National Assembly for Wales

Bore da. Good morning, everybody, and welcome to the Health and Social Care Committee this morning. Please note that the meeting is being held bilingually and simultaneous translation is available between Welsh and English. I'd like to welcome all Members to the meeting this morning. We have one apology, which is from Peter Fox. I would like to see if there are any declarations of interest from Members? I will start: I've known Kirsty for a number of years. Any other declarations of interest?

Yes, I've known Kirsty Williams for many years and worked with her.

Joyce Watson.

I also have known Kirsty for a number of years and worked with her.

Lovely. John, are you trying to—?

Similarly, Chair, I've known Kirsty for many years, and worked with Kirsty as well.

Lovely. Grand. That's all the declarations of interest done.

So, we move to our agenda item 2, which is the pre-appointment hearing for the role of chair of Cardiff and Vale University Health Board, and evidence session with the Welsh Government's preferred candidate, which is Kirsty Williams. Good morning. Thank you very much for coming today. We've got a number of questions from committee members, and I'll kick off the questions, if that's okay. Diolch yn fawr iawn. The first question is: why do you believe that you are well suited to the role, and how would you draw on your skills and experience to ensure that Cardiff and Vale University Health Board is an organisation with strong governance, accountability and financial management?

Well, to begin with, I believe that I have the unique set of experiences and skills that will allow me to be an effective leader of the Cardiff and Vale University Health Board. Those are, namely, experience in strategic thinking and helping organisations develop and implement strategies, most recently at Powys Teaching Health Board as the vice-chair, but also at South Wales Fire and Rescue Service, which have just launched a new strategic programme, or, for instance, in the field of education, where I'm the chair of the advisory board for the International Learning Exchange Programme and we've set up a brand-new international education exchange programme.

I have good governance knowledge and experience, again drawn across a wide range of sectors, in both the public and voluntary sectors. I understand what good governance looks like and, importantly, what poor governance looks like, and I'm able to influence organisations to improve their governance. That includes ensuring that organisational goals and risks and controls are all in place.

Crucially, after a career of some 16 years scrutinising Government, I have excellent scrutiny skills, although, I have to say, I've had to amend my approach, and I am far more constructive than perhaps some colleagues in this room would remember. Scrutiny is absolutely crucial, but doing that in a way that is not undermining of chief executives and executive colleagues, but, actually, just explores thought processes, explores assumptions that are being made, and tests the proposals that are being brought in front of you, and, if necessary, having constructive challenge to executives when potentially there may be a disagreement or they are advocating a course of action that, perhaps, you think would be detrimental to the organisation, but doing so in a way that does not undermine executive leadership and maintains those constructive relationships—being a critical friend, rather than necessarily always being the cheerleader for the organisation.

I am skilled in stakeholder management, in both good times and challenging times, and I'm not afraid to put myself before a hostile audience to defend decisions that are being made. I'm used to creating and working within teams, sometimes in unusual circumstances, where there perhaps has been a difference of opinion, but I'm able to put that aside to be able to focus on the good of the organisation to drive improvement, and I have knowledge of the health sector.

I hope that is a flavour of why I believe that I can bring the necessary skills and experience to this role.

Diolch. Thanks, Kirsty. You mentioned the role you have with Powys Teaching Health Board. I'd just like to dive a bit more into that, if I can, and the knowledge and experience you have in the healthcare sector within Wales. The health board that you currently sit on is predominantly a rural health board. Cardiff and Vale serves rural and urban, but mainly an urban population. So, I was just wondering about the experience you have around the urban needs across Wales with regard to health and how you're going to bring that experience to the table.

Okay. Well, first of all, I think it's really important to recognise that, as the chair, this is not an operational role. This is a governance role. The operations and the delivery of service is, quite rightly, the responsibility of the chief executive, and the executives and the team are accountable to that. And good governance is the same, regardless of whether you're working in an organisation that is primarily rural facing or whether it is urban facing. The legislation, the compliance and the regulatory agendas are the same. But, of course, one has to recognise that individual populations will have very, very different needs. And that's one of the things that really inspired me to apply for this job in Cardiff, because I think it is a really interesting mix of services and populations that it has to respond to. 

We know that Cardiff and the Vale area is an area of population growth, rather than depopulation, and that is driven predominantly by working-age population. I'm afraid to say, statistics tend to show that that working population is probably of worse health than the older generation is now, because of lifestyle choices that they have made. Interestingly, it's a really, really diverse population in terms of socioeconomics, with the southern arc of the area suffering from some significant levels of poverty and deprivation, sitting alongside some of our richest communities within Wales. And ensuring that those voices that sometimes are the least heard are brought to the fore will be really, really important.

It's also a population that is more transient than you would find in other areas. It's a population that has to respond to its anchor as higher education establishments, with populations of both domestic and international students moving in and out, and the challenges that brings. Of course, it does not escape from the demographic challenges of an ageing population and how you deliver services to that population within this particular setting. And also, crucially, not forgetting that this health board also has a responsibility, both regionally and nationally, as the regional deliverer of services and the tertiary deliverer of services. Crucially, because it's within the capital city, there are things that the health board has to think and plan for that wouldn't be applicable in other areas. One thinks of the significant night-time economy the capital city has, as well as large, international cultural and sporting occasions, which we have to plan for. That's one of the things that I'm really excited about—having the opportunity to engage with a population that is so diverse, and, of course, the scale is very different.

But, having said that, those of us that live and work in rural Wales are not immune to the rest of the world and lack an understanding. There are two members of this committee who represent predominantly rural areas who aspire to be the health Minister next year. The fact that you represent a rural area doesn't preclude you from understanding the health needs of the entire nation. I'm used to working in a national capacity and looking to deliver services in education in both rural and urban environments. And, of course, as the commissioner for the South Wales Fire and Rescue Service, I'm already working within these communities and have an understanding of their needs.

Thank you very much for that comprehensive answer, Kirsty. Moving on, you did mention at the start a number of the boards you're on and your other appointments. So, just given the number of existing commitments that you currently hold, how do you propose to make sufficient time available to Cardiff and the Vale to do this chair role?

Well, of course, I would not have put myself forward for selection if I wasn't confident that I could fulfil the commitments that are required of me, and this was explored in my interview with officials. I am used to carrying a significant workload at present. As well as being the vice-chair of Powys Teaching Health Board, I am also the chair of their patient experience, quality and safety committee. I have two other committee assignments. I have one of the highest committee assignments of any independent member in the health board, and I also chair the Powys regional partnership board. And I manage that alongside other commitments. My chair would attest that I have excellent attendance and, indeed, I am often the first port of call when other independent members are not available to ensure that there is a quorum for business to be taken forward. I have run a political party and run a Government department, all whilst raising a family, so I am adept at managing and prioritising my time.

I would like to give some reassurance. Some of the roles that I have are time limited. I'm pleased to say that we're making really good progress in the South Wales Fire and Rescue Service, and I hope that that intervention will be brought to a conclusion, because I think we are making progress there. And, of course, I'm also very grateful to my colleagues, for instance, in Taith. That is a voluntary commitment; I'm not paid to do that. I do it because I believe wholeheartedly in the importance of that scheme, and, because they are aware of my other commitments, they are very flexible in ensuring that meetings are planned well in advance, in conjunction with my health board diary. Luckily, we're at the stage, for instance, in Taith where, at the beginning, it was very labour intensive, but we're now in business as usual. There are quarterly meetings, they're planned in advance, and I'm able to manage accordingly. So, I would not be putting myself forward—. If, of course, though, it became clear to me that I could not manage all the commitments, then I would have to reassess, but, at this point of time, I'm confident that I can do so.

Lovely. Thank you. And the final question from me: I was just want to get your view on whether any of the appointments you currently hold give rise to any potential conflicts of interest, or perceived conflicts of interest. If so, how do you propose to manage these conflicts or perceptions, including whether you would divest yourself of any of these roles? 

Well, as you'll seen in the questionnaire that I've sent to the committee, clearly, Cardiff and Vale University Health Board are subject to fire safety legislation and regulations, and although the chief fire officer is operationally independent of the commissioners, clearly, some of those issues come across our desks as a matter of oversight. I would ensure that both interests are recorded in the declaration of interests in both organisations, and I would recuse myself from any decisions or conversations where the work of one organisation may impact upon another. So, for instance, this time last year we held a consultation at the fire service on the introduction of a new policy to deal with automated fire alarms. As a result of that consultation—which we may come to later as an example of where I had to push back on an executive colleague who wanted to act in a way that I did not think was in the interests of an organisation—we gave an extended time period for the health boards to comply. So, obviously, in those discussions, I would have had to recuse myself. And so, I'm very well aware and would take the necessary action to ensure that there was no conflict.

Diolch yn fawr. Thank you very much. And now questions from John Griffiths.

Bore da, Kirsty. A couple of questions on the strategic direction of Cardiff and Vale University Health Board. We know that, currently, the health board's status is a little bit challenging in terms of the NHS Wales escalation and intervention arrangements. Given that state of affairs and the need to improve the health board's performance, what would you say to committee in terms of what need to be the short-term and long-term strategic visions, main aims, objectives and priorities to bring about necessary improvement? 

Thank you, John. As you say, the health board is currently in level 4 Welsh Government escalation for finance and planning, and this year is forecasting a deficit position in the region of £58 million, which, of course is really, really significant. What I would want to understand is why the health board has moved from a position where, just two years ago, it was predicting that it would have a sustainable balanced budget by the end of the 2025-26 financial year. What has happened in that intervening period to end up where the prediction at the moment, as I said, is circa £58 million?

I'm very conscious that this appointment, should I be confirmed, would not begin until 1 October. The ability to turn things around within almost half a financial year is going to be really challenging, so I think, for me, I'd want to be able to sit alongside colleagues to understand what that trajectory is over a one, two, three-year period and how we can make the necessary arrangements to satisfy the Welsh Government to see us move out of level 4 escalation.

I think that's really important, culturally, for an organisation. First of all, being in a level of escalation, actually, quite understandably, and rightly so, means that executive colleagues are engaged in that process. And when they're engaged in that process, they're potentially not doing other things. Also, if that status lasts for too long in an organisation, I believe that you almost get into a sense of resigned hopelessness—that that's the way it always has to be. I'm more confident and I'm more ambitious for our health services than that. I do not think it's an inevitability. I think we have got the ability in Wales to run a sustainable health service, and that's why I want to play my part in doing that and supporting executive colleagues in Cardiff and Vale to do it. So, I think the finances we need to look at.

Then, there are issues around performance. Can I just say, it's inevitable, isn't it, in conversations like this, and in the work that you all do as elected Members, that we often focus on the deficits with an organisation? Today, tomorrow, every day, for 365 days of the year, there will be staff in Cardiff and Vale University Health Board who are doing their absolute best to provide outstanding person-centred and quality care for the citizens of their area. So, I want to caveat anything else I'm going to say by recognising the massive commitment and the exceptional work that goes on day in, day out. Indeed, Powys commission services at Cardiff; myself and my family, over the years, have used those services.

But undoubtedly, there is room for improvement. One only has to look at the position around diagnostics. A significant amount of the long waits for diagnostics in Wales at the moment are currently held at Cardiff and Vale. Indeed, the ministerial advisory group report actually names Cardiff and Vale with regard to the long waits for non-obstetric ultrasound scans. So, clearly, there are performance issues, John, that will need to be addressed, and we will need to meet the challenge of the Cabinet Secretary's targets for this year. So, I think we need to make sure that the entire board has a real grip on where we are with regard to performance, both in terms of finance and in operational delivery. One of the really important jobs of a chair, and, indeed, the board, is to hold their executives to account for performance.

I have to agree with the ministerial advisory group—and this is perhaps controversial. The history of devolution, which I have dedicated my entire adult life to, is littered with reports and strategies. We really need to get into the business of really great implementation, and supporting organisations to implement what we know needs to happen. Sometimes, that can be the gap. So, for me, it's understanding what are the barriers to implementation.

And then, finally, we cannot ignore in this conversation the culture of the organisation. Some of that has been publicly laid bare, hasn't it, with the recent report into the culture at the operating theatres at the university hospital. There are obviously immediate make-safes in terms of patient safety that the executives would need to address and that the board would have to have assurance on. But those failures in patient safety speak to, I think, cultural issues that underpin that. Nobody goes to work deliberately to undermine their colleagues, to make life difficult for their colleagues, or not to do the absolute best.

So, it's understanding what sits behind a culture that has led to some of those really difficult-to-read findings in the theatre report, understanding that, and how do we address those cultural issues. How do people act when the eyes are not on them? What is the way that people behave in this organisation day in, day out? There are other reports, I understand, that are being looked at at Cardiff and Vale University Health Board at the moment. I'd want to look at what is the board doing to address cultural issues.

I'm conscious that, as always, I'm talking too much. But I'm very happy to explore my approach to delivering cultural change alongside executives.

I'm sure Lesley will bring that up in a bit.

Kirsty, is there anything additional you would say in terms of, were you to become chair, how you would guide and support the health board to make the necessary improvements? Is there anything more, other than what you've already said, that you would like to say?

As I said in my questionnaire, there is a necessary and understandable focus on secondary care, but I also don't think that the health board can take its eye off the ball in terms of improvements to population health. There are some of the biggest health inequalities existing in this health board area than anywhere in Wales. That's a difference, for male life expectancy, of 10 years; for healthy life expectancy for men, it's almost a difference of 20 years. That is absolutely staggering to think about the impact of that on life chances. So, how would I go about it? I would be a visible champion for both the acute side and the secondary side, holding executives to account.

For instance, in Powys, as chair of the patient experience committee and the delivery and performance committee, I have relentlessly pursued the issue, for instance, of neurodiversity, working with colleagues, persuaded them to do a deep-dive, found an internal waiting list that wasn't being reported. With consistent work on that area and scrutiny and accountability, we've eliminated the internal waiting list. Waits still are too long, and we have more to do, but that internal waiting list of 500 children has been cleared. So, that's the kind of approach, working alongside colleagues, to identify where improvement needs to happen, and supporting that. And being a visible leader around some of the services that perhaps are seen as cinderella services or can be lost with the understandable and necessary focus on some of secondary care. We cannot afford to take our eye off the ball on population health either.

Happy, John? Thank you. Questions now from Lesley Griffiths.

Thanks. Morning, Kirsty. You've just referred to cultural change and the culture of an organisation. It's a massive challenge, isn't it, particularly in such a big organisation. How would you ensure that staff feel fully involved and engaged with how they can contribute? It's really important, from a public confidence point of view, that there's good morale with staff. How would you have that vision as chair and ensure that the structure and the culture is there for staff to feel engaged?

I think one of the things that struck me most about the theatre report was that the experience of the staff was they were too scared to speak up, for fear of consequences and retaliation, and there was a pessimism, a learnt helplessness, that, 'Even if I do speak up, because I have in the past, literally nothing will change, so what is the point of trying to speak up?' Those are the elements that need to be addressed in a successful cultural change programme.

First of all, you need to create the psychological safety within an organisation that allows people to have confidence that they can speak up about what's happening to them and their colleagues without fear of retribution, or that being potentially a career-ending moment, or being labelled as, 'Well, that's the person who's always complaining'. So, creating that psychological space, and doing that by modelling compassionate leadership, leadership that is authentic and leadership that is visible, so staff know that you care about them and that you, at the executive level, both on the board and your executive colleagues, are leading in that way. There has to be a shared vision across an organisation as to what a good culture is. Executives and the board will need to communicate why there is a need for change—what is the impact if we don't change the culture here. 

What we've done in the fire service, who've had a torrid time—. When the commissioners went there, there was a palpable feeling of grief about what had been said about their organisation and the behaviours that a small minority of people had exhibited in that organisation. It's acknowledging that grief and then communicating the need to change. People come to work in the public sector to do a really good job. They care desperately about their communities. They care desperately about the people they want to serve. And making the connection for them between a good culture and having a good culture in terms of then the retention and the recruitment of staff, patient confidence, patient safety, the ability to deliver good care, helps make the case for change. And then that case for change has to be co-designed. It can't be imposed from the board down.

Staff have to have the opportunity to feed into that cultural change. In the fire service, what we did, we went out to—. Not me; I oversaw it. Colleagues went out to stations, talked to individual watches, really listened, fed that back in, and then when that feedback was put into a plan, we made the chief go back out and do it again. Even though he thought, 'Well, we've already done that; we've already done the listening exercise', we said, 'No. You need to go back and present to the staff whether they recognise what they've said in what you've come up with. Yes, it takes a bit of time, but you're going to go back out again so that those staff can see, "I said this, and it's included here".' So, it's that inclusion.

Then you have to align policy and procedure and process to make sure the system isn't getting in the way. Some of the issues around the theatre was that there was a systematic failure that wasn't helping those people do their job properly and contributing to that poor culture. So, you've got to get the system out of the way, and, crucially, you have to celebrate success and recognise success when it happens—and it will happen. With cultural change, ultimately, you've got to have persistence, because it is not a quick fix. Anybody who says that they can change a culture in an organisation quickly is not being candid with you. You need persistence and consistency and constant communication both ways to make it stick.

Just staying with that report that you've referred to, there were some serious findings in that report. You've just said yourself that it's not a quick fix. As soon as you go in, in October, what would you do immediately to have that cultural change and to make sure it's meaningful, and, then, in the longer term? Because, as you say, it's not a quick fix, so you'd have to have immediate and long term.

Yes, absolutely. Immediately, I'd want to be a visible leader within the organisation so that people can see me out and about, listening to staff directly. I'd want to have assurance from the executive colleagues about the cultural change programme piece that they already have in place—and, to be fair to them, they are trying to address some of that. So it's then holding them accountable for that process and then really engaging with stakeholders and staff groups. Because what's really important, I think, as a chair and as an independent member, is that whilst you are respectful of the information that is given to you by executive colleagues, you should never, ever just take that as it is. That's reassurance, it's not assurance.

I'd want to be triangulating, with conversations with members of staff, with partners, with staff groups, to understand whether the plan and the words were actually being implemented and were actually making change on the ground. So using staff groups, using the staff survey, having the opportunity to communicate directly with staff. In Powys, I like to get out and about and then I can test what my executives are telling me as opposed to the experience on the ground. That's how I triangulate information to gain the assurance that something is being effective.

But we would have to monitor that in terms of engagement and staff surveys and to really test ourselves around whether that feedback is informing change. I note in the structured assessment that was carried out by Audit Wales for the health board that the organisational learning group had yet to be established. I'm not sure whether they've addressed that recommendation from Audit Wales, but an organisational learning group, I think, will also be a really important part of reflecting and implementing change.

We all know that the majority of people receive really good service, but obviously—and sadly—sometimes things go wrong. It's really important that there's a culture not just for patients and families to be able to put in a complaint, but also for staff as well. What ways would you make sure that, right across the board, staff, patients, families and the public would be able to do that?

Complaints are a gift. They're an opportunity to do things better. That sometimes can feel really hard and really difficult, but actually, using staff and patient feedback and ensuring that those are fed into governance arrangements and a feedback loop to inform service is really important, and using patient experience and staff experience to drive change and improvement.

In Powys, what we've introduced is regular patient stories, but we've also introduced staff stories to board as well. And in board development sessions, we actually, in each session we have, invite a team in to talk about their work, especially those teams that perhaps might feel a bit hidden and a bit not seen within an organisation—so, bringing them in to talk about their work, to tell us what's good about it, what's bad about it, and, as I said, I do regular floor-to-board sessions with staff to hear directly from them. I greatly surprised the wife of one of your colleagues recently who is an employee at Powys Teaching Health Board, because she didn't recognise me under my hat and my hairnet as I was serving lunch in the canteen in Ystradgynlais hospital. But, you know, it's really important to get out there and to directly hear from staff. But using feedback, both good and bad, is a really important element—well, it can be, if done correctly—to drive service improvement, and I would want to be able to take assurance that that loop was happening.

Thank you, Chair.

Diolch, Lesley. We'll now take questions from Joyce Watson.

Good morning, Kirsty. I'm going to explore working relationships and how you are going to lead, develop, and support the board of Cardiff and Vale UHB and ensure that there are the required skills, they work together effectively, but, most importantly, perform to a high standard.

Thank you. One of the first things that I would want to do is to meet with fellow independent members on the board to understand their skill sets, their passions, their interests and how their experience to the board has been to date. I recognise that a new chair can be a really unsettling time for an organisation, so I would want to work very closely with the executive responsible for corporate governance to land appropriately in the organisation. I'd want to be able to also gain an understanding of what the skill sets are, and ensure those skill sets are strategically aligned and best used within the board and the committee structure—so, where are people's strengths and deploying those strengths in the areas of the board committee structure where they could be best utilised.

I'm also conscious that not only is the organisation having an incoming chair, they're also losing a very experienced third sector representative, who you will be seeing later today, as she, hopefully, takes on a role in Velindre University NHS Trust, and the finance member is also coming to the end of their term. So, there is a period of churn here, which can be really unsettling for an organisation. So, I'd want to settle everybody in quickly, and build that team ethos.

A really important relationship is that between the chair and the chief executive. Where it works well, that's a real, powerful force for change. Where it goes badly, as we've seen in other health boards, it can be a distraction—at best it can be a distraction, at worst it can actually be a weight pulling down on an organisation's ability to change. So, I'd want to have good, strong working relationships. I think that the 360-degree feedback that I've received from colleagues says that I do that well. I've built my life on working relationships, on the ability to influence and to persuade and to work alongside people, and have difficult conversations where necessary, hold people to account, but also be supportive.

And as you say, it's a balance. It's a balance between challenging, but not destroying, those relationships, which is absolutely key. And there's a reason, because you're monitoring the performance and you want to take it forward to achieve the goals. And you've given lots of examples of where you've done that elsewhere. How do you think you are going to do it in this particular role?

I think I bring a level of professionalism and experience to this role. So, I've done it before, and I have done so with lots of different personalities. So, it’s understanding what brings the best out in an individual and adapting my own style accordingly, so that people can bring their best self to those relationships.

I’m not afraid to have difficult conversations, but those conversations are always about the issue, and not about the person. And I think it’s the way in which you hold people to account that can make it feel a positive challenge, or can make it feel highly personal and can undermine somebody’s confidence and their ability. And that’s about asking open questions, being curious about how they’ve approached something, being open-minded, sometimes recognising that you’ve got the wrong end of the stick, and listening to that as well, and being open to a diverse set of views.

What’s really important for me on the board is to hear from a variety of voices, because, I think, if you hear that diversity of opinion around a board, that’s when you’ll get better board decisions. Those relationships need to be professional and respectful, but, as chair, you always have to have an element of independence that allows you to take that step back and look critically, and I don’t mean as in having a go at someone, but critical analysis of the information that’s being given to you, and whether you need to challenge that.

Of course, part of your role will be to support the chief executive in fostering more regional collaboration with other health boards. Do you think that that’s a priority—and you have come from one health board to another—and how would you champion that particular initiative?

Systems leadership will be really important in this role—so, that’s leadership not only just within Cardiff and Vale, but, actually, leadership across the NHS—and having assurance that Cardiff and Vale are playing their part in that regional approach, because they have a really important role to play in that, they already play an important role as the deliverer of regional and tertiary services, but just recognising that there are other partnerships that can bring things to the table and there is a need to be open-minded and willing to engage positively in those relationships. Because, after all, we are serving one population, and what I’m interested in is what is the best configuration of services that will deliver for the people of this particular area and region, what is our strategic role that we can play in that, and are executives engaging with that positively and with an open mind.

And finally from me, you’ve talked a lot about representing the organisation, engaging with the public and instilling confidence. How would you bring that to bear in this organisation?

Well, you’re right Joyce, I apologise, I have talked a lot. The most successful health services are the ones that have engaged with and have responded to their local population. And sometimes that can be really challenging. But we have to have a conversation with our population about what their needs are, what their aspirations are for their health services, and how we can respond positively to that, but also to have that conversation about what the constraints are within the organisation to be able to deliver on those aspirations. So, again, I would be highly visible, reaching out, making connections with local authorities, with the voluntary sector organisations, as well as patient groups and communities, to be able to listen directly to them. And sometimes that is difficult. Believe me, there’s no tougher gig than being sat at the front of the church in Llanidloes when the many hundreds of people there are not happy about a decision that you’ve made. And, actually, some of the advice was, 'Don’t go; you don’t have to go, just don’t go there.' And there was no way—. Having done the job that you’ve all done, there was just no way I was not going to go and listen to people. They deserve that, and we’re to be held accountable. As chief executives, as independent members, we are accountable—not just to the Minister; we’re accountable to the people that we serve. And therefore, it’s a really important part of the role of the chair to be visible and to have those conversations, and to get out and about and listen to people about their aspirations for their service.

And finally from me, the diversity of the people who you're going to serve, and it's huge—. And I know that someone else is going to be asking you about language, so I'm not talking about language.

Okay. Yes, certainly. So, the Cardiff and Vale region probably is the most diverse in the entirety of the nation, and that diversity comes in terms of cultural diversity, ethnicity, it comes in socioeconomics. So, that population is really important, and we also have to take that into the organisation itself, making sure that the organisation is representative of the communities that it seeks to serve, so that, when they look at Cardiff and Vale health board, they see themselves reflected in that. That helps to build that public confidence, it helps the organisation to deliver culturally competent care to people who perhaps otherwise would have concerns about coming into an organisation, whether they would be treated appropriately. And I have to say, Joyce, that now more than ever we have to hold on to the principles of why equality and inclusion and cohesion are really important, because, if we want to have those conversations with our populations about how to improve their health, they have to feel that they're going to be respected by everybody at the health board, regardless of who they are and what their personal circumstances are. 

Within the health board itself, we need to ensure that our workforce is diverse and our workforce is supported. Again, I try and take a very visible role in that, and I feel that it's my responsibility. So, for instance, I have participated, and am currently once again participating, in the Welsh Government's aspiring board members programme. I am the mentor for Powys. I participate in that scheme, looking at bringing on a new generation of more diverse independent members. So, I think it's important, if we're going to deliver truly holistic patient-centred care, that we have to be aware of and respectful of and culturally competent in how we deliver our services, recognising that not everybody is starting in the same place. Some of the ethnicity statistics—. So, for instance, the Gypsy, Traveller community has some of the worst health outcomes of any community in Wales. How do we get into that community to hear their voice about how we can deliver care that meets their needs? Sorry, does that—?

That's fine.

Thank you. Thank you, Joyce. We're running a little bit behind time.

Sorry, I'll be quicker.

Are you happy to stay for an extra five, 10 minutes? Is that okay? It's just because we have some important questions from Mabon on the Welsh language. 

That's fine by me. It would be very rude if I said 'no'.

Lovely. Thank you very much. Questions now from Mabon ap Gwynfor.

Well, technically, I'm accountable to the Minister who makes this appointment, and I have to agree to that, otherwise there'd be no point in being here. But, ultimately, we're accountable—all of us, including the health Minister—to the people of Wales and to the communities that we serve. And so the relationship that I would want to foster with the Minister is one of, obviously, respecting his national priorities, and I would obviously look to work with executive colleagues to marry those national priorities with local need and to align those, but also not afraid to have robust conversations and challenging conversations if I felt that there were barriers in the way that were not enabling us to meet the needs of the population. 

Certainly. One of the first things that drew my interest in Cardiff and the Vale is that I served for two years on the old Welsh Health Specialised Services Committee patient experience and quality and safety committee. It's now been subsumed, of course, by the NHS Wales Joint Commissioning Committee, and the health board members have been replaced by lay members. We were scrutinising the performance of services in Cardiff that were there to meet the needs of a population way beyond the boundaries of Cardiff and Vale health board, and those services were in escalation. And how could we, as a member of Powys, influence those services?

So, I think there are already existing regional and tertiary services that the organisation are commissioned to deliver, but I still think—. When we read the ministerial advisory group report, there are very fragile services. There are multiple patient pathways that are existing on minimal levels of staff, which are prone to falling over and, potentially, could be delivered more sustainably, hopefully—there's no point in doing it if it's not going to improve patient outcomes, but better patient outcomes. So I do think there is a role for the health board, working alongside other health boards, to look at what is a sustainable response to the fragility of services. And I think Cardiff has a role to play in that, but it has to be as an equal partner. It can't be, 'Well, we're the capital and we're the biggest.' So, that means it is about understanding how best we can meet the needs of that wider population.

Well, we have a legal responsibility, under the Social Services and Well-being (Wales) Act 2014, to work in collaboration with local authority partners and the voluntary sector, so I'd want to assure myself that those working relationships were secure and, I think, whether we were having oversight of those regional partnership workings.

If we're to achieve the goal of an integrated care system, the health service cannot, and should not, do that on its own. It has to be done in collaboration with local authorities, with the voluntary sector. In some cases, the social care system is dominated by the private sector. We have to engage with all of those partners to be able to realise the dream of an integrated care system.

As chair of the regional partnership board in Powys, it's difficult, my goodness, and if it's difficult for us in Powys, when there's one health authority and one local authority and one voluntary sector council, then it's going to be more complex in other areas, where there are multiple local authorities and multiple voluntary sector councils. But I think it's a valuable—really, really valuable—space for understanding shared problems, shared solutions, and working together to meet the need of the individual patient, or individual member of our community that either needs support or, actually, by a timely intervention, won't end up in the health service. So, those partnerships are really, really crucial to delivering a sustainable NHS service. It can't be done on its own.

So many of the factors of population health don't lie within the health service—it is about economic development, decent housing, a good education for people. And those, of course, rightly sit with local authorities. So, if we're going to make a difference to health inequalities and population health, we've got to do that together.

Well, it's easy to say, but it's really difficult to achieve, isn't it? So, there is that mantra, and we're all signed up to the mantra of the 'shift left'. We all know that prevention is better than cure. We all know that the end goal of a sustainable service does lie in that population health. But it is really challenging; it's really, really difficult to do. I think one of the ways in which we could do that—and it was suggested in the ministerial advisory group and in other groups—is that—. We do what we measure, I think, in public services, and understandably so. I think if we could look to start to measure the impact of some of that work, demonstrate its value in terms of patient outcomes and sustainability, we could make progress. But I'm not going to sit here and say, 'Yes, don't worry, I can sort that', because it's really, really challenging to do, with the pressure on the here and now and the burning platform that organisations are on.

And it's difficult for two reasons. It's not just about the money; it's about the capacity—the capacity within the service to lift its head sometimes, and to be able to have that space to do that innovative thinking and to do that planning and that delivery. And it's about the skill set to do that: have we got the skill set that allows us to make those changes? So, I think we have to look at capacity in the round, not just financial resource, to be able to successfully do that. Everybody's signed up to it, but I think we'd all agree within the health service—we certainly talk about it in the vice-chairs peer group—that it's proving more difficult to do.

Well, it's really important, because, in the last survey, Cardiff and Vale is the area with the greatest growth in the usage of the language. So, there is a service need to be met there. And I'm sometimes surprised why you still have to have that conversation—that it's not a 'nice to have', it's actually a really important part of patient safety, patient experience and delivering holistic care.

The health board currently has a target to increase the number of speakers with skills between levels 2 and 5 by 25 per cent, and that's the target for two years' time. I'd want to see early sight on where we are on that target and what is being done to achieve that target. I'd want to be able to audit our use of the active offer—how often is that actually happening? And I'd want to use patient-experience feedback to see whether that active offer is a live thing for them, or whether it's just on a piece of paper, and how many of our patients are actually being able to get the care that they want through the medium of Welsh.

My 88-year-old mother-in-law fell down the stairs last year. She needed 77 stitches across her forehead at Merthyr, at the hospital. Of course she speaks English, but her first language is Welsh. And a doctor came in, and he was from Caernarfon, and he could speak to her in Welsh, and immediately you saw her relax. Immediately, you saw her be more comfortable, more confident that she could have a conversation in the language of her choice. Of course, it didn't take long until they weren't talking about the stitches—she was asking him about every person she'd ever met or had ever come from Caernarfon, and whether he knew them. But that ability, it's not a 'nice to have'. And I have to say, I have had to have conversations within my own health board where people have said, 'What's the point—everybody speaks English anyway?', and to have a conversation about why it's important that that active offer is real. So, I'd want to be seeing our staff, our staff numbers, and our ability to actively provide that for people.

That's not the easiest question at all—it's the hardest question. So, immediately, my priorities would be to establish a high-functioning board that does its job in terms of strategy, scrutiny, overseeing implementation, and fulfilling its role. And I don't think people should take that for granted. It's a disparate group of people. It's a unified board. It's an interesting structure. So, my first priority is to develop those relationships and to have a coherent group of people working together to deliver for the people of the area that it serves.

My second priority would be to be able to have a line of sight on an improvement plan that would get us out of escalation. As I said, I think it's bad for morale, it undermines confidence, and it takes up resources that, potentially, could be used elsewhere within the organisation.

My final short-term priority would be to ensure that all non-obstetric ultrasound long-waiters are gone by the end of the financial year—that we've made significant impacts into our diagnostic waiting lists.

But my longer term goal would be to establish a culture within that organisation that ensured that its staff were supported to deliver exceptional patient care and outcomes in tertiary, secondary and primary care settings, in partnership with local authorities and the voluntary sector, and that those partners would look to us and see us as a good organisation to do business with and work with.

Diolch.

Diolch, Mabon. Thank you very much, Kirsty. I’m sure you’ll be pleased to know that that’s the end of our evidence session with you today, and thank you very much for staying for an extra 10 minutes.  

I suspect that was my fault. 

No, it's absolutely fine, not a problem. You will receive a copy of the transcript for factual accuracy of everything that we've discussed today, and you'll also receive an embargoed copy of the committee's report on Monday, before its publication on Tuesday. So, thank you very much again for coming in, and we look forward to seeing how things develop in the future. 

Thank you very much. Diolch yn fawr. Thank you very much for your time—I appreciate it. Hwyl fawr.

Now we move on to agenda item 3. So, under that, I propose, in accordance with Standing Order 17.42, that the committee resolves to exclude the public from item 4. Are Members content? I see that Members are content. We will proceed in private, and we'll be back at 10:45, for all those people watching at home. 

Welcome back to the meeting of the Health and Social Care Committee. We had our first evidence session earlier and now we move on to our second evidence session. I'd like to welcome Sara Moseley, who is the Welsh Government's preferred candidate for the role of chair of Velindre University NHS Trust. Would you like to introduce yourself?

I'm delighted to be here this morning. Thank you very much for the invitation. 

Lovely. Before we go into our questions, I'd just like to ask if there are any declarations of interest from any Members. Lesley Griffiths.

Yes, I worked with Sara during her employment with Welsh Government. 

Thank you. Any other declarations of interest? I don't see any. Lovely. So, we'll go straight into questioning now, and I'll start. Can you explain to the committee why you believe that you are well suited to the role and how you'll draw on your skills and experience to ensure that Velindre University NHS Trust is an organisation with strong governance, accountability and financial management? Diolch.

Yes. So, I've dedicated my working life to public service, and I've spent the last eight years as an independent member of Cardiff and Vale University Health Board, which of course is a really crucial partner for Velindre. And during that time, I've also run a charity, so I've been an executive and a non-executive director. My professional background is in communications. I had a 30-year-long career in communications, which included being a director of communications and engagement for a very large organisation in London, which is now called Barts Health NHS Trust, in the poorest and the richest areas of the UK. So, in terms of my own values and what I've chosen to do with my life, I would very much bring those values into this role. 

In terms of skills, communications and engagement are incredibly important, strategically and tactically. I think it's just key for us to understand who we're serving, what their experiences are, who our own people are and what we can bring to creating a service that people really trust, value and love, and which is collaborative and open to change. 

In terms of governance, I have governance experience both as an executive and a non-executive director, and I have clear experience both of drawing on my skills to develop a strategy and to deliver that strategy in a way where there's assurance and a clear line of sight around what we do. I have a lot of experience of being very accountable. I chair health and care professions tribunal hearings, which are in public, are often very contentious and long running, and it's my responsibility to lead a process that results in a very open, accountable and clear decision, which is all about protecting the public and upholding the public's confidence in those 15 professions. 

So, I hope that both my personal and professional experiences and skills can be woven together here. I chose to come back to live in Wales, having worked in London and England for a long time, and I'm very dedicated to Wales and to working in this country. 

Lovely. Thank you very much. Just picking up some things from your curriculum vitae, you've done a lot in the health sphere, so I'm just interested in what knowledge and experience you have of the health and social care sector in Wales, and specifically in Velindre's specialty, which is cancer services. So, if you could just pick some of that up, it would be very useful. Thank you.

Well, my role in Welsh Government included leading communications and engagement in the health department and in the health and social care sector. So, that cemented my knowledge in Wales. I'd come from being the director of communications, as I said, for a very large trust in London, and I've really built on that over a long period of time and from very many different perspectives. I think the perspective of being able to see it from a policy side, from a delivery side in terms of Cardiff and Vale, from the side of the beneficiaries from leading Mind Cymru, and from a cancer side at Moondance Cancer Initiative would enable me to take that really multifaceted approach, because it's very complex, it's multifaceted, and it's important, I think, that we take time to look at different perspectives. So, I believe that all those different strands of experience come together beautifully in this role.

Lovely. I'm just interested in your views on some of the other appointments you currently hold, and whether you think that they give rise to any potential conflicts of interest or perceived conflicts of interest. If so, how do you propose to manage those conflicts or perceptions, including whether you divest yourself from some of those posts that you hold?

I volunteer for Mind Cymru. I'm on the management group of Mind Cymru. I don't perceive any obvious conflicts of interest there, but, obviously, I would recuse myself from any discussion or decision that touched on that role. I'm also an appointed chair for the Health and Care Professions Tribunal Service. There is a minimum commitment of 10 days a year for the Health and Care Professions Council, and if I were to be working on a case that involved anybody who was employed at Velindre or with any of our partners, then I would declare that interest and step back from that involvement.

Lovely. Thank you very much. Now some questions from John Griffiths.

Thank you.

Thank you.

Bore da, Sara. Just some questions on strategic direction for Velindre. Firstly, if you were to be successful in this application, how would you strategically manage and integrate the diverse responsibilities, overseeing cancer services, Health Technology Wales, the Welsh Blood Service and the NHS Wales Shared Services Partnership? What specific strategies would you implement to ensure cohesive and effective management across those varied areas?

So, Velindre is responsible for really key regional services, but also Wales-wide national services. I would want, very early on, to understand the scope of those responsibilities, stakeholder expectations and the frameworks within which we were operating. I think the really important thing in terms of governance is that we are very clear about what our role is, that we have a strategy and a plan that are transparent, open, accountable and take account of all those stakeholder needs and views, and that whatever governance structure we have within the organisation provides us with assurance and oversight that there is probity, financial probity, patient safety and quality more than anything else, and that we are preparing the organisation for a sustainable future.

So, I think, coming into role, clearly there is a lot happening within the NHS in Wales at the moment. It's a time of change and flux, and so I would consider it good practice to review governance arrangements within an organisation once I got my feet under the table and really understood what that organisation was about and what its core responsibilities were from multiple perspectives. I think, as part of that, it's about making sure that the unitary board has the skills, the knowledge and the expertise that it requires in order to carry out that governance role.

Okay, thank you for that. As you say, there's quite a lot of change. Given the controversy and dissatisfaction among some staff and residents about the new cancer centre site, how would you strategically lead efforts to reconcile those differences and bring everyone together? And what specific approaches and initiatives would you implement to ensure a cohesive and supportive environment for both staff and the community?

In terms of the new cancer centre itself, clearly it's been an interesting journey to the beginning of the build, and that build is now under way, it is happening. And there's a lot of tribute to be paid to the current chair, Professor Donna Mead, and the vice-chair for leading the organisation through what can be a really very difficult process, but a very important one for patients and for Wales. The new cancer centre in Velindre is an opportunity really to create a beacon for cancer care, treatment, research, staff development, and teaching in Wales. And I think the crucial thing in terms of the local community is to do everything we possibly can to provide ownership of that centre for the local community, and to develop the pride and sense of belonging that that new cancer centre is in amongst them.

In terms of specific ways of doing things, I would need to understand that community first, and I would need to come from the point of view of what's right for them in terms of how to do that. In terms of principles, I'd be available, open, I'd want to listen, I'd want to open the doors so that there was that sense of belonging. Many years ago, I was involved in a plan to close and relocate probably one of the oldest children's hospitals in the UK from Hackney, and it was very contentious and very emotional, and the thing that really turned that around was the acknowledgement of people's stake in that, and opening the doors, so that it was a joint venture to create something much better. Have I answered all your questions, or have I missed some of them?

That's fine, thank you. One further question from me: in what ways would you instil a culture that encourages staff, patients, families and the public to raise concerns that are then appropriately addressed?

I think it is a planned strategic activity with multiple ways of making sure that that happens. So, there's not one route to making that happen, and it's something I've been very involved in in setting up and chairing the people and culture committee at Cardiff and Vale. I think we need to have regular data and understanding, qualitative and quantitative, around what people are thinking and feeling and what their experiences are, and that needs to be triangulated by board members getting out and about and just testing that, talking to people, seeing how services work, how patients feel. And we need to draw on external sources of expertise and knowledge, like Healthcare Inspectorate Wales, some of the regulators, for instance, to see for ourselves whether the services that we're running are safe, whether they're high quality, whether the staff are engaged, and how the trainees feel. That needs to be very visible to the whole organisation, both in terms of the visibility of the chair and the rest of the board, but also in terms of the visibility of that data and information that we're gathering. I think, fundamentally, if we do that, then we have to show that we're doing something about it, because I think that, to improve culture, there has to be integrity and there has to be trust, and integrity and trust come from doing what you say you're going to do, and if you can't do it, telling people why that is. And it's not a one-off process, it's an iterative process, so it's continual.

Okay. Diolch yn fawr.

Diolch. Questions now from Lesley Griffiths.

Thanks very much. Morning, Sara. As chair, how would you lead and develop and support the board to ensure that they've got that range of skills that are required, that they work together effectively, and that they work to a very high standard? 

So, there's been quite a lot of change.There's quite a lot of change amongst the independent members, new chair, relatively new vice-chair, a couple of new independent members, and the chief executive is also relatively new. So, I think, the first thing is that we establish a culture of openness and trust; secondly, that we understand very clearly what our roles are and what we need to supplement, in terms of our own knowledge and experience; and thirdly, to make sure that that is an integrated board, that we're working really well with clinicians and others who have real expertise within the organisation, so that we understand our own business and what's happening across the horizon. And that, again, is something that's very live.

Through board development, through appraisal and supervision of independent members and so on, it's important to discuss and spot when there are development gaps and needs. For instance, when I was chairing the mental health capacity legislation committee at Cardiff and Vale, I realised that independent members were coming on to that committee without knowledge of the legislation that we were scrutinising. So, that led to establishing training, so that we were fit for purpose in scrutinising that. That's very much about understanding your purpose and how that is actually working, and coming in, learning, developing, and changing that where you need to. 

You've just given an example, but could you perhaps widen it a bit around your skills and your experience to develop that working relationship, which you would need with the chief executive and with the board? You would need to be challenging at times, you will need to monitor. As you say, you'll need to appraise performance, you'll need to supervise. So, what skills do you have of that, and perhaps a bit more about experience? 

I have chairing skills that are current. I'm equalities champion for Cardiff and Vale. As part of that, I went to sit with the equality staff network to hear what was going on and understand people's experiences, and we were also obviously getting information back through the NHS staff survey and so on. The chair and I had a long discussion, and we decided that we needed a people and culture committee that was very focused on exactly that. I worked very closely with the director of people and culture and the governance team at Cardiff and Vale to establish that and set the scope, and then to develop the business of that committee.

One of our strategic aims at Cardiff and Vale is putting people first, and one of the board assurance framework aims is to develop a healthy culture. It's really difficult to know what your culture is internally and what measures you might be able to put in place to improve that. And to start with, that was very tricky at committee, because we were probably—well, we were—underdeveloped in understanding our own culture and understanding the levers. My style was described as 'high challenge, high support'. So, introducing that ambition, that sense of 'can do' and that sense of, 'We can develop this over time in a way that is really going to give us results' can be quite tricky, because you're starting from a point of saying, 'Actually, what we've got now is not good enough.' But I believe that, if you're very focused on your purpose, why you're there and what you're trying to achieve, challenge is then delivered within a really constructive framework, and it does lead to improvement. 

How would you lead the board and yourself, as the chair, in building and maintaining effective relationships with stakeholders, with partners not just within the NHS, but also outside of it? Obviously, Velindre is much more of a national organisation, so you'd have to do it locally and nationally, and of course with local authorities as well.

I believe that effective communication and engagement are an absolutely essential strategic tool, as well as being something that you just do. So, my starting point would be to understand really clearly who our stakeholders are, what their perspectives are, what they think and feel right now, where we can work together and where we can create spaces for listening and engaging.

I think the future of health and social care is absolutely dependent on collaboration and on building and rebuilding trust with patients and communities. So, that engagement needs to be a very structured, planned and deliberate activity, with ways of feeding back the intelligence and information you get from that engagement to continue to deepen and strengthen the relationship, identify risks, mitigate risks, and find opportunities for collaboration and improvement and act on those.

I think that your positioning—who you are as an organisation, how you want to behave—should follow through in everything you do in terms of engagement and communication. You should be able to see, in the way that an organisation communicates and engages, what kind of organisation it is and what its values are.

And local authorities. You mentioned health and social care collaboration. Obviously, local authorities are a key partner in that.

Absolutely, quite right. I think the same applies there, because, obviously, social care—. So many of the determinants of health are across public services, and, very importantly, sit within the purview of local government. We know in Wales that cancer outcomes are really different depending on your socioeconomic background. We know that a lot of the things that could prevent cancers in the first place require close working with local government and with other agencies. So, it's really important, as an organisation, that we identify those opportunities for collaboration and for prevention and improvement, and local government is absolutely crucial to that.

Finally, engagement with the public. In order for the public to be confident in the organisation, you need visibility. How would you go about ensuring that you engage with the public and the organisation engages with the public in a way that would really instil confidence?

That's a personal responsibility for me as chair, and it's also a responsibility for me as chair to make sure that that is a networked and shared activity for the whole board, so that we all understand our responsibilities and who we have specific relationships with in order to develop those relationships. I think that it's important that my own interaction is both proactive and planned, and reactive when we know that there's an issue or a problem or a concern or an opportunity. That would be a real priority for me and something, actually, that I would really love to do. Obviously, there's a very active charity at Velindre, which I'd also very much want to support and get involved in.

Okay, thank you.

Lovely, diolch. Questions now from Mabon ap Gwynfor.

Lovely. And questions now from Joyce Watson.

Good morning. I want to look at and ask questions around measuring success. So, you are going to have to have immediate priorities in your first year in the role. First of all, the outcomes you would expect within the immediate future, but also the long-term vision that you have and the outcomes that you expect to achieve consequently, how will those be measured? Also, are there any barriers you perceive to obtaining them?

Thank you. I've written that down so that I remember.

In the immediate future, I'd really want to build on what the organisation is doing now as a cancer centre, as a blood and transplant service, and as a host to really important national organisations. I think that if we can build and deliver a cancer centre that people are really proud of and love, and which has its doors open and is welcoming to everybody, that is an immediate priority, but it's also a basis for long-term success, in terms of us as a cancer centre and as a centre for training and developing the next generation of cancer specialists and researchers. It's the same, really, with the blood service. So, it's about making sure that that blood service is sustainable for the long term, that we have a really strong donor base, and that it is the basis for excellent research and delivery. So, I think the immediate and short-term priorities should lead to those longer term aims and aspirations to have a nationally and internationally recognised excellent cancer service in Wales, with benefits beyond south-east Wales, and the same for the national blood and transplant service.

In terms of the board itself, I think an immediate priority—and I think I touched on it earlier—. Lots of us are going to be new, there's lots of change, so an immediate priority is to develop and build that as a cohesive, compassionate, effective board that is delivering the priorities of the Government and the people that it serves, and which is open and transparent around that. I think that is always going to be very important, and I think, as we look at the governance of that and what we can do around governance, including in governance around shared services, I think the longer term aims and objectives will become clearer. Because I think it's fair to say that there is—. We have some fluidity in terms of how things are developing in Wales at the moment, and it's really important—. What's important is that we're learning and improving in terms of our governance, and that we've very much got our fingers on the pulse of how we do that over the long term, and that that board has the skills, the attitude, the culture, and the accountability and transparency to be doing that for the long term.

In terms of how it'll be measured, I think it's very important to be clear about the measures for which we are publicly accountable, through our integrated medium-term plan, through performance and safety targets, and through those things that are our foundational requirements for an organisation, and that people can see that, and they can see how we're doing, and they can ask questions around that. But I think it's more than that. It's how we are measured in terms of our reputation and our contribution, Wales wide, to the development of better patient outcomes and better outcomes in the blood and transplant service, and better support and co-operation in terms of the shared services. I think being clear about where we're going in the long term is really very, very important, and that's in terms of outcomes, training, development, research and ambition for Wales.

And what do you see as the barriers—or potential barriers?

The health service generally is under a lot of pressure. I think that, in terms of the workforce, we have just incredible people working in the workforce in the health service. I'm just amazed when I chair recruitment panels for consultants, or when I talk to staff, to the porters, everyone. But I'm very aware that lots of people are tired, they're very stretched, they're having to make decisions that are really difficult clinical decisions because of the sheer need and resource constraints. I think understanding the staff perspective and what we can do to really strengthen that and listen to that and improve, it's a constraint, but it's also really important as an opportunity. I know we've got shortages in lots of different specialties, and some of that very specialist workforce is an ageing workforce, so the focus that we have on training and developing the next generation, and keeping them here, is really important.

You've alluded to the fact that there are elements of the new cancer centre that have had quite a bumpy start. So, I think that the way that that's delivered now is really, really important. Velindre has lots of contract arrangements with other health organisations, and I think a potential barrier from a patient perspective is that they may be being seen by different parts of the service, and that can feel quite disjointed and that can have an impact on the cancer pathway. So, I think it's really important that we think about it from a patient perspective. Because it doesn't matter to them whether they're being seen by their GP, or Cardiff, or Velindre; the issue for them is, 'Does this service know who I am, what my needs are, and is that service joined-up and seamless?' So, I think that's a barrier we really need to overcome in terms of safety, quality and confidence.

Thank you. Diolch.

Thank you. Just one final question from me—and I think Lesley Griffiths touched on it earlier. It's around holding the chief executive and the executives of the trust to account. I'm just interested in how you would go about doing that, because, obviously, that's one of the main roles of the chair, to make sure that all the executives are delivering on the strategic priorities of the Minister, who you're directly accountable to. So, I'm just interested—. What are the processes that you would go through in holding, obviously, the chief executive and executive members of the trust to account? 

The relationship between the chair and the chief executive is absolutely pivotal. I'll talk about the chief executive first, because, clearly, the chair sets the objectives for the chief executive, and monitors those objectives. The objectives need to reflect what is being asked of us by Government, by our commissioners, and what we need to be doing in terms of patient safety, quality, equity and access. So, the objectives need to be rooted in that and need to be developed collaboratively with very clear measures for delivery, which are smart and can be monitored and are regularly reviewed and adapted. Obviously, that is a cornerstone of accountability, that people are clear about what they're there for, what their role is, what they're going to deliver, how that delivery is measured, and what happens in terms of if other things come into that mix, or if delivery's off target, and that needs to be absolutely consistent and regular and clear, and clearly reported.

There is then the issue of the chair being a sounding board for the chief executive, and indeed for the other executives, and for almost a coaching role. I'm an accredited executive coach, and I think those listening and coaching skills are potentially extremely valuable in the position that I'm going to go into. Obviously, the chief executive then sets the objectives for the other executives, which should flow, and there should be a really clear line of sight around delegation and delivery, responsibility, and so on. The chief executive should be able to come to the chair and discuss any issues with that level of delivery of the responsibilities that have been devolved amongst the wider executive.

And then, as a unified board, it's really important that we understand each other and that we're clear about our objectives, what we're doing, whose role is what, what expertise we might need, and that we have a healthy combination of focusing on data and outcome-driven information to provide assurance, underpinning that assurance through experience, and also looking strategically, so for our own organisation, but what is happening to cancer care, for instance, which is evolving really quickly, and are we preparing to be fit for the future in terms of what we are doing as an organisation.

Okay. Thank you. Are there any other questions from Members? We have two minutes left. No. If there are no other questions from Members, that brings our evidence session to an end. I'd like to thank you very much for your time this morning. You will be sent a transcript of everything that's been discussed here for accuracy, and then you'll see an embargoed copy of our report on Monday, before its publication on Tuesday. So, yes, once again, thank you very much for coming in, and we'll look forward to seeing how things develop in the future. Diolch yn fawr iawn.

Diolch yn fawr iawn, pawb. Diolch yn fawr.

Lovely. Thank you.

I'll now move on to agenda item 6. So, I propose, in accordance with Standing Order 17.42, that the committee resolves to exclude the public for item 7 and items 1 and 2 of the meeting on 10 July to consider the supplementary legislative consent memorandum, memorandum No. 4, for the Mental Health Bill, and the committee's draft report on the legislative consent memorandum for the Employment Rights Bill. Are Members content? Members are content. So, thank you everyone who's joined us online and watching Senedd.tv today; I wish you a pleasant day. We'll proceed in private.