Will the Cabinet Secretary make a statement on the investigation being undertaken by Betsi Cadwaladr Health Board into reports that the quality of care for dementia patients on the Tawel Fan ward at Glan Clwyd Hospital may have contributed to at least seven deaths? TAQ(5)0156(HWS)

As the Member, and other Assembly Members, will be aware, I established an independent panel to oversee the HASCAS—that’s the Health and Social Care Advisory Service—investigation and the Donna Ockenden review into the care of patients on Tawel Fan. Whether the quality of care provided could have been a contributing factor to the death of some patients will, of course, be what we’re looking to establish as part of that HASCAS investigation.

Thank you for that answer, Cabinet Secretary. These are very concerning remarks, which have been made in letters to patients’ families in north Wales. And, given that we are now two years into special measures, almost, and around two and a half years since the publication of the report by Donna Ockenden into the institutional abuse on the Tawel Fan ward, it will come as a serious concern that there may be individuals who are still employed by the NHS, paid for by the taxpayer in terms of their salaries, who are yet to lose their employment, and are yet to have to face resignation, and may still be working somewhere in the health service in spite of the potential harm that they may have caused to individuals in this particular ward.

I am concerned that some of the cultural issues that were identified in Donna Ockenden’s report are still prevalent in mental health services in north Wales, and that there’s still significant pressure on in-patient bed capacity. Just this week, I had an e-mail from a family whose loved one needed to be sectioned because of their poor mental health, and had to be sent to Bristol, because there were insufficient numbers of beds in north Wales. That is unacceptable. And it’s also unacceptable that some patients are having to sleep on sofas in lounges in mental health wards because of insufficient numbers of beds, and that some female patients are also having to sleep on male mental health wards in north Wales.

Clearly, there are still huge challenges. There are still issues that people in north Wales are facing, and we must ensure that we learn lessons from what went wrong. I appreciate that the investigations are continuing, and that those are in-depth investigations, and we have to get to the truth in terms of what has been going on in north Wales, but I would appreciate it, Cabinet Secretary, if you could give some assurances that, should those investigations find that harm has been caused, you will discuss with the police and the Crown Prosecution Service the possibility of bringing prosecutions for those responsible for causing harm, particularly where that harm may have led to deaths, because these are very serious issues, which people are very concerned about in north Wales, and we’re not confident that sufficient progress is being made to address those concerns.

Thank you for that series of slightly different questions, and I’ll try to answer them in the different parts in which they were put. I want to start by saying that, of course, I understand the significant and continuing public interest and concern into the events reported around Tawel Fan, and it’s been actually very difficult to meet the understandable demand for the process to be concluded as quickly as possible, which is entirely understandable, from the families affected and the wider concerned community within north Wales and beyond, but having a process that is properly robust, because part of my concern has always been, despite my personal desire to see this concluded quickly, that, if you don’t have a properly robust process, you potentially open up not just the health service, but individual families, to a wholly unsatisfactory position where the process itself collapses and you don’t actually deliver the sort of justice that I understand people want to see. And I do appreciate the fact that you indicated that the most important thing is to get to the truth, and, indeed, thousands of different documents have been reviewed, and, because of the rigour undertaken, there have been further fields and avenues of investigation undertaken that go beyond the number of people identified in the Ockenden report. And that’s important for you to understand, I think—there is real rigour that’s been undertaken in what is now a review with real, genuine independent oversight. So, the health board don’t control and have oversight of the HASCAS review, so there should be no misunderstanding that the health board are somehow going to re-interpret or alter the findings of this genuinely independent review.

I’ve not had sight of the letters that I understand have been reported, but, in terms of the challenge around harm caused and understanding what comes after that, there’ll be a number of different processes to go through, in which the Government won’t have a role to undertake. For example, the professional issues—that will be for the professional bodies to undertake. We expect them to do their job. I am concerned though about the length of time it takes for fitness-to-practice proceedings to be undertaken—that’s not a party political issue; it’s an issue of genuine concern across the Chamber—regardless of which professional body people are answerable to and responsible for.

On the point of prosecutions, I think it’s really important that Government politicians don’t get into the business where we are saying that we expect or require the police and the Crown Prosecution Service to prosecute. There is such a level of public interest that I expect the police to be properly aware that when the investigation reports they will need to review it and they will need to respond and indicate. And, at the time the report is available, I see no reason for me not to ask the police to confirm their position, but I think going beyond that would not be appropriate for me to do. Those are independent decisions to be made by both the police and the Crown Prosecution Service about matters that they think they could, should, and have a duty to investigate and then conclusions they actually reach. But I’m happy at the end of this process to ask the police for their view on whether they expect to take any further action.

On the broader cultural issues that you identify, I think this is an area where people should look again at the process of special measures with the oversight provided by regulators. This isn’t a Government politician deciding, ‘This is what I want the conclusion to be’. And I’ve always, as I know that Mark Drakeford has before me, tried to be really clear that this won’t be undertaken for the convenience of a Government politician in this particular role. It must be about independent advice from regulators about progress that has and has not been made through special measures, and about whether the organisation comes up, whether sufficient progress has been made in each of the areas. And mental health services are, I think, the most significant area of concern that caused the health board to be put into special measures. The new director has made a real difference, I think, but there is an understanding that there is a real and significant challenge in reconfiguring and improving that service. What should give me and other Members confidence is not just the process undertaken with independent regulators, but they recognise that real progress has been made to date. But it is about the further progress that is still needed. And I would not pretend to you or any concerned citizen that everything is perfect and that progress is smooth and easy. But we will have a properly transparent review from those regulators when they undertake their regular review of special measures, and, again, I will receive that and that will be publicly available, as have previous reports.

Clearly, we have to await the full investigation before we can make any decisions, or before any of the professional bodies can make any decisions about what consequences might flow on from that, so I agree with what the Cabinet Secretary has said and note his strong words in that regard. However, there have been administrative consequences from Tawel Fan: the chief executive was suspended and then, in turn, as the Minister has just outlined, the health board itself was taken into special measures. So, I want to understand what he’s done, as the Cabinet Secretary, around the administration now of Besti Cadwaladr, and two things in particular: can he just confirm that not a penny has been paid to the members of Betsi Cadwaladr health board after it was taken into special measures, because it would be wrong, wouldn’t it, for failure to be rewarded in that way? Secondly, can he also confirm that no money has been paid to Professor Trevor Purt after he began working in England?

On Professor Purt, we were completely clear about the secondment arrangement for him to leave the health service in Wales. He is now no longer part of the service. We are absolutely transparent about the arrangement for him to leave, including the financial measures that took place with that.

In terms of your comment that members of Betsi Cadwaladr health board have not been paid a single penny, I assume that you don’t mean the members of staff who work for Betsi Cadwaladr, but that you’re talking about the independent members who are appointed. Well, they are still undertaking a role—they’re still acting—and if I took the decision that they should not be paid, I should actually just simply remove them rather than simply saying, ‘I’m going to punish you by effectively taking a disciplinary measure to remove the moneys that you’re entitled to in undertaking this public appointment’. I think it’s really important that, in properly holding people to account, we don’t look for easy or headline-grabbing measures to try and say, ‘This is what we should or must do’.

For me, the most important thing is that the health board improves. You do need members there who are committed to providing the scrutiny that wasn’t undertaken to the level that we’d want it to in the past. We’ve seen a review of people; we’ve seen actually a renewal of people as independent members on that health board. We’ve seen new executive members come in, so there are new leadership arrangements in place within the health board: a new executive nurse director, a new medical director and a new chief executive officer as well. So, it’s really important to understand that the leadership has moved on from the time when the organisation went into special measures. For me, it must always be: are we seeing progress being made? Are we getting the independent reassurance from regulators that real progress is being made, and what are the continuing channels that we need to see resolved within Betsi Cadwladr? Because that, for me, is the most important thing, because I want people living in north Wales to have the same high-quality health service that I believe that every citizen in any part of Wales in entitled to.

The health board website states that:

‘The Board was made aware by families of serious concerns about the care of patients in December 2013.

‘Immediate action was taken to close the ward and patients…transferred to alternative care.’

However, I wrote to the chief executive of the then north Wales NHS trust in April 2009 on behalf of a constituent, stating that the treatment received by her husband in the unit nearly killed him, that three other patients, admitted around the same time as her husband, had similar experiences, and she was now worried about the treatment that others may receive in the unit. Her husband had Alzheimer’s disease and terminal cancer. Through that, I was copied on the complaint of another patient who had vascular dementia, which included distressing ‘before’ and ‘after’ photographs. The chief executive responded that it was being treated as a formal complaint and that she’d copied my e-mail to the chief of staff for mental health and learning disabilities. How, therefore, will you ensure that this inquiry not only considers the impact on the patients and the families, but considers why matters were raised with them several years—four and a half years—before they acknowledged that they were made aware of this, having been raised with them at the highest level?

I think it’s difficult to understand how the matters raised directly relate to the investigation that’s being undertaken. You raise matters that are historic, going back to 2009, as you indicate, and others. I’m not aware of how the independent HASCAS investigation has actually resolved all those issues, because that’s the whole point about being independent. It’s not for me to set parameters on the timescales for them to look at or to understand; it is for me, though, to understand that there is a properly rigorous, robust and independent investigation into what took place in the care provided around Tawel Fan, the lessons to be learnt from that particular part of the service, but also if there are wider lessons to learn about the future of the service not just in north Wales but beyond. So, if the Member believes that there are matters that he wishes to draw to the attention of the independent group overseeing the HASCAS investigation, then I think that’s perfectly proper for him to do. It must be for them to undertake that investigation as they see fit, rather than me deciding for them what they must do, because that then means it is not an independent investigation and inquiry. I think it’s really important to protect the independence, the robustness, the high quality and searching level of detail that that inquiry is undertaking. I look forward to receiving the outcome of that investigation report. We’ll then need to understand what we can do collectively to move healthcare in north Wales forward afterwards.

Any investigation needs to be undertaken thoroughly and fairly, of course, but how will the Cabinet Secretary ensure that the investigation is conducted in a timely manner? How will the Cabinet Secretary make sure that any findings are not simply written off by the stock line that seems to be used when a public body is found to be failing our people, which is ‘lessons will be learned’? Finally, will the Cabinet Secretary ensure that the results of this investigation are brought back to the full Assembly, not just the scrutiny committee, for a debate on next steps?

I’m happy to respond to the middle point first in terms of what will happen. In terms of what will happen, we need to see what the report says first, to then understand what an appropriate response is, what response the health board should undertake and are there points for the Government to respond to as well.

I’m robustly confident there will be questions as a result of the report when it’s provided, and, of course, we’ll need to consider with the leader of the house about how Government business is used in terms of responding to that report when it’s provided and having a proper response that actually informs rather than simply adds more heat to public debate around this matter. It’s really important we take a step forward rather than have an exercise in launching more criticism onto individuals who are not here, but actually look at what happens, for the people who need the service at the highest level of quality within north Wales.

Finally, o the point about the timely manner of providing this report, for me, the most important point is that it is a robust and independent report. I personally would have much preferred it if this report was available several months ago. It would be much more convenient for me if that were the case. I cannot—well, I could, but I will not interfere with the timescale for this report. Otherwise, as I said earlier, it is no longer an independent report. It must not be a report that is done for the convenience of a Government politician. It must be a report that carries real independence, real rigour and real robustness with it. That means, unfortunately, it’s taken longer than any one of us in this room or the families affected would have wanted it to have done. But, the robustness and the independence of that report should not be compromised, and I will not do that.

Thank you very much, Cabinet Secretary.