1. What is the Welsh Government's plan for bringing Betsi Cadwaladr University Health Board out of special measures? OAQ52790

Thank you. I've set out clear expectations for the health board to meet to be considered for de-escalation in the special measures improvement framework. I will make an oral statement on Betsi Cadwaladr University Local Health Board’s progress on 6 November.

Thank you for that answer. Cabinet Secretary, the north Wales health board has been in special measures since June 2015. At that time, we were told that the action taken reflected serious and outstanding concerns about the leadership, governance and progress of the health board. Cabinet Secretary, I'm grateful for the update you provided around the three-year anniversary of special measures, but what I struggle to assess is the trajectory of improvement and when the health board will be delivering the quality of services that my constituents deserve. Cabinet Secretary, if the health board is getting there, as you state, when will it have reached its final destination? 

It's a question that Members will continue to ask until we see real and lasting improvement in the delivery of the areas that are in special measures. We've seen progress on maternity. We have not seen adequate progress on mental health. We've some progress on out-of-hours. We've seen some progress on leadership.

Mental health has always been the most challenging area of activity, and so the health board has made progress on having a strategy, but it can't simply be a case, for the convenience of politicians, certainly for me, to set an artificial time frame. That's why the special measures framework has the chief exec of NHS Wales, together with Healthcare Inspectorate Wales, our regulator, together with the Wales Audit Office, to make sure this is not a process that is driven by what is convenient for me or anybody else in the Government, but a real and honest assessment of the progress that a health board has made. So, the improvement plan I set out is the plan for them to adhere to, to get out of special measures. There will be an honest and upfront report on their progress, both on 6 November and in the future. Members and the public should take the reassurance that there is a genuine independent oversight on the progress that is or is not being made.

You said you didn't want to set out a time frame for improvements, and yet I remember, when the previous health secretary actually put this health board into special measures, he announced there were 100-day plans to turn the situation around. Well, it's now been 1,228 days.

Many of the indicators in terms of performance in that health board are going backwards. It's a record-breaking health board now, because it has the record-breaking worst-ever accident and emergency department performance in two of its hospitals just in the last month, and we know that its financial situation isn't resolved, the mental health problems in that health board still aren't resolved, and there are still questions around the capacity of the leadership and the governance in the health board to turn the situation around.

You say that you're setting out your expectations, but you are absolutely failing to deliver on those expectations—the improvements that you have promised and which your predecessor had promised that would be made in this health board. I don't think leaving the situation completely open-ended is good enough. People want some direct accountability in our health board system. They don't have that at the moment—you don't accept responsibility, and the health board fails to make any decisions because it's in special measures and it says that you're the one making all of the decisions.

So, do you accept that the accountability arrangements in the national health service are not good enough, and that this is a prime example of why they're not good enough? And what are you going to do to make health boards more directly accountable to the public?

Well, as Members will know from our regular outings in the Chamber, in statements, in debates and, indeed, in questions that I receive every three weeks, there is regular and direct accountability. I answer questions and I'm held to account on a regular basis. As far as Betsi Cadwaladr is concerned, there is a new improvement framework, with improvements to be made, and I expect to be held to account for them. I have never sought to try and deny the fact that I have responsibility for the health service here in Wales—far from it.

The challenge about our framework for accountability is to have that honesty and objectivity within it, to actually measure the progress we're making, the additional support that we're providing, not just in people, but also in terms of the additional resource we've made, the additional resource we've made available from this June, for example—nearly an extra £7 million for providing additional personnel to deliver improvement. And I will be upfront about where the health board has made progress, just as I'll be upfront about where the health board still has more to go. Members should, though, take some comfort from the fact that our staff within the health board are actually much more positive about working for the organisation than they were two years ago and four years ago. As the staff survey shows, there have been significant improvements in whether staff rate the health board as a good place to work, or they say they're proud to work for the health board, and whether they'd recommend treatment for a friend or relative. So, there is real progress being made, but, until we see the significant and sustained improvement in mental health services in particular, and progress to be made on financial discipline within the health board too, as well as headline elective performance, I will, of course, continue to face questions, just as the health board will themselves.

One of the difficulties that the health board finds difficulty in tackling is in the transfer of care, and I don’t know if you can explain to me how we saw a situation that we saw in Chirk hospital recently, where it took 368 days to transfer one patient, according the community health council. Now, not only is that bad for the patient, but it’s also bad for the hospital and anyone else who needed use of that bed. So, when are we going to see health and community care services co-ordinated effectively in north Wales?

Thank you for the question. We have actually seen significant progress made on reducing delayed transfers of care right across our health service, including within north Wales. I and the Minister look at the figures every single month and where there is a falling back between health boards we absolutely make sure that action is taken and questions are asked. So, there's no lack of oversight or interest from Ministers in this Government about the progress that we've made, or complacency. That progress will be continued. It's only partly about resources: much of it is about working relationships, and, since I came into the department as a then deputy Minister, I can say there has been a significant improvement in relationships between health and local government, and that has led to an improvement in performance as well. 

In the individual case you mentioned, whilst I can't comment on the individual circumstances, I can broadly say that where a delay of that length has taken place it is almost always because there is a complex care package that is not available for that person. What I would be interested in, though, is if you'd write to me, and either I or the Minister will investigate and come back to you with the detail in that matter.