[R] signifies the Member has declared an interest. [W] signifies that the question was tabled in Welsh.

I’ve accepted an urgent question under Standing Order 12.66 and I call on Darren Millar to ask the urgent question.

Will the Minister make a statement on staff suspensions by the Betsi Cadwaladr University Health Board following concerns in relation to the Bryn Hesketh Mental Health Unit in Colwyn Bay? EAQ(5)0054(FM)

Yes. The Welsh Government was made aware of this situation by Betsi Cadwaladr university health board last week. I’ve been assured that the health board has taken action to ensure patient safety, and an investigation into the allegations has begun.

Thank you for that answer, Cabinet Secretary. This was obviously very concerning news when it came to light yesterday in north Wales, particularly given the fact that the dust has yet to settle on the Tawel Fan scandal, which, of course, rocked the people of north Wales just last year. I, like you, welcome the action that has been taken by the health board to date, over the past few days. It is, of course, essential now that they minimise the disruption to those vulnerable patients who are still in the care of that particular unit and keep people’s loved ones informed.

Can I ask you, though, Cabinet Secretary, what assurances can you provide the people of north Wales that there isn’t a more general problem with mental health services across the region? This is just the latest of a number of reports and concerns that are being raised over the quality of care and, indeed, the environment in which people are cared for in various units across north Wales. Can you tell us as well whether the bed capacity in north Wales, in your opinion, is fit to meet the needs of the population there? Can you also tell us, given that the health board is in special measures, and that it’s in special measures partly because of the problems within the mental health services in that region, when on earth are we going to see a mental health strategy in north Wales so that we can get the sort of security around the future of the services in that region, and we can be holding the health board, and indeed you as a Cabinet Secretary to account for delivery against that strategy? The current situation is not acceptable. It’s important that people have these assurances. At the moment, I’m afraid, there are big question marks over those services in the region.

I don’t think it is helpful to refer back to the particular events at Tawel Fan as a catch-all to try and beat the service across the piece in north Wales. There is a serious allegation that has been made about patient care, and I’m pleased, actually, that that member of staff felt able to raise that issue. The health board acted properly and appropriately. I think that’s an indication of what should have happened in the past, and didn’t in certain areas. That, I think, does show some progress and recognition of what needs to change.

The health board is in special measures, as everyone knows from the updates I have openly given in this Chamber and in writing. Mental health services in north Wales do need to improve significantly. It’s the scale of the challenge that is a significant part of the reason why I announced previously that the health board would be in special measures for a two-year period. We are part way through that. I don’t expect the service to be perfect now, I really don’t. It wouldn’t be realistic. The challenge is how they make progress from now. So, they do have a new and experienced director of mental health services. I’ve met him, and I’m impressed with his commitment and the message that he has given about needing to review and reform the service. So, that is something about having a proper strategy with buy-in from the public and from the staff, and that will mean some change.

But the particular issue that you raise in the question, perhaps, doesn’t really go back to that wider strategy. The strategy is important. The delivery will be important. We’ll have external reassurance, and there’ll be regular reports from me about those reassurance meetings. We have the Wales Audit Office, Health Inspectorate Wales and the chief exec of NHS Wales to review progress against special measures. I expect to see progress, and if progress isn’t being made, I expect to be advised properly about where that progress has not taken place. I will have an eye on mental health services across north Wales. I will pay particular attention and time to it, as I have done on each visit to north Wales. So, this is a serious issue. It needs to be dealt with seriously, and I expect to be open and honest with Members in this Chamber and beyond about what progress has been made and what is still yet to come.

You tell us clearly that you don’t expect the service to be perfect, but surely we should expect the service to be better. Yet, here we are again facing what could be another serious scandal of poor patient care in north Wales. Only this time, of course, the sanction of special measures has already been used. So, it’s difficult to see, if our worst fears are realised, where the Government can go on this one, really.

Doctors and nurses who misbehave can clearly be struck off, they can lose their livelihoods, they can even go to prison, yet we are seeing these scandals time and time again. Often, of course, when the investigation occurs, they highlight management failings. Now, is it time, do you think, Cabinet Secretary, to have NHS management under professional regulation, with managers able to be struck off if their decisions or their failures lead to patients coming to harm?

Part of the challenge in dealing with a particular issue is that I think we’ve got a responsibility not to speak as if those fears are facts. The action that has been taken has been entirely appropriate in that they suspended staff as a neutral act to allow an investigation to take place. There will be an external person from outside Betsi Cadwaladr undertaking that investigation, and that is important too, both for the staff and the families that might be concerned, but also the broader public as well, to understand that this will not be an internal investigation for the health board investigating itself. There’s a point there about the level of reassurance. I think that that should give other people confidence that the managers in this instance are doing the right thing. Rather than thinking about different ways to have different sanctions for managers, I think we’ve got plenty of potential sanctions for managers already about the accountability that they do not have within the system. Our challenge is: how do we make sure that they are held properly accountable and what measures do we have in place? Because, the ultimate sanction is that someone loses their job. You know, that’s such a high-measure sanction to take, and how many times will that improve the service? I’m always interested—. What do we do to understand our problems and challenges in the service? Who is responsible for that, how are they held accountable, and what do we then need to do to improve?

You will have seen that, in north Wales, there is a new management team in the mental health service because we recognised that that needed to take place. We’ve put expertise into the health board, with the senior nursing staff who have gone there over a period of time, and I’m pleased to see that they have recruited an experienced mental health director who is now taking responsibility for delivering a different strategy and an improved strategy, recognising that significant improvement does still need to take place. Though, at this point in time, I would not try and tell you that everything is perfect, and it’s only fair that I do recognise that that’s where we are, rather than tell everyone that things are well, things are perfect, and there is no change needed. We recognise change is needed. There are more difficult choices to be made in Betsi Cadwaladr to make sure that we don’t return to this position in the future, and people receive the services they’re entitled to expect.

Cabinet Secretary, I don’t know the details of what’s happened in this ward, but as you know, I’m a longstanding advocate of the need to extend the Nurse Staffing Levels (Wales) Act 2016 to adult mental wards. I have made the point previously in the Chamber that the patients on those wards are probably the most voiceless that we will see in the NHS. When this investigation has been completed, will you undertake to share the findings with Assembly Members? And will you in particular look at whether this can give further impetus to the need to extend the safe staffing levels legislation to adult mental health wards in Wales?

Thank you for the question. The report on the investigation won’t be for me, it will be for the health board, but I would expect they will make sure that Assembly Members are briefed. In fact, Assembly Members were briefed on this particular issue, and, again, it is to the credit of the health board—they were proactive in telling people about the problem, rather than waiting for it to leak out. So, the POVA—protection of vulnerable adults—investigation has started as well. So, as I say, they’re doing the right thing. In understanding what comes out in the report, I would expect Assembly Members to be briefed again as well, and I would expect that the learning from that would be provided to public representatives by the health board.

On your point about the nurse staffing levels Act, I’ve indicated that the Act will be rolled out in an evidence-based way. So, we understand—evidence now for when it will be rolled out in the initial stage, and in any further roll-out there has to be evidence about the impact of doing so, about where we are now and where we need to go. I’m really pleased I’ve had a very constructive couple of conversations already with the Royal College of Nursing about this point. They obviously want to see the Act further rolled out and not just in adult services, but in children’s services, too. I’ve been really clear, where there’s evidence that there’s a real gain to be made by the patient on rolling out the nurse staffing Act, then we’ll take that up and we’ll work in a way to understand how we need to plan the workforce to deliver that. But I’m certainly open to—we’ve got a commitment to roll the Act out in those areas where the evidence tells us it is the right thing to do. So, I’m happy to restate that commitment today.

Thank you, Cabinet Secretary.