The next item is a statement by the Minister for Health and Social Services, once again, and this time on the Cwm Taf Morgannwg University Health Board clinical review update. So, once again, I call Vaughan Gething.

Thank you, Llywydd. Last week, I published the first of three thematic reports setting out the emerging learning from the clinical review programme established by the independent maternity services oversight panel that I appointed. The programme is currently focused on reviewing around 160 episodes of care provided by the maternity and neonatal services of the former Cwm Taf University Health Board between 1 January 2016 and 30 September 2018. The first report focused on the care provided to mothers and specifically those who needed urgent care, which in the main resulted in an admission to intensive care.

As Members will have seen last week, overall the report's findings concur with those of the independent review that I commissioned by the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives in 2018. It did not make for good reading when the findings confirmed that, in 27 out of the 28 pregnancies reviewed, factors were identified that contributed to the quality of care that women received. It is a significant concern that, in 19 of the reviews, factors were considered to be major. That means that different care may reasonably be expected to have altered the outcome.

I do not underestimate how distressing this report will have been for the women and their families who have been affected. While I hope it has provided answers to concerns they may have had, the report confirms that those concerns were very real. I remain very sorry for what went wrong and I know that nothing can change what happened for these women and their families. While it is important to be transparent about these findings, I also appreciate that it may well have caused further distress for those affected. It may have triggered those memories of their poor and, at times, traumatic experiences.

The report stresses the importance of listening to women when they know that something is not right. Poor communication is a key theme that underpins the factors identified in the report. I was pleased, however, that the panel recognised the open and compassionate way that the health board has responded and the support that it has put in place for women and families through this review process. I'd also like to thank the community health council advocacy service for the important role that they are playing in this work.

We should not underestimate how difficult this report will have been for staff and particularly at a time when the NHS, including maternity and neonatal services, has been under immense pressure. It is important to acknowledge, as the report does, that considerable improvements have been achieved over the past two years and which the panel has confirmed in its previous reports. This is very much down to the commitment and hard work of the staff and, indeed, the renewed leadership. The thematic report also confirms that those areas of improvement were the right ones to be focused on. 

Last week, I met with Mick Giannasi, who is the chair of the independent panel, and the health board chair, Marcus Longley, to review progress and consider the next steps. The panel will now be turning its attention to completing the reviews of the care of babies who were sadly stillborn. Once individual findings have been shared with women and families, they will produce a further report describing the thematic learning. Their oversight of the maternity aspects of the improvement programme will continue.

In tandem, the panel is increasing its focus on the neonatal aspects of care. The reviews of babies who needed specialist care or sadly died after birth are under way. This is the largest category, involving around 70 reviews. The panel needs to ensure that the immediate learning that emerges from these reviews is aligned to the neonatal aspects of the health board’s improvement programme. This is essential to determine if all required actions have already been addressed or are in progress. 

To ensure that this is as robust as possible, the panel has identified the need to enhance its membership to include neonatal expertise. They have recommended to me that a neonatologist and a neonatal nurse join the panel. In doing so, they propose to draw on the expertise that is already part of the clinical review programme. This will enable them to ensure that the same level of rigour is applied to providing assurance on the neonatal aspects of improvement, in tandem with the learning emerging from the individual clinical reviews.

In order to take stock, they propose to undertake a deep dive of the current service, and to ensure that any improvements needed are being addressed, and are fully picking up the recommendations identified in the royal colleges' review. I was pleased that Marcus Longley, as the chair, confirmed that the board would welcome this development, and the added level of external, independent oversight and advice that it will provide them. This will ensure that they can be fully assured with regard to the quality of neonatal care, and the improvements that they are making.

Women and families remain at the heart of this process. I hope that they can see that I, the independent panel and the health board are determined that we should leave no stone unturned in ensuring that we learn from the past. This, too, is equally important for our staff, as they deserve to work in an open, learning and supportive environment at all times.

I will, of course, continue to keep Members updated, and will issue a further statement once the additional panel members have been confirmed. Thank you.

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

Thank you, Minister, for this statement, and for your recognition of just how difficult a scenario this has been. Like you, I just want to say to all those families out there how desperately sorry I am—and I'm sure we all are—that this has happened.

I was shocked to read that the independent clinical team actually said that, in most of these cases, they concluded that different treatments could reasonably have resulted in different outcomes for mothers and babies. In only one case would the outcome not have been different. So, Minister, that is an awfully big lesson for the health board to learn, and I wondered if you could outline exactly how we can guarantee that those lessons have indeed been learned.

I remember talking about the scandal at Cwm Taf a couple of years ago, when it first broke, and we were looking at it in the health committee. We looked at all of the various reports that had been pointing to the fact that there was a problem, but again and again and again, the then management team and board had just not recognised those problems, or they hadn't percolated up to them. There were all manner of reasons and excuses, et cetera. One of the things that really came out of those early discussions, which I see that the current report reflects, is that, although this is going well and is going in the right direction, it is a work in progress. There is still work to be done in key areas like culture and behaviours, leadership and communication.

Minister, I remember very strongly that one of the things that came forward was the fact that it wasn't just in maternity services, but actually in the whole Cwm Taf ethos, that there needed to be that step change in their culture—the leadership and the communication throughout. So, can you please talk to us a little bit and explain to us about why you feel confident that those lessons have been learned, that those cultures are still changing? We are two years down. The current report still says that there is a long way to go. Of course, we haven't yet touched on the other cases that were involved in this.

The reason why I'm very keen to understand about the culture throughout the whole of this area is because there are other warning signs that have come through on Cwm Taf. Now, you could say that they are completely unconnected, or are they triggers, are they just pointing us to say that, actually, this is a health board where some of these lessons still haven't been embedded throughout, and that this was a systemic failure? So, warning sign one is that negligence payments went from £4.5 million to £13 million in just one year. That indicates to me that there is a lot going on, and that there payments happening because there are unresolved and slowly resolved issues. So, is that a warning sign? Should we be looking at that?

The other area, of course, is the fact that Cwm Taf has had a very high number of COVID deaths because of hospital transmission. Again, that comes down to training, to communication, to leadership, to management. So, you could say, 'Yes, that's entirely unconnected with the matter at hand', but the point that I am trying to make is: have we broken the systemic issues? Was it really just in maternity, or, as has been discussed in various committee meetings over the last few years, part of a slightly bigger picture? I think that your assurance or your reassurance that that is being tackled and that you feel confident that the chair and the current team are really beginning to make that happen will actually start to answer a lot of the other questions, because talking about the detail of what did and didn't happen and all of the reports, as you said earlier, doesn't make any changes to what's happened.

Thank you for the comments and questions. I should just point out that in 27 of the 28 cases reviewed there were modifiable factors. It's in 19 of the 28 that there were major factors that could be reasonably expected to have led to a different outcome. That's important, I think, because it does show that, in 19 of the 28, there could have been a difference. In the others, those challenges, modifiable factors in care, would have made a difference to that person, but not necessarily affect the overall outcome. Many of us will know that the complaints we receive are often about the experience that people have of their care; even if the clinical outcome would be the same, a person's experience could be radically different in receiving the same outcome. It's important to recognise all of those different aspects in the improvement work that is still required.

I should say, though, that I think it's perhaps unfair to draw out the clinical negligence increase without any context, and equally the nosocomial transmission within hospitals. Because, of course—and you will understand this, Angela, as will some people watching this—the difference in an increase of that magnitude in clinical negligence payments could be one individual case. A traumatic incident at an early point in time could lead to a very high award. So, actually, it's really about the number and the magnitude, and I think there needs to be more context in that.

It's the same thing with the point about nosocomial transmission—so, those people that acquire COVID, likely or confirmed, from a healthcare setting. Actually, we know that it's a feature; when we have rates of community transmission, you will see those in health and care settings. Members who live in those communities are going to have transmission events and they're at greater risk because of the workplace that they operate in. So, actually, the COVID deaths are not really because of the way that our hospitals operate in terms of a major feature; they're actually a feature of community transmission, and the reality of where there are risk factors in the population. There's no surprise that areas of the greatest economic inequality in any part of the UK are the ones where we've seen the greatest amount of harm being caused. So, I wouldn't want to try to point out that those two issues somehow indicate a broader failing within the health board.

That doesn't mean that there is nothing to do in terms of learning from either of those points. In every clinical negligence case, there should be a point of learning and understanding what went wrong. In every instance of nosocomial transmission, there should be a point of learning and understanding how to get back on top of that, and whether it is about infection prevention and control practice, or whether it's wholly a feature of community transmission. I just wouldn't want it to be a given that that, without more context, is, if you like, a warning sign. Because, actually, there's an awful lot of attention being paid to this health board during the COVID pandemic. They have made significant moves in terms of changing the way they operate, and I think have drawn a lot of credit. It's actually improved relationships with the health board and the local public, because they've had to do so much together. I think it's engendered a level of trust and openness that is really important not to lose sight of, just as it has done in other parts of the country.

It's also worth reflecting that, of course, the independent panel is providing regular quarterly reports still. So, this is the clinical review report. We'll still expect there to be a quarterly report looking at the broader progress being made against the 70 recommendations that were made. Fifty of those 70 recommendations have been completed, the other 20 are in progress. Most of those now relate to the cultural changes that still need to take place. Cultural change—again, you'll be familiar with this, Angela—doesn't happen in the space of a few months, and it takes time not just for it to take place, but for it then to be confirmed that cultural change is embedded and secured and sustainable. There's always a risk that, after an improvement, you can start to see complacency return. That's why the board functioning effectively and not just leadership at an executive level, but actually through each of the wards and the community settings, is so important as well.

I hope to get to the point where a future health Minister will be able to confirm that the independent panel's work is done, but we'll still need to make sure that other board processes work effectively. I do think people should take some assurance from not just the panel being there now, but the fact that the health board's own quality and safety committee recognised that it wanted more assurance about neonatal services. So, there's been a proper conversation between the health board and the panel. There's been no attempt to deny that there is a need for further assurance, and that, I think, does reflect the sort of openness that we would want to see. That's why I have agreed to the recommendation formally, and I will return with a statement for Members in the future when we've confirmed who the two additions will be. Because this really is about restoring the trust and confidence the public should have, and that staff should have, and, indeed, Members will want to know exists as well.

It's not possible to overstate the pain, the hurt, the harm and the anguish that has been caused to every one of the families that has been affected by this scandal, and that is ongoing. It's not something that's in the past; it's something that people are living with every single day. The report says that, of the 28 episodes of care reviewed, in two thirds of these cases, different care may be reasonably expected to have had a different outcome. Can the Minister explain what he understands 'different outcome' to mean? Does he accept that this polite and diplomatic language used in these reports may well be part of the problem? The report mentions that only four of the 28 women in the cohort chose to share their stories, despite the community health council providing an advocacy service. Does the Minister accept that these low numbers are a problem, and a problem that illustrates that much more work needs to be done in order to restore trust from the community in the health board? The report and the statement put much emphasis on the improvements and learning that has taken place, but if we've learnt anything from the past year and other scandals that have taken place in other institutions, it's that learning can only be really embedded if there is accountability for wrongdoing. Can the Minister honestly say that there has been accountability in this scandal, when the previous leadership of the health board have received such large payouts and the women who've become bereaved, in some cases, have received nothing?

Thank you for the comments and questions. I think that, in terms of understanding what 'different outcome' would mean, that will always depend on the harm that was done, and you'd need to go through individual cases to come past that. But we do know that there were poor outcomes for mothers and/or their babies, and some of the modifiable factors could have meant that people did not need to go into intensive care and would have had a better outcome, and that harm could be temporary or it could be longer lasting. Within the 28 cases, it's about understanding the reviews as they are presented, and then in recognising that women haven't given their permission to share the detail of that.

So, the panel report is a summary of that by necessity, and it's really about—this goes to your second point and question—what does it mean that four of the 28 were prepared to share their experiences. Now, it's possible, I guess, to read into Leanne Wood's suggestion that this means that the public don't have confidence in the health board. I don't actually think that is a fair assumption, because, actually, this is so intensely personal. You started by talking about the hurt and the upset that is continuing; when I have met families, I am very well aware of the fact that that pain and that upset is very much continuing, years after the event, for a number of these people.

The reports today, and the one published last week, will be upsetting for many of them, and some people are not prepared to go through that. There are people whose reaction is that they want to explain and to talk through what happened to them, and they find that helpful, others feel that they should do it, because they want to help others, and others, for reasons that, I think, are entirely understandable, don't want to talk about it in public and don't want to share experiences with others. I think we all need to reflect that different people will react differently to different experiences and even similar experiences they've had.

That's why the independent review is so important, because the individuals get their detailed feedback, and we then have a summary that protects them and their identity. But I would say that for all of those women and their families who have shared their experiences, that does make a difference, because hearing directly from people what happened to them, how it made them feel when they were and weren't listened to, and all that it has meant for their life, is really important in terms of the learning. It's so often the case that first-person feedback from people is something that is not just a positive learning aspect, but that learning should lead to a better service being provided to other women and their families in the future. So, the clinical review process isn't just about embedding learning; it is absolutely about improving the quality of care that is provided. 

On your final point about accountability, there is always a question about when and how you make staff accountable. It's in the report itself as well about one of the things that was going wrong in terms of the staff culture, where people who felt that they had concerns did not feel that others would be accountable, and would actually feel that they would be punished if they spoke out and said that there was a problem. Actually, if you then go out and look for people to punish publicly, that doesn't necessarily help you to get people to come forward and have a conversation, acknowledge they've made mistakes, or recognise that there are concerns about the service they're taking part in delivering with other colleagues.

It's been a very difficult experience, not just for Ministers and not just for your own health board, but it's been a very difficult experience for all of the staff who have looked back on what happened. And for some staff, they've left the service because of it. That isn't because necessarily they felt they'd done something wrong, but actually, because of the extra attention and what that has meant for them and their ability to do their job, and to come in, they've been so upset they've left. So, actually, yes, the chief exec is no longer in the organisation, and I don't think that chief exec will work again in NHS Wales. The challenge of resolving what's happened at a leadership level while running through a lengthy process could actually have harmed the organisation more.

It's never a straightforward matter, but I've seen this from all sides of the fence, both as a Minister and as an employment lawyer, in having to resolve some of this as well, and equally here in making a choice about what is the right thing to do for the service. I think being able to move on with a new leadership sooner rather than later was absolutely the right thing to do for the service. Because, as I say, it's women and their families who are at the heart of this in doing the right thing to improve the service, and to make sure that there's openness and honesty about what happened, and the openness and the assurance that people will want about the path forward for improvement.

Thank you, Minister, for your statement today. As you will know, I have met with women and families affected by the failings of the former Cwm Taf maternity services, I've met with maternity staff who have since worked so hard to turn the service around, and have followed the work of the expert panel and its review throughout. I have three questions for you today. Firstly, I'm pleased that this report once again reaffirms that considerable improvements have been seen and are continuing to be seen within the maternity services. What reassurance can you provide to expectant mothers soon to use the service, and with the added pressure of the restrictions imposed by the pandemic, that they can have faith in the maternity teams at Cwm Taf Morgannwg to provide them with the very best care? Secondly, communications has been a recurring theme throughout the review; can you provide more detail about how the board has sought to address this key issue? And my final question: as the panel moves to focus on neonatal care, you say quite rightly that they need to ensure that immediate learning emerges from these reviews aligned to the neonatal aspects of the health board's improvement programme. Can you confirm what systems are being put in place to ensure that this learning is conveyed at speed into the board's improvement programme?

On the final point about the board's improvement programme, you'll see it transparently in both the quarterly reviews we publish and the responses from the board. This is a continuing high-profile area for the board and its governance, and the assurance that it is seeking. Again, as I said earlier, the health board knows that there is a high level of interest in what it is doing and the steps that it is taking, and they will also know that, as well as their own processes, the independent panel maintain a role in the oversight and assurance for the maternity service as well. And I think that's really important for members of the public, which I think goes into your point about what can expectant mothers expect in terms of the quality of care that they're entitled to receive and take part in. I say 'take part in' because there are choices for people to make about what matters and makes a difference for them.

On the point about being listened to during the course of their treatment, during the course of their care going through a pregnancy, I think, actually, the fact that the panel in this report, as well as in their quarterly reports, have recognised that improvement is taking place is really important. They recognise the commitment of the leadership, both at the executive nurse director level and, indeed, the chief exec, but also, through the teams who are delivering the care on the ground, as it were, in the ward and in the community. I think that's really important too, because the great majority of the women who work in the service—and I'm pleased that you've been able to meet staff, as well as expectant mothers or new mothers—most of these women live in their local communities, and it was why it was so hurtful when there were such challenges with the service, because some of them felt challenge about going into their local community, wearing the uniform and explaining that they were a midwife, because of the level of shock there was. Actually, it's really important that those women, and they are almost all women, who go about doing their job have a real sense of pride in what they're doing, and are delivering excellence in care, and have that supportive learning environment for them as well, because that will help them to deliver the sort of quality of care that I would want for my own family, as well.

That's also why the communications work and the direct engagement with mothers is really important, as well. So, that's one of the things that Cath Broderick, in particular, who is one of the independent panel members, has led, and that has been about reviewing and revising the liaison service and the maternity network that exists. So, they're deliberately going out, proactively looking for women's stories, to listen to them, to understand their experience of care, and to ask them what does good care look like to them, and then to go back and say, 'And is that what the health board is delivering?' They're much more open in terms of sharing those patients' stories now, as well. So, there are a range of women who have shared their stories, and good, positive stories of what good-quality care looks like within Cwm Taf Morgannwg. Again, I look forward to seeing that, whatever role I hold or do not hold in public life in the future, in the months ahead, because the pandemic may have interrupted many things, but it certainly hasn't interrupted the maternity service.

Thank you for the update, Minister, and my thoughts are with everyone affected. The fact that the independent review found that two thirds of the women affected would have had vastly different outcomes if only they had better care is a travesty, and this finding must place further stress on those affected, and I hope that those affected by this finding are receiving the additional support that they need.

Minister, will you expand upon the steps you are taking to not only learn the lessons, but also ensure that such a travesty can never again happen in any Welsh hospital? Minister, what impact, if any, has the COVID-19 pandemic had upon the health board's ability to deliver against the review's recommendations, and are you content that sufficient progress will continue to be made? And finally, Minister, whilst this report is rightly focused upon the failings with maternity services, it does highlight leadership failings, so what is the Welsh Government doing to ensure the safety and efficacy of all services at the health board? Thank you.

On your point about leadership, there is new leadership at the health board at executive level, and there's a new chief exec, there's a new nurse director. In fact, the nurse director arrived shortly after the independent review had reported. So, there are clean hands at executive level, which I think is really important in building staff competence, but also at clinical director level, there's new leadership there as well. That's important too.

But it's the change in culture that is the outstanding point to be able to give direct assurance that it's been embedded that I think is most important, because this is about the assurance that I think both Vikki Howells has touched on in her conversations with staff, and I know that Dawn Bowden has had similar conversations too with constituents about making sure that the environment is one where people feel supported to raise concerns and will not feel that those concerns are being suppressed, because that is what a number of staff reflected when the reviews took place, and when I went out and met with staff in both the Royal Glamorgan in Mick Antoniw's constituency as well as staff at Prince Charles. And the assurance that that culture has changed definitively and positively for the future is, I think, in many ways the most important part about making sure that women are properly listened to. 

And I think, in terms of your second point about assurance on progress, I think I've dealt with that extensively in answer to questions already, and, indeed the independent panel is part of that assurance process, as I've indicated. 

On your first point about better care, it does indicate that, in about two thirds of these cases, 19 of the 28, there could have been better outcomes for women and their babies, and that is important not to lose sight of. The panel, though, also reflect this, that these are exceptional events. Nearly 10,000 women used maternity and neonatal services between the time in the period of review, and the vast majority gave birth to healthy babies without significant complications or adverse consequences. So, the cases reviewed are a fraction of those delivered. But it is important to recognise that these cases are the exception, rather than the norm, but the danger and the problem is that, if you ignore these cases and if you try to explain them away, then you undermine wider confidence in the whole service. And the harm that has been caused has been really significant for women and their families. That's why the review of not just these 28 but the full 160 cases that are in the scope of this clinical review are so important, and it's why the panel will stay in place until it has completed its work to provide the assurance that I know that Members and constituents will be looking for. 

Minister, I think we need to acknowledge that this review also indicates that there are significant parts of the NHS that still find it difficult to enable informed consent to be given at the level that it has to be if we're going to have the best quality services, and the need for women to feel fully informed to make decisions about their care is really paramount. Also, patient involvement in the design and evaluation of care is another great safety valve if things are not operating as well as they should be. And the general point about communications, not only communications between patients and staff but also amongst staff. But this issue of informed consent is something that we really need to identify, and I hope the lessons will be learnt and shared in other parts of the NHS. And it does echo, does it not, the chilling findings in the Cumberlege review into NHS services in England.

I don't disagree with what the Member has said at all. I think there definitely are points here about patient involvement in the design and delivery of services that make for better services in terms of their safety, but in terms of the experience and outcomes for people. I think that's absolutely true.

And in terms of informed consent, I did have in my mind the issues around Cumberlege, because where consent is not informed and you take—. When I was a student, a law student, I did medical ethics and the law, we talked about a paternalistic approach to medicine, very much, 'The doctor knows best, and you will have things done to you that are in your interest and you need to agree to them.' Well, actually, that is not where we are, not where we should be, and yet you can see vestiges of that approach in parts of healthcare. So, there is learning for maternity services, not just in Cwm Taf Morgannwg, but across the whole service, and those learning opportunities will be taken up. We have a maternity network that will want to see what's happening in Cwm Taf Morgannwg to make their own assurance that they are doing the right thing as well.

And there is a much broader point that you referred to as well that I completely agree with as well: informed consent isn't just for this part of our NHS, it is for the whole of the NHS. And we may well find in the future areas where that is not dealt with perfectly. The point, I think, is when you uncover that, when you find that it is there, you should address it and not try to wash over it and explain it away. That is how we'll get a safer service and a better service, and the service that we value so much, not just in the pandemic but through all times in the fortunate political lives we live. 

It was about 15 or 16 months ago that I attended the hospital to discuss with the new staff, the new expertise brought in, to look at the new facilities, because at that time, I think all the representatives in the Cwm Taf area had had a lot of very emotive meetings with families, and continued to do so. And it was very clear that despite the investment and expertise, the restoration of confidence was clearly one of the major challenges.

So, the report that has been published for today identifies, really, three points that very much go into the need for culture change. There's the poor communication, the lack of information, but most importantly, the lack of empathy, and I think that was the item that really shone out most to me in terms of what was identified. And of course, in the restoration of confidence, we're going to go through a painful year ahead on this, because we'll be looking at the stillbirths and more morbidity over the coming months.

I was very impressed with the commitment of the new staff and the new attitude and the recognition, I think, of the challenges ahead in ensuring that we have the most excellent of maternity services for all the reasons other speakers have mentioned today.

Can I just then raise two points? One is the ongoing support for the families themselves—and I have to say, I've had families contact me who have specifically mentioned your involvement and oversight, and welcomed it particularly, and they see that as reassuring from Welsh Government—but in particular the lessons that are being learnt are not just ones for Cwm Taf, but I suspect they are for maternity services across the health boards across Wales, and I was just wondering what is being done in terms of the communication of that learning process that is going on as we go through the process in Cwm Taf.

In terms of your final point, I was trying to make this point in response to David Melding, and I think Vikki Howells as well, that we are deliberately looking at how we use the maternity network to share learning. This isn't just a learning opportunity for one health board; it's a learning opportunity for the whole service, and to consider and to think about how we make sure that we do deliver a high-quality level of maternity care in every part of Wales. The context may alter slightly, but actually, every health board will have a population that it serves that has higher levels of deprivation. Every health board will have a part of its population that lives in a more rural environment or an urban or town or city environment; well, a town environment at least. So, we have challenges that may vary by degree, but actually, the quality of care should be something that every health board can deliver, a high quality of care, and this is an important opportunity not to be put to one side.

And I do think that it's helpful to finish on a positive note about what needs to be done, but about the commitment that exists there, because when I met staff at the outset of this, there were very unhappy people, people who were worried, and people who recognised that the communities they live in largely had not been well served in every instance, and they were upset about the organisation they worked for as well. Many of them, as I said, didn't feel proud to wear the uniform in public, and a regular point of concern that was made to me was, 'Who will want to work here? We're understaffed, and who will want to work here now?' And yet, actually, Cwm Taf Morgannwg has been successful at recruiting people into its organisation. It is now in a position where it doesn't have failures in Birthrate Plus, and those are being openly communicated. That was one of the challenges about the previous management that I have already indicated in the past that I was particularly unhappy with.

So, we now have a better position on staffing, we have a workforce that I think is committed to continued improvement in the future, and that positive change in the environment and in the culture is what I hope we'll see more of in a continued way that will be embedded, and once again, people who go to Cwm Taf Morgannwg for their maternity care now should have confidence in the quality of care and expect the same high quality of care that each and every one of our constituents should expect and be entitled to.

Thank you very much, Minister.