Item 6 is next, and it's the Welsh Conservatives debate. I call on Sam Rowlands to move the motion. Sam Rowlands.

Motion NDM8231 Darren Millar

To propose that the Senedd:

Has no confidence in the Welsh Government’s Minister for Health and Social Services.

Motion moved.

Diolch, Llywydd, and I move today's motion in the name of my colleague, Darren Millar. As our motion outlines today, on these sides of the benches, we are proposing that this Senedd states that it has no confidence in the Welsh Government's Minister for Health and Social Services.

Usually, at this point in a debate contribution, I would say something like, 'It gives me great pleasure to move the motion today', but actually, today, I take no joy in standing here to move this motion. This is because we're having again to point out failings, and in particular, failure, in taking responsibility for poor performance and poor outcomes for the people of Wales, especially when it comes to their health and their well-being. This is what today's motion is ultimately about. It's about accountability and the role of individually elected representatives taking responsibility when it counts. I say this because we've seen, so far through this Senedd term, a regular pattern of concern being raised from Members from across the Chamber as to the performance of our health service and the ability of our hard-working NHS staff to deliver on what is needed because of the decisions of this Government.

These concerns have not been raised in this Chamber flippantly, but these concerns have been issues that people have shared with their democratically elected representatives, their MSs, and they rightfully expect these concerns to be shared with decision makers to effect change. But these concerns, far too often, have been ignored, dismissed, or approached with indifference by the Government and its Minister. Sadly, in particular for my residents in north Wales, these concerns have proven to be true, time and time again. In north Wales, we now see a health board back in special measures; a £122 million fraud investigation; a region with just 62 per cent of health service buildings deemed to be safe; major concerns with vascular services; risks to patients, and significant concerns at A&E in Ysbyty Glan Clwyd. Indeed, across Wales, we see the results of the nettle not being grasped, with one in four people currently on a waiting list for treatment, compared to one in eight in England. One in eight people are waiting over 52 weeks between referral to treatment, compared to one in 18 people in England and one in 14 in Scotland.

But here's the important bit in terms of today's debate. Who is deemed responsible for these failings? Who can residents in Wales hold responsible when they are let down? Surely, as those who believe in the power and right of democracy, it is clear that those elected to take responsibility are also those accountable when they fail to deliver on that responsibility. In this case, it is clear that the responsibility to take a grip on delivering on health services in Wales rests with the health Minister—[Interruption.] I'm not taking any interventions in the opening of a debate. [Interruption.] Not in the opening of a debate. But what we've seen in recent weeks—[Interruption.] What we've seen in recent weeks is a disjointed position—

The Member is not taking interventions, so allow him to continue. Allow him to continue.

Llywydd, I think it may be useful for Members to hear the opening of the debate.

I can't hear the Member. It's the Member's decision whether he takes interventions or not. He has said that he's not taking interventions, so can we allow him to carry on and complete?

Diolch, Llywydd. What we've seen in recent weeks is a disjointed position on the issue of accountability, because the Minister has acknowledged the issues in the health service, but has chosen to not be accountable for them. And for north Wales, it has been the independent board members, those who've been highlighting the failings, who've been holding the executive to account—it is they who the Minister has chosen to hold accountable for the failings, not herself. Indeed, today we read in the Daily Post that the former chairman of the board, the one attempting to sort things out on the ground, was also being ignored, and I quote,

'A range of longstanding shortcomings and concerns were escalated formally...not just to the then CEO but also to the Minister and the Director General. Those escalations and the basis for them were simply ignored by government.'

Llywydd, I think all of this starts to bring into question the seriousness in which this place is held in the eye of those who elect us, because we know the phrase, 'with great power comes great responsibility'. As more powers have been moved to the Senedd over the years, and with many seeking further powers, the responsibility on elected representatives and the willingness to be held to account also increases. I for one certainly don't want to weaken the inherent trust that our electorate put in us by electing us to this place to deliver on what they need. That is why we must show respect to those who elect us, and take responsibility when things go wrong. That is why, again, I move the motion before us today. Diolch yn fawr iawn.

Mike Hedges.

Oh, thank you, Presiding Officer. You caught me out there.

I don't often catch you out, Mike Hedges.

Russell George and I were both elected in 2011. Eluned Morgan is the best health Minister we've had in that time. This is the most difficult job in Government. The structure we have now is the one that she inherited. As merger mania hits the Senedd across parties, big is always better, isn't it? I've had Conservatives tell me that we should only have two health boards in Wales, and a former Plaid Cymru health spokesperson argued for one. Fortunately, the views expressed of putting social care into health have not happened—it would have made matters a lot worse. Too many Members identify problems without workable solutions. Why nearly everyone thought that joining primary care and secondary care would work, I cannot understand. Do you actually think it has worked? I take that to be a 'no'. Whilst the vast majority across parties supported the merger of primary and secondary care—no matter what goes wrong, let's make bigger and bigger organisations. Finally, we need the right sized health organisations. How has the merger of primary and secondary care benefited patients, who are they key?

There are problems in the health service in Wales. The structure of Betsi Cadwaladr is, I believe, unworkable. New chairs and chief executives are regularly appointed, but the problems are not resolved. The gap between the board and the ward is too big. I wrote that several years ago when no-one else actually had any point of agreement with me at all. Jenny.

I want to probe your proposal, Mike, because what you're saying is, if you want to divide secondary from primary care, you'd need to set up 22 local primary care organisations. That would just make the problem far worse. We already have far too many institutions in this country, so we have to go with the integrated system that we have and ensure that the health boards push the money down to primary care.

Well, first of all, I disagree entirely with what you just said, Jenny. I didn't say anything about having 22 individual boards; what I said is that primary care and secondary care don't work well together, and we've had a serious problem with it, and the very big board in north Wales hasn't worked. My advice is to keep Betsi Cadwaladr for back-office functions and primary care, not the 22, and bring in new arrangements for secondary care based upon the three main hospitals. There will be a need for the hospitals to work together, with their own management structure and board, reducing the gap between board to ward.

I'll just go through an e-mail I received on Friday, which shows the problems in health way outside the Minister’s control:

'We have called Llansamlet doctors for an appointment for my grandfather everyday, twice a day, since 27 February for an appointment due to a chest infection as he has chronic obstructive pulmonary disease. We couldn't get through for an appointment at all, despite calling twice a day. His breathing was deteriorating, and as he was not being medicated as he should have been, being a COPD sufferer, we had to borrow a nebuliser and solution to help him. He was uncomfortable and anxious about going to accident and emergency. We were finally able to speak to someone on 6 March. He was told that, because he was smoker, they would not issue antibiotics.

'Later that evening, he was so unwell, we had to dial 111. Then a paramedic came to the house to check him over, provided a rescue package of antibiotics and steroids. The paramedic advised to call the doctor the following day for a doctor to come out and check on him and issue a top-up of his antibiotics and steroids. As advised, we called the doctors, but we could only get through to general enquiries, where the paramedic report was sent by ourselves as the doctors’ surgery is not on online system, so that was the fastest way to get this report over to the surgery. We were told by general enquiries that a doctor would call back. We made them aware that he needed a top-up of his rescue pack, and asked a doctor to call back ASAP to issue this. Unfortunately, no doctor called back. We called again in the afternoon to check if the doctor was going to call back. We were told to wait. We did not receive a call back. We called again on 8 March—still no call back. We called again on 9 March, morning and afternoon— and they only had half a day of his steroids left—

'we tried the pharmacy, but they hadn't been told that his prescription had arrived.

'On 10 March, we called the doctor's again and finally got through to somebody who was willing to listen to us. A doctor was sent out to check on him. The doctor provided us with a prescription for his antibiotics and steroids, along with nebuliser solution. The doctor advised he needed to go into hospital that day. He was admitted to hospital, and by 2 p.m. he was told that half his lung had collapsed. He had fluid drained from it. I was furious to say that this all could have been avoided if, on 27 February, a doctor had actually been prepared to speak to him. To add to this, when the doctor came out, they could not tell when his medication had last been reviewed. The doctor took water tablets off him, as he shouldn't have been taking them, but had been for years.'

This is what is happening. This is not the Minister's fault. There are administrative problems within the health service. This idea that making bigger organisations is going to make it better, it beggars belief that people could keep on saying that with all the experience we've had that these bigger organisations don't work. But, yes, we'll keep on making bigger ones, because eventually they will work. 

Finally, I think we need to right-size health and support the Minister, who I think is doing a very, very good job. I ask the Conservatives to withdraw this motion. It will achieve nothing, and we're working with the health Minister, who's trying to work with us.

The Welsh Government health Minister is, of course, responsible for holding health boards to account, and must make her views known, as she has done—[Interruption.] and she does, I agree, Jenny; she does make her views known—when she doesn't have confidence in them. And, in the same way, for those of us in this Chamber who are not in Government, it is our job to hold the Government to account and raise our concerns when we don't have confidence in decisions that are being made by Ministers.

It is undeniable that the pandemic has recalibrated what we can expect from the NHS, but it's not a coincidence nor an ignorable fact—and a fact is what it is—that Wales is far behind England and Scotland in seeing the recovery in waiting times—[Interruption.] That is true; I can hear, 'It's not true' being whispered behind me. This is also in the context of Wales going into the pandemic in a much poorer state than in other nations of the UK.

Now, we are awaiting tomorrow's figures for January, and I want to compare Wales and England to demonstrate just how badly short-changed I think patients are in Wales. I do so—[Interruption.] Yes, sure, Jenny.

Cardiff and the Vale have not had to cancel a single operation throughout this winter, despite the strikes, despite the continuing of COVID, and I don't understand how, therefore, you're saying that this is an underperforming health board. It's much better than many of the organisations you—[Inaudible.]

Well, the statistic you point at there, Jenny, I mean, perhaps that should be explored; perhaps Betsi Cadwaladr health board can learn from areas in that particular health board. 

But, I think what I'm going to demonstrate to you—I'm going to raise some statistics between England and Wales, and I'm doing so in the context that there's great frustration amongst patients up and down Wales—there is across the UK. There are difficulties in this health service right across the UK, but they're more predominant in Wales, and there are huge frustrations and upset across Wales from patients. We hear—I see it in my postbag. But there are also frustrations from Members in this Chamber as well, because we get frustrated when our constituents raise matters of concern amongst the health boards in their areas with us—[Interruption.] Well, let me just—. Okay, Jenny, I'll take another intervention.

So, what would you do differently? Because you're supposed to be the official opposition. What would you do differently?

Thank you, Jenny. I'll come to that in my contribution. I will come to that in my contribution.

So, let's have a look at some of the statistics: 24 per cent of the Welsh population are on a NHS waiting list, twice the proportion in England. One in five of those patients are waiting over a year for treatment, compared to one in 18 in England. Over 45,000 patients in Wales are waiting over two years; in England and Scotland, these have been virtually eliminated. Then are the A&E waiting times, and it's been a very long time since Wales saw a greater percentage of patients within the four-hour target than England. And of course, the Welsh target to get 95 per cent of admittants seen in four hours has never been met in the 13-year existence of that particular target.

And ambulance times—and to be fair, it's not all bad. The average red calls in Wales in January were reported to be 19 seconds quicker than the average category 9 call in England. However, amber calls were more than 20 minutes longer to reach a patient in Wales than a category 2 in in England—category 2, of course, includes stroke. And this I think speaks of a lack of confidence that we have in the Welsh Government in tackling the issues, because there are people in the United Kingdom experiencing an inferior level of healthcare simply because they live in Wales, not in England or in Scotland, and that is wrong. That is the opposite of what devolution was meant to achieve. We were supposed to be better off, but we're worse off, and I have lost count how many times I have read 'the worst on record'. I listened to Mike Hedges's contribution—I agree with a lot of what Mike said, not just the fact that we were both elected in 2011—but I agree with him that the job of health Minister is the most difficult job in Government. I agree with that, and I think, in fairness—Mike didn't say this; I'm not referencing Mike now, but—I think that the Minister's predecessor should also take part of the responsibility for the state that our health services are in today.

And to answer Jenny's point, even when we as Welsh Conservatives have offered our solutions—the GP access plan, the NHS tech bundle, surgical hubs—they have not been taken up, to the detriment of patients and staff across our nation, despite the latter in particular being instrumental in tackling those waits in England.

Now, I really did not want this debate today, and I heard, when Sam Rowlands opened the debate today, some jeers from some Members about crocodile tears. I really do not want this debate today. I really take no pleasure in it. Believe me, I look forward to the day—[Interruption.] 'Funding Wales properly' is being said. Wales gets £1.20 for every £1 spent in England. [Interruption.] Right? Now, if—

Will you take a quick intervention? Very quick.

I don't think I can take any more. I don't think I can. Can I take an intervention?

Yes, you can. Yes.

Okay. Janet and then Alun.

Right, okay. I've been made aware this week of an 82-year-old lady who was diagnosed with stomach cancer, very late stage, in December—not heard anything, and we're now at the end of March. Do you think that is the product of a well-functioning health board? Time after time after time I've raised these concerns with you, with the Minister, here in this place. Do you not agree with me, when we're asked what should we be doing, we would spend the whole £1.20, we would put patient care above looking after the executive board members, wouldn't we, Russell?

Yes. Okay. For balance, yes, one other intervention.

Russell, diolch—thank you for taking the intervention. I take you at your word, actually. I accept that you didn't wish to bring this motion in front of the Chamber today. But the point about funding is a fundamental issue, and you quote the £1.20—and I won't argue about that—but you know and I know, and the secret right around the Chamber is, that a needs-based formula would provide Wales with the resources required to meet the needs of the people. I'd be prepared to work with you to deliver that. Would you work with me?

Yes, Alun, I would. I genuinely would. Let's do that. Let's meet after and discuss that.

I will end my contribution, Llywydd, by saying I look forward to the day that I can stand here in a debate and talk about the success of our Welsh NHS and how it is performing much better than any other nation across the UK. I genuinely look forward to that day. 

Now, it's no small thing to ask a Minister to step down or to be dismissed, but, having seriously considered the issue, that's what I and Plaid Cymru did some three weeks ago, because we were convinced that the time had come for a new start. 

We can refer this afternoon to a catalogue of failings in the NHS under this Government's watch, this current Minister and her predecessors: the worst waiting times ever; the stubborn failure to change tack when it's been obvious that efforts to cut those waiting times weren't going to succeed, far from it; the crisis of ambulance waits; staff shortages; attitudes towards those taking industrial action; the mess that is the dental service, laid bare in the Senedd again last week. But it's the Minister's handling of the Betsi Cadwaladr issue at the end of last month that was the straw that broke the camel's back for us on these benches, and which did lead us to call for her to consider her position or for the First Minister to remove her, calls certainly not taken lightly. In that context, and despite it being a few weeks on now, we will support this motion here today. 

But most important to me this afternoon is the opportunity to emphasise what's at stake here, what it is we're fighting for when it comes to the future of the NHS. Joyce Watson. 

Thank you for taking an intervention. I'm a little bit puzzled as to what you're hoping to achieve here, so maybe you can explain it. Could you explain to me how you think the health services in north Wales are going to be enhanced overnight by removing the health Minister? That's what you're not actually getting to. Or is it just political posturing? 

The Minister won't be removed today because Labour will win this vote. What I've said is that I see the importance today of having the opportunity to emphasise what it is that we're fighting for. And to me, it's about accountability. And I would hope that the Government and those on the Labour benches would welcome the opportunity to show that they want to be accountable. We need to know that we have a Government, that we have Ministers, who are accountable and desire accountability. To serve in Government is an honour. It's an enormous responsibility too, and, no doubt, it's a difficult job. But there can be no ducking of responsibility because it's a difficult job, and admitting when you're getting it wrong is an important part of that process of seeking accountability. 

Now, I note the Labour response to this afternoon's vote is quoted on the BBC's news website today: Welsh Labour said Ms Morgan is doing a great job. Now, I know that's just politics, and that's the risk when a confidence motion like this is laid, or, indeed, when there was a rather casual call from another Conservative Member just yesterday for another ministerial sacking: there's a retreat to political trenches. But we somehow have to try to rise out of that. So, why did I— [Interruption.] So, why did I say some weeks ago that we need a fresh start in health? This is my opportunity to explain. 

I'm going to turn to the words of the former Betsi Cadwaladr University Health Board chair Mark Polin, writing in the Daily Post today. I said I wanted to emphasise what's at stake, and I think he does it incredibly forcefully today. 'By any measure', he says, 

'patients across Wales, and in particular north Wales, are being placed at risk by an NHS system which is badly misfiring and arguably broken.'

And on that key issue of accountability, he refers specifically to that Senedd statement by the health Minister on 28 February, saying,

'the Health Minister engaged in what can only be described as an exercise in attempting to distance herself, her government and her officials from any responsibility for seemingly anything to do with improving healthcare across Wales and particularly here in the north.'

And that does cut to the heart of the matter. Remember the Minister's own words in that BBC interview about Betsi Cadwaladr: 'It's not my job to have a grasp of the situation.' Mark Polin goes on: 

'The government and the health minister also need to stop assigning failings to others and begin accepting and demonstrating responsibility rather than excuses.'

Damning words, but ones that echo comments I and others have made in this Chamber on many, many occasions, because there is a pattern here. This is a Minister and this is a Government that may well believe that they have a vision for the future of the NHS in Wales, but, if they do, it’s by now a hopelessly blurred vision, neutered by the constant firefighting, devoid of new ideas to see it through. Yes.

Thank you for taking the intervention. How would you respond to this comment from myself—that are you not, by doing this today and supporting this motion, playing two sides of the fence here? On one hand, you acknowledge fully the difficulties in terms of the lack of investment in Wales, the impossibility of what is trying to be done here from your point of view, but now today you are causing an agenda that is personal and political.

I’ll pick on one word: ‘impossibility’. I do not believe it’s impossible for us in Wales to run public services better than we currently do. I do not think it’s impossible for us to put together a vision and to deliver on that vision in a way that delivers better healthcare than we currently see being delivered here in Wales today, despite all the best efforts of our health and care workers. So, we need to see the ideas and the power behind them to see them through—on Betsi, the idea we need a brave Minister to drive through and to scrap the current health structure, start again. We’re clear on that, and we’re grateful to Mike Hedges for his support on that today. But in so many ways poor decisions have been made. We need better ones, put simply. As I say, taking responsibility for the things that haven’t gone well on this Government’s watch must be the first step to turning things around.

Finally, Llywydd, Mark Polin says that:

‘We are long past the point whereby patients and their families are entitled to expect a public enquiry or some other fundamental, independent review to be conducted.’

The health Minister brushed aside my calls for an inquiry, and again the conclusion many will come to is that this Government is doing all it can to avoid scrutiny. That has to change.

This debate should mark a line in the sand. We’ve had numerous debates over the years about poor performance by Welsh Government on the NHS. I don’t think this is the first time, and it saddens me to say that it’s definitely not going to be the last. For decades—yes, decades—the Labour Government has been in charge of the NHS and it has been in a managed decline ever since.

I’m going to be sincere with the health Minister: she’s picked up a brief that has been decimated by the now economy Minister, who presided over five of the seven health boards in special measures and targeted intervention, who took Betsi out of special measures too early and as part of his political point scoring before the 2021 elections, who saw over a quarter of COVID deaths as a result of ward-to-ward transmission, and who opened the Grange hospital too early, leaving it painfully understaffed.

He took over from the now First Minister, who was in place when Betsi Cadwaladr was first put into special measures in 2015, after the shocking fallout of poor mental health care at Tawel Fan. Sadly, the situation is still playing out in other health boards, such as Cwm Taf, which has recently been pulled up by Healthcare Inspectorate Wales for discharging mental health patients without even bothering to contact the local community mental health team.

Minister, you do have my deepest sympathies. You haven’t got to grips with spiralling waiting lists over the last two years and you’ve failed to meet your targets. I can now see the panic that is setting in with you, Minister. You’re quite rightly worried about waiting lists that are stubbornly failing to significantly reduce, unlike in England. In my constituency of south-east Wales we’re looking at nearly 5,000 patient pathways waiting over two years for treatment in Aneurin Bevan University Health Board. In Cwm Taf, this number doubles to over 10,000. That’s patients waiting in pain, in distress and frustration for over 105 weeks, 735 days, 17,520 hours. And it’s not just referral-to-treatment times that are out of control. Just over half—56 per cent—of patients at the Grange’s A&E were seen within four hours. One in five patients at the hospital are waiting for over 12 hours to be seen. In November 2022, Healthcare Inspectorate Wales declared that the A&E department at the Grange was in urgent need of improvement. This is despite the hospital being only two years old at the time. Is this acceptable in a flagship hospital?

I have a constituent who has laid bare the problems of your Government’s reorganisation of A&E services in Aneurin Bevan, relying on just one hospital, situated out in the back of beyond, to take the strain of health services in south-east Wales. They let me know their partner needed to go to hospital and, given no ambulances were available, despite the emergency, they drove to the Grange. On arriving, they found the waiting room full beyond its capacity, with relatives being told to go outside. During their lengthy wait, they saw patients who were being given infusions in every spare bit of space and they were told their partner couldn't be discharged due to a lack of bed space in other hospitals. Is this dignified care? Is this an NHS fit for the twenty-first century? I think not. 

Minister, we've given you the benefit of the doubt for the last two years and, yes, I wholeheartedly believe that you have inherited a really poor portfolio from your predecessors, being Mr Gething and Mr Drakeford. But you've taken so long to reach any decision: for example, you threatened Betsi with special measures in February 2022 if it continued to fail, and what happened? You saw services decline and still did nothing, even after a spate of Healthcare Inspectorate Wales reports that showed it wasn't managing. In Cwm Taf, things are going wrong—we have mental health services in crisis on top of the efforts to recover from the maternity scandal; no eating disorder target still; a lack of bereavement support services still and no support for adults diagnosed with ADHD still. These may just be drops in the ocean for you, Minister, and many others, but we're seeing through the warm words of support and lack of action, so are hard-pressed doctors and nurses, and so are patients. This is happening all over Wales and it's just not good enough, Minister. Enough is enough.

Well, the motion before us today is, in my opinion, a very unnecessary and, I have to say, a vindicative distraction. Yet another manifestation of an opposition whose only interest is unfortunately in grabbing a cheap headline. In the process, what they do is actually let down our public services and the people who rely on them by their failure to engage with the very real challenges that we do know we are facing. For example, we know in Wales that our population is older; we know that our industrial heritage brings with it a legacy of sickness and ill health. We know that responding to the coronavirus pandemic and 13 years of failed UK Government policies, which have increased poverty and have increased health inequalities, have therefore put unprecedented pressures on our Welsh NHS.

We know that this is leading to people having to wait longer than any of us are comfortable with to access treatment. But we also know that the Minister for health and the Welsh Government, working with those bodies responsible for the delivery of healthcare, are doing all they can to reduce waiting times. We know that this is paying off: waiting lists in Wales have gone down for the second successive month.

New ambitious interventions are planned to further encourage this direction of travel, such as the new diagnostics and treatment centre announced by the Minister just last month. Funded by Welsh Government, developed by three health boards working together and based in Llantrisant in Rhondda Cynon Taf, with an approach hingeing on clinician and patient involvement, that centre has the capacity to deliver innovative services to thousands of patients each year, and this could not just reduce, but actually eliminate backlogs in accessing treatment for people in the Cynon Valley and neighbouring areas. And if it's successful in doing that, it's a model that can be rolled out across Wales.

I was fortunate enough to visit another project in my constituency at the start of the year to see another groundbreaking initiative implemented by the Minister. I went to Gwynns Opticians in Aberdare to find out about changes to the services that they deliver. Local opticians are being trained to become independent prescribers, able to diagnose and treat really serious conditions, like glaucoma and macular degeneration, and this eliminates the need for patients to be added to hospital waiting lists and instead allows for treatment in a local setting. This reform of the NHS, relieving pressure on services, empowering practitioners and ensuring that patients can access swift, safe and specialist care is a priority for this health Minister, as is valuing the professionals responsible for the delivery of these services.

I'm proud that, proportionately, we have more doctors and nurses in Wales than they do in England; that we are training more doctors and nurses; that we pay the real living wage to all NHS workers. And lest we forget, the health Minister is also responsible for social services. With her team, the Minister has delivered on our 2021 Senedd election manifesto pledge to pay the real living wage to all care workers in Wales. And this is a tremendous achievement, substantively changing our perception of what is a vital role with our ageing population, ensuring social care work and social care workers receive the just reward they should be able to expect. So, on behalf of my constituents who work in social care, on behalf of all of the women in Wales who work in social care, and on behalf of my constituents who rely on social care, I would like to say, 'Thank you, Minister.'

For the remainder of my time, I just want to change focus and offer an alternative perspective. Our Minister for Health and Social Services has been in post since the May 2021 election. In that time, in contrast, four different people have served as health Secretary in the UK Cabinet.

First there was, of course, Matt Hancock, dropped for arrogantly ignoring the coronavirus regulations, for which he was responsible; presiding over a regime that gave billions to cronies in dodgy PPE contracts; then trading public service for a stab as a reality TV star; and further notoriety via his shameful leaked WhatsApp messages. Then we have Sajid Javid. Probably the best thing that he did as health Secretary was to contribute to bringing down Boris Johnson—bringing Boris Johnson down for arrogantly ignoring the coronavirus regulations for which he was responsible. Then we had Therese Coffey, whose contribution was to put on record her commitment to illegally sharing prescription medication. And now we have Stephen Barclay, described in a health service journal as:

'A real nightmare, vindictive, arrogant, a bully, hostile to the NHS and all its works, a micro-manager of the wrong things'.

That is what this opposition has to offer. That’s why the people of Wales will never trust them to run the NHS, and that is why I will be voting against this motion today.

This isn't a debate, much like Russell George and Sam Rowlands, that I take great pleasure in speaking in, and it’s one that I have wrestled with internally throughout the day. [Interruption.]

I'm not going to sit down, as the Deputy Minister suggested. I'm not going to sit down because I need to contribute on behalf of my constituents in Carmarthen West and South Pembrokeshire.

As colleagues have highlighted, Llywydd, the issue of good, reliable and safe access to healthcare remains one of the defining topics of correspondence in my inbox from constituents of Carmarthen West and South Pembrokeshire. So, with the immense privilege that it is in representing those people, I felt that I needed to contribute today.

I want to focus my contribution on healthcare in west Wales, and specifically two issues: the level of service received at our hospitals and the struggles facing the future of NHS dentistry. What truly hit home at the end of last week was the report from Healthcare Inspectorate Wales into the level of service offered by the A&E department at Glangwili hospital.

The report found that, despite the best efforts of staff, the independent body said that patients did not always receive consistently safe care. It went on to state that patients face long waits in the emergency unit due to problems with patient flow through the hospital. And in my eyes, most worryingly, it said that there was evidence of overcrowding and a lack of toilet and washing facilities. Inspectors witnessed some patients sleeping on chairs or on the floor.

What sort of health service is being presided over if that’s the inspectorate’s conclusion? I stress that none of these findings are the fault of our hard-working healthcare staff. The responsibility ultimately lies at the door of the Welsh Government and its health Minister.

Would you possibly take an intervention?

I will most certainly take an intervention.

Thank you so much for that. Bearing in mind the extreme challenges that NHS services are facing across the entire United Kingdom, why was there no extra funding for the NHS in the spring budget?

I'm grateful to the Member for intervening. I can imagine that the autumn budget released extra, additional funding for both education and the health service, by the Chancellor Jeremy Hunt, last October. But we are here to debate health services here in Wales. We are elected by the people here in Wales to sit in a Welsh Parliament.

I recently spoke—[Interruption.] Well, I'm very happy to join that meeting that you and Russell George will be having, Alun Davies.

Moving on, I recently spoke to a dentist who is a member of the Dyfed-Powys local dental committee. He told me that NHS dentists are facing large financial penalties if they fail to meet unevidenced and unachievable contract reform targets, which he described as a cliff-edge for NHS dentistry in Wales. A further quote from the Dyfed-Powys local dental committee reads: 'To be quite honest, Eluned Morgan's comments in January, showing a total lack of understanding of the situation, and her unwillingness to listen, has been the final straw for many of my colleagues, who will now vote with their feet and move to practise only in the private sector.'

Llywydd, I will close my contribution in the same vein in which I opened it. Russell George is a Member, politically, that I look up to immensely. Indeed, he was the first Member that came into my office after I was elected to ask for my advice on something, which filled me with great strength, and I'm very grateful to Russell for that. As a proud Welshman and a proud Brit, nothing would give me more pride than to look across Offa's Dyke and to think, 'Here in Wales, we have the very best NHS.' Unfortunately, at the moment, I can't say we can do that. Diolch, Llywydd.

I'd just like to start my contribution with this reflection on this debate: I feel this is a really poor way to do politics. This place, in my view, is much better than that. I don't see how spending 60 minutes, which we will do today, plus the time we have all spent, those of us speaking, in preparing for this debate, will resolve anything for the NHS staff and patients who have not received the care that they need.

I, as do the constituents who write to me, and I know, to many of you, week in and week out, want to concentrate on solutions and what we do next. What are we doing to tackle ambulance waiting times? What are we doing to tackle long waiting times for dentistry? And what are we doing to recruit and retain more nurses and social workers? I don't see how removing the Minister will actually do anything around those issues.

I have been critical, as many of you know, of the decision—[Interruption.] I won't, sorry. I'm not taking any interventions, I'll just be clear about that. I have been critical, as I know many others have, of the decision making around Betsi Cadwaladr. The Minister seems to have chosen the technicalities of the law and what authority she has or doesn't have in order to intervene at Betsi, rather than acknowledging that it is to her that staff and patients look to drive improvements. It was wrong to sack the independent members of the board, as it seemed they were the only ones who were actively raising concerns. This needs to be acknowledged, and the chaos that that decision caused as well.

I have been critical of poor performance across all of our health services, whether it's children and young people waiting months for mental health support, people waiting months and sometimes years for dental treatment, ambulance response times, targets being repeatedly missed. I've also disagreed with the Minister and other Cabinet members who deny that our health service is in a state of crisis. People in north Wales need to see a fundamental change in the improving of health services in Betsi Cadwaladr, and we all need to see and hear an acknowledgement of the scale of the crisis in our health service across Wales.

One issue that I've repeatedly raised is NHS dentistry, and I know some of you have touched on that as well. For the Minister to deny the existence of a different-tiered access to services to dentistry in last week's statement was, I'm afraid, quite astonishing. Again, it doesn't tell us, or the people we represent, that the problems in NHS dentistry are properly understood. The figures are clear: 93 per cent of dental practices are not accepting new adult NHS patients. In a recent survey of 250 high-street dentists, more than a third said that they would reduce their NHS contracts this year. Ninety per cent of dentists disagreed with the current reform measures, and there is no glossing over the rift in the relationship between dentists and the Welsh Government. I remain deeply, deeply concerned about the attitude towards the profession.

But, again, I say, 'Will changing who sits at the table resolve the issues in dentistry, with waiting lists, contract reform and investment?' In my view, this debate is an attempt to grab headlines rather than solve the issues at hand, and I think that it is dishonest and that the public will see through it. In closing, I make no secret of my significant concerns around the NHS in Wales, but I don't think a merry-go-round of Ministers around the Cabinet table will deliver the systemic changes that we need.

So, what could we have spent the last 60 minutes discussing? Extending nurse staffing levels to more parts of our NHS, progressing plans for a national care service, or whether we should consider the NHS executive being independent of Government to ensure scrutiny and accountability. I won’t be supporting the motion today, but I want to make clear that I’m not content with the performance of the health service. I will continue to ensure that I bring forward those challenges. This is an opportunity, I hope, for a reset, and that we move forward doing what people want and expect of this Senedd—to do politics differently, and better, and to shape ideas to tackle the challenges people face. Thank you. Diolch yn fawr iawn.

I usually start my contributions to debates saying, ‘It’s a pleasure to take part in this debate this afternoon’, but today, it’s not, and it’s with a heavy heart that I support this motion. I’ll share with you just a couple of reasons why I’m choosing to vote for this motion this afternoon.

I worked in Betsi Cadwaladr myself for 11 years on the front line, and I saw first-hand some of the failures on the front line from an internal perspective. That’s what tempted me to go into politics and stand for the Vale of Clwyd, because as you know, it’s got Ysbyty Glan Clwyd in the constituency, and having worked there and in north Wales all my life, I wanted to stand for office to make things better. I thought, ‘Well, I’ll stand for the Assembly’, as it was then, and now the Senedd, because I thought, ‘What I’ll do is I’ll take my transferable skills that I’ve learnt in my role in the NHS and project them to the people who make the decisions in Cardiff Bay.' That’s what I’ve tried to do so far in my short time that I’ve been here, and represent my home, which is the Vale of Clwyd. It’s always been my home. People say it’s just a constituency, but it’s more than that to me because I’ve always lived in Rhyl, Prestatyn, Denbigh, and I was born in St Asaph, so it’s more than just a constituency to me, and I care deeply about the issues that affect my people, I guess.

A lot of my inbox and things that I deal with on a day-to-day basis are complaints about the performance of the health board and Glan Clwyd Hospital waiting times, patients who have perhaps passed away due to medical negligence, and the failure to build north Denbighshire community hospital in Rhyl after 10 years of broken promises. But all of this—[Interruption.] Yes, certainly.

Since you worked inside the hospital, you must have surely come across people telling you that they were being starved of funds by your Government, the Government that you support. What did you say to those people when you outlined why we haven’t funded things? Did you tell them that it's because it was your Government, the Government that you support, that wasn’t providing sufficient funds so they could have their needs met?

I don’t really accept that, because health has been devolved to Wales for 25 years. You may have noticed that I’m the first-ever Conservative to represent the Vale of Clwyd, and I believe that the sole reason is because I put election leaflets and campaigned, and my number one priority on that campaign was that I’m going to hold the Welsh Government to account over some of the failures at Betsi Cadwaladr. That's what I’ve tried to do so far in my short time in this Senedd Chamber. I believe most of the things that I’ve said in this Chamber so far to the health Minister have always got good evidence behind them and they’re always projections of what constituents tell me on a daily basis. I try to project that to the best of my ability and what I’ve found in this time is that my issues that I’ve tried to bring here at times have been belittled and patronised. I get that you’re a Labour Minister and I’m a Conservative backbencher, and I know the natural political barriers in place with that, but I was elected on those pledges, and it’s my job in this Senedd to represent my constituents. I don’t believe that the health Minister has helped me at all in that process.

Yes, I’ve let my emotions boil over a couple of times in the Senedd; I fully admit that. But the only reason for that was because of the frustration and the passion that I’ve got for representing my home area. I don’t condone that sort of behaviour, but it’s purely on the basis that I don't feel that what I'm being told by constituents is being respectfully dealt with by the Minister. That was exacerbated—I think it was three or four weeks ago—when it was announced that Betsi Cadwaladr was going into special measures again. I got up and I asked a question and the health Minister just laughed at me. For whatever reason, you laughed at me and that is unacceptable. The fact that Betsi Cadwaladr has had so many issues and the Minister sees that as a laughing matter—[Interruption.]

He's not taking interventions.

I'm out of time. I will conclude by saying that I don't believe that the Minister has taken this role seriously so far. I think you will survive the vote, Minister, if my calculations are right, but what I hope for, as maybe a short positive to that, is that you will see this as a message that you need to up your game, basically, and take us on this side of the house seriously. Thank you very much. 

I heard one of the Labour Members referring to this motion proposing to remove a Minister because of failures of delivery as vindictive. Well, if the removal of a Minister for reasons of failure of delivery is vindictive, how would you describe the removal of an entire independent board? I wouldn't use the word 'vindictive', actually, but I would say it is troubling, and I think it should trouble all of us. There are concerns at the heart of what has happened here that, actually, we all of us, collectively, both Government Members and opposition Members, I think, need to address. 

It's certainly the case that the Minister and the Government, having received the auditor general's report—a damning and sobering report—had to do something. Indeed, I'm sure that we would have criticised the Minister had they not taken action. What is extremely perplexing and problematic is that it's a response that, while not wholly uncritical of independent board members, does point to the majority of the failings being on the side of the executive team, but then the Minister decides to leave them in place and sack the entire non-executive membership of the board. It just seems to me to run counter to natural justice to sack the non-executive board in its entirety when it's those board members, as Mark Polin pointed out in his piece today, who had commissioned the external reviews in a range of areas, like urology, vascular services, finance, which had corroborated what they were saying and actually proved that they were in receipt of inaccurate information. [Interruption.] And yet it was—

Are you taking an intervention?

—them who were sacked. Yes, I'll take an intervention.

There was a hole in your argument, which is that the Minister is not entitled to sack the executive board members. That is the problem. That is the job of the health board, to organise their own workforce. 

Your intervention deserves a good response, because that isn't true. The Minister has the power to remove the employee members of the board. Yes, not to terminate their employment, but what is at issue here is their executive leadership role, and the National Health Service (Wales) Act 2006, section 27, sets out absolutely clearly that the Minister has the right to remove all members of the board, including employee members of the board. So, I'm afraid that we are being given an incomplete picture by the Minister.

Let me turn to the manner in which the independent members were removed. We've been told in the various accounts that we've heard, none of which have been challenged by the Government, that they were called to an early-morning meeting, they were presented with an ultimatum, essentially, 'Either resign or you will be sacked', and they were given 30 minutes to make their minds up, a very short period of time, with all of the implications for their professional reputations. NHS Wales has signed up to the principles of what they term 'compassionate leadership', and yet here we have an example where the auditor general, in a report published just a few weeks before, had referred to several board members showing

'visible signs of emotional distress, giving us concern about their well-being.'

The auditor general goes on to say:

'Urgent action is needed to address this situation.'

I suggest the urgent action he was not suggesting was that you get those people into a room, you put huge coercive pressure on them, and present them with an ultimatum. That is the absolute opposite of compassionate leadership. It is not the way to behave, quite frankly, and it is not acceptable. It completely lacks empathy. 'My way or the highway'—that is not the way that we should be running public services in Wales.

I'll turn to the special measures regime. It just doesn't work—the entire escalation and intervention framework. Betsi Cadwaladr in special measures for five years, taken out, that doesn't work and it's put back in. It entirely is a system that is failing, and we should actually accept and acknowledge that. 

The First Minister, in response to questions from me a few weeks ago, said that Betsi Cadwaladr was taken out of special measures in November 2020 because the auditor general said that they should do so. Well, my understanding—and I'm quite happy to see the documentary evidence—is that that is not the role of the auditor general. They provide the information and the evidence for Ministers to decide, because it is Ministers, ultimately, that should be accountable.

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

Llywydd, it's not an easy job being health Minister after a pandemic when waiting lists went soaring everywhere and Tory austerity left our public services fragile and our older sicker and poorer population were left more desperate than ever. But I'm committed to delivering the best possible health service for the people of Wales, and I'm determined to support our health and care staff, who are under so much pressure as they deliver life-saving and life-changing care and treatment.

I wake up every morning worrying about the man who's been waiting for a hip operation, the woman who needs asthma treatment, the child who needs reconstructive surgery. I work tirelessly with my colleagues to ensure that the Welsh NHS provides high-quality, safe and effective care whenever possible. But chronic underfunding of this precious institution, caused by Tory mismanagement of our public finances, makes this extremely difficult. I'm disappointed that the health service is once again being used as a political football in this Chamber; disappointed at attempts to gain political capital from serious issues involving Betsi Cadwaladr University Health Board; disappointed but not surprised that the Tories have chosen to launch this attack on me today, when on the day I put Betsi into special measures I was assured by the Conservatives that they would not be calling for my resignation.

But the timing of this vote today is convenient, isn't it? On the day when the so-called saviour of the Tory party, Boris Johnson, the man they all cheered for, the serial—how shall I say this—fibber, who promised us £350 million a week for the NHS if we voted for Brexit, the man who told us all to stay at home when he partied, denying people the opportunity to say their final goodbyes to their loved ones—[Interruption.] 

If the Tory benches are expecting me to rule at this point whether Boris Johnson is a fibber or not, I'm not intending to do that. I'll just leave that to hang out there, and I'll call on the health Minister to carry on.

Today, he's desperately trying to persuade us that he didn't knowingly mislead MPs over all those lockdown parties at No. 10. This technique, calling for a no-confidence vote, has become a desperate act of distraction by opposition parties incapable of standing up for the people of Wales. You ask for accountability; here I am today, as I am every week. And let me be clear: you won't see the same transparency and accountability in England, where 18 hospital trusts are in the equivalent of special measures, but the UK Government, from what I can tell, never brings a statement to Parliament.

In relation to Betsi, the opposition seems to be blaming us for enacting their demands. We were told, 'We need urgent change at the top.' You called for a fresh start. Well, here it is. Here is the fresh start. Betsi Cadwaladr University Health Board was placed back into special measures. The chair and the independent members have been replaced. I took swift and decisive action to address the significant concerns that emerged from a series of independent reports.

But I have to say that the cry of 'toxicity', 'chaos' and 'dysfunction' at the top of an institution is really rich coming from Plaid Cymru after what we hear about their party. The confidence of local people in their health service would be helped enormously if this Chamber came behind our ambition to resolve past problems of the health board in north Wales. And don't take my word for it, for how important a united front will be; a leading nurse in Betsi contacted me recently and said,

'Thank you for standing up for me and my colleagues. The constant focus on the negative and the lack of acknowledgement of the hard work is having a significant effect on staff morale and recruitment'.

So, can we do that? Can we pull together? Can we stand with our workforce in north Wales? They don't want political posturing or empty gestures—they want our support. And I'd like to take this opportunity—

Are you giving way, Minister?

No, I'm not giving way.

I'd like to take this opportunity to address some of the false rhetoric being bandied about by the Conservatives today—that we voted to cut spending on the NHS. Many years ago, yes, we redistributed health funding to social care, and anyone who knows anything about health knows the absolute necessity of considering both these services together.

And I need to put them straight on something else. Our waiting lists here in Wales are coming down while they're going up in England, and the Tories know full well that we count far more conditions than they do in England. These are just some of the claims being peddled by a party with a curious relationship with the truth.

We're trying to address serious challenges in the NHS, but if our budget had kept up with the growth in the economy since 2010, it would have been £2 billion better off next year, some of which could have helped us with the NHS in Wales. I would love to have more surgical hubs, but how am I supposed to pay for them when we're given £1 million in capital this year? We can't work miracles.

This winter has been the most difficult in the history of the NHS, not just in Wales but across the whole of the UK. The system has dealt with extraordinarily high levels of emergency demand, high levels of COVID, flu, and a spike in scarlet fever cases. And yet, despite these intense pressures, our major emergency departments have been doing better on the four-hour target than those in England for four months in a row. And we've reduced the backlog of our longest waiters. We're employing more people than ever in the NHS. Every month, the NHS has 2 million contacts with the Welsh population. For a country with a population of 3 million, that's hardly performing poorly. We managed all this after a decade of Tory austerity and neglect by the UK Government, resulting in widespread industrial actions on pay and conditions. We've worked tirelessly with the health unions to find a resolution to the NHS dispute but, unlike my counterparts in England, I didn't wait until the eleventh hour to start negotiations after introducing a divisive anti-strike Bill, and neither did I have £4 billion tucked down the side of a flipping enormous sofa I could call on to help settle the strikes.

Being Minister for health after a pandemic is very difficult work, particularly when the resources aren't available after years of austerity as a result of the actions of the Conservatives. I have taken decisive action in terms of intervening in Betsi Cadwaladr health board, and I'm not going to follow the Plaid Cymru suggestion to restructure and to hold a public inquiry that will cost millions of pounds, will take years, and won't help a single patient in north Wales to be treated more effectively or more quickly.

I ask myself on a daily basis: can I do this thankless job? My response is: 'I have to, because I'm determined to see our NHS working effectively.'

Every day, I ask myself if I can continue to do this thankless job. But every day, I realise that I've got something to offer, and that is that I care. I want to provide the best possible health and care service for the people of Wales. I want our Welsh NHS to succeed. Llywydd, it's going to be my privilege to remain as health Minister for as long as I have the support and confidence of the First Minister. It's my duty to support the people of Wales, to support the NHS workforce, and I'll do my utmost to fulfil that duty. Diolch. 

I call on Darren Millar to reply to the debate. Darren Millar.

Thank you, Presiding Officer. I must say, I'm rather disappointed with the way that this debate has gone at times, because we tabled the no-confidence motion today with a very heavy heart, not because of politics but because, frankly, of poor judgment. And we've just seen some examples of that poor judgment being exercised, unfortunately, before our very eyes this afternoon in the tone and the style of response that the health Minister addressed us in.

I have to say, I had high hopes when you were appointed as health Minister by the First Minister. I felt that it would have given us an opportunity for a change of direction in the way that the health service was being run, an opportunity for a reset, particularly in north Wales, and for a fresh approach to the way that things were being operated. But, I'm afraid that those high hopes were very quickly dashed on the rocks. Over the period since May 2021, when you have been appointed, it is a matter of regret that you haven't listened to sensible contributions from all sides of this Chamber, including on your own benches, which we believe would have made a real difference to the quality of life for staff and patients of the health service across Wales.

We still haven't had an apology from the health Minister—I listened carefully to see if I would hear one today—particularly to those people in north Wales who have been badly let down since 2015, at least, when the health board there went into special measures. You are a Minister who has denied that the NHS in Wales is in crisis, when it's blatantly obvious to everybody that it is. 'Crisis' is a word that you've said you will not use in terms of the national health service. Now, if you can't recognise a crisis, then you're never going to solve it, and it's that sort of poor judgment, frankly, that we're concerned about, and that's why we've felt that we have an obligation to table the motion today—

Will you take an intervention?

No, I won't, Joyce. 

That's a shame. [Laughter.]

So, we've had no apology, there's no admission of a crisis, and we've seen poor judgment exercised in your refusal to positively engage with other political parties, and some on your own back benches, to try and resolve situations that we've been confronted with since you have been appointed as health Minister. And we saw the most despicable act, in my view, that we've seen from a health Minister in Wales in the years in which I have been a Member of this Senedd, when you hung out to dry decent people who were working hard as independent members of the Betsi Cadwaladr University Health Board, trying to drive change without your support and without the support of some of your officials—trying to drive change—and yet, they were left as the scapegoats—the scapegoats—for the failings in that health board, when you know and I know, and everybody knows, that the real problem are the senior executives in that health board as an organisation. You've called into question the integrity, frankly, of those independent members, and tried to tarnish their reputations in doing so in the way that their resignations were demanded.

It may be an affront to some on the Labour benches that we are asking you all today to vote in support of our motion of no confidence. And when I say we don't table it lightly, you know the last time that we tabled a motion of no confidence in this Senedd was 11 years ago. That's the last time we tabled a motion of no confidence in this Senedd—11 years ago. That's the last time we did it, because we don't take it lightly; this is not a game. We're not playing politics. We're not playing politics. What we're trying to do is get better services and put someone in charge who holds themselves to account for the responsibilities that they hold when they have their hands on the levers of power when it comes to our national health service. You have failed to listen, I'm afraid, and you've tried to blame everybody else other than accepting some of your own responsibility.

I've heard the comments about finances, by the way, I just don't accept them. For every £1 spent on the NHS in England, Wales receives £1.20 [Interruption.] You're quite right: we need a needs-based formula. The last time that a needs-based formula was considered by an independent commission in Wales, the Holtham commission, they said that that fee should be £1.15 for every £1 spent in England. So, we're actually getting proportionately more.

So, what would we do differently? What have we called on you to do differently under your tenure that you haven't? Well, we would certainly have removed those executives from the board. You do have the powers, as has already been pointed out today, to remove any employee from the board of a national health service organisation in Wales. You didn't use those powers, even though you have them. We've called on you a number of times to establish a NHS leadership register, requiring everybody who's in a senior leadership position in the national health service to be registered with that in order to work in the NHS, in the same way that clinicians and nurses are required; you refused to do so. We asked you to put Betsi not into the same special measures as before, which is effectively what we've got, but a set of reformed special measures to try and turn the organisation around. You didn't listen to us and then ended up, months later, putting it into special measures. We asked you as well—and have made this point on a number of occasions—to split the role of chief executive of the NHS from that of director general of the Department for Health and Social Care, because we believe that that would also drive some better accountability into the system, but you haven't listened to us.

And when we've got a Minister who won't listen, who won't accept responsibility, who tries to body-swerve around every single person who comes to her and says, 'Well, aren't you responsible?' then, I'm afraid your time's up and it is time to go. And so, for that reason, for this lack of accountability in our health service, for your failures to listen, for your failures to positively engage, for your poor judgment during your tenure, I'm afraid time's up. The buck stops with you and I'm afraid you must go. And I heard what you said about while you have the confidence of the First Minister—what about the other 3 million-odd people out there in the country? What about their confidence? Because I'm afraid that if you come with me to north Wales to meet my constituents—and I would invite anybody to do so—you will find many people who have lost loved ones, who have experienced terrible trauma and pain as a result of the failings in our NHS. And if you would care to speak to them, you'll realise that you don't have their confidence either. I urge people to support our motion.

The proposal is to agree the motion. Does any Member object? [Objection.] There are objections. We will therefore defer voting until voting time.

Voting deferred until voting time.