Part of the debate – in the Senedd at 5:32 pm on 4 June 2019.
Thank you for the series of comments and questions. I will endeavour to deal with all of Darren's comments and questions within the time allotted, Deputy Presiding Officer.
I would gently say that the link to the unfortunate patient death that he described and the six additional posts—there is not a direct link to be drawn in the way that the Member tries to. Since my time at the start of this term as a Cabinet Member for health, I've had discussions with orthopaedic surgeons in varying and competing groups across the three sites, bringing them together with the health board to look at a proper plan for orthopaedics. The challenge is about getting to the point where we're able to get behind a plan to invest in the service that all the sites are actually agreeing with. Now we're in a better place, and that's why we're able to deliver increased investment in that service. We recognise it is absolutely required.
And capital choices do take time—the process that we need to go through to make sure we're investing in the right part of the service—and it's part of my frustration that we're not able to do that more quickly than we are. Actually, I don't think special measures is an answer for a delay in capital choices; it's actually about the health board having clarity in the choices it needs to make together with its staff, to have agreement on what it could and should invest in. And I'm keen to make sure that special measures is an aid to doing so, not a hindrance, because part of the challenge is whether an organisation feels that it can make choices that it really could and should do, and that's part of the challenge about having the special measures oversight to make sure they are continuing to make choices.
On your point about maternity, the investment in the SuRNICC is of course welcome, but actually, the reason why maternity services came out of special measures was a significant cultural change in the way that department operated—a change in the leadership at midwifery level, in particular, and a change in the way that staff actually worked together. That was the biggest factor in improving maternity services across north Wales. That change has been sustained as well, and that's a real positive and it does show for the organisation that it has and it can improve services and sustain that improvement so that staff feel valued, and, actually, the patients, the people they care with and for, feel valued and receive better care as a result.
On your points about general practice, I would just remind you again that no person has been left without a general practitioner, and it is almost always the case that the care is delivered initially from the same place they're always used to. We will see, though, a change in the way that general practice is delivered. It will mean that we'll have larger groups of general practitioners, other GPs working for other GPs, in much the same way that most lawyers are employed by other lawyers in law firms. But I do think we also need to see that as a positive to move people into a place where their care will be delivered in a local community but in a purpose-built and fit-for-purpose setting. That's part of what we're doing in investing in the primary care estate across Wales.
And I'm glad that you did go to Wrexham emergency department, because they are a committed group of healthcare professionals struggling and coping with real challenges that come through the door. It's much easier to be a politician, frankly, even in this job, than it is to go and work in an emergency department in any of our hospitals in any part within the United Kingdom, not just in Wales. And it really does highlight the challenges across our whole system, not just at the front door. That's why I place so much emphasis, in the conversations I've had with partners across north Wales, on delayed transfers of care, on that as a barometer for the health of the whole system, health and social care together, and why we do need to reform and restructure primary care to make sure we have more capacity outside of the hospital, so people don't need to go in there unnecessarily. That, I think, will significantly improve the way that people deliver care and, actually, the way that people can be proud of the care they deliver, and that people continue to value and have real faith and confidence in our national health service. And I look forward to the health board in north Wales coming out of special measures and continuing to demonstrate it deserves the confidence and support of the public, and is a service that all of us here should be proud of.