The following amendments have been selected: amendment 1 in the name of Rebecca Evans.

The next item on our agenda this afternoon is the Plaid Cymru debate on health boards, and I call on Helen Mary Jones to move the motion.

Motion NDM7046 Rhun ap Iorwerth

To propose that the National Assembly for Wales:

1. Notes the publication of the Review of Maternity Services at Cwm Taf Health Board report on 30 April 2019.

2. Notes that major concerns about quality of care and governance of health boards has also been highlighted in the following reports:

a) Trusted to Care: An independent Review of the Princess of Wales Hospital and Neath Port Talbot Hospital at Abertawe Bro Morgannwg University Health Board,  2014;

b) Donna Ockenden External Investigation into concerns raised regarding the care and treatment of patients at Tawel Fan ward, 2014; and

c) Donna Ockenden Review of the Governance Arrangements relating to the care of patients on Tawel Fan ward, 2018.

3. No longer has confidence in the current Minister for Health and Social Services in the Welsh Government to address the systemic failings raised in these, and other reports.

Motion moved.

Deputy Presiding Officer, I rise today to propose this motion in the spirit of utmost seriousness. It is no light matter to ask any parliament to express a lack of confidence in an appointed Minister. The threshold for making such a call is high, and rightly so. The Minister's party holds the highest number of Members in this place and, through arrangements with others, the First Minister has secured a majority. This gives him a mandate to govern and to choose his own Ministers.

However, faced with a systematic pattern of failures in our health service and the Minister's apparent unwillingness or inability either to hold senior managers to account for those failures or to take responsibility for them himself, we on this side of the Chamber felt we had no option but to table this motion today. At its heart is a matter of accountability, and in this context, it feels right to remind this Chamber where accountability for our national health service lies. Legislation passed in this place in 2009 restructured the service, removing market mechanisms and making the health service clearly accountable to the health Minister, and through her or him to this Assembly, and through this Assembly to the people. There is no ambiguity here. Health organisations are no longer, and have not been for many years, quasi-autonomous bodies.

The Llywydd took the Chair.

The Wales Audit Office produced a memorandum in 2015 setting out clearly the accountability arrangements for the NHS. These roles are in the memorandum, in line with the legislation, and these are the roles that are attributed by that memorandum to the Minister, setting policy and strategic framework direction, agreeing in Cabinet as part of collective discussion overall resources for the NHS, determining strategic distribution of overall resources, setting the standards and performance framework, and crucially, Llywydd, holding the NHS leaders to account. We submit, Llywydd, that in this last regard the Minister has failed in his duties, and his failures had serious consequences for the people. It is our duty as an Assembly to hold him to account for this.

We discussed the Cwm Taf report at some length here last week, but I feel I must return to some of the issues raised. The experiences of families caught up in this situation have been truly terrible, and children's lives have been lost. The report highlights amongst other things the lack of consultant cover, the use of locum staff without effective induction programmes, the lack of awareness around appropriate action in response to serious incidents, and, crucially, a governance system that does not support safe practice, and a culture within the service that is still perceived as punitive. It is also clear that many families were treated with shocking disrespect and disdain, and that there was a culture in some wards and in some circumstances where the dignity and respect that should have been accorded to mothers and their families was shockingly and absolutely absent. That there was catastrophic failing in this service—of that there can be no doubt. The question for us today is: could and should the Minister have known and acted sooner?

The report lists eight separate reports between 2012 and 2018, any one of which should have been enough at least to trigger a close look, if not an intervention, by a Minister and his officials. I will not detail them all here. They are in the public domain and the report, which I am sure all Members will have read. Now, the Minister's defenders will undoubtedly say that some of these reports are internal, and that the report itself highlights a lack of transparency on the part of the board, and this is true. But the majority of these reports were available to the Minister and his officials. In 2012, the Healthcare Inspectorate Wales report raised serious concerns around the quality of patient experience, delivery of safe and effective care, and the quality of management and leadership. Questions should have been asked then.

The 2007 General Medical Council deanery visit identified six areas of concern around failings in the educational contract, including induction. The 2018 General Medical Council survey raised concerns with induction and clinical supervision. These reports, coupled with concerns being raised at the time by individual Assembly Members as a result of issues being brought to them by their constituents, should have shown the Minister and his officials a pattern. He should have stepped in sooner, and if he had, many families could have been saved the trauma and loss that they experienced in this failing service. So eventually, in the autumn last year, the Minister did take action. Reports were commissioned, and eventually that work went under way, though given the severity of the concerns, it seems pertinent to ask why a review commissioned in the autumn did not take place until January. We know, of course, what that review found.

So, how has the Minister responded to this? Well, he has apologised. He has placed the service into special measures. He has sent a board in to provide advice and challenge and he has spoken about the need to change the culture. But he has left in place all those senior individuals who presided over the development of this disastrous culture. The chief executive, who has held her role since 2011, has been allowed to remain in post. As far as we know, and more importantly, as far as the families know, no-one has been disciplined for allowing this situation to develop and continue. No-one has been held to account for the trauma to the mothers and the deaths of 26 children.

The Minister will no doubt be aware that there is extensive research in how to deliver effective cultural change within organisations. He should know that one of the key factors in delivering effective cultural change is fresh leadership—change at the top. Does he really expect the staff who were working in circumstances where it was impossible for them to raise concerns to believe that their managers want openness now, that they will be encouraged and supported to be open about service failings, by the same managers who silenced them before? Does he expect the families who have raised concerns and continue to feel ignored to believe that those same managers who have patronised them, belittled them, and in at least one case threatened legal action against them, will suddenly start treating them with respect and taking their concerns seriously? Are we expected to believe that these leaders, who have perpetuated a culture of silence and who have allowed terrible mistreatment of women and their babies to continue, are we to believe these people have suddenly come to the conclusion that openness and honesty is best? I doubt it. So, while the right things have been said, effectively nothing has been done and the families deserve better.

Now, I have focused my remarks on the Cwm Taf situation since this is the most recent and most grievous of the failings the motion highlights. Colleagues will speak to the situation in the north where Betsi Cadwaladr health board has been in special measures for four years without the necessary improvements having been achieved. Members will also recall the independent review of the Princess of Wales Hospital and the Neath Port Talbot Hospital in 2014 also highlighting serious failings. 

What all these situations have in common is a failure on the part of the Government to hold senior managers to account. While front-line staff can be struck off and prevented from practice, managers appear to be able to move from one part of the service to another with impunity, with no sanction, regardless of how poorly they have performed. How can the Cwm Taf families and the front-line staff believe that there will be real change when, after four years of special measures, Betsi Cadwaladr continues to need intervention? This will not do. 

We need a professional body for NHS managers with the ability to strike managers off for poor performance. We need to ensure true independence of Healthcare Inspectorate Wales. We need a legal duty of candour to apply to all health professionals including managers, and a genuine, robust and transparent complaints system that supports parents and families. Some of this has been promised, none of it has been delivered. A culture persists where it appears that managers are never held responsible. This is not new and it must change.

The Minister has presided over this service first as Deputy Minister and then as Minister since 2014 and the culture has not been challenged, let alone transformed. The Minister must take responsibility, and if he will not do so we must hold him to account. Presiding Officer, no-one doubts that any health Minister serving our nation has a very difficult job to do. She or he is accountable for a vast and complex service, a service that spends the lion's share of this Government's budget, and a service that is vital to every single one of us as citizens and every person that we represent.

We have to be able to rely on a health Minister to provide the service with really robust challenge, to ensure that where there is failure it is addressed, and where there is best practice it is shared. Instead, we have a series of serious failings with no-one held to account. There must be accountability for this series of failings and for the inadequate response to them. So, Presiding Officer, in the spirit of all seriousness, I must commend this motion, unamended, to this Assembly. 

I have selected the amendment to the motion and I call on the Minister for health to move formally amendment 1, tabled in the name of Rebecca Evans.

Amendment 1—Rebecca Evans

Delete all after point 1 and replace with:

Accepts the recommendations of the report and recognises the distress and trauma caused to families;

Notes the actions being taken to secure immediate and sustained improvement in maternity services in the former Cwm Taf Health Board; and

Notes the actions being taken to identify and address any wider governance issues within Cwm Taf Morgannwg Health Board and across the Welsh NHS.

Amendment 1 moved.

Formally.

I rise with a very, very heavy heart today. We read last week—I can hear the huffs of breath on the benches opposite, and I'm very disappointed by that. I sincerely mean that I rise with a very, very heavy heart. Last week, we saw the publication of another stomach-churning report into failings in our precious national health service. In that report, we read about front-line staff that were overstretched and under-resourced. We read about a lack of dignity in the care of patients, vulnerable patients. We read about patients and family concerns being dismissed, and some individuals being regarded as troublemakers by the staff when they made those complaints. We read of a complaints system that failed to learn from mistakes; inadequate and missing patient records; an unhealthy culture amongst the staff; unprofessional behaviour that broke professional codes of practice; false assurances that were given to elected representatives raising constituency problems on behalf of individuals; many missed opportunities for intervention; failures in basic governance requirements; information not being disclosed to individuals where it ought to have been disclosed and, as a result, patients coming to harm—deaths, the needless deaths of vulnerable babies, with the distress and the heartache that comes from that. And each one of those issues was almost identical to the report that disclosed the terrible failures and scandals at the Tawel Fan unit in north Wales. 

I could have listed any one of those and it would have been absolutely identical. And we were assured in north Wales that when that report was published into the failings at Tawel Fan, it would be the last of its kind because you would get to grips with those problems. You made statement after statement in the aftermath of the publication of the Tawel Fan report that things would change, that we would never see the likes of it again, and yet here we are, four years later, with the Betsi Cadwaladr health board still in special measures, still not delivering appropriate quality services, certainly in respect of its mental health care, and a situation where almost identical failings have been identified in terms of other services, this time for young babies and their mothers in Cwm Taf. 

What will it take for our national health service to learn lessons, to change practices and to deliver the improvements that we need to see? It will only change if we change those at the top of the organisation. And Helen Mary Jones has quite rightly pointed out that the buck stops with you as the Minister for Health and Social Services here in Wales. You were given charge over the special measures situation at the Betsi Cadwaladr health board. You took responsibility, and each time we raised concerns about the lack of progress, you had a familiar refrain that you had made it clear that you wanted to see improvement. Well, words alone don't deliver the sort of improvement that we need to see. People want a health service in Wales that is accountable for its failures, where people own up and they accept responsibility when things go wrong. But I'm afraid that all too often in this Chamber we see you, Minister, taking the credit when things go right and washing your hands when things go wrong in our national health service. That's what we've seen, and that's no doubt what we will see you attempt to do today. I'm afraid that, unless you accept your responsibility for these failings and your responsibility for failing to put right the situation in north Wales, we are never going to see the change that we need, and that's why I've got absolutely no confidence in you to deliver the improvements in our health service that we need to see. 

I don't doubt that there are many in this Chamber who would want to see you continue in your role, but I am afraid that I have lost confidence in your ability to do this particular job, and I think that people in north Wales, people in Cwm Taf and people elsewhere in this country deserve better. And, if I may say so as well, I think that where you have senior leaders in an organisation with dreadful failings, chief executives and chairs ought to resign, and if they don't resign, they ought to be sacked, with no pay-offs, no big retirement packages, they ought to go. When a board fails in its basic governance arrangements, the person responsible for those governance arrangements in the board, the chair, should leave. When a chief executive fails to show the leadership required to set the culture in an organisation, to make it open and transparent and to learn from mistakes, she ought to go. We've seen no resignations for these sorts of failings, and I would like to see people accept responsibility. It's about time we saw an accountable health service in Wales. We don't have one at the moment under your leadership.

Today, I want to thank you, Minister, for taking the correct step in commissioning an independent review of the maternity services in Cwm Taf, a review which must act as a fresh foundation in rebuilding greater faith in these important services. The fact that the Minister himself commissioned the independent review tells me what I need to know at this point.

I believe that, last October, the Minister took the action that was required in order to understand the problems in these maternity services, not an internal, inward-looking report, but a completely independent report of Government and of the health board that took decisive action that followed to place that service in special measures.

The message that I've heard most clearly is that the service must improve, so that other women do not experience what the independent review brought to light, and I would certainly want to add my voice to that. And we will expect that to happen, including dealing robustly with any individuals that are found to be responsible for failings.

And because of my concerns, I've taken the time myself over the last week or so to review and learn from this recent experience. I hope we've all done the same. It's important, as a review such as this does lead to some fundamental questioning. While I totally and fully accept all the issues of failure raised by families, I can honestly say that since my election in May 2016, I had no individual casework relating to Cwm Taf maternity services raised with me. That is until these recent months, when the independent review was announced and was in progress.

However, since the review started in October 2018, I have had direct contact with two constituents, and the view that I clearly heard from them was the need to improve the experience for those women using the services. Then, in January, as the independent review was in progress, I was one of several AMs that received an anonymous letter from some staff expressing their concerns, primarily about the management of the service. Together with at least one other AM colleague, I made the content of that letter known to the health board. And now that the independent review is complete, I will be following up those concerns to make sure that the issues raised in it have been adequately addressed, and I will expect that to include information on actions taken against anyone found to be responsible.

Last year, I wrote an entirely unrelated report on local health and care services in my constituency, a large part of which, of course, falls within the Cwm Taf health board area, and that report included a section on what we do when things go wrong. In the context of our health services, my thoughts at that point were that we need to be open about the mistakes, we need to review and learn the lessons, apologise and compensate where that is necessary, correct matters going forward, and ensure robust follow-up. 

Using my own words as a yardstick, then, it seems to me that the very important bit that we need to keep improving on is around openness about mistakes. As the independent report states, there are issues around culture that still need to be addressed, but as I wrote about the importance of robust follow-up, we need to look again at that. And as we review and learn, I know the public that I represent in Cwm Taf and those beyond will demand to be fully informed of the actions taken by this health board.

Finally, we will need the Minister's reassurance that there will be speedy notification about the progress being made, and I believe that we will get that reassurance. That is the responsibility upon the health Minister, and it is why I continue to have confidence in his leadership.

I was looking at one of the reports referred to in the motion in preparing for this debate today, and that mentioned how there were problems in terms of how senior management had acted in dealing with the risks that exist within the service. The report mentions huge problems in terms of reporting serious incidents, that there were delays in responding to complaints and, in some cases, those complaints received no response whatsoever. Well, what report was that? Well, the Ockenden report, or one of the Ockenden reports, on Tawel Fan. I looked at another report then, which echoed many of the same messages: an adversarial complaint system with slow management, problems with institutional issues, on patient safety, on developing capacity, on workforce planning, and some examples of appalling patient care. That was the Andrews report, referring to the Abertawe Bro Morgannwg University Health Board from 2014. And now, of course, we have the royal college report, which demonstrates once again that staff are overworked and are led by managers who don't deliver their roles effectively, that there is underreporting of serious incidents. The report demonstrates that patient safety is not a priority in terms of the decision-making process and that staff are reluctant to report concerns about patient safety because of fear of being barred from work over a period of time or facing disciplinaries for reporting concerns. And there are also concerns about the complaints process that are, again, outlined in this report.

The current Minister, of course, has been responsible for running the NHS on a day-to-day basis since September 2014, because that was his role as Deputy Minister at that time. And just a matter of months after the publication of the Andrews report on ABMU, and around the same time as the first Ockenden report was being drafted, was when he took up his role. And it would be reasonable, of course, for us not to blame the Minister for failing to halt the scandals, but he does have a responsibility for his response to them.

In my region of north Wales, of course, the Betsi Cadwaladr health board, as we've already heard, has been placed in special measures, and that was at a time when the First Minister was the Cabinet Secretary for health. That was supposed to be a temporary measure. Four years later, under direct management from the Welsh Government, and we still haven't seen the improvements that we would all hope to have seen when they were placed in special measures. Indeed, there is terminology similar to 'special, special measures' that has been used since then, and that is a cause of concern for us all. The board has faced a number of scandals over the years. One of the first issues following my election was the C. difficile scandal at Ysbyty Glan Clywyd, if you recall, and that was a number of years ago. But not a single member of the board or a single senior manager has been disciplined for that failing.

We've seen failures on workforce planning as well, and one recent example that I highlighted here previously, of course, was the farcical situation of nurses training in Wrexham Glyndŵr University, but unable to take up work placements just down the road at Wrexham Maelor Hospital and, as a result, of course, having to go out to the NHS in England and into private practice and those nurses being lost to the NHS in Wales. I raised yesterday the closure of community hospitals, including Llangollen, Flint, Prestatyn, Blaenau Ffestiniog, and the way the private sector is now stepping in to fill the void of those beds that have been lost.

We almost saw the first NHS staff in Wales transfer into the private sector under a new dialysis contract, hatched by the Minister's department recently. Because the staff actually contacted us, we eventually managed to ensure that they were not transferred, but that still leaves large chunks of the renal service in north Wales, of course, under the direct control of private companies. We've heard about Tawel Fan, and I don't need to revisit that particular example because, as we've been reminded, we were told that we would never see such a report in future because the lessons had been learnt.

Well, you know, we had two senior reports, as I mentioned at the start, that all highlighted the extent to which the culture of those boards and the way they operate needs to change, and we need to be seeing action to change those cultures. But what we see, of course, is that we get a third example and last week's royal college report, which highlights the very same failings, and we have to ask: what has been done to change the rotten culture that exists in some of these boards?

The symptoms are the same, of course, as I've listed, but I'm unaware of a single manager who's been disciplined for contributing to or maintaining this culture. Indeed, we are aware of one manager holding a senior position with responsibility for patient care in both Cwm Taf and Betsi Cadwaladr during the periods concerned who also secured employment in a similar position after the Tawel Fan scandal. Of course, at the same time, doctors and nurses have been struck off and faced criminal investigations for those scandals, but failing managers can just carry on.

As my colleague said, he's responsible for the performance of those boards and those chief executives. The Minister made a decision clearly last week to side with them and not with patients, and we can no longer have confidence in him.

Twenty years into devolved governance, you would expect that Wales and its population should be receiving high-quality essential services. Well, I can tell you that there is no greater example of mismanagement of the devolution process than those of failing health services. It is not devolution that is failing the hard-working medical professionals in our communities, but the Welsh Government's own handling and mismanagement of the Welsh NHS.

Now, we need look no further than the health board that encompasses the constituency that I am very honoured to represent to see the health board and the failings as a result of this Welsh Government. Despite Betsi Cadwaladr having been in special measures since June 2015, it has just recorded the worst A&E waiting times in Wales. Less than 60 per cent of patients were seen within four hours at Wrexham Maelor and Ysbyty Glan Clwyd. Despite these measures, it has seen the highest number of patient safety incidents out of all NHS trusts in Wales, and despite special measures, the health board treated the lowest percentage of people waiting for planned care within 26 weeks of GP referral in February. It also had over half the 13,000 people in Wales waiting more than 36 weeks for treatment in February and has just recorded the biggest deficit out of Wales's seven NHS health boards at £42 million.

Four years of special measures, still failure and frustration about future services. The Welsh Government knows this and the Minister, actually, admitted on 6 November 2018 that significant difficulties remain. Is this acceptable when considering that the health board has been under the direct control of you, our health Minister, for the longest time of any NHS body in Great Britain? My constituents and I think not. Indeed, Aberconwy says 'no'. Lack of progress was identified by Donna Ockenden, her review finding that, as of 2017, the board had failed to meet key targets, including governance leadership and oversight, mental health services, and reconnecting with the public and regaining public confidence. That is saying 'regaining public confidence'—that confidence isn't there, Minister. More so, Mrs Ockenden's more recent letter on insufficient progress in improving those mental health services—I'm shocked to learn that her offer to help, in fact, was declined.

I'm saddened that there are numerous areas that remain to be addressed before de-escalation from special measures can be considered. Clearly, the situation is not in my own constituents' best interest. However, it seems that the problems are prolific across Wales, with five, now, of the seven health boards in some type of special measures. These measures indicate failure. For example, the challenges faced at Cwm Taf. The review of maternity services at Cwm Taf found a lack of a coherent approach towards patient safety or an understanding of their roles and responsibilities towards patient safety beyond the care they provided for a specific woman or group of women, that assessors were repeatedly and consistently told by staff of a reluctance to report patient safety issues because of a fear of blame, suspension or disciplinary action, and there was hardly any evidence of effective clinical leadership at any level. A major revision of all aspects of maternity services is needed there so as to protect future families facing the losses we've witnessed and heard about. As your own Welsh Labour MP, Owen Smith, stated, the Welsh Government decision about reorganisation seems to have compounded the problems facing Wales. I'm aware that it has also taken far too long for the special measures action to be taken—nearly seven years after concerns were first formally raised. That is not proactive. You work on a reactive basis, Minister.

We are faced today with the Welsh Government's delays on action at Cwm Taf, continued failings to manage Betsi Cadwaladr. I certainly do not have confidence that the current Minister for Health and Social Services in the Welsh Government can address the systemic failings raised here today. Four years have passed since north Wales came under the direct control of the Welsh Government. So, how on earth can we be expected, Minister, to believe anything that you tell us any more? Now, I actually support wholeheartedly the motion today by Plaid Cymru, and I would ask that you do seriously consider your own position. I would, if I was you—I would resign. I would go one further: if you are not prepared to do the honourable thing so that my constituents and other patients across Wales can receive adequate healthcare, I would ask the First Minister to sack you. Thank you.

It's been a deeply upsetting week for anyone who has read or been involved with the royal college's review of maternity services in Cwm Taf. The testimonies of the mothers whose babies died cannot but move any of us, and the way they've been treated is enough to make anyone angry. Now, I asked the question last week about whether this would have happened in another area—say, for example, a hospital service in a wealthier catchment area, where the patients would be more likely to be middle class. Would we see a report highlighting dismissive attitudes and a failure to apologise, and responses that were formulaic and seemed to be more interested in defending the reputation of individuals and the health board in a wealthier area? I very much doubt it. And this isn't a controversial point; it forms part of the inverse care law that the Minister himself has acknowledged in plenty of other circumstances. The dismissive tone in which these concerns were dismissed by the Minister last week doesn't inspire confidence in me that things will be put right. After all, the crux of the problem here is that people, mainly working-class women, have been dismissed, and here was the health Minister doing that all over again. But holding the Minister to account does not mean that those responsible at the health board should also not be held to account—of course they should—and right up until last week, there were questions over their actions.

In October last year, before the external review was commissioned, a Cwm Taf spokesperson told the media that their internal review was a routine exercise about whether things should be done differently. At the very same time, the health board were in possession of an internal report that said that things were far worse. Where is the transparency here? Hiding that report was misleading us: evidence that the board is more interested in defending its reputation than correcting the problems within the service. It remains a grave injustice, in my view, that doctors, nurses and midwives can be struck off and face criminal investigation—rightly, of course—for failures in patient care, whereas not a single manager, to our knowledge, has ever faced equivalent sanctions. That is not right and it's symptomatic of the class-based culture that infects public life. The chief executives of our health boards are paid substantially more than the First Minister, and they face no equivalent accountability, whereas we all know, if a low-paid or a low-grade worker did something of even a quarter of this magnitude in their workplace, there would be a very, very different result.

The Minister himself has not acknowledged that he runs the health service in Wales. He is responsible; the buck is meant to stop with him, but to date, this has meant very little. But here today, at least, we can send a message that Ministers can be struck off. This is, after all, an issue of more magnitude than recent sackings in Westminster. Liam Fox resigned for inviting an ex-special adviser abroad to meetings. Amber Rudd misled a committee, and Gavin Williamson allegedly leaked confidential information. Now, I would argue that service failures that led to that damning report last week are much more serious than the matters that those Westminster Ministers resigned over.

Let's contrast the behaviour of the health Minister here over the past week with that of the former health minister in Tunisia. In March of this year, 11 babies tragically died in a hospital in Tunis, following an infection outbreak attributed to poor practices on the ward. The health minister in Tunisia looked at his conscience, took responsibility and resigned, despite only having been in the post for four months. It's time that we applied those standards of accountability and responsibility here. I think it definitely is.

We heard last week from Lynne Neagle that there had been problems in Cwm Taf over 16 years ago, and, clearly, we have to ensure that the problems that were identified then were then rectified, but, clearly, that doesn't appear to have been the case in that what other people are saying is that there continued to be problems throughout all this time. The question that I asked myself on reading this report was, 'Where was the supervisor of midwives in all this?' Because it was their duty to ensure that a unit was safe, and, if it wasn't safe, they had the powers to close it down. So, that is a big question mark that I'd like to have answered, because it isn't—. Their role was then changed in 2017, so that they wouldn't any longer have those investigating powers, but would instead be there in a supporting role, and that is, indeed, what midwives wanted. And Wales was, to some extent, ahead of the game in clarifying the role of the new clinical supervisors of midwives. But my understanding is that, in Cwm Taf, the role was never changed in line with the legislation, that they continued to be asked to investigate serious incidents as opposed to being tasked to support and develop good practice in midwifery. There were clearly lots of examples of why there were concerns about midwifery practice, because of the numbers of stillbirths, the numbers of caesarians, which should have been evident to the board at the time.

And, clearly, if neither the—. It's not fair on midwives, who are there to deliver normal births, if they don't have then the specialist people to call on when complications start to appear. The fact that the consultant obstetrician was often absolutely absent and was not available for up to an hour, which is a huge amount of time when a pregnancy is going wrong—. It was clear that the service—. It should have been clear, in plain sight, to all the very senior staff—the consultant obstetrician, the consultant paediatrician—that this was not a service that was equipped to look after the very immature 28-week gestation babies. And the whistle should have been blown by them.

I think the key moment occurred when the consultant midwife reported in September 2018, and it was clear that it was hidden from plain sight, because the assessors who went up there in January weren't even aware of it until the day that they arrived. But is it the case that the board didn't know about it, or they did know about it and they did nothing about it? Clearly, the Minister did know about it, because he then commissioned additional investigations in October last year. So, he took appropriate action, in my view. But I think that there are some very serious issues that shouldn't be blinded by trying to put on trial the health Minister. It's all of us who have to accept our collective duty to ensure that health boards have the powers, the remit and the responsibility for delivering the service for the community they've been tasked to serve.

So, what changes, if any, need to be made in the governance arrangements of health boards, and how do we ensure that the culture within health boards is one that strives for continuous improvement and better meeting the needs of populations? We have to ensure that staff on the wards are in an environment where they can blow the whistle if they do not think that the service is operating safely, and that clearly does not seem to have been in operation in Cwm Taf. So, I think those are the issues in front of us. I think that calling for the resignation of the health Minister is, frankly, a diversionary tactic. We absolutely have to get right the service—

Will you take an intervention?

No, I won't. No.

—the service that we have in Cwm Taf and in all our maternity services to ensure that they are fit for purpose, in line with 'Better Births'. So, I think that is the issue in front of us and that's the one we should be scrutinising in detail.

Yesterday, we saw another motion from this Labour Government that was little more than patting itself on the back, as if everything in the Welsh NHS was hunky-dory, and we see it regularly. The Minister's been sitting there most of this debate, with his little smirk on his face—I don't know how you can, Minister. Seriously, I don't know how you can.

The amendments tabled—[Interruption.] The amendments tabled by the Labour Government today demonstrate the denial and complacency, not that we needed more evidence of that. Yes, I note the actions the Welsh Government are taking in relation to Cwm Taf, but it's very little comfort. Do I think they'll be able to take the bull by the horns and make the tough decisions that they need to take to sort out the failures of Betsi Cadwaladr, Cwm Taf and others? No. It's pretty clear, particularly from the tragic reports of baby deaths last week, that the last thing Labour is entitled to is to congratulate itself, as it so often does, or sit in denial as it's doing today. It should instead be hanging its collective head in shame and submitting a motion giving a profuse apology to grieving families and giving us solid actions that they're going to take to recover the situation.

Labour have been running the NHS for 20 years in Wales, and every election they say they'll transform the NHS and that it's safe in their hands. Yet, every Assembly term, they make it worse. Why should we or the public believe that, all of a sudden, the services will improve when they've not done so for decades?

This Government bleats that our NHS is reliant on migrants and uses a recruitment crisis to hide behind—when, that is, the Minister isn't hiding behind the staff. But successive Governments, aided and abetted by this Welsh Labour Government, have created the recruitment problem in the NHS. It costs a great deal of money to train to be a doctor, making it that much more daunting a profession to join, as if the responsibilities involved weren't daunting enough. But, at the same time, training places have not kept pace with the population. In effect, UK and Welsh Governments have outsourced medical training to places like the third world, where we steal many of our doctors from communities that have desperate need of them.

And, of course, the recruitment problem is exacerbated by the reputation of some of the health boards in Wales. How can we hope to recruit staff when having some of the health boards in Wales on their curriculum vitae may damage their long-term career prospects? The point of having the NHS devolved to the Welsh Government was that it would be able to respond to local needs and perform better for the people of Wales than it had done previously. Instead, Welsh Government have damaged the NHS so it has problems, rather than benefits, unique to Wales. A health service that has every reason to be more responsive to local needs is in fact less responsive. There are longer waiting lists and worse outcomes than its English counterparts that Labour don't control, baby-killing levels of incompetence, waiting lists of thousands of per cent, young people having their lives ruined waiting for mental health treatment. How can people out there in the real world have any confidence that this Government can either come up with the ideas needed to solve the Welsh NHS chaos or implement the steps they're promising?　

Of course, I welcome any ideas and actions that improve the NHS, but I, like many others in here and out across Wales, have no faith that this Government can deliver anything other than continued crisis for our nation's national health service. The people who voted for this Government put them in place to govern, not to try and duck out of accountability. Those same people trusted Labour and placed their NHS system in its hands and in the Minister's hands. The Minister must now bear the ultimate responsibility for the failures in the NHS, and I will be supporting Plaid's motion today, but the Labour group will no doubt defeat Plaid's motion, and that will demonstrate quite effectively how wrong Labour voters were to place their trust in Labour. Thank you.

I would like to begin my contribution this afternoon by joining with my colleague Dawn Bowden in thanking the Minister very sincerely for taking such decisive action as soon as the issues in Cwm Taf maternity services came to light, commissioning this independent review that has allowed us to shine a spotlight on the failings in the service and begin to put things right. So, for my contribution today, I'd like to pick up on two important themes that I mentioned in the Chamber last week, and I will focus my remarks on the Cwm Taf report, as that's the one that directly affects my constituents in the Cynon Valley.

As I stated here last week, there's no doubt that, since I was elected to this place three years ago, that report is the most distressing thing that I have had to read, and my thoughts remain very firmly with all of the families affected. Firstly, for all the women that I have spoken to from my constituency and also the women from Cynon Valley whose views are expressed in that report, there is one theme that stands out very clearly, and that relates to the issue of notes disappearing or not being taken, of record keeping not being accurate, of women going through a very difficult time in labour and repeatedly being asked by different members of staff to verbally pass on information, rather than that information being there at hand. Take the example of Mountain Ash resident Joann Edwards. Joann has spoken of being constantly asked to repeat reasons for induction and type of delivery, and noted poor communication between staff and shifts. As she said,

'Not one person seemed to refer to my notes which even included scan pictures from the consultant with details of fluid measurements.'

Or Chloe Williams from Ynysybwl—now, Chloe had contracted E. coli during her pregnancy, which wasn't captured in her notes. She suffered tremendous pain and, tragically, her son was stillborn. Now, the reason that I give these examples in such detail—as Members will be aware, the Public Accounts Committee recently considered NHS informatics and had some pretty clear findings on that, and, similarly, I've had useful discussions in the last week with organisations like the Royal College of Nursing to discuss this, and it's clear to me that informatics must be used more effectively to ensure that all the information that midwives and doctors need is at hand in order to make the right decisions at the right time for mothers and for babies.

Secondly, a point I made was that Cwm Taf has particular issues around its socioeconomic make-up. There are resultant health issues that arise from this, and, whilst this is no excuse, they clearly have an impact on outcomes. But other areas in Wales have the same challenges, and those other areas also have fewer interventions and safer outcomes for mothers and babies. So, it's really important that the Cwm Taf health board draws on these experiences of similar health boards and learns from them so that things can be different moving forward. I very much welcome the assurances that the Minister gave me personally in the Chamber last week around this co-working.

I also want to spend just a little time addressing the report’s findings around governance. The report talks about inadequacies in clinical leadership, no training and no evidence of board-level plans to develop skills or support leaders, a lack of visible accountability, and, what is worse, the provision of false assurances to the board. And, even when unannounced visits to the board raised concerns to which there should have been a response, the characterisation is of lack of action. Moving to the fourth term of reference, it strikes me as incomprehensible that reviews of governance arrangements should be commissioned and then just left on the shelf. Moreover, there was a lack of clinical involvement. Standard systems of data collection, validation and audit were just not in place. There were no leadership expectations for these functions, so they became nobody’s business.

I want to briefly touch on the last point of the Plaid motion, and explain why I believe that it is the wrong approach. When the Minister gave his statement last week, he outlined a range of interventions to make things right. His focus on establishing an independent maternity oversight panel, strengthening board leadership and providing external scrutiny and support is, to my mind, the correct approach, and I expect that this should lead to a resolution of the challenges in governance systems that I've just described—governance systems that can have such a devastating effect on the lives of people accessing the services.

Similarly, in response to the concerns I raised after his statement, I welcome the Minister's comments around better use of technology to provide greater robustness and certainty about record transfer. Let us not forget, it is only thanks to the Minister's intervention that a light has been shone on these issues. So, instead of scapegoating or looking for an easy headline, let's focus on making things right for the people who rely on these services, and that includes the staff themselves.

I call on the Minister for Health and Social Services, Vaughan Gething.

Thank you, Llywydd. The report on Cwm Taf maternity services was published just last week. It shook everyone in this Chamber, as it should have done. The independent royal colleges review that I commissioned identified a range of failings and shone a light on poor care and distressing experiences for women and their families. I fully recognise the seriousness of the maternity review findings. I accept them in full. And I repeat again the apology that I have made to families that were failed.

I do, though, want to set out what I will not do today. I will not be drawn into trying to unpick a selection of reports over the last five years of our NHS. Each of those reports was upsetting in its own right. Each one was incredibly difficult for the people affected. There were lessons to be learned from all of them: lessons for our NHS; lessons for our approach to intervention and escalation. So, I am not going to trade on examples of NHS performance, to point fingers at other people or other parts of the NHS in the UK. I'm clear that a party political fist fight, just a week after the report was published, takes all of us away from what families have told us really matters. Our job is to listen to them and to put right what should not have gone wrong, and that is why we have tabled our amendment.

None of us can truly understand how distressing this has been, and continues to be, for the families affected. But, I have been struck by the dignified way in which they have responded. The level of commitment that they have shown in expressing their wish to work with us, to inform and shape the improvements required in maternity services, is testament to that. My priority now is to take every necessary action to meet their expectation that this does not happen to other families.

The independent oversight panel will be key in providing that assurance. Mick Giannasi, as panel chair, has begun his work immediately. I spoke to him yesterday, and he fully understands the responsibility of his role. Mick Giannasi and Cath Broderick, the author of the families report, will join with me next week when I meet the families. I want those families to have their say in shaping the work of the panel, but I also want to thank them personally for the way in which they have engaged with the review and for being prepared to share their experiences. I hope that they can take some comfort in knowing that they are being listened to, and that action will follow.

There is no denying that the standards that became the norm in parts of these maternity services are completely unacceptable. The failures in governance processes that meant that outcomes were not escalated to the board are equally unacceptable. I have made it clear to the health board Chair that I expect him and the board to fully consider how this happened, as it is a critical part of ensuring that we do not see a similar system failure in the future. I expect Cwm Taf Morgannwg board to do everything necessary to have robust governance arrangements in place from ward to board, and David Jenkins's role is to help them to achieve this.

The overriding requirement is to ensure the safety, care and well-being of mothers and babies receiving maternity services. That must include the more open culture and practice that Dawn Bowden identified, to replace the punitive culture that the report describes. It must equally include the improvements in practice, experience and outcomes that Vikki Howells referred to. The improvement that we all seek must be rapid and sustained, and that will be the driving force that guides my actions as I discharge my responsibilities. I'm determined that the whole of NHS Wales learns from these system failures. I'll make that clear to health board Chairs when I meet them tomorrow. They have been given two weeks to review the report's findings and report on their own services. So, I will receive those reports next week.

We all know that the vast majority of people receive excellent care from our health services, but there are occasions where things go wrong. That is sadly true of every healthcare system. We have shown that we will take decisive action to identify and respond to failings when they arise. We've learned lessons, developed and then adapted our approach to escalation and intervention as a result. We've commissioned research from the Wales Centre for Public Policy to further help inform our approach, drawing on international comparators, and we reflect on our own experience. So, I'm far from complacent. I will continue to take the advice of regulators, the independent panel, my officials and, as I have said, to seek the views of families as we respond to the failings identified by this report. So, I will continue to act.

I recognise that women and families, Members in this Chamber, and the wider public will continue to expect transparency, to see the actions identified by the independent royal colleges review fully implemented, to hear that maternity care in the former Cwm Taf area is safe, dignified, and meets the needs of women and their families, and to see that evidenced by the independent panel and by those receiving care. To see and hear the outcome of the independent panel that I have appointed. That independent panel will therefore report regularly, and I confirm that I will continue to update Members and the wider public on their work and their recommendations for future action.

As Members are aware, the work undertaken by the independent panel and David Jenkins will be complemented by the work of Healthcare Inspectorate Wales and the Wales Audit Office. Those bodies are independent of Government. They will set the terms of their own activity for themselves based on their analysis of the issues. And their findings will, as usual, be published.

Over the past week, there have been calls from a range of opposition Members for somebody to be sacked. As a result of the action that I have taken, the independent panel or board may find evidence of conduct that requires action by the employer or a professional regulator. In those circumstances, I expect them to act appropriately, but I have not—and will not require them to take action for my benefit. Their remit is to help improve our service, to help better serve our public. There are no silver bullets. That is why I chose to take the approach that I have announced. I made a choice, and I will not go back now to look for an alternative scalp for my benefit, to give false assurance, to give a false impression of a quick fix that would do little to deliver the improvements that women and their families expect and deserve.

A week ago, I published in full the independent royal colleges report that I commissioned. I set out the action that I am taking. I believe that women and their families who have been let down, women and families who still need maternity services, must be our focus. They certainly are mine.

Helen Mary Jones to reply to the debate.

Diolch yn fawr, Llywydd. We celebrated, yesterday, 20 years of this place as a parliament. The function of a parliament is to hold a government to account, and I am therefore profoundly disappointed to have just heard the Minister describe this serious and, I thought, on the whole very dignified debate as a political bun fight. I have to say to the Minister that if we wanted a political bun fight, we could have one on a weekly basis. We have not chosen to do so.

I am very grateful to the majority of Members who have contributed to this debate. I can’t possibly refer to all their contributions, but what we have seen across those contributions is a pattern, and I am profoundly disappointed that the Minister cannot see that pattern. He says that he is committed that what happened to the Cwm Taf families won’t happen to other families. Well, as we heard from Darren Millar, it is very, very similar to what happened to the Tawel Fan families.

The Minister said he would not be drawn into making comparisons. It is profoundly worrying that he does not see the commonalities. It is his failure to see those commonalities, and it is his failure to address those commonalities—the failure of management across the system, the failure to hold people to account—that has led to us bringing this motion before us today.

Now, Dawn Bowden rightly highlights some of the issues. She says that service improvement must deal robustly with individuals. I do not understand, on the evidence of today’s debate or last week’s statement, why she has that confidence. And I was touched by Vikki Howells's contribution. She obviously feels deeply what has happened to her constituents. She knows the impact that that’s had on her life. And yet, she thanks the Minister. She rightly highlights failures. She talks about the lack of action by the board. She talks about a wrong approach. Surely, those board members need to be held to account.

Now, Llywydd, I have known many Members on the Labour benches for many years, and I know them to be honourable people. And I know them to be loyal. But I feel I have to ask them today to whom their loyalty is due. Is it due to a Minister—and I should stress this is in no way personal—who has failed to understand the commonalities of the problems facing him, and failed to respond appropriately? Or is it due to their constituents, the people of Wales? I do not underestimate how difficult this must be for some of them, but it is our duty, as an opposition loyal to the people of Wales, to call upon them to reflect.

Yesterday I met—I've spoken to a number of families over the phone and by email, but yesterday I met a young father. He believes that his wife and his child would be dead if he hadn't happened himself to be a medical professional, and to be able to pick up on some of the issues that the service was failing to address. He had received first-class support from one of his local Assembly Members. She knows who she is. I will not name her. He said to me that he is grateful to us for speaking out because he does not believe that the service can change while the same people who dismissed his concerns, who belittled his wife, who mocked her while she was in labour, and who, when he raised concerns, eventually threatened him with legal action—he does not believe that while those same people are still in charge, that service would change. That young mother is expecting another child. She will not give birth to that child in Cwm Taf.

It is the duty of this Assembly to scrutinise Ministers and to hold them to account. It is what we are here to do. This was the point of the creation of this Assembly. This is what democracy is about. Now I think, Llywydd, we know how the vote is likely to go today. But I can say this to these families, to the Cwm Taf families: on these benches, we will not forget you. That was the message from the young father to me yesterday—please don't forget us. Don't forget what's happened. On these benches, we will not forget you, and if the Minister will not take his responsibility, then through the committee structures, through debates on the floor of this Chamber, through questions, we will continue to hold the Minister to account for the shocking experiences of those families and for those children gone.

The health committee will shortly undertake scrutiny of Cwm Taf on these matters, and I have sought assurances from the Chair that the voices of those families will be at the heart of that scrutiny. We will not listen to nonsense from unaccountable bureaucrats. We will take those families' voices to the Minister, and I'm grateful for the fact that he is intending to meet them, but I wonder how safe they will feel to be truly open and honest with him, faced with the complacency he's displayed last week and this.

It is with great regret, Llywydd, that I have felt the need to bring this debate to this Chamber. I would infinitely prefer that the Minister could see the systematic failures across the management of the system and be prepared to address them. He has told us today he will not do that. So it will come down to us, to the opposition in this place, to be the voice of those families—[Interruption.]—and I will happily take an intervention if anybody wishes to make one. No? I thought not.

I will end—

Oh, get hold of yourself. 

I am perfectly in command of myself, Mr Waters. It seems to me that you may not be.

Allow Helen Mary to conclude her speech, please.

I have to end my contribution, Llywydd, by asking what level of failure by a public service in our nation will it take for a Labour Minister—and that's my only party political point today—what level of failure will it take for a Labour Minister to do the honourable thing?

The proposal is to agree the motion without amendments. Does any Member object? [Objection.] I will defer voting on this item until voting time.

Voting deferred until voting time.