2. How is the Government addressing staff concerns and morale within Aneurin Bevan University Health Board following the publication of a critical Royal College of Physicians report? TQ573

Minister.

I'm aware of this report and I spoke to the Royal College of Physicians about it when I met them in August. The health board is taking these findings very seriously and has drawn up an action plan to address the recommendations and I very much expect to be kept informed about progress on those actions.

Diolch, Gweinidog. Coverage of the Royal College of Physicians's report on the experiences of staff within Aneurin Bevan University Health Board made for some disturbing reading. It is unacceptable that trainee doctors and consultants are, and I quote, 'scared to come to work'. Andrew Goddard, the RCP president went as far as saying,

'During our virtual visit some trainees told us that they were scared to come to work, in case they lose their GMC number. In my eight years at the Royal College of Physicians I've visited hundreds of different hospitals—and I had never heard that before.'

The reason why staff are so frightened of losing their General Medical Council number is down to serious concerns about patient safety under the new hospital model, which sees workforce and patients moving between multiple sites that are under-resourced. Many of my constituents will be worried about this news, so I want to hear from you today what steps you have taken to improve patient safety within Aneurin Bevan University Health Board. Can you provide the assurances that people in my region need? Furthermore, how are you addressing the legitimate concerns of hard-working staff who deserve better and should not be fearful of coming to work?

Diolch yn fawr, and I took that report very seriously as well and was extremely concerned when I heard about it first-hand from the Royal College of Physicians when I met Dr Olwen Williams earlier on in the summer. I think we do need to remember the context in which those visits were taking place. We must remember that the Grange was opened ahead of time and that was partly as a result of responding to the pandemic. And it was because of that that perhaps the checks that would usually be made before you open a hospital, perhaps were not made in the way that usually would have occurred, and it was at that time or very soon after that that the visit took place by the Royal College of Physicians. And so, clearly, there are issues to address.

I'm very pleased that the action plan is very detailed—that the health board is taking it extremely seriously and that they have started looking very seriously at quite significant additional recruitment to take pressure off the staff who are currently there. But also, one of the issues that I'm particularly concerned about is the well-being of the staff, and certainly there is a review being undertaken in relation to that—a review of medical staffing. There are strategies to address that medical recruitment situation. There's a board, which will focus on staff well-being and engagement, and they'll be meeting face to face with representatives of the staff on a fortnightly basis now. There will certainly be some work to do in relation to patient flow at the Grange, and provision of safe care for children at other hospital sites in the health board area, in addition to the fact that there will be a focus on training and education. So, I am pleased to see the health board has certainly taken this seriously, but as I say I will be watching to make sure that what they said they're going to do is actually enacted.

A flagship hospital, Minister, is of course supposed to be leading by example, and we know that the question today is about the Grange hospital, which has the worst A&E waiting times of any hospital in Wales. Now, the report in question today talks about the unhealthy workplace and talks about staff frightened to go to work. Understaffed departments, staff burnout and low capacity all of course add significant risk to patient safety. Doctors have told the Government of course the concerns that they have for patient safety regarding the Grange hospital being open four months early, as it would mean that the hospital would be understaffed. So, concerns have been expressed about capacity being too low for the demand that needs to be met across south-east Wales. Now, I'm conscious that the previous health Minister said that it would be a great pleasure to announce that the Grange will open ahead of schedule, saying that it would provide more capacity and resilience. So, my question, Minister, is: what's your assessment? Is the Grange providing that resilience? I suppose, ultimately, in regard to the report today, can you tell the Chamber what lessons in particular you've learnt as a result of the report's findings?

Thanks very much, Russell. We do hope that the Grange will become a flagship hospital, because we've spent a considerable amount of money on it; £358 million has been invested in this hospital to support the people of the Gwent area, and I do think that it's important that we remember the context in which it was opened. You must remember that, at the beginning of the pandemic, Gwent was one of the first places in the whole of the United Kingdom that was hit hardest by COVID, so having this hospital being able to take a bit of pressure off other hospitals in the area was a relief at the time. But of course, what it meant was that the recruitment that perhaps should have been done was not done in time. But you do, I think, need to remember the context in which we are working. I'm really pleased now, though, that the health board has understood that they do need to listen to the clinicians who have made their case very clearly through this report.

The Grange was initially designed as a specialist centre, and provision for general internal medicine wasn't prioritised, but it's clear that the local population are accessing the hospital in a different way from the way that was envisaged, and I think the plan now is to make sure that any new recruitment will, for example, help to establish a front-door-based frailty service, for example, which will be able to be led by a consultant and other senior therapists, which is a provision that wasn't envisaged. But sometimes you do need to respond to, actually, the way that the local population are using the facility, even if that wasn't the way that was envisaged in the first place. I know that the health board has done a huge amount of work to try and contact the local population, to try and point them in the right directions in terms of which hospitals they should be attending for what issues. We're still going through those teething problems. It's just that those teething problems, of course in the middle of a pandemic, have taken longer than they would have, probably, if we weren't in a pandemic.

For those of us who have worked with the health board over the last decade in the design and building and construction of not only the Grange but also the model that it underpins, we have seen, over the last year, the national health service in the Aneurin Bevan area respond in a way that is quite magnificent to the suffering of people in this region. We've seen how people have worked and worked and worked hours, days, weeks and months to keep people in our communities safe, and I think we should be working with them and acknowledging the sacrifices that those public service workers have made over the last two years during this pandemic. And we should recognise that commitment and hard work that they've put in over this time.

For the Welsh Government, I believe there are two challenges facing it. First of all, the model. I think the model—the regional care model—is the right model and it's one that the Welsh Government has sought to pursue throughout the whole of my time here. And Members, mainly in the opposition parties, have always sought to prevent that from happening. I think there is a real issue about the provision of healthcare in this country, because it's the easiest thing in the world to say, 'Don't change anything; don't deliver anything new'. And we've seen that. I saw it as a Member for Mid and West Wales, I've seen it as a Member for Blaenau Gwent, and I've seen people standing up making speeches here without understanding the reality of the situation facing doctors, nurses and medical staff on the wards in the hospitals and in the health centres of this country. And Welsh Government needs to understand what the regional model does on a policy basis, and I'm not completely convinced that the Welsh Government has always done that, if I'm quite honest. And—

Can I remind the Member that this is a question, not a speech?

—the second point is important as well, because it's about the practical response of the Government to this report and to what is happening in the region. I believe that the Welsh Government needs to ensure that the Aneurin Bevan health board has the support that it requires in order to deliver this model. The Minister has recognised what is happening in the Aneurin Bevan region through introducing the new hospital model in the middle of a pandemic. That was a decision of Government; it was the right decision. But now, the Welsh Government needs to ensure that that model can actually work by providing additional help and additional support to the Aneurin Bevan health board so that those people who've sacrificed so much have the support from this Government that they require in order to deliver the services upon which we all have the right to rely.

Diolch yn fawr, Alun. I think you're absolutely right. I think that the approach of a kind of regional approach to medicine is something that we need to take very seriously. I think that people are prepared to travel to specialist centres, where they know that they're going to get expert support and expert advice, and that means that people do need to understand that that may not mean a very local hospital and that sometimes, they're going to have to travel a little bit to get that specialist support that they may be looking for.

But certainly, in terms of the practical response, we will expect Aneurin Bevan to step up here to respond to those people who, you set out very clearly there, have really stepped up during the pandemic, who have worked their socks off during this time and who, frankly, are exhausted, particularly when the staffing levels are not where they should be. And that's why I am particularly pleased to see that Aneurin Bevan has already given outline approval to address the issues of staffing at a cost of £1.5 million additional funding for that. So, that is money that they already have in their budget. It's about how they're going to spend it and I'm really pleased that they are genuine, I think, in their response to this report. But, as I say, we in the Welsh Government will be keeping our eye on this because I must say that it was very sobering reading from the Royal College of Physicians and certainly, we will be keeping an eye on it, partly because we simply have got to stand by those people who have given their all during this pandemic.

Minister, concerns about chronic understaffing at the Grange hospital have been circulating since the hospital opened in November 2020. On announcing the early date of the opening, the previous health Minister said that the facility would provide more capacity and resilience in the system. However, at present, the Grange hospital has the worst A&E waiting times in Wales, with fewer than 41 per cent of patients being seen within four hours, and this statistic is from August 2021.

Last month, it was reported that patients were waiting up to 18 hours to receive treatment and that 15 ambulances were waiting to hand over patients. In reply to Andrew R.T. Davies's written question last month, you said that it was the responsibility of the Aneurin Bevan health board to meet the needs of their community. So, Minister, will you now take immediate action to address the staff shortages and excessive workloads that are demoralising the workforce and put patients' safety at risk, before the inevitable increase of pressure on services made worse by the coming of winter? I did hear your previous answer, so I just wanted to ask you, as a request: will you now be monitoring the Aneurin Bevan health board? I hope that you will give us an assurance that you will come back to us in the Senedd and report the findings to us before Christmas, if you indeed are. Thank you, Minister.

Thank you very much, Natasha. I'm very well aware of the issues around A&E, and I'm keeping a very close eye on the pressures in the system around A&E. That's why we have already made a significant addition in terms of recruitment to the Welsh ambulance service, which was significant not just last year—over 100 last year—but significantly more this year and more to come. Of course, you will be aware that we are also now getting the support of the army to help us out in this situation.

So, a lot of work is being put in place. But, as you say, the key issue here, and the key restriction, is staffing. That's why, as you have reported, we will be keeping an eye on what that staffing looks like. I know that there's a short-term strategy in terms of using the British Association of Physicians of Indian Origin and the European gateway route to really try and do some immediate stuff in recruitment. So, there's a short-term approach that they're hoping to get into place very, very quickly; I know that there are 12 staff that they're trying to recruit via the European gateway route imminently. So, things are moving very quickly in this space, and I'm very pleased to see that, because, clearly, this report needs a response.  

Finally, John Griffiths.

Diolch yn fawr. Minister, as we've heard, staff and services at the Grange are obviously under tremendous pressure. You mentioned the context of the pandemic, and, of course, we now have the context of ongoing COVID incidents and infections and hospitalisations, worries about a very significant flu season this winter, all of the backlog of treatments that we know about, and, of course, a very difficult emergency care situation, and difficulties in discharging to social care because of the staff shortages and pressures that they're under. So, I think that all of that means that the existing situation, which is really worrying, could get considerably worse. So, I am very pleased that you are going to take an ongoing interest in monitoring the position, because, obviously, there are considerable fears over the pressure that is yet to come.

Also, you mentioned the more complex general medical needs, Minister, which were not considered the province of specialised care at the Grange. But we do have quite a complicated model, I think, don't we, where staff and patients are moving between four hospitals. In hospitals like the Royal Gwent, they have minor injuries units now, but not accident and emergency. So, they haven't got the diagnostics and the treatments that can deal with the more complex general medical conditions. So, with the new model and some of the uncertainties and some of the responses that you've mentioned to those issues in play, it really does require Welsh Government, I think, to work very closely with the health board to make sure that all of these problems are overcome. It is a major challenge.

Thanks very much, John. You are quite right that we're not out of the woods yet in relation to the pandemic. The good news, of course, is that the translation of COVID cases into hospitalisations has been massively reduced as a result of our very successful vaccination programme. So, we're hoping not to see the kind of incidence that we saw in the first and second waves, where we are seeing very high incidence in our communities now. 

You are absolutely right to draw attention to the fact that flu is also likely to be a big issue this winter. Those winter pressures are already with us, I'm afraid to say, because, partly, of the issue of trying to address that backlog, in addition to all of those other pressures. One thing that I think is key, and that you alluded to there, is the fact that new model is quite complicated. So, we do need to make sure that the people who have that hospital serving them in that area—they need to understand what the model looks like.

I have been in touch with Aneurin Bevan about this, really asking them to make sure that they reach out to the public, to make them very aware of where they should be going for what. My understanding is that they have done a lot of outreach work, that they have done leaflets to all households within the area, so that people should be aware. But there are always people who, in that moment of an emergency perhaps, haven't got quite an understanding of where they should go under those circumstances. So, we need to monitor the situation, John, that’s absolutely clear, and I can assure you that I will be making sure that I keep an eye on the follow-up to this report. And I’m sure the Royal Collage of Physicians will be revisiting this, just to make sure that everything has been implemented as promised.

Thank you, Minister.