1. Will the Minister make a statement on Healthcare Inspectorate Wales's decision to designate Betsi Cadwaladr University Health Board's vascular services as a service requiring significant improvement? TQ605

Diolch yn fawr. I welcome the intervention announced by Healthcare Inspectorate Wales today. The escalation of the vascular service within Betsi Cadwaladr University Health Board to a service requiring significant improvement supports the strong steer I gave on 16 February 2022 that the health board needs to address the service issues with immediate effect.

The Deputy Presiding Officer (David Rees) took the Chair.

Thank you very much to the Minister. The announcement and the statement by Healthcare Inspectorate Wales is sobering. If you read the guidance for the inspectorate, they describe the process that they follow in placing an organisation under significant improvement. It's a body that requires action when standards aren't reached.

HIW tells us that this escalation process ensures that focused and rapid action can be taken by a range of stakeholders to ensure that safe and effective care is being provided. So, let's pause on that word 'safe'. HIW has put this escalation measure in place because the royal college of surgeons report identified a number of concerns that we believe indicate a clear risk to patients using the vascular service. Now, vascular patients have been put at risk because of poor management, just as mental health patients' lives have been put at risk through a number of scandals within the same health board. I genuinely feel for those trying to put things right and being knocked back time and time again. Now, this appears to me to be more special-ish measures, but I question if this process of escalation is enough in itself. So, I repeat my call today: put vascular services in Betsi Cadwaladr University Health Board in the highest possible level of special measures you have, and do so with the patient in mind—those whose faith in their local health board has been rocked to the core, those in the furthest reaches of the north-west who've been left at vast distances from core services by the centralisation at Ysbyty Glan Clwyd and who must see the strengthening of services accessible to them.

Now, I don't want reorganisation any more than the Minister does, but this again smacks of a health board that is too large, too unwieldy to be run effectively, and too distant from the people it serves. Episode after episode, such as the one we're discussing today, mean that the redesigning of health services across the north has to be left on the table. So, will it be that, or will Government at least bring back special measures for vascular services to show you're serious about resolving things within the current structures?

Diolch yn fawr, Rhun. I've said, and I'll say it again, that the vascular services and the services offered in Betsi are not at an acceptable standard. I did issue a written statement on 3 February following that report by the royal college of surgeons, and it was very disappointing to find that there were some really fundamental and basic things that were not being done—deficiencies in care, record keeping, consent taking, following up, all of these things that you would assume are basic things that happen in every department within the care service. So, I have been clear that I have given the board three months—and let's not forget that it was the board itself that called in the royal college of surgeons, so they did see that there was a problem. They took the initiative, they have looked at those 22 recommendations and they've put an action plan in place now. Now, I have made it clear that they've got three months to address these issues, and that has started already, and it's very clear to me that I will be receiving monthly updates from the health board, and if significant progress has not been made in those three months, I will require escalation measures or oversight, and we will convene a special tripartite meeting to consider that. I did receive the first update on Monday, and I'll be meeting with the chair of the health board to discuss this in more detail this coming Friday.

I thank the Llywydd for accepting this topical question this afternoon on an issue that's very important for every Member in the North Wales region, as it's such a pertinent and important issue to discuss.

Minister, while I welcome the intervention of HIW, the news is very worrying for my constituents, and I'd happily invite you to look at my e-mail inbox and the letters I receive week in, week out from constituents who are users of Ysbyty Glan Clwyd and have been victims of some of the failures in vascular services in the Vale of Clwyd and, indeed, across north Wales—both those who rely upon the service and the staff working at Ysbyty Glan Clwyd. We have to remember that this is the failure of the systems, not the hard-working staff at Glan Clwyd. Rhun has already covered some of the points I wanted to raise, but it's worth reiterating the concern that Betsi was taken out of special measures too early. Minister, do you now regret the decision of your predecessors, and what steps are you taking to ensure that the failings are addressed as a matter of urgency? Finally, Minister, what has happened in the intervening two weeks, between HIW taking the decision to utilise its escalation process and making the announcement public? Thank you.

Thanks very much. Of course, the standards that we're seeing, in particular in that service in north Wales, are not acceptable, and that's why we will be keeping a very hawk eye on the situation and those 22 recommendations. I think it's really important that we understand that there probably is a failure in terms of systems and that's why, of those 22, there have been some very clear undertakings by the health board in terms of what they intend to put in place. They have unreservedly accepted the findings, they've focused on both rapidly addressing the issues most recently highlighted, and I think it's really important that we recognise that a new independent chair, Susan Aitkenhead, has been appointed. She has been appointed to a vascular quality assurance panel. She will be looking and taking overall responsibility for addressing this. There's been a memorandum of understanding that's been agreed in principle with Liverpool, and the clinical teams have already started closer working on establishment pathways. We've got two diabetic foot pathways that have been approved. The General Medical Council is working with health boards to provide professional standards training for the vascular team, but also more widely across the clinical workforce. Two of these training sessions have already taken place. So, there's a huge amount and there's a much longer list of things that have already been put in place, but, obviously, the key thing is that we need to see an outcome and outputs from those things that have been put in place. So, that's what we'll be monitoring and that's what we'll be doing in the next few weeks. 

I thank the Minister.