1. Will the Minister provide the users of services in Cwm Taf University Health Board with reassurance as to the purpose of the enhanced monitoring announced today? 253

Thank you for the question. The purpose of the enhanced monitoring is to provide additional support to the health board to enable them to focus on appropriate actions and to return to normal monitoring arrangements as quickly as possible.  

Thank you for that response, Minister. As your statement acknowledges, since the escalation framework was introduced in 2014, the health board has always been in routine arrangements. And as well as their good financial track record, we've seen many good clinical and care initiatives delivered by the health board. So, while I was aware of the situation surrounding maternity services that we discussed in the Chamber a few weeks ago, I was surprised to see your statement this morning raising their status from routine arrangements to enhanced monitoring, due to the concerns in the areas that you've highlighted in your statement. However, I do think it's the needs of the users of the service in Cwm Taf that must be paramount at this point. So, can you assure me that the reasons for this escalation to enhanced monitoring are being clearly communicated so that users are provided with the extra reassurance that they need about local services? And can you give an indication of timescale for the resolution of the issues identified? 

Yes, and the health board should not be surprised by today's decision. There's been regular communication between the chief executive of NHS Wales and the chief exec of the health board. And since the issues were raised about maternity services, I've spoken on several occasions to the chair of the health board. And the additional matters that were raised by regulators in the audit office are ones that I do not think would have been appropriate to ignore. So, you reach a point where you either choose to do something or choose to avoid doing something, and I think it is the right thing to have made this decision, and to be clear about the limited and specific areas that are of concern. But those concerns do not mean that this is a health board that provides poor-quality health and care to its citizens—far from it. We know from not just patient satisfaction but a range of measures that this is a health board that is performing well in terms of its delivery against time measures, but also against financial performance as well, and there is regular positive patient feedback. I expect, having made the statement today, that the health board will communicate directly to its staff and to its public, but also the timescale for this should be viewed as within periods of months rather than years. There are specific issues that I expect the health board to have a clear action plan to address, with timescales that they can be properly measured and assessed by. Again, the point about reassurance for yourself and the constituents that you serve is that this isn't simply a matter of political convenience made by a Minister for a Minister. There'll be the reassurance that will be those—. The review arrangements by the chief executive of NHS Wales, Wales Audit Office and Healthcare Inspectorate Wales will provide me with advice on whether it's appropriate to change the escalation status to return to normal monitoring, but that is what I expect the health board to plan for and to deliver within a period of months. 

Minister, I'm grateful for the statement that you issued this morning. To the normal reader looking at this it would clearly indicate that this decision was taken out of the normal cycle of evaluation. I think I'm correct in saying that, but if you could confirm that I'd be grateful, because it would look to me as if a special meeting had been called in December for this measure to be taken today or announced today.

We must remember that 300,000 people depend on this health board for their healthcare and many thousands of staff depend on the health board as their place of employment and the service and professional development that they want to exercise in delivering excellent quality of care. But the list that you've identified in your statement this morning does cause great concern. Because, as the Member for Merthyr indicated, initially, obviously, this statement—. The Minister provided a statement on maternity services, now we have a list seven-strong, from staffing levels to delivery of Health Inspectorate Wales reports. This is a concerning time—that this isn't some sort of vortex that the health board is going into and ultimately more problems will be identified. Are you confident that the list that you've identified in your statement is a comprehensive list of the issues that this health board needs to address, and are you confident that the support that you identify in your statement in relation to governance arrangements and the support that you will be offering the board will rectify the problems and the health board will emerge out of this enhanced level of monitoring? Because to date I don't think a health board has emerged out of enhanced levels of monitoring here in Wales. As the health spokesman for the Conservatives identified, five of the seven health boards are in special measures at the moment here in Wales. 

First, to do with your point about—. Every health board has challenges to face in almost every single area of activity. We regularly discuss the rising demand, the changing nature of that demand, and, of course, those are challenges for a health board in the services that it provides. I don't think any person of any party political persuasion would be able to define an exhaustive list of challenges for the health board. What I have done is provide a clear list of the issues that have led to my decision to change the monitoring status of the health board. I expect these issues to be addressed and, if they are, then I would expect there to be advice that would mean that the escalation status of the health board could return to normal monitoring. 

This was a meeting outside of the usual cycle, and, again, that is a choice. We can either choose to say, 'Let's park the issue until the normal cycle takes place in a number of months', or we could say, 'There's a list of issues in front of us now and so a meeting should take place now to assess what the appropriate course of action is', and I do believe that was the right choice to make. There should be that reassurance for staff and the public that this is a specific list of issues to address. I do not expect there to be any kind of suggestion there is a list of issues that will see the health board return further and higher up the list of escalation status. I expect them, as a high-performing board, to take seriously the statement that has been made today and I expect them to respond appropriately and have a clear plan that they will adhere to to actually return to normal monitoring, as I've said, in a period of months. 

Thank you, Minister, for your statement today. Of course, the priority for this intervention is to ensure that the board and its staff are supported and that my constituents and other constituents can have the utmost confidence in their local health services.

Your statement highlights six areas of focus and I think this is important, as other Members have said—that it reinforces that this enhanced monitoring is only in certain areas of provision and not across the piece. How can we make sure that local people in communities like Cynon Valley, who may only be aware of the headline news, know that this does not refer to the overall quality of services? And how can we get that reassurance to people, using the NHS in Cwm Taf, and, of course, the hard-working staff who are employed there?

I welcome the comments by the chief executive of Cwm Taf that the health board is determined to work with the Welsh Government so that routine measures can be returned to as soon as possible, and I welcome your assurances on how long you expect that process to take, but could you provide any further details on the type of monitoring that will take place in the interim?

Referring back to your statement from October last year on maternity services in Cwm Taf, then you said you'd asked your officials to seek reassurance from all health boards in regard to incident reporting and escalation arrangements. In your statement today, one of the areas of focus is the quality of serious incident reporting. What initial findings have your officials found about the quality of incident reporting more generally across the Welsh NHS?

My final question relates to governance arrangements. In your statement, you note the need to provide external support in light of the relatively recent tenure of board members, and I think that's really important. I'm concerned that this type of support is only coming now after board members are already in post and concerns have been identified, so how can the Welsh Government in future best work with newly appointed board members before they take up their roles to ensure that they're all well placed to fulfil their obligations?

Thank you. I'm happy to reconfirm and to reiterate that this statement does not affect the overall quality of services, and it should not lead to a loss of public trust and confidence in the overall quality of services provided by Cwm Taf university health board. I hope that making that as a very clear statement will be helpful, and I'm sure the health board will be reiterating that to both its staff and the population that it serves. I'm pleased that you have contact yourself directly with the health board. I think it would be sensible for the health board to directly contact stakeholders like constituency and regional Members to confirm the steps that they are taking directly to reiterate the points about the seriousness with which they take it but also the steps that they are taking.

There is, of course, regular contact with my officials and the health board itself. I expect that to be more regular now following the decision that I've made and announced today, and, of course, I'll continue to speak with the chair as well. I'll make sure there is a regular conversation between me and the chair, not just about the plan but actually about how far ahead we are in doing it to make sure there is appropriate oversight.

The point you made about the quality of serious incident reports—this is something that is regularly discussed during the regular escalation conversations that take place. There is a range of areas that both the Wales Audit Office and the inspectorate actually raise, and this is a regular feature of it. So, there is the challenge about making sure that both the serious incidents are reported and reported in good time and that the quality of the information that is shared is appropriate as well. This should not be a difficult issue to resolve, and for me it's really important—it's about that culture of openness and not wanting to try and downplay the seriousness of it, because it's the nature of that open reporting and that appropriate learning takes place from them.

On your broader point about board development, I think it's a fair point about how we constantly review the board development measures that are in place as people take up their posts and then whilst they're new in post as well to make sure that they continue to have support to undertake their conduct effectively. And, certainly, following this, I'll be interested in looking again, not just in Cwm Taf, but across the broader system, to make sure that we're getting that right.

Many of my constituents, particularly to the east of Ogmore in Llanharan and Gilfach Goch and elsewhere, will be served by Cwm Taf health authority, both in primary care and secondary care and acute pathways as well, and it is worth reiterating that, up until now, of course, Cwm Taf have indeed been a high-performing board and organisation right across the piste with much to praise, so this is a bit of a knock-back, but there is much good in the performance of this organisation, regardless of this. But I note that, beyond the maternity services, which we knew of already, of the other points, we are talking about issues of compliance, actions not having been taken, reporting not having been up to spec, response to actions to Healthcare Inspectorate Wales inspection reports and actions not completed, compliance with the nurse staffing Act. It seems to me that these are things that can be done, can be achieved, in fairly short order if they get their act together, but the one that concerns me is the one in the middle of the list in your statement today, which is concerns in respect of quality governance arrangements. Now, I just wonder what does the Minister think in terms of whether the health board have got a real tight grip on needing to respond rapidly to these actions across the piste and bring it back into a health board that, across the piste, is once again high performing and takes itself out of the escalation measures today. Do they appreciate the seriousness of the Minister and the seriousness of the message that he's put in front of them—that there is no complacency, no resting on past performance; they need to get a grip and get out of this escalation?

And my second question is whether this has any implications for the issue of the transfer of the Bridgend area of ABMU across to Cwm Taf. I'm sure it doesn't, and this is a high-performing organisation across many areas, but I think many of my constituents, not simply in the Llanharan, Gilfach Goch area, but in the wider Maesteg, Garw, Ogmore valley areas, Sarn and elsewhere, who up until now have been served by ABMU, who are in the middle of that transition now across to Cwm Taf, will want to hear reassurance from the Minister that they should not have any worries based on what we've heard today.

I'm happy to give reassurance and confirmation on your second point simply at the outset. This won't affect the timetable for boundary change. I believe it would be entirely the wrong thing to do to try and pause or interrupt that now. That boundary change is due to take place from the start of April, and this should not affect the health board's ability to deal with the list of areas. The external review of maternity services has already been commissioned; they will need to respond to that. And the areas, as you rightly highlight, of additional concern that are in my statement, many of them are about compliance, about making sure that things are done properly and in an appropriate timescale.

The challenge about in respect of the quality of governance arrangements, that is partly a question for officers, employees of the health board, but it's also a challenge for the non-exec board members as well. It goes back to the point that Vikki Howells made about making sure that board members are in a position to properly undertake their functions, to both scrutinise the health board and not simply to be champions for the organisation. That is a dual role, but it's one we'd expect members to undertake.

So, that's my expectation, and I do think there is always learning to be taken from where things are not optimal. And I do expect that, within this, there'll be learning for other health boards to make sure that they look again at their own compliance again to make sure they're doing what they should do, when they should do it, and that, equally, members are supported to be able to undertake effectively their role as board members.

Thank you very much, Minister.