1. What assessment has the Minister made of Healthcare Inspectorate Wales’s report on the emergency department at Glan Clwyd Hospital? TQ757

The Healthcare Inspectorate Wales report notes the hard work and commitment of staff at Ysbyty Glan Clwyd's emergency department and there have been some encouraging improvements following the previous inspection. However, it is very disappointing that many of the issues have still not been fully resolved.

I appreciate your response this afternoon, Minister, and I'd like to thank the Llywydd for accepting my topical question this morning. I'm very pleased that it has been accepted as I've read the HIW report into emergency services at Glan Clwyd Hospital today and I'm shocked. I'm shocked that this is the third inspection within a 12-month period and we're seeing scant evidence of any progress being made on the recommendations supplied by the inspectorate. Let me make it clear that this is no attack on the front-line workers in the department, who are working way above and beyond their job descriptions, but they are firefighting. They are firefighting a high concentration of acutely unwell patients, staff sickness and a lack of space in the department to practise safely. But why are staff going off sick? There is good evidence that staff are going off sick because they are overworked, stressed, burnt out and becoming unwell, and it's a vicious cycle with the issue not being solved. The consequence of that is the perennial hiring of agency staff, which then costs a fortune.

As I've mentioned many times in this Chamber to you before, Minister, the people of the Vale of Clwyd, Denbighshire, Conwy, Flintshire and across north Wales have had enough of bad news after bad news within this health board, and are tired of years and years of no action and deflection of blame and accountability. When you combine this with the recent news that Betsi Cadwaladr has been returned to special measures in the last month, with the chair of the board and independent members being forced to resign by you, instead of the executives, then you can hardly blame my constituents for feeling this way. But I want to be constructive with you, Minister, today. Now you have survived the confidence vote last week, and have the backing and mandate from the First Minister, I want you to find a way out of this situation that we are currently facing in north Wales, and resolve some of these chronic issues in Betsi Cadwaladr. That will help everybody: my constituents, patients, staff and the overall culture within the board.

I have a few questions in my supplementary that I'd like to ask you this afternoon, Minister, if I may. What communication have you had with the new chair of Betsi Cadwaladr so far regarding this matter at Glan Clwyd Hospital? Are you satisfied that his and the new board's aims and objectives match that of the needs of the problems at the emergency department? I'm aware that you are unhappy yourself, Minister, with the current structural size of the emergency department—[Interruption.]

You have one question, effectively, but not a load of questions, so please keep it to the short and minimum, okay? 

Okay. I'm aware of the structural issues that you've got with the department, so what discussions have you had with the estates team to maximise that capacity and make a safe working environment for all staff and patients?

With the staff sickness problems within the department, what liaison have you had with the executives and the individual operational departments to improve the staff culture and issues within the board? You may say this is not within your gift to achieve, but let's remember, Minister, the health board is now in direct control of the Welsh Government, so it is in your and your department's remit to tackle some of these internal issues, and the liaison with all relevant departments is crucial in tackling this problem. 

What assessment does the Minister make of the internal triage system within the emergency department in consideration of heart attacks, stroke and sepsis, which require rapid treatment, rather than waits of up to two hours? What potential approved clinical pathways have you observed, both in theory and in practice, when visiting hospital sites, that could be implemented as a solution to this problem? And, finally, Minister, do you genuinely believe—[Interruption.]

The Member must be allowed to ask his question, and he will finish on this question. 

Thank you very much. Do you genuinely believe that the emergency department at Glan Clwyd Hospital has the potential, in the long term, to improve its fortunes, and be in a position in the future to get waiting times down and be a reliable service for patients in north Wales going forward?

I appreciate they are technical questions, Minister, but I hope they are also helpful to you in formulating some ideas to improve the situation, as I was elected by my constituents on the basis that the technical skills that I acquired in my time in the NHS would be effective and influential for Ministers. Thank you. 

Thanks very much. Obviously, I'm not happy with the progress that's happened in Ysbyty Glan Clwyd, and, obviously, I did have sight of this report prior to me putting them into special measures. I was very concerned, and it was one of the many factors that made me lead to that action that I took.

Staffing is a real issue. It's not an issue just in Ysbyty Glan Clwyd; it's an issue throughout the world. I was in a conference recently in Denmark, and the talk of the entire conference was about how difficult it is to recruit people to the health service. I've been talking, today, to the medical director in Betsi about what opportunities there are in relation to improving staffing facilities and recruiting more people in Betsi Cadwaladr, but specifically to see what more we can do in relation to providing that additional support in Ysbyty Glan Clwyd. 

You'll be aware that we've escalated this particular facility from targeted intervention to special measures; that means that, obviously, with the special measures, we will become more directive. I think it's really important that people understand that that doesn't mean that we are running the health board. So, it's really important that people understand that the responsibility for running the health board is still with the chair and the chief executive; I'm not running the health board. It's really important that people understand that what we're there to do is to make sure that we support them and we become directive in terms of what our expectations are.

I think it's really important that we try to ensure that people understand that the majority of people who have care, even in this emergency department, continue to receive good care and a good experience, but there are too many people who are not having that good experience. One of the things that I've been very keen to do is to make sure that we give more support to urgent and emergency care, and that's why we've earmarked £25 million across Wales. But, in addition to that, there has been a specific allocation of £418,000 to emergency departments in Betsi, because I do appreciate that, actually, this is not going to go away in the sense that the demand is constant. Obviously, we've got a lot of work to do on flow, but I want people, while they're waiting, to have a more pleasant time than they are now, which is why we're putting some additional facility and support into the capital and the infrastructure in emergency departments.

There's a lot of work to do, clearly, around the staff culture in relation to what is happening in the emergency department. There are, I'm sure, many, many able people; there are people who are working extremely hard. But, also, I think it is important to note that this report suggests that some of the staff were not always kind and courteous to patients, and we have to make sure that there is a no-tolerance approach to that. It's clear that things need to change in relation to the culture in Ysbyty Glan Clwyd, and in particular in the emergency department. I hope, this time, that the health board will pay heed to this report and that we will not see another poor report from HIW again. 

Here we are again—another damning report. We are talking about an inspection that had placed the emergency department at Ysbyty Glan Clwyd in May of last year under the designation of a service that needs substantial improvement. Let's be clear that this is the highest tier of concern that can be expressed, and nothing could be more of an incentive for the Government to act to ensure that things do improve significantly.

We could look at the positives, and note that the most recent report, after the most recent inspection, said that things had improved somewhat by that point, but what we read, I'm afraid, is—and I quote—that there have been 'minor improvements'. Now, I hope that I'm correctly quoting the Minister when she said:

'Many of the issues have not been fully resolved'.

Well, it's not that they haven't been fully resolved; there have only been minor improvements. There is one sentence that really struck me, namely that, 'Inspectors from Healthcare Inspectorate Wales had to assist one patient who needed help but no member of staff was to be seen'. How appalling is that—that inspectors are not only seeing those deficiencies, but they actually have to step in to help? It is quite frightening.

Through all of this, the staff are praised, and we, as a Senedd here, can praise those staff too. Their relationship with local managers is also praised, and it's worth noting that. The problem, and what we have to ask again today are questions about those senior managers—the executive board committee—and many of them have a lack of understanding of the problems in Betsi Cadwaladr emanating from the fact that they are at a physical distance from the area, as well as in terms of their understanding of the situation in Betsi Cadwaladr—many of them are interim positions of course. Now, the question is: why has the Government allowed things to drag on for so long? This is a copy of a report from nine months previously. If placing the board in special measures was the solution, why wait for nine months? But now that you, as a Government, have a hold of the board through those special measures, what steps will be taken to ensure that those staffing problems are resolved—that there is a new overview of how to tackle the staff rota problems and so on?

Unfortunately, what we have here is a board that has shown time and time again that it is broken and a Government that is failing to tackle the situation by taking those brave steps—taking those far-reaching steps of giving us a new start in Betsi Cadwaladr. The Minister can't use cost as an excuse for not reorganising because it has cost more to try and put things right and fail, and the Minister cannot use as an excuse the fact that that would be disruptive. There is nothing more disruptive than the lack of confidence and the lack of faith that people and staff in Betsi Cadwaladr have now in the ability to turn things around. So, let's have a fresh start. Will the Minister agree to my question once again today to put a plan B together, because I'm afraid that people's confidence in plan A—continuing with Betsi—has long since dissipated?

Well, I think the Government has acted—we've stepped in and given an opportunity to the board to act, and what we saw were not the kind of improvements that we would have expected to see. This report is not acceptable. The report does praise the staff to a certain extent. Some of them are critical of some of the staff and it is important that we monitor that because that's part of the culture that needs to be changed, particularly in Ysbyty Glan Clwyd. I do agree that we need to look at the role of the senior managers here and I know that the new chair is looking into these issues.

Regarding staffing, I am pleased to say that they are now in a position where there are two new consultants in the department, so it's up to a full complement in terms of what's expected in an emergency department. And we've also seen recruitment for bands 4, 2 and 5, and now what's happening is that there are monthly sessions that are being held where managers listen to the concerns expressed by staff and ensure that staff have an opportunity to have their say on their concerns.

I share the astonishment at the fact that we have yet another report before us that regurgitates many of the same concerns that we've seen twice before. I note that this inspection by HIW actually took place in November of last year. Why on earth has it taken so many months for these reports to see the light of day? And the Minister may well say that there have been improvements, and there do appear to have been some improvements, certainly in terms of record keeping, but we know, from our own post bags, as local Members of the Senedd, that there are still huge problems in that emergency department. Just this week, I was contacted by a constituent whose husband was conveyed to Glan Clwyd Hospital in an ambulance in a serious state and wasn't seen by a doctor, to be examined, for 28 hours—over a day. That is obviously unacceptable and potentially put that gentleman at serious risk of harm.

The siutaiton is not getting any better from a patient perspective. It seems to only be getting worse. I want to see these improvements driven forward. It's very clear in this report that the staff did not feel supported, and I quote from the report:

'...did not feel supported by health board senior leaders.'

These are the same senior leaders that you, Minister, have allowed to stay in post. When will we have an accountable NHS so that people like this, who are failing to resolve long-standing issues in that emergency department—when will they be sacked? We need to see the back of them. We won't see improvements before they are moved on. It's unacceptable and my constituents and other people in north Wales deserve a lot better than this.

Thanks very much. Obviously, it's not my report to publish, it's HIW's report, and they're the people who determine the timescale on which that happens. Look, I acknowledge that there are still very, very serious problems, in particular in relation to Ysbyty Glan Clwyd and in particular in relation to the emergency department. That's why I've had serious discussions with the medical director to ask about what exactly is being put in place. Of course it's unacceptable if somebody is not seeing a doctor for that length of time. Triage, of course, is really important, but there are occasions when triage is taking too long, as well.

What's interesting for me is that there seems to be a specific problem here with the emergency department in Ysbyty Glan Clwyd, because I visited the emergency department in Wrexham Maelor recently, and it seemed to be far more organised and under control, they knew what they were doing, and it was in a much better place. So, one of the things I think we've got to encourage is to learn best practice from the other emergency departments that are working better in Betsi.

I don't know how many times I can say this: I do not have the ability to sack people who I do not employ. I cannot sack executives, and I think it's really important that people understand that the chair will obviously be looking at what needs to be done in this space, and I know that he's looking at that very seriously.

Thank you, Minister.