The following amendment has been selected: amendment 1 in the name of Lesley Griffiths.

The Welsh Conservatives debate is next: mental health services. I call on Mark Isherwood to move the motion.

Motion NDM7861 Darren Millar

To propose that the Senedd:

1. Notes the findings of the Holden report into failings at the Hergest unit at Ysbyty Gwynedd.

2. Regrets:

a) that it has taken almost eight years and a direction from the information commissioner for Betsi Cadwaladr University Health Board to publish the report;

b) the delay between the publication of the report and Betsi Cadwaladr University Health Board being placed in special measures;

c) that the health board and Welsh Government have failed to address all of the issues identified in the report;

d) the lack of accountability for the poor performance of mental health services across North Wales;

e) the devastating impact of these failings on staff, patients and their loved ones.

3. Calls upon the Welsh Government to:

a) apologise to staff, patients and the families of those adversely affected by the failings at the Hergest Unit;

b) require all health boards to publish reports routinely and in a timely manner in the future; 

c) deliver radical improvements in the provision of mental health services in North Wales; 

d) undertake a fundamental review of mental health services across Wales with patients, families, professionals and other stakeholders;

e) publish meaningful information on the performance and quality of mental health services across Wales, including waiting times for mental health assessments and treatment, such as talking therapies;

f) establish a network of 24 hour mental health walk-in centres for those experiencing a mental health crisis;

g) work on a cross-party basis to deliver a new mental health Act for Wales. 

Motion moved.

My recent call for a Senedd debate in Welsh Government time on the Holden report published last month, documenting failings on the Hergest mental health unit in Bangor, was rejected. We have therefore brought forward this opposition debate on a matter that has long-standing Welsh Government involvement. 

In 2012, the deputy coroner wrote to the health board outlining her concern after a woman died in the Hergest unit. After Professor David Healy from the department of psychiatry in the Hergest unit raised concerns over developments in the provision of mental health services in north Wales, Lesley Griffiths, then health Minister, replied to Darren Millar in 2012, stating that an independent review would commence shortly. After I raised the same concerns with the health board's then chief executive, she replied to me in 2012 that she had initiated an investigation. But, the board was not put into special measures until June 2015, after an external investigation revealed that patients had suffered institutional abuse in Glan Clwyd Hospital's Ablett acute mental health unit. The health board stated that it was alerted to serious concerns regarding patient care on the Tawel Fan ward in the Ablett unit in December 2013, but concerns about this ward went back a lot further. For example, in 2009, I raised with the Welsh Government and health board the concerns of a constituent who said that the treatment received by her husband in the Ablett unit nearly killed him, that three other patients admitted around the same time as her husband had similar experiences, and that she was now worried about the treatment others may receive in this unit. 

Ahead of the Holden report's publication, I was one of five Members to receive correspondence from a retired NHS executive after he had seen the report and appendix. He stated that, up until then, the health board had protested that the main text of the Holden report and its appendix, completed in December 2013 and containing extracts from the damning statements of 40 whistleblowers, must remain hidden from public view in order to safeguard the confidentiality of the whistleblowers, and that the decision to withhold evidence of neglect on such spurious grounds was deliberate and wilful. The health board, he said, had finally given up this pretence by now accepting the information commissioner's ruling, first made over 16 months ago, that the report should be published in full. It is now crystal clear that the main body of evidence provided by the whistleblowers—all of them key members of staff on the Hergest unit—was deliberately kept hidden from view. This was done not to protect the identity of the whistleblowers but to conceal the acts and omissions of their senior managers that were causing staff to be bullied and patients to be neglected.

The health board, he said, made a brief summary of the report available to the Public Accounts Committee in November 2015, but publication of the full report now reveals just how much detail was concealed from the Public Accounts Committee at the time. As he asked, how, then, was it possible that in 2014, the most senior of these managers was allowed to make reports to the health board and its quality committee that concealed his own part in the Holden process, and has the health board now satisfied itself that the senior officials responsible for this mess and for keeping it under wraps for so long have now all been removed from any responsibility for the care of vulnerable mental health patients?

Speaking here in September, the health Minister said it was important to note that a summary report was published in 2015, including the Holden recommendations. But this is the very brief summary report referred to above, which did not describe the 31 concerns listed by staff. Throughout my time as a Member of the Senedd, since 2003, I have supported a succession of principled whistleblowers who have been threatened, bullied, denigrated or damaged for daring to tell the truth in Wales. An event that led directly to Holden involved two senior nursing staff who had raised safety concerns being summarily marched out of the building on a trumped-up basis. In the case of Tawel Fan, two members of the medical staff were put on restricted duties and referred to the General Medical Council. One of them had raised safety concerns with management, but was told that doing so indicated he was not a team player.

A letter I received from Professor Healy in 2019 stated, 'Several of my patients have died, in part because of difficulties in getting them input. I wrote to the health board about one patient—now dead—who was getting more care co-ordination from the north Wales police than from the mental health services, but I do not get even acknowledgement or receipt of letters.' False allegations were made against him; he was exonerated each time, and finally accepted a job offer in Canada. However, a letter received from him this week states, 'A merger of health boards across north Wales put Wrexham-based staff in charge of the entire service. Bullying, thuggery, summary dismissals based on trumped-up charges, invented sexual abuse allegations became par for the course; staff who raised safety concerns were told they were not team players and were dismissed. Some politicians at least acknowledge the receipt of letters from senior staff drawing their attention to these issues. Mr Drakeford never did. His recent comments on what happened have been jaw-droppingly wrong.'

Responding here to the 2018 statement by the then health Secretary Vaughan Gething on the Health and Social Care Advisory Service report on the Tawel Fan ward, I stated:

'in 2015, Welsh Government, the health board and Healthcare Inspectorate Wales all accepted the findings of Donna Ockenden's 2015 report.'

So, why now, when many serious allegations are peppered throughout the HASCAS report, has it come to the bizarre conclusion that care was good and that institutional abuse didn't happen? The 2018 Ockenden review found that the systems, structures and processes of governance, management and leadership introduced by the health board from 2009 were wholly inappropriate and significantly flawed. In January 2019, Donna Ockenden revealed that staff had told her services were going backwards. Two patients in north Wales mental health units have died from hanging and attempted hanging over the last year. Last month, a Public Services Ombudsman for Wales report revealed that the health board had made a fulsome apology to the son of a lady who had received treatment on the Hergest ward, David Graves, for the failings identified and injustice caused to him and his family. In a letter to the Older People's Commissioner for Wales, the health board's executive director of nursing and midwifery stated that Mr Graves had at times been verbally aggressive and made expressions that have forced the health board to consider the safety of the individual. In response, Donna Ockenden wrote, 'I have always found you, Mr Graves, polite and courteous.'

Yesterday, North Wales Community Health Council's chief officer wrote to me ahead of this debate, stating that when it comes to implementing recommendations of challenging reports, Betsi Cadwaladr University Health Board have been slow to act, some may say reluctant. Our motion therefore calls on the Welsh Government to apologise to staff, patients and the families of those adversely affected and to undertake a fundamental review of mental health services across Wales with patients, families, professionals and other stakeholders. This whole episode has been a disgrace, and a stain on the reputation of this establishment and the Government of Wales.

I have selected the amendment to the motion. I call on the Deputy Minister for Mental Health and Well-being, Lynne Neagle, to formally move the amendment tabled in the name of Lesley Griffiths.

Amendment 1—Lesley Griffiths

Delete all after point 1 and replace with:

2. Notes the progress being made to improve the quality and safety of mental health services in Betsi Cadwaladr University Health Board since the Holden recommendations were published in 2015.

3. Recognises the significant challenges that remain in mental health services in Betsi Cadwaladr University Health Board and the improvements needed to address them.

Amendment 1 moved.

Formally.

Thank you. Rhun ap Iorwerth.

Diolch yn fawr iawn, Dirprwy Lywydd. I very much welcome the opportunity today to debate the Holden report and build on the discussion we had as part of the short debate led by Llyr Gruffydd a few weeks ago. It's notable that, despite a few weeks passing now since the release, finally, of this damning report, the Government still hasn't used its own Senedd time to allow the Senedd to debate the report and scrutinise the Government's response.

Now that the report is out in the open at long last, work has to begin on restoring the trust of the people of the north of Wales, and that starts with the health board and Welsh Government acknowledging the enormity of what that report reveals, recognising the erosion of trust, the deep, deep erosion of trust in the system, and committing to learning each and every difficult lesson that will come out of this. We mustn't forget that this report was one of the factors in placing Betsi Cadwaladr health board in special measures in the first place, and the Welsh Government had direct responsibility for the health board up until last year, and even after it came out of special measures, patients continued to die, and questions persist in my mind and in the minds of many others about how that decision could have been made, to remove the board out of special measures when so many questions remained unanswered.

But this now is about far more than releasing a desperately overdue report; it's about accountability from all in charge of the health board, directly and indirectly, now and in recent years, during this most terrible episode. We will support the motion as it stands and reject the Government's amendment, the Government refusing to recognise the need for more transparency and the need for better resourcing to tackle the issues raised here. It will be of deep, deep concern, I know, and disappointment to many staff members and patients and their families that Welsh Government here is choosing to remove from the original motion the need for everybody involved to regret that lack of accountability, and to regret the devastating impact of the failings that we saw on staff and patients and their loved ones. They will be angered by the rejection of Welsh Government to calls for an apology, for timely production of reports in future, for the delivery of radical improvements in services, for that fundamental review of mental health services. For the establishment of a network of mental health walk-in centres—Plaid Cymru has asked for four years for such measures. I've discussed with the Deputy Minister plans that she also has to put measures in place, but we need to see those measures, of course, being put in place as part of wide-ranging changes to mental health provision throughout the whole of Wales.

But here with Hergest and what happened there, we have catastrophic events that led to the loss of life and to enduring pain for many, many family members who have grieved the loss of loved ones. Patients, families and many staff, many of whom I've had deep and distressing conversations with over the years, they will be listening intently to what the Deputy Minister is saying today, because the publication of the report itself mustn't be seen as the end of a campaign for the publication of the report. It must be seen and it must be evidenced that it is, in fact, the beginning of a new chapter after the sorry, sorry story that we have seen in Hergest and in mental health in the north of Wales in recent years. 

Thanks to my colleague Darren Millar for submitting this extremely important debate here today. As outlined by my colleague Mark Isherwood in opening today's debate, the findings of the Holden report are deeply concerning. In fact, they're absolutely shocking and make for very difficult reading for the residents that I represent in north Wales. As Mr Isherwood outlined, the long-awaited report, that was prevented from being published for years, revealed a culture of bullying and of low morale amongst staff in the Hergest ward, which is said to have been in serious trouble, according to the report. And relationships between staff and managers at matron level and above had broken to such an extent that patient care was undoubtedly affected. And it is devastating to hear that patients have come to harm and been neglected because of these issues. With these extreme failures, of course, are staff, patients and families who've had to endure these devastating events.

As we all know—it has already been pointed out—Welsh Labour Government have had oversight of this failing health board, and leading this oversight for much of this time was the First Minister, Mr Drakeford, who was then health Minister. As the First Minister outlined to me in questions last week, and I quote,  

'I agree that it is important to make sure that there is proper trust between people who use services and the provision of those services in north Wales'.

And this Government, Deputy Presiding Officer, has a huge amount of work to do, as currently many of my residents across north Wales simply don't feel that trust when it comes to mental health services in my region. 

As our motion states, staff, patients and families affected first of all need a simple apology from the Welsh Government. I don't think that's a difficult thing to ask for. Aside from words, what my residents also want are radical improvements in the provision of mental health services across the region of North Wales, including the establishment of a 24-hour mental health walk-in centre, and meaningful information on the performance and quality of mental health services across Wales that they use being published. Yet, despite this, the board is still experiencing difficulties with mental health provision. The latest figures show that the health board in north Wales has some of the worst waiting times in Wales, and what have we seen the Labour Government here do? Taking this failing health board out of special measures just months before May's Senedd elections, which I'm sure some would say was simply a political decision.

So, aside from some of the action or inaction we are experiencing from Government at the moment in this regard, we've seen today, in this motion we've put forward, Welsh Government's amendments to delete parts of our motion that point to the regret of the tragedies, and remove our proposals for practical and robust solutions to fix some of the issues that are in place, ensuring patients receive the best possible treatment and, as I said earlier, looking to, really importantly, regain their trust.

I was really pleased to hear Plaid Cymru's contribution supporting our motion unamended. It's really important that we send the right message to all those who have suffered. So, to conclude, Deputy Presiding Officer, the Holden report and its findings are truly disturbing, a very sad state of affairs, and it's just another failure in two decades of poor decisions and management from the Labour-run health service in north Wales, and behind these failures are sadly people suffering unnecessarily. It's time for the Welsh Government to learn from their mistakes and put patients first. I urge all Members to support this important motion. Diolch yn fawr iawn. 

I wanted to speak in this debate as a Member from south Wales who doesn't have a detailed knowledge of the workings of the Betsi Cadwaladr health board, but has had constituents contacting me with mental health problems in my constituency who are looking for support from the Aneurin Bevan University Health Board and associated health boards in my community. So, I take at face value some of the reassurances that we've had from the health Minister, and I'd like to hear more from the Deputy Minister today about how the Holden report has been responded to, and those issues that will be noted by the Welsh Government as a series of improvements that are being made as a result. So, I think that's important to have my support for the Welsh Government's amendment—for the Minister to make that clear in her response. But the clear point of part 3(d) onwards of the motion identifies things that can be done across Wales. Now, I can't see directly where—. It's quite a great leap from the Holden report to the whole of Wales, is the point I'm trying to make here, and I can't see where that leap can be made. So, I would say that from point (d) onwards, to undertake a fundamental review of mental health services, publish meaningful information on the performance and quality of health services across Wales, establish the walk-in centres, and deliver a new mental health Act, I think that is a deeper piece of work that needs to be undertaken by a committee investigation rather than simply be voted through in this Chamber today, because it seems to be quite an extrapolation from the Holden report itself.

That said, the First Minister did respond yesterday—I was listening to First Minister's questions—about mental health services, and he said care navigation is really important in reducing the pressure on mental health services. The problem with care navigation is that it creates a bottleneck, and the bottleneck happens at the point you approach primary care. And when you approach primary care, it can be very difficult to get to the right mental health service. I've actually written—. So, I do have a lot of sympathy for some of the reforms that are suggested, including a fundamental review of mental health services, because I've written to the health Minister to ask for an expert-led review into care navigation. I didn't get a response in the affirmative, but I did get an explanation of the work that's been done with GP services to improve access to care navigation, which has been introduced, which should see a reduction in the 8 a.m. type queues that happen on the phone, first thing on a Monday or Tuesday morning. The Welsh Government has taken steps in that regard. Nonetheless, the proof on that will be in the evidence that occurs after those measures are introduced. So, bottlenecks to care are important, and what often happens with people who are seeking mental health support is that, rather than going for talking therapy, the waiting list for such services is so long that they go for medication. And medication should not be the first option when it comes to mental health support. It should be talking therapy, exercise, lifestyle change. All of these things can support better than an immediate option to drugs and that kind of solution. So, those bottlenecks don't help, and I think the Welsh Government are taking steps to address that.

Finally, I'd like to identify specific issues that have been raised by me in my constituency. A constituent of mine who has attention deficit hyperactivity disorder and Tourette's syndrome has contacted me. She came as part of a campaign organised by a south Wales Tourette's society, and specifically there is no clinical pathway for Tourette's in Wales, which means difficulties in terms of securing a diagnosis and accessing further support. Those of you who've been in this Chamber for some time will know I have a daughter who is severely autistic, and I can see a pathway for her, and the treatment she needs. But those with Tourette's and ADHD don't have the same pathway and don't have the same access to mental health services. And I know the Deputy Minister knows this in depth and is working on this. In response to a BBC Wales story on this issue, the Welsh Government said,

'Regional Partnership Boards are rolling out a new framework to improve access to the right support' and that it was,

'reviewing all children's and adults neurodevelopmental services, to identify where there are gaps in provision and the demand, capacity and design of services for children, young people and adults' can be improved. Can the Minister therefore confirm whether or not those regional partnership boards have completed their roll-out of this new framework? And can she confirm if the Welsh Government is still on track to complete its review of children's and adults' neurodevelopmental services by March as intended, which would go some way to answering some of the questions in the motion?

Finally, it would be remiss of me, when we're talking about mental health, not to welcome back Andrew R.T. Davies to the Chamber. I thought, yesterday, his contribution yesterday was the contribution of someone who's taken some time out of politics, because he was very reasonable, very measured, and I think there's a lesson for us now over Christmas to take that step back, and probably come back in the new year with a spirit of kindness and mutual support.

The harrowing testimony of overworked front-line staff in this report and some of the scandalous content should give all officials and Government Ministers pause for thought. It is plainly unacceptable that a report of this importance, formed from 700 pages of testimony, provided by 45 members of staff, was kept out of the public domain for so long. 

Now, during a meeting with the chairman and chief executive of the health board last week, I raised my concerns in relation to this particular report, and I was reassured that future reports where things have been found to go intensely wrong will now be written with publication in mind. I think, to be fair, the health board have acknowledged that this is not the way that reports like this should be just left lingering, and families in agonising waits. However, given that the Betsi Cadwaladr health board now is currently at the second stage of an important report into vascular services, and the urology department, these too will also be subject to review. Minister, I hope that you will use your reply to confirm that the Welsh Government will look to require all health boards to publish reports routinely and in a timely manner so as to improve transparency and patient trust.

The findings of the Holden report, which include expansive notes on the understaffing of wards to the point that basic physical care and attention to personal hygiene were neglected, as well as concerns over fractured management structures, are merely reflective of enshrined issues at the health board. Indeed, the Ockenden review found that, from early 2013, Betsi Cadwaladr University Health Board was being told that their management and investigation of concerns, including serious incidents and never events, were not fit for purpose. Moreover, front-line staff within older people's mental health services have consistently reported significant concerns around staffing levels and lack of engagement with the senior management teams within mental health. Taken together, these findings only support the justification for a further inquiry into the workings and management of the Betsi Cadwaladr University Health Board.

Despite the fifth Senedd's Public Accounts Committee report in May 2019 noting that there were doubts as to whether the board would be able to get out of special measures within 12 months, after nearly five and a half years languishing in special measures, in November 2020, the former health Minister made a surprise move to lift the board out of special measures, and, as Sam Rowlands, my colleague, said, this was just before a Senedd election. So, it is vital that any inquiries examine whether this political decision has had a negative impact on the health board, particularly as it is still suffering from a lack of staff, spending £180 million on agency staff in the last five years, and the fact that around 40,242 patients are waiting longer than a year for their treatment.

Returning to the issue of mental health services, the latest figures show that this board has the second worst waiting times in Wales, with just 56.3 per cent waiting less than 28 days for an assessment in September 2021. Constructively, alongside a refreshed 10-year mental health strategy, I am standing with my Welsh Conservative colleagues to call for a new mental health Act, which would update legislation and include the latest thinking around mental health provision in Wales. My hope is that such an Act will help to establish a network of 24-hour mental health walk-in centres for those experiencing a mental health crisis, as well as support the return of trained nurses to GP surgeries. 

So, Minister, I trust that your reply will commit to working on a cross-party basis to deliver a new mental health Act so that we can urgently develop radical improvements in the provision of mental health services in the Betsi board and across Wales. And never again do I ever want to rise to speak in this Senedd to debate such serious findings as this report found. And I really do—. The points that my colleague Mark Isherwood said today: as Members who've been here more than one term, this really is probably the saddest day that I've even had to stand up in this Senedd. Diolch.

Thank you for the opportunity to once again discuss this issue. We've had a number of opportunities over recent weeks and months, and indeed recent years, to discuss the scandal of the Hergest unit and the scandal of not publishing the Holden report in full. And every time I get up to speak about this issue, I still can't believe that the board tried to evade accountability in the way that they did—they tried to avoid transparency on this issue—and, of course, how we have still not seen people held to account for the serious failings in relation to this case.

If you're a nurse or a doctor and you fail in your duties, then you're struck off the register; you are excluded from operating within your profession. If you're a manager in the health service who fails, then you get to carry on and, very often, you just move on to a different role, a similar role, somewhere else. That has to change, and there is a responsibility on the Government to ensure that that can't continue to happen in the future.

The culture of resistance to scrutiny, to change and challenge led, of course, to Betsi's hierarchy refusing to release this report, despite, even, the requests of the information commissioner. Grieving relatives had to wait unnecessarily due to a bureaucracy that didn't put people first—it put its own interests and its own reputation first, and, of course, in doing so, tarnished that reputation even further. And it's not just grieving relatives of victims at Hergest, of course—think of the Tawel Fan scandal and the many, many families affected there. The alarm was raised in Hergest, and had it been heeded across the health board with the timely publication of the Holden report, then we might not have had Tawel Fan. 

Now, I'm heartened by the acceptance at the very top of Betsi Cadwaladr health board in recent months that things must change—that's a very positive step and, of course, it's to be welcomed. But I'm not naïve. We've been here before; we've had these false dawns in the past—promises made to learn lessons and to be more open. But Betsi Cadwaladr can't afford to make any more promises and not deliver. So, the proof will be in the pudding, because we all accept that running the largest health board in Wales with such challenging demographics is difficult, and mental health care particularly is an ongoing challenge across all health boards, as we heard earlier, and I'm afraid that those challenges are, of course, only increasing.

I can't accept the amendment proposed by the Government. This Government has a direct responsibility for the failings at Betsi Cadwaladr due to the time it spent, as we heard, in special measures. It would be better for the Government to reflect on its complicity in the problems that blighted the health board during the past decade. Where was the leadership from Government when it was under its direct control? Why didn't you get rid of that cover-up culture and drag the health board out of this mess? So, we now move forward and we need far more transparency and accountability from those charged with running our public services.

Now, I want to touch on children and adolescent mental health services particularly. We know of the completely unacceptable backlogs in dealing with acute cases of child mental illnesses and I know that the Deputy Minister is painfully aware of that, and they are problems that have had traumatic impacts on youngsters, their families and the wider community. And the pandemic, as we know, has intensified these issues, so we have to look at intensifying the support as well. And that's why I am glad that the Plaid Cymru co-operation agreement with the Government commits to looking at how we can test community facilities, involving the third sector particularly, to try and develop the clear referral pathways into NHS services that can help support young people in crisis, or those with urgent mental health or emotional well-being issues.

The failings at Hergest should never have happened, and, of course, the whole farce around the initial non-full publication of the Holden report should certainly never have happened. So, let's hope now that Betsi Cadwaladr health board has finally learned its lesson and will finally start getting to grips with the serious failings in mental health services in north Wales. Now, that would at least be a belated but a positive and hopefully lasting legacy for all those who were so tragically failed.

It's a pleasure to take part in this debate this afternoon, as I worked in Betsi Cadwaladr for 11 years and I worked for four years in mental health as a support worker, so I'd like to consider this topic of debate fairly close to my heart. Although the Holden report is focused on the failings of the Hergest unit at Ysbyty Gwynedd, it has implications for patients right across north Wales, and it serves as a chilling reminder for many of my constituents of the failings at Ysbyty Glan Clwyd in Bodelwyddan and the Royal Alexandra in Rhyl.

It has been 11 years since the first inspections at the Glan Traeth ward at the Royal Alex and seven years since the publication of the Ockenden review, which was triggered as a result of serious failings on the Ablett unit at Ysbyty Glan Clwyd, yet many of my constituents feel that, despite a string of reviews and years in special measures, Betsi Cadwaladr University Health Board management are failing patients and staff who work for the health board.

Just before the pandemic, the Senedd's Public Accounts Committee highlighted staffing issues at the health board. They flagged the lack of progress on implementing the recommendations of both the Health and Social Care Advisory Service review and the Ockenden review. The committee also cast doubt on the ability to get the health board out of special measures. However, at the height of the pandemic, and months before the Senedd elections, the health board was taken out of special measures, as Janet Finch-Saunders and Sam Rowlands alluded to, much to the surprise of patients and staff across north Wales—so, read between the lines on that one.

There continue to be grave concerns about mental health provision across the health board. Three quarters of children and young people across the region wait longer than the recommended 28 days for an assessment. We know only too well that the pandemic has had a shocking impact on the mental health of young people across Wales, yet those living in my constituency continue to be served by a failing service, one that has been talked about for decades but continues to fail those it serves despite the best efforts of our amazing NHS staff, who go above and beyond their duties on a daily basis—staff who continue to be overworked and undervalued by senior management, and, sadly, it's not just mental health services in north Wales that are suffering. Staff shortages continue to put patient safety at risk—so much so that doctors at Ysbyty Glan Clwyd were forced to write to the health board warning about overcrowding and day-long waits for patients to be seen. Doctors warned that emergency departments were so crowded that time-critical interventions in sepsis, stroke, cardiac care, major trauma and resuscitation are compromised.

My constituents are rightly concerned about how the NHS is being run in north Wales. The serious failures at the mental health unit are just the tip of the iceberg, unfortunately. We need urgent reform of mental health care across Betsi Cadwaladr, and I urge Members to support our motion, but I also ask the Welsh Government this afternoon to get to grips with the growing crisis in our accident and emergency departments. Thank you. 

Samuel Kurtz.

Sorry, Dirprwy Lywydd, I was under the impression that I wasn't in this debate; apologies.

That's okay. Your name is here. If you don't want to speak, that's no problem.

No, sorry, it was my understanding that it was withdrawn.

I call on the Deputy Minister for Mental Health and Well-being, Lynne Neagle.

Thank you, Deputy Presiding Officer, for the opportunity to respond to this debate and to place on my record my recognition of the commitment of Betsi Cadwaladr health board to continue to improve mental health services. I'd like to acknowledge the dedication of the staff on the ground in north Wales, who work hard to deliver high-quality and compassionate care for patients who need mental health support. 

Members will recall that we debated this subject on 29 September, before the legal process around the freedom of information request for the full Holden report was completed. It was also the subject of a number of questions to the First Minister in recent weeks, following the release of the full report by the health board. But here we are again, debating a motion that seeks to apportion blame for events from eight years ago and does little to acknowledge that, whilst there is no doubt that significant challenges remain, the health board has taken steps to address the issues highlighted in the Holden report and, indeed, other failings in their mental health services.

On Holden itself, it is important to remember that the summary report that was published by the health board in 2015 included all of the recommendations made by Robin Holden. The health board took action at that time to address the issues raised, and commissioned work to ensure that the Holden recommendations had been implemented. This piece of work was reported to the health board’s quality, safety and experience committee in January this year, and is publicly available. This provided assurance that action was taken against each of the recommendations in the report. The chief executive has acknowledged that certain issues, including having older people with functional mental illness cared for in the same environment as acute adult mental health, have proved complex to resolve due to the design and layout of the Hergest unit and the staffing resources involved. This does not mean these issues are not being addressed. The needs of each patient are considered, and they are managed according to need. We are working with the health board around options for a longer term solution.

Some suggest there was some sort of delay between the report being produced and the health board being placed in special measures. However, as we know, the Holden report was one of a number of independent reviews commissioned by the health board in response to concerns about the quality of mental health care in north Wales, which led to its placement in special measures in 2015. There was no delay. In fact, the then health Minister asked the tripartite group of Welsh Government officials, Wales Audit Office and Healthcare Inspectorate Wales to review Betsi Cadwaladr University Health Board’s escalation status in June 2015. On being advised that the health board had not made sufficient progress in addressing long-standing concerns about governance, leadership and progress, he made the immediate decision to place the board in special measures, and that was announced in this Chamber less than 24 hours later.

Since the time of the Holden report, the health board has made considerable progress. Feedback from Audit Wales, HIW, and Welsh Government officials following the latest mental health round-table, held as recently as 22 September, found that there has been significant improvement in the openness and transparency shown by the health board about its mental health services. A new chief executive has been appointed to steer the health board on its improvement journey. Governance arrangements have been strengthened to provide greater oversight and scrutiny of mental health services at board level, as well as systematic ways of identifying and reporting issues as they arise. There is far more stability at a management level within mental health services, and increased confidence in the service to deliver.

Whilst we know that, as with a number of health boards across Wales at the moment, there are some performance issues that have been exasperated by COVID, Betsi's CAMHS and adult services have been better aligned to provide a more integrated service. The way that the health board works with local authority and third sector partners to support the preventative and early intervention part of the mental health agenda has also seen major improvements. It is clear from my own meetings with the health board, and those of my officials, that it is using the significant Welsh Government oversight and challenge in a positive way, and in line with its desire to be a learning organisation.

The targeted intervention framework is being used by the health board, and four maturity matrices have been developed with staff to drive improvements. The matrices are owned by the health board, developed with the staff on the ground, who’ve shown real insight into the difficulties they face and the challenges ahead. A key element of the matrices is that they are explicit about the need for the health board to demonstrate that it is responding to the recommendations from external reviews, and implementing new ways of working in response to these recommendations. Officials are meeting regularly with the health board to review progress against the matrices, and I welcome the transparency and openness demonstrated by the health board as part of this process. I myself have had the opportunity to discuss the mental heath matrix directly with the chair and chief executive, as well as the person in charge of mental health services. In its own self-assessment, the board has recognised there is much work to do. Whilst I acknowledge the baseline scores are low, they reflect an honest appraisal of the position the health board is in. It is important to note that these scores are not reflective of the whole area, but of those areas that are in targeted intervention, and they set a baseline against which we can track progress through the matrices.

Recovery and transformation will take time, but we have consistently made it clear to the health board that being able to evidence service improvement is key to progressing across the matrices with a view to further de-escalation. I do not shy away from the fact that there is much more work to be done to ensure mental health services in Wales reach a standard people expect and deserve. From my discussions with the chair and chief executive of Betsi, this is something that is abundantly clear to staff at the health board. We need to recognise, though, that progress has been made and continues to be made. There's a growing sense of confidence, that the building blocks are in place to enable the health board to push on from here and address the outstanding issues. Importantly, we are getting the sense that the staff themselves believe the organisation is committed to learning and growing. This sense of an organisation that they can be proud to be part of is crucial for attracting and retaining staff at all levels, and it's vital we support the health board in measures to raise staff morale rather than constantly attacking them.

Turning to the asks in the motion, I would like to point out that the health board have already apologised. We regret that people have had these bad experiences, and they have already apologised. The health board has already committed to making public every report it commissions. Staff had been informed they could speak to Holden in confidence, and the health board was concerned the identities of individuals would be revealed without appropriate redactions, and that doing so would undermine staff confidence in raising concerns in future. The health board, though, has learned from this process and now has a policy in place for significant reports that will be commissioned with a view to them being made public to prevent such issues arising in the future. We are asked to deliver radical improvements to the provision of mental health services in north Wales. We are already doing this.

Turning to the 24-hour crisis mental health centres, as I have said many times in this Senedd, our approach to improve the mental health and well-being of children and young people is to ensure that mental health support is embedded across settings where they live their lives, including schools, colleges and communities. The roll-out of our NEST framework will be a key part of this approach, and our learning will inform our work to develop a NEST framework for adults. I hope that our prevention work will stop issues from escalating to crisis point, but we know that there is a need to improve access to crisis support for children and adults. This includes our implementation of all-age single points of contact for mental health via 111, and further development of alternatives to admission. As part of the co-operation agreement with Plaid Cymru, we are also committed to testing sanctuary-type provision for young people as part of this broader pathway to improve—

Deputy Minister, you need to conclude now.

—the response to crisis. However, most people presenting with emotional distress do not need specialist mental health support. Often it is support for wider social and welfare needs that is required, and I am committed to driving a multi-agency and cross-Government approach to this.

This motion asks us to deliver a new mental health Act for Wales. We have signed up to the reforms of the Mental Health Act 1983 being taken forward by the UK Government, and I would remind Members that these stem from an extensive in-depth review by Sir Simon Wessely, which was well received by professionals and stakeholders alike. We are working closely with the UK Government on these reforms and it has promised to ensure the reforms work for Wales. I have no reason to doubt that promise, even if others clearly have.

Minister, you do need to conclude.

This motion fails to acknowledge any of the work over the last few years, but instead looks to assign blame. It fails to support the organisation. It fails to support the hard-working and determined staff on the ground—the same staff we clapped on our doorsteps not so long ago. It fails to recognise improvements in services made in the years since Holden. Most of all, it fails to recognise the huge efforts made by the countless staff who go the extra mile to deliver their best day in, day out. For those reasons, we cannot support it, and I urge Members to support the Government amendment.

The hard-working and caring staff in BCU deserve support from us in this Chamber, and we do the people of north Wales no favours by continually seeking some sort of respective trawl to see who can be blamed for past events. We all owe it to the people of north Wales to support the health board and its new management as it moves forward, and help it to deliver for them.

I call on Darren Miller to reply to the debate.

Diolch, Dirprwy Lywydd. I very much regret the tone of the Deputy Minister's response to this debate today. These are serious issues before the Senedd. It is not right that we are being critical of staff. In fact, we've called upon the Betsi Cadwaladr University Health Board, and indeed the Welsh Government, to apologise to staff for not addressing the failings. I think that indicates a great deal of support and sympathy for the front-line staff who've been working hard trying to deliver improvements.

But there is no doubt whatsoever that the Holden report exposed, as far back as 2013, serious failings in mental health care in north Wales: a culture of bullying and intimidation, staff shortages, patients being neglected, some coming to harm. And it's just a matter of fact that it then took a further period, until June 2015, in spite of the Minister's assertions that swift action was taken, for the health board to be placed in special measures, when another report was effectively saying the same things were happening in the Tawel Fan ward, further down the road at Ysbyty Glan Clwyd, that were also problematic and there were serious failings and institutional neglect.

I don't think that that was sufficiently rapid action. And in that intervening period, I'm afraid to say, Deputy Minister, that your Government allowed further patients to come to harm, to be neglected and to be subjected to that institutional abuse. That is a matter or fact, whether you like it or not. And for that, I would have thought it would have been decent enough of the Government today to offer an apology to the patients affected, some of whom have now passed away, their loved ones and, indeed, the staff, who were severely let down by the leadership of the Betsi Cadwaladr health board, and indeed the Welsh Government and the decision making of the Welsh Government at that particular time.

When the health board was placed into special measures, we were told, with great fanfare, that within 100 days there would be significant improvements in that health board in terms of the mental health care in the region. But that was not the case. Five and a half years later, that health board was removed from special measures, in spite of the fact that there were still huge challenges waiting to be addressed in terms of mental health care, and many of the failings that had been identified in Holden, identified in Ockenden, identified in HASCAS—in spite of their atrocious conclusion in their report that there'd been no institutional abuse—had not been addressed. These are just statements and matters of fact.

So, to bury your head in the sand and say that everything is improving—there have been some 'major improvements' is what you said—when we've had two deaths in the Betsi Cadwaladr health board on these mental health units over the past 12 months, which could have been prevented if some of the action that was promised had actually been taken, I think, is frankly disgusting. Frankly, it's disgusting. And to not be able to wake up and smell the coffee and recognise when a service is failing and needs to improve is unacceptable.

When are we going to see these promised improvements? It's still got these huge challenges six years later after it was placed in special measures for its mental health services. You're letting down the people of north Wales. You're letting down the mental health patients. You're letting down these vulnerable people who desperately need our support. And for you to simply suggest that everything's hunky-dory, that everything has been significantly improved, I think, is a disgrace. There was a significant delay in the action being taken by the Welsh Government.

You talked about discussions with stakeholders. What about the feedback from patients? What about the feedback from families? I didn't hear you refer to them at all in your response. Because I can tell you from my own casework that people aren't happy. The situation isn't good. The situation still needs to improve significantly, and unless we have a Minister who can recognise that, we won't have anybody getting to grips with these challenges.

Now I will say this: I do have a lot of faith in the new chief executive and in the chair of the health board, and I believe that they really are determined to want to get to grips with this issue once and for all. I very much hope that you will be part of that team to turn this situation around, but I'm afraid that with the attitude and the unnecessarily politically hostile response that you've given today—and I'm not being political here; I'm simply making the point that we need a Government that recognises that these are challenges—and unless you're prepared to get alongside them, to invest, to make sure that this situation is turned around, we're going to have more deaths, more neglect and more people who are harmed as a result of the situation. I'll happily take the intervention.

I'm very pleased to hear that you have faith in the new chief executive and the chair, but I just wondered if you would reflect on whether or not it is helpful to them, to improve the services that need to be improved in north Wales, by your shouting about things that occurred somewhere between six to eight years ago, when I have no doubt that the Welsh Government is working very closely with the health board to rectify these matters. But every time you stand up and go over the distressing things that took place in the past, you make it more difficult for them to attract new recruits into these services.

I'm afraid, Jenny Rathbone, we welcomed the fact that the Betsi Cadwaladr health board was placed into special measures back in June 2015. You can check the record. I was the shadow health Minister at the time and I was cheering on Mark Drakeford for taking that brave decision, because I believed, with all sincerity, that it was going to make the difference on the ground that we needed to see. It didn't. It didn't make the difference. That's why it's still got huge challenges, the Betsi Cadwaladr health board, in terms of the delivery of mental health care, even today.

I'm simply making statements of fact here. There has been no apology from the Welsh Government for its failure to respond to the Holden report back in 2013 when it was initially made available. There has been no explanation whatsoever as to why there was such a significant delay between that report being published and then the health board being placed in special measures. Essentially, the same things were happening on Hergest as happened at Tawel Fan. If the health board had been placed into special measures at the time that the Holden report was available to the Welsh Government back in 2013, then some of those things that happened on Tawel Fan could have been prevented. That is something that I believe that the Welsh Government ought to apologise for, because I think that if we could have avoided people coming to harm, then it's unacceptable simply to walk on by and to say that things have improved and not to acknowledge the harm that has been caused. And I'm afraid that's the situation we're in today in this Chamber.

I very much hope—[Interruption.] I very much hope, Deputy Minister, that you will be able to reflect on that position, on your inability to apologise to those patients and their loved ones for what's happened, and that you will continue, hopefully, to work with the health board's leadership to be able to turn this unacceptable situation, which has prevailed for far too long, around so that we can have a healthcare service for mental health patients in north Wales that we can be proud of. I want to be proud of it. I want it to be the best in the world, but the fact of the matter is it isn't.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Yes. I will therefore defer voting on this motion until voting time.

Voting deferred until voting time.