Part of the debate – in the Senedd at 4:17 pm on 28 February 2023.
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.