Health and Social Care Committee

As we know, the purpose of today's meeting is a pre-appointment hearing for the role of chair of Aneurin Bevan University Health Board. We are very pleased to have with us the Government's preferred candidate, Andrew Morgan, today for this pre-appointment hearing. It's an opportunity for us as a committee to ask Andrew a few questions, and we will perhaps move into that, if you're okay, Andrew. We'll start that now.

First of all, congratulations for being put forward for this position. I want to explore, perhaps, a little bit, even though I know you personally but for the wider audience as well, your knowledge and experience. I wonder if you could tell us why you believe you're well suited to this role, and how you would perhaps draw on your skills and experience to ensure the health board is an organisation that will have strong governance, accountability and strong financial management as a result.

Okay, thank you. So, on my previous experience, in my current role, I have led a major organisation, with over 10,000 staff, a budget this year of £900 million, and working with the executive team in terms of shaping policy and procedures within the local authority. In terms of governance—having that constructive relationship with officers, but also being able to challenge, using data, using performance management and our annual and monthly inspections in terms of our financial performance, our targets against the corporate plan et cetera.

So, I think I've got a lot of experience in that area in terms of being able to have a constructive relationship with an executive team, helping to shape the strategies and helping to make sure that an organisation moves forward in a way that is clearly set out by a board—in my case, it's a cabinet and an executive. But just making sure that the outcomes are being challenged and that we are following the plan in terms of corporate plans, to make sure that we then put resources into those areas. So, it's having that kind of feel, to understand where we're moving forward, and that is something I've done over the last 12 years as a council leader, but also I've been involved in strategies with the Welsh Government and other local authorities in my role as Welsh Local Government Association leader.

Thank you, Andrew. I recognise the breadth of your role over the years, certainly leading a large authority. I suppose that leads into my next question. So, whilst we in local government have a lot of interface with the social care side of things, obviously the health side is an area we don't touch so much or so closely on. I wondered how you believe, then, your experience—. How are you going to apply that to the health and social care sector of Wales? What's your vision of how you might see that and, using your experience, how you might be able to influence that for the future?

My largest role with health, certainly over the last five or six years and since the pandemic, has been around social care in particular, focusing on supporting hospitals. I’ve done a lot of work in terms of Welsh Government internal bodies and review groups, but also working on that local footprint. So, we often focus a lot on social care, trying to get people out of hospital, but 95 per cent of the effort, actually, is keeping people out of hospital in the first place. A lot of the work we've been doing—and I think health boards need to move more in that direction with local authorities and primary care—is that longer term planning. We've been carrying out work as local authorities in terms of how we can work closer with and bring together partners in terms of longer term planning. One of the concerns, I suppose, that now is being expressed, and I've raised in meetings, is that if we focus only on the here and now, that longer term planning in terms of getting primary care to be almost ahead of the stream, to try and focus on what is going to happen in terms of population needs in five and 10 years' time—. I think that's where local authorities, partners with primary care in the health boards, are key, and I think that's something that the health boards need to really focus on. I would hope that Aneurin Bevan now would have that longer term plan in terms of where we will be in five and 10 years' time.

So, do you feel that, in the past, there's been perhaps not enough joined-up thinking between health and social care, between the local government sector and the health sector, and perhaps you feel you can pull that together?

I think there's been a step change. It's had to be a step change in the last six years since the pandemic, so that has been a positive, because it's actually driven partners to work closer together. But I think there's a lot more to be done. As I say, the more we can do to keep people out to hospital—it shouldn't just be a focus on getting people out of hospital. So, I think that partnership and agencies working together is going to be key. The health board alone won't be able to do it and local authorities won't, and including, I have to say—we've relied heavily on the third sector as well. So, I think it's bringing everybody together around that.

Thank you for that, Andrew. The last one from me, really: you still hold quite a significant number of appointments—I'm just wondering if you foresee any conflict about current appointments. Obviously, you're going to continue in the WLGA role for a little bit longer, and things like that. Do you see any conflict with you being able to get to grips with this?

Just to be clear, I always intended not to re-stand at the next elections, and therefore it was the right time for me to step down a year before the next local elections. But to be clear, I would be stepping down as the leader of the council before this appointment if I was successful. And similarly with the WLGA role, although I had intended to step down at the same time, I've been asked if I would stay on for about four to six weeks as a transitional arrangement only, in terms of the elections, and that is to make it cross-party. There's been a request, in effect, that I should do that, but I certainly, then, would be stepping back and wouldn't be involved in the WLGA, as I wouldn't be a council leader, and I would be focusing on my priority, and I would be managing my time. I have to say, I've always been committed, if I'm going to go into a role, to give it my commitment, which is why, when I became the WLGA leader, for example, I gave up the position of Cardiff capital region chair. If I'm going to take on a role, I want to be able to give a commitment to make sure—.

In terms of managing any conflicts, I've always had to do that to make sure that it isn't anything, but I would make sure I would recuse myself and obviously declare if there was anything, and just make sure that I was careful that it isn't just a conflict, but perception is important as well. So, for that shorter time, I would certainly make sure that I would focus on that.

Yes, thank you for that, Andrew. Okay, can I bring James in, please?

On conflict of interest, before I move on to overall strategy, there is going to be a perception out there that you backed the current health Secretary to be the First Minister, you're a member of the Labour Party—there will be elements out there who will say this is a little bit of cronyism, jobs for the boys in a way. I'm just interested in how do you manage that perception going into an organisation like Aneurin Bevan, which has got some very big strategic challenges, which I'll come on to?

Well, I'd have to say, anybody who knows me knows that I wouldn't be that way inclined, in terms of if I go for something, I think it's based on ability. What I would say—I point to my track record. I think leading the second-largest authority as an organisation, which pretty much has got a good record—it's got exceptionally good outcomes in inspections over the last 12 months, amongst the best in Wales. In terms of my role at the WLGA, I think the fact that I worked cross-party and also really brought people together over the last six years goes to show that I do have some strengths in trying to work with people and trying to get the compromise. But I just think, even if I refer back to when we set up the city deal—we were the first in Wales to do that. It was a very new concept at the time, liaising with UK Government, which was a different political party et cetera, and bringing people together and having that fostering relationship. I think that has been successful, and I hope that people would judge me on my track record as an individual leading organisations, rather than my party politics, which I have to say—. I've always tried to be very middle of the road to work with everybody. I've always been that way inclined.

Thank you. So, on strategy, Aneurin Bevan, as you're probably well aware, has got its challenges. It's in level 4 escalation for financial matters, and for urgent care as well. I'm just interested—. They've got some models, so they're going to address that. I'm just interested in what expertise and experience you think you've got that can actually help get the health board out of that level of escalation and back into normal functioning practice?

I've been able to look at some of what they've put forward, but, obviously, if I was successful as chair, I'd want to make sure very early on that I'd get to grips and fully understand those areas of intervention they're looking to change.

In terms of the financial side, because of years of difficult budget setting for local authorities, I'm quite au fait with scrutinising budgets, looking at things like efficiencies in particular, and challenging, and also making sure that, when we've had to have financial planning, it isn't just on a 12-month period, it's over a medium term, so you don't just plan for your budget, but also your savings and efficiencies in the current year, and you do it on a rolling three-year basis. So, I think providing that level of challenge, but also support around financial planning I think is key, and just making sure that we are looking at the longer term in terms of those pressures. Because one of the big risks with savings et cetera is, if you don't make savings early on, the longer into a financial year you make the savings, the bigger the savings have got to be to get the full-year cost. So, I think having that medium-term financial plan and that medium-term view is key.

So, obviously, to do these things, the organisation is going to need quite substantial change. Do you have any ideas yourself currently of how the health board needs to—I'll just get my words out, and put my teeth back in—strategically change to meet these challenges as well? Because there are issues around workforce and all the rest of it with agency workers, elements of delayed discharge—. These are huge issues, and I'm just wondering whether you've had any thoughts leading into this process of how you'd like to strategically change the organisation.

In terms of having a focus on some of those key areas and, I suppose, some of the early priorities, I've been able to read up and look quite a bit over the last about four to five years in terms of agency use within Aneurin Bevan, and while there's been a substantial reduction, it still is tens of millions of pounds in terms of agency costs, so having that longer term staff plan is fundamental. Again, from the organisation I'm coming from, we found that as well in certain areas in terms of recruitment; you've got to think about the long-term staff plan and recruitment in terms of when there is turnover or when people are leaving the organisation. If you haven't got people readily available in key areas to be able to recruit, you've got to think about the long-term planning for those areas. So, I think that is one area in particular, on staffing, to be able to get permanent in-house staff rather than relying on agency, that I would want to really focus on.

It is balancing priorities and strategy, isn't it? I think there was a piece that came out yesterday in the South Wales Argus, wasn't there, about waiting list times having come down in Aneurin Bevan, but cancer waiting times are obviously not improving, or are slightly worse, and cancer is a strategic priority for the First Minister in the last part of this Government. I'm just interested in what your views are on cancer services, then, on a strategy point of view—how you can bring everything, then, into balance? And the Cabinet Secretary yesterday talked a lot about bringing the health service into balance. That needs to be as well in discipline areas, because cancer is a key focus area for us. I'm interested in what strategy you think you can use in that area to try and bring cancer waiting lists down.

Again, because I'm outside the health board, from what I've been able to look at, I particularly would want to focus and understand what those range of priorities will need to be. At the same time, of course, trying to address the financial position is going to be a challenge, in terms of making sure that if they are strategic priorities for the health board and for Welsh Government, then, obviously, the board will have to make some decisions around how you prioritise that, both in terms of financial resources, but also in terms of people resources. So, I think that would be something I'd want to get to grips with and have a good look at, should I be successful. But I am aware, again looking at last year's statistics, Aneurin Bevan was on the better side in terms of some improvements on cancer times, but still not meeting the target. And where there's been some slippage—again, it's one of those areas where, if you're trying to improve, I think the improvements you're putting in place need to be sustainable. You can't go from one area to another area and constantly move resources or prioritise where it may improve in the short term, but then it's not long-term sustainable in terms of the outcomes.

A final question from me—sorry, Cadeirydd—obviously, we've seen over a number of years a different view of hospital estates across Aneurin Bevan, with downgrading in Nevill Hall and the building of the Grange, which has got its own individual challenges. I'm just interested, from your perspective in terms of the strategy of the estate across Aneurin Bevan, how you see that evolving and changing, considering the financial pressures but also access to healthcare as well, and making sure that people who have got inequity in terms of access to healthcare, people who live in certain parts of that health board area, can access good, timely care as well.

I think probably the first thing I'd want to say is that, on the Grange, for example, I'm not suggesting a wholesale change, but I think I'd want to be confident and understand that the model can work. I know there have been extra resources put in and targeted intervention, for example, at the waiting areas at A&E, but I'd just want to make sure that the model is deliverable, and what is at present the barrier to stopping it being deliverable. There are a lot of good things going on at the Grange, but, at present, there are a smaller number of areas that are overshadowing, and some of the patient experiences are not good.

But there are other good areas. You mentioned about bringing services. At Nevill Hall, the partnership with Velindre in terms of cancer services there, I think, is exceptional, and that obviously means that people from the Gwent valleys don't necessarily have to travel down to Cardiff for their treatment, et cetera, so it is bringing services closer to residents.

I think it's getting that balance right. Again, there won't be an unlimited amount of funding or resources in terms of people resources, but trying to put the right services in the right location is key. I know, for example, at the Grange, for some time it's been discussed in my other roles in terms of transport, around the transport links there, and public transport in particular. So, again, trying to work out and look at the estate as a whole picture for the whole catchment area of Aneurin Bevan, I think, is key in terms of not just managing the service, but how you manage services that are more accessible to residents as much as possible.

Okay, lovely. Diolch.

Thank you, James. Mabon.

Thank you. I'm going to ask my questions in Welsh. In terms of the challenges facing the health service in Wales currently, thinking of Aneurin Bevan, but also nationally as we are looking at the health service, what is the biggest challenge, in your view, that is facing the health service?

I suppose, in terms of the biggest health priority, I'd probably say, especially in terms of the targets set by Government, is around the waiting lists and the impact that is having on people. All too often, we see people who basically should be living healthy and fulfilling lives, and in some cases should be in work, who are at present not able to do that because they are on the waiting lists. I think that is certainly an area that needs to be one of the biggest priorities in terms of addressing that.

But I think the longer term sustainability of services is the key, because there isn't going to be sufficient funding available, potentially, for what we would like to do for everything within health, especially balanced against all the other public sector areas. I think that longer term sustainability of services is key. Alongside that, and it comes back to the earlier point about that longer term planning, about how do we support residents to live healthy lives and, to a certain extent, take more ownership of their future health, I think that comes back to that collaboration around other key partners, about how do you plan for that five, 10, 20-year strategy, so we're not chasing our tail as a health service, and we are thinking about the longer term, to try and turn down the tap in terms of people. If people are going to live longer, have more complex issues in their lives, the demand will vastly outstrip what the health service will be able to provide, unless you have that longer term plan to support and work with individuals.

Yes. So, accepting your concerns about waiting lists and looking at the long-term issues, of course, the waiting lists are a symptom. One of the things within that that we know about is what the Government is calling the 'flow' of people going through the hospitals. That's because of this bottleneck where there are people who can't be discharged into the community for care. Would you accept that that is one of the main challenges that we are facing, discharging people from hospital?

Yes, that is a significant issue. Previously, as part of the care action committee I sat on with Welsh Government, looking at some of the deep-dive data in terms of what the bottlenecks were, quite often it is with local authorities in terms of social care provision, but when we did a deep-dive looking at it, it was around a 52:48 per cent split, where almost 50 per cent of the cases were down to hospital reasons. Sometimes they were complex reasons around delayed discharge, sometimes they were around prescriptions and medicines, and maybe not getting their prescriptions early enough in the day, so there was a lag in terms of people, four or six hours after they could leave hospital, still being in hospital waiting for their medication to go home.

So, there has been a series of pieces of work that I've been involved in with the Welsh Government under the care action committee, which has done some work around this, that has actually been able to flush out some of those areas. And in terms of delayed discharge, for example, weekends are a particular issue when getting people out of hospital, but also having those joint assessments where somebody is waiting to go, maybe into a care home or into a residential home, where they need to have the joint assessment. That also was an area flagged up that was probably on the higher end. It's a smaller number of cases in terms of the reason for delayed discharge, but in terms of the days of delay, that is quite a substantial chunk and it was quite interesting to see the breakdown. Over the last year or two—over the last 18 months or so, I should say, sorry—health boards, I know from my own area in Cwm Taf Morgannwg, have been challenging some of those particular lines to try and get the biggest intervention to get those numbers down on delayed discharge.

Thank you. In terms of the numbers of people across Wales who are staying in hospital unnecessarily and aren't able to leave, the highest percentage, according to the latest statistics I've seen, are in Rhondda Cynon Taf, under your leadership. Over 11 per cent of the people who are in hospital unnecessarily are from Rhondda Cynon Taf, because they can't get that agreement. So, what lessons have you learned from that experience in order to ensure better joint working between local government and the health board if you were to undertake this role in Aneurin Bevan?

In Cwm Taf Morgannwg and through RCT, we were one of the first local authorities in Wales to have social care staff embedded in the Royal Glamorgan Hospital. So, having staff there to, first of all, try and turn around people coming in, especially the elderly and frail, so that if they didn't need to be admitted, they were there to be able to provide support—was it a case that they've ended up in hospital as a last resort? We were one of the first local authorities, or if not the first local authority, with the health board to introduce that and I know it's now been rolled out in a number of areas, including more recently, I believe, at the Grange in Aneurin Bevan. That has had a significant impact in terms of turning people around, but also having our staff working with bed managers and hospital managers around clearly identifying, so we don't wait until the point where somebody is being discharged today to find a care package and to send them home. We are clearly working on that three, five, seven days ahead, so that there is a clear plan. So, that's the way that we've been able to address more of it.

Some of the data, I would just point out as well, because when I've challenged this in my own local authority, it doesn't always tie up with residents living in RCT; it can also be residents in RCT, in terms of the hospital, and that is something that we've gone back and looked at in terms of the data. Because when Cwm Taf Morgannwg overall was in a reasonable position, there was high incidence in Bridgend, but also some of those residents from Bridgend were in Royal Glamorgan, based in RCT. So, we've been able to unpick the data to look at the numbers, and that's where, on the back of that, we've been able to drill down using some forward plans around how we tackle this, because there isn't one size fits all, it isn't one particular issue. If you look at all the reasons for delayed discharge, which I'm sure you have, there are lots and lots of different layers. Some of them are bigger numbers, which are much more difficult sometimes to challenge and to change, other areas, you can intervene and you can make a difference, but sometimes the impact is smaller, but it's using all of that information to try and drive a strategy so that we get away from delayed discharge.

But, following on from that, from your experience, as the chair of the health board, how would you foresee collaborating, therefore, with local authorities within Aneurin Bevan in order to make sure that this is solved?

So, in the way that we've done it, certainly in Cwm Taf Morgannwg, when I've attended these meetings as leader, we've made sure that we've brought chief execs for the three local authorities with the leaders, so there's political buy-in and there's officer buy-in from local authorities with the chair and chief exec of the health board. We have regular fortnightly meetings, but also below that, we've been able to set up a set officer group between the three local authorities and it's about buy-in and making sure that this isn't passing a problem over, but it's getting everybody to buy in to the shared problem and then identifying what is the best intervention.

Thank you. James, do you want to come in with a quick one, and I'll move to Lesley then?

Just on this point, Andrew, because one of the big driving factors of delayed discharge is actually who's paying for it. That's what I hear from my own health board. I hear it from my own local authority. A lot of the back and forth goes between whether it's continuity of care, which the health board have go to pay for, or is it social care, which the local authority pay for. I declare an interest: one of my family members is a discharge manager for a health board, and they say there's an awful lot of butt there between the two. Perhaps you can get the buy-in from a senior level that we need to do this, but when it comes to the nuts and bolts and people signing off on the monetary side of it, it delays things for a long period of time, and you get people stranded in hospitals, basically. So, how do you think you can use your experience to try and get more into the granular side of it, because it's great having the political and chief exec sign-off, but if that's not filtering down through an organisation, nothing really changes, does it? It's just more warm words, really, when people are still stuck in hospitals.

I've got to say I recognise that type of set-up that you say. Probably about two years ago, we had something similar, and, in the end, there was a conscious decision made. First of all, the priority should be to get the person out of hospital, because if they shouldn't be there, they're at higher risk, potentially, of infections and various other reasons, so, either way, they need to come out, and what we agreed initially was that the local authorities picked up the cost and then the case would be reviewed and then decided at a later date and reimbursed, et cetera. We were able to significantly clear some of those cases by just getting that buy-in from chief execs, political leads, with the health board.

The overall numbers, I have to say, they're not significant in terms of the overall picture, certainly in my area in Cwm Taf Morgannwg, from what I recollect. The numbers are not significant, but the delays are significant. So, you may have a relatively small number of individuals, but they could be delayed by weeks and, in some cases, months, for the continuing healthcare package. As you say, it's arguing around who's paying the care element against the residential element and weighing that up. But we've been able to certainly try, by bringing people together and driving that message that, actually, finance is important, but the priority is to get that person out of hospital or into the right setting as quickly as possible, and we've been able to make some progress on that.

It isn't over the line, as in, it works all the time, but I think getting that senior level buy-in is key, because without that senior level buy-in in the organisation, as the message gets passed down, it just doesn't get implemented, and I think people will end up almost like silo working in terms of, 'It's my budget or your budget.' So, I think that's the priority we've set and that's what we've done relatively well. It has meant that local authorities—. My own has had to pick up costs initially and then be reimbursed later on when it's been worked out, but we've been able to do that. I think having that open approach and having that trusted approach is the way to take it forward.

Could I drill into that just one little bit?

Well, yes, I do want to bring other Members in.

Really quickly then, obviously a health board like Aneurin Bevan is in financial problems, as a number of health boards are, so, obviously, local authorities are picking it up. I'm just interested, from your experience, how you then try and get finance directors in the health boards to suddenly say, 'Oh, yes, we'll pick that cost up now', when there's obviously loads of pressure on them to try and balance their budget, whereas they might think, 'If we just keep deferring and pushing this away, it's going to save us in the long run.'

But I think that comes back to that shared purpose and shared understanding, but also having that trusted relationship, as trusted partners, to work together and ultimately focus on the patient and focus on the outcome. That's the way we've been able to drive it. It doesn't mean that every case is resolved and, yes, there are challenges and not every case may go down that route of being able to be dealt with quickly, but it's actually having that conversation and having that challenge and pushback to say, 'This person just needs to get out of hospital.' In some cases, I've had individuals write to me, and I'm sure Members of the Senedd and Members of Parliament would, where the impact on the family is significant, not just the individual. So, for those reasons, we've looked at it and said, 'Well, we just need to get this person out and then we'll work through.' But I think it does take that step of faith in terms of working together, but that's where we've got to look at it as a public sector; we shouldn't be in competition, we should be working together on the shared outcome.

Okay, thank you.

Thank you. Lesley.

Thanks, Chair. Good morning, Andrew. I just wanted to look a bit at how you'll develop your working relationships with key people within the health board. You've said a little bit about your experiences in a variety of leadership roles, but perhaps you could say how you will develop those working relationships with the board and the chief executive and, obviously, the staff of the health board, which is really important for a chair, I believe.

I think having the right culture in the organisation is key, first of all—using all the right principles, being approachable, openness, transparency—but, in terms of, then, the exec team, having that constructive relationship, where you can challenge, you can scrutinise, but also be that support in terms of a team approach. That's the way I've fostered in my current role, where we try to have an RCT team approach, as we call it. But it is having that right kind of culture and setting out from the start expectations in terms of supporting the team, but also, as I say, having the ability to have that openness and transparency so that you can challenge and you can scrutinise, and you can really get into the detail to understand that what is being presented and what is being put forward as strategies and what is being implemented is actually delivering.

In terms of with staff, one area in particular—. If you consider, for example, the staff surveys that the NHS does and health boards do, I know Aneurin Bevan is probably on the better side in terms of that about one in three staff do complete staff surveys and consultations. That's above, I think, the Welsh average, which is about one in four, one in five members of staff. So, it is on the higher side, but still only one in three staff actually do fill in a survey and give a view. But actually understanding then how, when staff do feel—. You know, are they feeling empowered, so that, when they are doing a staff survey, those surveys actually then influence both the exec team and the health board in terms of how the organisation and the culture is led, in terms of making staff feel welcomed and supported? We know the pressure on staff, and that's been very similar—. My approach in my previous, or my current, organisation, is about how do you have the right kind of culture to support staff, and also, as I referenced earlier, about having that staff plan for the longer, medium to long term about managing staff numbers, recruitment and also covering key priority areas.

Thanks. Collaboration between health boards is becoming even more important, I think, particularly when we're seeing the very specialised services—you mentioned earlier, particularly, Velindre. So, I was just wondering how you would support the chief executive in making sure that there is regional collaboration across the health boards. Do you think that's something that you think is important and that you would want to drive forward?

Yes, so, it's vital, it's not just important. In particular, I've played a role, over the last few years, in terms of Llantrisant Health Park. From the very start, when the site became available, as a local authority, we were involved in looking to purchase that on behalf of, potentially, Welsh Government and the health board. But, in the end, the health board took it forward with the Government. We've been in a series of meetings on a regular basis—updates on that—and it's clear that having bricks and mortar and having a really good facility are key for delivery, absolutely, but, for this to really work, it needs to have that collaboration.

And I know the Minister, I think in the last six months, has issued a ministerial direction around the health boards—I think Cardiff and Vale, Aneurin Bevan and Cwm Taf Morgannwg—working together. And it's clear from the meetings that I've been in internally around this that that model, for it to get the maximum output—. And it's not just about eliminating, maybe, the two-year and the one-year waits; the potential for big regional collaboration has been put forward that they could actually eliminate waiting times—almost eliminate them—in a matter of years. But that only comes about if the three health boards collaborate together in terms of people resources. So, that is a key area, and I know that there's a stream of work now that has been set up around the health park. And that is something that, again, as part of our regular updates that I get with the chief exec and the chair of the Cwm Taf Morgannwg board, we've been able to have an input into and work with.

So, I certainly would want to bring that knowledge and experience to Aneurin Bevan, because I know they are, fundamentally, going to be part of this for south-east Wales. And, actually, if this model comes off in the way that it has been put forward, and the evidence I've seen so far certainly does show it would work well, this could be an actual—. You know, we could be leading the NHS, actually, in Wales, in terms of south-east Wales, for the population. So, that regional collaboration, I think, is absolutely fundamental.

Thank you. And just finally, public confidence in our health service is really important. Would you see it as part of your role as chair to get out there, to engage with the public and to try and instil that confidence in them?

Yes, I absolutely think that is a fundamental role for the board, as well as the chair. And also, I think, putting out not just good news messages, but actually giving people the facts around—. For example, if you look at cataract figures—I was talking with my own health board recently—there have been massive improvements in the waiting times and the figures there, but, actually, we're not publicising it enough. And fortunately, there are really good areas within the NHS that are really delivering and making significant progress, but we don't speak about those areas, because, obviously, the pressure and the fundamental priorities are on some of the areas that are not delivering and are causing impacts on patients and on residents. But I think it's important to also speak up about the good areas and to have that engagement with the public, because I think it's also important for staff as well, for staff morale. So, where there is good work being delivered, I think that we should talk about that as well, but also have those open and frank conversations with the public about areas that are in difficulty and how we address those, going forward.

I've got quite a lot of experience in terms of looking at consultations, from the organisation I'm currently in, and consultations don't always change the outcome, but actually consultations are important to make sure that you're not missing anything. And I think that using that knowledge and using that information from the public and from staff is important to help shape services as well and to make sure that you're not missing something or that you are making sure that there are mitigations in place. So, that would be something that I certainly would like to see as the chair, that I would like to play a role in terms of getting that messaging out there.

Okay.

Thank you, Chair.

Thank you. Thank you, Andrew. Joyce.

Good morning, Andrew. I'm going to ask you about equality, diversity and the Welsh language and any experiences and skills that you can draw upon that will help you to include those in your thinking but also in your delivery.

In terms of diversity, equality and Welsh language, I suppose my starting point would be that they need to be embedded in the policies and strategies of the organisation; they shouldn't be an add-on. I think it's really important that that is in there from the outset so that they're not just seen as being a tick box. In particular, for the Welsh language, in terms of the Welsh language standards, that's the minimum we should be doing. So, I think that having buy-in and having that from the chair and from the top of the health board, having that embedded and that view is important to help to drive the organisation to look at those areas.

In terms of my own personal commitment, if I could just touch first on the Welsh language, when I suggested bringing, to my own area, the Eisteddfod to our area, that was seen as, 'Well, it's never been there in 20-odd years as the council', but, actually, my key line was, 'Well, the Welsh language is for everybody, and we are a county where Welsh numbers are growing, so why wouldn't we want to see it coming, and actually, not as a one-off, but how do we embed that now?' So, as a council, when we put on events—we've got an event this year—we've been able to put into that now that Welsh language bands, as part of a music event, are mixed in as part of the norm, so it isn't just a token or a one-off. So, I think that having that embedded culture in an organisation is really important, and making those, sometimes, strategic decisions.

I would say the same for equality, in terms of supporting staff. In my own organisation, we have staff support groups for different areas to make them feel empowered and also so that they have a voice in terms of how we deliver and do things in the local authority. So, I'm quite passionate about it. But I am always keen to say that it needs to be more than lip service. I know that the Welsh Government uses the term, I think, 'More than words'. But it needs to be embedded and not just simply a tick box or because we are under pressure to meet a certain standard. It should be the norm. So, that's the kind of approach that I would take to that.

In terms of all those things that you've touched on and the work streams for listening to staff, there are really good models around, and you've demonstrated that as well, and the listening element, for people to understand that. Your staff are going to be most important feature, and you've recognised that quite clearly, and they will come under pressure at times under the equality and diversity stream. So, heading up those and getting that to be fed back to the top if any change is needed will be critical and will require a structure, as you say, of embedding. So, how would you embed a structure that allowed that free flow of information so that you can get ahead, if you like, of any problems that could be building?

So, I think, first of all, having, if I use the term again, a cultural fairness in the organisation I think is really important. That's what I've tried to operate in my roles up to date, in terms of allowing staff to feel valued in terms of their roles, but also being able to have that internal voice. So, I mentioned earlier about the staff surveys. There are a number of sub-groups, there are a number of work streams within health boards where those opportunities are there to be able to capture that information, to make sure it's fed back. So, I think making sure that that information is fed back to the health board and to the health exec is key, and, as I say, when you're taking forward, then, strategies and policies in the short or long term, that that is thought of as part of that stage.

So, I do think there are opportunities. Nobody gets everything right initially, and I think that's why the ongoing dialogue is key, and, at the same time, having a constructive relationship, I would hope, with trade unions, in terms of with the staff as well, so that you try to head off and you try to address issues—I'm not the chief exec, I wouldn't be on the exec, on the operational, side, but—ensuring there is a kind of culture that, where there are issues being flagged up, they are addressed, and care and concern is given to that so they don't get escalated, so they don't then become an actual issue for the health board, they can be addressed at source.

Okay, thank you.

Thanks, Joyce. And lastly, John.

Diolch yn fawr, Cadeirydd, and bore da, Andrew. Just in terms of measuring success in the role of chair of the health board, and the overall performance of the health board, I wonder if there's anything more you would like to say, Andrew, over and above what you've already put on the record this morning, in terms of what success would look like for you, in terms, perhaps, of the first year and immediate priorities, but also over that longer term that you've highlighted.

Okay, thank you, John. I think, in the first year, clearly, the areas of escalation and addressing them and seeing either progress being made in terms of de-escalation, or certainly being well on the path to de-escalation in terms of the strategies being implemented by the health board, would be the immediate priority, certainly. I think, over the period—. So, if I was successful and appointed on a four-year term, I would hope that, by the end of the four-year term, patient care and pathways are in a much better position in terms of people being able to receive good quality or high-quality care, at the right time, and in a locality that addresses their needs.

So, I think there are more pressing priorities that would be the driving focus, I think, in the initial months, if I was successful, and that is very much around those areas of intervention and governance, financial pressures. Because I come back to the point earlier, where, if the financial side isn't brought under control—and I know there are plans in place, and I've read quite a bit about what the health board is doing, but if those plans are not implemented, and the financial side isn't delivered—then, clearly, priorities in the future could be derailed and you won't get, actually, the delivery and investment into the areas that the health board is really driving at.

So, I would say there are two clear areas for me—the immediate short-term interventions and priority, but, over the next four years, I would hope, and I would really strive for, that the health board is in a better position, providing that good quality care in a timely manner. That would be my priority.

Just on the back of that, Andrew, I wonder if I could ask you about that longer-term picture, which you've mentioned as very much in the centre of your thinking. It seems to me that the health service is often very reactive, and it's easy to understand why, really, isn't it? It has to cope with those immediate pressures at accident and emergency, to get the waiting times down for elective surgery, to deal with delayed discharges, the impact on ambulance response times and so on. And it's very difficult to sort of get heads above the parapet and look at the wider determinants of ill health or good health.

Coming from a local authority background, obviously, you're used to working in all sorts of partnerships with the third sector and so on. And it seems to me that if we are going to be more preventative and long term around health, it's going to take a big effort from quite a number of different players—grass-roots sport, the leisure trusts, all those activities that are available, and the ability to reach out into communities. It's a massive effort to really get to grips with a more preventative and longer term view around health. But is that something that you think it is possible to make significant inroads into, were you to be successful and become chair of the health board?

As part of a longer term plan, I think the areas you just covered there are essential again. Talking of my own personal experience, we've put in huge investment from the local authority into the sport area, in particular working, for example, with the Football Association of Wales. We're bringing in significant UK Government funding, because even in the Valleys now, football has overtaken rugby as the No. 1 sport. But actually, it isn't just about the here and now, as you say, in terms of the sport and the enjoyment they get; it's about having a healthy lifestyle, and having a healthy lifestyle for longer. Because in my own area, in Cwm Taf Morgannwg, but certainly also in Aneurin Bevan, the health inequality in terms of healthy lifestyles is quite significant. From one county to another, you can have as much as 10 or 12 years difference in a healthy life expectancy. So, addressing that through a whole range, a whole suite, of interventions is important.

There's the GP referral scheme—using leisure centres and doing referrals. Also helping people who've had strokes. While there are formalised support packages that are put in place, also there are those informal ones. We've developed this with our health board in terms of making referrals to our sports centres, so they can have some one-to-one coaching in gyms et cetera. It helps the individual to have a positive outlook, to be able to get out and not just be at home, but actually help them to redevelop over time. So, I think there are lots of softer interventions that are needed. But that comes back to having that really good relationship with partners at a high level and getting community buy-in, and seeing that it isn't all just the health service; it actually needs to be a whole range of partners that come together and really focus on this. I appreciate that you can't focus on everything, but there are certainly some areas where, for a small amount of resource and intervention by a number of partners, you can make a really big impact.

Thank you, John. Thank you, Andrew, and thank you for sticking with us. We've gone over time a little. Thank you for giving your time today to allow us to ask our questions. There will be a copy of the transcript for you to check for factual accuracy. You'll also receive an embargoed copy of the committee's report on Monday for you to comment on, prior to its publication at close of play next Tuesday, if that's okay. Thanks once again, Andrew. Thanks for finding time for us today, and we wish you well.

Thank you.

Members, can I take us to item 3, and that's papers to note? You will see there's a significant set of papers to note there. A lot of them are relative to ophthalmology, which were integrated into our ophthalmology report yesterday. Can I thank Members for taking part in that debate? Hopefully some of our messages would've landed well, albeit it was a pity there weren't more Members in the Chamber to listen to them. Are you happy to take those papers en bloc? You are. Thank you. We'll do that.

We move to item 4, a motion under Standing Order 17.42 to resolve to exclude the public from the remainder of the meeting. All in favour? Great. Thank you.