The next item of business this afternoon is a statement by the Minister for Health and Social Services: update on maternity services and targeted intervention at Cwm Taf Morgannwg University Health Board. I call on the Minister to make the statement—Vaughan Gething.

Diolch, Llywydd. Further to my written statement yesterday, I wanted to take the opportunity to update Members on the range of actions underway to secure and sustain improvements both in maternity services and the wider quality and governance arrangements across Cwm Taf Morgannwg University Health Board.

Yesterday, I published a second update from the independent maternity services oversight panel. I'm sure that, across the Chamber, we'll be encouraged by the overall assessment provided by the independent panel that there has been good progress in implementing the recommendations made by the royal colleges following their review of maternity services that I ordered and reported last year.

Importantly, and in the words of the independent panel members, they are now cautiously optimistic that longer term, sustainable improvements will be achieved. The panel has assessed evidence that has provided them with reasonable assurance that a further 25 recommendations have been delivered since they last reported. This includes: improvements in both the quality and uptake of training for both medical and midwifery staff, underpinned by robust plans for continued delivery; having a comprehensive clinical governance framework in place that is resulting in improvements in clinical practice; improvements in the reporting, investigation and learning from serious incidents; and, very importantly, confirmation that the midwifery staffing levels, which the health board has been working to over the past nine months, are now in line with Birthrate Plus recommended levels.

The panel will revisit these and other areas periodically over the next six to 12 months to ensure that they're embedded in practice and improvements are therefore sustained, whilst also assessing progress against the outstanding recommendations.

Whilst I am encouraged to see these improvements in the safety and quality of clinical care, I'm particularly pleased by the positive feedback about the experience of care being reported by women and families who currently use services. In addition to the health boards' processes for capturing real-time experience, this feedback is also corroborated by findings from community health council visits over recent months. Furthermore, the recent inspection report from Healthcare Inspectorate Wales found that care was being provided in a safe and effective manner at the Tirion birth centre, which a midwifery-led unit at the Royal Glamorgan Hospital.

However, as the panel has made clear, there remains much more to do to build on this progress. I confirmed in my written statement yesterday that an important component of the panel's role is to undertake a programme of clinical reviews looking at the quality of care previously provided. This is important to ensure that all possible learning is identified and acted upon, but equally, to try to answer any outstanding questions that women and families may have about their care.

I'm grateful to the panel for the extensive work that has been undertaken to develop a robust and thorough process, supported by a large team of independent, experienced clinical reviewers who have now been recruited. They are and I am determined that women and families will be at the centre of this work and will be supported to be involved if that is their wish. Additional advocacy support is also being provided by the community health council to assist with this.

I was pleased to have the opportunity to meet with women and families last week, alongside the panel. Listening first-hand to their experience is always difficult, but it is essential to understand how we ensure sustainable improvements in the provision of high-quality, women-and-family centred services.  

Before Christmas, I also met with staff at both Prince Charles and Royal Glamorgan hospitals. They told me that they now felt that there was more coherence and credibility to the leadership and delivery of their service. I got a real sense of commitment, ownership and pride once more in the improvements that they were seeking to sustain and build upon. This, without doubt, has been a very difficult time for staff, and I want to thank them for what that they have achieved in a short period of time, and that has been clearly recognised by the independent panel.

Much of the learning from maternity services is now helping to shape wider organisational improvements. Since my last statement in October, Members will be aware that Healthcare Inspectorate Wales and the Wales Audit Office have published their joint review of quality governance arrangements. This highlighted a number of fundamental weaknesses in those arrangements, and the report makes wide-ranging recommendations to address them. However, I was also encouraged that they confirmed that the organisation's new leadership had fully recognised the challenges, the need for change and that much of that work is already well under way. This includes making changes to ensure their governance processes are robust, open and transparent, with clear lines of accountability and escalation when concerns arise.

There are a number of work streams under way to engage staff to address the concerns that have been raised around the culture within the organisation, together with those actions needed to rebuild patient, public and stakeholder confidence and trust. I particularly expect rapid and sustainable improvements to be made in how the organisation responds to patient concerns and complaints. This is essential to drive learning and improvement as well as being recognised as an organisation that is open and transparent in all that it does.

The various reviews that have now taken place and have reported over past months have provided a comprehensive picture and diagnostic of changes that are needed. That includes ways of working and the underpinning values and behaviours that are expected to ensure the quality and standards of care that everyone has a right to expect. I'm confident that the board fully recognises the seriousness of the issues and the scale of the challenge that they still face in achieving sustainable change and improvement, and they are considerable.

As I set out in my written statement last week on NHS escalation and intervention, the current levels of escalation remain in place across all NHS organisations. So, in Cwm Taf, maternity services remain in special measures and Cwm Taf Morgannwg remains in targeted intervention.

There are now clear improvement plans developing to respond to the range of changes required. My officials will continue to work closely with the health board to ensure they are both supported and challenged to deliver those improvements. Many can and must be achieved at pace, while others will take longer to achieve and embed to ensure sustainable improvement. I will of course keep Members updated on progress.

The Deputy Presiding Officer took the Chair.

I'm very grateful, Minister, for the briefings that have been provided on this report, although I think that we must remember—and, once again, I wish to extend my deepest, deepest sympathies to all of those affected—the distress at the failings the maternity services in Cwm Taf have brought to many, many parents and at a time when it should have been one of the most joyful times of their lives. I must admit, I've also been surprised to read headlines in the media following publication of the update that said it had made significant progress, because my reading of this is that the panel are cautiously optimistic, and that's where I think we really need to set our expectations.

I do want to pay tribute to the work of the independent maternity services oversight panel. They've used their experience to help drive change in this health board. Can I also, Minister, take this opportunity to praise the hardworking front-line staff who must have found the criticism and failings of maternity services at this health board very upsetting and demoralising? I hope that the positives from this report demonstrate that a corner has been turned and that maternity services and, indeed, the whole of the health board are now all pulling in the right direction and that there is a real review going on throughout not just the maternity services but elsewhere in the board.

I was very pleased to hear that staffing levels are now at an appropriate level and that twice-weekly patient advice and liaison service surveys have been consistently positive. It was also very reassuring, Deputy Presiding Officer, to hear of the positive feedback following the CHC's unannounced visits and the positive reports from HIW as to the Tirion Birth Centre at the Royal Glamorgan. I do, however, reserve judgment on how much things have changed until we get to hear of the report that is due at the end of this month on the maternity unit at Prince Charles itself.

There do remain areas of concern, especially relating to that pace of change and the speed of response to requests for information provided to the panel, so I just have a few questions here, Minister. I understand that the panel have only been able to sign off 25 out of the 79 actions they requested that the board should complete. Some of these actions that remain unapproved include improvements in training, clinical governance and clinical audits. Are you satisfied with the pace of progress, and what time frames do you have in mind to get the rest of these actions approved?

I remain concerned to read, Minister, that there is still a need for more pace and better administrative discipline in the way that the change process is being managed by the health board. Specifically that there has not been as much progress on the integrated performance assessment and assurance framework, which enables long-term improvement in outcomes to be monitored and assessed. This has been requested to be achieved by December, but it's been put back to April. I would have thought that this was actually key to driving that change through and I wonder if you can tell us what assurances you can give us that that April deadline will be achieved, having been delayed once already.

The panel also noted that there was still work to be done to develop the maternity improvement plan into a responsible plan with clear milestones, targets and deliverables. Again, Minister, I find it concerning that this is not yet in play and the absence of it, I would suggest to you, gives off some really mixed messages. Because having that maternity improvement plan when this whole issue is about the delivery of maternity services would be key. We need to rebuild trust in the system. We need to ensure that families feel confident going forward. I would like it if you could give us an update on when you would expect that to happen.

The handling of complaints and concerns remains inconsistent. There are still significant challenges in terms of addressing that historical backlog of complaints and it's simply not good enough. This should have been a matter of priority to help grieving parents move forward. Because we all know when we have constituents come to see us about any issue where they think there's been a miscarriage of justice, that it's very hard to move on. And these parents are stuck in a time warp. I understood from a news article yesterday that there was a mother who lost her premature baby in 2015. The health board agreed they'd breached their duty of care, but she is yet to receive an apology from the board. I think we really need to move forward at pace on this.

There have been gaps in capacity and capability within the improvement team. For example, they had to defer the implementation of the clinical review programme by one month because the panel was not confident that the health board had the necessary arrangements in place to support and ensure that the needs of women and families could be met. So, could you please give us an update on whether or not you believe that the improvement team is now fit for purpose and can deliver this?

Finally, Minister, I do accept that welcome changes have been made, but there are still fundamental issues, issues that permeate the whole of the health board. We have seen small cracks and larger cracks, perhaps, even, arise in other areas. Many of the key personnel have changed and I welcome this. I accept that replacements take time to settle in, get their feet under the table and pick up and move forward. But are you confident—really confident—that the new-shape board, with the chair who oversaw some of the stuff that happened previously, are in the right place and that we've got the right personnel at a really senior level to now drive this forward? Because we need to be able to close the chapter on this really sad chapter in NHS delivery of care to mothers and families.

Thank you for the list of questions. I want to start with the point about the impact on families. In terms of meeting families it's hard to understate the impact on those families, not at a single point in time, and different people are on different points in their progress, in either being able to move on or not. Of course, different people with differing responsibilities. It's one of the real and significant difficulties that we face, not just as representatives, but of course in terms of the service and indeed the improvement action that we're taking around it. But that's definitely been added to by the direct engagement with families and that's one of the most encouraging things, I think, about the improvement action taken to date, that it's proactively looking for more feedback from people using the service in the here and now, as well as the engagement of families who have come forward and a number of whom will now go through the clinical review process at various points in time.

It's been useful, I think, with the two events that have taken place, one in Merthyr and one in Llantrisant, to actually ask women to come forward to explain their own views on recent practice too. So, I think those are encouraging. I, too, look forward to seeing the HIW report on their recent visit to Prince Charles, as well, to provide that level of assurance and honesty about the level of progress being made.

On that, your point about the way that this has been reported—well, of course, I'm not in charge of the way that other people report it, but what the panel themselves said was that there has been good progress and that they are now cautiously optimistic about the future, and that's the point. So, there isn't a clean bill of health saying that everything is fine and that no further work is needed, and, equally, part of the optimism is when it comes to progress that has been made, but, equally, some of the caution is about the fact that you need to see some of those points sustained. So, on a number of your questions about both the progress against the royal college review recommendations, on the pace of progress that's commented on in the report on page 35, as well as, then, page 37 and 36, about the maternity improvement plan. And there's something about the honesty of how fast the health board has moved and, equally, where there has been progress, about wanting to see that becoming genuinely sustained and embedded. So, the panel themselves have said that whilst they recognise that a number of recommendations have been delivered, that's why they want to come back themselves to look in the next six to 12 months to make sure they're still there. And on some of them, they recognise they are a work in progress.

So, on one of your questions about the pace of that progress, the honest answer is both 'yes' and 'no'. Yes, I'm satisfied they're making progress and they're doing it at a pace that is as quick as possible. However, I'm not particularly satisfied in that I would always want them to be able to move faster, but I have to balance the sort of demand that I push into the system, as it were, in that the overarching point has to be that they don't do anything to compromise the safety and the quality of the service, and the improvements they're making. And I certainly don't want to do anything that artificially makes people think back to how we got into some of this mess in the first place. People are looking for speed and looking to have a headline message that is convenient, as opposed to doing something that makes the best possible difference for our staff and the people that they are working with and serving.

In terms of your point about supporting needs during clinical reviews and the speed at which that's being put in place, then, yes, I am encouraged, particularly having had conversations over the last week directly with families as well as people from the health board and the improvement panel. And whilst I would have wanted that to have been in place before, the deliberate choice to not start until January was a difficult one because, on the one hand, I was particularly keen for those reviews to start sooner rather than later. There was then an honest challenge about whether you write out to people in the middle of December, just before the festive season, and tell them that their reviews were about to start, and that's not a simple choice to make. I think, on balance, it was the right thing to delay it until January before starting that process, so letters have gone out at the start of January. But also, that then has given more time to put support in place, and that's about doing what is right and what is appropriate, and not doing something that is fast. And equally, it's then important to be honest.

I hope that the second report from the independent panel does provide that assurance—that there is real honesty in the steps that have been taken and how long it will take before we can give the sign-off that the culture and the progress has been embedded, rather than simply looking to do something that is convenient either for myself or members of the health board. And I do have confidence in the members of the board, from the executive members, the interim chief executive and the new medical director and nurse director, and there's commentary in the report about the impact that those two people have had in helping to change positively some of the culture that was difficult for a range of staff, but also when I met staff they were positive about the leadership of the service and the difference in the meetings was palpable from the previous meeting that I'd had with staff. But there was also confidence in the chair and the independent members, and they take very seriously the failure that took place, and they've absolutely taken that to heart. And they've recognised that some of the ways in which the information was presented to them or not presented to them was simply not acceptable, and there is real rigour as well as determination, and I think capacity and capability within the board and its independent members, including the chair, to do the right thing.

May I thank the Minister for the statement? May I first of all say that we have to be very careful in measuring how far we've come? Yes, there has been improvement, but we are talking here about a scandal where babies died, where lives were destroyed. The latest report does show where we've come on the journey in responding to that scandal, and it shows that there's a long distance to travel to answer some of the most fundamental questions.

We have to be careful in suggesting that significant progress has been made, because reading the latest update shows that there are still significant concerns, and, in many ways, at a pretty fundamental level. I'll refer to several elements of the report:

'More than two-thirds...of the actions in the Maternity Improvement Plan are still work in progress';

'still significant work to do in order to meet the performance standards achieved in other Health Boards'; a lack of

'clear milestones, targets and deliverables';

'still a long way to go to improve critical business systems and process like those for handling complaints and concerns'— it's a pretty long list—

'gaps in capability in critical areas like performance analysis, quality improvement and patient engagement'.

I'll sum up some of my key questions, maybe three or four questions. Why are we yet to see the development of the key metrics and milestones that will allow the oversight panel to measure exactly where we are to provide a more evidence-based assessment of progress

'using a richer blend of qualitative and quantitative measures', to quote from the report? I think we need to see ways being developed of measuring much more clearly how far we have come in responding to the scandal.

On staffing levels, a particular question: you state in your statement, very importantly, confirmation that the midwifery staffing levels, you said, which had been given, which the health board had been working to over the past nine months are now in line with Birthrate Plus recommended levels. As I see it from the report, the panel is not able to sign off yet on that, because they still haven't seen the action plan. At the time of writing, not all vacancies had been filled. So, perhaps you could tell us if something has happened over the past three weeks that means that now this threshold has been met, which, actually, it hadn't by the time the report was written.

Could you explain—third question—why you think the panel says it has become increasingly concerned about lack of capacity to deliver improvements? It strikes me that, at this stage, if there are elements that are becoming increasingly concerning, that is something that should be ringing some very, very loud alarm bells indeed, and perhaps should lead to additional intervention to make sure that that issue of capacity in this stage is being addressed.

Finally, why, in relation to complaints, is the culture still apparently so defensive when that has been highlighted as a significant issue? I think we're still hearing of clinical staff saying that they find it difficult to raise complaints. And it's on that whole issue of a culture change needed, I think, that we need to keep a sharp focus still, and that culture change has to be assisted by and taken forward by a framework, I think, for holding NHS managers to account in the way that clinical staff are held to account. We have excellent NHS managers in all parts of the NHS—I met some excellent, innovative managers at Ysbyty Gwynedd last week—but, clearly, you will have poor managers and we need a framework in place to make sure that they are held to account exactly as we would doctors or nurses, who can be struck off if they underperform.

We are talking here as if we need a reminder about something that is as serious an issue as we could ever deal with in our Parliament, the kind of matter, as has been raised here before, that in other countries would have led to the resignation of Ministers, would have led to the disciplining or removal of senior managers. I think we need to remind ourselves that the fact those things have not happened here suggests that some of the most fundamental lessons that should be at the heart of all this have still not been learnt.

I'll deal with some of the more substantive points, and, again, point out that I certainly haven't gone out to try to overplay the level of progress or the level of challenge that still exists, and, in the words of the panel, the health board has made good progress and the panel are cautiously optimistic about future improvement prospects. There is no suggestion at all that all is resolved, and you wouldn't expect there to be at this point, partly because some of the challenges are longer term, in changing, improving and embedding culture and that cultural change. And if I stood up today and tried to claim that all of that cultural change had taken place and was embedded, then no-one in this room would take me seriously, and nor should you, and, equally, the families and the staff themselves wouldn't. So, there's an honesty about this—that you can't simply demand change and make it so. Some of this will necessarily take time, and whether it's a public service or, indeed, within the private sector, changing a culture and remaking it does not happen quickly or necessarily easily.

The other reason why you wouldn't expect to see everything resolved now is, of course, that we're about to start the clinical review process, and there's a lot of learning that we expect to come from that. And, at the end of the clinical review process, we'll be able to gather together the different learning that's taken place and understand how we expect that to be applied and how we expect people to see evidence of that progress. And I think that leads into your point about how will we know and what are the metrics. And that's the point about what's being developed now between the health board and the oversight of the independent panel and the maturity matrix that the panel have set out, and to talk about the levels and the stages of progress, and I think that's important. So, there is, then, an objective measure on how much progress has been made and how embedded it is, all the way through to providing a good service and then, potentially, an exemplar service as well. And that maturity matrix that the panel referred to, I think will be an important measure for all of us here, but also externally for the public and for staff as well, and, again, the honesty in the panel's assessment on how far progress has been made.

On your point that the panel are increasingly concerned about some areas of progress, it's difficult, without the proper context of the phrases that you've picked out, but I do think that, when you look at what the panel themselves say, they're recognising that, with the challenges that they are revealing, the health board are responding appropriately to them and making sure that resources are there to make sure that progress is made. And, obviously, as a Government, we've put some more resource around this improvement programme as well. That includes the extra funding we've made available to the community health council as well. But the panel themselves recognise that, in view of the progress and the ongoing commitment of the health board's improvement process, they don't feel it necessary to make any specific recommendations at this stage. That should give all of us, wherever we sit in the Chamber, some confidence about the progress, how seriously it's been made, because I absolutely expect that this panel, if they do feel the need to make recommendations, then they will do so without fear or favour, and they will publish those recommendations as well as making them to me. So, I do believe there are appropriate resources in place.

And, on midwifery Birthrate Plus, in fact yesterday, in direct questioning with interviews, the panel chair was able to confirm that the health board is now Birthrate Plus compliant. And that's both about the staff who are in place, as well as funding properly, to the appropriate establishment level, the recruitment of more staff. Now, it's never the case you can draw a single line and you're either one above or one below and Birthrate Plus compliant or not. It is actually, then, about how successful you are at maintaining a level of staffing, and genuinely being committed to actually having a properly funded establishment and the ability to recruit to that. And, again, all of us should take comfort in the fact that the health board have been successful at recruiting people to come and work in the organisation. At one point, there was concern they would not be able to do so because of the action that had been taken and the labelling of the organisation.

Finally, your point about managers in the health service—I just don't think it's at all helpful to suggest that I am siding with managers and not people directly affected. That certainly isn't the very direct conversation that I've had with families or, indeed, the staff. I am siding with the improvement that is required to provide the quality, the safety and the compassion in the service, and for staff to have the working conditions and leadership to be able to do their job and to do it well. We'll run around the issue about an independent regulator for managers many more times, I think, but I don't think that actually helps us in terms of moving forward with the improvement that is required. It would require a significant legislative change, and, if Plaid Cymru have more worked-up proposals that they wish to bring forward at this point, or in a future Welsh Parliament, then I'll be happy to engage with them. But I'm focused on delivering the improvement that those families plainly require and deserve.

Dawn Bowden.

Thank you, Deputy Presiding Officer, and can I thank you, Minister, for your statement? Like others, I'd want to place again on record my sincere sympathy for those families affected by the failings of Cwm Taf maternity unit. Some of those families I continue to have contact with, and I see, from that contact and that continuing dialogue with them, first-hand the impact that that's had on their lives, and that's something that we should never ever lose sight of. But can I also thank the oversight panel for their briefings and the improved communication that I think we're getting now with the health board, which I think is to be welcomed?

Now, I'm not going to go through all the issues raised in the report—I know the Deputy Presiding Officer wouldn't let me anyway—so, three brief points from me. Firstly, I think it's important to put on record that I'm still reflecting on the fact that, at so many levels, the situation at Cwm Taf maternity unit came as a shock to me, and I'll say again that my trust in the health board was badly damaged, and it's going to take some time and some tangible evidence of long-term improvement for that trust to be restored.

Secondly, I think it's fair to acknowledge some relief that the independent and expert oversight panel has identified progress in the period under review. Like Angela Burns, I was pleased to note that the panel seemed to be reassured that the reporting of serious incidents is becoming compliant, because this is important to have a clear understanding of patient experiences. We've seen real signs of improvement from the two-weekly feedback from women and the families themselves on the unit, which is much different to what had been reported previously, and that, as you've just alluded to in response to Rhun ap Iorwerth, staffing levels do now comply with Birthrate Plus amongst midwives, so there is more confidence now around safety. So, all of that progress is clearly to be welcomed.

But, finally, I note that there remains much to be done. This is still a work in progress, and I don't think for one minute that we can take our foot off the pedal, as has happened in the past. You'll know, Minister, that we have had reports in the past when actions have been implemented, the foot has been taken off the pedal and we've seen things slip, and that's potentially how we've arrived at the situation that we found ourselves in 18 months ago. So, it's clearly going to take whatever time it takes in order to review past cases and for families to receive answers, because families need those answers in order to get closure and to assure themselves that such failures are not going to be repeated in the future. As that review process involves extremely sensitive work, I was very pleased to hear you say that families will very much be at the centre of that work.

So, at this point, I'm again seeking your reassurance that the independent panel are receiving all the support that they require in order to complete their work in a timely, but not rushed, manner, and that families affected will also continue to receive whatever support they need while this is ongoing, because, despite the fact that this is going to take some time to address and turn all these issues around, I think an opportunity is presented, with all the support in place, and given the huge capital infrastructure investment, particularly at Prince Charles Hospital, that this could and should be an exemplar unit. I don't think that that is anything less than the women and families of the Cwm Taf health board area deserve. 

Thank you for the comments and the questions, and, in fact, obviously, I've met a number of Dawn Bowden's constituents at the family meetings, and a number of Dawn Bowden's constituents who work in the health service while meeting staff.

The point about rebuilding trust that Dawn Bowden makes is one that I recognise. Among the constituency Members who regularly engage with the board and regional Members, I think that's a common feeling, and, equally, from the Government's point of view, there's been an issue, and that's part of the reason why the service is in special measures and the organisation is in targeted intervention. They need to rebuild that trust in the way that they behave, and that's why the panel report on progress is important, but it's setting out what the health board are actually doing to respond to the challenges they face, both reactively and proactively, on this improvement journey.

The reporting of serious incidents is one marker of that. The fact they're now properly at Birthrate Plus levels is another marker of that, because, actually, concerns around Birthrate Plus were part of the markers of concern, when, having been assured through the chief nurse's office that they were Birthrate Plus compliant, it was plain that they weren't. That was one of the issues that staff complained about themselves, about persistent understaffing and not attempting to properly recruit to those vacancies. So, those are really important, because they need to be sustained to rebuild the trust that Dawn Bowden refers to. 

And on your points around the panel and whether they're properly resourced, 'Yes', I think is the straight answer to that. And if there's a requirement for more resource for them to do their job, then of course I'll want to make sure that they continue to have the resource to do what they require. A good example of what we've already done, though, is the fact that we've got this much bigger team of clinical reviewers. With the expansion in the scale of the reviews that need to take place, we've obviously had to make sure we have more reviewers; otherwise, we'd have had an unacceptably long period of time for all of those reviews to be carried out. It will take as long as it takes, but we have many more people engaging in the role now than we thought we might have had at the outset, when there were only 40-odd cases, apparently, to look at. There are now, as we know, around about 140. But that will be a matter for the panel to look at, as well as people who can self-refer into the process as well.

On your point about families being at the heart of the clinical reviews and the support for them, one thing that's been helpful is the way that the panel has produced a chart to help people to go through the process, with the 12 steps in it. It's not written as a document for healthcare professionals; it's written for the wider public. And I think it's been very helpful for me to look at that and understand how it's going to work. Right at the outset, I talked about the opportunity for families to tell their story, and to be able to do that and then to be supported to do that as well.

Because, as I said earlier, what has happened within each of those family groups doesn't just get switched off after a certain point in time. So, there's the ongoing support that people will need after the potential loss or harm caused to someone. And even if there's no physical harm that's been caused, then the way in which people are treated will be a cause when there's a need for support. And at the family events, we've had both the Teardrop group and the Sands group there to provide support as well, to make sure people are supported through the whole of this process, and for the health board to understand the ongoing care needs that exist.

Again, that is all part of rebuilding trust and confidence. We've been helped in that, though, by the fact that a number of families who we know have suffered harm and loss have been prepared to give their time to help the health board to improve, and it's a really altruistic motive that we recognise in many people, that they don't want other people to go through what they've gone through, and they've given up lots themselves to try to make sure that doesn't happen. It's incumbent on all of us to make sure that time, energy and effort aren't wasted.

My condolences also—I'd like to place on record—to all families who have been affected.

Thank you for your statement, Minister, and for facilitating the briefing with the independent panel and your officials. I welcome the progress being made to make maternity services in Cwm Taf Morgannwg University Health Board safe for my constituents.

As the panel highlights, there is a long way to go. The panel are cautiously optimistic. So, I ask you, Minister, how optimistic are you? One of the main takeaways from this quarterly update is that the local health board are not doing enough. In the words of the independent panel, they need to pick up the pace. Minister, what pressure can you bring to bear to ensure swifter progress is being made by the LHB?

As the panel highlights, the handling of complaints remains a matter of concern. The LHB is struggling with the process. Minister, given that the Andrews report made recommendations regarding complaints processes five years ago, it is concerning that the health boards are still struggling to deal with complaints and concerns. Do you have any confidence that local health boards can learn lessons from incidents at other health boards? How can we be assured that the failings at Cwm Taf are not being repeated at other health boards? After all, the maternity failings at Cwm Taf were happening under people's noses for years. Minister, do you have confidence that the local health board model is working for patients in Wales? How can you assure us of this?

Finally, Minister, the community health council has played a vital role during this process and has continued to provide advocacy for the women and families impacted by this situation. It is reassuring that there has been positive feedback from recent unannounced visits. Minister, do you agree that these unannounced visits are a vital part in reassuring the general public that NHS services are safe? And if so, will you amend your Health and Social Care (Quality and Engagement) (Wales) Bill to ensure unannounced visits can continue under the new body destined to replace the CHCs?

I welcome the progress that has been made at Cwm Taf and hope that you will do all you can to ensure that the independent panel's next report shows swifter progress toward implementing all 79 actions in the maternity improvement plan. Diolch yn fawr.

Well, as you'd expect, when I meet the chair and the chief executive of the health board respectively, this is one of the subjects we discuss: how effectively and how rapidly the health board is responding to the improvements that are required, and indeed the level of quality and safety that is being provided in maternity services today and in the future.

And as I said in my statement, and in the HIW review that was published in December on the Tirion birth centre, there's good feedback currently being provided by women, and there's a much more proactive effort to go out and secure that feedback from women to understand what is happening in the service today.

There is learning across health boards to be provided, both in terms of complaint handling, where we've seen real progress, and in fact complaint handling now in Cwm Taf is in a better place, but there's still a challenge about changing a very defensive culture and approach. So, the independent panel themselves make commentary on it, and there's definitely still more learning and improvement to come, not just in this health board, but across others.

In terms of your point about community health councils and advocacy, well, of course, we've provided extra resource for the extra advocacy needs we expect the community health councils will have. And on your point about visits, we have Stage 2 of the Bill coming up on Thursday, and I don't want today's statement—which is about maternity services in Cwm Taf—to get lost in that. There will be an opportunity to go through the commitments that I've previously given about wanting to have statutory guidance and a presumption in favour of visits. But this is not a point to confuse the function of the community health councils and unannounced visits of the inspectorate, which have taken place, and of course the larger piece of thematic work they're doing on maternity services across the country—I look forward to the publication of that later in the year.

But, what happened didn't so much happen under people's noses where people where aware of it, the challenge was what was happening was out of sight and hidden from decision makers and the board, and that's certainly one of the learning points we've had about that control within a limited number of people within the organisation.

Thank you. We've had speakers from all of the main parties. Can I just ask the next couple of speakers to just curtail their contributions, and can the Minister also curtail his answers, slightly, and then we won't run over too far? Mick Antoniw.

Minister, most of the points I wanted to make have already been made, and you've answered most of them. There is just one point that, obviously, is of concern, and that is the references to the punitive culture within the maternity services. Of course, it is something that has been rumoured of and of concern for quite some time. And you indicate in your statement, of course, that you've met with staff. Changing that culture is absolutely fundamental to the success of the whole reversal of the operation of maternity services and the delivery of it. I'm wondering what discussions you may have had, for example, with the trade unions that represent those staff and what the feedback has been from the staff, and how you evaluate the progress. Because, within the report, it does say that the culture within the service is still perceived as punitive. It does talk about work being under way, and of course it recognises culture change takes time, but this is very much work in progress. But it seems to me this is really one of the core points about change, and I'm wondering how you're evaluating and monitoring that specific aspect.

It's not just a fair point, but an important one, and part of our challenge about wanting to move away from a punitive culture to a learning one is counter-balancing that with people's demands for accountability, whether at the top, or in the middle, or at the bottom of an organisation as well. So, there's a fear that people will be punished if they stick their head above the parapet—that's part of what led to this being hidden—and it's then about our ability to break through that.

There's also, though—. When you look at the reports from women and families and the way that some had complained about how they were treated, there was a need to actually get into the middle of that prevailing culture amongst some parts of the staff team and to break some of it up. That was difficult because those staff, when they were moved, felt that action was being taken against them and that they were being punished. So, it's not straightforward, but I think that the nurse director in particular has stepped in to do the right thing, in terms of changing some of the rota patterns and in the leadership on values and behaviour as well.

It definitely involves trade unions, in particular the Royal College of Midwives and Unison as the two largest trade unions, and they're directly engaged with the health board in looking to change and improve some of this. That certainly came through in the staff meetings that I had. It was a significant change, from anger and disappointment and some people not feeling pride in the uniform, to a much, much better outlook from staff themselves. So, some progress made, but more to go. 

Thank you, Minister, for your statement today. It certainly suggests that there have been some green shoots of progress in terms of putting things right at Cwm Taf Morgannwg maternity services. I'm also really grateful that you've engaged with women and families and with staff, including families from my own constituency, who have engaged with such dignity in the process to try to ensure that no other families experience the kind of loss that they have endured. They'll know who they are, as I mention them here today, and my thoughts remain very firmly with them and with all other families affected.

You mentioned the clinical review process, and I agree it's really important that the family voice is heard within this. I know there have been some concerns around records being re-examined so we can get to the core of what went wrong. What assurances can you give around that specifically? I note also your comments around expecting rapid and sustainable improvements in the response to patient concerns and complaints, and I'd like to strongly add my support to that. When I raise casework issues with the health board on a variety of things, not just maternity issues, I am often surprised at how long it can take for complaints to be responded to, let alone resolved. What do you think improvements in this process would look like? Are there any examples of best practice of health boards dealing with complaints? And how will this be monitored so that any trends or patterns can be identified?

On the point about complaints, you're absolutely right, and I mentioned earlier about moving away from a defensive approach. I know, as a constituency Member, when I first arrived in this place, the response from the complaints function in Cardiff and Vale health board was very different, both in terms of the timeliness of it but also the quality of it. I absolutely think that, as a constituency Member now, I get a much better response from the health board than I did at the start—and that's not about the change in my position in the Government, I think it's actually about the way the health board now deals with those complaints.

The improvement in the complaints function that is taking place at Cwm Taf is certainly not completed, but there is practice within the NHS to look at and to learn from already. But in particular, there's something about, even as we are now, for those families who have gone through the process already and had an outcome, making sure that doesn't get in the way of a health board apologising. Far from it being an invitation to legal action, often it is what families are looking for. It doesn't affect the test on a breach of legal duty or not, but it makes a real difference to the families when they receive correspondence that appears to be more open and interested in them and their experience, rather than something that seems harsh and too driven by lawyers—and I say that as a former practitioner. 

On your point about the family story, this is really important to reiterate. The family story will be near the front of the clinical review process. So, people will be given a proper opportunity to tell their story and will be supported in doing so. That's part of the reason we've put extra resource into community health councils. And it won't just consider the notes, because some of the complaints families have are that they don't believe that what's in the notes is accurate and that's part of what's being challenged in some of the legal process that's ongoing. But also, the correspondence around that care will also be part of what the clinical review process considers. So, it won't simply be a matter of reading clinical notes and taking what's in there as entirely gospel; there will be an opportunity for patients to tell their story. Because some of this is about how people have felt during the process, and you can't always get that just from the notes.

I think it's also important to set out that, in the clinical review process, after the first tranche of reviews that are taking place there is still an opportunity to self-refer in. They've now agreed the way in which people who are concerned about their care can refer themselves in and then have a choice made, involving the independent panel, about whether they'll receive reviews for longer-standing concerns as well. 

But I want to end, Presiding Officer, by agreeing with the point that Vikki Howells made about the dignity of families—I'm incredibly impressed by the dignity people have shown—but also the ongoing hurt and the impact that it's having today.

Thank you very much, Minister.