3. Will the First Minister make a statement on accountability in the Welsh NHS? OAQ54256

I thank that Member for that question. Local health boards and NHS trusts in Wales are statutory bodies, and accountable for the planning, delivery and improvement of services they provide. Welsh Government sets the frameworks and requirements against which they operate.

First Minister, scandals in the care of elderly patients at the Tawel Fan ward in north Wales and in the care of mothers and babies in the Cwm Taf University Health Board area in south Wales have exposed, I believe, some very serious weaknesses in the accountability arrangements in the Welsh NHS. The fact that not a single person has been sacked for the serious failings in care that have been exposed in the hospitals concerned I believe is totally unacceptable. It's an injustice, and it adds further insult to injury for the families and loved ones of those affected. When will your Government address this accountability deficit in our Welsh NHS, and will you, as a former health Minister—and, indeed, your current health Minister—accept that you have a responsibility to act in order to ensure that we get to grips with the lack of accountability in the Welsh NHS and that people pay a price when they're responsible for things that go wrong?

Well, Llywydd, I just want to put on record the fact that, in terms of accountability, all our boards in Wales have model standing orders, all have standing financial instructions, they all have a behavioural code and they all have an accountability code. So, accountability in the Welsh NHS is something that has been part of the culture of the service since its inception, and has been further reinforced during the period of devolution. There is a further period now in which Members can engage with this agenda.

The Health and Social Care (Quality and Engagement) (Wales) Bill is in front of the Assembly. It will allow any Member who has proposals to make that can address deficits as they see them in the way that the health service operates to put those ideas forward to have them rehearsed in front of the scrutiny committee. But let me just say this, Llywydd: politicians don't sack public service employees in Wales. That is not the way that the system operates, and nor should it. Where things go wrong and where people make mistakes—and sometimes worse than mistakes—then there is an accountability system through professional organisations and employment law, and that needs to be effective. But we don't make those decisions on the floor of this Assembly—nor should we.

First Minister, there was an alarming number of deaths and a large number of patients suffering severe harm due to patient safety breaches in our NHS over the past 12 months. Two thirds of the deaths and 58 per cent of the severe harm occurred in Betsi Cadwaladr. I'm sure that you will agree with me that this is unacceptable. So, First Minister, what is wrong with the culture at this health board, which is being run by your Government? Do you accept that there is a problem in how our NHS operates, and will you now back Helen Mary's Bill to improve NHS accountability?

Well, Llywydd, the Member makes a fundamental mistake, I believe, in interpreting reports of serious incidents as evidence that this means that everything is going wrong. For years in this Assembly, we've had this debate. I remember it very well over the save 1000 Lives campaign, launched nearly a decade ago, where we have consistently said that we want a culture in the Welsh NHS that, if you see something that has gone wrong, then you report it and you make sure that you learn from that experience. It does not mean at all that those incidents have done actual harm. It means that the risk of harm has been identified. And, in a learning culture, people are encouraged to come forward, report it and get that known among their colleagues.

If, every time those figures are published, we have people saying, 'Oh, this means that people are in danger in the Welsh NHS,' all we will do is to persuade people not to take that course of action—exactly the opposite of the sort of culture that I think, across many parts of this Assembly, we have worked to try to engender. The fact that some health boards are better at it and have persuaded more people to buy into that culture should be a matter of commendation for them, not a matter of trying to say that they are the worst in the bunch. I want an NHS where people are confident that, if there are things that they want to bring to attention, they will know that that is a valued and rewarded part of the work that they do, and then, when we get figures that demonstrate that, we should all be willing to say that that is evidence of a learning organisation determined to make things better, not evidence of an organisation that's always getting things wrong.