1. Will the Cabinet Secretary make a statement on mortality figures in Welsh emergency departments? 120

You raised this yesterday with the First Minister, of course, and he made clear that the figures take no account of age, deprivation or ill health. I'll refer you back to his comments: 

'Now, the particular measure reported involved small numbers and it's consequently not age adjusted. Age is likely to be the main reason why this figure seems high, not least reflecting that Conwy has the highest percentage of over 75s in the whole of Wales. 

'More recent figures from the health board show some reduction in the peak reported. The overall in-hospital mortality rates for Ysbyty Glan Clwyd are in line with the Welsh average.'

As you will know, Conwy has always had an older population than other parts of Wales, and, indeed, historically, its mortality figures at Glan Clwyd's emergency department have been below the Welsh average. So, age is certainly no excuse for the extraordinary increase that we've seen in death rates in that emergency department in recent years. They have more than doubled since 2012, and I'm afraid that your complacent response will not wash well with patients in north Wales who want to know why they are almost twice as likely to die in that hospital as they are in other hospitals across the country, and the situation there appears to be much worse than in Wrexham and in Bangor.

This is a cause of significant concern to my constituents, many of whom have contacted me following the report, and it was clinicians who contacted me to say that they were concerned about these death rates. They say that the biggest problem in that hospital is a lack of access to hospital beds so that the individuals in that emergency department are not in an appropriate care setting to be able to look after their needs, and that is why people are dying unnecessarily in the emergency department.

Given that that is the view of the clinicians and the nurses who have contacted me to express their concerns, will you accept that the lame excuse that you've given to date is unsatisfactory? Will you undertake an immediate investigation so that we can establish whether the situation is being caused by bed shortages? And what assurances will you give to make the results of that investigation public, so that the public can see what action you're taking, given that this health board is in special measures and being run directly by the Welsh Government?

I have absolutely no intent of being bounced into an intemperate course of action by shouting and language that is deliberately fearful from the Member opposite. Sadly, he has form in this area.

Suggesting that there is complacency in the Government is simply not true. Just because I choose to remain calm and not engage in a shouting match, it's not because I do not care about the service and am not interested in improvement. It really is disappointing that an open system that we've put in place in health boards, to be open and transparent, is being traduced in this way, when you know very well that these figures are not adjusted to take account of other factors. You know that. You've seen the factual brief that comes out in stating that. 

Why is it double? Why is it more than double?

And I really do think that the Member should take account also of the fact that within our system here in Wales, we are the only UK country—[Interruption.]

Darren Millar, you've asked your questions, now listen to the answers.

We are the only UK country that has a full review of every death that takes place within hospital. There is already learning that deliberately takes place from deaths within hospital. I expect them to have an open and learning culture within our health service, to have a proper commitment to improving the quality and improving outcomes for people. If we are to work in a system where any attempt to have open and transparent publication of data is used in this way, to promote fear—and I do not accept Darren Millar's version of events as representing the view of the clinical community in Ysbyty Glan Clwyd or any other part of the country—then we'll run ourselves into a position where, actually, improvement will not take place at the pace that it could and should do. I take my responsibilities seriously, and I believe our clinicians do as well. And, yes, the results of those reviews are generally made available so we can see the learning that takes place from each of those reviews. And, in fact, other parts of the UK system now wish to learn from what we're doing in Wales to learn properly from every death that takes place in hospital.

Well, I hope they're not learning from Glan Clwyd, Cabinet Secretary. But I would say, as the community health council said yesterday, yes, you would expect the figures to be higher, but these figures seem extortionately higher and disproportionately high in relation to the demographic difference that we do have in that particular part of Wales. So, I would ask you again to consider asking an independent person or an independent body to review those figures, so that we can have the confidence that you have—and I'm afraid I don't share your confidence—that there isn't a more systemic issue at play here that is causing what are clearly very concerning figures in Glan Clwyd.

Can I ask as well, given that you recognise that there are special demographic needs for that particular part of the country, are you confident that the board is being sufficiently resourced to address those? Because if they are, then there's another question about the way that the board is being managed under your watch in this regard as well.

I'll quote from the publication itself:

'The following chart shows the number of deaths per 10,000 attendances for each major Emergency Department (A&E). It should be emphasised the figures reported are a crude mortality, and unlike deaths elsewhere in the hospital, no attempt is made to "standardise". As such there is no accommodation for factors such as age and severity of illness, factors known to impact on the risk of death.'

We can either have a conversation where we lay into the health board and try and suggest that there is somehow a political responsibility for an unacceptable death rate, or we can try to understand what has actually taken place. I would much rather understand what is taking place and to learn from that. That's why these figures are published. That's why there is a review into every death within the hospital. And, again, I will not be bounced into a suggestion that the clinical leadership at Glan Clwyd cannot be trusted. There are challenges right across our health service, and I will not collapse into blaming our hard-working staff for a range of areas in which we know that improvement actually is already there, and these figures are part of it. 

And I would remind everyone in this Chamber that, when it comes to resourcing, the north Wales health board is the best-resourced health board in the country, per head. And actually our challenge is how we get greater value from every single £1 that we spend in the health service, including in north Wales. I do not see this as an issue of financial resourcing. If you're actually looking about the overall amount of money we have within health and social care then we're squarely into the field of austerity and its impact on public services.

Well, on behalf of my constituents in Aberconwy, I would like to thank Darren Millar for raising this issue once again in the Chamber. And I have to say I was deeply disappointed yesterday at the flippant remarks made by our First Minister in response to the question that Darren Millar posed of him yesterday, implying that age is likely to be the main reason why this figure seems high. We are talking about people who have died.

Now, when you look at the figures, compared to the population that Betsi board covers, I raised in October the board having the highest number of patient safety incidents classed as moderate, severe or death in Wales, including 41 accidental deaths. Now, in the figures coming forward, my own father is one of those statistics—accidental death resulting from an operation.

But let me take you back to A&E. In that 18 months period of my father's last remaining months of his life, I had many experiences of being caught in A&E with him, caught with other people on trolleys in corridors, ambulance men not being able to get back to their ambulances. The system, the through-flow of patients, isn't good. But I'll tell you what: you've got all your north Wales AMs here, on regular occasions, and our Cabinet Secretary, who raised the fact that there are issues—severe issues—of concern within the Betsi board.

Now, all I have—. You've been blamed and accused of supercilious arrogance. Yesterday, I accused you of disinterest. Prove me wrong, prove everybody wrong. Please, come with me—let me take you down the wards, where the people are on catheters, where you will see full jugs of water where no-one has drunk all day, where you will see catheter bags almost bursting. Come with us, Minister, Cabinet Secretary, and then, if you come with us—unannounced would be nice; I'm prepared to do it—I will show you scenes that you will find abhorrent.

Cabinet Secretary, you've accused us of political grandstanding. There is no political grandstanding worth the sorrow that one feels when you've lost somebody very close to you as a result of poor treatment in one of your hospitals. I don't blame the consultants. I don't blame the staff. I blame the process. It's not about money. It's about procedure. This hospital is under your direct control, and it ain't getting any better. Please, Cabinet Secretary, do something. Do something for all those constituents who come to me—

Okay, you do need to bring this to a close now.

Okay. I have two ombudsman reports that I had to report to the ombudsman: one where someone was terminally ill, and one now, where, as a result of these problems, I had a constituent—. Both were section 16 public interest reports. So, the evidence is there, if only but you would listen. Please, for the sake of every single patient needing to go into hospital, or the ones who are already there, please do something.

Well, no-one could fail to recognise the grief that you clearly feel about the loss of your father. And I really am sorry for your loss. My job, in undertaking this role on behalf of the people of Wales, is to look at how we improve services across the system, to understand how individual examples can be used to learn from, and that's the way in which we set out quality improvement within our system. We don't just empower, we expect people to be a part of improving the quality within our service. And, actually, in Ysbyty Glan Clwyd, they have a better than average mortality after surgery, both elective and non-elective surgery. So, it actually has a good overall record. Now, that does not mean that there will never be a mistake that is made, because we don't have perfection in our system, and it's not a standard that it's fair to hold anyone to in delivering the national health service. But we'll always look for further improvement, and, for all the passion and the grief that exists and I do recognise from the Member, I don't think that I should willingly accept the accusations that are made about my integrity and interest in the national health service. I'm in the business of public life because I want to help make our country better. Doing this job is a real privilege, and I absolutely have a significant interest in the past, the present and the future of the national health service. That's why I'm doing this job. That's why I'll continue to do this job, and to work alongside people in every part of our national health service to try and make sure that the future is a better one, and that we do the maximum we can do with the resources we have to deliver better healthcare in every community in Wales, and that is absolutely my honest and sincere commitment. 

Thank you, Cabinet Secretary. The next question is from Simon Thomas.