Questions now from the party leaders, and, on behalf of Plaid Cymru, Helen Mary Jones. 

Diolch, Llywydd, and I'm sure I speak for everyone today in the Chamber wishing our First Minister a speedy recovery. Can I draw the Minister's attention to the joint Wales Audit Office and Healthcare Inspectorate Wales report into governance arrangements at Cwm Taf Morgannwg University Local Health Board that was published yesterday? I'm sure that, once again, our thoughts will be with the families affected by the catastrophic failing in maternity services. This report will make hard reading for them, as it will for the front-line staff, because it is clear that a lot of what went so terribly wrong could have been avoided, and that both the staff and the families were let down by failures of management and scrutiny. 

The report raises concerns that this was a board that appeared from the outside to be performing well if you measured them against the Welsh Government's targets, and that the pressure to meet financial targets skewed the board's focus away from the quality of patient experience. Now, I would ask the Minister, given that he sets the targets, whether he accepts that, given that, despite eight reports, surveys and visits into Cwm Taf that should have led to action being taken, it took a ninth report for him to do anything? Given that he and his officials failed to pick up on the issues in the Betsi Cadwaladr University Local Health Board until crisis point had been reached and that he's failed to sort them out after almost five years of intervention, does he accept that the Welsh public, and particularly the public in Cwm Taf, will have little faith in his ability to ensure that the issues raised in this report are addressed and the recommendations acted upon? 

I think there are three points I'd make in response to the Member. The first is that, of course, we have had the royal college's view because I acted, intervened and ordered that review to take place. I then acted and intervened in the health board in changing the escalation status of the health board. So, I have acted and I've put additional support around the health board, and, of course, at the time when I announced those measures, I indicated that this review from Healthcare Inspectorate Wales and the Wales Audit Office would be provided. And it's important that it is, because we want an honest picture of what's happened within Cwm Taf, as it was, and Cwm Taf Morgannwg as it now is, because the honesty and the clarity in what's happened and the steps that are being taken are important to provide reassurance and confidence for members of the public, including, of course, the staff. The second quarterly report on maternity services will be published and made public in January, on schedule, and I expect that there will be questions, which I'll be happy to answer at that point in time, about the nature of the progress that has been made and, indeed, the progress yet to come. 

And the third point I'd make is that I recognise the Member regularly uses opportunities to call for me to leave my post, but when it comes to the direct experience I've had with families, they have been very clear that they positively want me to stay in post as the health Minister to see through the programme of improvement that is required. [Interruption.] And I've had direct conversations with families who've made it very clear that that's their expectation— 

I can't hear the Minister and his response. I'd appreciate some silence from some people in particular.

—and I've committed to doing just that and to being utterly transparent in the nature of the progress being made and in any action that I have to take and any action that I choose not to take in supporting this health board and requiring this health board to make the improvements that are plainly required. 

I thank the Minister for his answers. He clearly doesn't speak to the same families as I do. But I'll be absolutely clear that I'm not calling for him to resign today. I think he needs to reflect on the fact that, as I've already said, eight reports, surveys and visits had taken place and raised concerns before his officials did anything. And we've had the first quarterly report that told us that, even after intervention, the service still isn't safe. I think it may be that the public in Wales will have some concerns about his apparent complacency.

If I can take him back to the report, where the report raises wider issues for the NHS in Wales, it says, and I quote,

'The Welsh Government will no doubt also want to reflect on the issues raised in this report and give consideration to how they will gain assurances on the robustness of quality governance arrangements across other NHS bodies.'

Now, referring back to previous questions I've asked him in his other role around the capacity of the non-executives in Cwm Taf, prior to his intervention, his special adviser—and he may want to look back at the transcript of the committee—made it absolutely clear that there was a very poor level of scrutiny, and this report confirms that, is the Minister prepared to accept today that there is a real need to look at the way in which non-executives, particularly very well remunerated chairs and vice-chairs are appointed? Does he need to ask questions across the service about their capacity to scrutinise? And does he need to look at the way that the health boards are structured, where the non-executives and the executive directors sit around a table together and it's very easy to see how a culture develops where the board is one board and the non-executives lose their focus in scrutinising the performance of their executive directors? 

Can I first just deal with the regular accusation that I'm somehow complacent in my duties? I take my duties seriously. It's a job that I enjoy, despite all the pressures, but that requires you to understand issues and to actually work hard to go about your duties and to recognise the impact on staff and the public. And I do think it's distasteful to regularly suggest that I'm somehow complacent because I don't always agree with what the Member demands of me. 

When it comes to the action being taken, I've already written today, and you'll have seen my written statement, to every single NHS organisation in Wales, requiring them to respond to me by the first week of January with the level of assurance they have about a number of issues that have been raised within this report today into Cwm Taf Morgannwg. I have provided a pro forma that I expect them to respond to to make sure that there are consistent responses to the same issues, for us to understand, both for each individual organisation but then collectively across the NHS Wales family. And I will, of course, report back to Members once we've had an opportunity to scrutinise and look at those responses to see if they have provided the assurance that I am looking for. 

When it comes to David Jenkins's role, he was really clear in the evidence he also gave to the committee that he felt that the board had done what it could and should do by that point in time, in terms of being properly reflective on what had gone wrong, and they're looking seriously to address and respond to that, but he recognised there was more to do.

On the broader point about how independent members behave, we are already taking a series of steps to reinforce the point that independent members are there in terms of their public duty, and they have a public role to undertake in scrutinising, challenging and, at points in time, supporting the way that health boards work. But it is not a role where they're there to be cheerleaders for the organisation. So, we're already acting on a range of the recommendations before the report today, and I will continue to do so as we take forward the measures that it recommends for us to undertake as well.

Well, Llywydd, I'm sure that what I would expect or demand of the Minister for health is unimportant. I would argue, however, that what the public, patients and, importantly, front-line staff expect is important, and they will come to their own conclusions about the way in which he responds to scrutiny, both here and in the health committee.

To refer back to David Jenkins, he said, of course, as the Minister rightly says, that, since the intervention, the board had done what they should have done in responding to the need for that intervention. But he was very clear that their performance before that was absolutely not up to scratch, and those families have suffered and those front-line staff have been put in an impossible position, because the people the Minister appointed were not up to doing their job until he intervened.

I would put it to him that, after 20 years of the Labour Party running the health service in Wales, GP numbers have fallen, the accident and emergency waiting times are the longest we've ever seen, life expectancy in Wales is falling for the first time in a generation. And I would say to him that, if he isn't able to transform this service in the way it needs to be transformed, perhaps he should get out of the way.

Well, it's a fairly predictable line that we hear yet again, and, in fact, what Helen Mary did say in her response was to recognise that, actually, following the intervention that I made, there has been a positive impact upon the organisation. The Wales Audit Office and HIW review recognises the new leadership in place are taking forward serious steps to address the issues of concern. And, when it comes to who the people of Wales trust to run the national health service, I look forward to their verdict in 18 months' time.

Leader of the opposition, Paul Davies.

Diolch, Llywydd. Minister, are you proud of your record of running the Welsh NHS?

I'm tremendously proud of the job that I do on behalf of the people of Wales. I continue to undertake my duties in a manner that I think befits the responsibilities.

Minister, if you are so proud, as my colleague Andrew R.T. Davies said, why on earth did your party feel the need to hire an actress to play a nurse in your recent party political broadcast? [Interruption.] Ah, yes, I know Labour Members don't like this, but it's the truth, isn't it? Is it—[Interruption.] Is it—[Interruption.] Is the reason—[Interruption.] Is the reason, as today's report confirms, that it appears you've presided over a culture of fear and blame that has resulted in staff feeling unable to speak out and raise concerns? Is it because your abysmal record of delivering health services is so poor that you couldn't find anyone working in the NHS to support your campaign? But, either way, it's not just a mark of embarrassment that Welsh Labour have stooped to this level, but shows a great disrespect to the people of Wales too. So, Minister, in light of today's damning report into governance arrangements at Cwm Taf Morgannwg University Health Board, what assurances can you now give staff working in the Welsh NHS that their concerns will be heard and acted upon? And how confident are you that there are no further distressing details yet to emerge from this deeply worrying chain of events?

It's my first turn doing these questions, so I think I have an excuse in terms of my performance. I'm not sure the Member opposite does, and I'm disappointed that he didn't bother to listen to the answer given to Andrew R.T. Davies. It is simply not true, as he asserts—we did not feel the need to hire an actress. My party did not do so. I'd be grateful if he'd listen and respond to the information and facts that are being given.

In terms of staff feedback and how staff feel about the national health service, actually, the feedback from our staff is positive about the view of this Government, certainly in comparison to the alternative offering across our border. We have a positive public service, we take seriously the investment we make in staff. I've invested a record sum in training the future of our health service. You'll have seen last week a 13 per cent increase in the budget for future healthcare staff, record numbers of nurses, midwives and therapists being trained, record numbers of GP trainees coming into the service here in Wales. These are matters of fact, not opinion, and, of course, when it comes to the investment we make in the health service, today's figures from the UK Treasury demonstrate that health spend in Wales increased faster than in England or Scotland, demonstrated that the combined spend on health and social care in Wales is higher than any other UK nation. I need no lectures from the party opposite on the nature of our commitment to our staff, our public and our national health service.

Well, I'm certainly not going to take any lectures from the Minister, because you are failing the people of Wales when it comes to our health services. Now, as you know, Minister, your colleague John McDonnell has announced the average working week in the UK would be cut to 32 hours within 10 years of a UK Labour Government. Minister, you can't seriously see this as a way forward for Wales, but perhaps you can just tell us, therefore, just how many extra doctors, nurses and other vital NHS staff will be needed to meet the reduced working hours, and how will your Government recruit enough staff to meet this new demand. Because if you thought things were bad now, just wait till we've had 10 years of a UK Labour Government. And let me give you—[Interruption.] And, Minister, let me give you some facts—[Interruption.] Let me give you some facts, because you gave us some facts earlier. This is your record as health Minister: over half of Welsh health boards placed in either special measures or targeted intervention status, services centralised further away from patients who desperately need them, A&E waiting times are the worst on record, cancer waiting times have not been met for 11 years, and people across Wales are desperately waiting to see their GP. Minister, that's not just Welsh Labour's record, it is yours too, and when will you take some responsibility? I do think that you should consider your position so that the people of Wales can be confident that, when system failures are made, the Government will take ultimate responsibility.

Well, of course, if we did have a UK Labour Government we wouldn't have had 10 years of austerity. I look forward to a decade of investment in public services. I look forward to the ability to properly remunerate our staff right across the public sector. I look forward to the ability to properly support our economy in an entirely different way to the one that the Member has supported on three if not four different UK elections in campaigning for a policy of austerity. When it comes to the record of the health service here in Wales, I've already set out the fact that we continue to invest in the health service here in Wales at a much greater level than across the border in Tory-run England. If you look at our record on the future of the health service: a parliamentary review at a time when people were prepared to be grown-ups about what was required for the future of health and social care, implemented with a joint long-term vision for health and social care—the only joint health and social care plan within the United Kingdom—record staff investment, and staff who are coming with us on a journey to deliberately redesign the future of health and social care together, I'm proud of what we are doing across health and social care. I can look patients in the eye, I can look our staff in the eye, and say, 'I am doing the right thing for this most precious public service', because our staff and our public know that you can't trust the Tories with our national health service.

Brexit Party leader, Mark Reckless.

Diolch, Llywydd. Minister, you didn't answer the question as to what increase in NHS workforce or, indeed, increase in spending you would need if this policy of a 32-hour average working week were to be applied to the NHS. Can you not tell us what is that average contracted full-time equivalent rate currently, and what would that change be if it was shifted to 32 hours, if indeed this policy will apply to the Welsh NHS? There was some confusion as to whether it would to the English NHS—Jon Ashworth, your Westminster spokesperson, said it was nonsense to suggest the policy should be applied to the English NHS. Will it be applied to the NHS in Wales? If so, how much will it cost? Or do you want to opt out?

Well, the man who stands on no manifesto he shows any loyalty to is regularly interested in what other people might do with the promises we make and that we keep. In terms of the 32-hour week, it's an aspirational policy for 10 years hence, and I'm certainly not getting trapped into trying to artificially produce figures for that. What I have real figures for is the 55 per cent increase in nurse training over the last five years, the record number of GP training places we filled in Wales—never before have we had that record of GP trainees here in Wales—a 71 per cent increase in midwifery training places over the last five years. That is a record of this Government with the resources given to us, the priority we place on our staff, on our health service, and a record that I am proud of. And it's one the public appreciate as well, because more than 90 per cent of the public in the national survey have had a good experience when they were last seen in either primary care or hospital-based care. This is a Government to be proud of. This is a national health service to be proud of.

I'm grateful to the Minister for his confirmation that this 32-hour week is merely an aspiration for 10 years' time. I think that will be quite reassuring to many of the health boards who are under enormous pressure already, with waiting lists having increased by 16,000 for hospitals just in the latest year.

One area of policy from your party at a UK level, which again I understand will apply here in Wales through law, is that they've stated that any ability to opt out of the 48-hour maximum on a working week will end. Now, I know there is guidance within the NHS as to how that applies for NHS contracts, but consultants currently are allowed to opt out of that 48-hour cap if they are then doing private work that, added to their NHS work, comes to more than 48 hours. Given the firm commitment from your party to remove that cap through UK law, what assessment have you made of the impact on NHS working hours for consultants if they choose to reduce NHS hours in order to facilitate private work within that cap?

Could you also say what consideration you've given to the issue of the taper for pensions, which is affecting many consultants, and whether you think that's a contributory factor to that 16,000 increase in hours? We've had a proposal, I think today, from UK Government for the English NHS. And I'm not recommending you accept it here—it seems to be quite 'make do and mend' in terms of that NHS consultants will pay out of their pension fund for the extra tax, but there's then a promise to pay it back to them at some point in the future.

If not that, are you giving consideration to any other mechanisms that might encourage NHS consultants to offer up more hours to try and help waiting lists, both in terms of the pensions and that 48-hour cap that otherwise is pending if a UK Government were—something we would certainly not want to see—to come in at the election, let alone for 10 years?

Well, I'm not going to get drawn into a fantasy list of hypothetical questions about a manifesto that is yet to be published. There is, though, a real issue in the comments that Mark Reckless has made, and that's the future of our consultant workforce in particular, but, more broadly than that, senior staff within the national health service. There is the unresolved challenge of our future relationship with Europe. And it's a matter of fact that both the General Medical Council and the British Medical Association have stated that, in surveys of their membership, a number of our European Union nationals are making preparations to potentially leave the United Kingdom, depending on the outcome of our future relationship with Europe.

The bigger issue, though, in the here and now is the challenges about tax and pensions. We just need to be clear about this: changes to tax and pension rules introduced by the UK Government have had a real impact upon staff within the national health service. They've led to unexpected and higher taxation bills; they've also led to doctors in particular withdrawing from providing part of the service. It's a genuine UK-wide issue, directly caused by changes introduced by the UK Government when the Member was in fact a Conservative Member of Parliament.

But more than that, I have written to, I have corresponded with, I have spoken with UK health Ministers—I've written to the Treasury about this as well—asking them to undo the damage that they have done. Because it will cost our national health service the goodwill of our staff that we've burned up and potentially lost for good. More than that, to recover the additional lists that we have lost, we'll probably end up paying more in the independent sector; it will cost us more to provide the same activity. And the solution on offer in England is not a long-term answer. They're using public funds to undo the damage done by a different decision in another part of Government. I issued a statement last week that highlighted that 15,000 patient treatment episodes in Wales over five months have been impacted by the tax and pension changes. It really is time for an attack of common sense in the United Kingdom to undo the damage they have done to our national health service, to our staff, and, in particular, the people who rely on the health service itself.