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.