We therefore move on to item 5, a statement by the Minister for Health and Social Services: update on Betsi Cadwaladr University Health Board. I call on the Minister, Eluned Morgan.

Diolch, Dirprwy Lywydd. Further to ongoing concerns at Betsi Cadwaladr University Health Board, many of which have been raised in this Siambr, I asked the chief executive of NHS Wales to hold an extraordinary tripartite meeting on 26 May as part of the NHS Wales escalation framework. The situation in Betsi is unacceptable and it needs serious work and effort to correct. Services are not as good as they should be, and we are determined to improve the situation for the thousands of people in north Wales who rely on these services.

Following the tripartite meeting between the Welsh Government, Healthcare Inspectorate Wales and Audit Wales, the NHS chief executive has recommended that the targeted intervention status at Betsi Cadwaladr University Health Board should be extended beyond mental health and governance issues to incorporate Ysbyty Glan Clwyd, focusing in particular on the vascular service and emergency department in Ysbyty Glan Clwyd, and I have accepted that advice. They did not suggest that we put Betsi back into special measures.

We will therefore ensure that significant new additional external clinical and practical expertise will be put in place to ensure that we embed sustainable change and improvements in the quality of the service. In this way, we'll be making improvements with the health board rather than doing things to the health board. The decision has been made in line with the escalation framework and reflects serious concerns about the leadership, governance and progress that have been a feature of Ysbyty Glan Clwyd. My decision has been communicated to the chair of the health board.

Firstly, let me address the issue of governance, leadership and oversight of Ysbyty Glan Clwyd. It's clear the current challenges facing Ysbyty Glan Clwyd require a focused intervention to support cultural change and promote leadership at all levels. I have therefore instructed Improvement Cymru, the improvement service for NHS Wales, to work with the health board to bring in external clinical and organisational development expertise into the hospital. The aim of Improvement Cymru is to support the creation of the best quality health and care system for Wales, so that everyone has access to safe, effective and efficient care in the right place and at the right time. I want to emphasise that this in no way reflects on the hard work of the staff in Ysbyty Glan Clwyd, but this is a source of external help and support to embed the change that is needed urgently, and we need to do this at pace.

Secondly, vascular services have been challenged since the service was centralised. This does not mean that the decision to centralise was wrong. Following a series of concerns raised by the Royal College of Surgeons and Healthcare Inspectorate Wales, the health board has responded rapidly and progress has been made in a number of areas, but the service remains fragile. There have been some serious incidents over the last few months and the benefits of the recent changes have not yet been realised. A new clinical leader has been appointed but has yet to take up post. My officials will continue to monitor the implementation of the action plan at least twice a month.

Thirdly, the emergency department at Ysbyty Glan Clwyd has been designated a service requiring significant improvement by Healthcare Inspectorate Wales. We have made £3 million available to the health board for the local six goals for urgent and emergency care programme. I have instructed clinical leads from the national programme to work closely with the health board to address the concerns identified by HIW.

Fourthly, mental health. This service is, without doubt, in a much better state than the one that went into special measures. But, while progress has been made, there is still much more to be done, particularly around culture change, and this will take time. Following discussions with the Deputy Minister for Mental Health and Well-being, I'm asking the health board to move with pace to ensure that there is a permanent leadership team in place, and to develop a robust recruitment plan to minimise vacancies and the use of interim staff. We must make this a sustainable service. I have asked Welsh Government officials to commission an independent assessment of the sustainability of the progress that has been made against the various mental health reviews over recent years, and ministerial oversight of these arrangements will be led by the Deputy Minister for Mental Health and Well-being.

Finally, it has become clear that the health board's current systems are largely reactive. External reviews have pointed to significant gaps in fundamental aspects of clinical service standards. That includes record keeping, incident management, team working, reporting concerns, leadership and morale. Many processes are in place, but there is not sufficient capacity in place and they're not broad enough to provide systematic assurance in these areas. The health board must become a self-improving organisation, sustained by clinical staff with the skills to practice continuous improvement in their daily work. This focus needs to be evident right through the organisation, from ward to board.

I am asking the health board to do the following things: review current governance, audit and effectiveness capacity and work arrangements with Improvement Cymru to invest in a rapid education and support programme that will be put in place quickly in order to improve skills. I have also asked the health board to ensure that a senior appointment is made to a director of safety and improvement post. This individual will support the new executive director of nursing to ensure that joint governance improvements and arrangements are put in place across the health board. On top of this, the board must do better to connect with and engage with its staff and the public. There have been a series of concerns raised about workforce well-being, cases of harassment, bullying and staff feeling unable to speak out. The board must build on the work it has started in terms of its organisational development, and it must do this quickly. Given the seriousness and exceptional nature of this escalation, these arrangements will be monitored closely and reviewed early to ensure that progress is made. A further tripartite meeting will take place no later than the end of October this year. 

Dirprwy Lywydd, this is an extensive and far-reaching set of targeted intervention arrangements for Betsi Cadwaladr University Health Board, and we will review these regularly and robustly over the coming months. Let me be clear that there are pockets of brilliant work being done in Betsi Cadwaladr University Health Board. What we need to see now is that that quality is replicated across the whole system, most specifically in Ysbyty Glan Clwyd. But more importantly, this is a set of arrangements that will support the health board on its continuing improvement journey so that the people of north Wales can be proud of their local health service. Thank you.

Thank you, Minister, for your statement, although I have to say that I'm disappointed by the lack of courtesy that you've extended to Members of the Senedd who have a direct interest in the hospital to which your statement has referred. As you will know, I've taken a great interest in the services at Glan Clwyd Hospital for many years, and yet, you didn't even give me the courtesy of a briefing before your statement this afternoon, nor did you give other Members who represent that hospital the courtesy of a direct briefing either.

You say that this is targeted intervention, but nothing could be further from the truth. It's a scattergun approach that you are now taking in north Wales. We have targeted intervention already for mental health services, for strategy, planning and performance, for leadership, including governance, transformation and culture, and for engagement because of the poor engagement with patients, public, staff and stakeholders. Yet, today, you've announced even more targeted intervention, this time at Ysbyty Glan Clwyd in respect of its leadership, which is already in targeted intervention, we are told, its mental health services, which are already in targeted intervention, or so we're told, and, of course, its vascular services now and emergency department. I have to say it's long overdue in terms of intervention required for those.

Some aspects of these services, which you say you are now putting into targeted intervention, have been in special measures or targeted intervention for seven years—seven long years. In fact, the seven-year anniversary is this week that mental health services have been in special measures. This week. It's the same with the leadership issues. And yet, time and time again, we have Ministers here, including your predecessors, who come and say, 'We're determined to get things changed. We're determined to kick things into shape. We need to move things on, with pace.' That word, 'pace', seems to make all the difference in your ministerial statements, doesn't it? Well, the reality is it doesn't. When does targeted intervention on such a wide number of things actually become special measures? Because I don't know, and I don't think it's very clear to the public either. You said that if there was not improvement in vascular services within three months, the health board would face consequences. Well, if this is the only consequence they are facing, another targeted intervention label, I don't think they've got much to be concerned about, frankly, because we know that targeted intervention doesn't work. It hasn't worked for seven years, as I've already said.

If you've got a leadership of a health board that is absolutely incapable of making improvements, why aren't you moving that leadership on? Why are you saying that we now need to appoint another executive director, at huge cost to the taxpayer, this time for safety and improvement? Why can't the extremely highly paid executive team already in place at the health board deliver the improvements that they are employed to do? That is their job. And if they're not up to it, they can ship out and go somewhere else, because we don't want them in north Wales. We want a team that works, that delivers the improvements that we've been promised. Because people are being let down, patients are being let down, the staff are being let down with the appalling working environment that many of them are having to endure, as a result of this dysfunctional health board that you as a Welsh Government have also been incapable of turning around over all this time.

You talk about the emergency services at Glan Clwyd needing intervention—and they do—but what about elsewhere in north Wales? What about down the road in Wrexham Maelor Hospital? That hospital has actually had worse emergency department performance over the past 12 months. In eight out of the past 12 months it's had worse performance figures than Glan Clwyd Hospital, so why have you left that out of this targeted intervention approach? You talk about a bullying culture, you talk about staff not being listened to, you talk about a culture of fear. We heard reports about the situation in Ysbyty Gwynedd, with staff there complaining about those things just a couple of weeks ago. Why isn't that hospital being put in targeted intervention for these things? It doesn't make any sense whatsoever.

You now tell us you're going to work with the health board, rather than work for the health board, in order to sort these problems out, and you've appointed Improvement Cymru as though it's some white knight on a horse that's going to ride in and turn this situation around. Why on earth haven't you deployed Improvement Cymru before? This organisation has been in place for years, and yet you haven't deployed them up until today. Why don't you use the experts that are out there to turn the situation around? Why not call the Royal College of Emergency Medicine in to turn around the emergency departments in north Wales? Why not call in the royal college that did the reports on the vascular services to actually come in and turn that situation around? Because they know best, I would suggest, in my view. I'll come to my concluding remarks now, Deputy Presiding Officer.

You say that you want to improve things with pace, and you say that this situation will be carefully monitored and reviewed, and yet you've said the next tripartite meeting won't take place until the end of October. That doesn't sound like an organisation that's going to make significant improvements at pace, if you're prepared to wait until the end of October for a further tripartite meeting. Minister, I have absolutely zero confidence that Welsh Government targeted intervention in these extra areas, on top of the other targeted intervention, is going to make any difference at all in this health board. We need to kick the current leadership out that has been failing people for so long. That's the only way to drive the significant culture change—

I have been generous to the Member.

—that we need. We need that action now, sooner rather than later.

Diolch yn fawr. I did, of course, offer a briefing to your political representative on the health committee, and I'm sure he communicated to you what that information contained.

There is nothing scattergun about this approach. We formally had measures in relation to mental health and governance, and now we are targeting this additional intervention at the area where we have greatest concern, and that is Ysbyty Glan Clwyd, vascular and the emergency department. You can't have it all ways; you can't tell me in one breath that it's scattergun and now you want me to spread that approach to Wrexham Maelor and everywhere else. You can't have it both ways. I think this is the right way to go. This has been identified by the tripartite group to assess where we can make the biggest difference in a short space of time.

There's a difference now in terms of Improvement Cymru. You're quite right, it was a question that I asked: why didn't we bring them in before? It was because they didn't exist until 2019. We had this little intervening issue of COVID that actually knocked a lot of things out of action during that time. The approach, in terms of Improvement Cymru, was based on 1000 Lives. What we have now is a very different focus for the organisation, and that's why things will be different this time.

On top of that, of course, we've put significant additional resources in place, £297 million until 2024. We have had, of course, detailed discussions with the chair and the chief executive in terms of how we can improve the situation in a practical way and to do it at pace. When you say we won't be doing anything until October, if you'd listened carefully to the statement, it was very clear that we would be taking the temperature on a fortnightly basis from the Welsh Government point of view to make sure that we see improvements on a regular basis. It will then be an opportunity to bring in Healthcare Inspectorate Wales again to see if that intervention has made any difference by the end of October.

Thank you for the statement. I fear that, however you look at this, the timing of this today doesn't reflect well on the Welsh Government. Indeed, it demonstrates once again how little understanding and how little appreciation there is within the Welsh Government of the gravity of the situation at Betsi Cadwaladr health board.

This is a very weak response to an extremely serious situation, I fear—an extension of targeted intervention, rather than a real rolling up of sleeves to deal with a problem that is causing so much anguish to staff and patients across the north. An extension of targeted intervention—why end here when there are so many problems right across Betsi Cadwaladr? The problems I've brought to your attention among nurses at Ysbyty Gwynedd and the fears of bullying and intimidation and working conditions that are not up to it in terms of retaining the staff, their knowledge and experience—why not include Ysbyty Gwynedd?

And in terms of the timing, which one is it? Is this yet another example of Welsh Government acting at the eleventh hour to try to take the sting out of a Senedd debate and a potentially difficult vote, acting because they have to to try to avoid embarrassment? Welsh Government does this all the time. It's a Government dragging its heels. Or is it that the Minister really failed to register the seriousness of report after report—that damning report on vascular in particular—and she decided to see how things went for another three months before deciding on the next step and if action was required, when it was pretty obvious that we needed further intervention? Government failed to act in a way that reflected the urgency of the situation.

The Minister says that there are pockets of excellence within Betsi Cadwaladr. Well, yes, there are. I wrote to the chief executive and chair recently following the publication of cancer figures showing that there was good work happening in north Wales. We do understand that. The Minister, I know, is eager for us to bear in mind the need to support staff through all of this. I couldn't agree with her more. Without staff, there is no NHS. In those departments facing the greatest challenges, there are staff that we need to retain, and we do remember them today and thank them for their work. But staff are many of those people raising concerns with us about health services in north Wales. Staff raised concerns about the loss of vascular services from Bangor. Today, despite the damning report, the Minister still insists that that decision to centralise services had been the right one. Well, if it was, why not centralise at Ysbyty Gwynedd where there was a centre of excellence already? In terms of mental health services, it is staff who have been describing to me, and to other Members, time and time again, why mental health services weren't ready to come out of special measures when the Government decided to do that prematurely just before the last election.

So, we do listen to staff, we do respect the staff, and we are mindful of the support that staff need. But does the Minister accept that many of those staff members will see that there has been far too much delay in taking these steps today, and that the steps taken are inadequate? And in the absence of any suggestion in this statement of how we will be able to gauge success or otherwise, does she accept that we still don't have a vision as to how a successful, sustainable Betsi Cadwaladr would work for the future? And that's why we on these benches, in tomorrow's debate, will be arguing that we need to take an honest look at the possibility of reorganising healthcare in north Wales. These plans are weak, I fear. I hope, for the sake of staff and patients, that they will make a difference, and that these plans can make a difference. But it's a very serious situation that needs a plan B ready to go. 

I am extremely aware of the seriousness of the situation, and it is clear that the situation in Betsi, in particular in those areas we've highlighted, is unacceptable. This is something that I made very clear to the chief executive and the chair when I met them last week. Can I be absolutely clear that this statement was earmarked before any suggestion of an opposition debate on this matter? It was very important for me—[Interruption.] It was important for me to—[Interruption.] It was important for me to speak to the chair and the chief executive face to face, and that's why I needed the opportunity to go and do that in front of them last week. So, I'm glad that I was able to do that, to go through the detail of what we were proposing.

The three months that we used to give us time to assess exactly what interventions were necessary not only allowed us to recognise the seriousness of the situation, but also made sure that we had a clear programme of action that we could put in place. I am not in the business of putting a label on something and not having a follow through for that label. And that's why it's absolutely clear to me that making an announcement that there will be an extension to the targeted intervention, with a clear programme of action to run alongside that, is the right way to go. 

In terms of the staff, I have been speaking to representatives of health unions in recent days. Certainly, they have been uncomfortable in certain situations of being moved around from place to place, but some of the unions are telling me that, actually, they don't recognise some of the issues that have been highlighted. So, I would suggest that, if there are issues, they also talk to the unions about those issues because they are not hearing some of the things that are being heard by Members here. 

It is important also for us to make sure that we focus on the staff within the organisation. The staff are the backbone of any improvements that we are likely to see here. It is why we have said that we are going to be standing with the staff and doing any interventions with the staff rather than doing things to them. That is the only way we're going to get sustainable change. 

I've had a request for a point of order. Darren Millar. 

Thank you, Deputy Llywydd. Can I just express my concern about a remark that the Minister made suggesting that this statement has been planned for a number of weeks? I'm a member of the Business Committee. The Business Committee look at the forward work programme each time we meet. We were not notified of any changes until today in respect of this statement; it was not agreed until today. Papers were circulated yesterday to the Business Committee, confirming this change. That suggests to me that the Minister may have inadvertently misled the Senedd.

Thank you for that point of order. I'm sure the Minister will reflect upon when the Government had decided it would introduce such a statement. Perhaps that may be an issue rather than simply the business statement.

Before we move on to the—

If you don't mind, I would like to respond to that.

Minister, I will in a second. But before we move on, can I remind all other contributors of the timescales, please? We have already used up a large proportion of our time, so can everyone keep to their timescales, please? Minister.

If you don't mind, I would like to respond to that. This is a statement that we've been preparing. Clearly, I did not want to put that on any agenda until I had the opportunity to speak to the chair and the chief executive of the health board, and that happened last week. And since then, we've been working very hard since that meeting last Tuesday to put in place these measures. So, we've been working this up. You might have noticed, Darren, that, actually, there's been a four-day bank holiday, so maybe that is part of the reason why you haven't heard anything about it. [Interruption.]

The Minister has given her response—[Interruption.] The Minister has given her response, and we will now move on to the next person. Janet Finch-Saunders.

Thank you. Whilst I thank you for the statement, Minister, I would like to thank my colleagues Darren Millar and Rhun ap Iorwerth more for actually calling you out on this statement, because it's far too inadequate. I've been here 11 years, and, prior to that, I had dealings, going back over the years, with the Betsi health board, under the late Mary Burrows, when she was the chief executive. And we've had countless numbers of chief executives since, we've had countless numbers of chairs, and we've had several health Ministers, and yet, the fundamental problem we have here is that this health board is going backwards. There are no improvements that I believe that will be forthcoming.

I, like other Members, have undertaken numerous meetings with the chief exec, deputy chief exec, and listened to several statements here since first being elected in 2011. The responses to serious casework issues are abysmal—

You do need to ask the question. I did ask Members to be succinct.

Yes, I know. I've got to be honest, things are so bad, Deputy Llywydd—

Janet, there are a lot of people who want to speak.

I will get to it. But it's a fact, and it's been raised by Plaid Cymru, the current model simply doesn't work. I asked you two weeks ago, Minister, whether we could have a meeting of north Wales Members, yourself, the chairman and the chief executive, and then we could have some full and frank discussions. Will you now agree to that meeting, please? That's all I have to ask.

Yes, I'm happy to have that meeting.

Well, if we need any proof, this statement, in my view, shows that the Welsh Government is going round and round in circles on Betsi Cadwaladr. You're tinkering with the symptoms rather than fundamentally tackling the illness that is stifling services in north Wales.

How many times have we been here before on Betsi Cadwaladr, Minister? How many times do we have to come here, and, quite frankly, listen to your cut-and-paste statements about more targeted interventions, more new directors, more tripartite meetings? You're like a broken record. It's a statement that you and your predecessors have made in various forms time after time, month after month, for the best part of the last decade. Front-line workers in north Wales are doing heroic work, but their Government is fiddling whilst Rome burns. Will you accept that the time has now come for a more fundamental consideration of how services are configured across north Wales? And, look, if the conclusion is that this current model is the best that we can be, then so be it—I'll accept that. But until you as a Government instigate that discussion, then you will have to be dragged back to this Chamber month after month, to give us more of the same excuses and more of the same guff.

I believe that reorganisation at this point would be costly, it would be a distraction from the significant issues in relation to planned care, it would divert resources, and my focus at the moment is on patient care. There is nothing 'cut and paste' about this statement; I can assure you I've spent a lot of time working on it. I think that I will retain my focus, as I'm sure the board will, on ensuring that we are doing the very best for the people of north Wales, and a costly reorganisation is not the answer.

Thank you for your statement this afternoon, Minister. The sad reality is that, back in the 1980s and the 1990s, Glan Clwyd Hospital was one of the best-performing hospitals not only in Wales but the UK, so it's sad to see how times have changed, to say the least.

I have just a couple of questions this afternoon. Do you honestly believe that these measures you've outlined can deliver improvements quickly and in a timely manner? And what additional support will be on offer to my constituents working in YGC? After all, this is not a failure of the staff working on the front line, it's a leadership failure—too many middle managers and bureaucrats. Do you have confidence that the leadership can deliver safer, improved services? And as you state in your statement, there are concerns surrounding morale and workforce well-being, so what steps are you taking to monitor the well-being of the staff working in YGC and what instruments are you going to use to measure that over a sustained period of time? And will staff at YGC be offered external reporting measures until the culture within the health board improves? And, finally, Minister, you have asked the health board to create a new director of safety and improvement. Given the recruitment issues facing the board, when do you anticipate the post being filled and how will the new director be able to drive these improvements that are well needed? Thank you.

Thanks very much. There are some things, Gareth, that I expect to improve very quickly. I think there have already been some improvements in relation to vascular. There will be others that will take more time. The cultural shift that is necessary within the organisation—the acceptance that it needs to be a self-improving organisation—is something that will not be able to be switched on overnight, but it's something where I expect to see improvements. The issue that you referred to in terms of the appointment of a new director for improvement is something that we discussed with the chief executive and the chair last Tuesday, and they have now gone away to think about how exactly that would work within the executive organisation that they already have in place.

And finally, Sam Rowlands.

Diolch, Deputy Presiding Officer, and thank you, Minister, for bringing forward today's statement. Before I get into the thrust of my comments, I would like some clarity from the Minister around the statement that bringing in Improvement Cymru was only possible because it's only been around since 2019. I understood that the 1000 Lives campaign, which was the predecessor name, has been around for quite a long time, so perhaps you could respond to that in just a moment.

As you state in your statement, Minister, the situation in Betsi Cadwaladr is unacceptable and needs serious work and effort. That's kind of written down like it's new news, but we've been saying this for years, as Members have already stated. Your rightfully point out that many of the issues have been raised in this Chamber by Members of all parties, and this is because we are representing residents, sometimes our own family, our own friends, our loved ones, who continue to be let down by this lack of access to quality health services in north Wales, which ultimately is your responsibility and the responsibility of Welsh Government. My concern is that many of my residents will think that this is only talk coming from Welsh Government to see improvements. So, I want to know, Minister, how will you personally be assured that these improvements will take place and that the people of north Wales will see the radical improvements that we need to see?

Thanks very much. First of all, on Improvement Cymru, you're quite right that it was an organisation that focused before on the 1000 Lives programme, which was a safety programme to support health boards and trusts in their efforts to reduce harm, waste and variation in Welsh healthcare. That included work on eliminating hospital-acquired pressure ulcers, assessing patients for risk of deep vein thrombosis, and ensuring the World Health Organization's safer surgery checklist is implemented in every surgical theatre. Now, what it didn't do is this broader approach that we are talking about now, and that's what changed in 2019 when Improvement Cymru was developed in its current form.

You are quite right, Sam, to focus on the need to improve the services that are struggling. That is precisely what we are trying to do with this approach. I will personally be overseeing this, having my regular meetings, as I did again this morning, yesterday. Last week, I had a meeting with the chair. I had another meeting with the chair of Betsi this morning. So, there's a continuous dialogue happening between me and the chair of the health board. Obviously, my officials will be doing the same thing at an executive level, and I can give you my assurance that I will be intervening personally to make sure that they are keeping on track.

I'd just like to say one other thing, and that is: let's just make sure that people are aware that there are literally tens of thousands of people being seen on a monthly basis in Betsi Cadwaladr who are actually getting good care—

Well, I wish they'd come and see me in my office. 

Well they don't, and that's the point. And that's the point. I think it's really important that we don't lose sight of the fact that, actually, there are people who are satisfied with the support and the service that they are having in Betsi. 

Thank you, Minister.