, actually, between operations and continuous innovation and continuous development. On top of that, the parliamentary review follows on from the Organisation for Economic Co-operation and Development review, which says that the key here in Wales is that we need to link local innovation with national direction. What the governance review was recommending was stripping out digital from health boards and from trusts, from what it called digital provider organisations, and consolidating all the innovation nationally, which, to me and to many others, felt quite far away from the front line, further away from clinicians, which is what the WAO and the PAC report said—we need more clinical and more user engagement. And that also permeates all the digital standards—more engagement with users, more front-line and more rapid, agile development.
Also, my feeling and the feeling of some others as well was that there is a risk in bringing in a CDO and giving that individual the job of innovating on behalf of the whole system, firstly because, again, as some of the recommendations and the governance review itself say, there is a risk, when you have very strong personalities in a system the size of Wales, but also that might allow other people to step away from innovation. In the digital world, you want everybody to be engaged with innovation, and you don't want anybody, really, in the system—health boards, NWIS or a national or local service—saying, 'Well, I can just carry on. Somebody else can take care of all the innovation and what's coming over the hill.' Everyone has to be engaged with it all the time.
That is, hopefully reasonably briefly, a description of why it is that we got to a different position to the governance review on that particular aspect. There are many, many other things in the governance review that we have adopted and you can see directly reflected through in the announcement by the Minister. And I think that the most encouraging thing is the degree of unanimity that we've had around this. The last question was around 'us and them'. There was—I was conscious of it, although not involved in it—a tendency to blame other parts of the system for things that aren't happening in digital. I haven't seen that over the summer. I've felt that there have been genuinely collective and collaborative leadership discussions, sometimes with a bit of honesty and a bit of challenge in that mix, but certainly the response to the written statement, the decisions that are in it—and there are some quite far-reaching decisions in there as well—has been unanimously positive and supportive on all channels, including some people who have been vocal critics of where we were a year and a half ago. So, I'm encouraged by that, because that is a necessary foundation for us to move on. We'd not be able to make faster progress if everybody's arguing about the direction that we should go in.
I think the committee recommendations were very serious and helpful for the system whilst we were trying to work on that, but it does feel that we have had to adopt a different approach to make sure that we can step towards the system, but also the system is able to separate through these recommendations.
I wouldn't say that everybody is always best friends and always completely agreed and in line on things, and I think actually it's important to have some grit in the system and different perspectives and different challenge. The important thing at the end of that process, though, is that everybody will agree on where we are. We've worked very closely with the community. It's not an enormous leadership community; we're talking around 1,200 or 1,300 people actively involved in the digital profession, if you like. So, it is possible to engage directly with a significant proportion of those, and my feeling, definitely, is that there is a consensus around the approach that we've set out and a recognition, which is also important, that there are challenges to go at. So, there's nobody saying that we don't need a workforce review, that we don't need a commercial review. My sense is that people absolutely recognise we need them and they're very much welcoming the fact that we're bringing some definition to that space, with a timetable so that we can work through it. And the experience of the architecture and the governance reviews is that we did very closely involve stakeholders all the way through, through the interviews and afterwards, to sense-check and to assure so that we can move on.
What have you done to ensure that the public reporting of progress and rolling out the new system is now more balanced? And how do you see the reporting of progress and performance working under the new strategic health authority arrangements?
Well, with the special health authority arrangement, it will allow us to ensure that appropriate information is handled in the public domain, not because it wasn't publicly available, but it just wraps the governance structure around it. The mechanisms that we have that underpin reporting in other health boards, trusts and other health organisations will be applied. So, it's the opportunity to make sure that there's a clear performance management framework, that there are quality and delivery mechanisms in place, that we'll be looking to sign off the three-year plans, which will give clarity on milestones that need to be reported on, the emphasis on the mid-year and end-of-year reviews that take place with organisations. We have all of that opportunity in the system to apply to it, to underpin that more public reporting.
And my final question: how do you see the chief digital officer role operating in practice, and how will it be different from the current roles of chief information officer and chief clinical information officer?
It's probably just worth us outlining the focus from the Minister's statement about the chief digital officer's role, and perhaps you can draw out some of the emphasis I gave earlier about the role for standards and outcomes, rather than delivery, Ifan.
I think the key thing is that the chief digital officer is an all-Wales role, setting rules for everybody who participates in the system. So, the one area of undisputed authority for the CDO, delegated from Government, because ultimately everything is the Government's authority, but from the Minister and from Government, is to set standards and to set the rules for interoperability so that everybody is playing to the same rules. And by 'everybody', that means NHS bodies, NWIS, vendors, third party developers, innovative universities, and everything. It is essential that everybody plays to the same rules, and we need an undisputed authority over that. Chief digital officers also have other important roles, but the Minister has defined in the written statement that the chief digital officer will also, if you like, own the future, so will have a strategic advisory role. 'Informed health and care' is coming up to four years old, I think, at the moment, or five years old, and it's important that we look to the future in digital, and the chief digital officer will have a key role in doing that, because that's something that relates to the entire system. It's not about individual organisations; it's about everyone.
When we get to the end of this line of questioning, but very briefly to add on to that, then, in terms of the overall mandate of this new post, which is very considerable across a very complex and multifaceted new system moving ahead, what sort of sanctions would the new role have in terms of being able to operate both the carrot and the stick, I was going to add.
As it's currently configured—. Well, if I just finish on the other two aspects. So, one is about digital professional leadership. That, again, is about workforce development in the round, around what the Wachter review says—I'm never sure how to pronounce it and I'm Welsh, so I say 'ch'; it might be the 'Watch-ter' review or it might be the 'Wa-ch-ter' review, I'm not sure—about clinical informatics, senior leadership, but also programme and project management skills, which is raised in the Wales Audit Office report, and other aspects of the digital profession, not the general digital literacy of the whole workforce, which is in the wider workforce strategy. And then, finally, to act as an ambassador and a champion of digital in Wales, again as a single all-Wales voice, not on behalf of any individual organisation. So, most of that is advisory, most of it is soft skills, I suppose, but on behalf of everybody.
There's a question, I think, that's still unresolved as to who exactly should wield the sharp edge of sanctions. So, if the CDO is setting standards, who cracks the whip? Does he or she have the power to force, and what does that mean in practice? So, they will sit within the NHS exec. The NHS exec will be very close to Welsh Government. As I said at the beginning, ultimately it's the Welsh Government's authority. The Welsh Government has a variety of tools and mechanisms—letters, health circulars and others—to impose and to enforce standards. So, exactly the extent to which that would be delegated to the CDO, I'm not sure yet, and I think we'll have to work that through. But the authority over standards on behalf of everybody, I think, is the critical thing there and, again, not to have accountability over delivery and a budget that deploys, because that will take that accountability away from the national delivery organisation and local delivery organisations, who need to remain accountable for delivering the services that they manage.
We do want the individual to be able to comment more freely on the system and the expectations. Whilst we want a system that can be agile and be innovative, it does need to make sure that people are playing by the rules, and I think they will have a role to orchestrate it, and it is a deliberate choice therefore to associate it not in the delivery organisation, but in the NHS executive function as we develop that to give clearer national direction and guidance, and then to be part of the sanctions and incentive system within Wales.
How will the chief digital officer relate to the chief executive of the new health authority in terms of structure and authority? And the second is: given the challenges of recruitment and limitations of NHS pay structures, are you confident that you can offer a sufficiently competitive salary to attract candidates with the right mix of technical and leadership skills and experience in the NHS?
On the accountability side, there is a clear accountability of the chief executive of the new organisation to me through the accountable officer arrangements. So, the chief digital officer will have a system-wide responsibility to comment. Clearly, they will be engaging and interacting with the chief executive and with their team, that they do not step into or oversee the accountability. That's a very direct route through to me. At the same time, just to be clear, that also means that the chair appointment, as is in line with the usual public appointments process, will be a direct line up to the Minister as well. Again, if I can emphasise the system leadership perspective, rather than the fact that they are suddenly directing and holding the system to account. Having said that, we do want clarity about concerns, and we want the CDO to feel able to communicate and share those concerns across the system.
On the ability to recruit at this stage, we have to work the post through in the normal way to be part of the pay framework arrangements that exist within NHS Wales. We are doing that piece of work to allow us over the forthcoming months to go out to advertise with a clear specification, but also that value. I would say that we'll have to wait and see. There are many individuals who are interested in this space and we'll have to test whether the pay framework that we offer is sufficient or not. What I would advocate though, irrespective of the salary issue, is the change agenda that is available to us in Wales, the opportunity to bring 'A Healthier Wales' to life around that, to have digital as a real, critical enabler. That is very attractive to colleagues who work in the system, and that ability to influence that level of change. But we'll obviously report back to the committee on the success of the appointment, and, at this stage, we'd be hopeful that we will appoint.
Thank you, Mr Goodall. And my final question is: do you expect there to still be other leadership roles for informatics within the Welsh Government and the lead NHS chief executive?
So, Welsh Government will still need to have oversight responsibilities. I'm the accountable officer for the system; that's why I regularly attend the Public Accounts Committee with you, and clearly—
Indeed; it feels like that sometimes. Also, of course, I would have directors who still have overarching responsibility, but we are trying to put in these very clear arrangements: a chief digital officer, who will sit within the NHS executive function, and also then a standalone organisation with its own reporting arrangements at this stage. So, I hope that that will give much better clarity within the system. It certainly steps up, I think, to the recommendations for better governance within the system.
I think the one outstanding question—and maybe this was more confusing in terms of how the committee had assessed this—was the role of the lead chief executive in Wales. I'd originally envisaged that to be more of a softer leadership approach, making sure that chief executives were able to have a representative voice around the table. I think I would actually see that the chief executive of the new national organisation would be the person who would facilitate that and take a very enabling approach. I've seen that work very well today with the establishment of Health Education and Improvement Wales as the workforce organisation, and I would probably expect that to be in place. So, I think my challenge to chief executives and to directors generally in Wales is that everybody has to be part of the digital agenda that will now have these clearer, national arrangements rather than a softer leadership role.
Okay. We need to make some progress. Jenny, do you have a very brief supp?
Yes, just quickly. Obviously you need to decide how much you're going to pay this person and what the person spec is, but there seems to be a bit of vagueness as to when you're going to get on with it. It's not rocket science. Are you saying that it's not going to be possible to advertise this post before Christmas?
We're not advertising it before Christmas. We're getting the specification clearly in place. We'd be looking probably for recruitment by the time we hit February, March, into the spring. There'll also be—
Because we wanted to be very clear about how it's embedded within the national executive development. That is work that is in train at this stage, and we have to make sure that it's complementary. On the specification side though, again, with the Minister's statement out of the way four weeks ago, he's given us the clarity that he's prepared to have a chief digital officer.
But as it was four weeks ago, how come it's not now possible to identify exactly what the person should—
Because we have to make sure that a new role, which is to have impact in Wales, is to the right specification to attract in the calibre of the candidates. We then need to just ensure that the post is appropriately worked through the paid framework, and we will do that as quickly as possible, but at this stage, because we're linking the post into the NHS executive, there will be a number of months that take place in that particular development. I'm very happy to report back to the committee, and in fact, Chair, if people want to see the specification that we've developed for it, just to know that the work has been completed, I'm very happy to share that with you.
That would probably be helpful to the committee. Thanks. We need to make some progress. Rhianon Passmore.
Thank you very much. In regard to the proposed delivery unit, obviously we're waiting on reviews—infrastructure digital, infrastructure digital workforce planning, digital commercial strategy, the communications strategy, and the many different strategies and proposed plans that are underpinning where we need to go to outside of the new post, and outside of the wider context of 'A Healthier Wales'. It seems very ambitious and aspirational, and where we need to be moving towards, and it is a big change agenda. In regard to the Minister's statement recently around the additional £50 million, bearing in mind that we are in a time of austerity and a very tight public purse, do you feel that that is enough jam to be able to spread across a very taught system, balanced against that big change agenda, not just in terms of structures, but in terms of workforce development culturally?
I think we have to find a way of labelling funds that are very specifically directed at digital, and with that label on, as we've been discussing here this afternoon. What I'm trying to generally do within the system though is make sure that when there is growth and allocation generally happening, and when we're talking about transformation and change, that it is perfectly acceptable for the system to realise that it is able to spend other allocations on digital as well, because, ultimately, digital isn't just about the buying of the kit or the expertise. Digital is about how it enables the clinical and the work practices to kind of change across the system.
So I am concerned that, having announced a material amount of funding, if we're not careful, although I think we've worked well with the system, people start to pursue the fund, rather than think about the way in which they'll apply the general allocation. So I've actually been more comforted and reassured to see that, actually, the system is approaching its investment in a variety of different IT and digital schemes across Wales, by recognising that they are part of their local allocations for organisations. So I think there is some progress.
The original exercise that we did to assess how short we are of what we need to have a fully enabled digital structure—you may recall evidence that I gave at the time—whilst it's a sum that stands out, it was originally intended just to try to bring a more collective discussion to the table, and for people to think beyond the year ahead of us, to genuinely think into the future, which I think has helped frame 'A Healthier Wales'. So, the £50 million itself is a very material increase in our funding; it's £0.25 billion over five years extra, on top of what we've got within the system. But I'd rather reserve our ability to check progress after 18 months, two years, and just see whether it is being applied as we would wish. But I do think that we need to allow people to say that they can invest more than that £50 million sum—they can use it from their local allocation. I think that's perfectly fair to ask.
Okay. Thank you. In regard to the £50 million, and the future NWIS, in terms of the special health authority, do you feel that there is a danger that if that framework isn't stipulated, the transitional costs and ongoing running costs could be sucked up within that particular mandate?
Ifan, you may want to comment in a moment, but if I just start to comment on that. I think, firstly, we have allocated within the £50 million some funding associated with the transition arrangements. Our experience of Health Education and Improvement Wales demonstrates there is a need to cover that off. And we've also allocated some funding associated with the reviews, because, clearly, they are going to be highly influential on our system and will help us with the solution side of things. The arrangements for how we will fund the special health authority on an ongoing basis, I think, are less about drawing on the £50 million; I think there are other funds and allocations that we can use for that. And so, getting the governance right around the table, those appointments, I see probably from a separate fund. But, certainly, the transition period we've established within that £50 million and it was outlined by the Minister back in September.
Okay. Thank you. In regard then to your written update, which outlines the alignment needed between NWIS's three-year financial plans and the ICT element of NHS bodies' spending plans, can you just extrapolate on how you see that in terms of those transitional movements, in terms of to the special authority, and how that aligns?
Well, firstly, the IMTP process has continued, so NWIS as an organisation provides its own plan to us, which we review and scrutinise. We've got a greater focus on digital in the guidance that we issued for the latest round of three-year plans, so we expect that to be much firmer. In answer to Assembly Member colleagues, the question earlier, I referenced the strategic outline approach that we've now introduced, so we actually have a digital pipeline available in Wales. I think one of our worries was that some of the local developments were being considered too much through the local digital workforce, and not enough probably at the board level. So I think we've managed to restate the ownership of that to make sure, for example, you would want your finance director to be very aware of very significant funds to be bidded at this stage. I think there is more openness generally within the system, about colleagues talking to each other as part of that development, and whilst we will be changing some of the committee structures in Wales, I think that in itself is important to respond to the recommendations. Some of the ways in which we've used the national informatics board over the last 18 months, actually, in developing a different approach, I think has been much more collective in its approach. But, Ifan, again, you've got your new experience of seeing the process work.
Yes. I think first I'd comment on the things that we've asked for in the IMTP framework and in the national IMTP that we've issued this year, which is about asking health boards and trusts to be clearer about what their own digital plans are, and also how that interacts with, or is aligned with, what NWIS will set out in its own plan. I think there's a balance to be struck between asking people to ring-fence digital as something that is separately identified and mainstreaming digital, which should be part of everything, as Andrew mentioned. Because digital is one of the primary enablers of everything that we do in healthcare—increasingly so—which is why it's so important, and why people get so frustrated when it isn't meeting the standards that they want, or the levels of performance that they're expecting. So, there's a balance there, but we are expecting more visibility. What I can say, over the last three to four months, is that directors of finance as a group have been more involved in digital than I understand they were previously. So, alongside their directors of informatics, they've been jointly working with us in terms of the prioritisation of how we allocate the £50 million as we go into next year. That has been very, very helpful. I think it's been very important, given the amount of money and the step increase that we're seeing—£50 million is a very significant amount in relation to historic spend on IT, and I'm very pleased that directors of finance have all been personally involved in this at that level, because it's important that we get it right.
Where we are at the minute is that, through those individuals, through directors of finance, directors of informatics, across the whole system from all organisations, we're seeing that integration, if you like, in-year, on the run. We've asked for a clearer setting out in next year's—or this current round of IMTPs that will describe things from 2020. But an SHA will bring a different mix into that. So, we'll be working very closely with NWIS and with Velindre and with others on the transition to an SHA. Again, there's a balance to be struck here about trying to make the initial transition as smooth as possible. There's the potential to disrupt and destabilise organisations as you move from one legal form—
So, on that particular point, you mentioned interoperability earlier on—there's an awful lot going on here in that regard. What do you think will be the biggest challenges in terms of a sea change culturally around mainstreaming to where we need to be, bearing in mind the context that we're in? What are your biggest drivers that would stop change?
Well, as Andrew will probably comment, I'm more of a 'glass half full' person, so I don't want to focus too much on the risks and the barriers. I've been leading innovation—
Turn it on its head: what would, then, enable you to make faster progress? Because this is at the root of where we are at, really—this scale of pace of this juggernaut that we're trying to manipulate into a faster, more agile beast.
For me, I think it's finding the balance in applying 'once for Wales' in the system, which is the use of the standards and the open architecture, as opposed to that there will still be areas where we have to call a national approach. I think that for me is probably the biggest change of the system that we're worked in. If you take the governance reviews and the way in which they've described our system, whilst it gave credit for foundations that were in place and developments that were perhaps appropriate for the time when they started, what is critical is that we end up with single-system solutions to areas. I think that is for me the biggest change.
That's a cultural change across the system, but I think our first examples of how we're implementing that approach are quite important. So, as an example, as we've been going through the cancer network information system Cymru commissioning and the purchase of the new system and those mechanisms, we've had to apply those criteria to that mechanism, working with the clinical staff, because that is a bit of a test about what is available and can we work through that open standards and architecture approach. So, that for me would be the biggest area of change.
If I could pick out two of the things that I've been trying to prioritise or to emphasise in the work that we've been doing with ADIs and digital leadership across the whole sector, one is about this sense of one digital leadership community, so I've been saying that I'd like to be in a position in a year or two where we're largely oblivious to the employing organisation of people who are involved, whether that is as teams working on code projects as squads, or whatever other terminology you want to use, or whether that is as programme boards and SROs—that it doesn't matter whether they work for an NHS organisation or for the special health authority, because we're all agreed that we're playing by the same rules with the same objectives.
And the second is about working in the open. That's the tag line that I've used. I've explored various other routes, but working in the open seems to be the one that's landed best. That covers everything from open source code, where it's code that we've developed ourselves, a clear definition of the standards that we're using—all of that out there—and the performance reporting on benefits and various other things, but also about being open about innovation at the very earliest stage so that people are sharing what it is that they want to drive harder against so that other parts of the system know that they're doing that. And that does two things: (1) it means that we're not duplicating effort and not ending up with multiple competing solutions, but secondly it primes the system for being able to scale out whatever that local innovation is.
So, we are very strongly committed, and 'A Healthier Wales' really reinforces this notion in the OECD that we need to innovate at the local front line and identify what is good and then scale it up nationally. Common standards across the system allows that to happen—cloud solutions, native web applications, various other things make that easier to happen—and I'd really like to see much more of that pace. It's a particular interpretation of agility in software development. But I'd like to see more of that pace, because digital is exciting. Digital is the most exciting space that we do, and I'd like to bring some of that energy back into the sector.
Well, at the moment, we are still working with the chisel and the slate, and doctors are having to act like vets a lot of the time, in terms of simply not having the information to hand that they need. So, I just want to remind us that the auditor general's report was pretty categorical about the frustration over the extensive delays in rolling out a modern informatics system. A lot of what you've been telling us just, I think, reinforces those concerns. We are not going to be advertising for this chief digital officer until February, and Mr Evans is telling us that we are not six months in; we're only four months in. So, why? Why is it taking so long for the report that was published in March 2019 to be implemented? It's a pretty clear report; I understand it.
To respond to concerns before that the system had different perspectives, was not co-ordinated, we needed to own it—to the extent to which we had two different reviews that we had to bring together, because they recommended different perspectives. It wasn't a single report that came out with a series of recommendations to handle. And, I think, as Ifan said earlier, when the ministerial statement happened, that was welcomed broadly across the system, both where there were concerns, where there were clinical voices, as well as where we needed to make sure that there was a balance between an action—
Because the processes required us to work through, and for the Minister also to make decisions and be persuaded about the way forward. He wanted to work through that during the summer period, and he made his announcement at the end of September. He had outstanding issues himself about the way in which he wanted to be assured that we would make progress, and he had very particular concerns that he expected to be dealt with in terms of having options around the structure and the governance side of things. That did take a lot of the time for him to be persuaded about the approach that he wanted to take.
Okay. Let's look at some specifics. What progress has been made on replacing the cancer system, CaNISC, which the committee had particular concerns about from the evidence that we had last time?
Ifan, do you want to just outline where we are on CaNISC?
Yes, certainly. So, we have considered the business case; the business case was submitted earlier this year. That's been considered by the Welsh Government. Welsh Government has confirmed the funding to CaNISC. Recruitment has started for the programme. We've agreed the timetable that there is, and—
—our prejudge. So, yes, the timetable is three years. It's a £7.5 million programme, and I'm sure that the committee would like it to happen much more quickly than that. I'd like it to happen more quickly than that. My team will be working with the CaNISC programme team to try to help it happen more quickly than that. But it's come off the back of a very robust business case process. It has a three-year timetable for a reason. There are risks involved in trying to compress or concertina a business case programme. And, as we seek to go more quickly, then we bring in—or we reduce the assurance that we have, and we reduce the ability that we—. We put additional pressure on to the system. All I can do, I think, is to assure you that I want to go as quickly as I can go, but I have got to balance that with appropriate assurance and the speed at which the system can go.
Although there's an announcement on Office 365, for example, that doesn't mean that every single person in the NHS in Wales will have Office 365 access four weeks following. It can't happen like that. There are 100,000 people working there. There's an enormous amount of work to be done in the background around active directory, around modernising devices, around enhancing their bandwidth and the broadband connectivity to sites because of a cloud-deployed system. It is a very, very complex system. There are 780 services that run across the system. Only 85 of those are national. I think that, seductive though it is to say, 'We need it by yesterday'—and we probably feel that, and I know that many clinicians feel that—there is still a pace that we need to go at that provides the level of assurance that we need around this.
So, all I can be is as transparent as we can there. So, CaNISC has been approved, has started, but there's a three-year programme for deploying CaNISC. It's not to say that some functionality won't come sooner; some already has. CaNISC case notes are being shared across the whole system through the Wales clinical portal, but there is still a three-year programme.
Yes. I would say that's an important interim arrangement. We've actually made sure that all of those records are now through the Wales clinical portal. So, we knew, when receiving your previous evidence, that was not available. So, it does mean actually we have access and it gives us some resilience within the system from that existing system. I would also say that the CaNISC replacement approach is actually being led by and driven by our clinicians. So, we've got the cancer network, who have developed that specification. It also went through a very significant market testing process, because obviously what we would have liked to have done is—if there was an available system that could have been purchased off the shelf then we would have done so. So, this reverts itself more to the process of needing to develop it, therefore, with protected resources. And that again is in line with what the clinicians have been asking for. So, they are happy with the progress, in terms of what they're looking for at this stage, and they obviously want the ongoing system support to make it happen—
—and that the funding is there.
Okay, thank you. So, turning to the other, more basic system, which is My Health Online, my constituents regularly say, 'Oh, the other practice over there has got it, why haven't we?' So, could you just explain what the latest position is on uptake, and what it's delivering so far?
So, if I could comment generally, and, Andrew, perhaps you could just report on the latest usage figures and developments. So, I think there are three aspects of My Health Online. The first one is how patients can access a system whatever the system, but just to make sure that they've got the access. The second issue is the ability of the GP practices and their commitment to make sure that it is available therefore to be used. And the third bit is: are the arrangements that we've got now going to be fit for purpose for what we need to do for the future? So, are there other opportunities to develop a successor to My Health Online more in the mobile territory, et cetera?
And, just to deal with the second issue of that, there was an issue that, whilst it was a national approach, some of the compliance within the system had been discretionary from GPs. What we can now report is—and we've also incorporated it within the general medical contract standards as well—that all practices do need to comply, and, on the latest reporting, it was at a 99 per cent level. I think there was a technical issue affecting probably one of the individual practices, and we have moved that very significantly from where we were back three years or so ago. So, it is—
Sorry to interrupt, but it's fair to say that the take-up figures are much lower than where you anticipated we'd be at this point in time.
Andrew, do you just want to talk about the take-up figures?
Yes, so the current figures—there are 350,000 people who've been registered to use My Health Online. The take-up historically is lower than we'd anticipated in the original business case. That's due to some of the factors that Andrew's already alluded to—that there was discretion for practices over whether they offered appointments or services via My Health Online. So, that has altered, and also again I think access to the clinical record was another feature that wasn't available in the beginning. We've now got a pilot running with that so that people can access their own test results, et cetera. But we do recognise that further work needs to be done in this whole area.
Repeat prescriptions is another area where I think we're seeing around about 75,000 repeat prescriptions a month going through on My Health Online. So, it is being used more and more, but we do very much see out of the new digital funds a real opportunity to get better patient engagement using digital tools and techniques, and that means a wider offering. So, currently, My Health Online, as you will be aware, gives access to GP systems. What we want patients to be able to do is interact with the wider health service digitally as well. So, there are plans in the new moneys to provide those facilities and to widen out that offering, which I think then will mean that the uptake will be greater, because I think the uptake is related to the degree of functionality—
On this point, Vikki Howells has caught my eye. So, Vikki, do you want to ask a supplementary?
Just a quick question. More and more GP practices are merging now, and I was shocked to discover from some local casework that, if you've got two practices that merge, one of them has used My Health Online and the other one hasn't, if they are continuing to operate with two different reception systems across the two practices, then they aren't able to use My Health Online anymore, and patients are unhappy about this, because what they consider to be a very beneficial programme is then removed from them. Is that something that you're aware of? And, if not, would you look into that to see whether there's anything that can be rectified within the system?
Yes, we'll look into that. One aspect of change over the years has been just reducing the number of GP systems across Wales to make sure that they're all able to accommodate it. It sounds like there's a bit of an administrative issue in there, but the policy should be no different, and certainly, as I said, it's been incorporated for this year formally now into the general medical services standards and the contractual arrangements. So, I think perhaps we could look to explore that and perhaps we could find a way of responding to that particular situation. But that surprises me. But, no doubt, we'll find a solution to it.
This is hugely frustrating, because people buy all manner of goods and services online. People have come to expect that they ought to be able to make an appointment with their GP rather than having to hang on to a phone at eight o'clock in the morning. It just seems such a huge waste of resources, both on the part of the individual person as well as staff managing health centres.
Indeed, that's why it's been put into the contractual arrangements, basically, so it's not a discretionary issue by practices that they have to work their way through, they have to have a system that works with their own appointment mechanisms. But I agree with you, I think that we need to acknowledge that the system that we have now does work and is effective, but it's not in the mobile technology route, which is why we do need to have some successor arrangements, as Andrew was describing, about how people get access. That's why we made it a contractual requirement within the general medical services standards and approach.
Okay. So, in six months' time to a year, we're going to see that there's going to be some sort of universality to this.
In the last three years, the users on the system—. I'm a user myself, and I've used the system to access it, in terms of practice arrangements, and whilst there may be some limitations about how people want to do it, it can be used to get in on there. But the users have actually doubled in size over the last three years, so we're up to about 350,000. It was 167,000. I think there would be enormous benefits from having this approach, whether it's with the label 'My Health Online' or not, I have, probably, a different issue. I think it's more important to focus on these more agile and mobile-based apps that can make sure that people can access it as well, and that's some of the work we'll be doing with the digital funding.
Okay. Well, I think we'd, obviously, like to be kept informed about that, because that seems to be crucial. Could you just tell us what progress has been made in adopting the Government Digital Service design principles, the agile approach to developing applications? The report by Channel 3 gives some specific examples, but maybe I'll come on to them in a minute. If you could just tell us about the generalities of how we are actually now adopting the agile approach.
Let me focus on the design principles. So, the GDS design principles and the GDS and the UK Government service design standards are quite high level, and they talk about a general approach to digital delivery and digital service delivery, about involving the user, about tackling these as a whole problem, about being open and about using interoperability standards and common architectures, about publishing open source code where you can. So, all of these things, I think, are very strongly reflected in the architecture review. The Welsh technical standards board, or WTSB as it's called, has done some work over the summer, as I was mentioning earlier, and has, at the end of September, confirmed a proposed architectural framework that draws on many of these, which gives a direct reference through into the service design standards, which were reissued by GDS in May of this year, I believe. So, we're making progress in those areas.
That is just a framing device though, for the changes that we all want to see within workforce teams and software agility generally. So, there's an agile business case and project-delivery approach, but there's also agile software that is itself based on open architecture, common rules, reusable modules, clear software development kits, APIs that are out there in the public domain, standard data schema and other things that make it far, far easier for people to engage. So, I think we are making progress. Digital health ecosystem Wales is a partnership project mentioned in the parliamentary review between NWIS and the Life Sciences hub, which has done a lot of work in terms of starting to confirm APIs, sharing those with the developer—
Application programming interfaces. So, a documented description of how different digital services and products can speak to each other, usually published in the open so that people can go off and develop on their own, without needing permission or special privileges to be able to do so.
So, I think there is progress there, but I want to emphasise that the design principles and the service design standards, they're descriptive, they're not really detailed, technical, specification standards like some of the messaging protocols that we would use, and they have a whole different set of acronyms—HL7 or FHIR and other things. These are descriptive of the way that we want to work, and I think we are seeing a move towards that, and we're definitely seeing an acceptance of that as the desired way to work, and a commitment from the whole community to go in that direction.
So, this new way of working is replacing the five strategic themes of the five-case model.
No, that would be a different process. So, we have a business case process associated with our capital spend in Wales. So, it works very well, it assures very well. It allows us to make sure that significant areas of public spend, of materiality, can be assurance-provided and they are delivered in the appropriate manner. There is feedback, however, within the system, and if you look at even the parliamentary review recommendations, a sense that the business case process in itself maybe isn't as fast-moving as is required. So, whilst it's a good way in governance terms of discharging it, there's some value-for-money concerns. It's not quite up-to-date and in line with the way and the pace of digital developments.
So, as part of the funding that's been announced, we've developed an approach about having a digital business case unit to try to lift up the experience and the expertise across the system in Wales. Our approach, which I described earlier, about having a digital pipeline of schemes that are ready to come off the books and having greater awareness of that also helps, but we will commit to just work through and see if there are some better alternatives to what has been a well-trodden but also a very effective approach to the way in which we spend capital. So, the five-case business model still stands at this stage, and, as I said, we would worry about removing it from the system because it's effective on public money, but I do think we need something that is a bit more convenient for a digital environment that is at a fast pace.
Also, can you put a timescale to when you're going to replace it with a business case delivery unit approach?
Well, I don't think we'll replace it with a digital business case delivery unit. I think that there are two things that we need to be very conscious of. The first two is that software increasingly is moving to cloud-based, pay-as-you-go bases, which are revenue rather than capital, but the five-case business process is principally a capital-oriented one. And, secondly, there's an increasing expectational demand that we are more agile, more responsive, changing very quickly within the life of a programme or a project. I think something like the national data resource programme is going some way towards that. So, it has an annual review and a refresh of its business case assumptions. So, it has been approved through the five-case business model approach, but every year it will go back and do a gateway or a refresh process just to check whether the assumptions and the context in which it is working still hold. It's a 10-year business case. We have confirmed funding for five years, and it will roll over that period. But it's built in, the ability for it to respond to the world around it, which I think is extremely important in digital.
The digital business case delivery unit will stand alongside the business cases that are coming through that process at the moment. It will help us to accelerate them on a prioritised basis, so that we're seeing a clearer pipeline coming through to us, and as it does that, it will also bring some additional challenge. It will eventually transition into more of a challenge process, which will bring clearer transparency on benefits realisation during the life of business case delivery and will support the, sort of, annual refresh check. Now, I would hope that over time that can start to refine the bricks and mortar business case approach for one that is more suited to revenue-based digital projects. I would hesitate to put a timetable on that. That may be evident two years, three years down the line. It may be four or five years. But it's not something that we can afford to get wrong because there are tens of millions of pounds going through this business-case process in the digital world alone, so we have to make sure that we've got a level of assurance. Before we move away from the existing business case approach, we have to make sure that whatever we move to is as robust, as assured, otherwise colleagues across the table will be asking some pretty hefty questions of us, I would imagine.
We are heading into the last five minutes or so. So, Jenny, do you have any more questions?
I just wanted to ask specifically about how you're going to bring all these 280 systems together or 74 national systems. So, there's a specific example given in the Channel 3 report that was published in March. You've got Patient Knows Best being used by three health boards and DrDoctor being used by Aneurin Bevan, and the Channel 3 report seems to indicate that Aneurin Bevan has got to be encouraged to converge on to a different approach.
So, I would have a different take, actually, on the report, because I think this is one of the dangers, that if we're not careful, we end up saying that we need to have a single system for everything in Wales and there is an underlying rationale for that, but that is the existing and old system that we were describing, that, actually, the Channel 3 review has criticised to say that there has to be much more flexibility. And if I could use the example that you've just given—
I think the way that we approach it at this stage—. And this is, again, through more of an open architecture and with some flexibility in the system, it may well be that our system is able to tolerate more than one of these systems—it may be two or three and there may be different opportunities for it. The key thing is actually that, what they can bring to the table is the patient outcome, and that's actually the standard issue. So, does the system achieve a patient outcome and can it be recorded? Can you track and measure the success? And, if the system happens to be Patient Knows Best or DrDoctor, then we tolerate that, because that's part of the local development rather than just national direction. So, I don't think our approach in Wales would be to translate nearly 800 systems all into a national system, I think that would really be repeating what we've been doing over these recent number of years. And that's why we've only got 10 per cent of the systems in Wales that are actually national anyway, because we haven't had that as our dominant approach.
Okay. So, basically, you're rejecting what they were suggesting, or am I misreading what they were suggesting?
I think there are things in the architecture review that you absolutely need to have: one prescribed source of data. You must have the same core information that everybody sees, but you can have multiple views onto that data. So, an example might be e-mail. I can read my e-mail on my Apple phone, through a web browser from anybody else's computer, or on the desktop Outlook client that I have at home. It's the same e-mail, but I can read it through several different ways. So, it's the same electronic health record, it's the same data, but whether it's Patients Know Best or My Health Online or something else, there may be multiple interfaces. And the architecture review says it's technically really important that we have the potential to have different interfaces, different views onto this data. There may well be policy decisions that say that for safety reasons, for training, for familiarity, for assurance and quality, we would mandate a single interface, or a single view onto that data, but technically, we should have a system that allows the possibility of having multiple views onto the same underlying data and infrastructure.
Okay. Finally, I just wanted to ask you about the latest information in the last 10 days that the contract for GP informatics from Microtest has been terminated.
Yes. So, if I start to comment and then, Andrew, perhaps you'd like to pick it up. Our process around procurement in Wales is established through a shared mechanism. That means that irrespective of the information expertise, it's something that's developed alongside with GP representation and with the General Practitioners Committee, I suggested there, and there was a very clear specification and systems were selected on the back of that specification. However, there is also a process that when purchasing systems, there is a clear set of expectations that the system is able to meet the specification even if it has come through that national process. So, Andrew, perhaps you just want to give an update, but also reassurance about how existing GP systems continue to be used.
The company you mentioned was a new entrant into the GP marketplace within Wales, so it had quite a bit of work to be done and there were some quite tight milestones for them to be able to achieve that entry. Unfortunately, we worked with them quite a lot and we were unable to get them to meet those milestones and, therefore, they couldn't satisfy the requirements of the GP system. What we then did, as you said, is ended the contract with them, but before doing that, we made sure that all the GP practices could use their existing systems for a longer length of time, and also, we put in arrangements to make sure that those were all safe and secure and that GPs had a choice over what system they were using. So, we're still working through some of those issues of how we'll take that forward. There are a couple of options for us in taking it forward now, one is to go back to the market again and see whether we can look for suppliers who can meet that specification, but we're still working that through, currently.
Yes, indeed we will. But, we will make sure that existing systems continue to operate, and we will always need IT suppliers to make sure that they're able to meet the specification. And I'd just like to emphasise that the approach that we took here was working with the GPs, the clinicians and obviously with the system, and the process that we went through for the procurement was always done through that mechanism, or we'll do the same again.
Okay. And, is it £40,000 that has had to be written off from the start-up costs or more?
Well, the company haven't been paid anything. Clearly, there's a cost to the delay because of the different arrangements, but we haven't paid the company anything.
Thank you, Chair. Data outages and resilience is an area that we've explored before as a committee and where we've expressed some concern. So, I just wanted to look at the most recent data around that and to begin with the incident at Blaenavon data centre, which appears to have lasted about four or five days. Could you give us some more detail on what actually happened there and what contingency measures were put in place?
Yes, I'll ask Andrew to comment. Just at the outset, really, it's important to say that this is a data centre that is not operated by NWIS itself. It's actually a public service data centre that was used more broadly. So, it's probably not quite in the same arena as the outages that you described before. Nevertheless, it was important that NWIS and other organisations in Wales worked through those issues. So, perhaps if you could outline that and also, perhaps, just be clear on some of the timescales.
Yes, okay. There was, as you indicated, a problem with the Blaenavon data centre on Saturday afternoon, where the air conditioning units failed and, as a result of that failure, the temperature in the room rose dramatically quite quickly and so systems were shut off. In that eventuality, all of our clinical critical systems failover to the other data centre. So, we have a two-data- centre strategy. The reason for that is because we recognise that incidents can happen, and so those systems then failed-over. Some systems were able to failover almost immediately; other systems, because of the technology and the way they're configured, necessarily take a longer time to failover. The system with the longest failover time is the laboratory system, and that takes around four or five hours to actually failover to another data centre. So, it's not a decision, as you will know from previous evidence, that we take lightly to do that failover.
It became clear to us in the afternoon on Saturday, when we became aware that the systems were falling over, that two things had happened: that the air conditioning had failed and also the monitoring of that and the alert for that had not come through as quickly as we would have expected. That being the situation, we made the decision to failover all available systems into the Newport data centre, because we were unaware at that moment in time what the issue was or whether it would reoccur later on. So, we started on that process and, by close to midnight on Saturday, or certainly the early hours of Sunday morning, all of the clinical critical systems were up and running.
We had some work to do then on the Sunday to try to make sure and test some of those. The GP systems were some of those as well that we needed to test and look at, and also some of the non-critical services we needed to review. What we then found is that, over the next number of days—three or four days—there were issues that arose as a result of moving all of the services from one data centre to the other one. Some of that was to do with network capacity, and we had to reconfigure some of the network capacity. Some things were to do with failure of kit that happened in Blaenavon as a result of the heat causing damage to the equipment. That meant that some of the routes through were changed and, for the load on the data centres, we had to tweak that over the remaining days. So, the impact of that was that, certainly on Monday morning, all those services were available. We had some issues with one of the GP system suppliers, where some of their services were still being run via Blaenavon, because of the design, which we then had to tweak through Monday morning.
So, there were various issues like that that occurred before we could say that all systems were now back as they had been previously. We worked with the data centre supplier to look at why those issues had occurred. We've done an external review of that as well. We're fully aware of what happened and why it happened, and we're working through some of what that means for us, moving forward. It was also a good test of our strategy of failing-over systems, which we do regularly anyway. So, our systems are tested to make sure that they can failover to the other data centre, but this was certainly a test of all of that happening at the same time. So, it was a big challenge for the team and I'm really delighted with all the people who came into work and absolutely worked flat out to make sure there wasn't a disruption to those clinical services as a result.
There are issues that it did raise for us, certainly in that, as we've been developing incrementally the services for clinicians, people are more reliant on them, as we're aware, and I think that really means that we need to reflect on the level of data centre coverage that we need. And so, as part of the infrastructure review, we'll be looking at whether a tier 2 data centre is suitable for the kind of environment that we're operating in. So, that will be part of that infrastructure review, going forward.
Thank you. And crucially, did any patients come to any harm or any significant inconvenience as a result of that data centre outage, but also of any of the other 16 outages related to the Cancer Network Information System Cymru and Welsh Laboratory Information Management System that you describe in your paper?
If I take the Blaenavon one first, clearly that was a particularly big incident for us, but in terms of the impact on patient services, all the services were back up and running in the early hours of Sunday morning. So, the only period where there was any gap was on the Saturday evening, and workaround arrangements were able to be put in place for those services.
I think we've made a big effort around resilience of our services since last year. We've worked previously on that, but we've continued to work and accelerated that. We've already had one example of where cancer notes are now replicated through the Welsh clinical portal. So, that means that if CaNISC is unavailable, clinicians can still see the clinical note. We're also looking at other resilience issues so that we've got a multiple supply of that data should one system go down, and we've put some of those in place over the last year.
We also do a full review of all incidents, so anything that means that a clinical system is unavailable, we do a full review that includes a root-cause analysis to understand why it happened and how we can make sure that that doesn't happen again. Also, that involves asking all the health authorities and trusts whether any patients have come to any harm or inconvenience as a result of that. And from all of those incidents, we've had no recordings of any patient harm as a result of those, and those have all been fully investigated.
It's probably worth saying that the outages reported for WLIMS and for CaNISC actually were very short, so they didn't constitute major, I think—
Yes. There were one or two that were a bit longer, most of them were of a short duration.
I know we're just about to come to a close now, but I'm just wondering, with Blaenavon, was it a stroke of a luck that that happened on a Saturday night? If it was in the middle of a week, could the outcomes have been different there?
I certainly would accept that if it had happened in the middle of the day then there would have been more disruption, certainly, but, on the other side, all staff would have been available, and it is also quite possible that we might have seen the alert sooner and been able to avoid it completely. So, it's a bit of a job to work through the various scenarios, but, yes.
Interesting. Thank you. My final question, and I know that, Ifan, in particular, you've talked around this, so I was just wondering if there's anything that anybody wants to add, really—. It's looking at the balance, really, between routine maintenance and new systems. So, is NWIS now investing more in routine maintenance and, if so, has this had any knock-on impacts for developing and rolling out new systems?
Yes, we are investing more in routine maintenance, I think, as a result of some of our experience last year. We're aware of the need, and it's the way that the technology is going as well, to keep on updating systems. So, more money has been put into that, and our teams make that a priority. The big thing I would say is that that is our No. 1 priority, to keep systems operationally running and, therefore, if there are issues, then, of course, it will have some impact. We've also tried to work with Welsh Government to make sure that we minimise that impact, and that's happened through additional funding that we've had this year to take account of some of those things, and also recognising that we've had an increase in staff to work on issues. So, we've been able to make sure that people are also concentrating on development, as well as keeping the systems up and running.
Good. By the way, on the earlier line of questions about My Health Online, I've got some figures here that show that the users increased from 220,000 to 330,000, but still way short of the 872,000 that was originally predicted. So, there's obviously progress, but some way still there.
As I said, Chair, I think, to some extent we need to look beyond the label of it. The access points, I think, can go there, but at least we have shown some increase and there's a material change in that. But I still think there is some work to do on the system. I think embedding it, as I said earlier, within the contractual discussions just changes the usage of it across Wales, as well.
Good. Thank you. I thank our witnesses for being with us this afternoon. That's been really helpful. We'll send you a transcript for checking before we finalise it.
Diolch yn fawr iawn. Thank you.
Diolch yn fawr. I propose we take a short break of five minutes to refresh, and then we'll have our second set of witnesses.
Gohiriwyd y cyfarfod rhwng 14:39 a 14:46.
The meeting adjourned between 14:39 and 14:46.
Welcome back. Can I welcome our witnesses? Thanks for being with us this afternoon. Item 4 is our evidence session with Natural Resources Wales on waste management. Would you like to give your names and positions for the Record?
Yes. My name is Becky Favager. I'm the regulation policy and approach manager.
I'm John Fry, and I'm the lead specialist waste adviser.
Good. As I say, thanks for being with us this afternoon and helping us with our look at this. I'll kick off with the first couple of questions. Thank you for your evidence paper as well, I should say. Your evidence paper notes that NRW is responsible for regulating the waste industry. Could you outline briefly for the committee the main features of that regularity—try again—regulatory activity?
Okay. Natural Resources Wales is responsible for providing a risk-based approach to the regulation of waste. So, any site that deals with, manages, treats, disposes of or recovers waste would need to have some kind of authorisation from ourselves, and, depending on the level of activity and the risk associated, there's a tiered approach in terms of authorisation. So, it can go from low risk, exemption up to a permit. With permits, we would undertake compliance activities on those sites to ensure that they're managing in accordance with the conditions within the permit. We also have a monitoring authority role with respect to the landfill allowances scheme and the local authority recovery targets.
You've mentioned monitoring. It's obviously quite an extensive role that you've got there. Do you think that the organisation has got sufficient capacity to be able to carry all that out effectively?
As I said, we do undertake a risk-based approach. So, we focus our resources according to the risk of the sites. So, we would focus on those sites that we would consider to be potentially the higher risk ones. So, yes, we have the appropriate resources to do that.
So, you prioritise. NRW's 2018-19 annual report suggests that you've seen an increased number of poorly performing waste sites. Why do you think this is and what challenges has this presented for your regulatory work?
Waste is a complicated sector to regulate. There are a number of different aspects to whether a site is managed well. An operator, if they apply for a permit, has legally committed that they would run that facility in accordance with that permit. The responsibility to comply with that is on the operator. We are there to monitor compliance and identify if there are non-compliances and what they need to do to come back into compliance. So—. Sorry, can you repeat that?
I think you've pretty much answered that. I just wondered what challenges it posed. I was going to ask you as well with regard to the waste infrastructure procurement programme. Have you identified any particular concerns with that?
We weren't heavily involved in the procurement process. We provided data and information to that service. I think, from our perspective, it has delivered or helped support delivery of infrastructure for local authorities, particularly to manage food waste and the residual waste at the energy-from-waste facilities. So, the procurement programme has delivered what it was intended to.
Yes, and what was needed as well to support local authorities in terms of moving the waste up the waste hierarchy, and ultimately help achieve the two sets of target—landfilling less biodegradable waste, and also improving the quantities of waste recycled, in accordance with the local authority recovery targets.
And finally from me, before I bring other Members in, do you see any risks in the fact that so many councils are reliant on the same facilities, and if a problem arose with that, do you think that there would be a knock-on effect then for councils across Wales?
It's difficult because there's an economy of scale, and, obviously, the waste industry will want certainty to invest in a facility. It wouldn't make sense that all types of facility are replicated in all places, because we would have too much. So, yes, there's probably a risk. However, if that facility is well managed and operated in accordance with the permit, then that risk, hopefully, should be low.
Overall, Wales seems to be making progress on diverting biodegradable waste from landfill, but how confident are you that all local authorities, particularly those in south and west Wales, will be able to live within their allowance for this final year?
So, the landfill allowance—I think we're pretty confident that all of the local authorities would meet their allowance targets for this year.
Yes. Ceredigion were very close, in 2018-19, to exceeding their allowance, but as I understand, for quarter 1, they were no longer sending the waste to landfill, so they were at most risk. So, we're predicting that all local authorities will be within their 2019-20 landfill allowance.
Okay, because, clearly, the objective is to ensure that no biodegradable waste is going to landfill—isn't it? And as this is now the last year in which local authorities are going to have landfill allowances, what is it that we need to get local authorities doing to ensure that they're going to be meeting that objective?
So, I think that's where the local authority recycling targets complement and take over, really, from the landfill allowances. So, in the drive for the higher targets, and certainly achieving 70 per cent, local authorities have to get more biodegradable waste out of the mixed residual stream, such as the food waste, which, in the composition analysis, is still a quarter of black bags. So, I think the drive for the recycling targets almost complements and will take over, and, as a consequence, the landfill allowance scheme has been almost superceded.
Okay, but if we've got—. It's also—. So, this is—. I think it's 25 per cent of the food that's in the non-recyclable waste—
—that's ending up in the wrong place. What leverage can you put on local authorities to educate the populations to ensure that they're not doing this, because we're not being able to recover the benefit of that food waste, and we're paying more for disposing of it in places where we don't need to dispose of it?
So, I think that's where local authorities are starting to do that, and they're starting to restrict the capacity of residual bins for the householders. And, again—
They're doing it—sorry, they're changing the frequency. So, fortnightly has been common for a couple of years now, but numerous authorities have now gone to three-weekly and four-weekly, and in doing so, that is making householders consider using, where they're not fully using, any recycling receptacle, which includes a food waste receptacle.
Okay. All right. So, your paper notes that there's going to continue to be certain types of waste for which landfill represents the best option, and, obviously, asbestos is one of those things. Are you confident that Wales will reach the 2024-5 target of no more than 5 per cent of municipal solid waste being sent to landfill?
I think so, because there's a number of energy-from-waste facilities coming online, which is obviously a step—in terms of the waste hierarchy, that's a step up from landfill. So, we've got one coming online in north Wales—
Yes. So, in terms of that residual waste, it will probably go to those types of facilities, rather than directly to landfill.
But if we do some crude mathematics, at the moment, we've got at least 30 per cent of waste not being recycled—it's residual waste. And we've got a target here of 5 per cent of municipal solid waste being sent to landfill. So, we've got some distance to go, have we not?
Yes, sorry, that is without incineration, or energy from waste, I should say. So, the recycling target is up to 70 per cent, but 30 per cent then is energy from waste or landfill, and that's where the gap is being currently filled by more energy-from-waste plants coming online.
Okay. Obviously, some people have concerns about energy from waste, and what comes out of the chimney. So, what is NRW's role in marrying up those concerns?
Our role would be to permit those facilities, and ensure that the proposed operation of those facilities, and the equipment that is being used, is compliant with the legislation, and is able to operate within the standards that we would assess against. Once the facility is operational, then we would be regulating by checking compliance of that activity.
Yes, very briefly in that particular regard. Obviously, there is concern about some of this activity, and there have been quite contentious cases recently—one of them in my own constituency, which I will try to speak more broadly around. So, what is your capacity, then, with regard to that—being able to monitor and evaluate the appropriate output from some of these facilities?
I'm talking more in terms of people resource. Do you feel that you have adequate capacity to do some of this?
When a facility is permitted by us, they have to pay us a subsistence fee; that's done on the basis of cost recovery. So, we will be receiving fees and charges from the operator, which will enable us to undertake compliance activity. The majority of conditions within the permit would be setting out what we would expect the operator to be undertaking, and we would be checking that. So, it's not necessarily us going to take samples—we would be ensuring that the operators are monitoring in accordance with the standards, they would need to get independent verification as part of that. So, there's an MCERTS—monitoring certification scheme—programme; we would expect that they've got that independent verification of the results that they would send to us.
Okay. And in the context of our overall commitment to be a zero-waste country by 2030, which includes not exporting our waste, could you just describe what the issues have been in terms of local authorities that have relied on exporting waste for recyclables, which has then led to some very adverse publicity, where, instead of being recycled, they've ended up on other people's landfill sites? So, what's been the impact then? Because people, when they recycle, want to ensure that what they are recycling then ends up being second-generation plastic bottles or whatever.
I think part of this is that waste is complicated, it's market driven. As I mentioned earlier, it doesn't make sense that Wales would have, necessarily, all the facilities within Wales to deal with every certain waste stream that we're dealing with. It may be appropriate that, for specialist or certain waste streams, we would be looking at a UK provision. But, yes, there is a reliance of exports outside of the UK for recycling green-list materials, so plastic, card, paper. Because there have been quite a lot of changes in the market, and some countries have introduced restrictions, we've been monitoring our sites—the ones that are permitted, that we know are exporting—to see whether or not there's been an impact in terms of stockpiling. So far, the market has adjusted, and materials have found a different final destination. And recognising there is concern around how waste is exported and it going to the appropriate facilities, we've been involved in a UK-wide trip to Malaysia recently, which was organised by the High Commissioner, to meet with Malaysia so that we can understand that whole waste flow and who needs to be doing what. So, it is something that we're aware of and are working with our partners and other regulators to—.
We shouldn't be exporting our waste to other people's countries, where they're much less able to deal with it than we are. So, what role does NRW play in ensuring that more materials are able to be recycled, because we know that some plastics are recyclable and other aren't? So, what's your role in either stopping the production of the currently unrecyclable or, alternatively, developing new techniques for recovering that material?
We are the regulator associated with the packaging regulations, so we would ensure that those obligated companies that are registered within Wales are meeting the requirements. So, that requires companies who produce packaging to ensure that they are collecting and recycling materials, depending on how much they're putting on the market—it's an obligation under that. So, we do have a role there. Does that make sense?
Yes, absolutely, because that will broaden it. Because at the moment, those schemes only pay for so much. So, the principles behind the extended producer responsibility scheme are to enable the full cost of collection. So, at the moment, local authorities obviously are picking up a lot of these materials. So, in future, there could be a different model that would ensure that that full cost of collection and processing would be met by the producers.
But you're saying that you still are able to strong-arm companies to pick up the results of their market activities.
There's a limited amount that NRW has direct influence over what people produce. We permit and regulate the larger industrial facilities, so places like Tata Steel, for example. So, as part of their permit conditions, they would be required to ensure resource efficiency and waste minimisation. So, we have an influence there. For sites where we do not have a direct regulatory remit, then their production and how they produce their products is limited.
So, that's where I think WRAP Cymru, who I think they came and gave evidence a few weeks ago—their role is far more focused on stimulating that change in behaviour at the production site, and that's obviously supported by things like the circular economy fund. But our role, I wouldn't say that—. It's a quite small part of what we do. The majority of what we do as a waste regulator almost is—in terms of this conversation, the waste has already been produced, so we are trying to ensure that that waste is managed appropriately so it doesn't harm the environment or human health et cetera. Once it's been produced, obviously we've missed the opportunity to ensure that it hasn't been produced, or that that can be reused or recovered in a different way.
Yes, on this particular issue. Obviously, with regard to procurement of services, and when we hear these stories about waste that is many, many hundreds of thousands of miles away, which we can identify may come from a particular area in Wales, it's very, very difficult to accept that. But in terms of ethical guidelines and the mandate of NRW, are you saying, then, that there is no oversight at all with regard to those supply lines and those subcontractors selling on to further subcontractors? And are you then telling this committee that you only deal with the very, very big guns in that regard? And if that's the case, who else would be following that?
So, I think what you're asking me about is how the regulation of exports is monitored from the UK to other countries. So, that is controlled by the international waste shipment regulations and, at the moment, there are green list waste, which are what I've mentioned earlier—plastic, card, paper—that can be exported from the UK without any notification to the regulator. So, we would not know when, or how much, or where that material is going out of the country. There are other materials that are notified to us. So, we are the competent authority in terms of waste that is exported either directly from Wales or has started its journey in Wales and transited through. Once something has been notified to us, then that, obviously, gives us the opportunity to ensure that that waste is appropriate. Because we’ve signed up to the Basel convention—I'm not sure if you're familiar with that—that's at least a European and maybe an international commitment of how waste is moving around the countries, and the requirement is on the competent authority of the receiving nation. If they found materials that were not meeting the standard, they would notify us and then a repatriation would happen.
Yes. If it started in Wales, yes.
Thank you very much, Chair. Good afternoon to you. Does NRW share the Welsh Government’s belief that, if applied optimally, its collections blueprint offers the most cost-effective, overall means of collecting waste from households?
We don't have direct experience of running a service, however, we're aware that Welsh Government has developed the blueprint based on evidence. So, we would support the adoption of that by local authorities.
And what benefits would you see in even greater consistency of approach across Wales, or how reasonable is it for there to be flexibility for local circumstances?
We were talking about this just now. I think, for me, it's about consistency of messages. We need to make this easy for people, so that people clearly understand what materials can be recycled and what they need to do with them, whether they're at home or in work, and I think that's where consistency is helpful.
And also, consistency is important for end markets and reprocessors. So, the production of high-quality, less contaminated material will be important for them as a feed stock.
Okay. And has NRW identified any concerns about waste disposal, notably fly-tipping, in areas that have reduced further the size of residual waste bins—you know, the bins being smaller—or the frequency of residual waste collections?
I'm not aware of any evidence that would link that, no. I'll qualify that: in terms of NRW and fly-tipping, the smaller end of that is dealt with, generally, by local authorities. We would deal with the more big, bad and nasty criminal activity. So, it may well be that the local authorities would be able to give you some information on that.
That's right. Thank you. What more could be done to encourage public participation in recycling?
I think, for me, again, it's about making sure that we are communicating the types of materials, the benefits of recycling to people, and making it easy so that they know what they can do and when they need to do it. I think, whilst recycling is really important, it still has a footprint. So, I think that the biggest challenge for us in terms of meeting the future aspirations of Welsh Government and Wales is more around how we move from a society that has very unsustainable consumption practices. You know, how we can prevent that waste being produced in the first place, I think, is a really significant challenge.
Thank you. What is your assessment of the role that WRAP Cymru is playing to support wider communication activity and how useful do you think the new MyRecyclingWales website is as a tool to support communication with the public?
I think the first question is what we think WRAP Cymru's role—
Yes. WRAP Cymru is one of our partners. My understanding is that their role is around communication and public participation, and that's part of their role and Welsh Government are funding them accordingly. I know that they offer local authorities—. They run a hub for the sharing of good practice between local authorities, and certainly, they've been running and leading campaigns like the Love Food Hate Waste campaign. So, they're very active in this area. There was a second part to your question, which was how useful—
The MyRecyclingWales website is a tool to support communication with the public.
That's a first-of-a-kind-type website and it is excellent for those purposes. It does provide transparency that you don't get anywhere else that I'm aware of, certainly not in the UK, perhaps globally. A householder can go on that website and can find out all the different collection types and the top destinations that key materials are streamed to, such as paper and plastic, which are reported as being sent by local authorities, all in one place. So, it is a UK-first and it does increase that transparency, which is essential for householders.
Thanks, Chair. Becky, you were talking about consistency. A lot of people are keen to recycle but sometimes find it confusing. Sometimes if people move from one address to another, there is a different system. I mean, I've lived in different local authorities and you can move somewhere and find that the system is completely different and it takes some time to understand it. But even within an authority like Cardiff, there are different areas of Cardiff that have different recycling methods. So, when it changes so much even within a local authority, how can you move towards that consistency, which would encourage more people to recycle?
And I've had a similar experience where I've been away to west Wales on holiday, and actually the information was brilliant in terms of setting out what could be recycled. What was missing was what day it was going to be recycled and when you put your bin out, so I actually took my bag home with me, because I knew the system. But I think your point, there has to be a way, whether it—. And I think local authorities are the experts in this area; they know their communities, they know the differences, but there has to be a way and a place, whether that's through the website or their customer hubs, where people can easily find out that information. It's really important, because if it's not there—
Yes. But, as an organisation, are you monitoring what the local authorities are providing?
No, we wouldn't monitor the communications side.
Thank you. In regard to the big question that you referenced earlier that was about prevention rather than firefighting and managing, and obviously your mandate there is very large, do you have any mandate, or would it be appropriate, do you think, that there should be a mandate for NRW, bearing in mind everything else that you do, for being able to work and drive manufacturing, work with industry in terms of innovating products that are going to, at the very source end, not deliver the amount of waste that we're all desperately doing quite well at, but we've still got a way to go in terms of where we wish to be aspirationally? So, is there a role for NRW around that? If there isn't, who is doing that? Would it be the organisation that we had in front of committee last week?
So, I think, yes, NRW is part of that role. As I mentioned, those people that come under our direct regulation, particularly when they're a producing industry, then, yes, we have a role. That's part of our regulation in terms of what they're required to do under their permit. The new regulations that are being consulted on now around separate collection, which will require producers to segregate their materials, we are going to be the regulator for that and we're expecting to be monitoring compliance. I think it's about—
So, outside of compliance, and I accept that that's positive, outside of that compliance regulatory framework, are you actually working with industry, manufacturers at source, in terms of how we provide goods and even services that are going to pollute less in terms of our mandate across Wales?
So, you'll be familiar that our purpose is around the sustainable management of natural resources. We have new posts within the waste policy team that are looking at a circular economy, and trying to understand where best NRW can play into this agenda and push it forward. I would see that WRAP Cymru, as the people that are funded by Welsh Government to stimulate this, are the—
Yes, but we would need to work with them closely, and I'm sure there are opportunities that we could work better, and—
Okay, because that would be my next question, if the Chair would be so indulgent, what is your capacity—
We also have a role in the public sector as well to be a leader and to drive sustainable procurement.
Okay. I'm sure we'll come back to that, if not in this committee, another one.
Okay. Thank you.
Thank you, Chair. How does NRW get involved with Recycle Week in Wales and other communication campaigns?
Recycle Week in Wales? I don't think that we would have a direct role. We would be part of raising awareness of that, so we would re-tweet the messages. We're obviously in the process of developing area statements, and we sit on the public services boards, so, again, we would use our representation in those places to raise awareness, but we wouldn't have a direct role in that.
Okay. Your paper highlights the WRAP report that suggests that the current street recycling on-the-go infrastructure is not being utilised correctly. Do you have a view on how recycling opportunities outside the home can be best maximised or increased?
The deposit-return scheme, I think, is one thing that will help, but obviously that will be limited to beverage containers, but it will certainly help to reduce contamination, the incentive being people would be able to get a deposit back if the proposal does go ahead and it is an on-the-go scheme. But, ultimately, there's a lot of waste being produced of different types as people are mobile. So, I think it comes back to, again, waste prevention and looking at those material types and saying, 'Is there a way we can prevent these?' The one that is high profile at the moment is coffee cups. A lot of the discussion tends to be at the moment—which is good, because it's high profile, people are talking about it—I think the immediate reaction is, 'Where can it be recycled, or what other type of material can it be other than plastic?' I think that discussion needs to move forward and become, 'How can we avoid producing this in the first place?' There are good examples of where trials have been done, a bit like the carrier bag, where instead of giving, potentially, discounts for bringing your own reusable coffee cup in this example, it could be that the normal price for a container is that reusable coffee cup, and people have to pay more for having a disposable cup. So, it's all about stopping the action of disposing of the item in the first place, just for a single use.
That's right, yes. So, it doesn't actually cost more, but the pricing is structured differently, so people can see that they are actually paying more if they do want an item to dispose of on the go.
It's going to take—and we're not the experts in this—a real shift in behaviours, of all of us. And I think we need some experts around behaviour change, to understand what it is that will help to push people in the right direction.
Okay. And, finally, do you share the Welsh Government's view that existing legislation is sufficient to support enforcement, and what do you see as the right balance between the carrot and the stick?
So, we work very closely with Welsh Government around existing legislation, particularly environmental permitting regulations, and improving those so that we have a stronger ability to ensure that competent people get into the industry, and that we can ensure that they are technically competent to run the operation. So, we're working with Welsh Government to improve existing legislation, to ensure that our powers and our tools available to us are fit for purpose.
On the carrot and the stick element, I think you do need both. But, I think, you look back and, in 1999, or 1998, we as a country were recycling 5 per cent. It's taken 20 years for us to get to when we are leading the way, and it is something to be proud of, but it's taken 20 years for us to get there. And, for me, I think the next step, which is around embedding the circular economy, changing the way that we consume, that is huge. And I think, to achieve that, you're going to need different interventions. You're just going to need a mixed box of taxes, or penalties, or—. It's quite a significant challenge.