1. Will the Cabinet Secretary make a statement on the improvement programme for Betsi Cadwaladr University Health Board? OAQ(5)0109(HWS)

Thank you for the question. The health board reported against the milestones set out under the improvement framework in November last year, which highlighted good progress. I expect to see continued and sustained delivery of the required improvement outcomes before I can consider removing it from special measures.

Thank you for the answer. I received an e-mail from somebody in Old Colwyn who was concerned about the fact that their general practitioner is now retiring, and 1,200 of the patients are going to be disbursed amongst different surgeries. Now, it seems to me that what we need to be doing is thinking creatively around this area around GPs retiring, and maybe bringing some of them back out of retirement, or people who are going to be retiring, encouraging them to stay on part-time. One of the major blockages for this is the fact that indemnity insurance can range anything from £5,000 to £40,000 per GP per year. Can the Welsh Government look into this and see if they can find a creative way in assisting GPs to cover these costs in order to cover GPs on the rota?

Thank you for the question. There are a range of things we are already talking to the GP and wider primary care community about—that includes what happens when people choose to retire; how patients have an uninterrupted access to a proper primary care service; and the sort of interventions the health board are able to undertake if they are not able to manage a smooth transition to another practice and actually continue. Actually, what Members should take comfort from is that, in each instance where someone has retired and handed back their contract, there has been no break in provision, that every patient has been found a new practice to go to, or that the health board themselves have managed to run a proper primary care service.

I recognise the particular issue the Member raised about indemnity insurance. It’s something we have active conversations with the British Medical Association about, and I’m hopeful that we can come to a solution in the near future.

Cabinet Secretary, you’ll be aware of the concerns that have been expressed about the pace of progress at the Betsi Cadwaladr university health board, particularly in terms of progress to deal with some of the mental health challenges in the region. Following the Tawel Fan scandal, quite rightly, the Government put the health board into special measures, and one of the reasons it did so was because of its failure to address concerns about mental health issues. However, there was a six-month delay before the follow-up work, which was promised in the wake of Tawel Fan, was actually commenced. As a result of that now, we are drifting into a longer period. We were told that the work would be finished by March; now we’re told it’s going to be at least until the summer that people will have to wait. No-one’s been held accountable for what happened at Tawel Fan. There are people who are still suspended on full pay, much to the consternation of taxpayers in the region. When can we expect to see the sea change in delivery in terms of mental health services in north Wales, so that people can be confident that they are of a high quality? There’s no mental health strategy yet. We’ve only got an interim director of primary and community mental health care. These are things that should have happened quickly in order that people could get over the past and look forward to the future.

I think there are two particular parts to the comments the Member sets out. There is, in fact, a substantive director of mental health services, and he is leading the approach to actually reform mental health services in north Wales. So, you will see engagement over the period of the next few months on that new mental health strategy, which is absolutely needed, because, as a Government, we recognise that mental health is one of the most significant challenges that the health board faces for the future, and it’s probably the one that will take the longest period of time to resolve properly. In many ways, that’s why we set out the length of timescale that we expect the health board to be in special measures. I actually think the new director’s had a significant impact, but it’s important that that continues and is sustained.

The second point that I think you’re making is about the ongoing investigation. The health board did the right thing in actually approaching the Health and Social Care Advisory Service to undertake a proper and independent investigation, and what has happened is that that investigation has lengthened and expanded. As they’ve gone through, more families have contacted them and more interviews have been undertaken. My understanding is they’ve already had to review 300,000 pages of documentation and there are more people who still need to be interviewed. So, I think the most important thing is that enough time is taken to do this properly, and I don’t want to set any artificial deadlines for timescales that would actually potentially compromise the thoroughness and the adequacy of the report that we will ultimately receive. However, I do recognise that it would be in everyone’s interest if this matter could be dealt with even more promptly and expeditiously from a time frame point of view. There are people who will want to know what happened, from both the families and individuals themselves to the staff members who are engaged and involved as well. It is in all of our interests that this is done quickly; however, the speed of the investigation should not compromise the ultimate outcome and the soundness of that investigation. But I have been very clear with the health board about what I expect them to do. We also need to think about the oversight and the governance of this as well. So, it really does matter that we get this right, and I hope that Members would support and recognise that.

The health board, of course, is in special measures and has been for a year and a half, and I agree with many of the points that have been made on the problems that exist. But would you agree with me that there are some more fundamental issues that need to be tackled and would you agree that three specific things need to happen to that end? One we’ve already heard about is that we need more doctors and nurses to respond to demand. The second point, of course, is that much more needs to be done to integrate health and social care services. And, thirdly, we need to reopen beds in community hospitals to facilitate that patient flow from general hospitals, otherwise, of course, we are not going to tackle the fundamental problems.

Thank you for the questions. We recognise and we regularly discuss the need for a new staff mix, not just the numbers of staff we have but who those staff are and how they’re used. So, the models of care really matter as well as the numbers of staff we have: doctors, nurses, therapists, pharmacists—there’s a whole range of different people we will need in the health service of the future, working a slightly different way. I agree with you about integration between health and care. That is a clear direction of travel for this Government, and we expect to hear more about that during the course of the parliamentary review and the recommendations that it will provide for us and every party in this Chamber.

On your third point, again, we do talk about patient flow, in the sense of those patients who don’t need to go into secondary care, don’t need to go into hospital beds, or into anticipatory care, to keep them where they are, a better relationship with residential care and domiciliary care, as well as primary care and social services, as well as understanding what mix of beds we need and what provision we need. Sometimes, that will be in residential services. It isn’t just about having alternative forms of community hospitals. We need to think about the whole mix that we need, so not setting a particular bar or a particular number on beds. We need an understanding of what our whole system needs, how people are getting to the right place for their care and, crucially, how we return people to their community and their home to continue receiving care, where they still have a need for care that doesn’t need to be undertaken in a hospital bed.