May I express my gratitude to the Conservatives for bringing this motion forward today? This is not, as Angela Burns has said, a situation that any of us would wish to find ourselves in, and this impacts, of course, very directly on a great many of my constituents in the west of the Betsi Cadwaladr area.

I'm really concerned that we get from this Minister a lot of complacency, a lot of 'everything's going to be all right'. I've been looking back through the six-monthly reports—they are full of assertion and they are not very full of evidence. And I just want to highlight a number—very briefly—of issues that are publicly evidenced. Waiting times have not improved since special measures were introduced and have only shown improvements in early 2018, when it was highlighted as an issue in Plenary again. The A&E system still consistently performs worse than the Welsh average, and the performance of two poorly-performing hospitals drag down the performance of a good one. Cancer waiting times show that, at the start of special measures, Betsi was actually performing better than the Welsh average and now performs worse than the Welsh average and there's been a 5 per cent decrease in the number of GPs in the Betsi Cadwaladr area over time, though I do accept what the Minister said yesterday about there being alternative services directly employed by the local health board being put in place to address some of those issues. Now, the Minister appears to be expressing some scepticism about this, but I'm basing this on publicly available figures, and if he's got other publicly available figures that tell us something else—other not publicly available figures—I urge him to put those in the public domain so we can see where this so-called progress is coming from and who is delivering it.

After four years, we need to have from this Minister some real understanding about why he thinks delivering change in Betsi Cadwaladr has been so difficult. Why is it so intransigent? What is going wrong there? Now, if I was to hear from the Minister today, 'These are the issues that I'm facing', 'These are the things that I cannot shift', 'These are the things that we need to build political consensus, perhaps, to deliver and change', then I would be the first person in his corner, because Jack Sargeant, of course, is quite right when he says that nobody wants to play any kind of political game with the NHS, but the reality, of course, Deputy Presiding Officer, is that issues surrounding the NHS are highly political: how the NHS is funded, how it is managed, is highly political, and here, in Wales, we have established—we legislated in 2009 for a system that made the system accountable to the Minister. I remember the then Welsh Minister, Edwina Hart, saying that the decisions about health in Wales needed to be made by the people that the people can sack. Now, at that time, the Conservative spokesperson, Jonathan Morgan, was of the view that we should continue to have a more hands-off approach. That was not the decision that this place made. It's a perfectly respectable position; not one that I shared at the time. So, the Minister is clearly totally accountable for this, and he needs to explain to us why things have not moved on.

Now, of course there's been some improvement; if you'd have left the system entirely alone for four years and done absolutely nothing there would have been some good people in some good places who would have been able to achieve some positive change. And, of course, as others have said, and we must acknowledge this, across that system—and I hear this weekly from constituents—there are really good people on the front line who are working their socks off. There are also some really good front-line managers who are doing innovative things, for example, co-operating with social services in Gwynedd. But, at the top of the health board, there is obviously something seriously wrong, and I believe that there is a cultural problem.

I wonder how invested the senior leaders in that health board are in delivering change. Now, it does worry me that six of the people leading that health board—not on the board side, but professionally—don't even live in this country, never mind in the area that they serve. Now, obviously, you wouldn't want to start discriminating against people on the basis of where they live, but, when you have such a high percentage of your management team whose families, whose children, whose neighbours are not directly affected by the decisions that they make, I think, potentially, you've got a problem. We used to, in the public sector in Wales, very often appoint senior leaders—I'm thinking particularly of chief executives of local authorities—on the basis that, 'We welcome you from wherever you come, but we expect you to come here, we expect you to live here, we expect you to invest in this community'. And Betsi is full of senior leaders who have not done that.

When I raised the question yesterday with the Minister about whether he believed the senior leadership understood the communities they were serving, I was profoundly disappointed that he dismissed that as a concern. But it seems to my constituents and the constituents of other colleagues that the decisions are being made by people who don't understand the nature of the communities, who don't understand the geography, and maybe that is something that is at the root of all of this.

I see my time is up, Deputy Presiding Officer, and I'll bring my remarks to a close. But I'd associate myself with what's already been said about the need to have performance standards for managers, to have core competencies, to have a register of NHS managers, off which they can be kicked, as doctors and nurses can, if they don't perform, because I believe this is a cultural problem across our NHS. The Minister has got to take some responsibility for this. If he wants our help, he can certainly have it, but, as it is, he dismisses our concern and it's not good enough.