4. When does the Welsh Government expect hospitals to meet the four-hour emergency waiting time target? OAQ53134

I expect local health boards to plan effectively to deliver safe, timely and high-quality health and care services to meet the needs of the communities that they serve.

Thank you for that answer, Minister. You'll be aware that, in north Wales, there are particular problems in each of the three main district general hospitals, all of which have been failing to meet the emergency waiting time targets for some time, including at the hospital that serves my constituents, which is Glan Clwyd Hospital in Bodelwyddan.

The situation appears to have been deteriorating and, in November, the figures were much worse than they were three years ago, in November 2015. This, of course, is a health board that is in special measures. Your responsibility is to improve the outcomes for patients as a result of your intervention in that health board, and yet the situation is getting worse. Can you explain to my residents and those in other places in north Wales why, in a health board that is currently in special measures, the situation is getting worse in terms of performance and not getting better? 

I have real concerns about the four-hour figures from each of the three centres in north Wales, but I've never tried to hide from those concerns. They're absolutely part of the conversations I've had with the new chair about the need to see improvement. They have got a 90-day improvement plan, but the point that I have made is, 'It's fine to have a plan, but you obviously need to be able to deliver on it and to deliver improvement, and to take the staff with you'. The worst thing that we could do would be simply to say, 'People need to try and work harder' and that's it. Actually, there are changes about how the services are organised, about getting people to the right place within our heath and care system, and having the right capacity within the system as well. It's instructed to me that there's something here about supporting good clinical leadership, because if you look across north Wales, then, at present, the area, certainly in the recent past, that has had the greatest physical challenges is Ysbyty Gwynedd. Yet, actually, often, their performance is better than the other two sites.

So, it isn't simply about the physical settings, but sometimes the physical setting does matter. It is about having the right clinicians in the right place and about leadership and actually about persuading members of the public to try and use different points in the system at the right point in time. But I expect that you and other Members from every party will continue to not just question me but to ask again—once we've had a 90-day plan, I expect to come back and have questions about that and what difference it has made. I do think the national arrangements we put in place with the national clinical lead, with Jo Mower, have been helpful, because, of course, she has the credibility of still being a serving clinician in an emergency department. So, I'm cautiously optimistic that we'll see improvement, if not in the busy time of winter, because that really is a hostage to fortune, but I expect over the next year that your constituents and others can have a better experience with shorter waits within emergency departments. But this is a longer term challenge and not something I'll be able to resolve with a click of my fingers, as much as I would like to be able to do so. 

Minister, I'll look at the two aspects of the four hours—that's the beginning and the end of the four-hour period. At the beginning, clearly, we can ask people to choose better with the prudent health approach and look at using different facilities such as minor injuries units across south Wales, and particularly in my area the fantastic services at Neath Port Talbot Hospital. I want to encourage more people to take up that opportunity. But also, at the other side of the four hours is the transfer of patients into hospitals. Last year, ABMU held a consultation on bed closures. It was a skewed—in my opinion—consultation, because the questions being asked were more towards the answers they wanted. But in future consultations, will you ensure that health boards have to put the question as to how it impacts upon accident and emergency services, because the removal of beds means fewer opportunities for patients to be transferred from the A&E into a bed in the hospital?

There are two broad points that I'd make in response to the Member. The first is that I completely agree with him—I think that's the best use of the whole system. Neath Port Talbot Hospital is a good example of a minor injuries unit where people sometimes underestimate the range of services that are available. There's often easier transport than going to either the Princess of Wales or indeed to Morriston, and there is often a much shorter wait as well. Actually, making available publicly some of the tracker times about how fast you're likely to be seen has been helpful in diverting people to those areas. There's also, of course, the job of the ambulance service to work together with the health board and make sure they take people to the appropriate setting. 

On your second point about beds across the system, there is a challenge here, and I know you've set out both in private and in this place your view on the previous exercise undertaken by the health board, but it's actually about capacity across the whole system. Because what's been really interesting for me in meeting with lots of emergency department clinicians is they do have a view on capacity within the hospital system, but they actually have a view about flow within the hospital part of the system and in and out of the hospital setting itself as well. I think it's really important to set out not just what happens with a number of the beds within one part of our health and care system, but actually to be sure that it's a joint plan between health and social care about how capacity is going to be met. Because often the right place to treat someone is not in a hospital bed—it's often somewhere else, but you need to plan for that and not simply talk about it. When reducing capacity in one part, if you haven't then also planned to increase and improve capacity in another part of our wider health and care system—. That is a conversation I've had this morning with a range of local authority members.