4. Will the Minister provide an update on any progress made in the recruitment of a new chief executive for the Betsi Cadwaladr University Health Board? OAQ55219

Yes. The health board is progressing the work on plans to recruit the right person to this crucially important role. Although decisions about employment matters are for the health board and its chair to make as the employing organisation, I am wholly committed to providing the support needed to the health board to deliver the improvements that are still required.

Thank you for that answer, Minister. Despite being in special measures for nearly five years, the problems at Betsi continue to let down those who rely on it. The issues at Betsi have not been replicated in all boards across Wales, so it's clearly the running of that particular board that's at fault. A new chief exec may help, but a chief exec doesn't act alone—he or she is part of a board who make recommendations as to how the NHS in north Wales should develop, tackle its problems and decide on its priorities.

Last year, a cross-party committee of this place found that the health board were making unacceptably slow progress in sorting out its failings, but the buck does stop with you. Isn't it time to review how these health boards are constituted? In order to ensure that the treatment and care of patients are prioritised, isn't it time to insist that the majority of the members on any health board should come from clinically trained backgrounds?

I think there are two points there: one is the point about how the health board is constituted and then the make-up of the board and clinicians making up the majority. In terms of how the health board is constituted, if there's a broader point about its organisation and the scale of it, I actually think that for north Wales to improve, to try to undertake a structural reorganisation in order to change to have not one Betsi but two I think would be a mistake. If we did that, we would definitely lose a significant period of time while people look inwards about who's going to run those new organisations—i.e. decouple—then what you do about the fact that there are three hospitals across north Wales. Where does the middle one go? What does that mean in terms of service planning and co-operation, both within the same health board now but, potentially, in more than one organisation? So, I'm not persuaded that more than one organisation in north Wales is the answer.

In terms of your point about the structure, when it comes to the independent membership around the board table, we have deliberately, over time, constituted a mix of executive members, people who work for the health board as employees and independent members with the mix of skills that people require. It certainly doesn't always follow that people who have been clinicians in the health service make good managers of the health service, and we'll see that in all walks of life. I was a lawyer—I had some skills as a leader and a manager. My wife, who is still a lawyer, was a better manager than me, in terms of some parts of the role, but that had not really much to do with our ability as lawyers. So, it's about how your professional background lead you into the choices that an organisation makes, because, actually, someone who was a great doctor isn't necessarily the right person to run the finance function. Someone who has been a great nurse through their whole career isn't necessarily the right person to sit around the board table as an independent member. That's why we have an independent public appointments process, overseen by the public appointments commissioner, to try to make sure we get the right people.

It's also why we've reset our expectations about the way that independent members are not just appointed, but how they behave and their willingness to not just support the organisation, which is only part of their role, but it's about the scrutiny and the challenge and the leadership role they have around the independent members' table. And, actually, within north Wales, with the relatively new chair—he's only a couple of years or so into the role—he has brought a different leadership style and a different level of scrutiny that's changed the culture of independent members around the table, and all of our independent objective assessment, including the inspectorate, say that has made a real and positive difference. The challenge is going from that to real, definable improvement in accordance with the special measures framework that I set out for Members recently. 

I do agree with you that you've got to have the right person in the right place doing the right job, and I also agree with you that the new chair of Betsi Cadwaladr has made some extraordinary changes and does appear to have the energy, the drive, the initiative and the experience to be able to lead that organisation forward. But the reality of the situation is that the ex-chief executive was basically in the job a couple of years too long, and so that health board has stagnated over these past few years. I appreciate you've got an interim—or the board have got an interim—chief executive in. However, what I really want to understand is how long will the hunt for a new chief executive take. And can you assure the Senedd that there are no barriers in place to ensure that that health board actually has the finances to recruit the best-quality individual with the best level of experience to lead it out of the doldrums that it has sat in for the past five years? Because not only will that chief executive need to have huge experience in running large public service organisations, but will also have to have a spine of steel in order to cut like a knife through butter to get rid of some of the other levels of management that perhaps are not experienced enough, and not capable of bringing that health board forward.

I think there are two points there. One is the licence but the expectation that a chief executive will make changes that are difficult—difficult internally within the organisation, but also, speaking honestly, within the broader politics around the health service. Any time difficult choices are made, most of us objectively end up seeing that there's a reason for a difficult choice to be made. But, actually, if you're a local political actor of any and every party—it's not a partisan point—it can be very difficult then to go along with either supporting that change or giving it the room to take place. Now, from my point of view, I want a chief executive within north Wales who is going to make the changes that the health board requires and that the people of north Wales deserve to see happen. For me, I'm prepared to wear some political flak and difficulty to get the right things done, because that's the overriding objective: to see north Wales healthcare improve and to take some of the robust choices that I think the chair wants to see made as well, that independent members are now signed up to do too. And, within that, then, having the right person, there is absolutely no bar in terms of money. If we need to go outside the normal salary range for chief executives within Wales, then we can do so because, again, I'm interested in getting the right person to make a real difference.

Objectively, I think most Members would sign up to that. We'll have to see what happens then when that person is in post and trying to deliver some of that change. But, whoever it is, it won't simply be a case of them sitting at a desk and banging it and saying, 'Now we have to do what I'm saying'. They've still got to be able to bring their staff with them, to set up plans that have logic to them, that have evidence behind them, and can set out why they'll improve healthcare in north Wales both for the staff who deliver it, and the public who receive it and take part in it.    

We've just heard that the recently departed chief executive was in post for a little too long; you could probably say that about the three chief executives who've served during the period that the board has been in special measures and under the direct control of Welsh Government. Now, I know that you're reticent to direct the board to do anything, but, as Minister, I'm sure you can convey a few key messages to the new chief executive officer. And one of those, I would suggest, should be that the board needs to get to grips with the number of management consultants that it's engaging with—up to 40, I believe, in recent times, costing over £6 million to the taxpayer. No wonder they're heading for another hefty deficit this year. So, will you convey to the new chief executive that the time has come for them to get a grip on this relentless engagement with consultancy managers. They have managers who are employed and, if they were doing their jobs, then we wouldn't need these additional people at a huge cost. So, please tell them it's unacceptable and it has to change. 

I think what has to change is delivery, and it's the delivery against an understanding of what their challenges are and their opportunities for improvement, and, actually, some of the work that we have commissioned around the health board, about the real understanding of where they could and should improve their finance function, what that means for the service, but also about having a clinical plan for the future to understand how they want to deliberately shape services in north Wales to provide better care. And that's the fundamental challenge the health board needs to grip, and of course they'll need the right people in post to do that, but, if they do have a deficit and if they can't recruit the right person at the time, they may need to make use of consultancy in exactly the same way that people, wherever they are in public services, or, indeed, in some parts of the private sector, from time to time need to use consultancy. But the level of that has to be appropriate. It has to help the health board on its way to the improvement journey that Members across the Chamber recognise it still needs to take.