10. Plaid Cymru Debate: A&E services at the Royal Glamorgan Hospital

– in the Senedd on 11 March 2020.

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(Translated)

The following amendments have been selected: amendment 1 in the name of Rebecca Evans, and amendments 2, 3, 4 and 5 in the name of Darren Millar. Os derbynnir gwelliant 1, caiff gwelliant 2 ei ddad-ddethol.

Photo of Elin Jones Elin Jones Plaid Cymru 5:09, 11 March 2020

(Translated)

The next item is the Plaid Cymru debate on A&E services at the Royal Glamorgan Hospital. I call on Leanne Wood to move the motion. 

(Translated)

Motion NDM7296 Siân Gwenllian

To propose that the National Assembly for Wales:

1. Notes that responsibility for the NHS lies with the Welsh Government.

2. Calls on the Minister for Health and Social Services to support the retention of a 24 hour consultant-led accident and emergency service at the Royal Glamorgan Hospital.

3. Recognises that recruitment is key to the retention of a consultant-led accident and emergency service at the Royal Glamorgan Hospital.

4. In order to help recruitment, calls on the Health Minister to rescind the decision made in 2014 to remove the consultant-led accident and emergency service at the Royal Glamorgan Hospital as part of the South Wales Programme.

(Translated)

Motion moved.

Photo of Leanne Wood Leanne Wood Plaid Cymru 5:09, 11 March 2020

Diolch, Llywydd. I move the self-explanatory motion. We've rehearsed the argument that people require an accident and emergency service within reasonable distance of their homes here on many occasions. The clinical evidence is clear that there's a relationship between distance and mortality in emergency situations, which is even clearer for respiratory conditions; in other words, the sorts of conditions prominent in the poorest areas of Wales like my constituency of the Rhondda.

But the Welsh Government is deciding now not to engage. Rather than taking responsibility and  making the case as to why Wales should have fewer accident and emergency units, which would at least be the honest policy position, this Government is hiding behind the notion that they can't do anything: 'It's not possible', we are told. But we were told it was impossible before. My colleague Helen Mary Jones—who literally wrote the legislation that says they can intervene and stop this under the One Wales Government, which was the coalition that ran between 2007 and 2011—will explain later how Plaid Cymru changed the impossible once before.

But I want to add a further argument to the overwhelming case for retaining accident and emergency services at the Royal Glamorgan and every other existing hospital that has that facility. That argument is that we are highly likely to need all the capacity possible in the coming weeks to deal with COVID-19. Wales lacks critical care beds. It lacks the workforce necessary for staffing those critical care beds. It makes absolutely no sense to argue that now is a suitable time to allow more capacity to be lost. We should be planning on the basis of maximising what capacity we do have, and being prepared to adapt wards if necessary.

But such is this Government's ideological obsession with moving services into the community—a euphemism for closing wards—that they've become incapable of seeing the importance of having secondary care when it's needed. Yesterday's statement on the COVID-19 illness was such a classic example of how embedded this obsession is that they probably don't even realise it. The statement yesterday made no reference to critical care beds. Surely, critical care beds can't be seen as less of a priority than having an online symptom checker, community testing facilities, or protective gear for GPs? Five per cent of people who will contract this virus will become critically ill, and that is not something that is likely to change with these measures. We need capacity to deal with ill people.

Now, there's no doubt we want to see investment in the health services that keep people healthy and enable people to avoid needing to stay in hospitals; this is in just the same way that we want to see fires prevented before the fire service has to be called. But we still need the fire service for when a fire does occur; and we still need an accident and emergency unit for when accidents and emergencies happen. With the best will in the world, many of my constituents already have chronic conditions that can't be prevented, and some of them will inevitably, from time to time, need emergency treatment. They will be put at risk from having to travel further.

Staff shortages have of course been cited as the chief problem—and this is real—but the board hasn't even tried. And why would they? The south Wales programme was approved by Labour and given the go ahead, and nobody was ever going to work in a unit that they knew was being run down. This is exactly why the Government needs to take responsibility, change course, and announce the south Wales programme no longer applies and the health needs of today support the Royal Glamorgan retaining its accident and emergency unit. You can do this. You've done it before. Do it again.

(Translated)

The Deputy Presiding Officer (Ann Jones) took the Chair.

Photo of Ann Jones Ann Jones Labour 5:14, 11 March 2020

Thank you. I have selected the five amendments to the motion. If amendment 1 is agreed, amendment 2 will be deselected. Can I call on the Deputy Minister for Health and Social Services to move formally amendment 1, tabled in the name of Rebecca Evans?

(Translated)

Amendment 1—Rebecca Evans

Delete all and replace with:

To propose that the National Assembly for Wales notes that:

a) in accordance with the National Health Service (Wales) Act 2006, the responsibility for the delivery of NHS services in Wales in geographical areas is the statutory responsibility of the respective local health boards;

b) Cwm Taf Morgannwg University Health Board is currently reviewing its provision for the delivery of accident and emergency services in the health board area which are specific to the Royal Glamorgan Hospital;

c) Cwm Taf Morgannwg University Health Board is currently considering a number of options relating to this service;

d) Cwm Taf Morgannwg University Health Board is carrying out data, modelling and recruitment analysis, staff and public engagement to inform a decision by their board;

e) no decision has yet been taken in regard to the future of accident and emergency provision at Royal Glamorgan Hospital.

(Translated)

Amendment 1 moved.

Photo of Ann Jones Ann Jones Labour

Thank you. I call on Andrew R.T. Davies to move amendments 2, 3, 4 and 5, tabled in the name of Darren Millar.

(Translated)

Amendment 2—Darren Millar

Insert as new point after point 1 and renumber accordingly:

Notes the resolution of the National Assembly for Wales on the 12 February 2020 in relation to the retention of 24 hour consultant-led emergency services at the Royal Glamorgan Hospital.

(Translated)

Amendment 3—Darren Millar

Add as new point at end of motion:

Regrets that the Welsh Government has failed to learn lessons from previous health board restructuring exercises and have not ensured that the principles on public engagement enshrined in 'A Healthier Wales' are adhered to by health boards.

(Translated)

Amendment 4—Darren Millar

Add as new point at end of motion:

Calls on the Welsh Government to ensure that Cwm Taf Morgannwg University Health Board consults with their communities in a timely and inclusive manner.

(Translated)

Amendment 5—Darren Millar

Add as new point at end of motion:

Notes with concern Cwm Taf Morgannwg University Health Board's recent oral evidence to the Assembly's Health, Social Care and Sports Committee on 27 February 2020 that the board had not been actively recruiting emergency department consultants to the Royal Glamorgan Hospital. 

(Translated)

Amendments 2, 3, 4 and 5 moved.

Photo of Andrew RT Davies Andrew RT Davies Conservative 5:14, 11 March 2020

Thank you, Deputy Presiding Officer. I welcome the opportunity to speak in this debate again. It was only some three or four weeks ago that we were debating this very subject with a Conservative motion before us and that motion, after amendments, did find favour. And it's regrettable that the Government haven't moved on this particular position, when the Assembly speaks in such a positive way. I would like to see a more positive reaction from the Government. 

I formally move the amendments that are laid in the name of Darren Millar. Obviously, amendment 2 reflects on that debate that was held, as I said, some three or four weeks ago that had a positive outcome for retention of A&E services at the Royal Glamorgan. Amendment 3 and amendment 4 touch on the engagement process that the health board should always undertake when discussing any major proposals, and to be fair to the health board, to a point, they have done that. And obviously, the south Wales programme did that in its time as well. But what is a fundamental flaw here is the flaw of the south Wales programme when it talks about delivering services for this particular part of the community that I represent as a regional member for South Wales Central.

The Royal Glamorgan is not an old hospital; it’s a relatively new hospital. The surrounding area is expanding rapidly. I’ve heard the Member for Pontypridd talk of about 20,000 new houses being erected in that particular area. The whole surrounding area is a growth area—it’s not a diminishing area, it is a growth area. And then you couple that with amendment 5, which was the evidence put forward by Cwm Taf themselves at the Health, Social Care and Sport Committee, where the health board had not been actively looking to promote jobs at the Royal Glamorgan Hospital. And today, there’s a story in the local papers highlighting that freedom of information requests have identified that there’s been no positive action to attract full-time—and I use the word 'full-time'—consultants. There has been action to try and attract locums to fill the gaps. Well, you cannot build a sustainable service, as everyone knows, on locums. And so, everything points to this need to retain the accident and emergency provision at the Royal Glamorgan Hospital—a modern hospital, with a growing population surrounding it and growing demand.

And yet, the health board, over the last several years, has been hellbent on delivering the south Wales programme, which, to a point, they are mandated to deliver, because it’s a programme that obviously the Government has endorsed, and ultimately has said to the health boards that are signatories to it, 'This is the blueprint for health services within the area.' I don’t think there’s a person who believes that that blueprint is a sensible way to deliver accident and emergency provision within the Llantrisant and the Valleys areas. And indeed, the medical professionals at the Royal Glamorgan Hospital have said so much themselves. They identify that, obviously, there are gaps in the rotas—no-one’s disputing that fact—but when you take the point that the health board has not been proactively promoting availability of employment on that cycle of consultants, and to take themselves forward in their careers, is it any wonder that there are vacancies that have struggled to be filled?

And so, on all fronts, there is a positive case to be made for the retention of A&E services at the Royal Glamorgan Hospital. And the Government’s amendment saying that this is all the fault of the health board is ridiculous, I have to say, because the Government is in a position to give direction to the health board over the overall strategic direction of health provision here in Wales. Yes, I accept that, day-to-day running is delegated to the health boards, but the overall strategic direction of health provision here in Wales is at the door of the Minister of health. That’s his role, or her role, depending on who occupies that office. And so, it is incumbent on the health Minister to listen to the representations that are being made in this Chamber, made wider by the communities that are served by the Royal Glamorgan Hospital, and ultimately by the evidence that supports the retention of the A&E service at the Royal Glamorgan Hospital. And I do hope that we will get a positive response from the Deputy Minister this afternoon that it builds on the vote that was held some two or three weeks ago in this Chamber, rather than, ‘This has nothing to do with us. Pass it back to the health board’. That just will not do and I hope that the motion, with amendments, will be supported this afternoon.

Photo of Ann Jones Ann Jones Labour 5:19, 11 March 2020

Thank you. Can I just gently remind Members that in a half-hour debate, it's three minutes—each contribution is three minutes, apart from the Minister's? I've got a number of speakers who I'd like to try and get in. Delyth Jewell. 

Photo of Delyth Jewell Delyth Jewell Plaid Cymru

Thank you, Diprwy Lywydd. I'm speaking in this debate, because I'm concerned that if the A&E and the Royal Glamorgan Hospital is not kept open as it is, that will have a negative impact on many other hospitals, including the Prince Charles Hospital in Merthyr, which is in my region.

In response to an FOI, Cwm Taf Morgannwg University Health Board acknowledged that, in 2017, there were 60,072 instances of patients attending the A&E in Prince Charles, whilst there were 63,691 who attended the Royal Glamorgan. By 2019, 63,341 patients went to Prince Charles, and 64,649 attended the Royal Glam. So, what do those figures mean? It stands to reason that if one of those A&E centres closes, those tens of thousands of patients requiring emergency care don’t dissipate or disappear—they'll need to go elsewhere. They'll need to travel a greater distance, at greater expense to themselves and at a greater risk to their health.

Photo of Suzy Davies Suzy Davies Conservative 5:20, 11 March 2020

Thank you, Delyth. I didn't want to cut you in your flow there, but those figures also show that we need all those A&Es as well. If there's going to be any removal of the south Wales programme, that cannot be an excuse to start looking at closing other A&Es.

Photo of Delyth Jewell Delyth Jewell Plaid Cymru

I would agree entirely. With the point, absolutely.

Now, I know from personal experience how long waiting times in A&E already are in Prince Charles. The staff do an excellent job under tremendous strain, but patients are routinely left waiting for hours and there aren't enough beds. My grandmother passed away last year after a number of years of ill health. During her final year, she attended Prince Charles A&E on a number of occasions with my parents, and later with carers after she'd fallen. On one occasion, my grandmother was waiting for nine hours on a trolley in a corridor because there weren't any beds. She was 99 at the time and suffering from dementia. Now, again, the staff did everything they could, but it was not appropriate for a woman of that age to be without a bed for that long. Imagine what impact an influx of new patients will have on this already struggling A&E.

Now, time is short, so I'll say one other thing. I am going to echo what's already been said in this debate. I am dismayed with the Government's amendment that implies, in some way, that responsibility for the NHS lies ultimately not with the Welsh Government, but with health boards. That isn't true, and the Government's amendments is almost a slight of hand in that way, and it will confuse voters.

The main argument of those who seek to undermine the Senedd is that it has failed to deliver, but this plays on people's confusion between the legislature and the executive—that is the Senedd that is an institution and the Government that sets the policies. I'm afraid it is in the interests of the Welsh Government to feed this confusion in this instance in order to avoid accountability, and this is what they've done with the Royal Glam. A Labour backbencher recently went as far as to claim publicly that the Welsh Government is not responsible for managing NHS, only for its funding. Now, that's simply isn't true, and Labour, I'm afraid, should be ashamed that they are attempting to paint the whole of this Senedd with the brush of a failure that is purely their own.

Now, the Welsh Government has here decided to delete the first clause of the Plaid motion, and in doing that, the Government has failed to acknowledge its own role in overseeing and ultimately managing the NHS. Now, worst still, it's actions like that that feed an atmosphere of distrust in politics and a general confusion over what areas are devolved and who controls what. Now, I am finishing now. It might not seem like a lot—this 'delete all' from the Government—but it's actions like this that are more damaging than we can realise. Trust matters, and we should all care about that.

Photo of Mick Antoniw Mick Antoniw Labour 5:23, 11 March 2020

My support for the retention of a 24-hour consultant-led A&E at the Royal Glamorgan is total and is unwavering, and I believe that it is the only viable option. The community I live in is galvanised as perhaps never before in fighting for this outcome, and I'm pleased that this campaign also has the support of the main hospital trade unions—Unite, Unison and the GMB. I've attended both recent local health board meetings; I've spoken at the rallies and public meetings in support of the retention of 24-hour A&E at the Royal Glamorgan. And I'm also pleased that the motion that I moved in the Assembly several weeks ago, with the support of my colleagues and with cross-party support, in support of keeping the A&E at the Royal Glamorgan was successful, and supported by all parties. I want to reiterate that motion for the record, because it calls on the health board to rule out the closure of the accident and emergency service at the Royal Glamorgan Hospital, or the replacing of the existing accident and emergency service with a 24-hour minor injuries unit, and to reinstate the option of maintaining a full consultant-led accident and emergency service at the Royal Glamorgan.

I am sad that, on an issue as important as this, Plaid have chosen only to allow 30 minutes for debate, which really seriously limits the ability of Members to participate, and I'm limited to three minutes. The Plaid motion tabled today is inaccurate and misleading, and that is why I will not be supporting it. It refers to rescinding a decision by Welsh Government, which has never existed—there is nothing to rescind. It also calls for the health Minister to take action, which he cannot take until the health board has actually taken a decision. Now, that situation may change, but only once a decision has been taken and that is why all my efforts until that time is reached will be focused on persuading the local health board and its members that 24-hour A&E must be retained and I believe that we are winning the argument and that we will succeed.

The motion, I believe, takes our eye off the ball, and it diverts our focus from where the key decision is going to be taken, and that is where I and my colleagues will concentrate our support. I will, however, be supporting the two Conservative amendments 2 and 5, because they do make an important contribution to this debate. Firstly, unlike the Plaid motion, they reiterate the important motion already passed by this Assembly—this is important.

Secondly, they highlight the key issue of this campaign, which is the failure of the local health board for the past seven years to recruit consultants, and, in fact, the failure to advertise for full-time consultants until recently. It is no wonder the A&E has been blighted. Commitment to a 24-hour permanent A&E is fundamental to being able to recruit.

Llywydd, my colleagues and I are concerned and committed to ensuring that 24-hour A&E will be retained at the Royal Glamorgan Hospital. Our strategy is based on actually winning this campaign and I believe that we will.

Photo of Vikki Howells Vikki Howells Labour 5:26, 11 March 2020

I'd like to place on record again my support for full 24-hour A&E at the Royal Glamorgan Hospital. This is such an important topic, so I'm a bit mystified, really, as to why Plaid Cymru have only used 30 minutes for this debate. I hope it's not an attempt to stifle the voices of Labour backbenchers, who represent areas affected by this. I'd have thought that they would have wanted to give more time for a full and sufficient discussion.

I'm also disappointed because to my mind, this motion isn't really truthful. Plaid Cymru know all too well that decisions about local delivery are made and have to be made by health boards on a day-to-day basis. Now, other parties may disagree with the way that that system operates, and that's a perfectly valid position, but then they need to bring forward a plan to change the system, rather than simply to point score. 

The motion also fails to consider the bigger picture—

Photo of Ann Jones Ann Jones Labour 5:27, 11 March 2020

Are you taking the intervention? No.

Photo of Vikki Howells Vikki Howells Labour

—that was addressed in the amendment a few weeks ago that I co-submitted with Mick Antoniw, Dawn Bowden and Huw Irranca-Davies. That was much more thorough wording that holistically considered service provision throughout Cwm Taf and didn't just try to set communities against each other. For example, our amendment called for the retention of a full A&E service, not just at the Royal Glamorgan, but also at Prince Charles and the Princess of Wales Hospital and it is vitally important that we have that wording set down there, so that we don't just protect A&E at one hospital to the detriment, possibly, of another—[Interruption.]

Photo of Vikki Howells Vikki Howells Labour

Our amendment also called for improvements to GP out-of-hours services and to extend minor injury unit opening times, for example, at Ysbyty Cwm Cynon—a practical solution to improve performance by A&Es by removing some of the pressure.

So, to close, I would just like to reiterate my support for a full 24-hour service of A&E at the Royal Glamorgan Hospital, and to place on record my disappointment that, in tabling this motion, Plaid Cymru have shown that they don't want to offer solutions or innovations; all they want is political point scoring.

Photo of Ann Jones Ann Jones Labour

Thank you. Can I now call on the Deputy Minister for Health and Social Services, Julie Morgan?

Photo of Julie Morgan Julie Morgan Labour

Thank you, Deputy Presiding Officer. Unfortunately, the Minister for Health and Social Services is unable to be here in person this afternoon, as he is required at the UK-wide COBRA meeting in relation to our response to coronavirus, but I'm pleased to be here to debate this here today.

Members will be aware that the Minister spoke in the Conservative debate on this matter on 12 February, and similarly, I'd like to start by thanking all the staff on the front line that many Members have referred to today, because they worked tirelessly to provide the care and treatment that patients need, day in and day out.

We all recognise the importance of the NHS, and the public attachment to it continues to be reflected here in the Chamber, and rightly so. We can assure you and the public that the safety of our NHS now and in the future is of paramount importance. Members will also be aware that the safety and transparency of the service is crucial. I'd like to take this opportunity to clarify, as has been already said here today, that health boards have a statutory requirement to deliver safe and sustainable healthcare services for their local population. In that context, Cwm Taf Morgannwg University Health Board is currently considering the most appropriate model for the future delivery of emergency care at their hospitals.

Photo of Leanne Wood Leanne Wood Plaid Cymru

Do you accept that the south Wales programme is actually preventing the recruitment of consultants? If you do accept that point, do you think that the Government can intervene to get that changed?

Photo of Julie Morgan Julie Morgan Labour

At the point we're at, the health board has not yet made a decision about what its plans are. [Interruption.] I'll go on to the south Wales programme now, when I speak. But no decision has yet been made. I think that is the very important point. It has to be made locally, but no decision has yet been made.

So, to turn to the points about engagement that are made in the motion, we don't recognise the issues raised in relation to previous health board restructuring exercises, and the principles on public engagement. There are clear protocols in place that set out our expectations on engagement with the public. If this is specific to the Bridgend boundary change, I can assure Members that there was significant engagement, and the Government will therefore oppose amendment 3. The health board is currently undertaking an ongoing engagement process with staff, local representatives and the public on their A&E proposals, and it would not be appropriate for Ministers to intervene by directing or attempting to direct any health board or trust to run an unsafe service as long as it's local.

We've been clear that the health board, in any change of this nature, has to be open and transparent. I know that a number of events have already taken place. The health Minister has also made it clear that evidence underpinning proposals for change and their impact should be made publicly available or an explanation of why not. The Government will therefore support amendment 4. There is a clear mechanism in place for escalating concerns about public consultation on significant changes to the Minister for Health and Social Services.

I'd also like to reiterate that the south Wales programme was not determined centrally by the Welsh Government. It came from engaging over 500 front-line clinicians who live, work in and serve communities across south Wales. This was NHS-led, and rightly so. In considering a way forward, I understand that the health board are reflecting upon the outcome of the programme, the changes made in the delivery of healthcare, and the healthcare needs of the current and future population in the area—so they are looking at the future population in the area, as Andrew R.T. Davies referred to.

Photo of Andrew RT Davies Andrew RT Davies Conservative 5:32, 11 March 2020

Thank you, Deputy Minister, for taking an intervention. I appreciate you've gone through the amendments. The one significant amendment that the Member for Pontypridd drew attention to as well is amendment 5, because that is a statement of fact, that the health board have not over the last 12 months actively recruited consultants to the A&E department of the Royal Glamorgan Hospital. I take it the Government will be supporting that, because that is factually correct, as confirmed by the health board to the Health, Social Care and Sport Committee here in the Assembly. Could you just confirm that? Because I notice you didn't speak on amendment 5.

Photo of Julie Morgan Julie Morgan Labour 5:33, 11 March 2020

On amendment 5? I'm going on to amendment 5 now, yes.

So, I understand, as I said, that the health board are reflecting upon the outcome of the programme, and they are looking at the current and future population in the area, and of course the reality of staff recruitment. Members across the Chamber will know simply calling for the south Wales programme to end doesn't really answer the problem—it avoids the problem. The health board is responsible for ensuring that they have sufficient staffing to deliver safe services for patients, and it's not for Ministers to intervene in local operational matters. The Government will therefore abstain on amendment 5.

While I understand some concerns have been raised about the health board's attempts to recruit, it's important that we recognise that the health board has been actively recruiting to ensure that there is sufficient consultant support, but that has been through a reliance on locums, and more recently utilising some consultants from the Princess of Wales, but this is not a sustainable position going forward. The health Minister has also discussed at length on a number of occasions the challenges of attracting and retaining emergency medicine consultants in what is a shortage profession across the UK. The immediacy of the current position in Cwm Taf Morgannwg has arisen because of staffing shortages, and it would be wrong to ignore the challenges the health board is facing.

Health Education and Improvement Wales is already developing a joint health and social care workforce strategy. Four doctors in training are expected to achieve their certificate of completion of training in emergency medicine this summer and take up posts as consultants across Wales. Between 2021 and 2025, a further 62 doctors are expected to achieve their certificate of completion of training. The national unscheduled care board has been established and has reviewed the workforce requirements for emergency medicine and the further expansion of the consultant workforce, supported by Health Education and Improvement Wales. However, that in itself isn't an answer to all the concerns of Members and the public. There are no quick, easy fixes.

We know that people care deeply about the future of our NHS, and everyone here does as well. We expect all of our decision makers in the NHS to listen to what their public and their elected representatives have to say, to be open, honest and transparent with the public and their staff. We expect our NHS to make choices and deliver a robust, safe service.

The health board will be receiving a further update on the exploratory work being undertaken on the future proposals, including the feedback received during the engagement process, at their next public board meeting at the end of March, where they will decide the next steps. I repeat: no decision has yet been made. 

Photo of Ann Jones Ann Jones Labour 5:36, 11 March 2020

Thank you. Can I now call on Helen Mary to reply to the debate?

Photo of Helen Mary Jones Helen Mary Jones Plaid Cymru

I'm very grateful to you and to all the Members who have taken part in this debate. I won't have time to fully respond to everybody's points, but I do want to respond to some of them. 

I would say to Mick Antoniw and to Vikki Howells that I completely accept that their commitment to this cause is genuine, but if they want more time to debate it, perhaps they should ask their Government for that. It is not the business of the opposition to make time for you to make your points. That's up to the party that you represent. 

I'm grateful for the tone of the response—[Interruption.] If anybody wishes to intervene, I'm more than prepared to take an intervention. 

Photo of David Rees David Rees Labour

Just briefly, in fairness to my colleagues, this is a debate set by Plaid Cymru, and you have 60 minutes to debate; you decided to give it 30 minutes, not the Government. This is your decision. 

Photo of Helen Mary Jones Helen Mary Jones Plaid Cymru

No, we absolutely did and my point, David, was that it's up to us to decide that and if your colleagues want to seek further time, they've got other opportunities to do that, but it's up to us how we use that time. So I'm not taking any lessons on it. But that's not the main substantive point. 

I need to make a correction to my colleague Leanne Wood, because she said that I wrote the legislation to which she referred. That's not true. I supported the then Minister, Edwina Hart, in writing that legislation, but I do know what it contains. The Government either knows or it should know that the legislation that they referred to, the National Health Service (Wales) Act 2006, has been, and was during the time of the One Wales Government, amended. I want to remind Members of the tone of that debate at the time when we made those decisions. There was a legitimate debate about whether the health service should be managed by arm's-length bodies, like the old trusts, or whether it should be directly accountable to the democratic process. It was a legitimate debate, and I will quote what the Minister said at the time. During the course of that debate, Edwina Hart said that she fully understood the case for arm's length, which is what the Government amendment is suggesting, but this is what she said: the decisions about health need to be made by the people that people can sack, and those are the politicians. 

I am not disputing the point that, now this process has begun, the point at which the Minister might be able to intervene is after a decision is made one way or the other, but the context of this is that the Welsh Government appoints all the non-executive directors of the health boards. The Welsh Government sets its budget, the Welsh Government sets the policy context within which it operates, and it is simply disingenuous to say that this is a matter for the health board in isolation. It is not. The Government needs to take responsibility. Leanne Wood said that there is a tendency to centralise these emergency services. If that needs to be done, then let it be done, but let it be done openly and honestly and let the people who are responsible take the responsibility for those decisions.

People have made comments here and outside about playing politics with the NHS. Well, Dirprwy Lywydd, the NHS exists because of politics. The NHS is a political decision and, at the time of the One Wales Government, we made a very clear commitment to the people of Wales that the Government, whatever Government it was, would stop hiding behind the semi-independent trusts, that we took out the market mechanism and we created the larger health boards, and those health boards are directly answerable to the Government. Now, you can dress it up whichever way you like, you can quote outdated legislation if that's what you want to do— 

Photo of Ann Jones Ann Jones Labour

No, sorry, you're out of time. 

Photo of Helen Mary Jones Helen Mary Jones Plaid Cymru

I do apologise, Mick Antoniw; I would have taken the intervention if I could. 

You are accountable, you are responsible. If you want to change that, change the legislation, but don't keep hiding behind an independence of the health boards that simply doesn't exist. 

Photo of Ann Jones Ann Jones Labour

Thank you. The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Therefore, I defer voting on this item until voting time. 

(Translated)

Voting deferred until voting time.