1. Will the Minister make a statement following the announcement regarding the departure of Betsi Cadwaladr Health Board's Chief Executive? 391

Thank you. The chair of the health board announced yesterday that the chief executive will be leaving the organisation. Decisions about employment matters are for the health board and its chair to make.

Thank you very much. It's never nice to personalise these issues, but it's clear that confidence in the ability of Gary Doherty has been lost for some time to secure the kind of progress needed within Betsi Cadwaladr University Health Board after almost five years in special measures. If truth be told, I see plenty of evidence in many areas that things have been getting worse recently, and now things must improve.

The chairman and the board clearly had run out of patience with the chief executive, but let me say clearly that the people of the north of Wales have run out of patience with the failure of the health board, in direct partnership, of course, with this Labour Welsh Government. They have nothing but respect for dedicated health workers, but they need to have their faith restored that Betsi Cadwaladr health board is fit for purpose.

I have no desire to pursue reorganisation for its own sake, but I've certainly concluded, and more and more people in and around the national health service tell me that they agree with me, that there may already be no option now but to split up this failing health board—a step, as things stand now, I would be willing to take if I were to become health Minister after next year's election. But it's now up to the new leadership, both interim and permanent, and the Welsh Government to prove over the next year and a half or so that things can be turned around in order to avoid that. All eyes now are on the board, on the executives and on you, Minister.

I have five questions here. I understand, firstly, that the health board will continue to pay Gary Doherty through not only the severance period but also through his secondment to Lancashire Teaching Hospitals NHS Foundation Trust. Do you believe that that can be justified? Secondly, can I ask whether the appointment of Simon Dean, who is NHS Wales's deputy chief executive, of course, as interim boss marks a stepping up in some way of special measures? Thirdly, is it your expectation that when a permanent chief executive is appointed that he or she should have a deep understanding and experience of delivering healthcare in the kind of area that we have in the north of Wales—a largely rural area and a bilingual area? Fourthly, will the Welsh Government outline the expectations of the performance of the new chief executive? I would appreciate avoiding vague terms like 'improving matters'. Finally, do you agree with me that it isn't just about one individual? It's about the lack of leadership of the Welsh Government too, and the ability to have managerial teams capable of delivering improvements that, so far, we haven't seen.

Thank you for the questions and comments. To start, I will deal with the comments you make about the organisation of the health board. I think it's often a tempting answer to suggest that reorganisation will deliver improvement in services, and anyone who wishes to run that argument—and there are arguments to be made; it isn't my view—will need to explain how that organisation would run and function, how quickly you'd start to see improvement taking place, and what you'd do about the framework. To go back to three separate organisations, I think you'd have three quite small organisations, and even if you had two organisations within north Wales, you'd have to decide what to do with the middle part of north Wales and Ysbyty Glan Clwyd. These are not simple questions to answer, so anyone who is an advocate for an entirely different framework and an entirely different footprint needs to consider what those look like, and how they would actually lead to an improvement in the quality and delivery of care, as well as of course the practical arrangements for separating the single organisation. I don't share the view of others that say that the health board is unmanageable and that it's unachievable to have an organisation that makes progress.

Turning to your five particular points, on secondment, it's entirely normal during secondments for wages to be paid by the organisation that is seconding someone out, then the employment comes to an end, but these are matters for the health board to set out and explain. I don't think that is unusual.

And in terms of the prospects, these are very practical choices that are made. When people leave senior leadership, there are choices about what is in the best interests of the organisation and being able to move on, and the health board has made a choice that they want to be able to move on and to begin the process of having a permanent chief executive in place.

On the interim chief executive arrangements, again, this is a practical point. Simon Dean has stood in at the health board in the past and, at the time, he stabilised the organisation. He's aware of not just that time there, but his role as a deputy chief executive means he has an awareness and knowledge of all the organisations within Wales. He has significant experience within the wider health service, but he also has a significant amount of respect from staff and wider stakeholders within north Wales. It's a very practical point, and we want to see the health board continue to make progress and not simply stalling over however long it takes to recruit a new chief executive.

In terms of that future chief executive, there will of course be comments about the way in which healthcare is delivered here in Wales and, in particular, in north Wales. They will also need to be given the licence of support from people across the political spectrum to actually take steps to improve the organisation. So, that means not being afraid to make choices about the future, to be able to have an open conversation with not just the team that they will lead within the health board, but with the wider public and their elected representatives. I appreciate there's going to be an election in just over 15 months' time, but healthcare will need to be delivered in that time, and I expect all people in this room who have an interest in the future of the health service in north Wales to engage openly and directly on that. And the chief executive, whoever they are, will understand that they're walking into an environment where there isn't just an election coming, but there's a need to see genuine improvement in the way that health and care services are delivered. It's what the staff and people themselves are entitled to expect and receive.

And on performance, I've set out the performance expectations in the revised special measures framework that I published in November. It sets out revised areas for the health board to make progress against to be able to move on from special measures, and then beyond that, too. I think the test that we set for the health board has to be a fair one. It has to be: what does this organisation have to do and need to do to move beyond special measures, then what else does it need to do to get to the position where it is what we would all hope to see, a high-performing healthcare organisation? And I don't think it would be tenable to expect them to move from special measures into that particular frame in the one single jump.

On the point about individuals and the point about collective responsibility, I regularly get the opportunity to set out my role in the system and to answer questions upon it, not just in the press but in this Chamber and beyond. I have always been clear that I've got political responsibility, ministerial responsibility for the health service, and that comes with accountability for it. I don't try to step into operational choices, but every time something happens within the health service, it's entirely possible that I'll get asked about it and I'll be expected to provide an answer to it. That goes with the territory and I don't resile from that, but I'm looking for new leadership to help change and set not just the tone about what they expect from the top, but how they expect staff and the whole team within the health board to actually deliver the cultural improvements and the performance improvements that, as I say, I recognise everyone in this Chamber and beyond would expect to see.

I have to say, Minister, I'm a little surprised by some of the comments that you've made in response to this urgent question today. For many of us in north Wales, it feels very much—

Sorry, it's a topical question, not an urgent question. 

Sorry? 

It's a topical question, not an urgent question. 

Pardon me. 

For many of us in north Wales, this feels very much like groundhog day and as though we are absolutely going right back to square one. We've got the same interim chief executive that was appointed on the day that special measures were initially imposed, almost four and a half years ago—almost five years ago now. We were told by Simon Dean at that time that there were 100-day plans to turn around the fortunes of this failing organisation. We saw no improvement. We've seen over the past four and a half or so years an organisation that has had even worse performance—record worse performance. It's the worst now in the whole of Wales on many performance measures, and it's got a governance system that is absolutely broken. It is not working.

We saw a report that came into the public domain just over a week ago, which had not even been shared; a report that was identifying serious failings in mental health services, particularly in terms of psychological therapies by TogetherBetter, which was not even shared with the chair of the health board, in spite it being in the possession of the health board for many months. So, the system is broken. You're part of the system. This is an organisation in special measures.

Can I ask you, Minister, do you accept now that special measures under your regime in Wales do not work, that you are not able to secure the sorts of improvements that the people of north Wales deserve to see in the performance of the health board? It's quite clear that Gary Doherty was not up to the job, as nice a man as he was. He was leading an organisation with a team of executives, some of whom were not up to the job, and, frankly, we've been glad to see the back of. We need a new team. We need an approach that is going to drive improvement forward. I'm not convinced, frankly, that you're the Minister that's going to be able to deliver the improvement we need to see, and I seriously do think now it's time for you to consider your position as health Minister in order that we can turn a page in north Wales and get a decent level of service for patients in the region. We're going back to square one, and, frankly, after four and a bit years, it's not good enough.

Well, there's not much there that I agreed with, and the tone in which Darren Millar with real relish attacks individuals doesn't do him any credit at all. I saw the press release he issued about Simon Dean, and I have to say, to speak in the terms in which he has done about someone with 37 years of NHS experience, who's capable, committed and respected across the national health service, I just don't think that highly personal attack does Darren Millar any credit at all, and I really do think he should reconsider, withdraw and apologise for the comments he's made about Simon Dean.

And he should recognise that, actually, in terms of Simon Dean's previous time within the health board, it did make progress, and that's part of the not just disappointment but the challenge in where we are because progress did start to be made on a range of measures during his time there. So, on primary care, on maternity, and even on mental health, progress was made during his time, and yet, during the longer period of time, the approximately four years—the last four years—we've seen the health board go backwards on performance and on finance, too.

Now, the health board have made a choice about changing the executive leadership, and the challenge now is how we have a new leadership in place, not just interim, but a permanent leadership to actually undertake the further progress that's plainly required on performance and finance against the special measures framework that I set out in November of last year, and that's my very clear expectation. I know very well that people will be looking at what happens in practical terms, both the public and of course the staff who work at that health board, and I will, of course, be reporting back to this place and I look forward to having questions next week. People have a regular opportunity to ask me questions; that's part of the job. I'm certainly not contemplating leaving this job. I'm looking forward to doing the job and continuing to make a real difference. 

Can I start by thanking all the staff who work incredibly hard to deliver healthcare in north Wales each and every day? However, it is clear that we do need a focus on improvement and that vision comes from the very top. Minister, you'll be aware that I, along with my colleagues from north Wales—Labour colleagues—have been raising this issue with you and issues of concern with you on a regular basis, and this is mine and my colleagues' No. 1 topic of conversation. I will be looking forward to meeting with the interim chief exec at the earliest of opportunities and I will be raising issues that constituents raise with me on a weekly basis.

Firstly, accident and emergency services: the need for more minor injuries provision across Flintshire. One particular solution that I can see would be introducing a minor injuries service at Deeside hospital. Additionally, I will be raising mental health services. At the moment, Betsi do not live up to the motto that mental health services should be delivered with the same importance and urgency as physical health, and that does need to change and it does need to improve. And, finally, Minister, I will be raising the structure of the health board, and I look forward to that conversation in the future. So, Minister, will you join me in raising these issues on behalf of my constituents in Alyn and Deeside, but on behalf of the people right across north Wales, in your communications with the health board?

In my communications with the health board, I continue to stress the importance of making progress against the special measures framework. I've set out objectively and clearly and in public—and it's the same conversation that I have in the direct accountability meetings with the health board—to make real progress on unscheduled care and scheduled care, to continue to make progress on mental health services, to continue to see improvement in the finance function as well—without that financial discipline, they're unlikely to see improvements in other areas—and the support that the Welsh Government could provide is actually about having a proper plan to be able to get behind and support the health board with. And I recognise that Jack Sargeant, of course, as with other North Wales Members, have raised issues with me over a period of time, and I'm sure that the interim chief executive will be keen to meet elected representatives across the spectrum, sooner rather than later. 

And, in terms of the particular point that you raise today, which we've discussed in the past, about minor injuries provision, part of the interesting point here is that, on major emergency department performance, we're within 2 percentage points of England on major performance. Our challenge is largely because of our ability to deal with some of our emergency patients but, actually, not to see minor injuries provision left to the side. So, there is a challenge, not just in north-east Wales, but more broadly, and I know that's one of the challenges that not just I have discussed, but I know that the interim and the future chief executive will want to address as well. 

And, on mental health, the health board does have more work to do. But, actually, if you look at what the health board is able to do, it is in a much better position now than it has been previously. And, in fact, if you look at the roll-out of I CAN Work, thousands of people are going to take part in an initiative developed in north Wales, recognised outside of Wales as well, and it's something other people are interested in doing. And it's had a roll-out in Conwy and Denbighshire too. So, there are good reasons to be optimistic about a range of things the health board has, and yet we also know there are significant challenges in the main functions of the health board to deliver. So, it's an honest reflection of where it is, but not collapsing into the idea that everything is going wrong and everything is unacceptable in north Wales, because that simply isn't true. 

I would actually like to just pay some tribute to Gary Doherty for what he has attempted to do. Clearly, when anyone takes on such a responsible role, they do so with the hope that they are going to make those necessary improvements. And I think it is rather coincidental that Gary came to a health board in Wales from an English health board setting, and that it's to an English health board service that he has gone back to—whether that speaks some volumes. But we now have a situation in the Betsi Cadwaladr University Health Board where it is being described as being in crisis by the very front-line nursing staff to patients. I have, on regular occasions, constituents coming to me, and they say, 'Janet, we are frightened. We are frightened about our actual chances when we go into hospital.' That's a very profound statement, when people haven't got confidence in that health board. We have, as Jack Sargeant has quite rightly pointed out, fantastic front-line nursing staff, and we have fantastic consultants that are there, but the frustration, the chaos, the mismanagement, continues after five years. 

Now, Mark Polin, the chairman, is correct to acknowledge that performance in some areas is not acceptable. And I think, really, if any Member has taken you to task over Betsi Cadwaladr health board, I hold myself up there as being one of them, because we are on the front line, on a Friday, in our constituency offices, and it's heartbreaking to witness some of the cases that we see, the people that we talk to. These are individuals whose lives are being affected by the poor performance of this board. And it breaks my heart, I'll be honest with you. Now, this is despite the fact, Minister, that this particular health board has no less—and I gained this from an FOI—than 63 highly-paid directors. Sixty-three directors. Sixty six per cent of patients were seen within the critical four-hour period in December. And, last month, there were around 2,900 patients waiting for orthopaedic procedures at Ysbyty Gwynedd, with a waiting time of around, approximately, 114 weeks. Compare this to England, where the waiting time is 18 weeks. And shockingly, only yesterday, from an FOI—. I asked a simple question: how many planned operations were cancelled due to non-clinical reasons between September and December? If I was to say, 'Hazard a guess'—do you know, Members, do you know how many planned operations were cancelled due to non-clinical reasons between September and December? The figure is 2,463, and some of those are my constituents.

Now, when the health board was placed in special measures in June 2015—five years ago, nearly—one of the areas of concern was leadership and governance. Those leadership and governance concerns are still there now. Now, when I've spoken to senior people within the board—and it's a bit embarrassing, really—they tell me that it is, in fact, your Government's interventions that are causing some of the issues as to why they cannot actually get back on track. So, will you be looking again at your own model of special measures and Government interventions to see whether you are in fact supporting them, or whether you are hindering the process?

According to the improvement framework, it is asked that leaders understand the challenges, and ensure relevant expertise and capability across the system are addressing the barriers. Now, I put an FOI in on how much has it cost so far: £83 million for these special measures Government interventions. How many operations could that have actually paid for? How many staff, new nursing staff, could that have employed? I'm going to be honest with you now: the brand— Betsi Cadwaladr University Health Board is now a toxic brand. And I feel very, very sorry for the memory and for the family members of Betsi Cadwaladr. Because to have my name associated with such failure—if I was alive, but certainly long gone—is not a legacy that I think is one that you as a Welsh Government Minister should be proud of. 

Now—

Can you wind up, please?

Yes. I'm going to ask my questions now, if I may. [Laughter.] Do you—? Oh, this is such a serious issue. Do you plan to provide Simon Dean with additional support, and, if so, what? The Simon Dean walking into this board now will be the same person, but the challenges will be different to five years ago. Will he be expected to provide a compelling vision for the health board that is understood, recognised and accepted from top to bottom of this organisation? And might it actually be the case that the chief executive role of this toxic health board is, in fact, a poisoned chalice, and that the board now could be in special measures for an immeasurable amount of time?

There were a good deal of comments, but I think there were really only a couple of questions. And, look, just on intervention from the Welsh Government, you can't have it both ways. You can't, on the one hand, say, 'Do more, be more active, get involved', and then, on the other hand, say, 'You're doing too much, get out of the way, let them get on with it'. You can't have it both ways. The challenge is actually how we get people who understand the operational challenges of running and delivering the service, who can deliver on improving the relationships between staff across the organisation and with communities.

And, on your points about Simon Dean, he will have all of the support that he requires and asks for. He will also have the opportunity not just to go in from his own understanding of being the deputy chief executive and working with all of the health boards and trusts within Wales, but his time on the ground, to provide an idea of, if there are additional challenges from that perspective, where the Welsh Government could be helpful or not. But, really, the future plan and the longer-term vision is for the next chief executive to actually deliver, together with the team. We're not looking for Simon Dean to stay within the health board for another year—it's a much shorter interim period I'm looking for, so a new chief executive is in time and has time to actually deliver that vision and to work with the team who are there. And the team isn't just around the executive table; it's around the whole health board.

There are 19,000 people who work for Betsi Cadwaladr, people rooted within their local communities—a source of knowledge, a source of understanding, and, for other members of the community, really important views about where the health board is going. And, actually, it's encouraging that, in the last staff survey, there was significant improvement in people who are proud to work for the health board and actually recognise that the health board was actually starting to improve. Now, that's a challenge that you need to see reinforced time after time. It's the objective evidence from staff themselves. That's hugely important for the wider community, and I look forward to, again, having an entirely honest conversation with people in this place, and when I regularly go to north Wales, about where the health board is, what more needs to be done. And I'm looking forward to the journey through and beyond special measures, because that is what people in north Wales expect and deserve.

Thank you very much, Minister.