Y Pwyllgor Iechyd a Gofal Cymdeithasol

Health and Social Care Committee

29/06/2022

Aelodau'r Pwyllgor a oedd yn bresennol

Committee Members in Attendance

Gareth Davies MS
Jack Sargeant MS
Rhun ap Iorwerth MS
Russell George MS Cadeirydd y Pwyllgor
Committee Chair

Y rhai eraill a oedd yn bresennol

Others in Attendance

Colin Dennis Yr ymgeisydd a ffefrir ar gyfer rôl Cadeirydd Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru
Preferred candidate for the role of Chair of the Welsh Ambulance Services NHS Trust

Swyddogion y Senedd a oedd yn bresennol

Senedd Officials in Attendance

Claire Morris Ail Glerc
Second Clerk
Dr Paul Worthington Ymchwilydd
Researcher
Lowri Jones Dirprwy Glerc
Deputy Clerk

Cofnodir y trafodion yn yr iaith y llefarwyd hwy ynddi yn y pwyllgor. Yn ogystal, cynhwysir trawsgrifiad o’r cyfieithu ar y pryd. Lle mae cyfranwyr wedi darparu cywiriadau i’w tystiolaeth, nodir y rheini yn y trawsgrifiad.

The proceedings are reported in the language in which they were spoken in the committee. In addition, a transcription of the simultaneous interpretation is included. Where contributors have supplied corrections to their evidence, these are noted in the transcript.

Cyfarfu’r pwyllgor yn y Senedd a thrwy gynhadledd fideo.

Dechreuodd y cyfarfod am 09:29.

The committee met in the Senedd and by video-conference.

The meeting began at 09:29.

1. Cyflwyniad, ymddiheuriadau, dirprwyon a datgan buddiannau
1. Introductions, apologies, substitutions and declarations of interest

Bore da. Good morning. Welcome to Health and Social Care Committee this morning. This meeting is in hybrid format with some Members and our witness attending virtually and some Members, three of us here, in the Senedd. The Standing Orders remain in place, as they normally do, and there's translation available from Welsh to English. We have apologies this morning from Mike Hedges and Joyce Watson, and if there are any declarations of interest, please do say now. No, great.

09:30
2. Gwrandawiad cyn penodi ar gyfer rôl Cadeirydd Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru: sesiwn dystiolaeth gyda'r ymgeisydd a ffefrir gan Lywodraeth Cymru
2. Pre-appointment hearing for the role of Chair of the Welsh Ambulance Services NHS Trust: evidence session with the Welsh Government's preferred candidate

In that case, I move to item 2 this morning, and this is in regard to the pre-appointment hearing for the role of chair of the Welsh Ambulance Services NHS Trust. This morning, I'd like to welcome Mr Colin Dennis, who is the Welsh Government's preferred candidate for the role of the chair of the Welsh Ambulance Services NHS Trust. So, good morning, Mr Dennis, and thank you for being with us this morning.

Can I just ask you a first opening question, Mr Dennis? Why do you think that you are suited for this role, and how would you draw on your skills and experience to ensure that WAST is an organisation with strong governance, accountability and financial management?

Okay, thank you for the question. Yes, I hope that my past experience really gives you a good insight into why I think I'm suitable for this. I did serve as a non-executive director on an NHS trust and acute hospital trust as my first NED appointment some years ago, and since then, I've been very much in connection with the NHS because, as I left there, I took the chair of a significant adult social care operation owned by Dorset Council, and I've just stepped down from there after nearly eight years in that role, which was very much working alongside and supporting the NHS. So, I hope I've got those skills.

I've also got quite a lot of chair skills from experience in the housing sector and elsewhere, and also quite a lot of executive experience from my day job before I took early retirement in 2015, which I hope is experience that is useful in a multiple range of different settings.

And in terms of what I would bring to the role, good governance is critical, and I think the chair has a very major role to play in ensuring that. I had excellent grounding in terms of governance training when I took my first NED role in the NHS, which I've carried with me through all of my chair roles, and I think I've seen good governance at work, I've seen bad governance at work, and I know the difference and can help steer good governance.

And I hope also I've got the genuine interest and expertise to help in what's a significant culture change journey, which the Welsh ambulance service—all ambulance services—are moving towards in terms of bringing care closer to the community, moving from being more just a kind of transport service to actually being a clinically led practitioner service that is bringing care into the community. So, I hope I understand a lot of those issues and can bring those skills and information and knowledge to bear.

And finally, I'd say that I've had a lot of experience working in political environments—'political' with a small p—in terms of working with stakeholders and elected members and officers, and in kind of quite complicated partnership arrangements, which really does characterise the health service, I suppose, and it now characterises housing and the other things I've been involved with over recent years. So, hopefully, that's an answer for you.

Thank you very much, Mr Dennis. And perhaps you could outline what knowledge or experience you have working within the Welsh NHS and social care sector and how you would apply that to this role.

Yes, of course. As you will know from my application, my experience is in England, it's not in Wales, and so, one of my first challenges will be to completely understand what differences there are. But I think there are probably more similarities than differences, and my experience of working within both adult social care and in the hospital sector in the UK is, as I say, having been a serving NED and serving on committees within an acute hospital trust for a number of years, and again, more recently—particularly, really, I suppose—serving as the chair of the adult social care business down in Dorset, which was involved in a lot of support to the NHS, particularly in relation to end-of-life care, dementia care, providing support for people with learning difficulties, and it was really all about care in the community. It was all about bringing care, making sure that people could live in their homes independently for longer, and where they couldn't, bringing the care and the support as near to their home base as possible, and trying to reduce stays in hospital, trying to reduce stays in residential care as well. So, I think I understand that.

I think I understand the way in which the system works. I understand the integrated care systems of the UK quite well. I understand the interplay of all of the partnerships that have to work in order to bring a health service to be effective across the piece. And I think I've got a good understanding of where the ambulance service fits into this complicated almost spider's web or network of support, from primary care, in the communities, through to the ambulance service, to hospitals, social care services, and how the transport services and the ambulance services mould into that, with the 111 service and the 999 service, of course, being vital parts as well. So, I think I understand the UK sector generally. My specialism is in England, of course, but I'm hoping that that's not going to be too difficult to transfer that into the Welsh environment.

09:35

Diolch yn fawr iawn, a chroeso atom ni, Mr Dennis. Mae problemau'r gwasanaeth iechyd a'r ffordd mae'r rheini'n effeithio ar y gwasanaeth ambiwlans yn rhai sydd yn hysbys iawn yng Nghymru. Yr hyn dŷn ni'n ei weld yn aml iawn ydy'r rhesi o ambiwlansys yn aros tu allan i ysbytai, ond, wrth gwrs, mae'r broblem mewn rhan arall o'r system. Dŷch chi yn dweud ei bod ni'n nod gennych chi, yn yr un o'r tri nod, i weld, a dwi'n dyfynnu:

Thank you very much, and a warm welcome, Mr Dennis. The problems of the health service and the way that they affect the ambulance services are well known in Wales. What we very often see is the ambulances piled up outside our hospitals, but, of course, the problem is in another part of the system. You say that it's your objective, one of three objectives, and I quote, to see: 

'Demonstrable improvements in service levels'.

O ystyried bod cymaint o'r problemau mewn rhannau eraill o'r gwasanaeth iechyd a gofal na fyddwch chi â chyfrifoldeb drostyn nhw, ydych chi'n hyderus go iawn fod modd hyd yn oed gosod y math yna o nod?

Now, given that so many of the problems are in other parts of the health and care services that you won't have responsibility for, are you truly confident that you can even set that kind of objective? 

I think that's a really good question, and it kind of goes to the real heart of the whole issue in the health service in that no individual part can operate in isolation; everything is dependent upon everything else. And the ambulance service, as I was saying in my earlier answer, I think is almost in an unique position in that it kind of sits in the very centre of all other systems. The performance of the ambulance service is going to be, as you've so rightly said, influenced very much by the demand. If the demand for or the supply of medical services in terms of primary care is insufficient, then people will be relying on ambulance services too much, so there are issues are around primary care. And, as you said quite succinctly, issues in the hospitals, the traditional delayed transfer of care issues, and also the flow going through A&E causing delays, all of those things also increase great demand upon the ambulances, tie up ambulances and make it difficult for them to get back on the road. So, you're quite right that the ambulance service is, to some extent, the victim in a way, of the difficulties elsewhere in the system, and all the other parts of the system create difficulties and pressure that the ambulance service is potentially going to be a victim of.

So, in my role, yes, it is an ambitious objective, but what I'm sure you want from the chair of the ambulance trust, exactly the same thing you would want from a chair of your acute hospitals and your primary care providers, is that they work together, because if they don't work together, then you will never find a solution to these things. And everybody's got to understand the system-wide issues and work together to try to solve them. And actually, the ambulance service, I think, is critical. It's one of the reasons I'm so interested in it, because I think the ambulance service, if it can transform itself from being primarily a transport service to a service that also provides care at the roadside or in somebody's home, thereby avoiding the need to go to hospitals, and the way in which you're improving the training and providing a higher level of expertise for the practitioners in the ambulance service, that is going to assist. So, I think, as a partner, we in the ambulance service—if I can say 'we' at this stage—are able to offer our friends and partners elsewhere in the system an ability to help them, and they in return, of course, if they can solve some of their resource issues and their flow issues, then they again can help us by releasing ambulances quicker from outside the A&E and get them back on the road. So, it is a team effort.

One of the things I've been involved with a lot over the last few years has been working within these groups. Certainly, when I was in Dorset, Chair, in the adult social care, we were working with three different local authorities, we were working with the NHS, private providers and so on, and my role there was about bringing people together and trying to share responsibility for a common good. So, yes, it is ambitious, but I hope I can play my part in it. I can't solve it in one go, but if I were to be appointed, if I don't play my part in terms of acting in a collegiate and collaborative way, then everything will suffer. So, hopefully I'll play my part in it.

I'll pick up on a couple of those points that you've raised there. The Minister made it clear in a statement on 19 May, I think, that she expects 'consult and close' techniques, or ways of working, to lead to a 15 per cent reduction in the number of patients who need to then go on to hospital. Do you think that that's achievable?

09:40

Yes, absolutely. And I suspect it could be even more. And if you look at the strategic plan that Welsh Ambulance Services NHS Trust has published recently, they're looking at an 80:20 switch so that, in a number of years' time—. The percentage, I think, is something like 60 per cent of ambulance calls at the moment result in a hospital visit, and I think the suggestion is that that will be reduced to more like 20 per cent in a few years' time. I think that that's entirely reasonable, because so many—. If you can get the practitioners from the ambulance service, particularly in terms of mental health, falls and the kinds of issues that are end-of-life issues—. I was talking to the chief exec just a few days ago and there's a really interesting move to actually develop some of the end-of-life specialists. And again, you've got people who are being cared for in their homes, and I know, because my neighbour's been through this very, very recently, how difficult life can be if you are in that end-of-life phase in your own home; you do need the support of somebody who can prescribe, who can change prescriptions. I think that there's a huge amount that can be done to give the ambulance service a cultural shift, an uplift in terms of skills and abilities. And I think it's achievable, yes.

Of course, the ambulance service is already doing this and has already been trying to do this, and you've said a couple of times that you would like to see more of a shift from a traditional transportation role to more of a core caring role. I can hear people screaming right now, saying, 'We do that already.'

Yes, of course. And you are doing it. As I say, I was talking to your chief exec only a couple of days ago and he was telling me about the way in which he's already started to do that, to introduce the rapidly mobile practitioners, demonstrating new skills and new levels of learning, and being able to introduce new prescribing limits, for example, for practitioners. Yes, of course. But it's in its early days, isn't it? I mean, a lot of these are pilots, a lot of these are new initiatives. And you've got an ambulance service that consists of two different cohorts of staff: you've got people who joined many years ago, the non-graduate entries, but then you've also got the newer people who are all graduate entries. And gradually, like nursing, you've got this kind of cultural change.

So, it seems to me that it's a process. You've definitely started and I think what you've definitely done is proved that by moving in that direction, you are able to do it. So, when you said to me, 'Do I think it's realistic to expect that kind of level of change?', I think it is realistic, because I think what you've got is you've got a real transformation of the workforce, which will take some time to work through. And you've also got new challenges then about retention and so on, because your retention levels are different for these two cohorts, I know. But nevertheless, old challenges are replaced by new challenges. But you've got a movement, you've demonstrated that these things can happen and there's a willingness in the community for these to happen as well.

You've also got an educational issue, because some patients will expect to be taken to hospital and may not feel comfortable, necessarily, with an ambulance practitioner turning up and prescribing something or suggesting an alternative way. You've also got issues around the 111 service and the 999 service, and I know that there's a lot of work to be done, again, to try to deal with as many cases as possible, even without resource to an ambulance or to a paramedic visiting, but trying to do it either through a video call or through a telephone conversation. So, you can try and head people into a different direction, rather than automatically going to hospital. But you see on television all the time, don't you, the medical programmes, the tv programmes following ambulance crews and all of those sorts of things. You see the worried parent who kind of expects for their child to be taken to hospital, and their worry and their anxiety won't necessarily immediately be alleviated by a paramedic, however well trained they are, because that member of the public may have a slightly different expectation. So, there's a lot more work to be done in all areas. So, yes, it's happening, and yes, of course, the organisation's doing it, but it's early days. But what it's done is it's shown that it works. 

You're right: there's a culture change that's needed in our relationship with health and care in many ways. You've quite rightly emphasised the need for co-operation across health and care. WAST itself has said that it wants to see the whole system as being far more integrated. Point us to some experiences that you have had that put you in a place to make sure that the ambulance service can really influence that sort of co-operative way of working.

Okay, that's fine. Let me talk about two examples. One is a good example and one is not, and by that, I mean an example that didn't really work. When I was a NED in the acute hospital trust in the UK, in England, it was at a hospital in Kettering in Northamptonshire, which had a neighbouring general hospital in Northampton. They're separated geographically by only about 10 miles, if that, and yet they had worked completely in isolation and were actually competing against each other, particularly for the recruitment of specialist staff. And there was a huge move from, I think it was NHS Improvement in those days, to try to get these two hospitals to work together, and I was a great voice—I tried to be, anyway, a great voice—on the board of Kettering to say, 'Look, we need you to work more'. And, actually, there's a really strong argument for these two hospitals coming together as one collective, with one board and one chief exec and so on.

There was an enormous resistance from my board colleagues, and it just highlighted how difficult sometimes it can be to actually make those kinds of cultural changes, because the human condition sometimes is about protecting your own turf, even when you know intuitively that it's not the right thing to do, people, for some reason, still seem to do it. So, sometimes it's difficult to break down barriers, and I saw that, and, actually, now, over the years, those two hospitals have become one. I think they do now have a common board, a common chief exec, but it took about six or seven years, and it took some heavy-handed intervention from the regulators to actually make that happen. So, there's an example of where I saw it not working, but could see the huge benefit that it should work, and I was really just a bit of a lone voice in those days.

Now, where I was actually able to make a much bigger influence was in Dorset, because, in Dorset—. Dorset, when I first went down there to be the chair of the social care business, it was a social care operation that was a transfer of services from three different local authorities—it was from the Dorset county, it was from the Bournemouth borough and from Christchurch—and these three different local authorities pooled all of their resources, including nearly 2,000 staff, care homes, reablement services, all sorts of things into one. But the real challenge was actually to get all of these different workforces, who'd come from three different local authorities, actually with different contracts, different remuneration systems, different ways of working, to actually get them to act as one and to provide a county-wide service.28

Now, that, in a smaller way, is kind of a microcosm of what you're talking about in terms of the Welsh health service, because, obviously, Wales is a much bigger geographical area, but, if you take Dorset as an example, there are some interesting similarities—very rural, but with some very tightly high population areas along the south coast. So, you had a huge difference in service and a huge difference in the management styles and the requirements to give a service to people living in isolated villages, in the very rural areas, alongside similar levels of service for people living in the Bournemouth, Poole, Christchurch conurbation, which is where the high population centres were. So, I think what I was able to do there, working with all of the councillors—we had three different sets of councillors, we had different three different sets of officers, we had three different groups to deal with—plus the NHS, plus loads of other stakeholders and partners, and over that period of time—and it wasn't just me; I mean the board and the exec and the whole team—we did create, and have created, a really unique operation, which is alive and well and is demonstrably giving that level of service now across the community, and has been taking on more and more responsibilities.

Only about three months before I left—and I left in February—only about three months before I left, we were asked to take over a lot of the assessment-to-discharge work in the hospitals right across Dorset, as a kind of sub-contracted work. So, we were trying to speed up the discharge, because there were issues that we all know about actually preparing patients and even just agreeing that a patient is ready and able to be discharged. And that discharge process, the assessment process, was going on, and we were taking that on. So, we grew the operation, through collaborative working, through demonstrating capability and through demonstrating that we could take these people and deliver a service.

09:45

Thank you for that, and thanks also for, if you like, the long version of your view of what the ambulance service could and should be. But I'm just going to finish off my questions by asking you, if you could, to just sum up. When somebody asks me later today, 'What did Colin Dennis tell you was his long-term strategy?', sum it up for me. We know the scale of the challenges and the failure to hit the target times on red calls, on transfer of patients at hospital. What is Colin Dennis's short-term and longer term strategic vision for WAST?

Okay. Can I look at it in two different ways? Can I look at what they would say about me personally, looking back? I hope that, after a period of time in the role, they will say that what I did strategically was to bring different players across the whole integrated care piece together, working with chairs, working with chief execs, just educating, talking, being involved in the dialogue that will bring the players closer together.

And then, in terms of performance strategically, you said, 'Is it possible to demonstrate demonstrably that there are changes?' Everything that can be measured is measured, so it is possible to demonstrate that you've done it. We know exactly what the key performance measures within the organisation are. I don't mean just how many hours ambulances they're on the road, how many hours they're queueing outside hospitals, I mean some of the softer things, like sickness rates and absence rates and retention rates and those sorts of things, which are the secret measures, if you like, about the health of an organisation. So, strategically, I would like to see an organisation that is healthier, and you can demonstrate that it is healthier, because all of those HR issues and financial issues are all in the green, if you like.

I'd also like to be able to demonstrate that the actual performance in terms of what the ambulance service are delivering to the community is demonstrably better again, and the way you will do that will be you're looking at the call centre times, you're looking at all of the metrics around 111 and 999 call rates, abandonment rates, answering them, all of those things you can measure; that should be an improving trajectory. The number of patients who are actually dealt with in the community should be improving, and you can measure that—so, you're not seeing as many people being taken unnecessarily to hospital, but being dealt with in in the community, and you're seeing the hours that ambulances are able to provide useful, practical work are increasing as well, rather than them being sat outside in a layby in a hospital parking lot. So, I think all of those things you can measure, and I would very much want to ensure that, as the years go by, all of those things are moving in the direction that they should be.

09:50

Diolch yn fawr, Cadeirydd. Bore da, Mr Dennis, good to have you in committee this morning. Just picking up on some of the comments you've made in response to Rhun earlier, you have got an ambitious objective and vision there. This is going to take a huge culture shift, and you've discussed some of your previous roles where culture has been a major part in change. We know, don't we, that to achieve any shift in culture or any change in an organisation then staff are key, and it's how you bring staff along with you, and that's not just the board and the executive, that's right through everybody in the organisation. Can I just ask how you're going to ensure that the board and the executive set up this structure in place for this ambitious vision and how they will ensure that the culture within the organisation is one where staff feel welcome, their morale is high? And how are they—? We know what the ambition is now; we've heard it. How are you going to ensure that the staff play a key role in implementing this much needed change? And given the fact that we all know that, over the last couple of years, staff in the health service, including the ambulance, have been through the run of the mill, and they do deserve our thanks, but they also deserve some credit going forward, and it's an important role that they play—. So, I'm just wondering how you're going to ensure that the executive and the board create that structure in place for the staff to have their say and help implement this change.

Clearly, culture—. You're quite right, culture change can take a very long time, and, although I'm sitting here talking about these strategic ambitions, and they are quite significant and they're very challenging, they're not going to be delivered overnight. They're things that are going to take years to bring about, because culture change can take years. But you are absolutely right that the issue around culture change is it has to be right the way through the organisation. The mistake that a lot of organisations make is they think that, by changing an executive team or changing a few faces on the board, that is automatically going to have some impact way down through an organisational hierarchy, particularly one that is distributed widely around a huge geographical area, like the Welsh ambulance service is. So, you are absolutely right in pointing out that culture change will only be brought about demonstrably over time if you can actually influence the behaviours of everybody in the organisation, from the board all the way down.

Therefore, it's very much a team effort and it's about getting the right behaviours at every level through the organisation. The board can only do so much, because the board can only influence at one level, but it needs to be clear that it's influencing and reaching those levels it can reach and that those behaviours are then being cascaded down through an organisation. The only way the board can take assurance that those things are happening, apart from being out and about and walking and talking and meeting with people, is actually through all of the data and all of the information that comes to board on a regular basis, and we talked about some of that data just a few moments ago.

So, actually, I think the way in which you ensure, that I would be looking to ensure, and that my colleagues on the board would be looking to ensure, that we're seeing these culture changes is to actually be able to see that we are seeing that trajectory change in some of the behaviours and some of the deliverables, which would be evidence that the culture change is happening, and then you triangulate that with your visits and your talking to people at all levels.

But I don't underestimate the challenge, and I don't underestimate the fact that I, as one individual, sitting on a board as the chair of that board, can only do so much, but it has to start there, because the board needs to do that. So, what you have to do is you have to ensure that your board behaviours, where you're recruiting new board members, and the same with the executive when executive members are coming in, as and when change happens, and it always does, inevitably, that you are really focused on ensuring that the people that you bring in are going to display the right behaviours and have the right attitude, the right openness—they're open to things like duty of candour, they're open to the honesty and the integrity that you expect all the way down through the organisation. And it does have a profound impact. You will know that I spent a lot of time in the aviation sector, and the thing that actually transformed aviation safety was culture change in the cockpit and introducing things like candour and a duty of care, and the fact that everybody, whether it's cabin crew in the back or the flight crew at the front, is able to speak up and talk about and give warnings about a potential mistake or a potential danger happening. That took years to actually be brought about, but it revolutionalised flight safety. So, it can be done, but it's a slow process, it starts from the top, and I would hope to be able to steer that process. I've done it before in different organisations, and I think I can point to organisations where there has been very significant culture change over a five- to six-year timescale, and that, I suppose, is probably the timescale it'd be worth looking at.

09:55

Thank you for that. Just to clarify your last point, this appointment is four years, if I'm correct. Would you see—? You wouldn't expect the whole—and I'm not saying you should expect this, I'm just trying to get your views—you wouldn't expect the culture to fully shift, but just maybe perhaps some way to where you would like to see it being in the future. Is that correct and what you're saying?

It is in a way. I would just explain, though, that I think—. I mean, culture change is a continuous journey, and I don't think you can ever get to a point where you're going to be able to say, 'Right, we've done it', because the world changes and expectations change. So, I don't think you will ever get to a point where you can all sit back and say, 'Do you know what? We've done this; we've changed the culture', because the moment you get to that point, there will be other changes due. So, it is a long-time journey, and I think that whoever is the chair of Welsh ambulance and whoever is the chair of any of your NHS organisations, that they will be in their own way helping to steer and develop culture change; it will move at the pace that it's able to move at. Some will move faster than others, but it's a moving wave of culture change that's going to be happening all through the different trusts within the care system, and, at a particular point in time, whether it's three years, four years or whatever, hopefully everybody will be looking back and saying, 'Well, we've made significant change, but, of course, there is more change to go.' So, when I complete my term of office, if I am confirmed in post, then, at the end of that time, I will be handing it over to a new chair who will be continuing that journey. I would very much hope that we will have made significant strides during that period, but I'm not naive enough to think that we will have finished it. And at whatever stage we've got to, there'll be more change, because that's just the nature of life, isn't it? Nothing stays the same forever.

Well, diolch yn fawr for that. As a former engineer, with continuous improvement in mind, I'm pleased with that answer. I'll pass back to the Chair.

Thank you, Jack. Mr Dennis, I was just thinking, in my time of being a Member of the Senedd for 11 years, over that 11 years, numerous times constituents come to me, from members of staff, from WAST, and bring forward concerns of unhappiness and concerns about changes and changes to the structures et cetera. Sometimes, they make an appointment; sometimes, it's just at an event. But they want me to take up issues on their behalf, but they never want their name attached to the complaint or the concern. It always worries me why that has to be. Do you think that there can be a position where I'm able to say, 'Well, you need to go and speak to Mr Dennis, and he'd be very open to speak to you one to one'? Can we get to that position?

Yes, absolutely, and it should be that way. Of course, you have to understand that, actually, it would be another measure that your cultural change has really shifted if somebody comes to you and says, 'Look, I've got an issue. There's a problem going on in a particular ambulance station or with a particular hospital', or whatever it might be, or perhaps a particular manager—there's a particular personality issue—and if that member of staff who is raising the concern is actually able to be quite open about it and not to mind their name being mentioned and not to mind the whole issue being aired in a semi-public kind of arena, that would, I think, demonstrate that you've really made a big shift, because part of the struggle within organisations and bullying cultures and people feeling that they don't have the freedom to speak out, people being worried that they're going to make use of their freedom to speak and then they will end up being penalised in some way for doing that if ever it was found out that they had been the person to raise the flag—that is all evidence of a very bad culture.

I have been, in all of my roles—. I think all my colleagues say I'm a very approachable person, and, if somebody were ever to want to come to me and say, 'Look, can I talk to you in confidence?', that confidence would be maintained. One of the things I would be looking to see, as I've just been saying, really, is that, over time, if you actually get fewer people wanting you to be confidential and more people wanting to air things for colleague debate, if you like, then that, I think, is evidence of a great culture shift. But I am a very approachable person. I chair a very large housing association at the moment, as you will know, in the midlands. I have tenants coming to me, I meet tenants regularly, I join the tenant forums, and they are not shy in telling me about damp and mould and building issues and neighbourhood issues and anti-social behaviour issues and all of the things you get in the housing sector that people want their landlords to be addressing or the staff to be addressing. And I get staff talking to me the same as well at all levels. So, yes, I'm very familiar with that, I'm very open to it and would actively encourage it.

10:00

So, I can speak to my constituents and others more widely across Wales and say, 'Look, if you've got an issue, Mr Dennis has told me you can speak to him in confidence, there will be no repercussions, and he'll be very open to speak with you.' You're happy with that approach. 

Yes, absolutely.

Thank you very much, Chair, and thanks, Colin, for joining us on the health committee this morning. I just want to focus a little bit more on working relationships and structural things on the board. How would you lead and develop the board of WAST and ensure that the board members have got the right qualifications, the right skills, the right experience, so it can effectively work together and perform to a high standard and make it reflective of the service that WAST are offering?

Clearly, the board members fall into two forms, don't they—it's a unitary board. So, you've obviously got the executive members, who come under what I would call the professional level and, clearly, they've got their own development in terms of their professions. But I think there is still a role for the chair and for other members of the board, actually, to help those individuals, particularly when they're newly appointed if they haven't actually sat on boards before, because their role is very difficult. On the one hand they are discharging a professional service in the day job, but also they're sitting as a director of a unified board, and they have to be able to contribute to that almost like a non-executive executive, if you see what I mean—they're sitting alongside their non-exec colleagues to create the skill matrix necessary. One of the things I have done in the past and continue to do in housing at the moment is to help to develop some of the executive directors so they can provide better support to the non-execs and actually can play a better role as a director on a board. So, there are some skills there.

I think the area to focus more on is actually the non-execs, where you get the opportunity to recruit people. You will know that, in all sectors, one of the big governance calls, one of the big governance changes of recent years is to move to a skills-based board so that you're looking for individuals with a particular professional skill or maybe a personality that you actually need to fit into the overall matrix. So, step number one when you get the opportunity to recruit a new non-exec or a director is you're looking for the right kind of personality and the right kinds of skills, and those are the things that you can select for. And gradually you can mould the board to be more open, to be more collaborative, to be more sharing, to be more discussive on issues, to be more probing—all the things you want a board to be. You can do that by good-quality recruitment, and then you can do it by good-quality training as well.

I was blessed when I went to the NHS to become a NED in receiving some really great training as a new NED that helped me tremendously, and I would want to make sure that all of the NEDs are continuing that journey so that they can fulfil their obligations. I think that, quite often, you get non-exec directors joining boards, maybe it's their first non-exec appointment, and they may have in their heads a particular view as to how non-execs behave and what their particular role and responsibilities are and how they discharge those. And I think, sometimes, that's misplaced, actually—they don't necessarily have quite the right video message in their head, in way, as to how you can collectively work supportively rather than being maybe a bit difficult or a bit forensic about things.

So, I hope that I've learnt over the years, first of all how to recruit the right people and then how to develop them and to give them the right encouragement and opportunities so that they can grow and develop into their respective roles.

Thanks for that answer. Just to focus on public perceptions, looking at the board, you've got a chairman, seven non-exec directors, a chief executive officer and four executive directors. How would you make sure that their roles are represented in the public eye? Because all these roles are very expensive in the public purse, and when they see the board structure compared to what they see on the ground—. My grandmother, for example, lay for six hours on the floor when she broke her hip, and the health Minister herself has said that there are issues with waiting times in the ambulance service. So, how would you use your role to make the board reflective of these issues and engage better with paramedics on the floor to make sure that we get these waiting times down efficiently?

10:05

As you say, the board is quite large, and quite often on a unitary board you would expect maybe there to be parity in terms of the number of executive directors and the number of non-executive directors. The board is a little bit weighted towards non-exec. I’m not suggesting that that should necessarily change, but I think you’ve identified that what the board has got to be able to demonstrate to the public listening and watching its work is that it actually is effective.

Boards only really have three main functions. They’re there to scrutinise performance, they’re there to take the assurance that the strategy and the performance is being delivered correctly, and they’re also there to advise and, finally, to sign off on strategy. But it’s the first two that are the day job, isn’t it? Time and time again you’re looking at performance, and you’re questioning and you’re looking to see improvements. I think we’ve spoken a bit this morning about hoping very much that we’re going to be able to demonstrate an improving trajectory on all of the key performance measures, and that’s what the board is there to do. It’s not there just to meet every month or every two months and pontificate about things. It has a very real practical purpose, and that practical purpose is to hold the executives and the whole system to account to make sure that, whatever it’s said it’s going to do, it is doing it, and it’s doing it, hopefully, in the timescales and to the costs that have been agreed.

The board has to demonstrate that it is actually doing that, and it also has to demonstrate that it’s living the values of openness and integrity and honesty, and supporting duty of candour, and supporting the kind of change of strategic direction to bring care closer to people’s homes. I think if people can dial in to board meetings and they can see that the non-execs and the execs are working together to question and to give that level of assurance or otherwise, and if the assurance isn’t there, they’re looking at ways in which they can get that assurance, and they’re holding the executive to account for the delivery, and are looking for the executive teams to work to find ways of actually improving matters, and the board, outside of its traditional board role, is actually working with colleagues across the sector, and demonstrating that the sector is trying to work together to solve some of these intractable problems, which are all interrelated, then I think that will hopefully give sufficient confidence to people that the board is doing its job.

The board clearly isn’t personally going to be driving ambulances, and the board can’t physically change those appalling wait times, which we know people are suffering, actually in physically doing something—it’s not going to leap out of the room and drive an ambulance—but what it has to do is do its job properly, and be seen to scrutinise and to hold to account, and to be able to demonstrate that there is an improvement in performance as time goes by.

Thank you for that. What skills and experience can you draw upon to promote equality, diversity and inclusion in the role? Of course, as well, there's the Welsh language. I read in your CV that you’re not a Welsh speaker. Are you going to embark on some Welsh language lessons in your role as chairman?

I’m not a great linguist. I was thrown out of French at school and I failed my Latin O-level twice, so I have to be realistic that my ability to learn what is obviously a rather difficult language, for someone like myself, is going to be quite a challenge. I would, however, be rather embarrassed if I couldn’t at least speak a little bit, and at least make a few passing remarks, even if it’s only hellos and what have you. So, of course I would try and pick up phrases and some words as best I can. I’m very conscious of the Welsh language and I’m very conscious of the importance of the Welsh language to the Welsh people. I’m a great supporter of that.

I spent quite a lot of time working in Cornwall, with Cornwall Council, and you will know they also take great pride and great pleasure in the Cornish language, which is a real minority language compared to Welsh, of course, but you still see the duplication of road signs, and in all of Cornwall Council’s letterheads and paperwork and so on, they translate into the Cornish language to try and keep it alive. That’s difficult in Cornwall, because of the very small number of people speaking it. It’s much easier in Wales, of course, because it’s still very much a live language. So, I’m very alert to the Welsh language issue, and will do my best on that.

I think in terms of just being able to deliver, I hope the experience that I’ve had in all sorts of other organisations that have been through some similar things is relevant. In the housing sector there are some very strong similarities in terms of the culture change and governance changes, the political position of it and the importance in the community. I think there’s a lot of learning there that is transferrable into this role in the ambulance service.

I appreciate your answers and I’ll hand you back to the Chair.

Thank you, Gareth, and Mr Dennis. I think you’ve answered my last question more fully, but I wanted just to end the session, really, by trying to encapsulate in a very brief way—. Just give us, in very bullet-point form, your priority for your first year and your longer term priorities. Perhaps in just a quick bullet form, if you can.

10:10

Yes, of course. I think the first priority for any new chair is to really get to understand the organisation and the people. And that is a challenge, because particularly with the Welsh ambulance service, it spreads right across the country, and it's not just the people in the command and control centre, it's not just the exec team, it's actually getting to understand some of the issues, the beliefs and the culture and the feelings right the way down the organisation. So, for me, bullet point No. 1 is to really get to understand the organisation.

Bullet point No. 2 is an extension of that, it's to get to know the partners, get to know the individuals, the key decision makers, fellow chairs, the chief executives of other trusts and so on. So, it's really to get to know all of those things. It's to get to understand what has happened over the last few years in terms of culture change and development in the organisation, the post-COVID ways of working and so on.

Then, I think the bullet points simply are going to be, over the next few years, to really focus the board's attention on the culture change, on the measures that will indicate it's going in the right way, holding the executives to account, being clear on what are the absolute priorities and monitoring those and making sure that we are delivering them to a cost and to a timescale that has been agreed.   

I think you said your term in office would be four years; at the end of those four years, how do you measure your success?

I think there are two key things. I think the first is that I'm very familiar with the 360 degree appraisal process. I think in terms of me as the chair, how have I done as the chair, that will be monitored, of course, as we go on year on year, but I would hope as I leave that people would be sad to see me go and I'd be going on the basis that that chairmanship was a good period where we brought change. So, there would be good words spoken and there would be demonstrable evidence through the 360 degree appraisals that I have been an effective, inclusive chair, helping to steer the organisation through the difficulties that we all know it's got. 

And then in terms of the actual performance, that is even easier to measure, because there should be a very clear difference and we should be able to see—. In the strategic document that has been published recently, there's a nice little triangle, which is showing that, at the moment, the vast majority of calls end up with a patient being conveyed to a hospital. And then in four or five years' time, the hope is that that triangle is reversed so that actually the vast majority of calls are being dealt with in a way other than being conveyed to hospital. And that will be the most important measure that will show that culture change has taken place and that the performance and the behaviour and the skills and the competence of the ambulance service had risen to a point where it can be dealt with either through 999, 111, extended paramedic services or other community based and home-based care, not to go into hospital. And that will be the evidence, I think, that we've achieved that big shift.

Thank you, Mr Dennis. Are there any parting, final words you'd like to leave us with?

No, just to thank you very much for your time. I'm very much hoping that I will be appointed. I'm very enthusiastic about it, as hopefully you can tell by my answers, and I wait to hear whether it's happening or not. 

Thank you, Mr Dennis, for attending our session and hearing this morning. It's very much appreciated. We'll, of course, consider our report as a committee and publish that before the end of the week, and no doubt we'll be in touch. So, thank you very much. Diolch yn fawr iawn. 

Thank you and thank you to all the committee members for your time. Have a lovely day.

3. Papurau i’w nodi
3. Paper(s) to note

I move to item 3. We have quite a lot of papers to note today, so I'm not going to go through them all. We have correspondence from the Chair of the Petitions Committee, we have correspondence back and forth on a number of matters with the Welsh Government, and we have correspondence between the chair of the cross-party group on medical research and the Government, which happens to be me—not the Government, the chair of the medical research group. And we have correspondence from the Equality and Human Rights Commission. So, are Members content to note those papers this morning? Yes. Diolch yn fawr iawn. 

4. Cynnig o dan Reol Sefydlog 17.42 (ix) i benderfynu gwahardd y cyhoedd o weddill y cyfarfod hwn
4. Motion under Standing Order 17.42 (ix) to resolve to exclude the public from the remainder of this meeting

Cynnig:

bod y pwyllgor yn penderfynu gwahardd y cyhoedd o weddill y cyfarfod yn unol â Rheol Sefydlog 17.42(ix).

Motion:

that the committee resolves to exclude the public from the remainder of the meeting in accordance with Standing Order 17.42(ix).

Cynigiwyd y cynnig.

Motion moved.

I move to item 4, and I propose in accordance with Standing Order 17.42 that the committee resolves to exclude the public from the remainder of today's meeting. Are Members content? Great. Our final meeting of this term will be next Wednesday. We'll now go into private session.

Derbyniwyd y cynnig.

Daeth rhan gyhoeddus y cyfarfod i ben am 10:14.

Motion agreed.

The public part of the meeting ended at 10:14.