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

The second urgent question has been accepted by the Llywydd, and I call on Llyr Gruffydd to ask that urgent question.

Will the Minister make a statement concerning the Ombudsman’s report, which found ‘systemic failure’ in a cancer patient’s care at Glan Clwyd Hospital in Bodelwyddan? EAQ(5)0076(HWS)

Thank you for the question. The health board has fully accepted the identified failings and recommendations in this individual case. I’m pleased the chief executive of the health board will apologise personally to the patient concerned. I expect the health board to take swift action on the recommendations, and officials from the Welsh Government will be monitoring progress closely.

Thank you for that response. I too would want to acknowledge the way that the health board has responded to what has been said in the report. Unfortunately, it feels as if these reports are appearing almost on a weekly basis these days, and it’s important to note that many of these are historical cases that are emerging and that the board is trying to resolve problems—and they are, of course, in special measures. But, there’s no signal, as far as I can see, that some of these fundamental problems related to staffing—which have been at the heart of many of these cases that have been highlighted—have been resolved. The chief executive, in response to today’s report, said that the urology department was still under huge pressures. The ombudsman says that there needs to be a capacity review. My question therefore is: would you accept that the fundamental factor in many of these cases that we have seen, including this latest one, is the shortage of staff, and that staffing problems, of course, lead to increasing pressures on individuals and services, which in turn unfortunately make it more likely that mistakes are made? Can I ask you, therefore, what your Government is doing to resolve this fundamental issue?

Thank you for that series of points in the follow-up question. As I mentioned earlier in response to your colleague Rhun ap Iorwerth, when he mentioned this particular case, there are challenges about the care provided and the model of care provided, but also, this case highlighted a very real challenge with the unacceptable way in which the complaint itself was dealt with. That’s absolutely part of this as well. I think a lot of the anxiety could have been taken out if the health board had dealt with the complaint in a more timely way, and hadn’t decided to move the complaint to the end of actually receiving a form of care. I don’t think that was acceptable, and I want to be really clear that that should not happen at this health board, or any other, in the future. In terms of the points about the make-up of cancer services and the pressure, some of these are UK-wide pressures and some of them are more localised pressures as well. We know that urology services are under pressure right across the UK, so there is something here about understanding how we have, again, the right form of service. So, that’s something about capital investment and it’s also about a model of care as well.

This really does go to the heart of the point you make about workforce challenges, because I said in response to questions earlier today—and in pretty much every questions I deal with there is almost always a question about the workforce—it’s who we have, whether they’re the right grade, whether we have enough of them, and how we get more staff in what is almost always a really competitive market, not just within the UK, but further afield, too. That’s why having the right models of care really does make a difference. We make it much more difficult to recruit to models of care that are not delivering and are leaving people in a position where the service is unlikely to be seen as sustainable. So, there’s a range of different things that we need to do.

You’ll see action that the Government will take on the way in which we commission places and the way in which we design and deliver the workforce to improve workforce planning in the current weeks and months. That’s long-standing work; decisions will get made on that in the near future. You’ll then see also the work that we’re going to do in terms of the investment we’ll make again in education and training places here within Wales, and the way we support our students, too, as well. It goes with the point your colleague Dai Lloyd made as well about understanding what we need to do to both bring more people in, whether it’s primary care or secondary care, but also to keep the people that we’ve got. There’s a range of different points in all this, and I wouldn’t pretend that there is one simple answer to deal with any of this. The challenge for the Government and the health boards is—and the deanery as well—how do we make sure the environment we create in Wales is one where people are valued, people are respected, and at the same time our high expectations are met, and what we need to do to see the system change positively is to deal with those workforce challenges and to continue to deliver the high-quality care that people, quite rightly, would expect from our national health service.

Let me begin by thanking Glan Clwyd and Wrexham Maelor for the cancer treatment they’ve given to members of my own family. Nonetheless, this does raise serious concerns. I have—I won’t read them all out—upheld complaints by the ombudsman against Glan Clwyd here in 2012, two in 2013, and one in September this year, when a gentleman with chronic renal failure died and the ombudsman felt there was a complete lack of responsibility by the consultant physician and a lack of renal physicians on the day concerned. I had another one this month, where a complaint was upheld when a daughter complained her father’s treatment post-operatively at Glan Clwyd was inadequate, resulting in his death from sepsis, and now this. You say the health board has apologised, and I’m sure it has, and I welcome that, but in each instance, the ombudsman has made a range of recommendations to the health board for the review of procedures, audit and training and, in each case, his recommendations have been accepted by the university health board. How do you propose to drive the cultural change within the institution so that, whether people are cleaners, maintenance staff, nursing staff, doctors or clinicians, they all feel motivated and part of a team with management that minimises these sorts of problems in the future through a patient-focused approach, notwithstanding, of course, the pressures upon them and other hospitals throughout Wales?

I thank the Member for his series of questions and points. There is a something here about cancer—and I was pleased to hear him acknowledge the treatment that members of his family have received, because, as I said earlier in response to Rhun ap Iorwerth, actually, Betsi Cadwaladr has a good reputation for the speed and the quality of treatment in cancer services. But that doesn’t mean to say that you should simply then ignore those areas where we recognise that that quality has not been provided. I’ll make this point: the reports of the ombudsman do not get ignored, either by health boards or by the Government. So, the health board, as it will know, can expect to see follow-up from this report, to see that the recommendations are being implemented.

The challenge always is how we have a reporting system that can acknowledge where there have been failures, to give people some recourse and, at the same time, how we try to deliver a learning and improvement environment as well, because the challenge is—in this instance, there were four different consultants involved in the care of this one individual. There’s learning for each person and each member of the wider team. The challenge is how to ensure that learning is then implemented and we don’t move to a system where it’s effectively a system of providing blame, because that is actually the worst thing that we could do, because that would either lead to people wanting to hide their mistakes or to move away from them, or actually, if we want to hire more people to come into a service and more people are blaming each other, that is not the right focus for the national health service. So, it has to be on improvement as well as accountability, and that balance, I think, is being struck, but it doesn’t mean to say that we’ll get everything perfectly right in the Government in our relationships with health boards, and the health boards themselves as well. And that’s why we want some maturity in the conversation about the future.

I do think, though, that, over the course of this next term, Members should expect to see an improvement in quality and outcomes within the service, and where there are complaints, as with any service of this scale and size—and there will be, there will be times when we don’t get things right—. Even in a fantastically performing system, the challenge is what we do about things so that we minimise those risks, and that unacceptable treatment, and what we do to learn from those, to understand what we need to improve in the future and make sure that we don’t see happen in the future as well.

So, I take on board the points that are made, and, as I say, these reports are not ignored, they’re taken very seriously, both by the Government, and, indeed, the health boards themselves.

I know from the experiences of a family member who had cancer some years ago, and was treated at Ysbyty Glan Clwyd, that the medical staff on the front line do their utmost to provide prompt, high-quality care. However, this isn’t the first time that the ombudsman has found failures at Ysbyty Glan Clwyd surrounding treatment, despite the obvious efforts of the staff on the front line. What is the Welsh Government going to do to ensure that the medical staff at Ysbyty Glan Clwyd receive the resources and assistance that they need to provide an effective and efficient medical service, and what direct action is the Minister going to take to address the failures in care in Ysbyty Glan Clwyd that the ombudsman has highlighted?

Thank you for the question. I believe most of the first part of the question has been answered, in response both to Rhun ap Iorwerth and Llyr Gruffydd, and also Mark Isherwood. And I’m pleased to say and acknowledge that this isn’t down to a lack of effort, but there is something about a learning culture, where people genuinely challenge, and constructively challenge, the way in which care is provided within multidisciplinary teams.

In terms of the direct action, again I’ve explained that the Welsh Government won’t ignore the report. I’ve explained, in terms of the accountability conversations that are happening with both the chief executive and with the chair, that the issue will get raised, and that they can expect there to be follow-up from officials as well, to make sure that the learning is actually carried out, and can be evidenced now that that learning has been taken on board, both by individual staff and across the whole system. Because, as I say, I want to see learning and improvement take place as a result of each of these reports, rather than simply looking to blame a particular individual and not look at what the whole system could and should do differently.

Thank you, Cabinet Secretary.