So, we will move on to item 6, a statement by the Minister for Health and Social Services on the escalation and further intervention to improve the quality of services in Betsi Cadwaladr University Health Board, and I call on the Minister to make the statement, Eluned Morgan.

Diolch, Dirprwy Lywydd. Further to my written statement yesterday concerning the extraordinary measures I’ve taken to stabilise and support the Betsi Cadwaladr University Health Board, I want to explain the decisions that I’ve made, what support I’m putting in place and what I expect to happen in the next few weeks and months.

These were not decisions I took lightly. Firstly, I want to reassure the people living in north Wales that they will be able to use their local health services as normal. Every day, thousands of people across north Wales are receiving an excellent service by the NHS, but there is a lack of consistency when it comes to quality, safety and efficiency, and correcting this will be at the heart of the changes that will need to be made. I know that we also have thousands of dedicated health board workers who may be concerned at these developments, but I’d like to reassure them that their day-to-day services and activities will continue and will not be immediately affected by 'special measures' status.

In 2020, we took the controversial decision to de-escalate Betsi from special measures. Many of you will say that it was the wrong decision to take, and we’ve heard some say again today that it was a political decision and one that was premature; this was not the case. There were several reasons behind our decision to de-escalate Betsi from special measures in November 2020. The health board responded well to the COVID challenges, and we received a number of reports that signalled that the health board were taking positive strategic steps towards improvement. We were of the view that the appointment of the new chief executive and the targeted intervention support that was put in place would enable the board to continue to make the improvements that we expected to see. Indeed, the leadership from the new chief executive and developments of a new operating model all signified that the organisation was strategically taking positive steps forward.

But more recently, the health board’s response on many issues have not provided the assurance needed, despite the considerable additional financial resources that have been provided, and HIW's unannounced visits, as well as my own unannounced visits, have demonstrated that improvements are not taking place at the pace required. I have serious concerns relating to the performance and governance of the board as well as concerns about the leadership and culture in the organisation. The description of the board being ‘dysfunctional’ in the recent Audit Wales report further enhanced those concerns. We need to fundamentally change the organisational culture, and I announced my decision yesterday to place the health board into special measures. I’ve subsequently taken further action to ensure board stability.

It has become clear that there is a need for new leadership and direction. As part of being placed into special measures, I have spoken with the non-executive members and as a result, the chair, vice-chair, and independent members have stepped aside. It’s important that we do things correctly and for the right reasons, and that we do them compassionately and at pace. I’ve made four direct temporary non-executive appointments to the board to ensure stability, and they join with immediate effect. Further appointments will be made in the coming weeks and months. These appointments have extensive and wide-ranging experience, especially in the areas in which the health board needs to improve. I’m pleased to announce that they will be led by Dyfed Edwards, a former leader of Gwynedd Council, and deputy chair of the Welsh Revenue Authority. Further direct appointments will follow soon. They will undertake the statutory requirements of the board chair and independent members. In doing so, they will review executive leadership arrangements and structures and take the necessary decisions for improvements, taking into account the findings of the Audit Wales report. A campaign to recruit new independent members to the board beyond this initial period of stabilisation will commence later this year.

I am also of the view that now is not the time to make structural changes. It’s important to focus on the quality and delivery of services, which need significant and rapid improvement, and therefore I have no intention of breaking the health board into smaller organisations, in particular at a time when we are encouraging regional co-operation and working, which is needed to support better clinical outcomes for patients. A reorganisation would be hugely disruptive and would take attention away from the need to focus now on providing the best possible service to the people of north Wales.

The special measures arrangements will involve the creation of a health board intervention and support team. I am today able to update you on the appointment of four health board advisers. They are: Mick Giannasi, Alan Brace, Dr Graham Shortland, Susan Aitkenhead and—I'm sorry, there were five appointments—David Jenkins.

The advisers will initially be contracted for six months, starting today, and will support the health board on board governance and other issues related to special measures. This will include a level of personal support to the new chair and independent members, and to provide feedback where appropriate to the board from discussions and observations. In addition, they will report formally to me, as Minister, in respect of their assessment and views of the board’s ability to deliver and whether any further work is required to develop the board to ensure that it has appropriate finance and audit arrangements. We will also appoint specialist HR support to the new chair and the board to review the organisational structure and portfolios and to provide quality assurance for the underpinning systems and processes and provide support to the board in the first six months.

As independent advisers, their function is not to take executive decisions but to analyse and assess the way in which the board is discharging its decision making in order to assist the chair and the board to meet Welsh Government expectations. This will also involve providing Welsh Government with their assessment of issues, necessary actions and progress. One of the key objectives of this new board will be the permanent recruitment of a new chief executive for the health board. The new board will need to appoint someone with a track record of turning around a health organisation, and someone who has the determination, vision and skills to ensure that the health board meets its potential. Plans are already under way for this key appointment. I will also be looking to the board to ensure that the structures and processes are in place to drive the improvements needed.

Whilst special measures will apply to the organisation, I wish to reassure both the patients and the communities served by the health board, as well as the staff working for it, that day-to-day services and activities will continue as normal, with an increased focus on quality and safety. This is not a reflection on the hard-working and dedicated front-line staff of the health board who work tirelessly to help patients and improve their lives. I want to say again, as I have many times before, thank you to all of the staff members of the health board for their commitment and dedication to helping people. I hope that the decision taken yesterday takes us on the path to a health board that the people of north Wales deserve, that they have confidence in, and that they can be proud of. Thank you.

I have many Members who wish to contribute this afternoon, understandably on such an important statement. If I may ask all Members to keep their contributions to their time limits so that I can actually ensure that all are able to speak today. Darren Millar.

Thank you, Deputy Presiding Officer. I listened very carefully to your statement, Minister, and I didn't hear an apology to the people of north Wales for the failure of this Welsh Government to sort out the deep-seated problems in our health board in the region, that have been ongoing, not just since 2015 when the Welsh Government first put Betsi Cadwaladr into special measures, but for a long time before that too. It should never have been taken out of special measures; I still believe that that decision was political, no matter what you have said today, and it should never have happened. We called in this Chamber last June for the organisation to go back into special measures, and you refused to listen to our calls. It wasn't just the calls of these benches; it was the calls of every single person representing a constituency in north Wales and every single person representing that region. We know what goes on in that health board. We see the letters that come in from constituents, and we see the whistleblowing letters that come in from staff as well. And frankly, your response to date is woefully inadequate. I have read with great interest the Audit Wales report—the Audit Wales report that you say has initiated the action that you took yesterday. I'll read some quotes from it. It says, 

'We found clear and deep-seated fractures within the Executive Team',

'we have significant doubt as to whether working relationships'— this is within the executive team—'are reparable'.

There are

'significant problems with working relationships within the Executive Team'.

'The evidence presented to us points to dysfunctionality and factions within the team'.

It's within the executive team that this report points to these problems, not with the independent board members, who you forced to resign yesterday, instead of the very people who are responsible for the failures on the ground—that executive team, not one of whom have held themselves accountable and offered their resignation to you. I find that appalling, and I think it's about time that we had mechanisms in Wales to remove people like that who do not accept their responsibility for failures when things go wrong. We have a situation in north Wales where patients have died, where patients have come to harm, as a result of the failings that have taken place, and frankly, people are owed an apology. We've got problems in our vascular services, our emergency departments, our urology services, our ophthalmology services, our mental health services, and our cancer services too—people waiting too long for treatment, and the situation under the watch of various health Ministers in this Government has gotten worse, not better, during periods of targeted intervention.

'We need some new leadership'—yes, you're absolutely right we need new leadership. We need new leadership both in the health board on the executive team, and, frankly, we need a new Government, because this Government is incapable of being able to sort these problems out. I don't know why that is. And even when you triangulate the evidence that's in the Audit Wales report to other pieces of evidence, you can see that all of the fingers of blame for the problems and the culture in that organisation point to that executive team. So, can I ask you, Minister, why on earth would you get rid of the independent members who've been doing their best to try and hold to account that executive team in recent months? Why on earth would you ask them to resign and not ask for the resignations of those executives who have been collectively responsible for these failures?

I know, from the letter that was sent to the First Minister yesterday and shared with Members of the Senedd that the chair of the health board has written to you on a number of occasions, most recently in September of last year, raising concerns, escalating concerns to you, and of course to the director general of the department, who is also the chief executive, of course, of NHS Wales. He didn't even receive a response—didn't even receive a response, and this is a health board that is supposedly in targeted intervention. And it's not just his letters that you seem to not pay proper regard to. Geoff Ryall-Harvey of the North Wales Community Health Council wrote to you in August of last year, talking about the assurances on which you were basing your responses to that organisation. He said that the assurances weren't worth the paper that they were written on. But you defended the executive team that were giving those assurances to you to provide to him; you didn't acknowledge that there were serious concerns about the quality of those responses at all. It's unacceptable, Minister, and some of the blame for this has to be laid at your door. Now, can I ask—? The report, the Audit Wales report, refers to the fraud investigation. It talks about the Ernst & Young report, which was commissioned before the NHS Counter Fraud Authority came and had a look over the books because of this missing £122 million-worth of expenditure for which there was no proper records. And it says that that piece of work uncovered some serious problems in the health board organisation. In fact, the letter from the chair of the health board to the First Minister yesterday made specific reference that there was evidence of serious malpractice. I'd like to see a copy of that report. I think, from a transparency point of view, that the people of north Wales deserve to see a copy of that report too.

Darren, you need to conclude, please.

Because that will be a third report pointing to problems in that executive team. Can I ask one final question—

Quick.

—if I may, Deputy Presiding Officer? Lots of these executives have a close working relationship with people, understandably, in your Government department, including, of course, the chief executive of NHS Wales. I want to know what the chief executive of NHS Wales actually does to hold those individuals responsible. Because if she's the chief executive of NHS Wales, you'd expect her to be holding these people to account for their behaviour, which is unacceptable. I want these people out. I want these people gone. The people of north Wales want to see them gone, and we're holding you accountable for not getting shot of them yesterday.

Diolch yn fawr iawn. I'm just going to give you a quick lesson in how the system works, because I think it's really important that people understand—[Interruption.]—understand how the system works. So, I am responsible for the NHS, but I delegate that responsibility to independent boards. I set them parameters, I set them goals, I set them targets. But then I appoint people to those boards to oversee independent organisations, and their job is to run the organisation. It's their job to hold the executive to account. It's not my job. That is why I appoint them—[Interruption.] If you don't mind, I will carry on. When they fail to do the job that we've asked them to do, holding the executives to account—because it's their job to do that—then I have to step in, and that's what I did.

You sacked them for doing that.

The executives are still there. The executives are still there, and the whole point is—[Interruption.]—the whole point is and I think what's important is that we do listen and read carefully the Audit Wales report, which does talk about deep-seated fractures in the executive team, but it also says that there was a deeply worrying degree of dysfunctionality within the board and senior leadership in Betsi. And I think what's important is that people understand that the step I took yesterday was simply the first step, the first step in a process where I am sure the new chair will want to read very carefully that Audit Wales report, and I'm sure and I hope will take action in relation to that. And I can assure you that I very much read the riot act to some of those executives—[Interruption.] I do not have the power to—[Interruption.] I do not have the power to require executives to step down. I do not employ these people.

Members need to allow the Minister to respond.

I do not employ these people. These have legal rights that need to be respected, and there has to be a process that it is gone through. So, I think it's really important that people understand the system and understand that this is the first step of many.

Now, I think that those powers that I have actually need to be strengthened. That's one of the conclusions that is clear to me—that I do not have the tools that I need to hold some of these organisations to account. And so I have asked officials to set up a group to look at how we can improve accountability within the NHS, and I will be choosing people myself in terms of who will be involved in advising me on how to tighten up accountability within the NHS. I think we're in a position where of course it's important that people understand where responsibility lies, but the independent bodies, I appoint them to do a job. What I've done is to step in when I don't think they've done the job that I needed them to do, which was partly to hold the executive to account, to take the next step, which they'd identified, and that didn't happen.

So, can I just also respond to the issue of Ernst & Young? Let's talk about that. So, there has been an issue in relation to fraud, which is extremely concerning. I think it's probably worth underlining that this money has not gone missing; this is about poor accounting, which is also unacceptable. It is an ongoing inquiry, so it's not possible to publish that report, but what I do know is that there has been the suspension of three members of the finance team already in relation to that situation. But it's an ongoing inquiry. Again, this is something that's going to have to be at the very top of the list for those new incoming members of the health board.

I'm going to start with where I agree with the Minister—that's on the placing of Betsi Cadwaladr in special measures. But it's pretty clear, isn't it, that it shouldn't have been taken out in the first place, conveniently and prematurely. But the Minister wanted to apportion blame too. She says the recent Audit Wales report was the straw that broke the camel's back; it spoke of the dysfunctionality of the board. She referred in a Radio Wales interview this morning to the huge amount of criticism of the executive board members, but it's the independent members, of course, that she decided to very publicly hang out to dry yesterday. She's defended her actions, saying, 'I don't have the powers to intervene directly in terms of the executive.' She's said that again this afternoon. But that's exactly what special measures allow the Minister to do, effectively running the health board, even supporting the chair and independent members if that's what she wanted.

Now, we have a sugar-coated description, don't we, of what happened yesterday in the Minister's statement—'spoken with the non-executive members. As a result, they've decided to step aside.' Let's be a little bit more direct, shall we, for anybody else who may be considering taking up an appointment by this Government and considering what kind of backing they can expect. The Minister may want to confirm that, having summoned them to the meeting, she told them they had 50 minutes to resign or she'd sack them, and in so doing bar them from other public appointments for two years, and that, even before the 50-minute deadline was up, a draft letter of termination had been handed to them, just to press the matter home. How could they not resign? But their dignified response will have resonated with many. In a damning public letter to the First Minister, they said,

'We have no confidence in the Welsh Government's grasp of the situation.'

Now, that was put to the Minister this morning, and let me tell you what she said:

'It wasn't my job to have a grasp'.

This is the health Minister.

'It wasn't my job to have a grasp, they were in charge', she said. Responsibility and accountability ends with the Minister. She did actually agree with that, but said that she delegates down to others. And by the way, this isn't an unconditional defence of the independent members; this is to show the glaring difference between blame apportioned to them and the complete denial of any responsibility by the Minister.

Let's return to that meeting yesterday. I believe that the Minister told the independent members that their role was to hold the feet of the executives to the fire. But didn't they do that over vascular, urology, Ysbyty Glan Clwyd, with their judgment being found right time and time again?

Let me read more from that statement of theirs after their resignation. They say they

'uncovered serious failings in the financial management of the Health Board. We commissioned a specialist review...which confirmed our concerns, found evidence of serious malpractice, and resulted in a counter fraud investigation.‌‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌ This is underway, but has serious implications for other NHS organisations and the Government.'

You, Minister, will be aware, no doubt, of the questions that some are asking about possible links between that and the actions taken yesterday. I will read on. 'We have also previously and repeatedly escalated concerns to Welsh Government as evidenced by way of correspondence to the director general at the start of September, which highlighted many of the matters captured in the Audit Wales board effectiveness report, which has our full support, and yet we did not receive a response, let alone support in reply to those escalations.'

That's very strange, isn't it, not receiving a response on such serious matters. Perhaps the Minister can confirm that. You'd have thought that the Minister would want to work with and listen to anyone raising concerns of that kind. I told you the Minister said her actions yesterday followed the publication of the audit report. Perhaps the Minister can confirm suggestions that there was a search on for new independent board members as much as five weeks ago, before the audit report. Now, I must say that I found it very troubling indeed that the first message I got this morning, via someone close to that audit report, was this: 'The Minister has got rid of the wrong people.' And do you know what? I think they might be on to something and I think many others will conclude that too, just as many have concluded, as I have, that Betsi, in its current form, is beyond repair.

The Minister refers to culture problems within Betsi, but I tell you that this cultural dysfunctionality runs to Betsi's core. It's years since I said, if things can't be turned around, Government should look at breaking up Betsi into smaller, more manageable parts. Well, the sand on that particular timer ran out years ago. It's been clear to me, and many staff and patients, for some time that Betsi has to go. Successive Welsh Governments, health Ministers, have tinkered, but they haven't taken that decisive action, saying, as the Minister says again today, that this would

'take attention away from the need to focus now on providing the best possible service'.

But we're going around and around in circles, spending more money on failed attempts to get things right than we would on reorganisation. She tells us that breaking it up would be wrong when we're trying to encourage regional co-operation. Betsi can't even co-operate with itself.

Rhun, you need to conclude now as well, please.

Let's have a fresh start.

And finally, on the Minister's role herself, I suggested yesterday that she should be considering her own position and her own role in all of this. She said this morning she'll remain health Minister as long as the First Minister has confidence in her. Well, I can tell you that confidence in this Government and Minister's ability to sort out Betsi has long gone.

Thanks very much. Well, I think it's really important that people understand that this is a first step and there will be more steps that follow this, so I'll just repeat some of the points that I made earlier to Darren. But I think it's important that people understand that I have the power to dismiss the board; I do not have the power to dismiss executives. They have rights; they have employment rights. I do not employ them; I cannot dismiss them. That is the reality of the situation. So, I'm not sure what exactly you want me to do. Do you want me to directly employ all 105,000 people who work—[Interruption.] No, I do not have the powers, even under special measures, to sack people who work directly for the health boards. [Interruption.] No, I don't, and I think it's really important that people understand that I do not have those powers, which is why one of the reasons—[Interruption.] One of the reasons I want to look at the accountability mechanisms is because I don't have the levers that I think that I require to make the kind of interventions that I think are necessary. So, that is something that I will be looking at and already I've approached a few people to help me in that task.

Now, just in terms of this letter to the chair. So, the chair of Betsi forwarded an e-mail on 1 September, and it was an e-mail from the chair himself to the then chief executive, Jo Whitehead, and it was marked 'for your information'. Now, I don't know about you, but I don't answer all of the e-mails that I get 'for your information'. And the director general, as a result of that, arranged to meet—despite the fact it was 'for your information'—followed up and arranged to meet with the chair on his return from leave on 21 September. No formal correspondence has been received from the board by the director general. I think it's really important that people understand that. And Plaid's answer to everything is reorganisation, new structures, more managers—that's what we need: more managers. I want more front-line people. Trying to get rid—. [Interruption.] You will be getting more managers if you restructure, I can tell you. That is the consequence of restructuring. So, I want to focus on the front line. I want to focus on getting through those waiting lists. I want to get those cancer referral times down. I want to make sure that people in north Wales can get the service they require, and I don't think that a massively distracting reorganisation is going to help in that task.

Minister, can I thank you for your statement today and begin by recognising the efforts made by those boards members who've departed, regardless of the situation facing BCUHB, as amongst those members are some of the most respected and competent individuals in north Wales?

The statement you've made today indicates that further change is to come. We've heard that you wish to fundamentally change organisational culture, that the new directly appointed board members will review executive leadership arrangements, and that yesterday's action was the first step in what will be a series of significant changes. And I therefore infer that we will see huge change potentially within the executive team, possibly further into middle management. 

Minister, you've also been very clear on your position concerning structural change, but in order to realise cultural change within the organisation, will you commit to an extensive and genuine exercise in engaging with the citizens of north Wales to ascertain what the people of region want from any future arrangements? Will you also examine the possibility of allowing the people in north Wales to directly elect board members, in order to make independent members fully accountable to the region's citizens? 

And finally, would it be possible, not necessarily today, for the Government to set out the circumstances that would trigger structural change? I ask this because being clear that failure could lead to structural change should certainly focus minds. Diolch.

Diolch yn fawr, Ken. I think it's important that we do recognise that members of the previous board had made big efforts to try and hold the executive team to account. What they haven't done is the next step, which is to follow through on the findings. And I think what's important is that there's an understanding now that it's that next step that needs to be taken. So, I would like to recognise the considerable talent that there is amongst those members of the board who stepped down.

I think it's really important that we engage, as you say, with the citizens of north Wales. We do need to, first of all, give confidence to them that, actually, these services, the day-to-day work, will be carrying on. And it was really interesting, actually, yesterday in Glan Clwyd Hospital, just speaking to some of the members of staff there about what's happened and what difference this will make, and they were saying, well, actually, they're just getting on with their jobs. This is just a big organisational structural thing at the top. The problem is that, sometimes, you need a little bit more assertiveness at the top in terms of changing the culture that will then filter down. And I guess the fact that they did see that disconnection also suggested that there's a problem there as well. 

I think making sure we do not lose focus on those front-line services, but I think it's really important also that we recognise that, actually, the grip that the board have, and the executives more than anyone else, is quite shocking. I did an unannounced visit to a facility in north Wales and I was stunned by the lack of activity going on there. What was upsetting was the fact that, actually, nobody was monitoring that. That is an executive failure. It's an executive failure, and what's important is why was it, not just that there was an executive failure, but, actually, how come the board wasn't aware that the kind of activity that should have been going on wasn't going on? So, I think that's important.

In relation to staff, I think it's really important also that we understand that there are many people who work for the Betsi Cadwaladr health board; it's a workforce of about 19,000 people delivering care to about 700,000 people. I did a video yesterday, both in Welsh and English, just to try and explain directly to them about what was happening in relation to the board.

I think your idea of electing board members directly—. Well, look, I’m interested in accountability, because at the moment I feel like every single thing that happens in relation to health falls on my head and my head alone, and I’m not sure if that’s a fair system. I think it’s important that we understand that there needs to be a different system. And you’re quite right: in England, that doesn’t happen. So, there are 500 hospitals in England, and I can tell you that the Secretary of State there doesn’t get anything like the kind of scrutiny that I get here on the 20 hospitals we have here. So, I think it’s really important that we start to understand, right, where is accountability? I think that conversation needs to happen.

If we go down the directly elected route, I think there are issues that we need to consider there because we do need people who understand governance and accountability and whatever, and they’re not necessarily the people who can win elections, so I think we’ve just got to do some thinking around that. But I am very interested in looking again at the accountability within the system, because at the moment I’m prepared to take accountability, but I do think that at the moment it all falls on my desk time after time, and, obviously, in terms of holding to account people when I’ve already delegated responsibility, I think we need the public to understand that that is the mechanism that we use.

I’m afraid I’m also seeking to understand what’s happened in relation to the independent members of the board. We’ve all heard how important it is for Betsi Cadwaladr to go into special measures, and we all want to thank the staff as well. But it is critical that we understand the process, as we’ve all heard from people—and, in my case, from a very well-respected former independent member of the board—of the situation. We’ve heard that that board had a role not in operational management, but in maintaining oversight and delivery of strategy and performance, and we’ve heard exactly what they were doing, and what they were starting to do. Therefore, it seems to me that to actually dismiss them in these circumstances, when they were starting on what feels like a very important journey, seems entirely wrong. So, I would like you to answer these specific questions. What did the independent board members do that was so wrong? How did they depart? And I’m following on from what Rhun said, because I’m afraid I’ve also heard of the situation in which they departed. And what confidence do we have that the next tranche of independent members will not feel silenced, having seen the way that the last group were treated? Thank you, diolch yn fawr iawn.

Thanks. Well, I think it’s really important that people understand that I do have the legal authority to dismiss independent members of the board. So, that’s the first thing: I have that authority, and I can do it immediately, and obviously we checked very carefully before we went down that path.

You talked about them starting on an important journey. Well, you know, they’ve been in targeted intervention for a long time, and prior to that in special measures. It shouldn’t be a journey that’s starting. This has been a journey that’s been ongoing for a very long time. Now, they’ve got some way down the path, but actually it’s the next step that hasn’t been taken. The fact that it has taken so long to get to the point where we’re appointing a new chief executive—. It’s really interesting, actually, just speaking to people in Welsh Government about the differences in terms of the way that the board there responds, the executives there respond. So, in other health boards, other people get on with the job. In Betsi, they wait, they ask for permission, they wait for advice. They need to get on with it. They’re responsible. They’re paid a lot of money to do a job, and they haven’t been doing that. So, the executives are not taking the kind of steps that they should have.

I think the question is not what the independent board members did, but what they didn’t do, and what they didn’t do is the next step, and that’s part of the problem. We needed them to take the next step of really focusing in on, 'So, what are you going to do about the executives?' I think what's important is that people understand that there is a role for independent members to take responsibility, but accountability is key within the system. My role is to set out some goals. This year, I have set objective targets—measurable targets—for chairs, because that is my—. I have so few tools—I am shocked by how few tools I have, as a Government Minister, to effect change in the system. So, what I'm starting to do is to crank up and use the tools that I have at my disposal in a more significant way. But, actually, that's why I'm very keen to have this review of accountability to make sure that it's very clear to everyone where this accountability lies.

Can I ask, Minister, what are your criteria for taking the health board back out of special measures? I ask that question in the context of—. You said in your statement today, Minister, that your predecessor took the health board out of special measures just before the Senedd election in 2020 because they were taking positive steps towards improvement. Well, I would suggest that the health board remains in special measures until it has demonstrated improvement. If you agree with that statement, therefore, do you disagree with your predecessor—that he was wrong to take the health board out of special measures back in 2020, before the Senedd elections?

Secondly, Minister, the chair and the independent members wrote to the First Minister, and they said, 'We have also previously and repeatedly escalated concerns to the Welsh Government.' They did not receive a response, let alone support, in reply to those escalations. Well, Darren Millar and Rhun ap Iorwerth asked you this question, and I think your response to them was, 'Well, actually, it wasn't sent directly to me or the Welsh Government'—it was for your information or you were copied in. [Interruption.] But, my question is: what you said, Minister, is that if you're copied into e-mails, or you're carbon copied into e-mails, you don't always reply. Well, I don't always reply, but if I was sent something of serious concern, I would certainly reply. So, can I understand why that e-mail was ignored?

Well, first of all, I think you're right: I think we need criteria for knowing when it is we've reached the point to take people out of special measures. So, I've asked officials to look at that, so that we've got a more objective measure for how we can measure improvement and how we know we've got to the place we need to get to.

I have tried explaining the situation in relation to the letter that you talked about. I did explain that, despite the fact that it was 'for your information', the director general did follow up and had a meeting with the chair as a result of that. I think it's really important that that is understood. Thank you.

Many of us, and I'm sure you're amongst us, will remember learning a saying in primary school, which reminded us that every time we point a finger at somebody, there are always three fingers pointing back at us. I don't think that that's been truer than it is this afternoon, because the past 24 hours have demonstrated to us that you, as a Minister, and this Government are going around and around in circles when it comes to health services in north Wales. Into special measures; out of special measures; back into special measures; chief executives being appointed; chief executives being forced, very often, to move on; new chairs being appointed; new chairs being asked to stand down. We have been here a number of times and things are not improving.

Now, when Mark Polin was appointed, I was confident that if anyone could turn this board around, then he was that person. But the fact that he and his fellow members of the board have failed to do that highlights to me that there are deeper, more systemic problems here, and that means that there needs to be more radical action and that there needs to be more far-reaching action from you, as a Minister, and from this Government. So, will you at least commission a piece of work to look at alternative options in terms of the future of the health board? Perhaps it'll come back and say that what we have now is the best we can have. Right, fair enough, but ask the question and start that process, because if you don't, we will continue to go around and around in circles, and it's your successor who'll be here in a few months explaining why we're still in that position.

Thank you. Well, Plaid Cymru's answer to everything is restructuring and more management—[Interruption.] That's what happens. In terms of commissioning a piece of work, no, I'm not going to commission that. I think that the new board will come in, and if they want to look at it, it's up to them, but I won't be commissioning that work. Thank you.

Minister, can I thank you for bringing forward today's statement and also for meeting with the north Wales MSs yesterday? I appreciate you taking that time. But I'd still like to echo the comments made by colleagues from across the Chamber, first and foremost, because, as outlined by them already, it's clear that the executive team of Betsi Cadwadladr University Health Board are not delivering the aims of the Welsh Government or were delivering on the aims of the independent members of the board. They're continuing to fail the people of north Wales, and we cannot continue to see this happen. As you'll be aware, and has already been highlighted, we are probably 10 years down the line now of these consistent failures, eight years of which would have been in special measures if the special measures would have continued as they should have done. It's no exaggeration when we talk about this being a life-and-death situation. People's lives are on the line with the health service in north Wales. It's my residents' quality of life that is suffering as a result of poor management of the health board in north Wales. It's my residents that I care about most in this situation.

Minister, you've mentioned that you don't have, you believe, the levers that you need to be able to make the changes that you want to see, so I'd be interested to hear when you think you may get those levers that you need in your capacity as health Minister to rectify this poor situation. In addition to this, Minister, it's clear that politicians from across the political spectrum want to work with the health board to improve the situation for our residents in north Wales. We don't want to stand up here week in, week out saying how bad things are, we want to stand here and be proud of the health service that we have in north Wales. We want to see change happen desperately for our residents in north Wales. So, Minister, how do you believe we can work more closely together to better serve our residents, not just through scrutiny and challenge in this Chamber, which we continue to do and seemingly continue to be ignored as we highlight the issues that we see in north Wales? What structures do you think could be put in place to better enable us as locally elected Members to support and scrutinise the work of the board to help to have the change that we all want to see? Diolch yn fawr iawn.

Diolch yn fawr. I think it's clear that the executive team needs a lot of work in Betsi, and I do hope that the next chair and chief executive will understand the importance of that. I've talked about the levers that I don't have, the fact that I cannot dismiss people that I don't employ. I think it's really important that people understand that these people have rights, you need to respect those rights and due process needs to be followed. But this is the beginning of a process, as I've said time and again.

There were considerable concerns in relation to Betsi in relation to leadership, management, board effectiveness and governance, organisational culture, service quality, patient safety, operational delivery, leadership and financial management. I think what's important is that, despite all of the issues where we have concerns, we don't talk down Betsi. We've got to be really careful about actually trying to attract new people to work in the health board. I think there are things that we can do. I think the north Wales medical school is a real opportunity for Betsi. I think we could be attracting some significant new people to north Wales as a result of that new medical school. We have the north Wales dental academy. We've now got the '111 press 2' mental health service. All of these things are things where there has been progress. I think it's important that we don't forget that, actually, day in, day out, there are thousands of people who are really benefiting from the health and care that is given on a daily basis to people in north Wales.

We've been here before, of course, but the major, necessary changes were not introduced, and, indeed, poor decisions were made in the previous time in special measures. The board was in special measures when the vascular service in Ysbyty Gwynedd was dismantled in the name of centralisation, and we all know what the upshot of that was. So, the fundamental question is what will be different this time. How much time will you give for that difference to start to reveal itself? I assume, and I very much hope, that you as Minister have set out your timetable for implementing change over a full list of measurable deliverables. Can you confirm that, and what exactly that timetable looks like?

I would suggest that you also need to be willing to say what you will do if improvement isn’t made within a particular timescale. You have to have a plan B, ready to go, because I’m concerned that plan A, which is what has been in place since yesterday, will not bear fruit, and certainly won’t do so swiftly enough. Plaid Cymru has set out its plans for the creation of smaller units, and I’m sure if you followed the advice of Ken Skates and asked people in north Wales to tell you what they would like to see happening, then their answer would be the same. But you have rejected that, and are doing so at the moment, so what exactly is your plan B?

I would also like to know what else—

Siân, you must conclude now.

I will ask one further question. The First Minister, in the question session, mentioned that there were other pieces of information that led you to this announcement yesterday. What is that information? Is all of the information underpinning yesterday’s decision out there in the public domain, or is there more to come?

Thank you very much, Siân. I think it’s very important to understand that these changes aren’t going to happen overnight; we’ll have to go through a process. It will take some time to get a new chief executive in place, and I hope that that appointment makes a big difference. I do know that the new chair is very eager to set out a timetable for what he expects to achieve during his initial period, so hopefully we’ll be able to see what he has in mind in that context.

In terms of those pieces of additional information, what we do know is that Healthcare Inspectorate Wales have been in several times, and we’ve seen their reports. We’re aware that the King’s Fund has compiled reports, and there’s the Ernst & Young report, which is something that obviously hasn’t been shared yet, but we do know that that will cause some problems. We know that three suspensions have already happened. We also know that there’s an independent audit, and once again, that hasn’t come to an end yet.

After Betsi Cadwaladr University Health Board attended the Senedd's Public Accounts and Public Administration Committee last March, I wrote to them as Chair regarding concerns about some of the responses that they provided us with and seeking clarity on certain points. Our letter included that we were disappointed by the lack of ownership and responsibility taken by the executive of the problems at the board, referring to various reports over the previous decade, including Holden, Ockenden, HASCAS and Public Account Committee reports. This letter stated:

'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.'

In your written statement yesterday, Minister, you stated that you've agreed that it is time for the chair, vice-chair and independent members of the board to step aside. How, therefore, do you respond to the alternative perspective placed on this by the independent members of the board in their letter to the First Minister yesterday, on which north Wales Members were copied? They state:

'We are writing to express our sincere concerns about the future of health services in North Wales following this morning’s meeting with the Minister when we were left with no option but to resign as Independent Members with immediate effect.‌‌‍‌‌‌‌‌‍‌‌‌‌‍'

They said that they are gravely concerned at the Minister's response to the Audit Wales report and that to have focus on independent members rather than the operational executive and their delivery exposes patients across Wales and the organisation to significant risk going forward.

Finally, the Senedd's Public Accounts and Public Administration Committee has consistently highlighted concerns around the oversight of the health board by theWelsh Government. Why have you and your predecessor health Ministers allowed matters to reach this head, when the Public Accounts Committee reported concerns regarding board functionality in its reports on the board published in 2013, in 2016, in 2019—

Mark, you need to conclude now, please.

—and the North Wales Community Health Council has also been raising these concerns with you throughout?

Thanks very much. I think it's important that you recognised that there was an issue in relation to responsibility on behalf of the executives, and obviously that is something that we're very concerned about. That, I hope, is something that the new chair will undertake in terms of his responsibility. I will be speaking to him to recommend that he reads your report to make sure that he's understood your concerns as a committee as well. 

I think it's important to understand also that the Audit Wales report did say that what is needed is a unified and a cohesive response, and a cohesive approach within the board. It was clear to me that that was not going to be possible with the board as it was structured at the moment, and that was one of the reasons why we took the steps that we did. I think the relationships in terms of trust and candour, accountability—. Those were things where there was so much resistance. I think that what's important is that the chair will understand that there is a need to act on the proposals within, or at least the findings of, the Audit Wales report. 

It's clear to everyone now that taking the board out of special measures was a cynical political step, which was done less than three years ago. And in that time, some things have deteriorated: vascular, urology, and emergency services, for example. But, I have a series of questions that constituents in Dwyfor Meirionnydd have asked me to put to you today. 

We've been here before, and clearly it didn't work the last time. So, what does the Minister think will be different this time? The Minister has mentioned a change of personnel and mentioned some of the weaknesses that have existed, but is the Minister willing to recognise the role of the independent members in highlighting some of those weaknesses? The fact that the Minister has got rid of the independent members suggests that she thinks that this is where the blame lies, but it's the Minister who appoints these independent members, so will the Minister at least take some responsibility for these difficulties? The independent members are appointed for specific terms. Some are relatively new, but the deep-seated problems in the board go back a decade, so is the Minister willing to accept that there is blame beyond those independent members? Indeed, in this decade, we have seen five chief executives and three chairs, so it's clear that the blame lies beyond these members. Indeed, the one consistent thing throughout this time is a Labour Government, so isn't it time for her and her Government to take responsibility? 

You've refused to reorganise because you want to centralise expertise. It's regrettable that I have to remind the Minister that vascular services were centralised during special measures, and look at the mess that was made there. You've often mentioned that this would be too expensive. According to the Minister herself, special measures cost £84 million to the Government last time. Doesn't it therefore make sense to look at reorganisation? This cost would be less than you are currently facing—

Mabon, you have to conclude soon.

—and would be less disruptive than what is currently happening. When will you accept that the board is too large, is ineffective and needs to be reorganised? Thank you.

Thank you very much. I'd like to read a message that I had from one of his constituents yesterday: 'Great news. Well done, Eluned. Now we have hope.' That's from one of your constituents as well. I do think it's important also for us to understand that the responsibility does go beyond independent members. I accept that, I've said that time and time again. This is a first step and we need to take the next step and ensure that the people who are acting on behalf of the board and are funded by the board directly do understand that changes are coming. In terms of reorganisation, I've said very clearly that I have no interest in reorganisation, I'd prefer to see that £82 million going to the front-line services rather than reorganising. That's what's happened. I wouldn't want to deviate from that.

Thank you for your statement, this afternoon, Minister, and, indeed, for inviting MSs and MPs to the Welsh Government office in Llandudno Junction yesterday to receive your briefing.

I'm going to be straight with you, Minister, really. The people of the Vale of Clwyd have had enough, and it's not funny—I can see you're smiling there—because they've had years of excuses, with failure after failure from this Labour Government in Cardiff: the closure of 13 beds in Denbigh infirmary; the Tawel Fan report; the Health and Social Care Advisory Services report; Donna Ockenden; the failure to build a north Denbighshire community hospital in Rhyl after 10 years of broken promises; and the scores and scores of ambulances outside Glan Clwyd hospital. All of which occurred under the last round of special measures, Minister, that you're responsible for. And you often come back to me and say, 'Well, I wasn't health Minister at the time and therefore it's not my responsibility, but that doesn't wash, I'm afraid, as you fall under a collective responsibility in Government and have a duty to provide quality healthcare provision across north Wales. So, how are you going to make sure that you get it right this time, Minister? And how are you going to personally make sure that the failures end now? And if you can't improve Betsi Cadwaladr and take accountability, will you reflect on your competence to do your job and consider your position, as this can't go on any more? The people of north Wales are sick to the back teeth of a failing health board and a failing Government here in Cardiff Bay. Thank you.

Thanks, Gareth. I was smirking because I just thought it was very odd for you to say, 'I'm going to be straight with you,' as if nobody else before you had been straight with me.

I think it's really important that people understand some of the expectations that we will be putting in place in terms of what happens next. There will be specialist advice on board governance and effectiveness. There will be mentoring to the board. There will be specialist HR support for the chair and executive team. There will be increased capacity and expertise in clinical service planning to deliver that transformational reform that we want to see, and there will be work to finalise the improvement plans. So, all of those things are measures that we will be putting in place to support the board, and obviously we have those additional five experts who will be helping out.

And finally, Janet Finch-Saunders.

Thank you. Minister, you can fool some of the people all the time, and all the people some of the time, but you cannot fool all the people all the time, and we are not fools; we are elected Members representing our constituents, and they are not fools either.

Now, the audit report picks up the fact of four chief execs in less than four years. You mentioned your reasoning for taking the board out of special measures, that,

'The health board responded well to the COVID challenges, and we received a number of reports that signalled that the health board were taking positive...steps'.

I certainly haven't seen any of these reports. What I can remember, though, is that, during this period of time, just coming out of the pandemic, but we weren't still out—. Do you not agree with me that it would have been more prudent to have seen more outcomes measurably improved, because the Record of Proceedings is quite clear that, during this period, many of us were raising concerns on a regular basis about all these reports, these damning reports? Why, Minister, did it take a report from the auditor general to make changes to the board when we have known since before 2015 that leadership and governance in this board has failed? Why was the fact that £122 million was not accounted for not enough to trigger special measures? And why was the fact that building safety, whereby carrying out medical treatments in not-fit-for-purpose hospitals, had got worse since 2019 not enough to trigger special measures? People are responsible for this, and it is the executive members. My constituents believe, as I do, that you are ultimately responsible for the many failings in this health board, and that you should take bolder steps than using the independent members as scapegoats. The failings that my colleagues—

Janet, you need to finish now, please.

The failings that my colleagues have raised have been largely related to executive failings. Now, you've told us here today that you don't have those powers. Well, I'm asking you, Minister, and I don't care what it takes, but you certainly need to get those powers to ensure that you can actually become less detached from a health board that is failing in its ability to deliver safe and appropriate healthcare to many constituents. Colleagues have mentioned how people have died as a result of these failings of the executive board. My final point: if I was the health Minister, believe me, there wouldn't be an executive member still in post. Thank you.

Thanks very much, Janet. And you're right. Look, it's not an acceptable situation where you've got four CEOs over four years. We need some continuity in this post, which is why—

With all due respect, can you call a point of order on a ex-health Minister who failed during their—[Inaudible.]

Oh, for goodness' sake. Do you mind if I—?

Wait, no.

Sorry.

There will be no point of order. I was about to ask for quiet so that the Minister can be heard, and that's what I'll ask for: quiet so that the Minister can be heard.

Thank you.

Thank you. I took my advice in terms of special measures also from Audit Wales and HIW. So, there's a tripartite system that gives me advice in terms of when I need to step in. So, this is the first time they've said, 'You need to step in.' So, that's quite important as well.

So, just in terms of you mentioned buildings and the situation getting worse. Well, I can tell you that the capital fund has been cut by your Government. By your Government. I would love to spend far more on capital within the NHS, and it's your Government that's cut that funding.

Let me tell you also, and I am going to say it slowly again: I do not have the power to dismiss members of the executive. I do not have those powers. Now, if you want me—you know, what you're suggesting is, 'Right, okay, get those powers'. You honestly want me, directly, to employ 19,000 people in Betsi alone? Apart from the 105,000—[Interruption.] No, no, it's the reality of the way the—. I do not employ those people.

Minister, you do not need to respond to sedentary comments.

I do not employ those people directly. Those people have rights. There will be a process, and they need to understand that that process, I'm sure, will be followed.

My constituents have rights too.

Thank you, Minister.