4. What assessment has the Welsh Government made of vascular services in north Wales? OQ57582

Vascular services in north Wales were reorganised in 2019. Specialist services have been developed at Ysbyty Glan Clwyd, while other vascular services remain at Ysbyty Gwynedd and Wrexham Maelor Hospital. The new model was endorsed by the Royal College of Surgeons and the Vascular Society.

I thank the First Minister for that response. Llywydd, some years ago, the health board in north Wales had something to boast about, namely the vascular service at Ysbyty Gwynedd, which was among the best of its kind. Then, for some reason, as you have mentioned, beyond my understanding, somebody somewhere, under the guidance of this Government through special measures, decided to centralise services at Ysbyty Glan Clwyd. Now, the vascular service in north Wales is suffering huge problems, with the highest rate of deaths following amputations. Do you believe that this is acceptable? I certainly don't. Siân Gwenllian, our Member here on the Plaid Cymru benches, has already called for a public inquiry into this centralisation. It's disgraceful that a service that was at one point among the best of its kind has fallen to such a state. Will you ensure that there is a public inquiry held to the centralisation of services?

I think there are two things that have be distinguished here. There is the original decision to concentrate specialist vascular services at Ysbyty Glan Clwyd. The Member said that that had happened 'for some reason' as though it was a trivial matter that had just been plucked out of the air. He will know perfectly well that the case for the concentration of specialist services was one, as I said in my original answer, strongly supported by the Royal College of Surgeons, supported by the Vascular Society of Great Britain and Ireland, because of the evidence from elsewhere that specialist services have better results when you have people who carry out that work day in, day out and do those specialist things. Twenty per cent of services were to be carried out at Ysbyty Glan Clwyd, leaving 80 per cent of vascular services still to be provided in Wrexham and in Bangor. Out-patient appointments, varicose vein procedures, diagnostics, review of in-patient vascular referrals and rehabilitation are still carried right across north Wales.

I don't myself believe that the model, as originally proposed and supported by the board and not opposed by the community health council, was the wrong one. [Interruption.] I know there are people who don't agree with that. I noticed that the Royal College of Surgeons in its report said that the constant undermining of the model by local criticisms has made the implementation of the model more difficult to achieve. [Interruption.] Well, this is what it says. I know you don't like it, but that is what it says. They said that the constant attempts to undermine the model have made its implementation more challenging, and that the undermining of the morale of people who are responsible for the services by those criticisms could lead in the end to poorer services for patients. You may not like it, but that is what the report says.

I distinguish myself between the model, which I think was the right one, and the implementation issues, which have to be put right. The original report—there's a two-stage report by the Royal College of Surgeons—identified a number of things that still needed to be done to make sure the patients in north Wales derived the maximum benefit from the new model. It remains the responsibility of the clinicians who lead that service, and the board, to make sure that the investment that has been provided—investment in the infrastructure at Glan Clwyd and in the specialist staffing of the service at Glan Clwyd—now delivers the benefits that the model was there to derive. If there's more to be done, then I look to the people who are responsible for the service to make sure that they learn the lessons from the Royal College of Surgeons and put anything that needs to be put right right, because the model itself is the right one for people in north Wales. 

Thanks to the Member for submitting this important question today. I also note that a fellow Member has a question on this topic tomorrow, so it's clearly a pressing issue for residents in north Wales. First Minister, as already outlined here, the vascular services have seen that significant change in north Wales. Mr ap Gwynfor has highlighted many of the issues that he's aware of, and I'm certainly aware of similar, with those changes. You mentioned, First Minister, a report by the Royal College of Surgeons; they've highlighted significant bed shortages and confusion over staffing levels, and they've outlined also a safety risk to patients in their report as well. Of course, members of the health board in north Wales have outlined progress being made to rectify this issue. But, First Minister, as you asserted, if there's nothing wrong with the model that is there at the moment, wouldn't you accept that a public inquiry would be a good step to restoring that much-needed public faith in this service? Diolch.

I don't believe that a public inquiry, with the length of time that it would take, would be of much benefit to patients in north Wales. What I think is that there is an independent review of the service carried out by the Royal College of Surgeons, and there is part 2 of that still to report. I expect that report to be taken seriously by the board and by the people responsible for the service so that the changes that have taken place in vascular services, not just in north Wales, as the Member says—. Vascular services have changed across the whole of the United Kingdom. It is a more specialist discipline than it used to be, and if you need not just the day in, day out vascular attention but specialist services, then you are better off as a patient being looked after by people who undertake those procedures all the time, rather than by people who do it every now and then as part of that wider range of duties that they undertake. That is the nature of modern medicine. It's challenging, because people inevitably see things changing and people are very attached to the service that they have. But right across the United Kingdom in vascular services this has been the pattern—specialist services brought together, and the more routine aspects continue to be carried out more locally. That's what the model provides. It is now, as I say, for those people who are responsible for that service, clinically responsible for it and responsible for it at a board level, to make sure that all the investment that has gone into it pays off in a better service for patients in north Wales.