The next item on our agenda is the short debate. If Members who are leaving the Chamber could do so quickly and quietly, I will call on Dai Lloyd.

Diolch yn fawr, Llywydd. This debate is about protecting and developing regional centres of medical excellence, and I’ve allowed Mike Hedges some time at the end of my speech as well.

We mustn’t forget that short debates in this place are important and can be effective in shaping Government policy. It’s almost 10 years to the day since I had a short debate on organ donation and opt-out and now we see it as the law of the land and several other lands.

Also, a previous short debate about 18 years ago started moves for a Swansea medical school. I’m hoping that today’s short debate will foster a similar change in mindset because the future of major trauma in Wales is the subject of a current review that is going out for consultation.

There’s a perception in south-west Wales that all key services are being centralised in Cardiff. The major trauma centre for south Wales is the latest example—the suggestion is one major trauma centre for south Wales and it should be in Cardiff.

Seasoned Senedd watchers will remember a previous debate on paediatric neurosurgery. Was it going to be—? We needed one unit—was it to be Swansea or Cardiff? Swansea had the only paediatric neurosurgeon at the time, 15 years ago, yet the unit went to Cardiff, which didn’t have a paediatric neurosurgeon. A couple of years later, about 10 years ago now, we had the same debate about adult neurosurgery units. There was one in Swansea, there was one in Cardiff. Review says: ‘You can only have one’. Hey presto, it goes to Cardiff. So, we’ve been here before.

The leader of this independent review, Professor Chris Moran, in leading the review that suggested the one major trauma centre should be in Cardiff, further suggested that the award-winning burns and plastics unit at Morriston would also, ideally, be located in Cardiff then. So where does all this stop? There’s a review down the line about thoracic surgery. We’ve got thoracic surgery in Swansea, we’ve got thoracic surgery in Cardiff. I’ll hold another short debate nearer the time, shall I? I’ve had representations this week that neurosurgery in Cardiff—which, as you know, we’ve lost from Swansea—is under pressure. You need neurosurgery for a functioning major trauma centre, yet I’ve had patients this week telling me that they’re on the waiting list for neurosurgery in Cardiff and have been offered neurosurgery in Liverpool, Oxford and elsewhere, because neurosurgery in Cardiff is under pressure.

Rhaid i Lywodraeth Cymru gydnabod nad yw Cymru’n dod i ben yng Nghaerdydd. Ni ddylent esgeuluso Abertawe, de-orllewin Cymru, canolbarth Cymru a rhanbarthau eraill o Gymru. Mae pobl yn ne Gwynedd a sir Drefaldwyn yn defnyddio gwasanaethau arbenigol Abertawe. Mae angen i Lywodraeth Lafur Cymru ddatblygu gweledigaeth ar gyfer Ysbyty Treforys yn Abertawe i ddod yn ganolfan rhagoriaeth rhanbarthol gwirioneddol, ac yn saff o’i dyfodol. Nid yw’r canoli yma yn broblem sy’n wynebu de-orllewin Cymru yn unig, wrth gwrs. Mae angen i ni weld Llywodraeth Cymru yn datblygu gweledigaeth ar gyfer y gogledd hefyd, a buddsoddi mewn ysgol feddygol ym Mangor a chynlluniau eraill o’r fath. O ystyried y ddaearyddiaeth, y dalgylch a’r arbenigedd allweddol sydd yma, mae gan Ysbyty Treforys y potensial i fod yn ganolfan rhagoriaeth rhanbarthol allweddol yn ne orllewin Cymru, nid yn unig o ran dadl bresennol y ganolfan trawma, ond mewn llu o feysydd eraill, ac i fod yn gadarnle i ddiogelu presenoldeb pob arbenigedd yma yng Nghymru.

Morriston is a specialised tertiary centre now. Any dilution of specialised tertiary services at Morriston could potentially undermine attempts by the Swansea bay city deal and ARCH—a regional collaboration for health—to further develop health research and innovation in south Wales. Swansea’s excellent medical school is already a focus for high-quality research and development, as is the institute of life sciences, attracting the very highest calibre researchers, not to forget, obviously, the £450 million bay campus as well. Only by having high-quality and challenging tertiary services will Swansea and south-west Wales ever be able to attract the very best medical staff and researchers. The Swansea bay city deal and ARCH programme are founded on the principle of developing south-west Wales as a leader in terms of health innovation and research. Welsh Government must not undermine that.

Previous UK-wide reviews—this is the latest one—have seen services based in Cardiff lost to Bristol because the two cities are so close together geographically. Paediatric cardiac surgery was lost from Cardiff to Bristol some years ago. There was a review of cardiac surgery following the Bristol cardiac unit’s deaths scandal. It was decided: ‘Too many units, let’s have fewer units’. Cardiff was pitted against Bristol and despite the problems being in Bristol originally, Cardiff lost out to Bristol in cardiac surgery at that time. We currently send a number of neonatal cases from south Wales to Bristol. We need to be strengthening the high-level specialisms here in Wales, and that means not just in Cardiff, but in other parts of Wales. As regards major trauma centres, there are 27 now in England, and one in Wales will be. What is to say that a subsequent UK review of 28 major trauma centres will not recommend centralising in Bristol as has happened previously, if we’re going to have Cardiff and Bristol sat next door to one another?

In terms of trauma services, there are many questions that need to be asked and many points that need to be clarified, and hopefully the consultation coming up will do some of that. It is therefore vitally important that the public in south-west Wales and mid Wales are given an opportunity to scrutinise these plans in detail. We know that over a third of all major trauma patients in Wales originate in south-west Wales; this is as a result of the particularly high rate of road accidents on rural and semi-rural roads, agriculture and activity-based accidents often linked to tourism in rural west Wales.

Other Members in this place are also concerned. We’ll hear from Mike; I’ve obviously raised my concerns already with the First Minister, ABM and the community health councils. This matter is hugely important and needs in-depth scrutiny. The concerns of people in south-west Wales and other parts of Wales need to be heard. We need an open debate around these issues and the long-term future of hospitals such as Morriston and other regions of Wales, and that means the Welsh Government setting out a long-term vision for these regional centres of excellence.

With the proposal for the one trauma centre in Wales to be sited in Cardiff, with the implication that burns and plastics may well follow and be lost from Swansea to Cardiff, triggering yet another domino effect, what happens, as I’ve already implied, to thoracic surgery reviews subsequently? Siting everything super-specialised in Cardiff makes the NHS in Wales vulnerable to losing those specialisms completely, if a subsequent UK review pits Cardiff against Bristol—so close together geographically.

Burns and plastics in Morriston is an excellent unit, a leader in its field. It held off competition from Bristol to be the burns and plastics unit for the whole of south Wales and the south-west of England. We need regional centres of medical excellence dotted around Wales—Cardiff, yes, Swansea, Aberystwyth, Bangor, Wrexham—to attract our most talented doctors, nurses and consultants to all parts of Wales in the face of a recruitment crisis in all parts. So let us have a mature debate about Swansea and Cardiff working together in the same ‘team Wales’—now that would be radical in a medical sense—instead of being driven apart by that same old tedious Swansea-Cardiff competition, and Swansea always coming second.

Now, the NHS is not awash with money. We’ve heard the budget; we’re not awash with money. We cannot move an excellent burns and plastics unit to consolidate a decision on trauma on a whim, just to consolidate a Cardiff decision because you need burns and plastics in a major trauma centre as well. Why not have the major trauma centre in Swansea? That wouldn’t be a radical solution, because burns and plastics are already there. We could keep the unit there, not have to move it, expensively, elsewhere. And in closing, why not have a truly collaborative, Swansea and Cardiff together, approach? Considering the NHS in Wales as a whole and the people in Wales—yes the people in south Gwynedd, Powys, Pembroke, Ceredigion, Carmarthenshire, they depend on Morriston now for their tertiary care. Let’s put a stop to the domino effect of haemorrhaging tertiary services to Cardiff and beyond. Diolch yn fawr.

Can I thank Dai Lloyd for giving me a minute in this debate? South Wales has two major hospitals—that is without argument—that is Morriston and the Heath. Really, what we’re looking at is: how can we make the best use of both? We need to support both. To west Wales—and I include the area that you represent, Llywydd—Morriston is the major hospital. Anybody who has spent any time there will know that major road accidents from Machynlleth end up in Morriston. It may be slightly over an hour away, and I know people talk about this really important hour, but I think an hour and five minutes is an awful lot better than two hours. And I think that, perhaps, is saying that, yes, an hour’s great, if we can get it in an hour, but don’t write it off as ‘Well, if you can’t do it in an hour, well it doesn’t matter, it might as well get there the next day’. That’s not necessarily the way forward.

On burns and plastics, it is inconceivable that burns and plastics will move to Cardiff. It’s conceivable that it will move back to Bristol. Swansea won it in competition with Bristol because of the high quality of staff in Swansea and that it has created a reputation, and it’s a reputation that has been hard earned by a number of very talented physicians. I think it really is important that we look at what is best for the people of south Wales, and it’s not one place suits all. Can I just say, as somebody who used to travel back to the old Welsh Office—? I used to know that halfway from my house in Morriston to the old Welsh Office in Cardiff was somewhere along Northern Avenue in terms of time. I’ve seen ambulances make their way down there and I’ve seen the cars parting, but the cars are parting and the ambulances go through at 10 mph not 70 mph. So, let’s do something that benefits all the people of south Wales, and keep two centres working for the benefit of the people.

I call on the Cabinet Secretary for health to reply to the debate—Vaughan Gething.

Thank you, Presiding Officer. I’m happy to get a lectern and respond to the debate. Thank you to Dai Lloyd for bringing the debate today, but also to Mike Hedges for taking part as well. I recognise the very real concerns that local Members in and around south-west Wales have about the future direction of not just policy, but the practical reality of what that means in terms of where services are located.

I want to start on a more general point, though, about specialist services, because we already accept that people in any modern healthcare system will travel for specialist services. How specialist they are will affect how far they travel, whether that’s for a secondary care service or, in this instance, a tertiary service. There are some instances where, of course, we have people travelling outside of Wales to access highly specialist services, and with Morriston people travel into Wales from south-west England, in particular, to access the excellent services provided by the Welsh centre for burns and plastic surgery.

If I can just say at the outset, I recognise that the comments made by the person who led the independent review into major trauma services were particularly unhelpful, floating the suggestion that the burns and plastic unit might move or should move. He then qualified that, but there’s something about people getting involved in a highly charged political debate and not understanding the power of the words they use. So, I hope it’s helpful for me to clarify that this Government has no intention of moving the burns and plastic unit. Our challenge is how we sustain our services, and how we actually recognise and be proud of the excellence that the burns and plastic unit already provide. It’s my understanding that any choice about a major trauma network or centre does not require the burns and plastic unit to move.

On a more general point, we recognise that as we have new and more complex procedures and technology changes what we’re able to do, that means that, actually, some of our services are becoming new and groundbreaking. We’ve had a conversation about interventional neuroradiology, for example—a new service being developed in a small number of services. So, we recognise that some of our services will develop anew in a limited number of centres, and equally there will be times when we need to concentrate some of those centres to give them the robustness and stability that they will need, and make them attractive to staff. We know that in doing that, we are concentrating services so that people travel longer or a further distance to get to those services. Conversely, of course, technological advances will mean that we can deliver more care closer to home.

There’s a challenge here, though, about our general message about reform. I’ll talk later on about more care closer to home. As we have a conversation about reform in the health service, this isn’t new; we have always talked about the health service changing. As the reality of demand changes and the reality of what we can do changes, we need to then talk about how we keep changing our service to make sure it continues to provide the quality of care that people rightly expect. But in doing that, I think we have to have a conversation with the public based upon evidence. I recognise that in the past some of the current unhappiness is because people were simply told, ‘This is what will now happen’, as opposed to there being a conversation within the service so that staff feel part of the conversation, and also a conversation then with the public. In having that conversation, we need to have a real ambition for the quality of our services, rather than simply trying to explain to people that it would be acceptable for them to have a lesser service in different parts of Wales. That can be difficult, because that challenges local politicians in every party about the current location and organisation of services, and I know that just isn’t easy. But if we’re not prepared to have real ambition about what quality looks like and what better looks like, then we’re going to get stuck into a way of doing business where models of care that will be unsustainable will continue to the point of near collapse.

So, in terms of reform, we know there’s been a consensus for some time amongst a range of clinicians, the public and politicians that change is essential for NHS Wales. The challenge always comes when you get a local decision that really challenges how and where that is located. But for me, I think we have to be bold enough to change parts of our service, to reform them because we choose to do so, because there is a clear evidence base to do so as well as a consensus in clinical advice and opinion. And that’s why that’s still part of the conversation with the public. I actually think that, if we allow ourselves to be trapped in a position where we fight for the status quo then we’ll change our services but we’ll change them when they’re at the point of collapse or at the point where real clinical harm has been done as well, and that simply is not acceptable.

So, reforming our services is difficult, but it must be embraced with maturity and leadership to meet the challenges that we know that we face in Wales today and across every modern developed healthcare system. Those challenges include a rising number of our ageing population, enduring health inequalities, increasing numbers of patients with chronic conditions and, of course, austerity and the undeniable financial challenge that Dai Lloyd mentioned in introducing this debate. We can’t pretend those challenges aren’t with us and that we can simply carry on as we are and as we have done.

We also know—again, going back to comments that were made in a variety of debates and questions—that we have very real workforce challenges. Planning for a workforce when we know that there are challenges over money is difficult. Planning for workforce when the health service is changing and with the care system—that is difficult—and also, planning for workforce when we know we have speciality shortages, in particular, in Wales, in the UK and internationally as well.

So, we do know that, in a range of our services, in amongst all of that challenge, to maintain the right level of skill and quality, doctors and the wider team will need to see a minimum number of patients to maintain their skills and expertise. There is a wealth of evidence that, in some cases, that is best done by concentrating those specialist services into fewer centres. In fact, the interim report for the parliamentary review of health and social care reconfirmed the compelling case for change, highlighting the need for further integration of services that are more readily available within the community. Again, it makes clear that doing nothing is not an option going forward. And that brings us back to local care. We spoke yesterday, actually, about the fact that telehealth and the new technologies are big enablers to delivering more care closer to home. They give clinical staff anywhere in Wales potential to have the information they need to provide better, safer, more integrated care, and we see that in a range of services, whether it’s eye care or whether it’s dermatology—a range of things that are already happening now as a matter of course, and the potential is there to do more. It isn’t just the potential; I think there’s a real demand and a real expectation that we need to do more, because otherwise our system is unlikely to last. We’ll miss out on the opportunity to give people a better experience of working with the health service if that is not our absolute ambition, and I do look forward to receiving the final report from the parliamentary review, and there will be undeniable challenges that each of us will face in trying to do so.

I said earlier that, when a service change is proposed, it has to be clinically led—proper engagement with our staff so they understand and agree whether there is or isn’t a proposal for change that should be supported, and accepting from the outset that people won’t always agree within the health service as well. Clinicians in specialities do not always agree on the physical relocation or indeed the service model for how services should be run and managed. But we have to be able to have that debate within the health service and then to engage wider stakeholders, including, of course, the most obvious and important stakeholders, the public, and focus on how we improve both experience and outcomes. So, staff, the public, carers must be more involved in the design, implementation and evaluation and subsequent development of new models of care to show that they are clear on their shared roles and that responsibilities are better understood.

Turning to the comments made more directly about the major trauma network and centre, it is the case, of course—and people in this room will know this—that, ultimately, it’s possible that I will have to decide on this if, following the current and ongoing consultation and engagement process, it’s referred in to me. So, I won’t make any comments about the proposed location between the two tertiary centres. But what I will say is that, when we look at our major trauma network in itself, we already know that north Wales participates in a major trauma network. It’s not seen services pulled out of the three major accident and emergency units across north Wales, despite the fact that the centre is based in Stoke. We also know that there is clear evidence that outcomes for people in north Wales, from north Wales, have improved, as a result of being part of that network. For me, the overriding objective here is how we get to a point where we understand that having a major trauma network with the centre will improve outcomes for people—there’s a good evidence base for that—and then to make sure that, actually, we say, ‘Well, that must be delivered.’ We have to make sure that we don’t continue to have a conversation in south Wales where we argue over a choice rather than ultimately making a choice, because we’re then denying people in Wales, I think, an improved quality of care and outcome.

I recognise that our NHS needs to make that choice for people in south and mid Wales in creating a network, and for me, there’s something about understanding how people, whatever the choice that is made about a centre, can get to that centre properly, because if the centre was in Swansea or Cardiff, there would be people who would live, physically, at a decent distance from that.

It’s why, regardless, when you think about our transport options, the choices that are made, even now, when there are significant accidents, people are taken by helicopter. They don’t get asked what will happen. These normally are people who are unconscious—they’re taken by helicopter to the most appropriate place for them if they need to be there rapidly. So, the development of the emergency medical retrieval and transfer service—the flying doctor service—in all the different things that it does, is a real bonus in the treatment of trauma—so, the treatment at the scene, the treatment in transit and the rapid transit to the right place for those people to receive their care. Whether that would be a major trauma unit within a new network, or the centre—that’s a choice for clinicians to make about what is appropriate.

For me, it’s that focus on outcomes for the public. That’s my overriding priority. In every choice that I make and that I try to make in this job, that will be where I start with my focus. I will continue to be guided by the best available evidence on what we should do to configure our service, the outcomes we can expect and the experience that people expect to get from that care. I look forward to the more difficult conversations that are to be had, but, ultimately, to getting to a point where we make choices because we understand the evidence, and we’re making a choice based on that about what to do with this most precious and most trusted public service.

So, I appreciate I can’t give, perhaps, the direct guarantees that some south-west Members may want me to give, but I think people understand in this Chamber why I do that. But I hope the comments I’ve made about the burns and plastics unit have been helpful, and, ultimately, the basis on which I will make any choices I have to in the future is helpful too, about the direction of travel. And I really do look forward, again—I’ve said this before—. The maturity and the leadership that went into creating the parliamentary review—I hope that each of us who took part in that can continue to behave in that way as we face many more difficult challenges in the months ahead.

Thank you, Cabinet Secretary. That brings today’s proceedings to a close.

The meeting ended at 17:52.