6. Welsh Conservatives Debate: Betsi Cadwaladr University Health Board

– in the Senedd at on 21 February 2024.

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(Translated)

The following amendments have been selected: amendment 1 in the name of Lesley Griffiths, and amendments 2 and 3 in the name of Heledd Fychan. If amendment 1 is agreed, amendment 2 will be deselected.

Photo of David Rees David Rees Labour 4:13, 21 February 2024

(Translated)

Item 6 today is the Welsh Conservatives debate on Betsi Cadwaladr University Health Board. And I call on Gareth Davies to move the motion.

(Translated)

Motion NDM8489 Darren Millar

To propose that the Senedd:

1. Recognises the work and dedication of hardworking staff at the Betsi Cadwaladr University Health Board.

2. Notes that:

a) 27 February 2024 marks one year since Betsi Cadwaladr University Health Board was placed back into special measures;

b) the health board was previously subject to special measures between 8 June 2015 and 24 November 2020, less than 6 months prior to the 2021 Senedd elections; and

c) the health board has spent longer in special measures than any other NHS organisation in the history of the National Health Service.

3. Regrets that since being placed into special measures, patients and staff are yet to see the required improvements.

4. Calls on the Welsh Government to:

a) listen to the concerns of healthcare professionals when concerns are raised about the quality of services; and

b) ensure patients in North Wales get the timely, high-quality healthcare that they deserve.

(Translated)

Motion moved.

Photo of Gareth Davies Gareth Davies Conservative 4:13, 21 February 2024

Diolch, Deputy Llywydd, and I'm pleased to be opening this debate today, although I regret the fact that we are compelled to do so.

Having worked for the NHS within Betsi Cadwaladr University Health Board for 11 years, I am proud of the work undertaken during my time with the board, and I sincerely want the best for Betsi, principally for the sake of patients. I also want to thank the staff at Betsi Cadwaladr University Health Board for their hard work and dedication in the face of mounting pressure, and I have heard as recently as this week constituents commending clinical staff at the Glan Clwyd Hospital. But I also frequently hear concerns raised about the management of the health board and its top-heavy management structure. I truly wish I was standing here this afternoon hailing the successes and improvement of the health board, but, unfortunately, a year on from the health board being placed back into special measures, the appropriate improvements have not been made. In fact, we are nowhere close to seeing the improvements that we should be seeing after a year in special measures. The culpability for this lies squarely with the Welsh Government. The chief executive's position was empty for nearly a year at Betsi, but we haven't seen the necessary leadership from the Welsh Government either. And please permit me to outline some of these failings.

The health board has spent longer in special measures than any other NHS organisation in the history of our health service, so, clearly, there needs to be a re-evaluation of the Welsh Government's solutions to the myriad of issues in the health board, because the current method has, as demonstrated, not worked. In 2019 the health board changed its model of care for vascular services, leading to Healthcare Inspectorate Wales declaring in 2022 that vascular services required significant improvement. Things have started to improve, but vascular services are still subpar, which senior coroner John Gittins referred to, said in so many words, following inquests into four deaths of vascular patients within the Betsi health board. 

Betsi's performance regarding mental health and well-being is dreadful and it's anyone's guess how improvement is expected when the mental health budget has been slashed by 8.8 per cent. As of November 2023, just under 175,000 patients were waiting to start treatment at Betsi, thousands of these patients on a cancer pathway. That is the second worst in Wales. Recent data reveals that Wales as a whole is among the worst for cancer survival. Life expectancy in Wales has been declining since 2012, and these are truly harrowing statistics.

There are also ongoing issues with workplace recruitment and retention. Waiting times—as we know, a recurrent issue in Wales—are the poorest within Betsi Cadwaladr and data from December 2023 shows that just 83 per cent of patients were seen within the 12-hour waiting-time target, over 10 per cent behind the Cardiff and Vale University Health Board

I could stand here ad infinitum naming the dire issues and failures in the health board and I'm sure we'll hear more from my colleagues later on in this debate. But what would we, in the Welsh Conservatives, do to remedy these issues? Firstly, we would spend the full Barnett uplift that the Welsh Government receives for health and actually spend it on health—something that the Welsh Government could achieve by dropping the poorly timed pet projects like the planned spending of £120 million on more politicians and the blanket 20 mph policy. We would spend this on doctors and nurses instead. We should listen to the concerns of healthcare professionals to ensure that patients in north Wales get the high-quality healthcare that they pay for and that they deserve, and are treated in a timely fashion. 

We support calls for an independent inquiry into the running of the health service in north Wales and to enact a workforce plan that includes a tuition fee refund for healthcare workers to solve the recruitment and retention issues. 

To close, Deputy Llywydd, the Welsh Government needs to start listening to patients and healthcare professionals regarding the quality of service in the Betsi Cadwaladr University Health Board. You will hear how the health board is failing on most metrics. The figures—many of which I am sure you are familiar with—are enough to turn your hair white. The board has been in and out of special measures since 2015 and, on the anniversary of its most recent placement into special measures, there needs to be a recognition that a drastic change in thinking is required, and, most importantly, action. 

I look forward to hearing the contributions from other Members in this debate. Thank you. 

Photo of David Rees David Rees Labour 4:18, 21 February 2024

(Translated)

I have selected the three amendments to the motion. If amendment 1 is agreed, amendment 2 will be deselected. I call on the Minister for Health and Social Services to move formally amendment 1, tabled in the name of Lesley Griffiths

(Translated)

Amendment 1—Lesley Griffiths

Delete all after 2(a) and replace with:

any decision to escalate or de-escalate an NHS organisation must be based on a proper consideration of an extensive range of factors and factual evidence;

Further notes that:

a) the recent Audit Wales follow-up review of Board effectiveness recognised improved board stability and concluded that the dysfunctionality within the board described in its previous report is no longer evident; and

b) performance for planned care has improved since February 2023, with a 1.5 percentage point improvement against the 26-week target, a 15.5 per cent reduction in the number of people waiting over 52 weeks for a first outpatient appointment and the lowest number of people with total waits over 104 weeks since August 2021.

Acknowledges that:

a) the Welsh Government recognises significant challenges remain; and

b) the Welsh Government continues to support the health board and hold it to account to ensure it listens to the concerns of healthcare professionals when concerns are raised about the quality of services and delivers the timely, high-quality healthcare that patients in North Wales deserve.

(Translated)

Amendment 1 moved.

Photo of David Rees David Rees Labour

(Translated)

I call on Llyr Gruffydd to move amendments 2 and 3, tabled in the name of Heledd Fychan

(Translated)

Amendment 2—Heledd Fychan

Add as new sub-point at the end of point 4:

publish a clear de-escalation process, explaining who will contribute to the de-escalation process and who would make the final decision, while also providing an explanation of the decision;

(Translated)

Amendment 3—Heledd Fychan

Add as new point at end of motion:

Welcomes the appointment of Dyfed Edwards as the new Chair of the Health Board and further calls on the Welsh Government to provide a clear timetable for the appointment of a full complement of executive directors and independent members.

(Translated)

Amendments 2 and 3 moved.

Photo of Llyr Gruffydd Llyr Gruffydd Plaid Cymru 4:18, 21 February 2024

(Translated)

Thank you very much, Dirprwy Lywydd, and I want to start in exactly the same place as the motion itself, by recognising the work and commitment of all of the health board staff—not just those on the front line, but those who provide support services also—because I've said many times that they go beyond the extra mile and do so despite all of the problems and failings, particularly at a regulatory level, as we have seen in the past. 

And it is difficult to believe that 12 months has passed since the board found itself back in special measures, and that for the second time, having spent almost five years in special measures up to 2020. 

Now at that point, of course, there was a question as to what impact the special measures had. Because the situation took far too long to right itself, with the board still going from one crisis to the next, with the decision ultimately taken to take the board out of special measures just six months before an election, raising all sorts of concerns about the motivation in doing so. 

But the question now is: what's different this time? Is the situation different? I've already placed on record that I do feel that the atmosphere has altered, and that, in and of itself, is a positive development. Much of that is down to the work of the new members of the senior management board, mainly the new chair, Dyfed Edwards, and the new chief executive, Carol Shillabeer. The follow-up report of the auditor general notes that the position is more stable and that the relationship between senior leaders is more positive, generally speaking, now as compared to the turnover in board members that was identified in that initial report early in 2023, and that that is thanks to the more positive environment that is now obvious within the board.

I have been witness to that myself. I've referred in the past to the public meeting I held in Betws-y-Coed with Llais in order to address the fact that the general practitioners there were giving up their surgery. The chair himself came to a public meeting with 200 local people, the chief executive was there and the head of the relevant department was there. That wouldn't have necessarily happened in the past, and there was that direct engagement, facing the public, and being transparent and accountable, and that was a breath of fresh air, in my view. So, the early signs are positive, but it will take time for that new culture to permeate down through the whole health board.

The Minister yesterday referred to some day-to-day improvements, that the number of patients waiting over three years for treatment has reduced and the number of people waiting over eight weeks for a diagnostic appointment has also reduced.

Photo of Llyr Gruffydd Llyr Gruffydd Plaid Cymru 4:21, 21 February 2024

And although we see these figures decreasing, of course, the fact that these data sets exist in the first place is probably unacceptable, isn't it, because they mean that patients are still waiting over three years for treatment and over eight weeks for a diagnostic appointment, and they are substantial waiting times that no person should have to endure.

Now, in order to see the necessary improvements in the performance of the health board, the auditor general emphasised the need for further appointments to ensure that the board is at full capacity as quickly as possible. It has been 12 months; we still see essential parts of the organisational structure not in place. The Minister told us yesterday, in fairness, that she was waiting for recommendations on the final four independent members, which will be announced very soon, I think. Maybe you could tell us what that means when you respond to the debate. That corresponds, of course, with the findings of the auditor general's report, but what I'd like to ask is: since the appointment of board members is so important to the effective running of the health board, it's frustrating, isn't it, and disappointing, I have to say, that it has taken over 12 months for those to happen, because, by not having those members appointed, then, obviously, fundamentally that journey of improvement has been held back to a greater degree than many of us would have wished.

All of us in Wales, of course, share the same goal of getting Betsi to a position where it can be removed from special measures, but that has to be done when it's ready for that to happen, and the Minister, in fairness, recognised that in the statement yesterday. I think you said that they will come out of special measures when they're ready to come out of special measures, not before. I'm not sure whether that's some sort of implicit suggestion that you accept maybe, that you've finally realised, that they were rather prematurely removed out of special measures last time. But, of course, that isn't a reason for anybody to sit back and take their foot off the accelerator either, so it's disappointing, I suppose, that it has taken a whole year to get the board fully appointed. I understand that there may be reasons for that, but surely 12 months is more than enough time to get that in order.

Similarly, yesterday, and I'll conclude with this, the Minister said that a series of sustainability conditions had been set on the board that needed to be reached before considering de-escalation; those would include strategic vision and culture change. But she also said that, in the coming months, she would supplement these conditions with de-escalation criteria. So, we're a year into special measures and critical criteria aren't in place. Now, I know you're probably waiting for the new board to be in place in order for them to have ownership of that, but, again, I think 12 months—a whole year—for us to be able to articulate what that looks like is unacceptable, and that point is captured, I hope, in the other amendment that we make. Diolch.

Photo of Sam Rowlands Sam Rowlands Conservative 4:24, 21 February 2024

I'm pleased to be able to take part in this really important debate today, because, as we've heard, it's almost a year since the health board for north Wales, Betsi Cadwaladr University Health Board, was placed in its latest version of special measures. It's important to remember that this is just the latest version of a fairly sorry tale. The latest version—the exact date—started on 27 February 2023, but we're looking, since the summer of 2015, at a similar situation formally way before that in terms of what Members of this place were raising with Ministers. And as Gareth Davies has already outlined, this is a health board that has spent longer in special measures than any other NHS organisation in the history of the national health service. As a proud Welshman, that really shames me, actually, that, in Wales, we have that sorry badge of having a health board that's spent the longest in special measures of any health board in the history of the NHS.

This latest chapter in this sorry tale is highlighted through the Audit Wales report again, which has some positives in it. It shows a level of progress in there that has to be acknowledged, but it still talks of fundamental challenges that the health board faces. There are references there, still, to substantive appointments, a cohesive and unified board and ongoing personnel issues. This does, for me, point to some significant issues, still, within the management structure, which haven't been fully fixed. Now, I know that the Minister will want to highlight where there is progress—and I do understand that, Minister—when you speak in a few moments' time, but I think that you should also seek to acknowledge that outcomes are still nowhere near where they should be. The one that strikes me most at the moment is our emergency department, where just 83 per cent of patients are being seen within a 12-hour waiting time target. That means that nearly 20 per cent of people are having to wait more than 12 hours in our emergency department. That's not a position that any of us wants to be in and our residents should not accept that, either.

Now, point 1 of our proposal today rightfully recognises the work and dedication of hardworking staff at the health board, and let's keep that on record, because it's very important that their hard work continues to be noticed. But, unfortunately, they are working in an environment that does hamstring them, and this, for me, is because of the structure that's been in place for far too long in the management of the health board. But also there has to be accountability by Welsh Government and by Ministers in Welsh Government. Now, I understand that, in the past, Ministers have pointed to responsibility lying at the health board level or by management in health boards, which is absolutely right; there is responsibility there. But, ultimately, for us as parliamentarians, accountability rests here in this place. As a delegated work of Wales, accountability lasts and rests here with Ministers in the Welsh Government. And it's the same Welsh Government that, as Llyr Gruffydd pointed out a moment ago, pulled Betsi out of special measures just before the last election and plunged them back into special measures pretty soon afterwards as well—clearly a mistake. And Gareth Davies has already pointed out what we would do as Conservatives, which is to properly fund it with the full amount of funding that Welsh Government gets from the UK Government, from taxpayers.

It's Labour's underfunding that is causing people to suffer in north Wales. Two years ago, the Welsh Government set a target that no-one should wait eight weeks or more for a diagnostic test, which is a wonderful target and it is very, very important, but, as of November last year, a staggering 40 per cent of waits were longer than the eight-week target—47,000 people waiting longer than the target that's in place. I think the point here is that I just don't think Welsh Government completely gets it—the experiences that my residents are feeling, day in, day out, in north Wales. I think another highlight of this that shows this issue is the recent leadership debate that took place in Mold between Mr Gething and Mr Miles, as they were drumming up support from the Labour faithful up in Mold. In that debate, there was not a single question about the NHS. From my understanding, actually, questions were filtered and not one question in that debate was about the NHS. So, when it comes to getting this issue and understanding what residents in north Wales are facing, to have not one question about the NHS, I think is something for the Labour Party to reflect on here in Wales.

With that summary in mind, Deputy Presiding Officer, I would encourage all Members to support the Welsh Conservatives, who would do the right thing for people in north Wales.

Photo of Jack Sargeant Jack Sargeant Labour 4:29, 21 February 2024

I'm very grateful to have the opportunity to be able to speak in today's important debate. I'll start, Presiding Officer, by echoing the calls from colleagues across the Chamber to thank those who go in day in, day out, and go above and beyond day in, day out, to support residents in Alyn and Deeside and across north Wales.

Like many Members have already said this afternoon, health casework makes up a significant proportion of my own case load as Member of the Senedd for Alyn and Deeside, and the responsibility for delivering the services my residents rely on sits with Betsi Cadwaladr University Health Board. As I said in the Minister's statement yesterday, whilst most residents view health provision through the lens of whether they can get a GP appointment, how long they and their loved ones wait for treatment and access to things like dental care, many are also well aware of the health board's performance. The Minister, I'm sure, would not want me to say this in any other way or sugar coat this matter, but there is real frustration about the health board's past failings in Betsi Cadwaladr University Health Board, whether that's mental health services, whether that's access to GPs, whether that's waiting times or, as quoted in previous reports, Presiding Officer, the dysfunctionality of the health board. We all know, the Minister knows as well, it's not been good enough. All this and more is why the health board has gone in, out and then back into special measures, and it's clear that the problems were deep-rooted.

I very much welcome the auditor general's report that progress has been made, but when I do speak to residents and healthcare workers in north Wales, they are still clear that a lot more progress has to be made and has to be done consistently and quickly. We need a clear plan for that, we need a plan that we can hold the health board against, and that starts with getting the right people in post at board level so that they can, as the Minister said yesterday, and I quote, 'stabilise the ship'. I'm pleased the positions on the board are being filled. These things should have happened some time ago, but I do hope now that we have finally turned that corner.

Presiding Officer, more than 20,000 people work for the health board, and hundreds of thousands of people rely upon it. They mark progress against how they can access services, and we should not lose sight of this. What we're talking about here today is making sure that we drive improvement in access and outcomes. That's what my residents in Alyn and Deeside deserve and expect; it's what I expect as well. In response to the statement yesterday and my contribution to the response yesterday when I asked the Minister are my priorities and my residents' priorities the priorities of the Minister and the Welsh Government, I was particularly pleased to hear that they were. Diolch yn fawr.

Photo of Janet Finch-Saunders Janet Finch-Saunders Conservative 4:32, 21 February 2024

Well, we know even more from yesterday that the beleaguered Betsi Cadwaladr University Health Board still faces some huge issues. As my colleague Darren Millar pointed out, a new report, only out yesterday from the quality, safety and experience committee, outlined some enormous risks to patient safety: oxygen cylinders not connected correctly, resulting in no oxygen to patients; severe backlogs in urology, and patient pathways not being actioned due to dire staffing levels; and 1,133 letters identified during a search as being dictated by clinicians but having not yet been issued, the oldest of which was dated 13 June 2023. I dare say that some of those letters were intended for us, following constituent complaints that we've raised and not received any responses to. Most alarmingly, during the search of the office, 100 plus radiology reports, internal referrals and histology reports, around 300 collectively, have been identified as not having been reviewed or actioned. This is just simply not acceptable.

There is no denying that key public services have worsened over the past years under the leadership of the First Minister, Mark Drakeford, with waiting times in such disarray. Currently, there are four times as many Welsh residents waiting more than a year for treatment compared to those in England, and a staggering 40 per cent rise in the number of Welsh patients now seeking treatment in English hospitals. Confidence is at such a low level now as regards our health board. You can see why when patients in Wales are waiting, on average, six weeks longer to receive operations, yet I have got constituents who were waiting two years pre COVID, still waiting for operations now. This exemplifies to me just how slow the Welsh Government has been in reacting to the crisis in the Betsi health board.

Specifically, I'm reminded of the Bryn y Neuadd Hospital in Llanfairfechan, where, in February, I criticised the Welsh Government’s failure to discuss and deal with the backlog of £27.7 million of repairs, with 70 per cent of the occupied floor level being recorded as not functionally suitable. This is a hospital treating some of the most vulnerable in society, many with complex health needs. I myself have requested a visit there many times over the last 12 months, to no avail. So, I can go and visit any hospital any time, yet I’ve asked several times to visit Bryn y Neuadd.

Over the last few years, we’ve witnessed so many terrible and scandalous reports. Ten reviews have been carried out, all highlighting the significant problems we are hearing yet again this afternoon. It does beggar belief how much these reviews are costing the taxpayer, and I would be grateful, Minister, if you could confirm today how much taxpayers’ money has already been spent on the special measures over the last 12 months.

Despite all this investigation and inquiry, the Welsh Government seem no closer to understanding the wider issues at play. The most serious in my eyes is the Ernst & Young report. The investigation revealed that the finance team intentionally entered inaccurate information into the accounts, falsely attributing expenditures to a single financial year, instead of accurately reflecting their distribution over multiple years. I keep being asked by my constituents, Minister: what is happening about that? What is happening about the scandal around the £122 million?

This is still not a good time for the Betsi health board, but I reiterate that I’m grateful now for the work being done by Carol Shillabeer, the chief executive, Dyfed Edwards, and hopefully in time to come, a team, a good working team, with a good plan.

We are left with record waiting lists and the subsequent consequences for survival rates. Life expectancy in Wales has been declining since 2012, with Wales the third lowest in the UK. We made calls back in January for Llandudno minor injuries unit to receive some of the £2.7 million made available. I really sympathise with Darren Millar, Gareth Davies, Sam Rowlands, all our north Wales Members who raise the issues, with the promises of other minor injury units and emergency departments elsewhere. These smaller hospitals are really, really crucial in battling the pressures that are facing our health boards.

We, the Welsh Conservatives, are keen to address the underlying issues at play here. Urgent action is needed to finalise substantive appointments to the board to ensure its full capacity. We need a strong leadership. Governance issues have been ongoing in this board since 2012. We need compelling proof that the Government—and you as the Minister—have grasped the necessary lessons signalling a departure from the pattern of normalised dysfunctionality—

Photo of David Rees David Rees Labour 4:38, 21 February 2024

You need to conclude now, Janet, please.

Photo of Janet Finch-Saunders Janet Finch-Saunders Conservative

—and declining standards. Enough is enough. Wales, and my constituents, and constituents across north Wales, deserve better. 

Photo of Mabon ap Gwynfor Mabon ap Gwynfor Plaid Cymru

(Translated)

As I mentioned yesterday, Betsi Cadwaladr is my own health board, and it has the daunting responsibility of looking after my loved ones—my wife, my children and my extended family—during their hours of need. So, I will forever be grateful to the miraculous midwives who brought my children into the world at Wrexham Maelor Hospital, and the nurses who gave tender care to Nain and Taid, my grandparents, during their last days, not to mention Dr Thomas and Dr Liddell, who are there for us as a family every time. So, when things do go wrong, it is not just the patients who suffer, but the excellent workforce suffers as well.

When the health board was created 15 years ago, it was clear that there would be initial problems as three health boards merged to create one. But even though 15 years have passed, those rifts continue to exist, and this is a core part of the board’s failure and the Government’s failure to recognise the weaknesses and address the weaknesses that were there from the outset.

First, I fear that the Government is not putting enough emphasis on health outcomes, with far too much emphasis being placed on short-term solutions, without enough attention being given to developing a long-term strategy. Secondly, it’s also clear that early intervention is very rare, which has normalised and allowed the failure of health services. Mental health provision is a perfect example of this.

And thirdly, the Government has failed to present us with a vision of how the health service should be delivered in the north. The Government hasn't even explained what success looks like in the context of the board. Consider this: it's more than a year now since the board was put back into special measures, and it is only now that the Minister is starting to think about creating a framework for de-escalation.

This is what the Minister said in her response to me yesterday:

Photo of Mabon ap Gwynfor Mabon ap Gwynfor Plaid Cymru 4:40, 21 February 2024

'I'm going to supplement those sustainability conditions with clear de-escalation conditions in the coming months'.

Photo of Mabon ap Gwynfor Mabon ap Gwynfor Plaid Cymru

(Translated)

In all seriousness, consider for a moment what this tells us. More than a year since the board was put back into special measures and only now is the Minister thinking of starting to set de-escalation conditions for the board. It's no wonder that the board is failing. It sometimes feels like it's being set up to fail. How is it possible for the board to proceed with urgency in tackling the problems if it does not have that clear framework with the necessary milestones in place to come out of special measures and build towards a more prosperous future?

Rather than trying to control or micromanage everything that the board does on a daily basis and hinder its ability to be innovative and flexible, the Minister should try to develop an understanding of the region's health and welfare needs and work together with the dynamic new board to create a long-term strategy with clear milestones along the journey to measure success and growth. Without this, I’m afraid that we will be stumbling on from one crisis to another, with staff losing confidence and patients continuing to suffer.

That brings us, finally, to consider the essential change in culture, and that being a change from the top, namely the Government. Rather than the attitude of learned helplessness that has seeped into all of this Government’s work, which, in turn, has corrupted the health board, we must change the attitude to one that aims for the best and shows confidence in our ability here to provide the best possible care in accordance with the needs in the region, and to do so in the unique environment of north Wales. Thank you.

Photo of Mark Isherwood Mark Isherwood Conservative 4:42, 21 February 2024

Well, let me start by thanking staff in the health board's audiology, speech and language and vascular screening departments for the excellent service they've given me personally over recent months. However, my personal experience with some of the departments has not been so good. I also note a Welsh Ambulance Services NHS Trust response regarding a constituent, which included that an investigation concluded that all the emergency ambulances on duty during the 999 call cycle were attending to other patients in the community or were delayed at Betsi Cadwaladr University Health Board hospitals waiting to transfer patients from emergency ambulances to hospital staff.

Regrettably, Labour Ministers dismissed and derided our evidence-based warnings about this health board over very many years. On each occasion, they dodged responsibility by instead accusing us of talking down our Welsh NHS and staff, when we were instead speaking up because staff, patients and families had asked us to do so. 

Commenting on last week's Audit Wales report, following up on the board effectiveness of Betsi Cadwaladr University Health Board, the auditor general stated that 

'It’s assuring to see that the dysfunction within the health board’s senior leadership that we described last year is no longer present.'

Despite this, he subsequently told me that the report does, however, go on to say quite clearly that fundamental challenges still remain. These include the need to build an executive team with the capability and experience to tackle the significant operational challenges the health board still faces, and the need to further strengthen the way in which executives provide assurances to the board and its committees. He said that it was also important to stress that his report focused solely on board effectiveness and not the effectiveness of the wider organisation or, indeed, on specific service areas, such as mental health or urology. Audit Wales also emphasised that further action in a number of areas is still needed. 

The core problems always lay within the executive. The letter I sent to the health board in March 2022, as Chair of the Public Accounts and Public Administration Committee, included that we were disappointed by the lack of ownership and responsibility taken by the executive of the problems at the board. And, referring to various reports, including the Holden, Ockenden, HASCAS and Public Accounts Committee reports, we said that we were also concerned about the ongoing presence of executives and managers at the health board who were implicated in the conclusions of these reports and about their ability to deliver the internal change required. We never received a response to these concerns.

At the Public Accounts and Public Administration Committee meeting on 3 May 2023, we also received evidence from John Gallanders and John Cunliffe following their forced resignation as independent non-executive members of Betsi Cadwaladr University Health Board by the Minister on 27 February 2023. We heard that the forced resignation followed attempts by the independent members of the health board to hold the chief executive and senior management team to account through purposeful challenge and scrutiny after they were no longer prepared to tolerate the poor performance and unwillingness to be held to account of certain executive members of the board.

The central questions about this functionality within the health board therefore remain unanswered. Are those executive members referred to still in post or otherwise still able to influence governance and/or to manage staff teams? If 'yes', are they the same colleagues referred to in the statement I received on behalf of the former independent members of the health board following their forced resignation, which I shared with the Public Accounts and Public Administration Committee, where it stated that some well-intentioned executives have been tarnished and undermined by the behaviours of their colleagues, such that the team itself became dysfunctional and ineffective as a group? If 'yes', are these the same executive members responsible for blocking accountability, burying reports and bullying whistleblowers over more than a decade?

Functionality, effectiveness and efficiency require transparency and accountability, and we need concrete facts about this accordingly. This is not just historic. Only last Thursday, I was written to regarding the situation in urology services. This included, 'It is no wonder that the relevant executive has put off the royal college review now for over 12 months'. They conducted a search of the office to find massive issues: that patients should have been having treatment, but the reports and letters not processed. The sacked independent members knew about the situation; look at minutes from 12 months ago, when they were being fobbed off by executives. That is the core of the problem. Diolch yn fawr.

Photo of David Rees David Rees Labour 4:47, 21 February 2024

(Translated)

I call on the Minister for Health and Social Services, Eluned Morgan.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour

Diolch yn fawr, Dirprwy Lywydd. I'm pleased to have the opportunity to respond to this debate this afternoon and to continue the discussion around Betsi Cadwaladr University Health Board.

Yesterday, I set out some of the improvements that have been made over the last 12 months, and today I will highlight a number of service changes that will have a positive impact on the people of north Wales. But I do want to echo the comments made by other speakers around the commitment and dedication of the more than 20,000 staff who work in the health board. They are an integral part of the health board's improvement journey.

While it's correct that the health board has been in an escalated status for a number of years, I think that everyone in this Chamber would agree that my decision to escalate the board to special measures almost a year ago was the right decision. As I said yesterday, I have no intention of de-escalating the health board to level 4, which is 'targeted intervention', until I'm absolutely sure that the serious issues and drivers of poor performance, governance, leadership and culture are resolved.

As I reminded you yesterday, I set out a series of sustainability conditions last year, which will need to be met before any de-escalation can be considered. I think it's really important to note that over the past year, there's been a huge amount of work done. The key thing that we wanted to set out, against a very clear set of measurable targets, was the stabilisation of the board. So, it's not that we haven't had a framework to work from; we've had an incredibly closely monitored framework that we've been working to for the past year, and it's only now that that stability is in place that we can move on to the next one. So, I think it's really unfair to set out that there's a suggestion that it's only now we're getting to it; it's a very deliberate approach.

There are real signs, I think, that the health board is starting to change for the better. As people have referred to, the Audit Wales follow-up report on board effectiveness shows that the health board is moving in the right direction, with more stability and better working relationships. It's interesting to see that Llais, as well, an organisation that has always been ready to criticise the health board in the past, has also recognised that actually things have changed. I recognise that there is a long way to go before we can restore the confidence, though, of many people in north Wales in relation to their health service. But there are thousands and thousands and thousands of people every week who are getting an excellent service.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 4:50, 21 February 2024

Over the last year, there have been many changes within the health board, with support and advice provided by expert independent advisers. There has been a change in leadership and approach with a new chief executive. Yes, it took a while to get the permanent chief executive in post, but actually the interim chief executive was in post the next day when we announced special measures. There's the chair, the vice-chair, there are the new independent board members. They're all committed to improving ways of working, the handling of finances and improving the quality of care provided, and the experiences of patients and their families.

I know that many of you were keen to see changes to the executive team, and these are taking place. The director of corporate governance will start in April and recruitment to the posts of director of workforce and organisational development, chief operating officer and director of therapies will commence in the coming weeks. But there are other posts that have already been appointed and that are transforming the organisation. We collectively need to support the health board. We need to start talking about the good things that are being delivered to raise the morale of the staff in the service and the confidence of the public, whilst of course we need also to focus upon improvements in the area of concern.

There are plenty of new ways of working in place, including an expanded post-anaesthesia care unit at Wrexham Maelor Hospital for people who need specialised care after surgery. An eight-bed respiratory support unit has been opened in Ysbyty Glan Clwyd to support people with respiratory issues who need regular observations but don't need high-dependency care. It was amazing to see how that was working in a recent visit. Cutting-edge laser surgery is being used to remove kidney stones, and the orthopaedic team at Ysbyty Gwynedd has performed over 100 knee replacement surgeries using robotic technology. I was also pleased to learn that doctors in training have ranked Ysbyty Gwynedd's emergency department as the best place to train in the whole of the United Kingdom.

Wrexham Maelor Hospital is the first in Wales to use a new procedure, a cutting-edge laser, to remove bladder tumours or suspicious areas, and this is going to improve people's outcomes and experience. A new stroke rehabilitation centre has opened in Llandudno General Hospital to ensure patients have the best chance of a good recovery after having a stroke. A straight-to-test pilot approach has been introduced so patients have an mpMRI test sooner after being referred for diagnostics on suspicion of cancer. People can be seen more quickly, undergoing an MRI scan around 18 days after a GP referral.

The decision by Healthcare Inspectorate Wales to de-escalate vascular services from a service requiring significant improvement last June was encouraging, and I'm glad to hear that my colleague Mark has had a good service in that vascular department as well. The subsequent assurance assessment by the NHS executive also indicated that the service is making the required improvements, and I look forward to the outcome of a further case notes review, which is due to report in March.

Last year, waiting times for orthopaedics across Betsi Cadwaladr were considerable, with 2,472 patients waiting over 104 weeks. Waiting times for orthopaedic pathways have improved, with 1,100 patient pathways now waiting over 104 weeks. That is still a long way to go, but it's a 52 per cent improvement since they were put into special measures in February. Work has started on the new orthopaedic hub in Llandudno, and that's expected to be operating at full capacity early in 2025. The aim is to deliver 1,900 orthopaedic procedures per year.

The leadership and management of the mental health service, including children and adolescent services, remains fragile, but I would be very interested to hear where Gareth got this idea that the service has been cut by 8 per cent. We ring-fenced the mental health budget when it came to the budget, and my colleague Lynne Neagle made sure that that was not removed. Of course, we know there's more room to be done there, but there have been a number of positive HIW inspections over the last 12 months, suggesting a stabilisation of the service. Performance against the various measures—

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour

If you don't mind, I'll just finish the bit on mental health. Performance against the various measures for adult and child and adolescent mental health services has generally improved, although, of course, some challenges remain. I'm happy to take an intervention.

Photo of Mabon ap Gwynfor Mabon ap Gwynfor Plaid Cymru

Diolch. While I accept that you say that funding for mental health is ring-fenced, do you not accept that the health board, and other health boards for that matter, actually spend significantly more on mental health services than what is ring-fenced? So, you could still have a state where the funding is cut from where it was last year, because the ring fence is only a base to go from.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour

The ring fence was increased by £25 million despite our dire financial position, so I think it is probably worth noting that we are absolutely committed to this. It is one of the priorities that I always set for the health boards: that we are absolutely determined to make sure that mental health gets the same attention as physical health does. There's the fact that we have now the '111 press 2' service, which is transforming the way that people interact. I think it is important that we demedicalise our approach to mental health. I can't remember who talked earlier about the need to intervene early in relation to mental health, but that's precisely the approach that my colleague Lynne Neagle is really robustly pushing. You were here for the debate yesterday in relation to mental health; you'll know that that's precisely where we're heading.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 4:56, 21 February 2024

(Translated)

I know how much time people have had to wait for appointments, care and treatment over the past year, and I know that that's been frustrating. There are reasons for hope, however. We must always remember that thousands of people across north Wales receive healthcare, support and treatment of high quality every week. The thanks for that is to the commitment and expertise of staff at the health board.

For patients waiting for planned care, the numbers waiting 52 weeks for a first out-patient appointment has reduced by 15.4 per cent, and the number waiting 104 weeks for treatment has reduced by 24.9 per cent since February 2023. The number of patients waiting longer than eight weeks for a diagnostic test has reduced significantly, with 5,943 people waiting in November 2023, as compared to 10,000 in May 2023.

Emergency care continues to be challenging, and that's no surprise as we see how many people are coming in to our emergency departments. People are still waiting too long to be seen. The performance against the four-hour target is consistently lower than the level we would expect. Although there has been an improvement in reducing delays of four hours in transferring patients from ambulances, we still need significant improvement.

Photo of David Rees David Rees Labour 4:58, 21 February 2024

(Translated)

Minister, you need to conclude now.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour

(Translated)

Thank you. There are so many things that have improved during the past 12 months. There's stability now in terms of the board, but what we need now is ongoing improvement. I do think that the change of culture that has come from the top of the organisation does mean that things are on the right track. There's a long way to go, but certainly, as a Government, we are keeping a close eye on that and we're there to help the health board. Ultimately, the health board must do this work itself. Thank you.

Photo of David Rees David Rees Labour 4:59, 21 February 2024

(Translated)

I call on Darren Millar to reply to the debate.

Photo of Darren Millar Darren Millar Conservative

Thank you, Deputy Presiding Officer. I think it's been a good debate that we've enjoyed this afternoon, talking about the challenges that the Betsi Cadwaladr University Health Board has, whilst recognising the very hard work of front-line NHS staff and the positive experiences of many patients. You're quite right, Minister; many patients do have positive experiences. I think the problem with the Betsi Cadwaladr health board is that it's inconsistent. It's inconsistent from one hospital to the next. It's inconsistent from one department to the next. And as a result of that, we've got a plethora of problems that the health board is still grappling with, almost 10 years since it was first put into special measures—nine years at least.

And we do have to hold you to account. I know that you like to pass the buck to the health board and blame them for things that go wrong, and then take the credit for the things that go right. That's the nature of the Welsh Government, I'm afraid. But the reality is that we need some more transparency. Our constituents are telling us their experiences, and they don't chime with the very positive impression that you're giving of improvement at the health board. Unfortunately, many people are still waiting over three years for treatment, and as I referenced yesterday, the health board only told us this week that they had finally eradicated six-year waits in the health board from referral to treatment. Now, how they can have been allowed to develop is beyond me, but if we don't see the information to be able to challenge you, and you don't see the information on six-year waits, five-year waits, four-year waits, then how on earth are we going to get to grips with the challenges in that health board? Because you've got to know what you're dealing with in order that you can focus attention and resources at dealing with them, and I'm afraid there's no transparency. 

The health board, of course, told us, as I advised you yesterday, that 10 reviews had been completed, 10 reports had been received, 10 lots of recommendations had been made, and that they were working to implement them. Not one of those reviews has been published in the public domain, or shared with Members of this Senedd. We want to hold them to account for the implementation of those. I trust that they've been made available to the Welsh Government, and I think that you ought to get those published, frankly. Given that it's in special measures, you should direct the board to publish those reviews so that we can see them.

And we still have these terrible horror stories coming to light like the administration of oxygen problem that Janet Finch-Saunders referenced, and these urology letters and scans that had gone missing. We know that at least 62 of the 100 plus scans were abnormal. I don't know whether that's caused harm to patients as a result of delays in them getting access to treatment and care, but clearly that is a concern, and, to me, the fact that that's been allowed to develop for over a 12-month period, while the board has been in special measures, suggests to me that special measures are rubbish and they don't really work, and that you are not having the focus on the health board that there needs to be in order to make sure that its administrative functions are working.

What I can never understand is why the information from Members of the Senedd who come to the health board with complaints—. We know the parts of our postbag and the parts of the services in north Wales that we get complaints about, and I can tell you, we get no complaints, as Mark Isherwood has said, about the audiology services, because they're excellent, but we get lots of complaints about mental health services, we get lots of complaints about urology services, we get lots of complaints about the overly long waiting times that people have to endure in order to get their tests, their treatment and their access to the support that they need. I would have hoped that the healthcare inspectorate and indeed the Welsh Government would be asking us to help point you in the right direction so that you can investigate the concerns that are there, and that's why I cannot understand why it took so long for them to realise there was a problem in the urology department, because I've been writing to them, frankly, for years about that department.

In terms of mental health, we're still waiting for the review of reviews to be published. It was supposed to be completed by the end of last year; I still haven't seen it. March is soon approaching. You told us that you were going to do things at pace in order to improve the situation there. It certainly doesn't feel like things have been moving at pace, I'm afraid. We also know that a urology review was commissioned by the previous board members. Presumably, that's ended up somewhere—we haven't seen it. So, it seems to me that the only time we ever see a review is if it's got good news to tell us, not if it perhaps has got gory details to tell us, and we need to see both because we need to have the balance. That's why I'm saying we need a more transparent Government. We want to help you to do the job that you want to do and that we want you to do, which is to improve that health board. [Interruption.] I'll happily take the intervention.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 5:04, 21 February 2024

Thanks. Well, I know 10 reviews, as you say, have been commissioned. Four of them have actually been published, so it's up to you to go and have a look at those, because they are out there and they are published, and the others will be published once they have been reported, once the committee has decided. So, there's no lack of transparency here, but if they've been published, we're not going to hand them to you in your hands—you can go and look for them as well. They're all out there, they're ready. There is transparency.

Photo of Darren Millar Darren Millar Conservative 5:05, 21 February 2024

Yes, of course we should spend hours trawling the health board's website, searching for these reviews in order to find them, so that we can have a look at them. And I would say this: one of the previous criticisms, actually, of the health board, was that you couldn't find the wood for the trees in the board papers, right, so how you expect us to have the time to go searching and trawling the internet to try and find reports is beyond me. And let me tell you, I expect you as a Government to be publishing these things and to be drawing everybody's attention to them. That is what we expect from our Ministers. We want some transparent accountability. [Interruption.] We want some transparency and accountability. 

Photo of David Rees David Rees Labour

Can Members please allow the speaker to speak?

Photo of Darren Millar Darren Millar Conservative

We want some transparency and accountability. Now, you've talked also about the challenges that the health board has in many areas. I've talked about urology, I've talked about mental health services. Another one, of course, is in the emergency department—some of the worst-performing emergency departments, I'm afraid to say, particularly at Glan Clwyd and Wrexham Maelor, in the whole of the United Kingdom. It's not something we should be proud of; we need to improve them. One of the solutions, 10 years ago, that this Government said it was going to implement in order to improve that situation was the development of a new minor injuries unit and a new community hospital in Rhyl. Where are we? We are still waiting. And you keep throwing the buck back to the health board, saying, 'We're waiting for the health board to do this.' Well, you should be chasing them. You should be hunting them down in order to bring forward a plan that you believe that you can invest in. If you promise the public a new minor injuries unit, to take pressure off the emergency department down the road, I'm afraid you should deliver. You should put your money where your mouth is and get on and deliver these things. We haven't seen that for 10 years.

And north Wales hasn't been getting its fair share of capital investment either, has it, Minister, not compared to other health boards across the country? We've been left far behind. Part of that is because nearly every plan that the executive team tried to bring forward, to improve the situation and improve performance, was swatted back under the previous escalation arrangements. So, that's why I do agree that there needs to be more freedom to innovate amongst the executive team and the health board, to address the challenges that they face, because it's local solutions that will deliver the improvements that we need to see.

So, I ask you, Minister, let's be more transparent, let's see the good and the bad. You read a long list of brilliant things that were happening at the health board, and I take my hat off to them. I want to celebrate those things too. But there's a long list of really bad things, really bad experiences that our patients in north Wales are having to put up with, that they shouldn't have had to put up with for so long. We need to depoliticise these decisions about when things go into special measures and when they're taken out of special measures. You shouldn't be making those decisions, it should be an independent process that arrives at those decisions. And only then, when we start to see the improvements in our patient experiences in north Wales, are we going to have confidence that this health board is out of the woods and charting a new road to success.

Photo of David Rees David Rees Labour 5:08, 21 February 2024

(Translated)

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] I've heard an objection, and I will defer voting under this item until voting time.

(Translated)

Voting deferred until voting time.