3. Will the First Minister make a statement on allegations of historic institutional abuse in mental health units in north Wales? OQ61181

Thank you for the question.

The issues related to the quality of care in several mental health units in north Wales are recognised and well documented. They were part of what contributed over the last decade to the health board being placed in special measures. A comprehensive programme of work is under way to ensure that the health board makes the sustained progress that is required in mental health services for the staff and the people they care with and for.

Mental health units, such as Tawel Fan, of course, have been making the headlines, as they have done for a number of years. But this time, I'm aware that the Nursing and Midwifery Council has decided to strike off a psychiatric nurse after a hearing for what they describe as institutional abuse at the unit, going back over 10 years. Now, obviously, the abuse happened before your time as health Minister, but during your time as Minister, you stated that no institutional abuse had taken place. So, in light of the new evidence, do you wish now to revise your previous view? Should you not have done more at the time to get to the truth? And do you now regret painting a very different picture when you were Minister, given that we now know that the reality was very, very different?

I think there are two slightly different things here. So, the use of the term 'institutional abuse' is one that I don't shy away from in the NMC's decision—the Nursing and Midwifery Council. I should say that I represented people in regulatory practice hearings during my former career as an employment lawyer; I know the hearings are difficult. But actually, in this case, it was particularly upsetting, not just because of the conduct of the individual in question and the impact on the patient, but also the impact on other members of staff. A trainee witnessed the incident and complained and she found it so upsetting, it took her away from nursing as well. So, there is a point about when senior people in an organisation behave in that way, there are multiple layers of harm that come. 

When I was both the Deputy Minister for health and, indeed, the Cabinet Minister for health, I was always really clear about the fact that there were significant failings in healthcare, and at the time when I made those comments, there wasn't the evidence to support the finding of institutional abuse. What we did, though, was to have a searching investigation into what had taken place there, and, indeed, that continues now, not just in the one unit but actually to look at mental health services across north Wales. So, the Government, Eluned Morgan, has ensured that the Royal College of Psychiatrists have undertaken an independent review of mental health services to understand and provide assurance on progress that is being made against previous recommendations.

So, this isn't simply about going back to specific language; it's looking at the challenge that we have today, and understanding where the health board is making progress. That report will be published and discussed in public at a board meeting at the end of this month. That openness, I think, is really important to rebuild relationships and trust in the service, to make sure that we learn from times where that hasn't been the case, and to want to move forward and to improve the service that people should be entitled to rely on today and in the future.

The Vale of Clwyd has a long history of mental health institutions and facilities, dating back as far as the 1800s, with the north Wales hospital in Denbigh and, most recently, the Ablett unit with the Tawel Fan ward. Given those historical cases of abuse, my constituents have been subject to the most harrowing situations of mental health abuse perhaps across the whole of north Wales in recent history. So, given that Betsi Cadwaladr is under special measures, which means the direct control of your Welsh Government, what direct strategies or frameworks can you develop with Betsi Cadwaladr University Health Board to make sure that cases like this never happen again?   

Well, that is always part of the challenge, is it not: to recognise when there are failings, to never try to minimise the failings that have taken place and to listen to the voices of people who are complaining or people who say that they have been failed, and, at the same time, to make sure that you don’t condemn an entire service and try to say that nothing good ever happens. Because, actually, not addressing the very real problems that are highlighted actually undermines the position of all of those dedicated professionals who do provide high-quality care. So, this is actually about trying to do all that we can to make sure that lessons are learned from failings in the past, and to make sure that there is proper accountability, where you can identify who is responsible at either a leadership level or an individual level. But you've got to have a culture where, if people feel they're being blamed, you understand that, if that’s the process you have in place, people won’t come forward, and, actually, your opportunity to put right the things that have gone wrong will be put to one side, and the situation will get worse, not better. So, the cultural challenge is a really important one for what improvement looks like.

I don’t want to see any constituent in any part of Wales who has to go to a healthcare facility where they're not treated with the dignity and the respect that they deserve, and they don’t get the quality of care that they deserve, and that our staff feel that they're working in an environment where their concerns will be listened to and they will provide the quality of care they need to and want to. That’s why the report from the Royal College of Psychiatrists, for example, is so important—to give that assurance that recommendations previously have been listened to and are being worked through.

This is, of course, part of the special measures framework: to see improvement in this area and to get independent, objective advice before the Cabinet Secretary for health can make a decision about the next stages in special measures, whether they continue or, indeed, whether there is a path to de-escalation. I’m confident that those processes and those conversations are in place, with external assurance, to do just that.