2. How does the Welsh Government intend to meet demand for accident and emergency services in the Rhondda and beyond if 24-hour A&E services are reduced at the Royal Glamorgan Hospital? 386

Thank you for the question. As you know, the health board is responsible for the provision of safe and sustainable healthcare for its local population, including timely access to emergency care services for those who need it.

Last week we received the news that the dreaded south Wales programme is being resurrected after six years, in terms of accident and emergency configuration. This means consultant-led services are recommended for removal from the Royal Glamorgan Hospital in Llantrisant. During the same briefing, we were told that the Royal Glamorgan has the busiest A&E of the three district general hospitals under Cwm Taf Morgannwg University Health Board.

The A&E department will lose its last consultant at the end of March; then it will be entirely reliant on locum consultants. In contrast, the Princess of Wales Hospital in Bridgend has eight consultants in A&E, and the Prince Charles Hospital in Merthyr has the equivalent of four and a half consultants in A&E. Many people are questioning how and why this disparity has been allowed to develop. People are also questioning whether they will be able to get to hospital in time in an emergency. I've heard from people this week who say they would have died, or even worse—that their child would have died—had they been forced to travel further afield than the Royal Glamorgan Hospital.

A survey from a few years ago found that fewer than half of people questioned in Wales knew that health is devolved. Therefore, many people do not know that Labour runs the NHS in Wales, and has done so since the beginning of devolution in 1999. As you have responsibility for health in Wales, and you are a member of the political party that has run health in Wales for decades, what can you say to the people in the Rhondda who believe that this decision will cost lives? Will you take responsibility for it, and how do you justify making people travel further in a life-threatening situation?

Well, I think it's important to set out that the safety of the service is the first priority for the people who work in, run and deliver, and have responsibility for the service—from myself to the chief executive, to the medical director, to front-line staff. And the paper that the board will be considering tomorrow, in the name of the medical director, sets out the risks that exist, and that, actually, the risk is that there is much greater risk in terms of safety and the quality of the service in continuing to try to run a service without any substantive consultants in place.

And in terms of the numbers of consultants and where they currently are—people make choices about where they work, and we can't actually force people to move between one department or the other. It's not a question of the health board refusing to try to recruit to the Royal Glamorgan. It's not a question of there being plenty of doctors who are prepared to work. Actually, the challenge is about the number of staff we have, and the emergency department consultants themselves have the ability to move jobs in different parts of Wales and beyond, and, as we've seen in other parts of the UK, people do make those active choices. The challenge is: are we prepared to run our health service on the basis that safety and quality are the primary considerations, or do we place a different premium on the locality of services?

And in terms of the examples you gave where people would say that their lives could be lost—that's the sort of language that people understandably use when people are concerned, but I don't think it necessarily leads to a rational debate, because if someone is really at risk of losing their life, then they should be under blue-light conditions to go into the most appropriate point for their care, however near or far that is, and whether that's in a helicopter or on the ground.

Our challenge is how we have a regular pattern of services that is sustainable, genuinely safe and will last into the future and will recruit staff into it. And in the four options that are in the public domain in the executive medical director's report, it sets out two options that the medical director says are not viable and not sustainable. It sets out the challenges that existed at the time the south Wales programme was agreed—[Inaudible.]—got worse, and it sets out two options that they recommend that the board considers to properly engage with the public and wider stakeholders, including elected representatives. That's my expectation for the health board: to take seriously their responsibilities, not to duck the challenges that have a real impact on patient safety, to engage properly with the public and wider stakeholders about what each of those things mean, and what you will actually get in terms of where services are, and the quality that each one of us would expect for ourselves and our own families.

I appreciate there are challenges across the health board but, in particular, around staffing. But what is really important here is, obviously, that the decisions that have been taken on A&E at the Royal Glamorgan are predicated on the south Wales programme. The Royal Glamorgan is located in an area of high density population, with a growing population and growing demand. Now, I take it that the health board have the day-to-day function to run health services within its area, but you, as Minister, and your officials in Cathays Park, obviously set the strategy and direction of the health service here in Wales. Predicated on the south Wales programme, no consultant would have gone to the Royal Glamorgan on the basis that the service was going to be downgraded. 

Can I ask you, Minister, to intervene personally, as Minister who has responsibility for the strategic direction of the health service here in Wales, and insist that the health board re-evaluate their proposals and retain accident and emergency 24-hour provision at the Royal Glamorgan Hospital, because every indicator shows that that is a growing demand area for that service, and a withdrawal of such a service will be devastating to the area it serves? You have the ability to do it, Minister. If you choose not to, I respect that, but you will be turning your back on the communities which live in that area and depend on the Royal Glamorgan Hospital. And it is now time that the health board in that particular area re-evaluated the options available to it, and, in particular, the decisions it took around the south Wales programme, which I would suggest, taken some six years ago, are out of date today. 

Well, thank you for the questions, but the truth is, if you've read through the paper from the executive medical director about the challenges they face, he sets out that, if anything, the reasons and the rationale behind the programme have grown in number as opposed to receded. And I just don't accept that every indicator suggests that changing the footprint of services at this hospital will have the dire consequences that you've set out—far from it. The executive medical director sets out the need and the rationale to address the issue. 

Now, we're not talking about your view or my view as a politician. We're talking about the executive medical director with direct responsibility on the ground, and the ability for him and the whole team within that health board to do the right thing and to make choices based on the right service, and to provide the right quality and the safety of that service. And I think that, for politicians here, whether in my seat or any other, to try to demand that the health board continues running a service, where they are very clear that the safety of that service will be compromised if they don't make changes, is exactly the wrong thing to do. 

Minister, during the south Wales programme, I and other Assembly Members and Members of Parliament campaigned together to successfully retain accident and emergency in the Royal Glamorgan Hospital. So, six years on, I again share the widespread concern at these new proposals to consider a number of options, including the possibility of downgrading or removal of A&E services. 

Now, short-term modifications to health service delivery to keep patients safe can, of course, be necessary and right, but I believe, in this case, it is vital that the Royal Glamorgan continues to offer a robust accident and emergency service well into the future. Now, whilst it's important to note that this review is driven by clinicians, and it's not about money, it is now six years since the south Wales programme, which was the starting point for the health board's review, and much has changed since then. There are now a complex number of factors in play, which need to be fully understood, including the challenge of recruiting consultants, the increased demand on blue-light services and the substantially increased demand on A&E, and the massive housing and growth of population in the immediate area around.

So, I'm going to again ask the Minister to urgently intervene in this issue to commit to support a full review of the south Wales programme before any changes to A&E provision are considered. 

I recognise the point that Members across parties are making, and I reiterate that the challenge here is to understand how we have a genuinely safe service that is available for constituents across the country, and what that means in terms of either trying to change a service model, where people regularly say that they're concerned about the safety of changing that model, but, equally, the challenge of trying to maintain a service model if you can't staff it and run it safely. And, in the changes since then, the executive medical director's report that the board will consider it tomorrow sets out a range of the factors that you referred to about the changing context in which healthcare has been delivered, about the changes in the way that the health board delivered certain services, and in the four options that are set out in that paper for the board to consider.

Now, again, it's not for me as a politician in this position to set out to change the operational evidence and understanding of what's happening, and it must be a proper engagement with the wider public and stakeholders, including yourselves and other elected representatives, about the differing factors that you will want to see the health board address. That includes the ability to recruit and retain staff on any of the proposed models, including the ability to try and retain that on the current model—the health board themselves say they don't think they can do—what that means to people, how people access care, and what care will be in place and still available on the Royal Glamorgan site. Those are all matters I expect the health board to set out in its consultation, and to set out transparently how it proposes to make those choices when it has to come back, given that the last substantive consultant will be leaving their post at the end of March. There is a real urgency to this, and this is not something that could or should be put off; I expect the health board to do its job properly, with the public and its staff, in providing an answer for the future.

Minister, this is an issue that is of great concern to my constituents. Those who live in Cilfynydd, Glyncoch and Ynysybwl depend directly upon the A&E facilities at the Royal Glamorgan, whilst the rest of my constituents, who depend upon A&E provision at Prince Charles Hospital, are rightly concerned about the additional pressures that could be placed upon facilities there if A&E at the Royal Glamorgan is removed or downgraded. At a meeting of Assembly Members, MPs and council leaders last Friday, the health board talked us through very candidly the problems that they are facing with the sustainability of services at the Royal Glamorgan, with A&E there being run, as you've said, by one permanent consultant and three locums, and that one consultant now bringing forward his retirement, thus leaving the service in a potentially unsustainable condition.

The health board assured us that they'd been engaged in a continuous open recruitment process for several years, but, despite that, had been unable to recruit any other consultant. What assistance could you as health Minister provide to Cwm Taf Morgannwg University Health Board to help bolster their recruitment drive and encourage consultants to take up these vacant positions at the hospital? What resources could be provided to both Prince Charles Hospital in Merthyr, and the Princess of Wales Hospital in Bridgend, to help ensure that their A&E departments are able to support the additional demand that would be placed upon them if A&E at Royal Glamorgan is removed or downgraded?

And, finally, we all know that some people who arrive at A&E could be better dealt with at a minor injuries unit, which can do so much more than treating minor injuries—such as dealing with broken bones, for example. But the closure of minor injuries units, or the reduction of hours that we have seen at some, such as Ysbyty Cwm Cynon, in my constituency, leaves patients with little choice but to go to A&E. So, as part of these proposals for the Royal Glamorgan, will you, Minister, commit to working with Cwm Taf Morgannwg University Health Board to explore the possibility of strengthening minor injuries units in community hospitals such as Ysbyty Cwm Cynon and Ysbyty Cwm Rhondda, thus bringing health services closer to the people and relieving pressure on A&E?

Thank you for those questions. I think there is a challenge about the service model the health board propose and that they will actively consider with stakeholders. Because one of the possible options that they set out is about reduced consultant cover, but having minor injuries provision instead. And there's a challenge about the public understanding the range of minor injuries services that are available—in my recent visit to Neath Port Talbot Hospital with David Rees, seeing an excellent nurse-led service, led by a consultant nurse, and a wide range of activity that, not that long ago, you would have expected to have been provided in a doctor-led emergency department.

So, there's a challenge about public understanding, but equally about how the health service helps people to get to the right place. And if you're in the back of an ambulance, you don't need to worry about where you're being taken, because it's the job of the service to take you to the right place for the care that you require. And it's then about how we help the public to make their own choices, if they're going to get to a hospital site themselves. But the driver for this is the change in staff and what that means for the service. And I come back again—in the medical director's paper, he points out that it is becoming increasingly unsustainable, and safe services cannot be sustained beyond the immediate short term without unacceptable risks to patient safety. And I just don't think that any politician, in any party—in or outside the Government—can ignore the direct warning that's being provided by the medical director who's got oversight of the medical provision through the health board. So, the challenge is how they take into account the points that you make now about the different questions, about the services that are provided, where they're provided and how they're provided, and, if there is to be a change on the Royal Glamorgan site, then what that means not just for the two hospitals within the same health board in Bridgend and Merthyr, but also what that means potentially in the flow down to Cardiff as well.

So, there's a challenge that is a reasonable one that is not just about the health board, and I expect them to set that out openly and transparently. And I think the engagement with staff, as well as the public, will be really important within that, because staff will have very clear views about the safety and sustainability of their service, and that often drives helpfully the way that service change should and shouldn't take place. It's not about money, it's not about political will to maintain the current services—it's actually what is the right service to be provided and how do you provide the sort of care that I want for my family and all of us want for ours and our constituents. 

Finally, Huw Irranca-Davies. 

Diolch, Llywydd. The Royal Glamorgan Hospital serves my constituents from Llanharan and Gilfach Goch and Evanstown areas, though the Princess of Wales Hospital in Bridgend, which also now falls within the Cwm Taf Morgannwg University Health Board footprint, is also of vital importance to those and other constituents. So, whilst none of us, as responsible Members of the Senedd, can ignore the implications of the imminent retirement, earlier than expected, of the sole permanent consultant at the Royal Glam, and the subsequent reliance on locums, my constituents do have questions, which require some frank answers. 

How did we arrive at a situation where there is only one permanent consultant at the Royal Glam? And why has the health board been unable to recruit additional consultants over a lengthy period? This has not come out of the blue. The implications for the Royal Glam are significant and immediate, as it seems untenable to run a fully functioning A&E with the appropriate degree and depth of expertise on locum-only provision. Locums are a vital part of A&E, but the depth and breadth of expertise required in modern A&E requires numbers of full-time specialist consultants. So, can I ask, for my constituents, whether attempts have been made to source additional A&E consultants across the wider health board footprint, or even in neighbouring health boards, to sustain the service there temporarily, while further efforts at recruitment continue?

And, of course, lurking in the background is the original south Wales programme for A&E, which goes back some years now, and it was never put into place. So, can I ask whether this is, through accident or design, an attempt to belatedly put into place the south Wales programme, and, if that is so, whether the proposals in that plan are up to date to take account of the current pressures in the system and future pressures, including the development of thousands—thousands—of new homes in the east of my constituency, as well as thousands more in the Pontypridd area, west of Cardiff? Is that programme in any way part of this, and, if so, isn't it the case that some of those calculations will, indeed, be out of date? And, on that basis, what assessment has been made of the impact of the fresh proposals not just on Royal Glam, but on the Princess of Wales in Bridgend and the Prince Charles in Merthyr Tydfil, which have their own A&Es, which are under, of course, intense pressure at the moment?

And, finally, Minister, can you urge to the health board that they have to continue their engagement—frank, honest engagement, open engagement—with the public, not only with elected leaders, to get through this? It may be that they've now found themselves in an invidious position, but the only way through this is to be honest and open and constantly engaged with constituents, who genuinely have fears over what may come. 

I certainly recognise the last point you made. There are people who are genuinely fearful about change being proposed of this kind, and it is important that the health board are entirely open and honest about what they're proposing and why, and that people involved in the delivery of the service are actively part of that conversation with each other, with their health board leaders and managers, and the public as well.

And I think we come back to points that are set out in the paper, and, again, the medical director, who wasn't around at the time of the south Wales programme, but has looked at what the south Wales programme said, in his paper, he sets out that the situation described by the south Wales programme had since become more urgent, taking into account the challenges in service pressure. But also, in that paper, he also takes account of the fact that there is already residential development that has taken place and is taking place now—so, about the population and the nature of the demographics.

And I think it's fair to say that, if there had been an attempt to address this matter proactively earlier and make changes, there would always have been very real concerns and ones that we hear today. And yet I think it's likely that, if this issue had been grasped sooner rather than later, we would be in a different position. Because, actually, part of the challenge in having staff coming into a service is the point of having a longer-term model that people agree with, are prepared to sign up to, and want to see their careers being part of.

But in terms of sustaining the model, the health board, not only within its current staff—I understand they're already talking to partners about sustaining a service whilst they come to a new model of operation. But to try to prevail upon the consultants, who currently work in Merthyr and the Princess of Wales in Bridgend, to sustain consultant cover on the current model in the Royal Glamorgan Hospital, I think, would not be sensible.

And I think that, if you look at patterns in recruitment and consultant behaviour and where consultants have gone to, that is exactly the sort of challenge that, if presented or required, would lead to those people seeking employment elsewhere. Emergency department consultants can get employment pretty much anywhere around the country. They are a band of people who are much sought after.

It's about protecting the group that we currently have, making sure that they stay within our system, and having a model of care that will work for the local population and will work for the health service in a sustained way. And to do that, to come back to your final point, the health board must be open and transparent about what they're doing and why, and how they are taking account of the messages they are getting from members of the public, electoral representatives and their own staff, including addressing the very real concerns that I recognise members of the public do have.

I thank the Minister.