The following amendments has been selected: amendment 1 in the name of Siân Gwenllian.

Item 7 today is the Welsh Conservatives debate on Betsi Cadwaladr University Health Board. I call on Sam Rowlands to move the motion.

Motion NDM8015 Darren Millar

To propose that the Senedd:

1. Regrets that the Welsh Government has failed to deliver promised improvements at Betsi Cadwaladr University Health Board.

2. Believes that the decision to move the health board from special measures in November 2020 was inappropriate.

3. Calls upon the Welsh Government to impose a reformed special measures regime to provide the health board with the leadership and resources necessary to address failings, and deliver the high-quality health care that the people of North Wales deserve.

Motion moved.

Thank you, Deputy Presiding Officer. I'm grateful, today, to be able to move our Welsh Conservative motion on Betsi Cadwaladr University Health Board, tabled in the name of my colleague Darren Millar. Now, when Betsi was put into special measures in June 2015, no-one would have believed that, seven years on, we're still debating severe failings at the health board. As we know, Betsi serves around a quarter of the population of Wales, and it is they who have been let down, time and time again, and are rightfully angry and frustrated. We in this Chamber, too, are tired of the same old underperformance and same old excuses.

The Llywydd took the Chair.

Before I move on to the experience of patients, I want to put on record my thanks to the great staff at Betsi, and also put on record that my brother and sister are both nurses in the NHS as well. When I speak to staff—whether it be doctors, nurses, midwives, support staff, admin staff—the story is always the same: they are trying their level best, day in and day out, but they're just not being supported by this Government, who have not taken the drastic action that we need to see in north Wales. For example, healthcare professionals who work at Wrexham Maelor have said, and I'll quote:

'There just aren't enough people on the rota. The choice is between going into clinic or leaving very junior doctors to cover a ward on their own.'

The front-line staff in our hospitals continue to do their best under difficult circumstances every day. Minister, I urge you to give them the support they need to do their job well.

In my contribution today, Llywydd, I'd like to focus on three issues that I believe are the drivers behind today's debate, the first being patient experience. The fact of the matter is that the lack of support from the Government means that the health board can't deliver services properly. Anyone who's visited healthcare settings in my region in north Wales and sat down with patients knows just how bad things can get.

Referral to treatment times in north Wales are among the worst across the country. One in four patients are waiting over a year for treatment, with 18,000 patients waiting more than two years. I'll take a constituent case of Mrs Jones from my region; Mrs Jones has been waiting for a hip replacement for more than a year. In that time, she's received little to no communication from the health board, and during this year, Mrs Jones has suffered with substantial pain. She's had to give up driving, she is stuck at home in pain. Had previous health Ministers gotten to grips with the issue, Mrs Jones would not be in the situation she finds herself in now.

Secondly, I'd like to focus on ambulance and A&E waiting times. The performance at A&E waiting rooms across north Wales is simply not good enough. In April 2022, Betsi recorded the worst A&E waiting times in Wales, with just over half of patients being seen within four hours. And the story's even worse at specific hospitals, at Ysbyty Glan Clwyd and at Wrexham Maelor, where the figures are below 35 per cent of patients seen in four hours, and 40 per cent respectively at Maelor, with one in five patients—listen to this; one in five patients—having to wait for more than 12 hours. Twelve hours in A&E; that's an emergency. Twelve hours.

The failure to deal with the pressure on our A&E departments adds significant pressure to our ambulance services. In April 2017, 79 per cent of ambulances would arrive within eight minutes for those important red calls. Five years on, in 2022, after years of special measures and intervention from this Government, that figure now is at 46 per cent, a dramatically worse position than in 2017. And these are real people, waiting for those ambulances, in need of emergency medical attention. 

I'll give another example, another constituent case. Rev John Morgan from Kinmel Bay reached out to our north Wales office last week to share his experience. In the early morning at 3 a.m., Reverend Morgan experienced chest pains and called an ambulance. Six hours later, one arrived, and took him to wait outside A&E and he waited outside A&E for a further six hours. He was then placed on a trolley in the A&E department, where he was ignored. Despite being diabetic, he was not offered food. After a restless night in a cold A&E department with no blanket or pillow, he went to the bathroom to freshen up, but found there was no running water to even have a wash. Rev Morgan was then left waiting to receive his medication. After being left with nothing but a drink since lunchtime, he decided to self discharge at 5 p.m. In his own words, Rev Morgan said he felt the conditions in A&E were inhumane; he would rather die at home alone then go back into the hospital. Rev Morgan, Members, is 70 years old and a veteran, having served in the RAF for 25 years. Experiences like Reverend Morgan's are wholly unacceptable, but sadly, far too common.

I could go on to mention a handful of failures at Betsi: vascular services are a shambles, access to dental services is a lottery, GP surgeries are ending contracts with the health board. I'm sure Members will mention those today in the debate. The thing for me, Llywydd, that sums up this Welsh Government's failure to improve things at Betsi is the performance of the mental health services, which I'll end on today.

Only as recently as April, S4C's Y Byd ar Bedwar revealed patients were being denied in-patient treatment—being denied in-patient treatments that they needed. Staff are scared to come into work, and too frightened to speak out. This does not suggest there's been any progress at all since the special measures in 2015. It's almost unbelievable that the same health board that was responsible for the Tawel Fan scandal still hasn't learnt lessons. It's clear to me that taking Betsi out of those special measures was the wrong decision, and, just months before the Senedd election, it was certainly a political one. It's time to reverse the politically motivated decision taken by your predecessor, Minister, and take the radical action we need to see.

In closing, things have been in bad shape at Betsi for far too long, and it's the Welsh Labour Government who are to blame. Former captains Drakeford and Gething spent too much time rearranging deckchairs and not enough time deploying the lifeboats, with the current Minister being given captain of the Titanic after it's already split in half. With Welsh Labour failing to deliver adequate health services for the people of Wales, I propose it's time to slap a health warning on this Government. The side effects may include one in five people on waiting lists, 10,000 people waiting for more than 12 hours in A&E, over 70,000 people waiting more than two years for treatment, 42 per cent of cancer patients not starting treatment within two months, and a 50:50 chance of getting an ambulance in the time that you need it. It's time for change, and it's time for new solutions. Minister, I urge you to do what your predecessors couldn't, and tackle the issues at Betsi head on once and for all. Diolch yn fawr iawn.

I have selected the amendment to the motion, and I call on Rhun ap Iorwerth to move amendment 1, tabled in the name of Siân Gwenllian.

Amendment 1—Siân Gwenllian

Add as new point at end of motion:

Calls for an independent review to be commissioned to consider the possible benefits of replacing Betsi Cadwaladr University Health Board with new structures to deliver healthcare in the north of Wales, due to its chronic problems.

Amendment 1 moved.

Thank you very much, Llywydd. I'm very pleased to move the amendment formally. We've been here before, haven't we? We've been here so many times previously, and it saddens me. There's no criticism of staff here; indeed, in the face of all the questions about the health board, we need to do more to support them. We thank you for your tireless service, and that goes for front-line staff, clinical staff and those who manage and who share our concerns. But our amendment today says this, to all intents and purposes: are we asking them to do the impossible? I'm speaking on behalf of Plaid Cymru today, but we all, as residents in north Wales, speak as services users, we speak as parents and children to older parents perhaps, and we speak as those who know and who are friends with dedicated staff, and we've all had a gutful of the failure of the Welsh Government to resolve the situation in north Wales.

Yesterday, a suite of interventions, too weak, too late, were announced by Welsh Government—a Welsh Government that has failed to address the problems of Betsi Cadwaladr time and time again. The suite of interventions was in response to more damning reports—hugely damning reports. But where's the next report? Experience tells us that it may not be very far away.

Betsi Cadwaladr University Health Board was established in October 2009, the largest of Wales's new health boards, both geographically and in terms of population. It's a complex health board. But it was only a little over five years later that it was put in special measures. As we moved into the 2020s, the board found that it had been in special measures for around half of its existence. After five years and more of special measures, those measures cease to be special. They become the normal state of affairs. I and many of us question how ready it was to be brought out of special measures then, conveniently in the approach to the last election. But even then it was only a move to another lower level of targeted intervention, extended yesterday, though, as I say, not far enough. There's continued intervention for mental health services—not surprising after the scandals of Hergest, of Tawel Fan, the suppression of the Holden report. Vascular services at Ysbyty Glan Clwyd are under targeted intervention. What on earth took the Minister so long, waiting three months to see if something might happen? Even a glance at that damning report published in February told you that urgent action was needed.

Another critical report leads to placing the emergency department at Ysbyty Glan Clwyd in special measures. Of course, there's been criticism of services elsewhere, not covered by targeted intervention. There's a report from the ombudsman saying that Betsi Cadwaladr caused injustice to eight prostate cancer patients after failing to undertake appropriate monitoring of their care and treatment. I recently raised concerns about intimidation or bullying of nurses at Ysbyty Gwynedd; nurses being moved away from their areas of expertise, concerns that triggered an immediate review. And, of course, I hear regular concerns of patients and staff worried about the unsustainability of services. I was discussing a constituent's case this morning. Her son had a fit, she couldn't get an ambulance, she couldn't praise staff enough as they treated her son in the corridor in the ED whilst 13 ambulances waited outside—I think it was 14 yesterday according to a physician. Are these Betsi Cadwaladr problems or are they just wider NHS issues? You see, the problem we have is that we have a fundamental lack of confidence that this cumbersome health board is the best way of delivering healthcare in the north of Wales. And it gets worse, that lack of confidence, with every report. At the end of the day, it's about patient safety. Staff leave, recruiting is difficult, patients complain.

Minister, you'll have seen the same figures as I've seen, showing Betsi going from below average complaint numbers in 2012 to twice the average in 2017. And you will have seen the national reporting and learning system figures collated by your own delivery unit, showing that, since 2007, Betsi reported far more severe incidents and almost as many deaths as the rest of Wales put together. Something is not right, and I'm afraid that we have to be ready to think outside the box to try to sort things out. Our amendment calls for an independent review to be commissioned to consider the possible benefits of replacing Betsi Cadwaladr with new structures to deliver healthcare in the north of Wales. This Government has tried special measures and it has failed. It is trying a few targeted interventions, and as I said yesterday, I hope that they can make a difference, but let's at least look for an alternative. We owe it to the people of the north of Wales to have that conversation on how we could bring healthcare back closer to the people.

Russell George.

Thank you, Presiding Officer. I wasn't expecting to be called just at that moment. Thank you, Darren Millar, for tabling this debate today. Since Betsi was suddenly taken out of special measures in 2020—and it was suddenly, as Rhun ap Iorwerth pointed out—by the then health Minister, Vaughan Gething, significant failings have, of course, continued to occur, ranging from mental health services to vascular services and emergency departments across the board. For me, it's repeated errors that have been continued since 2015 that is the issue here. I'd have some more understanding if these were new failings, but they're failings that have been repeated for the last seven years and I think that that is what the frustration is that you hear in the Chamber today, and you have heard, Minister, for some time.

We have poor communications—there were a couple of examples in Sam Rowlands's contribution—and lack of escalation for staff to air their concerns. Continuing mistakes leading to a risk to patient safety and even death have been highlighted over and over again by independent reviewers. As was discussed yesterday, we're all too familiar, of course, with Ysbyty Glan Clwyd's emergency department—waiting times have not improved since the report was published. You've heard specific examples from Members across this Chamber a number of times—I listened to Sam Rowlands's examples, specifically, as well—and very often, it can be said, 'Well, these are just one-off examples', but that is, of course, not the case. We know that two in three patients are waiting more than four hours—that is completely unacceptable. The Minister, in fairness, has accepted that that's unacceptable, but the failings are still happening, and what the Minister does fall short of is putting the board into special measures. These are continuing over seven years of special measures and targeted interventions and this continues to be the case. It's worth saying, of course, that it's not just Ysbyty Glan Clwyd's emergency department that is failing, it's Wrexham Maelor also failing as well—60 per cent of patients waiting over four hours there.

Now, I listened to the statement yesterday and Members asking questions and the Minister responding—I didn't ask any questions myself; I listened carefully to the questions and the responses. The Minister wants to move at pace and improve services, and that's all good to hear, but the Minister's proposals, I suggest, suggest otherwise. The tripartite group will not meet until not just—and I can see the Minister looking at this—will not meet perhaps next month or this summer, but not until October. Now, yes, I heard your response to this yesterday, Minister, but four to five months away, that doesn't show any kind of urgency. Now, the Minister said yesterday that, 'Oh, there are going to be meetings every two weeks', but staff and patients are crying out for more swift and decisive support. What actions will be taken every two weeks? What will the level of transparency be in those meetings that are taking place every two weeks in those monitoring—? What kind of monitoring will take place in those two-week meetings? So, I'll be interested if, in the Minister's response, the Minister deals with some of those issues.

Now, three out of the four issues that the Minister outlines—leadership, governance, mental health services, emergency services—they're reflected in other hospital services across the board. I previously mentioned the Wrexham Maelor emergency department, but I also mentioned the Ablett mental health unit as well in Ysbyty Gwynedd. Also, in that particular instance, we saw one patient sadly take their own life. And just last month, the assistant coroner for north Wales east expressed the serious concerns into the health board's investigations into the patient's death. Now, I would have some sympathy, actually—I have had some sympathy in the past—with the Minister's strong view that now is not the time to reorganise, but it's been a decade of extremely poor management and seven years of special measures or targeted intervention. This isn't an issue of the pandemic; this has been happening for over a decade. And, for me, I have to come to the conclusion that if now is not the time to relook at organisation or relook at how services are delivered, when is the time? When is that time? So, people in north Wales, patients in north Wales, but also staff in north Wales, do deserve a quality health service, and I would hope that Members today across this Chamber will support our motion and also Plaid's amendment put into this motion as well today.

There is no doubt that health provision is the single biggest issue of concern to people in north Wales right now, and by some distance. And whilst the vast majority of people in the region would doubtlessly applaud the phenomenal and tireless efforts of the healthcare workforce, there is considerable concern over service provision and outcomes.

Now, the Conservative motion sees a different set of special measures as the answer to the health board's failings. The Plaid amendment offers reorganisation as the answer. I've considered both really, really carefully, and I do feel that both are worthy of further investigation and also an open-minded response from the Government. But I can also appreciate the likely response to both, that now is not the right time to reorganise, and that we have an established process for placing specific services and entire boards into special measures. And so, in considering today's motion, also Plaid's amendment, and further, yesterday's statement, I'd make the following suggestions: firstly, conduct some form of a truth review to completely—with an independent and authoritative review—to completely look at the special measures process as a means of delivering improvement. If special measures oversight arrangements are found to be deficient in any way, then let's move to revise them. Secondly, conduct a truly independent assessment of the real and likely short-term impacts of reorganisation on service outcomes. Let's have our eyes opened to the likely short-term consequences before examining the long-term possible benefits of reorganisation. Deciding on whether to embark on such a journey should be informed by the long-term potential benefits, but also by the short-term likely impact on services and outcomes. Thirdly, I'd recommend establishing, without delay, to be honest, a people's panel in the north, to interrogate the challenges and all possible solutions—without limits, without fear, without boundaries. A people's panel could offer, I think, an objective, informed, depoliticised and citizen-led view of what needs to change. And fourthly, let's improve communications and transparency, establish an easily accessible online data dashboard for the seven health board areas, so that the public can see how their services compare to other parts of Wales in terms of outcomes.

Now, I'll support the Government today, but we can't be back here again in six or 12 months having the same debate. I'd implore the Minister to consider all constructive suggestions, such as those that I've offered, in order to restore public confidence in health services in north Wales and to restore—

Can I just cut across Ken Skates for one second? There's an intervention request for you from Rhun ap Iorwerth, would you accept that?

Of course, yes.

Thank you very much for taking the intervention, and can I thank you also for making that series of very constructive suggestions? I'm particularly interested in the second of those, which seems to me to mirror exactly the kind of conversation that we are asking to take place on potentially how reorganisation could work and the benefits that could come from that. Can you confirm that you are minded to support that amendment from us today?

Actually, Rhun, it's very close, but I think, first of all, what we need to do is look at the short-term impact of reorganisation. We've got a huge backlog at the moment that Betsi Cadwaladr are facing, we would need to understand before we review and appraise the potential benefits, long term, of reorganisation—. I think we do need to be informed as to what the short-term impact could be in terms of service provision, waiting times and outcomes. So, they are two different reviews, I'm afraid, and I believe that the first review should be to assess what the short-term impact would be in terms of outcomes in service provision. If it were to be found that those short-term impacts are very minor indeed, then I'd suggest moving on then with the second review, the review that you propose in your amendment today. I hope that clarifies my position and my recommendations.

I know that Ministers are always being advised that now is not the right time to reorganise any organisation, regardless of the time and events of the moment, and Ministers are often overwhelmed by the voice of the organisation facing reorganisation. But how much of the patient's voice actually gets through? I do think that a people's panel, reporting directly to Ministers, could ensure that future solutions, no matter what they may be, have the backing of the people that we serve.

Speaking of the citizen's voice, I've today tabled a statement of opinion that I'd invite all Members to support. It's a statement calling for the citizen voice body for health and social care to be headquartereded in north Wales. In my view, it's essential that that body is based in the north, where we have the largest population under a single health board and, arguably, the greatest challenge faced by any of our seven health boards.

Finally, may I ask that health matters in north Wales continue to be a core consideration of the Cabinet sub-committee for north Wales, chaired by my friend and colleague Lesley Griffiths, and that, through that Cabinet sub-committee, the views of key stakeholders, such as our six local authority leaders, are fully considered? Diolch.

Healthcare, unfortunately, in the Vale of Clwyd, is a real mess and has been for many, many years now, as successive Labour Governments have failed to get a grip on recruitment issues. You only have to look at the Betsi Cadwaladr website. I think, currently, it's about seven or eight pages of job vacancies, and most of them, to be honest, are front-line staff who make the change to people's lives day in, day out. We're very good at creating managers and red tape in the NHS, but really bad at putting staff on the front line.

Ysbyty Glan Clwyd, as I said yesterday, used to be one of the best hospitals in the United Kingdom in the 1980s and the 1990s, until the Welsh Government got their hands on it. Now the hospital needs external, clinical and organisational development expertise in order to provide a safe working environment and safe treatment for my constituents.

The issues facing healthcare in the Vale of Clwyd are not new, they have existed ever since Jane Hutt's disastrous reorganisation almost 20 years ago, and Edwina Hart's reorganisation in 2009. It has caused many to question whether the creation of Wales's largest health authority was a sensible approach, to ask whether Betsi Cadwaladr University Health Board is fit for purpose. After all, the board has required some form of Government intervention for most of its life. It spent five years in special measures before it was taken out of direct Government intervention just before the last election, as Sam Rowlands alluded to in opening the debate, a move of political expedience rather than a sign that everything was rosy at the top. I know from personal experience it wasn't, as I worked for Betsi Cadwaladr for 11 years, between 2010 and 2021, when I was elected to the Senedd. I worked in YGC, Ysbyty Glan Clwyd, for many of those years, and many of my friends still do. We knew things were wrong at the top, yet, despite the culture and bad leadership, our patients continued to get excellent care. But fewer and fewer people wanted to come and work for what they perceived to be a failing health board, because it doesn't exactly look good on the CV, if you're looking for some career progression, that you've been employed by a failing health board for many a year. So, the problems became entrenched as there were fewer and fewer staff working on the front line, and the pressures placed upon staff became unbearable and unsustainable. And that's when patient safety starts to suffer, really.

My mailbag is overflowing with issues from YGC and, like I've said before, Minister, you're more than welcome any time to come up to my office and view my inbox to see what I deal with every day, and I'm sure Darren in Clwyd West and Sam Rowlands, Mark Isherwood, Janet Finch-Saunders all have the same experience, and other Members too of other parties. One of the most recent cases I had was a constituent that had a fall at home just before 10.00 a.m. They were advised by ambulance call handlers to remain on the cold floor for ambulance attendance, despite advice that the ambulance would take an hour. An ambulance only arrived at 3.30 in the afternoon, but its lifting aid was not functioning. A further ambulance arrived an hour later. Paramedics advised that although they did not suspect any fractures or bleeds, her blood pressure and blood sugar were now so low that, after so much time on the floor, she would therefore require hospital admission. After arrival at the hospital, a further six hours passed before admission into YGC. The patient was eventually moved to the acute medical unit ward. Finally, the family received a call three days late advising them to come to the hospital quickly. They arrived too late—their family member had sadly passed away. It was therefore of little surprise to me when the Healthcare Inspectorate Wales report was released. It was still shocking. The most damning line in the report points to the crux of the problem—leaders for the department had attempted to raise concerns about issues of patient safety, however these had not been listened to or acted on.

The fish rots from the head, and the stench from Betsi is overpowering. We need urgent change at the top, and the measures outlined by the Minister yesterday is just rearranging the deckchairs on the Titanic. We need a new approach, not more of the same, which is why I'll be supporting Plaid's amendment today, and I urge colleagues to follow suit. Thank you very much.

I have resisted commenting on the concerns raised to date, and I'm always wary about discussing the reform of health boards, particularly mindful of the significant disruption that reorganisation would have in the aftermath of COVID-19. Betsi is one of three health boards that are in our region, and although I do get casework from the other health boards, it has to be said the ones from Betsi are extremely serious in my view. Here's one I had only yesterday. Mr Jones said, 'My condition was urgent. After seven months of a referral by the GP for an urgent appointment, I still have heard nothing and there's no forward plan. Personally, my confidence in Betsi is zero.'

There is never a good time to reorganise. There are never the right situations or conditions for a massive review. But, reluctantly, it feels to me like this is the only time, because, as has been said, when is the right time? I've heard that time after time here in this Chamber, and that's why I've been reluctant to comment, but in representing the views and the experiences of the people that I represent—and I know you do as well, health Minister, and others do—it feels like they cannot be ignored any more.

I really do want to put on record my thanks to you, Minister, because I know you've been dedicated to this issue, and I did read your statement yesterday in detail. I do want to put on record my thanks as well to the staff at Betsi Cadwaladr—it is the staff and patients who are being let down right now. Staff have been working hard in difficult circumstances and it is important that we have a frank and honest conversation about the failings and what must be done to provide confidence to the staff and the public we all represent. Therefore, I will be supporting the Plaid Cymru amendment and the motion when amended. Diolch yn fawr iawn.

Thank you to the Conservatives for bringing this debate forward; it's a very important debate. Back in 2013, I, Mark Jones and campaigners from Blaenau Ffestiniog, Prestatyn, Llangollen and Flint established the north Wales health alliance to oppose the changes that were being forced on the people of north Wales against our will. It was all put forward under the heading, 'Healthcare in North Wales is Changing'. Yes, our health service changed, but not for the better. Two years later, the board was placed in special measures.

In the nine years since then, the board has had four chief executives. Indeed, Betsi Cadwaladr could challenge any Premier League club for the longevity of their managers. What we're seeing is an urban model of service provision being forced on a rural area without any consideration given to the needs of isolated and remote communities. Why should people in the Dysynni area, for example, see their doctors leaving, their dentistry being lost and their pharmacy closing? Why should my constituents in Dwyfor Meirionnydd have to have just two community nurses on call in such a vast area at night, with one occasion where they had to go from Tywyn in the south of the county to Morfa Nefyn in the north in one call? Why should an 82-year-old woman have to wait 13 hours in A&E before being seen, without food or drink, never mind the vascular, urology and mental health problems, all of these things that we are aware of? 

But I'm sad to say that, along with all of these individual problems that we all no doubt are aware of, I also have little faith in the stats and the data and information provided by the health board. For instance, the health board have informed the ombudsman that blinds with ligatures were taken down in 2010, but we know of patients who tried to strangle themselves there later than that date, and they were in fact taken down in 2018. So, people were misled by their health board. In their own annual reports since 2012, Betsi Cadwaladr have told the board that they've had 1,021 referrals to the ombudsman. But, in a freedom of information response last week, the ombudsman confirmed that the correct figure was 1,579—500 more than they've declared publicly. But, most damningly, the Minister must also explain to us why it is that Betsi Cadwaladr has more recorded severe patient safety incidents recorded every year than the rest of Wales combined, and more deaths recorded in this one health board than the rest of Wales combined. According to the national reporting and learning system, there were 239 severe incidents and 12 deaths recorded between December 2020 and September 2021, while the figures for the whole of the rest of Wales were 113 severe incidents and eight deaths. 

Finally, we heard yesterday that now is not the time for costly reorganisation. I'm afraid that that's a naive and blinkered view. If reorganisation improves the health outcomes for the people of north Wales, then surely it should be considered. And how much more money has the Government had to spend on Betsi Cadwaladr because of special measures and targeted intervention since 2015? We need this solved sooner rather than later.

It's more than regrettable that the Welsh Government has failed to deliver promised improvements at Betsi Cadwaladr University Health Board and that successive health Ministers, term after term, have failed to address serious issues regarding the health board that I and others have raised with them on behalf of constituents. It would be a dereliction of duty if this Welsh Government rejects our call today for it to impose a reformed special measures regime to provide the health board with the leadership and resources necessary to address failings and deliver the high-quality healthcare that the people of north Wales deserve. In saying this, I note that the special measures regime introduced in England after the Keogh review requires intervention by an external team to make the necessary improvements. 

Further, the Minister's statement yesterday that new targeted intervention need only be extended to include Ysbyty Glan Clwyd is contradicted by my constituent casework, and challenged by the evidence received by the Public Accounts and Public Administration Committee. After the health board attended the committee on 9 March, I wrote as committee Chair to their chief executive and chairman regarding Members' concerns about some of the responses they had provided, and seeking clarity on certain points. As our letter said, overall, there appeared to be no firm action plan for securing the improvements required within the health board, no sense of the scale of the problems, or urgency to address these. There was no clarity provided on what the priority areas are for the board, and the evidence lacked sufficient detail, including no set timescales, particularly in respect of the transformation of vascular and mental health services. We were disappointed by the lack of ownership and responsibility taken by the executive of the problems at the board. There were many references to what staff across the organisation are doing, rather than what senior management are doing to set strategic direction and take responsibility. 

In terms of mental health services, our letter asked them to provide a detailed response about how they intend to address issues in this area, with timescales for implementation, and to provide us with details of their objectives and priorities, and how they are measuring performance against these, including any benchmarking activity to compare the board's performance with similar health boards. Although their response was 235 pages long, I stated on the record at the committee's meeting on 25 May that the letter notes that the BCUHB board has approved its integrated medium-term plan, IMTP, for the next three years; it also notes that the health board has engaged external support to give an impartial view of their evidence gathering and progress assessment, but provided no further details. The planned stated priorities don't include mental health services, but do include some general information about the work under way in this area. The plan doesn't mention accident and emergency services. The letter and plan note that BCUHB must make £105 million in savings over the next three years. The letter and plan don't detail how these savings will be achieved, although a broad set of opportunities for savings are listed in areas such as planned care, unscheduled care, mental health and other. And in terms of mental health services, many of these areas of concern remain unaddressed, despite recommendations and conclusions made in various reports over the past decade, including the Holden, Ockenden, Health and Social Care Advisory Service and Public Accounts Committee reports.

We are also concerned about the ongoing presence of executives and managers at the health board who were implicated in the conclusions of these reports, and about their ability to deliver the internal change required. As a north Wales resident put it to me in an e-mail last Saturday, quote, 'Those Teflon managers whose bullying of staff went unaddressed must be removed in a clear and transparent way.'

There are many other serious areas of concern, including recent stroke data showing that the stroke units in north Wales only scored overall grades of D and E on admission to stroke units, on a scale of A to E; case after case of Flintshire children with neurodiverse conditions denied diagnosis by child and adolescent mental health services, with bad parenting blamed instead, and families pushed into crisis—yet another only yesterday—and serious allegations raised that the health board has not been accurately reporting the complaints against it, and about the number and severity of nationally reportable patient safety incidents being reported to the health board. 

It is more than clear that the decision to remove the health board from special measures in November 2020 was inappropriate, and serious questions need answering. 

Can I just start by saying that I support Ken Skates's proposals that he made earlier? I thought they were really good. I welcome the interventions that Welsh Government are making: training new nurses, providing bursaries, building a new medical school in Bangor, trying to overcome the shortages in staff that Brexit and the pandemic have brought about, including complications with visa applications. And the interventions are really welcome. We need to retain our existing good staff— 

Member of the Senedd:

Will you take an intervention?

—and build a steady workforce if we are to build an organisation capable of self-improvement.

The feedback I have been having from health professionals is that morale is low, they are exhausted, and that there is a vicious cycle where, as soon as more staff are recruited, existing ones are leaving because of the long hours and pressure. This is recurring across many areas of employment where people have increasingly been expected to work longer hours and unrealistic shifts over the last few years—I think about the last five to 10 years, in fact—where productivity and efficiency have been driving the workforce in a race to the bottom. And now, following Brexit and the pandemic, people are re-evaluating their lives and saying, 'Enough is enough', across the UK.

I'm worried that, until working hours and wages are addressed, not just in the NHS but also the social healthcare sector, which is at breaking point—and these are intermingled—we are going to continue to have issues. This is not just here in Wales but also in the UK. Minister, could I ask what conversations you've had with the UK Government to properly fund the public sector, following years of cuts under austerity, and ensure that adequate funding is made available to fund decent wages and working conditions for those in the health and social care sector?

We have seen that, where there has been improvement, such as in mental health, this is incredibly fragile, because we don't have that long-term commitment from the people who have driven it. Retention is a huge issue. I know of senior clinicians who are committed to the NHS, committed to Betsi, but who are unable to commit the hours they would like to because of pension tax implications brought on by the UK Government. Fundamentally, employees need fair tax—sorry, fair pay—flexible working conditions and continuing professional development, for their own health and well-being. We're seeing this right across the UK.

The workforce need to be heard and know they are being listened to. In my humble opinion, from what I've heard from staff, I don't believe putting Betsi Cadwaladr into special measures will improve the situation, where morale is low and the health board is trying desperately to recruit and retrain. I welcome the decision to intervene in a way that works, alongside the staff in Betsi, to build capacity and capability, to build teams that deliver in the short and long term. However, targeted interventions with definitive measures and timelines in place, so that they know improvements have to be made in a timely measure this time, would be most welcome. 

The Minister said in the statement yesterday that the tripartite body recommended not to put the health board in special measures and that there would be a review in October, and that she will be keeping a fortnightly eye on progression. Would the Minister tell me what will be the trigger for intervention? How will Welsh Government and the health board communicate to staff and residents what the interventions are, to give some level of reassurance that something is happening now? I heard that communication is poor. Staff need to be empowered, valued and listened to. So, how will communication be improved?

I am told that, to deal with the backlog of elective surgery, there needs to be capital investment. This is also needed to attract new, expert professionals. We need modern facilities with modern technology. I am aware that there is a reduction in capital funding over the next three years of 11 per cent from the UK Government. How will this impact on being able to deal with the backlog? Could you answer that, please? I get asked if the issue is that Betsi Cadwaladr health board is too big. The leadership admits they are large and a complex organisation. My reaction is that, yes, it's too big, but when I ask health professionals—also in the social healthcare sector—they tell me that such a reorganisation would be a costly distraction at this time, and all their limited resources need to be focused on dealing with building up the existing workforce and facilities.

Moving people around doesn't change culture by itself. Almost regardless of structure, we need to recognise that the work to change culture at every level has to be a priority. They also told me that there are areas of good services, such as maternity and cancer care, and it's a disservice to presume that all areas are poor. I also hear about patches of excellence from my constituents, and urge all those here today to celebrate that excellence where we see it. We shouldn't avoid scrutiny or constructive criticism where it's deserved, but, equally, we should celebrate what's good.

We need to seek every opportunity to attract, and specifically retain, good staff and allow them to work in their capacity, and we are fortunate in some ways that, here in Wales, there is public scrutiny and accountability, unlike in England, where trusts will just close services as they have done with A&E—

I think you're going to have to bring your contribution to a close now. 

Okay, thank you. I'd just like to end by thanking all staff that have worked really hard during the pandemic and continue to do so now. Thank you very much.

As the Member for Arfon, which includes Ysbyty Gwynedd of course, I have been very concerned about the health board for some time, and I fear that yesterday's announcement will not move us on to better days. Over the years, constituents have highlighted their concerns, some of which relate to the loss of services from Ysbyty Gwynedd. We had to fight a threat to maternity services. The case was made for retaining and building on the vascular service, but it was moved eastwards, destroying a unit of excellent quality, and we are well aware of the damning and shocking consequences of that decision for all patients in north Wales. Serious concerns were also raised about the Hergest mental health unit, but there was an attempt to bury the Holden report. 

These concerns have come to my attention mainly through the staff of Betsi Cadwaladr health board, the wonderful workforce that we have, and the people who are battling against these significant challenges on a daily basis. I'm very grateful to them for their work, but I'm also grateful to those who have brought their concerns forward. It is through them that I have been able to understand the true nature of the problems. 

Staff have come to me recently again for other reasons. I've received complaints about a culture of bullying at Ysbyty Gwynedd—very serious complaints—and I'm very pleased that Rhun ap Iorwerth has pursued this also and has secured a review of that situation. 

Each time a member of staff comes to me, he or she emphasises that I should not mention their names when discussing issues with the health board. For years, there has been a culture of brushing issues under the carpet; of a lack of transparency; of intimidating staff who wish to speak out, and, unfortunately, this seems to be getting worse rather than getting better, despite all of the interventions that have been made over the years by the Welsh Government. And yesterday's announcement is not going to improve that culture, and that culture is at the root of many of the problems.

The organisation needs wholesale change in order to drive the massive change that's needed. We need urgent action across the organisation to create an open culture that welcomes the input of staff, not one that seeks to silence them, and certainly, we need to give serious thought to whether the current model is fit for purpose. And that's the purpose of our amendment, and I'm very pleased to have cross-party support in this Chamber for that. So, I do urge you to think seriously about the suggestion that we are putting before you together today. I urge you to leave no stone unturned—no stone unturned—in search of improvement. Listen to what the front-line staff are saying. And, please, will you recognise, unconditionally, that the situation is a very, very serious one?

The Minister for health to contribute to the debate. Eluned Morgan. 

Diolch yn fawr. Yesterday, I gave an oral statement concerning the escalation status of the Betsi Cadwaladr University Health Board, in which I advised that I had received and accepted advice from Welsh Government officials that targeted intervention arrangements at the health board should be extended to include services at Ysbyty Glan Clwyd.

I would just like to make it entirely clear that I do accept that the situation is very serious indeed, and that's why we are taking these steps.

I was accused yesterday of deliberately pushing in a statement to undermine today's debate, and I'd like to assure you that that was not the case. On the afternoon of 26 May, the tripartite meeting took place. On Friday 27 May, I was given a briefing on the recommendations. On Monday 30 May, at 2.25 p.m., my oral statement was commissioned from lead officials. And at 5 p.m. that afternoon, the motion for the Conservative debate was published. I had a meeting with the chair and chief executive of Betsi, along with the NHS Wales chief executive, on Wednesday, 1 June, and I apologise that yesterday I suggested this was a Tuesday. And of course, we informed the Plenary agenda on 1 June that things would be changing in terms of the agenda. Yesterday, therefore, was the earliest opportunity for me to bring the recommendations of the tripartite committee to the Senedd.

Now, the decision, as I highlighted yesterday, reflects very serious and outstanding concerns about the leadership, governance and progress, in particular in Glan Clwyd, including the vascular service and in the emergency department. And I'd like to make it absolutely clear that experiences like the one referred to—Reverend Jones, for example—are absolutely unacceptable. The example given by Gareth—again, all of these things are unacceptable, which is why we're putting these measures in place. I also have serious concerns about the allegations of bullying and harassment amongst staff that have been raised by Siân Gwenllian and others. This has not been ignored in the widening of the targeted intervention, and I have instructed the health board to review their approach to staff engagement, to ensure that these issues are addressed as part of their current targeted intervention escalations. And Carolyn, you're absolutely right that the voice of the staff needs to be heard.

Now, in taking this decision, I reflected on whether or not the health board should be escalated into special measures. I've decided that special measures, at this time, is not appropriate, and this is because the board and the chief executive have highlighted their determination to make progress, and have committed to addressing our concerns, and have already started to do so. I'm also mindful of the impact that the special measures status previously had on the health board's ability to recruit and retain staff—an issue that many of you have highlighted today—and the importance of being able to attract the right people into the organisation.

Special measures had a negative impact on the culture within the organisation, as they relied on others to make key decisions, rather than the health board developing their own solutions. And while we and the health board recognise that there are significant and serious failings, it is important to build confidence and support the organisation to be more aspirational, to be more ambitious, and to look forward to a better future. It's important that we support the health board to continue its improvement journey, and to promote an open culture, where problems are acknowledged and investigated, and we want to promote learning. A special measures designation will not achieve that. But, of course, if we don't see improvement, then that is still on the table as an option.

What will the trigger for that be? An example, for example, is the non-implementation of the action plan around vascular, and, therefore, building upon the existing programme for targeted intervention, as described in my statement yesterday. And, Russell, I'll tell you that I will be monitoring. I'm monitoring already on a fortnightly basis the action plan on vascular and we'll be watching for the impact of Improvement Cymru and the difference it can make in accident and emergency.

And I want to be clear that I have no intention to undertake a restructuring of hospital services in north Wales, and I'll tell you why. And, Ken, you asked what the short-term impact of this would be. It would be costly, it would distract from the work going on to improve services, and it would not in itself address the challenges the health board is facing, including the long waiting lists. It's essential that we support the health board to drive forward transformation and not undertake a disruptive restructure that diverts resources from patient care. I think it's important for us to recognise that we do listen to the voices of patients, and I also get many, many e-mails, I can assure you, from people in Betsi, and they're not saying, 'Please reorganise', they're saying, 'Speed up the time that you can do my hip operation', 'Help me with my cancer treatment', 'Make sure I can get quicker access to GPs'. I think one point that I'd like to make, and that is in response to Ken's, is that there does need to be more transparency in terms of the improvements that are being made and I've already asked the health board to act on that.

Yesterday, I explained the significant interventions that are being made, and I won't rehearse those now. Significant improvements have taken place across the health board over the past seven years and the institution is fundamentally different from the one that was placed under special measures. The executive team has been renewed, including a new chief executive and medical director, among others. The way that the health board engages with staff, partners and the public does demonstrate that there is greater maturity and increasing efficiency within the board. That can now support their work in delivering the long-term strategy for clinical, integrated services and the service transformation related to that.

The health board has demonstrated the ability to drive improvement that enables services to be taken out of special measures. Maternity services and out-of-hours services have achieved this progress and they are now part of a continuous improvement campaign by the board itself.

We must bear in mind that over 19,000 members of staff care for the population of north Wales every day and, for the majority, the care is good, be that in a GP surgery, in out-patient clinics, in the community or in hospital. Although the institution is now under a higher level of targeted intervention, I would like to reassure the patients and communities served by the health board, and the staff who work in that health board, that services and day-to-day activities will continue as usual. However, there are significant areas of concern that must be carefully addressed by the board, and I will ensure that they are monitored.

I call on Darren Millar to reply to the debate.

Thank you, Presiding Officer. Betsi isn't working. You've heard it time and time again in this Chamber over a number of years now. Patients are being let down. Patient safety is being compromised. Some patients have come to harm; others have even died as a result of what has happened in the health board.

We know that the working environment for staff is unacceptable. Staff are under huge pressure. There are significant shortages of nursing staff in particular at the health board, and indeed some consultant posts as well have not been filled. And that pressure leads to mistakes. And this is why we're in the position that we are. We know that staff also have been discouraged from speaking out when they have concerns. We know that when they do speak out and raise concerns, they've been ignored. That's effectively what the Healthcare Inspectorate Wales report said about the situation in the emergency department. And we know that there's been intimidation and bullying of staff, not just in Ysbyty Gwynedd, but frankly in every hospital across the whole of the health board and in most of the departments—I wouldn't say all, but certainly in most.

Workforce planning, of course, has been the responsibility of the Welsh Government for 20 years. They're nothing new, these pressures, in terms of our hospitals. They have been the responsibility of the Welsh Government for 20-odd years. So, it's not actually Brexit or visas that are causing these issues; it's a failure to plan for the workforce effectively and to train sufficient numbers of people to go into these very important health professions.

It's also not just about funding. There is a health service across the border in England that seems to have better performance. It's difficult to compare directly, but it seems to have better performance when it comes to emergency departments and other aspects of care—waiting times—and it spends less money per patient in order to get there. We spend more money per patient and seem to have worse services and it's a postcode lottery within Wales of course, because not everywhere, thank God, is as bad as the Betsi Cadwaladr health board in terms of the services that are being delivered.

But it's because it's nothing to do with money, and it's something to do with workforce planning, and we know we've got these issues, and we know what the issues are, that I was a bit disappointed by your response, Minister. How many more reports are we going to have to receive before the Welsh Government as a whole wakes up to the fact that Betsi is broken? I have always defended the Welsh Government's position, for many years, that the last thing that the health board needs in north Wales is reorganisation. I've defended that. I'm no longer convinced that that's sustainable. I think it might be the right answer, and that's why we're prepared to support the Plaid Cymru amendment today, to say, 'Let's have an independent person to look at the structures to see whether they're right,' because if that is part of the problem, then I want it sorting.

My father-in-law had the misfortune to break his neck of femur; he had a neck of femur fracture—his hip—just a couple of weeks ago. He was in A&E for 15 hours. If it hadn't had been for the fact that my wife was with him, and this was after six hours waiting for an ambulance, he wouldn't have been offered any drinks, any food. He was confused. In the middle hours of the night, he was in a bright, light clinical room, not even in a bed to be comfortable. And this was after the HIW report was published, and after we had received briefings as local Members of the Senedd that the services were improving and that those sorts of experiences weren't happening any more. So, I appreciate your confidence—the confidence that you have in the leadership team there. You said that one of the reasons you hadn't put it into special measures this week was because you'd received assurances from the board and the chief executive that they were determined and committed to make the changes necessary to improve things. I've heard them all before. I heard them the day before my father-in-law went into that emergency department and had his terrible experience, and he's just one of many examples that you've heard today.

We've also got a revolving door of leadership in that health board. It's not stable. It's not stable at all. We've had all of these different chief executives, half a dozen finance directors, medical directors galore as well, and it doesn't seem to be delivering the change, the culture change within the organisation, because unfortunately, Minister, there are still some people there in senior key positions who need to move on and haven't. 

Now, today, what you've got in the Chamber is a majority of people representing north Wales constituencies who will be voting for a review, and who will be voting for a reformed package of special measures—not the special measures we had before, because they didn't work, and not the targeted intervention that we had before, because that hasn't worked either. And when you're seven years down the road and it's seven years this week since special measures were imposed on things like mental health and leadership and governance, when you're seven years down the road, you have to think, 'Are we doing the right things here?' and I don't think we are. And if you've got a majority of Members in this Chamber from north Wales saying to you, pleading with you, 'Please, for goodness' sake, we need to solve this problem now because people are dying and coming to harm, and families are losing loved ones, and staff are burning out and they're having mental health problems because of the situation in Betsi,' I urge you just to reflect with some careful sincerity.

I know you're sincere in wanting to drive this change forward—I really do and I know that your Deputy Minister is as well, for mental health—but I am pleading with you. I have seen enough tears, I have seen enough bereaved loved ones, I have seen enough reports from the coroner saying that this shouldn't have happened and that shouldn't have happened, I have seen enough ombudsman's reports to persuade me that it ain't working. It ain't right. So, let's have this independent review of the structures. Let's make sure that we keep the public informed and the staff informed about the changes that are going to need to be made, and let's get a special measures programme that works. Let's get rid of those people who are responsible for that underlying culture in the organisation, those people who have never moved on, who have been around throughout, and let's get this right for the sake of the population in north Wales and the people that I serve as my constituents.

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

Voting deferred until voting time.

And we now reach voting time. We will now take a short break to prepare for that vote technically.

Plenary was suspended at 19:19.

The Senedd reconvened at 19:25, with the Deputy Presiding Officer in the Chair.