Y Cyfarfod Llawn - Y Bumed Senedd

Plenary - Fifth Senedd

06/11/2018

The Assembly met at 13:30 with the Llywydd (Elin Jones) in the Chair.

1. Questions to the First Minister

The first item on our agenda this afternoon is questions to the First Minister, and the first question is from Helen Mary Jones. 

The Welsh Government's Budget

1. What assessment has the First Minister made of the impact of the UK Government's budget announcement on the Welsh Government's budget? OAQ52851

The UK Government budget did nothing to repair the damage inflicted by nearly a decade of cuts to our budget.

I, like, I'm sure, many Members in this Chamber have received a great deal of correspondence from local government leaders particularly, most recently from Emlyn Dole, leader of Carmarthenshire County Council, about the pressures on local council budgets because of the consequences both of your draft budget and of the Westminster Government budget. You did, I think, commit to the councils being, I think, first in the queue should there be any additional resources for Wales from the UK budget. When are the councils likely to see the money that you've promised?

We hope to give informal indications within the next fortnight. It's not the case that every single penny of consequential will go to local government, but they are very much in our minds, and, as I said, they are first in the queue. We understand the difficulties that they face. We've had to take, of course, very difficult decisions in terms of what we have not been able to do, in order to make sure that the cut in local government funding wasn't as severe as it otherwise might have been, but those discussions are ongoing and we want to see what we can do in order to help local government, although it will still be tough. 

Well, First Minister, looking on the bright side, the UK Government's budget will see an extra £551 million coming to Wales over three years, an average uplift between 2015 and 2020 of over 4 per cent in real terms. Can I concur with the question and issue raised by Helen Mary Jones about the local authorities? We also know that around £26 million of that money from the UK budget is a result of the UK Government's extra support for businesses, reducing business rates for businesses with a rateable value of up to £50,000 by a third. We know Welsh businesses have been crying out for greater support here. Will you give a commitment to use that consequential money to further reduce the burden on Welsh businesses?

Well, let's knock down that £550 million-odd consequential that's been alleged there. I can say that more than half of the funding that was announced had already been announced. It's money that has already been spent. It's been spent on pay and pension decisions. There has been a cut of £32 million from the money originally pledged as part of the NHS seventieth anniversary celebrations. So, it means that our consequential in reality this year is somewhere in the region of £60 million in revenue and £2.6 million in capital. Well, thanks a bunch for that; that's marvellous. So, once again, a magnificent example of spin by the UK Government that's not borne out by actual figures. What I can say to him is that we are awaiting the exact details of the business rates relief fund that's proposed in England, because, so far, those details have not been made available. 

First Minister, we know that the Welsh Government has a proud record of supporting small businesses here in Wales with generally a more generous package of rate relief, and has supported more small businesses than anywhere else in the UK. I note that, in the recent UK budget, the Chancellor announced additional rate relief for small retail businesses in England, who will see their rates cut by a third for two years from April 2019. What analysis has the Welsh Government given to how it can respond to this to make sure it still offers a generous package of support that meets the needs of small businesses in my constituency of Cynon Valley and across Wales?

The Member is right to say that we are committed to supporting businesses in Wales. We have provided in the course of this year around £210 million of rates relief to support businesses and other ratepayers. Those reliefs are available to all those ratepayers who meet the criteria. We note, of course, the Chancellor's announcement. We have yet to see what that will mean in terms of a consequential. We do not know either how that system will actually work in England. When we have those details, of course, we can give the matter further consideration. 

The Impact of Brexit on Recruiting Students

2. What recent assessment has the Welsh Government made of the impact of Brexit on recruiting students from the EU 27 countries to educational establishments across Wales? OAQ52862

We've worked with our higher education funding council and Welsh universities to understand the impact of potential changes to EU student recruitment. Of course, universities as autonomous institutions will be undertaking their own assessments and developing contingency plans for a range of scenarios.

Thank you for that answer, First Minister. With only weeks left for the Brexit negotiations to be concluded, we're still faced with continuing and huge uncertainty in so many areas, including our higher education system. I'm told that applications from EU students are down across Wales, but, for those EU students actually accepting places at the University of South Wales, which of course includes Merthyr college in my constituency, the figure is some 33 per cent. There's no doubt that this is going to impact on university and college finances, the sustainability of jobs in the sector and on many local economies. So, do you share my concerns about these recent recruitment figures, and what more can we do to help our university sector through this period of uncertainty?

13:35

Well, through working, as I said, with the higher education funding council, we're assessing what the effects will be. It is right to say that we have seen 22 per cent fewer EU domiciles placed at Welsh providers for 2018-19. We will, of course, continue to press the message that Wales is open for business and is an attractive destination for students, with well-ranked universities, quality teaching and affordable living costs. But there's no doubt that there is a feeling amongst students not just from within the EU, but from outside, that the UK in some way is not welcoming as far as students are concerned. For years, I listened to people from the Indian Government, for example, and those representing them, saying that they felt that their students were not welcome in the UK any more, and now we're seeing that perceived lack of a welcome being extended to other nationalities as well. But, as far as Wales is concerned, we welcome the brightest and best, wherever they're from.

Official figures show that Welsh universities saw the biggest drop in the United Kingdom in the number of applicants from the European Union between 2017 and 2018. Applications from EU students fell by 10 per cent in Wales, compared to a 2 per cent increase in England and a 3 per cent increase in Northern Ireland. Given that Brexit will affect the whole of the United Kingdom, why is it that Welsh universities have performed so badly in attracting students from EU countries compared to England and Northern Ireland? And, First Minister, what is your Government doing to reverse this trend in Wales, because this is a devolved area?

Well, there's no doubt that the changes in student finance policy will have had an effect. It was very generous, of course, for EU students; that's not the case any more in the same way. That may well be part of the reason why we've seen a decline in Wales, given the situation with our own student finances. Those changes, of course, were made following an independent review. It is, though, encouraging to see an increase in EU applicants to Welsh universities for early deadline courses, which include most medicine and dentistry courses—that's to commence study in 2019. But, of course, we will continue to work with our universities in order to make sure that it's understood that Wales is an attractive place to study.

I think many Assembly Members have given the context of Brexit and how that may impact EU students and also those coming from further than the EU. But, looking at the current situation, there are no Welsh universities in the top 10 across the UK for EU student numbers, so that is something in the here and now that we are not performing well on. Yes, your Government has confirmed that EU students will continue under the same rules until 2019-20, but I want to understand what you are going to be able to do after that point. An announcement that covers only the next financial year might not be sufficient enough for those students who are planning their future careers, be it within the EU, or beyond that. So, what can you do to encourage them to see Wales as a viable place for them to come and study?

Well, we established the higher education Brexit working group over two years ago. That was established to share intelligence and to provide advice to the Welsh Government. We work with our universities, of course, to make sure that their voices are heard abroad, and of course to ensure that they are able to market themselves abroad. Now, within Europe itself, until last year, the only two offices we had in the EU, outside of the UK, were in Dublin and in Brussels. That's changing, with Paris, with Dusseldorf, with Berlin opening; there will be others in southern Europe in the future. I would anticipate those offices being available to higher education institutions, to help them to promote their message in important European markets, and of course to assist students to find out more about Wales.

Questions Without Notice from the Party Leaders

Questions now from the party leaders. The Plaid Cymru leader, Adam Price.

Thank you, Llywydd. Twice over the past few weeks—in a Confederation of British Industry conference and in an interview with Guto Harri—you have referred to the increasing numbers of successful Welsh businesses that are selling out to companies outwith Wales. You said that you  want to follow the mittelstand system in Germany, where indigenous companies grow and develop from small companies into medium-sized companies, rather than being sold. Have you made an assessment of the length and breadth of this problem? How many medium-sized Welsh businesses have been taken over during the past 12 to 15 months?

13:40

No, but what I do know is that we need to change the culture as regards businesses in Wales. The tradition of mittelstand in Germany is an exceptionally strong one, and there is a tradition there where companies continue to manufacture and don’t sell out to other companies, but that hasn’t been the case in Wales. This is an old problem. One of the things we were considering at one time was whether we could reopen the Cardiff stock exchange. By now, of course, most are digital in nature. The reason we were looking at the feasibility of that was to ensure that more companies or businesses from Wales would consider being listed on that stock exchange, but, by now, I would say that that’s no longer relevant.

Culture change is the thing for me, to ensure that more businesses from Wales think, ‘Right, we want to grow. We want to stay as we are', and to not always think, 'We must sell out to a larger company'. This is not the case in Ireland, and neither is it the case to some extent in Scotland. So, a change of culture is what’s important.

In terms of the scale of the problem, perhaps I can provide the First Minister with some information. Since the summer of last year, the civil engineering company Alun Griffiths from Abergavenny has been sold to Tarmac. Gap Personnel from Wrexham, one of the five largest recruitment companies in Britain, has been sold to Trust Tech from Japan. Princes Gate, from Pembrokeshire, one of the eight largest mineral water companies in the UK has been bought by Nestlé. Even in your own constituency, there are two substantial Welsh companies that have been bought by foreign companies recently: Harris Pye engineers, a company like Alun Griffiths, with a turnover of over £100 million, was purchased by Joulon from France, and Aircraft Maintenance Services has been purchased by the American company JBT. There’s been some talk about the missing middle. At this rate we’ll have nothing left soon. So, can you confirm whether your Government made any request to the market and competitions commission to prevent any of these sales, and do you accept that one of the problems is that the bank of Wales currently doesn’t have the financial capacity to fund the management buy-outs at the necessary scale? One or two of these deals would take all of the bank's annual funding, so isn’t it now time to look at what’s being offered in Scotland, which is a far greater fund and which could ensure that we are in a position to offer alternative options to these companies rather than being sold?

Well, it’s true to say that you have examples there of the culture that we have. People tend to retire and sell out, rather than thinking about ensuring that the company can carry on. So, the next question is: what can we do about this? So, I think I would like to consider what’s happening in Scotland to see whether there are any lessons that we can learn from Scotland, because it’s one thing to say that we must change the culture, but we have to find ways of being able to do so.

Is part of the problem the overemphasis in terms of Government policy on inward investment? Two years ago, you referred to attracting Pinewood to Wales as one of the main successes of your economic policy. Yesterday we heard that only 20 per cent of the proposed economic benefit has actually come to pass. Your economic director said that more transparency in this case would have been useful, but in this case and in the case of Aston Martin you have refused to be transparent because of commercial confidentiality. You argue that you need to strike the right balance between indigenous development and inward investment, but how can we judge if this balance is right if we don’t have the figures?

Now, of course, we need a strategy for overseas companies, but rather than writing blank cheques for white elephants, wouldn’t it be better for the Welsh Government to look more at safeguarding the companies that we have? To this end, does the Government intend to respond to the European Commission inquiry into the merger of ThyssenKrupp and Tata, which could mean the sale of the Trostre site? And, remaining with Llanelli, can I ask specifically when the Welsh Government became aware of Schaeffler’s intention to close the plant in Llanelli? And as there uncertainty about Brexit is noted as one of the main reasons for that decision, to what extent has Jeremy Corbyn’s opposition and the Labour Party’s opposition to membership of the single market contributed to this decision?

Well, there were a number of questions there. As regards the last one, I don’t think that any contribution has been made by Jeremy Corbyn in relation to Schaeffler, to be fair. I heard this morning about Schaeffler. I wasn’t aware of the company’s plans prior to that. Overseas companies are crucial to the economy of Wales. We know that. Aston Martin will be crucial. Pinewood has secured millions of pounds of investment in the Welsh economy, and it's something we shouldn't be afraid of. But there is a point as regards in what way can we ensure that more companies from Wales grow, because, it's true to say, if a company has their headquarters in a particular country, they tend to stay there. So, that's the challenge. I don't think that we need to make a choice; we have ensured that the bank of Wales is available to assist and support companies in growing. And we also want to ensure that it's possible for those companies to prosper, and also to collaborate with international companies. We know that international companies not only employ their own people, but they are all important in terms of employment in SMEs in Wales that ensure they sell products to them.

I remember, in the days of the WDA, they had no interest whatsoever as regards small businesses. Everything was concentrated on inward investment. Of course, that's very important, but we must ensure that the pyramid that we have, where we have a lot of small businesses, very few large businesses—that that pyramid grows over the years in order to give Welsh companies the confidence that they can grow and expand and that they can stay as they are.

13:45

Diolch, Llywydd. First Minister, as you may know, this week is International Stress Awareness Week and November is Men's Health Awareness Month. Considering that over 63 per cent of adults and over 55 per cent of children in Wales are waiting longer than four weeks to access mental health treatment, and given that the Equality and Human Rights Commission believe that getting timely access to mental health services should be a top priority, why isn't it a top priority for your Government?

Well, I would argue that it is. We've seen huge improvements, for example, in ensuring access to mental health for children and for adolescents, and also emphasis made on ensuring that counselling is available rather than clinical intervention at an earlier stage. We have the Mental Health (Wales) Measure 2010, of course, which I would argue is a unique piece of legislation that improves access to, and delivery of, mental health services. It's driven improvement since its implementation in 2010, it does provide effective and helpful services at an early stage through the local primary mental health support service, and it ensures that those in need of specialist services receive the highest quality of care and treatment.

There are many other things I could refer to, of course, such as, for example, the 'Talk to me 2' strategy to help prevent suicide and self-harm. That strategy, of course, is overseen by a national advisory group. So, I would argue, in fact, that services in Wales have much improved over the years, and that's recognised by the amount of money that we've invested in mental health.

Well, First Minister, clearly, it's not a top priority for your Government, otherwise these people wouldn't be waiting so long. When your Government laid its budget last month, there was no clarity on how you would improve Wales's mental health service provision. This is in huge contrast to the UK Government, who made clear its decision to invest further in the NHS to support those with mental illness in its budget.

Now, First Minister, I know you like talking about England, so, as a result of the Chancellor's announcement last week, the UK Conservative Government is implementing a new mental health crisis service, with comprehensive mental health support available in every major A&E. It's introducing children and young people's crisis teams in every part of England, it's introducing more mental health ambulances, it's introducing more safe havens in the community, it's introducing a 24-hour mental health crisis hotline—all of this, but not on this side of the border. It's becoming clear that mental health provision in Wales is falling behind that of England and other parts of the United Kingdom. Will you now be exploring some of these measures and looking to implement them here in Wales?

What he's suggesting is, in some ways, what we're doing already; he seems not to know that. Can I say that the last published data shows that we are meeting the targets for assessment and interventions on an all-Wales basis? Over 184,000 people have been seen by local primary mental health support services in Wales since their introduction as part of the Measure.

I can say, in terms of crisis care, well, we introduced the Wales mental health crisis care concordat in 2015. That's been successful in significantly reducing the use of police custody for people detained under the Mental Health Act 1983. We continue to work with local health boards, with local authorities and police authorities across Wales to support front-line services that are most likely to be the first contact for people in mental health crisis. We're improving out-of-hours and crisis care; that's a priority in the mental health transformation and innovation fund, which is supported by £7 million of additional funding by the Welsh Government, and, as part of that, we've committed over £1 million this year for a range of approaches to improve support, including liaison services, crisis support and street triage. And, a priority, of course, for our mental health crisis care concordat assurance group is to better understand the context of crisis presentations, and we are developing the data to support this. England is playing catch up.

13:50

Not at all. This is just absolute complacency from you and your Government, as usual. We know that, without timely treatment, a person's mental health, just like any other condition or illness, is likely to worsen. Time and time again, children and adults have to display a serious level of illness, often to the extent of harming themselves, before they can access timely services. But, sadly, it's clear that your Government is failing to drive forward the comprehensive sea change that our mental health services desperately need. Even when proposals were put in front of you by the Assembly's Children, Young People and Education Committee on how to improve the dire state of preventative mental health services in Wales, you refused to take on board the majority of those recommendations, even against the wishes of some of your backbenchers. So, can you tell this Chamber today why did your Government refuse to accept those recommendations, supported by Members of all parties, and why, in spite of a 4 per cent real-terms increase in the Welsh budget in 2015 to 2020, you are not sufficiently investing in mental health services in Wales to bring down the unacceptable waiting times for people with mental health conditions?

We are investing in mental health services in Wales. All the data show the improvement that is there. He didn't listen to the answer I gave, did he, for the second question—I gave him a number of answers to his question illustrating what we were doing in Wales. So, let me try, if I can, to help him further. We know that prevention is important. It's why it's a key theme, along with early intervention, in 'Together for Mental Health', and that includes a focus on non-clinical support. We have the healthy and active fund, launched in July by the Cabinet Secretary for Health and Social Services and the Minister for Culture, Tourism and Sport—that is a partnership that delivers an integrated way in which we can introduce a well-being bond and a challenge fund for sport. During phase 1, £5 million is available to invest over three years, with the aim of improving mental and physical health by enabling healthy and active lifestyles, with a particular focus on strengthening community assets.

The Cabinet Secretary also recently announced our investment of £1.3 million for Mind Cymru and the British Red Cross to deliver social prescribing projects across Wales—they'll help to deliver evidence for social prescribing for mental health issues to support our future—[Interruption.]—I know that he didn't expect this answer, but he's going to get it—to support our future actions in this area. We recognise, of course, the impact of adverse childhood experiences on our life outcomes; that's why we funded the ACE support hub. This is a centre of expertise to increase understanding of adverse childhood experiences and resilience. And we continue, finally, to support the Time to Change Wales campaign to end the stigma and discrimination faced by people with experience of a mental health problem in Wales. Phase 3 of that campaign will run for the three-year period from April, jointly funded between health and social services, economy, transport and Comic Relief.

I think I've illustrated very, very strongly the commitment of this Government to mental health issues and have illustrated the commitment that, financially and politically, we have made. And I'm glad that the party opposite has decided to catch up.

Diolch, Llywydd. First Minister, for the next financial year, it has been forecast that just over half of the Welsh Government's entire budget will be spent on health. However, when we look at opinion polls, it's clear that the Welsh people don't think that the NHS is working in Wales. In May 2014, after 15 years of the Welsh Assembly, the BBC and ICM Research asked people if having the Assembly had led to an improvement in the NHS, a decline, or had made no difference. Less than one in four people believed that it had led to an improvement. Health is clearly a vital area for your Government and for the people of Wales, but do you think that spending 50 per cent of the whole budget on health is sustainable, and are the Welsh people getting the health service they deserve?

Well, if he's suggesting that spending 50 per cent on health isn't sustainable, he is advocating another model. Now, if he's advocating another model that includes a reduction of coverage or the introduction of an insurance-based scheme, then I'm willing to hear what his ideas are. I'm sure he can explain those to the people of Wales. We have shown the people of Wales that we have continued to spend the money that's needed on the health service, despite, of course, seeing enormous cuts—£4 billion in real terms of cuts—over the past eight years from the UK Government. And I know full well that, if you ask people in England what are their views of the health service in England, you're likely to get very similar results to those in 2015. And, since 2015, things have hugely improved: the new treatments fund that's been launched, the fact that we have, of course, targets, more targets, that have been reached—if we look at ambulance response targets in terms of red calls, they are being reached, and that's a sign of the commitment that we have made to the health service.   

13:55

Clearly, your assessment of your Government's performance isn't really shared by the people of Wales, but one key issue that is clearly having a detrimental impact on the NHS is health tourism and immigration. [Interruption.] Yes. The UK Government has estimated that treating health tourists costs up to £300 million a year. There is also the pressure caused by mass immigration. The Office—[Interruption.] The Office for National Statistics stated that, in 2017, there were 280,000 more people migrating into the UK than migrating out, so 280,000 more people having access to our NHS. That's more than the population of Swansea. So, First Minister, do you accept that uncontrolled immigration has played a major part in the huge crisis in our NHS?

Well, my experience of people who have come to the UK is that they are young, fit and vigorous. They don't put much pressure on the NHS because they are net contributors, tax-wise, and they take very little out as a result of it. Let me give him an example of health tourism: the doctors who work in our NHS, the nurses, the physiotherapists, the medical staff—all of whom have come to Britain to work within the national health service. The national health service could not exist—could not exist—without being able to access the medical expertise of doctors, nurses and others from other countries. Yes, I think health tourism is a good thing because it makes sure our people stay well and alive.

Yes, First Minister, I thought you would do you your usual thing and trumpet on about all of the foreign nationals working in the NHS. And, of course, you normally add how Brexit will be threatening the health service. However, BBC research revealed that, as of September 2016, just 2.5 per cent of all NHS staff in Wales are from the European Union. In fact, more than 93 per cent of staff working in the Welsh NHS are from the UK. If you are really worried about filling the gaps, then you should be asking yourself, 'Why are we not training more British people to work in the NHS?' Yet, again, your side is condemning me for mentioning uncontrolled immigration. However, this year—[Interruption.] This year, a Migration Watch poll found that 73 per cent of—[Interruption.]—73 per cent of voters support the goal of immigration being reduced dramatically. This also includes a majority of Labour voters. Is this not another case, First Minister, of you being out of touch with the Welsh people in general and, even worse, out of touch with your own Labour voters? 

Well, we win elections on this side. I don't know about you over there, but your group has gone down quite significantly since you first arrived in the Assembly. I know you have a rotating leadership scheme within UKIP. But let me say one thing to him now: people will be amazed at his dismissal of the contribution of those from outside the UK to our health service. Even on his own figures, he says that 7 per cent of those working in the NHS are from other countries. Is he saying that they shouldn't be there because they are the wrong skin colour or they're from the wrong part of the world? I don't care where they are from. What I care about is that they make people well. I don't care where someone was born. What I want to make sure is that somebody has the expertise to treat cancer, to treat heart disease, to perform operations in orthopaedic wards. That's what I care about. I could not care less about their background, as long as they are providing services for our people. Take the blinkers off your eyes, open your eyes to the world, and stop thinking that, somehow, anybody and everybody who lives in this country from a migrant family is in some way not welcome.

Every single person, as I've said before in this Chamber, is the descendant of an immigrant—every single person. It's simply a question of when our families came. In some ways—. UKIP don't seem to recognise that, but take the blinkers off and stop saying to the people of Wales, 'We want to get rid of doctors that make you well because of our own strange political—and often racist—dogma.'

Air Pollution

3. What is the Welsh Government’s strategy for tackling air pollution in light of the warnings from the World Health Organization? OAQ52869

Tackling air pollution in Wales requires a multi-pronged approach. As part of the clean air programme, the Minister for Environment has established an air quality evidence, innovation and improvements project that will, amongst other things, consider the practical application of WHO guidelines for air pollution in Wales.

14:00

I'm sure you'll join me, First Minister, in deploring the fact that 90 per cent of the world's children are now breathing toxic air as a result of our collective failure to safeguard our environment.

We know that air pollution kills more people than road traffic accidents, and the British Lung Foundation published data in the last 10 days highlighting that there are 57 health centres and three hospitals in Wales that are in areas that exceed the safe air pollution levels. Unfortunately, 26 of them are in Cardiff, including the five most polluted, which are in my constituency, where the PM2.5 levels are just well above WHO guidelines. Will you, as a Government, consider adopting the WHO guidelines as the bible that we need to adhere to? And how does the Welsh Government think that this ought to be informing City of Cardiff Council’s transport and clean air green paper, which considers, amongst other things, charging for people entering a clean-air zone as one of the measures that they are considering?

Well, on 24 April, the Minister announced the package of measures that will improve air quality throughout Wales. We have the clean air Wales programme, the clean air plan for Wales, the Welsh Government supplemental plan to the UK’s for tackling roadside nitrogen dioxide emissions, with a clean air zone framework for Wales as well. All these are issues that will help Cardiff council in terms of developing its transport and clean air strategy. I know that paper has set out the issues for the city as it grows, and the potential options for the future. What are they? Well, there are a number of opportunities to significantly change transport within the city. Charging is one possibility. That would be a matter, of course, for the council. But, of course, we see the development of the south Wales metro, improvements in cycling—and I’m glad to see Cardiff taking that forward now at a good rate—improvements in the walking infrastructure, and, of course, further roll-out of the nextbike cycle-hire scheme. So, yes, more work to do in the future, but, obviously, there are schemes already in place now that will look to help in the future as well.

First Minister, this is a very serious issue. When the Public Health (Wales) Bill was going through its passages in the committees, we had some very compelling evidence from many companies and organisations about how we could tackle air pollution and how we could improve the quality of air. Your Government chose not to take those recommendations forward, despite some of the committee recommendations. Given the severity of the World Health Organization's report, can I ask you if you intend to revisit the Public Health (Wales) Bill? And will you ask your Minister to review, again, the evidence that we took, and the recommendations we made, to see if now might be a more appropriate time for your Government to actually take action?

Well, the concern we have about the World Health Organization guidelines is that they are based solely on scientific conclusions about public health aspects of air pollution. So far, so good. But they don’t consider the technical feasibility or the economic, political and social aspects of achieving that. And this is where we have to have a balance as a Government. There is no doubt at all, for example, that air quality in Port Talbot would be mightily improved if there was no steelworks there, but nobody would seriously suggest that that is a reason, then, to see the end of steel production in Port Talbot. And yet, we know that the steelworks inevitably—despite, of course, the fact that it's improved hugely over the years in terms of the reduction of its carbon footprint—will always be a polluter in that way. So, the balance we seek is a Government is, of course, to promote, for example, more sustainable forms of transport, and we're doing that through the south Wales metro, working with local authorities like Cardiff to do that. But, of course, there will be—. If the guidelines were incorporated into Welsh law, that might well create many problems in terms of the economy and jobs if we weren't careful.

The Building of Incinerators

4. Will the First Minister make a statement on the Welsh Government's policy on the building of incinerators? OAQ52842

'Planning Policy Wales' and technical advice note 21 on waste provide a comprehensive framework for assessing proposals for waste management infrastructure in Wales. And we, of course, support the implementation of overarching waste management policy that's contained in 'Towards Zero Waste'.  

Thank you for that answer. TAN 21, as you've just outlined, covers waste disposal, but, unlike opencast, where, since 2009, coal mines have to be built more than 500m away from homes, there does not appear to be a rule on distance of incinerators from houses. I've an incinerator planned for the Llansamlet area of Swansea that is close to both houses and a school. Will the Welsh Government consider a distance from houses and schools for the building of incinerators and amend TAN 21 accordingly?

14:05

Well, there'd have to be a scientific basis for doing that—as to why 500m would have a beneficial effect. But what I can say, of course, is that incineration and co-incineration are subject to the stringent protective requirements of the industrial emissions directive. They've been incorporated into Welsh legislation for a number of years and they include requirements that there should be strict emissions limits for potentially polluting substances; there are monitoring requirements and operating conditions that are applied through environmental permits issued by the environmental regulator. I can also say that, if there are adverse impacts, of course, on amenity or the environment, and they cannot be mitigated, then planning permission, of course, can be refused on those grounds.

First Minister, back in March of this year, the environment Minister indicated that, in relation to the incinerator in Barry, the Government were minded to have an environmental impact assessment undertaken. The Government informed the developer back in February of this year that that was going to be the case. To date, the Government haven't instructed that environmental impact assessment to be undertaken, at some eight to nine months' waiting, given that the Government at the time in March were 'minded'—when are we going to move from 'minded' to instruction that the environmental impact assessment will be undertaken? Can we have a date from you?

Well, the Minister will be making a decision shortly. If I could write to him with a date to give him some idea of what the timescale might be, I will do that. But the Minister will be making a decision about the need for an EIA at the Barry biomass plant—perhaps if I write to the Member then with more details in terms of the timescale.

Swansea Bay Tidal Lagoon

5. What assessment has the First Minister made of potential delivery models for the Swansea Bay tidal lagoon? OAQ52890

Well, we continue to be open to ideas to find an alternative way to see tidal lagoon technology delivered in Wales. The Swansea bay city region has established a taskforce to find an alternative funding model for a private sector-led tidal lagoon product.

Further to that, First Minister, I have to say that I was disappointed to hear recent statements by the leader of Swansea council, as he mentioned that he thought the best way of delivering the lagoon in Swansea was to leave it to the private sector entirely. In his view, the private sector should do the design work, find the investors, build the project and maintain the tidal lagoon, but there is no certainty, of course, that this will happen. If the Welsh Government is truly committed to introducing a tidal lagoon in Swansea bay and then developing the renewable industry in Wales, why don’t you lead the way on this agenda and create a national energy company for the people of Wales?

There is a taskforce, and we have representation on that taskforce, and a bid has been received for additional funding from the taskforce itself in order to consider another study as regards the way forward, and of course we are considering that at present to see whether it is possible to fund another study to see which model would be best for the area.

Well, considering the criticism of the UK Government from that particular source, the comments made by the leader of Swansea council referred to by Dai Lloyd, I think that's quite a turnaround from the comments that were made by him, and, indeed, your Government, when it was the UK Government that was responsible for a decision on viability for the lagoon. Do you agree with these comments, or are you still offering £200 million of taxpayers' money in order to support such a project?

Well, the reality is the UK Government controls the market. The UK Government controls the strike price, it controls contracts for difference. We control none of those things. The UK Government could have committed to Swansea bay, but it failed to do so, as it did with electrification to Swansea—it didn't do that even, though it was able to find £1 billion to give to Northern Ireland.

This problem arises as a result of a lack of commitment from the UK Government. It was their scheme. We were willing to work with them. It is right to say that we would consider a loan or equity investment to support the lagoon, but the UK Government were not prepared to offer a contract for the difference, and that's what stymied the original plan. But we will continue to work with Swansea council and others to see if an alternative plan can be brought forward.

The Barnett Consequentials

6. Will the First Minister make a statement on how the Welsh Government plans to allocate the Barnett consequentials that emanate from the UK Government's budget? OAQ52844

Decisions on the allocation of additional funding will be made by the Welsh Cabinet in the usual way.

We look forward to hearing those details in due course, if not today. But the First Minister did say to the Member for Cynon Valley earlier that she's right to say the Welsh Government offered support to business. He didn't repeat her perhaps more questionable claims that it offered more support than anywhere else in the UK, or that more businesses in Wales received support than elsewhere. He said that he didn't know what the Barnett consequential was. The number we have is £26 million over the coming two years. Can he tell us whether Welsh business will be getting that type of support, as will be available to their competitors in England?

14:10

And the Member knows full well that picking out one consequential doesn't give the full picture, because our consequential comes as part of a block. As part of that block, there will be some things that will be additional and some things that will be removed, because of a consequential cut in funding in the equivalent department in Whitehall. So, we have to deal with what is there in the block, but, of course, we will, over the next week or so, look at how the extra money—although it's nowhere near close to what was described—will actually be allocated. 

The Economy of Bridgend

7. How is the Welsh Government supporting the economy of Bridgend? OAQ52885

Our policies to support the economy across Wales, including Bridgend, are set out in the 'Prosperity for All' national strategy and in the economic action plan.

Thank you for that answer. I know we've both been very disappointed to have heard of the Bridgend Ford plant's situation recently where staff were told to take a week off and to stop producing the Land Rover engines. It's news that many had been dreading, not just families and staff, but of course, employees in the supply chain. You'll also know how disappointed we all were when you didn't get a chance to meet Ford bosses when you were last in the United States, but perhaps you can tell us now who have you spoken to in the company following the recent development and have you been making provisional plans for a support package for employers and, indeed, supply chain employees, in the same way that you did for Tata Steel, should Ford think the unthinkable?

Well, I spoke to their government affairs person on Thursday. I asked her a number of questions. She provide me with assurance that this is a temporary issue. It's out of Ford's hands and to do with Jaguar Land Rover, and much of it is to do, ultimately, with Brexit at the end of the day. So, Ford are major suppliers of JLR. Because JLR are in the position that they are in, then Ford have had no option but to take the action that they have, even though that action—I've received complete assurance—is temporary.

Now, of course, Ford remains the largest private employer in the Bridgend area and celebrated the production for the first Dragon engine last month. It's completely new. The production line necessary to produce it was supported by the Welsh Government, so, I'll be visiting the factory next week on 14 November to celebrate the production of that new engine, and we'll continue to work with Ford, as we have for many, many years, to ensure the plant's future in Bridgend.

Housing Provision for Vulnerable Children

8. Will the First Minister make a statement on housing provision for vulnerable children? OAQ52888

We made clear our commitment, and we've demonstrated through our policy and funding decisions, our support to the most vulnerable in our society and, of course, to ensuring that everyone lives in a home that meets their needs and supports individuals and families to flourish.

Thank you, First Minister. The Children's Commissioner for Wales, Professor Sally Holland, has said that the provision of secure homes for vulnerable children is inadequate in Wales. And this issue has been raised frequently with your Welsh Government. In the last year, 20 welfare placements were made for our Welsh children, yet half of these were placed in England. Indeed, BBC Wales reported on a teenager who was placed in a secure children's unit some 250 miles away from their own home. First Minister, this is not acceptable. So, why has your Government not acted upon these previous concerns, and what are you doing to ensure that vulnerable children can access the facilities they so badly need so much closer to their homes where they originate?

The problem is the lack of devolution, because, of course, secure welfare provision is currently managed on an England-and-Wales basis through a network of 15 secure children's homes. We do look to work with the UK Government's Department for Education and the Ministry of Justice as to how best to reconfigure youth justice provision, but this is another example of why justice needs to be devolved, to avoid a situation where we are entirely dependent on departments in London to provide services in Wales. And that is something, certainly, that I'm sure will be a matter for discussion over the next few years.

Reduced funding for Welsh Women's Aid has impacted upon their ability to provide dedicated support for children accommodated in refuges, and this is no surprise. Across Wales, services have seen a 14 per cent reduction in funding from local authority children's services and the Families First grant programmes. Some specialist providers do not receive any funding specifically for support for children, which means that children affected by domestic abuse face a postcode lottery. From my previous employment with Women's Aid, I know that some of these children have witnessed unimaginable horror and can have been subjected to some real trauma and they need support. With this in mind, when are you going to deliver on a model for specialist violence against women, domestic abuse and sexual violence support, as promised in your national strategy published two years ago? If you were serious about tackling adverse childhood experiences, and if you're serious about creating a safe country for women, this is a serious oversight that needs addressing swiftly.

14:15

I think it is correct to say that there have been funding difficulties as far as local government is concerned. What we seek to do and what we will continue to seek to do is to work with local government and other providers to ensure that there are no gaps—and there are gaps. It is true to say that coverage is not even across Wales. That is not something that we can rest easy with. We will look as part of the gender review that's being taken forward by the leader of the house and we will look at what funding might be possible in the future, given the financial squeeze that we have, in order to fill in the gaps in service provision that have been identified and that the Member raises.

2. Business Statement and Announcement

The next item, therefore, is the business statement and announcement. I call on the Cabinet Secretary for Energy, Planning and Rural Affairs to make the statement on behalf of the leader of the house. Lesley Griffiths.

Member
Lesley Griffiths AM 14:16:31
Cabinet Secretary for Energy, Planning and Rural Affairs

Diolch, Llywydd. There's one change to today's agenda: the statement on the reform of fire and rescue authorities' governance and finance statements has been postponed until next week. Draft business for the next three weeks is set out on the business statement and announcement, which can be found amongst the meeting papers available to Members electronically.

Can I ask the Cabinet Secretary what assessment she has made of the opportunities to commemorate the significant contribution of the Royal Welch Fusiliers, of the 53rd Battalion, to the war in Palestine and Egypt during the first world war? The Cabinet Secretary will no doubt be aware of the Wrexham museum exhibition that has taken place, which was excellent, but the only exhibition of its kind that was actually marking the contribution of the Royal Welch Fusiliers on that particular front. I'd be grateful to know whether the Welsh Government has considered undertaking some work to mark this and what discussions there may have been with the Israeli Government in order to take that forward.

Can I also ask for a statement from the Welsh Government on the work that it is doing to promote experiences with cadet programmes in Wales? The sea cadets have recently launched a report on the impact of sea cadets, which was published by New Philanthropy Capital, which touched on the tremendous benefits that participation in sea cadets can bring to young people across Wales, including engaging with a wide range of socioeconomic backgrounds, driving social mobility, reducing social exclusion, increasing academic aspirations and outcomes, improving relationships with parents, and improvements in mental health and well-being. I wonder what work the Welsh Government might be able to do in order to promote cadet experiences, particularly given the resources that have been made available from the UK Government to promote these across Wales.

Thank you for those two questions. In relation to the first question, the Cabinet Secretary for Local Government and Public Services will be making a statement later today. On the second point, I understand the same Cabinet Secretary met with the Ministry of Defence just yesterday and will be very happy to update Members in due course.

Cabinet Secretary, you will no doubt agree that the way in which complaints are handled by public bodies is vitally important to people's faith in any system. You'll also be aware that under stage 2 of the Social Services and Well-being (Wales) Act 2014, local authorities appoint independent investigating officers to look at complaints against the local authority. What is apparent however is that, even though independent investigating officers perform a statutory public service, they are not subject to any professional regulatory standards. Social workers are; doctors are; nursers are, but these independent investigating officers are not subject to any professional regulatory standards. There is currently no national register of investigators. I understand that some even have no social care practice experience either, which came as a bit of a surprise to me, to say the least. I'd therefore be grateful if the Minister for social services would agree to bring forward a statement on the role of independent investigating officers. I would ask that the statement look at whether we need to establish specific standards for investigators, registration and training, and what role a professional body could play in this. These investigators are an integral element of the social care community in Wales, but they are largely hidden from practice development staff and policy makers. I would be grateful if the Minister would commit to starting to change all this.

14:20

I think you're absolutely right that people need to have confidence in a system if they complain. The Minister will, I understand, meet with the Member if he wishes to discuss—obviously, you've got very specific concerns, to address those.

Cabinet Secretary, I was delighted to join the First Minister yesterday at the Living Wage Week launch event at the Bigmoose Coffee Company and to welcome the rise in the real living wage rate to £9 an hour. We already have a number of accredited employers paying the real living wage. In my constituency, the Vale of Glamorgan, it includes Barry Town Council, Glamorgan Voluntary Services, Citizens Advice, Santander—branches of—and more employers are coming on board in the new year, including Cardiff Airport. Supporting the real living wage campaign will help tackle low pay, counter the growth of indebtedness and use of food banks and support a fair work economy. It makes economic sense and is the hallmark of a caring, compassionate and fair society. Can we have a statement on Welsh Government measures to support employers in the public, private and third sectors to adopt the real living wage in Wales?

Thank you for that question. As you said, yesterday the First Minister launched Living Wage Week in Wales, announcing the new rate, and in doing so outlined many of the actions being taken by the Welsh Government to promote the living wage across the economy, reiterating the commitment in the programme for Government to take action on the living wage. This includes action right across the public sector—the Welsh Government, our sponsored bodies, NHS Wales, national parks and local authorities. You mentioned Cardiff Airport, they've just recently announced they are bringing forward their own commitment and, of course, our higher education institutions are also increasingly adopting it. I think we all need to make that commitment. We all need to talk about the living wage and to spread that message very widely.

You'll be aware, in parallel, earlier this year, the First Minister established the fair work commission. We are waiting for it to conclude its work. It's already met with a range of stakeholders, including trade unions, businesses and representative organisations. And I think probably after the commission has reported would be the appropriate time for the relevant Minister to bring forward a statement.

Acting leader of the house, may I ask for a statement from the Cabinet Secretary for Finance on Welsh Government support for the retail industry? The Welsh retail industry is under considerable pressure due to the growth in the number of customers shopping online and the increased burden of business rates. Welsh retailers already pay a quarter of all Welsh business rates and it is becoming increasingly expensive to operate from property, so much so that the Welsh Retail Consortium has projected that over a fifth of shops could close as the next decade progresses. The Chancellor, in this budget, announced funding to cut business rates by a third over two years, saving 90 per cent of all shops in England up to £8,000 each year. Can we have a statement on what measures the Welsh Government is taking to support the retail sector in Wales, please?

I think you make an important point about people's shopping habits having changed. We have done a great deal as a Welsh Government to support many businesses in relation to rate relief. Obviously, again, you will have heard the First Minister say that Cabinet will be making a decision around the additional funding we are receiving.

Could I request an update on what the Welsh Government is doing for those with complex care needs, especially those people with muscular dystrophy? I hosted an event last week—a cross-party event—with regard to muscular dystrophy, and we had many families there who raised concerns about the lack of medical awareness among key staff in the NHS. Two of the people at the meeting told the group that they or their family member had been to a hospital where medical staff were sadly not listening to the specific needs and pharmaceutical requirements of these patients and, in one case, medical staff asked the patient to take medication that could have—had she taken it—led to her death. I think this is something that needs to get more political priority. We need to understand how specialists are engaging with those with muscular dystrophy. There may not be hundreds of thousands of people suffering from this condition in Wales, but when they do have it it is something that they have for life. So, I would like to have a statement from the Welsh Government on an update on what's happening in this area, so that we can go back to those people who have concerns and raise them appropriately. 

14:25

Thank you. Obviously, there are many conditions that health boards have to look to address, and I'm sure that muscular dystrophy is something that the Cabinet Secretary for Health and Social Services will have discussed with health boards. I will ask the Cabinet Secretary if there is something specific in relation to muscular dystrophy, to write to the Member.  

Cabinet Secretary, I've just had a letter from the managing director of Schaeffler in the UK confirming that they're beginning their 45-day consultation period, with a view to closing the long-established plant in Llanelli with the loss of some 220 jobs. Clearly, this is very disturbing news for Llanelli and for the country. We can hardly afford to have further losses to our manufacturing base, and for the economy of an area like mine, this could be a very serious blow. The Cabinet Secretary has kindly agreed to meet with me, I've spoken to the First Minister this morning and I'm touch with the trade unions, the company and the Engineering Employers' Federation, because I hope there's something we can do to persuade Schaeffler that they can adjust their business model and continue to make things that they can sell at a profit in Llanelli.

I was disturbed to read that one of the reasons they cited was the continued uncertainty around Brexit as one of the factors that has influenced their decision making, because we have been pressing for the last two and a half years that certainty of access to the single market is essential to make sure that these multinational companies in all our communities feel that they can stay here. So, would the Government consider making a statement about what they can do to work with Schaeffler to see if there is a way forward for them staying in Llanelli?  

Thank you and, obviously, this is devastating news, as you say, not just for your own constituency in Llanelli, but for other parts of Wales, too, and our thoughts are definitely with the workers and their families. I'm very pleased you've spoken to the First Minister and, obviously, Ken Skates, the Cabinet Secretary for Economy and Transport. Obviously, Welsh Government stands ready to offer every assistance we can within our power to the plant, and I'm very pleased you will be having a meeting with Ken Skates. We should do everything we can to support the workers. However, I do think that the UK Government has some serious questions to answer. As you say, we've raised time and again over the last two and a half years the detrimental impact that their approach to Brexit is having. Businesses need clarity and they need the confidence that a deal will be struck that will not adversely affect them and, unfortunately, really, that's just been so woefully lacking and we're not getting that, and it is now starting to cost jobs in Wales.   

I'd like to ask the Government for clarity regarding when it intends to hold the debates and votes in relation to the terms of the UK's departure from the European Union, if a deal is actually reached. The First Minister confirmed while giving evidence to the External Affairs and Additional Legislation Committee yesterday that the Government intends to hold two debates and, presumably therefore, two votes, first on the withdrawal agreement reached between the UK and the EU, and then another in the form of a legislative consent motion on the withdrawal Bill itself. Given that the legislative consent motion will only be brought forward if the withdrawal Bill has been agreed to or it looks like passing unamended, it seems to me that the vote on the withdrawal agreement gives Assembly Members the best opportunity to express a view as to whether this Assembly accepts or rejects the deal. Could you ask, therefore, the leader of the house to confirm that the debate and the vote on the withdrawal agreement will be held here in Wales before the meaningful vote at Westminster, in order to ensure that the voices of the people of Wales, as expressed through this Assembly, will be meaningfully expressed as well? 

Thank you. I will ensure that Members are updated on that point in the business statement next week when the leader of the house returns. 

Many people in Wales, especially in my region, are very worried, very concerned and, in some cases, devastated by what is happening to family members in the Yemen with the conflict, and family members literally being bombed out of existence. What I'd like today is a statement from the Government about what you could do to help the Welsh Yemeni community in terms of mental health support for people in Wales, and also grief counselling. I think we really should do something, and I'd like a statement about what we could do, or what you could do as a Government, please.  

Thank you. We obviously work widely with the black, Asian and minority ethnic sector across Wales to identify and seek to address issues that affect people's everyday lives. So, you'll be aware, I'm sure, of several of the programmes that we have within our equality and inclusion funding programme. We have a Cardiff co-ordinator who works with the Yemeni communities. Findings from that project feed into Welsh Government policy development. You may be aware there was a BAME remembrance event held last week at the Temple of Peace, in partnership with the Horn Development Association, and Welsh Government formally honoured the contribution made by such communities during the first world war and second world war, and that included Yemeni merchant seamen. 

We do have a broad programme of work to support the community, under our community cohesion and tackling hate crime programmes, and that works with a wide variety of communities, obviously, not just Yemeni, and individuals in Wales. 

14:30
Motion to appoint an Acting Standards Commissioner

The next item, therefore, is the motion to appoint an acting standards commissioner, and I call on Jayne Bryant to move the motion. Jayne Bryant. 

Motion NDM6856 Jayne Bryant

To propose that the National Assembly for Wales:

1. Notes that the National Assembly for Wales Commissioner for Standards is unable to act:

a)  in relation to a complaint from Joyce Watson AM dated 8 May; and

b)  in relation to any other complaint arising from the same subject matter.

2. Appoints, in relation to any complaint referred to in paragraph 1, Douglas Bain CBE TD as acting Commissioner, in accordance with Section 4(1) of the National Assembly for Wales Commissioner for Standards Measure 2009, on the following terms:

a)  the appointment takes effect on 7 November 2018.

b)  the appointment ends immediately when notice is given to the acting Commissioner by the Clerk of the Assembly.

c)  the acting Commissioner’s remuneration is to be a daily rate of £392 (or pro-rata for part of a day) for activities that relate directly to the role and responsibilities of the post plus reasonable expenses.

d)  all sums referred to in paragraph 2(c) are to be paid to the acting Commissioner by the Assembly Commission.

Motion moved.

Apologies that Mark Reckless wasn't in his space. [Laughter.] I had assumed that the Chair of the standards committee would be speaking first.

There's no notice of this event on the computer system we have here for the agenda. It wasn't mentioned as a change to the agenda by the acting leader of the house. I did get an e-mail at 12.34 p.m. with a link to an agenda, with this as an unnumbered item between No. 2 and 3. And I just want to share my concern about the way that we're addressing this. It says in the motion that the standards commissioner can't consider the matter of this complaint from Joyce Watson in May, or the other complaints relating to the same subject matter, and the reason he can't consider it is that he has already considered it and determined that, in his view, in that consideration, it did not merit consideration by the standards committee as a whole or a report. 

Now, I don't know the merits of that decision. I haven't seen the video that's been complained about. All I know is that we have a standards commissioner. I respect him and his decisions, and if he's considered a matter, surely we should accept that decision rather than complain about it and pressure him to retake that decision in a different way, when, actually, our procedures don't allow us to. So, we now look to have a different motion to get around this by appointing someone else to come in and do it over the head of the standards commissioner who's already considered it, and we propose to pay him £392 a day, as well as having a press officer coming in for the standards commissioner in future. I would just question the way this is done. I think it's important that Members and others in the justice system, as in the justice system outside, don't suffer double jeopardy, and just because a Member may be unpopular or people may take a different view from the standards commissioner on a certain thing he's considered, surely it would be better to accept his decision rather than seek to reopen it. 

I wholly agree with everything that Mark Reckless has said. I believe that this motion raises fundamental questions of due process in the context of our standards committee and the way it works. This is a quasi-judicial body and it does have the power to impose sanctions that are both financial and of other kinds. It has the power to exclude from this Assembly to which we've all been elected by the people outside. These are very serious powers and therefore should be exercised with caution, and the procedures for the investigation of complaints, on the basis of which any sanction is applied, should be fair and should be relied upon by everybody who is a member of this place, equally, and individuals should not be singled out. 

Now, this motion applies only to one complaint against one Member. The commissioner has written to say that there is no provision in the procedure laid down by the Assembly for reconsideration of a complaint, either at the request of the original complainant or a third party. However, each of the requests that he has now received in relation to this specific matter contained a complaint about the video, and he has decided that each request should therefore be treated as a fresh complaint. Now, this is a reconsideration of a complaint that has already been considered, not on the basis of compelling new evidence, which the double jeopardy Act, brought in following the Lawrence inquiry, has provided for, for example, DNA evidence that was not available before. In those circumstances, one can well see that miscarriages of justice involving serious crimes like murder may call for a reconsideration on the basis of new evidence. There is no new evidence in this case. There is only the video, and it's a matter of subjective opinion what one thinks of it. I haven't seen the video either, although I have myself been the subject of such a video—[Interruption.] I have myself been the subject of such a video on YouTube, where my head was put in place of Miley Cyrus's in 'Wrecking Ball'. I laughed that off; I certainly wouldn't regard that as a serious criticism worthy of consideration by the standards committee.

I do believe that double jeopardy is a serious matter. The United Kingdom is signed up to the International Covenant on Civil and Political Rights, article 14.7 of which says:

'No one shall be liable to be tried or punished again for an offence for which he has already been finally convicted or acquitted in accordance with the law and penal procedure of each country.'

If this motion passes this afternoon, it is flatly in contradiction of Britain's obligations under that specific provision. And I see a fellow lawyer laughing at this, which I'm very surprised at, actually, because he could well find himself in a similar position in future. If we are to say that, regardless of the commissioner's decision, further complaints that are identical in form can be considered and reconsidered ad infinitum, then there is no end to this process. One of the main reasons for supporting the double jeopardy rule—

14:35

Will you please shut up and listen? [Interruption.] I'm trying to make a serious point here, which is—[Interruption.] I'm trying to make a serious point—

—of a non-partisan nature. It may be Gareth Bennett today, it may be anybody else tomorrow. Therefore, the procedure that we set up has to be fair and reliable and to be applied equally. Yes, by all means let us set up a process of appeals from a decision of the commissioner, but let us not do it in an individual case, where it might easily be said that this is a case of victimisation, against a specific individual, because he is not popular in the Assembly. That would seem to me to be the correct way in which to proceed.

Organisations like Liberty have spoken up for the double jeopardy rule to be maintained in the past, and many organisations that should be revered by Members of Plaid Cymru or the Labour Party have explained publicly, and in documents, how abhorrent it is that individuals should be subjected to a retrial, unless there were compelling new evidence, which is allowed for in the European convention on human rights as well. In this particular instance, there is nothing new whatsoever, as I understand it, in these complaints.

Now, Mr Bain, I'm sure, is a totally acceptable choice for such a position; I've nothing against him whatsoever. If he comes to a different conclusion from Sir Roderick Evans on this matter, where does that leave Sir Roderick Evans's credibility? Whose decision are we to accept as preferable and why? Are we then to have a third commissioner appointed, in order to resolve the impasse between a difference of opinion between the existing two? And how many times does this have to go on? Should we have a people's vote on this matter, ultimately? This seems to me a matter of extreme importance to not just the liberty of the individual, but also to justice, and justice should matter to all of us, even though it may not be apparent to some who have noisily been trying to intervene in my speech today.

Diolch, Llywydd. I think it might be helpful just to outline a few points here. As stated in the motion, the commissioner has indicated that he's unable to act in the matter relating to the complaint made by Joyce Watson, and any related complaints, and he has asked for an acting commissioner to be appointed. The provision for an acting commissioner has been included in the Measure, and therefore it will have no bearing on the commissioner's position. In this instance, after careful consideration, the commissioner decided that this was the best option to deal with the matter.

The commissioner made it clear in his statement that he'd received further complaints, and has concluded that he should not act in this matter. And it's permissible within the legislation for an acting commissioner to be appointed. There is nothing in the Measure to prevent a complaint being looked at where one of a similar nature had been dismissed.

Will the Member give way? I wonder if she could answer a question—very genuinely. When she says that the commissioner asked for this acting commissioner to be appointed, can she assure Members that no pressure was brought on the commissioner by any Member prior to that decision in any way?

It certainly was the decision of the commissioner to do this, so, yes. Thank you, and that was—. I was coming to—you've intervened right at the end of my speech, so thank you. 

14:40

Good timing. 

The proposal is to agree the motion. Does any Member object? The motion is therefore agreed, in accordance with Standing Order 12.36. 

Motion agreed in accordance with Standing Order 12.36. 

3. Statement by the Cabinet Secretary for Health and Social Services: Findings of the Independent Accelerated Programme for Amber Review

The next item, therefore, is the statement by the Cabinet Secretary for Health and Social Services on the findings of the independent accelerated programme for amber review. Vaughan Gething.

Thank you, Presiding Officer.  In my statement on 15 May 2018, I informed Members that I had commissioned a clinically led, independent review of the Welsh ambulance service’s amber category. I'm pleased to be able to provide Members with an update following the completion of that review. Members will recall that an independent evaluation of the clinical response model, undertaken in 2017, found a universal acknowledgement from within the ambulance service and external partners that moving to the new model was the right thing to do. It found that the new clinical response model had helped the Welsh ambulance service to focus on the quality of care that patients receive as well as improving efficiency in the use of ambulance resources. It also made recommendations for further improvement, including a review of the amber category. 

In light of that recommendation, the amber review that I ordered sought to establish whether patients in the amber category are waiting too long for an ambulance response, and if so whether this is resulting in poorer outcomes and experience for patients. I'm encouraged to note that the amber review has echoed the findings of the previous independent review—that our clinical response model is safe. Our model continues to ensure that those in the greatest need receive the fastest response to improve their chances of a positive outcome, whilst also providing appropriate and timely care for patients who do not have immediately life-threatening conditions.

I've previously outlined the review process in place to keep all prioritisation codes under ongoing review. This review process, undertaken by experts in the field, ensures the allocation of codes to the red, amber and green categories remains clinically appropriate. Members will be aware of my focus on evidence-based measurement. It is interesting to see that the review has advised against introducing new time-based targets for ambulance services. Instead, we will continue to pursue a whole pathway measurement for conditions like stroke, and develop further clinical indicators and measures of patient outcome and experience in line with 'A Healthier Wales'.

Incidents in the amber category will generally receive a blue light and siren response, much like those in the red category. The main difference is that for red incidents all available nearby resources are despatched, whereas in the amber category the nearest and most suitable response is sent. This should help patients to access the right specialist care sooner. The majority of ambulance staff that took part in the review said they believe the prioritisation system works well, and the number of vehicles attending amber calls has decreased. And that should give us confidence that we're getting the right resource to people first time more often. That should improve clinical outcomes for people with conditions like stroke, heart complaints and fractured hips.

The review’s findings also, of course, present opportunities for improvement. The median response time for amber calls has increased by an average of seven minutes during the review period, from April 2016 to March 2018. That's clearly not acceptable and will be addressed through focused and collaborative work. Findings suggest timeliness of response has been affected by a number of capacity-limiting factors. That's despite additional Welsh Government investment of £11 million for patient care services over the last two years, and £38 million in capital investment over the same period.

Ambulance handover delays and staff sickness need immediate attention through a whole-system approach and improved staff well-being. I expect health boards and the Welsh Ambulances Services NHS Trust to work with partners to take responsibility for these issues and to take immediate action to address them. We will of course monitor progress closely.

The review was able to use innovative techniques to track patient-level data through the system. It found no direct relationship between long waits for an ambulance response and poorer outcomes for the majority of patients. However, the experience of patients and their families will be negatively affected and that is supported by public feedback. I expect action to be taken to enable reassurance and welfare checks to be provided when people are waiting longer for an ambulance to arrive.

The review found that incidents relating to people who have fallen accounted for the largest call volume within the amber category. In view of this, I have decided to allocate £140,000 to the chief ambulance services commissioner for a collaborative falls response project involving St John Cymru Wales.  

Anecdotal evidence from operational staff suggested that there were a significant number of calls from nursing homes for patients who had fallen and that it would be beneficial for all nursing homes to have lifting cushions. The national programme for unscheduled care will, therefore, fund several hundred lifting cushions for nursing and care homes across the country. Both of these initiatives should reduce the unnecessary dispatch of emergency ambulance resources to people who have fallen but are not injured and can be safely resettled.

The review found evidence to suggest that there are opportunities to better manage people in the community, either through providing clinical advice over the telephone, referring to alternative services or discharging at scene. Public feedback to the review suggests it is important to people that they avoid going to hospital if it isn't necessary. Eighty four per cent of those surveyed said they would prefer to stay at home, and 88 per cent of people felt it was important to them that medical advice was provided over the phone. Ambulance service staff also felt that expanding the numbers and roles of clinicians in the control room was essential to manage demand effectively. Given these findings, I have agreed to fund the recruitment of more paramedics and nurses to provide clinical advice to the public over the telephone to help manage demand in the community.

Investment of around £450,000 for the remainder of the year will also include a winter pilot of mental health liaison nurses in ambulance clinical contact centres, and that is based on feedback from clinical contact centre staff, who said that they do not have the required training to support people in mental distress. They believe that having a mental health specialist in the control centre would help to relieve pressure and allow more people in distress to be treated in the community.  

We will, of course, continue to work with the Welsh Ambulance Services NHS Trust, health boards and the chief ambulance services commissioner to take forward the review’s recommendations with pace and purpose. I look forward to Members' questions. 

14:45

Thank you, Presiding Officer. First of all, Cabinet Secretary, I'd like to thank you for the technical briefing you offered this morning from your officials. It was very helpful. It's a big report, there's an awful lot in it and it makes for interesting reading, much of it welcome, some of it concerning. 

Four areas particularly leapt out at me in terms of sheer statistics that caused me concern. The first is that, over the past two years, over 7,000 people waited over three hours outside a hospital to be transferred in, and over 15,000 people waited over three hours for an ambulance wherever they were when the incident they were involved in happened. There's been a rise in the amount of hours it takes from handover to clear, which is obviously an area we need to look at, and, of course, a very concerning one is the rise in sickness of ambulance staff and trying to discern why: is it down to stress? What are the issues here? Of those four areas themselves, two are indicators of where we're not performing well, and two are indicators of where there might be logjams in the system.

The report as a whole makes some very interesting recommendations, but it does repeatedly reference placing clinicians in settings such as control rooms, nursing homes, police services as a means of improving management of the service and assessing the situation. In terms of implementation, how sure are you that you have the capacity to already put those clinicians in place? Are we aware of how many roles will be needed and where they are? Because it's all very well for this report to say, 'We could do so much better if we have people over there, over there and over there', there's a great devolution from the Welsh ambulance service, and it may well be right—I'm not certainly not arguing that—but what I am concerned about is that it's all very well saying, 'Let's put these clinicians in the control room'; 'Let's put more people here, there and everywhere', but we know the staff shortages we have. So, I'd be interested to know what you've done to assess that particular issue. And, again, with reducing the long waits of patients such as non-injury fallers—it tends to be our older population—this, again, is looking for social care workers and district nurses. So, how are they going to be better incorporated into the care pathways for these individuals? How are you planning to build that capacity? 

I do welcome the bespoke plans with the local health boards, but the implementation of these plans is highly dependent on those health boards. We know that ambulance services have received additional capital investment in this year's budget, but in order to drive forward change, how will you, how will health boards, be supported to put in place these improvements? Will they be asked by you to demonstrate how they will do that in their integrated medium-term plans, because if you don't monitor this, it could very easily get lost in the mix?

With regard to improving the service, we did initially expect this review to be made public in September, and it is now the first week of November. One quote from the review says,

'In order to avoid the combination of factors that were seen last winter, the ambulance service and the wider NHS must ensure it takes every opportunity to maximise the availability and efficiency of resources in order that the patients of Wales receive the highest quality and timely ambulance response.'

So, how, then, are LHBs going to be able to implement this ready for this winter and Christmas period? Were they privy to this review before us here in the Assembly? Have they been able to put in place resilience plans prior to the winter?

Presiding Officer, I just have one last question. At the back of this review is a list of the protocol cards that are used by call centre staff, and I was really surprised to see that there is not a sepsis protocol card. As you know, sepsis kills more people each year than bowel, prostate and breast cancer combined. And there are key indicators. I know it is a chameleon, but the key indicators of chills and shivering, confusion and slurred speech, severe muscle pain, fast breathing and very high or low temperatures are real indicators that someone might be having a sepsis episode. We know if we can rescue people early, they've got more chance of a proper, full recovery. No protocol card. Would you please undertake to just have a look at that and see if it would be appropriate to put a protocol card and add it to the 19 other protocol cards that the ambulance service currently work to?

14:50

Thank you for the comments and the range of questions. I'll try and deal with them as well as I can in the time available. You, of course, referred to a range of figures at the start, particularly on the focus on handovers and others, and, of course, you have 475,000 calls to the service. But there's a recognition that there's more improvement needed on a more consistent basis across the country, because there is some variation in the country about not just handover rates, but that's one part of the whole system. What the review tries to do is to place all of that within the whole-system context. So, lots of improvement in getting the right response to the right people. They need that to discharge at the scene where possible, and, if they need to go to hospital, properly discharged, and also for them to be able to leave a hospital setting promptly as well. So, it is part of a wider system.

I recognise your points about sickness. There are certainly measures to take, and I'm pleased to say they will be taken forward by employers, together with trade unions as well. And I don't know if you've seen the constructive response to the recognised trade unions within the service, but it's positive; there's a recognition of the need to improve sickness rates in particular in the service, and, of course, that's also partly recognised in the pay and conditions conversations and negotiations that are taking place in the recent months.

On your point about recruiting appropriate clinical staff to contact centres, it might help to reflect that there are three clinical contact centres in the country, so, three centres to recruit staff to. There'll be a challenge there about making sure we have the right staff to recruit. We're confident we'll be able to do that, as well as staff within the wider system. And, actually, in the wider system and the points you make there, actually we're looking at being able to get on with the winter plans, drawn up by health and social care together, including the ambulance service. So, that money is based on funding those plans in addition to the £10 million that I announced previously, together with Huw Irranca-Davies, the Minister, to actually put into the social care system. We're looking at the whole system as part of that, and those plans are consistent with findings in the amber review.

You also talked about clinical leadership and accountability to be able to take this forward. And in this, we're in a positive place because you have leadership within the paramedic workforce that is positive about our direction of travel, including the need to invest in the numbers of people we have. So, that's about training, about retaining the bursary as well as recruitment of experienced staff. It's also about investing in the skills of the workforce in social care and in the health service. I hope you've had time to look at some of the investment in the future of advanced paramedics as well, what they can do, both within a contact centre, but also in their job on the ground, of being able to see and treat, and hear and treat, as well. I'm really pleased that Jo Mower, the national unscheduled care lead, is having an impact with her colleagues in the wider unscheduled care system. She comes with real credibility because she is still a serving clinician. She's a consultant in emergency medicine, and she's working part-time in that role and part-time as the unscheduled care lead. So, she has real credibility with colleagues across the system.

I'll deal with your point about sepsis as well, because, if you look at the national early warning scores that are used, that's part of the early warning system for sepsis. Now, I'll happily have a look at the specifics you mentioned, but I do just want to get over that this is a challenge for the whole system. And actually, in my time in the job and previously as the Deputy Minister, I have definitely seen over that time a much higher profile of sepsis within ambulance centres, where staff are based, with much more visible material, and, actually, we know that we are getting better.

Now, the challenge is what else we could and should do to continue that improvement. So, it's not about complacency; it's a marker of improvement that's been made and what more we could do. Actually, I think the NEW scores and the fact that they're in here as a measure that we use is really helpful, because that should help us to identify people at risk of sepsis and to make sure that that is a risk that is properly and appropriately resolved. On this, I know that we share the same objective about wanting to do more, to see more lives saved and to see more avoidable disability not taking place within our health and care system.

14:55

Thank you, Cabinet Secretary, for your statement. There are obviously things to welcome in the report, as Angela Burns has already said, and in your statement. I'll be particularly interested to see how the falls response project with St John Ambulance progresses, and I hope you'll come back to us to tell us. I'm very optimistic that that will have some positive outcomes.

The financial investment that you mention in your statement is also welcome. Can you confirm to us today that that is new money for the ambulance service? And can you also, perhaps not today—. If it is new money, it will clearly have come from another part of the health budget and I'd be very grateful if you could write to Members to confirm out of which part of the healthcare budget the new money for the ambulance service—if it is new money—has come.

The report makes a number of recommendations, and I'm struggling a little bit to see quite how your statement reflects the recommendations, but I would accept that it does, broadly, in spirit. I'd like to draw your attention to one particular recommendation where the report recommends a programme of engagement to ensure clarity on the role of emergency ambulance services and how calls are prioritised and categorised. Do you accept that specific recommendation and, if so, can you tell us whether this programme of engagement will provide opportunities for concerns to be raised again about the breadth of calls that are included within the amber category? Your statement says that prioritisation, as it stands,

'should improve clinical outcomes for people with conditions like stroke, heart complaints and fractured hips.'

But would you accept, Cabinet Secretary, that these are actually quite different conditions and that, for some of them, they are much more time sensitive than others? I would suggest, for example, that stroke is much more time sensitive, in terms of the ultimate outcome for the patient, than fractures. In fact, of course, the report shows that internally the service does effectively use an amber 1 and an amber 2 code, as well as protocols to prioritise based on the information of what's happening for the patient. And it also states that the relationship between time and care has been established for a number of conditions, such as acute heart myocardial infarctions and stroke. So, therefore, wouldn't you accept that this shows that time actually does matter for patients and that this internal categorisation reflects that? Would you be prepared to consider, as you work with the ambulance trust to move this forward, whether it is time to look again at formalising a target, particularly for those amber 1 calls? I understand the reluctance to overburden the system with targets—none of us would wish to do that—but where those calls are time sensitive for patients like patients with stroke, I'm a bit bemused by your reluctance to be prepared at least to consider setting a target.

In terms of categorisation, the report also identifies that, sometimes, calls are initially regarded as amber and then get upgraded to red calls because of additional information becoming available. The report also states that there are times when the staff felt that there was an inability for call handlers to deviate from the system because the system was restrictive, and I wonder if you would take another look at that to see whether it needs to become a little bit easier for staff to use clinical judgment to move calls up a category to red or perhaps from amber 2 to amber 1, if necessary.

And finally, can I just ask you again a little bit more—? You did respond to Angela Burns's question about the sickness rates and the stress that I think we can accept is probably at the root of those sickness rates. You mentioned in your response to Angela Burns that you will be expecting the local health boards and the ambulance trust to work on that and to work with the trade unions on that issue. But can you give us a little bit more detail about what exactly that work will consist of and the time frame for it? Because you know very well, of course, Cabinet Secretary, that our health and care services—and none more than our ambulance service—depend entirely on our staff, and, if there's a question about the well-being of the staff, I think that we would all like to be further reassured about how those questions with regard to their well-being are being addressed.

15:00

Thank you. I'll deal with that last point first. The challenge about dealing with staff well-being is obviously important, and it's an issue now. So, I've made it clear that that work should begin immediately in the conversation between employers and the trade unions. There is a regular ongoing conversation about staff well-being in every part of our national health service, especially as we look—following the agreement on a three-year pay agreement—to try and reduce levels of sickness. That means we need to understand some of the reasons why staff are going sick. It's not just about managing people efficiently; it is about understanding the stresses that exist. I've announced over the last year a range of measures to try and support staff, because this is a particularly stressful job. So, it has to come from what our staff, through their trade unions as their elected representatives, are telling employers, and to make sure that's taking place. I expect to receive a report within a period of months about what that looks like from the employer's side. It'll be part of the regular conversations I have with not just the chair of the ambulance trust, but also with the chief ambulance services commissioner and the chair of the Emergency Ambulance Services Committee.

That leads me back to your point about money. The money announced is new for the ambulance service trust. There's a challenge over where money comes from, in that some will come from a central pot. But you should remember that this is a service that is commissioned by health boards. That's a model that's been set up following the review that Professor Siobhan McClelland undertook, and so it is for health boards to fund the service that they are commissioning. They can't expect that service to deliver new and additional measures without looking sometimes at not just the efficiency of the use of the resource, but the amount of it as well. There are times when we've intervened in the past to make sure that money is provided from health boards. I'd much rather not to have to do that in the future. We can always top slice. Sometimes that is appropriate to make sure it happens quickly, but, moving forward with the range of the recommendations, I'd expect those decisions to be made by the system as a whole.

On falls response, which you mentioned at the start of your statement, I'll be happy to return to Members to give an update on the impact of both the £140,000 that I announced to go together with the project with St John, together with the projects about delivering lifting cushions and the impact of that. On your broader point about reviewing categories of clinical conditions, and whether they are in the right target of red, amber or green, in some ways, this goes back to the reason why we have a new clinical response model. It's still relatively new. Because we understood that we had a 40-year-old target, which covered a huge a range of conditions, that actually didn't do much good for the patient. It sent resources in different directions to try and meet a target that made no difference to outcomes. It was the only measure we had in the ambulance service. We are in a much better place now in having a proper category of red calls, where time does make a difference, and in having other quality measures that are published every quarter on the quality of care that is provided. There is much more scrutiny now of what the ambulance service does—and the good that it does—than there was in the past.

You can see that isn't just a good decision because of the independent review that we had done in 2017, or indeed this one, but the fact the work that we have done is being followed up and copied in the USA, Canada, Australia, Chile and beyond internationally. And, here within the UK, a similar approach is being taken in both England and Scotland. One of the differences is that England has introduced, without evidence that has persuaded the independent review here, a time target in some parts of what we have in the amber category. Scotland, though, have taken the exact same approach that we have done, in saying that it is not appropriate to introduce a time target within the amber category. We are, though—as I'm sure we've seen from the review and the briefing that you'll have had the opportunity to attend today—looking at the whole pathway approach for a range of conditions, including stroke, for example, where the whole pathway matters. We're working alongside people like the Stroke Association to understand what it is appropriate to measure to give us a real understanding of what the whole system is doing, as well as the ambulance service's part of it. But I do not intend, on the basis of a review that has said very clearly that we should not introduce a time target, to nevertheless, as a political imperative, try and introduce one nevertheless. I don't think that's the right way to run the service. I believe that undertaking, seriously, with real pace, the recommendations in this review will be the right thing for both our staff and, crucially, for the public that they serve.

15:05

I, too, welcome the statement and, indeed, the report, which is a mine of information, which I’m sure we will, after full consideration, find is useful in many respects.

I fully accept what the health Secretary says about targets, but I think we ought to acknowledge that, without the Government’s failure so spectacularly to meet the targets that it set itself, we’re unlikely to have had this report in the first place. We must continue to have targets, but, of course, those targets must be meaningful targets. That is a point that is incontestable, and we certainly don't need targets that are misleading. Nevertheless, I was somewhat troubled by the page in the report—page 23—which really sets out to pooh-pooh targets, I think, if you look at it with some care. It says, for example:

'The value of a response time as a measure of the impact and quality of ambulance service care is… questionable',

'if health services are preoccupied with hitting targets then the actual journey an individual patient experiences becomes secondary',

and various other expressions of that kind. I think that the public at large, of course, do want to have ambulance services delivered as quickly as possible, and the failure to do so causes inevitable stress, and that stress impacts, of course, upon ambulance staff themselves, who are trying to give the best possible service to the public.

Much of this is perhaps beyond even the health Secretary’s control. We all know about the needs and means problems of the health service and the excess of demand over supply, which will probably always be there, but I would like the health Secretary to give us an assurance that, because the Government has consistently failed to meet many targets, and has failed to meet them by sometimes very large measures, which are exemplified and illustrated in the report itself—and, indeed, the health Secretary in his own statement says that the median response time for amber calls has increased by an average of seven minutes during the review period itself—. This is all very unwelcome news, but the existence of targets is essential if they're properly used, not just as a stick to beat management with, but as a tool to improve the service, and are essential to achieving the result that everybody in this place wants, which is better healthcare for as many people as possible. And, if we are able to square that particular circle, obviously, that’s going to impact upon sickness rates of staff as well. I think the 7 per cent staff sickness rate is an indictment, in a sense, not necessarily of the Government, but of the inability of the country actually to have a proper debate about the amount of money that ought to be put into the health service and the way in which that can be done to produce the most effective results. But, ultimately, we're all trying to achieve the same objective, but we've got to have the right information upon which to make the necessary political decisions about allocating resources and how to manage them, which are vital to a successful health service in Wales.

I agree with some of the broad narrative, even if I disagree with the conclusion that the Member reaches on some of the points. I'm sure that, with this report—. There will be an opportunity for the Government to appear before the committee to discuss it, at some point, I'm sure. I see that your neighbour isn't in the Chamber at the moment, but I'm sure that comrade Lloyd will want to have a look at the report in more detail.

I don't share your view or your statement that there’s been a spectacular failure to meet targets and that why I have this report in the first place. We actually moved to a different system on targets before your arrival in this place, and the decision that I took as the Deputy Minister. That was a challenge to recognise that we had an inappropriate target. Even if we had met the target, it would not have delivered the right care for patients. And it was a view that was widely shared within the paramedic workforce in particular; they were deeply frustrated about being required to try and hit a target regardless of the good it did for the public. So, we undertook a review; Professor McClelland undertook a review. We then made a decision to actually pilot a new clinical response model, after a proper review that actually looked at the effectiveness of the old target and came up with a possible way forward of a better way to run our system. And that’s why we have a different target. We were the first UK nation to do that, and now other UK nations are following us, but not just because we have a different target—it is a more appropriate target, and that's the point. 

When you refer to the report, about whether the targets are being pooh-poohed, if you actually look at the reference to it then actually it's looking at response times as the sole indicator of the service, and actually that's not an appropriate way to look at the way that the whole service delivers care. Again, the challenge even there is, if you only have one time-based target, even if that is an appropriate measure for that part of the service, we all know that is then used as a way to try and judge the success or otherwise of the whole service.

Just on your point about the public view, the public view about ambulance services is of course they want a timely response, but, in undertaking this independent review with assistance from the Picker Institute, the public view has come back that timeliness matters, but the right response matters more, and people are prepared to wait a slightly longer period of time for the right response. But that does not mean that people are contracting out to wait for a very, very long response in all or any circumstances; we recognise some waits are too long, and action will be taken to address them. I'm sure I'll have the joyous opportunity to be scrutinised by Members in this place or in the committee to see whether we actually manage to achieve that in the near-ish future.

15:10

Thank you, Cabinet Secretary. It's reassuring that the new clinical model is shown to be achieving the objectives that we've set for it, and that it is clinically safe. But, as you acknowledge in your statement, the patient experience still is seen to be wanting in some areas. Inevitably, if you shift priority from one area to another, there are going to be longer waits for some. You say in your statement that there is no direct relationship between long waits and poorer outcomes for the majority of patients, but the patient experience does get negatively affected, and I don't think we should dismiss that. The patient experience is important, and I'd like to know a little bit more what we plan to do aside from making sure the patients who are waiting are still clinically safe. That aside, what are we going to do to make sure that the patient experience itself does not become overly negative? You said during the review period the median response time for amber calls increased by an average of seven minutes, which is disturbing. You say this is going to be addressed through focused and collaborative work, and is affected by a number of capacity factors. Perhaps you can tell us a little bit about that. I think it is important we keep scrutiny on this. I think it's good that it's safe, but there's still much more to be done. You say the review is independent, and, of course, it is independent of the ambulance service, but it's still a review by the NHS, and I wonder if you would consider involving the Wales Audit Office to provide a degree of external assurance as well.

Thank you for the comments and questions. The Wales Audit Office, with their own programme, regularly decide what to look at in terms of public service delivery, and I have no difficulty at all with the Wales Audit Office taking a greater interest in where we are. I'm sure that, at some point, they will want to, when they decide in their judgment that it's the right time to do so.

On your broader point about what we're doing about capacity, that partly goes back to the comments made with Angela Burns about having the right capacity in different parts of the system, so whether it's the local contact centre or the number of staff we have on crew, on shift, at the right time, and the different peaks and troughs in demand that are relatively predictable throughout the year as well. And I expect not just to report that, but you'll see in the quarterly ambulance quality indicators a range of information about how we're able to meet demand throughout the whole year. For example, in the amber area we publish information every quarter on the average response on the sixty-fifth percentile and the ninety-fifth percentile, so you can tell how many long waits there are within the system; you can tell where they are in different parts of the system by health board as well.

What we'll also be doing immediately this winter is we will be looking to have what are referred to as welfare checks. The challenge there is whether people are calling back to check, if someone is still waiting, how they are, because often people are reporting back when deterioration has already taken place and some time ago. People often wait before they call back and say, 'This person is a lot worse', and so actually there's something about being able to more regularly call back that person and say, 'This is the position. Is there any change in the condition?' That goes back into that being the call of someone in the contact centre, or the clinician ringing them back, as to whether to change the categorisation of their call. It's not done to try and fix the system. It's done if there's extra information that the condition of that person has changed and that's the right thing to do. So, this winter we'll make sure those welfare calls are being done through the winter, when they'll be needed.

On your point about whether long waits cause harm, the report also recognises that it is a challenge about patient experience; you're right to point that out. But the relationship between harm is complex and uncertain. That's why further work is needed, because the logic says that, for some conditions, if you wait a long period of time, it may well cause harm, or the condition may deteriorate. We need to understand that better to then understand whether we do need to change anything about the system to properly meet and understand people with those conditions,

So, evidence has lead us to this point. The evidence we now have has led to recommendations that we'll undertake, and I'm sure that we'll have further evidence in the future on the back of the unanswered questions that the review has prompted. So, we're completely open about where we are and, as I say, I have no problem at all with the Wales Audit Office wanting to add their view as to how successful we have or haven't been on generating an improved ambulance service here in Wales.

15:15

Thank you for your statement, Cabinet Secretary. The move to the clinical model for ambulance response was one of the most important changes made to unscheduled care. Ensuring patients got the right response based upon their need also sped up response times for the most vulnerable patients.

Unfortunately, other factors have hampered the Welsh ambulance service’s ability to deal with the large volumes of calls they receive that are not immediately life threatening. The Welsh ambulance service received almost half a million calls last year—around 1,300 calls per day—the vast majority of which were amber calls. Nearly 50 per cent of those amber calls took longer than 30 minutes to respond to. Some responses have taken many hours. We are losing thousands of hours each month from delays in handover at hospital. According to the latest ambulance quality indicators, this averages around 4,000 hours each month.

Cabinet Secretary, what assessment have you made of the impact LHB bed cuts are having upon the Welsh ambulance service? The majority of our hospitals are now operating at bed capacities of around 90 per cent. Do you consider this to be a safe level or will you be opposing further bed cuts?

Another drain on resources is the large number of repeated calls by frequent callers, which make up between 6 per cent to 7 per cent of all calls each month. Cabinet Secretary, what steps are the Welsh Government taking to reduce the number of frequent callers?

I welcome the fact that you are recruiting more nurses and paramedics to provide clinical advice over the phone, in order to help manage demand. Is this in addition to the roll-out of the 111 service, and will you outline how the roll-out is progressing? How will it complement the Welsh ambulance service?

Finally, Cabinet Secretary, a large number of calls to the ambulance service each month relate to dental problems, and dental issues are the top reason for calls to NHS Direct. Cabinet Secretary, with some patients facing a trip of 90 miles to see an NHS dentist and hundreds of people prepared to queue for five hours to register for an NHS dentist, it is clear that shortages are having an impact on the NHS as a whole. So, what is your Government doing to ensure shortages of staff in one area of the NHS are not leading to increased demand on unscheduled care services, particularly the Welsh ambulance service?

The Welsh ambulance service is a vital part of our NHS, and I hope that implementing the amber review team’s recommendations will lead to greater improvements for patients and staff. The Welsh public support the approach that delivers the best response, even if it’s not the quickest. However, that doesn't mean we leave patients waiting for hours in pain. Hopefully, the amber review will deliver similar improvements to those we saw in red call responses. Thank you.

Thank you for the comments and questions, and I welcome the praise and acknowledgment for the model and the move to implement that. That was not a straightforward or necessarily popular decision at the time.

I'll try and deal in turn with, I think, the four areas that you covered on bed cuts and the ambulance service. I don't believe that the numbers of beds are actually the challenge for ambulances as to why they're spending too long outside hospitals when they need to discharge patients. Actually, it's about flow through our whole system. It's a system-wide problem. And, actually, we do know that unlocking flow in a better relationship with other parts of the health service and a better relationship with social care will actually deliver results throughout the system. That's, actually, why myself and the Minister are putting money into partnership between health and social care, to try and make sure that health recognise it's in their interest as well to work with local government to do that and not simply to pass responsibility between the two, as well, of course, as the health service taking control and ownership of what it could and should do to see flow throughout the system.

On your point about frequent callers, there are two points there. One is about individuals. There's quite a lot of work that's been done on a range of NHS Wales awards over the last two years on frequent callers. Often, they don't need an emergency ambulance response, they have a different healthcare need. So, the Welsh ambulance service, together with both other parts of the health service and, sometimes, local government and partners and the third sector too, have gone to those individuals and discussed what their need is, even if it's clear that it isn't an emergency ambulance service.

We've actually seen a reduction in frequent callers over the last two years. That hasn't come from a ministerial directive, that's come because we've had greater scrutiny on our figures, greater information, and our staff have chosen to address that because they recognise it's good for them and the job they do, but also good for those individuals and the healthcare need they have. 

The second part of frequent callers are some care homes. There is a challenge here, for some care homes are much more likely to call out than others. Often. it's a fall response, people who aren't injured but staff won't undertake lifting. So, that's partly why we're investing in a lifting pilot. There's an unfinished piece of work to be done between myself and the local government Secretary about the role of the fire and rescue service as well, as a potential answer for a lifting service. That's also why, in my statement, I made reference to lifting cushions, because we do have to reduce the level of unnecessary call outs to care homes. They are part of the frequent callers challenge we face. 

On 111, the roll-out is being successful. I'm pleased with how those proceedings have gone through in Powys as well as the next port of call. We're seeing, around the country, a roll-out of a successful service, and that's actually run and administered through the Welsh ambulance service trust. They're actually running the call centre for it, but it's in partnership generally with each of the health boards. So, I'm content that it's a good news story for Wales. We're rolling out a successful service at the right pace in different parts of the country. 

Finally, on dental services, I won't deal with the question properly today because I will have the opportunity in the coming weeks to deliver a different statement on dental services and reform in Wales. 

15:20

Diolch yn fawr, Llywydd. You mentioned fire and rescue services there. I wonder if you could just give us some indication of your thinking on the role of co-responders in response to amber calls. You'll be aware, obviously, of the service they provide. You've raised the effects of pain and so forth on an amber call, but they're also extremely well placed to spot when an amber call could be turning into a red category call. I've brought examples to the Chamber before where actually the presence and absence of co-responders have arguably been the difference between life and death on amber calls. Can you reassure me now that there will be no move to limit the role of co-responders to red calls only, and that your term 'the most suitable response' can still include co-responders to some amber calls to prevent them turning red and, obviously, prevent all the pain and suffering and, in some cases, danger that can arise when an amber call does turn red? Thank you.

The Deputy Presiding Officer (Ann Jones) took the Chair.

I can offer you reassurance that where a co-responder is the appropriate response, then that is what should take place. That should be a matter for clinical judgment as to the right response, rather than any kind of directive from myself or the head of the service not to use co-responders where they are the right resource for the right person at that time.

4. Statement by the Cabinet Secretary for Local Government and Public Services: Reform of Fire and Rescue Authorities' Governance and Finance Arrangements

Item 4, a statement by the Cabinet Secretary for Local Government and Public Services—reform of fire and rescue authorities' governance and finance arrangements—has been postponed until 13 November. 

5. Statement by the Cabinet Secretary for Health and Social Services: Betsi Cadwaladr University Local Health Board—Special Measures Update

Therefore, we move on to the statement by the Cabinet Secretary for Health and Social Services—Betsi Cadwaladr University Local Health Board, special measures update. I call on the Cabinet Secretary for Health and Social Services—Vaughan Gething.

Thank you, Deputy Presiding Officer. I made a statement on 5 June on the progress made in some key areas during the time that this health board has been in special measures, the significant challenges that remained, and plans to work with the health board during the next phase of improvement. My statement today will focus on the progress against those expectations that I set out for the health board in May in the special measures improvement framework.

The framework sets out milestones for 18 months in four key areas: leadership and governance; strategic and service planning; mental health; and primary care, including out of hours. The health board is required to report on progress every six months, and the first report was discussed and agreed at its board meeting held last week.

I met with the new chair and the chief executive for one of their regular accountability meetings with me and the chief exec of the national health service in Wales last Tuesday to discuss the progress made and plans to deliver on the challenges and difficulties that remain.

On leadership and governance, there has been a strong focus on improving board capability. From May to September this year, all the board vacancies were addressed. Mark Polin has been appointed as the new chair, and a new vice chair and independent members appointments have been made. In line with my expectations, an executive director of primary and community care has been appointed to drive the required improvement in this area. A new executive director of planning and performance has also been recruited and will start in post in November.

More robust appraisal and reporting and assurance systems are now being introduced by the new chair to further drive improved good governance. There has also been increased commitment to and impetus on partnership working from the board to support ‘A Healthier Wales’ and the transformation agenda. I was pleased to announce last week support from the transformation fund for a north Wales project across north Wales to help people with learning disabilities live more independent lives and to get the care that they need closer to home. That will involve sharing resources, skills and expertise across health, social care and the third sector.

In relation to finance, the health board remains in a challenging position. However, if the control total set for this year is met, it will represent a real improvement on the previous year. The board are in no doubt that achieving this will require focused action over the latter part of this financial year to deliver the turnaround needed to secure stability and to drive the shift to transformation in its future plan. I announced in July additional funding of £1.7 million under the special measures arrangements to strengthen the management capacity and analysis capability in the turnaround team.

A key expectation of the improvement framework was that the board responded promptly and appropriately to the Health and Social Care Advisory Service—HASCAS, investigation findings and the Ockenden governance review recommendations. I am content that the plans the health board has put in place to implement the recommendations, both with mental health and more widely, are comprehensive and robust, with operational leads identified and being held to account. My focus now is on ensuring that there is rapid progress on implementing these plans.

We are already verifying the progress so far reported by Betsi Cadwaladr in their regular reports, and that is recognised by front-line staff in mental health, and that is in addition to the Healthcare Inspectorate Wales inspection programme, which is also reporting progress. Improvements so far include the confirmation of a new and visible senior management team, appointment of a new mental health nursing director, creation of listening leads across front-line staff and the launch of the 'Today I can’ approach. Furthermore, a stakeholder group has now been created to further test the improvements being made, and I am pleased that some members of the remaining Tawel Fan families have agreed to be part of this group, together with the community health council and other stakeholders.

Recently, I met with a number of Tawel Fan families, when I met them last week. I understand very clearly that a small number of families are not content with the process or the outcome of the HASCAS investigation. However, there was consensus on the need to ensure that the health board reports and action plans are prepared and that they do result in sustainable and meaningful improvements in both mental health services and care of those with dementia across services. My officials have been very clear with the health board on the need to ensure it communicates plans and actions effectively to all staff.

The focus of developments in mental health to date has been around immediate improvements to in-patient services, including environmental works. The health board is also working to assess and improve community services by implementing its mental health strategy, working closely with local authorities, the third sector, service users and the police to deliver local implementation plans. A key focus for the next six months will be to improve and maintain performance against the Mental Health (Wales) Measure 2010 and child and adolescent mental health services targets  To support this work, the delivery unit is reviewing demand and capacity and my officials are discussing what further support might be needed in this area to rebalance capacity and demand.

Improvement to engage and involve staff is ongoing, and the results of the NHS staff survey 2018 show positive changes since 2013 and 2016, most notably in staff engagement. That includes an 18 per cent increase from 2013 of staff who say that they are now proud to work for Betsi Cadwaladr. 

The strategic and service planning area, including performance, requires acceleration and more focused effort. There has been progress in individual specialist strategies with the sub-regional neonatal intensive care centre—otherwise known as SuRNICC—and primary percutaneous intervention plans implemented, and the vascular surgery plan under way. These plans increase success in recruitment and in delivering specialist services within north Wales for the people of north Wales. Work on other areas, including orthopaedics, needs to be further progressed on a whole-system basis and described more clearly in its plans for service transformation and improvement.

In primary care, the new executive director will provide increased focus to deliver further improvements, working in partnership with clusters. Work is continuing to improve GP out-of-hours services and the health board performance is now more in line with the rest of Wales. The ambition of the health board is now to transform the service model so that it becomes fit for purpose and sustainable.

In this statement, I have noted areas of progress but also outlined the significant difficulties that do remain. I am determined that special measures is not a sticking plaster, but that it delivers sustainable improvement and puts in place the capacity and capability required for the medium and long term. During the next six months, the health board will need to focus on finance, strategic and service planning, especially in unscheduled care and referral to treatment, and delivering on the recommendations from both the HASCAS and Ockenden governance reports.

The chair and the board are clear on the work needed and are committed to making progress. Welsh Government will work alongside to provide the necessary support and I hope that regional partners and key stakeholders will also play a key role in ensuring improved and sustainable health and care services for the people of north Wales.

15:30

Thank you, Cabinet Secretary, for your statement. I think it's important that you keep this Chamber up to date with the situation in terms of the special measures in north Wales. You know that I've been extremely critical of the lack of progress that there has been over the past almost three and a half years since this organisation went into special measures. We've seen performance on a range indicators, including A&E waiting times, referral-to-treatment waiting times and mental health challenges, not going in the right direction so far, and I think that many people are very concerned also about the sustainability of their GP services in north Wales, given that 24,000 patients have had to find alternative arrangements as a result of their practices handing back their contracts across the north Wales area in recent years. 

We know also, of course, that the financial situation, rather than getting better under special measures, which was always the intention, has actually gotten worse. The deficit was £26.6 million at the year-end—[Inaudible.]—2015, and we note that that deficit—[Inaudible.]—was £38.8 million in the last financial year. Also, of course, there is concern about the control of escalating costs, with even things like capital projects. We saw in the news—

I'm sorry to interject. We have a technical problem, in which none of the microphones are working. So, I have been advised—. I'll let you have another extra two minutes. I've been advised to adjourn for 10 minutes. So, the sitting will now adjourn for 10 minutes, or until such time as the technical problem can be resolved. 

Plenary was suspended at 15:33.

The Assembly reconvened at 15:45 with the Deputy Presiding Officer in the Chair.

15:45

[Inaudible.]—why that was happening. We'll move back now to the spokespeople, so I'll come back to Darren Millar. So, you can start again, Darren. 

Thank you, Deputy Presiding Officer. Can I thank the Cabinet Secretary for his statement? I think it is important that this Chamber is updated on a regular basis about the situation in terms of any progress that is taking place in north Wales under special measures. My party has expressed significant frustration over the past three and a half years about the lack of progress. We know that some of the key indicators in terms of emergency department waiting times, referral to treatment times, outcomes for patients with mental health problems in accessing GP appointments, and, of course, the closure of a number of surgeries in north Wales have all been features of the public debate. In fact, 24,000 people are clients of surgeries in the north Wales region who, unfortunately, have had to make alternative arrangements, usually the health board taking over those surgeries in order to provide some continuity of care.

We also know, of course, that on the financial side, the situation has also deteriorated. The deficit in the financial year before the health board went into special measures was £26.6 million, but that has inflated itself to £38.8 million in the last financial year. And if I heard the Cabinet Secretary right earlier on, he's set a control total, whatever that actually means, to allow for some flexibility in expenditure this year. I would be interested, Cabinet Secretary, to know what that control total actually is in order that we can hold you to account for the delivery against it.

Now, I do welcome some of the changes that have been made at board level. I welcome the appointment of Mark Polin and wish him all the very best in the significant work that he and his fellow new independent board members have to get to get to grips with, because it is a significant challenge. But I am still concerned—and I will keep flagging this up—that there are people around the board table who are part of the executive team that was responsible for the significant failings of this board when it was put into special measures. There are two people at least who are still around that table—one of whom, rather astonishingly, has now appointed as the turnaround director at that particular health board, which I think is absolutely scandalous, frankly, given the history at this board.

Now, can I ask you: you made mention of the fact in your statement that you've announced additional funding of £1.7 million under the special measures arrangements to strengthen the management capacity and the analysis capability in the turnaround team? Is that going to be recurrent because, of course, this capacity is going to need to be there going forward, not just in the short term? Can you tell us whether that cash is going to be recurrent?

Can you also tell us as well what the outcome of your meeting with the Tawel Fan families was? You suggested that just a small number of families were dissatisfied with the outcome of the independent investigations that have taken place so far, but that is not my experience in terms of the communications with me and my post bag. Indeed, I had it reported back to me that from your meeting with those families, there was a request for an Assembly inquiry to be commissioned. Now, I would hope that you would support such an inquiry if there were calls for such an inquiry being made by Members of this National Assembly. Perhaps you can tell us whether that will be the case, because I do think that many people have a complete lack of confidence in the two very significantly different overall conclusions that arose from those independent reports by the Health and Social Care Advisory Service and Donna Ockenden. 

Can you also tell us—? You made reference to developments in mental health. One of the developments in mental health that has taken place in recent months is a withdrawal of funding for capacity-building organisations in the third sector, which I think is of significant concern across the region. So, the organisation Un Llais, which has developed advocacy services in recent years, has had its funding pulled, with effect from December of this year. That funding has been responsible for training advocates, for establishing advocacy services, and we know that the capacity of advocacy services is not managing the demand that is being placed upon them at the moment. So, I would be interested to hear what assurances you have that those advocacy services, given the quality of mental health services in north Wales, are going to be able to meet demand in the future.

You made reference as well to the results of the most recent NHS staff surveys, which show some positive change, and I acknowledge that there's been some positive change and that there is increasing confidence in most parts of the new leadership team. However, you haven't mentioned patient confidence levels, and we know that those have been on the slide of late. We also know that the complaints system is broken. In north Wales, we have people waiting sometimes for over two years for outcomes to their complaints, even in respect of mental health services, at a time when the board is in special measures. Now, that's clearly unacceptable, and I'd like to know what you are doing to make sure that this is an organisation that learns from its mistakes, particularly those that are brought to its attention through the complaints process. Even Assembly Members have problems getting substantive responses when we are asked to intervene in securing them. So, I think, frankly, we deserve an explanation as to what you're doing to build the capacity in this organisation to be able to learn from its mistakes and respond to Assembly Members and other elected representatives who are helping to raise questions.

You also made reference, of course, to the neonatal intensive care centre, which I absolutely welcome, on the Glan Clwyd Hospital site. You didn't mention the fact that 10,000 people had to march on the streets in north Wales in order to secure that. I appreciate the intervention of the First Minister, but if it hadn't have been for those people marching on the streets, we wouldn't have that neonatal intensive care centre. We'd be sending poorly babies and small babies over the border into England in order to be born where there were predictions of problems for mothers. So, I do think it's a bit rich, really, to claim all of the credit for that, when the reality is that you bowed to public pressure in terms of your Government's position. 

On capital investment, I welcome capital investment that's going into the board. I do think that there are problems in terms of the sign-off process, while the board is in special measures, for securing capital investment. I've raised in this Chamber before concerns about the orthopaedic capacity, for which the board has a plan in place to improve, but it can't do that unless it gets the capital investment from the Government in order to implement its plan, and it's taking sometimes years to get a response once a plan has been submitted. Now, how do you expect a board to make the sorts of improvements that we all want to see on a cross-party basis in this Chamber if you're not putting the investment in in order that it can actually help to deliver that? And we know of the rising costs, of course, in terms of some of these capital projects. Pre-election promises of a new hospital in Rhyl, for example, which have never been realised, as yet, in spite of the fact that they were promised back in 2013, when some facilities closed in that locality and in neighbouring Prestatyn, that a new hospital would be built. Now the forecast is that it won't be built until 2022 and that the cost will almost double. So, I think what needs to happen here is we need more rapid progress, we need to see greater levels of capital investment in order to get the systems right and the capacity right, and we certainly need to see more investment in those mental health advocacy services and the complaints process in order to make sure that this health board learns from its lessons. 

15:50

Thank you for that range of comments and questions. I will, of course, keep the Chamber up to date on progress with special measures. As we have the reports and the updates on the special measures, I fully expect that statements will be made in this Chamber for Members to ask questions.

I just want to correct a point at the outset: 24,000 people have not had to make new arrangements themselves for GP services. The health board has always managed those arrangements, either in partnership with surrounding general practice or, indeed, by running a managed service until that service is able to go back into the usual manner of delivering general practice services. So, it isn't that people have to go out and make their own arrangements, it is about the health board still managing and delivering that service. There is, though, within north Wales, for the significant challenge that there is in GP clusters—and I recognise that, I've met a range of GPs and others in north Wales, just as around the country—. The appointment of the new exec director for primary and community care is a real step forward—somebody who is a primary care clinician who has trust and credibility within the service and is now in a place to try and bring people together to have a more positive plan for the future and for what could be done, who understands the real challenges of colleagues, not just in general practice as doctors, but the nurses and the therapists and others as well.

Finance remains a major concern with a £35 million deficit control total set. That in itself would not be a significant marker of success, because success is living within the budget, and I've been very clear about that since my appointment. But we want to set realistic improvement targets to meet that control total and then to move on to be able to live within their means in future years. That is why the turnaround needs to be accelerated. That is often about the short to medium-term improvement before longer term and medium-term transformation, but that is also why the finance delivery unit will continue to work alongside the finance team within the health board to try to make sure there is real purchase on delivering on those savings. That's why we've put in short-term support around the health board. Recurrent funding commitments will be made to health boards, as we need to do, but we're adding significant additional investment to help this health board through special measures.

On advocacy, I have undertaken to write to you, and I will chase it up to make sure that I do, because I recognise you've raised the point in the Chamber before, so I don't want to avoid dealing with that.

On Tawel Fan families, the remaining families are a small number but have significant challenges and significant unhappiness about the process as they have seen it and the outcomes of the report. They don't share and don't accept all of the outcomes into the care that their loved ones received. The great majority of families who are part of the HASCAS investigation have not contacted us and they're still unhappy and not content with either the process or the outcome. That does not mean that we won't take seriously the remaining families' concerns. That's why, in half term, I was in north Wales for an evening meeting that lasted much longer than originally planned for because it was important to have a full opportunity for them to express their concerns rather than simply me hitting the bell after a certain period of time and saying, 'I'm leaving'. That would have been entirely the wrong thing to do.

Within that meeting, the call for an Assembly inquiry was far from unanimous. A person made a call, there was some support within the room for that call, but other people made clear they did not want yet another inquiry. It is, though, for the Assembly to decide if it wants to take another inquiry; it is not for the Government to say there should be an Assembly inquiry. I've made clear that the Government's responsibility is to make sure that we do what we could and should do, and that the health board is held to account for what it could and should to to take forward the HASCAS recommendations. The plan they have to do so is a credible one; the challenge is that they need to deliver it. The plan looks like the right one, but they need to deliver it and they need to do so in a way that commands confidence, which is why the stakeholder group exists. It's why it's important there are some of the Tawel Fan family representatives on that group as well. So, it is not a group of cheerleaders for the health board—there'll be real scrutiny.

On your broader point about patient confidence, well, if the health board is regularly written about in terms that do not command patient confidence, it's hardly surprising people are concerned. And with a health board in special measures, I would hardly be surprised if patient confidence in that part of the country is different, say, to other parts of the country. However, I don't accept your statement that the complaints system is broken. The complaints system has a significant backlog, but, actually, the leadership of the nurse director has made a real difference to the complaints system. It is both important to learn from mistakes, but also to deliver the improvement that is required. And, actually, you don't need to take my word for it that the system has got better—the ombudsman has actually commented that he recognises that real improvement has been made, but he's also pointed out that that needs to continue and things are not perfect as they are now.

On the choice about the sub-regional neonatal intensive care centre, it was a decision the First Minister made with significant capital investment, and it came on the back of an evidence-led review by the royal college. There are people in this room who campaigned for a further review of the initial decision, and we took an evidence-led approach to do so. That has been the right thing to do, and, actually, it was only when the unit was delivered, and ready and open, as I said previously in the Chamber, that staff believed that it would definitely happen. It's a real positive. I think that the Government listened, listened to the evidence and we now have a new facility in north Wales for the people of north Wales. On the orthopaedic plan that you referred to, it is simply not true to say that the health board have been waiting for years for a response from the Government. Part of our challenge has been to get, within the clinical community within north Wales, an agreement on what to do between themselves as well as the health board that employs them, but, equally, to have a plan that can not just deliver more activity, but actually meet the demand and the capacity that exists now, let alone in the future. This Government or any other cannot be expected to spend significant sums of money not to meet the demand within the system. So, they have to have a plan that is approveable in the first place, and then the Government will have a choice to make about whether revenue or capital funding is made available. And I think that is entirely appropriate and what any Minister from any Government should expect from the service. But we are not afraid to invest capital within north Wales to deliver a better service. 

And that brings me to the Royal Alexandra proposals that finally went to board last week and have been approved by the board. They will now come to the Welsh Government investment board and I will then have a choice to make and I am determined to make an early decision. I can tell you that the most effective advocate, lobbyist and sharpest voice that you'd do well to listen to on this issue is, of course, the local Member, who happens to be sat in the Chair at this point in time. I will make the right choice for the service and I know that I will be tested on a regular basis by the local Member.

16:00

Thank you, Cabinet Secretary for your statement. There are some elements, definitely, to welcome. I'm particularly pleased to see the appointment of an executive director of primary and community care—I think that's clearly absolutely crucial, although I would share some of Darren Millar's concerns about some of the other people who are still there from the previous regime. I trust that you and your officials have satisfied yourselves that those people will be able to operate in such a way that they will fully comply with your expectations of a fresh start for Betsi Cadwaladr. I would not expect you, here in this Chamber or publicly, to say anything about those reassurances, but I would like to be reassured that you have received them.

I want to first of all look at something that you don't say very much about in your statement, and that is about staffing. You do refer to the fact that you now have 65 per cent of the staff saying that they're proud to work for Betsi Cadwaladr. Well, that is a good thing, but, of course, that means that you have 35 per cent of the staff who are not. Now, if that was a private sector business and it had 35 per cent of its staff not being happy, they would still be very concerned, and I'd just like to seek your reassurance that there's no complacency from your or your officials about that percentage, because it isn't a good place to be. That 35 per cent is an awful lot of people on the front line who are dealing with patients every day.

I'd also be grateful if you can tell us a little bit more about the issues with recruitment and retention. Are you seeing an improvement—are you and your officials seeing an improvement—in the board's ability to recruit crucial staff and to retain them? Because, obviously, it's those front-line staff who are dealing with the patients and their families every day who are the crucial building blocks for the board, and, of course, for the trust of the public in the area, because those are the people who interface with patients.

I'd like to refer back to the Tawel Fan families. I was somewhat relieved to hear your response to the points raised by Darren Millar, because if one read or listened to your statement, one could be left with the impression that you were dismissing the concerns of those families who are not satisfied. Now, you have reassured us that that is not the case and I'm very glad to hear that. In your statement you refer—that section of the statement that refers to Tawel Fan—to your officials being clear about the need for the board to communicate effectively with staff. I hope that you will be able to extend that comment to say that you're being very clear too on the need for the board to communicate very effectively with those families, because it's very often the case, is it not, that if people don't feel informed—. Even if they're not entirely happy, if they feel informed and they know what's happening, that provides us with some reassurance.

I won't repeat some of the questions that Darren has already raised with you, but I finally want to come back to the point about timescale. Now, nobody would expect you to set some sort of artificial exit point for this, because you've got to be reassured that the board is in a fit state to run itself and manage itself and manage its staff before you can withdraw special measures. But it would seem to me that the special measures have been in place for so long now that they're beginning to feel like the status quo. So, are you able to give us some assessment—? You mention your expectation around further and more rapid progress, and I'm sure we'd all agree with that, but are you able to give us some sort of assessment about how much longer you expect this to go on, bearing in mind, as I've said, that nobody would expect you to say, 'Right, we'll be out of here by 30 June', or whatever it is? Because it is getting to the point, I think, when people are beginning to feel that this is going—you know, 'When is the end point?' Now, of course, it could be argued that there is merit in the Welsh Government actually managing the health service in Wales directly and taking direct responsibility for it. But that's not the situation here. So, if we could have some sort of sense about how much longer you think this is going to take, I think the Chamber—and, more importantly, the people of the north—would be very grateful.   

16:05

Thank you for the comments and questions. On scrutiny and accountability, as you said, I'm not going to comment on individual employees. The challenge for me is whether people can demonstrably do their job individually and collectively, and that's what the board scrutiny and oversight is for. That is my expectation, and, of course, the new chair is in a position where—as I've said in my statement—there is additional scrutiny on the process, both for the chief exec and the executive team, but more broadly about expectations across the organisation.

I recognise what you say about the improvement in the staff survey, in terms of people who say they are proud to work for the health board. The 35 per cent who aren't in that category doesn't mean that they are all unhappy, but it does highlight not just the improvement that has been made—the 18 percentage point improvement, which should be welcomed by everyone across the Chamber—but also, plainly, that further improvement is required. I certainly wouldn't want to soft-soap or try and avoid the fact that there is further work still to do.

On your points about whether we're seeing an improvement in training and recruitment, I've had a number of conversations with your colleague Llyr Gruffydd about the opportunity to have different training arranged, for example, for nurses in north Wales. I've also had conversations about recruiting two nurses in north Wales from across the border. There's a range of people interested in working in the Welsh system from across the border. That's particularly promoted by very proud nurses within the RCN and Unison in particular. But also, as a good example, in vascular services, we have been able to recruit new consultants—new surgeons—on the back of the change in the vascular service network and the way it's being organised, the additional investment in theatres that I have approved, but also, following special measures, the improvement made in midwifery services, we have managed to recruit successfully into hospital-based and community-based posts. I hope that those are good examples of where we are now seeing more staff successfully brought into the organisation.

On your broader point about public involvement and engagement on mental health, of course that's part of what the stakeholder group will allow us to do, to listen to the views of the public in that setting, as well as the regular point that we should always listen to the public, and for them to have a proper role. Whether we call them service users or patients, the reality is that citizens should be at the centre of the service, and, of course, we want to listen to them to improve every part of the service.

On your broader point about special measures, I've been really clear that special measures cannot and will not be normalised. It is not a normal way of delivering the service. What I hope to see is that we will see organisations at different points of escalation go through both being raised as there are challenges, but also to come back down through escalation, as indeed Powys health board has done, as indeed the Welsh ambulance service has done. I want to see large health boards in a heightened state of escalation move backwards as well. To do that, though, we work together with Healthcare Inspectorate Wales and the Wales Audit Office, so it is not simply the Government marking its own work, or a Minister making a political choice. On special measures, the publicly announced and published specialised improvement framework goes up to September 2019. I would be delighted if the health board has made sufficient progress to come out of special measures before that, but that must always be on an objective basis to judge that, rather than doing it for my simple convenience; that would be the wrong thing to do.    

I thank you for the update, Cabinet Minister. As you say, much has been done, and there's still work left to do. I'm sure that patients and NHS staff would be reassured to know that special measures is not a sticking plaster, as you say, but is an approach and an intervention that is there for as long as it is needed. And that can be a positive, because it means that the Government, Welsh Government, are there to support those people, both the staff and the patients, for as long as that might be the case, and, within that, they can sort out the structural problems and make sure that this service, to those people and the staff who work within it, becomes sustainable in the long term. This cannot be, and it isn’t, a short-term fix. You do say that there will be a key focus for the next six months on improving mental health provision, and I’m sure, again, that that will be very much welcomed, especially in light of all the discussions that have happened here this afternoon regarding Tawel Fan.

I think what people would want to know is how that process will go along, what those improvements might look like, and what any of those target areas are. You do mention additional funding of £1.7 million to strengthen the management in the turnaround team. In August, you also announced £6.8 million to support improvements directly for patients at Betsi Cadwaladr university health board. Are you able to provide any update on the outcome of that spend, or where that spend has happened?

16:10

On the new spend, we recognised that the health board didn’t have the required level of capacity in some of the senior and middle management roles that actually make the service work to allow clinicians to do their job. So, we have a range of new directors in post to make sure that hospital management, but also management in community services, is improved. And I expect that we'll see, over the next quarter, not just that the money's being spent, but actually that those staff are then making a difference.

On the broader point about mental health, it is an area where the visible leadership really matters. On the areas of mental health provision that I've visited, in the community and within secure and semi-secure settings, the leadership at both direct level—so, staff and their peer leadership, as well as their managers—but also the mental health director has been very important, and, since returning to work after a period of unavoidable long-term sickness absence, the director has made a real difference, not just in having a strategy, but a plan for the future that's involved staff and people using the service. And, actually, there is much greater optimism about the future of the service. 

This highlights two things, I think. One is the importance of visible, high-quality leadership, because that person is making a real difference. The second challenge, though, is that Betsi Cadwaladr as an organisation—it doesn’t yet have the significance both in the structure and the fragility of leadership that exists, because, if you took that director out of the position now, I would be less confident about improvements being made in the future. So, there's a job of work to do to build a team around that person who can continue to drive improvement even if that person is not there.

That will also need to be borne out, as I said earlier, in making sure that, in the action plan following the HASCAS report, led by the nurse director, who I think is a good person with a real grip on her part of the organisation to make sure that improvement is real—. So, that should give us confidence: a high-performing member of the executive team and a director who know what they are doing, and engagement and involvement of our staff and the people that they’re serving.

Thank you for your update, Cabinet Secretary, but I have to say that it’s such a shame for the people who need Betsi Cadwaladr that the Cabinet Secretary’s statement doesn’t contain more good news than the broad assertions that there have been unquantified improvements in some areas.

Now, I’m not going to rehearse the disgraceful statistics that have come out of Betsi Cadwaladr; we're all aware of them, and they’ve been rehearsed many times in this place. At the same time, I acknowledge that Betsi’s problems are complex and have built up over a long period of time. Similarly, I acknowledge that the Cabinet Secretary doesn’t possess a magic wand that he can wave and instantly solve the problems at Betsi.

But to solve the problem, or a myriad of them, which is what we’ve got at Betsi, you have to understand the nuts and bolts. Expert reports of course show a big part of the picture, and they're very useful documents; they're detailed investigations and they go a long way to helping you solve the problem. But staff who are delivering these health services on the ground, and those other staff and workers who enable them to do it, also have a wealth of knowledge about Betsi and form a pool of solutions that appears to be untapped. I understand the Cabinet Secretary has conducted a staff survey, and it's one of the positives that the Cabinet Secretary reports that staff satisfaction has risen markedly, although, sadly, how good a piece of news that is very much depends on the content of the survey itself. But on the face of it, it's very good news.

So, I'd be interested to hear whether the Cabinet Secretary would consider the suggestion that staff at all levels, from the cleaner to the chair of Betsi's board, be asked to complete an anonymous and confidential survey into their opinions on the challenges they face in their own role, those they face when interacting with other roles in the organisation at all levels, and where the successes are as they see them, where the problems are, and seeking their opinions and suggestions as to the solutions in their particular department and around them. It's something that private sector businesses do periodically when they experience problems of a similar seriousness.

Now, I appreciate that there are whistleblowing mechanisms and a way of reporting concerns confidentially. I also appreciate that the kind of survey I'm suggesting would be a big task, but I think it's a valuable task, and it would be a worthwhile task, because surely the time now has come for a full, proactive 360-degree review of Betsi Cadwaladr at all levels via the staff, who actually live this organisation day in, day out; one that goes out of its way to seek the input of the clinical and other staff in a way that’s guaranteed to be anonymous and confidential and comprehensive.

Now, moving on to the board itself, I know that on the board there are journalists, an ex-police officer and a variety of other non-NHS-related backgrounds. None of the top three posts—chairman, vice-chair or chief exec—is held by anyone with a single day's clinical training or work experience under their belts. The chairman's an ex-police officer, the vice-chair's from the BBC, and the chief exec is a politics and economics graduate. Now, all of the members of the board have worthy curriculum vitae and they're impressive in their own fields, but I'd like the Cabinet Secretary to explain what the purpose is of appointing non-clinical people to run a health service, and what he believes they actually bring to the management of the NHS in north Wales. Doesn’t he think that perhaps the majority of the board should be clinicians if the service in north Wales is to be clinician-led, as the Cabinet Secretary has said in the past that he wants? And does the Cabinet Secretary think that it's acceptable, and does he feel that the public feel that they can trust the decisions of a health board that has comparatively few health professionals on it? Does the Cabinet Secretary not feel that the public would be more assured if his actions also included ensuring there were far more board members with clinical practice backgrounds, together with direct and current experience of the NHS as it exists in north Wales? The Cabinet Secretary's party likes to talk about quotas on management boards when it comes to gender and other things, but why not when it comes to knowledge and experience? Thank you.

16:15

Thank you for the comments and questions. There were two broad questions. On an anonymous staff survey, actually, I took part in a number of anonymised staff surveys when I worked in my previous job in the private sector, both as an individual member of staff, when I was not a leader or manager, and then again when I was a leader and a manager, including a 360-degree review of how my staff saw me in that role, and it was a useful point of learning and improvement. So, I recognised the value before coming into this job, and that's exactly what the NHS Wales staff survey does. It is anonymous and it is detailed, and we actually saw an encouraging increase in a range of areas of people actually taking part in the survey. The more people that take part, the greater the value of the survey, and that includes a range of comments—it isn’t just a tick-box exercise—a range of comments about how people feel about working in their part of the organisation, and comments for improvement. So, we do essentially, with the NHS Wales staff survey, do what the Member asked us to do, and I'm not persuaded there is value in undertaking a health board-specific exercise when we have just completed the NHS Wales staff survey.

It's also worth pointing out, from a staff point of view, there is real excellence that takes place within healthcare in north Wales as well, as highlighted in the recent NHS Wales staff awards, and I think people in this Chamber could and should be very proud of the real excellence that those staff deliver.

On your broader point about the make-up of the board, we have, of course, consulted on the shape and nature of boards, and if we are able to, and time permits, within this term, the First Minister's already announced we'll take forward a healthcare quality and governance Bill. We currently have a range of clinical roles. We have a medical director, we have a nurse director, and we have a director for, essentially, allied healthcare professionals, So, we have a range of clinicians around the board in executive director roles.

These are roles in running significant organisations. The chief executive of a health board requires the skills to be a chief executive. They require the skills to be a significant leader and manager within a service. Now that doesn't mean that they have to be a clinician or, indeed, have had time in clinical practice. This isn't about providing the best clinician with an opportunity to run a health board. If you look in general practice, a range of general practices employ people as either the practice manager or as a business manager to run the business part of that organisation, to make sure that they can do what they need to do. Because the skills that a general practitioner has in training and then in many years of practice are actually how to treat and care for people. The chief executive's job is to make sure they do their job properly as the chief executive officer. That is what I expect, and I certainly won't be introducing a requirement that somebody has to have had a level of clinical experience, because I don't think that is going to deliver a better service and, ultimately, that is what I am interested in.

16:20

Thank you. And finally, Janet Finch-Saunders. And can I remind you, you are the second speaker from your party?

Yes, and thank you for allowing me to speak. Cabinet Secretary, it's fair to say that over the past 12 months in particular, I've been extremely vocal. It's not wise for anybody to stand up in this Chamber and just pontificate or use anecdotal information here. When I speak, I speak clearly from what I receive coming into my office. And I can tell you, my casework file is—[Interruption.] There's no let-up in the number of complaints and the type of serious complaints that are coming in as regards this particular health board. Now, you'll be aware, no doubt, of my constituent, where it's just only been announced—. Can I carry on?

Seven hours ago today, one of my constituents, sadly, has passed away, through waiting for an ambulance for over four hours and bled to death. A 37-year-old constituent. That is just one of many people that I'm dealing with. Another lady, who had a very bad fall in Conwy, waited three hours for an ambulance then waited for 10 hours for treatment. She was taken to Llandudno hospital, and then, such was her bleeding on her leg, and it was a replacement knee joint, they had to cut her jeans off her, 10 hours later. So, she wrote to the chief executive. To date, she wrote to the chief executive in July. I followed it up, asking him where the response was, in August. We're now in November—no response. 

We have dozens and dozens of complaints. You know, because sometimes, I get very frustrated because my constituents come to me in all good faith and they say to me, 'Janet, we don't want to get anyone into trouble, we don't want to criticise, we just want the people at the top running things to know just how bad things are', and they don't receive any response.

And I just find, if a chief executive or anybody working within a senior management team cannot put pen to an e-mail, a standard response even saying, 'I'm very sorry to learn of your experiences, but your information coming back helps us to improve the service'—. There's nothing like that. I've asked Gary Doherty, I've asked Andy Scotson, and, you know, things are so bad for my constituents that now we have a weekly phone session with a member of my staff to go through all the cases where they are just massively delayed.

I had an e-mail when I was sat in Plenary about four weeks ago. An elderly gentleman has been waiting four and a half years for a hip operation. He's in agony. He said he finds it hard getting out of bed. These are people who are not being supported by care. He lives alone. He just needs—. He's been told by the doctor, his GP, he's been told by his consultant he needs a hip operation. Luckily, as a result of him contacting me, they are now prioritising him some treatment. So, please God that he gets his operation, and I think it's going to be fairly imminent.

But people are coming to me, and I want them to, but there's an awful lot of people out there who are not coming. There has not been any improvement, honestly, Cabinet Secretary, as regards their complaint processes.

Now, I know that the senior management team—