The next item is a statement by the Cabinet Secretary for health on the specialist and critical care centre, and I call on the Cabinet Secretary to make his statement—Vaughan Gething.

Thank you, Presiding Officer. Yesterday, I announced the full business case for the specialist and critical care centre, otherwise known as the SCCC, at Llanfrechfa Grange and the release of capital funding of approximately £350 million. The hospital is expected to open in 2022. This is good news for over 600,000 people served by Aneurin Bevan Local Health Board and, indeed, other populations in the surrounding area who will have services from this new hospital. It marks the next stage in the implementation of the Clinical Futures strategy. Members will recall, of course, the substantial investment made at Ysbyty Ystrad Fawr and Ysbyty Aneurin Bevan, which opened in 2010 and 2011 respectively.

The Deputy Presiding Officer (Ann Jones) took the Chair.

The health board is continuing to develop primary care services, and works closely with its local authority partners on integrated approaches to public services. Innovative examples include working with local authorities and the third sector to identify older people at risk and developing a Stay Well plan with the person; the introduction of specialist diabetic nurses in primary care; and the treatment of wet age-related macular degeneration in the community.

The SCCC will create a highly specialised environment to support the treatment of patients who need complex and acute emergency care in the region. It will play a key role as part of the healthcare system for south Wales as a whole and it will be the focus for one of the three acute care alliances established following the south Wales programme. I expect the NHS to continually improve outcomes for patients, and we know that consolidating the more specialised services will help to achieve that aim. The SCCC will provide a modern purpose-designed environment that will allow highly specialised multidisciplinary teams to provide the best possible treatment and outcomes for patients.

The evolving model in Aneurin Bevan university health board is of a service based on prudent principles that ensures local access to most services whilst bringing together expertise in more specialised areas to secure sustainable and high-quality services. The health board is preparing plans for the Royal Gwent and Nevill Hall hospitals, and for St Woolos Hospital. I expect those plans to be radical in scope and to ensure that these hospitals play their role in supporting primary care and the local general hospitals whilst being supported in turn by the SCCC. My decision to approve the SCCC brings with it an expectation that the health board will ensure that its healthcare provision works together as an integrated, effective and efficient system.

Support for the SCCC is strategically significant not only for Aneurin Bevan university health board, but for south Wales as a whole, as I mentioned earlier. The SCCC was supported by the south Wales programme—a major planning process involving a number of health boards. I have been very clear since becoming Cabinet Secretary that planning and service development at a regional level are essential as we work to deliver our ambitions for the health service. Organisational boundaries can too easily get in the way of effective planning with a focus on delivering benefits to citizens.

I made clear my ambition to be the last health Minister to have to make a decision on the SCCC proposal and to provide real certainty as soon as I was able. I also made a commitment to reach that decision by the end of October, and I’ve delivered against that commitment. I do understand the frustration that has been felt by some around the time it’s taken to reach this point. However, my priority has been to make the right decision following a robust examination of the SCCC business case. I had to be sure that the SCCC was the right fit not only for Gwent, but for the configuration of health services across south Wales. That is why I instructed officials to carry out more work over the summer after an independent review.

My decision to approve the SCCC is a practical demonstration by this Government that we will support changes that bring benefits not only at a local level, but across the wider health and care system. I now expect the NHS to build on this decision and accelerate the pace of development to ensure that the Welsh NHS remains focused on quality, innovation, integration and ambition on behalf of the people that it serves.

I welcome the announcement, but I should add that to say it’s been a long time coming would be something of an understatement. I’ll get straight into a number of questions. A £350 million centre is worthless without the skilled staff necessary to work in it. I should ask: is the Cabinet Secretary sure that recruitment won’t be a problem? I guess what answer I will be given, but a state-of-the-art facility such as this should be a real attraction for people to work in the NHS. How does the Cabinet Secretary plan to use the SCCC facility as a recruitment tool in itself?

Secondly, how flexible is it intended for this building to be? I’m thinking here of future adaptations and what future adaptations the Government might have in mind. Thirdly, what intentions are there to use this project as a procurement boost for Welsh companies, including the use of Welsh steel in its construction?

And finally, in transport terms, I’m concerned that here we have a major development built with the car in mind, rather than public transport and rather than, certainly, rail, as it is not on the rail network. What commitment can the Cabinet Secretary give on ensuring that sustainable transport is genuinely taken into consideration in planning future NHS infrastructure developments considering that, perhaps, the synchronisation between transport and health needs hasn’t been achieved as well as perhaps it could in this particular case?

Thank you for the points and the questions. I think it’s worth reminding ourselves that the current two sites in Nevill Hall and at the Gwent are not exactly immediately close to rail network links. In designing and delivering the future healthcare system, of course, public transport access is important, so I would expect there to be public transport access to this site as it’s being developed. However, it’s also important to recognise, for lots of people who attend, particularly for emergency care, that lots of people out there do drive themselves, they tend not to get on a bus if they’ve got an emergency, but also access for other emergency services. But, the transport plan will obviously be part of what the health board and their partners need to consider in delivering the hospital successfully.

It’s also worth taking up your point about procurement, because obviously in a capital project of this size, we expect there to be real benefits coming from that spend in the construction phase. If you’ve seen, for example, the twenty-first century schools programme, you’ll have seen significant gain from the procurement of each of those sites. I’ve seen for myself the numbers of local apprentices who have taken advantage of that construction as well, and I expect that to be the case again. With an investment of £350 million, I absolutely expect there to be very real gain from the procurement and the building of the site, and not just the operation of it.

That brings me to your point about the workforce, and you should not be surprised to hear me say that, actually, delivering this new site should aid workforce recruitment and retention. It’s been a very consistent theme from the staff within the staff within Aneurin Bevan university health board, but also surrounding health boards, too, that if we can’t reconfigure parts of the way in which the capital estate works and the way we deliver those services, we’re unlikely to be able to successfully recruit now and in the future. So, this is a really important remodelling on a whole range of fronts. Recruitment should be positively benefited by having this decision made about what the future will look like. And when it is up and running and people can see a purpose-built facility with models of care that are appropriate for now and the future, that should mean that people of all grades and all professions are more likely to want to work within this sector. It isn’t just about the hospital, of course. As I said in my statement, this is part of the whole healthcare system: how primary care works more effectively together, how care goes out into the community, away from hospitals, as well as what really needs to take place in a specialist centre being delivered in a genuinely specialist centre that is fit for purpose.

Cabinet Secretary, thanks for your statement today. Some good news, at last; it has been a long time coming. When you mentioned the frustration of certain Members, I think a large chunk of that frustration has come from the Member for Torfaen and me over the last few weeks and months. We have called for this statement, and you did say you would deliver it at the end of October, and you have, so thank you for that.

You told us what we’ve wanted to hear and what clinicians have been calling for for a very long time in south-east Wales. I think I attended my first Gwent Clinical Futures meeting on the development of the specialist critical care centre back in 2004—the work, in those days, of the Gwent NHS trust. So, we really have waited a long time to get to this decision. Indeed, we’ll have waited even longer by the time it does finally open in 2022. So, first of all, can I ask why has it taken so long to get to this point, given the level of support from clinicians and the public? I do appreciate that a number of ducks have had to be got into a certain row for us to get to this point, but it has been an inordinate length of time. Currently, services at the Royal Gwent and Nevill Hall are creaking under the strain of the demands being placed upon them. We’re all having complaints from constituents about this state of affairs, but reform of these hospital services—and I’ve had to tell my constituents this—has been dependent on waiting for the critical care centre to be developed so that pressure can be relieved. So, it’s been a question of getting the horse before the cart in that sense.

Back in those meetings 10 years ago, I remember being told that the redevelopment of Nevill Hall was 10 years down the line, behind the development of the critical care centre. Well, we’re actually beyond the point now at which Nevill Hall was supposed to be redeveloped, so can you update us on the timescale for the redevelopment of Nevill Hall and the Royal Gwent? I don’t mean a firm timescale, but can you at least give us an indication of when you think that those hospitals, or general hospital replacement, will be coming online? Will this not happen fully until the transfer of services in 2022 or do you anticipate a phased transition to the new site and a phased decommissioning of services at other hospitals, with capacity being released as we go along the way, or do you see that everything will simply happen after 2022?

Although there’s been overwhelming backing for the scheme, it is, true to say, a fair distance from south Powys to Abergavenny and it’s clearly considerably further to the Llanfrechfa Grange site in Cwmbran. So, what reassurances can you give the people of north Monmouthshire and south Powys that these increased journey times will not cause too many problems, and what modelling has been done for ambulance journey times? It’s less of an issue for me in my constituency, but I know in Kirsty Williams’s constituency in Brecon and Radnor that there has been a concern about the extension of journey times to the new centre. So, what work has been done in this area?

We are now faced with another five or six years before the new centre opens. What certainty is there for recruitment during that time? This has been raised already by Rhun ap Iorwerth. Are those being recruited into the NHS being made aware of these changes? We need to allay any uncertainties during the transition phase.

I do agree with your comment, Cabinet Secretary, that this is about creating an integrated, efficient NHS, with one hub dealing with the most complex emergency treatments, freeing up capacity across the rest of the health board area for better primary care. In reference to the concerns about public transport, Cwmbran is not so way off the public transport network that I think that that will cause massive problems—there are many good bus services and train services to that area. Of course, the whole point of the critical care centre is it’s not going to be a general hospital where people are generally dropping in by car; it is going to be something that is visited by people in ambulances after their involvement in serious accidents—people with serious conditions. So, I don’t think that that is such an issue as it would be for a general hospital, but nonetheless I’m pleased that you did address that earlier.

Gwent Clinical Futures was dependent not just on this new centre, but also high-quality community services. I remember looking at a diagram with a pyramid. You had the triple care centre at the top and you had primary care in the middle and you had community services at the bottom. Back then, clinicians were very clear that this new system would only work if those community services at the bottom of the pyramid were brought online at the same time. You seem to indicate in your statement that you’re confident with the level of progress, the rate of progress, you made in developing those community services. Can you give us an assurance that when we get to 2021, 2022—whenever that final opening date is—that all of this will work together as an integrated, cohesive NHS in south-east Wales, and there won’t be any surprise at that point with a lack of capacity that hasn’t been anticipated at this point in time? Thank you.

Thank you for the series of questions. I recognise your point about the length of time and the fact there has been lobbying, and, again, recognise that the Member for Torfaen has brought a delegation of Members to see me in the short time I’ve been the Cabinet Secretary on more than one occasion, and I’ve always found her assertive and charming, you’ll be delighted to know. This has been an issue over time, but we’ve made a choice and I’ve done what I said I would do. I’m not going to rehearse about what’s happened in the past, the length of time it’s taken to get here; it’s important to look at where we are now and what we will now do with the significant investment and the challenges that brings, both about delivering this project but the challenge it brings in other parts of the estate, not just in Gwent but beyond as well. The services at Nevill Hall and Royal Gwent that you refer to as ‘creaking’, well, part of the challenge is that if we hadn’t made a decision and given some permanency about what was going to happen here and a real definitive statement, actually those services would have been in an even more challenged position. So, the decision is really important for those services as they exist now, and having a proper input so that when some of those services are then challenged into a more appropriate setting that actually will be better for staff and the patient.

It goes to your point about access, because, indeed, you made this point as well about who would be going to the SCCC—what sort of patients will be going there? Actually, for those people, you want access to the best quality care, that’s what you want. You don’t want access to local care if it isn’t the best and if it isn’t appropriate care as well. This is about delivering on appropriate care in the appropriate place: specialist centres delivering specialist care, other hospitals delivering other forms of care, and then primary and community care as well. In fact, Aneurin Bevan have a good record of the change they are delivering within primary and community care services. I made the announcement in Cwmbran, deliberately visiting a service in Cwmbran that recognises a link between the local authority, the national health service, therapists and scientists, but, in particular, seeing two consultants who come out of their hospital base on a regular basis to attend those clinics and be part of the team. That multidisciplinary team working is already part of the reality. The challenge will be, in the future, making sure that the model that Clinical Futures sets out and more broadly, right across NHS and social care, is delivered on a more consistent basis, so we really do have the right care at the right time and in the right place.

On your point about 2022, one big bang, well, we’ll have to operate a system in parallel to make sure services don’t just suddenly disappear, but, actually, the practical decanting and moving of services isn’t something that has been part of my decision now. It’s really a practical operational matter for the health board to get right with those commissions that are delivering the services and with the citizens who are taking part in those services as well. So, I think you will see some gradual movement, and, as in every new building, the building is open before the official opening to understand what is and isn’t working there. So, I think you’ll see, over a period of time, a transition that we can have some confidence in from previous projects as well. It will have to be delivered on time, it will have to be delivered within budget—that’s part of the procurement challenge as well, but the challenge also is to make sure that there is a proper seamless transition into those services for staff and the citizens they serve.

Can I thank the Minister for his statement and also thank him for coming to Cwmbran, to the falls clinic, yesterday to make the announcement? As you rightly highlight, it was an excellent opportunity to see the kinds of services that are being delivered at a community level by health and social services working together. But I was absolutely delighted that you were able to make that announcement yesterday. It is tremendously good news, not just for Torfaen, but for the whole of Gwent and for south Wales. I think it will provide first-class healthcare provision for all the communities it serves, but it also provides the foundations for ensuring that we continue to recruit the highest quality staff to work in the hospital. So, the very warmest possible welcome from me for your statement and the announcement yesterday.

I just wanted to ask a couple of questions. I endorse what Rhun ap Iorwerth has said about the importance of procurement and I would be grateful for your assurances that you will keep a close eye on the procurement issues, so that we can ensure that, where possible, local businesses actually benefit from what is a huge capital investment in the local area. We know that the project has slipped from its original timescale and you’re well aware of the frustrations that have existed around that. Can I just ask for your assurances that you will keep a very close eye on any further potential slippage, particularly in relation to the fact that it may cause difficulties now with contractors that had been agreed, et cetera? So, will you keep a very close eye on this to ensure that this is now driven forward with urgency and that we do not see any further slippages in this?

In terms of transport, those issues have been raised today, but, of course, there was a very extensive study of the access to the site and this site was found to be the best possible one for the whole of Gwent and south Powys. But I do think that we also do need to keep an eye on the issues around public transport, not just, of course, for people visiting the hospital as patients, but for visitors. I know that the health board has a very good track record of facilitating access issues, so can I just ask for your assurances on that as well? But, the warmest possible welcome from me and, of course, a recognition that this Welsh Government is continuing to make massive investment in public services at a time of huge austerity and massive pressures. Thank you.

Thank you for your comments. As I said, assertive and charming—probably more assertive than charming, sometimes. But, no, seriously, it’s been important to see local Members standing up for their communities over a long and a difficult period and I do recognise that. So, the decision has real impact, you’re absolutely right, and, as I tried to make clear yesterday and today, across the whole of south Wales—it’s not just a Gwent decision. You’re right to remind Members that the transport study that was done sees this as the most appropriate site. We’re not going to go back and re-look at that again. This is the decision. It’s about how we make that access real now as well, and you are right, of course, to point out that it’s for patients and visitors to have access there that is convenient and allows them to see loved ones and friends.

On your point about work starting, it’s very much in my mind that I want this project to be visible and happening, and to achieve the timescale provided now for it being up and running. In fact, the chief exec of the health board indicated yesterday that she thought that work may be able to start again on that site in about spring next year. So, it’s not a long pause, even with some re-tendering that needs to be done. But I really do want to re-emphasise a point that you make as well about procurement. It’s a huge capital investment that we’re making, and there has got to be a return—and a proper return—during the construction phase that people can understand and that people can see. People should know that local labour is being used on the site, and local apprentices. There’s a challenge there about making sure that there’s enough labour locally to be able to deliver that, actually. So, it is about maximising the opportunity.

Finally, I want to again reinforce the point about recruitment. This is a real opportunity to recruit people to a model of care that people have called for, that clinicians fully support, and it’s about making those opportunities real and how that affects the whole healthcare system—something that is really joined up and is being built for the future, with a design and a plan that clinicians support, and the public overwhelmingly support too. I’m very grateful for your continued challenge. It’s part of the deal to be in Government to have to deal with local representatives, and I’m sure that people in Torfaen know what an assertive champion they have.

Cabinet Secretary, I don’t know whether it’s your birthday today but you’ve certainly had a great deal of praise, both in the last debate and in this one. I am unashamedly—[Interruption.] I am unashamedly going to carry on in the same vein. I thank the Cabinet Secretary for his statement on the long-awaited construction of the SCCC at Llanfrechfa, and I’m sure that the news will be well-received by the peoples of south-east Wales and the regions thereabouts. I also congratulate him on such prompt action, at least on his part, particularly as this is so early in his tenure as Cabinet Secretary for health. I would also like to make note of the considerable input over some number of years by the AM for Torfaen, Lynne Neagle, which has helped secure this project. I know that it has been a project very close to her heart. Obviously, I’d like to mention Nick Ramsay’s input into this project as well.

As indicated in his statement, the Aneurin Bevan Local Health Board are now free to implement this project and proceed with the construction at the earliest possible convenience. It, of course, also frees up the board to produce a complete strategy for services across the whole of the board’s region. I look forward to it transforming the entire healthcare experience throughout south-east Wales, but I would ask the Cabinet Secretary, as has been mentioned by Lynne Neagle earlier on, that you keep an eye on what’s going on and make sure that the board does deliver on these promises. Thank you.

Thank you for the comments. I can confirm that it isn’t my birthday—not yet, and I do have to wait some significant period of time for that to happen again. In terms of where we are, Members make a series of points about the time and where we are now, but, on the opportunity that this decision represents, the health board has always said that they want a decision made that would unlock their ability to go on to do the next stage of developing the whole healthcare plan: health and care systems working together. Actually, as I said earlier, I think Aneurin Bevan have a good story to tell on their development of primary and community care. They make more moves of services out of hospital and into communities than other parts of Wales have achieved in some parts, in particular in eye care, and this should actually help to see that transfer moved on at that pace. So, I’m still optimistic about the future for all the challenges that we have, but there has got to be, as I said in my statement, a real commitment to delivering at pace the service reform and transformation that is necessary to accompany this decision.

I wish to, firstly, again, congratulate the Cabinet Secretary for Health, Well-being and Sport on this important and historic news that the Welsh Government will invest £350 million in the building of Gwent specialist critical care centre. This announcement will be greatly welcomed by my constituents in Islwyn and it’s wonderful news for the people of Gwent and beyond.

The 460-bed project, which will serve a 600,000 population, reinforces what everybody knows: that, when it comes to the national health service, the party that created it—the Labour Party—are the party whose hands it is safest in.

Thirteen years in the making—an unlucky number—makes this decision very, very important for us, under that rigorous spotlight of scrutiny, but it is a lucky number for the people of Gwent and south-east Wales.

Just reading out the facilities that the specialist and critical care centre will provide demonstrates why the Minister was right and courageous to green-light this expensive project at a time when Wales is facing severe cuts. It will incorporate major emergency treatment and assessment with critical care beds and acute cardiac care beds. The in-patient service will handle major cases, with specialities such as general surgery, medicine, orthopaedics, haematology and vascular care. Also included will be in-patient obstetrics, midwifery and consultant-led services, gynaecology, emergency endoscopy, in-patient paediatrics and neo-natal intensive care, and I can go on.

Can I ask the Cabinet Secretary how he will enable effective transport links to be carried out? But, before all that, I also wish to underscore the sentiments that have already been presented. Thank you for this decision; thank you to this Welsh Labour Government, putting the people’s priorities first and ensuring that we have an NHS fit for our times, fit for the people of Gwent and beyond and fit for Wales.

Thank you for the comments. Going back to the point about transport again, it’s a significant issue to get right for both private hire and private transport, as well as public service transport, to the site, thinking about the needs of patients and their abilities and also access for emergency services. I expect that local Members who were engaged directly in their conversations with the health board—I know they briefed local Members; they’re quite proactive, actually, in making sure that local Members are on board and understanding what is actually taking place.

I also think as well that it was helpful to hear the wide-range of services that the Members actually reminded others will now take place on this new site when it is delivered. But it’s important also to recognise that this is a project that’s maintained support, not just within the clinical community, but other public services in Gwent too. So, it does enjoy the support, and continues to enjoy the support, of all the local authorities in the Gwent area. Regardless of where it is physically situated, there’s been a recognition from those local authority partners that actually having a model that is a specialist care centre to deliver a proper model of care at this end is a good thing for all of the services around it. I’ll look forward to seeing that delivered on by local authority partners, by the health service and other wider stakeholders as well.

Thank you very much, Cabinet Secretary.