Co-ops & Mutuals Wales response to Welsh Government consultation ‘Services fit for the future’ #consultation #welshgovernment #socialcare #wales


David Smith, Co-ops and Mutuals Wales has kindly shared an extract from their response to the Welsh Government consultation ‘Services fit for the future’. The consultation closes on the 29th September.

Welsh Government are consulting on proposals to:

  • strengthen leadership in NHS organisations
  • introduce new duties of quality and openness
  • strengthen the voice of citizens in the way health and social care is planned and provided
  • design a clearer process for service change plans
  • improve the legal framework for the inspection and regulation of health services
  • establish a new independent body for patient voice and regulation and inspection.

For more information and to respond please visit:

Response to the Welsh Government Consultation: ‘Services Fit for the Future’

by Co-ops and Mutuals Wales* and Wales Progressive Co-operators+

A 2016 O.E.C.D. report judged that stronger central direction was needed from Welsh Government with Health Boards weak in innovation and slow to disseminate good practice.

If Government is modelling Citizens’ Voice on the Scottish system, we note Scotland is reviewing its current system with a view to going back to a quasi CHC model. Below is an extract of a response by Ron Walton+ and David Smith* covering ‘Promoting Cultural Change’ and ‘Effective Citizen Voice and Co-production, with valued comments from Adrian Roper. A detailed paper can be obtained from

Promoting Cultural Change:  A Wide Duty of Quality is proposed to encompass the population needs of Wales, promote collaboration at Health Board, Regional and National levels and across Health Social Care and other organisations. Key points are promoting co-production, prudent health care and being person centred.  These are in line with the Social Services Act 2014 and the Wellbeing and Future Generations (Wales) Act 2015 and would reference the Regional Partnerships (LAs) and Public Service Boards. Promoting health and well-being is part of the underlying philosophy although prevention, including education is not mentioned. Co-production includes the respected involvement of citizen-users in the co-design and co-provision of their services. The Codes of Practice to the 2014 Act give detailed guidance about how to achieve co-produced well-being, and this includes promoting user-led organisations, co-operatives, social enterprises and third sector organisations because they lend themselves to being “democratic membership organisations” and because they “add social value”. Under the same Codes, Regional Partnership Boards are required to establish Social Value Forums in order to promote, engage with, and benefit from, these “social value” organisations. In the interests of proper alignment between health, social care and well-being activities, and between Boards with over-lapping responsibilities for these activities, it would sensible to see the mirroring of the promotion of care co-operatives and other social value organisations in the arrangements for promoting cultural change supported by access to co-operative education and support.

Effective Citizen Voice, Co-production and Clear Inspection: It is proposed that CHCs should be replaced by a new organisation “Citizen Voice to advise and provide independent assurance.” It is clear that Health Boards and Welsh Government are unhappy about the degree to which CHCs challenge Health Board proposals for substantial change.Therefore it is proposed that new arrangements for Citizen Voice should only have a consultative role on the acceptability of a Health Board’s public engagement process. Citizens Voice would lose the current CHC powers to visit premise but focus on engaging with community groups. It is not clear if the new organisation would have any rights at Board meetings. The proposal for the CHC/Citizen Voice to cover health and social care is sensible as is the intention to maintain the advocacy service hosted by the CHC. The danger is that for all its faults the present system of CHCs has been very effective about holding Health Boards to account and is a repository of considerable expertise and knowledge about the health service and its operation at the patient level. Issues about overlap with inspection are already sorted out.

Our real concern is that Citizen Voice is not described in any detail. It will have reduced functions and ability to challenge Health Boards. It will have less opportunity to engage with patients directly in health settings which at present gives CHC members essential understanding of how the health services work. Other unanswered questions are: How is the membership to be recruited? What will be the local and national structure? What will be the level of resources to the new organisation? Pressing ahead with a new organisation without a thorough picture of how it will operate is a high risk strategy which unintentially could significantly weaken citizen contribution to health service design, operation and quality. Welsh Government are urged to issue a separate consultation document making the argument for abolishing CHCs, reducing the “clout” of patient/citizen voice and giving full details of how a new body such as Citizen Voice would function.

We are unaware of evidence that CHC powers are mis-used. If a Health Board faces awkward decisions because of the different interests and views of patients in different geographical areas, limiting CHCs (Citizens’Voice) to commenting on the consultation methods, rather than also giving views based on their knowledge of the actual operation of services, would seem to substantially weaken citizens’ ability to question plans. Much of the emphasis on continuous  engagement with patients /community seems to reflect a mindset which is proactive in getting comments on the current detailed operation of services but resistant to involvement in big decisions. One of the CHC strengths is that claimed benefits for changes can be checked by the CHC once the changes have been introduced.

If Government is modelling Citizens’ Voice on the Scottish system, we note Scotland is reviewing its current system with a view to going back to a quasi CHC model as they are unhappy with the purely consultative body.

7 September 2017

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