Y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon - Y Bumed Senedd

Health, Social Care and Sport Committee - Fifth Senedd

17/10/2019

Aelodau'r Pwyllgor a oedd yn bresennol

Committee Members in Attendance

Dai Lloyd Cadeirydd y Pwyllgor
Committee Chair
Darren Millar Yn dirprwyo ar ran Angela Burns
Substitute for Angela Burns
David Rees
Helen Mary Jones
Jayne Bryant
Lynne Neagle

Y rhai eraill a oedd yn bresennol

Others in Attendance

David Jenkins Cynghorydd Annibynnol i Fwrdd Iechyd Prifysgol Cwm Taf Morgannwg
Independent Advisor to Cwm Taf Morgannwg UHB

Swyddogion y Senedd a oedd yn bresennol

Senedd Officials in Attendance

Lowri Jones Dirprwy Glerc
Deputy Clerk
Philippa Watkins Ymchwilydd
Researcher
Sarah Beasley Clerc
Clerk

Cofnodir y trafodion yn yr iaith y llefarwyd hwy ynddi yn y pwyllgor. Yn ogystal, cynhwysir trawsgrifiad o’r cyfieithu ar y pryd. Lle mae cyfranwyr wedi darparu cywiriadau i’w tystiolaeth, nodir y rheini yn y trawsgrifiad.

The proceedings are reported in the language in which they were spoken in the committee. In addition, a transcription of the simultaneous interpretation is included. Where contributors have supplied corrections to their evidence, these are noted in the transcript.

Dechreuodd y cyfarfod am 09:29.

The meeting began at 09:29.

1. Cyflwyniad, ymddiheuriadau, dirprwyon a datgan buddiannau
1. Introductions, apologies, substitutions and declarations of interest

Croeso bawb i gyfarfod diweddaraf y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon yma yn y Senedd. O dan eitem 1—cyflwyniadau, ymddiheuriadau, dirprwyon a datgan buddiannau—dwi'n falch iawn o groesawu fy nghyd-Aelodau i gyfarfod y pwyllgor iechyd y bore yma. Dŷn ni wedi derbyn ymddiheuriad gan Angela Burns, a bydd Darren Millar yn dirprwyo ar ei rhan, ac mae e'n cerdded fewn yn brydlon iawn i'r trafodaethau. Croeso, Darren. A allaf bellach esbonio bod y cyfarfod yma yn naturiol ddwyieithog? Gellir defnyddio'r clustffonau i glywed cyfieithu ar y pryd o'r Gymraeg i'r Saesneg ar sianel 1, neu i glywed cyfraniadau yn yr iaith wreiddiol yn well ar sianel 2. Dŷn ni ddim yn disgwyl larwm tân y bore yma, felly, os bydd larwm tân yn canu, dylid dilyn cyfarwyddiadau'r tywyswyr yn hynny o beth. Oes gyda rhywun unrhyw fuddiant i'w ddatgan? Na. Pawb yn hapus. 

Welcome all to the latest meeting of the Health, Social Care and Sport Committee here in the Senedd. Item 1—introductions, apologies, substitutions and declarations of interest. I'm very pleased to welcome my fellow Members to the meeting of the health committee this morning. We've received apologies from Angela Burns, and Darren Millar will attend as a substitute on her behalf, and he's walking in promptly to the discussions. So, welcome, Darren. I can explain that the meeting, naturally, will be bilingual. Headphones can be used for simultaneous translation from Welsh to English on channel 1, or for amplification on channel 2. We're not expecting a fire alarm this morning, so, if there is a fire alarm, directions from the ushers should be followed in that regard. Does anyone have any interests to declare? No. All content. 

09:30
2. Gwasanaethau Mamolaeth ym Mwrdd Iechyd Prifysgol Cwm Taf Morgannwg: Sesiwn dystiolaeth gyda David Jenkins
2. Maternity Services at Cwm Taf Morgannwg University Health Board: Evidence session with David Jenkins

Reit, symudwn ni ymlaen i eitem 2, gwasanaethau mamolaeth ym Mwrdd Iechyd Prifysgol Cwm Taf Morgannwg. Dyma sesiwn dystiolaeth gyda David Jenkins. Fel cefndir, wrth gwrs, bydd Aelodau yn ymwybodol ein bod wedi cynnal sesiwn casglu tystiolaeth tebyg gyda Mick Giannasi a Cath Broderick o'r panel goruchwylio gwasanaethau mamolaeth yn ystor tymor yr haf. Yn naturiol, mae pawb yn ymwybodol o'r cefndir ynglŷn â beth sydd wedi bod yn digwydd yn yr adran famolaeth ym Mwrdd Iechyd Prifysgol Cwm Taf, ac, wrth gwrs, cawsom ddatganiad arall yn ddiweddar gan y Gweinidog yma yn y Senedd. 

Heddiw, bydd y pwyllgor yn clywed gan David Jenkins, cyn-gadeirydd Bwrdd Iechyd Aneurin Bevan. Fel dŷch chi'n ymwybodol, mae'r Gweinidog wedi gofyn iddo fe helpu cadeirydd Cwm Taf Morgannwg i wella effeithiolrwydd trefniadau arwain a llywodraethu'r bwrdd, a chynghori'r Gweinidog ei hun ar y camau gweithredu sydd eu hangen i ddatblygu trefniadau llywodraethu a sicrwydd y bwrdd. 

Felly, i'r perwyl yna, croeso yn ffurfiol i David Jenkins, cynghorydd annibynnol i Fwrdd Iechyd Prifysgol Cwm Taf Morgannwg. Diolch yn fawr iawn i chi am eich tystiolaeth ysgrifenedig ymlaen llaw, am eich papur. Mae hynna wedi bod yn help i bawb yn eu cwestiynu. Ac, felly, awn ni'n syth fewn i'r cwestiynau, a dweud y gwir. Lynne Neagle sy'n mynd i ddechrau. 

Therefore, we move on to item 2, maternity services at Cwm Taf Morgannwg University Health Board. This is an evidence session with David Jenkins. As background, of course, Members will be aware that we held a similar evidence gathering session with Mick Giannasi and Cath Broderick from the maternity services oversight panel during the summer term. Naturally, everybody will be aware of the background of what's been happening in the maternity services department in Cwm Taf, and, of course, we had another statement recently from the Minister here in the Senedd. 

Today, the committee will hear from David Jenkins, former chair of Aneurin Bevan Health Board. As you are aware, the Minister has asked him to support the chair of Cwm Taf Morgannwg in improving the effectiveness of board leadership and governance, and to advise the Minister himself of further actions needed to develop the board's governance and assurance arrangements. 

So, in that regard, a formal welcome to David Jenkins, independent adviser to Cwm Taf Morgannwg University Health Board. Thank you very much for your written evidence beforehand, for your paper. That has helped us all in our questioning. So, we'll go straight into questions. Lynne Neagle is going to start. 

Thank you, Chair. Good morning. Can I just start by clarifying precisely what your role entails? Because your paper tells us that you're not specifically working on maternity services in Cwm Taf, that you've got a wider role, yet, when Mick Giannasi came in to give evidence to us, we were pressing him on the independent midwife's report, which we are very keen to get to the bottom of, and he told the committee that that was something that you'd been tasked to look at by the Minister. So, can you just clarify precisely what your role is in relation to the maternity services?

Good morning, everybody. My role is not specifically targeted at maternity services. My role is to support the board in improving its general governance and leadership, which was seen to be wanting in Wales Audit Office and Health Inspectorate Wales inspections about a year ago. I do that by providing advice and comments to the chair and others, on the basis of observations and discussions I have with them, and on reading board papers and so on. 

Now, quite clearly, maternity services is an important part of the services provided by the health board, and what happened with regard to maternity services is a tragic example of what can happen when a board's general governance and leadership is not as it should be, and isn't paying the correct attention which it should be to the quality of the services it provides. So, the maternity services, to me, is a tragic example of where things were going wrong, but it's not the prime focus and only focus of what I'm doing. I have looked—I'll be quite honest with you—I have looked and had discussions with people regarding what happened in maternity services, trying to get to the bottom, for my satisfaction, as to why the board wasn't aware of what was going on, why maternity services wasn't figuring more highly on the board and the committee agendas, but I've seen that more as a background piece of information to me in then supporting the board in moving forward and improving its governance and leadership for the future, recognising that it wasn't doing it very well in the past. 

So, are you the right person to ask about the independent midwife's report? Have you gone into that as part of your background work?

09:35

I wouldn't say I've gone into it in as much detail as I presume that Mick Giannasi and his independent maternity services advisory panel have, and neither have I gone into it to the same extent as the review that the board chair, Marcus Longley, commissioned—the Coombs report, which is about to be published shortly—which is specifically into the independent midwife's report. So, I haven't gone into it to the same extent, but I have looked at it.

But would you agree that the fact that that independent midwife's report didn't see the light of day in a timely way is, in itself, a really good example of very poor governance and clinical management? 

It's a very good example of what can go wrong when a board's culture is wrong. I think there was a habit at that time within Cwm Taf, as far as I can see, where things were dealt with at a senior executive level—principally by the chief executive, I have to say—which, in a proper governance way, should have been shared more broadly with the board so that the board could have got assurance that things were happening and matters were being dealt with more appropriately.

I think there was an attempt to solve issues and to not get too much publicity. Cwm Taf was perceived—let's be quite honest about it—Cwm Taf was perceived between 2012-13 onwards up until fairly recently—I'm talking about a year or so ago—as a well-performing successful health board. People would say, 'We've got problems here, we've got problems there, but at least Cwm Taf is okay', and there was a culture in Cwm Taf, which said, 'We are a successful health board'. The board believed that they were successful, the executives believed that they were successful; I'm sure the chief executive, as she then was, believed that she was overseeing a very successful board—'Of course things go wrong, and of course issues emerge, but we can deal with them'. The board certainly wasn't informed as it should have been as to what was going on, and I was never able to find out why and I have to say that, in the discussions I had with the chief executive, she wasn't able to explain otherwise. She said that it was inexplicable. She had no—. She couldn't offer any reason as to why it had happened; it just did.

Well, that's a useful point for me to come into, because I wanted to ask you very specifically—. If I've understood from your paper—and I think there is some confusion, certainly in my own mind, about the different interventions that are happening with Cwm Taf and who is responsible for what; you seem to be very clear in your own mind what it is. Mick Giannasi told us something different, but that's something I think we'll need to pick up with the Minister, Chair; we can't ask Mr Jenkins to be responsible for that level of confusion. But you are very clear in your paper that you are responsible for giving the chair and the board advice.

Can I ask very specifically what advice you gave them with regard to the departure of the chief executive? Because I think what you've just said about her, frankly, is pretty damning. If she didn't know that this was going on, she should have done, and if she did know that this was going on and she didn't tell the board then that's bad too. Now, it's certainly a public perception—I'll be honest, it's one that I share—that she's been allowed to walk away with clean hands, with no consequences, having presided over an organisation that was in crisis, certainly in parts. So, even if only from a public perception point of view, I wonder what advice you gave the board as to whether she should be allowed to go in that manner, as if she was just resigning/retiring and nothing had happened.

Okay. The advice I gave to the chair, which was following having one-to-one discussions with board members—independent members and executive members, but the independent members in particular—was that, in my judgment, and from those discussions, the chief executive had lost the confidence of her board. And therefore it would be impossible, in my view, for a chief executive who had lost the confidence of their board to then pick that back up and continue into the future. I thought her position had become untenable and, clearly, discussions then had to take place with her in that light. Discussions, as I understand, and to my knowledge, did take place with her and that resulted in her eventually deciding to resign from her position.

I hear what you say with regard to her walking away scot free. I should put out very clearly that, whilst there will be issues around the extent to which she kept the board fully informed of the maternity issues, it is highly unlikely, in my view—. I'll say this with a degree of professionalism with regard to employment law—I would say it's highly unlikely that the actions that she failed to undertake would have been sufficient to warrant gross misconduct or dismissal. So, you're in a situation, as ever, with the chief executive of any organisation—they're in an unusual position, in that they cannot successfully continue their role if they do not have the confidence of their board, but the lack of confidence by the board, of itself, is not a sufficient reason to warrant or to justify a legal and lawful dismissal.

09:40

Okay, so not enough to justify legal and lawful dismissal. Did the chair share with you the text of the letter and the press release that were put out at the time of her resignation? Because the text of that letter—I was reading it last night—is full of gratitude to her for everything that she achieved. There's nothing in that letter that says that she'd lost the confidence of the board. That's never been put into the public domain until you've said this now. What would your advice be to a chair in that position? Would it not be better to clarify that she is leaving under a cloud, rather than trailing clouds of glory, which is what you would think if you were a member of the public who wasn't aware of the history? Surely, in terms of the board's relationship with the people that it serves, that was unwise.

I wasn't consulted about the content of that press release or that letter. I would have thought that a parting of the ways on that basis would have been a normal and understandable parting of the ways between a chief executive and their organisation when they had lost the confidence of their board.

Well, yes, I think it very probably is normal, which is why we see people who are failing dismally in some parts of the NHS in Wales and popping up elsewhere, but that, again, is something we must take up with the chair of the board, perhaps.

Can I bring you on to the part of your paper where you talk about the board development programme? Now, you've got extensive experience in managing change in organisations. Is it your experience that it is possible to deliver change in organisations when all the personnel who presided over a difficult situation remain the same? I've talked about my views about the chief executive having walked away scot free. You've spoken in your responses to Lynne Neagle about a board that, prior to this coming about, was perhaps not asking the right questions, was perhaps not challenging enough of its executive team. I hope I'm not putting words in your mouth, but that was what I heard from what you said. And yet, it's my understanding that there are to be no changes at board level. Is it your experience that it's possible to achieve the kind of serious cultural change that you're portraying to us is needed without any change at the top?

I think you're probably misinformed, then, because I think there's been significant change at board level. We have a new interim chief executive, we have a new medical director, we have a new nurse director, we have a new therapies director, we have a new interim director of workforce. I'll just list those. That is a significant and important change in the make-up of that board. I imagine where you're coming from is that there's been no change—

—in the non-execs.

That was what I was talking about. We were obviously aware of the change of staff.

Non-executive members of the board are very reliant—naturally very reliant—upon the information that they're provided by their executive leads. There are things they can do, there are things that I think the independent members of Cwm Taf have learned and are now learning, with regard to how you can go outside of the information provided by your executives to double-check and to ensure that it's consistent with what you're hearing from staff, what you're hearing from patients, what you're hearing from regulators, inspectors and so forth. So, there are other ways that an independent board member can be assured that the information they're getting is correct and is reliable, and it would be true to say that the independent members on the Cwm Taf board were not used to doing that triangulation exercise as much as they needed to have been doing, and as much as they now recognise they need to do, and that, in my view, was because of the false assurance that they were gaining from Cwm Taf, and they were recruited into it, because they themselves were fairly new. Bear in mind that the independent members and the chair of Cwm Taf were only appointed, most of them, in 2017, so they were new members, and they were brought into an organisation that was widely regarded as successful.

09:45

Not by the patients that we've heard from.

I just want to raise one other point, Chair, because I'm very conscious that other people will need to come in. Your paper tells us that you—I want to explore your role as a bridge between Welsh Government—. Because in a sense you've got a dual role, one of which is advising and supporting, but the other is feeding back to Welsh Government. Your paper tells us that you've reported directly to the Minister on three occasions. Now, given the seriousness of the situation in Cwm Taf, does that feel adequate to you? Do you feel that if you needed to see him more often, or to be in touch with him more often, that would be possible?

I have no doubt whatsoever that if I wanted to see the Minister, I would see the Minister. I use this phrase deliberately: because of the soft nature of the work I'm doing, you're not going to see quick and easy solutions. I believe the health board has put [Correction: 'is putting'] in place most of the nuts and bolts and procedures and processes now that it needs to put in place to be a quality-focused, high-performing organisation, but it's going to take a long time for the culture and the behaviours to change. So, it's going to a slow process. My reporting back to the Minister three times in the process of six months I think has been sufficient.

Okay. And just one further question from that, and this is a sort of hypothetical question, but it relates to the dual nature of your role, which, as you say, on one level is a soft role, it's a supportive role, it's an advisory role, but on the other hand, you have a role to report to the Minister and an accountability role there. In terms of your terms of reference, in terms of what you're there to do, if you were giving the chair or giving the board advice that they were refusing to take, what would be the consequences of that? What would you need to do? Would you need to report that to the Minister? How would that work? It sounds as if it's completely theoretical, because from what you're saying, it sounds as if people are taking your advice.

If I was giving advice that I thought was critical and the chair or board members or the chief executive said, 'Absolutely not. We're not going down that road. That's a load of nonsense', I would have to report that, obviously, back to the Minister. It would then be for the Minister to decide whether my supportive role was still credible. My role only works if the people I'm giving advice to are open to receiving that advice, and I think my background, as I said in the letter I wrote to your Chair, at Aneurin Bevan, and therefore my experience of working in a health board, gives some credibility to the comments and advice I give. I've been there and I've done it. 

I'll see what other people pick up on and I may come back, Chair. 

Thank you, Chair. Good morning. Just following on from Helen Mary Jones's question around the board development programme, how will that programme be evaluated?

It'll be evaluated primarily by Deloitte themselves, who will be self-evaluating and—I was going to say 'amending'. The programme will be a living programme and will be developed and framed as the programme is being delivered, so it will be an ongoing process of delivering the programme of advice, information and training and so forth, but at the same time learning from that and picking feedback from that and adjusting the programme going forward. So, the feedback is built into the contract with Deloitte.

But, clearly, as well as that, there will be the evaluation that the health board themselves would be making of the programme they're receiving. And from discussions I've had with the Minister, I would imagine that I will probably have some ongoing role going forward with regard to seeing how that programme works in practice.

The board is very much engaged with it. I think it needs to be pointed out that this programme was brought forward at the request of the board by the board chair to Welsh Government. Obviously it's very good that Welsh Government are providing the funding for this development programme. I think Welsh Government are probably perceiving it as an interesting prelude to what may become a more systematic programme of training for health board members across Wales.

Obviously, being a board member of a health board is an extremely important position and I think, on reflection, looking backwards, perhaps we haven't done enough to support and enable board members to undertake their role to the highest possible levels. So, I think all board members of health boards in Wales could probably do with some ongoing support, and that's what I would hope will eventually come from this particular development programme.

09:50

Okay, thank you. In your experience, do you think there's clear recognition and a sense of ownership, not just at the board level but throughout the organisation as a whole, about the seriousness of the issues that have happened at Cwm Taf?

That's a difficult question to answer. I have absolutely no doubt that, at board level—and I would go a little bit further than that to say that, certainly, of all the people at senior management level that I have seen and met, I've absolutely no doubt that they are totally in recognition of what has been happening, of where the deficiencies have been and what needs to be done to correct those deficiencies.

As to the extent to which it goes deeper into the organisation, I think there has to be a question mark over that. The health board has been working and operating with insufficient attention to quality at a health board level for a number of years. Just stop me if you don't want me to go into this, but, essentially, if you were to go back to around about 2012, the health board, in its first couple of years, was perceived to be a not very good health board, putting it frankly. It was not very good on performance, on its key performance targets; it wasn't very good on finance, it was overspending. And the then chair of Cwm Taf and the newly appointed chief executive put the organisation into what was described to me as, 'We're going into turnaround mode in Cwm Taf, because we're going to have to do something about our performance and our finances.'

And Cwm Taf was in turnaround mode, and the focus became on balancing the books, living within their resource allocation and, at the same time, meeting the important and key performance targets that were set for them, in terms of accident and emergency department four-hour waits, referral-to-treatment figures, cancer waiting times—there's a huge list of performance targets that health boards have to meet. And, largely, they were successful, and that then moved Cwm Taf into being seen as a successful health board, because they were delivering on those things that most health boards saw as the big priorities.

The price for that in Cwm Taf, I think, on reflection, was that there was—and the board now recognises this—under-attention to quality and underinvestment in the quality agenda. There was, perhaps, a presumption that the quality didn't need to be worried about, that that would take care of itself—'This is a health board, for goodness' sake; it's a health service. We don't have to worry about quality, do we? Isn't that what it's all about, delivering a quality service? The real pressures are on the timeliness and the waiting times and the finances.' But what we've seen, of course, is if you take your eye off the quality agenda, then it can be too easy for quality to start going amiss. And that's what they had to learn, and have learned, and now recognise, at some very sad cost. 

That takes me on to my final question. Just to end, in your experience as a former chair and, obviously, in your role as an independent adviser to the board of Betsi Cadwaladr University Local Health Board, you talk about it being widely regarded as a successful health board, you talked about the turnaround that was perceived and the impact that had on quality—to what extent do you think that this is something that could be seen in other health boards in Wales?

I think it must be a risk. I do believe, and I've said this to the Minister, so there's no point in me not saying it to you here, that it would be useful, to put it mildly, for the expectations on health boards to be reviewed and revisited so that it is absolutely clear to health boards and to independent members that the quality of the services they provide is up there amongst the most important issues that they need to be on top of. There is always the danger—and this is not just, I have to say, a ministerial or Government issue; it's a matter for all politicians—that it's too easy at times to focus on the easy stuff, which is how many people are waiting, how long they did wait for; easy to count, easy to measure.

There are some indications of quality in that; don't get me wrong—if you have to wait a long time, it's not a very good quality issue, but it doesn't really get to the root of the quality issues. We need to make sure that health boards are on the quality agenda, and I think that will be helped by a new expectation from this place as to what health boards need to be doing.

Most health boards, I would say, will be overseeing good quality. Certainly, my experience to date has been that quality hasn't been a big issue across NHS Wales, but that's largely been almost despite, rather than because of, the targets that are placed and the statutory obligations that health boards work under, which tend to be very time performance and finance orientated.

Finally, the importance is to ensure—and I think most health boards are managing to do this—that the professional leadership within health boards—. Every health board will have around their table a qualified nurse, a qualified medic, a qualified therapist, a qualified public health expert. Those professional leads need to be heard around the board table, need to be heard in committee, need to be heard strongly at executive level, to keep the focus on quality. I think there's perhaps some evidence to say that the drive in Cwm Taf to financial turnaround took the focus off them a bit and put the focus onto other parts of the Cwm Taf organisation.

09:55

Thank you, Chair. Two points. Can we continue that theme, in a sense, because you're there to look at and support Cwm Taf following the reports on the events there? But, clearly, what you're also going to be reflecting on, and what we should also be reflecting on, is whether this is widespread across health boards in Wales. But let's go to Cwm Taf in the first instance. In your report, you mention the steps needed to be taken in light of leadership and governance failures, demonstrate insight into and an understanding of what had gone wrong, accept responsibility and commit to rectifying the situation. My impression from this is that you believe that those three things have been acknowledged by the existing board. 

But are you comfortable that they actually have the ability to do all those? 

My answer to the first part of your question is positive. I have absolutely no doubt that the health board has shown insight. I think that's an absolutely essential first step. A lot of organisations and a lot of individuals don't always have insight as to where they've gone wrong and as to what has happened. Cwm Taf health board has individual members of the board that have got insight. They've also accepted responsibility for what has happened. They're not running away from it, they're not trying to pretend it's someone else's fault, they're not saying, 'If only Welsh Government had given us more money, we'd all be all right'—the usual stuff that can easily happen, pass the buck on to someone else. They accept responsibility for what's happened. They accept that they have personal responsibility for what's happened, as well as collective, and they are committed to making the changes necessary to ensure that it doesn't happen again, and that Cwm Taf health board—Cwm Taf Morgannwg health board, I should say; I'm short-handing it here—is able to provide a level and quality of services that they believe their community deserves. So, I've got no doubt about that. Have they got all the wherewithal and all the necessaries to do it? Probably not, and that's why the Welsh Government has agreed to fund a board development programme to assist, support, to provide maybe a few extra skills here and there, as is necessary, to provide an opportunity for them to practise and to discuss amongst themselves better ways of doing things, to learn from others.

The Independent Maternity Services Oversight Panel work, for instance, is also helping them to engage with Morecambe Bay on maternity services. So, they've got things to learn. Do they want to learn? Yes. Have they yet learnt it all? Probably not. Have they got all the capacity in place? Well, no, there are still capacity issues in Cwm Taf on the quality agenda. They are addressing it, they are recruiting, they are changing ways of doing things. They're reorganising the way the health board is managed so that there's a stronger focus on the quality agenda.

These things will take time, and there's probably still, I'm sure—in fact, I know there's still—a need for further recruitment to be made and further skills to be brought in to ensure that Cwm Taf does have the composite skills across the board that are going to be necessary. But they're making, I think, good progress, given the scale of the agenda that they're trying to grapple with.

10:00

Okay, because, in your earlier answers, when you'd highlighted the fact that you thought they'd lost the eye on quality as an issue—

I think they had, yes.

—I got the impression, very much, that you might have been in a situation where people who join the board were very complacent because they were getting this positive message from the chief executive, and complacency set in, effectively, in that they didn't have to do a scrutiny job, which is what they should be doing in this situation now. Clearly, this health board, and other health boards as well, I would assume, and I expect, need to start really looking at their role as a scrutinising body of the executive, effectively. And, therefore, do you believe that this programme will ensure that they have the skills to do a proper scrutiny job so that they will ask the questions that they should have been asking before?

The health board themselves have recognised—. I think the phrase they've used is that, 'At times they were too trusting. At times, they were overconfident, and, at times, they were even complacent.' 'This is a good place. This isn't a place where we need to crawl over everything and investigate everything. This is a good board that we've joined.' I think that most of the newer members coming in would have been encouraged with the view that they were joining a successful organisation. And I think we're all human, and if you think that what you're being told is correct, and if you believe that the information you're getting is going to be sufficient—

I think it also comes down to what you understand is your role. Because when we get elected to this place, we understand what our role is. And people are going to health boards and their role actually—and they're paid to do this— is to ensure the health board delivers, and it's not simply to be complacent and to accept the comments that come back; it's to actually question the comments and question the data that comes before them. And it appears to me, in this case—and I think you also mentioned earlier why weren't they aware of what was going on—it seems to me that they didn't understand that their role was to question the executive and check it.

I think there was a degree of questioning. Don't get me wrong, I wouldn't want anyone to think that somehow the health board wasn't asking any questions at all of the executive. There was questioning going on. So, I ask you a question and say, 'Is so and so, so and so?', and you'd give me an assurance that it's all okay. If I've got good reason to trust you, because everybody else trusts you and everybody else says that you're a wonderful guy and you're really one of the best around and are highly reliable and you've been there a long time and you're overseeing a very successful organisation, am I going to say, 'I don't think he's telling me the truth'?

Yes, we don't rely upon what everyone else says; we have our own interpretations and we have our own work. Can I also ask, as part of your work therefore, because I'm aware of other circumstances within Cwm Taf, beyond the maternity, which clearly are linked to the culture of—I don't want to use the word 'bullying', but I probably will—bullying that had been going on in the health board, are you confident that this health board now, as it stands, will look carefully at every aspect that has been going on, not just in maternity but across the health board, to ensure that whistleblowers are supported, that equality is the agenda they want to drive forward, so that they will encourage support for people who will bring forward these agendas, to ensure that people are not victimised if they do raise these concerns?

10:05

I'm absolutely confident that the new leadership of Cwm Taf will be doing that. The new leadership of Cwm Taf has seen this as a high priority. The underlying culture that has been identified—the phrase used was a 'bullying, harassment-type culture'—clearly is inappropriate and should never have been allowed to fester, should have been dealt with some time ago, but is being dealt with now. I've been delighted with the approach immediately adopted by the incoming interim chief executive who quickly identified this as one of the big things to be done, and she's investing a lot of time and a lot of effort in developing relationships with staff, talking with staff, and putting these things right. It's going to take a while, because you're talking about thousands and thousands of people working in health boards, and it's going to take a while to get that culture across the organisation to change, but there is a high priority being attached to it, and I'm confident that they will do it.

Okay, I appreciate that culture change doesn't happen overnight and does take time, but the confidence in the leadership to be able to drive that culture change can happen quickly. You believe with sufficient confidence that the leadership is able to drive that change. 

You have a new leadership at Cwm Taf Morgannwg. I think you have two things, both of which work in favour of a positive future. You have a new organisation—Cwm Taf Morgannwg is a new organisation; the problems were with Cwm Taf. But there's an opportunity, which the board is now taking, to look at itself and to look at its organisation in a new light with a view to putting right those things which were wrong in the past and ensuring that Cwm Taf Morgannwg is a different organisation and that it has a different culture to that which existed within the old Cwm Taf. You have new leadership, and the professional leadership is absolutely critical in this, and the professional leadership has changed.

The leadership I accept, but I would challenge the concept that it's a new organisation, because it could have ended up with Princess of Wales going into Cwm Taf and then falling into the culture already existing in Cwm Taf. So, the fact that you've just got a new organisation doesn't mean to say—

That could be in the approach. The approach actually is to look to take advantage of the opportunity, at an organisational level, that increasing the size of Cwm Taf Morgannwg has given it. It does give an opportunity to revisit structures, it does give an opportunity to revisit culture, it does give an opportunity to revisit staff engagement—a whole panoply of stuff. It has a better opportunity, in my view, as an organisation that can be perceived to be being reborn than it would if it was simply the old organisation. I'm not saying it's the panacea for the future, but it's an opportunity.

I accept the opportunity is there, but the only reason that opportunity is allowing that to happen is because the report came out and found out the faults beforehand. If that report hadn't come out, those faults would still be there, so the opportunity wouldn't have been taken. It's the fact that those reports came out that has given rise to that opportunity. 

Thank you very much. I'm very, very troubled by the evidence that you're presenting us with this morning. You've suggested that this is a new organisation. It's not; it's just an extended territory that has been annexed to an existing organisation. You've said it's under new leadership, and I accept it's got new professional leadership, but it's not got new non-executive leadership; they're all the same faces around the table. We know that the report, which was published earlier this year, highlighted that there were basic governance processes not yet in place in that health board, and this is in spite of people on that health board, who ought to have the sort of very basic governance knowledge that you have suggested they need to be trained in order to be able to be equipped with, which I find pretty extraordinary.

You've got people who have been on this board, and reappointed to this board by Ministers, who, frankly, I think should also bear their responsibility for what went wrong in those governance processes. I'm very surprised indeed that, while we've had significant change on the professional side, not one person has had the decency to go or been asked to step down on the non-executive side. Why do you have such confidence in these people, given that basic governance requirements were not being met?

10:10

I have confidence that they recognise where things were going wrong, they recognise their own omissions and they recognise where they need to put things right in governance terms.

Anyone can do that when they're told where they've gone wrong and what needs to be put right. 

No they can't—[Interruption.] Sorry, I do apologise.

Why on earth are we in a position where people—? People who are appointed as chair and vice-chairs of organisations ought to be people who ask the difficult questions, who try to triangulate the evidence, who don't just accept the word of a professional, but seek alternative assurance sources to be able to demonstrate that those answers that they receive from the executive team are accurate. This is basic stuff. Why do you think that these people should have stayed in place, given their role in allowing this situation to develop? Have you not advised the Government in any way that perhaps there ought to be changes around the non-executive table?

No, I have not. I don't see that there would be any particular gain to be made from changes around the executive table—sorry, around the non-executive table. I believe that the people they have got there are perfectly capable, with the right support and with the right learning, to be a very effective board.

Why should they need to be trained in basic governance requirements? Shouldn't people have basic governance skills before they're appointed to our health boards?

You might think so. I would say that good governance skills are not something that are naturally held by people.

What, for people who are appointed as chairs—you don't think that that should be a good test that they should meet before they are appointed to chair a health board in Wales?

There would certainly be an expectation that they could do it, yes, but I would equally say, from my own experience of having been appointed to Aneurin Bevan health board back in 2009, that in my first couple of years I learnt a lot.

I'm sure you do learn a lot about the organisations that you go into—

—but you come in, surely, with some governance skills. You don't come in completely green, never having sat on a board or had any experience of being able to—

I learnt a lot about—. I learnt a lot in my first couple of years about governance skills as well as about the organisation.

I'm sure you acquire new governance skills and it's a lifelong skill, which you hone and develop over your career as a board member. But what I'm saying is: surely, someone who's appointed as a chair or a vice-chair of an organisation as significant as a health board, on which the population of Wales relies, ought to have some basic governance skills and be meeting basic governance requirements before they're appointed, shouldn't they—not be trained on the job.

I think there's probably a case to be made—. In fact—. Sorry, I have a habit, at times, of talking in a minimalist way. There is certainly a case to be made for looking at the transition of membership of health boards. There is certainly a case to be made to say that it is not helpful to have wholesale changes all at the same time. I think it would have been much better if Cwm Taf's independent membership had changed incrementally rather than wholesale back in 2017. That, in my view, probably means looking at the appointment process of independent members, the length of service that they can do. The idea that everyone can do eight years does tend to give a bit of a cliff edge at the end of the first eight years. So, 2017, eight years on from 2009, became a cliff edge. The same thing happened in my own health board, Aneurin Bevan. It would be better if incremental change took place because then new members coming in would have a better opportunity to learn from experienced members who are sitting round the table. I think there was certainly evidence of a weakness in Cwm Taf, with a lot of new members who had no—or limited previous experience; I wouldn't say no previous experience, but limited previous experience in these types of roles.

10:15

Not all of them, no.

Some of them had been there for four years previously. In fact, the chair of the quality and patient safety committee, as the vice-chair of the organisation, had been there for four years previously before she had her term renewed. I mean, someone in such an important position, given that you said that quality was not being paid proper attention in terms of services—don't you think that that individual might accept some responsibility for the failings, for example? If you don't think that the chair ought to accept any responsibility and you don't think that the other independent members who are new should accept some responsibility, surely someone who's been in charge of the quality and patient safety committee ought to accept some responsibility.

I think, on the basis of the information she had, and the information she gleaned, she did not expect and did not anticipate the information that eventually came to light.

But this is someone who was reappointed by a Minister.

Yes, and she had been undertaking the role, she had been undertaking site visits, she'd been talking with staff, she'd been talking with patients, and she had not picked this up.

So, can I ask you, then, about the appointments process? Because I'm pleased that you've come on to the appointments process. Do you think that the appointments process for board members in Wales is fit for purpose, given your thoughts that you've just expressed to us about the lack of quality in terms of basic governance requirements and people having to be trained in some of these very basic things, even after being on a board for more than six years, in the case of the vice-chair, for example?

As you asked me the question, I suppose I'd better give you an answer. I mean—

I don't think that public appointments methods—. This is not just with health boards. I think the general approach in the UK—it's not a problem in Wales—the public appointments procedures place too much emphasis on interview and not enough emphasis upon skill analysis and ability. 

If you're good at interviews you've got a good chance.

We're obviously interested in Wales and health boards in particular. So, you would suggest that the appointments process for health boards in Wales, if we can bring it back to the purpose of this evidence session—

Should be strengthened.

—should be strengthened, it doesn't focus sufficiently on skills, and it's more about the strength of interview than it ought to be.

I think there's too much emphasis placed upon your skill at interview.

And can you tell us a little bit about the learning processes in the Welsh NHS? Because I represent a constituency in north Wales and, when I picked up the maternity review report into Cwm Taf, I had a déjà vu, because, in terms of the problems that were identified—information not being shared with boards, a lack of understanding about governance from independent members, staff being run ragged with insufficient people on the wards, patients not being listened to—all of that stuff, frankly, could have almost been cut and pasted from similar reports that we've read in terms of failings in north Wales and their governance processes on the Betsi Cadwaladr health board. So, given that those failings occurred a number of years back in the Welsh NHS, why did the same mistakes happen in Cwm Taf and how does the NHS get around this problem of failing to learn from these errors that seem to take place so regularly, unfortunately, in some parts of our health service?

It's a very good question. There's absolutely no doubt that, following every significant service failure, all health boards are expected to, and do, undertake a fairly detailed review of their own services to learn the lessons from what's gone wrong elsewhere and to provide assurance that there isn't a likelihood of similar errors occurring within their own domain area. Cwm Taf will have undertaken, and did undertake, a careful root-and-branch analysis of what went wrong in Morecambe Bay. 'Can we be sure, can we be assured that there's no likelihood of similar problems here in Cwm Taf?' Every health board in Wales would have gone through the exercise following Morecambe Bay. Every health board in Wales went through an exercise after the Mid Staffordshire business. Every health board in Wales went through a similar exercise following the issues at Abertawe Bro Morgannwg University Local Health Board some years ago. So, this is normal practice, to learn from the mistakes of others. 

10:20

Well, that is the normal practice. If you ask me why it is that it's possible to review yourself against the failures of others and to be assured that there is no likelihood of it occurring, only to find—

—that it does occur, I have not got an answer for that. 

But that is one of your tasks, surely. It's within your remit, is it not, to make sure that these governance processes pick up on those lessons that can be learnt from other health boards. 

Yes, and that's something that has to be moved forward. 

Board development, for example, was a big issue in north Wales that then had to be followed up. So, surely there's a failing at a Welsh Government level for not making sure that there are sufficient controls in place, or support being given, shall we say—'support being given' is probably a better phrase—to help health boards ascertain what their development needs might be, in terms of their independent members in particular. 

I think, looking backwards, it would be true to say that the Welsh Government has perhaps put insufficient emphasis on the training and development needs of independent board members. There have been some programmes, but I don't think they've been hugely successful, and certainly independent members, if you were speaking to them, would be probably somewhat critical of those processes and programmes. I think Welsh Government now do recognise the need to improve the support that is provided to independent members to enable independent members to be better at their jobs. And, just like with everybody else, being an independent member is a job, if you like, and you need constant skill development and support in improving your performance. Improvement is not a one-stop shop, it's a never-ending cycle you should be on, and I think Welsh Government do now appreciate the need to improve the training support, the development support, for independent members. I think we're yet to see it coming through into fruition, but I believe that the development programme that is being put in place in Cwm Taf will be successful. I've got a lot of confidence in the programme that is being put in place by Deloitte, and I've had some discussions with them about the programme and how they intend to develop it. And I think that will, hopefully, provide a basis for a development programme for all board members in the future. 

Surely, there ought to be some mechanism, when there is a significant failing in governance in a Welsh health board, that requires some responsibility to be taken by independent members, particularly those charged with being chair and vice-chair of those organisations. I find it rather astonishing—. To be fair—to be fair—in north Wales, at least when there were failings identified at Betsi Cadwaladr University Local Health Board the chair fell on his sword and resigned from that organisation. We haven't seen that in this case, and this is years on, in a situation where there should have been learning from the situation in Betsi Cadwaladr and a situation where the vice-chair has been a member of this health board for at least six, well, five years, as I understand it, at least five years, and charged with responsibility for quality and patient safety, who you say was interacting with patients, interacting with staff and still didn't have a clue what was going on on the ground, which I frankly find pretty astonishing, given that an independent person can come in from the outside and ask a few questions to members of staff and ask a few questions to patients and their families and get horrific feedback, the sort of which made our eyes pop out, frankly, when we saw that report before us. So, I'm sorry, but I don't have the confidence that you have, Mr Jenkins, in the ability of the chair and the vice-chair to help to turn this organisation around. You've talked about new leadership. We need it on the non-executive side of the table as well in our health boards, and we need these people to accept their responsibility also for what went wrong, and to depart this organisation, and not be allowed, frankly, to return to any NHS board in the future. 

10:25

I presume you're doing that more as a punishment exercise than a—

It's not a punishment exercise. It's about accepting responsibility and holding people to account for the failings in poor governance at this health board that, unfortunately and tragically, impacted on the lives of young babies and the families of those who lost them. I find it unacceptable and untenable that these individuals have not been asked to step down, and I find it extraordinary, frankly, that in spite of what you've told us this morning, you still feel you have confidence in these individuals to be able to run that organisation properly.  

I have confidence in their ability going forward, having learnt—

—having learnt—. I have confidence in their ability to deliver good governance in the future. I think they have the strengths and the abilities to do so, with some support, with some development. As I say, insight, taking responsibility and committing to improve are important ingredients. No-one wants to in any way minimise the tragic events that have occurred, and no-one wants to minimise the consequences of the failures that occurred in Cwm Taf some years ago. But, going forward, I think the health board under its current leadership, both at non-exec and executive level, is in a good position to ensure that, going forward, the health board gets it right.  

One final question, if I may. I can remember meeting the chief executive of Cwm Taf and I can remember watching the evidence sessions that were displayed on our tv sets when the chief executive came to give evidence to this committee. At that time, she acknowledged the failings, said that she was aware of them, said that she knew what needed to be done in order to put them right, in the same way that you're saying that the chair of the health board and the other independent members also have recognised. And yet, you said it was the right thing for her to depart the organisation. Why do you think it's right for that individual to depart the organisation, having recognised the failings and said that she was going to work with other people in order to sort them out, and yet you don't think it's appropriate that these individuals who are, effectively, giving the same sort of responses—which I don't have a lot of confidence in, frankly—why do you think that they should stay around, that they should be allowed to survive, if you like, in their positions, and yet the former chief executive not be allowed to survive in her position? 

The former chief executive had lost the confidence of her board, and it is not possible, in my view, which is why the comment I made was that I thought her position had become untenable—and I made that comment to her as well as to the chair—I don't think it's possible for any chief exec of any organisation to continue once the trust and confidence of that person's board has been diminished in—

What about the trust and confidence of the patients and population that's served by the Cwm Taf health board? They do not have confidence in the chair, they do not have confidence in the vice-chair. Don't you think that their views ought to be taken into account, rather than the views of a few people around the table in a boardroom? Isn't it a matter of trying to persuade the public to have confidence in these people and, frankly, they don't?

And the way that the health service works, as you well know, is that the public view—because it's a public service—is delivered through a democratic process and through this house [Correction: 'place'].

It's not delivered through democratic processes in terms of the appointments of non-executives on our health boards. 

The appointments are made via a democratic process. 

We don't have an election until 2021, frankly; I think that's a very lame excuse—a lame response. 

Helen Mary has been very patient, so Helen Mary. 

Uncharacteristically, Chair. If I can just take you back to the process that's going on at the moment, because I've been reflecting on your responses to other Members. We've got the independent oversight panel doing their job; we've got you doing yours; there's the review that the chair has commissioned. Now, it may not exactly be for you to unpick this for us, but are you able to provide us with a bit more information, from your perspective, about how these processes are working together? Because in terms of delivering change, you need challenge and you need support, and I'm finding myself actually more confused after this morning than I was when we spoke to Mick Giannasi and the independent oversight panel before. So can you tell us a little bit more about how you're working together, or if it's appropriate for you to be working together? Because I am a little bit muddled.

10:30

Okay, let me tell you as I understand it. That's all I can do.

The Minister appointed Mick Giannasi and the independent maternity oversight panel to ensure that the health board delivered in a timely way against the recommendations of the royal colleges. That, in essence, is what they're doing. The way they're doing it of course is to review cases, to talk with the community, to talk with people that have used the service. They're doing it by supporting the board, advising the board and helping the board to strengthen their maternity services going forward and to correct areas of deficiency that they identify. They've got professionals involved in that panel, and there are people with clear maternity professional backgrounds working with the professionals in Cwm Taf. So in my view, the work of the Mick Giannasi panel is essentially trying to ensure that the work that was undertaken by the royal colleges in their review of services and the recommendations they made are actioned speedily and appropriately.

In many ways, a lot of the work of IMSOP is backward focusing, because they're looking to see what has happened and to make sure that all the right lessons are learnt from where things have gone wrong, very specifically in the area of maternity services as they're provided by Prince Charles Hospital and the Royal Glamorgan Hospital. Pause on that.

Steve Coombs's report, which was commissioned by the health board chair, was very specifically in light of the royal college's report, who said that they thought that the health board had been misinformed and wanted to [Correction: 'needed to'] get to the bottom, or try to get to the bottom, of why. Were there any lessons for the health board to learn from that specific event that meant that the health board was unaware of the existence of the internal maternity report? That's what Steve Coombs has been looking at, and Steve Coombs's report I believe is going to be published imminently. The extent to which it comes up with answers, I don't know, but it may well be that the messages I picked up, which were effectively that people weren't able to explain at the end of the day why information wasn't shared, why information wasn't put into the correct domains, and why the quality patient safety committee wasn't given the reports that they should have received—. 'Inexplicable' was the way it was described to me by those right at the centre of that decision taking. Whether Steve Coombs gets below that again, I don't know. We'll have to wait and see. That, again, is backward-looking.

My role as I see it is forward-looking. My role is to say, 'Okay, what's happened in Cwm Taf has not been very good, putting it mildly, and has been pretty poor or very poor, to put it more accurately.' On the basis of moving forward, what does a health board need to do in my experience and on my advice to make sure that those things don't happen again and to make sure that it puts itself into a position where it's exercising strong, quality governance, a strong focus on quality services, and strong, effective leadership that engages and listens to staff and engages and listens to service users, patients and the communities it serves? So, that's a forward look. That's how I differentiate between the two. I think IMSOP and Steve Coombs tend to be looking at what's happened, and I'm trying to look towards what's going to happen in the future.

10:35

Okay. I think one of the things that clearly went catastrophically wrong—and I'm at a loss to understand how people didn't know, because this has gone on for a while—was the relationship with patients and the way that patients' concerns were addressed, or not addressed. In terms of your forward-looking role, obviously we know that the oversight panel is having direct engagement with patients who were directly affected and, in another forum, Chair, I'm very concerned about how that's being done, but that's not—. Are you engaging directly with patients in terms of that forward look and what their expectations—? And I don't mean necessarily specifically the patients who have suffered, but are you engaging with patients at all to think about what they—picking up on some of the stuff that Darren Millar has said about the community's confidence and how they're going to feel moving forward—and what they would expect, particularly from the board and particularly from the non-executives, going forward? Has that been part of your role at all?

Should your role be extended, because, obviously, it's coming to an end, actually, shortly—the initial appointment? Do you think there would be any value in that?

I don't know—

It may not be a matter for you. I'd be perfectly happy to take it if you say that that isn't something that would be the right thing for you to do. 

I don't think that a lot would be gained from me having direct discussions with patients. I think it's important that I am sure, and that I'm assured, that the board going forward has a high priority on patient engagement and listening to the patient voice. It's a board function, not my function. I think my function is to ensure the board is doing it—or to be assured the board is doing it. 

But just going back to your earlier points about scrutiny, because part of your job is or has been, because you may or may not continue, to scrutinise what the board is telling you. So, do I take from what you're saying that the board is telling you that they are now investing sufficiently in listening to the patient voice and patient concern? How will you know whether that's true or not if you don't do some—? You don't want to find yourself in the same position that the board did by believing what their chief executive was telling them when, clearly, it was a load of old nonsense. It may not be that it's your job, it may be that the Minister needs to do something else to find out whether that's right or not. 

I can see where you're coming from, yes. Just to pick up on a word you used when you said 'to be assured that the board is investing enough', I don't know at the moment—

And I don't just mean money, I mean priority, time, staff, whatever. 

Certainly in terms of giving it a priority, I've got no doubt. It's one of the big, key development issues that the chief executive identified almost from day one. There are a few big priorities she's running with, and patient engagement, dealing with patient issues, involving patients in service discussions, are key as far as she's concerned. I know it's happening. There's a lot more to be done. This is the beginning of a process, but I'm confident that, under her leadership, this is where the board is going. And this will be part and parcel of the new culture that she's trying to create, which is a patient-focused culture in the health board, which hasn't necessarily existed in the past. So, I'm fully confident there. Whether I've got a role, I don't know. I don't tend to think that there's a role I could easily undertake. 

Okay, thank you. That's helpful. And the last set of questions from me: I think we were all very worried last week to find out that, after six months of intervention, the maternity service still isn't safe. Nobody expects the culture to have been completely transformed, but you don't need to completely transform a culture to make a service safe. And I'd like your views about that.

And in terms of your engagement with the board, I suppose I was a little bit worried to hear you say, 'We are all human', in response to a question from somebody else, because board members aren't paid to be human, they're paid to be sceptical. They're not paid to take what professionals tell them at face value. If you talk to any member of a local authority who sits on a scrutiny committee anywhere in Wales, they will tell you that, when the director comes in front of them, it's their job to dig beneath what she or he says. And so in terms of the way that—. Because you've had a role to challenge and support, where has that balance been, and are you happy you've struck that balance properly? I suppose I'm building a little bit on what Darren Millar has said, because, clearly, if you can support those individuals to change and to be able to do their work properly, then that's so much the better, but presumably there had to be some rigour in getting them to the point where they realised that they needed to change. So, is it all right that, six months on, mothers who pick up the phone and speak to me don't feel safe going into that hospital to have babies, and have you pushed hard enough, I suppose? 

10:40

Let me pick up on—. I think there are two elements to that. 

Yes, there are, but the rigour of challenge is partly about—. You can only answer for yourself and your bit of the process; we have to look at the process as a whole. I suppose my sense is that if, six months on, the service still isn't even safe, there perhaps needs to be a bit more rigour in the process, but I'm looking at that very much from the outside; I'm not a professional. 

Right. Picking up on the rigour issue, I don't want to give the—. Perhaps I've given the wrong impression. I don't want to give the impression that, somehow, the board members—. They've self-identified that they think that, at times, they were over-complacent and, at times, they were over-trusting in what they were being told. They've self-identified that but, from my own perspective, I came into contact with the Cwm Taf board not long after all this became known to them. Bear in mind that the Cwm Taf board, including the chair, knew nothing about the independent maternity report effectively until it was published with the royal college report. They'd seen a draft a couple of weeks beforehand, I think, but it was—. You're into April. Exec members didn't know about it. Only a small number of executive members actually knew about the existence of this report and what it was saying. 

So, when this news broke, the general reaction from board members, executives and non-executives was absolute horror. They could not believe that this had happened on their watch; they could not accept that such events had unfolded when they were sitting around ostensibly responsible. So, there was a great deal of heart searching and soul searching as to how on earth this had occurred, hence their acceptance and recognition that they hadn't been doing the job that they were expected to have been doing, that they had been over-trusting, they had been over-reliant upon information, and relying, really, upon the system to be looking after things as opposed to maybe digging sufficiently. 

But they also recognised, I think, that they had the ability in themselves to do a much better job. I think that from my discussions with independent board members, right from those back in the beginning of May when I first came into contact with them, was absolute commitment from member after member to be contrite as to what had happened, to be responsible for what had happened, but at the same time to be committed to wanting to improve matters going forward so that the services that were being provided within that health board met the needs of the population that they wanted to serve.

So, that's why I've got confidence going forward. I do believe that they have got the passion and the commitment to want to see this put right, and I think in many ways they are in a stronger position to put it right, having been through what they've been through, than somehow rubbing them all out, knocking them all out of the way and bringing a whole group of new people into play.

Anyway, there was a second part to your question— 

The second question, I suppose is—. So, you're characterising them as people who have essentially learnt a very difficult lesson, and we know that's possible. I've seen that happen in other organisations. But yet, six months after the process began, the service isn't safe. Have you discussed that with the chair? Is that all right, because I really don't think it is?

Absolutely. Yes, I have talked about it to the Chair, and I’m seeing Mick Giannasi shortly as well. I do keep in contact with Mick Giannasi and with the IMSOP. They've got a meeting next Monday, for instance, which I’ll be attending.

The headlines don't look good. The headline, which is it’s going to be a considerable time before we can declare maternity services in Cwm Taf to be safe, doesn't sound good at all. But I think you have to try and dig a little bit underneath as to what they really mean, because what they're really being asked is, 'Can you give assurance that the service is now safe?' So, if everybody walked away, if IMSOP packed up its bags and walked out of the room, if everything just moved away, could IMSOP tell the Minister, 'Okay, Minister, we've done our job now; we can give you full assurance that there won't be any more problems in maternity services at Cwm Taf because it’s all been put right'? What they're saying is, 'no', for the same reasons that I'm saying it’s going to take quite a while for the culture and the behaviours to change across the organisation. In effect, what IMSOP are saying is much the same. They're not saying—. The reverse is not true, you see. They're not saying, 'Maternity services in Cwm Taf are now unsafe.' That’s not what they're saying. What they are saying is they cannot give the Minister assurance that it is sustainably safe into the future on the basis of current evidence. They want more evidence, they want more demonstration of sustainability and continuing and sustainable improvement before they can turn around publicly to the Minister and tell him, 'We can assure you our job is done.'

10:45

Well, perhaps it would have been helpful if they'd said that—

I think it might have been—

—because that wasn't what they said. What they said is they cannot be sure that the service is safe today. But I'll leave that there, Chair.

Can I just ask you about—? You say that you've emphasised this need to improve quality and safety at the board, and I've no doubt that you have. The quality and safety committee has met only once since this report was published. Do you think that that’s acceptable?

The quality and safety committee of this particular health board has met only once since the report was published. 

I think you've got the wrong information there, I'm afraid.

Well, I'm looking on the health board's own website.

It's been meeting every month.

Well, it isn't clear from the website that it's meeting every month. If it is, I would very much welcome the correction on the website, which suggests it meets three times a year.

It wouldn't be the first health board to have a website where every page of the website is not fully updated.

These are formal meetings. I can see that it met in May 2018, December 2018, March 2019 and 3 October 2019. They're the only dates listed on the website. It doesn't suggest that much attention is being paid.

No, it doesn't. Obviously, I haven't got it in front of me, but I take your word for it. 

I'm pleased that you are suggesting that that is not the case, but that is a cause for concern.

The quality committee, I can tell you, has been meeting every month and is continuing to meet on a monthly basis. I can also tell you, just to put it on the record, that my advice to the chair and to the board is that they are actually meeting too frequently at the moment. [Interruption.] You may laugh—

No, no, I understand that if an organisation is in panic, one of the things you do is you—

You have lots of meetings.

—and it's not always the best way to do things. I wasn't dismissing the concern.

And my suggestion is I think they need to move to bi-monthly meetings, meeting in the months in between the full public health boards, to get an orderly movement of information into the committee, out of the committee onto the board. The weakness of the quality and safety committee in fact wasn't so much the committee itself, and having lots and lots of meetings of itself wouldn't have sorted anything. The problem was it didn't have the support structures sitting underneath the committee to ensure they were getting the right information in a timely fashion. That now has been addressed with a quality and safety framework, and with new support structures and support bodies underneath the committee that will enable the committee to properly focus on the work it's got to do.

One of the important functions of a website, of course, is to help hold the health boards to account for what it does. Clearly, if the information is inaccurate on there and the formal meetings certainly are only being recorded on a very infrequent basis, I don't think that's helpful. My final question to you—

10:50

I will take that back. 

My final question to you, Mr Jenkins, I'm sure you'll be pleased to hear, is around this accountability issue again. Given that you don't feel that this was a resigning matter for the chair and vice-chair of the health board, under what circumstances do you think a chair and a vice-chair should resign, because I can't think of many reports that are worse than this?

I would have thought any independent member, whether they're chair or otherwise, would be resigning from a health board if they felt that they themselves had not got confidence in their ability to undertake the work going forward, or—and this is important because they're public appointments—if the appointing body—in this case, the Welsh Government—had lost confidence in their ability to so deliver. Independent members, and in particular the chair, act on behalf of the Minister. That's their role. That's why they're appointed. That's why I said earlier on that, ultimately, they are publicly accountable and they are accountable through a democratic process. They're accountable to the Minister who, in turn, is accountable to the National Assembly, or Senedd, as I should call it.

That's like saying that EU commissioners are accountable to people in Wales, isn't it, frankly, because they're appointed by different Governments around Europe, even though we might have—

So, you don't think that they should—. You're talking about their future confidence in themselves and their own ability. You don't think there should be any resigning matters for their past performance, ever.

An individual may well take that decision, yes. I'm not sure whether there's any—

But you don't think that that should be a resigning matter—their past and previous performance in the role. 

If an individual felt that they could not continue in their role—

That's a different point. If they think they can survive, they will survive, many of the individuals, given the significant sums that they're being paid from the public purse. The point I'm making is—. 

I've got to be frank about this; these are the questions that the public want us to put to you. I know they're uncomfortable, but they're the questions that the public want us to put. These individuals are being paid significant sums of money from the public purse. They have very little incentive, if they think that they can survive in their posts, to fall on their sword and step down when things go wrong. You've suggested that there are two circumstances under which people ought to consider resigning from their post: one, if they've lost the confidence of the appointing body and, secondly, if they don't think that they are confident in their own ability to perform in the future. But don't you also think that they should consider their previous performance in a role as one of those other things that might cause them to think about resigning if things have gone terribly wrong on their watch?    

I would have thought that your assessment of your previous behaviours and actions, or lack of actions and behaviours—. Looking backwards at yourself is one of the things you will be doing in assessing whether you have confidence that you are currently able to continue in the role. If an independent member looks and decides that they believe that they can continue to provide a service going forward, if they believe that they can make a positive contribution, then from a personal point of view then they have reason to stay. However, because they're publicly appointed, it's also a matter for others to form a view about their performance, others to form a view as to whether they're able to continue to have the confidence of the process as public appointees.   

What if they're misguided in their own ability and confidence in themselves to turn an organisation around? 

Then you'd expect the usual process to come into play, which would be through the assessments they get. Board members have appraisals and assessments on a regular basis by the chair, and you're going to say, 'Well, the chair should be gone anyway, so how can he make the appraisals?' I know where you're coming from on that one. The chair, in turn, is regularly appraised and assessed by the Minister. So, there is an appraisal and assessment process in place. You may well say that you don't think that's operating as effectively and efficiently as it might do, and that is a view you may want to hold.

I don't know, because I don't get involved in that discussion. 

So, do you think it's operating effectively and efficiently, given that basic governance processes weren't been adhered to in this health board?

10:55

In terms of my own experience of the process, it was working in my instance, yes.

I don't know.

But I wasn't there.

You don't. Even though you've got the evidence in front of us in a text that says that basic governance processes weren't—

I do not know any discussions between the Minister and Marcus Longley as chair of the health board. I don't know the details of discussions that had taken place between Marcus and his independent members with regard to their personal appraisals. Those matters are on record, they are on file, and they are confidential as they're matters pertaining to their positions.

The report, the interim report that you've provided to the Minister—just for the record, is that going to be published at any point and put in the public domain for us to scrutinise?

'I don't know' is the answer to that. As far as I'm concerned, I have no reason to want to keep it private. It's a matter I've sent to the Minister. I should say that I have shared it with the board members at Cwm Taf in a private session discussion, so they are aware of what I've said about them, but it's not yet, as I understand, in the public domain.

Ocê. Diolch yn fawr. Rwy'n credu dŷn ni wedi dod i ddiwedd y cwestiynu. Felly, diolch yn fawr iawn am eich presenoldeb y bore yma. Diolch yn fawr hefyd am y papur y gwnaethoch chi ei ddarparu ymlaen llaw. Gallaf i gadarnhau y byddwch chi'n derbyn trawsgrifiad o'r trafodaethau yma er mwyn i chi allu gwirio eu bod nhw’n gadarnhaol ac yn ffeithiol gywir. Gyda chymaint â hynny o ragymadrodd, diolch yn fawr iawn ichi, a dyna ddiwedd yr eitem yna.

Okay. Thank you very much. I think we've come to the end of our questions. So, thank you very much for being here this morning. Thank you also for the paper you submitted beforehand. Can I further confirm that you will receive a transcript of these discussions in order for you to check that they're factually accurate and correct? So, with those few words, thank you very much, and that's the end of that item.

3. Papurau i’w nodi
3. Paper(s) to note

Symud ymlaen i eitem 3 a phapurau i'w nodi, bydd Aelodau wedi darllen y wybodaeth ychwanegol gan y Bwrdd Cynghorau Iechyd Cymuned ynghylch y Bil Iechyd a Gofal Cymdeithasol (Ansawdd ac Ymgysylltu) (Cymru). Hapus i nodi hwnna?

Moving on to item 3, which is papers to note, Members will have already read the supplementary information from the Board of Community Health Councils regarding the Health and Social Care (Quality and Engagement) (Wales) Bill. Are you happy to note that?

4. Cynnig o dan Reol Sefydlog 17.42(vi) i benderfynu gwahardd y cyhoedd o weddill y cyfarfod.
4. Motion under Standing Order 17.42 (vi) to resolve to exclude the public from the remainder of this meeting

Cynnig:

bod y pwyllgor yn penderfynu gwahardd y cyhoedd o weddill y cyfarfod yn unol â Rheol Sefydlog 17.42(vi).

Motion:

that the committee resolves to exclude the public from the remainder of the meeting in accordance with Standing Order 17.42(vi).

Cynigiwyd y cynnig.

Motion moved.

Eitem 4, a chynnig o dan Reol Sefydlog 17.42(vi) i benderfynu gwahardd y cyhoedd o weddill y cyfarfod yma. Pawb yn gytûn? Cytuno, felly awn ni i mewn i sesiwn breifat.

Item 4 is a motion under Standing order 17.42(vi) to resolve to exclude the public from the remainder of the meeting. Is everyone content? Yes, therefore we will move into private session.

Derbyniwyd y cynnig.

Daeth rhan gyhoeddus y cyfarfod i ben am 10:57.

Motion agreed.

The public part of the meeting ended at 10:57.