The next item, therefore, is the statement by the Minister for Health and Social Services on an update on Cwm Taf Morgannwg University Health Board, and I call on the Minister to make his statement—Vaughan Gething. 

Diolch, Llywydd. In April, following publication of the royal colleges' report into maternity services at the former Cwm Taf University Health Board, I committed to updating Members on the interventions I had put in place to secure immediate and sustainable improvements. In addition to maternity services, this extended to improving the quality governance arrangements in place across the organisation as a whole. Earlier today I published the first quarterly update from the independent maternity services oversight panel that I established in April. This is a comprehensive report that sets out the extensive work the panel has overseen in the past months.

The Deputy Presiding Officer took the Chair.

I am encouraged to hear the health board have fully engaged in this process, in an open, honest and transparent way, and fully recognised the scale of the challenge that they face. This is a consistent message that I have heard from all parties, including regulators, about the health board’s engagement in the wide range of interventions that have been put into place. As an organisation, they are now showing that they're determined to learn and improve. They welcomed the supportive, and at times challenging, way in which the panel has engaged with them. It is positive to hear that the work to involve and engage women and families is developing at pace in particular. Equally, the feedback from women about their experience is improving, with high levels of satisfaction being reported significantly more often than not.

I'm sure that we will all be pleased to hear that there is early evidence of improvement across a number of the recommendations, and that the foundations for this are now in place, albeit initial progress was slower than the panel had hoped for. It was important for the panel in their first update to place a particular focus on seeking evidence, both written and observational, through their check-in visits with staff to be assured that the immediate 11 'make safe' recommendations from the royal colleges’ review are being embedded in practice. In addition, my officials continue to have weekly calls with the maternity leads at the health board, reviewing a core set of metrics including staffing levels, acuity and any clinical risk issues to ensure patient safety and that women are receiving a good experience, and this information is also shared with the panel.

So, today I have also published the panel’s clinical review strategy. One of the key responsibilities that I set for the panel was to design and deliver a plan to review past cases. This will initially extend to cases falling from January 2016 to the end of September 2018, as proposed by the royal colleges' report. However, it will not end there. The panel have advised me that they wanted to start with a clean-sheet approach and take every opportunity to maximise opportunities for learning. They have therefore agreed a broad criteria, over and above those already required to be reported to existing national review systems. This included reviewing information relating to around 350 cases in which either the mother or baby had needed to be transferred out of the local unit for care. From this extensive first look they have determined that, across the full criteria, approximately 150 cases should be covered by a multidisciplinary review. This includes the original 43 cases that had been identified by the health board. It is important to make clear that these are not all serious incidents. This does however underscore the independent panel’s determination to look at a comprehensive range of cases so that they can determine what has gone well, in addition to determining where this may not have been the case. It is important to learn from good practice as well as from failings in care.

All of these cases will have an independent multidisciplinary review. My officials are working closely with the appropriate royal colleges to identify additional teams to work with the panel to get this next stage under way as soon as possible. I do want to assure all women and families, whose care is being identified for review, that they will be contacted by the panel and be given the opportunity to contribute to the review if they wish to do so and to pose any questions that they may have. They will be supported to do so as is needed. I also want to confirm again that any family who have concerns about their care can self-refer to the panel to seek a review. This process needs to be done thoroughly and robustly, but it will clearly take some time, so I'm not setting any deadlines for completion.

I'm determined that women and families must be at the heart of all the work that is in train to take forward all aspects of the improvements needed. I'm grateful to the panel for meeting with families yesterday so they could hear at first-hand about the work to date and the next steps. Whilst I want to ensure the greatest transparency and engagement in the work, I also recognise that these updates may be distressing too. But I sincerely hope that a continued focus on improvement, to ensure the very highest standards of care are provided going forward, will offer some degree of comfort. I do, however, recognise the loss and heartbreak that many families will have suffered, and for that I am truly sorry.

I also recognise that this is a difficult and challenging time for the staff, and I do want to thank them for their continued commitment, day in, day out, to continuing to provide maternity services in the area.

The past months have required much soul-searching for the board. I have no doubt from my conversations with the chair, Marcus Longley, and David Jenkins, who I asked to provide support and advice to the board on its leadership and governance, that the board accepts the need to make fundamental change to their previous way of working. They have reflected that they were not sufficiently focused on understanding service quality, patient experience, or engaging with their staff. They fully appreciate the need to rebuild public, staff and stakeholder trust and confidence.

The board acknowledge that the arrangements they have in place for the management of concerns and incidents needs significant improvement. A number of work streams are already under way to improve leadership and culture, as well as their quality governance arrangements. These actions will undoubtedly be further informed by the findings and recommendations from the joint Healthcare Inspectorate Wales and Wales Audit Office quality governance review in the coming months.

Overall, I am encouraged that there are clear signs of improvement and, importantly, a strong desire and will to achieve it. There is, without doubt, a long journey ahead and we are not yet in any position to consider any change in the organisation's escalation status. I'm grateful to the panel for their contribution and initial assessment, and for the advice and support that David Jenkins has provided. I'm confident that the interventions that have been put in place are proving effective. This is very much down to their professionalism and their approach, together with the reflective approach adopted by the board. There is, however, much more to do to deliver and sustain the lasting improvement in maternity care that all of us would wish to see.

I'd like to thank you, Minister, for your statement today and also for the opportunity you afforded my staff members to receive a technical briefing on the report this morning. Of course, your statement is entitled 'Update on Cwm Taf Morgannwg University Health Board', and I appreciate that in the content you mainly focused on the progress report and the clinical review strategy, which indeed I will do—I have a number of questions just to ask you on it. However, I do want to put on record again how incredibly sorry we are that this has happened to these families in this health board. How incredibly sorry that they've had to go through not just the trauma of losing a child but now trying to put right that exercise. We will try to support you in whatever way we can to ensure that those parents get the answers and, indeed, the justice that they seek. So, I have to ask you this first question, which is: what reassurances, Minister, can you provide that the senior management involved at the time are held accountable for the failings within the health board, in light of the panel's clear statement that they are not there, rightly so, to establish who is to blame? That is a separate area and we'd be grateful for an update on that.

In terms of the clinical review strategy and the quarterly progress report—very interesting reading. The update states that the interim minimum staffing levels have been agreed with the health board. Minister, could you just explain what those levels are and do they meet any existing recognised minimum staff levels for this service? I know we are waiting for the publication of Birthrate Plus, which isn't until later this month, but can you tell us whether those minimum staffing levels are above Birthrate Plus, about what you anticipate it would be, or slightly below? Can you shed any light on that at all?

In the report, the authors say that they are seeking independent validation of the board's claims that 30 per cent of those initial recommendations have been fully embedded into the working practices of the board. How satisfied are you? What confidence can we have in the health board, that this panel have to go out and get that independent validation?

Despite feedback that's been sought from surveys and comments collected from social media, the update states that the data of all of this has not yet been fully analysed and that the themes that have been identified are not influencing yet the improvement, quality and safety of the maternity services. So, could you please clarify, Minister, whether that's because of a lack of allocated resources, or is there this ingrained cultural inertia still within the health board?

Are you able to give us a time frame for when the 150 identified cases will be reviewed, so that there's peace of mind to be given to the patients? You said yourself that the panel is taking on self-referrals, which I think, actually, is an incredibly positive and outreach way of trying to handle a very difficult situation. But can you clarify whether those 39 so far are in addition to, or included in, the 150? What extra resources are you able to give to ensure that these referrals are heard in a timely manner, because there's been an upturn in complaints, as you yourself have identified. Not all of them will be serious, but nonetheless there's obviously still concern and worry about this whole issue, so we obviously need those additional resources.

Finally, could I ask what training is being put into place to retrain people who may need that retraining? During the technical briefing your officials offered this morning, they talked about the fact that it was very evident that they could see an ebb and a flow in practice and outcomes. It's very identifiable who, perhaps, needs that extra hand, who needs that extra support. So, what steps have been put in place to ensure that specific front-line staff members have been given that additional support that they need to improve the way they deliver midwifery care to the mothers and families in this health board?

My final point is your issue No. 11: culture within the service. The report says it

'remains work in progress and is likely to do so for the foreseeable future'.

I totally understand that. They say

'it is unrealistic to expect that longstanding issues related to culture, attitudes and behaviours can be addressed within a few months.'

Of course they can't. Cultural change does take a long time to embed. However, we can't wait too long. We do not want to see this dragging on and on and on as a running sore, like we have seen running sores in other health boards over other issues. Are you able to give any sense of time frame as to when you might hope to see some of these changes embedded right into the culture of that health board, and, of course, not just in maternity services but, as the panel said in one of their witness statements to the Health, Social Care and Sport Committee, there's an indication that some of this malaise, if you like, runs in other areas within this health board, and we need to drill down to see whether it is a one-off just in maternity services or whether this is a systemic issue. And if it's a systemic issue, really we have to get on top of it. But I do commend you and your team for the work that you've done so far, but we cannot take our foot off the accelerator on this.

Thank you for the comments and questions. I'll try to deal with as many of them as I can. If there are things that are missed, then, obviously, at the end of this, I know I'll have an opportunity to go to committee, and Members will, of course, be free to, and I'm sure they will, contact me.

At the outset, and on the point you started with, I just want to speak about the continuing commitment to families to continue being engaged with improvement. Lots of families have come forward since the report and since the work has started, in particular the engagement work. That has led to an increase in complaints, as you'd expect, and that's part of the reason why there's a challenge with the complaints function, but, actually, that's a complaints process that wasn't functioning as effectively as it should do, and the interim chief executive has recognised that, in terms of one of your points about resources into complaints. But I do want to thank again all those families who are not just engaged in wanting an answer for what went wrong, potentially, with their care, but also want to make a more general improvement, because some of these families may have children again, but some of them also, in a very selfless way, just want to make sure they're part of improving the whole service so other families don't go through what they've gone through. And that is quite an altruistic thing to do and a difficult thing to do, given the experiences they're having to go through again.

On your point about senior managers' accountability, at the outset, and again today, I made it clear and the panel are clear that it isn't their job to go and find people who are responsible, from the staff side. What they are also clear about—and they've had a joint meeting with the two regulators, the NMC, the Nursing and Midwifery Council, and the GMC, the General Medical Council—is that, if they do find issues in the clinical reviews that are undertaken that should be reported to professional or regulatory bodies for further investigation, then they will do so. But it's not their job to go looking for that. But, as they go through the reviews, if they find evidence of it, then they will make the referrals that are necessary. Obviously, if that happens, then they'll be reporting back publicly about what referrals have or haven't been made in terms of the numbers.

On your point about staff levels, in terms of the minimum staff levels, they're working towards doing that. Because there has been recruitment into the unit at the doctor level. Some people have left. In terms of the leadership, there's a new medical director, who has been in post for about two months. There's a new clinical director in the service, who has been in post for less than a month. And, when it comes to the midwifery numbers, I can't give you an indication, because I think that that would be the wrong thing to do until the Birthrate Plus assessment is made. That will give us a proper understanding of how staffed up the unit is.

Now, the health board—. Part of the challenge previously was—. The information provided announced their willingness to actively recruit to all of the vacancies. They're very clear about doing that now. They've done rather better on early recruitment. So, within the next few weeks, we'll have the Birthrate Plus assessment, and I'll make sure that the output of that is made available to Members generally. So, rather that me going on the fly today, I think, if you wait another few weeks, then everyone will have something that they can rely on in terms of the figures.

On the 11 'make safe' recommendations made in the royal colleges' review, eight of the 11 have been at the stage where the independent panel say that they've been achieved; three are still a work in progress. They're, to a large extent, about staffing and about the ability to embed change. So, they recognise that, in each of those areas, progress has been made, but they want the reassurance that it's been there over a longer period of time before they say that they've been achieved, and I think that that's the right approach to take.

I'll come back to one of those in particular that relates to another one of your questions. On the time frame for reviews, the panel themselves indicate that they expect those reviews to start next month—for the reviews to actually start. They're not giving, and I'm not giving, any kind of timeline for when those reviews end. They'll do them in batches, so they won't all get all held up to the last one being done. They'll be done in batches, and we have got to work with other royal colleges to provide independent staff to do them. Because it won't just be the college of obstetrics and gynaecology and the college of midwives that will have their members needing to be there—some of them, the care will be wider and we'll need to have other people involved in the reviews as well. And I think that it's important that they're done right, rather than done quickly. I understand that the Member and others will ask me to try and provide a time frame, but I think that it's the wrong thing to do. It's much more important that they're done properly, and that families, as I say, have the opportunity to be involved.

In terms of the self-referral in, that's a self-referral for an assessment. It doesn't mean that everyone who has a concern will need to undergo a full clinical review. But I think that the assurance for members of the public who are concerned is that the panel will be involved in that assessment. So, it won't be the health board deciding for them whether they need a full review or not. The panel will be engaged within that as well. So, we'll have that independence from the panel about whether a full review or not is required, but they will have the opportunity to be supported in doing so.

In terms of when the intervention will end, well, again, there'll be quarterly reports on the general improvements provided through the independent panel. I've committed to publishing those on the escalation status. You will know that there's a long-running process where we consider the escalation of every organisation. And it's when the organisation itself has made the requisite improvement that that status will change. So, some of this will be longer term, and that's the same about the cultural change that's highlighted in the report as well. I don't think that it'd be reasonable to expect all of that cultural change to have taken place. It is a work in progress. The ebb and flow you're describing is what we'd expect to see in any, not just public service, but any private sector business where you need to make a significant cultural change with your staff. So, that will need to carry on, not just in midwifery but in the medical service as well. It's not just a change at one point in time, but something that is actually within the culture of the organisation and expectations of staff of each other, and indeed the way that they treat and work with the public.  

I thank the Minister for his update on the situation at Cwm Taf. You will be aware that the health committee is also scrutinising events in Cwm Taf, because this is a very grave issue. Babies have died. Families have been torn to pieces. This report today is, of course, of huge concern. Five months since the vote of no confidence in the health Minister, ensuring that maternity services in Cwm Taf are safe still hasn’t happened. Families have the right to expect services that are, above all, safe, but are also effective and efficient and well managed. With the health board in special measures, the health Minister should ensure as a matter of urgency that improvements are made. The Minister says that he is content that people have accepted the need for change. Now, with all due respect, that simply isn’t enough; Plaid Cymru and the families called for change five months ago. What has he been doing since May?

Talking about improvements is not what’s necessary now—we need action. The health board has a huge job of work to do and, on such an important issue, particularly when these services are directly overseen by the health Minister, he must pull up his sleeves rather than sitting back and expecting improvements to be made without him. This report today says that feedback from staff and patients suggests, and I quote:

'There remains a need to change the underlying culture and values so shockingly revealed in the Listening to Women and Families report'.

Yes, it was hugely shocking that such things happened, and we need urgent action. We cannot be content that things are only now starting to change and say there is a long way to go. We need action as a matter of urgency. And, as you’ve mentioned, three of the 11 urgent recommendations by the royal colleges have yet to be implemented—the review of safe staffing levels in maternity services; the health board isn’t content that staff exercise safety guidance adequately; and a change of culture will take a long time. Yes, that may be the case, but cultures can be changed and it needs to be changed as a matter of urgency, because families in Cwm Taf have suffered dreadfully over many years and continue to suffer. The death of a baby is an appalling event for any family. So, what are you doing to hasten the necessary improvements in maternity services in Cwm Taf? 

I think there were two broad questions in the comments made by the Member. The first was about the rapidity of the change that has taken place to date and I think the second was broadly what I'm doing myself. On the three of the 11 'make safe' recommendations that were made, the panel have been really clear about the fact that work is in progress in each of those areas. It is not the case that nothing has happened in any of those, and, actually, if I'd stood up today and said that the cultural change required has taken place, then people in this Chamber and outside it would not believe me and nor should they. I know from my own experience outside of life in this place that, if you're looking to deliver significant cultural change in any workplace, it is not something that happens rapidly and it is not something that happens by demanding that it takes place. You have to bring people with you. And this is difficult. You have to be honest. This is difficult for people—[Interruption.] This is difficult for people working with each other in delivering that cultural change in the way they've worked in the past, and we need to take people with us to make sure the service is not just delivering and saying, 'Look, the right sort of things are happening now', but that that change is embedded and is sustainable. So, I think for me to try to say today that, 'Actually, there's enough progress made in each of those areas and everything is fine' would absolutely not have been the right thing to do.

And the same point—when I met the panel yesterday, they made the point that, on the implementation of protocols, they were clear there was much greater awareness and adherence to all of those protocols, which is one of the real problem issues identified in the royal colleges' report, but they wanted to see that adherence carry on for a longer period of time before they signed off that that change had been achieved rather than being a work in progress. And I think that's the honesty that all of us should want to have from the panel and from me as well rather than—. The convenience factor for me would be to say that everything is achieved, but I need to be able to look myself in the mirror, as well as, when I meet families at the end of this year, to look at them in the face and say that we're doing the right thing and being honest about this.

And that comes back to what I'm doing: I've been really clear in my expectations in public and in meeting the panel that the most important thing is to do this properly. The most important thing is to deliver the improvements. So, we are providing all of the resources that we could and should do to make sure that the clinical review process takes place with the appropriate expertise that is required, with the additional resourcing that it'll require to make that happen, and, in addition, the clarity and expectation in the work that's being done, and that additional scrutiny is taking place, not just with the board, but with other stakeholders too.

In all of the other parts of ministerial life, the other factors and challenges at the moment, I can honestly say this is one of my very top priorities and one of the biggest calls on my time, as it should be. So, there's no lack of understanding, there's no lack of ministerial effort or engagement. But what I won't do is to say that I can, and will, deliver change faster than anyone should believe is possible at the expense of actually doing the right thing by all those families and those staff who, understandably, have been let down in the past, and to make sure they're not let down in the future.

Can I thank you, Minister, for your statement? And, at this point, can I once again put on record my condolences and thoughts with the families who were affected by the failings in this health board and have had to live with those tragedies since then? Can I also repeat the thanks to the members of the independent maternity oversight panel for their work, and, in particular, Mick Giannasi, who gave me several hours of his time at Prince Charles Hospital when I had the opportunity to talk to him directly about the work of the oversight panel and see at first hand some of the things that were being put into place, including talking to some of the staff and some of the new managers who were there? So, I was very grateful to him for having the opportunity to do that.

I was also pleased to attend the briefing this morning that you facilitated with the oversight panel, together with my colleague Vikki Howells, and we had the opportunity to directly ask the oversight panel questions at that briefing. What I would say is, unlike some of the comments that I've heard this afternoon, I see this slightly differently in terms of what I've seen, what I've heard and what I've experienced in talking to some of the staff and patients. And I do take some reassurance from the thorough work that the panel has now put in progress and as a result of your intervention, although no-one, as you've said, and as others have indicated, should underestimate the challenges that still lie ahead. Indeed, one of the things we heard from the briefing this morning was that, following the inquiry into the Morecambe Bay maternity services, it took some six years from the point at which Morecambe Bay went into special measures to the time that they were considered to be a good unit. And that unit now is actually seen as an exemplar of maternity provision. So, I think the point I'm making here is that anybody who thinks that there is a quick fix to this is clearly not on top of the brief in terms of what needs to be done. There are no quick and easy solutions, it seems to me.

However, I'm sure that you would agree that the experience of women and families must remain at the heart of this improvement journey. So, to that extent, the response to the 11 'make safe' recommendations so far is encouraging, though, as you've already indicated, there clearly is much more to do. Now, I note that the number of cases in the clinical review has been extended as the criteria of the panel has been broadened, to ensure that all appropriate lessons can be drawn from the process. While that is something that I welcome, I will await the expert evidence from those reviews before making any detailed comment on them. But I am encouraged to hear about signs of improved performance as a result of the changes already in place.

Now, Minister, you've talked a lot about resourcing, but, as the work has to be centred on improving the experience of women using this service, can you assure us that you will continue to provide the resources that are required to support the work with those women and families who wish to continue to be involved with this review?

And, finally, do you agree with me that, if we are to achieve some of the cultural changes that clearly are needed, we must create an environment in which people, staff, feel confident about speaking up and speaking out without fear or favour about poor practice and poor behaviour? Because, for too long, doing that has been a career-ending decision for too many staff. And, if we are to see that cultural change, people have to feel secure in the knowledge that they can make those concerns known to the highest levels of the authority without fearing for their own careers in the process.

Thank you for the comments and the questions that you've asked. In terms of your first point about there being no quick fix, that is absolutely right, and I just need to be honest with people about that at the outset, as I have been in the first statement today as well, rather than suggesting that there will be a point of political convenience that will drive what happens, rather than doing the right thing by the service and honestly reporting the level of progress that has been made, as well as that that is still required. Again, I'm happy to reiterate that women and families will be at the centre of the work that is being done in the engagement work that is being led initially by Cath Broderick, and now the health board are taking a greater lead on, as they should do. In taking that forward, there are going to be three public-facing events—one in Merthyr, one in Llantrisant within the next six weeks or so, and then one in the new year in Bridgend, so that the health board will try to co-produce their future strategy with women and families to try to make sure that there isn't a disengagement between the service and the people using it. 

The improvements are real that the panel set out, but they're not even, and we're not in a state of perfection. In any human service, there is always room for error, even in a good service. But I wouldn't try to pretend that people won't have things come to their postbag that are more recent, where there are reasons to go back to the health board. I wouldn't try to say that to anybody. But it is, nevertheless, true that it is in a better place now than it was before the intervention had started. My ambition is to see that improvement carry on and on and on, because I don't want to hear continued, justified complaints being made about the quality of care and the experience of women and their families in any of these services.

That's why I can confirm that there will be future resources to support women and families who are engaged in this. There are the resources in the support services that are often provided by the third sector. So, for example, the Snowdrop support group and the Sands service, again, are available to families to make use of, and what I think is a very helpful 'frequently answered questions' sheet that the panel have produced for the public that sets out how to get in touch with them. But, in addition, if women and families need to be supported in engaging with the panel on some of the review work, then we'll look to see how we actually properly facilitate that to make sure they're supported. And, obviously, the community health council are engaged in doing that work as well. 

On your final point on supporting people to speak up, that's part of the culture change we need to see happen, to move away from a punitive culture, where people feel that if they step outside, either with their managers, or in a prevailing group of opinion with their peers in work—that people feel punished in their day to day work—and that, actually, we do move to being a learning organisation, where people recognise where things go wrong, as well as recognising excellence, to be able to point that out and to talk about it in a learning environment. And that's part of the reason why I'm really clear the panel can't have a role in saying 'It's your job to go and find people who are responsible', because, actually, that will turn it into a blame culture. It will reinforce a punitive culture, rather than moving on to being a genuine learning environment, where people are supported to point out when things go wrong, to hold their hands up for themselves when things go wrong, to make the improvements that all of us want to us to see in a real and sustained way. 

Thank you for your statement, Minister, and your earlier written statement. May I too offer my condolences to all those families affected? I welcome the steps being taken to make maternity services in Cwm Taf Morgannwg University Health Board safe, but there must be accountability, because families have suffered unimaginable grief. The fact that, as the independent review states, there is a very long way to go is of great concern to my constituents who became part of the health board earlier this year. Of course, we also have the huge problem of restoring public faith in the service. Unfortunately, solving this issue will be one of the biggest challenges. We need action and change, and we need it sooner rather than later. Minister, how will you address the concerns of future parents in the Bridgend area about maternity services now that they come under the Cwm Taf health board?

Whilst I understand the changes will take time, and progress is being made, my constituents will be rightly concerned for their safety, and the safety of their babies. Minister, will neighbouring health boards be called upon to support maternity services in Cwm Taf to alleviate the fears of expectant mothers, who will be concerned that services are still unsafe? I note from your statement that your officials have weekly calls with the maternity leads at the health board to review metrics. Given the criticism from the outgoing chair of ABMU, who stated that weekly calls from Welsh Government were hampering improvements, Minister, are you satisfied that Welsh Government officials are not hampering improvement efforts at Cwm Taf?

And finally, Minister, given the failings of Cwm Taf, ABMU and Betsi, many people are calling for a wide-ranging inquiry into the NHS in Wales. Are you satisfied that the current structures are fit for purpose, and how will you ensure that no other systemic failures materialise at this or any other health board? Diolch yn fawr.

On your final point about a wide-ranging review of the whole structure of the health service, of course, we had an independent parliamentary review at the start of this Assembly term, and they indicated that the structure of the health service in Wales makes sense. They were very clear that they did not recommend a wide-ranging structural review and turning the apple cart upside down. It's often attractive for a politician to say the answer is to reorganise the structure of a service, and there are times when it does need to take place. But we've just had an independent review that says that is not the right thing to do. And of course we've seen the challenges in a wholesale restructure across our border, where, regardless of your view on the Lansley changes, there has been a significant amount of churn within the English system. I don't think that is something that I would recommend or be prepared to impose upon the service here in Wales.

In terms of your point about whether the Welsh Government is hampering the improvement, given that we've put maternity services in the former Cwm Taf area into special measures—and the whole organisation is in targeted intervention—it would be extraordinary if there wasn't regular interaction between Welsh Government officials and the service. It's part of the point about the whole escalation status and what it means: the further up you go, the more interaction, the more oversight, the more scrutiny you can expect from Welsh Government. And if I were to say, 'Actually, I'm taking a light-touch approach to improvement', then I think Members in this place would quite rightly question what on earth I'm doing and why my officials aren't in more regular contact. We heard the exact opposite point, of course, made in Dai Lloyd's contribution. He wanted to see even greater intervention and forcing the pace more. I've been really clear about the approach we're taking—I think it's the right one. So, those weekly calls will continue until we're clear that the service is on a more sustained improvement trajectory.

On neighbouring health boards and support, it's true that neighbouring health boards are supporting the service in Cwm Taf Morgannwg. The heads of midwifery meet as a group and they look at service issues in a very collective way. That's been really positive—and the proactive offers of help that have been provided, and the way in which recruitment issues have been dealt with around the service, to try to make sure that the service wasn't capsized by taking people out of the Cwm Taf area. But more broadly, it's about supporting people to make their choices, because some people have made a choice, saying they don't wish to attend a birth centre in the former Cwm Taf area, and that choice has been made available to them. It's important that people are supported in making those choices and start that conversation with their local community midwife. But that's been important in the way that neighbouring services have happened.

Bridgend is not in the same position as the former Cwm Taf area, it is not in special measures for the maternity service there. We've had a recent interaction with Healthcare Inspectorate Wales; there has been no suggestion that that's a required action for that part of the Cwm Taf Morgannwg area. So, I want to provide that reassurance to people who are going to give birth in the Bridgend area—they do not need to have any concerns on the level of improvement that is required in the former Cwm Taf area. But of course, every part of our service has the opportunity to reconsider what's happened, to reconsider what improvement it could still make in its own services.

Thank you. We've had all the major spokespeople now on this statement, and I have still a number of Members who wish to contribute. So, can I ask the remaining speakers now if they would just do a brief introduction to their one question, please? David Melding.

Thank you, Deputy Presiding Officer. It's quite simple what we need to know: when do you expect maternity services in Cwm Taf to be safe—not good, not excellent, not sector leading—when will they be safe? This report says there's a very long way to go. And, frankly, I find your approach remarkably passive. You've sat on your hands, you did nothing about the chief executive—you waited for her to resign. You calmly now tell us that you think the board that was unable to oversee the performance of this health board and the services they provide is the one to get us out of trouble, and the only thing you've done about that side of the senior management is send David Jenkins in there to keep an eye on things. I think we need better than this, frankly. We still, according to this report, have problems with the complaints process and responding to complaints. The culture still needs to improve dramatically, staff are not confident and neither are patients. Guidelines and protocols are not yet adequately embedded. What sort of training scheme is going on? How long is this going to last where we are providing health services that are not in accordance with protocols and guidelines? And in terms of the current progress on the improvement plan, I just read from the report that from the beginning of July, the pace of progress has started to falter. Minister, you need to take some responsibility here, because the one thing that hasn't happened is that we've had leadership and energy from you.

Well, I completely reject the accusation made by David Melding. He's regularly urbane and reasonable as opposed to the rather temperature-raising approach he's taken today. I have intervened in the health board. I have set in train a proper process of independent scrutiny and oversight for that improvement, and I will continue to be honest with people about the level of improvement made and the actions still required. If you look at what the panel themselves say about the progress made, they themselves are honest about the areas where progress has been made and is embedded and the areas where progress has been made but it is not yet at the point when they are prepared to sign off to say that that is progress that has been embedded. They're also clear about the work that is ongoing every day to provide assurance about the safety of the service. I'm not going to give a free pass to anyone in the health service to sit back and allow things to wash over them; I've taken action, I've been clear about what that is and I will continue to report back honestly and openly about the progress made to date. And if any further support is required, that is the point about having an independent panel to make clear what is required, as well as the interaction of my officials, and I will continue to act to safeguard the service.

Minister, thank you for your update today. My question is around the issue of cultural change. We all know that cultural change is something that's very, very difficult to implement, but it's so important and underpins all the work that needs to be done to put Cwm Taf maternity services on a safe and sustainable footing. The oversight panel began their work in May of this year, and I know that they are currently looking back over historic cases of concern, but if cases of concern are brought forward by families relating to the period after May of this year, will the panel be made aware of these, or will they just be dealt with in-house by the health board? I ask this because it is absolutely imperative that we see evidence of culture change, and I am concerned that any potential new cases, which may indicate a continuation of some of the cultural issues we have seen previously, absolutely must be examined if we are to be confident that this cultural change really is happening on the ground. 

I'm happy to deal with that. You're right about the length of time that cultural change takes—not just to take place, but to be sustained and embedded within the service. It's important to note that the normal complaints process should still continue, so 'Putting Things Right' is still the first point of access and people can be supported by the community health council in making those complaints as usual. However, if families do want to refer in to the independent review process, then they can do so. As I said in my statement, the panel will be involved in determining whether those cases do need to have an independent review or not. So, it's not simply the case that people will need to only and uniquely deal with the health board; if they have concerns in this area, they can refer in and the panel will be involved in determining whether a full clinical review is required or not. 

My thoughts also go out to all the families who've suffered deep and enduring loss. Could I add to the comments that were made by my colleague Dawn Bowden on the issue of the ability to encourage and support whistleblowers on the front line, but also to encourage people to speak out at board level as well? Because it does seem to me that one of the failures here was the lack of confidence to challenge at board level and the lack of information put in front of that board. And I'd appreciate his thoughts, bearing in mind the progress that has been reported, but also the need for fundamental change at board level, as to whether we are now confident that board members are confident to challenge, to ask questions, to contradict, because that is also a point of failure here and we need to challenge that. Is he confident that the board is now fundamentally changing in that way?

If you look back to the initial royal colleges review, they recognise that information presented to the board was not always the full picture. It's one of the big challenges that face the organisation. The phrase that the board received false assurance was a real concern for me when reading that report. When I said in my statement there has been lots of soul-searching at board level, there really has. People really have taken very seriously and very much to heart what has happened on their watch and their responsibility for putting it right.

The work that David Jenkins has done is important in both not just advising the board, but providing a different level of assurance to me about the change in the board's behaviour and approach. So, they are already more challenging, they are already seeking further information and they're being very clear in wanting to have more independent members involved in different parts of the work of the board, as well as in reorganising their quality, safety and risk function, as well. These may sound, occasionally, as if they are simply moving pieces around, but it actually really matters about how an organisation works and functions. Actually, for Members here, I think David Jenkins has been invited and has accepted an invitation to go to the health committee so that people have an opportunity to question him directly about the behaviours he's seen and the move on that has plainly been required from the way they had previously worked.

Thank you very much, Minister.