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

I have accepted two urgent questions under Standing Order 12.66. I call on Simon Thomas to ask the first urgent question.

Will the Cabinet Secretary make a statement on the £150 million overspends forecast by local health boards this year? EAQ(5)0153(HWS)[W]

Thank you for the question. The position in these four health boards is unacceptable. We have made it clear that we expect them to take action to significantly improve their financial position.

I thank the Cabinet Secretary for that statement, which didn’t actually say what he was going to do about it, however, which I hope he will now tell us. First of all, can he just clarify the situation? Because I think there could be some confusion, following the leader of the Conservative party’s questions earlier on, that though the health boards have not been bailed out, his department has been bailed out to the tune of a similar amount of money. The supplementary budget that we passed a couple of weeks ago actually gives his department this money, not the health boards themselves, and therefore there has been a bail-out, in effect. And so, if there hasn’t been any consequences for the health boards, we must ask ourselves, ‘How can we achieve better financial planning going forward?’ The First Minister mentioned the NHS finance Act, which was passed three years ago by this Assembly. When that Act was passed, the then Minister said and promised that we would get better financial planning, and went on to promise that it should result in better decision making and optimal solutions by local health boards. I don’t think we can say we’ve had better financial planning or optimal solutions from health boards since the passing of that Act. Can he confirm that there’s still a financial duty on health boards to not exceed the aggregate in each financial year, even taking a three-year planning model, and what consequences can there be for health boards in not meeting proper financial planning under the NHS finance Act? And isn’t it time at least to consider not paying the allowances and payments to members of the health boards if they cannot bring themselves into line?

I thank the Member for the follow-up comments and questions. I think looking at these four particular organisations, and then trying to say there’s a judgment on the whole system just on the basis of these four, is not taking a whole-system approach. Actually, when you look at the six out of 10 organisations that are in balance, that is partly as a consequence of the new regime that we have. What I’ve been very clear about is that we’re not going to cover over the fact that these four health boards are not going to live within their means within this year, and there’s got to be an exercise in financial discipline and clarity about that. And that goes into your point about accountability. I don’t think the somewhat cheap shot about saying you should take allowances away from board members is a particularly helpful way forward for a real and serious challenge that we have. I expect the service and the system to take seriously the financial challenges that we face. Every single country within the United Kingdom faces a real and serious challenge about funding the health service. We know the consequences of continued austerity and what that does for our public services. We know that putting extra money in the budget that this Assembly has passed into the NHS comes at a real cost to other parts of public funding. That is why I have been very clear over an extended period of time that the health service has a real responsibility to live within its means. That’s why I’ve been very clear that we expect a significant improvement in financial planning and management that will not compromise patient care.

Cabinet Secretary, people talk about this in tones of shock and horror as if it’s a surprise, but it’s certainly not a surprise to me when looking at some of the integrated medium term plans. Could you please confirm which of the health boards’ IMTPs showed a deficit from the beginning of this funding round? Could you also confirm to me where you see the health boards could review their spending? Because for all the tough talk from everyone, I assume and hope that doctors and nurses, porters and community health workers will still get paid over the next few months. Thirdly, Cabinet Secretary, do you accept that a number of these health boards have already instigated ambitious savings programmes? Now, these will obviously take time to kick in. Do you think you are giving health boards sufficient time for this to improve? Fourthly, do you welcome the improvement in services that we have seen as a consequence? Many of the health boards’ performance indicators have slowly risen. I know that in Hywel Dda health board it’s the best in Wales in cancer and four-hour A&E delivery times. And would you agree that we wouldn’t want to see reversals in service delivery? Do you accept that we should have a rural uplift for some of the rural health boards, as discussed and promoted by many organisations, not just the health boards themselves? Finally, Cabinet Secretary, could you tell me where Wales is in terms of spending on healthcare as a percentage of gross domestic product? My understanding is that only three countries in Europe spend less than us, and is that not the real problem? We’re just simply not spending enough on healthcare to ensure that boards do not go into deficit. As Andrew R. T. Davies said earlier, the deficit in Wales is double that of the UK.

I’ll try and deal briefly with the series of questions that were asked. First of all, I want to welcome the acknowledgement from the Conservative health spokesperson of the range of improvements in the service that the NHS provides to the people of Wales. That’s probably the first time I’ve heard that from a health spokesperson from her party and that’s very welcome indeed. No-one should be surprised, though, at these challenges, because I’ve been absolutely upfront about these over a period of months. When I refused to endorse the IMTP submitted by Abertawe Bro Morgannwg and Cardiff and Vale health boards, I was absolutely clear about the range of issues within that. And money was part of the challenge as well, so they did not get their IMTPs approved. Equally, you and others in the Chamber were in health committee on 3 November, when I answered questions about this position, and about the money in particular. I made clear at that point that Hywel Dda and Betsi Cadwaladr would not live within their means. I also made clear the very real risk to be run by Abertawe Bro Morgannwg and Cardiff and Vale. Members are, of course, free to check the transcript and the follow-up letter to the health committee that was absolutely clear about this as an issue. So, this should not surprise people if people have been paying attention.

The challenge is what are we prepared to do, but that goes into the other points that you’ve made. I want to be really clear again: people will get paid; bills will get paid; this will not lead to a trimming in the service that is provided. We will cover this from the centre, but we’ll have the clarity that these health boards have not lived within their means. I don’t accept at all your point that we don’t spend enough money on health. If that really is your view, then you could set out in an alternative budget where you would take that money from. Let’s remember this: when we put in the extra £240 million into the budget that we proposed and this place passed—for the NHS—that comes at a significant cost to every other part of the public service. That means that £106 million in cash terms will come out of local government. If the Tories really wish for there to be further cuts in other service areas, they should set those out. This is not a consequence-free game. We spend nearly 50 per cent of our budget on the NHS.

And finally, the real challenge for getting into financial balance and having a genuinely sustainable service is service transformation, and that requires difficult choices and difficult questions for all of us—all of us as citizens of Wales, all of us as elected representatives—and that conversation with clinicians about how we improve our service by changing it, and not waiting for change to happen to us because we waited too long for those services to be reformed. That’s why I set out very, very clearly to the service, in particular in the NHS Confederation speech last month, what I expect of them and what I require them to do in planning and managing the service over this next year where decisions will have to be made.

Prudent healthcare requires us to do everything differently so that we eliminate waste and avoid duplication of effort. I’m aware that in my own health board, Cardiff, they’ve made enormous strides, for example, in the improvement of stroke patients, which has enabled them to leave hospital sooner, and that’s an obvious financial saving. But I wondered what else can these four health boards do that maybe they could be replicating from other more successful, financially, health boards to, for example, offer more services in primary and community care, as this can be proved to have better outcomes and also save money. What else can these health boards be doing that they’re not doing at the moment?

Thank you for the question. You’re right to point out that there are a range of service improvements already taking place even in these health boards that are not living within overall means. There are good examples across Wales. For example, Abertawe Bro Morgannwg piloted community cardiology, moving services out of hospitals into the community. It’s a better experience for patients and, equally, it means that people who do need to be in a secondary or tertiary care centre are seen more quickly. Often it is the case that a service improvement can lead to financial savings. It is not always the case that you need to spend more money on improving your service. The challenge is that often comes with a difficult conversation—a conversation with the public about why and how services are changing, but also with our staff as well. Not every member of staff is a keen advocate for changing the way that a service works. But we do see a range of different examples where service improvements are delivered, and stroke care is a good example. I had not just a conversation with Cardiff but also with the Aneurin Bevan health board I recently visited with Jayne Bryant—a real improvement in their service and, actually, something for the rest of Wales to aspire to. But, of course, other areas of improvement have been made as well. For example, ABM acknowledged yesterday that they’ve got £4 million of medicines waste within their health board area. So, they’re significant sums of money that could and should be saved that will deliver a better service for our patients, but it still won’t get around the challenge that we do need to see the way in which our service is delivered reformed to improve patient care—the quality and experience. And I fundamentally believe that will also mean that we will live within our financial means as well.

As you know, Cabinet Secretary, two of those local health boards that are affected are in my region. Before the hares start running—and they already have today—I would like you, if you will, to please restate that services will not suffer, and I will ask you also if you will bring back to this Chamber the programme for action that you intend to ask those health boards to implement to provide the changes that are needed in reducing these overspends. And I will ask you, Cabinet Secretary, if you will immediately put to bed the suggestion that was alluded to by Angela Burns that staff won’t be paid as a consequence of this.

I did not say that.

You did.

I’m happy to confirm yet again, as I’ve done in every interview and every question that I’ve been asked about on this, that bills will get paid, staff will get paid and we will not see treatments interrupted as a result of the position of these health boards. We’ll cover this money from the centre, but we’ll make sure that there’s clarity in the amount of overspend from each of these health boards individually. And in terms of the future, well, of course, we’re going through the planning round for the year ahead. And so, health boards that are in a different position, and trusts, will have their integrated medium-term plans approved. There’ll be greater differentiation between those that are approved organisations, and those that are going through the escalation process, and are either in targeted intervention or special measures. There’s got to be clarity about where each health board stands and where each trust stands, and I will provide that.

I’m saying nothing to Members today that I have not already said to people leading and running these organisations, and I am having the same conversation in public as in private about the need to deliver significant financial improvement, and to deal with the need to transform our services as well. And I will, of course, update Members again on the progress in the financial management position and also the service position as well. I will do so when I come back to report on those IMTPs that are approved, and those that are not, and the measures that we are taking in supporting and challenging those organisations that are currently not in a position where I can, or will, approve an integrated medium-term plan.

I’ve listened very carefully to your answers to these questions about the problems being faced by health boards, and I have to say I find it a little rich that you’re sitting there criticising the health boards, telling them that they need to get their act together in terms of the finances, when you’re responsible for one of those health boards that is in special measures. One of the reasons that the Betsi Cadwaladr University Local Health Board was put into special measures was because of poor financial management. You’ve been there nearly two years and still that financial management is looking like the health board is going to be overdrawn by £30 million at the end of this year. Do you accept your responsibility for the failure to balance the books in that particular health board, and what are you doing about it given that it’s in special measures?

I recognise Darren Millar’s consistency in this area, in never accepting that anything is not the responsibility of the Welsh Government when it goes wrong, or there is a challenge or a problem.

It’s in special measures for its management of finances.

Betsi Cadwaladr, as an organisation—

It’s one of the things that it was put in special measures for.

[Continues.]—is improving on a range of different areas, and I look forward to the regulator’s assessment coming up next month on the rate and level of their improvement. And on its finances, Betsi has improved this year compared to last year. I expect it to improve again next year as well. And Members can either take the Darren Millar approach and say that everything is awful and it’s all the Welsh Government’s fault, or they can take a rather more honest and mature approach to the improvement that is taking place within north Wales. And, frankly, a rather and more honest and mature approach to the responsibility for funding public services across the United Kingdom. It is rich beyond belief for a Tory politician to come here and complain about the fate of public services and their adequate funding. Your party is responsible for the parlous state of funding going in to public services right across the United Kingdom. You should take some—[Interruption.] You should take ownership and responsibility yourself.

Listen to the Cabinet Secretary’s answer, please. That was it. Thank you very much, Cabinet Secretary. Point of order arising out of the urgent question. Angela Burns.

Diolch, Llywydd. I’d like to raise a point of order, Presiding Officer. I have absolutely no problem with the rough and tumble of politics. What I do have an objection to is being deliberately misquoted. I know what I said, because I was very, very clear, because I wanted to make sure that people in these health boards are reassured. What I did say was that I know that—and I think I quoted nurses, porters and community workers—they will continue to be paid, and where would the Cabinet Secretary say that the areas should be reviewed for cost savings. Joyce Watson deliberately, in my view, misquoted me on that, and I would like to have that put on record.

Can I thank you for that clarification? The Record will deliver the verdict on this matter, when it is published. But I will ask all Members, as I have reminded Members in the past, to listen very carefully to what other Members are saying, and to interpret that carefully as they do. And I ask that of all Members.