Committee of the Whole Senedd

Group 2 is next. This group relates to training and guidance for medical members who do not hold a licence to practise. Amendment 2 is the amendment, and I call on Adam Price to move the amendment.

I move amendment 2. Obviously, at the heart of the Bill is the decision to amend the eligibility for medical membership of the Mental Health Review Tribunal for Wales, to remove the need for a current licence to practise, provided those medical members are fully registered with the GMC. And we understand why the Government wants to amend the Act, for the reasons of restoring capacity and protecting patients' rights to timely hearings. But if that is the policy, then we have to be equally clear in our view about the safeguard that must sit alongside it that hearings remain not only timely and fair, but informed by up-to-date clinical expertise.

The Counsel General rightly referred to training and guidance arrangements in her remarks yesterday, but the statutory duty on the president of Welsh Tribunals is a general one—training and guidance across the tribunal system. What this amendment seeks to focus on is the need to ensure currency in terms of medical knowledge of those members particularly who do not hold a licence to practise. That matters, Llywydd, because while a licence to practise is not a perfect proxy for competence, it is closely associated with a doctor being in an ongoing framework of professional updating. Once we remove that requirement, it becomes even more important that the tribunal's training arrangements include specific provision for medical members who are not in current licensed practice so that clinical knowledge doesn't drift and confidence in decisions doesn't erode. That's exactly the concern raised by stakeholders. Mind Cymru has asked what safeguards exist to ensure that those usually retired medical members who no longer hold a licence to practise are sufficiently informed of modern practice as it develops, and Adferiad has put the point clearly as well that patients and families need reassurance that hearings will remain timely, fair and informed by up-to-date clinical expertise. So, these are not abstract concerns; they go to legitimacy and trust in a tribunal that makes decisions about liberty.

Now, I want to be clear about what we're not saying. This is not a criticism of retired clinicians—many bring deep experience—and it's not a suggestion that legal or procedural training, which is the focus of the current training that's provided, is unimportant—of course it is. But the training that we often point to in tribunal contexts does tend to skew heavily towards law, procedure and process. What this amendment is aimed at is something slightly different: making sure that, where we rely on non-licensed medical members, there is an explicit expectation of clinical currency—updates in clinical standards, guidance and contemporary mental health practice—that will be relevant to tribunal decisions.

So, the amendment is deliberately modest. It does not create a new bureaucracy. It does not cut across the emergency purpose of the Bill. It simply makes explicit that the training and guidance arrangements must include provision appropriate for medical members who do not hold a licence to practise. Now, if the Government's position is that arrangements already exist and are robust, then accepting this amendment should be straightforward. It shouldn't reduce capacity, but it would strengthen legal certainty and public confidence. And it's on that basis that we present it to the Senedd.

Counsel General.

Diolch, Llywydd. Once again, I agree with the intention behind this amendment, but respectfully suggest the amendment isn't necessary, stroke doesn't quite say what's intended in its wording. So, section 60 of the Wales Act 2017 already provides that the president of Welsh Tribunals is responsible for

'the maintenance of appropriate arrangements for the training, guidance and welfare of members of the Welsh tribunals within the resources made available by the Welsh Ministers'.

This responsibility extends to all members of the Welsh Tribunals, including medical members of the Mental Health Review Tribunal for Wales.

Llywydd, I'll just rehearse again what I set out yesterday about just how well qualified these individuals are in practice. Each medical member has been appointed by the Judicial Appointments Commission, following a rigorous process. They have registration with the General Medical Council as a fully registered medical practitioner. They will, at the time of their appointment, have held a full-time or part-time appointment as a consultant psychiatrist for at least three years, one of which in the last five years, and they will have membership of the Royal College of Psychiatrists, so they are qualified to do the work.

I understand from Adam, and I'm grateful for the conversation earlier, that the amendment is targeted at the theoretical risk about specific individuals not necessarily keeping up to date with the latest developments in practice. There's also a limit to how far that is actually required. [Interruption.] Yes, of course.

Thank you very much. What I haven't heard during this discussion is any mention of the Mental Health (Wales) Measure 2010, which is a devolved piece of legislation, as we all know, that was passed by this Senedd 16 years ago, and what your assessment as Counsel General would be of the integrity of the Welsh mental health Measure, given the amendments that we're discussing here this afternoon, and whether that piece of legislation that was passed in 2010 needs a review to keep on track with non-devolved legislation, such as the amendments to the Mental Health Act 1983 that we are discussing now.

Thank you. I'm not aware that it has any effect at all, but I will definitely look again at that before Stage 3, and if it does have an effect, I will mention it then.

What the Measure does essentially focus on is the delivery of mental health services, which is obviously what we're discussing today, with the qualifications of the GMC practice and people who are qualified to work on those conditions. So, on that aspect of the delivery of mental health services, I think it could be prudent on the Government and yourself as Counsel General to look into those aspects to see how that can marry up with the devolved pieces of legislation that, indeed, we're looking at in a more global sense here this afternoon.

Yes, thank you for that. As I said, I don't think it has any effect on it at all, because we're talking here about the qualifications of people sitting on tribunals and not the qualifications of people in clinical practice in Wales, but I will check again, just to be absolutely certain. At this point in time, I'm as certain as I can be without that one additional check that it has no effect at all.

As I was saying, there is a limit to how far keeping up to date with the latest developments in practice is actually required. If the extent of requirements for people to sit on the tribunal were to be as extensive as the requirements to retain a licence, that would again, to some degree, negate the purpose of the Bill, as those people may simply stop sitting because they're obviously retired and they don't want to keep their licence up.

As we discussed earlier, my officials and I are working to discuss the practical implications and risks of this amendment with various people, such as the president of Welsh Tribunals, this afternoon, on whom the statutory responsibility would sit. And in respect to that office, I ask the Member not to press to the vote at this stage, while we consider with the president of the tribunals what it might mean. And if it is something the president of the tribunal wants to do, then I think there would be a small tweak necessary to the wording in any event, as we discussed earlier. So, I'm more than happy to return to it at Stage 3. Diolch.

I thank again for the Counsel General's response. I think the issues, it strikes me, are these: there is a general requirement, the Counsel General is absolutely right, of course, on the president of the Welsh tribunal system as a whole, to provide training across the tribunal system. That general training generally relates to law and procedure, yes? The problem or the issue that we're trying to solve here is a very specific one—in removing the need for a licence to practice, as stakeholders have raised with us, how are we able to make sure, as time goes on, that medical members, who don't have a current licence, are keeping up to date as clinical practice and knowledge moves on, in as much as it’s relevant to the decisions of the tribunal?

I think that the point in relation to the eligibility requirements at appointment—. Again, they make the point for me, really, because there are these higher requirements at appointment, including, as the Counsel General says, having been a consultant, either full time or part time, within a certain previous period, or membership of the Royal College of Psychiatrists. Both of those, in some ways, give some assurance in terms of current knowledge. The problem is, well, what if you, then, are on the tribunal for 20 years? In a different context, we did discuss—. Indeed, the president of this tribunal was the president for over 25 years. So, there needs to be a mechanism to make sure that we check that current knowledge for medical members who are not currently licensed to practice, not just at the point of appointment, but consistently over the period of their membership of the panel. And I think it would be possible. That's why we don’t go into the detail of what the standard should be. It just places a requirement. I don't think that needs to be onerous. I don't think it’s the same as clinicians having to maintain the very same standard that they would in order to maintain their licence to practice. But there needs to be something, and I don't think that we can subcontract this to the JAC, either, because I don't think that this is going to be high up the order of priority, if I can put it in those terms. We need to make it our priority, because, obviously, the robustness of our arrangements, in terms of our medical health review tribunal, are important. But on the basis that the Counsel General has set out, as we continue to engage with stakeholders, I'd be happy to continue to engage with the Government, withdraw at this stage, and return to this matter at Stage 3.

Adam Price is proposing to withdraw the amendment, and unless anybody disagrees with that in committee, then that can happen. The amendment is withdrawn.

That concludes Stage 2 proceedings of the Mental Health Review Tribunal for Wales (Membership) Bill, and I declare that all sections of the Bill are deemed agreed. Stage 3 will begin immediately, with proceedings taking place later today. The deadline for tabling amendments is 5 o'clock this afternoon.

This meeting has finished, therefore, and Plenary will start in about 10 minutes. We need that time to make the practical transfer arrangements, and the bell will be rung five minutes before Plenary proceedings start. Thank you.