So, we reconvene on item 4 on the agenda, which is a statement by the Minister for Health and Social Services: update on special measures arrangements at Besti Cadwaladr University Health Board. And I call on the Minister for Health and Social Services, Vaughan Gething.

Thank you, Deputy Presiding Officer. Members will be aware that health boards and trusts in Wales have their escalation and intervention status considered as part of our joint escalation and intervention arrangements. This involves Welsh Government officials meeting with Audit Wales and Healthcare Inspectorate Wales twice a year to discuss the overall position of NHS Wales organisations in respect of quality, service performance and financial management. A wide range of information and intelligence is considered to identify any issues to inform their assessment and advice to me as the health Minister. There is also an opportunity to hold additional meetings, if the group deem it necessary.

At the last full tripartite meeting held in September, it was agreed to hold a further meeting before the end of the calendar year, specifically on Betsi Cadwaladr University Health Board. I am pleased to say that a special tripartite meeting took place earlier this month. The clear advice and recommendation to me was that the escalation status of the health board should change. I have accepted that advice. I have decided that Betsi Cadwaladr University Health Board will come out of special measures with immediate effect. The escalation status of the health board has now moved to targeted intervention.

The tripartite group reviewed further evidence submitted by the health board that demonstrated progress over recent years, including on the areas that had originally been designated as special measures concerns. The group noted that the health board has demonstrated improved engagement with partners, particularly during the current pandemic. It also recognised the level of insight shown by the health board into the challenges that it still faces, together with the determination demonstrated by the board and the incoming chief executive to make further progress.

The tripartite group noted the detrimental impact the special measures designation was having on the health board’s ability to recruit and retain staff, particularly at senior level. This has led to a number of the executive director roles currently being filled on an interim basis. This is, obviously, not helpful for the health board in moving forward. Special measures was also having an impact on the health board’s ability to make the necessary further progress.

There continue to be concerns on some aspects of performance, particularly in mental health services and the ability of the health board to prepare an approvable medium-term plan. Going forward, to provide the clarity and assurance of the necessary focus, a maturity matrix approach will be used, similar to the processes that have been in place in Cwm Taf Morgannwg University Health Board.

On 3 November, I announced a package of support for the health board. This support amounts to a further £82 million per year over three and a half years to support the health board as it enters a new phase under targeted intervention, and continues its ongoing work to improve. The chair of the health board has already responded outlining how this support will be utilised to improve unscheduled care, to build sustainable planned care, including orthopaedics, to deliver improvements in mental health services and, of course, to benefit the health of the population of north Wales.

It should be remembered that targeted intervention is still a heightened level of escalation. This requires significant action on the part of the organisation, and will be accompanied by a level of continued oversight from my officials. However, the move out of special measures marks an undeniably positive step forward for the staff of the health board who have made and sustained the progress to end special measures. This is also of course a positive step forward for every community in north Wales that is served by the health board.

I hope that Members across the Senedd will join me in congratulating staff at the health board as they move into the next phase of their improvement journey.

Can I take the opportunity to put on record the thanks of everybody on the Welsh Conservative benches to those front-line members of NHS staff in north Wales who've been working so hard, particularly during this pandemic?

It's a great shame, Minister, that you didn't have the courtesy to brief any Members on opposition benches today about your decision, and in fact, you even gave the great discourtesy of not even sharing your statement until a moment before it was actually read from your lips. The reality is that today's announcement appears to have more to do with the prospects of the Labour Party in north Wales at next year's Senedd elections than it does with any evidence of real improvement on the ground in north Wales. Your decision to remove special measures cannot be justified and you cannot fool or hoodwink the people of north Wales into thinking that everything is hunky-dory. Your description of improvement bears absolutely no resemblance to the reality of patient experiences across the region.

Let's look at the facts. The Betsi Cadwaladr University Health Board was in its sixth year of special measures. In that time, it's had a revolving door in terms of its senior leadership team, with a number of chief executives, a number of finance directors, and a number of directors of mental health. In fact, the current director of mental health departs his role at the end of this month, another notch on Betsi's bedpost.

Since 2015, A&E performance has gotten worse, waiting lists and waiting times have deteriorated and gotten longer, and the financial position of the health board has also deteriorated. The recent figures show that Betsi still has the worst emergency department performance in the whole of Wales, with one in 10 people waiting more than 12 hours before they're able to be discharged after arriving in A&E, and over half, almost half the population who turn up not being able to be released within four hours.

We know that GP services are still fragile in the region, with more managed practices than any other health board area in Wales. And, of course, we now know that dentistry services are fragile across north Wales as well, with 20,000 patients being given notice that their NHS services are going to stop early next year. This is not a health board that is fit to come out of the special measures arrangements. 

You referred to a number of reasons when this health board was put into special measures, and governance, leadership and oversight was one. We know that there are still weaknesses there because there's been a recent outbreak of coronavirus in two of the hospitals in north Wales, none of which came to light because of the situation in the health board, but because local Members of the Senedd had written raising concerns.

Mental health services are still not out of the woods. In spite of the promises of new, shiny buildings, the culture in those departments is still the same. We've got 1,600 patients who, earlier this year, were discharged from services without their knowledge, or being made aware. Bed capacity is still a huge problem. Child and adolescent and mental health services are still not adequate, with patients still being sent hundreds of miles for in-patient treatment. And a quarter—a quarter—of all mental health safety incidents in the Welsh NHS are incidents in the Betsi Cadwaladr University Health Board. This is not a health board that is fit to come out of special measures.

Just a few weeks ago, last month, you said that there were still big challenges in north Wales. Just a few weeks ago, you said, and I quote,

'Specifically, the group wanted some further assurance from the health board in respect of progress in mental health services.'

This is just a few weeks ago. Now, either this really is the most miraculous recovery since Lazarus was raised from the dead or you're trying to hoodwink the people of north Wales into thinking that services are better, when the reality is that they're not.

So I ask you, Minister, how can you justify your position given that many of the issues on that original list—and I quote one, for example: reconnecting with the public and regaining the public confidence. That's one of the reasons it was put into special measures. I can tell you what, the public in north Wales have no confidence whatsoever in your ability to improve their services. They've only seen them deteriorate, as I've just pointed out to you, in terms of some of those facts on the ground. So how can you say that that item has been dealt with?

How can you say, when there are so many GP services that are fragile, and so many health board intervened and managed services, that the concerns about GP and primary care services have been dealt with, especially with the looming crisis now in dentistry care as well? And how on earth can you say that governance has been addressed when the health board itself didn't know the rate of hospital-acquired infections in relation to COVID until I pointed it out to them? And how on earth can you say that mental health services are better when, frankly, they're just as bad now as they were back in 2015?

Well, it's disappointing, but perhaps not unusual, to have a predictably unreasonable response from Mr Millar. The refusal to give any credit to staff for progress made over the last few years that has led to special measures being lifted is unfortunate. In particular, I remind Members, both in this Chamber but also externally, of not just the progress that has been assured by the tripartite process, which I'll come back to, but in particular the response to the pandemic, a once-in-a-century healthcare crisis. I think that Betsi Cadwaladr and its staff deserve huge credit for the response. It would be unusual to say that there has been a first-class response to the pandemic and yet the organisation must remain in special measures, because that would suit the perspective of Mr Millar.

When it simply comes to the basis for this organisation to come out of special measures, I referred to it very plainly and clearly in the statement, just as we have done on previous occasions when referring to special measures updates about the advice from the objective tripartite advisory process. The chief executive of NHS Wales, together with Welsh Government officials, Healthcare Inspectorate Wales and Audit Wales, provide advice to me as the Minister. Their clear advice was that this is no longer a special measures organisation. And I should say that the NHS Wales chief executive, Healthcare Inspectorate Wales and Audit Wales do not make choices on their advice to me on the basis of party politics. The suggestion from Mr Millar to the contrary is a slur on their integrity and a matter that he should withdraw and reconsider.

The tripartite advice is the advice; it is my decision. Targeted intervention is not a free pass; more progress is required, as I have made plain. I think reasonable people will recognise that, but they will also recognise that this is a positive day for healthcare in north Wales, a real credit to the staff of the health board, and I look forward to further progress being made.

Diolch, Weinidog. Thank you for a statement that confirms that Betsi Cadwaladr is staying at a level of intervention for another period at the hands of Welsh Government, which has failed in five and a half years to turn around the problems that put it in special measures.

I always praise the front-line staff in the NHS, in the north of Wales, as I do in the rest of Wales. Their response to this pandemic has been second to none. I'm proud to know many of them, and I'm proud of the work that each one of them has done, tirelessly. Your invitation for us to praise them specifically for bringing the board out of special measures, are you saying that they didn't do their bit to bring the board out of special measures over the past five and a half years? What I've seen is the Welsh Government failing to take the adequate steps, and steps that you could have taken previously. The statement, to me, basically says, 'You know what? We can't make progress, it seems, whilst we are in special measures.' Has it really taken you five and a half years to get to that point?

And how did you reach this point in a matter of weeks? We're now—where are we? 24 November. You told us on 7 October that there were big problems that needed to be faced still, in mental health in particular. But it's not today that you're deciding; apparently earlier this month, by that point, the tripartite meeting had told you, 'All is good'. So, in a matter of three or four weeks things had been turned around. And that, to me, seems very, very odd.

You say that special measures were having an impact on the health board's ability to recruit and retain staff. Again, are you only just realising that now, after an extended period of jobs being unable to be filled, both on the clinical side as well as on the management side? Are you only now realising that special measures are affecting negatively the ability that we have to attract the best people to work in health in the north of Wales?

Of course, on one level, I'm pleased to see a moving forward from special measures to another level of intervention. But I'm still of the opinion, as are many patients and staff members within Betsi Cadwaladr, that the north of Wales needs a fresh start. It has taken too long to get to this point and there is very little faith in how we are going to get to the next point, where we can really say that we have, in the north of Wales, a health service that works and that is designed in a way that staff and patients deserve. We need new health boards for the north of Wales, a fresh start, and today does not convince me that the Welsh Government has a handle on the real problems, not least in mental health, which was at the root of putting the board into special measures in the first place, to the extent that I can say that the problem is anywhere near resolved.

Thank you for the questions and the comments. I particularly welcome the recognition from the Member that the pandemic response from staff and organisations in north Wales has been second to none. It has been a very positive and impressive response. And, again, that underpins an organisation where others would have been concerned about the ability of the organisation to work effectively in the face of a once-in-a-century pandemic, and yet, actually, they have risen to the challenge significantly, with not just the creation of the rainbow hospitals, but the way they've worked across their whole healthcare system. And I think it should give more people more confidence for the rest of the unfinished pandemic that we are all still facing. 

And, again, to go back to the point about the advice that is given and the assurance from the previous update I gave from the regular tripartite meeting, at that meeting, in the discussion around north Wales, they recognised that further progress had been made and they asked for a further meeting because they sought further assurance on areas of progress. They've considered the extra information that has been provided, and that group of people—the chief exec of NHS Wales, Healthcare Inspectorate Wales and Audit Wales—have given clear advice that Betsi Cadwaladr should move out of special measures, and that is the basis for my decision.

I don't think it's difficult or complicated to understand, and, of course, other people are entitled to say that they reject the advice of Healthcare Inspectorate Wales, Audit Wales and the chief executive of NHS Wales. They're entitled to say that, and I think people are entitled to judge whether they think that is the right thing to do, for me to base my choice on, as a Minister, or for rather more partisan reasons not to change the status of the organisation, but to keep it in special measures when the clear objective advice is that it is no longer the right thing to do for the organisation and the people it serves.

I recognise that—. The Member has a clear view that he has set out on more than one occasion, that he believes a reorganisation with more than one health board in north Wales will provide a better future. That is not a view I share. I think the loss of focus, the money you'd spend, the upheaval, would have a real cost within it and you'd then have to remake all those partner arrangements that have definitely moved forward over the last few months and the last few years. So, I don't share his view, but I recognise he's perfectly entitled to put it to people. Members will decide, but as I say, this is an undeniably positive step forward for all the staff of the health board and indeed for every community in north Wales that is served by Betsi Cadwaladr University Health Board.

Thank you, Minister, for your statement. I massively welcome the significant investment and the news today that the health board is now out of special measures. I do still, however, have some concerns that I'd like to raise today, and I'd be grateful for your comments on those. I am still concerned particularly about mental health services and I'd welcome your thoughts on how the service is improving. Secondly, can you also outline how you feel the health board is performing with regard to elective surgery? And finally, parts of Alyn and Deeside in particular do need better GP provision; particularly places like Saltney are underserved. So how confident are you, Minister, that the health board will properly address this? And if I may, in closing, Deputy Llywydd, can I put on record my thanks to all the staff across north Wales in the NHS, and across the whole of Wales, not for just what they're doing now and continue to do, but for what they always have done in supporting us through the healthcare system in Wales? Thank you.

I'd like to thank the Member for the three specific areas of questions. I'll deal with them in reverse order. On general practice, and Saltney that he mentioned in particular, there's good news in that every scheme in north Wales for GP training has recruited or over-recruited to its capacity, so we're attracting people to work right across the whole country. It's good news for the whole of Wales, including north Wales. We did have some particular challenges at the start of our work on ‘Train. Work. Live.’ to get people to take up the training places in north Wales. We're now in a position where we've got this surplus, which is a really good position to be in in terms of our normal places, but we want to keep all of those people that do their training in north Wales, because we do want to see people seeing north Wales as an attractive place to train, work and live. And if the Member wants a specific conversation on Saltney or other areas in his constituency, then I can happily arrange that both with the health board and/or myself, and I'll look forward to hearing from his office further to see how he wants to take that forward.

On elective capacity, as with the whole of Wales, there has been a particular challenge. North Wales has a bigger challenge than other parts of Wales on elective and planned care, partly because of the way in which normal healthcare takes place, and he will know this, having a border constituency. A number of people are used to, as part of their healthcare, travelling over the border. In the future, we can be confident that the English system will have a huge catch-up in terms of its elective capacity as well. We're unlikely to see lots of planned care capacity within the English system. That's why the orthopaedic challenge that I set out and the funding we're providing is even more important, to have a more sustained position for planned surgery—orthopaedic and others—within north Wales as far as possible, as well as the conversation we need to have about regular healthcare across the border.

And on mental health, there is a particular concern that I've highlighted in my statement—again, because there has been progress on mental health, but there's definitely more to go. And so the 'Together for Mental Health in North Wales' strategy that has been designed with service users in north Wales—it's really important to see that transformation continue, and that will be a particular concern that we'll be looking for further reassurance and progress on in the targeted intervention arrangements that are in place. So, I want to reassure the Member and everyone else watching that mental health is very much in our minds—again, about the unfinished improvement journey that is still required. But undeniably, mental health services in north Wales are in a better place now than when the organisation was placed into special measures five years ago.

Betsi Cadwaladr, according to you, is now out of special measures. Okay. I agree exactly with what Rhun and Darren have said, but we will see going down the line how it works out, and my contribution today will still stand. I've had a look, Minister, at my previous statement when it was in special measures, and my responses, and they're all along the same lines. So, I could, if I wanted to, basically present exactly the same speech I gave in June 2019. However, considering the year that we've all had, where the NHS and associated services are very much on the front line, I feel it more appropriate to be as constructive as possible.

Firstly, I'd like to place on record my thanks to all of those in the NHS who have contributed to keeping services going in the face of fear, pressure, illness and death. It does appear that we are winning the COVID battle. As world case numbers have risen over the last couple of months, deaths have not risen relative to those numbers. Minister, I can only imagine how massive the weight is on your shoulders. The fact that you are still standing is testimony to your own tenacity. While any party in opposition can differ as to the approach taken, I doubt anybody in this Chamber would actually swap places with you—at least during 2020. We know that Betsi Cadwaladr has been in special measures for a record amount of time and, as I said, fingers crossed that your approach now works. And the increased funding from last month was very, very welcome.

In your estimation, Minister, what difference does being in special measures make to the level of service afforded to our constituents, and how will it change now? What I'm trying to tease out is whether special measures meant longer waiting times, more difficulty in getting a GP appointment and harder-to-access dental services? Because it seems to me that, in our COVID-recovery world, every citizen in Wales will have difficulty in all of these areas due to the impact of the pandemic. Having asked that question, I must put on record that I, for one, am sick of the health service being used as a political football, as it continues to be. I think we've all realised that health is more important than anything else. We know that the health service takes up over 50 per cent of the budget allocation for all of the devolved services, and the COVID response across the UK has been driven by the NHS—its capacity, its funding—at the expense, it seems, of every other area of civil society.

I mentioned in my remarks to your statement on strategic support for Betsi Cadwaladr that a fundamentally different approach might be needed to solve what I see as a structural problem with the north Wales health board. It is the largest in Wales, so perhaps that needs to be looked at—the structure. Perhaps it's time for the health service to stop being that political football. It is now time to consider what sort of cross-party commission can take responsibility for the health of the nation and the Welsh NHS. There is, after all, no monopoly on good ideas and collective political responsibility, and an element of consensus has got to be better than the type of debate that we have had, or that we will have today. Thank you, Minister.

Thank you for the comments and questions. I should say, in terms of your final point, that of course we did start this Assembly term, as it was then, now a Senedd term, with a parliamentary review. The UKIP group at the time supported the creation of that group and, indeed, the membership of it as well. So, we had an independent group of experts who came up with a report on the significant challenges we faced and ideas about the future for health and social care, and that has led to 'A Healthier Wales', which is our long-term plan for health and social care.

So, we're trying to undertake the transformation that we were plainly and clearly advised would need to happen, and that involves both some concentration of specialist services within hospitals, as well as a further move to more services being provided in the community. And that move around and reform for a purpose in healthcare is really important, together with the deliberate steps that we know we need to take to create a more integrated health and social care system. That's why we've provided updates on the transformation fund and building that new service. And actually the pandemic has reinforced the need to do that. It's also reinforced the progress we have already made in improving relationships between health and social care.

Again, I recognise the point the Member makes about the potential to reorganise healthcare in north Wales. I don't think that achieving the vision in 'A Healthier Wales' requires a reorganisation of the health board in north Wales, but it's a view that Members are entitled to have. It's not one that I share, but I'm looking for the results and the progress that we are looking to make. I hope the Member will see that in the action, because she started off by welcoming the move and recognising that she'll want to see the results on the ground, and as someone who lives in north Wales, that's an entirely reasonable place to be.

When it comes to special measures, the reason for going into special measures was—. Our assessment on the delivery, the quality and the sustained status of special measures was about our assessment on the progress that the organisation had made against those challenges, but also the confidence for the future about sustaining improvement. Because I have regularly reported that some improvement has been made, but it's the confidence about that being sustained and continued in the future. We are now at a point today where, with the tripartite advice, they themselves have confidence that this is no longer the right place for the organisation. That's why I've moved it out of special measures, based upon that clear and objective advice.

There will continue to be an extra focus and scrutiny of the health board in targeted intervention. I have already announced the financial support that will go with that as well to help them in their improvement journey. I think that it's a good thing for everybody who lives in north Wales that the health board is now in this position to move out of special measures, and I hope that people see it in those terms. Finally, I'd like to thank the Member for her kind words about the reality of dealing with the pandemic. There are many more difficult days ahead for all of us.  

Thank you, Minister, for your statement. Ordinarily, of course, I would have been extremely delighted to learn that you were bringing the Betsi Cadwaladr health board out of special measures. Indeed, in a north Wales meeting recently with MSs and MPs, the chairman himself was looking forward to being taken out of special measures because, as has been rightly pointed out here today, recruitment—you know, it's almost like a toxic brand now, isn't it, the Betsi board, which is really sad. But, I would like to put on record and endorse the comments by my colleague Darren Millar, who expressively said of his thanks, his gratitude, his appreciation to everybody working in the NHS in the Betsi Cadwaladr health board across all levels, not only for their work under the tensions of special measures, but also their heroic efforts during the COVID-19 pandemic. So, again, for you to dismiss that, Minister, was pretty low.

Now, this health board has been in special measures longer than any other health board in Britain. Since June 2015, nearly £100 million has been spent by the Welsh Government under your directorship on intervention and improvement support, which simply hasn't materialised. Now, £1.7 million was spent on securing sustainable musculoskeletal and orthopaedic services last year. Yet, earlier this month, you announced £30 million to improve unscheduled care and to build a sustainable planned care programme, including for orthopaedics. Now, while I fully understand and appreciate that the crisis in orthopaedics has worsened as a result of COVID-19, how is it that we still do not have a sustainable plan after the £1.7 million investment?

Only a few weeks ago, you mentioned some of the challenges facing us. Well, I can tell you that, on 3 November of this year, which is actually 15 working days, you stated that a number of actions were required on the need to further improve leadership and governance: that you needed to develop a long-term integrated clinical services strategy, that we needed further strengthening in leadership capacity within mental health to enhance stability and resilience, that the development of a robust three-year financial plan was needed to meet financial duties as part of the integrated medium-term plan, that there was a need to finalise and implement a revised accountability and performance framework, and that there was a need to deliver improvements in performance, particularly in the acute sector. That was—   

Can you wind up please?

—on 3 November, Deputy Llywydd. So, how have you, in 15 days, managed to overcome all of those things that needed improving? Now, given that you are pulling the health board out of special measures—

Can you wind up, please? 

Yes, I am doing—

You have had well over your minute.

So have many other Members.

Excuse me. I decide who asks what and I'm asking you to wind up, please.

Okay, I am doing that. Can you confirm that the health board has addressed all of those areas? And will you promise this Chamber that this move today isn't politically motivated, is in the general interests of the patients of north Wales, and not in the interests—

No. I'm sorry. Thank you. The Minister to respond. Before you do, can I just remind subsequent Members of parties that they have one minute, and that your business managers should enforce that for you for the safe running of this Chamber? Minister.

Thank you, Deputy Presiding Officer. I will deal with the specific points, and then I will come back to the accusation at the end. It's worth pointing out for—. I think that there's an element of misunderstanding in terms of the comments about the musculoskeletal service and its link with orthopaedics. This was actually north Wales that took a lead in the 'physio first' approach and looked at having an approach that rolled out and actually lessened the demand within the orthopaedic service. Where planned, elective operations were then required, it's been good news, and actually, north Wales have led on some of that work and the rest of Wales has benefited from that experience. So, in investing around that service, we have avoided the need for some operations that were unnecessary, and it's also about helping people to manage if they do still nevertheless need to have an operation in the future.

However, the orthopaedic plan that I've referenced, that is about investment for the continuing need for a range of people to nevertheless have surgery. So, this is about how we have a plan that all the centres in north Wales buy into, because at the start of this year I received comments from Members in different parties who had talked to clinicians in different parts of north Wales, who all had a competing plan that they wanted to promote. We're now in a position where we have got some unity in the clinical group. They're prepared to sign up to a common plan, and this is about getting behind that plan. It will not just be about how we make the service more efficient; it will require some capital investment, too, along the way, I think. So, I'm looking forward to a finalised, unified business case that allows us to help north Wales to move on with an orthopaedic plan to deal with the real nature of the need and demand. The musculoskeletal service that's been invested in is a really good example of north Wales taking a lead and looking at how it positively reforms its service.

And then the broader accusations that have been made. I know the Member started by saying that she would 'ordinarily' be 'extremely delighted' with progress out of special measures, and I think there is an issue here that I don't think won't just be recognised within this Chamber, but outside as well, about the refusal to acknowledge good news and progress here. The direct accusation made by the first Conservative speaker was that this was somehow an exercise in straight party politics. That is not the way that the chief exec of NHS Wales gives advice. That is not the way that Healthcare Inspectorate Wales or Audit Wales provide their advice—through the tripartite escalation and intervention arrangements. And Members in this Chamber know that very well. The suggestion otherwise, that this is really nothing more than an exercise in party politics, does not reflect well on any of the Conservative Members who have tried to do so. This is my decision on the basis of clear advice. I'm very pleased to have made this choice, and welcome the progress being made in north Wales.

I have nothing but praise for the heroic, hard-working medical staff working in our north Wales hospitals. Concerns lie elsewhere. In January, the north Wales community health council wrote to you, attaching the independent review of psychological therapies in north Wales, which described the service failing in many areas, and stating that after nearly five years in special measures, much of it related to mental health issues, these findings are deeply disappointing. North Wales community health council does not recognise the picture painted in the special measures improvement framework report. This is not reflected in our complaints and advocacy caseload or the reports of the community health council visiting teams. Last Friday, they announced that they will be hosting a series of events on Zoom, inviting NHS staff, patients, carers and families to talk about mental health services. As they said,

'It is vital that we present the experiences and suggestions of all those who use mental health services to those who make decisions and policies.'

Today, Betsi Cadwaladr University Health Board stated that they will consider arrangements for the leadership of mental health and learning disabilities with their incoming chief executive Jo Whitehead when she takes up her post in the new year. Why aren't you waiting for these things to happen, putting patients before politics, rather than leaping into the dark?

This decision today puts patients before politics in making what is always a difficult choice, but a choice that is driven by the very clear advice we have had in the tripartite process. I recognise that Conservative speakers are predetermined not to accept or recognise this good faith decision. That is a matter for them, and people watching will make their own judgments about whether they should trust the views of north Wales Conservative politicians, or the clear, objective advice from the chief exec of NHS Wales, Audit Wales and Healthcare Inspectorate Wales that underpins my decision to lift Betsi out of special measures.

Thank you very much, Minister.