2. Will the Minister make a statement on Healthcare Inspectorate Wales's (HIW) decision that Ysbyty Glan Clwyd's emergency department has been identified as requiring significant improvement? TQ624

Thank you very much. This is a disappointing report, and the failings in care that have been noted are unacceptable. The health board has confirmed to us that stringent arrangements are in place. We expect the health board to work with Healthcare Inspectorate Wales to accelerate improvements, and we will continue to provide support in order to enable change.

Well, how many times have I heard that answer before, Minister? Another scandal, another damning report, another urgent question in the Senedd, and another poor response, I'm afraid, by the Government. We're going around in circles here, aren't we? We are going around in circles. How many times do we have to listen to you promising that things will improve, whilst bodies such as HIW and community health councils and others are telling us a very different story? When will you accept that words like this aren't enough, and that the time has come to consider structural changes to how health services are provided in north Wales?

Patients in north Wales have been promised improvements for years on end, and they just never seem to materialise. You tried special measures, and it failed; you tried all sorts of heightened interventions and they're clearly not delivering. Just a few weeks ago, we were here discussing the serious failings of vascular services in north Wales and the risk that was posing to patient safety. Before that, of course, it was the continued failures in mental health services in north Wales, and the way patients were coming to harm despite warnings from reports published years previously. And today, now, it's Healthcare Inspectorate Wales warning that the emergency department in Ysbyty Glan Clwyd is the worst it has ever seen, and that that, of course, has serious consequences for patient safety.

So, do you not agree, Minister, that the time has now come for the Welsh Government to start a wider conversation around reforming health services in the north of Wales? They say, 'If it ain't broke, don't fix it.' Well, do you know what? It is broke and it needs fixing. So, will you finally accept that this time, it's time up for Betsi?

I'm absolutely clear that this is not acceptable. The situation is—

We've heard this before.

If you let me finish—it's not acceptable. As soon as I heard there was an issue, I went to spend the whole day in the hospital just to see for myself what was going on and to see the pressures they were under. And I can tell you that I met some staff who had to stop because they were, frankly, in tears because of the pressure they were under. Of course we need to stand by those staff and we need to help them, and the health board now has assured us that they will strengthen operational and executive oversight over Glan Clwyd Hospital's emergency department. If your answer is to restructure at a time when people are waiting for operations, and you want the whole health board to be thrown up in a tizz at this point in time, when, frankly, I want to get on with the job of healing people—

Well, it's not working. [Inaudible.]—is not working. [Inaudible.]—10 years. [Inaudible.]

Let—. I will—

If you think that restructuring is going to be the answer at this point in time—

Minister—. I think it's important we let the Minister answer without interruptions, please.

Restructuring at this point in time is not the answer. We will have a tripartite meeting in June and that will provide recommendations to me on the appropriate level of escalation. I have asked to make sure that my officials are ready for any eventuality that comes from that tripartite meeting, and we have different methods now of making sure that we can support and intervene in the most practical way possible to give the support that they need. Now, your answer is always to run down the service and the people—[Interruption.]—and the people working in that service who are on their knees, who are in tears. And, of course, we've got a duty and responsibility to serve the people of that community. If you think that restructuring at this point in time is the answer, I'm afraid I think you're mistaken. That is not what I'll be doing. I am not going to be restructuring in the middle of a pandemic. That is not the way to go about change. We are putting pressure on the health service in the area, we are meeting frequently with the NHS in the area, and we will continue to make sure that we are responding in a productive and in a progressive way, which is constructive. And, of course, this kind of situation is unacceptable, but we will stand by them to make sure that they make improvements.

Minister, we are fed up, frankly, in north Wales, of you telling us that we cannot shine a light on the terrible things that are happening in our health service in north Wales. The report today was not just disappointing, it was, frankly, alarming. It might not be alarming for you, but it's alarming for those people in my constituency who that emergency department serves. People in my constituency depend on that emergency department, and when they read that there are problems in it because of insufficient beds, insufficient staff, poor or non-existent record keeping, patient safety being put at risk time and time again, vulnerable patients who should be seen in 10 minutes who don't get access to a consultant or a specialist for six hours, mental health patients who are suicidal being put in parts of a waiting area where they can't be seen or monitored and sometimes disappearing without the knowledge of anybody in the hospital that they've actually left—. This is a health board that has been in targeted intervention or special measures for its mental health services for over six years. The list goes on and on and on. And if you care to read the report, you'll see that there are echoes of nearly every report that has been brought to the attention of this Senedd while I've be a Senedd Member, well over a decade, as has already been said. And, frankly, I'm sorry to say that it came as no surprise to me, this report, because week in, week out, we get patients, we get their family members and loved ones, in our surgeries, e-mailing us and on the phone telling us that there are problems in these departments. We raise them with the health board and we get this sort of flannel, frankly, that you've just given us today—that they've paid attention to these things, that things are improving, that they've produced a wonderful plan that is on a shelf to be implemented. 

The Member now needs to ask his question, please.

And this is just two months after another report on the vascular services. You know, there are just two services in Wales that have been described as services requiring significant improvement by HIW. Both of them are in the Betsi Cadwaladr University Health Board—nowhere else, just the Betsi Cadwaladr University Health Board. This health board needs to improve, Minister. I don't know, frankly, whether a structural change is appropriate. I'm not yet persuaded that that is going to be the case—

Darren—

I'm happy to have that conversation.

Darren, you need to ask the question. I know you're passionate, but you need to ask a question.

I'm going to ask a question, and if you please allow me to ask it, I will. But the fundamental problem that staff tell me that there is in that hospital is that there are not enough in-patient beds, there are not enough members of staff. What are you going to do to make sure that the balance of in-patient beds is right for that local population in Conwy and Denbighshire that rely on that hospital? Because, demographically, it is the oldest population in Wales, and yet there are fewer beds for the number of residents who are served by that hospital than in any other part of the country. And do you accept—do you accept—that the decision that was taken by your predecessor, who's sat right next to you in the Chamber and has been smirking during this question—

I have not been smirking.

You have been smirking during this question. Do you accept that the decision—

Can I—? [Interruption.] Wait. Hang on a second, everyone, please. [Interruption.] Darren, wait a second. We need to be careful of the language being used in this Chamber on all sides, please. So, let's make sure the questions are focused on the issue that has been raised today, and let's keep to those questions on the issue.

The question is on the issue. Do you accept that the person who is sat next to you, your predecessor, took the wrong decision when he decided to remove this health board from special measures in advance of the last Senedd election? That was the wrong decision, Minister, and you need to sort it out.

I'm going to try and calm things down here a little bit, and let's try and get a little bit more constructive. Now, HIW have said exactly what needs to be done in this situation. They've said—they've listed what needs to be done. The response wasn't what it should have been when they went back in; now there has a been response from the health board. So, let me tell you what they are planning to do. They are planning to strengthen operational and executive oversight of Glan Clwyd Hospital's emergency department; they are planning to put more senior leadership input and spot checks in there—that was certainly something that I felt needed to be done on my visit; they are going to be having two-hourly safety meetings so that approaches are strengthened within the emergency quadrant, along with that senior increased visibility; training is going to be increased across a number of areas. You can imagine that training during the pandemic had to be paused because there was so much going on—that training is going to be reinstated. Vulnerable patients will be identified and discussed at the two-hourly safety meetings, and discharge planning will commence on arrival.

And beds, frankly, are not always the answer—that's certainly not what HIW is saying, and I would rather listen to HIW, who are the experts. And let's be clear that, actually, putting people in beds is not the answer. Our proposal and our policy approach is to get people home from hospital as soon as possible. There's going to be a new digital patient tracking system that is going to streamline patient journeys with increased training for staff to use it. So, there are measures in place. They've been very clear about how they intend to respond to this and we, of course, will be looking at this in the tripartite meeting in June.

Minister, we already knew, as local Members, that, Ysbyty Glan Clwyd is not a good-performing emergency department in Wales. I'm just sad, myself, to read the report and learn that it is now the worst-performing emergency department in Wales. In March 2022 only 44.1 per cent of patients were seen within the four-hour target; 62.4 per cent within the eight-hour target; and 1,351 people spent more than half a day, 12 hours, in A&E. Now, our casework does highlight the critical situation at Glan Clwyd, but the HIW report gives us just a glimpse of how bad things really are there. And I do acknowledge that you acknowledge it, and I thank my colleague Llyr Gruffydd, because if you hadn't had raised this as a topical question, I was hoping to raise it as some kind of urgent question.

The comments by Darren Millar I stand by 100 per cent. It is heartbreaking to be a Member when people contact us on a daily basis with things that are going wrong in this health board. And we're not out to put undue criticism on this health board. We've got fantastic staff there working their socks off, but they themselves are becoming very stressed. You're going to lose members of staff, not because of what we say here, but because of the conditions and pressures that they're working under. And, Minister, how do you think I feel when I read this? That the generic environment, clinical room, resuscitation equipment, oxygen suction equipment, manual handling equipment are dirty; that the utility and ward kitchen was found to be dusty or soiled; that patients who require a trolley in the major areas, if available—

We need the question now, please.

Yes, I'll come to it now.

Now, please.

You've allowed others, allow me, please.

Ask the question now, please.

They're routinely accommodated in the waiting room; that high-risk patients aren't subject to any consistent or ongoing checks. That could be any one of our relatives or the relatives of our constituents. Compliance with—

I've turned the microphones off, because I've asked several Members to keep their questions—. You are limited in question time, you know that, and therefore you have gone beyond the time already allocated. Please keep to the question.

Okay, I will do. Thank you, Deputy Llywydd.

Minister, when the health board was placed in special measures in 2015, improvements were required in leadership and governance. The HIW report highlighted serious concerns. So, is it the case that, seven years on, these special measure objectives still haven't been fulfilled? That was question 1. And a final question, Deputy Llywydd: Minister, you know well my view on emergency departments in north Wales—in view of the failing of this particular hospital, will you look now to Llandudno General Hospital, and at putting some measures in place there that at least would take pressures off Ysbyty Glan Clwyd and hopefully bring about some safer outcomes for our constituents? Thank you.

Thanks very much. Well, of course, Glan Clwyd, along with other accident and emergency departments, are seeing a massive increase in demand, some of which has come as a result of people not presenting themselves during the pandemic and now coming forward. But the situation in Glan Clwyd is worse than in other hospitals, which is why we do need to make sure we shine a light on Glan Clwyd—and nobody's saying that you shouldn't shine a light; my God, if you don't shine a light, I can tell you I'll be shining a light on it. So, it is important that we understand that that leadership and governance, which was part of special measures but is now part of targeted intervention, which is something we are still monitoring, and needs to be improved, which is why we'll be revisiting this when we have a response and the recommendation from the tripartite meeting in June—we'll see what they've got to say in terms of that. I think it's important that people understand that an enhanced hospital management team and an executive presence will be at the A&E department, and there will be an increased use of spot checks in terms of record keeping. It is utterly unacceptable for a situation to be described as 'dirty' in a hospital, especially in the climate in which we are living. It's not a pretty report, and it is clearly something that we need to make sure that they understand the seriousness of what is happening here.

What I can tell you is that Llandudno is already being used as a place where people go to be discharged. So, that is already being used, and I've been to visit—[Interruption.] I've been to visit it, and it is being—. It's quite successful in terms of taking some of the pressure off. And, obviously, if that needs to be continued for a longer term, I'm sure that the health board will consider that. But I do accept that the situation in Glan Clwyd is really in a very difficult situation, and we will certainly be making sure that the health board understand that there is a real urgency now to improve the situation.

I myself read the HIW quality check report this morning, and what it contained was shocking—truly shocking. And I am deeply concerned for the safety of my constituents in the Vale of Clwyd, and I'm also concerned for my constituents working on the front line in Ysbyty Glan Clwyd. Both patients and staff have been badly let down by the hospital and the health board's leadership over the last few years. The fact that this report highlighted the need for significant cultural change in order to make the department a safe and effective environment for patients and staff is extremely worrying, as is the fact that learning from incidents is not routinely shared across Betsi Cadwaladr University Health Board. Minister, do you believe that the local health board is fit for purpose? And my colleague Darren Millar asked you the question, and I believe you didn't answer the question, so I'll ask you again: do you regret your Government's decision to take the health board out of special measures before the Senedd elections last year? And do you have any plans to review services across the region in order to ensure a safe environment for patients and staff?

Thanks very much. Well, certainly we have seen massive pressure in Glan Clwyd, and it's one of the reasons why, as soon as I saw the first report, I made a beeline for the hospital and spent the day in the hospital, not just a quick visit, but I actually spent time with people on the front line in ED, just watching the kind of pressure they were under, and I can tell you that the pressure was intense. I also met with the trade unions, who talked me through how staff are coping. These are difficult times and difficult situations, but it's clear that Glan Clwyd and Betsi are not coping as well as some other health boards in Wales. And of course, therefore, we do need to look at that, and that's why the tripartite meeting will give us some indication of whether we need to escalate the situation.

I think that my predecessor did the right thing in actually looking at the way that Betsi was running and making sure that he did downgrade them from the intervention that they were on. But, since then, we've had a new chief executive, we've got I think a chair who is active and very engaged with the workforce and is absolutely determined to change the situation. And I think it's really important that we get the balance right here between making sure that we see massive improvements in Betsi, particularly in ED and vascular, but that we also make sure we stand by the staff, who have been under incredible pressure over a very long time.

And finally, Carolyn Thomas.

Thank you. I wasn't going to speak on this, but I will now, so hopefully what I say is okay. I often get asked do I think that the health board is too big. And my commonsense thought about it, gut reaction, would be, 'Yes, it is.' It's a huge region—[Interruption.] Common sense. But I like to ask people, so I asked health professionals, I asked people in social services, what did they really think, you know, do we need to do something now. And they said it would be a costly distraction to do something now, reorganisation is really expensive, and there are immediate things that need to be attended to right now. There are many services that are excellent in Betsi Cadwaladr health board, and I'm so glad that my daughter, who lives just across the border, was able to have her child in Wrexham, because, just across the border in Shropshire, it's really, really bad, the maternity health services there. So, there are really good departments, and I don't want to knock them, but there are some that need investment.

But you need to ask your question as well, please.

Sorry. Sorry, I did say I wasn't going to—. So, I know that the Royal Alexandra Hospital were hoping to have investment in that, to help take the pressure off minor injuries—[Interruption.] Minor injuries. But I know there is an issue because of a reduction in capital funding from the UK Government by 11 per cent—[Interruption.] No, I'm talking, I'm asking a question.

Wait a minute. Please, just ask your question, because we are moving on, the time is going on. 

Yes. Thank you.

Please ask the question.

So, I'm asking the Minister if that lack of capital funding, from UK Government to Welsh Government, does have an implication on us being able to build extra services to take the pressure off certain hospitals. Thank you.

Thanks very much. Well, I would agree with you, Carolyn, that I think that to think about reorganisation in the middle of the pandemic, when we have the longest waiting lists in history, would be a distraction. I think it's really important that we focus on what matters to people, and what they want is to be treated well and to make sure that they get seen in a very timely manner. I think also it's really important that we talk up where Betsi's doing well. They've got the best cancer rates, for example, in Wales.

I think it's important also to recognise that you're absolutely right that, due to the restriction on our capital funding, it is difficult therefore for us to put the investment in that we would have liked. Look, I think it's really important—[Interruption.] I think it's really important that we understand that, as a Government, we are committed to improving the situation in Glan Clwyd, but also more generally across Wales, where, frankly, all of our accident and emergency departments are under intense pressure. They have never seen demand like this before. I've had meetings today with the ambulance service, just to make sure that we understand the kind of pressure that they're under, and I can tell you that they are seeing a month-upon-month increase in terms of the numbers of people calling on their services.

Diolch, Weinidog. Before I move on, can I just remind Members, please, that, when we have a passionate issue such as this—and it does create passion and emotion amongst Members, because you represent your constituents—please respect the Chair when the Chair requests that questions be asked and no long speeches. It is important that we get to the questions so that Members can ask them and the Ministers can answer them. Please keep your focus on that.

The final question today will be answered by the Counsel General and Minister for the Constitution. I call on Huw Irranca-Davies.