If Members are leaving the Chamber, can they do so quickly?

We now move to the short debate, and I call on Paul Davies to speak on the topic he has chosen. 

Thank you, Deputy Presiding Officer. I'm pleased to once again take the opportunity to raise the issue of protecting services at Withybush hospital in this Chamber, and I'm happy to give Helen Mary Jones a minute of my time.

I'm sure the topic of my short debate will come as no great shock to the Welsh Government, as I have raised this particular issue on many occasions, not just in this Assembly, but in previous Assemblies too. However, I refuse to apologise for raising this vital issue once again, as it remains to be the single biggest priority of my constituents, who are continually facing a threat to their vital health services. 

Now, to bring Members up to speed, in recent years Hywel Dda University Health Board has embarked on a ruthless centralisation agenda in relation to delivering health services in west Wales, and as a result of that agenda, services have continued to slip away from Withybush hospital in my constituency and move eastwards to Glangwili hospital. As we all know, the health board did launch a consultation on the future of services and decided on a way forward that would effectively see Withybush hospital lose round-the-clock general hospital status and be repurposed, and a new general hospital would be built somewhere between Narberth and St Clears to provide accident and emergency, specialist, urgent and planned care. At the time, Steve Moore, the health board's chief executive, said that it, and I quote,

'offers us the best chance to deal with the fragility our NHS faces and to provide the population with safe, effective care that meets their needs.'

So, let's fast-forward to 2019, and where are we now? Well, there have been recent reports that the health board are once again revisiting how maternity services should be delivered in Pembrokeshire, following media speculation that Withybush hospital's midwife-led maternity services are set to be reduced to a day staffed service. This would effectively mean that midwives would be on-call for women who want to give birth at Withybush hospital out of designated hours. Of course, when pushed to confirm exactly what would happen to the service, Hywel Dda University Health Board denied these reports. But given that this was reported in the first place, it does leave a huge question mark over the future of the unit. Unfortunately, these reports create uncertainty over the current service provision. Now, in announcing changes to neonatal services in 2014, the then Minister for Health and Social Services and now the current First Minister said that, and I quote,

'An essential factor in any maternity model of care is that the mother should be able to make a clinically informed decision on the place of birth.'

Now, yesterday, during First Minister's questions, the First Minister confirmed that there are no proposals of any sort to make a change in maternity services at Withybush hospital. So, at long last, the Government has clearly made its view clear on a service at the hospital. I hope, therefore, the Welsh Government will now ensure that the local health board comes forward to confirm categorically that no changes will take place to maternity services at Withybush hospital, so that mothers living in the area are reassured that these particular services will continue.

Members will be aware that I have continually raised constituents' fears that the closure or downgrading of one service has a detrimental impact on the whole hospital and calls into question the sustainability of other services. Indeed, the Minister's predecessor admitted that he didn't know what to say in relation to the slippery slope theory but that the hospital would have a secure and significant place in the health services that are provided in Pembrokeshire. Well, that was in 2014, and I think it's safe to say that that is certainly not the case now. Since 2014, we've seen services downgraded, others under threat, and no certainty or assurances from either the local health board or the Welsh Government. Members may be aware that Hywel Dda University Health Board is under targeted intervention status and has been for some time now, and there's a very real belief amongst some in the community I represent that the constant mismanagement of services now means that the health board should be placed in special measures. Perhaps then the Welsh Government will choose to finally intervene and ensure that people living in all parts of the region are treated fairly and have access to the services that they so desperately need.

Following news that the health board is planning to build a new hospital between Narberth and St Clears, it became clear that this would result in there being no fully functioning A&E service at Withybush hospital but rather a minor injuries unit serving the area instead. That is simply unacceptable to the people that I represent. In fact, Members will remember the enormous petition raised by local campaigner Myles Bamford-Lewis objecting to the removal of A&E services from Withybush hospital, which gathered over 40,000 signatures. That is a hugely significant statement, which makes it abundantly clear that the people of Pembrokeshire will continue to oppose the downgrading of services at Withybush hospital. And those 40,000 voices deserve to be listened to.

Pembrokeshire is a county that needs desperate upgrades to its public transport infrastructure network, has significant poverty levels and has a particular high age demographic—all factors that demonstrate the need for an accident and emergency service to be maintained in the constituency. Let's not forget that, through the summer in particular, Pembrokeshire also welcomes thousands of tourists and visitors from across Wales and further afield, all of whom should be confident that emergency services are available quickly in the event that they are needed. What advert does that send to people across Britain and indeed right across the world? 'Welcome to Pembrokeshire, enjoy our landscape, enjoy our food and drink, and please be careful, because if you need emergency treatment, then you will have to go elsewhere.' And let me remind the Minister that it's not only politicians on this side of the Chamber that believe that A&E services must stay put. Last September, in a debate on a petition saying 'no' to the closure of Withybush hospital's A&E service, his own party colleague, the Member for Swansea East, said, and I quote:

'The ability to access an A&E department is something that people want as close to their homes as possible. Requesting one in the ancient county of Pembrokeshire should surely not be too much to ask.'

Unquote. At least this helpful intervention shows that the need to protect services at Withybush hospital is not a party political issue, and that, even in the Labour Party, there are some that understand and agree with the voice of local people. Despite this, the health board is determined to push ahead with plans that would directly put lives at risk by forcing people to travel further afield for emergency treatment. We in Pembrokeshire accept that we have to travel further afield for specialist treatment, but forcing us to travel further afield for lifesaving treatment and emergency services is totally unacceptable and dangerous. I use the word 'dangerous' because, from time to time, we see the A40 closed and getting further eastwards in an emergency situation when the road is closed is nigh on impossible. And what have the Welsh Government said on this issue? Very little, to be perfectly honest.

The Minister has been right to point out that he may have to take a decision in the process and so has stepped back from giving a view on the proposals. But the First Minister was more than happy yesterday to give his view that no changes should take place to maternity services. Nevertheless, to refuse to confirm whether or not the money will be made available for the health board's plans to build a brand-new hospital somewhere between Narberth and St Clears is simply extraordinary. Either the money is there or it isn't, and let me remind Members that it would probably cost at least £500 million to build a brand-new, state-of-the-art hospital.

Given that the health board is under targeted intervention status, the Welsh Government cannot simply wash its hands of it and remain silent on the affordability of its plans. In the meantime, the people of Pembrokeshire are completely in the dark about how services will be delivered in the future. Is it any wonder that communities in west Wales feel so let down and neglected by their local health board and the Welsh Government? Sadly, the local health board have a terrible track record when it comes to cutting services and leaving the public without new facilities. Even now, it has yet to give any concrete assurances over the future of some of Withybush's most essential services. Now, in August 2014, when the special care baby unit was closed, we were promised the delivery of a new, state-of-the-art facility at Glangwili hospital. Over four and a half years on, they still have not built this new facility. We are still waiting for these new services. So, where do we go from here?

The health board and the Welsh Government are keen to point out the problems that Withybush hospital has had in recruiting staff, saying that reform must happen to confront these challenges. However, to my mind, the constant removal of key services from Withybush hospital in recent years, coupled with downgrading other services, has done nothing to attract junior doctors or other medical professionals to Pembrokeshire. Clinicians will feel disinclined to consider roles at a hospital that has been earmarked for downgrading, and this creates an even bigger wave of unsustainability over current services. We already know that the health board is struggling to fill posts in other areas, and I sincerely believe that the years of uncertainty and the erosion of services locally in Pembrokeshire has certainly not helped the situation. The health Minister himself has said that—and I quote:

'People have powerful emotional attachments to the venues in which healthcare is delivered, but it is about investing in communities, attracting doctors, nurses, therapists, scientists, by operating a modern healthcare system to make the best use of digital technology and to keep hospitals for those who really need it.'

Unquote. And I completely agree. That's why further investment is not just needed in Pembrokeshire in relation to its primary and community-based services, but in its hospital services too. To allow any further reduction of services at the hospital and to support the removal of A&E services from Withybush hospital would simply work against that ambition. Indeed, any decisions that result in patients travelling further for treatment is a direct contradiction to the Minister's previous remarks that we want people to receive as much care as possible as locally as possible. Therefore, in responding to this debate, at the very least can the Minister confirm that, to meet the Government's intention to deliver services locally, it will ensure that A&E services will not be removed from Withybush hospital? 

Dirprwy Lywydd, in recent years all but one thing has remained, and that's the local health board's inability to listen to the people of Pembrokeshire and meaningfully engage with them on the future of services at their local hospital. Members may point to the consultation on the transforming clinical services programme, but each one of the options offered to patients in Pembrokeshire resulted in services being downgraded at Withybush hospital. There was no option that would transform services for the better at Withybush hospital; in fact, it just demonstrated the health board's ongoing efforts to centralise services further away from communities in Pembrokeshire. 

As a result, the views of the people of Pembrokeshire were, once again, thrown to one side and ignored. At the crux of this issue is a health board that refuses to take on board local people's views and, as such, the patient's voice has been lost. That's why it's more important than ever that politicians of all colours and at all tiers of Government do all that they can to ensure the views of people are heard loud and clear. 

Therefore, in closing, Deputy Presiding Officer, I reiterate the title of today's debate: 'Fighting for Future Services'. We are fighting to protect vital services at Withybush hospital, fighting to ensure Pembrokeshire has a health service fit for the twenty-first century, and fighting to protect the patient's voice. Hywel Dda University Health Board has proven yet again that it is incapable of working with the people it serves. Therefore, it is time for the Welsh Government to intervene and to take control. Leadership is now needed, and I once again appeal to the Minister to step in and save those vital services at Withybush before it's too late. It seems that the First Minister can step in and make it clear that there will be no changes to current maternity services, so it goes without saying that the Welsh Government can now step in and save these other vital services, including A&E as well. Pembrokeshire needs and deserves a first-class health service fit for the future, and only by working with local communities, not against them, will that service be delivered. 

I'm very grateful to Paul Davies for giving me a few moments of his valuable time. I associate myself with the remarks that he's made. There is a real issue of trust with those local communities, not only in Pembrokeshire, but across the Hywel Dda health board. Simply, they don't believe that they will be listened to when they raise their voices. The underlying problem here is that we have health service managers trying to impose a model of service that works very well in big English urban centres on rural communities in Wales. It is time for this to stop. It is time for us to look at more comparable countries like Canada, like Australia, like Scotland, as more appropriate models for healthcare that will really work for our rural communities. Paul Davies is right: the people in the communities we represent have a right to expect us to speak up for them.  

Can I now call the Minister for Health and Social Services to reply to the debate? Vaughan Gething. 

Thank you, Deputy Presiding Officer. Today's debate is a subject that we have discussed on numerous occasions. As with Paul Davies, I make no apologies to Members—they will hear me reiterate again why services across our national health service must change if we are to provide the health service that the people of Wales need and deserve. That is true for services not just in Pembrokeshire, but across the whole of Wales. So, let me remind Members again of the challenges faced by our NHS, not just in Wales but across the UK: the rise of our older population, enduring inequalities in health, increasing numbers of patients with chronic conditions, a difficult financial climate, and a UK-wide shortage of health professionals in certain specialities that causes difficulties in recruitment in every single nation of the UK.

Now, these are well established facts that we keep returning to. It does the NHS and the public that we serve no good to try and keep re-running old arguments of why things should stay the way they are. The adage, 'If it ain't broke, don't fix it', could not be more inappropriate in healthcare. Waiting until it is broken means waiting until real avoidable harm is caused. No public servant, and certainly no Minister, should contemplate doing that. So, our health and care service must change. That was a very clear message from the parliamentary review, which clearly advocated the need for a revolution within our health and care system to meet future demand. It concluded that our current system is not fit for the future. Across the Chamber, parties said they signed up to the recommendations of the parliamentary review, yet, here we are, debating again why change should not happen. 

There will always be contentious choices to be made in every single part of Wales. We, of course, must continue to engage and confront those challenges by having difficult conversations and by addressing them with clinically led choices, because, if we do not, change is less likely to happen until a point of crisis and a service collapses. We either allow change to happen to us in a chaotic, crisis-led manner or we empower our health service, our staff and the public to take ownership and to choose what the future should be.

Now we do, of course, need to build additional capacity into community and primary care—that's central in our plan, 'A Healthier Wales'. We need to do that to keep people well for longer and to look after them closer to home, which is not just seen within 'A Healthier Wales', but is also within the Hywel Dda strategy. People should be able to receive advice and support across a wide range of health and care issues that matter to them and their families and also to be able to attend more current out-patient appointments outside of a hospital setting. And there are good examples across Hywel Dda of how care really is being delivered closer to home already.

Now, I do, as Paul Davies has mentioned, understand the powerful attachment that people have to the future of healthcare and, in particular, to hospital locations. But the future of healthcare is about so much more than the current location of buildings; it's about that investment in communities, attracting doctors, nurses, therapists, scientists, and that does mean operating a modern healthcare system, making full use of digital technology and keeping hospital for those who really need to have their care delivered within a hospital setting.

In Hywel Dda, the health board recognised that a number of their services are fragile and dependent up on significant numbers of temporary staff—it's a point our own Public Accounts Committee have made on more than one occasion. Having a large number of temporary staff delivering care can lead to poorer quality and certainly higher costs. To meet these challenges, the health board began engaging with staff and the public on its transforming clinical services programme in 2017, and a number of clinically led proposals were developed and formally consulted on between April and July last year, and I recognise that Paul Davies does not support those proposals—he's entitled not to do so. At the public board meeting in September, 11 recommendations were agreed, and, importantly, these recommendations were developed and put forward by the doctors, nurses, therapists, scientists and wider staff groups who live in, work in and serve the people of mid and west Wales.

Now, some key decisions were made, including developing a business case for the construction of a new major hospital between Narberth and St Clears. I don't recognise the figure that Paul Davies came up with of £500 million. Actually, when you consider that the specialist critical care centre that I decided should be built in Gwent—the price tag for that is about £350 million, so I don't recognise Paul Davies's figure. But, even for that, they had to develop a business case to come forward to say, 'Here is the detail of why we want to spend a significant sum of public money'. 

Now, it did also look at the repurposing of both Withybush and Glangwili hospitals. And the health board did investigate the feedback provided during the consultation. Clinicians and staff worked with the public and other organisations on that additional detail to put together a 20-year strategy for the area. And that strategy, 'A Healthier Mid and West Wales', was agreed at the end of November last year. That sets out the direction of travel for the next 20 years. The detailed plan to support implementation will be developed over the coming months and years and, of course, I expect the health board to carry on working with key stakeholders, other organisations, their own staff, and, of course, the public. 

Now I really do understand the concerns felt locally by people in Pembrokeshire about Withybush. As I say, I understand the powerful attachment that people have to a local hospital, and Withybush will continue to have an important part in the future of healthcare services in the area. And, of course, we have invested in a range of services within Withybush. That includes £7.5 million for a new dialysis unit, £3.9 million to refurbish the pathology department, £600,000 for a new single photon emission CT multimode scanner, and over £3 million to complete the improvements on wards 9 and 10 to modernise haematology, oncology and palliative care services at the hospital.

Will you take an intervention?

Yes, I'd be happy to.

I think it’s important at this stage to resettle the community and for you to confirm, Minister, that there are no plans as we speak for the maternity services that currently exist in Withybush hospital to change, to be removed. Because, clearly, this rumour is out there. I don’t know how or why it’s got out there, but we need to put it to bed pretty quickly, because we'll have distress being put on expectant parents, who will be clearly needing those services in the very near future.

And the other issue that I think I would like, if you could confirm, is that, should the business case be successful, should it be the case that a new hospital is to be built, that’s going to be an extremely long-term plan and that the services that are currently enjoyed by people will be the same services in place, where they currently are, before any major hospital is rebuilt.

Thank you for the question and the two points. I’m happy to reconfirm the statement set out yesterday by the First Minister. It reconfirms what the health board themselves have said. There is absolutely no threat to 24/7 deliveries being made at the Withybush midwife-led unit, and I do hope that will put an end to the scaremongering that is taking place. It is actively scaring members of the local community who rely on those services.

And I take on board your point about a future hospital. I made the point that they hospital that is being developed now, the Grange University Hospital in Gwent, well, that took several years to agree a plan and then to get to the point where a business case was approved, and I then made the choice to actually invest that money in delivering a hospital. It does take several years to get to the point of the work starting, and, actually, the work to deliver the hospital takes time, of course, to build it. Within that time, services have to be delivered within the current footprint. Any changes around the way services are delivered have to be led by need and the ability to deliver those services. I do not expect there to be a large-scale disinvestment in services from either of the current hospitals, at either Glangwili or, indeed, Withybush, as a result of what might happen in the future on the back of a business plan that I have yet to receive.

It’s also worth pointing out, when we’re talking about services, that a number of concerns were raised about the changes to women’s and children’s services previously, about the concentrating on Glangwili. And, actually, I’ve made choices about investing in those new services to make sure there’s a better service for patients there, to make sure we're investing in neonatal services there, because I said absolutely at the time that it is not appropriate to wait until a future choice is made and not to invest in the current service provision. So, we are actively investing already in the way care is delivered.

And when we talk about A&E services, you should just take a think about the fact that this is a choice that’s been led by staff who deliver those services. The lead consultant in A&E at Glangwili is an advocate for the plan that’s been put forward. He’s not saying, ‘My workplace should not change’. He’s saying that this will deliver better care for people right across the region that we serve. And that’s the voice of staff who live in that part of Wales, the voice of people who deliver the care that is provided, and that is a voice that we should take seriously. And it's certainly one that is in my mind as I make my choices as a Minister for the whole country.

I look forward, though, to continuing to listen to our clinical voices—those clinical voices in the Royal College of Paediatric and Child Health who have confirmed the move in services to Glangwili for neonatal care has improved the quality of care and the compliance with national clinical standards, and better patient outcomes.

As I said at the start, this is a well-rehearsed debate that we may yet return to again. I have previously called for maturity and leadership from all of us, in every party, in taking service change and improvement forward, and I do so again now, because doing nothing is not an option. The quality of care, high quality in terms of experience and outcomes, that is what should drive us. I recognise that change and reform for a purpose are still difficult. However, they are essential if we are to improve healthcare and provide the quality of care and treatment that every community in Wales is entitled to expect.

Thank you. That brings today's proceedings to a close. Thank you.

The meeting ended at 19:05.