8. Plaid Cymru Debate: Mental health and learning disability services at Betsi Cadwaladr University Health Board

– in the Senedd at on 12 June 2024.

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(Translated)

The following amendments have been selected: amendment 1 in the name of Jane Hutt, and amendment 2 in the name of Darren Millar. If amendment 1 is agreed, amendment 2 will be deselected.

Photo of Elin Jones Elin Jones Plaid Cymru 5:15, 12 June 2024

(Translated)

Item 8 is next. This is a Plaid Cymru debate on mental health and learning disability services at Betsi Cadwaladr University Health Board. I call on Mabon ap Gwynfor to move the motion.  

(Translated)

Motion NDM8604 Heledd Fychan

To propose that the Senedd:

1. Notes the Royal College of Psychiatrists’ Invited Review Services Report into Mental Health and Learning Disability services at Betsi Cadwaladr University Health Board, which has assessed the progress made by the Board on 84 recommendations featured in four separate reports since 2013.

2. Regrets that of the 84 recommendations, six were categorised red, showing little or no evidence of implementation, and 41 were categorised as amber, showing only some or moderate evidence of implementation, over a decade on after the publication of the final report.

3. Believes that progress made on implementing the recommendations was undermined by the contentious decision to lift Betsi Cadwaladr University Health Board out of special measures in November 2020.

4. Calls on the Welsh Government to:

a) provide the required support to ensure that Betsi Cadwaladr University Health Board implement the recommendations of the IRS report in full and to set out clear timescales for achieving this; and

b) publish the ministerial advice that led to the decision to lift Betsi Cadwaladr University Health Board out of special measures in November 2020 and any other relevant information specifying the implications on mental health provision in North Wales.

(Translated)

Motion moved.

Photo of Mabon ap Gwynfor Mabon ap Gwynfor Plaid Cymru 5:15, 12 June 2024

(Translated)

Thank you very much, Llywydd. If we've learnt one lesson from the story of the Betsi Cadwaladr health board, then that story is that lessons aren't learnt. This unfortunate practice is highlighted in the Royal College of Psychiatrists report into mental health and learning disability services in Betsi Cadwaladr. As everyone here knows, serious concerns were raised about mental health services in Betsi Cadwaladr back in 2013, as an inquiry was held into the poor relationship between staff and managers at the Hergest unit at Ysbyty Gwynedd. Then, the Tawel Fan ward at Ysbyty Glan Clwyd was closed. Concerns were raised about the safety of patients at the Ablett unit at Ysbyty Glan Clwyd, and targeted measures were introduced by the Government. 

Photo of Mabon ap Gwynfor Mabon ap Gwynfor Plaid Cymru 5:16, 12 June 2024

The Royal College of Psychiatrists invited review service report has therefore reviewed progress on implementing the series of recommendations made in four separate reports into mental health services at Betsi. Of course, we welcome the commissioning of this report, but it is a damning indictment of the glacial to non-existent pace of reform at the health board that, of the 84 recommendations reviewed in total, well over half have been classified as either amber, reflecting only some or moderate evidence of implementation, or red, reflecting little or no evidence of implementation.

Some of the more serious oversights make for grimly familiar reading—for example, the lack of coherent and comprehensive digital platforms across the health board. Then there's the overabundance of interim posts at managerial level and the sense of instability that inevitably engenders, a recurring theme that I've raised in response to the update report on special measures at Betsi back in September of last year and several times afterwards. Most glaring of all is the continued lack of a specialist consultant nurse with specific responsibility for dementia within the mental health and disability directorate.

These recommendations have been in place for at least half a decade. Paucity of time for proper implementation is simply not an excuse. We are therefore calling on the Government to provide all necessary support to ensure the health board can enact the recommendations of the IRS report in full, and to set out clear timescales for achieving this. We also believe that the findings of this review highlight the need for full disclosure and transparency on the part of this Government regarding the contentious circumstances that led to the board being lifted out of special measures in November 2020.

We have long been of the view that this was a premature decision that undermined work to address issues at the health board, a view that is reinforced by the fact that the other partners in the tripartite escalation framework, Audit Wales and Healthcare Inspectorate Wales, have since confirmed that they advised against this course of action. It is for this reason we are also calling for the ministerial advice that informed this decision to be released into the public domain so that we can ensure that progress made on improving services at Betsi is never again compromised by opportunistic political considerations.

I can assure the Cabinet Secretary that it gives us no pleasure to have to revisit this age-old theme of chronic failings at Betsi Cadwaladr University Health Board. We're tired of it, and without a doubt, the people of north Wales are tired of it, too. But until there is clear evidence that improvements are being made in a timely fashion, we owe it to both the hard-working staff and the patients of Betsi Cadwaladr to be persistent in holding the board and the Government to account. For this reason, I urge the Senedd to support the motion.

Photo of Elin Jones Elin Jones Plaid Cymru 5:20, 12 June 2024

(Translated)

I have selected two amendments to the motion. If amendment 1 is agreed, amendment 2 will be deselected. I call on the Minister for Mental Health and Early Years to formally move amendment 1. 

(Translated)

Amendment 1—Jane Hutt

Delete all and replace with:

1. Notes that:

a) the Welsh Government commissioned the Royal College of Psychiatrists’ Invited Review Services Report on Mental Health and Learning Disability Services in Betsi Cadwaladr University Health Board, to provide an independent assessment of the progress made since 2013;

b) of the 84 recommendations made in relation to four previous reports, the Royal College of Psychiatrists found the vast majority had been implemented;

c) Betsi Cadwaladr University Health Board has accepted the Royal College of Psychiatrists’ report in full and will formally respond to it at its next Board meeting; and

d) the Welsh Government will continue to support Betsi Cadwaladr University Health Board to improve mental health and learning disability services in North Wales as part of the special measures intervention.

(Translated)

Amendment 1 moved.

Photo of Elin Jones Elin Jones Plaid Cymru

(Translated)

I call on Gareth Davies to move amendment 2. 

(Translated)

Amendment 2—Darren Millar

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

Issue an apology to people who have lost loved ones and patients who have come to harm as a result of recommendations not being implemented and a failure to deliver improvements.

(Translated)

Amendment 2 moved.

Photo of Gareth Davies Gareth Davies Conservative 5:20, 12 June 2024

Diolch, Llywydd. Many of us feel exasperated at the lack of improvement overall within Betsi Cadwaladr University Health Board, and this report compounds the view that necessary improvements are not being made anywhere close to the pace they should be. Concerns surrounding the health board date back as far as 2009, with issues beginning to be officially recognised in 2012 when Healthcare Inspectorate Wales and the Wales Audit Office identified concerns regarding the health board's governance arrangements. It has been put in and out of special measures, with the necessary improvements never having been fully implemented. And patients of Wales's largest health board have been consistently let down. 

The improvements that started to be made following the recommendations in the 2013 Holden report, both Ockenden reports and the Health and Social Care Advisory Service report halted in 2020, due to the Welsh Government removing Betsi from special measures for reasons of political expediency, which is nothing short of scandalous. The Welsh Government should be under no illusions that this is something we will forget about. We will be relentless in continuing to call for the publication of the ministerial advice that led to the decision to lift Betsi Cadwaladr out of special measures just before the 2021 Senedd elections. 

The health board is not a political football or something to be swept under the rug when the election comes around. These are people's lives we are speaking about and they are routinely being failed. The Royal College of Psychiatrists invited review service report into mental health and learning disability services at Betsi Cadwaladr University Health Board has demonstrated pitiful levels of progress since the recommendations were drawn up, starting in 2013. And in over 10 years, the Welsh Government has only been able to fully complete 36 per cent of the 84 recommendations, with six still categorised as red and 41 still categorised as amber. 

Are we therefore to expect that this will take another 10 years before we see two thirds of the recommendations fully implemented, and another 10 years on top of that to see all recommendations implemented completely? Does that sound reasonable to the Welsh Government—three decades for recommendations of a report to be put into place?

In terms of key areas for further development, the report highlighted that there are too many interim posts, which leads to instability, and an inability to provide assurance that recommendations had been fully embedded. This is something that I and others have raised frequently. Interim posts do not work and where funding is provided it must be on a permanent basis so that the health board can offer more permanent positions. A lack of access to electronic records was also an acute concern, with the needs of older adults not being adequately represented in the management structures, which also do not allow for adequate representation of all disciplines.

I realise I'm running out of time—my remarks are longer than the time allowed—but I would just say finally that the—

Photo of Elin Jones Elin Jones Plaid Cymru 5:23, 12 June 2024

Thank you for drawing my attention to that, though. [Laughter.] 

Photo of Gareth Davies Gareth Davies Conservative

I do apologise. I see the red flash up and I think, 'Gosh, Gareth, you've gone on too long here, mate'.

And finally, the Welsh Government should show contrition for removing Betsi from special measures in 2020, admit that this was the wrong decision that was against the recommendations at the time, and publish the advice given to Ministers as to why they believed the health board should have been pulled from special measures before the Senedd elections in 2021—very convenient.

Photo of Siân Gwenllian Siân Gwenllian Plaid Cymru 5:24, 12 June 2024

(Translated)

I was concerned and disappointed to read the Government's amendment to Plaid Cymru's motion, an amendment that claims that that the majority of the recommendations have been implemented. Unfortunately, that's just not true, because of the 84 individual recommendations that were reviewed by the Royal College of Psychiatrists across the four reports, just over half of them are yellow, 41 are yellow or amber, and six are red.

We know what red means, but amber is also problematic. It's a reflection that there is only a moderate level of evidence available to show that the recommendation has been implemented. A total of 47 recommendations, therefore, that have not been fully completed. That leaves 37 that have been completed or are green. Now, 37 is not a majority of 84, by any means, and perhaps the Cabinet Secretary can justify using the term 'majority' to describe a figure that is actually less than half. 

The Government is to be commended for commissioning this review in the first place, but the Cabinet Secretary must surely accept the findings. Those findings are not good. There is a great deal of work still to be done, and constituents are still suffering more than 10 years since the Holden report, more than 10 years since the closure of Tawel Fan.

The north Wales health board has had an opportunity to discuss the report, and it is agreed that further consideration of the findings of the review is needed, and a formal response will be drawn up and discussed at the next board meeting in July. The report makes for sobering reading, and I would like to draw attention to three matters of priority that I would ask the board members and the Cabinet Secretary to pay particular attention to. First, and I quote from the report,

Photo of Siân Gwenllian Siân Gwenllian Plaid Cymru 5:26, 12 June 2024

'The review team recommend that urgent attention is given to ensuring that all remedial works necessary to ensure patient safety are completed, and this particularly applies to ligature risks.'

Photo of Siân Gwenllian Siân Gwenllian Plaid Cymru

'A consultant nurse with specific responsibility for dementia within the directorate had not been appointed. The review team was concerned about the lack of psychological input and multidisciplinary working in the Hergest unit.'

Photo of Siân Gwenllian Siân Gwenllian Plaid Cymru

'The large number of interim posts was a particular concern to the review team, who were not clear that there was full multidisciplinary input at a senior management level'.

Photo of Siân Gwenllian Siân Gwenllian Plaid Cymru

(Translated)

Those are findings that are terrifying and disappointing, aren't they? And they are significant issues that need to be resolved, never mind the other issues that have emerged in the wake of this review. They need to be resolved, they need to be resolved urgently, and we need to see progress quickly.

(Translated)

The Deputy Presiding Officer took the Chair.

Photo of Jayne Bryant Jayne Bryant Labour

Diolch, Dirprwy Lywydd. I want to start by apologising to everyone who has received care from Betsi Cadwaladr University Health Board that falls below the high standards we set for the NHS in Wales. We take this very seriously and are continuing to work with the board and the thousands of staff in north Wales to raise standards and the quality of care. A succession of reports and reviews have rightly exposed these failings, and, through the special measures intervention, we are working with the health board to make sure that services, staff and systems are in place so that mental health and learning disability services remain safe and help rebuild public confidence. That's why this independent review, commissioned by the Welsh Government, has been so important.

The health board has shown its commitment to learn from the past, has apologised, and is engaging with families who have experience of its services. Copies of this report were shared with families, and they were offered an opportunity to share their views with the health board at the end of May. I am meeting the health board later this month—next week, in fact—and it will be the first in a series of quarterly meetings. I'll be setting out my expectations for improvement and for the need for clear and robust evidence of progress being made.

It is important to recognise that leadership and management of these services is improving. The vice-chair is providing leadership at board level, supported by a newly appointed executive director for mental health and therapies. I want to take this opportunity to thank the Royal College of Psychiatrists for its work in completing this review. Overall, it shows that progress has been made in taking forward the recommendations from the four previous reports, but there is clearly more to do. [Interruption.] Yes.

Photo of Mabon ap Gwynfor Mabon ap Gwynfor Plaid Cymru 5:30, 12 June 2024

Thanks. You say that the vice-chair is taking responsibility, but in the last board meeting the vice-chair admitted that they didn't have the speciality and the skills required in order to understand fully the problems. So, do you not agree with part of, at least, our motion, that we need a specialist nurse or specialist individual on the board that can lead on mental health so that we have assurances that they are learning and improving on the delivery of mental health services?

Photo of Jayne Bryant Jayne Bryant Labour

As I said, I'm going to see the health board next week and I'll be meeting with the vice-chair and I'll be seeing for myself and being able to speak with the health board and the vice-chair. And, as I said, this will be the first of many quarterly meetings, so I will be monitoring progress very closely at those meetings. 

The original reports were completed some years ago, and some of their recommendations may have been superceded by changes in clinical practice or by changes the health board has made to services. It would not be fair to criticise the health board for failing to implement a change that is no longer considered clinically appropriate or relevant, but it is disappointing that there is little or no evidence of implementation against six of the recommendations, and despite some of the evidence of progress, many of the recommendations are not as advanced as they should be at this stage. I expect the health board to prioritise recommendations that will have the greatest impact on the safety of its services. The health board has committed to ensuring Llais and patients are actively engaged with services' redesign and to listening to their views. The new board have started to do this well, and I'll be asking Llais to update me on this twice a year.

Over the past year, there have been two independent safety assessments of mental health and learning disability in-patient settings by the National Collaborative Commissioning Unit and the NHS executive. Both have identified examples of good practice and improvements, but they've also highlighted areas where further improvements are required. Recent Healthcare Inspectorate Wales inspections of mental health and learning disability services have also identified positive changes and improved patient safety and experience. We're expecting to receive a full business case of the new in-patient mental health unit on the Ysbyty Glan Clwyd site early next year, which is likely to require a significant capital investment of excess of £80 million. We will work with the health board to ensure it also has a robust plan in place to ensure a sustainable workforce for the unit can be achieved. In addition, a comprehensive programme of work has been agreed as part of the special measures intervention, and I'll also be making site visits to mental health settings in north Wales over the next couple of months to gain a direct perspective on how services are working. We will continue to support the health board to improve mental health and learning disability services and rebuild people's confidence in mental health services across north Wales. Diolch.

Photo of David Rees David Rees Labour 5:33, 12 June 2024

(Translated)

I call on Llyr Gruffydd to reply to the debate.

Photo of Llyr Gruffydd Llyr Gruffydd Plaid Cymru

(Translated)

Thank you, Dirprwy Lywydd. Mae I thank everyone who has contributed to this debate? It's disappointing that no Members from north Wales in the Labour group contributed, but I do thank the Minister for her comments. She says that she is working with the board. It's a shame that the Government isn't willing to work with the motion before us today, because our aim in tabling this motion was to try and create some cross-party consensus around the findings of the report, so that perhaps it could be a moment where there's a turning point for the health board in mental health services. Because, after years of mismanagement and malpractice, failings within the board too often over recent years have been normalised.

Now, one would hope that the corner is being turned under the new leadership within the board, but, unfortunately, as we've heard from three contributors to this debate, the Government's interpretation of the review shows a shocking unwillingness for them to accept the scale of the problem. The amendment laid by Government deletes all of our motion, and then, as we've heard, states that the 'vast majority'—word for word—the 'vast majority' of the 84 recommendations 'had been implemented', although the evidence shows clearly that more than half of those recommendations are either categorised as amber or red. Namely, they haven't been implemented. They have not been implemented.

Photo of Llyr Gruffydd Llyr Gruffydd Plaid Cymru 5:34, 12 June 2024

So, here we are, back in Labour's Betsi Cadwaladr parallel—if I can even say it—universe. It's the same parallel universe, isn't it, as the one that told them that it was fine to take Betsi out of special measures in the first place, despite the advice of Audit Wales, Health Inspectorate Wales and others. Placing mental health services in Betsi, on a sustainable footing, is a collective responsibility, yes, and a range of different stakeholders have an important part to play, but the Government has to lead on this, and has to lead from the front, and you can't do that unless you accept that the scale of the problem—[Interruption.] Your amendment? You can't—

Photo of Llyr Gruffydd Llyr Gruffydd Plaid Cymru

Yes, well, accept the recommendation—. Are you sticking to your amendment that the 'vast majority' of the recommendations have been implemented? Because they haven't. I will give way to Mark Isherwood.

Photo of Mark Isherwood Mark Isherwood Conservative

Don't you agree that, in order to draw a line under this and go forward, the Welsh Government also need to apologise to the families of the victims, especially given the denials over many years that there had been institutional abuse and that there's now been a Nursing and Midwifery Council striking-off order against a nurse who's been found guilty of abusive conduct on that ward?

Photo of Llyr Gruffydd Llyr Gruffydd Plaid Cymru

In a word, Mark, 'yes'. Now, this amendment—[Interruption.] Yes, and you can make that point. The Minister's making the point that she has apologised. This amendment will just simply reinforce people's perception, across north Wales, that the Government is simply out of touch when it comes to this issue. So, please, consider very carefully what kind of message it will send if this amendment is passed. We have to treat this review with the seriousness that it deserves and not risk another decade of lost opportunities and recommendations for reform being left to linger, and it's for that reason that Plaid Cymru urges Members of this Senedd to support our motion. Diolch.

Photo of David Rees David Rees Labour 5:36, 12 June 2024

(Translated)

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Yes, there are objections. I will defer voting under this item until voting time.

(Translated)

Voting deferred until voting time.

Photo of David Rees David Rees Labour

But I notice the Cabinet Secretary is not present at this moment in time, so can we suspend the meeting for five minutes to ensure that we get the Member here to respond to the debate?

(Translated)

Plenary was suspended at 17:37.

The Senedd reconvened at 17:40, with the Deputy Presiding Officer in the Chair.