6. Will the Cabinet Secretary make a statement on the future of health services in the Hywel Dda University Health Board area? OAQ52043

Hywel Dda university health board is currently consulting on its proposals to transform community and hospital services in mid and west Wales. I encourage everyone with an interest to engage in and participate in the consultation, and have their say in helping to shape future services for the region.

Thank you, Cabinet Secretary, for the answer, and I will of course participate fully, as I'm already doing, in that conversation, but I think the people of west Wales deserve excellent healthcare delivered at a reasonable distance, and this includes the best healthcare possible, including urgent care and teaching hospitals. Bronglais in Aberystwyth looks after the northern part of the Hywel Dda area, and is in all scenarios being kept as it is. The question is: how do we deal with those aims and ambitions in Pembrokeshire and Carmarthenshire?

Now, you know that the options put forward by Hywel Dda involve a new hospital, potentially, in that area. if we're going to have a genuine conversation about really revolutionising our community beds, our mental health and our hospital services in west Wales, then we need to understand that this is a genuine consultation based on understanding that this can happen. That means that, since we have not had major hospital investment in west Wales for the last 30 years, a new hospital is a potential way of delivering excellent healthcare. So, in order to ensure that this consultation is not a sham to hide further cuts, will you commit now that if the outcome of this consultation leads to Hywel Dda recommending a new hospital in the Carmarthenshire and Pembrokeshire areas, you as Welsh Government will work with Hywel Dda to realise that ambition?  

I can't answer all of that question, because otherwise I'm in danger of putting myself into a position of not being able to make a decision at the end of the consultation. What I would say about healthcare in every part of Wales is that every community in Wales deserves excellent healthcare, and I agree with you about every community deserving excellent healthcare. As ever, when we talk about the future of healthcare, in committees we talk about primary and community care needing to do more of our activity and more of our budget in primary community care, and then we spend all of our time arguing about the hospital network. What I would remind Members of is that when, in the Gwent area, they had their clinical futures strategy, it took them some time to build support from stakeholders and it took them time to develop a business case for a new hospital that was part of that. They delivered in a variety of areas and then we were able to get alongside them and deliver the new hospital that is being constructed at this moment in time as the Grange university hospital.

What I would say about every area of Wales, rather than any specific proposals, is that if there are proposals that are designed to deliver and there's clinical support and evidence that they will deliver a better healthcare system, then we will of course get alongside any and every organisation to try and help them do that, bearing in mind the ability of the Government to do so. So, yes, we will think positively about every area of Wales when real and significant proposals are made, but I just can't comment specifically on the potential for proposals in Hywel Dda, because it is entirely possible that I will have to determine those at a point in the not-too-distant future. 

Cabinet Secretary, all three options in this consultation will result in the downgrading of Withybush hospital from a general hospital to a community hospital, which is totally unacceptable to the people that I represent. The consultation, as far as the people I represent are concerned, is worthless, given that they have no choice in this matter whatsoever. Surely this cannot be right. In the circumstances, I urge you to intervene in this matter and force the health board to actually bring forward proposals that are actually fair to the people of Pembrokeshire. Will you now intervene—'yes' or 'no'?

I've been very clear that this is a public consultation for members of the public to get involved with. I've also been very clear there's got to be clinical leadership about any other proposals, which is why it was important that clinicians took part not only in a presentation and conversation at board, they've got to be part of the conversation with the public. If I intervene now and if I say that, actually, it does not matter what clinicians themselves have come up with—it does not matter what comes from the public consultation—I will determine that for them, that actually will stop healthcare innovation and progress and reform in every part of the country. It matters that a conversation takes place, it matters that people are focused on delivering better healthcare and it matters that we're in a position as a country to make difficult choices. That is the challenge set for us by the parliamentary review. It tells us on the one hand that there is a good evidence base that some specialist services should be delivered in a smaller number of centres across the country—that will involve, for any community, greater travel—but also that we're able to provide more services within a wider network of community healthcare. Where those proposals come forward, where they're agreed with a clear clinical strategy, the Government will do what it can do to get alongside that. If we are to do that, if we are to meet the challenge set for us, which everybody in theory accepted in the parliamentary review, then we have to be able to have a difficult public consultation and the Government has to play its part as the potential ultimate decision maker. 

Cabinet Secretary, I do welcome the fact that we're moving into a consultation period and I did hear what my colleague Simon Thomas was asking, and I might well ask the same in the not-too-distant future, but what concerns me at this stage, at the moment, is that people have been in touch with me saying that the opportunities for them to engage in this process are limited, that they are geographically far apart from where those individuals might live and at times where people might not be able to attend these public events. My question to you today is if you could encourage Hywel Dda health board to widen the scope in terms of time and geographic location of their public consultations at this stage.

I'm happy to respond positively and say that Hywel Dda should respond positively to requests for further public engagement. It is in everyone's interest to have the maximum level of public engagement, not just with the health board at a leadership level but actually with clinicians in their local communities, whether in general practice or whether in hospital-based services or other community-based services, to make sure there is real clinical engagement with each other and with the wider public. I'm more than happy to say that I would want Hywel Dda to maximise all of those opportunities to engage with the public, including at locations and at times of the day that are properly convenient for everyone to engage and have their say.