National Assembly for Wales

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Y Cyfarfod Llawn

Plenary

05/06/2019

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

1. Questions to the Minister for Education

The first item on our agenda this afternoon is questions to the Minister for Education, and the first question is from Mick Antoniw.

External School Activities

1. Will the Minister make a statement on Welsh Government policy in ensuring that external school activities are inclusive to all pupils? OAQ53970

Equity of provision for all learners constitutes a major priority for this Government. I strongly encourage schools to ensure that inclusivity and equity are at the forefront of all decision making when it comes to any activities that could lead to additional costs for families.

Minister, thank you for that answer. I know the efforts that have been taken to ensure that there is inclusivity. But, of course, there is the growing concern, arising from the Musicians' Union report, about the accessibility of music lessons, the issues that arise now in terms of the affordability of children being able to attend external trips—arts, culture, and so on. And, of course, there's one new one, which we seem to have inherited from America, and that is the development of school proms, where the cost seems to be not only rising, but it appears to be a competition between parents—some having limousines, and so on, going to schools. And it does raise this concern more broadly, when put within the context of all the other things, that there is a growing issue with regard to those who may or may not be able to afford to participate in some of these. And I wonder if this is an area, Minister, where you could indicate whether you'd be prepared to undertake further research and analysis, to assess what the scale of this is, and how it might be tackled.

I am familiar with the phenomenon that is the prom, and it's a world away from the senior school discos I'm sure we all attended. The cost of the school day is an issue that I'm very interested in. I am fully aware of the significant impact it can have on some children, often from groups that would benefit most from those extra-curricular and out-of-school activities. I have asked Children in Wales to produce resources for schools, to encourage the consideration of the impact of additional costs on families, and the first series of guides will be available by September and will cover a range of specific issues. Of course, additional to that, we will be investing more than £5.1 million in the pupil development grant access fund this year, to help parents with the costs associated with the school day, including school uniform, and kit and equipment, as well as spending a record amount on PDG in itself to support the education of some of our most disadvantaged children.

Can I concur with some of the points that have been made by Mick Antoniw? The issue of mental health in schools has been one that's been rising up the agenda, and I think there's growing evidence that extra-curricular activities in school are beneficial, in many cases, to pupils' mental health. But, of course, the costs that Mick Antoniw talked about—the associated costs—can also have a negative effect, so those two need to be balanced. In terms of the wider mental health issue, what are you doing in terms of making sure that pupils do have advocacy available to them at the earliest opportunity, and that they're aware of where to go if there are issues of not being able to attend extra-curricular activities and of feeling excluded?

Thank you for that. You're correct—the opportunity to participate in a wide range of activities can have a very positive effect on mental health and well-being for our children, and an inability, or a worry that you won't be able to do that can have the opposite effect. And that's why, as I said, we have commissioned Children in Wales to produce these resources and guides for schools, so that they can be cognisant of that when they are making decisions. With regard to general health and well-being in school, you'll be aware that both I and the Minister for Health and Social Services continue to work with a wide range of stakeholders to ensure the successful implementation of the recommendations of the Children, Young People and Education Committee's 'Mind over Matter' report. And some of these issues were, indeed, discussed at this week's meeting.

Educational Outcomes in the South Wales Valleys

2. What action is the Welsh Government taking to improve educational outcomes in the south Wales valleys? OAQ53947

The Welsh Government, regional consortia and local authorities are collectively supporting schools in the south Wales Valleys—and, indeed, throughout the whole of Wales—to improve educational outcomes, in line with the priorities in 'Our national mission'.

Thank you, Minister. As we know, the life opportunities of people living in areas like Merthyr Tydfil and Rhymney are determined by many factors, but especially their educational and training opportunities. The Learning and Work Institute Cymru has recently published a youth opportunity index, showing that young people in my constituency, and across the south Wales Valleys, have the least access to opportunities. For too many young people, it remains the place of their birth which determines their opportunities and outcomes in life, and not their own abilities. What further action can you take as education Minister to help end this unfairness?

13:35

Well, Presiding Officer, given that the question is about schools in the south Wales Valleys, can I give a warm welcome to Tredegar Comprehensive School pupils, who I think have joined us in the viewing gallery this afternoon? Tredegar comprehensive is the old school of Alun Davies AM. I'm not sure whether the children have a suitable role model in Mr Davies, but it's something to aspire to. And I do know that some of the pupils who are with us today are ex-pupils of Deighton Primary School, which, again, is Mr Davies's old primary school, whom I had the pleasure of meeting when they were in the primary school. 

But returning to Dawn's question, can I agree with you, Dawn, that it's totally unacceptable for children's success to be determined by their social or economic circumstances? And underpinning all of our work is the belief that someone's ability to benefit from education should not be determined by where they live, what their background is or what their parents' income is. As I said in my first answer, we are investing unprecedented amounts in the pupil development grant—over £190 million last year—to improve outcomes for some of our most disadvantaged learners, and we're also looking at different types of opportunities. We have committed a total of £1.5 million to fund shared apprenticeships across the Valleys taskforce area, and our junior apprenticeship programme offers year 10 and 11 pupils the opportunity to study full time for a future career in a college setting, from the age of 14, and that is specifically targeted at those children who may have low aspirations or are in danger of being not in education, employment or training. 

Minister, you cannot improve educational outcome without providing the necessary number of teaching staff required by the schools. Recent figures show a shortfall of 40 per cent in reaching your own target for new secondary school trainee teachers. You have also missed your target for primary school trainee teachers for the third year running. Minister, what action are you taking to address the crisis in teacher recruitment in Wales, please?

Teacher recruitment is challenging not just within Wales, but, actually, it's an international issue. The statistics that the Member refers to relate to the academic year 2017-18, and, since then, we have undertaken a major reform across initial teacher education. And whilst we have missed our targets with regard to full-time recruits to these programmes, applications to our graduate teacher programme for a route to qualification as a teacher is oversubscribed. 

You are aware of my concerns about your over-reliance on supply teaching firms. These firms usually charge schools exorbitant rates for providing teacher cover and only pass a small proportion of that on to the teacher commissioned. Now, I know we've discussed this before, but the question also needs considering from the point of view of providing teacher continuity for pupils. Of course, there'll be times when supply teachers are required, but I've received anecdotal evidence that supply teacher agencies pay no mind to ensuring that the teachers that are on their books stay the course during a specific teacher absence. A supply teacher recently contacted me to say that these consultants do not care about continuity of cover at all so long as they get their commission. Minister, are you aware of this issue and the consequences, and can you please tell us what you intend to do to remedy it? 

Well, as the Member will be aware, we have a reform programme with regard to the practices of supply teacher agencies. The new framework will be on stream before the start of the new academic year, which will provide for minimum rates of pay for those staff employed by those agencies, better employment rights, guaranteed access to training. The Member makes a very good point with regard to continuity. Continuity of supply staff in schools is beneficial not only to those individual members of staff, but, crucially, to the pupils that they teach. And this is one of the benefits that we have been able to quantify as a result of our cluster supply model that we have constituted over the last two years, and we will continue to do what we can to ensure that, when supply is needed—and the Member is right; from time to time, it is needed—those that are providing that are well trained, well qualified and supported, and are able to deliver impactful lessons to students. 

13:40
Questions Without Notice from Party Spokespeople

Questions now from the party spokespeople. The Conservative spokesperson, Suzy Davies. 

Diolch, Llywydd. Good afternoon, Minister. I see that you're going to be meeting your Scottish and UK Government higher education ministerial colleagues shortly—you may have already done it, I don't know—to discuss Brexit and the findings of the Augar review. The issue, of course, of funding post-16 education is devolved, but the systems in all these nations support competition between institutions across the UK, and with 40 per cent of Welsh university students already studying in England, with far less traffic coming the other way, I just wondered what your initial thoughts were on the review's findings on Welsh universities and colleges, were they to be implemented in England. 

Just to clarify for the Member, I meet regularly with my counterparts in Scotland and England. We have set up regular quadrilateral meetings at my request. And, despite assurances that were given to me at the last meeting by Minister Skidmore, it is disappointing that his civil servants did not feel able to properly brief my civil servants ahead of the publication of the Augar report, which is disappointing. I am, of course, aware of the contents of the report, and, in my letter to The Times earlier this week, I was very clear that any proposal for reform in England will inform but will not dictate the choices made by the Welsh Government. I am proud that Wales will continue to have the fairest, the most progressive and the most sustainable student support system in the UK, even if the Augar recommendations are implemented fully in England. But, given the chaos in the Government in England, who knows? 

What a warm answer. I wasn't suggesting for a second that we should be following England's lead in this. I just wondered what the impact or what you thought the impact would be on Welsh universities of this particular review, and I don't think I've learned any more from this. One thing that Augar does say, though, in his review is that there are already differences between the nations' funding systems, so further divergence shouldn't be a problem. One of the areas where there isn't any divergence, as far as I can tell, is that the terms of repayment for student loans, even though the loans themselves are different here, especially in the way that maintenance costs are covered and subsidised—. If there is no divergence at the moment, and whether we agree or not on Augar's particular proposals, one thing he is trying to address is this question of the number of loans that are effectively written off or not paid off in full over time, and I'm just wondering what your current thinking is on this problem—how it can be addressed in a way that doesn't adversely impact upon university income or deter attendance.

Well, the Member asks me what impact the Augar report, if it was to be implemented, would have on the Welsh higher education system. I would refer her to the comments that have been made by Cardiff University, and, indeed, University Wales, as the representative body of HE in our nation, who have issued briefs outlining their concerns at the content of the report, and their concerns about the financial impact of the recommendations are not a surprise, I'm sure, to any of us. Now, given the financial implications for Wales and the other devolved administrations, we have consistently and constantly reminded the UK Government of the potential of those implications or any amendments they decide to implement, and I will continue to do so whilst they are considering their formal response to Augar. 

Right, well, Minister, that's two questions you haven't answered now. I have read the Cardiff University briefing, as you clearly have. I just wanted to know what you thought, and I do want to know what you think about this situation generally regarding unpaid loans, which effectively become Government grants, and what you think Wales could do to improve the situation in a way that doesn't deter attendance at university or compromise their income? And I didn't get an answer to that question. 

Higher education, of course, is a very competitive field, and exam results matter when student offers from universities can be very demanding. The WJEC is by far the biggest exam board relevant to 16-year-olds thinking about the steps they want to take after that, and I wondered if, like me, you're concerned at all to hear about the difficulties there—lack of revision guides, errors in French A-level papers, technical issues with computer science exams. What conversations have you had with the body to reassure yourself that recent problems won't compromise Welsh students' exam chances and so their chances of getting into the university of their choice?

The Member says that she is concerned about people being deterred from pursuing higher education. What we know from the work of Professor Ian Diamond is that it is the lack of support for upfront living costs that is the greatest deterrent to people pursuing a university course, especially if you are a student from a non-traditional background and do not have parents with significant incomes to support you. That's why, even if Augar was to be fully implemented in England, we would have considerably higher levels of non-repayable grants available to Welsh undergraduates.

The Member makes some very pertinent points with regard to the performance of the WJEC. My officials and Qualifications Wales continue to work with the WJEC to demonstrate what our expectations are of a national exam board for our nation.

13:45

Whilst the consultation on the draft curriculum is ongoing it’s appropriate that we should discuss certain aspects of it with you today, and, first of all, the history of Wales. I’ve just come from a seminar that I staged at the request of Ymgyrch Hanes Cymru—the campaign for Welsh history—and there concerns were expressed that an excellent opportunity will be missed to teach the history of Wales in every school unless that is entirely clear in the new curriculum and unless resources and appropriate training are available.

The young people of Wales learn about events such as the drowning of Tryweryn through murals, and that’s wonderful, but the education system has a key role in teaching the story of our nation to our pupils, a role that isn’t being delivered and hasn’t been over a period of decades—not properly, at least.

The draft curriculum talks in general terms, and conceptual terms, about the Welsh experience, but, when one looks at the guidance under the heading ‘history’, there’s no mention of Wales or the Welsh experience or Welsh history. So, I’d like to know how you intend to amend the draft curriculum in order to reflect the aspiration that every pupil in Wales should know about the history of our own nation.

Well, the Member will be aware that the draft curriculum is available for feedback at this particular time and I'm sure that she, and other people, will be availing themselves of the opportunity to feed in views.

The principle of cynefin, I believe, is one that runs throughout the draft areas of learning and experience, and not confining itself just to the concept of teaching children about Welsh history. I want the story of Wales—its history, its language, its culture, its geography, its contribution to the world—to be a golden thread that runs through every aspect of the curriculum and I don't think we should be confining ourselves just to the humanities AoLE or one particular subject.

It would be interesting to return to this at some future point, perhaps discussing what the definition of 'cynefin' is, because there is no definition in the draft curriculum as it stands, and that is perhaps a weakness.

Another aspect of the new curriculum that’s been given some coverage is sex and relationships education, and I quote from the draft curriculum that teaching,

'Welsh, English, religious education, relationships and sexuality education, and the three cross-curricular responsibilities of literacy, numeracy and digital competence'

will all be statutory duties. So, it’s entirely clear that sex and relationships education will be mandatory, which is very good news, as will be religious education and digital competence. But I’m having some difficulty in understanding the rationale of making certain elements of the curriculum mandatory whilst exempting other important elements. There is no mention in the general description that I’ve just quoted of well-being and mental health. This is a surprise to me, bearing in mind the warnings in the ‘Mind over Matter’ report drawn up by the Children, Young People and Education Committee. So, can you explain the rationale as to why certain things are mandatory and others are not in that general description?

Well, can I thank the Member for her personal and, indeed, her party's support for the inclusion of RSE in the curriculum and putting it on a statutory basis? I'm very grateful for that. I think we both understand why that is really important.

You'll be aware that in the original document, 'Successful Futures', by Graham Donaldson, he made some specific recommendations on why some things should be explicit on the face of the Bill. I have added to that RSE in response to the work done by Professor Emma Renold of Cardiff University and the expert group that was created when they were very, very clear about the necessity of putting RSE on the face of the Bill and as a statutory element of the curriculum, given the importance of that subject, and also given the importance that is placed on this subject by young people themselves. We know from the work of the Youth Parliament here that life skills are an important priority for them, and they have been very positive about the inclusion of RSE on the face of the Bill.

The Member asked the question about mental health. Well, she will be very familiar that health and well-being forms one of the six areas of learning and experience within the new curriculum. The inclusion and the focus that has been placed on those topics and that area of learning again is very welcome and puts us in a very different place from other education systems nearby us. I will be reflecting, as a result of the consultation on the White Paper, on how we will, through legislation, be able to make good on my desire to have a broad and balanced curriculum and to ensure that all six AoLEs and the 'what matters' statements that lie beneath them are adequately provided for in individual local school curricula.

13:50

Thank you, and of course I welcome the inclusion of well-being and mental health as a core part of the draft curriculum, but I am still slightly concerned as to why it’s not contained within that general statement, which is also at the heart of the curriculum, whilst relationships and sexuality education is there. I’m struggling to understand the rationale for that, whilst welcoming of course that RSE is there. I’m sure you would agree that we do need expertise in teaching in that particular area, and the panel that looked at that has made a number of recommendations, and I’d like an update if possible this afternoon on the issue of training. The panel has called for the inclusion of training in RSE as a particular pathway as part of initial teacher training and professional development, including a Master’s level qualification. So, how much progress has been made in that area? Thank you.

You’re absolutely right to talk about the need to ensure that our professionals in our schools have the confidence to be able to deliver really effective RSE lessons. We know from the work of Emma Renold and consultation with young people that sometimes the staff that are delivering these lessons are not those that have had particular training in these elements of the curriculum. New financial resources were made available specifically to work on training materials and training opportunities for those teachers delivering RSE. And you be will be aware that we’re investing over £21 million over two years with regard to professional learning opportunities for teachers in preparation for the implementation of the curriculum, and I would expect RSE and health and well-being to form an important part of the opportunities that are available. We continue to discuss with our initial teacher education providers the nature of the curriculum offer that they have, and I will write to the Member with regard to a Master's qualification.FootnoteLink

Teaching Welsh to Adults

3. Will the Minister make a statement on teaching Welsh to adults? OAQ53969

Welsh for adults is a matter for the Minister for International Relations and the Welsh Language. However, we work closely on this and in co-operation with the National Centre for Learning Welsh in order to ensure that a variety of opportunities are available to learn Welsh.

Certainly, there are areas here that overlap with different responsibilities and different Ministers. Tourism is important to the Welsh economy but can I draw the Minister’s attention to a report by Cylch yr Iaith on the issue of tourism and the Welsh language? Certainly, there are impacts to tourism that need to be tackled, and one thing that we can do is try and move from the back foot to the front foot and to try and take the Welsh language, through education, more directly to tourists and those who are here on a more permanent basis, perhaps, as the owners of second homes.

We in Plaid Cymru, by the way, see clear potential to develop language tourism, but that’s a matter for a different Minister again. But what plans does the education Minister have specifically to promote the learning of Welsh for adults in the context of tourism and those who settle in Wales permanently or partially, and what does she see as the way forward in driving a recruitment campaign for learners that would tie into the Welsh Government's strategy of a million Welsh speakers?

13:55

Well, you're absolutely correct to say that adults learning the language, whether they are infrequent visitors to Wales or people who move to our nation, will play an important part in the Government's reaching its target of a million Welsh speakers by 2050. Following the 2021 census, the assumption is that an additional 2,000 adults will become Welsh speakers every year, and the Welsh for adults sector will be the main mechanism for achieving this. As I said, we continue to work across ministerial portfolios and with the national centre to look to see what more we can do to promote the availability of our adult learning, as well as making sure that, when people do come to Wales as tourists, we increase the opportunity for young people who work in that industry to be able to utilise their Welsh language skills. And that's one of the reasons why we have extended the role and remit of the coleg cenedlaethol, not just in higher education but also into further education, so those children who are developing technical qualifications can see a real place and a real economic as well as a social and cultural value in being able to continue to study through the medium of Welsh, or utilise Welsh medium skills they've acquired earlier in their educational journey. 

Well, I think that our learners of Welsh are an under-utilised resource in Wales. And, as we know, not all adults living in Wales will have been through the Wales school system. For many of them, their first approach to perhaps learning some Welsh will be through the Learn Welsh website, and I was surprised to see that the disparity between the availability of taster sessions—specifically taster sessions—for adults is surprising. There are 11 in Gwent, 10 in Nant Gwrtheyrn alone, as you might expect, but none in Swansea bay or Pembrokeshire—or at least they're not on the website. If the issue is the well-documented lack of Welsh teachers, what thought has been given to encouraging non-teachers and competent learners to play a greater role in running those courses, duly supervised by professionals, in order to increase the availability of those taster courses?

Well, it is concerning to learn that those taster courses do not seem to be available, or at least it's not well known and it's not well advertised, if somebody was to go looking for those courses, that there's an opportunity, and I will raise those matters with my colleague, the Minister for International Relations and the Welsh Language, who has primary responsibility for this area.

The SenCom Service in Gwent

4. Will the Minister provide an update on the SenCom service in Gwent? OAQ53957

Can I thank the Member for the question? Following a competitive tender exercise, the Welsh Local Government Association has now appointed an independent contractor to undertake a review of the SenCom service. My officials will remain in regular contact with the WLGA as this review progresses.

Thank you, Minister, and I'm really relieved that there is now somebody appointed to take this forward, because I'm sure, like me, you recognise that the uncertainty hanging over SenCom has been very poor for the staff morale in the service. I'd like to thank you for your oversight and input into this, and I'm pleased to hear that that's going to continue. I wonder if you would join me today in recognising the vitally important work that the staff at SenCom do, not just at the centre, but in the work that they do in upskilling teachers and others across Gwent to work with children with sensory impairments, and will you agree to visit the centre with me, in Cwmbran, to meet with staff and some of the children and families as soon as your diary allows?

Well, Lynne, I would be delighted to visit the staff and to see for myself the nature of their work, which I know has been greatly valued by you, as the local Member, schools in the area and, most importantly of all, the parents and young people who are directly affected by that service. My understanding is that the review will be completed before the end of the current school term, and that the review will indeed take the opportunity to meet with political leaders and senior managers in each of the local authorities, SenCom staff themselves and parents whose children are in receipt of the service. And, as I gave my assurance to you earlier, my officials will be keeping a very close eye to ensure that that timetable is met. But I would be delighted, as I said, to visit the service for myself. And can I take this opportunity to thank you, as well as other Members who have taken a keen interest in this, and also the leader of Torfaen council, Councillor Anthony Hunt, who has shown great leadership in this regard and a great passion for this service? I'm grateful to everybody involved.

14:00

I also agree with the comments that Lynne Neagle has made. We have been asking you and, indeed, the First Minister about this issue for some time. I welcome the agreements that have been put in place by the five local authority leaders so that SenCom, a very valuable service, will continue in its current form until 2022, I think I'm right in saying. This should give greater security to the skilled staff.

It has to be said, Minister, that we ended up in this position because one of the partners—at least one of the partners—gave six months' notice, I think it was, about their decision to withdraw. I appreciate there are pressures on local authorities, but, really, we don't want this sort of situation to happen again with such short notice in future. So, I wonder whether you could tell us what steps you could take to make sure that this sort of situation doesn't arise in the future and that vulnerable children are given the security that they need to make sure that these sorts of services are going to continue to be available to them.

Can I thank the Member for his recognition of the value of the SenCom service in his area? It is, indeed, a matter of regret to me that there has been any alarm or confusion caused in this process. It's been a difficult time, I know, for the staff and for the families.

Undoubtedly, as you said, there are pressures on councils' budgets. That means, actually, we need councils to work more closely together on more areas, rather than think that they're able to deliver a comprehensive service by working on their own. In these specialist areas, it is by working together and pooling resources to create a regional service that we can best meet the needs of children and young people who have very, very specific support needs.

Cooking Knowledge by the End of Key Stage 3

5. What plans does the Welsh Government have to ensure that all pupils know how to cook by the end of key stage 3? OAQ53963

Thank you, Jenny. Our current curriculum provides young people with opportunities to explore a wide range of issues related to cooking and healthy eating, and with the introduction of our new curriculum the health and well-being area of learning and experience will re-enforce this provision.

Minister, you and I both had the privilege to see the wonderful facilities at Howardian Primary School, which is one of our new twenty-first century schools, where there was a dedicated cookery teaching area—that was wonderful—as well as some fruit trees and strawberries growing in the playground. Cookery lessons were popular with the pupils I spoke to in year 3, although some of what they were learning to cook wouldn't have been suitable for an evening meal.

But, unfortunately, we know that many school leavers leave without knowing how to cook. In some cases, that's because no cooking goes on in that household—everybody relies on pre-cooked food of one sort or another, which is far too full of sugars, fat and salt. So, how are we going to change the culture through our education system in order to achieve the 'Healthy Weight: Healthy Wales' objectives, which require us to completely rethink our relationship with food?

I wonder whether you can tell us what the uptake of the GCSE in food and nutrition is since it was launched, I believe, three years ago. Higher up the learning curve, I raised yesterday with the environment Minister the uptake of horticulture apprenticeships being as low as 30 so far this year, up to 31 July. The average age of horticulturalists is 55, and the needs of the agriculture industry are huge.

We know from the work being done in Lesley Griffiths's department that there is an upcoming skills shortage of about 6,000 people working in food if we're going to achieve the ambitions we have for this aspect of the foundational economy. So, I wondered whether you could give us some idea how the education system is working to ensure that we have the skills we need for this industry. 

It was, indeed, fabulous this morning to be at Howardian Primary School, one of our new twenty-first century schools, and to listen to the children talk so enthusiastically about how one of the best aspects of their new school building is the cookery room. They have been busy making cawl and cake and various other items, and that was very, very pleasing to see.

With regards to GCSE entries into food and nutrition, entries in 2018 stood at 1,960. Entries in this summer series stand at 2,120, so we've seen an increase this year in the number of students taking that particular qualification.

With regards to skills, regional skills partnerships are continuing to strengthen, and that gives us an opportunity to influence courses and training opportunities that are available, either in our further education colleges or in our higher education provision. We will need to continue to strengthen those RSPs and ensure that we have the training opportunities and qualifications at an even higher level available for those people, and be able to signpost them into what a rewarding career horticulture, food, nutrition and agriculture can be. 

14:05

Minister, the core food competences framework was reviewed by all the administrations in the UK in 2014, and 'Food—a fact of life' draft guidelines were published in February. I wonder when full guidance will now be issued, and how will it be introduced into the new curriculum?  

David, as I said earlier, health and well-being is an important new addition to the curriculum in Wales, and you will see from the 'what matters' statement that enabling children to make healthy choices about the food that they eat and the activities that they participate in will be an important part of what we expect children to learn. I will need to write to the Member with regard to the latest update on publication of guidance.FootnoteLink   

Supporting Pupils Excluded from School

6. How is the Welsh Government supporting pupils excluded from school? OAQ53939

Our message is clear: exclusion should be used as a last resort. Where exclusion cannot be avoided, our exclusion guidance sets out the support schools and local authorities must put in place for all children who have been excluded from school and from pupil referral units.

Thank you. Last August, a landmark court ruling in a school exclusion case made it clear for the first time that all schools must make sure they have made appropriate adjustments for autistic children or those with other disabilities 'before they can resort to exclusion'. I've recently in the last two weeks received a letter from a constituent, a father with whom I've been working for some months after his young autistic son was excluded from school, with a decision letter regarding their Special Educational Needs Tribunal for Wales case, which ruled that there had been no evidence of reasonable adjustments. It said the school had been forced to admit that the exclusion itself was discriminatory, and it required the school to provide a written apology, to include an apology for the disproportionate length of the exclusion, an apology for not providing sufficient support to address their son's additional learning needs, and explaining how the school will address the issues raised in this decision. It also instructed them to arrange additional training for staff and governors in relation to autistic spectrum conditions and ALN more generally at a level that is more advanced than introductory level. 

This isn't the only case I have like this; I have many. At a time when local authorities and schools should be fully aware of the ALN Act and the impending significant changes, how are you going to on the ground ensure that children like this don't continue to be punished for being who they are, and are engaging with staff who truly understand what their needs are so that they can live happy, healthy and fulfilled lives? 

Thank you, Mark. A significant proportion of the £20 million ALN transformation programme funding will be used to support activity to upskill the workforce so that they can better recognise and better meet the needs of all learners with ALN and learners with autism. And that's one of the reasons why we have taken through our ALN legislation and why we are committed to reforming it. Under the new system, the learner will be placed at the heart of the process, and better collaboration between agencies will be encouraged, and that's to ensure that the needs of learners are identified early and the right support is put in place for them so that their educational opportunities can be properly met and their aspirations reached.  

14:10

I wholly endorse what the Minister has said about exclusions needing to be an absolute last resort. Sadly they are sometimes necessary, and as well as children then perhaps being educated at home, in academic terms, for a short time, those children lose out on a whole range of social opportunities that are associated with being in school, and all kinds of other learning and access to sport. What are the Minister's expectations of local authorities with regard to how such children, who perhaps only temporarily are being taught at home, but who are being taught at home, are unable to participate in activities like sport, like art, music, drama—some of the enrichment activities that go beyond the purely academic curriculum?  

Can I just take this opportunity again to say that exclusion should be an absolute last resort? I recognise that we have got more to do to ensure that schools and individual practitioners are better supported to understand why children have difficulties in school that can result in behaviour that ultimately, in some cases, leads to exclusion. Only this week in the 'Mind over matter' group, we were talking again about the need to improve support for teachers with regard to understanding the process of adolescence—literally, the neurological changes that can't be seen as a child goes through puberty, which mean that sometimes their behaviour might not be particularly good—but a better understanding of the challenges that adolescence brings. We are absolutely clear, where a child has to be excluded, that there is a responsibility for both the school and for the local authority to ensure that that child has access to a range of opportunities, both academic and social. We are currently working on the implementation of our education other than at school improvement plan, because we do know that curriculum opportunities can be severely curtailed for those children who find themselves out of school. Clearly, that is not in their best interests in many cases. 

Far fewer pupils are actually excluded in Wales than in the middle of the last decade, from over 450 in 2004-05 to just 150 in 2016-17. So, Minister, would you agree with me that this is to be warmly welcomed and that pupils are best served in nurturing and supportive education environments, and that such positive outcomes validate the progressive guidance issued by the Welsh Government formerly in 2012, setting out how exclusion should be used and to do so permanently should be, as has been stated today, a final step in the disciplinary process? So, Minister, how can Welsh Government monitor consistency of understanding of this philosophy throughout Wales so that wherever a child lives they experience the same determination for minimising exclusions, irrespective of the location and educational needs?

Well, what the Member is absolutely right to say is that we have seen a drop in the number of permanent exclusions and that's to be welcomed and represents hard work that is going on in schools. The Member asked for an example about what we can do to ensure a national approach to this issue. You'll be aware that we have supported, as a Government, the creation of the adverse childhood experiences support hub for Wales, which has developed a programme for ACE awareness training for all schools. The programme is currently being rolled out across Wales, so again staff have a better understanding of maybe some of the issues that lead to a child behaving in a way that might be deemed unacceptable. By March 2020, all schools in Wales will have been able to access that training.  

Primary Education in Ogmore

7. What support does the Welsh Government provide to improve primary education in Ogmore? OAQ53946

We are providing support and driving improvements for all learners in all schools in Bridgend through the partnership of the local authority and the regional Central South Consortium.

I welcome that response and I have to say it's very welcome for me that I seem to be, every other month now, attending the opening of a new facility within Ogmore, either primary or secondary schools. Most recently, in fact, the former First Minister in September opened the new Betws primary—wonderful for that community where the previous school had been damaged by fire only a few years before—but also, even more recently, in the same community, on the same site, opening the new Welsh-medium primary school as well, Ysgol Gynradd Gymraeg Calon y Cymoedd. Now, this is part of a £10.8 million investment in the south Garw area, which of course has, as part of it, match funding of £5.4 million from Welsh Government. But could I ask the Minister: how do we match that investment in buildings and facilities with also the investment in leadership—both at a school level and an executive level, but also in governorship as well—so that the standards that we want coming out of those schools, the futures of those young people, are matched by the investment in capacity to give them that support from the people around them? And I see such good examples of it, I have to say, in my own area as well as the twenty-first century facilities.

14:15

Well, I'm delighted that the Member is pleased with the results of the investment in Betws, Calon y Cymoedd, Pencoed Primary School, which is another one I'm sure the Member is very pleased to see. Hopefully the children will take pride in and thrive in those buildings. I believe it is so important that we demonstrate to our children and our educators that we believe in them and that we want to invest in them by providing them with the very best facilities for them to learn and work in.

The Member makes a good point with regard to leadership. No education system can exceed the quality of those who lead it, whether that be in individual schools, whether that be in our local authorities or, indeed, in Welsh Government. And, because of that, we have invested in the creation of the National Academy for Educational Leadership, a first for Wales, which is working with its second cohort of headteachers, which is evaluating and accrediting new leadership programmes so that there is a national standard across all of Wales for professional development opportunities for leaders. It's starting at the moment with new and aspiring heads, but we will be developing a programme for existing headteachers as well as looking at the potential to provide leadership and professional learning for governors, for local authorities and others who are involved in providing that strategic vision for education of whatever level they currently are working at.

Educational Opportunities for Young People

8. What action is the Minister taking to improve educational opportunities for young people in each local authority area across Wales? OAQ53962

Our national mission is to deliver an education system that is a source of national pride and which enjoys public confidence. In partnership with local authorities and the regions, we are delivering high-quality educational opportunities across the whole of our nation, ensuring every learner has their chance to reach their full potential.

Thank you. The Learning and Work Institute's youth opportunity index provides an invaluable insight into the opportunities available to our young people across Wales. Having considered the findings, however, I cannot disagree with the institute's conclusion that there are some stark inequalities across Wales. It has shown that young people are more likely to have fewer qualifications and have poorer access to higher level study in the most economically deprived areas in Wales, a good example being Conwy, which has a relatively strong higher education index score of 81; Flintshire is less than half of this. Minister, the index does seem to indicate that opportunities in education remain unevenly distributed across Wales. What measures are you taking to address this?

Well, as I referred to earlier, we are providing unprecedented amounts of financial support to educate children from lower socioeconomic backgrounds via our pupil development grant. We continue to maintain education maintenance allowance for those children from a poorer background, allowing them to be able to stay on in school or in further education, and we have introduced the most generous system of maintenance grant support for those people from a poorer background who want to study at a higher education level. Of course, it should not be the case that a pupil's destiny is dictated by the size of their parents' bank balance, but I have to say to the Member who sits on those benches: the effects of poverty on a child's education are devastating, and the schools I go to say to me that it is getting worse and worse every year, and we are trying to pick up the pieces and mitigate for that in our school system, and the Member should be mindful of that when she asks such questions.

2. Questions to the Minister for Health and Social Services

The next item is questions to the Minister for Health and Social Services, and the first question is from Jack Sargeant.

Support for NHS Staff with Mental Health Problems

1. Will the Minister make a statement on the support available to NHS staff with mental health problems? OAQ53953

Thank you for the question. The Welsh Government is committed to working in partnership with NHS Wales employers and trade unions through the Welsh partnership forum to support staff with mental health problems. This is in line with the NHS Wales core principles and the quadruple aim of 'A Healthier Wales' for a motivated and sustainable health and social care workforce.

Can I think the Minister for that reply? I wanted to raise this issue because we know that mental health-related issues in the NHS are obviously an issue, as they are in all workplaces, and although we have the support networks in place, I'm sure Members will agree with me that we can always do more. Llywydd, sometimes we have to draw on the most tragic circumstances to act. Shocking figures recently revealed online show that more than 300 NHS nurses have committed suicide over the border in England in just seven years. The highest on record was 54 in 2015. Minister, would you agree with me that ensuring we have the right support for NHS staff is very important, not only for patient safety, but also to ensure that we reach our ambitions as outlined in the Nurse Staffing Levels (Wales) Act 2016? Can I also ask the Government to redouble its efforts to support our heroic NHS staff here in Wales who every day look out for others, so it's only right that we all look after them?

14:20

Yes, I'm happy to give the commitment about the Government's approach to supporting our staff within the health service. That goes into not just wanting to recruit the right numbers of staff across the service but also the additional investment we're making in training. I'm pleased to confirm that on the nurse staffing levels Act we are taking forward our commitment to roll out the Act, as well as making sure the duties are real in the first area we've chosen. And in terms of the broader support that the NHS should provide as an employer—the largest employer within Wales—that is a particular focus of activity within the partnership forum. One of the things I'm looking at is a well-being service introduced in Swansea Bay University Health Board. That's a Bevan exemplar project and it's been taken forward to the partnership forum as part of their consideration of best practice to try and further include the support we do give to our NHS staff.

I'm pleased this issue has been raised. Clearly, mental health is an issue that affects all areas, but our NHS staff clearly are vulnerable to the effects of it. You mentioned there—I think it was the Swansea area that you said there's an element of good practice. It's obviously important that that good practice is rolled out across the rest of Wales as soon as possible. So, could you tell us what steps you're taking to make sure that where there is good practice in a local health board other health boards that might not be experiencing such good practice are able to benefit from the lessons that have been learned?

Yes, I'm happy to expand further because it's a good example of how we do use our system here in Wales. The partnership forum draws together the Government, employers and trade unions. So, the partnership forum is already taking steps to look at that good practice, to draw it together, and then to try to make sure that the recently agreed policy on managing absence in the workplace that does look at prevention and supporting people to return to work earlier and to remain in work if at all possible is actually supported by practical examples of good practice, to make sure people are aware, and we then understand how the good practice is being properly rolled out across our services. So, it's a good example of looking at evidence, looking at best practice, in order to learn from it right across the system.

I'm sure the Minister will agree with me that staff can suffer considerably from stress at times of service change, even if that service change will eventually deliver, potentially, improvements in their own working terms and conditions. The health committee this morning heard from the Velindre University NHS Trust who seem to have a very positive and proactive approach to managing their staff stress through times of necessary service change, and a good understanding, I thought, of the pressures that those staff will face even though the staff themselves acknowledge that those changes will be changes for the better. What further steps can the Minister take—potentially through the partnership forum as he's already referred to that in his answers to Nick Ramsay and to Jack Sargeant—to ensure that where there is good practice in the NHS around supporting staff through service change that that is shared, and that those inevitably stressful periods are effectively managed so we don't risk situations where what is inevitably challenging actually turns into a situation that is actually bad for somebody's mental health and well-being?

I fully recognise there are different points of stress within the life of staff within our national health service, and for those in particular who deal with emergency aspects or end-of-life aspects there's particular stress that goes along with that. Any element of service change is unsettling for any group of staff in any particular part of business, industry or the voluntary sector. So, we are looking to deliberately learn from that through the partnership forum, but also to learn from where that service change has already taken place and is taking place.

We're seeing significant service change taking place within Hywel Dda, and what has changed significantly from the last time service change was proposed is there's been much greater engagement with staff at the start of that process. You will recall when you were an Assembly Member previously, that, actually, lots of staff within Hywel Dda did not feel they were engaged in those discussions. And even now, when there's much greater agreement on what the future will look like, there are still challenges to work with. And Aneurin Bevan is another good example. We're changing the system in Aneurin Bevan, with the creation of the new Grange University Hospital, and assess that there's change in other parts of the whole healthcare system. So, we are learning about what is happening now as well as in the past. The partnership forum is exactly the place to make sure that learning is shared across the whole of Wales.

14:25
Support for People with Muscular Dystrophy

2. Will the Minister outline the Welsh Government's support for people with muscular dystrophy? OAQ53958

Thank you for the question. Our support for people living with all neurological conditions is set out within our neurological conditions delivery plan. The vision is for people with a neurological condition to have timely access to fully integrated primary, community, secondary and specialist care designed around the needs of the individual person.

Okay. Thank you very much for that reply. As you will know, I chair the cross-party group on muscular dystrophy and we spend a lot of time talking about how clinicians deal with, or don't have the capacity to deal with, the particular condition. In one example in west Wales, one woman said a clinician tried to give her medication that was incompatible with her condition that could've led to creating very serious harm. Another gentleman from mid Wales said that he actually doesn't bother calling the local hospital or any emergency service because of the lack of understanding in that particular hospital of anything to do with his condition.

Obviously I'll write to you with those individual concerns, but I was wondering if you would agree to come and meet with the cross-party group in future to see how you can understand what is being discussed there and how we can build resilience in the system, so that there are more clinicians with an understanding of muscular dystrophy, if not a specialism, so that they can aid and help them feel more comfortable when they enter that setting.

That is the point about what we're looking to try to deliver: a service that is genuinely designed around the needs of the person; to understand those needs will be different according to that person, not the condition. You see the person, not the condition and that is the way on all aspects of healthcare to be delivered. I recognise there's further to travel in some aspects than others. In principle, I'd be happy to attend a future meeting of the cross-party group. I already meet the alliance of neurological conditions, and I recognise that for all the excellent work that takes place across our service, there is always a need to change and to reform. Part of my frustration is that we don't change as consistently as we would like to, as, indeed, I believe that the people that we serve deserve us to.

Can I add, Minister, to Bethan's point? We've all had casework in this area and time and again people with muscular dystrophy or other neuromuscular conditions emphasise the importance of specialist posts like specialist nurses who can train other medical staff, but also enable people to live with conditions that can last many years, decades sometimes. We really do need to see an improvement in the number of specialist posts.

And that's part of the work that the implementation group are leading. I've actually asked my officials to meet with the implementation group to look at the progress that we are making because I do think progress has been slower than it should have been, and commitments that were made within the delivery plan on how the money that the Government has allocated should be used. I expect there to be a meeting between relevant parties, including the third sector, later this month because I do want to see real progress being made, and the promises that we are making and the expectation that people should have about the service to be met in reality and not simply in theory.

Questions Without Notice from Party Spokespeople

Questions now from the party spokespeople. Conservative spokesperson, Janet Finch-Saunders.

Diolch, Llywydd. Care Forum Wales, and I do hope the Minister is fully aware of this, has undertaken a major survey into care homes across Wales. The results are startling. What has been revealed is that 16 per cent of care homes across Wales expect to close in the next five years. This is alarming, as is the fact that Care Forum Wales has estimated that more than 1,500 beds could be lost in Wales between now and 2024. To put this into context, the number of care homes for older adults has fallen by 4 per cent and the number of beds is already down 247 from 2014-15. Clearly, care home numbers have been and continue to decline. What action are you taking to reverse this and actually enable an increase in the number of appropriate care home beds?

This is a matter of concern to the Government. We are concerned about the fact that the care system is stressed and we are trying to do what we can to rebalance the care sector. One of the things we're doing is to try and encourage different models of care. So, for example, we are encouraging local authorities to consider taking more care homes in-house. We also are looking to see if we can develop co-operative models. So, we are looking at the care home system in a wider way. We're also trying to encourage the status of those working in care homes. For example, we've had a big campaign to try to attract more workers into the care section, stressing the importance of qualifications, and how to develop. And also we've improved the registration system. And we think that all those issues are going to make the care system more viable.

14:30

Thank you, Deputy Minister. A central issue that needs addressing, however, is care home funding. This is supported by Mario Kreft, who works very hard in this sector, chair of Care Forum Wales, who has commented publicly—this is what he says:

'We know that we’ve got over 80 per cent of the social care providers saying how difficult it is to attract and retain staff and the only way that be addressed is through increasing fees to realistic levels so money can be invested in the front line instead of the back office.'

The message is clear, Deputy Minister: care homes are underfunded by local authorities, and by your Welsh Government, and our health boards, to such an extent that staff—[Interruption.]—can you allow the Deputy Minister to respond to me, please—to such an extent that staff cannot be retained or paid appropriately. This is unsustainable. So, will you commit to reviewing the funding formulas used to determine fees for publicly funded individuals?

What we already have done is we have increased money to cover the living wage, so that that will help care homes in bringing up the payments to their staff to the living wage. And we're also doing some of those things that I mentioned in my earlier question—we're doing all we can to improve the status of care home workers, because I think that is one of the crucial things to do. Because looking after elderly people and children surely must be one of the most important jobs there is, and yet the status of those staff is not very high. And we do know that the wages are something that we are addressing, we've been addressing the zero-hours contracts, and we've been looking at the time that people take to travel for domiciliary care. So, I think that we are addressing these issues, but I don't deny that it is an issue, and it is a problem that we are addressing.

Thank you. Deputy Minister, you'll be aware that care homes do apply to local authorities to authorise deprivation of liberty safeguards applications. Now, according to the annual monitoring report for health and social care 2017-18, managing bodies such as care homes have been waiting an inordinate amount of time for authorisation of applications. Now, despite Welsh Government guidance stating that standard applications should have been received, and a decision made within the 28 days before it is required, the average number of days in Wales between an application being received and a decision being made by local authorities reached over 200 days in Rhondda and Flintshire, and over 300 days in Ynys Môn. Clearly, social services across Wales are struggling to process applications. What action are you, or, indeed your Government, taking to help them, so that care homes receive these very important decisions sooner?

I thank Janet Finch-Saunders for raising that important issue. This is something that I will have to go back and have to look at, to look at the details, and come back to her with an answer.

Diolch yn fawr, Llywydd. Does the health Minister accept that the finance of the NHS and the finance of social care are interchangeable, and getting the best value for money and best outcome for patients requires investment and sensible planning of how to use that investment in both services?

Yes, we're taking an integrated approach to the future of health and social care. That's why we have, for the first time across the United Kingdom, a properly joined-up health and social care plan, 'A Healthier Wales', designed together between health, local government and the third sector. And you'll see that, in the last budget, I took a decision to put part of the moneys through the health budget, and to put it back into social care. Much of the work we're doing on delivering 'A Healthier Wales' actually looks at how we fund health and social care to work more closely together. The transformation fund and proposals that I've approved are good examples of this in practice. 

14:35

Thank you for that response, even though it is actually contrary to your Government's decision to increase the NHS budget at the expense of local authority budgets. But I'm sure the Minister would agree with me that one of the non-negotiable hallmarks of the NHS is that it is free at the point of delivery, and, of course, that means free prescriptions, free surgery, free x-rays and so on. Now, we would all be outraged if we heard that somebody, upon receiving a cancer diagnosis, was faced with a bill of hundreds of thousands of pounds and they had to sell their home to pay for their cancer treatment. We would also react to a proposal to allow them to keep £50,000 instead of £30,000 in these circumstances with sarcasm about the generosity. So, why is there still discrimination against people with dementia?

Because we still have a system where social care, as you know, has a means element within it. And we're actually looking at the future funding of social care, as you know as well. I'm the chair of a cross-ministerial group looking at social care funding options for now and the future, and you'll know from previous, very public comments that I'm interested in how we use the new powers of this place, as available to us, to have a new funding stream for social care purposes. And you can't get away there from your first point, which was about the budget allocations. You know, as I do, that we are on the back of the tenth year of austerity. It means there is no consequence-free choice. If we chose to put more money—significantly more money—into the local government settlement, then that would mean less money going into the health service. There's no way of avoiding that. That's why I think, for the future, we need to not hold back in our campaign against austerity, but also to think about how we use our new powers to have a new funding stream for social care in particular. 

The funding of social care, and the predicament faced by the recipients of social care, is a significant historic injustice caused by the failure to create a national care service funded by general taxation. Would you therefore not agree that the Welsh Government proposal to introduce a social care levy, without any guarantees that this would lead to the eradication of social care charges, is unfair, and a missed opportunity to put health and social care on an equal financial footing?

There are two points that I'd make on this one. The first is that, of course, when we're comparing opportunities to use general taxation, we're not yet in a position to do so. But I do recently note a study picked up by the BBC that noted that, in Wales, citizens have a much more generous level of support from this Government for their social care needs than citizens across the border in England. So, we are making real choices even in a time of austerity to put real money into supporting social care. 

The second point is I don't want to spike the work that I'm actually doing by peremptorily announcing before my ministerial colleagues have considered all the evidence what those options might look like. And we do need to think about maximising the level of income to come in through a levy or any other means, and what that actually means in terms of what we can then do. We need to think about what our powers allow us to do, and how then best to use them, including difficult questions around intergenerational fairness, who accesses support and at what time? There are different answers around the roles. There's a report from both the select committees in Parliament, the joint select committees—the communities committee about housing and local government and also the health select committee—that I'm sure you're aware of, which may come up with an answer that would require a rise in general taxation across the United Kingdom. They've even had Conservative backbenchers signing up to a tax rise, which is unusual. So, we need to think about what the whole taxation base is and what choices we then make. 

And the second question we can't avoid either, I think, is whether or not we're prepared to have an element of ring-fencing or hypothecation, because I think there are real issues about whether politicians should be trusted to raise taxes, or whether that money should be protected, and whether that would be acceptable to the public over a longer period of time to make different choices about how we use taxation to fund the future of social care. 

Bereavement Services

3. Will the Minister provide an update on the review of bereavement services in Wales? OAQ53956

Yes. Thank you for the question. The bereavement scoping study that I've previously committed to is making progress. Over 200 responses have been received and the data collection period has been extended until the end of this month. An interim study report will be provided to the end-of-life care board later this month, and the final report is expected in October of this year.  

Minister, you're well aware of my concern that there is a lack of support for people bereaved by suicide in Wales. This matters not just because suicide is a uniquely devastating loss, and that it's the right thing to do, but also because we know that those bereaved by suicide are much more likely to die by suicide. So, support for those bereaved is in itself suicide prevention. The health committee's report 'Everybody’s Business: A report on suicide prevention in Wales' made very clear recommendations about suicide bereavement. How will you ensure that the review you have commissioned will take into account the needs of those bereaved by suicide, including listening to lived experience? And what steps will you take to ensure that a proper postvention pathway for suicide, as recommended by health committee and Professor Ann John in her review of 'Talk to me 2', will be properly resourced and developed as a matter of urgency? 

14:40

I want to reassure the Member that I do take the issue seriously, and I recognise exactly what she says about the likely risks of people dying by suicide in the future if they are bereaved by suicide in the first place, and I do take that very seriously. I want to move as quickly as we possibly can. We have choices to make about not just what the data, the evidence and submissions tell us about the support we should provide, but whether we have a national system, because that would probably mean a national organisation like Samaritans or Cruse Bereavement Care, for example, providing, potentially, a service, or whether we have, potentially, national standards where there can be local or regional delivery, because there are much smaller and more distinct groups that provide a service at present. We need to think about what sort of model we want and what sort of service we then want to be able to provide. But, for me, it is essential to listen to people who have lived experience and people who are already providing bereavement support. And I'm happy to reconfirm that Professor Ann John is absolutely part of the consideration of the comments on what we should do next. So, it is a matter of what we do, not if we do something, and I recognise that the Member will continue to ask questions until we're in a position of not just making a choice but to see a real difference having been made. 

Minister, one thing that impressed me, when I was health spokesperson for the Conservative group, around bereavement support was when I visited Nightingale House Hospice in Wrexham—a wonderful hospice, I would say, that offers great support to individuals in the last weeks and days of their life. And at that particular time, they had a specific project to support young people affected by bereavement. And very often, the youngsters, the children, that are left behind—'overlooked' is the wrong word, but the systems that are in place tend to not respond to their needs. What work has your department undertaken with the Minister for Education's department to make sure that there is the crossover from health and education in providing those bereavement services? And will the review that you have outlined be looking specifically at support that is afforded to young people who are affected by bereavement?

I'm happy to go and look properly at the issue that the Member raised. I've visited the Nightingale hospice myself, and I recognise the comments that the Member makes about their work and, indeed, other significant parts of the hospice movement here in Wales. So, I'm interested in understanding not just the work that they do, but how any strategy—and, of course, the Minister for Education is due to publish a further guidance about suicide bereavement support for schools, for children and young people—uses an understanding of the lived experience of those children and young people to further improve our service. I'm happy to write, not just to the Member, but also to make sure that the committee is kept up to date, when, of course, I and the education Minister are due to attend in a few weeks' time.FootnoteLink FootnoteLink

Supporting People with Sensory Loss

4. How is the Welsh Government supporting people with sensory loss? OAQ53938

Thank you for the question. The Welsh Government continues to support people with sensory loss through key initiatives, such as the integrated framework of action of care and support for people who are deaf or living with hearing loss and the eye health care plan for Wales.

Diolch. Well, just like people without a sensory loss, there's no one-size-fits-all way of providing information in accessible format for people with sensory loss. Some local authorities fund local organisations to provide support services to residents, enabling British Sign Language users and, in some cases, people who identify as hard of hearing or deafened, whilst others have no provision at all. The services that do exist not only provide people with a sensory loss access to information, but also go hand in hand with an advice or advocacy service. But for local authorities and Government departments, provision of information is usually produced in BSL only or in BSL with subtitles, without access to people with a visual impairment, although videos etcetera could be produced with that provision, and provision in both Welsh and English languages also. These concerns have been raised with me by sensory loss charities in north Wales. How, therefore, will you respond to their concern that the inequality in access to information for people with sensory loss is affecting the people they work with and that we need parity of funding between the general population, access to information, and that for people with sensory loss in all local authorities and not just those that choose to do so?

14:45

Well, this is a point about whether we require local authorities to provide a service where they have national standards they must meet or whether actually it's a matter for local authorities to make choices on. We do know that, because of the Social Services and Well-being (Wales) Act 2014, each health board and local authority are due to undertake, or have undertaken, a joint assessment of need in their area and they are then supposed to meet those needs. I would expect that the analysis of local need would properly take account of the communication requirements of people with sensory loss. This is hardly a marginal area of activity, given the statistics on the number of us in this room who can expect in our lifetime to have hearing or sight impairment. So, I expect this to be core business in the way that local authorities run their services. 

If the Member does want to write to me and the Deputy Minister with detail of those areas where he does believe there's an inequality in provision, we'll happily look at them and undertake to look at whether there is more that we could do or whether it is a matter for local authorities to resolve issues themselves.

Minister, the First Minister, when he held the finance Secretary portfolio, announced that the Welsh Government was committing £2.9 million to fund specialist employment and training services for people with sensory loss, and Rebecca Woolley, the director of Action on Hearing Loss Cymru, said at the time that

'We are delighted to receive this funding. Not only will it ensure that people with a sensory loss are supported to achieve their full potential but employers in Wales will be empowered to confidently support them to thrive in the workplace.' 

Minister, the commitment from the Welsh Labour Government to the Job Sense project is further evidence of the ongoing priority that the Welsh Government places on improving the employment and training prospects of people with sensory loss. So, what further actions are the Welsh Government now considering to build on such good practice so that all persons with sensory loss can access improved access to employment and training?

I think this probably crosses over a number of different ministerial portfolios, but I'm happy to recognise the improvement that has taken place, and also the work that Action on Hearing Loss in particular do in their excellence awards to highlight the areas where good practice is already taking place and where further examples can be taken from. The recent awards, held in May this year, are a good example, and indeed they highlighted the work of a number of different employers. I'm happy to talk further about this with ministerial colleagues, both the employment Minister and also, I'm sure, the Minister leading on equalities, who is in the room and who will be happy to join that conversation as well.

Dystonia

5. Will the Minister commit to establish a national action plan to guarantee that people living with dystonia in South Wales Central are able to receive the right treatment at the right time? OAQ53945

Our updated neurological conditions delivery plan sets out our commitment with NHS Wales to both raising awareness of neurological conditions and ensuring those affected by any neurological condition have timely access to high-quality care, irrespective of where they live and whether these are delivered through hospitals or in a community setting.

Thank you for that answer, Minister, and I thank you for your written response to me on previous questions that I've put to you.

You've indicated that, this month, June, you will be meeting the dystonia relatives support group and also other Members in this Chamber, along with the chair of Cardiff and Vale University Local Health Board. There have been recent cancellations in the botox clinic that is available to dystonia patients, and some 300 patients have had their appointments cancelled as I understand it. There are 3,500 patients across Wales who suffer with this condition. Will you be addressing these cancellation notices that have been sent out to patients and making sure that, where patients do have appointments for this very troubling condition, those appointments are honoured and that serious thought is given to a national plan of delivery for dystonia patients, because, as I said, there are 3,500 patients across Wales suffering with this condition?

I thank the Member for the follow-up question. I did meet yesterday with the Dystonia Society support group and two Members who aren't in the Chamber today—Vikki Howells and Dawn Bowden—to disucss some of the challenges that the Member raises. I've committed to intervening and clarifying expectations, and to making sure that there is further movement made. It's partly about staffing within the service. It is a service that is delivered on a hub-and-spoke model, with Cardiff being at the centre of it for south-east Wales, and led by Swansea Bay University Health Board for south-west Wales. I want to see proper investment made in staff, because that's the key issue to making sure that people are seen on time, because I do recognise that not having an appointment does have a real impact on people's quality of life, whether people are in work or not. So, yes, I'm committed to seeing further action taken, and I'll happily update Members when that further action has been undertaken.

14:50
Hywel Dda University Local Health Board

6. Will the Minister make a statement regarding the provision of care services in the Hywel Dda Health Board region? OAQ53966

Ensuring that people have access to high-quality care is a key priority for the Welsh Government. This is why we are investing £180 million this year that will be targeted across the health and social care system to support the development of seamless models of care in all regions.

I'm grateful to the Deputy Minister for her answer. The health Minister himself will be aware of a very distressing individual case that's been brought to me from a family in my region. The gentleman had very complex care needs and an agreed package for him to be able to released from hospital to go home under continuing healthcare. The collapse of Allied Healthcare Ltd led to a situation where the care package that was provided for him at home was unsustainable and, in fact, dangerous. He was then readmitted to hospital. There's been a whole history—and I will happily copy the correspondence to the Deputy Minister—around this, because there has been a whole catalogue of issues that have led to the gentleman being readmitted now, after six months of this, to acute hospital.

I'm wondering if the Deputy Minister will undertake today to make an assessment of how many patients have been affected across Wales by the collapse of Allied Healthcare Ltd. It is, after all, now 12 months since the financial warnings were first made and six months since the company actually collapsed. So, I'd like to know how many patients in Wales have been affected by this. I'm sure that my constituent won't be the only one, unfortunately. Can the Deputy Minister please undertake to investigate how many of these patients still lack an adequate care package and whether that's meant that they're at home and are not receiving the care package they should have, or whether that's meant that perhaps they're inappropriately being placed in residential care?

Could I ask the Deputy Minister, with the Minister, to undertake to look at the effects of this, potentially, on district nursing teams? In this particular individual case, the district nursing team did their best to step into the gap, but that simply wasn't possible. And can the Deputy Minister undertake to have discussions with the Hywel Dda health board—but there may be others across Wales—and the relevant local authorities, to look at what work they're doing to replace the specialist care packages that have been lost by the collapse of Allied Healthcare Ltd? And finally, does the Deputy Minister agree with me that this particular case highlights the risk of depending on private sector companies to provide these extremely important care packages for some of our most vulnerable citizens? Will she undertake to work with local health boards and local authorities to develop more alternative and sustainable models so that no other patient will have to put up with, and no other family will have to put up with, what this family and this gentleman have gone through?

I thank Helen Mary Jones for that question. I am aware of the correspondence that Helen Mary Jones had with the Minister about her constituents, and I'm aware of the distressing nature of what happened. I do believe that the financial failure of Allied Healthcare before last Christmas undoubtedly did put huge additional stress on the local health board and on the local authority. And, I think it's important to remember that the regulation put in place under the 2016 Act requires providers to listen to what matters to the individual, which is something that I think came out very strongly in the correspondence that I saw. Also, it emphasises the quality of care, and it was very regrettable when the the situation developed as it did with your constituent.

We know that there are huge pressures on domiciliary care and on continuing healthcare, and I think there's no doubt that the Allied Healthcare situation did make that worse. I'm certainly prepared to look at some of the points that she made. I mean, we are already looking at trying to diversify the whole sector, because the strain of having this total dependence on private care provision is not healthy. We need the private care provision and there's some excellent provision there, but we also need, as I said in response to the questions from Janet Finch-Saunders earlier, some other models of care so that we're not dependent on one area—for example, developing social value businesses and co-operatives, and also encouraging local authorities to take more provision back in-house. So, we're already doing that because it is part of our workstream, and I think this has all highlighted that. And I think the effects that it's had on the district nursing service and the effects it's had on individuals and how many they are is something we could look at as part of the wider inquiries that we're looking into about how the social care system is going to develop.

So, again, I'm really sorry for the experience that her constituents had, and we do want to try to avoid that happening. But I think it is also important to say that when Allied Healthcare did collapse, Carmarthenshire and Pembrokeshire did move quickly to take their homes in-house, which is obviously a good move forward. But, with the continuing healthcare situations, I know that has been more difficult.

14:55

Deputy Minister, I recently met with representatives from Solva Care, a registered charity currently operating in the village of Solva in my constituency. Now, the charity operates a very innovative model for delivering care, with a clear focus on keeping people in their own homes. The aim of the charity is to improve the health and well-being of the community, and it holds events to counteract loneliness and isolation, as well. If you haven't already done so, I'd encourage you and, indeed, the Minister to look at the specific model of care, given that Solva Care is doing a fantastic job in its community. Bearing in mind this model's specific success, what consideration has the Welsh Government given to these kinds of community models and what support can the Welsh Government provide to organisations such as Solva Care?

I thank Paul Davies very much for that question, and, indeed, I'd very much like to visit, perhaps, Solva Care and see exactly what they're doing, because what they're doing is completely in line with what we want to do as a Government. Certainly, combating loneliness and isolation, keeping people in their own homes, I think those are exactly the things that we are trying to promote as a Government. As part of our survey and review of all the types of community care that are being considered, certainly care by the third sector and the voluntary sector is one of the key areas that does provide the variety of care that we're looking for. So, certainly, I think this is an example that we'd be very keen to look at and to see if we can encourage it, and others like it, to bring this variety of care that we need so that we are not put in the position where we are very heavily dependent on one sector.

Ambulance Services in Blaenau Gwent

7. Will the Minister make a statement on ambulance services in Blaenau Gwent? OAQ53952

I thank him for the question. The Welsh ambulance service continues to deliver a safe and timely service to the people of Blaenau Gwent. In April this year, 71.2 per cent of emergency responses to red calls within Aneurin Bevan arrived within the eight-minute target, with a median response time of just five minutes and 38 seconds.

Thank you very much, Minister. I think all of us recognise the hard work that goes in from paramedics to ensure that people do feel, and are, safe in their homes. We also know that some calls are delayed, particularly amber and green calls, and we also know that there are some significant issues that prevent the ambulance service operating efficiently. I'm thinking particularly of the handovers in hospitals, and you will have seen some reports about that in the press and the media earlier this week. We also know from the statistics you yourself have published that something like 21,000 hours were lost in the first quarter of this year in terms of ambulance handovers at hospitals. Now, we know we have very hard-working staff in accident and emergency, who feel under enormous pressure because of the pressures on that service, and we also know that ambulance workers are working at capacity as well. So, it appears to me that we have a system where we have two groups of people who work extraordinarily hard to keep us safe and to provide us with the services we need, but the system itself seems to be preventing them from always doing that. Minister, would you undertake to look again—and I know we've discussed this before—at the way in which ambulance handovers at A&Es are operated to ensure that ambulances are able to meet, I think, the 15-minute target that you have established for them and are able to spend more time providing this service and less time at handovers?

Yes, I'm happy to look again. In fact, there is work already taking place. Yesterday, we had an opportunity to talk about the amber review, and in eliminating those really long waits that do take place, part of that is actually about releasing the capacity that is often held up at a hospital site. Within Aneurin Bevan recently, in the last quarter, they had the highest number of delays of over one hour. We have two particular measures: one of whether ambulances are released within 15 minutes, and the second measure of whether they're released within an hour. So, there's real pressure within the current system.

Now, in the medium term, we'll have a new facility in the Grange, which should mean that we have a better process and a better system for people to work in, but that does mean that, for the next couple of years, before the Grange comes on stream, we do need to make sure that we improve the system that we have. That is about the whole system. It is about social care. It is about the way in which we organise different parts. It is also about the practice and procedure within emergency departments as well. I'm actually meeting a group of clinicians to look at a review of emergency department measures to try and help to change the leadership and the culture within those by listening to their peers as well. This isn't about the Government centrally dictating; it is about good practice in different parts of our system, learning from each other and real leadership. I'd be more than happy to discuss some of the detail with you outside of the Chamber as well.FootnoteLink

15:00

Further to Mr Alun Davies's question, Minister, figures show that ambulance crews across Wales spent more than 65,000 hours waiting to offload patients at hospitals last year—and you mentioned already the 25,000 hours since 2015, also on top of it. What action is the Minister taking to address the problem of extended handover delays to improve ambulance services in Blaenau Gwent and elsewhere in Wales? We know the ambulance people are doing a wonderful job, but what are the reasons and facts and figures that the handover time is so much outside hospital rather than people being in hospital? Thank you.

I'm not sure, Llywydd, I can detect anything different in the question the Member has asked to the supplementary asked by the Member for Blaenau Gwent. I repeat again there is a series of work already in place to look at measures within emergency departments, as I indicated in answer to Alun Davies. Overall within our system, we've had improvement within the last quarter, but there is a challenge within the Aneurin Bevan University Health Board area, and I'm looking to see what happens across the whole system to deliver the improvement. But, other than that, Llywydd, I don't think I can add to the answer I've already given on the same subject.

The North Wales Speech and Language Therapy Service

8. Will the Minister make a statement on the north Wales speech and language therapy service? OAQ53968

Thank you for the question. It's the responsibility of Betsi Cadwaladr University Health Board to ensure it provides adequate access to therapy services, including speech and language therapy, taking account of relevant best practice. I am happy to confirm, though, that within north Wales no-one waits beyond the 14-week target for therapy services, and that of course includes access to speech and language therapy.

Diolch. I've been, since 2017, in touch with a constituent, a former therapist, who was among staff who decided to blow the whistle on concerns they had relating to Betsi Cadwaladr's speech and language therapy department. The concern is two fold: firstly, a clinical governance issue, with real concerns about workload pressures, negative workplace culture, dilution of services and a risk to both staff and service users, they believe. But there is also a deep feeling that, in their own words, the whistleblowing process in Betsi Cadwaladr University Health Board is broken.

Now, we know that children who don't get the help they need with their communication can experience lifelong impacts—education, employment, mental health, well-being and so on. I've dealt with a number of cases where children have had prolonged waits for therapy, or have experienced unsuitable therapy—one case identifying a prolonged wait for therapy in Welsh, for example. I'm pleased that we are finally at a stage where an external, independent investigation has been completed. 

Now, whilst it's clear to me that there needs to be a review of the whistleblowing process, based on my constituent's experience, will the Minister agree with me that, in the interests of transparency, the independent report, which I'm told won't include any recommendations as such, is made readily available to my constituent and others with similar concerns, and that opportunities are then given to those who have raised concerns to work with the health board to discuss their needs and how to improve services?

I think there are two points that I would make in response. The first is to recognise that, in making sure that the current performance of people being seen within a reasonable time continues, it is important to continue to look at how the service is organised. And there are times we underplay the efficiency or inefficiency that we build into the healthcare system by continuing to run a system in the way it always has been run. For example, the place an appointment takes place—is it easier and more convenient to see people in community settings? What do we need to do to make sure those settings are appropriate for people to have appropriate assessments made, rather than potentially asking people to travel to hospital-based services? So, there is something about the community footprint as well. Your point, really—in terms of the focus of the constituency issues that I understand you've been dealing with, I'm not aware of all of the details, so I won't claim to be, but I know you say there's been an independent investigation. I don't think I can give commitments to publish an independent investigation that I'm not sighted on—I believe it's the health board that have agreed to appoint someone to undertake an independent investigation—but I'd want it to be properly transparent and also to make sure people do want to work together to try and improve the service. So, perhaps you'll want to write to me or talk to me afterwards. I want to make sure there's a maximum amount of transparency to help further improve the service.FootnoteLink

15:05
Supporting Victims of the Contaminated Blood Scandal

9. Will the Minister provide an update on what the Welsh Government is doing to support victims of the contaminated blood scandal? OAQ53972

Yes, and thank you for the question. Through the Welsh infected blood support scheme the Welsh Government provides a comprehensive package of not only ex gratia payments but extensive wraparound support that includes psychological support, benefit advice and support and signposting to other public services that we provide across Wales.   

The Minister will be aware that the BBC reported the case of Kirk Ellis from Caerphilly, who contracted hepatitis C when he was a toddler, and it first came to light he had that when he was 13. He receives £18,500 a year in compensation. In April, the Prime Minister announced that patients in England would receive an extra £10,000. That would not apply to patients affected in Wales. It isn't fair that the 175 people in Wales with haemophilia who were infected in the 1970s and 1980s get less financial help than in England and Scotland. Health—although it's a devolved matter, Kirk Ellis recognises that this happened before devolution, during the UK Government's watch, and that they should be responsible for making payments. But, whatever happens, this needs to be resolved, and I'd like to know what the Minister is doing to get this issue resolved and ensure that fair payments are happening across the United Kingdom.

Yes. I've seen the interviews that your constituent has given, and he does recognise, as you say, that this happened pre-devolution, and you would ordinarily expect the UK Government to take on continuing responsibility for what was a real scandal undertaken, over many decades, where people were innocently infected and their whole life has been affected. I was disappointed that the UK Department for Health, on the day that the inquiry finally started, announced an entirely new payment system only for English residents, without any kind of notice or discussion with Wales, Scotland or Northern Ireland, that ran contrary to previous agreements and discussions that had taken place, because there are differences in the support schemes that are available across the United Kingdom. I think it would be sensible if we could come to the point where we had a support system that was consistent across the United Kingdom. That requires the four Governments to work together. That was given to us before the inquiry started, and then a surprise announcement was made. Our officials, though, do continue to talk, and there's a meeting due to take place between officials in the next week, and we are looking to have a date when UK Ministers can discuss these matters together—from each of the three Governments, Ministers, and a representative from the Northern Ireland Government as well—before the end of summer recess, because I do want to make progress, and I certainly don't want to leave this issue to carry on with an annual competition between the four Governments, rather some sense and sensibility to recognise we need to support the people who have been affected, because there's still quite a lot of their life to be lived.

Thank you, Minister.

A point of order in relation to questions, Mark Reckless.

Llywydd, previously groups of four or more Members have been allowed the same number of questions as have larger groups. When the education Minister led a group of five that was embedded in the Cardiff Bay consensus, there was no question of cutting back their number of questions. Now it's the Brexit Party you want to cut us back to only a quarter of the number of questions of other groups. Presiding Officer, won't people conclude that you are biased as part of the remain establishment?

I was going to thank you for giving me notice of the point of order, and for our discussions on this matter earlier this week, but I probably won't thank you after that contribution. Just to reiterate, as I did in our meeting earlier this week, that the allocation of leaders' and spokespeople questions is at the discretion of the Chair, and I've decided to give the brand new Brexit Party group the same allocation as the UKIP group had most recently. Allocations reflect the general balance and are not an exact science or a pro-rata calculation. So, it'll be my responsibility to ensure that your group has a fair, general allocation of time across questions. But to do that I need to point out to you that I can only call your Members if they make requests to ask questions, and, for the record, for Members, I received no such requests from the Brexit Party today.

15:10
3. Topical Questions

Therefore, the next item is topical questions, and that question is to be asked by Russell George.

The Expert Commission on the M4 Corridor around Newport

1. Will the Minister make a statement on the expert commission that will be appointed with regards to the M4 corridor around Newport? 318

Yes, of course. Earlier today I issued a statement informing Members of the expert commission, including the terms of reference.

Can I thank you, Presiding Officer, for accepting this topical question? And it would have been helpful, I think, if the Minister had brought an oral rather than a written statement on this matter. Of course, I read your statement today, Minister, and, as far as I'm concerned, from reading the statement we are going back to square one, with another expert commission appointed to look at alternatives to the Welsh Government’s own proposals after, as we learned from the statement today, £114 million of public money being spent or wasted on developing proposals for a two-year long independent public inquiry. I would agree with the comments in your statement today, Minister, that the Welsh Government does need to find a solution quickly, so I do have a number of questions.

What will be the timetable for the expert commission to report? What budget will you be allocating specifically for the works of the expert commission? Who will appoint the members of this commission, and how long will this recruitment process take? And will you commit to abiding by the commission’s conclusions or will there be capacity for this expert commission’s reporting to be disregarded? Minister, you’ve told this Assembly that it is essential that we plan transport holistically and that we do not see transport modes in isolation, and you went on to say that, if you were to maximise the capacity on the metro, the maximum you could remove from the M4 was only 4 per cent. Do you think that any alternative proposals you make will remove more than 4 per cent?

The First Minister pointed out yesterday that a series of fast-tracked targeted interventions to alleviate congestion on the M4 will be made in the interim period, and your statement today has alluded to that. If the Minister thinks that short-term measures are effective, why have they not previously been implemented when they could have been in place years ago?

And finally, Presiding Officer, the Minister has previously said, and I quote here, that piecemeal and useful improvements have been undertaken over time, but they’ve only postponed the issue— they’ve only postponed the issue—this piece of infrastructure needs a major long-term upgrade. So can I ask: does the Minister now believe that such a major infrastructure upgrade on the M4 will no longer be needed?

Can I thank Russell George for his questions, and assure him that we are most certainly not going back to square one? And that’s why we are able to ask the commission to bring forward recommendations within a period of six months from being convened. We’re not going back to square one, because all of the traffic flow models, all of the assessment, all of the analysis of 28 plus proposals now exist. The inspector’s report is comprehensive and provides an assessment of each and every one of those 28 proposals. However, the commission will be free to consider alternative and additional proposals. The commission will be established with expertise from the transport field in which to do so. And, therefore, the money has not been wasted. Indeed, when you compare the proportion of the cost for the development of the M4 against other major road schemes, the developments cost as a proportion are actually very favourable—they amount to 6.3 per cent. In contrast, Llywydd, the A487 Caernarfon-Bontnewydd bypass was 9.4 per cent, the A465 section 3, 9.8 per cent, the A40, 11.5 per cent.

Projects cannot be developed for free, and it's only right and proper in a democratic process that a full opportunity is given to the public to scrutinise the Government's case. The Government's case was strong and compelling, as was shown by the inspector, but times have moved on quite considerably since 2016, when we pledged to construct a relief road, and it's my determination now to move forward at pace with alternatives and a combination—not just one potential intervention, but possibly a combination of interventions, many of which may be contained within the 28 that were presented to the inspector, and to move ahead with them at great speed.

I can tell Members today, regarding the timetable for putting together and inviting the commission to report, that we'll see members appointed—they will be agreed between the chair and me—before the summer recess. Their work will commence as soon as possible after that date, but I will be meeting with the chair on Monday to discuss the work and the inspector's report and the assessment and the analysis that has taken place already. As I said in the statement, I expect an interim report within 6 months, but I've been very keen and clear in saying to the chair and to the public that, if the commission is able to bring forward viable suggestions that can be delivered in the short term, immediately, within that six-month period, then it should do so without delay.

Now, Russell George asked the very important question of whether the recommendations will be binding. They will be considered by Government, but they will be conditional on them showing value for money. I do not wish to waste public money on projects that will not deliver. They will also have to be affordable, given, not least, the position of the First Minister on the M4 black route, where it was judged to be unaffordable. And then, thirdly, they must be deliverable. We saw during the course of the public inquiry some suggestions proposed, including a very, very lengthy tunnel that would not be deliverable. We wish to see deliverable solutions implemented.

Russell George is also right when he points to the 4 per cent figure concerning how many people we can take off the M4 and utilise public transport. Public transport could be part of the mix of interventions, and that's why I've said that we're not just looking at one single solution, one magic bullet; we're looking at potentially a combination, and a combination of solutions that may have to be sequenced in a certain way.

In terms of the fast-tracked interventions that I have detailed in my written statement, I'm pleased to say that we are in a position now, having tested some of those interventions on the A55, to move ahead with them immediately now on the M4. And where we have introduced them on the A55, I think they've proven to be very successful indeed in alleviating congestion quicker when incidents and accidents occur. And insofar as the question of whether a major piece of new road infrastructure would be considered, well I've said to the commission chair that his remit should be broad; he should be able to consider, with the people that will be appointed alongside him, road-based solutions, but they must meet the bar that has been set by the First Minister. They must be affordable and they must not contribute significantly to climate change. They are fundamental positions that will not shift during the process of the next six months.

15:15

I'm pleased to have an opportunity to pose a couple of questions. I think it was the correct decision not to press ahead with the black route. I'm not as convinced as the Minister is that things have moved on so much since the proposals were originally made. There have been plenty of people, including my party, who have been arguing—and the Minister sat behind you—for many years that this was likely to be seen, ultimately, as being unsustainable both environmentally and financially. And, for the record, I would be pleased to see a significant amount of money being spent on improving the road network in the south-east of Wales, but that has to go side by side with a real drive for modal shift in the south-east of Wales, as elsewhere. I think that was what was completely lost in the commitment to spend as much as was being proposed on the black route.

A couple of questions arise, really, from your statement this morning, the written statement. You say that a number of short-term steps will be taken—additional traffic officers, for example, not closing lanes during major events, more rescue vehicles and so on, just to keep traffic flowing. Why on earth, people will be asking, were these measures not already in place, given the serious congestion on that stretch of the M4?

On the commission, I, too, want to see and hear a bit more on a timescale for the work that you expect to be carried out by the commission. I think we should be very wary of looking for things that the commission say can be done within six months. I don't think it is that kind of short-term knee-jerk response that we need. If it isn't an oxymoron, I think we need an urgent look at long-term strategic answers for transport, not just in the south-east but a wider look at what can be achieved with the money that is available.

So, one on timescale, but secondly, surely the work that you're allocating to this commission should be work that you should be giving to the National Infrastructure Commission for Wales. That already exists. And I know you say that this is a vehicle that will be charged with delivering a specific project, but surely this could be a real test for that new infrastructure commission for Wales, in being given a task that has a long-term strategic mission. I just don't understand why you'd want to create a new commission when you already have that body in place.

15:20

Can I thank Rhun ap Iorwerth for his questions? The latter question, I think, is particularly valid—the question of whether NICW should've been tasked with this particular piece of work. That was something that I carefully considered, and I judged that because the National Infrastructure Commission for Wales has already commenced work in various areas looking at other forms of infrastructure—for example, in digital—if we were to invite the National Infrastructure Commission for Wales to undertake this piece of work, it would swamp them and prevent them from moving ahead with other important pieces of work that must be considered in our long-term interests.

In terms of the timescale, well, my statement is very clear about this: the commission will consider short-term interventions and longer-term solutions, including the behaviours that lead people to travel in certain ways and to choose to travel by certain modes. We always showed, with our evidence, that the black route—it was recognised fully by the inspector—was designed fully in conjunction with other forms of transport, particularly with the south Wales metro, in order to design a fully integrated, modern transport network across the region. That work, as I say, was recognised by the inspector.

We do wish to see a significant modal shift take place, which is why we are investing more than ever before in active travel, and why, with my deputy leading on active travel, we are determined to see more people leave their cars for other forms of transport. I can tell Members today that one of the pilot schemes that we are rolling out on bus travel—demand-responsive travel—has been tested elsewhere in the UK, where it's found that more than half the people using that particular service were first-time users of buses. That's the sort of modal shift that we are leading on in the Welsh Government.

Rhun ap Iorwerth recognised that this was the correct decision—I am grateful to him for agreeing. I think it's important to recognise that when times change and when circumstances change, then you have to consider afresh proposals that are promoted and put forward by a Government. It's important to recognise equally, I think, that one of the alternatives that others have proposed in this Chamber—the blue route—was roundly destroyed by the inspector as a valid alternative to the black route. Therefore, the commission will have to be not just analytical but very creative in looking at alternative solutions.

Like others, I was grateful to you, Minister, for your statement this morning and grateful for some of the detail that it contained—I very much welcome what you've said. Can I say that one of the reactions I've seen from my own constituency has been concerns about timescales and concerns about the time that this is going to take? I'm very interested in the terms of reference that you've set out for the commission, and I should say I welcome Terry Burns's appointment as well—I think somebody of that stature is somebody who can drive this work forward.

But, what isn't clear from the terms of reference is what the objectives are for this work—what is the purpose of this? Reading through the terms of reference, you could very easily come up with the black route and start again. I'm sure that's not the intention, but the terms of reference are drawn quite widely, which, on one level, is something to be welcomed. But I think also people want to know what is it that you seek to achieve and on what timescale. I would like to see a very clear commitment to reducing congestion—but by what proportion? How do you intend to reduce congestion? What is the target for reducing congestion? What is the impact going to be for the wider economy? I'm sure others will discuss the issues around Newport itself, but this is a key part and a key driver for the economy of the whole of south-east Wales and the Gwent valleys, and so there will be people who'll be very concerned to ensure that what we do in Newport in alleviating the difficulties around the M4 also has a wider economic impact than would have been the case with the black route.

So, I hope over the coming weeks when you are able to come back to us with further statements on this matter we will see clear targets, clear objectives, we will see clear timescales. There's a great deal of cynicism, Minister; people don't believe that you as a Government are actually going to achieve something through this commission. I do believe that we do need a clear timescale, clear ambitions and also very clear targets for achieving the objectives that you will set yourself, and also doing it in such a way as to ensure that the whole economy of this region benefits from this work.    

15:25

Can I thank Alun Davies for his questions? I do recognise the frustration that many people across the region feel. This is a problem that has affected south-east Wales for decades, and it's a problem that we are determined to get to grips with and to solve. That's why we've appointed Lord Burns to chair a commission of experts. That's why I have great confidence in the commission to be able to propose solutions that will lead to reduced congestion and as near as possible to free-flow traffic. 

I've already identified the timescale for the work that will take place, and we have informed the commission chair that we would wish to see immediate interventions produced in their interim report, if not sooner, as I have said to Russell George. And the purpose of the commission's work is crystal clear: it's to identify deliverable alternatives that offer value for money to the black route scheme that will reduce congestion to a level as close as possible to enable free-flow traffic to take place.

Now, of course, each and every suggestion and proposal that are presented by the commission will be scrutinised by Ministers for the deliverability and value for money that they present, but given that we are appointing traffic experts or transport experts to the commission, I have every confidence in them proposing deliverable and affordable solutions within that six-month time period.   

Obviously and inevitably, many of the questions that I was posing or about to pose have been asked, but the Minister will obviously be sensitive to the general concern amongst the public about the cost implications of this new commission, given the enormous amounts of money already expended in the long-ranging and long-running inquiry. I'm sure he would agree with me that they have a right to ask how much it will cost, how long it will run for and who will constitute the commission. I know that in your statement, which I thank you for, Minister, you have given some indication on some of these questions, but would you reiterate them here this afternoon so that the general public may have some of their concerns somewhat allayed? Given that there were some 100 submissions on alternative strategies to the black route given to the inquiry, how will these be evaluated and are there closing dates for new submissions? Last but not least, when can we see actual physical work commence to alleviate the ongoing dire problems with the Brynglas tunnels? 

Can I thank David Rowlands for his questions? It was remiss of me not to answer the question that I think was first put by Russell George concerning the cost of the commission. I can assure Members that the cost of the commission will be kept to an absolute minimum, because we'll be providing the secretariat services and we'll be providing the transport expertise in the form of existing officials and their time.

In terms of the composition of the commission, I am also keen to see potentially a police representative—a traffic officer who is able to offer advice and expertise and intelligence on that particular stretch of road. In terms of new submissions, this will not be a fishing exercise by the commission. The commission will consider all of those proposals that already exist, and any that those experts themselves wish to consider. That said, I'm also determined to ensure that the citizen's voice is heard, and so, as I said in my statement, I have asked the commission to come forward with proposals for how the people, not just of the area that this road affects, or the region that it affects, but the whole of Wales, can become part of a co-produced process. 

15:30

Minister, the problems on the M4 around Newport are urgent and pressing, and obviously they do need short-term, medium-term and long-term responses. Personally, I believe that 'predict and provide' has largely been discredited as a model for dealing with these issues, and that's why I very much welcome the decision that Welsh Government has made, because trying to predict traffic growth and then building new roads to accommodate those predictions has been seen to merely result in those new roads filling up with more and more traffic journeys, and that doesn't benefit anyone. So, I do believe we need new thinking, more imagination and that modal shift, together with better traffic management. 

So, in order to achieve that, Minister, we will need some early actions. And I wonder whether, as I raised with the First Minister yesterday, one of those early actions might be consideration of the Magor and Undy walkway proposal for a new train station under the UK Government's new stations fund. And, as you know, the local community group are seeking Welsh Government funding to match that available from Monmouthshire County Council to take forward that application into the next stage of the UK Government process. So, I wonder if you could give any positive indications on that. 

In terms of the commission, Minister, obviously Newport City Council will be required to deliver many of the actions—inevitably, I think—that will be coming forward, so it seems to me appropriate for Newport City Council to have a presence on that commission, and I wonder if you would indicate that that will be case.

Just in terms of some of the calls that I think we've already heard, Minister, we've heard calls from Members in this Chamber for spend from these available moneys right across the length and breadth of Wales, and that's understandable in a way, because, obviously, Members have their own pressing concerns in their own areas, but obviously what we're talking about here is the M4 corridor around Newport. That's where the problems are, and that's where the spend of available moneys must take place. And I wonder if you would agree with that, Minister, and give some reassurance on that front. 

Can I thank John Griffiths for his questions, and for his contribution in particular with regard to the 'predict and provide' model? This is something that the inspector considered in great depth, and I'd like to take this opportunity to put on record my thanks, not just to the inspector, who has sadly passed away, but to his team that did such a commendable job over many months. I, more than a year ago, said that I wished to ensure that every person had the ability to be able to contribute to the public local inquiry. I think that did occur, and that's why the public local inquiry took such a great length of time, but the inspector and his team did a fantastic job in ensuring that all evidence could be carefully considered and presented. 

John Griffiths is right that there is no free money attached to the announcement that the First Minister made. There is no windfall that will see vast amounts of money spread right across the length and breadth of Wales. Why? Because much of the cost would have come from other transport projects that would either have to be cancelled or delayed, would have come from school building projects, hospital and healthcare building projects, or new homes. Those projects will now, as a consequence, go ahead. So, we won't necessarily be introducing new pet projects to a list. A list that yesterday, the First Minister said, amounted to about £2.2 billion; today, it's £3 billion. And I'm sure that it will continue to rise. 

The commission are tasked with solving a very specific and definable matter—that being congestion on the M4 in and around the Brynglas tunnels. And so it will be for the commission to consider any proposals that will contribute towards the alleviation of congestion, including any work that might have to be undertaken in opening stations or enhancing stations in order to get more people to use public transport, which could then contribute towards a reduction in congestion. I do not wish to prejudge the work of the experts in this field; instead, I wish the commission to judge any proposals that might come forward.

15:35

Thank you for your statement, Minister. And, as the Member for Newport West, I'm sure you'd appreciate I have many questions, but I'll keep them as brief as I can.

Firstly, I welcome the Minister's commitment to listening to the people whose daily lives are affected by the road. How exactly will the commission ensure that these views are fully captured? The vast majority of M4 traffic around Newport is not local traffic. With so much cross-border travel and an increase of 10 per cent of journeys on the bridges, can the Minister confirm that the commission will look at traffic travelling to and from England?

I'm pleased that the statement recognises the need to alleviate congestion and resultant air quality issues. In the immediate instance, what discussions have the Minister's officials had with Newport council officials to ensure that Newport are able to access funds already in place to tackle air quality?

In reference to the projects designed to bring modest but immediate benefits, such as the additional traffic officers and dedicated recovery vehicles, my constituents will be asking why these haven't been put in place before. And what evidence has been drawn upon that demonstrates that these will work effectively?

And, finally, and possibly most importantly, the people of Newport have suffered for long enough and have seen many reviews come and go. What reassurances can the Minister provide that this commission will finally be the one that actually delivers meaningful results?

Can I thank Jayne Bryant for her questions, and her very great concern over the impact that yesterday's decision will have for her constituents? I know that Jayne has been a very keen supporter of the black route, and is very disappointed that the project is not going ahead. However, can I assure the Member and her constituents that we are determined to solve the problem of congestion on the M4 in Newport, and to reduce levels of air pollution along that particular corridor? I believe the figure for the reduction of air pollution that was considered to be medium or high would have been about 500 for the black route—500 homes; I think 12 would have seen a very significant reduction; and over 10,000 would have seen a very small reduction—nonetheless a reduction. So, I'm conscious of the need for us to implement solutions that will drive down levels of air pollution, and I'm absolutely committed to that—so are my colleagues across Government.

Newport council, I'm pleased to say, have engaged already with Welsh Government concerning proposals for the M4. Engagement has gone on now for many years and will continue with regard to alternatives. Insofar as the immediate responses, and the question that was raised about why we haven't implemented these to date, well, it's because we have tested the additional patrol systems and the immediate response and recovery systems on the A55. They have been tested and they have proven to be successful. That enables us now to move them out onto the M4, with confidence that they will alleviate congestion.

Jayne Bryant also raised a very important point of ensuring that citizens have a voice in this process. And I'll be discussing on Monday with Lord Burns how people will be able to contribute, in terms of their views, opinions and their concerns. And it may well be in some form of a citizens' assembly, but that is something that I wish the commission itself to bring forward proposals on. Again, I would like to thank Jayne Bryant for her keen concern over this issue, for many months and years. I can assure her that the commission will look at all of the transport models that exist, and all of the transport flow data that we are armed with, including the transport data concerning cross-border flows, in order to ensure that we produce either a solution or a set of solutions that are deliverable in the short term, as well as also, of course, leading to behavioural change and modal shift in the longer term.

Whilst I agree with my colleagues for Newport East and Newport West that we need to spend the bulk of the money around Newport to alleviate the congestion there, is it not also important that these transport experts look in detail at the data that we've got? For example, the fact that there is nearly a 40 per cent increase in the number of vehicles using the M4 east of Newport compared with west of Newport, suggesting that they are on their way to Cardiff, and that surely we must look at the mobile phone data and other data that's available to see where we need to put in public transport to encourage people to use public transport rather than individual cars? 

15:40

Can I thank Jenny Rathbone for her questions? Of course, Cardiff is one of the fastest growing cities in Europe. It's something that we're very proud of. It's an attractive city for people to invest in, to work in, to learn in, to bring up families in, and we wish to ensure it remains an attractive city for people to come to. Likewise, we wish to see other places across the M4 corridor and in the wider region of south-east Wales benefit from improved transport infrastructure that will enable them to be more attractive places to invest in, and to live in and to study in. In order to ensure that we go on investing in transport, we have to ensure that equally it's affordable and that we're investing in the right transport solutions. Utilising experts in the form of transport experts and economists in this commission will enable us to do that.

But I would just give a note of caution when it comes to mobile data. Of course we use data that enables us to ascertain where traffic is coming from, where it is going to, whenever possible the purpose of those journeys, but there are legal constrictions on what mobile data we can use. We, I can assure the Member, will only ever operate within the law. 

4. 90-second Statements

The next item is the 90-second statements, and the statement from Darren Millar. 

Diolch, Llywydd. Tomorrow marks the seventy-fifth anniversary of D-day. On the morning of 6 June 1944, the largest armada in history anchored off northern France preparing to disembark thousands of allied troops onto the shores of Normandy. What followed resulted in one of the bloodiest episodes of the second world war and marked a pivotal moment in the campaign against Hitler. Waiting in the ships, as part of Operation Overlord, were hundreds of Welsh soldiers, all of them from the formidable South Wales Borderers of Rorke's Drift fame.

They spent two months in training and were now ready for the invasion to begin. Their task was to follow the first waves of troops by landing near Arromanches and to push inland to the high ground north of Bayeux. On their way, they were to capture a radar station, as well as the guns and bridge at Vaux-sur-Aure, and to link up with American forces. It was a daring plan. As they waited, the smoke from the battle rose into the air and the sound of explosions echoed across the water. The order to land came just before noon. On landing, they pushed quickly forward, driving the Germans out of the radar station and by nightfall they had taken the guns and the bridge at Vaux-sur-Aure. By midnight, the South Wales Borderers had captured more ground than any other unit involved in the invasion. 

Some 11 months later, they'd fought their way all the way from those beaches to Hamburg at the vanguard of the allied drive through France and into Germany until the defeat of the Nazi regime. Today, we salute those who fought and thank them for their sacrifice.

Motion to elect a Member to a committee

The next item is a motion to elect a Member to a committee and I call a Member of the Business Committee to formally move the motion.

Motion NDM7063 Elin Jones 

To propose that the National Assembly for Wales, in accordance with Standing Order 17.13(ii), elects Caroline Jones (Brexit Party) as a Member of the Business Committee.

Motion moved.

The proposal is to agree the motion. Does any Member object? [Objection.] I will defer voting until voting time, where a two-thirds majority of Members voting will need to vote in favour for it to pass.

Voting deferred until voting time.

5. Welsh Conservatives Debate: Betsi Cadwaladr University Health Board

The following amendment has been selected: amendment 1 in the name of Rebecca Evans.

The next item is the Welsh Conservatives' debate on Betsi Cadwaladr University Health Board. I call on Angela Burns to move the motion. Angela Burns.

Motion NDM7058 Darren Millar

To propose that the National Assembly for Wales:

1. Notes that 8 June 2019 marks four years since the Betsi Cadwaladr University Health Board was placed into special measures.

2. Further notes that ministerial oversight of special measures arrangements at the Betsi Cadwaladr University Health Board has consistently been with the current health Minister.

3. Regrets that the Betsi Cadwaladr University Health Board still has significant improvements to make in its mental health services and its governance, leadership and oversight, in spite of spending longer in special measures for these matters than any organisation in the history of the National Health Service.

4. Calls upon the health Minister to accept his responsibility for failing to deliver the required improvement at the Betsi Cadwaladr University Health Board over the past four years and resign.

Motion moved.

Diolch, Llywydd. I'm grateful to have the opportunity to open this debate today marking an anniversary that none of us wanted to see. Minister, you and your predecessor, now First Minister, have presided over four years of Betsi Cadwaladr University Health Board in special measures. Not only has this board spend the last four years under the management of your Government, but, as we heard in yesterday's statement, we do not seem to be any closer to a clean bill of health being declared and the health board being able to stand on its own two feet once more.

15:45

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

Residents of north Wales, under the care of Betsi Cadwaladr, are spread across a huge area of the country, making up 23 per cent of the entire population of Wales. Despite this scale, patients suffer the worst A&E waiting times in the country, the highest number of reported patient safety incidents and an almost crippling shortage of GPs, midwives and community nurses.

Now, the Welsh Conservatives have brought this debate forward on the week of the fourth anniversary not to further demoralise the hard-working staff who are under considerable pressure, but to try and get some tangible answers as to what progress has been made in the last four years, whether lessons have been learnt, and most importantly, whether the reasons that were given for these special measures have been addressed.

The statement provided by the Minister yesterday on this same subject painted a far rosier picture than the reality of patient experiences and what we hear from staff. Whilst I accept that some positive actions were taken and improvements have been made, yesterday’s statement seemed to correspond more to a health board that had only recently entered supported status, and not one that’s been in special measures for four years—the longest period that any board or trust has been in special measures for concerns around their services, leadership and governance arrangements anywhere in the UK.

I want to revisit 8 June 2015, four years ago, when the board was initially placed in special measures by the health Secretary of the day and his deputy—today’s current Minister for health. The written statement, issued by the Welsh Government, centred around the following aspects of the board’s operation: governance, leadership and oversight; mental health services; maternity services at Ysbyty Glan Clwyd; GP and primary care services, including out-of-hours; and reconnecting with the public and regaining the public’s confidence. I was hopeful that the statement yesterday would provide some answers to those initial concerns, and perhaps recognition and a little humility from the Minister for health that these reasons for special measures have still not been resolved. What the people of north Wales really want to know is whether their health board has turned the corner, and, Minister, from all the evidence available, the short answer is 'no’.

The past four years have seen 13 written statements by the Welsh Government, three external investigations, and millions of pounds of taxpayers’ money invested in the board. Maternity services did emerge from special measures in 2018, but only after a reversal of the decision to close the services provided at Glan Clwyd in July 2015, which managed to unite politicians from across the Chamber, given the foolishness of the health board’s plans and, of course, consequently, it did a great deal of damage to the public reputation of the health board.

Out-of-hours care followed maternity services, and this is to be welcomed, although you must recognise, Minister, that out-of-hours care is not stable given the shortage—the chronic shortage—of GPs in north Wales. And the GPs are saying this, not just me.

However, mental health services and financial governance remain in special measures, and a report from the Assembly’s Public Accounts Committee stated that the senior management team admitted that the board would not be on a truly transformational journey by 2020.

When it comes to the fifth reason for special measures—reconnecting with the public—then it is much harder to judge. Given the years of spin, confusion and poor consultation exercises, the wounds will take much longer than four years to heal between the board and the public. As, again, the Public Accounts Committee identified, placing the board in special measures has become the new normal. Progress is unacceptably slow and the Welsh Government intervention has had little practical impact.

Minister, progress has been made in some aspects of the failings of this health board, but some of the original issues remain unresolved. In your statement yesterday, you said, and I quote:

'The special measures oversight has, however, identified other concerns across the whole system to deliver the progress needed in finance, planning and waiting-time performance. The health board has not met the expectations set out in the framework in these areas.'

So, on the one hand, you say that there’s been headway made, but with the other hand, there are new problems rising rapidly, with no obvious solutions in place. It’s concerning that it’s taken four whole years for these issues and concerns to be identified.

Now, my colleagues will focus on some of the more specific aspects of the failings of the management of this health board, but I want to turn my attention to what special measures or Government intervention actually looks like in Betsi and what it should look like. Because under your stewardship, Minister, five of seven Welsh health boards are working under some form of Government intervention. Now, Betsi Cadwaladr obviously gets the most attention due to the length of time it's been in place, but we should not ignore what's happening in other parts of the country.

What is not clear to many outside of this Chamber is what happens when a health board is placed under special measures. In Wales, the Welsh Government, Healthcare Inspectorate Wales and the Welsh Audit Office work together to identify and respond to serious issues that affect services, quality, safety of care and organisational effectiveness. Actions can, but not always, involve placing key individual specialists or people with turn-around experience to provide support settings, actions, milestones and an improvement framework. Welsh Ministers are also able to suspend or remove powers and duties from Members of the health board, or to direct a health board to ensure that functions are performed by a specific person.

In Scotland, their special measures encompass a five-stage process, ranging from surveillance to formal recovery plans, with the ultimate sanction, at stage 5, for the Scottish Government to dismiss or appoint senior leadership of a board, such as they bravely did in NHS Tayside in 2018. In England, there are five types of action that can take place, ranging from the appointment of improvement directors to the removal of freedoms that some NHS foundation trusts have compared to other NHS organisations.

An innovative approach in England has been the buddying system, which acknowledges that some trusts in special measures can suffer from insularity, therefore it is essential that trusts look outwards as they seek to improve their quality. This was first introduced in 2013 and recognises how trusts can understand how other trusts approach their operations. They can learn, they can benchmark, and quality improvements come through. Buddying with another trust has often proved very valuable, but it does require committment from both parties. It helps to define the specific terms of reference for the relationship, for example a specific clinical areas or speciality.

There are a number of case studies I would love to raise with you demonstrating best practice, because the length of time it's taken to introduce some of these measures makes me realise that you have not gone out and looked at best practice around the UK. I just want to highlight the case of one, Wexham Park Hospital in Slough, where problems were identified in 2014. The Care Quality Commission described a culture of 'learned helplessness', and I think we can say that identifies closely with Betsi, and changing this was made a priority for the new leadership team. The focus was on putting patients at the heart of everything, asking staff to treat them as if they were their own family members. An external view of what looked good helped to change and challenge ingrained behaviours, allowing the hospital to make significant change to the culture in a relatively short space of time. 

I'm not saying that all the answers lie over the borders, but I do want to ensure, Minister, that you look at the best practice that is out there to acknowledge that there are other systems in place. I also understand that in Wales we couldn't possibly buddy up because we'd only have two health boards and they would crash under the weight of the five. But we could ask Scotland and we could ask England for their advice and support.

Yesterday, in your statement, you acknowledged that a transformation team was needed, and this is a point I've made on repeated occasions. I acknowledge that you've finally decided to engage PricewaterhouseCoopers to help deliver substantial financial improvements, and, again, I applaud this. But why has it taken so long—four years? 

I'm not just going to say to you how awful I think this whole process has been managed. I want to give you some help. This is what the Welsh Conservatives would do: we would draught in help from experienced change managers working in the NHS throughout the UK to help drive those changes forward. We would implement robust and independent consultation and feedback events to engage and empower staff, to help them identify areas of concern free from external pressures. We would underpin the areas that have shown such devastating failures of performance and provide them with day-to-day management support and funding to improve.

We would look at rationalising the management structure, devolve the power to the lower levels of management so decisions can be made quickly, and green shoots of promise can be encouraged to grow and people feel empowered to make the difference that's so desperately needed. And—something Welsh Government seems so reluctant to do in so many health boards—we would review the core competency and skills of senior management to ensure that the right people are in the right jobs.

Minister, I would like to close my contribution—. Chamber, I would like to close my contribution with a little bit of reflection. It's disheartening to remember that this struggling health board is named after Betsi Cadwaladr, a famous nurse who treated the wounded soldiers of the Crimean war. Born in north Wales, her courage on faraway battlefields inspired visions of a legacy of health provision for the people of her homeland. I only hope that, in her memory, it won't be long before the spirit of her legacy can be properly honoured again. The staff of the health board have this spirit. They just need the leadership to fully release their potential. Perhaps through proper leadership, which borrows just a little of Betsi's famous courage, this vital resource can be restored again for the people of north Wales. And, Minister, if you do not have the courage to provide this leadership, then make way for someone who does.

15:55

Thank you. I have selected the amendment to the motion, and I call on the Minister for Health and Social Services to move formally amendment 1 tabled in the name of Rebecca Evans.

Amendment 1—Rebecca Evans

Delete points 2, 3, and 4 and replace with:

Recognises the progress made in the initial areas identified as concerns in 2015 and the continued focus and improvement required for de-escalation.

Notes that any decisions on changing the escalation status of Betsi Cadwaladr University Health Board will be taken after receiving advice from the Wales Audit Office, Health Inspectorate Wales and the NHS Wales Chief Executive.

Amendment 1 moved.

For over 154,000 people in Flintshire and over 675,000 people across north Wales, Betsi Cadwaladr health board provides life-saving operations, cares for our most vulnerable and elderly, supports our friends and families through the trauma of death, whilst also supporting mothers and fathers bringing new life into this world. So, Deputy Llywydd, I'd like to start by acknowledging that and thanking every single NHS staff member across Wales, across the UK, for their work and the leadership they show in their communities, as well as the part they play in the health and social care service.

I know, as other Members across this Chamber who represent north Wales will know as well, that the care that many of our constituents receive from the health board is up there with the best. When I speak to certain patients and my own constituents, many tell me that they have received excellent care and of the professionalism of the staff members. But I also have too many who turn to me for help having been let down. Firstly, I think the health board has made some very positive steps by recognising the risks to its performance, namely the failure to maintain the quality of patient services, maintain financial sustainability, develop plans and reconnect with the wider public.

When constituents get in touch with me, it's more often than not relating to GP out-of-hours, primary care services, mental health services and ambulance response times. So, touching briefly on primary care, I know that, in my constituency, the issues are recognised and that more does need to be done to ensure a sustainable primary care workforce. Equally, on GP out-of-hours, I know there has been significant investment and that performance is comparatively good when viewed with the rest of Wales, but Members for north Wales will also know that several challenges remain in relation to the workforce, performance, risk management and finance of such services.

Members will also know that I've spoken a lot about new technology and how that can assist our public services in the future. Deputy Llywydd, I genuinely believe that if we are bold and brave enough, Betsi Cadwaladr is well placed to lead on the new technology, and will benefit from doing so, whether that is letting them lead on certain technological trials or by using more online services to reduce the pressure points within the GP services.

On mental health, which is, of course, one of the most personal issues for me, I know the significant scale of the ongoing challenge to improve those services across north Wales. The Minister will know that, since I was elected, I've had a lot of casework on mental health, and I particularly look forward to his reply to my recent query on the availability of dialectical behaviour therapy in north Wales, something that will help many of my constituents.

Finally, on the issue of the health board's make-up as it is—because I know this has been a controversial topic of discussion in the past, but, from the correspondence I continue to receive and the meetings that I have had, I believe it would be wrong to shelve completely the idea of reorganising Betsi Cadwaladr. For me, any change needs to weigh up the evidence—not political, but clinical, and led by professionals. At the same time, we need to make sure that any such changes wouldn't have unintended consequences or impact on the difficulties it already faces. Ultimately, our goal should be ensuring Betsi Cadwaladr health board gets out of special measures and regains the confidence of those who feel let down.

I'll finish my contribution shortly, Deputy Llywydd, but I'm also very keen to ensure that patients across north Wales, particularly my constituents, continue to be able to receive cross-border services, just as we are happy to welcome English patients to Wales. But I want to take this opportunity to say thank you for bringing everyone together, because we shouldn't be using the health service and debates about the health service as a political football, but we should speak openly and honestly about the issues whilst respecting the hard-working NHS staff. That is the way I see change and it's the way we all need to see change. Diolch.

16:00

May I express my gratitude to the Conservatives for bringing this motion forward today? This is not, as Angela Burns has said, a situation that any of us would wish to find ourselves in, and this impacts, of course, very directly on a great many of my constituents in the west of the Betsi Cadwaladr area.

I'm really concerned that we get from this Minister a lot of complacency, a lot of 'everything's going to be all right'. I've been looking back through the six-monthly reports—they are full of assertion and they are not very full of evidence. And I just want to highlight a number—very briefly—of issues that are publicly evidenced. Waiting times have not improved since special measures were introduced and have only shown improvements in early 2018, when it was highlighted as an issue in Plenary again. The A&E system still consistently performs worse than the Welsh average, and the performance of two poorly-performing hospitals drag down the performance of a good one. Cancer waiting times show that, at the start of special measures, Betsi was actually performing better than the Welsh average and now performs worse than the Welsh average and there's been a 5 per cent decrease in the number of GPs in the Betsi Cadwaladr area over time, though I do accept what the Minister said yesterday about there being alternative services directly employed by the local health board being put in place to address some of those issues. Now, the Minister appears to be expressing some scepticism about this, but I'm basing this on publicly available figures, and if he's got other publicly available figures that tell us something else—other not publicly available figures—I urge him to put those in the public domain so we can see where this so-called progress is coming from and who is delivering it.

After four years, we need to have from this Minister some real understanding about why he thinks delivering change in Betsi Cadwaladr has been so difficult. Why is it so intransigent? What is going wrong there? Now, if I was to hear from the Minister today, 'These are the issues that I'm facing', 'These are the things that I cannot shift', 'These are the things that we need to build political consensus, perhaps, to deliver and change', then I would be the first person in his corner, because Jack Sargeant, of course, is quite right when he says that nobody wants to play any kind of political game with the NHS, but the reality, of course, Deputy Presiding Officer, is that issues surrounding the NHS are highly political: how the NHS is funded, how it is managed, is highly political, and here, in Wales, we have established—we legislated in 2009 for a system that made the system accountable to the Minister. I remember the then Welsh Minister, Edwina Hart, saying that the decisions about health in Wales needed to be made by the people that the people can sack. Now, at that time, the Conservative spokesperson, Jonathan Morgan, was of the view that we should continue to have a more hands-off approach. That was not the decision that this place made. It's a perfectly respectable position; not one that I shared at the time. So, the Minister is clearly totally accountable for this, and he needs to explain to us why things have not moved on.

Now, of course there's been some improvement; if you'd have left the system entirely alone for four years and done absolutely nothing there would have been some good people in some good places who would have been able to achieve some positive change. And, of course, as others have said, and we must acknowledge this, across that system—and I hear this weekly from constituents—there are really good people on the front line who are working their socks off. There are also some really good front-line managers who are doing innovative things, for example, co-operating with social services in Gwynedd. But, at the top of the health board, there is obviously something seriously wrong, and I believe that there is a cultural problem.

I wonder how invested the senior leaders in that health board are in delivering change. Now, it does worry me that six of the people leading that health board—not on the board side, but professionally—don't even live in this country, never mind in the area that they serve. Now, obviously, you wouldn't want to start discriminating against people on the basis of where they live, but, when you have such a high percentage of your management team whose families, whose children, whose neighbours are not directly affected by the decisions that they make, I think, potentially, you've got a problem. We used to, in the public sector in Wales, very often appoint senior leaders—I'm thinking particularly of chief executives of local authorities—on the basis that, 'We welcome you from wherever you come, but we expect you to come here, we expect you to live here, we expect you to invest in this community'. And Betsi is full of senior leaders who have not done that.

When I raised the question yesterday with the Minister about whether he believed the senior leadership understood the communities they were serving, I was profoundly disappointed that he dismissed that as a concern. But it seems to my constituents and the constituents of other colleagues that the decisions are being made by people who don't understand the nature of the communities, who don't understand the geography, and maybe that is something that is at the root of all of this.

I see my time is up, Deputy Presiding Officer, and I'll bring my remarks to a close. But I'd associate myself with what's already been said about the need to have performance standards for managers, to have core competencies, to have a register of NHS managers, off which they can be kicked, as doctors and nurses can, if they don't perform, because I believe this is a cultural problem across our NHS. The Minister has got to take some responsibility for this. If he wants our help, he can certainly have it, but, as it is, he dismisses our concern and it's not good enough.

16:05

Self-proclaimed 'party of the NHS', Labour, is responsible for just seven health boards in Wales, and it is shocking that five of these are in special measures of some kind. The largest of these, serving around 1 million people, Betsi Cadwaladr University Health Board in north Wales, will not be celebrating the fact that next Saturday it will be four years since it was placed into special measures. Ministerial oversight of these special measures arrangements have been with the current Minister. No Conservative Prime Minister has ever cut a NHS budget. Under Labour, however, Wales was the only UK nation to see a real-terms decrease in identifiable expenditure on health between 2010 and 2016.

Betsi Cadwaladr entered special measures after horrific reports emanated from the Tawel Fan mental health ward. The Welsh Labour Government had failed to heed the warnings of the Ockenden—or has failed to heed the warnings of the Ockenden—review of this and consistently ignored the concerns of families involved. It may have met them—continued to ignore them. The Welsh Government instead relied on the 2018 Health and Social Care Advisory Service review, which was described by the families as a cover-up.

In January, Donna Ockenden said she had seen insufficient progress in improving mental health services and revealed that staff had told her that services were going backwards. Her 2018 review was repeatedly informed that, from the health board's birth in October 2009, there was very significant cause for concern in the systems, structures and processes of governance underpinning a range of services provided by Betsi Cadwaladr.

Speaking here in May last year, I asked the health Minister why the conclusions of the HASCAS report, commissioned by Betsi Cadwaladr, did not stack up with the findings of Donna Ockenden's 2015 report, which the Welsh Government had accepted, or with the Healthcare Inspectorate Wales report, or dementia care mapping work, both in 2013, the year that the health board states that it was alerted to serious concerns regarding patient care on the Tawel Fan ward. In fact, I had highlighted concerns with them and the Welsh Government in 2009.

While front-line staff are working incredibly hard, last month the Public Accounts Committee found that the Welsh Government's intervention with the board has had, quote, 'little practical impact'. The North Wales Community Health Council stated that it totally agreed with the report's recommendations and referred to a letter sent to the health Minister in which they stated there is a belief among its members that special measures is now the new normal and appears to have lost its impact. The Welsh Government's A&E target to see 95 per cent of patients within four hours, in place since 2008, has never been met. So, the latest figures show that Betsi Cadwaladr remains the worst-performing in Wales. Wrexham Maelor Hospital's A&E department only saw half of its patients within four hours.

In January, the north Wales coroner, John Gittins, stated that ambulance hold-ups, staff shortages and the difficulty of getting speedy A&E care have contributed to numerous deaths and may claim more lives. Last month, a senior consultant, Ian Smith, told the coroner's inquest into the death of Megan Lloyd-Williams at Glan Clwyd Hospital that it was over two years since he had highlighted a gap in geriatric care and treatment at a similar hearing, but nothing had changed, despite assurances that improvements had been made. How familiar that rings. Following that inquest, the coroner gave the health board until the end of this year to make improvements to its orthopaedic care.

In March, North Wales Community Health Council wrote to the Minister expressing their disappointment with the Welsh Government response to the NHS Wales GP performers list options paper, stating that the difficulties in north Wales had been present and increasing for at least five years. There is no question about if or whether the difficulties in recruitment and retention will continue. They added that the other ways tried by Betsi Cadwaladr to address the recruitment problem were, quote, 'not as successful as have been reported'. They're now working with community health councils across Wales to review experiences of people having to stay too long in hospital when they're well enough to leave. Is it any wonder, therefore, that this thin-skinned Labour Government is now seeking to replace community health councils with a centralised body that they can control?

Only last month, the Royal College of Physicians stated that only 43 per cent of advertised consultant physician posts in north Wales were filled last year. The health Minister's repeated statements that he expects to see action—we've heard it today, we heard it four times yesterday—have become hollow. He needs to accept his responsibility for failing to deliver the required improvements at Betsi Cadwaladr University Health Board and honourably resign.

16:10

As we’ve heard, special measures was to be a temporary measure for Betsi Cadwaladr University Health Board. Now, four years later, they are still in special measures. I can tell you, Minister, that the people of north Wales don’t consider those measures to be temporary and the people of north Wales don’t consider special measures to be special in any way whatsoever, because, as the community health council in north Wales has said, the special measures are now the new normal in north Wales.

The health council believes, and I agree with them, that direct management by Welsh Government of the board has lost its impact. There is a lack of confidence among the residents of north Wales in the way in which the Government is seeking to deal with this situation, and, indeed, as a result of that, in the ability of the health board to provide the care that the public in north Wales wish to see, expect to see, and have a right to receive.

This new normal, of course, represents an ongoing financial crisis, it represents recruitment problems, failures in long term planning, particularly in terms of the workforce, GP services collapsing, an over reliance on locums and agency staff, and a failure to deal with complaints in a timely or appropriate manner. Increasingly too—and this is something that I have raised in this place in the past—there is more and more involvement of the private sector in health services in north Wales. I’ve raised in the past the campaign to prevent the privatisation of aspects of the dialysis service in Wrexham and in Welshpool, including transferring staff from the national health service to the private sector, and now, of course, we are facing the privatisation of pharmacy services in general hospitals across north Wales.

People are complaining that Donald Trump is going to be a threat in privatising elements of our health service in Wales—well, perhaps we need to look closer to home when it comes to that particular agenda. I do hope that the Government and the Minister will have the honesty, when they do condemn the privatisation of health services in England, to be aware of what is happening on their watch in terms of similar services in Wales.

I am going to refer to the case of one constituent of mine who is 90 years old, living in Flintshire. She went to hospital very recently after a fall in her garden. She’s now well enough to return home but she will need some support of course. Her family clearly want her to return to her home having spent 10 days in Ysbyty Glan Clwyd and more recently in Holywell Community Hospital. But, there are no care packages available to allow her to return home. The family are therefore in a quandary. Do they leave her in the community hospital where clearly she is becoming demoralised, or do they pay privately for a care package that will cost a total of £210 a week?

I highlight this because back in 2012, Betsi Cadwaladr home enhanced care packages—I’m sure you will all remember the HECs, as they were called. The aim was to help people out of hospital and back into the community, and the claim made at that time was that patients would be able to see consultants in their homes and that would replace the community hospitals that were being closed across north Wales as part of a radical restructuring and centering of services across north Wales. But the truth is that even support workers aren’t able to visit patients in their homes now, never mind anyone else. There is too much demand for the service and they can’t meet that demand.

Now, it’s not the front-line staff who are to blame here. They are doing their very best despite the circumstances and difficulties. The problem, I fear, is senior management who have made these poor decisions, which have led to the health board reaching this point and have led to special measures. And of course one of those was appointed to be responsible for turning the board around, which raises further questions.

But unlike doctors and nurses who occasionally make errors in their work, there’s no way for health board managers to be held to account. If it’s right for nurses and doctors to be struck off—we’ve said as a party that should also be the case for senior managers. In north Wales, we’ve been through three chief executives and three chairs and there’s a feeling of shifting the deckchairs whilst the ship is sinking. The one consistent factor throughout that period of course is that you, previously as Deputy Minister, were responsible for the day-to-day running of the health service and the situation in Betsi Cadwaladr. So, rather than changing chairs and chief executives, isn’t it true that you are the one who should resign?

16:15

Caring for the health and well-being of the population of north Wales should be the fundamental aim and purpose of the Betsi Cadwaladr University Health Board, and I bear witness to the fact that, as regards front-line staff, they work hard every day with their hearts and minds, trying to deliver just that. Four years ago, however, the board was placed in special measures as a result of significant failings. On 8 June 2015, our now First Minister declared that this significant decision reflected serious and outstanding concerns about the leadership, governance and progress in the health board over some time and that a thorough and balanced assessment would taken place on areas of concern to form the basis of actions to be taken as a result of those special measures.

Those actions have been guided by you, Minister, from your time as Deputy Minister and your statement on 14 July 2015 to this debate today. Nearly 48 months represents the longest time any organisation has been in special measures within the history of the NHS. This is double the length of time Vaughan Gething AM initially claimed it would be. So, after 1,460 days of your direct control, I and many of my constituents and many Members here today in this Chamber would have expected the health board to be back in good health.

However, after 13 written statements and three external investigations, the situation today is still alarming. North Wales mental health services have still not been de-escalated, and seem a long way from reaching so. Shockingly, Donna Ockenden has reported that she's seen insufficient progress, and it was revealed that staff believed that mental health services were going backwards. Only last month, the Public Accounts Committee—and I thank the Chair and his team for this—outlined key concerns about the delivery of the board's mental health services, including an insensitive release of the HASCAS report, which let down the families of Tawel Fan patients, insufficient progress on implementing the recommendations of the HASCAS and Ockenden reports, lack of engagement with the North Wales Community Health Council and correspondence from BCUHB staff in which they, the front line, explain that staffing was worse, they were exhausted, and they do not expect positive change in the foreseeable future. Minister, you should—I'm sorry—hold your head in shame at these findings, and the fact that on Donna Ockenden's offer to help—that you declined this.

Actually, you have overseen the development of a monetary migraine also. Betsi Cadwaladr board has just recorded the biggest deficit of all Welsh health boards at the end of 2018-19—the only board to increase its debts between this period—and has only managed to make 85 per cent of its savings target by March. The accounts at Cadwaladr seem to be spiralling out of control, with major pressures from all directions: £900,000 has been spent on just eight health legal cases, Cardiff are demanding that the board pay back £1 million for failing to hit waiting time targets, and a shortage of front-line staff saw £34 million spent on agency staff in 2017-18. Clearly, the health board still has significant improvements to make in spite of special measures.

The Minister's poor management is having a negative impact on staff, and I have it on good authority that your intervention is actually causing some of the problems there now. It is indicated by the fact that sickness absence from October to December 2018 is up on the same period in 2017. Sadly, the situation is directly impacting on my constituents. Almost every day, I am receiving new complaints and having to resort now to having weekly appointments with the chair's office—the new chairman—who is working really hard to oversee my collection of constituent concerns. You know what the problems are: referral-to-treatment times no better, the highest number of patients waiting more than four hours at A&E, and serious staffing gaps. Clearly, any reasonable person cannot but agree with the Public Accounts Committee's findings that special measures has become a normality and that Welsh Government intervention has had little practical impact.

The residents of north Wales, and certainly my constituents in Aberconwy and my other colleagues—they deserve better. The health service in any nation must be considered as its ultimate priority, and how disappointing that the First Minister himself cannot be present for such an important debate today. As we seem set for yet another 12 months of special measures, we have no sustainable clinical strategy in place. It is time for the First Minister and the Welsh Government to be collectively held responsible. But I hold you responsible, Minister. I will echo my colleagues' concerns. Please do not bring the name of Betsi Cadwaladr in vain, and please, Minister, if you are—. You're shaking your head now. If you remain in denial as to just how bad things are, please do us all a favour and make way for someone who might—just might—be able to turn that situation around. Thank you.

16:20

I thank the Welsh Conservatives for tabling this debate today. The state of the NHS in north Wales does leave a lot to be desired, and Welsh Labour must accept blame here, because the reforms over the last 20 years have directly led to the situation in Betsi Cadwaladr.

As my colleague Mandy Jones pointed out yesterday, this health board has been in special measures for nearly half of its existence. The fact that there has been a slow pace of change and limited improvement, given that nearly four years have passed since the health board was placed into special measures, is not only deeply concerning to the Public Accounts Committee but indeed to us all. However, I don't believe calling for the current Minister's resignation is the right answer, and the fact that success in delivering improvements in healthcare in north Wales has been limited points to a more structural problem than which Government Minister is in charge. It clearly indicates that the current local health board system is not fit for purpose, and while the issues are most keenly felt in north Wales, most of Wales's health boards are in some form of escalation and intervention arrangement. What must happen now is not a change of Ministers but a change in approach. Welsh Government need to accept responsibility for the mess they have created and take immediate action. 

We all know the challenges facing the NHS in the coming decades, and if we don’t have the right governance structures in place, the problems we see in Betsi today will pale into insignificance. So, we need to end ministerial appointment to health boards. Health boards need to make clinical decisions, and not political ones. We need to strengthen Healthcare Inspectorate Wales and ensure that it too is free from political interference. HIW should have the power to intervene and give direction to health boards when problems are identified. And we need to ensure that problems are identified early on. This means introducing a no-blame culture to identify mistakes and ensuring every person working in the NHS or with the NHS has a duty to disclose.

We need to make urgent and significant progress in ensuring our NHS has the right structures in place to meet the needs of patients in every part of Wales, now and in the coming decades. While the current minister shares some of the blame for the problems in Betsi and across the NHS, I truly believe he has attempted to address some of the problems that have been in existence prior to his being handed the health portfolio. And if blame is to be cast, then predecessors must also accept a portion of that blame equally, and not allow one person to be used as a scapegoat. So, blame is sometimes direct, and other times indirect regarding the current messy governance arrangements.

I urge the Minister to accept that mistakes were made and to take urgent steps to rectify them. This is how we will address the problems. A change of leadership may only exacerbate them now. Minister, I am confident that you can deliver the necessary changes, but it is urgent that you act now. 

16:25

I think it's fair to say that the ongoing governance and management problems at Betsi Cadwaladr University Health Board since 2013 must, without a shadow of a doubt, be an enormous source of deep regret and embarrassment for the Welsh Government. Despite several reviews and reports being conducted over the past four years, progress has been dreadfully slow, financial management has been ineffective, and most importantly, concerns over patient care still remain. The staff and medical professionals in north Wales who are working hard under very difficult circumstances deserve proper and appropriate leadership and support from the Welsh Government.

As Mark Isherwood and Janet Finch-Saunders said earlier, only a few weeks ago the Assembly's Public Accounts Committee published the latest in a string of reviews into the governance arrangements at the health board. That cross-party report concluded that Welsh Government support has been insufficient and that actions had little practical impact on changing the health board's performance. After four long years of the health board being placed in special measures, the Welsh Government has simply continued to preside over a service that is continuing to let some patients down. Now, in giving evidence to that inquiry, Mark Thornton, the chair of the North Wales Community Health Council, shared their frustrations by comparing the Welsh Government's inaction with action that had been taken across the border. He said that, and I quote,

'They seem to have a slightly different approach in that they actually bring much more resource, expertise, whatever's needed to actually set a health board onto an even keel and provide a stable platform for a health board to make the improvements required to come out of special measures. As far as we're aware, the health board was provided with some expertise in terms of the special advisers, but certainly initially at least we didn't see a lot else.'

Now, those aren't my words, or even the committee's words, but the words of the community health council in representing local patients. The evidence they gave to the inquiry is damning. Despite the Welsh Government knowing of the ongoing governance and financial difficulties of the health board, it seems to me that the CHC believe that rectifying the matter is simply not a serious priority for the Welsh Government. As a result, patients is north Wales are continuing not to receive the health service they deserve, particularly when it comes to mental health services, as Jack Sargeant said earlier.

The reality on the ground is that whilst report after report criticises both the health board and the Welsh Government, real people in north Wales are simply not receiving the care they need and deserve. As Angela Burns said earlier, there's also a real question here about humility and the Welsh Government's handling of the whole situation. In responding to the Public Accounts Committee, the Welsh Government said that, and I quote:

'We also recognise the further progress and action must be delivered to tackling long standing issues and will work alongside the Chair and the leadership team to ensure turnaround and de-escalation from special measures.'

Nowhere, nowhere in that statement is there a genuine apology to those families in north Wales who, in the past four years, have suffered. Nowhere in that statement does the Welsh Government come forward with concrete action or take any leadership of the situation. Instead, the Welsh Government just dusted off its regurgitated 'We'll work with the heath board' statement. Well, that is simply not good enough anymore, and it’s simply not going to wash with people in north Wales who've heard this all before.

It should be a matter of regret for all Welsh politicians that there’s a part of Wales that will shortly be entering its fifth year of being placed in special measures, and yet the Welsh Government seems settled on special measures being the new norm for healthcare services in Wales. What will it take for the Welsh Government to show some leadership and commit to fully addressing this crisis? And in the meantime, how many patients will have to suffer? If the Welsh Government does not make real progress in the immediate future, then people in north Wales will feel let down by a Government that they will see as just being too Cardiff-centric. And can you really blame the people of north Wales for feeling that way?

Dirprwy Lywydd, today’s debate gives the Welsh Government an opportunity to change the record and come forward with a concrete strategy that provides a real commitment to the people of north Wales that it will finally get a grip of this issue. And hopefully, the Minister will show a little humility to those people for the catalogue of failings that he and his Government have overseen.

At the start of this year, Donna Ockenden told the Minister directly that staff had told her that services were going backwards. Fast forward to two weeks ago and a report endorsed and signed off by every party in this Chamber concluded that it is apparent that the Welsh Government's interventions have had little practical impact. Therefore, it's time that the Welsh Government steps up and finally accepts responsibility for the failures that have taken place while Betsi Cadwaladr has been in special measures, and make this matter an urgent priority. And so I urge Members to support this motion, and I call on the Welsh Government to start delivering a service in north Wales that’s actually fit for the twenty-first century.

16:30

Can I now call the Minister for Health and Social Services, Vaughan Gething?

Thank you, Deputy Presiding Officer. As the motion laid notes, on 8 June it will mark four years since Betsi Cadwaladr University Health Board was placed into special measures. My statement yesterday recognised the need to use the anniversary as an opportunity to reflect on the reality and the pace of progress to date, but also the actions still outstanding. I also mentioned yesterday a range of actions already being taken with regard to finance, performance and turnaround. I do want to deal at the outset with one other point made about the First Minister’s absence today, in particular remarks made by Janet Finch-Saunders, and as most Members will be aware, the First Minister is not here today because he is exactly where he should be, at the D-day commemorations in Portsmouth.

Four years ago, the special measures framework required improvement across a range of areas: governance; leadership and oversight; mental health services; maternity services at Ysbyty Glan Clwyd; reconnecting with the public; and general practice and primary care, including specifically out-of-hours services. In the statement I gave yesterday, I set out the areas in which improvement has already been made. I also outlined those areas in which the health board has not made the progress that we expect, and further action is plainly required.

On two of the significant areas of concern set out in 2015—maternity services and GP out-of-hours services—improvements have resulted in the de-escalation of those areas from special measures. It’s important to recognise the good practice, innovation and improvement that staff across Betsi Cadwaladr University Health Board have delivered. And on one point of agreement across speakers, it is to recognise the dedication of our staff within the national health service delivering front-line care in each and every one of our communities.

In 2015, though, we and the people of north Wales had significant concerns about, for example, infection rates, access to therapy services and timely access to treatment for people on the cancer pathways, and in each of those areas, there has been real improvement. Today, we've heard of other areas in which Betsi Cadwaladr should develop their services to improve outcomes and experience for the people of north Wales—areas of concern, of course, that go beyond special measures that we could discuss in any particular part of public service. The challenge is not to wipe those away, but to focus on improvement in every area and to understand what Betsi needs to do to move beyond special measures. It is important to note that the health board is stepping up to take the action necessary to deliver improvement. The view of the independent advisor is that the board is now better placed to do so and in particular that the chair has brought new vigour and drive to real leadership and improvement.

In relation to the areas for improvement covered under the special measures arrangements—[Interruption.] I'll happily take the intervention. 

16:35

Thank you. The Public Accounts Committee report into this has been mentioned by a number of Members, and recommendation 1 of that report was that, if things are to be turned around, we do need to have more specialist external staff brought in—external advice brought in—to assist the board, in addition to the turnaround director, or whatever else they have done. What progress have you made in making sure that that additional support is put in place?

I did manage to go over some of this yesterday, but we're already working together with the chair to look at the finance function with external expertise being brought in to help, the appointment of a new finance director and thinking about the team that needs to go around that person to deliver the function—and not just a person, but a turnaround function. So we're already taking seriously the need to have external help and opportunities for improvement within the organisation. 

I, myself, though am obviously frustrated at the progress in a number of areas, and I recognise that a whole-system integrated approach is required if improvement is to be sustainable. I outlined yesterday the renewed focus that is required on planning, financial management performance, mental health, planned care and unscheduled care, and I also outlined the further support that is being provided to the board to help deliver improvement. I've written to the chair of the board to set out expectations for this autumn, to confirm that there will be an annual plan with performance trajectories for 2019 by the end of summer to progress the development of a sustainable clinical services strategy, in partnership with clinicians and wider partners; to have an agreed financial plan, including identified savings, efficiencies and opportunities to be taken by the health board throughout this year; and to have sustainable, improved performance in areas of quality, mental health, unscheduled care and planned care; and to make real and sustained progress is delivering the mental health strategy and actions agreed in response to the HASCAS and Ockenden recommendations. There is already a functioning stakeholder group to provide real oversight and challenge to the progress that is being made. 

In moving our amendment, I noted that any decisions on changing the escalation status of Betsi Cadwaladr will be taken after receiving advice from the Wales Audit Office, Healthcare Inspectorate Wales and the NHS Wales chief executive. That is as standard under the escalation and intervention arrangements that we do have in place, so I won't set, as I've said time and time again, an artificial timetable for the health board to move out of special measures. It will be when real progress has been made and there is real confidence of further progress to be made. But it is simply not appropriate to suggest that five out of seven health boards are in a form of special measures. It is a deliberate using of the special measures label to cast doubt and throw mud over the rest of the health service. The intervention and escalation arrangements are there to highlight where improvement is required and not as an opportunity for mud-throwing over the health service. That goes back to a comment that Jack Sargeant made about not wanting to see the health board used as a political football, and of course it is an obviously political topic.

We spend half of the Government's money on the national health service here in Wales. Everyone has a view on the health service, and we should do, but we did hear then a series of nakedly political statements in the debate. Now, I accept that's the nature of business in this place. Politicians will have a view, and of course people will look to try to have political solutions to answers in this area. My job is to make sure that the health service is continuing to move forward. It is a public service—proud to be a public service. We are not privatising the national health service here in Wales. We are engaged in looking at practice within Wales for improvement, and across the United Kingdom too, in both our intervention framework and on the recovery and improvement within health services. This is not an insular service, only looking inwardly for improvement. I continue to be open to good practice, as, indeed, is our wider healthcare system, wherever it exists, especially across the United Kingdom.

I have been asked about reorganisation, and I know Jack Sargeant mentioned it in his comments, and I do want to say this, very simply: I don't see any objective evidence that reorganising Betsi Cadwaladr into two or three smaller boards would improve services or outcomes. I think the last thing that the health service in north Wales needs is another reorganisation, rather than a continued focus on improvement in its current setting.

I am far, though, from sanguine or complacent about the continuing challenges that we face. My focus will continue to be on improvement and moving Betsi Cadwaladr beyond special measures. I will continue to be honest and transparent about improvements made and improvements that are still, plainly, required.

16:40

Thank you, Deputy Presiding Officer. As others have said in this Chamber, it's a very sad day, actually, that we're standing here four years after the Betsi Cadwaladr University Health Board was put into special measures, yet still this organisation has not made sufficient progress to come out of them. 

As has been said, a quarter of the population in Wales is served by this particular health board, but it's breaking records, and it's breaking them for all the wrong reasons: record-breaking poor performance when it comes to emergency departments; record-breaking waiting times for people waiting for orthopaedic surgery; and, of course, as we've already heard, a record length of time in special measures for those particular services and aspects of the health board that are in special measures.

You know, the front-line staff in our hospitals in Wales—in all of our hospitals, including in north Wales—are absolutely heroic. They are trying to do their best in difficult circumstances each and every day. I mentioned the fact that I had visited Wrexham Maelor Hospital on Monday, and I saw what people were having to deal with in the emergency department there.

They are amazing and incredibly talented people, but that doesn't take away from the fact that all of the evidence points to the fact that special measures in the Betsi Cadwaladr board are not working. They're not working. We've seen some improvement, yes, in maternity care, but that's because people marched on the street in order to secure those improvements—it was nothing to do with you, frankly, Minister. The reality is that unless we'd marched on those streets, those changes would have been implemented.

There has been some improvement, very lately, in terms of GP recruitment, or certainly training, in terms of securing more training. But, the fact remains that the GP out-of-hours services, which you have de-escalated, still have big gaps on their rotas on a frequent basis. I understand that one of the reasons why they are more able to meet their targets now is because if you phone the GP out-of-hours service, instead of having to get back to somebody within half an hour, as was previously the case, the target is now an hour. Well, of course, it's easier when you're moving the goalposts to be able to meet those targets, which is why you've managed to de-escalate that particular service. But, the Public Accounts Committee report, the Donna Ockenden comments and a whole host of other evidence point to the fact that these special measures don't work.

So, five out of seven health boards are in some sort of intervention or another, and that, to me, suggests that there's a systematic problem in the Welsh Government in terms of the way that it tries to bring improvement in our health service. It doesn't seem to learn from good practice and it doesn't seem to learn from its mistakes. We know that Cwm Taf, for example, recently entered into special measures, and one of the reasons it entered into special measures was because it repeated many of the mistakes that had taken place in Betsi Cadwaladr.

I've got to conclude. I will say this: I agree with the Minister on this one thing. I don't think we need reorganisation in north Wales. I do think that the name 'Betsi Cadwaladr' has been tarnished, and I think you ought to think about a change of the name of that health board in order to restore its reputation out there in the world. But you are the person who's been responsible for this ministerial oversight for the past four years. You've failed to turn this situation around, and the NHS seems to be slipping further into these intervention arrangements in all sorts of other ways across Wales. I think you ought to accept responsibility, carry the can and step down from office.  

16:45

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Therefore, we defer voting under this item until voting time.  

Voting deferred until voting time.

6. Plaid Cymru Debate: A confirmatory European Union referendum

The following amendments have been selected: amendment 1 in the name of Caroline Jones, amendment 2 in the name of Darren Millar, and amendment 3 in the name of Rebecca Evans. If amendment 1 is agreed, amendments 2 and 3 will be deselected. If amendment 2 is agreed, amendment 3 will be deselected.

Item 6 on our agenda this afternoon is the Plaid Cymru debate: a confirmatory European Union referendum, and I call on Delyth Jewell to move the motion. Delyth. 

Motion NDM7059 Rhun ap Iorwerth

To propose that the National Assembly for Wales declares its unequivocal support for a confirmatory referendum on whatever terms proposed by any Prime Minister that the United Kingdom leaves the European Union, with remain on the ballot paper.

Motion moved.

The Llywydd took the Chair.

Diolch, Dirprwy Lywydd. Today's debate promises to be a lively one. It's an issue on which nearly everyone has a strong feeling that they are right, and the stakes could not be higher. The motion before us calls on this place to declare its unequivocal support for a confirmatory referendum. Yes, we have called for unambiguous, uncouched in potential circumstance, clarity, because, goodness knows, the policies of the main Westminster parties have been a little confused of late, tacked together with tape to mask the deep division in their own ranks on this most divisive of issues. We welcome the Welsh Government's change of policy in support of a second referendum, come what may. It's the only way of untangling the Brexit knot. 

I've mentioned that Brexit is divisive; of course it is. It is difficult, and I understand why this issue is mired in tribulation for many elected representatives. But it is crucial that we think and do what is best for our constituents, not what is politically convenient. I recognise too why thousands of my constituents voted to leave, because of the apparent opportunity to take back control. That slogan resonated but it was cynical—cynical because it was untrue. The exact opposite has, in fact, happened, with events spiralling out of everyone's control—Westminster included. That misleading mantra promised an alternative to the frankly dire situation too many of my constituents are in, but the riches they were promised on the side of a bus will never reach them; we know that.

The problems people face are not as a result of the EU, they're the result of the actions of the Westminster Government, negligence towards left-behind communities on one hand, and deliberately cruel policies targeting vulnerable individuals on the other. The hardship that people face is a result of the cuts, not the continent. Even many Brexiteer commentators have long since given up claiming that the UK's poorest communities will benefit from Brexit; it's now all about sovereignty or, to be more precise, the illusion of sovereignty. But in what guise does sovereignty entail losing control of our NHS, as Donald Trump has made clear it will have to be on the table in return for a trade deal?  

We are faced with a future where the next leader of the Tory party could very well be ready to throw our economy—my constituents' livelihoods—under that infamous bus in order to become Prime Minister. Most worryingly, there is a creeping, nefarious tendency amongst more and more advocates of Brexit, including the majority of conservative leadership hopefuls, to say that no deal is not only acceptable, not only falsely that people voted for it in 2016, which they did not, but also that no deal wouldn't be all that bad, really. I find it distasteful that Members here or in Westminster would claim that no deal would mean anything other than catastrophe and destitution for some of my constituents. This is not a parlour game. It is not a blinking contest. It will affect people's lives. So, we will support the Labour amendment, and it will come as a surprise to no-one that we will not be supporting the other amendments. 

Those who advocated leaving the EU have had one opportunity after another to deliver on the result, but when it came to the crunch, they had nothing to bring to the table except empty rhetoric, so they resigned instead. They've had their chance and they've failed, leaving us with no choice but to revisit the original decision, but this time knowing what's at stake, including our NHS. It is a far cry from the £350 million a week that was promised.

Llywydd, one of the most worrying newspeak-esque sentiments that is parroted now is that having a second vote would be undemocratic. I cannot fathom how anyone can claim that putting a vote to the people undermines democracy. It is a contradiction in terms. Let me remind Members in this Chamber: a second vote would still involve a choice and people will be free to campaign for either side.

I remain very concerned at how Brexit has poisoned debate—name calling, shouting from a sedentary position, jeering. Society is also divided and a referendum alone will not be enough to heal those divisions. I know that. That will involve a far more inclusive, cross-party, cross-communi