What is not clear to many outside of this Chamber is what happens when a health board is placed under special measures. In Wales, the Welsh Government, Healthcare Inspectorate Wales and the Welsh Audit Office work together to identify and respond to serious issues that affect services, quality, safety of care and organisational effectiveness. Actions can, but not always, involve placing key individual specialists or people with turn-around experience to provide support settings, actions, milestones and an improvement framework. Welsh Ministers are also able to suspend or remove powers and duties from Members of the health board, or to direct a health board to ensure that functions are performed by a specific person.

In Scotland, their special measures encompass a five-stage process, ranging from surveillance to formal recovery plans, with the ultimate sanction, at stage 5, for the Scottish Government to dismiss or appoint senior leadership of a board, such as they bravely did in NHS Tayside in 2018. In England, there are five types of action that can take place, ranging from the appointment of improvement directors to the removal of freedoms that some NHS foundation trusts have compared to other NHS organisations.

An innovative approach in England has been the buddying system, which acknowledges that some trusts in special measures can suffer from insularity, therefore it is essential that trusts look outwards as they seek to improve their quality. This was first introduced in 2013 and recognises how trusts can understand how other trusts approach their operations. They can learn, they can benchmark, and quality improvements come through. Buddying with another trust has often proved very valuable, but it does require commitment from both parties. It helps to define the specific terms of reference for the relationship, for example a specific clinical areas or speciality.

There are a number of case studies I would love to raise with you demonstrating best practice, because the length of time it's taken to introduce some of these measures makes me realise that you have not gone out and looked at best practice around the UK. I just want to highlight the case of one, Wexham Park Hospital in Slough, where problems were identified in 2014. The Care Quality Commission described a culture of 'learned helplessness', and I think we can say that identifies closely with Betsi, and changing this was made a priority for the new leadership team. The focus was on putting patients at the heart of everything, asking staff to treat them as if they were their own family members. An external view of what looked good helped to change and challenge ingrained behaviours, allowing the hospital to make significant change to the culture in a relatively short space of time. 

I'm not saying that all the answers lie over the borders, but I do want to ensure, Minister, that you look at the best practice that is out there to acknowledge that there are other systems in place. I also understand that in Wales we couldn't possibly buddy up because we'd only have two health boards and they would crash under the weight of the five. But we could ask Scotland and we could ask England for their advice and support.

Yesterday, in your statement, you acknowledged that a transformation team was needed, and this is a point I've made on repeated occasions. I acknowledge that you've finally decided to engage PricewaterhouseCoopers to help deliver substantial financial improvements, and, again, I applaud this. But why has it taken so long—four years? 

I'm not just going to say to you how awful I think this whole process has been managed. I want to give you some help. This is what the Welsh Conservatives would do: we would draught in help from experienced change managers working in the NHS throughout the UK to help drive those changes forward. We would implement robust and independent consultation and feedback events to engage and empower staff, to help them identify areas of concern free from external pressures. We would underpin the areas that have shown such devastating failures of performance and provide them with day-to-day management support and funding to improve.

We would look at rationalising the management structure, devolve the power to the lower levels of management so decisions can be made quickly, and green shoots of promise can be encouraged to grow and people feel empowered to make the difference that's so desperately needed. And—something Welsh Government seems so reluctant to do in so many health boards—we would review the core competency and skills of senior management to ensure that the right people are in the right jobs.

Minister, I would like to close my contribution—. Chamber, I would like to close my contribution with a little bit of reflection. It's disheartening to remember that this struggling health board is named after Betsi Cadwaladr, a famous nurse who treated the wounded soldiers of the Crimean war. Born in north Wales, her courage on faraway battlefields inspired visions of a legacy of health provision for the people of her homeland. I only hope that, in her memory, it won't be long before the spirit of her legacy can be properly honoured again. The staff of the health board have this spirit. They just need the leadership to fully release their potential. Perhaps through proper leadership, which borrows just a little of Betsi's famous courage, this vital resource can be restored again for the people of north Wales. And, Minister, if you do not have the courage to provide this leadership, then make way for someone who does.