|Alun Davies AM|
|David Melding AM|
|David Rees AM||Cadeirydd y Pwyllgor|
|Delyth Jewell AM|
|Huw Irranca-Davies AM|
|Mandy Jones AM|
|Dr Tim Peppin||Cymdeithas Llywodraeth Leol Cymru|
|Welsh Local Government Association|
|Mairwen Harris||Prifysgolion Cymru|
|Nesta Lloyd-Jones||Conffederasiwn GIG Cymru|
|Welsh NHS Confederation|
|Professor Colin Riordan||Prifysgolion Cymru|
|Aled Evans||Cynghorydd Cyfreithiol|
|Claire Fiddes||Dirprwy Glerc|
|Rhys Morgan||Ail Glerc|
|1. Cyflwyniad, ymddiheuriadau, dirprwyon a datgan buddiannau||1. Introductions, apologies, substitutions and declarations of interest|
|2. Gwaith dilynol ar barodrwydd Brexit—sesiwn dystiolaeth gyda gwasanaethau cyhoeddus||2. Follow-up work on Brexit preparedness—evidence session with public services|
|3. Papurau i’w nodi||3. Papers to note|
|4. Cynnig o dan Reol Sefydlog 17.22 i benodi Cadeirydd dros dro ar gyfer cyfarfod y Pwyllgor ar 18 Tachwedd 2019||4. Proposal under Standing Order 17.22 to appoint a temporary Chair for the Committee meeting on 18 November 2019|
|5. Cynnig o dan Reol Sefydlog 17.42(vi) i benderfynu gwahardd y cyhoedd o weddill y cyfarfod||5. Motion under Standing Order 17.42(vi) to resolve to exclude the public from the remainder of 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 14:03.
The meeting began at 14:03.
Good afternoon. Can I welcome everyone to this meeting of the External Affairs and Additional Legislation Committee? Before we go into our business for the afternoon, can I just do some housekeeping? Can I remind Members that the meeting is bilingual? If you require simultaneous translation from Welsh to English, then the headphones are available, and please tune in to channel 1. If you require amplification, then that's also available through the headphones, but that's on channel 0. Can I remind Members and others to turn mobile phones off—or any other electronic equipment that may interfere with the broadcasting equipment. There is no scheduled fire alarm today, so if one does take place, please follow the directions of the ushers to a safe location. Do any Members have an interest they wish to declare?
My chairing of the European advisory group of the First Minister, Chair, and two other related European groups.
We move on to our item of business this afternoon, which is a follow-up scrutiny session on Brexit preparedness in relation to public services. Can I welcome Nesta Lloyd-Jones, representing the Welsh NHS Confederation; Tim Peppin, representing the Welsh Local Government Association; Mairwen Harris of Universities Wales; and Colin Riordan is on his way. We anticipate he'll be here shortly. He's also representing Universities Wales.
We'll move straight into the session. We've obviously had evidence sessions with you before in relation to Brexit preparedness, but we have moved on a little bit since then. I suppose the first question is a very simple one. We are now in a situation where there was a deal on the table, and we are working with that concept of that deal at this point in time. Have you had a chance to look at that withdrawal agreement—the latest one—and what implications that now means for your organisations in relation to departure on 31 January, as it is now? Tim, go on.
Shall I kick off? We have had a look at it, and I think our concern is that it perhaps goes a step backwards, in that, if anything, it's moving more towards a harder Brexit, and our concern has been all the way along about going out with a hard Brexit and the implications of that. I think the terms of the agreement are moving more towards a free trade agreement than an alignment arrangement, so that has made us feel that we need to continue with the work we’ve been doing for preparations for a 'no deal'. All the way along, we've felt that if we can get authorities to prepare for a 'no deal' scenario, which we see as the worst-case one, then, whatever other outcome may come about, at least they've taken the necessary steps.
I would say something very similar to Tim in regard to the NHS. Throughout the last couple of months, our preparations have been very much around preparing for a 'no deal' Brexit. Even though we have an extension, we are still meeting regularly and ensuring that the contingency plans that we put in place—the preparations that we've put in place—are tested and that we're confident that those mechanisms are ready if a 'no deal' does happen at the end of January.
It's similar for us as well. Our focus has been very much on 'no deal' preparedness, and we've done a lot of work across the sector with that. As far as the new deal is concerned, if that was to come in, all our work would be done on a post—[correction: done on post-Brexit negotiations]. Once the deal is agreed, we would then use the transition period to work out with the Commission whether we can still participate, and also we'd be dependent on the Government. So, there's not much more we can do. We've done our 'no deal' preparedness, and then we will have 11 months, which is a very short time, to agree these things—whether we can participate in Horizon Europe, whether we can still be part of the Erasmus+ programme, what the new immigration system would look like. So, we're stuck now until there's a deal.
I'm interested in where we've progressed from, although, listing to your answers, I'm not sure there's much progress at all since Halloween. At the time of preparations for a potential 'no deal' exit from the European Union on 31 October, there were many organisations, or sectors, if you like, who warned about the seasonal issues involved with a 'no deal' departure on 31 October, and many of those were about retail sometimes and other areas of communities' needs. I'm interested to understand whether you feel that there are any seasonal issues that might specifically affect your sector or area of expertise if the United Kingdom were to crash out of the European Union on 31 January.
So, for the NHS, we are preparing for winter, as we always do, and unscheduled care boards are looking at winter preparedness, but a key part of that is Brexit. So, Brexit has been considered alongside and as part of that process again this year. I think the key challenge will be if there is high flu in January, or if we have a winter like we had two years ago, where there were lots of spouts of cold weather, of snow, and it did increase demand on the NHS. Winter pressures are all year round. In the summer that we've had, demand had increased again on accident and emergency departments, and that does look like the demand is increasing. It's a question of looking at how the winter is, really, this year, and whether there is a spike in flu.
So, what you might be suggesting is that the weather may be more important than the actual season, in that sense.
Yes, and working with our partners. So, for example, if people who are working in our communities can't get to vulnerable people in their houses—social care, domiciliary care—that could affect them, if we have a very cold winter.
Building on that, one of our issues is about getting stuff transported, even in good weather, getting stuff from the ports to the places where the goods are needed. Clearly, if we have bad weather, even hold-ups [correction: meaning hold-ups] at ports followed by hold-ups on the road network because of bad weather, it just adds to that scale of the problem, really.
Certainly the weather would be a concern. I think the other issue is about getting the financial side of things sorted out. There had been concerns with an October exit that it would be coming around about the time when budgets are being set. Obviously, we've got a delay till January, but, because of the election, we've now got a period where there is continued uncertainty over budgets and the budget-setting process will be later. So, we'll be going into a period when local authorities and other bodies need to be putting their budgets together with a lot of uncertainty.
Not weather related, but, timing wise, October was better for us for things like Erasmus+ placements. They'd already been agreed and students were already placed. Come January, the deadline is they start putting in for the 2020-21 period in February. So, we'd be then in a position where we're unsure whether we can place our students abroad. And we'd be required to, because we'd already advertised that. So, under the Competition and Market Authority law, we would have to find placements. So, we'd then go back to our work that we've done on 'no deal' preparedness, to reinstate bilateral agreements with institutions and things like that, but, timing wise, it would be problematic for us for Erasmus.
For things like student recruitment, we've already got in place agreement that 2020-21 tuition fees and access to the student loan book would be available to incoming EU students. And, on things like Horizon 2020, we have the Government underwrite guarantee. So, yes, it would be problematic, but more so for Erasmus than anything else.
Can I just add, as well, with regard to the stocks? So, medicines and consumables—the stock levels have been higher, with six weeks additional stocks with the warehouse. As you're aware, the Welsh Government purchased a warehouse at the end of March, and it's a question of those stocks having remained, and remained high. So, what's the economic impact, both for smaller suppliers and for the pharmaceutical industry as well, who have ensured that those stocks have been maintained at an additional six weeks? So, again, there's been that uncertainty that has probably had an economic impact on industry but also on small providers.
Could I just ask one question on Erasmus+? In 2020-21, clearly you talk about the numbers for that year, but if there is, as a possibility, as the Prime Minister hinted yesterday, there will be no extension to the transition period, we could well be leaving without a deal on 31 December 2020. How does that affect those students?
I believe that they'd still be, because that frame—
I think they'd be covered because they'd already started in that, and it's that academic year.
Yes. It's whether we can find placements for them. If we crash out at the end of January, we won't be able to have those standard placements that we'd have with our European partners. So, that would be our big concern there.
Thank you, Chair. Can I take you back to the preparations for no deal? We learnt from the Yellowhammer documents that were released that the—I can't remember the exact wording now—effect of a 'no deal' Brexit was going to be most harsh, then, on the most vulnerable in society. Can you talk us through, please, how you would see that playing out in your sectors and what steps you've taken to try to combat that?
So, for the NHS, as you're aware, Public Health Wales did a health impact assessment. The original report was published in January, and they updated it in October. And it did highlight that there is an increased risk, especially for people in communities, with mental health. So, how that would manifest itself would be if there's an economic downturn, if there are local employers that close—what impact is that going to have on the population? So, with regard to that report, it has been discussed regularly at the Brexit leadership meetings that were held weekly up to the end of October, and they're now meeting fortnightly. That report was also discussed with the ministerial advisory group and, also, there was a specific event that Public Health Wales organised with Welsh Government in August to look at the report—to look at its findings and then put forward recommendations. That report, from that event, hasn't been published as of yet but I think it's imminent. It's looking, really, at the disadvantaged groups and economic deprivation, and it was very clear that it's around all public sector organisations working together. So, if there is an impact on people's health and well-being, it's going to be wider than the NHS that would need to provide support. So, working cross-sector is going to be key for the future, really.
I think that that cross-sector working is one of the, perhaps, silver linings of a lot of the Brexit [correction: the Brexit cloud]—there's been some really good collaborative work between different organisations. We worked with the consultants Grant Thornton to put together a checklist for local authorities, and, within that, we encouraged all local authorities, in their planning, to think of themselves as an organisation, as a service deliverer and as a community leader. And, in the community leadership role, a key part of that was about the well-being of local residents, especially vulnerable groups. So, all authorities have been encouraged to think about how that could impact locally. We've done profiles to help authorities look at what the impact could be locally, which sectors are most at risk and which could result in high unemployment in some areas, for example.
We've also been working very closely with Welsh Government. We have a regular meeting with them where we bring together a number of representatives from local government with Welsh Government and we've been looking at things like what routes we could get money to households that are disadvantaged and vulnerable in the case of a 'no deal' Brexit. So, we've looked at things like the discretionary assistance fund, DAF, which would be one possible route to get money out to people. We've also just recently engaged with Welsh Government on a scheme to assist people working on food poverty at a local level, so there's some capital and revenue funding coming via WLGA to local authorities at the moment—small-scale stuff, but it could help with, say, the purchase of a freezer or some revenue funding to help food banks and the like that are working with communities to help them if there is an increase in demand.
I suppose similar. We've provided our institutions with a Brexit readiness checklist. We had a roadshow on 21 October where we had the Department for Education and UK Research and Innovation come and talk to people and they had a chance to actually understand how underwrites might work. But then also we've been working very closely with Welsh Government on higher education issues, and I think where the sector may be able to come into play there is to help train and retrain quickly in the event of a 'no deal' or a sector collapsing. So, that's the sort of thing we've been looking at.
Thank you. The Chair has already referred to the fact that the Prime Minister has—well, it's been suggested that the Prime Minister wouldn't be looking for an extension to the transition period, so it is very possible that we will be facing a 'no deal' at the end of next year instead. Is there anything else that you'd like to add in terms of the steps that your sectors are taking to prepare for a delayed 'no deal'?
I suppose the only good thing about having that slightly longer time is that there is more time to prepare, and, if it looks like we are going to be coming out in December, we've got a bit more time to get that in place, as opposed to the end of January.
My final question is about the Get Ready for Brexit information campaign. Were you involved in that campaign at all? Or can you talk about any involvement that your sectors have been involved in?
We weren't involved in that campaign. In regard to the information coming from Welsh Government, they have released a number of bulletins and circulars. So, we are part of the Brexit communications sub-group, so, when information is coming out there are experts from social care and health there, there's a head of communications for Hywel Dda on that group, looking at how information, specifically for front line—. So, posters have been produced for community pharmacy around medicines and ensuring that clear message around 'Please do not stockpile your medicines'. So, a lot of the campaigns that we've been involved in, it's very much with Welsh Government and the information that they're disseminating, and there's a cascade model that we have put together with Welsh Government and our social care partners to ensure that the messages are reaching the front line. We have tested them, and the feedback that we've had is that it's getting to the NHS, because it is easier to get that message across to the NHS. It's slightly more difficult when it comes to social care, due to the vast number of organisations and providers, but I'm sure Tim can give a bit more information on that. But in regard to the UK-wide one, no.
Very similar. We were involved—the WLGA is on the communications group as well, and we try and make sure that's co-ordinated across all organisations.
We do have occasional meetings with the Ministry of Housing, Communities and Local Government, either in London or we do it by teleconference, and that's alongside the Local Government Association, the Convention of Scottish Local Authorities and the Northern Ireland Local Government Association—so, it's the four associations and the ministry. They talk about their campaigns and their communications there. Our concern is always about getting the right message in Wales, because, quite often, there are things about, 'Contact us and feed back if you've got information,' whereas our message to local authorities is, 'Where it's devolved, you contact the Welsh Government, it's not the UK Government.'
We weren't involved either in the campaign, but our parent body, Universities UK, has run an extensive campaign, and we've made sure that it's nuanced for our Welsh audience.
I was just listening to those answers to Delyth, and it appears to me that you're all expending a great deal of resource on these matters. Is that correct?
I think, for the Welsh NHS Confederation, we received the transition fund from the Welsh Government, which enabled us to employ two members of staff. They started in March. Before then we were trying to keep on top of the preparations, the co-ordination across the NHS, but, since having that grant, it has enabled us to be more proactive. So, we've produced toolkits, we've produced briefings that our members have asked us for on a wide range of areas, such as future EU funding, reciprocal healthcare—that is another key issue that people have raised with us. We've got frequently asked questions that we keep up to date regularly whenever guidance comes out from the UK. So, without that funding for us, it would have been very, very difficult for us.
Then, within the NHS itself, the estimate is between 50 and 100 people have been involved in Brexit preparedness. The majority of our members—it's additional work, so contingency managers will include Brexit in their work. One or two of our members have employed people who just deal with Brexit, but the majority are just—you know, it's part of their day-to-day work.
Like Nesta, we've had money from the EU transition fund to provide a support programme to local authorities, and, yes, there is a resource going in, but what we've tried to do is make it as efficient as possible. We didn't want 22 local authorities all doing the same thing, researching the same issues, so they rely very much on us collating information, getting it out to them.
Part of the grant was to appoint a co-ordinator in every authority, and that has proved extremely effective. So, we now have a network of 22 Brexit co-ordinators. We do a lot of the correspondence with them by e-mail—that's almost daily contact with them. But we also had a meeting with the 22 recently, which was very useful, to exchange details of what they're all doing. I think, by having those straight lines of communication, it has enabled us to keep it proportionate, because our concern is that this could consume huge amounts of time. And, without doubt, there has been a big opportunity cost from the work going into Brexit from work that we would have put in on other areas.
Similar. It's difficult to quantify how much effort has been put into this and what you would have been doing otherwise. So, as I've said, we've spent a lot of time looking at getting ready for a 'no deal' and making sure our institutions are prepared for that, with risk registers and things like that. But also we've received £3.5 million from the EU transition fund to look at mitigating issues on leaving the EU. We received the money in 2018, so it goes 2018 to 2021, so we're about halfway through it at the moment, and we've currently got a number of scholarships, but also we've got extensive recruitment campaigns now running in Vietnam, England and the US. So, we've got a baseline report for that, and we'll be running an annual report to see what significantly changes in recruitment post that. We'll be running annual reports.
Can I just ask one question? Do you receive communication also from the UK Government? Because, clearly, you're Welsh Government, you're devolved responsibilities, but I was just wondering if you received UK Government communications and your views—and it's an opinion—as to how much clearer that may be or may not be in relation to what the Welsh Government is doing.
So, for us, we have met with the Home Office, we've met with Home Office Ministers, partly through the Brexit health alliance, which we're a member of, which the NHS Confederation UK-wide chairs, but also we are part of the advisory group that looks at future immigration. So, I guess that the most work with the Home Office specifically has been around settled status, raising awareness of settled status, looking at the future immigration rules, but, through our wider confederation, the links have been there.
Personally, I think the communication and accessibility to Welsh Government is greater here. The feedback that we've had from sharing the toolkit and the front-line scripts that we've been sending to front line, to royal colleges and others— they've come back to us and the English equivalent have said, 'Can we share this? This isn't the kind of thing that is coming out of the UK Government'. So, information that we're providing for our members in Wales is being used in England as well because the information is clearer, and I guess messages are clearer coming from the information that we're putting together.
Yes, very similar. We do get communications from UK Government. Where we think it's useful and it's additional, we would put it on our website and point people to it, but in the main we work with Welsh Government.
Through our parent body we get quite good access to UK Government, so we receive those sorts of guidelines as well. But, like Nesta, we are also on the national advisory group looking at immigration. It always feels—. You asked for a personal opinion—it always feels from the Government officers that they're not quite sure what's going on, so it's a little bit in the dark. So, the national advisory group, for instance, are looking at what the immigration system will look like in the future. They're not quite sure what their terms of engagement are. So, we can give our views, but it's always a little bit—we're not quite sure where they're going with it.
I just want to talk about the auditor general's report on public sector bodies and their preparedness. It was quite a positive report—it’s a difficult area, so you wouldn't expect straight As, but it was kind of B++, I guess. But he did pick up this issue of communication, saying that he was getting the sort of feedback that public sector bodies were really quite concerned about how the public were going to react to all the risks, and that there was still quite a gap between what they needed to be prepared for and what had been achieved so far—a lot of unknowns still in the system. So, this is the third time, really, now, that we'll be facing this rupture. Are we better positioned with the public and their understanding? I suppose the classic one is not to stockpile your medication. But I thought that was an interesting insight that he picked up.
I think for us communication from the beginning has been key, it's been a priority, and, whenever we and others have raised it with the Minister, they have taken that on board and then looked at it within Welsh Government, both within the comms sub-group, but also wider. So, for example, we produced a toolkit, and it's quite long and it's quite detailed, and the feedback that we received from some of the chief executives in the NHS was: 'What are the key messages? This is too detailed for front line, so what can you do?' So, we've taken that feedback on board and then looked at the ways that, as an organisation, we could produce a shorter script. So, that was done recently.
In the comms sub-group, like I said, they've produced posters around medicines. So, even though that message has been clear since, say, February time through bulletins and circulars, it wasn't really always going to the front line. So, now these posters have been produced and they've been sent to community pharmacists as a hard copy, and they will, hopefully, now be in community pharmacies, so the public will see those posters. Because before it was very reliant on front-line staff being able to answer those concerns and those difficulties.
I found it interesting, just picking up on the issue of how difficult it is, actually, to predict public behaviour, and, you know, I just think on—. When we have severe winter weather, say, a real freeze, we can often get a fairly accurate weather forecast a good week out, sometimes 10 days. Does that have an effect on the patterns of repeat prescriptions and—[Inaudible.]—because there you could assess the level of risk, then, that people will react in a similar way? So, do you have those models that can be used?
So, that is being looked at in regard to the heads of comms within the NHS organisations. So, over the Christmas period, there's always clear communication going out, making sure that people have got their prescriptions, that they've got their repeats, that they're not accessing A&E when they don't have to. I think one of the challenges for the NHS is that there are so many public-facing messages, and it's a question of balancing—
I understand this but, at the minute, when we face severe winter weather, advance forecasts give you a week or 10 days' warning. Do you see the public going in and saying, 'Well, I need the next two months of my prescription; I know I've still got two weeks left, but I don't know how long this weather's going to last'? Does that happen?
I'm not quite sure whether that happens. I think the key message is for the public not to change their habits when it comes to medicines and Brexit. The clear message has been that we have got enough stock, that the stocks are above what usually happens—we've got six weeks extra. And I think the biggest challenge would be if the public changes their habits, because the industry, the pharmaceutical industry, have worked very closely with the UK Government to ensure that they have the stocks that are required. If the public then started changing the level of their need, it will just impact on the whole process. So, that's why especially those posters to front-line community pharmacists have been key, really, to just build confidence within the public that the stock levels are fine.
Yes, I think there's always a risk of scaremongering with communications, and, when there is so much uncertainty, it's very difficult to know how to play it, because you could give information out and you can actually have a self-fulfilling outcome that you didn't want. Equally, you could give out information and find you've given out the wrong information, because you've advised people to do something, like encouraging people to, say, stockpile parts, and then there's a further delay and the companies that stockpiled parts feel they've been disadvantaged because their cash flow is tied up. So, it's very difficult knowing when you can go out and make the communications.
So, I think one of the—. Nesta mentioned earlier frequently asked questions. I think they are incredibly useful, because, if you think of all the questions that could come up, we've encouraged authorities to share those with their front-line staff so that, when you do get questions, at least if they've got a first line of response based on possibilities, then, depending on how events unfold, hopefully, you're geared up to deal with the questions as they arise. But I think trying to prejudge and go out is difficult.
Universities UK conducted a survey in September with its members to assess how prepared they were and how they felt that they could deal with a 'no deal' Brexit, and we published that information, but at a very high level, because I think, like Tim says, there's a real risk of going out and scaring the horses without actually knowing what is going to happen.
Okay. To move on, then, the auditor general also picked up the fact that the partnership council was meeting, I think, on 2 October. Do you have anything to report on that and how useful that meeting was in terms of preparedness and these general issues?
Yes. The partnership council has had a couple of dedicated discussions on Brexit issues, which has been quite useful. So, this is a number of our leaders meeting with Welsh Government Ministers. And, at the meeting, Julie James gave an update from the Welsh Government perspective, and then our leader, Councillor Debbie Wilcox, just gave an overview of the steps that are being taken by local authorities across Wales. So, there was a good exchange of what the issues are, what the local authorities are doing, and we did have a discussion there about this support for food poverty, food banks and so on. So, that was raised. So, it was a good opportunity to make sure everyone knows what's going on, and also an opportunity to agree on things where local authorities can put assistance in place, for example.
And I understand there was a stakeholder summit at the same time, or overlapping, or whatever, which may have involved higher education and health organisations. I don't know if you've got any reflections on how that went.
There was a series of meetings that week. So, the partnership council was with local authorities, but there was also a round-table, which Lesley Griffiths has with the farming community, and I think there were a range of other—.
So, the ministerial health and social care meeting—we had one in October, we had one in September as well, where there's an update from Welsh Government, usually. And any issues and concerns from the sector are raised with the Minister then. One of the areas that was highlighted specifically was around social care, and settled status, and supporting vulnerable adults, and children, to apply for settled status. So, it was wider than Brexit preparedness—it was looking at raising awareness of the settled status scheme as well.
And we have regular meetings with the Welsh Government, as I said—so that's higher education. The last meeting was 23 October.
And finally from me, the auditor general did raise this issue that, when we look at the public sectors, of course, they're made up of lots of providers—22 local authorities, and a number of higher education institutions; seven, is it, local health boards? And he did hint that he wasn't absolutely assured that there was a consistency of best practice yet embedded. Is that your feeling as well, and have you been working, perhaps, to encourage those members that are having a little more difficulty in certain areas, potentially, with those that really have nailed that part of the preparations? I just wonder how you're trying to deal with variable performance that inevitably, in something like this, you probably would expect to see.
I think there's within-sector and across-sector support, and certainly within the local authority family, any good practice we're sharing. So, examples of work that authorities have done, for example on their risk matrix, we're sharing that round so others don't have to start from scratch. But also, I think, across sectors there have been some good joint meetings, where we've had an opportunity to share views, and, often, you pick up good ideas and your awareness of what's going on in other sectors is raised. And that is important, because we can then feed that out to the local authorities, and make sure they're aware as well.
I think it's very similar for the NHS. We meet—we were meeting weekly with senior responsible owners across all the health boards and the trusts. So, every week, people were coming together, sharing information. We received all their risk registers, so, again, sharing that information, in confidence, across the 11 people, just to say, 'This is the kind of thing, say, that Betsi have highlighted—is that a risk within your organisation?' And also, any areas that the SROs were saying to us, 'We need more information on', whether it was around reciprocal healthcare, then we had a role then at the confed to put a briefing together, or put information together. So, instead of 11 organisations going off and writing their own, we are able to provide that resource. So, overall, I think it is easier for the NHS, because we are supporting 11 organisations—the three trusts, seven health boards, and Health Education and Improvement Wales. So, it is easier. But as well, it's working, as Tim was saying, with the WLGA, the Association of Directors of Social Services Cymru, Social Care Wales. So, there has been significant cross-sector working in the Brexit preparedness.
Same, really. We've produced risk registers—we've worked with our institutions, to make sure they're all producing risk registers. We've also done some webinars on key issues, so that our members are all able to access that, and have that sort of detailed input. And, like I said, we had the roadshow, where 60 people from across Wales came, who were able to talk to Government Ministers [correction: Government officials], and understand how the underwrites would work, and things like that.
Just briefly, to come back on the point that David raised—because we've had a dry run at this, back at the end of March, this issue of either individuals stockpiling medicines at home, or, alternatively, deferring use of medicines that they have in order to safeguard themselves against difficulty—is there anything that we know from the dry run that we've had, either from social services' perspective, or from GPs and so on, that there was any deviation of the pattern of people pre-ordering prescriptions, or, alternatively, not actually using their medicines? Do we know anything?
I'm not aware of anything in regard to that. I think that the risk, like you said, around people rationing their medicines as well—we have been talking about people not stockpiling, but, I guess, in the last month or so, that conversation has slightly changed, because it is a question then, like you said, of people possibly rationing. I think the testing majoritively has been around looking at whether the message from Welsh Government and the UK Government around medicines and not stockpiling has reached the front line, and it has. We had a call from a GP receptionist, who'd found our toolkit and said, 'We've got somebody here who’s talking about the repeat prescription. What is the advice?' So, we know that the information that we're sending out is reaching the front line. Whether that's changed public attitude and behaviour—that would be something that we would have to look into in a bit more detail.
And I think that’s what I'm pushing at. I'm just wondering whether, anticipating a future date, it's worth finding an intelligent way in which you can see whether this is a concern or not—whether people are, once the front-line professional—once they've left their GP, once they've ordered whatever or once their front-line professional with social care has left their homes, they are changing their behaviour. It might not be an issue, but it worries me that we don’t quite know—we haven't been through a dry run. So, I just wonder whether you think that’s something you would take back and have a look at—a way of seeing if there’s something under this.
I'm happy to do that and with regard to, when in the news, there are issues around an issue with a certain medication, we do go to the directors of pharmacy, and say, 'Is this a result of Brexit or is it just that there's an issue with the stocks?' And all the feedback that we are getting back from the directors of pharmacy is that there have been no issues with a medication as a result of Brexit. It is easier for us in Wales, because, again, we go to seven directors, and in England, it's a lot more difficult, so we are feeding that information back to our London office as well.
In the dual analysis, can you check—[correction: can you check replicated medicines]? Because, obviously, again, you can have medicine prescribed and it can be from a different manufacturer and sometimes there are different fillers within that particular medicine, and have you done an analysis as to which ones would be available and which ones would not be available, because different fillers—I believe you may have experienced it—can have different impacts upon people? You can have a wrong [correction: bad] reaction because of a filler, as a consequence. So, are you doing also any analysis to ensure which medications are more easily available than others, shall we say, as a consequence of a possible scenario there?
Before I ask Mandy to ask a question on trade, can I just ask one question on the local authorities, because there are 22, and we are talking about them working: what is the consistency across local authorities in their preparedness? Are they all reasonably at the same level? Are there some lagging behind others?
We asked Grant Thornton, as part of the work they're doing on this, to ring around all the authorities, to talk through a range of questions to assess where they were, and their response was, 'You can't prepare fully for a "no deal", but all the authorities had taken the steps that had been advised.' There were no reports back of any particular authorities where they hadn't done it or they were lagging behind. The picture we got, which was across the board, was that they'd taken on the advice, they had their co-ordinator, and the co-ordinator had made sure that the various recommendations and the guidelines had been followed.
We met with all 22 of them. We had a round-table session where they all gave an update and there was nothing from that that suggested to us that there was an authority that was particularly struggling. I think the support that we've been able to put through to the authorities has worked quite effectively.
Shortly before 31 October, the UK Government issued a list of medicines on a list that would be protected from secondary sales and wholesaler trading. Do we know if that's now been lifted or is still in place? They identified and published a list of medicines because of the danger of secondary trade in the market and actually losing medicines—being exported by either individual pharmacies that hold their own trading licences or by wholesalers in the UK. I thought it was quite a signal moment in time when they said, 'This is important enough now to say: do not sell these.' I'm just curious: is this still in place, as we wait for another date?
I am aware of that list, but I'm not sure whether it's been lifted or not. So, I'll—
It would be helpful for the committee to know whether it's been suspended temporarily, waiting for the next occasion.
It was definitely raised at the ministerial meeting in October.
Thank you, Chair. I'd like to talk to you about trade post Brexit. Have any of your organisations completed any analysis on the impact of any free trade deals the UK might sign post Brexit?
We've previously been involved in work with Welsh Government that has looked at different scenarios, and free trade agreements was one of the scenarios that was looked at then. So, we looked at the implications for agriculture in particular. More recently, we've been having discussions with Anglesey council about the potential of the latest deal and the border in Irish sea and what impact that could have on Holyhead. We're having discussions with Grant Thornton about them potentially doing some work on that, but we'd like to broaden that out and look at the impact of trade more widely on authorities in Wales, ports in Wales. But we'll need to discuss that with Welsh Government first to make sure we're not duplicating any work. So, that's very recent, since the deal has been struck.
For us, the NHS Confederation in London and our European office has produced a briefing recently around future trade and the possible impacts for the NHS. The NHS hasn't often been high on the agenda when it comes to trade deals, but it has because of recent comments made. I think key is that the NHS remains free at the point of access, that any trade deals don't impact on population health, around public health, and that any future trade deals—the impact on the public health should be part of that.
I'm happy to share the briefing with the committee, because it goes through the key points that we would put across here. We have looked at it in Wales to see whether it's all relevant. The majority of it is. So, the likelihood is, if we were going to make a Welsh version of the briefing, it would only need slight amendments, and we have shared that with Welsh Government as well.
Can I just apologise for being half an hour late? I wasn't, I was in the waiting room, but nobody seemed to know. Anyway.
Free trade—not really, we have a research group led by Patrick Minford that has done a lot of work on this, so we've got lots of analysis of it, but they've never said anything about the way in which it might affect universities directly, and I can't see any obvious way in which any future trade deal would have a specific effect on our organisation. The thing that interests us most will be whatever's in the immigration Bill. That will be the key to us, really.
Okay. And what do you think of the deals Liz Truss has nearly got so far, which can't be signed until, obviously, after we've left? Would any of those impact? Do you know things about grandfathering trade deals as well?
I suppose just in a very general sense, our concern would be that some of these trade deals that are under discussions with other countries are dwarfed by the scale of the trade with the EU at the moment. So, whilst there may be progress with some of those deals, the priority for us would be to make sure that there's as frictionless trade as possible with the EU, because without that, we fear that companies within Wales will reconsider investment plans. That could result, over a period of time, in job losses, and then that will feed through into a whole range of extra pressures on local authority services, if areas go into a decline because of loss of business and major companies. So, whilst it's good if there are trade deals being negotiated, it's the scale factor, really.
I think what we've highlighted in our briefing is the fact that, first of all, the trade deals should be done between UK and Europe to ensure continuation of the regulations that we've got. But it's also looking at where improvements could be done through regulations, so whether it's around advertising and, again, public health before looking at other countries, whether it's the US or Australia. So, there are opportunities with future trade deals that we would be highlighting as well, specifically around the public health population and improving public health and population health.
For us, it would be maintaining our research networks across Europe, so being part of the Horizon Europe programme, maintaining our links with Erasmus+ and being part of that programme. That would be our preference.
Colin, can I just come back to you for one tiny bit around—. I'm very aware of time. You mentioned Patrick Minford's paperwork. I've read quite a bit of his. What do you think of his overall assessment?
I actually asked—well, not him, but Kent, who works with him—. What's Kent's surname?
I can't remember.
Matthews. Yes, he's one of his—. He's a professor who works in the same field. Also, somebody of the other body of opinion—I think it was Calvin Jones. I asked them each to do me a briefing on what would happen. But it was just completely contradictory, and based on different assumptions. So, it's very difficult to know what's really going to happen. It's a matter of dispute amongst economists, clearly.
Oh, yes. The huge weight of opinion is on the remain side—I mean, there's no question about that—amongst economists, yes.
We're not here to discuss which ones—. That's not our role. We are looking at, obviously, the issues that the public sector faces. Finished, Mandy?
I was just going to add, from our environmental health, trading standards perspective, what happens now in terms of trade deals in terms of maintaining standards is quite an important issue. Some of the aspects that were changed in the withdrawal agreement do potentially allow for standards to be changed, because we are moving away from alignment. So, trading standards would be concerned, with trade deals, to make sure that the standards of products coming on to the market are of quality—or if it's livestock, things like animal welfare. So, we just need to keep an eye on that side of things as well.
I doubt that UK Government will drop their standards. I'm hoping not. Thank you, Chair.
Yes. I want to follow upon this issue of immigration, which I know might affect foreign students. How vulnerable are we on the temporary leave to remain programme? I understand that, at the minute, after 36 months—and a lot of undergraduate programmes go beyond 36 months—. Obviously, the EU system works very well. There is something analogous for non-EU foreign students—I hope I've got this right—the tier 4 visa. So, does that work well, and would you expect that to cover European students who are currently on the temporary leave to remain scheme? Or do we really have a potential problem here in terms of recruiting students from overseas in the future?
Well, that very much depends on what the immigration Bill says and what the new policy is going to be. The tier 4 process has been hugely improved over the last couple of years, particularly since it became apparent that there wasn't this very large number of students overstaying their visas. Once that was proven to be the case, things have eased up. Also, we now have the prospect of a post-study work visa, which attracts students to come. There's never been a cap on international students; it's just been pretty difficult to actually go through the whole visa process, and expensive for them. So, if that stays as is proposed now, I don't see why that should be a problem for us. The bigger problem is with students from the European Union, who would only be given three years to remain or to complete their studies, whereas in fact they would doubtless have to actually be here longer than 36 months, if an undergraduate, to be able to do that, and, of course, if they're a PhD student or they're taking certain programmes that take longer than 36 months anyway. So, I think that really needs to be looked at.
And the European scheme that we currently have is presumably fairly streamlined, is it, and it's much easier than the tier 4 scheme that applies—
Yes. EU students are treated exactly the same as Welsh students.
I'm interested to know, Chair, between last March and now, where we are, and possibly next year as well, how much has changed in your knowledge base, in terms of the—under different scenarios—exposure of individual member institutions within Wales, in terms of noting the interplay between social and economic well-being. What parts of the country, what parts of south Wales, what parts of mid Wales are most exposed under different scenarios in terms of health and the workforce and health and social care? So, what is different now in your knowledge base, if anything, than prior to last March?
I think, for us, the intelligence and the information now that we've got on the workforce is significantly more than we had two years ago. So, every person who works in the NHS, they are part of the electronic staff record. When the referendum results happened, about 48 per cent had put their nationality on that record. That's up to about 68 per cent now. So, we know, roughly, how many EU citizens work in the NHS, which areas. So, it's about 2 per cent. But, if you look at medics and dentistry, that's up to 7 per cent. So, we have a better understanding of who is working within the NHS, but also, especially with the immigration White Paper and the proposals around the £30,000 salary threshold, through the information we've received through the electronic staff record, around 52 per cent of EU staff who are working in the NHS now would be impacted by that threshold. We are talking about nurses, therapists—such as occupational therapists, speech and language—and that was information that we weren't aware of before—the details we weren't aware of before.
Our understanding of the workforce situation is much improved to where it was, because, previously, there were very few records about non-UK EU nationals. We've got a better picture of that for the in-house staff, but also there's been survey work done on the social service sector, which has given us more information there.
I think, on the economic front, we've produced profiles for every local authority now, which looks at the sectors that have been identified as 'at risk', and then we've looked at where they are concentrated around Wales. Each local authority has been given that picture so that they can start to assess the risks locally.
There's also been some very good work done by Welsh Government looking at spatial vulnerability mapping, which is looking at three different scenarios and how that would play out in terms of land use. The Welsh Government went out regionally to local authorities, and confidentially shared that with each of the regions, so that they could start to get a better feel for what different scenarios would mean for their area.
I would say, for the higher education sector, that there's a much better understanding of the benefits of Europe now, of what we've got from them, whether it's from the research funding programme from Horizon 2020, whether it's from Erasmus, or—just the knowledge level of what structural funds do for us. We haven't actually mentioned structural funds today, but it's quite unusual to be in a meeting where structural funds aren't mentioned. So, I think there's a much better understanding of what Europe has done for us, and how big the gaps might be if we're not able to participate.
The reason probably structural funds have not been mentioned is because we know there's a shared prosperity fund, but that's all we know, effectively. We know nothing else.
Can I just point at one question? Because we know that, if we do leave on 31 January with the current withdrawal agreement in place, the Prime Minister has indicated that the freedom of movement will cease when we leave, which means 31 January. Are you in a position to look at what the staffing and workforce needs are? Because, as you say, the immigration Bill has not been published. It will not be going through by that stage. So, what are the issues that you're going to be facing in the short term with the loss of freedom of movement of people? I know the Prime Minister's talked about reducing or having special visas. We don't even know what that means or looks like yet. Are you in discussions with the UK Government as to what will happen on 1 February if that scenario happens?
So, we are aware that there have been a lot of consultations recently, and we have been feeding that information in. The NHS has recruitment and retention issues that many people are aware of. Health Education Improvement Wales is looking at producing a long-term plan. But, over recent years, we have been actively recruiting internationally through 'Train. Work. Live.', and going to European countries, such as Portugal, to recruit in areas where there are challenges, such as nurse recruitment. So, we have been highlighting that, and when we've met with the Home Office as well. We are aware that we do need to train more people from the UK, but in the short term we will not be able to train the numbers that we need. So, it's a huge challenge for the NHS, and, if that £30,000 threshold does come in, that will impact on therapies, on nurses. So, we are highlighting that because, with the demographic and the age of the population in Wales, we will not have enough people from Wales to be trained as well. So, we are highlighting that quite closely and also highlighting the demographics when it comes to social care, which—. There are a number of professions within the NHS that cannot reach £30,000. Fifty per cent, like I said, of EU citizens who are working within the NHS now would have been impacted by it, and, for social care, that percentage would be significantly higher. And it's key for health and social care to work closely together, which we are doing.
But are you getting any messages from the Home Office to say that will be—we will have a policy by 31 January to ensure that you're able to recruit those Portuguese nurses?
I think the challenge we have now is that the advisory meetings that the Home Office organise, which were happening every other week, they've all stopped now because of purdah. So, again, that is a significant challenge for us, with purdah happening now.
And for staff in the higher education sector, obviously, we've seen some staff already leaving.
Many of those issues affect us as well, especially the £30,000 salary threshold. We've been arguing very consistently that that needs to be much lower, somewhere around the mid twenties, maybe, because we have highly specialised technicians, for example, or post docs, who wouldn't be paid, at least in the lower echelons, at that level, but we still need them. It's quite difficult to get these people. And just generally in the kind of workforce we have, a big proportion of it is highly skilled, and quite specific skills that are relatively rare and very competitive to get people. So, if there are barriers of that nature, it could make life extremely difficult quite quickly for us. Populating research projects—. If we win research grants, you've then got to appoint people to various positions. So, we do have some concerns around all of that.
Okay, thank you. We've come to the end of our session. I'd like to thank the witnesses for their evidence this afternoon—very much appreciated. You will receive a copy of the transcript. If there are any factual inaccuracies, can you please let the clerking team know as soon as possible so that we can get them corrected? Thank you very much for your time.
Members, can we move on to the next item of business on the agenda, and our papers to note? We have one paper to note, which is correspondence from the Minister for International Relations and the Welsh Language regarding the draft international strategy. Are Members content to note that letter? They are. Thank you.
Item 4 on the agenda. I am, unfortunately, unable to be in attendance next week. Therefore, we need to elect a temporary Chair for that meeting, which the Minister for International Relations and Welsh Language will be attending. So, can we have a nominee for temporary Chair?
Any other nominations? No. Therefore, can I thank you for that? Huw Irranca-Davies will act as temporary Chair next week on the meeting on 18 November, 2019.
Penodwyd Huw Irranca-Davies yn Gadeirydd dros dro.
Huw Irranca-Davies was appointed temporary Chair.
bod y pwyllgor yn penderfynu gwahardd y cyhoedd o weddill y cyfarfod yn unol â Rheol Sefydlog 17.42(vi).
that the committee resolves to exclude the public from the remainder of the meeting in accordance with Standing Order 17.42(vi).
Cynigiwyd y cynnig.
Okay. The next item on the agenda is a motion under Standing Order 17.42(vi) to resolve to exclude the public from the remainder of today's meeting. Are Members content to do so?
Therefore, we now move into private session for the remainder of this meeting.
Derbyniwyd y cynnig.
Daeth rhan gyhoeddus y cyfarfod i ben am 15:03.
The public part of the meeting ended at 15:03.