Part of the debate – in the Senedd at 4:28 pm on 5 June 2018.
Thank you for the questions and the comments. I'm happy to state at the outset that I certainly don't see special measures as a permanent status or indeed something that could or should be normalised. It is absolutely different, not just to the rest of the healthcare system, but there is also the fact that there have been real improvements in some areas of activities that I've highlighted in my statement.
Mental health hasn't made quite the progress that we wanted it to. That actually highlighted some of the fragility in the structure of the service, in not just delivering a new strategy but, actually, a part of the hold-up in the improvement journey was due to the absence of a key member of staff. There was something then about the resilience of the whole service. We're now seeing further progress again being made in the wider mental health service. But, actually, maternity services, which were one of the big triggers for the board going into special measures, have come out of special measures. They've been de-escalated and that, in itself, is a positive, and not just for that service, but for other parts of the health board, to recognise that it absolutely is possible to de-escalate out of special measures—a very real and significant and sustained improvement to be made and recognised through the escalation and intervention measures and frameworks.
That should provide the assurance that members of the public and members of staff will want because this is not a process where politicians are making a decision for their own benefit, or for my benefit, to take the health board out of special measures. It's why we have a tripartite process involving Healthcare Inspectorate Wales and the Wales Audit Office. We'll continue to have that structure to make clear to the public and to the staff that there won't be the choices made simply to deal with the convenience of a politician within this Chamber.
When we talk about a description of consultants to assist and work around the board, actually, in the part of my statement where I talked about additional system leadership and support, we are talking about having extra pairs of hands around the board to help them do things that, currently, we don't think they're able to do, and not just to get them in through a short-term fix, but actually to have a more sustained position in recruiting not just figures to go to the health board, but the organisational culture in planning and delivery that we recognise is plainly required.
I'll deal with your three points in the questioning. I think the second two go into each other in some respects, but a straight answer to your first question about whether the structure is fit for purpose: I do not think that the challenges that the north Wales health board face are because it is a single health board across north Wales. Actually, when we had a previous consultation on this there was a very clear message from staff that they did not actually want to see the health board broken up into two or three constituent parts. So, I don't think that is a reason why the health board should not be able to perform to high standards. If you look at other health boards within the country, there is a significant geographic spread in Powys and in Hywel Dda, and the geographic spreads themselves are not the reasons why the health boards do or don't succeed, just as having a significant number of partners is not a reason why other health boards don't succeed, because in Gwent, where they have five local authority partners, they're actually one of the better performing health boards in the country. So, it isn't the size or the number of partners. But there is something about the culture and the operational ability and planning function within the health board to deliver improvement.
I'm pleased, in terms of your point about emergency department improvement, that you saw that as a system-wide challenge, because it absolutely is, both in primary care, about how people are supported to stay within their own homes—that's part of the reason we've invested in health and social care centres across the health board area, and that's a strategic choice we've made not just in north Wales but across the country—but also the link between what takes place in a hospital and with our colleagues in social care. Now, I'll have more to say on health and social care integration over the next week or so in taking forward a response to the parliamentary review. But we will need to see an improved way of working between social care partners and the health board, and that is absolutely true. That's something about how they plan and deliver services, as well as agreeing on what those services should be, and having a joint way to understand the health and care needs of their population, and then being able to meet them. I'm positive that we'll be able to support not just north Wales but other health boards and their local authority partners to do so, but I don't want to pre-announce matters that we'll go into at some length next week on more about the way in which we expect health and social care to work more closely together. But we already see a range of teams that exist across the country, including north Wales, where there is already recognition that they must work together to deliver improvements for services for citizens, regardless of whether that person has a need that is a social care need or a healthcare need, and it's not simply about getting people out of hospital quickly.
Your final point about health and social care centres, whether they might be able to deliver improvement without the further conversation with the health board about assigning priorities and sinking money into the hospital system—that's part of the challenge in running an integrated unplanned system. I do not expect health boards to simply be hospital provider trusts with a bit of something else tacked on to them. They are genuine, population health board—. They are genuine population health level organisations. That is a requirement that we have of them, and they must look more clearly at prioritising more and more of their primary healthcare—not just early intervention, but prevention work as well. We'll see more of that as we not just make budget choices, but in the conversation we'll have next week and through the rest of this term. There are clear examples of local authorities already being more engaged in and around those centres, not just in Tywyn and not just in Flint, where I did the formal opening of the health centre, and I was pleased to have the Member, the local Member for Delyn, there as well, and to actually meet members from the local authority who are already running services from that centre. And, indeed, when I visited Ysbyty Alltwen, again, seeing members of the local authority there from Gwynedd, they were talking about what they were already doing with healthcare staff there to take account of the health and social care needs. So, we are already seeing some of that partnership work on a local level, and our challenge now is to scale that up and to have a more considered and joined-up approach across the whole of the north Wales region, which every local authority recognises is good for them and their citizens, just as the health board do as well. But I recognise the challenge that the Member provides.