I am moving on to the next point of business and that is item 3, which is the statement by the Cabinet Secretary for Health and Social Services on the report into—. I have this in Welsh in front of me, so I'm going to change to Welsh at this point. 

The Health and Social Care Advisory Service Report, HASCAS, into the care and treatment provided on Tawel Fan, and I call on the Cabinet Secretary to make his statement. Vaughan Gething. 

Diolch, Llywydd. On 3 May, the Health and Social Care Advisory Service published the outcome of its investigation into the care and treatment provided on the Tawel Fan ward. I am acutely aware that this has been a very difficult period for all individuals, families and staff directly affected by the concerns over care and treatment at Tawel Fan. I acknowledge the additional strain caused by the length of this investigation. It was, however, essential that the investigation remained focused on a thorough and fair process that was not compromised to achieve restrictive timescales.The report set out a range of failings that let down patients and led to real harm being caused. I am deeply sorry that this happened and I apologise for it without hesitation.

The scope of the investigation was significant and broader than the original commission. It ultimately involved reviewing 700,000 pages of documentation, 148 interviews and 108 case reviews. It also considered material provided as part of previous investigations. This was a broad remit, and unlike previous reports, it was able to have access to a comprehensive set of documentation, including clinical records, and draw in specific mental health expertise. HASCAS maintained an independent and evidence-based stance throughout, with the aim of providing as accurate an account of events as the evidence available allows. This has been done with the support of an expert panel of 16 individuals of national standing.

I do need though to address the accusation made that there was a direct link between the Welsh Government and HASCAS that affects the independence of the report. The inference of a conspiracy directing the report to protect the Government or a political party is a direct attack on the integrity of HASCAS and the individuals on the investigation panel. None of the investigation panel were practitioners in Wales. The legal advice to the HASCAS investigation was independent of the Welsh Government, and HASCAS, as an organisation, has undertaken a range of reviews, for example, into the English health and care system without fear or favour, and there is no reasonable basis to attack their integrity in this matter. 

The Deputy Presiding Officer (Ann Jones) took the Chair.

I do understand that many will have been surprised by the findings of their report. However, anyone who has taken the time to read the report carefully should appreciate the thoroughness of the investigation and understand how the conclusions have been reached. In relation to the care on Tawel Fan the independent findings are that the levels of care and treatment provided on Tawel Fan ward were of good overall general standards and that good nursing was provided.

Whilst assurance can be taken from some of the findings, the report is a difficult read. It is far from a clean bill of health. I do not shy away from the significant issues it highlights across a number of areas, including governance and clinical leadership; service design and care pathways; and safeguarding. Many of the issues go beyond mental health services at the Tawel Fan ward.

HASCAS will be meeting individually with each family to discuss individual patient reports, which are crucial in providing the detail of the care provided. I hope that, alongside the thematic report, the individual reports will provide assurance to families about the integrity of the investigation. A similar process will also take place for staff who have been affected. I have already sought assurance that the health board is providing appropriate levels of support to both staff and families during this process.

As I have already stated, it is very clear that further, sustained improvement is still required by the health board. This will require further focused oversight under the special measures arrangements. 

The report does though acknowledge the considerable journey that the health board has embarked upon, recognising that it hasn’t stood still since the period being investigated. The report states the health board has made significant progress in key areas detailed in the dementia strategy, for instance, having a designated consultant nurse in dementia care. It also recognises the steady progress that Betsi Cadwaladr has made in relation to patient and carer support, and working proactively to support the care home sector.

The report also references many areas where they saw good practice. I am keen that, despite the criticism in the report, we recognise the excellent care provided by so many staff across the health board, both then and every day since the events that this report examined. For example, the nursing team on the Bryn Hesketh mental health in-patient unit have been shortlisted for an award that recognises those who have achieved excellence in their field of nursing. 

However, despite some positives, I continue to be very clear with the health board about the need to increase the pace of improvements and to deal with issues that are again highlighted in this report, and I will set out my expectations for that improvement. I will today publish a special measures improvement framework that sets out the milestones and expectations for the health bard for the next 18 months in leadership and governance, strategic and service planning, mental health and primary care, including out-of-hours services.

This improvement clearly references the work required by the organisation as a result of the recommendations from HASCAS. It may require a further update after Donna Ockenden’s governance review, which is expected shortly. This will take the form of a detailed quality and governance improvement plan to be prepared by the health board and to be available by the board’s July meeting this summer. I will continue to provide ministerial oversight with monthly accountability meetings with the chair and the chief executive. I expect Betsi Calwaladr to provide detailed progress reports against the new improvement framework and the first report will be provided in October this year.

Key to improvements is strong leadership for the organisation. I previously reported that a new chair will lead the next critical phase of the health board’s improvement journey. I am pleased to announce today that Mark Polin has been appointed to the role. He will bring a wealth of public sector leadership and governance experience, commitment to and knowledge of the communities of north Wales from his current role as the chief constable of North Wales Police. I will provide a further update on his appointment and the special measures arrangements in an oral statement in early June.

I expect strong leadership, and especially clinical leadership, from all parts of the organisation to address once and for all the issues that this report identifies. There must be a significant culture change to move from the current underlying resistance to clinical policy and consistency in practice. The board will need to give this rapid and serious consideration to determine what steps need to be taken to change ways of working. I expect, at the least, to see this demonstrated in clinical leadership and engagement to support the design and delivery of a care pathway for older people with dementia, together with the significant improvement in mental health provision that is still required.

I expect both the health board and local authority partners to carefully consider the findings in relation to the operation of safeguarding arrangements. Protecting people at risk from all forms of abuse and neglect is one of the key priorities of the Welsh Government. This is clearly reflected in the legislation and policy that we have introduced in this term and the previous one.

I expect the findings in this report to be used to hold a mirror up to all NHS organisations in Wales. I am therefore writing to all chairs and chief executives of NHS organisations in Wales, asking their boards to consider the report's recommendations and to confirm how they will use the findings to improve their organisation. I will also expect the chief medical officer and the chief nursing officer to engage with professional executive leads to ensure that lessons drawn from this report are embedded in the future planning and delivery of healthcare in Wales. These are immediate actions being taken in response to the findings of the HASCAS report. I will of course continue to update Members on the progress being made on the wider required improvement.

In your statement to us, you state,

'anyone who has taken the time to read the report carefully should appreciate the thoroughness of the investigation and understand how the conclusions have been reached.'

We have to disagree. But, of course, we're not alone. The chief officer in the north Wales community health council has said that dismissing the testimony of Tawel Fan families is akin to not believing survivors of sexual abuse. He insisted the evidence given by relatives of dementia patients at the Ablett unit was absolutely credible. The older person's commissioner for Wales, Sarah Rochira, said the headline findings of the report will be of little comfort to the families of the patients on the Tawel Fan ward, who had been clear that their relatives suffered standards of care that were quite simply unacceptable.

Was not your use of the word 'reassuring' in initial press reports following the publication of the report at the very best insensitive to the relatives and families, who themselves were reported as stating they found this report devastating? They were angry and in uproar over the abuse report. They again talked about how their loved ones were seen being dragged by the scruff of the neck, barricaded and left in their own mess. One spoke about how his mother was bullied and forced to sleep in an ant-infested bed. There was more than one occasion when she'd be in the same clothes for at least two days, lying in her own mess. He described the report as a huge cover-up, as reported in the press.

The Tawel Fan mental health board, in the Ablett unit report in 2013—in that report, the health board said it was alerted to serious concerns regarding patient care in December 2013. Of course, reports go back a lot, lot further. In 2009, I represented a constituent who alleged the treatment received by her husband in the unit nearly killed him and that three other patients admitted around the same time as her husband had similar experiences and that she was now worried about the treatment others may receive in this unit. Her husband suffered from Alzheimer's and terminal cancer. I was also copied in on a complaint in respect of another patient at the time who had vascular dementia, which included distressing before-and-after photographs. These were shared with both the health board and its predecessor and your predecessor. No action appears to have been taken. 

Thankfully, in 2015, Welsh Government, the health board and Healthcare Inspectorate Wales all accepted the findings of Donna Ockenden's 2015 report. So, why now, when many serious allegations are peppered throughout the HASCAS report, has it come to the bizarre conclusion that care was good and that institutional abuse didn't happen? Why do the conclusions not stack up with the findings? The HASCAS report doesn't chime with concerns raised in other reports. Why doesn't it chime with the Healthcare Inspectorate Wales report in July 2013, which found a patient locked in a room sitting in a bucket chair, incontinent in their own faeces and urine. It found no activities for patients. It found the garden unkempt and inaccessible. It found insufficient staffing, and much more—HIW, July 2013.

There was internal work on dementia care mapping in October 2013, which revealed that patients were desperately trying to engage with staff, and it reported an elderly patient found to be smearing herself with her own faeces resulting from that lack of engagement. The HASCAS report on page 115 talks about this dementia care mapping, but then on page 116 says no serious concerns were raised and no poor practice was observed. Why does that not agree with the October 2013 report, which found precisely the opposite? If this was your own grandmother, your mother or your sister, would you not consider this a serious concern? Any other rational human being would consider this to be a matter of the most utter and utmost seriousness.

Page 64 of the HASCAS report says that 29 families described significant concerns with communication and dementia diagnosis, and 18 families alleged unexplained bruising and injuries. This isn't an election; it's not a poll. It's not a question of how many people had one experience or another to decide on the outcome. These are the experiences reported by dozens and dozens of families regarding the people that mattered most to them. Page 66 says that 10 families described relatives as being dirty and the ward smelling of urine. Why is this not a breach of care to these patients and, by association, to their families?

The HASCAS findings are based, quite properly, on clinical notes. You refer to the clinical notes in your statement, but they acknowledge that they understand that when they came to start their review, the clinical records they needed had not been secured. Why therefore, in breach of standard NHS practice to stop clinical notes being got at, were these notes not secured? And how, even if they weren't got at, can we have any confidence regarding their content in these circumstances, especially given the different findings of different reports I've referred to previously? 

Is it not therefore the case that our colleague, Darren Millar, who can't be with us today, is right to have written to the Public Accounts Committee asking them to examine this matter, reflecting both the inconsistent evidence and the huge concerns caused to north Wales in general, but particularly to the families of these dozens of victims, I will call them, where the evidence is so strong that we have to accept that they were clearly telling the truth? I hope, Cabinet Secretary, you're going to change your tune on this, that you're going to listen, that you're not going to shoot the messenger, and that you're going to reconsider your approach, because, if not, you will have failed in your duty to these people, you will have failed in your duty to the patients and staff, and you will have failed in your duty to Wales. I look forward to your response.   

I recognise that there'll be a range of people who won't accept the findings produced in the independent HASCAS investigation report. I recognise that there'll be a range of families who will simply not be able to accept the conclusions they have reached, and I think it's easy to understand why that might be, where people have witnessed challenges that they have reported on. But, as the report set out, it certainly does not provide a clean bill of health for the health board—far from it—and it does recount failings in the care that some people were provided with, but it says that, overall, it does not support the previous finding of institutional abuse and neglect. 

And it's fair again to reflect that, whilst some families are angry and hurt, and you understand why in the conclusions reached, there are a range of families who did not wish to engage because they had no complaints about the care provided. Other families did engage and confirmed they had no concerns or complaints about the care provided. It's also true to reflect on the fact that there were disagreements within families about the care provided as well. So, in that contested environment, where people have different versions of the same events, where there's an acceptance that, on occasion, the care was not as it should have been and that people were let down when that happened, it is not surprising that there are different views on the overall conclusions of the report. But, as I say, that does not affect the integrity of this report. 

It's worth again reminding you and others that, of course, this report had access to a much wider range of information. It interviewed 168 witnesses that were not available to the initial report. It considered 190 witness statements in the police report that were not available to the first report as well. There were real problems highlighted.

In terms of the response from HASCAS, we should remember what they themselves have said. They say that their report does not cast doubts on the validity of families' concerns. Indeed, it actually upholds very many of their concerns. It is important that this is a highly critical report. And that is the approach that I will take to seeking further improvement. I wish to see families that are affected, even including those who do not accept the report, being supported in the continued life that they will have. I wish to see support provided to staff directly affected, and I wish to see, for the future, real and sustained improvement that will take forward the real concerns and criticisms in what is a highly critical report.

It is for the Assembly, though, to determine whether it wishes to review the 300 pages of the HASCAS report and the 700,000 pages of documentation and witness evidence that underpin it. That is a matter for the Assembly, not the Government, to determine. For my part, I will do what I can and should to provide the reassurance that all of us, I'm sure, will wish to seek, and that is that people have their concerns listened to and that we take seriously the requirement for improvement that does exist within north Wales healthcare.

Thank you for your statement today, Cabinet Secretary, but you've read, I'm sure, the statement issued by the Tawel Fan families group in response to the HASCAS report's publication:

'we cannot and will not accept the findings', they say. They say that what they've read in this report doesn't stack up compared with all else that has gone before it—the experiences of the families themselves, the public emergence of those experiences that led five years ago to the closure of the Tawel Fan ward, the previously critical reports, the apologies from the health board itself for, and I quote:

'the appalling treatment and subsequent harm...experienced'.

Of course, as you say, it still is a very damning report. We heard you say this afternoon that 

'The report set out a range of failings that let down patients and led to real harm being caused. I am deeply sorry', you say,

'that this happened and I apologise for it without hesitation.'

So, the report highlights serious failings, but, somehow, it not only concludes that this didn't amount to institutional abuse and neglect, in direct conflict with the Ockenden report, but also that some of the light that ought to be shed on what happened should be reflected back onto the families themselves. Cabinet Secretary, how do you account for the difference in conclusion between this and previous reports? How do you account for the difference between the clear description of multiple and serious failings in the way that Tawel Fan was run and the conclusion that (a) this didn't in effect mean poor care for patients and (b) that, really, the patients and their families were somehow themselves to blame, at least partly for having unrealistic expectations or for not understanding dementia or for changing their recollection of their experiences in response to media coverage.

Looking forward, I wish Mark Polin well taking over as chair of the health board. I note your planned publication today of a special measures improvement framework, but, of course, Betsi Cadwaladr has been in special measures for nearly three years and people must have confidence that lessons have been learnt about the past before they can have confidence in what the health board can provide for them in future.

Many have already concluded that this is a cover-up. Families don't find this to be a credible report. And bearing in mind what we've heard from you today—that you wish for this report, which the families don't consider to be credible, to be the basis for moving forward to better healthcare—how do you now regain those people's trust?

I, again, refer back to the reality, the factual, undeniable reality, that this report by HASCAS, an independent group, an independent organisation, considered a much wider range of evidence than previous reports. And it should not be surprising that, when more evidence is available, including the 108 clinical records that were reviewed, it is possible to reach a different conclusion. That does not cast doubt on the integrity of people who previously gave evidence—far from it. And, in fact, HASCAS themselves say, 'Our report does not accuse any families of changing or elaborating on their stories. It does, however, make clear that many families had no concerns until the publicity surrounding an earlier report. They then wanted to know if their loved ones had been abused, and sought reassurance in this respect.' 

And I think that's quite easy to understand. The challenge is how all of us in our different roles, including me, with my role within the Government, actually take forward the very difficult messages from this report and understand the real hurt that has already been caused to a range of families and how those people are supported through that. And that is not easy; it goes into your final point about regaining trust. Well, I think part of that is to be honest, and that is sometimes to say things that are not automatically easy to say or to hear. So, when I accept the report and its findings, and we have to work through our recommendations, that will please a range of families who will be reassured. It will also mean there are a number of families who are angry and upset and will not agree that is the right thing to do. There is no way to please everybody in this position, and you start from accepting there have been failings in the care provided and that is what we need to resolve.

I think that it also comes back to the point about the suggestion that there has been a cover-up. The more that that suggestion is made and the ferocity with which that suggestion is made will make it more difficult to regain trust. I accept there are questions people will want to ask, but the pre-emptive strike on the integrity of HASCAS and their individuals is something that I really do regret. HASCAS is an organisation that has undertaken reports like this into a range of health and care establishments and failings right across these islands. They have never yet had the same level of attack upon their integrity provided. If you look at the CV of the dozen people who are on the panel and the four different lawyers, including a Queen's Counsel who was engaged around this to provide reassurance about legal advice, to say that they are part of a cover-up is an extreme accusation to make, and I do not think any of the evidence available really honestly supports that accusation. And, in that, I think it is different to seeing how families are upset and will lash out—you understand that. How could you not have real, human sympathy for those families involved? But I think that we have to hold ourselves to a higher standard, to be more objective about what has happened. That may make us sound cold and unsympathetic, but we have to be able to do our job in understanding how people feel and then recognising what we think is right for the whole service.

And your point about the Tawel Fan families—I have seen their statement, of course I have. And the Tawel Fan families, a group of about nine or 10 families that have been the most engaged in the process—. But the challenge in this—I think all of us should be able to understand—is that some families do not wish to be engaged in that collective process. They have not themselves thought that that was an environment where they could themselves put their individual concerns. So, we've had different ways for families to engage in this report. Thirty-five families gave direct witness evidence to this investigation. A further 25 families were engaged but chose not to give direct evidence, and they made it clear that they were broadly content with the care that their loved ones had received. So, there are inherent contradictions between the events recounted by families over the same period of time, and this report is an honest attempt to understand those and to report on the evidence provided. I restate my commitment to trying to regain the trust of families across north Wales and beyond by actually making sure that we take seriously the criticisms in this report and take seriously the requirement to see further and sustained improvement in healthcare services in north Wales, especially as they refer to the older adult patients suffering with dementia, because that is the real challenge that this report sets out.

Thank you for your statement, Cabinet Secretary, as well as your earlier written statement. Although I was not a Member of this Assembly when the Ockenden report was published, I remember the shock and outrage I felt when I learnt of what these poor people endured on the Tawel Fan ward. Listening, even last week, on the radio to families reliving their experiences and how they feel when they even have to pass the area concerned—which was more reminiscent of how people in mental ill health were treated in the eighteenth and nineteenth century, not the twenty-first. 

Three years later, we now have the findings of the Health and Social Care Advisory Service investigation. No-one can dispute the independence or expertise of HASCAS, with Dr Johnstone and her team carrying out the investigation and publishing the report. HASCAS found chaotic and poor governance and problems across all mental health services in north Wales. They found nine key factors that compromised patient care. However, there is a disconnect between the HASCAS findings and the earlier investigation conducted by Donna Ockenden, and it is this disconnect that has led families to reject the findings of the HASCAS report, branding it a whitewash and a cover-up. 

I agree with you, Cabinet Secretary, that we should avoid jumping to conclusions, but until we can fully address the concerns of the families involved in the Tawel Fan scandal, or those treated in the Ablett Unit at Ysbyty Glan Clwyd, we cannot move on from this. Cabinet Secretary, have you considered asking Donna Ockenden to work with HASCAS in order to address the concerns of the families? While I am pleased that Dr Johnstone and her team found no evidence of systemic abuse, they did find institutional failings in both the governance and care pathways at Betsi Cadwaladr. Cabinet Secretary, this is not the first report to highlight failings in clinical governance, not just in north Wales but across the NHS. Do you believe that the current governance model is fit for purpose in a modern healthcare system? 

I welcome the announcement that you will publish a special measures improvement framework for Betsi, and I look forward to seeing the first progress report in October. Cabinet Secretary, as Betsi are already in special measures, what recourse is open to you should they fail to make progress against the improvement framework?

Finally, Cabinet Secretary, you have indicated that there are lessons for the wider NHS and that you expect NHS organisations to consider the report. With regard to social care implications, what discussions have you had with Social Care Wales, and do you expect local government to also consider the recommendations of the HASCAS report?

I look forward to working with you to ensure that the events that occurred in the Ablett Unit can never happen again. Diolch yn fawr. Thank you.

I want to start again by reiterating that this report is certainly not a whitewash or a cover-up. If the report, on the basis of the evidence available, had come to a different conclusion, then, again, I would have been in a position where, of course, I would have been duty bound to accept that. There is precious little point in having an exhaustive independent investigation process, taking nearly three years, if the first response of a Government Minister is to say, 'I don't like the conclusion. Get me a different one.' This was deliberately undertaken as an independent exercise away from the health board with people who are not practitioners in Wales but with real independent expertise and integrity to get at the truth to allow us to understand what happened, but also to help set a path for the necessary improvement.

The Ockenden report, the second report, is about the governance structure of the health board, and, as I said in my statement, I expect that to be provided within the coming weeks. It will be published, it will be made available through the board, and, indeed, the response to it. That may require me to look again at the special measures improvement framework. As I've indicated in my oral statement, I will be happy to do so to make sure that all the required measures are in place and I will then transparently report back on progress made. It's an important part of the special measures framework that the health board didn't go into special measures at the convenance of a politician; there was independent and objective advice that it was the right thing to do. And in all of the progress—or lack or it—that has been made under special measures, again we have had independent assurance, both from the Wales Audit Office, from Healthcare Inspectorate Wales, and, indeed, the chief executive of NHS Wales. So, this is no one person providing advice, no one politician making decisions to benefit themselves individually. Frankly, it would have been to my own selfish interests to have seen them taken out of special measures and this report provide an entirely different conclusion. These are independent, objective and robust conclusions that have been reached both in the report, but also in the continued requirement to keep the health board in special measures, and that will continue to be the case as we report on progress or otherwise. I've indicated I'll report back on the wider improvement work that the rest of the NHS family is undertaking as a result of this report and we will have more to say on the safeguarding work to be undertaken both in north Wales and what that may mean for the rest of the country, too, involving health, local government and others working together.

Can I thank you for your statement, Cabinet Secretary? I also welcome your recognition that the report does set out a range of failings that led to real harm being caused. I had a few specific points that I wanted to ask about in relation to the report. The first relates to the concerns that are raised about the treatment people get, with dementia, in A&E and in other medical settings in hospitals. I'm sure you'll be aware that Dr Katie Featherstone at Cardiff University has recently published a new report into the hospital care of people with dementia, and we know that 25 per cent to 50 per cent of hospital beds in Wales are going to have someone with dementia in them. So, it is absolutely critical that everybody in our NHS has the skills and awareness needed to provide person-centred care to people with dementia. So, I wanted to ask you what further lessons you feel what's been found in this report can bring for the wider NHS in Wales.

The report refers to the financial pressures, which, it says, have led to things like occupational therapists and the multi-disciplinary team not being available. I know that you are well aware that I've said to you previously that I believe that patients on older people's mental health wards in Wales are some of the most voiceless citizens in our country. They're often on locked wards; they're not wards that people go back and fore to very often. Some of them don't even have relatives to visit them. So, can I ask whether you think there are any further steps that can be taken to strengthen the profile of these patients at health board level, such as by having dementia champions on the board, et cetera, so that they are not out of sight, out of mind?

I very much welcome the reference in the report to the need for clarity on legal frameworks in relation to the Mental Health Act and the Mental Capacity Act 2005. I have to say that I think there are definitely wider lessons there for the NHS in Wales, as I genuinely don't believe that those Acts are being fully complied with across Wales. There are recommendations that there is new guidance issued, that these are kept under review and even audited on a patient-by-patient basis, which I really welcome. Can you say a bit more about how you intend to take that forward?

The report talks about the need for advocacy. A recent written answer I had off you confirmed that all health boards are currently meeting the all-age target on the provision of independent advocacy, but what I would flag is that we are well aware of the concept of an active offer of advocacy for children and young people in Wales. The current target under the Mental Health (Wales) Measure 2010 refers to people who have requested advocacy receiving it within five days, and I wonder whether you might want to say something about what more we can do to ensure that there is an active offer for older people as well, because there are real challenges in offering advocacy and ensuring advocacy take-up for older people with dementia, and I do think that particular measures need to be put into place.

Finally, I know that you are well aware of my view that we should move, at the earliest opportunity, to extend the safe staffing levels legislation to older people's mental health wards in Wales. I think that this report and the issues arising from it confirm the need for that, because many of the issues highlighted would be addressed by staff having the necessary time to do their job properly and to provide person-centred care. So, can you update us on your plans to extend the legislation? Thank you.

Thank you for the range of questions. Forgive me if I don't answer all of them now in the time available, but I'm happy to take them up with you directly after today's proceedings as well. I think, actually, the point you raise about accident and emergency shows the scale of the challenge we face in dementia care, because people with dementia are a regular feature already of care within the hospital sector, and will become more so in future. We expect more people to be diagnosed, we expect undiagnosed people to arrive in our hospitals requiring care and treatment, whether in accident and emergency or in elective care, and it will be a bigger feature of health and care delivery here in Wales. Actually, the fact that the accident and emergency issue was raised shows that the HASCAS report did listen to what the families were saying, because it wasn't part of the earlier remit, but it was raised by families during the course of the investigation, and so the remit of its investigation was broadened to allow that view of the wider care and treatment pathway, to get a broader view on what was going well, as well as what wasn't going well, in providing health and care within north Wales.

I recognise your points about the range of activities that are provided to people, the range of recovery and rehabilitation that is still possible from a physical point of view, but also the fact that these are people who are, by their nature, vulnerable and often don't have a voice. So, your point about advocacy is well made, about there being a genuinely active offer, and that is work that we are seeking to undertake to make sure that—. The focus that we often have on children's advocacy is not often there when it comes to the older adult, which is surprising, and I think that it's largely because people assume that there is a family waiting to look after that person or advocate for them, and often there isn't, either because they don't have a family or because their family is no longer around, and that is a very sad reality that many of our older citizens face.

I also recognise your point about capacity and the work we're doing on the mental health Act and the review that is taking place across England and Wales with the mental capacity Act, and in particular the deprivation of liberty safeguards. So, there is work that we recognise needs to be done right across our system, not just in Wales, and we're working with partners across the four nations to understand what our approach will need to be in the future, because that can be difficult for the individual, for their family and the health and care system itself as well. We have already provided interim annual investment of more than £300,000 to support health boards and local authorities to deal with the challenge that that has provided.

On the nurse staffing Act, I will come back to you, and I'll happily provide a statement to Members, on the work that we're doing to deliver on the commitment of the Government to extend the nurse staffing Act. There are a range of different options and potential priorities that I've previously reported on, and it probably is time for me to provide an update, whether that looks at in-patient paediatric care, whether it's community nursing or, indeed, around care for older adults as well. So, I will provide a fuller update on that, and it's a useful reminder that it is about time to provide Members with that factual written update.

May I thank the Cabinet Secretary for his statement this afternoon? Like many Members, I do feel it's unfortunate that this report does create a tone that almost questions the voice of the victims and the families of the victims. We read sections of the report that talk about them recasting their experiences in light of things that have developed later. Questions are raised on the behaviour of some families and things such as that. Of course, it points to some families who have had a positive experience, and that's fair enough, but that, in no sense, should actually invalidate the families who have had different experiences.

I have one simple question, and I want to make one simple point. History has told us that, until the victim's voice is believed, then there can be no justice. I just want to ask the Cabinet Secretary: does the Government believe the evidence of the families of the victims here? If you don't, then it's no surprise that many of them will have no faith in this process. 

I think it's important that HASCAS were given a remit to independently investigate and reflect back on the evidence they found. That was the remit that they were given. You then have to accept that when that independent review is undertaken, when you accept the integrity of the people, that may well provide very difficult messages that are critical of the Government, critical of the health service, and don't always support all of the conclusions reached by individual Members of the public. That does not, though, mean that those people are not being honest. I refer back to what HASCAS themselves have said: 'Our report does not accuse any of the families of changing or elaborating on their stories. It does, however, make clear that many families had no concerns until the publicity surrounding an earlier report. They then wanted to know if their loved ones had been abused, and sought reassurance in this respect.'

When you look at the conclusions reached by HASCAS, it is very clear that they substantiate a wide range of the concerns and complaints made by families. Our challenge is how we deal with those and how we actually set out to properly improve upon those, to try and make sure that other families don't go through the same experience. That's partly about the individual care, but it is much more about the systemic failures that took place within north Wales. That's not—to go back to the point that the leader of the opposition made in a question to the First Minister—to say that, in principle, creating Betsi Cadwaladr was the wrong thing to do, but the report is very critical of the way in which the health board went about its business in those first few years, having a medically led model of delivery. The clinical programme groups in particular have been criticised previously, and it's no surprise that HASCAS, in their investigation, have criticised that model as providing a disjointed health board—so, the disconnection of the different clinical programme groups that didn't speak to each other, effectively quasi-autonomous organisations within the health board, and the three different cultures of the three provider trusts that previously existed. And it has produced challenges that are still here with us today. That is one of the significant challenges we still have to address to make sure, as I say, that once and for all those are addressed, confronted and resolved, to make it a better place for staff to work, but crucially a better place to deliver health and care for our people.

Thank you very much, Cabinet Secretary.