Health and Social Care Committee

Thank you, Chair, and a very good morning to you and to the committee. I think I bring varied experience to the role. For the past 12 months, I have been one of the independent members on the board at Health Education and Improvement Wales. For the past three years, I have been chairing the board of a major housing association in Cardiff that delivers not only homes but also a range of social care services, both domiciliary care and residential and nursing care. I spent three years, some time ago, heading up the business unit for the Association of Directors of Social Services. So, what I hope I bring, certainly in my experience and my work in the past 12 years, is a deep understanding, not only of the workings of the health service, but certainly the opportunities that exist with social care, housing and other partners to better deliver the services that people need. That breadth of experience I would hope to bring to the role. I was very fortunate to spend three years chairing the audit and risk committee for the Public Services Ombudsman for Wales, and I currently sit on the audit committee for the Future Generations Commissioner for Wales, and that understanding of governance—the importance of firm, robust governance arrangements—I think will also stand me in good stead, if the Minister were to confirm the appointment.

Thank you. Is there anything else that you would like to add in terms of drawing on your experiences or specific experiences that you would apply in terms of the position?

If I were to look at my role as chair of Hafod housing, one of the important areas of board responsibility—and probably the most important area, of course—is to set the overall strategy and to work collectively with the executive team, providing that support and challenge, to understand how that strategy is being implemented. That is done in a variety of different ways, but making sure you have those robust, fair, open, transparent relationships between independent and non-executive members and the executive team is really quite crucial. What I would hope to bring to this role is a deep understanding and experience of having done that at a major housing association. At the point at which I was brought in as chair, it was under what's termed 'a regulatory judgment'. One of the reasons was governance, and we have worked extremely hard to improve the robustness of those governance arrangements, the openness and transparency of those working relationships, the quality of the reporting to board. All of those things are relevant in any organisation where you have that relationship between executive members and non-executive or independent members. So, robustness of governance is something that I would bring. There are probably a number of things I would want to review in Cwm Taf Morgannwg, if I were to be appointed chair, particularly around the governance, just to assure myself that things were as robust as they can be. I think that experience of having achieved that elsewhere would be a benefit to the organisation.

Thank you. It might be that some Members want to pick up on some of your answers to the opening questions. Finally from me on this section, are there any other appointments that you currently hold that you believe could be a conflict of interest, or could be seen as a perceived conflict of interest, and how you would deal with or manage that?

There are those matters that would certainly be conflicted if I were to take up the role, if the Minister were to offer the appointment. My understanding is that the appointment would run from April; I think that is the timescale that we were informed of. Certainly, I would be standing down from the board at HEIW, because you're not allowed to sit on two different health boards. I would not be a member of the audit committee of the future generations commissioner, because health bodies, as you know, Chair, fall within the remit of the commissioner. And I would be standing down as chair of Hafod housing, the conflict there being that Hafod housing provides some nursing care support within the Cwm Taf Morgannwg region. So, those conflicts would cease. In fact, if the role were to commence in April, then my three final meetings of all those organisations will be in the last week of March. I would put the arrangements in place to ensure that those conflicts were dealt with immediately. The other area of work that I've very much enjoyed in the last 12 years is that I've undertaken some consultancy work in the field of social care, a lot of which has been within the Cwm Taf Morgannwg region. Obviously, I will ensure that no other work, if there was to be any other work—and I don't think I would have much time left on my hands if I was undertaking this role—would conflict with the role of chair.

I notice from your CV that you also work for some Senedd Members as well.

That would come to a conclusion.

Lovely. Thank you. Sarah Murphy.

Thank you very much, Chair. Thank you for being here this morning to answer some of our questions. This follows on quite nicely, I think, from what you were just saying about social care. As the Member for Bridgend, obviously, CTMUHB covers my community and we have the Princess of Wales Hospital in my constituency as well. I know just from constituents and talking to many stakeholders that there are quite a few issues facing CTMUHB at the moment, including, for example, the anticipated publication of the regional area plan, questions about the future of critical care across the three main hospital sites, the distribution of community and step-down beds, and also whether Maesteg Community Hospital will be reopened for community beds. The committee, of course, wouldn't expect you to have detailed answers on these matters today, but could you tell us more about your vision for the integration of health and social care, and how you would plan, as chair, to lead the health board through these challenges?

Thank you, Sarah, for the question. If I could just deal very quickly with the vision and the mission of the health board, as you'll be aware, the health board's mission is to build healthier communities together. All health boards are attempting to respond to the challenges of emerging from a global pandemic, and now are facing quite significant challenges, particularly in the additional costs that health boards have met around increases in energy supply costs, the increase in agency nursing, and the challenges of ensuring we have an appropriately skilled, motivated and supported workforce.

What I will say is I think it's important that we set out very clearly our ambition to provide high-quality safe care to everybody within the Cwm Taf Morgannwg region, and to set our work accordingly to achieve that particular agenda. I think we are able to do more in partnership than we have yet been able to achieve. That's not a criticism of our health boards; it's sometimes difficult to find ways in which to get organisations to work. The regional partnership boards have been, I think, somewhat successful in pulling people together strategically to have those conversations about where organisations can better work together, but if you look at what we spend across health, social care and housing and look at the capacity of our third sector partners, there is clearly a lot more we can do.

I think Sarah is right to raise the integration agenda, particularly in the context of Bridgend. There is an ambitious piece of work being done at the moment between the health board and Bridgend County Borough Council to look at how we can better integrate adult health and social care services. I really welcome that. Having spent a lot of time in the past 12 years working with different organisations who have the ambition to work more collectively with other organisations, it's really good to see this happening. Perhaps the Bridgend model could be a model that's held up for other parts of the country. We know we can get more out of a substantial amount of working together, greater integration of services.

There will be consequences. I think it will mean that we have to think more carefully about workforce planning, about different roles, modifying roles in the future to make sure they're fit for purpose, but I think the opportunity to provide better services closer to home, helping people to remain as healthy as possible without the need for hospital admission, is something that we have to really grasp very, very quickly. It's about the opportunity of caring for people closer to home without the need to go into hospital, and also ensuring that we have the right sort of facilities to help people leave hospital when they are well enough to do so, I think that’s been a challenge for all of us in Wales.

There are examples elsewhere of where there are different schemes that help people leave hospital. There are certain parts of England, for example, where there are discharge-to-assess schemes, where, if you’re medically fit, you leave hospital and you go somewhere else for a period of time where your needs are better assessed. I think we need to be looking at all options. We should be considering where our facilities are. We need to be looking at our overall estate to see where we can support people to leave hospital more quickly so that their needs can be better assessed. Assessing someone’s needs whilst in hospital isn’t always the best place to do it, and I think that—. Sorry, Sarah.

I was just going to say ‘thank you very much’. I think that’s an excellent answer.

Do you have any further questions, Sarah?

Yes. I was also just going to raise with Jonathan that the escalation status in maternity and neonatal services is very worrying. The quality governance and quality related to performance and long waiting times are currently at targeted intervention level, and the escalation status for planning and finance is at enhanced monitoring. So, how confident are you that you have the ability to guide and support the health board in making the necessary improvements to performance and quality governance, but also at the same time instil that culture that encourages staff, patients and families and the public to raise concerns and know that they’re going to be appropriately addressed? And how that’s communicated to patients as well, please.

Thank you, Sarah. Firstly, I think it is important to recognise, as Welsh Government has already done, the enormity of the work in the past four years that has been achieved by the health board in addressing the very real concerns that were raised about the quality, safety, leadership and governance of the maternity services. I would like to ensure that we continue to build on that. There’s always a risk when organisations believe that improvement is being secured that somehow you can take your eye off the ball and just focus on other things. There are other things, of course, that the health board has to focus on, but certainly a continued, relentless focus on the quality and the safety of maternity services is something that will have to feature over the next few years within the health board. I will ensure that that happens as a matter of course, not only within the health board meetings, but certainly with the opportunity to hold specific board development sessions where we focus in more acutely on how well we are delivering services in maternity care.

It does come down to leadership. Those improvements I think are now being felt. Obviously, people have to have confidence in services. I think that certainly my view is that we should continue to do more to communicate those improvements to the wider population so that they can see and feel the changes. I think it’s important that we continue to demonstrate that we will focus on it as much as we’re able to by looking at data, by looking at case studies, and by ensuring we engage with staff, because the staff are absolutely critical in the delivery of our services. I have no intention of sitting back and assuming that everything’s been sorted. There is still a journey. We’re still under targeted intervention, and I expect that process to be very robust.

Thank you very much. Thank you, Chair.

Thank you. Rhun ap Iorwerth.

Diolch. You’ve touched on this already, at the end of your answer there. You’ll be taking the role at a time of unprecedented disquiet among NHS staff, with an ongoing pay dispute. You wouldn’t be able to offer a resolution on the pay front or on changing terms and conditions, but you would be expected to play a leading role when it comes to staff morale. What would be your approach in the incredibly difficult context to ensuring that morale is as good as it possibly can be?

You’re right, I can’t sit here and make a promise that I can suddenly resolve all of the challenges that we face. There are a range of issues that I think the health board, and the NHS collectively, needs to respond to, and I think it's doing quite a lot to do that.

So, firstly—. I'll come to the pay dispute secondly, but, in respect of staff recruitment, we have, in Cwm Taf Morgannwg, around 14,000 members of staff. Do we have enough staff doing all of the right things? I don't think we do, and I don't think any other health board in Wales could claim that it does. We know that recruitment and retention have become more challenging. We saw the impact of the COVID pandemic on our staff. I know from my role as an independent member at Health Education and Improvement Wales that a huge amount of work has been done in the last few years to increase the commissioning number of postgraduate nursing places that we are offering in Wales. That has increased substantially in the last three-to-four years. It's becoming more difficult now to recruit people into those training places and it's becoming more difficult to hang on to them before they even qualify. It's then difficult, again within the first two to three years, to keep them in post when they are there.

As chair, I'm acutely aware of those problems, of those gaps, where those gaps are, and what I will say to our staff is that I will be a very visible, vocal advocate for our staff. I have got nothing but praise for the professionalism, the compassion and the skill that our staff have. I think we have some of the best staff anywhere in the world. Do we articulate that enough? I don't think we do, and what they will get from me is somebody who will listen very acutely; who will not just listen to what they say to me but ensure that we use that information from our staff in our board considerations. There's no point just saying, 'I've got an open door; please come and tell me what you think.' Yes, come and tell me what you think, and then I'll ensure that we use that information in our discussions with the executive team and our team leaders throughout the health board to see how we can improve the experience of our staff.

On staff well-being, for example, I know that, in all of the major health sites within the health board area, we have well-being champions. I think that's really important, and I think we ought to be doing more to promote our sites for exercise and recreation, which I know that many of our staff take advantage of. That in itself, I think, goes some way to supporting and recognising the challenges that many of our staff face.

The pay dispute has been very challenging, obviously, and people do have the right to strike if they wish. As a health board, all we can do is respond to that by ensuring that we do everything possible to put the right number of nurses and clinicians in place when such action is taken. If I could solve the pay dispute today, I would, but there are other things that I could do as chair. Making sure that I am listening to our staff, engaging in those staff groups, talking to our team leaders—all of that, I hope, will make a difference, because there's nothing worse than working in a challenging environment where you feel that no-one is listening to you. It can't just be your immediate line manager; it needs to be the people right throughout the organisation.

What do you think are the particular lessons that have been learnt relating to maternity services and special measures, and then targeted intervention, around that need for communications?

I certainly think, in terms of the way teams operate, it does come down to the quality of leadership. The world is, I suppose, flooded with examples of where organisations fall flat because of problems in the quality of leadership. That doesn't just happen at board level—it can happen at hospital level and it can happen at service/team level. For me, it is about the quality of leadership and ensuring that those people who lead those teams are doing so compassionately, that they are aware of how effectively to manage other people and how to respond and reflect on the challenges that their colleagues may face, and to do so carefully and to do so compassionately. I think the notion of compassionate leadership is something that the NHS talks about quite a lot, and I want to make sure that we embed that throughout the organisation, not just at the top but all of the way throughout our service teams. It's really important that people understand what leadership requires.

So, I think that if you're confident that you can get the leadership right, you will solve some of those challenges around service delivery and around the engagement of staff. Governance and oversight, as part of that, are hugely important, and I would expect to see very robust reports back to the board and I would want to see the different committees that serve the board effective in their work. Health boards have a lot of committees, and one of the things that I'm committed to doing is ensuring that we have the right number of committees doing the right thing, because independent members, other than the chair and the vice-chair, only spend a handful of days per month in this particular role. We have to make sure that we use the time of independent members effectively in understanding how performance is to be judged and whether the strategic direction that they set is being achieved. Quality of leadership, quality of information, robustness of structure, but also making sure we use people's time effectively.

If I can look the other way, you've looked at leadership and the oversight of the chair over the board. What about the relationship with the political leadership? I'm not expecting you to comment on what's been happening in Betsi Cadwaladr over recent days, but what kind of relationship do you think it's important to have between a chair of a health board and, ultimately, the Minister?

If I can just take political relationships first, there are a number of different political relationships. The obvious one, of course, in terms of the key line of accountability, is to the Minister, and I'll come back to that relationship in a moment. I certainly would expect to have very robust conversations with all Members representing the communities of Cwm Taf Morgannwg, but in that robustness would also be an openness and honesty about the challenges that the health board faces, about the opportunities to do things differently. But I think it's important that chairs of health boards engage with their political representatives on a frequent basis and to have those early conversations when health boards are considering making what could be quite wide-ranging changes.

There are other, I suppose, relationships that fall within the political context, and that's the relationship with the local authorities. Cwm Taf Morgannwg, as you know, has three local authorities within its region. I'm really looking forward to developing the relationship with the three local authority leaders; that's absolutely critical if we're going to get that integrated health and social care agenda off the ground.

Fundamentally, however, chairs and vice-chairs and independent members are accountable directly to the Minister; they are ministerial appointments. There is a code of conduct that governs how you behave as an independent member, something that I've adhered to rigorously since being appointed as an IM at HEIW in January last year. The Minister, of course, sets chairs' objectives, and the Minister, obviously, as part of the integrated medium-term plan process, sets broader objectives for the organisation and for all health organisations. So, it is right that the Minister has confidence in me, not just to discharge my duties as chair but to be able to account to her for the performance of the entire organisation, and I'm confident that I can do that, but it is a robust relationship and you'd expect that to be in place.

Diolch.

Joyce, you wanted to come in.

Yes. Good morning.

Morning, Joyce.

Just in the same vein, really, there's a lot of balance—you're accountable to the Minister, but you're giving oversight to the chief executive officer. So, whilst you can, and will, according to what you've said, be robust in ensuring that the CEO is delivering what the patients want, how are you going to manage that push and pull from, perhaps, sometimes two different directions? Because, whilst you've quite rightly outlined all of the challenges, you won't be responsible for delivering the change; it'll be the CEO—the chief executive officer—who will do that. You have to come from the same page and travel in the same direction, so how do you see yourself managing that?

Thank you, Joyce. Firstly, it's important, and I know that the health board has been doing this, to ensure that the executive team and the independent members have that shared sense of purpose about what the mission is. There's no point having any—. If you've come to a point of going through a process of deciding the strategic direction and there's a massive disagreement at the end of it or a huge degree of uncertainty, then, clearly, something has gone wrong. So, I think that what is important for health boards, and certainly what I've seen thus far in Cwm Taf Morgannwg, is that a lot of work has been done in developing those board relationships, particularly in setting the strategic direction. That is, firstly, the important starting point, because if we get that wrong everything else falls apart.

Then, it is around relationships and trust and confidence and information and communication. What I've seen so far with this health board is that there is a lot of work that's done between the executive team, the chair and the independent members in holding regular, sometimes quite informal, discussions with independent members about issues that are coming up. They may not just be challenges, they could be about opportunities and successes, of course, which is what we want to see. But there is a—. It is important to have that free-flowing process of information whereby independent members are not surprised or caught out by anything that happens, that they are regularly engaged.

Now, that regular engagement isn't just about the board meeting that takes place every other month; it's not just about the board development session that takes place on the other month; it's not just about the committees that people sit on. Those are the formal bits, which are hugely important to the governance of the organisation. Those more informal discussions that take place between the independent members with the chair, between the independent members and the executive team, and between individual members of the exec team and individual members of the independent members team—. Because there will be different relationships that will be built up. So, for example, you know that the chair of the audit committee will spend obviously a lot of time with the finance director. So, I think it's about encouraging independent members to also use their skills to focus on areas of the organisation where they have perhaps more of an unique interest and develop that—develop those relationships. There is a risk—and you are right to raise it—that dichotomy of, on the one hand, you're setting strategy collectively, but then holding a group of people who've also contributed to the setting of the strategy to account for the performance of delivery, and I think it is, literally, just finding that balance between support and challenge.

Having read the auditor general's report into Betsi Cadwaladr, although the report is acutely about the operation of the board in north Wales, I think there are learning points or at least things from that that I would want to ensure that we sense-check in Cwm Taf Morgannwg. And I suspect that every other chair of a health board will want to do the same thing, because, fundamentally, although there is a huge architecture of governance that supports the operation of boards—it's loosely called the board assurance framework, but it's not one document, it's a whole suite of things—if you've just got that in place, don't think for one second that everything is perfectly fine. All of that works, providing the relationships, the communication, the trust, the reliance—. If all that falls apart, then, just because you've got the architecture, it doesn't mean that it works. And I think it comes down to, fundamentally, the nature of that relationship, that reliability, that reliance, that knowledge that things are being done in the interests of the board, and that collectively individuals are content, have signed up to the direction of travel, and are also content with the information that's provided to them to show performance and improvement, but, fundamentally, it comes down to those personal relationships.

Okay.

Thank you. Gareth Davies.

Thank you very much, Chair, and thanks for joining us this morning, Jonathan. I want to focus on working relationships, if I may. And it's to ask how the board of Cwm Taf Morgannwg can ensure that it has the required skills, can work together effectively and perform to a high standard. And how will that be measured by yourself?

If you look at the composition of the board, in addition to the executive team, there are 11 independent members, and they all come with a particular skill set. There will be people, for example, with a background in local government, background in the voluntary sector, background in business and finance, and audit and legal matters. Your board members are recruited according to the skill set and expertise that the board requires, and that does give the board a greater opportunity, I think, to use a variety of skills in the development of its work. Working relationships come in a number of different ways, don't they? I suppose, if you look at the operation of the board, it's the working relationship within the independent member team, and that's really important, that there is a cohesiveness and openness and a transparency between the chair, the vice-chair and the other independent members. There is a working relationship between the independent members, of course, and the executive team itself, which is fundamental to the health of the organisation.

But, externally, a health board that is doing its job effectively has to have a very open, a very frequent set of meetings, and, therefore, relationships with the local authorities that sit within its area. So, I would want to ensure that we have those regular discussions and dialogue with the chief executive and the leaders of the three local authorities and appropriate cabinet members as well. There are those relationships with the third sector, which are absolutely critical. If you're looking at a region such as Cwm Taf Morgannwg, where population health has been a particular challenge for many, many years, and which is a focus of the strategic direction of the health board, then working very closely with the third sector, in partnership with the third sector, who are ingrained in our communities, I think, is one way of perhaps approaching some of those population health challenges. So, those working relationships, those partnerships are important.

Cwm Taf Morgannwg also has a working relationship with Cardiff and Vale and Aneurin Bevan health boards and there are regular meetings throughout the course of the year between the chief execs and the chairs of those three health boards. You may be aware, for example, that, in Llantrisant recently, the Minister announced the purchase of a building that was owned by BA. That's going to be a new diagnostic and treatment centre, which will be of huge benefit to the people of Cwm Taf Morgannwg, but also to the wider south Wales area. Those sorts of things are done very much in partnership. So, health boards themselves don't just operate in isolation, they work with a whole myriad of other organisations outside of the health arena and very much within the health arena, and it's right that we do that. Now, that takes time and effort. Those are relationships that have to be built over time and relied upon, but they have to be open and honest in discussion as well, and that's something that I'm looking forward to tackling.

Thanks. We've obviously seen the news this week of the issues in Betsi Cadwaladr, and the news from the Minister was that she felt that the board wasn't holding the executive to account in an effective way. How can you use your skills and experience—because you mentioned the targeted intervention in Cwm Taf Morgannwg—to effectively stop that happening within that health board and ensure that the board does effectively hold the executive to account there?

The ability of independent members to hold exec members to account for performance will largely be determined by the quality of information that's available to members. Over the last 12 years, I've sat in various meetings where agendas are huge, where paperwork provided by colleagues can be endless. I think it's really important to always reflect on the amount of information that's put in front of people and the quality of that information to ensure that independent members get a real understanding of performance and improvement, and that they don't get confused by what's being put in front of them. I'm not suggesting that that happens, but I think there's always a risk, because of the size of our health organisations, by virtue of the enormity of the services that they have to provide to the local population, there are so many things going on, it's important to try and focus on those areas where scrutiny of the health board can make the most improvement and most impact. So, it does come down to the quality of information.

I've already said to the chief executive that if the Minister confirms my appointment, I would want to review the type of information that's put in front of the health board, the amount of information, the amount of paperwork, making sure that we really hone in on the detail and the information that allows members to understand really quickly the extent to which performance is being delivered and improvement is being secured.

I would also want to review the effectiveness of all of the committees. There are statutory committees that have to exist—audit and risk, for example. I'm not suggesting for one second that we do away with that, but I would want to talk to the independent members about the nature of the committee arrangements to ensure that they are as effective as possible in helping independent members to understand to what extent the strategy, the IMTP, but also the broader strategy of the health board is being delivered, and also making sure that those committees then can give assurance to the board that everything is being done to secure the improvement that we want to see. So, those relationships are really important, making sure that you identify the type of information, the detail that members want to see. I certainly think that that will come out in the conversations that I'll be having with the independent members if I'm appointed, because, clearly, they will have a view already as to how effective those arrangements are. So, I will be in listening mode.

In terms of public engagement, how will you represent the board in the public arena to engage with people and, indeed, instil confidence in the health board, in the public eye, anyway?

I'd want to be a really visible chair. I think anybody undertaking this role needs to be out there, they need to be seen. It's no good just turning up for a nice visit to one of the health sites and just having a conversation with the managers and colleagues. I think it's about that, but it's also about making sure you talk to patients, talk to patients' families. I'd want to make sure that we were engaging with the third sector and talking to the people that the third sector talk to. I'd want to make sure that I was out there talking to our GPs and our primary care clusters, where so much is done to promote healthier lifestyles, where so much is done to tackle some of the challenges of mental ill-health, for example. So, I'd want to be a very visible chair.

I would want to make sure that I meet very quickly with the chair of the new citizen voice body. That body, I think, will be quite critical in finding new ways of gathering patients' views. I'm sure that it will be advising health boards on the quality of the information that health boards gather from citizens to ensure that we are reflecting the views of people in the design and delivery of services.

If you believe that services ought to be patient-centred—which they should be, as social care services should be citizen-centred—then you have to involve people and you have to find different mechanisms to engage them. Now that's not just me standing up in a room in a suit and talking to people; there'll be other ways that we can collect qualitative information, and ensure that we use that at board to understand the impact of our services on people, because if you can't get that right, then what on earth are we doing?

I agree. Just finally, quickly, which key stakeholders and partners would you see to be most helpful to help you in your role in terms of turning around some of those targeted interventions and that public perception of the health board? Who would you see as the key players in helping with that?

I think the success of the health board over the next few years will be based in a number of areas. There is a very ambitious agenda called CTM 2030, which is all around population health. We have to be better at supporting people to lead healthier lives. I don't think that's something that the health board can attempt to do on its own; I think that relies very heavily on those members of staff who are working in our communities, whether that's GPs and our primary care clusters, whether it's working with the third sector, who have a fantastic ability to reach into communities and families in a way that perhaps statutory services traditionally struggle with.

I think delivering that CTM 2030 agenda is important, so if I give you one example: avoidable mortality in Cwm Taf Morgannwg is currently 339 per 100,000 of the population. The Wales average is 287 per 100,000 of the population. So, we need to be doing more to help people to live healthier lives. Sixty-four per cent of early deaths—and that's below the age of 75—are caused by, essentially, diseases that are impacted by harmful personal behaviours; so, whether that's drinking, smoking, obesity, for example. Now it's in all of our interests, particularly the interests of those individuals and their families, that we collectively do more to help people. Health inequality is a major challenge and it's something that the health board has been focused on. There is a population health and partnerships committee within the health board that focuses very acutely on the data, it looks at diabetes, smoking, obesity and cardiovascular disease, and I think that's extremely valuable. But we have to use that information to better inform how we provide some of those services and how we work with others to get information out there. So, those partnerships will be critical in delivering on that CTM 2030 agenda.

We have a backlog in elective care, and I think delivering that new diagnostic and treatment centre will go a significant way to responding to the demand pressures that we face.

I'd like to see us do more in the area of mental ill-health. It's something that I was very passionate about when I served here as a Member, but that will be something that I will pursue with the executive team; it's something that I want to ensure that our primary care clusters are very much involved in delivering, making sure that the experiences of in-patients in mental health facilities is improved. So, those things I think will be very much on my agenda.

There are a number of things that I would like to see us achieve over the next four to eight years, and fundamentally, how effective we are comes down to the quality of those relationships with our external partners, and I think this is where the integration agenda becomes so really important. The regional partnership boards have done a lot of work in the last 10 years or so, trying to understand strategically what it is that health, housing, social care and the third sector could all do collectively together. I think that has been a step change in bringing people together, but the statutory duty for delivering services rests with the health boards and the local authorities. So, that is where we need to get that shift, and I think it is a tribute to the leadership of the health board and the leadership of Bridgend County Borough Council that work has started to look at how we can integrate our health and social care services for adults.

Now, if that is successful, as I hope it will be and we will work very hard at delivering it, then I think there's a great opportunity there for elsewhere in the Cwm Taf Morgannwg region and elsewhere in Wales. But I think that will be a mark of the success of the next few years if we can really focus on delivering that. It will really improve patient experience; it will co-ordinate services far more effectively; it will stop people having the same conversation with a myriad of different professionals, which happens all too often, I'm afraid. We've been told about this for a long time and I think the more we can do to address that, the better.

Thank you. We're a little short on time. Joyce Watson.

You sort of skated around it without naming it and that's the equality and diversity that exists within the health board. And some of the regions are really poor, and with poverty, we know, come related health problems and none more so than all the challenges that people are currently facing with the cost-of-living crisis—the inability to feed themselves properly and the inability to heat their homes equally properly. So, those are just two examples.

Of course, the other example is the Welsh language and how you manage the equality, the diversity and the Welsh language to ensure that both the workforce is inclusive, the membership—it's nothing to do with you, the membership, but the people, the voices are heard. And I heard you mention the citizen voice body and I'm hoping that that, in itself, is a diverse group and that it's not made up of the same people, so that you're relying on the lack of diversity in the first place for your information. How are you going to address that?

Thank you, Joyce. If I can, Chair, just deal with the matter of the Welsh language and ensuring that we can deliver services in the language of choice. I do know that the board, as all public bodies are, has been strongly committed to the 'More than just words' strategy. There is strong support and promotion of that across the health board. There are, I've been told, gaps in some of our work and those gaps need to be addressed. So, there's no point someone saying, 'Well, yes, we think the strategy's great and we're all signed up to it', unless you understand the nature of service provision and perhaps where some of those gaps are. And I would be very keen early on, if I am appointed by the Minister, to ensure that we address those gaps as quickly as possible.

On the wider EDI agenda, I don't think that organisations in Wales traditionally have done enough to, firstly, find ways of recruiting people into their organisations who are more diverse. So, if I can give you an example: as chair of Hafod housing association, we participated in something called, the pathway to board programme, and, as a result of that, we supported a number of people from the black and Asian communities. I mentored one of the participants in the programme, who attended our housing board meetings over the course of a year and it supported that individual to understand how the board operated and what the nature of being a board member was and, as a consequence of that, she's now secured a really interesting trustee position within a major charity. Now, more of that can be done. I think health boards could be doing more of that so that we ensure that we reflect some of that diversity at board level. I think that is extremely important. And as chair of the housing association, I've led very strongly on the whole nature of inclusion, equality and diversity, because it is something that organisations need to reflect and when you are providing services to diverse communities, then we need to look more like the communities to whom we provide services.

I do know that, in Cwm Taf Morgannwg, there have been quite well established staff networks for all of the protected characteristics, which I think is extremely important, and they will have a very articulate and visible supporter in me as chair, and I would look forward to meeting with those staff groups over the course of my time as chair, if the Minister appoints me. But I think it's important that health boards can do as much as they can do in demonstrating that they are open, that they're equal, that equality of opportunity is something that is ingrained across the organisation, but that we do more to reflect the diversity of our organisation so that people feel that they are included in the work of the health board and the delivery of our services.

Okay.

Thank you, Joyce. One last question from me. You will have followed the news from Betsi Cadwaladr health board this week. Is there anything different that you would do, in terms of your reflections on what has happened over the past week, that you would reflect on that and think, 'Well, I would do something differently', perhaps? Or perhaps there isn't.

I said earlier, Chair, in response to a question that, essentially, organisations can have this architecture of the board assurance framework and everything that sits under that—your standing orders, your financial instructions, your audit and risk committee, your risk appetite, your board assurance report, your annual review of board performance and independent member performance—and all those things are really important; they are. But where things fall is in relationships, and the reliability and reliance that people place on others within an organisation. And I think the only reflection I would make, and I think it is drawn out in the auditor general's report, is on the nature of those relationships, ensuring that you do everything you can to make sure that they are healthy, they are open, that colleagues are involved in discussions and decisions.

I think it's important for chairs of health boards to spend time with their independent member team, but, likewise, they have to spend time with their executive team as well. And I think that it is in that pursuance of that relationship building and maintaining the quality of that relationship that demonstrates a healthy organisation. People should not feel that they've been caught out by a problem, and, if they have been caught out by a problem, then clearly something has gone awry in the nature of that relationship between, potentially, the independent member and the executive team. But I think developing and working on those healthy relationships is something that has to be a focus of the chair, because, despite having everything in place that you're required to by law, despite having everything that Audit Wales expect to see, despite having a really robust internal audit plan that every health board would be expected to have, unless those relationships are there, unless people feel that they can ask difficult, challenging, searching questions, in an appropriate way that isn't deemed to be, perhaps, as I think the auditor general alluded to in north Wales, in a challenging way that perhaps leads to a fractious arrangement, then of course things do fall apart.

And I think, as chair, what I would want to do is to ensure that I would continue a programme of regular meetings with the independent member team, in addition to leading the board, in addition to robust discussions with the chief executive, and ensuring that our board development sessions allow the board to focus on those areas where perhaps they are more likely to have concern or a level of interest. But it's about that openness and transparency, because, without that, I'm afraid nothing else works.

Okay. I think that's a fair answer. Thank you, Jonathan Morgan, for being with us this morning. Diolch yn fawr iawn. Our committee will consider its report and aim to publish our response early next week. So, we wish you well in the process.

Thank you, Chair.

Thank you, Jonathan.

Thank you. Good to see you.