National Assembly for Wales

I call Members to order.

The first item on our agenda this afternoon is questions to the First Minister, and the first question, Gareth Bennett.

Yes. By 31 December of next year, all trains must include provisions for people of reduced mobility, in line with European Union and United Kingdom Government standards, and the procurement documents for the Wales and borders rail services contract will mandate compliance with people of reduced mobility standards.

Thanks for that. We know that we are going to have a new train operator in Wales from next year. The problem is that the new operator may not be able to get new rolling stock for perhaps four years, so it could be that, in order to comply with that legislation that you stated, we may have a tactic of the new train operator having to, or believing they have to, leave toilets locked up on the trains, meaning that nobody can use them. Do you see that as a potential problem for the new franchisee?

No, under no circumstances will toilets be allowed to be locked.

First Minister, one of the frustrations for disabled passengers is that many trains only have a single wheelchair space, which is too often taken up by pushchairs or luggage. Now, I've been informed that, in Australia, a whole carriage is dedicated to those passengers with reduced mobility, where there are additional spaces for wheelchair users. Can you outline a bit more detail on how the next rail franchise will cater for the needs of those with reduced mobility?

Well, we wouldn't want a situation where those people who are in wheelchairs are effectively segragated—and the Member is not suggesting that, in fairness. It's hugely important that people are able to travel on all sections of the train. Coming back to the point I made earlier on, the technical specification, as I said, will need to be complied with by 31 December next year. I can say that agreements are already in place to modify a significant proportion of the existing rolling stock, and plans are in place to deal with the pacer trains. Some of the existing fleet already meet the compliance requirements, but, by the end of next year, all of them will have to.

I'd be grateful if the First Minister could just clarify: has the Welsh Government requested in its specification from the bidders that all trains in the metro will have toilet facilities that are compliant with the new rules on board?

What I can say is that we're considering a number of options at the moment. If the trains don't have—[Interruption.] Well, if the trains don't have toilets on board, then we would expect the operator to provide very much enhanced services at stations in order to ensure that people feel comfortable when they are travelling. There are, of course, examples of metro services elsewhere, such as in Greater Manchester, where there are no toilets on board, and quite often there are no facilities for passengers who wish to use a toilet. That is not what we want; we want to make sure that people are able to access toilet facilities as easily as possible.

First Minister, Cabinet Secretary Ken Skates has been proactive in setting out the Welsh Government's ambitions for rolling stock fit for a twenty-first century rail network. In July last year, Ken Skates stated, and I quote,

'I've made no secret of the difficulty in adding good quality rolling stock in Wales',

and it's been absolutely clear that the next franchise—the Welsh Government's first—must have the passenger at its heart. First Minister, this commitment of the Welsh Labour Government can be evidenced by Wales being selected by Construcciones y Auxiliar de Ferrocarriles as the new location for its new centre of excellence for the manufacture of UK rolling stock. What opportunities, in the First Minister's opinion, will £30 million of investment, and the creation of 300 high-calibre jobs in a facility that assembles, tests, and commissions new railway vehicles, afford the railway industry to ensure the accessibility of trains for persons of reduced mobility in Wales?

Very much so. This is one of the biggest public transport projects outside of London. It will utilise, of course, some of the existing lines that are already there. They're all heavy rail at the moment, and we'll need to see which will remain as heavy rail, which will be converted to light rail, which new routes would then be rolled out using light rail, alongside some of the existing routes that have rail tracks on them but haven't been used for many, many years. These are all matters that are being considered as part of the franchise tendering process.

Ministers and officials have met representatives from the Cardiff capital region cabinet several times since October 2015 to promote the preparation of a strategic development plan for the south-east of Wales. The next step now is that the cabinet must identify a responsible authority so that formal preparation of the plan for the region can begin. 

On 27 April, elected representatives of the Cardiff capital region wrote to the Cabinet Secretary for Energy, Planning and Rural Affairs and said they firmly believe that the best opportunity to deliver positive planning outcomes and deliver the transformational change is to prepare a strategic development plan for the region that is genuinely a regional plan, based on regional evidence, rather than a plan that simply knits together existing local development plans. They added that if the Welsh Government continues to force all seven local planning authorities with the 2021 planned expiry date to review their LDPs, there will not be sufficient resource within the region to progress the SDP and this opportunity will be lost for many years. Basically, what they're saying is that we need to move ahead with the strategic development plan, and we can't then review LDPs in the depth that the Government wants with those resources. There's a choice to be made, and I urge the Government to back a strategic development plan for south-east Wales. 

First of all, we want to see a strategic development plan, but it's hugely important that there are LDPs in place because if LDPs run past their expiry date, if I can put it that way, then, of course, often you can get uncontrolled development because applications will come in in the absence of a development plan. We want to see a strategic development plan, but the ball is in the court of the region. They must identify a responsible authority now, and then, of course, we can commence the process. We want to work with them to develop a strategic development plan. That is, by far, the most sensible approach—he has said it himself in this Chamber—but it is important now that they do identify which authority is going to be responsible for its development. 

First Minister, any plan to secure the maximum economic benefit from the Cardiff capital region must include a relief road for the M4. I have been contacted by a number of business owners who have expressed their dismay that the Cabinet Secretary for Finance, and your potential successor, recently appeared to pour cold water on the proposed black route. As one business owner said,

'This is not a picture of Wales open for business.'

First Minister, in your Government's discussion with the Cardiff capital region cabinet, have you committed, and will you continue to commit, to building a relief road for the M4 in or around Newport please?

Well, first of all, I think it's only fair to point out the context in which the comments were made by the Cabinet Secretary for Finance. He was saying quite properly that cost is clearly an issue. Of course it is. He would not be acting in his role as Cabinet Secretary for Finance if he didn't point that out. And that is an issue, but not the only issue, of course, that will need to be considered. Now, just to remind Members, what will happen is that when the planning inspector's report is received—we expect in the summer or the early autumn—that will be the time to give consideration to that report, and a decision will then be taken as to which route is the way ahead. What we do know is that the congestion will not improve in the Brynglas tunnels—that much is, to me, obvious. But I have to keep an open mind on which route should be taken forward because I will be the person taking the decision. And so, when the inspector's report arrives on my desk, that and any other relevant considerations will form part of my thinking. 

Questions now from party leaders. The leader of the opposition, Andrew R.T. Davies.

Thank you, Presiding Officer. First Minister, last week, we had the report into Tawel Fan up in north Wales, and many Members have had the weekend to digest the contents of that report. One of the startling conclusions of the report was the mishandling of the creation of Betsi as a health board for north Wales. It talked of lines of accountability that were impossible to track; a rift between the health board and the ward into how to deal with patient safety; clinical policy was seriously flawed; and senior nurse leaders were disrespected and ignored. All that was the language that was in the report, on their thoughts about the creation of Betsi as a health board for north Wales. You were a Minister in the Government that made the reorganisation of the health service in 2009 a possibility, and you've been First Minister for the duration of that health board's existence up in north Wales. Do you now not regret the way that that reorganisation was undertaken in north Wales, which has led to such observations and, indeed, can directly be correlated to some of the findings of the mistreatment on the Tawel Fan ward?

Well, first of all, it's clear that the report contains findings that will need to be acted on. It's far from a whitewash, as was described by one member of his party. It's a report that does identify many of the difficulties that are rightly there for all to see and will need to be acted upon. I don't believe that, in principle, the reorganisation of the health service at that time was a bad idea. We haven't seen similar situations occurring elsewhere, but it is clear that, as far as Betsi is concerned, they will need to act on the report's findings, and as a Government we will support them in order to deliver what the people of the north of Wales would expect to see in terms of rectifying what has been found to be wanting in this report.  

First Minister, I appreciate your answer, but, really, these findings in the report point clearly to that reorganisation as being the starting point of many of the problems that accumulated in the events on the Tawel Fan ward. I have asked you whether you have any regrets about that reorganisation and, if you had your time again, would you do that reorganisation differently? When you have such a report that talks about accountability being impossible to track, where you have a rift between the health board and the ward, when you have seriously flawed clinical policy, and when senior nurse leaders were disrespected and ignored, because of the process that you politically, as a Government, put in place at that time, then surely, on reflection, you can reflect on the point that all measures were not taken in the right manner to put a health board in place to deliver a first-class health service in north Wales. And is it not now incumbent on the Government to actually start delivering that first-class health service for north Wales? 

First of all, I don't accept that reorganisation was a major cause in terms of what happened at Tawel Fan, although it was obviously part of it. If that were the case, then we would see problems with reorganisation across Wales and, indeed, in other wards and other hospitals across north Wales as well. That it is a factor is something to consider. Now, people will want to know what happens next, because the report is there and it needs to be acted upon. Well, the recommendations are clear. The Cabinet Secretary for Health and Social Services will be making a statement later on this afternoon, explaining to Members what the future plans are, but it is important, of course, that the plan is acted upon and that is what we intend to do as a Government. 

I regret that you couldn't identify the flaws that the report identified as being at the heart of the reorganisation that happened in 2009. The language that I used was directly taken from the report, and, obviously, that is what the investigations have unearthed.

But, moving on, First Minister, the health board has now been in special measures for three years—or nearly three years, should I say. In an interview you gave to the BBC some two weeks ago, you said that there was no unfinished business left now that your term as First Minister was coming to a close. We could debate that across this Chamber and we most probably wouldn't move much further forward, but one thing certainly residents in north Wales would appreciate an understanding of—. Given that you think there's no unfinished business, surely one of the items of business that needs to be addressed is the normalisation of the structures that Betsi operates under, rather than direct Government control. So, do you believe that by the time you step down as First Minister, Betsi will be out of special measures come December of this year? 

Well, I suppose there will always be things that will need to continue to be proceeded with when you leave office. That's inevitable. But, for me, what's important is that people continue to see a continued improvement in the health service across the north of Wales. I have never been prepared to put a time limit on when Betsi should come out of special measures. It will remain in special measures for as long as is necessary to ensure continuous improvement. How long that will be will depend, of course, on us being satisfied that there is sufficient progress to enable us to release Betsi from special measures. That's not the case at the moment, and I don't think it would be wise to put a particular date on that. 

The leader of the UKIP group, Neil Hamilton. 

Diolch, Llywydd. The Welsh Government remains committed to the universal adoption of the Welsh baccalaureate, but the elite universities don't seem to be terribly interested in it as a qualification, indeed the top three universities don't require it at all. I've been written to by a school student who says that the Welsh bac is a burden for students and teachers alike and the work is tedious and not useful for more able students, and because these two subjects are compulsory for year nines it will be very difficult to compete with English pupils for jobs and university places as they'll have done two more valuable subjects. So, in the circumstances, does the First Minister not see that this is at best a distraction from more useful use of time in schools?  

Well, it's not correct to say that the Welsh bac is not recognised by the top universities, as he put it. People do recognise it for the breadth it gives to the skills that students are able to acquire when they're in school. My son is in school: I've seen the work that he does via the Welsh bac and, I have to say, both he and I found it extremely useful, because it takes him beyond looking at just academic subjects and enables him to develop more as an individual and therefore have a more rounded education. I believe that students, whatever level they leave full-time education, are more employable as a result of the skills that the Welsh bac gives them. 

Well, that is a debatable point in itself, I believe—it's not one I'm going to pursue at this minute, but, to take the wider point that the First Minister has raised, yes, I do agree that the Welsh baccalaureate course might have some use beyond formal learning in classrooms, making students think about wider issues in the world. That, in itself, could be a good thing. It depends on how the course is structured and how it is taught. One of the things that the Welsh bac contains is a global citizen challenge, which deals with issues such as cultural diversity, fair trade, future energy, inequality and poverty. These are all highly political topics, which need to be taught in a balanced way if education is not to degrade itself into mere propaganda. There are serious debates, for example, about the causes of poverty in other parts of the world: why is a potentially rich country like Venezuela reduced to destitution? We know that's because it has a Corbynite Government. Why is a country like Singapore, which has virtually no natural resources, now the country in the world that has the highest per capita income? None of this features in the Welsh baccalaureate course on poverty. So, does the First Minister not agree with me that we need to be very careful about the way these political subjects are taught in schools to make sure that the course is balanced and it teaches students how to think critically about issues, rather than just to swallow what they're told?

I trust our teachers, bluntly, and I also trust our students to be able to think critically for themselves. There are education systems that, if you look at the Programme for International Student Assessment, perform better on the figures than ours, but I'm not sure they necessarily give students the ability to think critically. They can pass exams, but that's not the same as being prepared for the world of work or to think about the world around them. The issues that he has identified there are surely issues that concern us all. There'll be different views on how to address inequality, different views on how to address poverty, nevertheless, they are hugely important issues that I think every young person needs to think about. But I've seen no examples at all of any kind of bias being introduced into the curriculum, and, from my perspective, I think it's hugely important that our students do have the ability to go beyond academic subjects, because I think it makes them more rounded individuals when they do think more critically and more widely.

Well, all I can say is, having looked at the various materials that are used in teaching these courses, they're all from a centre-left disposition. Now, we can all—[Interruption.] Well, matter of fact—and I think the false indignation coming from the other side proves the point that I'm trying to make here, that, because they control the education system, it is being used as a tool of propaganda. There is nothing, for example, in the topic of wind energy that calls into question the efficacy of this even to deal with the problems of man-made global warming if that is held to be a problem. So, what I'm saying to the First Minister is that parents should be very worried. And, yes, the First Minister has said he trusts teachers, and, of course, I'm not saying that teachers set out in order to propagandise children, but the mindset of a teacher is very important as a background to this, and considering that 72 per cent of secondary school teachers, according to the Times Educational Supplement, vote Labour, 10 per cent vote Liberal, only 8 per cent vote Conservative, there is clearly—[Interruption.] There is—[Interruption.] Well—[Interruption.] That, of course—[Interruption.] That, of course, is a highly unrepresentative sample of the population as a whole. And, therefore, even if bias is subconscious, it must be regarded as a potential danger.

You do wonder. Well, it's quite clear why teachers are reluctant to vote UKIP then, given what they've just heard. I do wonder, listening to the leader of UKIP, whether he regards, from his perspective, George W. Bush as a dangerous communist, because—. Was he somebody, for example, who backed section 28 of the Local Government Act 1988 and the demonising of gay and lesbian people as a result of that? Well, if he did, and I think I'm right in saying that he did do exactly that, then, yes, anything is centre-left from his perspective. From our perspective, we want to make sure that young people get a balanced view of the world and not a view that says, for example, well, man-made, as he put it, global warming, if such a thing exists—the vast weight of evidence supports that. The fact that a few people choose to say it differently doesn't mean that the proper weight should be given to their evidence, because there are so few of them. If he is really saying that the point of teaching young people, through the Welsh bac, information about energy, for example, is to ignore the full weight of science, then that gives us some idea of what he would like to be taught in our schools. We prefer balance; he wants right-wing revisionism.

Plaid Cymru leader, Leanne Wood.

Diolch, Llywydd. The EU withdrawal Bill, as amended, will still allow the Assembly's competence to be restricted without its consent, and the inter-governmental agreement does not provide water-tight assurance that this will not happen. Does the First Minister agree or disagree with that statement?

I disagree with the way that it's been put, because I think we've come a long way from where the UK Government were; they have given a lot of ground. It's not ideal from our perspective, of course not, but the nature of an agreement is that you come to ground that you believe to be common ground. What the agreement says is that the UK Government will not normally legislate in devolved areas. That simply reflects what's already said in the devolved settlements across the UK. It is something, I think, that will need to be addressed in the future, but I believe we have an agreement that shows that a lot of ground has been given by the UK Government, particularly the introduction, in effect, of the Sewel convention into secondary legislation, something that didn't exist in the same way before, and I believe it gives us the protection that we need. We will, of course, be very vigilant in making sure that the UK Government keeps to the terms of the agreement.

The words in that statement, First Minister, were not my words. They were taken from an analysis by the National Assembly for Wales's legal team that confirms the damning repercussions of the dodgy deal between the Tories in Westminster and your Labour Government. Last week, Labour frontbench Members claimed that Plaid Cymru didn't understand the outcome of this deal when it came to the powers of this Assembly and its ability to withhold consent. First Minister, the legal advice shows the opposite to be true. The advice says any indication that this Assembly will be able to block Westminster by withholding consent is, and I quote, 'misleading'. It goes on to say, and I quote again, 'the Assembly's competence can be restricted without its consent'. Does the First Minister agree with the Assembly's lawyers that Westminster can now meddle in our Assembly and there is absolutely nothing we can do about it?

The way she presents—. This has been the case since 1999; it's not new. The reality is that it's always been the case, both in Scotland and in Wales, that the UK Parliament—the expression is 'would not normally legislate' in devolved areas, but it's always been able to do it because of the doctrine of parliamentary sovereignty. The agreement's not going to change that. Now, in the future, I agree that there needs to be a debate about whether parliamentary sovereignty is appropriate—and I've said it before—publicly, for the future. I think we do need to move to a constitutional settlement that recognises that there are different centres of democratic legitimacy within the UK itself. But, as far as the current devolution settlement is concerned, we now have a situation where, in effect, there will be a very high political cost for any UK Government to pay if it wished just to ram through whatever it wanted to. Can I say as well, if it was the case that the UK Government wanted to ignore completely the Assembly or Scottish Parliament, it would've done so already? It hasn't done so—not for me to defend it, and I don't do it often—but, in reality, the UK Government has come to an agreement where they have conceded, I recognise, a great deal of ground. And we are in a position where—whilst we would have preferred to get rid of clause 11 completely, we are in a position where safeguards, sufficient safeguards, have been put into clause 11. A level playing field has been created in terms of the making of legislation that we were nowhere close to a year ago. I certainly pay tribute to my colleague, Mark Drakeford, for the work that he did on a week-to-week basis in coming to the agreement that we did.

First Minister, this is a dodgy deal, and it's one that you have signed up to. And it's not simply created constitutional chaos. Your decision to give this Bill consent will have ramifications for our economy as well. Whilst your party is all over the place on this question, your Ministers and Labour Members continue to campaign for membership of a customs union. By advising that we consent to the withdrawal Bill, however, you are serving up a hard Brexit to the Tories on a plate. Will the First Minister confirm that he understands that by consenting to the withdrawal Bill he is ensuring that it is Westminster that will decide whether Wales leaves the customs union and the single market?

Well, it was always the case that, in law, it's Westminster that decides whether we leave the customs union. In reality, as she has heard me say many, many times, that would be madness as far as the UK is concerned. It is hugely important that the UK remains within the customs union. Trade policy is not devolved—that is reality. But we have ensured that we have a voice to make sure that the voice of Wales is heard.

I have to say, last week—I listened to Plaid Cymru last week; it was almost as if there were two different debates. I listened to Rhun ap Iorwerth and what he said—a measured, detailed response. It was a measured, detailed response compared to what we had before from the leader of Plaid Cymru, where she used words like 'capitulation', 'betrayal', 'dodgy deal'. She sounds like Jacob Rees-Mogg when talking about Brexit. I don't mind criticism, but at least—[Interruption.] Let's look at the detail. Let's look at the detail. [Interruption.] Let's look at the detail. If there are disagreements on the detail, fine, but, in the answers that I gave, not once did she come back to me and say, 'Well, look, what about this? What about this? How does that provide us with reassurance?' I have to say that I thought the answer that was given by, or the speech that was given by, Rhun ap Iorwerth, certainly, last week, was measured and something, I thought, on which we could have a proper debate.

I expect Hywel Dda Local Health Board to provide a range of safe and effective services out of hours to respond to the urgent healthcare needs of their population when GP surgeries are closed.

Well, perhaps the Welsh Government expect them to do that, but, on a number of occasions this year, patients within Hywel Dda have been left without out-of-hours cover on weekends, because of what the health board itself describes as a dire shortage of GPs. It affects the three counties within their area, but it is specifically having an impact on Carmarthenshire, because of particular problems at Glangwili and Prince Philip hospitals. Now, the health board itself has apologised to patients on a number of occasions. Is the Welsh Government going to apologise too? You decided not to include Carmarthenshire in the 'Train. Work. Live.' programme to attract GPs to Carmarthenshire. Doesn't some of the responsibility fall on your shoulders?

Well, what we wish to ensure, of course, is that people do come to work in Wales. We have seen the numbers increasing because of that. We've seen, for example, the numbers increase in Ceredigion and in Pembrokeshire. Also, in Pembrokeshire, for example, in 2016, in terms of doctors coming into the training places, the percentage was zero, and then it's increased to 100 per cent within a year, in 2017. Now, is it true that there are pressures? Yes. Is it true to say that some services have not been sustained? Yes, that's correct. So, what's next? Well, Hywel Dda is employing advanced paramedic practitioners—people who can work within the local area. Adverts have been placed by the health board seeking to attract people into the Hywel Dda area. There is discussion ongoing at present on the potential to develop regional working, particularly during the night hours, and those are discussions with ABMU and Hywel Dda and also the Welsh Ambulance Services NHS Trust. We are also looking at GPs working from home. That is being considered at present, and that, of course, will need to be considered to see how effective it is. So, yes, it’s true to say that the service has not been of the quality that we would expect, but the health board is working on resolving the situation.

First Minister, there is clearly a huge problem in terms of out-of-hours doctors in the Hywel Dda health board area, and one of the impacts of this is to place significant pressures on A&E services, for example. Now, the options for the health board's current consultation mean that Withybush hospital will be downgraded to a community hospital without A&E services, which is entirely unacceptable. Would you agree with me, therefore, that it is even more important that A&E services should be available to people in Pembrokeshire, given that there is a huge problem with out-of-hours doctors, and that the Hywel Dda health board should at least recognise this in its consultation on reconfiguring health services in west Wales?

Well, I cannot express a view on the consultation, of course. It's important that this takes place and that it is an open consultation where people have the opportunity to express their view on the process itself, and to say how strongly they feel about any issue. As regards Pembrokeshire, there are an additional six GPs that are being trained in Pembrokeshire, and that, of course, will be of assistance to the area. Also, there are an additional six doctors on the hospital rota in the local area, because those doctors will have a role to play in the hospital itself. So, we have succeeded in attracting doctors to the Ceredigion and northern Pembrokeshire area, and we would expect Hywel Dda to continue to attract more doctors in order to ensure that there is a sufficient number of doctors available out of hours.

Supporting care leavers into independent adulthood and successful futures is a key commitment in 'Prosperity for All'. Through the ministerial advisory group and investment in key initiatives, a strong collaborative approach will improve outcomes for those involved, and we're beginning to see the beneficial effects of what has already been announced.

Thank you, First Minister. I'm very proud that, despite the challenges of austerity, Torfaen council became the first local authority in Wales to exempt care leavers from paying council tax until 21, or 25 in some circumstances. As you'll be aware, that decision was followed by six other local authorities. This exemption will provide care leavers with a vital opportunity to transition and adapt to independent living, and this peace of mind should be available to all care leavers in Wales, not just in the seven local authorities who have introduced the policy. First Minister, what can you do to assist the remaining local authorities in Wales to provide this exemption to care leavers to ensure that care leavers in Wales can access the support wherever they live?

'Learn from the good example of others' is what I would say. We've already asked local authorities to use their powers to exempt care leavers from paying council tax. I would not think it's a massive financial hit on the budgets of local authorities. I very much welcome what Torfaen has done, and the other local authorities. I would very much urge the others to follow suit.

It's a really good question that's been asked here today. Because of the seven local authorities that have already introduced this—the actual cost across Wales would be £2 million. Sixty local authorities in England have implemented this, and in October it was announced for all care leavers in Scotland. So, First Minister, what commitment will you make to provide funding to local authorities here in Wales to provide a 100 per cent council tax exemption for young care leavers?

Some local authorities have done it already. Because they've done it already, I can't see why others cannot follow suit. I believe, actually, that it's now eight, rather than seven, across Wales that have exempted care leavers from paying council tax until at least the age of 21. Two local authorities have exempted all care leavers up to the age of 25, and three have exempted up to the age of 25 in certain cases. Now, I understand that a further 10 local authorities have plans to move ahead with this, subject to the necessary approvals. We haven't had information back from four local authorities, but we will continue to press. If one local authority can do it, the others can do it, and so I would very much urge the other local authorities to follow the good example of those who have already committed to this policy.

First Minister, the best support we can give to care leavers is ensuring that they have the knowledge and skills needed to prepare them for an independent adult life, the skills most of us are taught by our parents. What is the Welsh Government doing to ensure that corporate parents equip those in care with the skills needed in later life and will you learn from the Roots Foundation in my region who focus on helping those in care to transition to independent living?

I think our carers, and our foster carers particularly, do an incredible job. I've met people who have fostered many, many children and they've fostered children who have come to them in the most difficult of circumstances, sometimes more than once. I've seen foster carers who foster children at a very young age who then, of course, see them go for adoption when they're 18 months or two years old. It's very, very emotionally difficult for people, and I really take my hat off to them.

She asked what we have done as a Government. Well, we have established the £1 million St David's Day fund. That supports care leavers to access opportunities in education, training and employment. There's £625,000 for the local authorities to develop apprenticeship and traineeship opportunities within the local authority, acting as good corporate parents, and £1 million has been provided to local authorities so that personal adviser support can be provided for all care leavers up to the age of 25. Those are just some examples of what we have done as a Government in order to provide the sorts of funds that are required to give our care leavers a better start in life.

Since its launch in 2014, Help to Buy—Wales has helped nearly 6,900 households to buy their new home, with around 75 per cent being first-time buyers. In addition, of course, the scheme is attracting development funding into Wales and providing jobs and opportunities for the Welsh supply chain.

Thank you, First Minister. The value of homes in Newport has grown by 4.7 per cent in the last year, with the average house price now in Newport over £185,000. The Welsh Government's Help to Buy scheme has helped over 1,200 first-time buyers to purchase their homes in Newport, and that's one fifth of all Help to Buy homes purchased in Wales. With the removal of the Severn bridge tolls fast approaching, and people moving from Bristol and Cardiff to Newport, increasing rents and house prices continue to put a real strain on young people and families. Consequently, there's a real risk of young first-time buyers being priced out of the market. What more can the Welsh Government do, with the local authority and social landlords and developers, to ensure property hotspots like Newport are attainable for those who want to get on the housing ladder for the first time?

Help to Buy—Wales is part of that, but other schemes such as Rent to Own are hugely important, and also making sure, of course, that there's sufficient supply of housing in the area. That's not just about building more and more homes—although we have our target of 20,000 homes that we will reach by the end of this Assembly term—but also, of course, bringing more empty homes into use, and Newport, of course, has a good record of doing that. And, of course, it's looking at alternative ways such as shared equity schemes, such as community land trusts, in order to make housing more affordable, and particularly to make sure that the price of housing doesn't go up so fast and so far that the housing then becomes unaffordable. One way of doing that is through shared equity. One way of doing that is through community land trusts, where the land is owned by a landlord and the people who own houses on the land are leaseholders. It helps to control the price of houses. I think all these things can be looked at by house builders, in order to make sure that more and more houses become available.

First Minister, I certainly agree that the Help to Buy scheme has been successful, as it has been in England, and the other demand-side measures that you mentioned—most of them are also in England—have also been helpful, but they're not as powerful as supply-side measures. Can I tell you, now, the latest figures? Since March 2018, just gone, the average house price in Wales is now over £181,000. That's between six and seven times the average income. That's why we have a housing crisis. It's not your fault in particular; it's all of us who have been active in politics for the last 25 to 30 years. We've got to have a complete change, starting on the supply side.

I agree, but I think it's about more than that. The most difficult part of the housing market in the UK is that people have become used, over many, many years, to seeing a house as an asset—as something that potentially could be something where they could see an increase in their financial investment, or something for their children. It doesn't happen everywhere else, in other countries. Quite often, in some countries, renting is seen as the norm and property isn't seen as something you invest in. But it is, in reality, the case that people do invest in houses with the expectation that prices will go up. The question is getting the balance right: prices will go up, but it's making sure they don't go up at an astronomical rate, and that means increasing the supply. He's quite right about that. But it's about making sure that the supply properly matches the demand that's there. There's no point increasing the supply of high-end housing if the market isn't going to help those people who are at the lowest end of the income scale, which is why I've always emphasised the fact that, yes, we need social housing, yes, we need to make sure that there is more good private rented accommodation, yes, we need more houses for purchase, but we also need to look at other ways in which people can get a stake in property without having to buy a house outright, which would be beyond them financially.

The 'Prosperity for All' national strategy and the economic action plan sets out the actions we're taking to support economic growth in the Cynon valley and across Wales. Just some examples, of course: our Vibrant and Viable Places town centre loans fund is helping to support town-centre regeneration across Wales. Aberdare, in particular, is seeing the benefit of that. If we look, for example, at the Cynon valley, the Cynon valley has attracted four investments from foreign-owned companies and two investments from elsewhere in the UK over the past five years. And, of course, there are examples of home-grown businesses in the valley that are doing well, such as Ashwood Designs.

Thank you, First Minister, and I agree with everything you said there. I recently visited Pontus Research, which is an award-winning aquaculture research and development business in my constituency, with a global client list. The company has done incredibly well, but they've now reached capacity and they need to grow. They've applied for funding from the European maritime and fisheries fund, but have been told that their application could take at least 120 days—that's 120 working days—just to process. This is preventing them from developing, from possibly securing match funding, from taking on new staff and thereby contributing to economic growth even further in my constituency. First Minister, will you look at how the EMFF is working in Wales to see whether improvements can be made to timescales so that other businesses like Pontus don't lose out?

Well, first of all, the appraisal process should take up to 120 working days, not at least 120 working days. What I can say, though, in relation to Pontus is that the application is currently being appraised. The company has received a letter confirming that it can start work, at their own risk, from the point the application is submitted, and that was in January 2018, in order for that work to begin. I can also say that the company has been able to benefit as well from funding made available by the Welsh Government through the fisheries business development advisors scheme to help to pay a consultant to develop the business idea. If your constituent has been told that it's at least 120 days, let me give the assurance that it is 'up to', with the objective, of course, that the appraisal process is finished long before that.

David Melding. 

Diolch yn fawr, Llywydd. I'm obviously in your good books this afternoon, and long may it continue. [Laughter.] First Minister, Cynon Valley is the third least economically active constituency in Wales, and we know the association between economic activity and prosperity. The main reason that people remain economically inactive, when they could, actually, for health reasons, be fit enough for work, is that they don't have the basic skills to enter the job market, as it changes rapidly. Therefore, investment in basic skills is as important as driving towards the great knowledge-based economy, which, of course, we also want to see in Wales. These programmes are what we really need in areas like Cynon Valley.

I agree. The reason why, of course, productivity is historically low, not just in Wales but in the rest of the UK, is that over many years, there was a lack of investment in skills development. We know that the more skilled people are, the more productive they are and the more they can earn. I've said this before in the Chamber: why is it that, if we give a German worker a particular machine, we get far more out of it than a worker in the UK? Why? Training. That's the reason for it, and that's the lesson we must learn. How are we doing it? Working with higher education bodies, who are working hard in their communities. Further education colleges—we have new colleges that have been built across Wales, offering fantastic facilities for local people. The Valleys taskforce has, at its very heart, the desire to ensure that people can have better jobs closer to home, and that means, of course, making sure that they have access to the skills that they need. But it is hugely important as well to make sure that jobs don't leave Valleys communities, and that's why I was so disappointed to see that the Department for Work and Pensions have decided to centralise lots of jobs that have come from other valleys in Treforest. They're not new jobs; they're jobs that have simply been moved around. Unfortunately, for many people, that will mean that they will now find they have to travel further in order to keep the jobs that they have. That is the wrong direction.

Tthe clinical audit and outcome review programme for the NHS doesn't include provision—that's true—for a national clinical audit of ovarian cancer services. We do, however, encourage ovarian cancer charities in Wales to approach the Wales Cancer Network to consider alternative approaches for reviewing services.

Thank you, First Minister. You'll be aware that today, in fact, is World Ovarian Cancer Day. On Mother's Day, I joined hundreds of others on a walk in memory of Lesley Woolcock from Barry, who was a tireless campaigner on ovarian cancer who sadly passed away in 2016.

According to Ovarian Cancer Action, ovarian cancer is the UK's deadliest gynaecological cancer, and the UK has one of the lowest survival rates in western Europe. So, an ovarian cancer audit could provide the data to help find out why this is and where the challenges lie. And, of course, recognising the importance of national clinical audits—and they have improved survival rates for lung, bowel and head and neck cancers—I understand that Scotland has just completed an ovarian cancer audit, and the chief medical officer in England has called for an audit. So, I hope, indeed, there will be consideration for an audit for women in Wales.

Well, there already exist clinical audits for a number of other cancers, as the Member clearly pointed out. We keep an open mind on whether clinical audits are appropriate for all cancers, but what I can say is that there is already a system in place in order to examine the way in which ovarian cancer is detected and, indeed, treated—that's part of the approach set out in the cancer delivery plan for Wales. We do have a significant amount of data on ovarian cancer that is provided by the Wales cancer registry, and we do learn from that in terms of what impacts cancer survival through our participation, for example, in international studies. 

I can also assure Members that ovarian cancer services are subject to a peer review programme. That has taken place this year, and that is intended, of course, to support quality improvements in services.

And finally, question 8, Llyr Gruffydd. 

All procurement by any health board should be undertaken in accordance with its standing financial instructions, the principles of financial management set out in 'Managing Welsh Public Money', and with the specialist advice and support of NHS Wales Shared Services Partnership procurement services to assure compliance and value for money.

In response to questions from Plaid Cymru on proposals to privatise dialysis services in north Wales, you said, on 30 January, that you were entirely opposed to privatisation:

'We are completely against privatisation'.

Those were your words. We now hear that Betsi Cadwaladr is proceeding with plans to privatise those dialysis services across north Wales. The staff tell me that they don't want to transfer from the NHS into the private sector, and they also tell me that they don't feel that there has been sufficient consultation with them. There certainly hasn't been consultation with patients or the public more generally. And I have a letter from the health board confirming that they have your Government's support for this proposal. A Labour Government allowing public services to transfer from the NHS into the private sector—it's something that you are very critical of when the Conservatives do it in England.

So, when you told us on 30 January that you were entirely opposed to privatisation, did that suggest that you didn't know what was happening within the health service in north Wales, or, indeed, were you trying to mislead us?

No, not at all, and I would like to see the letter that the Member alludes to, to see exactly the content of that letter. So, I will wait, therefore, to see what will happen on that.

This is a process that Betsi Cadwaladr trust has begun, and it will be complete by July. What they are trying to do is ensure that the best possible service is available for their patients, and they are duty-bound to ensure that that happens.

Thank you, First Minister. 

The next item, therefore, is the business statement and announcement, and I have been informed that the Cabinet Secretary for Energy, Planning and Rural Affairs will make the statement today on behalf of the leader of the house. Therefore, I call on Lesley Griffiths.

Diolch, Llywydd. Two statements by the Cabinet Secretary for Health and Social Services have been added to today's agenda on the recently published reports on Tawel Fan and the use of the vaginal synthetic mesh. Business for the next three weeks is shown on the business statement and announcement found among the meeting papers that are available to Members electronically.

Could I seek two statements, Cabinet Secretary, please, today, if possible? One is on the proposals to build a new road from junction 34 in the Vale of Glamorgan to Sycamore Cross. I do declare an interest in that, potentially, some of my land could be affected by it. There was a large public meeting that I was unable to attend on Thursday night, but I know that the Member for the Vale of Glamorgan was there. This has caused considerable concern in the locality of Pendoylan, and whilst the consultations have been welcomed, there is still much vagary around the dates and timelines of possible delivery, or not, as the case may be, and exactly who is driving these proposals? Is it the local authority, is it the Welsh Government, is it a combination of the two? A statement from the relevant Cabinet Secretary would benefit informing the community around the issues around this proposal.

Secondly, could we have a statement from the health Secretary around the news over the weekend from the Royal College of Physicians that there has been potentially a computer glitch that has affected 1,500 job offers to junior doctors and their placements in other parts of the United Kingdom and, indeed, I dare say, in Wales as well—how that might or might not have affected positions to be filled here in Wales? We're all aware of recruitment issues in the health service in whatever part of the United Kingdom, but to hear of this glitch from the royal college, which has potentially affected at least 1,500 job offers, is of concern. In particular, could we understand how that might or might not have affected health services here in Wales?

Thank you, Andrew R.T. Davies, for those questions. In relation to the first one, around the proposed road at junction 34, I understand the Cabinet Secretary for Economy and Transport has already written to the constituency Member, and so he will now update all Assembly Members in relation to that.

The second part of your question: the Cabinet Secretary for Health and Social Services is aware of, I think, this very unfortunate situation, and of course it does raise concerns. His officials are now in contact with the Wales Deanery to ensure that they will be very clear about any developments and to understand what impact it will have here in Wales. We need to ensure that the situation is, obviously, rectified as soon as possible.

Today, new leader of the house, for the time being, pro tem, the House of Lords is, of course, on its last realistic opportunity on Report Stage of amending the European Union (Withdrawal) Bill, and before them is a very important amendment in the name of a Labour lord, Lord Alli, supporting remaining in the European Economic Area as a negotiating objective of the UK Government. Now, that's precisely the aim, the stated aim, of the Welsh Government—leaving the EU but remaining in the single market and customs union—and is one of the negotiating objectives in the White Paper published by the Welsh Government. The fudge of a customs partnership—for once, I think Boris Johnson's probably got it right—is not going to suit anyone, and is a ridiculous way forward, and won't work. You're either in or you're out of a customs union. So, can we have a statement from the Welsh Government on what work it is doing now to support this vital amendment, which would in turn allow the House of Commons to make a decision, because it is the stated policy of the Welsh Government? In particular, has the Government instructed the two lords who are members of the Welsh Government to attend the House of Lords today and vote in line with Welsh Government policy? [Interruption.] My question is to the leader of the house, if I may.

Secondly, can we have a debate led by the Cabinet Secretary for Economy and Transport on cycle safety? I enjoyed a glorious cycle ride myself on Sunday, from Aberystwyth to Pontarfynach and around the back lanes of Ceredigion. Much of it was on a Sustrans route, so I was disappointed to read that our own First Minister doesn't feel safe to cycle in Cardiff. What does it say to how we prioritise cars over safe routes, and how we design our cities, if our own First Minister doesn't feel safe to cycle in his own capital city? Now, I've raised cycle safety before with the First Minister directly, and perhaps now we will all take it seriously, and take action so we see a genuine change in the way we travel and live our lives. We need to get past the welcome, yes, additional resources for safe routes to debate—and that's why I'm asking for a debate—what the alternative is for car journeys in our cities, and how we make our cities more accessible for all of us, including the First Minister when he wants to cycle. If he ever does want to cycle, when he's retired from his current role, up the Rheidol valley, I would be delighted to accompany him.

Thank you, Simon Thomas. In relation to your first point, it has always been the Welsh Government's position that we should remain in the single market. We believe that's absolutely right for the economy of Wales, and I'm sure the Cabinet Secretary will update us at the appropriate time.

I'm not quite sure that's what the First Minister said. I only read the article very briefly, but I thought the reference was more to his age than to the fact that he didn't feel safe, but I'm sure he'll be very pleased to take you up on your offer.

Obviously, the Cabinet Secretary for Economy and Transport has made £60 million available to local authorities. It's now for local authorities to make sure that they have the cycle paths that are required by their local population.

Can I just ask two questions, Cabinet Secretary? Last week, I attended the real living wage leadership group and I met the directors of the Living Wage Foundation and Cynnal Cymru, which undertakes the accreditation of real living wage employers in Wales. It's reported that there are now 143 accredited real living wage employers in Wales, drawn from the public, private and third sector, as part of 4,000 real living wage accreditations UK-wide. Can you update on whether the real living wage will be acknowledged as part of the economic action plan and the gender review?

And, secondly, can I add to the question, following Andrew R.T. Davies, regarding the proposals affecting the people living in the Pendoylan area? I did attend a PACT meeting last week regarding the Welsh transport appraisal guidance road proposals to link the M4 to the A48.FootnoteLink Ten years ago there was a consultation over similar proposals and the Welsh Government decided not to proceed, but undertook to invest in improvements to Five Mile Lane, which are taking place, and improved frequency of bus and rail services on the Vale line to half-hourly. Can the Cabinet Secretary give a statement as to why those half-hourly rail services have not been implemented? I believe those would be the best way to improve access to Cardiff Airport and the St Athan enterprise zone in the Vale of Glamorgan.

Thank you, Jane Hutt, for those two questions. In relation to the real living wage being acknowledged as part of the economic action plan and the gender review, you'll be aware that when the economic action plan was launched in December 2017, that really set out Welsh Government's vision for inclusive growth to boost our wealth and well-being and the narrowing of inequalities that we have across Wales. So, absolutely at the heart of that plan is a commitment to developing a new and very dynamic relationship between Government and businesses, based on the principle of public investment with a social purpose. I think, in particular, the focus on fair work as a key element of our new economic contract really will provide an opportunity to promote and raise awareness of the business benefits of the real living wage. And what we want to see is that increasingly adopted across Wales.

In relation to your second point, around the meeting you attended and whether the half-hourly rail services—why they haven't been implemented. As you know, we will take over the full responsibility for the Wales and borders rail service later this year and that will then enable us to introduce our own improved contract, service and systems for rail users across Wales and the borders. Obviously, specific services will be for the new operator and development partner, but our minimum requirement for the bidders tendering for the contract is that services will at least be equivalent to those currently provided. Obviously, the procurement process is still ongoing, so it's not appropriate for me to comment further on the outcome. 

Cabinet Secretary, may I ask for a statement on respite services for people affected by dementia in Wales? The older people's commissioner has produced a report claiming that traditional respite care that does not meet people's needs is detrimental to their health and well-being. The report further claims that traditional respite services often lacked flexibility and did not always deliver positive outcomes. Cabinet Secretary, could we have a statement from your colleague, another Cabinet Secretary, the Cabinet Secretary for health, providing us with a full response to the concern raised in the older people's commissioner's report, please?

Thank you. Once the Cabinet Secretary for Health and Social Services has had time to consider the report from the older people's commissioner, I'm sure he will then update Members, as he sees fit.

Thank you, Cabinet Secretary. I've got two issues. The first one: it was clearly a desperately disappointing day last Thursday as we learnt of the news that nearly 800 jobs are to go at the Virgin Media call centre in Llansamlet in Swansea. The loss of hundreds of jobs is clearly going to have an impact locally. It means a huge uncertain and distressing time for staff and their families. Now, I realise that written statements have been produced, but I would hope that the Welsh Government will now provide as much support as possible to those affected. But the announcement also raises questions about the level of communication between the Welsh Government and major companies such as this, because last year we had a similar announcement with a Tesco call centre moving over 1,000 jobs from Cardiff, with the Welsh Government again seemingly being made aware only when the announcement was made public. Now, given that the call centre sector is a key employer in Swansea, as in other parts of Wales, I would expect the Welsh Government to be fully aware of any difficulties faced by employers or of any planned changes before such public announcements are made. The Virgin Media announcement therefore raises questions about the type of relationship that the Welsh Government has with business and the mechanisms that you have in place to gather intelligence and to formally discuss and resolve any business pressures or planned changes. So, with all of that in mind, I'd be grateful if the Cabinet Secretary would bring forward a statement that we can debate here on the Virgin Media call-centre decision.

And my second issue is on the costs of medical indemnity for GPs. That's the cost of medical insurance that we—all GPs, all doctors—have to have. Before you can practise as a doctor, you have to have insurance to cover any possible costs of litigation, which runs into several thousands of pounds, and for GPs this is paid personally. Full-time GPs pay as much as £6,000 to £8,000 a year, and even as part-time GPs, that cost can be £3,500 or more. And that is paid personally by GPs. Hospital doctors have those costs paid for them. The situation as regards GPs increasingly going part-time, or doing locum work later in their careers, is that they are now weighing up the costs of still paying that medical indemnity insurance with the costs going up, with wanting to do one or two days' work, and finding that doing one or two days' work does not pay for the costs of the medical indemnity. So, I'd be grateful if that situation could be looked at in some detail by the Cabinet Secretary, because we are losing a valuable and experienced sector of the GP workforce through inaction on this point. Diolch yn fawr.

Diolch, Dai Lloyd, for those two questions. In relation to Virgin Media, obviously we're extremely disappointed by their plans to close their customer engagement centre in Swansea, and Welsh Government was not informed of this prior to the announcement. Obviously, we can only act if we're told, but the Cabinet Secretary for Economy and Transport has set up a task and finish group, on the same model as the one that he set up in relation to Tesco, which you mentioned earlier. And, also, alongside that, the Welsh Contact Centre Forum will work, where it can, with Virgin Media and the affected employees to help them secure, obviously, employment again. One of the reasons that we provide financial support to that forum is to enable them to do that. Employment opportunities are being created at other regulated customer service centres across south Wales, so I know the Cabinet Secretary is confident, as with Tesco, that alternative employment can be found.

The Cabinet Secretary for Health and Social Services will have heard your request for a statement around medical indemnity fees for general practitioners, which I think is a very pertinent point.

Can we have a debate on the announcement that the First Minister mentioned in his questions today, that the Department for Work and Pensions plans to close five offices across south Wales and centralise those jobs in one new build, in Treforest? The plans will affect jobs in Newport, Cwmbran, Caerphilly and Merthyr, as well as 714 staff working at the Gabalfa office, in my constituency of Cardiff North—1,700 jobs altogether. Does she agree that this will take public sector jobs away from many needy communities, and will impact unfairly on staff, in increasing travel time and costs, and it will particularly affect those with caring responsibilities? And, above all, it is not supporting the Valleys taskforce, as Fiona Jones from the DWP says in her letter to Assembly Members, because these are not new jobs, and they are being moved from many needy communities. So, could we have a debate on this very important issue?

Thank you, Julie Morgan. And you will have heard the First Minister's concern around this decision. Obviously, it's a non-devolved matter; it's been taken by the UK Government. We understand that approximately 1,400 DWP staff will be affected by the relocation proposals, which were announced by the DWP last week. As the First Minister said, these are not new jobs. We know that staff are currently based in benefit offices in Merthyr, Caerphilly, Cwmbran, Newport and Gabalfa, Cardiff, in your own constituency, and the prospect is of moving to a new building in Treforest in 2021. We do understand the DWP are working to ensure that there are no job losses for staff resulting from the relocation, and that staff will be offered alternative roles, if relocation is not an option. But, clearly, as a Government, we are very concerned about this decision by the UK Government.

May I ask for an early statement on SchoolBeat and its funding? It's a matter that I and others have raised regularly over the past few months. There is some uncertainty. The service doesn't know whether it will be able to persist until the Government makes a decision on its funding. It's an important service, with police forces going into schools to work with pupils and staff on developing resources and providing classes on online security, the misuse of substances and so on and so forth. But we're now in a situation in north Wales where there are vacant posts within the programme where it isn't possible to recruit staff because of the uncertainty emerging from your Government's decision. So, can I ask you for an early statement on this because this is a service that is appreciated by pupils, by staff, by teachers, and it's the Government's duty to provide that clarity?

I am very well aware of the service and I will ask the Cabinet Secretary for Health and Social Services, whose remit it comes under, to write to the Member around that issue.FootnoteLink

Thank you, Cabinet Secretary. Point of order, Joyce Watson. 

Llywydd, following the point of order that I made last Wednesday in this Chamber, I wish to correct the record and confirm that I did in fact use the words quoted by the leader of the UKIP group during a previous debate. 

Further to that point of order, Llywydd—

No. The point of order has been clarified and corrected, and I am satisfied with that and there is nothing further to this point of order to be made at this time. [Interruption.] 

We move on, therefore, to the statement—

Your microphone is not on. The people of Wales cannot hear you, and if the people of Wales cannot hear you, then the Assembly Members in this Chamber are not to hear you. [Interruption.] Yes, thank you very much for writing to me in advance, and as I have already told you this afternoon, I met with Joyce Watson, and she has agreed and corrected and clarified the matter that was raised last week, and this matter has no place else to go. And I am moving on to next business. [Interruption.] Neil Hamilton, you will sit down at this point because you are not being asked to speak or to make any further contribution to this point [Interruption.] Nothing you have said during this point has been on the record or on microphone.

I am moving on to the next point of business and that is item 3, which is the statement by the Cabinet Secretary for Health and Social Services on the report into—. I have this in Welsh in front of me, so I'm going to change to Welsh at this point. 

The Health and Social Care Advisory Service Report, HASCAS, into the care and treatment provided on Tawel Fan, and I call on the Cabinet Secretary to make his statement. Vaughan Gething. 

Diolch, Llywydd. On 3 May, the Health and Social Care Advisory Service published the outcome of its investigation into the care and treatment provided on the Tawel Fan ward. I am acutely aware that this has been a very difficult period for all individuals, families and staff directly affected by the concerns over care and treatment at Tawel Fan. I acknowledge the additional strain caused by the length of this investigation. It was, however, essential that the investigation remained focused on a thorough and fair process that was not compromised to achieve restrictive timescales.The report set out a range of failings that let down patients and led to real harm being caused. I am deeply sorry that this happened and I apologise for it without hesitation.

The scope of the investigation was significant and broader than the original commission. It ultimately involved reviewing 700,000 pages of documentation, 148 interviews and 108 case reviews. It also considered material provided as part of previous investigations. This was a broad remit, and unlike previous reports, it was able to have access to a comprehensive set of documentation, including clinical records, and draw in specific mental health expertise. HASCAS maintained an independent and evidence-based stance throughout, with the aim of providing as accurate an account of events as the evidence available allows. This has been done with the support of an expert panel of 16 individuals of national standing.

I do need though to address the accusation made that there was a direct link between the Welsh Government and HASCAS that affects the independence of the report. The inference of a conspiracy directing the report to protect the Government or a political party is a direct attack on the integrity of HASCAS and the individuals on the investigation panel. None of the investigation panel were practitioners in Wales. The legal advice to the HASCAS investigation was independent of the Welsh Government, and HASCAS, as an organisation, has undertaken a range of reviews, for example, into the English health and care system without fear or favour, and there is no reasonable basis to attack their integrity in this matter. 

I do understand that many will have been surprised by the findings of their report. However, anyone who has taken the time to read the report carefully should appreciate the thoroughness of the investigation and understand how the conclusions have been reached. In relation to the care on Tawel Fan the independent findings are that the levels of care and treatment provided on Tawel Fan ward were of good overall general standards and that good nursing was provided.

Whilst assurance can be taken from some of the findings, the report is a difficult read. It is far from a clean bill of health. I do not shy away from the significant issues it highlights across a number of areas, including governance and clinical leadership; service design and care pathways; and safeguarding. Many of the issues go beyond mental health services at the Tawel Fan ward.

HASCAS will be meeting individually with each family to discuss individual patient reports, which are crucial in providing the detail of the care provided. I hope that, alongside the thematic report, the individual reports will provide assurance to families about the integrity of the investigation. A similar process will also take place for staff who have been affected. I have already sought assurance that the health board is providing appropriate levels of support to both staff and families during this process.

As I have already stated, it is very clear that further, sustained improvement is still required by the health board. This will require further focused oversight under the special measures arrangements. 

The report does though acknowledge the considerable journey that the health board has embarked upon, recognising that it hasn’t stood still since the period being investigated. The report states the health board has made significant progress in key areas detailed in the dementia strategy, for instance, having a designated consultant nurse in dementia care. It also recognises the steady progress that Betsi Cadwaladr has made in relation to patient and carer support, and working proactively to support the care home sector.

The report also references many areas where they saw good practice. I am keen that, despite the criticism in the report, we recognise the excellent care provided by so many staff across the health board, both then and every day since the events that this report examined. For example, the nursing team on the Bryn Hesketh mental health in-patient unit have been shortlisted for an award that recognises those who have achieved excellence in their field of nursing. 

However, despite some positives, I continue to be very clear with the health board about the need to increase the pace of improvements and to deal with issues that are again highlighted in this report, and I will set out my expectations for that improvement. I will today publish a special measures improvement framework that sets out the milestones and expectations for the health bard for the next 18 months in leadership and governance, strategic and service planning, mental health and primary care, including out-of-hours services.

This improvement clearly references the work required by the organisation as a result of the recommendations from HASCAS. It may require a further update after Donna Ockenden’s governance review, which is expected shortly. This will take the form of a detailed quality and governance improvement plan to be prepared by the health board and to be available by the board’s July meeting this summer. I will continue to provide ministerial oversight with monthly accountability meetings with the chair and the chief executive. I expect Betsi Calwaladr to provide detailed progress reports against the new improvement framework and the first report will be provided in October this year.

Key to improvements is strong leadership for the organisation. I previously reported that a new chair will lead the next critical phase of the health board’s improvement journey. I am pleased to announce today that Mark Polin has been appointed to the role. He will bring a wealth of public sector leadership and governance experience, commitment to and knowledge of the communities of north Wales from his current role as the chief constable of North Wales Police. I will provide a further update on his appointment and the special measures arrangements in an oral statement in early June.

I expect strong leadership, and especially clinical leadership, from all parts of the organisation to address once and for all the issues that this report identifies. There must be a significant culture change to move from the current underlying resistance to clinical policy and consistency in practice. The board will need to give this rapid and serious consideration to determine what steps need to be taken to change ways of working. I expect, at the least, to see this demonstrated in clinical leadership and engagement to support the design and delivery of a care pathway for older people with dementia, together with the significant improvement in mental health provision that is still required.

I expect both the health board and local authority partners to carefully consider the findings in relation to the operation of safeguarding arrangements. Protecting people at risk from all forms of abuse and neglect is one of the key priorities of the Welsh Government. This is clearly reflected in the legislation and policy that we have introduced in this term and the previous one.

I expect the findings in this report to be used to hold a mirror up to all NHS organisations in Wales. I am therefore writing to all chairs and chief executives of NHS organisations in Wales, asking their boards to consider the report's recommendations and to confirm how they will use the findings to improve their organisation. I will also expect the chief medical officer and the chief nursing officer to engage with professional executive leads to ensure that lessons drawn from this report are embedded in the future planning and delivery of healthcare in Wales. These are immediate actions being taken in response to the findings of the HASCAS report. I will of course continue to update Members on the progress being made on the wider required improvement.

In your statement to us, you state,

'anyone who has taken the time to read the report carefully should appreciate the thoroughness of the investigation and understand how the conclusions have been reached.'

We have to disagree. But, of course, we're not alone. The chief officer in the north Wales community health council has said that dismissing the testimony of Tawel Fan families is akin to not believing survivors of sexual abuse. He insisted the evidence given by relatives of dementia patients at the Ablett unit was absolutely credible. The older person's commissioner for Wales, Sarah Rochira, said the headline findings of the report will be of little comfort to the families of the patients on the Tawel Fan ward, who had been clear that their relatives suffered standards of care that were quite simply unacceptable.

Was not your use of the word 'reassuring' in initial press reports following the publication of the report at the very best insensitive to the relatives and families, who themselves were reported as stating they found this report devastating? They were angry and in uproar over the abuse report. They again talked about how their loved ones were seen being dragged by the scruff of the neck, barricaded and left in their own mess. One spoke about how his mother was bullied and forced to sleep in an ant-infested bed. There was more than one occasion when she'd be in the same clothes for at least two days, lying in her own mess. He described the report as a huge cover-up, as reported in the press.

The Tawel Fan mental health board, in the Ablett unit report in 2013—in that report, the health board said it was alerted to serious concerns regarding patient care in December 2013. Of course, reports go back a lot, lot further. In 2009, I represented a constituent who alleged the treatment received by her husband in the unit nearly killed him and that three other patients admitted around the same time as her husband had similar experiences and that she was now worried about the treatment others may receive in this unit. Her husband suffered from Alzheimer's and terminal cancer. I was also copied in on a complaint in respect of another patient at the time who had vascular dementia, which included distressing before-and-after photographs. These were shared with both the health board and its predecessor and your predecessor. No action appears to have been taken. 

Thankfully, in 2015, Welsh Government, the health board and Healthcare Inspectorate Wales all accepted the findings of Donna Ockenden's 2015 report. So, why now, when many serious allegations are peppered throughout the HASCAS report, has it come to the bizarre conclusion that care was good and that institutional abuse didn't happen? Why do the conclusions not stack up with the findings? The HASCAS report doesn't chime with concerns raised in other reports. Why doesn't it chime with the Healthcare Inspectorate Wales report in July 2013, which found a patient locked in a room sitting in a bucket chair, incontinent in their own faeces and urine. It found no activities for patients. It found the garden unkempt and inaccessible. It found insufficient staffing, and much more—HIW, July 2013.

There was internal work on dementia care mapping in October 2013, which revealed that patients were desperately trying to engage with staff, and it reported an elderly patient found to be smearing herself with her own faeces resulting from that lack of engagement. The HASCAS report on page 115 talks about this dementia care mapping, but then on page 116 says no serious concerns were raised and no poor practice was observed. Why does that not agree with the October 2013 report, which found precisely the opposite? If this was your own grandmother, your mother or your sister, would you not consider this a serious concern? Any other rational human being would consider this to be a matter of the most utter and utmost seriousness.

Page 64 of the HASCAS report says that 29 families described significant concerns with communication and dementia diagnosis, and 18 families alleged unexplained bruising and injuries. This isn't an election; it's not a poll. It's not a question of how many people had one experience or another to decide on the outcome. These are the experiences reported by dozens and dozens of families regarding the people that mattered most to them. Page 66 says that 10 families described relatives as being dirty and the ward smelling of urine. Why is this not a breach of care to these patients and, by association, to their families?

The HASCAS findings are based, quite properly, on clinical notes. You refer to the clinical notes in your statement, but they acknowledge that they understand that when they came to start their review, the clinical records they needed had not been secured. Why therefore, in breach of standard NHS practice to stop clinical notes being got at, were these notes not secured? And how, even if they weren't got at, can we have any confidence regarding their content in these circumstances, especially given the different findings of different reports I've referred to previously? 

Is it not therefore the case that our colleague, Darren Millar, who can't be with us today, is right to have written to the Public Accounts Committee asking them to examine this matter, reflecting both the inconsistent evidence and the huge concerns caused to north Wales in general, but particularly to the families of these dozens of victims, I will call them, where the evidence is so strong that we have to accept that they were clearly telling the truth? I hope, Cabinet Secretary, you're going to change your tune on this, that you're going to listen, that you're not going to shoot the messenger, and that you're going to reconsider your approach, because, if not, you will have failed in your duty to these people, you will have failed in your duty to the patients and staff, and you will have failed in your duty to Wales. I look forward to your response.   

I recognise that there'll be a range of people who won't accept the findings produced in the independent HASCAS investigation report. I recognise that there'll be a range of families who will simply not be able to accept the conclusions they have reached, and I think it's easy to understand why that might be, where people have witnessed challenges that they have reported on. But, as the report set out, it certainly does not provide a clean bill of health for the health board—far from it—and it does recount failings in the care that some people were provided with, but it says that, overall, it does not support the previous finding of institutional abuse and neglect. 

And it's fair again to reflect that, whilst some families are angry and hurt, and you understand why in the conclusions reached, there are a range of families who did not wish to engage because they had no complaints about the care provided. Other families did engage and confirmed they had no concerns or complaints about the care provided. It's also true to reflect on the fact that there were disagreements within families about the care provided as well. So, in that contested environment, where people have different versions of the same events, where there's an acceptance that, on occasion, the care was not as it should have been and that people were let down when that happened, it is not surprising that there are different views on the overall conclusions of the report. But, as I say, that does not affect the integrity of this report. 

It's worth again reminding you and others that, of course, this report had access to a much wider range of information. It interviewed 168 witnesses that were not available to the initial report. It considered 190 witness statements in the police report that were not available to the first report as well. There were real problems highlighted.

In terms of the response from HASCAS, we should remember what they themselves have said. They say that their report does not cast doubts on the validity of families' concerns. Indeed, it actually upholds very many of their concerns. It is important that this is a highly critical report. And that is the approach that I will take to seeking further improvement. I wish to see families that are affected, even including those who do not accept the report, being supported in the continued life that they will have. I wish to see support provided to staff directly affected, and I wish to see, for the future, real and sustained improvement that will take forward the real concerns and criticisms in what is a highly critical report.

It is for the Assembly, though, to determine whether it wishes to review the 300 pages of the HASCAS report and the 700,000 pages of documentation and witness evidence that underpin it. That is a matter for the Assembly, not the Government, to determine. For my part, I will do what I can and should to provide the reassurance that all of us, I'm sure, will wish to seek, and that is that people have their concerns listened to and that we take seriously the requirement for improvement that does exist within north Wales healthcare.

Thank you for your statement today, Cabinet Secretary, but you've read, I'm sure, the statement issued by the Tawel Fan families group in response to the HASCAS report's publication:

'we cannot and will not accept the findings',

they say. They say that what they've read in this report doesn't stack up compared with all else that has gone before it—the experiences of the families themselves, the public emergence of those experiences that led five years ago to the closure of the Tawel Fan ward, the previously critical reports, the apologies from the health board itself for, and I quote:

'the appalling treatment and subsequent harm...experienced'.

Of course, as you say, it still is a very damning report. We heard you say this afternoon that 

'The report set out a range of failings that let down patients and led to real harm being caused. I am deeply sorry',

you say,

'that this happened and I apologise for it without hesitation.'

So, the report highlights serious failings, but, somehow, it not only concludes that this didn't amount to institutional abuse and neglect, in direct conflict with the Ockenden report, but also that some of the light that ought to be shed on what happened should be reflected back onto the families themselves. Cabinet Secretary, how do you account for the difference in conclusion between this and previous reports? How do you account for the difference between the clear description of multiple and serious failings in the way that Tawel Fan was run and the conclusion that (a) this didn't in effect mean poor care for patients and (b) that, really, the patients and their families were somehow themselves to blame, at least partly for having unrealistic expectations or for not understanding dementia or for changing their recollection of their experiences in response to media coverage.

Looking forward, I wish Mark Polin well taking over as chair of the health board. I note your planned publication today of a special measures improvement framework, but, of course, Betsi Cadwaladr has been in special measures for nearly three years and people must have confidence that lessons have been learnt about the past before they can have confidence in what the health board can provide for them in future.

Many have already concluded that this is a cover-up. Families don't find this to be a credible report. And bearing in mind what we've heard from you today—that you wish for this report, which the families don't consider to be credible, to be the basis for moving forward to better healthcare—how do you now regain those people's trust?

I, again, refer back to the reality, the factual, undeniable reality, that this report by HASCAS, an independent group, an independent organisation, considered a much wider range of evidence than previous reports. And it should not be surprising that, when more evidence is available, including the 108 clinical records that were reviewed, it is possible to reach a different conclusion. That does not cast doubt on the integrity of people who previously gave evidence—far from it. And, in fact, HASCAS themselves say, 'Our report does not accuse any families of changing or elaborating on their stories. It does, however, make clear that many families had no concerns until the publicity surrounding an earlier report. They then wanted to know if their loved ones had been abused, and sought reassurance in this respect.' 

And I think that's quite easy to understand. The challenge is how all of us in our different roles, including me, with my role within the Government, actually take forward the very difficult messages from this report and understand the real hurt that has already been caused to a range of families and how those people are supported through that. And that is not easy; it goes into your final point about regaining trust. Well, I think part of that is to be honest, and that is sometimes to say things that are not automatically easy to say or to hear. So, when I accept the report and its findings, and we have to work through our recommendations, that will please a range of families who will be reassured. It will also mean there are a number of families who are angry and upset and will not agree that is the right thing to do. There is no way to please everybody in this position, and you start from accepting there have been failings in the care provided and that is what we need to resolve.

I think that it also comes back to the point about the suggestion that there has been a cover-up. The more that that suggestion is made and the ferocity with which that suggestion is made will make it more difficult to regain trust. I accept there are questions people will want to ask, but the pre-emptive strike on the integrity of HASCAS and their individuals is something that I really do regret. HASCAS is an organisation that has undertaken reports like this into a range of health and care establishments and failings right across these islands. They have never yet had the same level of attack upon their integrity provided. If you look at the CV of the dozen people who are on the panel and the four different lawyers, including a Queen's Counsel who was engaged around this to provide reassurance about legal advice, to say that they are part of a cover-up is an extreme accusation to make, and I do not think any of the evidence available really honestly supports that accusation. And, in that, I think it is different to seeing how families are upset and will lash out—you understand that. How could you not have real, human sympathy for those families involved? But I think that we have to hold ourselves to a higher standard, to be more objective about what has happened. That may make us sound cold and unsympathetic, but we have to be able to do our job in understanding how people feel and then recognising what we think is right for the whole service.

And your point about the Tawel Fan families—I have seen their statement, of course I have. And the Tawel Fan families, a group of about nine or 10 families that have been the most engaged in the process—. But the challenge in this—I think all of us should be able to understand—is that some families do not wish to be engaged in that collective process. They have not themselves thought that that was an environment where they could themselves put their individual concerns. So, we've had different ways for families to engage in this report. Thirty-five families gave direct witness evidence to this investigation. A further 25 families were engaged but chose not to give direct evidence, and they made it clear that they were broadly content with the care that their loved ones had received. So, there are inherent contradictions between the events recounted by families over the same period of time, and this report is an honest attempt to understand those and to report on the evidence provided. I restate my commitment to trying to regain the trust of families across north Wales and beyond by actually making sure that we take seriously the criticisms in this report and take seriously the requirement to see further and sustained improvement in healthcare services in north Wales, especially as they refer to the older adult patients suffering with dementia, because that is the real challenge that this report sets out.

Thank you for your statement, Cabinet Secretary, as well as your earlier written statement. Although I was not a Member of this Assembly when the Ockenden report was published, I remember the shock and outrage I felt when I learnt of what these poor people endured on the Tawel Fan ward. Listening, even last week, on the radio to families reliving their experiences and how they feel when they even have to pass the area concerned—which was more reminiscent of how people in mental ill health were treated in the eighteenth and nineteenth century, not the twenty-first. 

Three years later, we now have the findings of the Health and Social Care Advisory Service investigation. No-one can dispute the independence or expertise of HASCAS, with Dr Johnstone and her team carrying out the investigation and publishing the report. HASCAS found chaotic and poor governance and problems across all mental health services in north Wales. They found nine key factors that compromised patient care. However, there is a disconnect between the HASCAS findings and the earlier investigation conducted by Donna Ockenden, and it is this disconnect that has led families to reject the findings of the HASCAS report, branding it a whitewash and a cover-up. 

I agree with you, Cabinet Secretary, that we should avoid jumping to conclusions, but until we can fully address the concerns of the families involved in the Tawel Fan scandal, or those treated in the Ablett Unit at Ysbyty Glan Clwyd, we cannot move on from this. Cabinet Secretary, have you considered asking Donna Ockenden to work with HASCAS in order to address the concerns of the families? While I am pleased that Dr Johnstone and her team found no evidence of systemic abuse, they did find institutional failings in both the governance and care pathways at Betsi Cadwaladr. Cabinet Secretary, this is not the first report to highlight failings in clinical governance, not just in north Wales but across the NHS. Do you believe that the current governance model is fit for purpose in a modern healthcare system? 

I welcome the announcement that you will publish a special measures improvement framework for Betsi, and I look forward to seeing the first progress report in October. Cabinet Secretary, as Betsi are already in special measures, what recourse is open to you should they fail to make progress against the improvement framework?

Finally, Cabinet Secretary, you have indicated that there are lessons for the wider NHS and that you expect NHS organisations to consider the report. With regard to social care implications, what discussions have you had with Social Care Wales, and do you expect local government to also consider the recommendations of the HASCAS report?

I look forward to working with you to ensure that the events that occurred in the Ablett Unit can never happen again. Diolch yn fawr. Thank you.

I want to start again by reiterating that this report is certainly not a whitewash or a cover-up. If the report, on the basis of the evidence available, had come to a different conclusion, then, again, I would have been in a position where, of course, I would have been duty bound to accept that. There is precious little point in having an exhaustive independent investigation process, taking nearly three years, if the first response of a Government Minister is to say, 'I don't like the conclusion. Get me a different one.' This was deliberately undertaken as an independent exercise away from the health board with people who are not practitioners in Wales but with real independent expertise and integrity to get at the truth to allow us to understand what happened, but also to help set a path for the necessary improvement.

The Ockenden report, the second report, is about the governance structure of the health board, and, as I said in my statement, I expect that to be provided within the coming weeks. It will be published, it will be made available through the board, and, indeed, the response to it. That may require me to look again at the special measures improvement framework. As I've indicated in my oral statement, I will be happy to do so to make sure that all the required measures are in place and I will then transparently report back on progress made. It's an important part of the special measures framework that the health board didn't go into special measures at the convenance of a politician; there was independent and objective advice that it was the right thing to do. And in all of the progress—or lack or it—that has been made under special measures, again we have had independent assurance, both from the Wales Audit Office, from Healthcare Inspectorate Wales, and, indeed, the chief executive of NHS Wales. So, this is no one person providing advice, no one politician making decisions to benefit themselves individually. Frankly, it would have been to my own selfish interests to have seen them taken out of special measures and this report provide an entirely different conclusion. These are independent, objective and robust conclusions that have been reached both in the report, but also in the continued requirement to keep the health board in special measures, and that will continue to be the case as we report on progress or otherwise. I've indicated I'll report back on the wider improvement work that the rest of the NHS family is undertaking as a result of this report and we will have more to say on the safeguarding work to be undertaken both in north Wales and what that may mean for the rest of the country, too, involving health, local government and others working together.

Can I thank you for your statement, Cabinet Secretary? I also welcome your recognition that the report does set out a range of failings that led to real harm being caused. I had a few specific points that I wanted to ask about in relation to the report. The first relates to the concerns that are raised about the treatment people get, with dementia, in A&E and in other medical settings in hospitals. I'm sure you'll be aware that Dr Katie Featherstone at Cardiff University has recently published a new report into the hospital care of people with dementia, and we know that 25 per cent to 50 per cent of hospital beds in Wales are going to have someone with dementia in them. So, it is absolutely critical that everybody in our NHS has the skills and awareness needed to provide person-centred care to people with dementia. So, I wanted to ask you what further lessons you feel what's been found in this report can bring for the wider NHS in Wales.

The report refers to the financial pressures, which, it says, have led to things like occupational therapists and the multi-disciplinary team not being available. I know that you are well aware that I've said to you previously that I believe that patients on older people's mental health wards in Wales are some of the most voiceless citizens in our country. They're often on locked wards; they're not wards that people go back and fore to very often. Some of them don't even have relatives to visit them. So, can I ask whether you think there are any further steps that can be taken to strengthen the profile of these patients at health board level, such as by having dementia champions on the board, et cetera, so that they are not out of sight, out of mind?

I very much welcome the reference in the report to the need for clarity on legal frameworks in relation to the Mental Health Act and the Mental Capacity Act 2005. I have to say that I think there are definitely wider lessons there for the NHS in Wales, as I genuinely don't believe that those Acts are being fully complied with across Wales. There are recommendations that there is new guidance issued, that these are kept under review and even audited on a patient-by-patient basis, which I really welcome. Can you say a bit more about how you intend to take that forward?

The report talks about the need for advocacy. A recent written answer I had off you confirmed that all health boards are currently meeting the all-age target on the provision of independent advocacy, but what I would flag is that we are well aware of the concept of an active offer of advocacy for children and young people in Wales. The current target under the Mental Health (Wales) Measure 2010 refers to people who have requested advocacy receiving it within five days, and I wonder whether you might want to say something about what more we can do to ensure that there is an active offer for older people as well, because there are real challenges in offering advocacy and ensuring advocacy take-up for older people with dementia, and I do think that particular measures need to be put into place.

Finally, I know that you are well aware of my view that we should move, at the earliest opportunity, to extend the safe staffing levels legislation to older people's mental health wards in Wales. I think that this report and the issues arising from it confirm the need for that, because many of the issues highlighted would be addressed by staff having the necessary time to do their job properly and to provide person-centred care. So, can you update us on your plans to extend the legislation? Thank you.

Thank you for the range of questions. Forgive me if I don't answer all of them now in the time available, but I'm happy to take them up with you directly after today's proceedings as well. I think, actually, the point you raise about accident and emergency shows the scale of the challenge we face in dementia care, because people with dementia are a regular feature already of care within the hospital sector, and will become more so in future. We expect more people to be diagnosed, we expect undiagnosed people to arrive in our hospitals requiring care and treatment, whether in accident and emergency or in elective care, and it will be a bigger feature of health and care delivery here in Wales. Actually, the fact that the accident and emergency issue was raised shows that the HASCAS report did listen to what the families were saying, because it wasn't part of the earlier remit, but it was raised by families during the course of the investigation, and so the remit of its investigation was broadened to allow that view of the wider care and treatment pathway, to get a broader view on what was going well, as well as what wasn't going well, in providing health and care within north Wales.

I recognise your points about the range of activities that are provided to people, the range of recovery and rehabilitation that is still possible from a physical point of view, but also the fact that these are people who are, by their nature, vulnerable and often don't have a voice. So, your point about advocacy is well made, about there being a genuinely active offer, and that is work that we are seeking to undertake to make sure that—. The focus that we often have on children's advocacy is not often there when it comes to the older adult, which is surprising, and I think that it's largely because people assume that there is a family waiting to look after that person or advocate for them, and often there isn't, either because they don't have a family or because their family is no longer around, and that is a very sad reality that many of our older citizens face.

I also recognise your point about capacity and the work we're doing on the mental health Act and the review that is taking place across England and Wales with the mental capacity Act, and in particular the deprivation of liberty safeguards. So, there is work that we recognise needs to be done right across our system, not just in Wales, and we're working with partners across the four nations to understand what our approach will need to be in the future, because that can be difficult for the individual, for their family and the health and care system itself as well. We have already provided interim annual investment of more than £300,000 to support health boards and local authorities to deal with the challenge that that has provided.

On the nurse staffing Act, I will come back to you, and I'll happily provide a statement to Members, on the work that we're doing to deliver on the commitment of the Government to extend the nurse staffing Act. There are a range of different options and potential priorities that I've previously reported on, and it probably is time for me to provide an update, whether that looks at in-patient paediatric care, whether it's community nursing or, indeed, around care for older adults as well. So, I will provide a fuller update on that, and it's a useful reminder that it is about time to provide Members with that factual written update.

May I thank the Cabinet Secretary for his statement this afternoon? Like many Members, I do feel it's unfortunate that this report does create a tone that almost questions the voice of the victims and the families of the victims. We read sections of the report that talk about them recasting their experiences in light of things that have developed later. Questions are raised on the behaviour of some families and things such as that. Of course, it points to some families who have had a positive experience, and that's fair enough, but that, in no sense, should actually invalidate the families who have had different experiences.

I have one simple question, and I want to make one simple point. History has told us that, until the victim's voice is believed, then there can be no justice. I just want to ask the Cabinet Secretary: does the Government believe the evidence of the families of the victims here? If you don't, then it's no surprise that many of them will have no faith in this process. 

I think it's important that HASCAS were given a remit to independently investigate and reflect back on the evidence they found. That was the remit that they were given. You then have to accept that when that independent review is undertaken, when you accept the integrity of the people, that may well provide very difficult messages that are critical of the Government, critical of the health service, and don't always support all of the conclusions reached by individual Members of the public. That does not, though, mean that those people are not being honest. I refer back to what HASCAS themselves have said: 'Our report does not accuse any of the families of changing or elaborating on their stories. It does, however, make clear that many families had no concerns until the publicity surrounding an earlier report. They then wanted to know if their loved ones had been abused, and sought reassurance in this respect.'

When you look at the conclusions reached by HASCAS, it is very clear that they substantiate a wide range of the concerns and complaints made by families. Our challenge is how we deal with those and how we actually set out to properly improve upon those, to try and make sure that other families don't go through the same experience. That's partly about the individual care, but it is much more about the systemic failures that took place within north Wales. That's not—to go back to the point that the leader of the opposition made in a question to the First Minister—to say that, in principle, creating Betsi Cadwaladr was the wrong thing to do, but the report is very critical of the way in which the health board went about its business in those first few years, having a medically led model of delivery. The clinical programme groups in particular have been criticised previously, and it's no surprise that HASCAS, in their investigation, have criticised that model as providing a disjointed health board—so, the disconnection of the different clinical programme groups that didn't speak to each other, effectively quasi-autonomous organisations within the health board, and the three different cultures of the three provider trusts that previously existed. And it has produced challenges that are still here with us today. That is one of the significant challenges we still have to address to make sure, as I say, that once and for all those are addressed, confronted and resolved, to make it a better place for staff to work, but crucially a better place to deliver health and care for our people.

Thank you very much, Cabinet Secretary. 

Item 4 is a statement by the Cabinet Secretary for Health and Social Services on the report of the Welsh task and finish group to review the use of vaginal synthetic mesh. I call on the Cabinet Secretary for Health and Social Services, Vaughan Gething.

Diolch, Dirprwy Lywydd. On Friday, I published the report of the task and finish group that I established to review the use of vaginal synthetic mesh tape and sheets in the treatment of stress urinary incontinence and pelvic organ prolapse. This report provides a comprehensive account of the use of mesh in Wales and the problems associated with it. Importantly, it makes recommendations on what action we should now take to make necessary and rapid improvement. I thank the members of the task and finish group for the work they have undertaken. I do want to acknowledge the courage and commitment of those women who have worked tirelessly to highlight this issue. Whilst, understandably, they chose not to participate directly in the group’s work, the evidence that they provided has informed the findings and recommendations—and, of course, I've previously reported meeting a group of mesh survivors themselves. 

All reviews to date have shown how difficult it has been to have a reliable assessment of the scale of the problem that can be linked to the use of vaginal mesh. However, what is clear is that while many women may have benefited from such treatment, some women have suffered serious and life-changing complications as a consequence. The report reaffirms this and provides clear advice on what needs to be done to support those who are living with the debilitating effects of mesh complications. It is also clear about the need to improve our approach to the management of pelvic health problems going forward.

There are clear limitations with the adequacy of our data to understand the level of complications. The report explains why this is the case and proposes some short term and longer term solutions to address this. However, what is clear from the data presented is the sharp downward trend in the number of patients who have had mesh procedures in Wales over past 10 years. During the course of this review, the National Institute for Health and Care Excellence published new guidance, in December 2017, stating very clearly that transvaginal mesh repair for vaginal wall prolapse should only be used in the context of research. I note the task and finish group welcomed this decision by NICE and had reached the same view. I, of course, expect that advice to be followed in Wales.

The report’s overall findings and recommendations fall within five key areas: the initial care pathway required to support women’s pelvic health and well-being, which includes access to multidisciplinary teams of clinicians incorporating continence care, physiotherapy, pain management and, where appropriate, psychology skills; providing better information for patients to ensure they can make a fully informed and shared decision about treatment options; ensuring GPs can have direct access to specialist advice, so they can better support their patients; making significant improvements in the processes associated with data capture of both procedures undertaken and any implants used; and ensuring access to specialist support for mesh removal by developing one or more fully accredited multidisciplinary specialist centres. I now want to ensure that the report’s recommendations are taken forward at pace.

What is particularly clear to me, after reading this report, is that we need to have a fundamental change in the way that the NHS supports women with pelvic health problems, moving to a focus on prevention and conservative therapies, with surgical intervention as a last resort. At the same time, we need to ensure there is early access to specialist support for those with treatment complications to prevent the worst outcomes. I am therefore establishing a ministerially directed implementation group to oversee specific areas of women’s health requiring urgent attention and improvement. In the first instance, its priority will be to oversee the implementation of the recommendations from the vaginal mesh and tape review. Alongside this, I also want the group to consider any recommendations arising from the endometriosis and faecal incontinence reviews that are in progress. The mesh and tape review highlights that we can expect there to be a number of overlapping areas that need to be brought together.

Following this initial focus, I will take advice from the chief medical officer and the chief nursing officer in determining what the group’s next priorities should be. The membership of this group will need to be flexible as, although the initial focus will be on mesh and tape, the group will require appropriate representation—both professional and lay representation—from across other areas of women’s health. I'm pleased that Tracy Myhill, the chief executive of Abertawe Bro Morgannwg university health board, has kindly agreed to chair the group.

I've made funding of up to £1 million a year available to support the improvements needed. There will, of course, be much that can be done within existing resources, through service redesign and potentially the shift of services from hospitals to communities, to ensure that a community-based pelvic health and well-being pathway is put in place in each health board across Wales. This resource should help these pathways becoming the norm across Wales on a consistent basis. In the meantime, I expect all health boards to consider the report’s findings and recommendations to consider what local improvements can be made immediately. Our aim must be to ensure women receive the best possible care and treatment when they present with stress urinary incontinence or pelvic organ prolapse, or any other complications as a result of existing treatment.

I've asked my officials to set up the implementation group without delay, and I will expect regular updates on progress. It will, of course, be important for the work to be underpinned by a range of measures in order to be able to demonstrate improvements in patient outcomes and experience. The group will also need to keep its work under regular review in line with any new evidence that emerges. I have also shared the report of the task and finish group with the chairs of the Medicines and Healthcare Products Regulatory Agency and NICE, and asked that it informs their ongoing work in this area. I believe these steps provide the opportunity to have a much-needed focus on women’s health and enable the NHS to tackle key areas that have long needed improvement.

I'd like to begin by thanking the Cabinet Secretary for taking many of the concerns forward by commissioning this work in the first place and then, again, through your statement here today. Because I've got to be honest, I was totally, myself, oblivious to this issue until it started presenting to me in my own constituency office. Some of the numbers that I've had, and the harrowing experiences by, I have to say, predominantly women, have being quite, quite startling. Then, of course, I've been well aware that many patients that have suffered are now taking to social media, and trying to—you know, we've all been copied in. I admire these people because many of them are patients who have suffered, and they're not suffering in silence. They are getting out there and trying to put out the warnings about just how unpleasant—if things go wrong—this mesh is.

Of course, I need to remind the Chamber that the issue of synthetic vaginal mesh, or the tape, is not one that just affects women, because I think there has been a tendency for it to appear that it's just an issue affecting women. I understand that where it could apply to affecting men hasn't been part of the review. But, of course, it can be used as a hernia mesh for male and female patients. The side effects of the problems caused by mesh are wide-ranging. We're not only talking about the physical pain that patients are constantly in, but also the associated mental issues related as a consequence. Confidence is lost and many people suffer depression whilst struggling to cope, and evidence does suggest that the numbers are increasing as the years roll by, because it is, actually, after a number of years post operation that problems can start. Many patients are calling for an overall ban on this procedure, and I worry that this is something that you will not confirm from your statement today. The National Institute for Health and Care Excellence in England have called for a ban of the use of vaginal mesh, an action that has been taken in New Zealand and Australia, and where it has been referred to as the biggest health scandal since thalidomide. Across the UK, about one in 11 women have experienced problems. In Scotland, former Scottish health Secretary, Alex Neil, requested a suspension of mesh implants by the NHS in 2014, but figures obtained by the BBC in December 2016 showed that hundreds of operations have been performed since. And it is worth noting that a number of Scottish health boards have stopped using mesh implants all together. 

Cabinet Secretary, we are grateful for this statement, but it doesn't go far enough. There is clearly the evidence, the public support and examples of where this mesh treatment is causing horrendous, life-changing problems. Therefore, why will you not commit to following the examples of Australia and New Zealand and bring in an outright ban at the earliest possible opportunity? Now, the dilemma for me here today is that in my own constituency I have a number of patients who have approached me, and I'm dealing with their casework, who are, as they describe, living in agony. But at the same time, I have cases where the mesh procedure is to be implemented quite soon on patients who are suffering. Now, they've raised concerns, or tried to, with the consultants, and it has to be said, they get fobbed off. They raised their concerns with GPs, and there just isn't a clear line on this, and I do think that we need something more definite from you as the health Cabinet Secretary responsible for the health our women and men across Wales. 

So, would you explain why the report has based all its figures on mesh implants, mesh removal and over-sewing. Why have outpatient appointments, covering all documented side effects, been omitted? In recommendation 3.2, you state:

'Meaningful estimates of complication rates related to mesh procedures
would require a retrospective audit'.

Does this mean you will instruct an audit to take place? If not, why not? I certainly would if I was in your shoes.

In recommendation 3.21, do you not agree that the low numbers reported in Wales could be due to it not being mandatory for clinicians to report adverse incidents to the MHRA, and also the difficult nature that may mean that the numbers held by the MHRA are inaccurate? You really should be going all out on this now to establish the absolute and exact state of play here.

What can be done to rectify this? Recommendation 5(c) states that

'Only one health board in Wales currently has a multi-disciplinary pelvic
pain clinic.'

So, you know the natural progression there is to make sure that we've got that available again for everybody in Wales. However, in a response provided to Neil McEvoy in Plenary on December 13 last year, you stated:

'My understanding is that, yes, we do have multidisciplinary teams around each surgical procedure. ' 

Can you now clarify which is accurate—your report or your response to Neil six months ago in Plenary?

Recommendation 6(a) states that

'Ways for GPs to have direct access to specialist advice should be
established.'

How will this be monitored and how soon will it be rolled out? 

Finally, Cabinet Secretary, why, when the UK Government has conducted an audit into the effects of vaginal mesh implants, is your Government still stubbornly refusing to do so? What are you worried about? Why are you not putting the interests of Welsh patients first? And I respond to you today on behalf of myself, but also on behalf of Angela Burns, Assembly Member, who sadly cannot be with us today. She is very concerned about this. She is speaking to the people, like I am, on this. We have this issue approaching us as Assembly Members on a very regular basis. It is down to you, Cabinet Secretary, to make sure that you have a very steadfast approach to these concerns. Thank you. 

Thank you for those questions and comments. I make no apology for saying that the hernia issues are separate matters, with a different group of surgeons and a different process in place to understand the level of complications that exists. This has been unashamedly focused on women's health issues, and, bluntly, if the same level of complications had affected men's health issues, I suspect we would have heard about them much sooner.  

I'll deal with your final point first about the multidisciplinary teams. Of course, recommendation 5 deals with multidisciplinary teams for pelvic pain clinics, as opposed to broader multidisciplinary teams that are in place around surgery. There's a challenge here about making sure that we have the right number of multidisciplinary teams in place, including, of course, for a specialist centre for mesh removal, and to look at one or more of those, and in particular about what happens currently in south Wales and having an accredited multidisciplinary surgical removal centre, but also about the continued use of Manchester for patients in north Wales. 

On your points around the banning of—. No, I'll deal with your audit point first, before I come back to the point about banning mesh, which has featured very heavily in what we've been asked to do over a period of time. If we look at the auditing that's taken place in England, they're looking at it on an experimental basis in England to try and retrospectively audit what has happened. What's been helpful is that, between officials in the Welsh Government and the Department for Health for the UK Government, acting for England, there has been a really constructive transfer of information about the audit taking place, and there are similarities in the range of challenges that we expect the audit in England to reveal. Before I look to undertake retrospective action, where we can't be sure of the exact value of that, I am interested, though, in understanding what happens in England and what lessons we can learn from that, as well as looking more proactively at the issues for new implants of medical devices.

There is a European Union directive, due to be implemented in 2020 or 2021. Of course, that will still be an issue for us, regardless of what the transitional deal is or isn't agreed by the United Kingdom Government and our relationship with the European Union. But that is looking at being able to understand and have a proper register what devices have been implanted into people more generally. Now, there is a challenge there about understanding whether they're able to scan that and understand how that's done, and that is covered in the recommendations in the report. In taking forward these recommendations, we'll need to determine what our approach to that will be. That is not something that is simply covered over or about to be forgotten. And that will help us to deal with some of the requests from the women involved. In the requests they gave us, I think on pretty much every area we're going to be able to show progress, apart from the issue of a ban. 

You mentioned Scotland, and the request for a suspension made by the Scottish health Secretary. Well, it's a matter for the Scottish health Secretary to answer for themselves about their approach, but, as you say, a range of people have still undergone mesh implants since that time. That's because the Scottish health Secretary, just like me, doesn't have the power to ban mesh implants. The challenge is that whilst these are regulated devices that are available, and are available for use, it is an issue of consent between the health provider and the individual citizen about whether they wish to have the surgery provided.

Now, as I say, there are a number of women who have had the surgery without complication. Part of what the women asked us to look at, and part of the terms of reference for the task and finish group, was about properly informed consent to make sure that people really did have the challenges and the risks explained to them, to make sure it really is a very last resort. And even then, some women will choose not to have the surgery, and that should be an informed choice to make, just as women who do choose to have surgery, if that is their choice—it must be their choice on a properly informed basis.

I have, though, written to the MHRA asking them to reflect on the regulated decisions in Australia and New Zealand in particular to ban mesh. The MHRA have responded and said that they do not intend to do so. However, since then, the Cumberlege review is in place to look again at a number of these issues, and there will be engagement both from the NHS and the Government in that review, and I expect women from across Wales will engage in that review too. So, this is not an issue that's about to go away. Whilst I don't have the power—and you'll understand why politicians don't have the power to ban in particular surgical devices or equipment available for the health service—we are fixed with a proper division between a regulator's power and the power that a politician has. But as I say, I have provided them with a copy of this review, and I look forward to the Cumberlege review and what that will tell us and about this decision being kept properly under review in light of the evidence available. 

May I thank the Cabinet Secretary for the statement? And I thank those women as well who showed such bravery and commitment in working tirelessly, as you said, to underline this issue.  And, yes, women have suffered complications that have changed their lives. I welcome elements in the report relating to several elements of this: the need to work proactively on the preventative aspect to prevent women from having to have surgery in the first instance; the need to stick to NICE guidelines and increase awareness of those guidelines—as with so many things, there's a weakness in the way that this Government operates in general, the failure to keep the kind of data that allows us to plan better health services; and also the specialist centre for tackling the mesh issue—the funding for that is to be welcomed, of course. But, I have several questions, nevertheless.  

The report highlights that some women, having described their symptoms, were dismissed by medical professionals who had wrongly ascribed symptoms to normal post-operative pain, perhaps. Many women felt they were patronised as a result of that, describing their battles, frankly, to be taken seriously. And this isn't the first time that we've seen this kind of thing; we remember, back in the 1990s, with chronic fatigue syndrome. Can you, as Cabinet Secretary, be a little bit more specific about how that particular issue can be addressed, how awareness, for example, can be raised, and how attitudes can be changed, so that people with unexplained symptoms are regarded as patients first and foremost, with symptoms that need investigating, rather than as people who should frankly just accept a little bit of pain? Because we know now, through the hard work of people who have campaigned for change here, that what was dismissed now has to quite rightly be taken very, very seriously.

The report also highlights the weaknesses with the adverse reaction reporting system for medical equipment, for the medicines healthcare regulatory authority. It's not something that is devolved, but can you describe how your department is going to try to improve that system so that we have earlier warnings?

Finally, regarding the specialist centre for mesh removal, whilst welcome in itself, we could do with something a little bit more concrete in terms of timescales, so I'd be grateful for a proper timescale for that development, so that people can see that words now will turn into action in the not distant future.

Thank you for those comments. There are broadly three questions provided in there. On the point about whether women who were not believed, and the battle to be believed, and how that will be overcome, well, the significant publicity around this—again generated by, as I said in my initial statement, the courageous and determined women who raised the isue—is part of that. The patient safety notice that was issued by the chief medical officer in 2014 is a part of that. The work undertaken by NICE is all a part of that. These are a range of different measures that are being undertaken to try and make sure that people are believed.

And there's also a broader challenge here about the way in which health and care are delivered, and it goes back to prudent healthcare, a concept started in the middle of the last Assembly term here in Wales. It's about understanding what matters to the patient, and about having a much more equal relationship with that person and the healthcare professional. And when that person raises concerns, rather than simply dismissing them and taking a rather more paternalistic approach, it's actually about listening to that person to understand what is happening and to recognise that they do have a continuing health and care need.

In addition to your point about GPs, I think it's worth while referring to recommendation 6 and how we take it forward in ensuring that there is access to specialist advice for GPs. It was part of the concern by the GP representative on the task and finish group to make sure that GPs themselves are properly equipped in being able to understand, not just potential symptoms, but then where they could go for that specialist advice, help and support. That comes back again to the opening of this that there was not a high level of awareness of the problems as they were being reported, and I do think, bluntly, that if there'd been a men's health issue, there'd have been a higher level of awareness and higher and more immediate acceptance of the challenges that people were facing in reality.

In terms of your point about when and how we'll be able to take forward the recommendations, including the specialist centres, well that's why I've announced there'll be an implementation group to take that forward, with the requisite level of weight within the health service. So, that's why there'll be a chief executive of one of our larger health boards taking forward and chairing that group, and understanding the right number of people who will need to be on that to understand how we draw up those service plans and then to make sure there is funding to try and advance that as well, rather than simply asking people to eat into current resources. You will understand that, in the financial position that we are in, adding new money to this area is a significant commitment when we're looking to make compromises in other areas of delivery.

So, this is a real priority, and I do recognise there is more that we will need to do. I mentioned the endometriosis review that is coming in as well, and the faecal incontinence review that is coming in as well, to make sure that we don't just see these issues in isolation, but understand them together, and make sure that we do see a real improvement. When I have more definite timescales, I will of course report back to you and other Assembly Members.

Thank you for this and your earlier statement, Cabinet Secretary. Complications relating to vaginal mesh implants have left thousands of women, worldwide, living in constant, debilitating, chronic pain, and it is therefore welcome that the Welsh Government undertook a review of the use of such implants. I would like to thank Professor Emery and his team for their report.

Whilst survivor groups would like an immediate ban on all use of such mesh and tape implants, I accept that these implants have benefits for some women, but their use should not be widespread and should be controlled. I therefore welcome the task and finish group’s recommendations to improve the pathway, to encourage greater informed choice and to affirm that mesh surgery should be a last resort.

Cabinet Secretary, the task and finish group made a number of recommendations and I am grateful that you have indicated that you support their implementation. When do you expect the implementation group to complete its work and ensure that all recommendations are put in place?

Cabinet Secretary, are you aware of the research being undertaken at the University of Sheffield, published in the journal 'Neurourology and Urodynamics', which supports the use of a softer and more elastic material, better suited for use in the pelvic floor, and one that releases oestrogen into the surrounding pelvic tissue to form new blood vessels and ultimately speed up the healing process? They concluded that a different material, polyurethane, would be a much better material to use as a vaginal mesh due to its flexibility and its likeness to human tissue. The next step is clinical trials. Cabinet Secretary, can you ensure that Welsh patients have access to these trials?

I look forward to seeing the details of the new care pathway and support available to women who have stress urinary incontinence or pelvic organ prolapse. Diolch yn fawr, thank you very much.

I'll try to deal with the point the first question raised about the implementation group and the timescale to complete their work. I will of course report back to Members, but as the group has yet to meet, and to consider how to take forward those recommendations, I'm not in a position to give an undertaking or commitment on that today, which I hope Members will understand. But I will report back about that.

On your second point about the research published by Sheffield, there's a variety of research that is carrying on about alternative surgical options, whether that is artificial or biological material to be implanted. But I can't really comment on the clinical trial that they're looking to undertake. I will, though, look to discuss with my officials to see if there is something useful that we can come back to Members with. But of course the Government isn't in control of those clinical trials and access to patients.

What's interesting in the task and finish group report is that I think there are some people they can identify who are more likely to be at greater risk of complications or having significant pain after the event. There's something about understanding and having that conversation about generally informed consent will be women that are involved. Because, as I say, whilst mesh has not been banned, whilst I do not have the power to ban mesh—even if I were minded to do so, I don't have the power to do it—we do need to make sure that consent is generally informed and that people understand the nature of what the current problem is and the treatment available for that, but also the risks and the potential benefits of any form of surgery, whether it involves mesh or not. And that was a really clear part of both the task and finish group's report, but also Members who wish to see a change in practice said, 'If we didn't have a ban, we need to make sure there was a real change in consent.' One of the more upsetting things that I heard about this particular issue was where people said that they just weren't told properly what the risks were, and that there was no problem at all with it. And that can't be a way to practice healthcare in the here-and-now today, let alone in the future.

Can I thank the Cabinet Secretary for your statement today and can I welcome the recognition, at long last, of the adverse impact of the use of synthetic tape and surgical vaginal mesh sheets for treating pelvic organ prolapse and stress urinary incontinence, leading to appalling, long-term and life-changing consequences for women's health? I welcome the recommendations in your report that relate to preventative measures and conservative management of these conditions and with surgery as a last resort. I welcome also, for example, the recommendation for a new pelvic health and well-being pathway. And can I thank the Cabinet Secretary for meeting with my constituents, Jemima Williams and Nicola Hobbs, whose lives have been so adversely affected by vaginal mesh implants? I'd like to praise them for their courage and their leadership in the Welsh Mesh Survivors group. But can I clarify, Cabinet Secretary, the position regarding my constituents, Jemima and Nicola, and the task and finish group? Because in your written statement you said that they chose not to take part in the group, but can I draw attention to the context of their decision not to take engage? They were deeply concerned about the membership of the group, the papers presented to the group and the lack of notice and draft terms of reference, because both also are suffering from constant pain and severe ill-health.

But it was very helpful that you agreed to meet them, with me. Can you confirm that you took full account of their full and harrowing evidence at that meeting? They did provide an extensive folder of patient experience of adverse impact. And also, can you confirm and clarify, Cabinet Secretary, what cross-border engagement is taking place to share clinical expertise, evidence from patients, mesh sufferers and funding also that could be available for referral to mesh removal experts?

Finally, as you are aware, the Welsh Mesh Survivors group are calling for mesh use to be suspended until a full audit has been carried out. And it's hard to believe that the procedure can still take place in Wales, despite the point that you made today in your statement, that all reviews to date have shown how difficult it has been to have a reliable assessment of the scale of the problem that can be linked to the use of vaginal mesh. That is as we are today. So, Cabinet Secretary, will you consider holding a retrospective audit of the use of mesh in Wales and consider suspending the use of vaginal mesh until this takes place? Thank you.

Thank you. I can confirm that in relation to your last point, and I'll link that to the cross-border work on evidence and progress, as I indicated in response to the first set of questions, the audit being undertaken in England is on an experimental basis and has not been undertaken in that way before. And I will, of course, be interested in the evidence provided by that and officials are engaged around the review being undertaken by the Department of Health. I would not expect there to be a significant difference in the number of problems that arise from these procedures. So, we have to start by recognising that there is a problem here in Wales. We know that because we have people who have survived complications and are living with them now. And part of our challenge is understanding the number of people and understanding the reluctance of some people to come forward. It is quite easy to understand why some people do not wish to highlight the problems that they have, particularly if they feel that they've not been believed at an early stage when complications were arising. And removal can be complicated and difficult and not always completely successful surgery. There are risks in that too.

As I've said in response to a number of people already and I tried to say at the outset, I'm not in a position to ban mesh. I'm not in a position to suspend its use either. What the report, though, does make clear is it should be a last resort. As I said, people then say, 'Well, what is a last resort?' Well, it's something about making sure that all of those conservative non-surgical treatment options are exhausted first, and that's why there has to be a proper focus on making sure that we have a more consistent arrangement surrounding the multidisciplinary teams to make sure those options are provided early, and then, when going through any treatment options, that the potential consequences of each of them are highlighted to the women involved. Because as I've said, I do recognise that some of the real challenges that we have understood are not that the risks have been explained and people have gone in with their eyes open about those risks, many women have said they were simply not given a genuinely informed basis upon which to make that choice about whether to consent to surgery or not.

In terms of the attempt that was made in attempting to try and have people who were living with the complications of mesh engaged in the task and finish group, having decided to set up the task and finish group, I wanted to make sure that there were people living with those complications who could input into that work. That meant the invitation was at relatively short notice, with the terms of reference, the people involved and indeed the evidence they would be considering. It wasn't just at that early stage, though, that an attempt was made to involve women in that work. Throughout the life of the task and finish group, for a number of months, we've tried to find a way in which they could have a real input, either to the whole group or to members of it. That proved not to be possible. I absolutely do not wish there to be any kind of criticism inferred or taken from that at all as to the decision that those women made not to engage directly in the work of the task and finish group. I think it's easy to understand why they chose not to do that. But, they did however continue to have an input around that.

As you are aware, we met your constituents to have that conversation and their accounts and the written evidence they provided were taken into account and were provided to the task and finish group, and it's part of the reason why the work of the task and finish group was extended, because they did consider the evidence that was provided by both Jemima Williams and Nicola Hobbs, and it's referenced in the report. So, I hope that does help provide some assurance that their evidence was taken seriously. And in taking forward the work of the implementation group, we need to find a way for women themselves who are living with complications to actually have an input into the work of that implementation group, as well as those people who are on the pathway already and are undergoing conservative treatment options in the here and now. So, there is much more for us to do and, as I've said in an earlier response, I will happily report back to Members on the work that is being undertaken and the progress that we're making.

Thank you, Cabinet Secretary, for your statement today, and I'm glad the Welsh Government's task and finish group have now completed their report. The Cabinet Secretary is aware that I, like many other Members here, have heard the heart-breaking experiences of constituents suffering from the impact of surgical pelvic mesh implants—experiences of women being left in agonising pain and with extreme worries about the future. For women like my constituent who first brought this to my attention, financial and professional worry still come with the long-term physical and emotional pain. Indeed, my constituent has said that this has had a devastating effect on both her and her family. I'd like to take this opportunity to pay tribute to my constituents and all the other women who have come forward to bravely share their harrowing experiences. So, whilst I welcome the task and finish group's report, can the Cabinet Secretary provide reassurances that any new pelvic health and well-being pathway will include listening to patients' ongoing concerns?

Yes, I really do recognise the life-changing consequences that mesh complications have had for a number of women, including the correspondence and your questions in this Chamber and the conversations we've had outside it, about the physical, social and financial consequences, but also about the very real impact on people's relationships, not just with partners, but with a whole range of other people that the pain and discomfort has caused, and also a lack of trust with people who they trusted at the outset about the advice given, and indeed trust between healthcare professionals as well about the treatment options that have been provided.

Your point about listening to people directly engaged and involved is essential, not just as part of our continued improvement and prudent healthcare and what the parliamentary review has told us we will be taking forward in particular; this really highlights where, if you don't understand what matters to the person and what risks they're prepared to accept, how they have genuinely informed consent, where information is made available to them not hidden from them, but genuinely made available to them so they can make choices about their treatment options, then you understand why people end up in this position where they don't trust everything that is done around them.

It is essential, therefore, that in taking forward the work of the implementation group and taking this report forward, the patient voice is absolutely central to what is done and how that is then explained. Much of the task and finish group's report does focus on how information is provided to people to make choices and for them to say what matters to them. So, I take on board the point, and I can give that reassurance that that will be an essential part of our work moving forward. 

Cabinet Secretary, on 13 December I asked you:

'Given the growing number of mesh implant survivors, England has adopted multidisciplinary teams of specialists who support patients who have had issues with mesh and advise them on treatments. Do these multidisciplinary teams exist in Wales and, if so, where are they?'

You commented, as was mentioned earlier, that

'we do have multidisciplinary teams around each surgical procedure.'

Now, that is simply not the case, and I'd like you to correct the record today. 

Moving on, if we look at pages 6 and 7 of the report, people were informed incorrectly about the potential risks and life-changing effects in consequences. People were not warned of the potential devastating life-changing complications. There was an inadequate consent process. People's problems after operations were disregarded and put down to just simply post-operative symptoms. People were turned away and made to feel like they were making a fuss, and I read here that consultants reduced some people to tears, and that there were inappropriate referrals to other specialist areas, and so on. It's a pretty grim report, and people have been permanently disabled. So, another question that I have is: what is going to be done to compensate these people? 

Thirdly, an expert panel was set up in Scotland on this matter in 2013, in England in 2014. The Welsh NHS was invited to take part then. In December 2014, an oversight group was set up in Engand with no Welsh NHS input. Action was taken in the United States in 2014. So, why did the people of Wales have to wait until October 2017 for the task and finish group to be set up? Was it your negligence or was it the negligence of your predecessor? I don't understand why it's not mandatory to report on problems that have been reported to doctors after surgery has taken place.

I want to move on now to your—       

No, sorry. You can't be moving on—

It's a question.

A question then, please, because we're short of time as well. Thank you. 

So, that was a question. My next question is: what about men? You seem to dismiss hernia operations. People suffer the same problems using these meshes. I spoke to a constituent just before walking in this Chamber earlier, and he still does not know what material was put inside his body. That's an absolute scandal. Will you undertake to make sure that my constituent is told exactly what was put into his body without his consent? Will you undertake to do that? 

Thank you. Cabinet Secretary. 

Obviously, I can't comment on individual matters that I'm not aware of, but your constituent should approach the health board where the procedure was undertaken. I would expect that information to be made readily available to him. 

I also need to deal with the point about hernia that I mentioned in response to Janet Finch-Saunders at the outset. Of course, hernia operations are undertaken on men and women, and I've indicated previously in answer, I believe, to questions from Jenny Rathbone that we would be looking to undertake, and we are looking to undertake, a review of hernia procedures to understand if the same level of complications exist. But it is the case that people do react differently. It is the case that between men and women there are procedures undertaken that simply don't affect men. And, as I say—I make no apologies for saying it again—if a similar issue had affected men uniquely, then I do not believe that it would have taken this long for that problem to have been highlighted and for further action to be taken. I set up the implementation group to look at this issue and the issues that arise on the record for improvement and the range of linked women's health issues that I've mentioned, both endometriosis and faecal incontinence.

There is, of course, more that we need to do, to do consistently and at pace. That's why the implementation group that I have directed be created. And I certainly don't defend a failure to provide genuinely informed consent. I've made that very clear, both before today and on a number of occasions during today as well. I go back to multidisciplinary teams. Multidisciplinary teams do exist as a matter of course around surgical procedures. Our challenge that this report lays out for us is whether we have the requisite amount of expertise within those teams, whether they're as consistent as they need to be, and how we actually recommit ourselves to improvement. That does not mean that there is a widespread failure to do what is right. It does mean you need to take the opportunity to improve, and that means that you have to accept that there is a challenge to be resolved in the first place to be able to set yourselves out on a path to improve on current process and current action. So, I see no reason to correct the record. I'm accepting the recommendations that we have, and I look forward to reporting back to Members in the future on the action that the NHS will undertake to deliver that required improvement.

Thank you. Finally, Jenny Rathbone. 

Thank you very much. I'm particularly interested in prevention and causes, because, obviously, prevention is much better than treatment, and we need to obviously ensure that the treatment is appropriate. We have to remember that thalidomide was once prescribed as a way of dealing with morning sickness. So, clearly, this has been latched onto as something for dealing with incontinence and prolapse. The issue really is what we can do to support people not to have incontinence and prolapse—things like preventing third and fourth degree tears and, where possible, ensuring they're sutured by an appropriately qualified, appropriately skilled doctor.

I'm interested that other European countries systematically refer all women who've had babies to a physiotherapist prophylactically because, often, the problems that are later encountered by women aren't immediately evident but could be detected by a physiotherapist. So, a thought to bear in mind as we're considering future treatment. Of course, how much of this is something that women previously used to put up with because, before the NHS, women had to put up with incontinence and prolapse because they didn't have the money to get it rectified—. 

One of the issues that concerns me about the report is where we are told that the task and finish group approached both the British Society of Urogynaecology and the British Association of Urological Surgeons for data on the numbers who had undergone this procedure and, to date, they have not had a reply nor, indeed, the clarification that not all surgeons in Wales are necessarily registered with these bodies and, therefore, wouldn't have been able to record their data anyway. So, there's a clear indication there that we need to use digital technology to ensure that we have the data that my colleague Jane Hutt is now calling for retrospectively to be arrived at.

I'm very pleased that you're taking forward the task group in association with the anal sphincter injuries task group and the endometriosis task group, because, clearly, these are related matters, and I look forward to the linked reports when they're ready to be published. Thank you.

I'll deal with—I think there are three particular points coming from that. The first is on a point you've made previously about physiotherapy, and what I'll do is I'll try and make sure that someone from the chief nurse's office is able to provide us with a note on care for women after pregnancy and to understand the role of physiotherapy. I know you've made the point in particular about France, for example, where physiotherapy is offered as a matter of course after birth.

I recognise the point you make about voluntary registries by the two relevant professional bodies, and it is disappointing that those two bodies did not provide information when requested to in the way that it was requested.

That leads into the point around medical coding and recommendation 7, which looks at the coding that we should have available, the improvements that we could and should make in the here and now, as well as the longer term choices we have to make about understanding which implants are put into people—of whatever form, not just in this area—and understanding where that is made available, but, crucially, the requirement will be that that information is publicly available, and so I think will provide real transparency about what has been implanted and where and allow us greater transparency and audit for the efficacy both of those operations and any post-operative complications. So, there is more work for us to do, and that is definitely covered by the recommendations the report has made, and, as I say, I look forward to reporting back to this place on the progress that has been made at a future point.

Thank you very much, Cabinet Secretary. 

Item 5 on the agenda is a statement by the Cabinet Secretary for Economy and Transport, ambitions for Great Western and north Wales main lines, and I call on the Cabinet Secretary for the Economy and Transport, Ken Skates. 

Diolch, Dirprwy Llywydd. 

Following the cancellation of electrification on the Great Western main line between Cardiff and Swansea, the Secretary of State for Transport announced the development of business cases for rail enhancement schemes across Wales, including improvements to the main lines in south and north Wales, enhancements to the line between Wrexham and Bidston, and improvements around Swansea and to Cardiff Central station. This commitment is welcome. I have made it clear to the Secretary of State my expectation that development and delivery now needs to happen at pace to implement early in the next decade improvements for passengers in Wales who are experiencing slow speeds, poor reliability and inadequate network facilities on a daily basis.

Electrification of the Great Western main line is a starting point for future enhancements; it is not the final destination. The next Wales and borders rail services contract—the first to be designed and delivered in Wales—will deliver transformational change to passengers. However, our train services rely on efficient and reliable railway infrastructure to deliver the speeds and capacities that meet the connectivity needs of people in our cities, towns and rural communities.

I have also recently shared my ambitions for the new Great Western franchise with Members and reiterated my expectations for the west coast partnership franchise procurement with the Secretary of State. Back in 1977, it was possible to get from London to Cardiff on the then new high-speed train services in one hour and 45 minutes, 15 minutes shorter than the current fastest journey times. At that time, the service to Manchester from London took 2.5 hours. As a result of the £9 billion west coast main line upgrade in the early 2000s, Manchester is now just two hours and five minutes from London, the same as London to Cardiff, even though Manchester, of course, is 50 km further away. This investment has also allowed journeys from Stafford to London in one hour and 20 minutes—a similar distance to Newport to London, which is 30 minutes slower.

Following the curtailed electrification of the Great Western main line, Cardiff to London journey times will, at best, be one hour and 45 minutes, the same as 30 years ago, and Swansea will still be two hours and 45 minutes. Similarly, the train journey from Cardiff Central to Bristol Temple Meads is slow and infrequent, hindering the development of stronger cross-border economic bonds.

Meanwhile, the UK Government is investing £55 billion in high speed 2 line to further reduce journey times to Manchester to just over one hour and to provide significant improvements in journey times across the midlands, the north of England and Scotland. If the UK Government make the right choices on HS2, particularly around the Crewe hub and proposed service patterns, it will provide significant economic benefit to north Wales.

Connectivity across the south-east of England is being further enhanced by the £15 billion Crossrail scheme and across the north of England through the £3 billion trans-Pennine route programme, while ambitious plans are being developed for Northern Powerhouse rail and Crossrail 2. Whilst these investments will deliver much-needed capacity on the UK rail network, their impact on journey times will be even more significant. Those places being directly served by HS2 will benefit from significantly faster journey times to London, potentially reducing the competitiveness of locations in Wales for inward investment. The UK Government's own figures suggest that HS2 will have a negative impact of up to £200 million per annum on the economy of south Wales.

Now, as we look beyond Brexit, Wales's connectivity with Britain's economic hubs and international gateways becomes even more important. We in Wales cannot afford to be sidelined and must develop a positive and compelling case for major transport investment that addresses both our economic ambitions and our broader well-being objectives. We rely on the UK Government to provide funding for enhancements to rail networks in Wales, but we cannot stand in the margins complaining; we need to set out our expectations for the network and be clear about the anticipated social and economic benefits.

As a starting point, we will set out some overarching needs, which include: improving connectivity and reducing journey time between cities in Wales; expanding the city region areas across Wales; growing cross-border economies; enhancing connectivity from Wales to London; improving access to airports; maximising the potential benefits and offset negative consequences of HS2; providing compelling journey choices to users of the congested M4 at Swansea; and meeting trans-European network standards. These requirements have many inter-dependencies. The solutions will include multiple complementary projects. A strategic outline programme case is a way to pull these strands together, ensuring that the economic, geographical and social context within the potential schemes are developed and are consistent and universally understood. I have asked Professor Mark Barry to lead on this, working with my department and Transport for Wales.

Since HS2's impact is different across Wales, Professor Barry will be producing one case for north Wales and another for south Wales, and we will not be neglecting the Cambrian line through mid Wales, which also provides important connectivity within Wales and across the border. This work will inform the individual scheme strategic outline business cases currently being developed by Transport Wales and the Department for Transport, and the purpose of these programme business cases is to establish the need for investment and to articulate high-level outcomes. They will establish an overall vision for the future of the north and south Wales networks that meets the Welsh Government's and, indeed, other key stakeholders' aspirations. They'll also identify and consider options for investment that complement the ongoing work to design and deliver metro systems in north and south Wales.

From this, those options that merit more detailed investigation will be identified and developed through a detailed business case process where we rely on the UK Government to take decisions in the interests of travellers in Wales in order to complement the investment that the Welsh Government is making in improving its own transport infrastructure. At this early stage, no options have been ruled in or ruled out. To determine the most appropriate interventions requires a strategic approach and a long-term plan and one that builds upon Network Rail's route studies, local authorities' and city regions' plans and ambitions, and which also complements the enhancement plans of the Department for Transport and wider UK Government.

We are committed to work with agencies on both sides of the border to deliver an integrated transport system. This means links with our major city regions, between them, and across the border to England, building on my recent meetings with the metro mayors of Manchester and Liverpool, our memorandum of understanding with Transport for the North, our work with Growth Track 360, Merseytravel, Midlands Connect and the West of England Combined Authority. This work is being undertaken using our own WelTAG guidance and will meet UK Government requirements. I want to see an ambitious programme of improvements that deliver a step change for passengers and that, regardless of final deal reached in respect of Britain's exit from the European Union, result in the main lines in north and south Wales developed as trans-European corridors by meeting standards currently applying to them under regulations.

It is my intention, Deputy Presiding Officer, to subject some of the emerging proposals and choices to a public consultation in the second half of this year. We are determined that, in the future, schemes coming forward will be robust, deliverable and based on a sound strategic imperative and economic analysis. I want to see enhancements to the rail network that deliver on the broader objectives I described earlier and, in doing so, provide a firm foundation for the Welsh economy and its future development.

Can I also thank the Cabinet Secretary for his detailed statement this afternoon? I can agree with much of what the Cabinet Secretary has outlined. It's interesting that he mentioned that journey times in 1977 were actually faster between London and Cardiff than they are today.

With regard to your list of overarching needs, I was pleased to note that you've made reference to access to airports. Particularly, I'm thinking of Manchester, Birmingham and Liverpool—all important airports, of course, for mid and north Wales. I'm sure I don't need to tell you, Cabinet Secretary, about that. But it'd be interesting if you could, perhaps, expand on your ambition in that regard. From what I've understood, you've outlined that Mark Barry is going to undertake a strategic outline programme case, and two cases are being proposed, for the north and the south. It would be useful to have some timelines on that for when those cases and reports will be reported to you and when you'll be able to report back to Members. Will this happen before the consultation that you have outlined that will take place later this year? I was pleased to see that you made reference to the Cambrian line and mid Wales not being neglected, but I'd be interested to see if that does sit in your north Wales case or your south Wales case. It's surely got to fit in one or the other.

I'd also like to ask you, Cabinet, Secretary, how your plans dovetail with existing policy documents that the Welsh Government has already published. How, for example, do you intend for your ambitions that you've outlined today to complement the existing economic action plan? And also, how are the proposals that you've outlined today going to directly complement the growth deals, which, of course, have a huge potential to drive forward economic growth right across Wales?

Can you also specifically outline how your ambitions will benefit Welsh commuters based in both urban and rural communities across Wales? Now, it's my view that it is, of course, vital that we build an integrated transport system that can support a host of wider economic and social policy objectives. I don't think you mentioned at all plans for how rail will be integrated with bus services to ensure that improvements will result in benefits for passengers across Wales, so can you give some views on this?

Finally, Cabinet Secretary, can you outline how the delivery of these proposals, or your ambitions, will be supported by the two new bodies that have been created to help drive forward the creation of new transport infrastructure in Wales? I don't think you mentioned the national infrastructure commission for Wales in your statement, which I'm surprised about, and if that's the case, perhaps you could just explain some rationale behind that. And with regard to Transport for Wales, I think at one point that you mentioned that Mark Barry will be working with your department and Transport for Wales, so I'm just keen to understand the relationships between Transport for Wales and your department and how they work together. And finally, does the national infrastructure commission for Wales have the resources and support that are required to deliver your ambition?