Questions now from the party spokespeople. The Conservative spokesperson, Angela Burns. 

Diolch, Presiding Officer. Minister, you'll be very familiar with the core principles of NHS Wales, and I'm sure that, like me, you will have read the various mission statements and heard the aims being promoted by health boards. Ambitions such as putting people at the heart of everything we do, and caring for people, keeping people well, and my personal favourite and the new mantra that's often quoted at me now is 'to be kind'. And the principles themselves make much of putting patients and users of the service first, then learning from experience, and so on.

My constituent, Georgina, was scheduled for an urgent spinal operation in January of this year. Without it, her spine would deteriorate to such an extent that her temporary paralysis would become permanent. From January, Georgina's operation was cancelled five times by Swansea Bay University Health Board, until we had a result last week, and a result pretty much because members of my staff camped on the door of that hospital. Not only was the quality of her life going forward compromised, but, and I'm now quoting directly from a letter from a consultant who says,

'I regret to inform you that the situation with access to spinal surgery in Swansea is creating such delays that I am witnessing people coming to harm. These cases have been appropriately reported as they occur.'

This is deeply concerning, Minister, for clinical safety. I don't think this is a service that adheres to the principles and mission statements often touted by NHS Wales and our health boards. Do you?

Well, obviously, I'm not aware of the individual circumstances the Member has referred to, but I wouldn't try to defend five cancellations for serious surgery. I'd want to understand what's happened and why. And, in each of these cases where our system doesn't deliver the outcomes in the timely manner that we'd want, there is always learning for what to do in the future, as well as a need to reflect back to that person and be honest about the fact that they haven't had the care or support that we would want them to have. But if the Member wants to write to me with more specific details, I'll happily look at it in more detail to understand what has happened in this case, as well as what that tells us in the future. And of course I'm concerned that an individual clinician says that people are coming to harm. 

Minister, my constituent, Mr Chell, was 91 years old. He fell in St Non's ward, which is situated opposite the main Withybush hospital, and, for those of you who may not know, the distance would be roughly the same from this Chamber to the fifth floor of Tŷ Hywel. Poor Mr Chell, already unwell and very frail, with the added complications of three fractures of the hip, waited on the floor of St Non's ward for five hours until an ambulance came to transport him the 380 yards to Withybush. Mr Chell was then forced to wait in the ambulance for a further two hours because of delays with ambulance handovers. Now, following a freedom of information request, I found out that, at the same time that poor Mr Chell was trying to get to Withybush, there were 13 ambulances waiting to offload at Withybush. I don't think that this is a service that adheres to the principles and mission statements often touted by that particular health board, and by NHS Wales. What do you say to Mr Chell's family, and do you think that this is acceptable service?

Again, I can't obviously comment on an individual case that I haven't heard about before. But, again, I'm not going to try and defend what doesn't sound like appropriate care and what doesn't sound like the sort of experience or outcome that any of us would want to have. I'm interested in understanding the individual's circumstances and what that tells us about the whole system. And, as you know, it is entirely possible to have a very poor experience, and yet the system overall delivers high-quality care the overwhelming majority of the time. We know from the national survey that most people's experience of the health service, in hospital or in primary care, much more than 90 per cent of the time, is a very positive one. That does not mean that we ignore those cases where that doesn't happen, and it does not mean we ignore the pressure within our system, and, of course, our responsibility to improve that.

Minister, I've been an Assembly Member for 12 and a half years, and in that 12 and a half years I've had a pretty good life, actually. But one of my constituents—and you know her—Ayla Haines, in 12 and a half years has been treated more like a prisoner than a person in need of healthcare. She was a young lady when I first met her—she was 17 years old. She's now 25. She's in a secure unit in Northampton. She was sent there in 2016 to get her off her medications. Since she has been up there, her health has deteriorated. She is self-harming, she is losing weight, she has been assaulted, so she's fighting back, so now she's an assaulter as well as an assaulted. Staff know that she has OCD, for example, but tell her to hurry up and try to stop her from the middle of doing a routine, so she then gets worse. She's losing weight, she's on worse medication and tougher medication than she was on when she went there. Her physical being is being compromised.

But what really, really, really gets me, and why I've brought this to you today, is because I cannot, after 12 and a half years, get anybody to admit to saying, 'This problem, this girl, is on my desk and I'm going to sort out her issue.' I've written to you, the Welsh Health Specialised Services Committee, Hywel Dda University Health Board—all of them: 'Not my problem, not my problem, not my problem'. You, thankfully—thank you—have finally said her placement in Northampton is under the direct oversight of Hywel Dda health board. Right. Meetings are held; nobody from Wales goes, nobody from the health board goes, her advocate doesn't go, her parents aren't allowed to go—they've been marginalised. That girl's mental health, frail then, is even worse now, because she's over 200 miles away from her support network. Her family are not very wealthy, they live in Llansteffan, they cannot afford to go up there and see her. By the way, they're not allowed to, because they're told by Northampton that her telephone calls are monitored, they're cancelled at short notice, they're not allowed visits, they've got to be supervised. This girl is being driven into a small hole.

I don't know, clinically, what's wrong with her, but what I do know is that nobody here in Wales is actually taking the responsibility for monitoring that, for oversight, to make sure that she's constantly in the right place, being seen, with the right treatment, by the right people. Everyone's washed their hands of her—she's hundreds of miles away, she doesn't matter anymore. But she does matter—she matters to me, because I think of her most weeks. You said the other day, on television, that it keeps you awake at night, wondering about the waiting times for certain things. Well, Ayla Haines keeps me awake at night. She's 25; how many more years is she going to spend there? And all I want is one person in Wales who says, 'She is my job. I'm just going to check that she is having the best possible treatment'. The lack of accountability, the lack of responsibility—. And I'll tell you what it is: it's the consequence of being one. If you've got a big problem, like we have in Cwm Taf—task and finish groups, ad infinitum. But, as one poor person, there's no-one who'll actually advocate for them. Please, Minister, will you look at this? These health boards spend all their time telling us that they put people at the centre of what they do. But again, and again, and again, and again, they fail. That's three failures—everybody here will be able to tell you of more. At some point, we've got to hold these people to account. That's your job—please do so.

Well, I think it was unfortunate in the reference to Cwm Taf, because we're dealing with a system failure there with real individual harm it's caused, and we're looking at it at a system level. There's never been an incident where I've tried to say that the healthcare system does not have responsibility to individuals throughout it, and I expect our system to be able to deal with those.

In the figures that I referred to earlier, about satisfaction with the health service, those themselves don't say that every single person says that every single interaction has left them satisfied. There is always learning in where things go wrong. And in the individual case that you referred to, again, you know that I can't comment on it. I am, of course, interested in every single person who has cause to complain and cause for concern about the health service. But it does not matter whether they are physically being treated or cared for in England or within Wales. I expect people who commission and have responsibility for that care to maintain their interest in the quality of the care that's being provided as well, because a number of the statements you've made today are of real concern, about the quality of care and about what the relevant inspectorates both here and in England should be interested in, given the seriousness that you've outlined.

I will check through my office about the interest that the health board continues to take and the responses to the concerns being raised by your constituent, her family and her advocates. I recognise that I have responsibility for the whole system, both the good and the part that needs improving. I don't walk away from that, and I'll certainly take up the individual matters. I'd be grateful if you could raise all three of them in writing with me and I'll make sure that they are dealt with.   

The Plaid Cymru spokesperson, Helen Mary Jones.  

Diolch yn fawr, Llywydd. I'd like to take the Minister back again to the situation in Cwm Taf. I am aware, of course, that a further statement was made to this Assembly a fortnight ago—I think it was a fortnight ago. Unfortunately, I wasn't able to be present then, but I have had the opportunity to read the Record. And I do accept, as the Minister said in his response to the remarks of my colleague Dr Dai Lloyd, that it isn't possible to entirely transform a culture in a matter of months, but I wonder if the Minister will accept that it's very difficult for people to understand why a service can't be made safe within six months. And can the Minister tell us today when he expects to be able to reassure the people of Merthyr Tydfil and the surrounding areas that that service is safe? 

Well, I've set out a process of intervention to provide the appropriate reassurance that everyone would want to have, whether they live within the Cwm Taf area or not, about the safety and the prospects for the future of that service, and I've set out not just the independent oversight panel, but the work being done around the board. And I will make statements when I'm in a position to do so. It's really important that I don't give artificial timelines that are about the convenience for me, rather than actually providing the robust reassurance that people would expect and want to see. There's regular engagement that is ongoing between officials and the Government and the health board and between the oversight panel, and, with their next quarterly report, we'll have a view of what's happened within the last quarter as well. That's the honest and objective process set up and it's the one that I'll stick to. 

I accept what the Minister says, of course, about not wanting to create artificial timelines, but I certainly know that if I was a woman of child-bearing age living in that region, I would want to know that there was a timeline and that at some point I could expect that service to be safe. 

I've received representations, and I know that other colleagues have, suggesting to me—well, proving to me—that the cultural issues, which again I accept can't be changed overnight, in Cwm Taf extend well beyond maternity services. I recently met a family who gave me evidence of grave issues regarding the treatment of both of their elderly parents separately in different parts of the Cwm Taf service over a period of a couple of years. Now, these issues raise similar themes as to some of the issues around women's experiences in the maternity service—issues around lack of respect, around not listening to patients and their families, lack of basic care, like supporting eating and drinking for older people. This family then went on to have a very unsatisfactory experience, again similar to some of those who used maternity services, of the complaints procedure. Can I ask the Minister today whether his current interventions that he has put in place in Cwm Taf will pick up wider concerns like these about culture within the organisation beyond maternity services? And does he accept that there may be a need for him to extend his intervention if such issues are made public? 

In terms of the work that's already being done, you will no doubt have read the comments made by not just the independent oversight panel, but they do extend and they do recognise the more broad improvements that are being made under the leadership of the interim chief executive, and that change in culture is taking place at board level, from the reports provided by David Jenkins. I'm not sure if he's actually given his evidence yet to the health committee. If he hasn't, then I know that's imminent. And you'll understand that there is a real recognition that they need to look across the services provided to reassure themselves at board level that the work they are doing to put right, in particular, challenges in the complaints function actually addresses also the culture and the provision of the service. That's both for staff within the system as well as the people that they care for. 

Now, I'm not going to give a hostage to fortune about what may or may not happen in the future. I am, of course, guided and make judgments based on advice, advice given by officials, but also about the tripartite process, along with the chief executive of NHS Wales, Healthcare Inspectorate Wales and the Wales Audit Office. If new issues come to light that require further intervention, then I will do that. If those issues do not require further intervention, but still require improvement, I expect that improvement to take place without the need for direct Government intervention.

I'm grateful to the Minister for his response and I'm glad that he mentions the health board himself. I don't know if the Minister has had an opportunity to review the proceedings of last week's health committee, but I can't be the only person who was shocked by some of what David Jenkins, the independent adviser, had to say about the state of the local health board. He was very clear that the scrutiny was profoundly inadequate and when pressed on that, he said that the independent members were only human and could be expected to be told what they believed.

These people are employed to scrutinise the executives. The chair gets paid a minimum of £55,000 a year; the vice-chair a minimum of £45,000; and there are seven independent members paid £10,000 a year each. And yet, David Jenkins was very clear that they were not fit—they are not able to effectively scrutinise. They now, as I understand it—and just as an example of their inability to effectively scrutinise—this summer, let the failed chief executive walk away scot free with no stain on her character whatsoever. 

I understand that the board is now being given a 12-month development programme, provided by Deloitte UK. I can't imagine that's coming cheap and I understand that that comes out of the Minister's budget. I have to say that I am at a loss to understand how this number of people who were not capable of scrutinising their executive were allowed to be appointed in the first place. Again, in response to questions from the committee, David Jenkins said that he felt that there were real issues with the appointments process. But, Presiding Officer, I have to say that the Minister has to take responsibility for this. He appointed all those people. He sets the process and yet, they were only human and could be expected to believe what they were told. 

Now, we have a situation where we have five out of the seven local health boards in some kind of special measures—

That isn't true.

—we have people being appointed, who clearly cannot do their job, and then have to have a very, very expensive intervention to enable them to do it. Is it not time for the Minister to acknowledge that the local health board system isn't working? The whole point of it was to have independent scrutiny to be able to scrutinise the professionals. It's clearly not working. Isn't it time for a radical rethink about how our health and care services are governed?

Well, I really do regret the tone and the content of a significant amount of what the Member said.

I bet you do.

When the Member says that five health boards are in a form of special measures, that is simply not true—simply not true—

Well, it's what your independent adviser said.

The Member should deal with the range of the facts of the matter and the reality of the commitment to improvement and the reality of what is said. I don't take the Member's recollection and recounting for all of the exact language used by David Jenkins, but I do know, in the meetings that I've had directly with him, his view is that they've done all you could expect them to do to make the improvements that are required. They've shown insight; they've shown a commitment to behave differently and they are behaving differently in the level of scrutiny and oversight you would expect them to have. 

We have made changes to the induction process and to how independent members understand the nature of their role and their job. So, we are listening to and learning about what is happening within our system. I don't share the Member's view that a wholesale reorganisation of the way we deliver healthcare and oversight is required. That is exactly what the health service in Wales does not require. And, in fact, all of the independent reviews we've had into our healthcare system, including of course the parliamentary review, have said that actually that is not what we need to do to deliver improvements in our service. I'm committed to improvement in the healthcare system for our staff and the public they serve and I look forward to doing so with all reasonable people across the Chamber and outside it.

Brexit Party spokesperson, Caroline Jones.

Diolch, Llywydd. Minister, we are, once again, battling an outbreak of measles and mumps amongst university students. Around 30 suspected cases of mumps have hit students at Cardiff University, Cardiff Metropolitan University and the University of South Wales. This follows the loss of the UK's measles-free status earlier this year, just three years after we were rid of one of the world's most contagious diseases. The rise of these terrible diseases can be attributed to too few people getting vaccinated. We are ahead of the rest of the UK in vaccine rates, with 92 per cent of the children in Wales receiving the MMR vaccine, but this is still below the target. Minister, what new measures are you considering to increase vaccination rates in Wales, particularly amongst university students?

Actually, the first port of call is to look at the childhood immunisation rates in addition to the potential for catch-up, because if we do safely vaccinate an even higher portion of the population, then that is the best protection for all of us. Public Health Wales, working together with colleagues and public health teams in each of the health boards, are looking again at what to do to raise again the high level of vaccination we already have to improve that even further. But the reason why the UK lost its measles-free status from the World Health Organization was because of the particularly low level of vaccinations being achieved over a period of time in England, where they're down to about 85 per cent. And it does show both the impact of investing in the earlier years part of our health and care system, but it also shows the real damage that has been done by the anti-vaxxer movement, and in particular by the legacy of Dr Wakefield, who is now disgraced and has been struck off, but there are still people prepared to support and promote his work. The real impact is in the compromise that that has left on public health right across United Kingdom, in particular in England, but there are parts of Wales where there are real gaps as well.

Thank you for that answer, Minister. Of course, one of the biggest hurdles to increasing vaccination rates is the rise of online misinformation and, as you mentioned, the anti-vax movement. When celebrities and so-called experts are spreading myths and indeed telling lies about vaccines on Facebook and Twitter, it makes the job of Public Health Wales so much harder. Minister, what discussions have you had with your counterparts in the rest of the UK to tackle the misinformation about vaccines, and have you considered a public information campaign to talk about the safety and efficacy of vaccines?

We regularly provide statements to reassure the public about the safety and efficacy of all the vaccines that are provided and the science and the evidence base behind them, as opposed to the suspicion and the growth of fake news in particular, a range of its proponents in a variety of different positions of influence. We're not in a position where we need to consider what Matt Hancock has talked about in terms of trying to make vaccination compulsory. I think that is very difficult to achieve and I think that may cause more harm than good for those who are already not having their children vaccinated, it may drive them even further away.

I think it is about how we persuade and provide evidence from people that they trust, which is why again investing in our earliest years and in services when people are pregnant really matters, about the level of trust that is provided and the assurance about what that means for doing the right thing for them and their children. We'll continue to do so. I think the challenge with wider public information campaigns is that often there's a very poor return. We need to understand where people get their information and who they're likely to be persuaded by to have the biggest return on any investment that we make.