1. Will the Minister respond to the Healthcare Inspectorate Wales review into Abertawe Bro Morgannwg University Health board’s handling of sex assault claims from patients with learning difficulties against a care worker? 272

Thank you for the question. I commissioned an independent review of the health board's handling of concerns raised about Kris Wade. Healthcare Inspectorate Wales published that report yesterday. I now expect the health board to take urgent action to address the findings and recommendations. We will implement measures in response as quickly as possible across Wales. 

Thank you for that reply. This report is, of course, the third one if we include the desktop review into safeguarding at the health board, and the report shows there is still a lack of clarity on how some recommendations, which stretch back before this particular scandal, have or will be put in place. When we discuss this report, I think we should all remember what it's about—sexual assault against very vulnerable women in a care setting where they thought that they were safe. The women did not feel that they were believed, and do you agree, Minister, that this is totally unacceptable? If the #MeToo movement is to have impact, public authorities must listen to all women, be they vulnerable or not, but, more importantly, believe them too.

There are parts of the report that are deeply problematic. There is criticism of governance at the health board. It says that board members were aware of allegations individually, but nothing formal was done until far too late. Disconnect between the board and operational services has been apparent since the 2014 'Trusted to Care' report. What are you going to do differently, Minister, now in relation to governance, so we don't have to have another report in a few years' time and the same press-ready, recycled responses from you? Will you look to explore the possibility of special measures to oversee the implementation of recommendations, particularly in this report? And will you personally instigate a review of governance in ABMU and an urgent change of leadership at the board level?

Finally, I'd like to ask, as I did yesterday, to seek assurances of the independence of Healthcare Inspectorate Wales. And I say this again because I think it's vitally important. The press were given a briefing at 9 o'clock in the morning and I was only afforded the same report at 6 o'clock that evening, under the alleged proposition that they had to keep that private for families. If it was so private, why were the press afforded that briefing before elected politicians in this place? I only got the report because I proactively asked—no other AM got that report—and an MP that has taken an interest in this area also. Just for the sake of clarity, we need assurances that HIW is entirely independent, because if they are, why did they treat the press differently to elected politicians in this place? 

Thank you for the series of questions. I'll start with your final series of questions about HIW and their independence. Yes, they are operating independently. They made choices about who to see and how to conduct the investigation. I think they saw about 40 different people, current and past staff members, as well as the families of the three women, together with the family of Christine James, who, as we know, was murdered by Kris Wade.

The report was made available to the women who had complained, their families or their representatives, a week before publication of the report. As well, HIW met with the women a week before the report. The report was then made available to them on 28 January. And, on the twenty-eighth, HIW held a technical briefing for the press and they also provided you with a copy of the report. Publication of the report is a matter for HIW, and not a matter where there was any kind of interference from the Welsh Government. There is no question that the conclusions of the inquiry and the process to reach those conclusions was anything other than independent. 

I want to return to the point that we are talking about—three vulnerable women who were let down. And I am deeply sorry that those three women were let down not just by an individual within the health service, but actually how the whole service then reacted to the complaint, and in particular the reaction after the first complaint, where it's acknowledged that it was not promptly recognised as a safeguarding issue and dealt with as such. The second and third were. As we know, the police and the Crown Prosecution Service decided not to proceed with a prosecution. Now, that is outside the remit of both the health board and indeed the Welsh Government. But I do agree, you start by believing the complainant—that has to be your starting point. Otherwise, we know that we will not encourage people to raise complaints as they should do, and then to handle sensitively the complaints when they're investigated.

On to the, I think, two further points that you raised—in terms of an action plan and what will now happen, within a matter of weeks, the health board will need to submit an action plan to Healthcare Inspectorate Wales. They won't submit that plan to the Government, it will go Healthcare Inspectorate Wales, and they will determine whether that action plan is adequate. And no doubt, Healthcare Inspectorate Wales will return to see what progress, including the pace and consistency of progress, that the health board makes against dealing with those recommendations. There are three recommendations for the Government that I've already committed to taking forward. 

In terms of your call for special measures and a change in leadership at the health board, of course, the chief executive is new and was not in place at the time of the desktop review, nor, indeed, when the incidents took place, and, indeed, in terms of the board themselves, there is no suggestion from Healthcare Inspectorate Wales that there should be changes at board level. And I do remind the Member and others who are here or watching that placing a health board or a trust in special measures takes place following advice given by both the chief executive of NHS Wales, the Wales Audit Office, and, indeed, Healthcare Inspectorate Wales. Should that have been a matter that Healthcare Inspectorate Wales thought was appropriate, then they would have said so and there would have been the opportunity to convene an extraordinary meeting under the escalation status.

So, these are matters where I'm advised by people who are properly independent, and that is a safeguard for people in Wales that we're not either placing within special measures or out of special measures healthcare organisations simply to suit a politician within Government or outside, and that is absolutely the right thing to do. But I'm determined that the health service will deal with the recommendations in this independent review and will do so seriously and promptly. 

This is a situation of utmost gravity and the fundamental issue is: why are issues relating to the care of people with learning disability persistently ignored? That's the fundamental issue here, because the AMBU board knew of both the allegations against Kris Wade and the problems in the learning disability directorate itself, but failed to act. The Crown Prosecution Service failed to take the women's allegations seriously, despite police going back to ask them to reconsider. The police wanted to pursue the situation; the CPS failed to take any action. The view from the service is that the Welsh Government always kicked the attempts to develop effective liaison between learning disability services and the criminal justice system into the long grass. I'm not going to have the political debate about what's devolved and what's not devolved now, but, surely, with matters of such potential gravity, you need to be able to work together as opposed to just ignoring the situation, because, over the years, there are myriad reports on the additional morbidity and mortality of people with learning disability in general hospitals. They're not being listened to either there. And I know about the multi-agency learning disability advisory group, but that is exactly what it says on the tin—it's an advisory group only. There's no change in outcomes for people with learning disability. This case highlights a situation of utmost gravity. So, also, can I ask: why didn't senior health board executives think or feel that the allegations in the Kris Wade case were serious? Why did Welsh Government agree to an internal desktop review back in October 2017? If there was no case to answer, why have a review? If it was serious, have a proper review, not just an internal desktop review. And, finally, is Welsh Government proud of the treatment of the medical whistleblower in this case?

I agree with a fair amount of what Dai Lloyd has said about this being a matter of real seriousness and gravity. It is a serious issue. That is why I ordered the inquiry, with the report that we've published. And, if you look at the report, there's no hiding place in the report. It sets out a range of areas where there is a need for real improvement. It sets out a range of failings and disappointments about past conduct. And that is important to have an honest picture to improve upon. But, actually, in terms of learning disability, I recognise what Dai Lloyd says about differential mortality. That is not a cause for celebration, it is a cause for not just for concern, but for action. That is why the Government has, of its own volition, undertaken a review across Government in terms of learning disability services, which I, Rebecca Evans in a previous role, but also Huw Irranca-Davies in a previous role as well, have been actually part of undertaking and reviewing and taking forward, because we do recognise we need to do better. We recognise there are real challenges and a need for improvement. There's no lack of understanding or commitment from the Government to do better. If you want to see examples, there's real leadership from the chief nursing officer as well on this issue. She has made it a real priority within the last few years, because of the mounting evidence about differential outcomes and the failure to make appropriate progress.

For example, earlier this term, I met the family of Paul Ridd to look at what had happened with his care, where, again, he was let down, and the family then came back, after a period of time—we quite understand that they were angry and did not want to come back. They then decided they wanted to do something to make sure others did not go through the same experience. And that has actually been a really positive experience for this health board as well. The learning they have taken on board for matters on the ward—and, indeed, Melanie Thomas, one of the nurses they have dealt with, the learning disability co-ordinator, was actually recognised for her work on learning disability within the recent new year's honours list. 

So, there is good practice within Wales. As ever, the challenge is how consistent is that and that the learning isn't simply kept in one part of our service. So, I do recognise that there have been failings. I want to be clear that the Welsh Government does not authorise a desktop review as the only response that should take place. The health board undertook a desktop review, and, following that, I was not satisfied that was the appropriate course of action, that the learning had actually been deep enough or, indeed, that they'd learnt all the lessons and asked all the right people. So, I ordered Healthcare Inspectorate Wales to undertake a review.

In terms of the treatment of the whistleblower, well, the challenge here is that Healthcare Inspectorate Wales went through that. I would always want whistleblowers to be believed, and I would want—. Again, you start off by believing the whistleblower and taking what they say seriously if you want the right culture to take place. I certainly do believe there's more learning to take place and it's been raised directly with me by the British Medical Association. I think we will be in a better place but, as ever, we will continue to learn from where we get things wrong as well as where we get things right. There is much that we should not be proud of here, but also I think what is most important is the commitment to do better in the future. 

Thank you very much, Minister. The second topical question this afternoon is to the Minister for Economy and Transport. Rhun ap Iorwerth.