Part of the debate – in the Senedd at 5:10 pm on 15 October 2019.
I thank you, Minister, for a copy of your statement in advance. I was very interested to hear your references to the success of the integrated medium-term planning system. I know that, certainly in terms of a number of NHS organisations, they have been living within their means and they were successful in developing three-year medium-term plans that seem to have been largely on track. But, of course, that can't be said for a number of health boards, which, unfortunately, are not yet in a three-year planning time frame, and, of course, those include the Betsi Cadwaladr University Health Board, the Hywel Dda health board and the Swansea Bay University Health Board, none of which have had any integrated medium-term plans actually agreed.
That concerns me, because, obviously, we're a number of years away from the point at which the legislation giving them a statutory duty to have those plans in place was introduced, and, of course, certainly in the case of two of those health boards, they are spending significantly beyond their means and have been for a number of years. I think that it is necessary to look at the capability of some of those health boards to actually meet the financial challenges that they face. I know that you put some additional resources into Hywel Dda a number of years back, and that was extremely welcome, I think, because there was a structural deficit that that organisation inherited when it was founded. I think the same can probably be said, actually, about the Betsi Cadwaladr University Health Board, and perhaps you could tell us whether you're considering taking a similar view in terms of the structural deficit that I believe underlies the Betsi Cadawaladr health board's finances to see whether there is something that can be done from the Welsh Government's side in order to assist that health board so that it can not completely switch off from making proper financial judgments, but that it can focus perhaps more on some of the performance issues that also are besieging that particular health board in question.
You made reference to the fact that there's no statutory duty on some of those other NHS organisations that have been developing their own plans, including NWIS, WHSSC and the Emergency Ambulance Services Committee. I think it's very commendable that they are working in the same planning framework as the other NHS organisations, but perhaps you can tell us whether you will have plans at some point in the future in order to bring a statutory responsibility onto those other NHS organisations that aren't boards or trusts, because I think it may be useful, actually, in getting this NHS-wide approach, so that everybody's working in concert.
Now, I know that, clearly, there are still many challenges ahead. Obviously, I've looked at the priorities that you've got set out in your planning framework, going forward. You touched on workforce earlier on, and, of course, there are huge challenges in terms of making sure that we've got a workforce that can meet the demands being placed upon it across the country. I wonder if you could give us a little bit more detail about the work that Health Education Improvement Wales is actually doing, and how that ties in with the work of individual health boards to make sure that they are working together to address these issues more widely.
Capital and estates, of course, are very important in terms of being able to deliver improvements in healthcare, and one of the concerns regularly raised with me when I visit different health boards across the country has been the delay in decision making over estates. Now, I know we've got a finite sum that we can invest in capital infrastructure, but, clearly, if many of the improvements in healthcare are absolutely linked to investment in estates, then I think it's only right and proper that people are able to get on and crack on with investing in new buildings, or extensions, or refurbished buildings in order to make those things happen. Perhaps you could tell us what work the Welsh Government is doing in order to improve its decision making on capital, going forward, so that we can get decisions out more quickly.
In addition, you made reference in your document to timely access to care, which, of course, is very, very important to patients across Wales, as is equality of access in all parts of Wales. Now, one thing that we do know is that performance from one health board to the next can be very significantly different, and I would like to know to what extent within those three-year plans, those intermediate plans, you are expecting to see some levelling up, if you like, to the best performance across Wales, and how you're expecting those plans to actually show progression towards a levelling up, so that we're not losing out on momentum for improvement going forward.
Just finally, if I may, one final question, and that is about the diploma in healthcare planning. I'm very pleased to see that going forward. Obviously it's important that people are able to access that diploma and training in that diploma in all parts of Wales. Can you tell us whether that is going to be possible, to make sure that people are able to do these things alongside their day job, as very often that can be quite difficult? What resources are you making available to encourage people to take up that opportunity to be trained in that way? Thank you.