The Health and Social Care (Quality and Engagement) (Wales) Act: summary

On 1 June 2020, The Health and Social Care (Quality and Engagement) (Wales) Act became law.

The act came into force on 1st April 2023, and work continues on its implementation.

 The act aims to:

• strengthen the existing Duty of Quality on NHS bodies extending this to the Welsh ministers in relation to their health service functions
• establish an organisational Duty of Candour on providers of NHS services, requiring them to be open and honest with patients and service users when they come to harm during their care
• strengthen the voice of citizens, by replacing Community Health Councils with a new all-Wales Citizen Voice Body (known as Llais) that will represent the interests of people across health and social care
• enable the appointment of Vice Chairs for NHS Trusts, bringing them into line with health boards

In 2018, the Parliamentary Review of Health and Social Care in Wales set out a number of recommendations including those relating to improvement in the quality of services and closer integration of health and social care.  These form key threads within the Welsh Government’s response:' A Healthier Wales: our Plan for Health and Social Care' and are supported by provisions in the act.

Continuous improvement in quality is key to making the health and social care system in Wales both fit for the future and one which achieves value. The establishment of Llais, covering both health and social services, ensures that the voices of citizens are engaged, listened to and clearly heard. This will support the delivery of health and social care services that are designed around the needs and preferences of individuals.

Quality is more than just meeting service standards; it is a system-wide way of working to provide safe, effective, person-centred, timely, efficient and equitable health care in the context of a learning culture. To help achieve this, the act:

• places an overarching Duty of Quality on the Welsh ministers
• reframes and broadens the existing duty on NHS bodies

This ensures the concept of 'quality' is used in its broader definition, not limited to the quality of services provided to an individual nor to service standards.  

The act ensures the Welsh ministers (in relation to their health functions) and NHS bodies exercise their functions with a view to securing improvement in the quality of health services.  

Details of how the Duty works in practice for the NHS  can be found in statutory guidance, which has been developed in partnership with stakeholders, whilst training has been developed and delivered to support implementation.

Further information can be found on our Duty of Quality in healthcare webpage.

A culture of openness, transparency and candour is widely associated with good quality care. To help achieve this, the Act places a Duty of Candour on providers of NHS services (NHS bodies and primary care) - supporting existing professional duties.

The duty requires NHS providers to follow a process when a service user suffers an adverse outcome which has or could result in unexpected or unintended harm that is more than minimal and the provision of health care was or may have been a factor. There is no element of fault, enabling a focus on learning and improvement, not blame.

Guidance has been developed with stakeholders, and can be used as a practical document to aid implementation of the duty. In particular, the meaning of 'more than minimal' harm has been clarified in more detail in the guidance with examples and illustrative case studies in order to aid understanding and promote consistency in the application of the duty across Wales.   

The duty seeks to promote a culture of openness and improves the quality of care within the health service by encouraging organisational learning, avoiding future incidents.

Using existing statutory powers, the Welsh Government continues with plans to make separate regulations (under the Care Standards Act 2000) to place a Duty of Candour on regulated independent healthcare providers. 

Further information can be found on our Duty of Candour webpage.

Llais replaces Community Health Councils (who have represented the patient voice in the health service for nearly 50 years) as a new national body that will exercise functions across health and social care. The aims of the new body are to:

• strengthen the citizen voice in Wales in matters related to both health and social services, ensuring that citizens have an effective mechanism for ensuring that their views are heard
• ensure that individuals are supported with advice and assistance when making a complaint in relation to their care
• use the service user experience to drive forward improvement.  

This new organisation has been established as a national body but is structured in such a way as to enable it to perform its functions at a national, regional and local level. The act places duties on the new body, NHS bodies and local authorities to make arrangements to co-operate, with a view to supporting each other to promote awareness of Llais. They are also under a duty to make arrangements to support the new body in seeking the views of the public in respect of health services and social services.

Welsh Government will publish a code of practice about requests from Llais  to enter health and social care premises to seek the views of individuals. There is also new statutory guidance to which NHS bodies and local authorities must have regard when dealing with representations made to them by Llais.

The statutory guidance can be found on our webpage and information about Llais can be found on their webpage. 

Previously, NHS Trusts were only able to appoint a Vice Chair from their existing independent members and these are only able to provide cover in times where the chair may be unavailable or unable to undertake their responsibilities.

The new powers within the Act provide for Welsh ministers to appoint a specific Vice Chair role on the boards of NHS Trusts. This enables Vice Chairs to fully contribute to the work of NHS Trusts, strengthen the capability of their independent membership, improve governance and decision-making processes, and provide consistency across Wales.

Appointment to a position with a defined role and greater time commitment may lead to widening the application pool and interest from candidates, with ministers able to clarify a different and more appropriate skill set within the job description.