Questions now from the party leaders. The leader of the Welsh Conservatives, Andrew R.T. Davies.

Thank you very much, Presiding Officer. First Minister, the news that the Welsh Government was putting Betsi Cadwaladr into special measures yesterday took some people by surprise, but wasn't unexpected, given the auditor general's report from the week before. The actions of the health Minister in requesting the resignations of the independent board members, given the content of that report, were surprising, because in the report it talks of the cohesiveness of the independent board members in their ability to hold the executive members to account and their frustration at the executive members not being able to engage fully. The chief executive or chief operating officer of the community health council up there has said he was shocked to see that the independent board members had to resign. Why did the independent board members, bearing in mind the words in the report about the cohesiveness and the work that they were doing as independent board members, have to resign? 

Well, I don't think, myself, Llywydd, that it could have come as a shock to anybody who was reasonably well-informed about the operation of the board. I'm looking now at the letter sent by Janet Finch-Saunders, a member of the leader of the opposition's own group, to the Minister in which she called for the entire removal of the board, including independent members who are found to be unable to deliver what is required by internal interventions. If it was apparent to a local Conservative Member that independent members needed to be removed, I find it difficult to imagine that it was shocking news to anybody else in the north of Wales. What the Minister did was to make an assessment of what the auditor general had said, plus other sources of information that concluded that the fractured relationships within the board were clear, ongoing, deep-seated and intractable and that working relations could not be repaired. That is the basis on which the Minister made her decision. 

The point I was making about the special measures, First Minister, was that residents in north Wales, given that the health board was only recently taken out of special measures, would understandably be shocked that it's going back into special measures after being in special measures for six years. The independent members of the board, by the words of the report of the auditor general, were working in a cohesive manner to hold the executive to account. Now, I hear what you say about my colleague Janet Finch-Saunders, the Member for Aberconwy, and I'm sure, through her interactions, she has formed an opinion, but the comments from the health Minister, stating that these independent members had to resign, do not bear fruit with the evidence that the auditor general had in his report. The point I am making to you is that, throughout that report, the executive members were held to be deficient in their work and their responsibilities, and, actually, the arguments and discussions that were held within the board, very often, were at the feet of those executive members being poorly informed, not across the issues that they had executive responsibility for, and yet each and every one of those individuals is still in place. So, can you not see where the ability to understand the logic of demanding the independent members resign—? But executive members, who are criticised right the way through this report—right the way through this report—are still in post.

I understand a number of the points that the Member makes, and what I think he needs to do is to allow the story to continue to unfold. What you saw yesterday was the first set of measures that the Minister has taken. There are very real criticisms of executive members and those, too, will need to be attended to. The fact that those actions were not taken yesterday should not be taken as meaning that no action will be taken at all. It's just that things have to be done in a way that respects people's legal rights and in a way that would stand up to external scrutiny. The board, however, has to operate as a coherent whole, and you cannot, I think, sensibly separate the responsibilities of the executive and the independent members. When you have reports of a breakdown in those relationships, when you read of the way in which the conduct and behaviour of the board has itself become part of the problem of providing health services in north Wales, then actions to deal with the whole of the board, including its independent members, who are not exonerated in any way by the auditor general's report, nor by other information from north Wales—. What you saw yesterday was a starting point. There is a good deal more to do.

With the point about 'a good deal more to do', First Minister, what is the vision for the Welsh Government's thinking when it comes to health provision in north Wales? It isn't right. It isn't fair for the staff within that health board, and importantly the patients and people of north Wales who depend on their primary and acute care for delivery by Betsi Cadwaladr health board. Can the existing model be resurrected, reinvigorated and re-energised to deliver that healthcare, or is the thinking of the Welsh Government that a clean break is required, and, ultimately, over the medium to long term, given the evidence that has accumulated to date, something completely different needs to emerge about providing health in north Wales?

Well, Llywydd, the immediate action is to appoint a small number of individuals to discharge the legal functions and to stabilise the organisation. You know that a chair has been appointed and there will be three other members alongside the chair, and their job in the short term is to stabilise the organisation, to concentrate on the appointment of a new chief executive.

What I would say to the leader of the opposition is this: I think one of the things that we have learned from the difficult experience from time to time at Betsi Cadwaladr, a board, by the way, which does go on, through its staff, providing successful treatment to thousands of patients every single day, is that reliance on heroic individuals, the idea that a new chair, by him or herself, will solve the problems of the organisation, or a new chief executive by her or himself is the answer—I think we've learnt that that is not a sufficient response to the way in which services over such a diverse population, with cultural differences between the north-west and the north-east, that our reliance on the idea that if you could only get the right person that that would solve the issues that have been there now over a persistent period of time, that, by itself, is not the answer. It will need something that is more fundamental than that, and the actions the Minister took yesterday and the statement she'll make later this afternoon will explain how that more fundamental reform of the organisation will be taken forward in the future.

Plaid Cymru leader, Adam Price.

Diolch, Llywydd. Betsi Cadwaladr is a failing health board. It's failing patients and it's failing staff. The Tawel Fan inquiry found a catalogue of shocking and unacceptable failures in the care of some of the most vulnerable patients, some with dementia, left to lie naked on the floor. Patient safety risks have been identified, with several critical reports into vascular services. An amputee's wife had to carry him to the toilet after he was sent home from hospital without a care plan. There are fractured working relationships, as you've just referred to, First Minister, fundamentally compromising the health board's ability to deal with the significant challenges it faces—not my words, but those of the auditor general. I've highlighted just three reports, but that's just the tip of the iceberg, as you yourself have just intimated. How many more damning reports are you willing to accept on your watch before a Labour health Minister takes responsibility?

Well, Llywydd, the Labour health Minister took responsibility yesterday, and there are 60 minutes for Members to ask questions of the Minister later this afternoon.

Your Government's decision to take Betsi out of special measures was a blatant attempt to pull the wool over people's eyes. Two years ago, and with an election looming, you wanted to give the impression that you had guided the health board through significant reform, that you had done your job. It was premature. It's proved to be reckless, and it demonstrated a lack of judgment and leadership. In a BBC interview last night, the health Minister said, 'I can't be there doing the operations myself.' It was, to say the least, a glib response. There's no expectation that the Minister wears scrubs, but at the very least we should expect Ministers to show the necessary leadership to turn the health board around. This morning, the Minister said:

'It wasn't my job to have a grasp on things, they were in charge.'

Will there ever be a point where the buck stops with the Minister? Or is it just the board that can be hired and fired?

Well, given his contribution so far this afternoon, I think the Member will wish to reflect on his use of the word 'glib' in relation to anybody else's contributions. Let me tell him now that that I utterly reject what I regard as a disgraceful charge that the decisions made in November 2020 were motivated by anything other than the advice that the Welsh Government received from the tripartite system on which we rely. The decision, and it is a decision of Ministers, to take the board out of special measures was because we were advised that that is what we should do by the auditor general, by Healthcare Inspectorate Wales and by Welsh Government officials whose job it is to provide Ministers with the advice. That was the basis of the decision, and I think the Member should withdraw what he has said by casting, I think, a slur on the reputation of those bodies. He's happy enough for us to follow their advice when it suits him, and when it doesn't suit him he wants to cast aspersions on the motives of Welsh Government Ministers. He should know better.

The King's Fund that was working with the health board on governance, this is how they described things in the winter of 2020, when you decided it was fit to take the health board out of special measures: the fund observed deteriorating executive behaviour, with individual executive team members criticising each other to the chair and independent members, deepening independent member concern about executive team cohesion. How, on the basis of that informed judgment on behalf of the King's Fund, who were working with the board at the time, could you decide that it was right to take them out of special measures?

I have to say to the First Minister, this is part of a wider pattern, isn't it, of a catastrophic mismanagement on the part of this Government of healthcare. And after 25 years of responsibility for delivering healthcare in Wales, isn't it true that you've simply run out of ideas? You're throwing money at short-term, sticking-plaster solutions, with ever diminishing returns. Are you prepared, in looking at a root-and-branch review and reform of Betsi Cadwaladr, are you prepared to consider the option to break up the board completely and have a different structure, as Plaid Cymru has consistently advocated, rather than simply, once again, rearranging the deck chairs on a sinking ship?

Well, Llywydd, the King's Fund report was published in November 2022, not in November 2020, when the decision was made. I advise the Member to read what was said by the British Medical Association on 6 December, when they said that the problem of the Welsh NHS was that 'wolf' had been cried too often, including by them, and I think he's just at it again today. The Welsh NHS, every single day, provides successful treatment. I know he wants to shake his head, but this is simply the truth of the matter, isn't it? To his constituents, to my constituents, and to constituents of every other Member here, the health service in Wales provides, every single day, effective treatment provided by dedicated people who go far beyond what could be expected of them to do. We don't get more out of the health service or tend to the very real challenges that it faces in north Wales and elsewhere by not recognising that it is a system that continues to succeed far more than it fails. Where there is a need for action, as there was yesterday, the Minister took that action, and she's here in the Senedd this afternoon to explain to Members and to answer further questions on why her action was necessary and what will now take place.