National Assembly for Wales

Croeso, bawb. Bore da. Welcome to the Health and Social Care Committee this morning. We are operating hybrid this morning; we have some Members and witnesses on the estate and some attending virtually as well. And, of course, as always, we operate bilingually in Cymraeg or in English. So, at the start of the meeting, I would like to just put on record the committee's thanks to Jack Sargeant and Gareth Davies, who have been on the committee since the beginning of this Senedd, so to thank them for their work on the Health and Social Care Committee and wish them well in their new committee roles. And also to welcome Mark Drakeford and Sam Rowlands to committee, who joined the committee this week and are here at this session today. So, welcome, Sam and Mark to committee. Diolch yn fawr iawn.

Right. I move to item 1. There are no apologies. Mabon ap Gwynfor is joining the meeting later; there are no substitutions. If there are any declarations of interest, if Members would like to indicate that now—. Mark, Mark Drakeford.

Thank you, Mark. There are no other declarations. 

In that case, I move to item 2. Item 2 this morning is our pre-appointment hearing for the role of chair of Swansea Bay University Health Board, and we have a session this morning with the Welsh Government's preferred candidate, Jan Williams. So, Jan Williams, welcome to the committee meeting this morning and thank you for being with us. Members will have a series of questions—an opportunity for Members to ask questions of you, Jan, as the preferred candidate for the role. So, perhaps I could just start and ask: why do you think you will be well suited for this role?

Thank you. Diolch. Bore da, bawb—good morning, everyone. Thank you for the opportunity. I think, firstly, I was born in Swansea, and Swansea has always been my family home, wherever I've worked. I've worked across the NHS in Swansea and Neath Port Talbot, across acute, community, primary and mental health services. In fact, my first role—. When I joined the NHS, my first role was in Morriston, on 1 October 1979. So, I understand the patch, although I've worked away for some years. But, of course, I do have considerable lived experience as a patient and I have 17 years' experience as an unpaid carer, accessing services and supporting that patient through treatment processes. So, I am familiar; it is my home. Swansea educated me; I'm an alumna of the University of Swansea, although it was the University of Wales then, and, in a past life, I've sat on the council and I've watched, with huge pride and interest as the university has really developed over the years. And the Institute of Life Sciences there now is world-leading and it would be a great opportunity to work in partnership with the university.

But, in addition to my personal background, being from Swansea, of course, as I've said, I've got extensive experience working across the healthcare system—planning, delivery, evaluation and policy development. I've worked nationally and locally across the years and, throughout my time as a professional, in my professional career, I've always held non-executive positions, so I understand the role of the non-executive, because I have decades of experience doing so. And as one of the key roles of the chair is to maintain good governance, I can also offer years of different experience on different audit committees, the university, Acas, the IPCC, the HTA, Human Tissue Authority—Independent Police Complaints Commission, sorry. So, I've sat on their audit or finance committees over the years. I've also chaired in very different contexts in different models, but the most relevant for this role, of course, is my six and a half years' chairing Public Health Wales. So, I've got that contextual understanding of the role of the chair and the role of a non-executive.

I also bring with me a lot of very well established networks and I'm known for working in partnership. I think, as well, I also focus on learning and improvement, whether that's in policy or practice. My roles over the last 12 years have all been about improvement and learning. But I think that, above all, I am a public servant. I think that I have said in my paperwork that the NHS is in my DNA, and it would be the greatest honour for me to go full circle and go back home to work.

Thank you, Jan, for your very full answer there. I appreciate that. Of course, the health board needs strong governance and good financial management, and you have outlined much of your past experience. So, how would you draw on your past roles in terms of ensuring that there is good governance and financial management in the health board?

Thank you. I do understand and appreciate that the health board is in enhanced monitoring in respect of financial management. So, if I start with that first, it is my practice to follow the money—to actually track, from allocations coming in, where it is going, and make sure that the spend is as it should be.

For example, at the moment, Swansea Bay posted a deficit at the end of 2023-24. So, first, I would undertake a diagnostic, and I'd ask questions around what constitutes the deficit, how much of it is non-recurrent or recurrent, and I would look into the plans for 2024-25. So, I'd look at the diagnostic around what's the underlying deficit, what are the unavoidable cost pressures that the health board was posting, and how did they compare with other health bodies. For example, there are a whole range of different, unavoidable cost pressures: primary care drugs, secondary care drugs, non-pay inflation, et cetera.

So, in terms of what Swansea Bay health board is posting, how does that compare, and how does that compare with good practice? Then, I'd look to see what use the health board has made of all of the opportunities and the work coming out of the national value and sustainability board, because there has been a huge raft of evidence around waste, around efficiencies, and I'd look to see if the health board was really applying all of the efficiency opportunities, together with the productivity opportunities.

I'd get a sense then of following the money and where opportunities might be. But that, then, would need to link to the whole process that the board had put in place to develop its annual plan, and that comes back to the governance agenda. Was there a structured process? How did it fit together? Were all of the different dimensions of the Welsh Government's planning and performance framework taken into account? Were the ministerial priorities taken into account?

Then, I'd look at the scrutiny processes that the board and its committees had undertaken before it had approved the plan to go forward. So, that would be my sense of trying to understand the plan that's gone in. Of course, hopefully, should I be appointed, I would know the Welsh Government's initial response to the plan, so I'd know where the organisation needs to focus.

But in terms of broader good governance, there are a number of dimensions to this, of course, starting with what the board is responsible for; what it delegates to committees; what is delegated to the executive in terms of the running of the organisations; all of the systems control processes in place to actually ensure that the health board's standing orders are actioned properly. There is a board assurance framework that would set out all of the different dimensions of corporate, financial, clinical governance.

I particularly want to see what Audit Wales's last structured assessment report had been around that. I would want to understand the board's whole approach to setting strategic risks, and the risk appetite, and how that was all playing through. I could go on, but—

I know that some other Members have got some questions around some of what you have talked about, so I will let them expand a bit further. But the last question from me is this: in some of the other roles that you currently hold, do you think that there is any conflict of interest, or perceived conflict of interest, at all?  

I only hold one other role at the moment, and I have just been appointed to that in February. I was delighted to be appointed as a Welsh Government independent member to Amgueddfa Cymru, because I've long had an interest in arts and health, and the benefits of arts and culture across the health domain. That's a 12-day-a-year appointment, so I don't see a conflict, because I think I will be able to manage the time commitment, and I would hope as well to forge very strong links between all the fantastic work that Amgueddfa Cymru and its teams have under way across the piece on arts and culture, and really forge and strengthen the relationship. The maritime museum in Swansea is a museum of sanctuary, Swansea is a city of human rights, and I think there's an awful lot we could do together in terms of the whole sanctuary agenda. I'm really excited about it, as you can see, but I don't think it's a conflict. I think I can actually meld the two for mutual benefit.

Thank you. I appreciate that. Sarah Murphy.

Thank you very much, Chair, and thank you for being with us this morning to answer our questions. I'm going to ask some more now about the strategic direction of Swansea Bay University Health Board. We've already touched on the escalation and intervention arrangements that NHS Wales has put in place, and you've talked about the enhanced monitoring for planning and finance. But would you be able to talk to us a little bit more about the enhanced monitoring for maternity and neonatal, and also the level 4 for performance and outcomes, and how you would set the strategic vision—short term and long term—that you think the health board should have to meet the aims, the objectives and the priorities to improve that performance? Diolch.

Thank you. Diolch, Sarah. Of course, I'm confined at the minute to what is in the public domain in terms of my reading, as I'm just the preferred candidate. I have read the Healthcare Inspectorate Wales report on maternity services, and I have read the health board's response. I think there are, clearly, issues across the piece around quality, safety and sustainability. I know that the health board has conducted a review, and I know there is an independent review process under way, so it would be one of my first priorities to see where they are in terms of that review process. But quality and safety have to underpin everything that the health board does, so I will be looking to see what processes does the health board have in place to build in safety and quality into everyday working. There are a number of different dimensions of that report. I'd be looking at staffing, I'd be looking at security, I'd be looking at standards and compliance with the National Institute for Health and Care Excellence guidelines, et cetera. So, that would be my intention: to set off and really make that one of the first priorities.

There are other quality and safety priorities, as you've identified, through the targeted intervention. Access has clearly got to be very much up there, and that's access across the board, whether that's access to primary care services, whether it's access for acute mental health help and treatment, or whether it's the waiting times—both planned care and unscheduled care. So, I think, from my reading of the waiting times analysis that came out last week for February into March, the health board has clearly made progress this year on both the 52-week out-patient waiting time, and the 104-week in-patient treatment time. So, there is progress. That's been very hard won, I would guess, given that we are on an upward trajectory of referrals into the system. That's been hard won, and I'd want to ensure that that was at least maintained. 

One of the other key things in terms of access, of course, is to unscheduled and emergency care. I mentioned earlier that I have a lot of lived experience as a patient, and I have current experience of the unscheduled care service in Morriston. It's not really the optimum patient experience, but it's not the optimum working environment for staff either, and they are facing significant demand day in, day out. So, I think, in terms of that, that's got to be one of the key features of year one for me. I'd want to understand where's the demand coming from, because there are a number of other options in Swansea: there's 111, there's access to emergency GPs, there's acute same-day services. So, I'd want to understand what is driving the demand into the emergency department.

Of course, Swansea Bay has recently changed its service model, and all emergency unscheduled care, GP and everything else—ambulances, et cetera—is all going into that ED. When I’ve been there as a patient, and even if I look around as a patient—but of course, remember I have commissioned and planned hospitals myself—it’s too small. It’s too small, and it needs capital investment. Also, from my perspective, which I think the health board is certainly looking at, it needs a much better and separate assessment facility for frailer older people. Even as a patient and a carer I could say that. I think one of the key things to sorting that out, Sarah—and it won’t be done immediately, but it must be a priority—is that the department needs resizing. It needs reshaping because it’s not the right environment, and I feel for the staff who have to work in it, because it’s not fit for its purpose anymore.

So, access and unscheduled care access would be one very important part of a whole approach that must underpin the health board’s strategy. But I will be looking to lay the foundations in year one for that long-term strategy. It will have quality and safety at its heart, but it’ll also have the health board’s strategic population health responsibility at its heart as well. Because one of the things I think we absolutely need to do is start helping the population more with self-help and self-care.

Some of my colleagues are going to delve a little bit more into what you've already touched on. Thank you for such a thorough response. I think you've answered my follow-up question, so this will be the final one from me under this section. In what ways would you instil a culture that encourages staff, as you touched on, patients, families and the public to raise their concerns and then have them appropriately addressed?

Thank you. I have engagement with individual patients, families and communities wired into me throughout my whole experience. I think it is about the board setting the tone and culture for the organisation. And of course we have the duty of candour, we have the duty of quality as legislative underpinnings now to help us. But I think it’s for the board to actually set the tone and culture, very much as the board of Public Health Wales does.

For example, I open every board meeting of Public Health Wales by emphasising that we want staff to come to work to be able to give their best, to be their best authentic selves. We don’t want them to be afraid in any way if things go wrong, because things will go wrong. We’re in a human system. But if things go wrong, in Public Health Wales, we’ll say ‘sorry’. We look to put it right, we look to improve. And we want staff to work in that culture. So, I would be looking as part of my approach to the cultural development of the board under my chairmanship. And of course, I’m only looking in on the board externally at the moment, so I’m looking to the future. But that would be very much my approach.

But also then, I’m not an office-bound chair, I’m out and about all the time talking to staff, and my messaging will be very, very important, and I’d hope the messaging of other board members when they were out and about as well is that many, many things will go right. Thousands of things will go right every day, and patients will be really happy, and staff will have done their absolute best. But things will go wrong. And we need to know that, and people need not to be afraid. I think I’m known for that, and I think that is certainly something I take with me.

I really appreciate that. Thank you very much, Jan. Thank you, Chair.

Thank you. And if other Members want to come in on the back of anything that Jan has said, then obviously please indicate. Jan, I know we're a little short of time, so do you mind if Members politely interrupt if they want to move on to the next question? No. Thank you, I appreciate that. Joyce Watson.

I want to continue with staff. Good morning, Jan. You've talked about taking the organisation with you, but in terms of staff, we've seen in some cases morale being on the floor—their words, not mine. So, how will you be fully engaged with the staff, particularly to raise morale, but also your vision and your structure, and the culture that you will create?

Thank you. Well, I am conscious that Swansea bay does have a people strategy, so I will want to understand the dimensions of that strategy, how it's playing out now. But I think the fundamental underpinning for me is that the health board needs to attract the right people, keep them, develop them and enable them to give of their best every day—as I've said, to come to work, be their best, authentic selves, know that they've had the right training, they've had the right opportunities in terms of development, we have the right staffing mix, they're not completely overwhelmed by the pressures of the working day, and their working environment is helpful and they know there's support for them, for example, in terms of reasonable adjustments or preventative health support. 

That's my vision. So, I would need to set off on a listening exercise, first of all, with the current board members as well, just to find out how things are. Now, health boards, of course, have a non-executive staff member on the board, so that would be my first point of contact, to say 'Just let me know how are things around here.' But you can't govern if you don't know what's going on, so I would be out and about talking, understanding what the mechanisms are currently—the trade union input, the local partnership forum input, any staff networks input that they have.

That would be my key approach to it, really, because it's such an important public service and staff come to work—and there are some fantastic staff everywhere across the NHS—very highly trained, wanting to work at the top of their professional codes of conduct. So, I think it's really, really important that the culture is opened up and people feel they can contribute in that way.  

Sorry, Chair. I can't hear Jan anymore. I'm not sure—[Inaudible.]

Oh sorry, Sam, I turned to the side. Sorry. 

I can't hear anything, actually. 

Oh, right. 

Hold on a moment, Sam. You shouldn't need to touch this. It should just come on automatically, but can I just—

Can you hear me? 

We can hear you, Sam. Can you hear me, Sam? 

Sorry, Chair, I can't hear anybody. 

You can't hear anyone. We'll ask one of the technical team to take you into a breakout room, Sam, and try and sort out what's happened. I don't know why I'm saying that because you can't hear me. [Laughter.] We'll just do that anyway—that's for everybody else's purpose. Sorry, Jan. Joyce, would you carry on? 

So, in terms of—because we're going to have a lull now; we've got somebody that can't hear—in terms of the networks you described, I think that they are particularly key in trying to deliver anything. So, will it be one of your first intentions, if they're not already established, to understand that, and then people, the staff we're talking about, are more able to talk freely and share the experiences, which will give you a much wider picture? 

Yes, and I would take with me my experience from the Public Health Wales board, because, when I first went back in 2017, there were five staff networks but there wasn't that line of sight from the board to the networks. And what I did was set up a rolling programme of the networks coming to the board. Now, the first round we did, the network members were quite nervous of coming to the board in public session, because this had not tried before. So, they came to the board in private session. They made asks of the board, three asks per network, and we committed to act on the asks.

So, we now have a rolling programme, and now we have two more networks and they come to the board in public session, which I think is fantastic, because they know that they can and they know that it's safe. And I think that's one of the key things is to feel—. Staff must feel psychologically safe. And, for me—. In November of 2023, one of our networks came and gave us the most powerful presentation on some people's experience of not having reasonable adjustments made for them. This is in public session to the board, and staff felt safe enough to do it. It was the most powerful thing, and we took immediate action as a consequence.

But, for me, I just thought how far we'd come since 2017. I'm working with Tracey Cooper as the chief exec—we deal with these things together—but I was so proud of that. So, I understand the value of staff networks. I understand the value of making people psychologically safe. So, that's how I'd hope to do it, Joyce.

Thank you.

Thank you, Joyce. Do you have any further questions, Joyce?

Sorry?

You didn't have any further questions.

No. I'm fine.

Thank you. Mark Drakeford.

Thank you. Diolch, Mark. Well, we do have both underpinning legislation and guidance and plans around things like the all-Wales anti-racism plan. So, there's a legislative framework, there's a policy framework, we've got the statutory equality duty. And what we must do then is ensure that all our decisions, all our work, are underpinned by proper equalities impact assessment, which will run alongside health impact assessment as well for our population. So, firstly, I'd want to understand what is the make-up of the workforce, the 12,500. What is it in terms of all the different protected characteristics that we have? And in Public Health Wales, we have a very sophisticated approach to this, in terms of tracking people coming in, whether we are attracting the right percentage, for example, from the black and ethnic minority population. And the one thing at the minute for Public Health Wales would be trying to attract more people from the world of disability, for example. So, we get an absolute understanding of what the make-up is, and then we make sure that all the policies and decisions that come actually span all the equality implications we need them to do. And, if necessary, we would take targeted action to try and target specific communities or sub-groups, to actually make them feel more encouraged to apply and then to put themselves forward for promotion.

But you'll know, Mark, that I have a career-long interest and history in the role of women in public life—[Inaudible.]—and it's worked. I can demonstrate, throughout my personal work, and the roles I've had, for example as the opportunity 2000 commissioner for the NHS in Wales. We were able to stand my work down early, earlier than 2000, because we'd hit our targets. So, of course, I do accept—. And I built on the fact that, at that time, we were working with largely white women; since that time, I've really expanded my role and worked with women of diversity. That's the approach, but I think the board needs to have the right metrics to know, once you know the baseline, what progress you're making and whether you go backwards, or whatever. And of course, in Swansea Bay as well, there's a large international dimension to the workforce as well, so that's a really important feature. But it does, it really does, underpin my whole approach.

And I think, you know, we take 'More than just words' really seriously in Public Health Wales, and we have a Welsh language non-executive and executive champion. We make access to courses and training available for staff, and I encourage other board members too. We at least say a few things in Welsh every day, at every board meeting and every development session, and we have a whole structure. We have the Ymlaen network, so we have a staff network, and we make every opportunity available to staff, and, obviously, we adopt bilingualism et cetera in all our publications. And we've just had a visit from the new Welsh Language Commissioner, just to see how we're doing, and she was very pleased with the way that we are developing. There's an awful long way to go.

But, in terms of the closer working with Hywel Dda, as you say, Mark, really, there's a lot of cross-border working, so we have to make sure that, people who want to be cared for and treated through their first language of Welsh, we have sufficient numbers of staff trained to do that, or we have translation facilities available for them. It will be a fundamental principle of the approach to joint working. And, of course, Eluned Morgan did issue a direction to the two health boards, on 19 March, to set up the joint committee. One of the design principles for that joint working will be to make sure that we not just comply with the Welsh Language Act 1993, but we actually build it into the culture, and we make sure that residents from both Hywel Dda and Swansea bay can confer through the medium of Welsh. But I think it is something—. You can tell me later about my accent, but I do—I'm trying.

One final question, then, from me, and, Jan, you've said a lot already about where you think your immediate priorities would lie and the things that you would need to grapple with in chairing the board. I wanted to ask you one sort of sub-set of that, because I think you could argue that, for 70 years, the response of the NHS across the United Kingdom to challenges has been to focus on the supply side of things—more staff, more services, more facilities and all that. But you've referred already to the demand side, and I think there's very plausible research that shows that, unless the health service is able to grapple with demand, then it'll always be unendingly chasing something that it can't reach. So, given your experience in Public Health Wales, what would your priorities be, early on, to trying to deal with that ever-growing demand of health services? How do we persuade the population to do more for themselves, so that the health service can deal with the things that only the health service can deal with?

Yes. That is the fundamental question for all of us at the minute, and, for me, I mentioned earlier that I would want to lay the foundations for the longer term strategy for the health board. The health board does have a population health strategy and the public services boards do have a very well-developed well-being needs assessment, so bringing those together, you've got the state of the nation, if you like, in Swansea bay.

So, for me, I would look to use the resources already in the system, because of the argument that we have to keep the show on the road, we can't move resources. Let's use the resources we have in the system, and I will take a very keen example of tackling diabetes together: the NHS spends 10 per cent of its budget on diabetes, 10 per cent of hospital admissions, it's in the top three reasons for economic inactivity in the country, together with chronic pain and mental health. If we don't do anything, by 2035, one in 11 adults in this country will have type 2 diabetes, and we will be fundamentally overwhelmed because of the complications: amputations, kidneys, hearts, loss of sight. So, we have to tackle this, but we can by using resources we have currently in the system. If people with type 2 diabetes had their eight annual checks at primary care level, that would ease the situation and start to halt the upward trend we're seeing. So, in Public Health Wales, we've just published advice and support for GPs and optometrists, Making Every Contact Count, so that they could help people, and Professor Jim McManus, the national director for health and well-being, has set out what could be a national programme, Tackling Diabetes Together, and, Chair, we'd happily send the detail of that to the committee because it's like a national social movement here we're talking about, but it's actually helping people to help themselves, but using additional resources. 

And if I give you another example, Mark, which, again, is using money already in the system: Bowel Screening Wales. In the least deprived quintile of Swansea bay, take-up of that programme is over 70 per cent. In the most deprived quintile of Swansea bay, it's 15 per cent to 16 per cent less than that, and that means later presentation, the worst outcomes—horrible outcomes for individuals and families—and pressures on the system. So, we need to start thinking about, 'How do we actually help people to help themselves better?', and in Public Health Wales, as you know, we have an expert behavioural sciences unit to actually work with us to help people. Bowel Screening Scotland, they've had huge success changing the nature of the communication, and it's something as simple as, 'Did you realise that six out of 10 people actually come forward for screening?' So, you move on and on, and then you're left with, 'Well, there's me—why not me?' So, it's little things, and, of course, we had such a big success on changing Stop Smoking to Help Me Quit. So, those are just a couple of practical examples, but Public Health Wales has national resources that can be applied, and, of course, the health boards now have the local public health teams, but I would want to work very, very closely with the public services boards to actually make sure that we work on the wider determinants. 

Thank you, Jan. Welcome back, Sam Rowlands. Sam, you've got about seven minutes for your last set of questions. 

Diolch yn fawr, Chair, and good morning, Jan. Apologies I'm not with you in person—

Morning, Sam. Bore da.

—and apologies for cutting across you earlier when I lost all audio, but a classic reboot of the computer did the trick.

I just want to ask a few questions around your role as chair and relationship with the board more broadly as well. So, perhaps, first of all, could you describe how you see your relationship as chair with the board and what your fundamental role is in relating with the board?

Thank you, Sam. Well, it's as chair of a unitary board, so it comprises both non-executives, independent members and executive directors, and the essential role of the chair is to lead the board and to ensure that the board is effective across all its roles and responsibilities, and that is, as you know, setting strategic direction, building and sustaining strategic partnerships, setting risk appetite, overseeing strategic risks, overseeing delivery against in-year plans, and most importantly, setting tone and culture for the organisation. So, there's a very prescribed set of roles and responsibilities for the board.

So, the role of the chair is to ensure that the board has the right capacity and capability around the table to make its decisions in the optimum way, and of course accepting that the appointments of independent members are a matter for Ministers, not a matter for the chair, but the chair would lead the interview process and then produce the outcome of interviews for ministerial consideration. And as I said in an earlier question, currently in Public Health Wales you're still having to look at proper representation from the world of disability. So, when I would get to Swansea bay, I would look to see what the composition is. One thing I would need to do very early on is—there are five interim executive directors around that board table, so I'd need to undertake a recruitment process to secure substantive appointments. And that is in no way me commenting in any way on any of the individuals who are in interim roles at the moment. I don't know four out of the five, and the fifth I hadn't met for 12 years. So, that's not a commentary on them. But it would be my role, as the chair, to ensure that a raft of substantive appointments are made, because the fundamental thing is you need the right capacity and capability around the board table. The board needs to be absolutely clear what its role is. And, of course, Sam, as you know, the unitary board—it's one of the most sophisticated but complex governance models to pull off, because you have the non-executive and the executives. The executives run the organisation, but they are equal members around the board table. They'd have a vote each, if it ever came to voting. So, it's quite a difficult model to pull off.

On that point with the executives, I'm just wondering maybe you'll be able to point not just to your experience in having that working relationship with the executives whilst holding them to account and challenging them around targets and performances. Some of your experience and how you see that experience being able to support you in this new role as well—whether you see any challenges in the near future about getting that balance right between working alongside whilst also being able to challenge effectively.

And I think that's where board development programmes really come in, because the whole board has to come together and understand the role and purpose of it coming collectively, but of the individual parts. And as I said, it is one of the most complex roles to pull off, because one of the things you have to avoid is executive capture, so that when you get to the board situation, the executives have already determined stuff, and the independent members just nod it through. So, that is a unitary board not working well at all.

So, as a chair, you need to meet with each board member, executive and non-executive, to be absolutely certain that they understand the nature of the role. But in terms of the executive, that will also be done through the role of the chief executive, of course, because that's the prime relationship—the chair and the chief executive. It's a symbiotic one. The chair leads the board, the chief executive leads the organisation, the executive team et cetera. They have to come together to ensure effective board operating. So, that's how I'd do it, Sam. I'd be absolutely certain. And then also, during and outside board meetings, it's giving constant feedback and getting constant feedback as well about how the board is operating.

But the chair, to bring it all together—the best way to bring it all together is creative tension. I look in on Public Health Wales board meetings that I've chaired, because they're all recorded, and so I will look in on my performance, and I will look in on everybody else’s performance. So, I build up that knowledge base and understanding, and I tweak. The chief executive and I will tweak. But it's a constant, constant—

Did you want to come back in, Sam?

Chair, can I come in just with one last point? The other complexity, of course—there's complexity within the board, but you'll be fully aware of the complexities around the board with regional bodies, and you’ve mentioned it in your written evidence—'the existing partnership architecture' I think you called it. Whether the 'architecture' is strong or weak is a different matter, but you'll be aware of RPBs, the PSBs and every other acronym going. I'm just wondering how you think you're going to be able to balance your engagement with those, which are well and good, whilst also delivering your fundamental role of chairing the day-to-day business of the board, and whether you think there's a risk of being distracted by some of the broader tempting areas to get involved in, and perhaps leaving some of the duties as chair of the board—whether you see that as a risk, and how are you going to manage that? And then, briefly, I know you mentioned earlier about your engagement, which you see as important, outside with external bodies—perhaps you can just speak to how you think you'll best deliver on that external engagement as well, just briefly. Thanks. 

Thank you. Well, Sam, I have a different perspective from yours on whether the partnership agenda is an integral part or a separate part of the role of the chair of the board. I mentioned earlier that one of the board's roles is to build and sustain strategic partnerships, because the NHS does very little on its own, and we certainly can't keep or help people to be healthy without a whole range of wider partnerships. So, it is an integral part of the role, and, for example, in Swansea bay, they have a partnership and population health board committee that actually makes sure that the health board is discharging its full role as a full partner across the regional partnership board, the public services board et cetera. 

It is about ensuring that the board plays its full part in the synergy of partnership working, so that every different partner comes together and has that common purpose. And I think that is the role of the chair of the board to make sure that that happens. So, for example, I mentioned earlier about the need to really think about the care of frail, older people. With the partnership across—there is the sort of west Glamorgan regional partnership board—they have a 'home first' policy, and they share that, and that is really important. So, whether it's different parts of their life course, in terms of access to mental health, and child and adolescent mental health services for children and young people, or access to the right kind of care for frail, older people, that's a shared agenda. So, I suppose my perspective is different from yours, Sam, on that. I don't think it's outside of the day job. 

And then, in terms of engaging with partners, I'm a very people person, as I've said, and I will go out and meet people. I'll go to events, and I'll often do this in the evenings and weekends, because I like to build trust, because you can't have effective partnership unless you have trust. So, I would just take the way I've always done it. So, I have personal working relationships, for example, with all of the commissioners, with chairs of Social Care Wales, Sport Wales et cetera, but I build them up personally, and I would carry on doing that, because I'd just be 100 per cent committed to doing that. 

Thank you, Jan. Thank you, Sam. Any further questions, Sam, or have you asked all your questions? Thank you.

Thank you, Jan Williams, for being with us this morning. We appreciate your time with us, and thank you for, obviously, the information provided prior to the meeting as well. So, we hope to publish our report by the close of play on Monday. So, diolch yn fawr iawn. Thank you, Jan. 

Thank you very much. 

I move to item 3, and I propose, in accordance with Standing Order 17.42, that the committee resolves to exclude the public from items 4, 6 and 7 of today's meeting, if Members are content. They are. That's agreed, so we'll proceed in private. 

Good morning. Welcome back to the Health and Social Care Committee this morning. I'll move to item 5, and this is our session where Members have an opportunity to question the Welsh Government's preferred candidate for the role of chair of Hywel Dda University Health Board. I'd like to welcome Neil Wooding this morning to the meeting as, of course, the Welsh Government's preferred candidate. Thank you, Neil, for being with us this morning. Members have a series of questions, and the first set of questions is from Sarah Murphy. 

Thank you, Chair. Thank you, Neil, for being with us this morning. I'm going to start us off by asking you some questions about your knowledge and experience. Why do you think that you would be well suited to this role, and how would you draw on your skills and experience to ensure that Hywel Dda University Health Board is an organisation with strong governance, accountability and—crucially—financial management? Diolch.

Diolch, Sarah. It's a complicated question, when I try to think about how I pull together or blend all of my skills and experience. Primarily, I think I bring a blend of two streams of experience. One is having worked largely within the community voluntary sector since I was about 17 or 18 years of age, so starting off in a very physical kind of role, but working through the hierarchy of those kinds of organisations—I'm currently the chair of the Wales Council for Voluntary Action—and having spent the last few years working largely with large-scale national charities in a trustee position. So, I think that's connected me to the thing that I love best, which is community—community well-being and community health. That's some of my passion driving this. I suppose the other stream that creates that blend is very much having worked in public service for a very long period of time, having worked inside the NHS, both as a workforce and organisational development director for NHS Wales, but also as the director of the equality and human rights centre, and also a number of other human resource development roles within health authorities.

I feel as if I've had a very long-term partnership with NHS services over the years, which has allowed me to understand the complexity of them—not in totality, but just to appreciate the way in which these services are constructed as models. So, I think that gives me a degree of confidence that I'm entering into a space that I have some understanding of and I can evaluate from my experience. I suppose the other element I bring is, having worked primarily in the public service, largely in Wales but latterly in London and other places, at the senior levels of the civil service, then you develop this enhanced understanding of good governance, probity, spending well, saving well, understanding the importance of engagement with boards and the decisions they make and their accountability to Government and to Ministers inside that space. I think my appreciation of that as an essential part of managing a board well, leading a board well, has been really important. I think I bring those three things to the role. I'm hoping that, in discharging the role, all of those things will come together, and I'll bring some insight, depth, inquiry and challenge to the way in which the board works, not least because I think I've had that broader level of experience as well.

That's really helpful. Thank you very much. You did mention there the complexity, and you also mentioned that you've had experience inside and outside of Wales. So, it would be helpful for us to get a little bit more of your insight into the health and social care sector in Wales, how it is at the moment, and how you would navigate that, I suppose, and lead and chair the health board.

I think the challenges facing the health service currently are enormous. Arguably, I think of it as an adaptive change process. Adaptive change means you stop trying to change things and you start seeing yourself as the problem and changing yourself. In a way, there's something about the fact that the health service has to own itself as the problem inside this space. I'm not saying it's deliberately created it, but the solution lies with rethinking how it operates and how it develops.

I suppose my appreciation of that complexity is very much recognising that we still have two relatively conflicting journeys through the NHS. We have a secondary care system that is enormously expensive, digitally underpowered, needing some quite significant reform. We have models of delivery that are often low value and outdated. We have significant waiting lists inside that space. So, we have a system that's suboptimal, in my view. We have lots and lots of professions involved in that. So, it's not a clean system, it's a system that has lots of voice, clinical voice, inside that space, all of which, I think, makes it cacophonous, loud and often very difficult to understand. And then we have primary and community care services—what should be the front end, the sharp end inside this space, the bit that really engages with wider community, and, frankly, takes the load and acts as the kind of space in which people stay well and their ill health is prevented. It's a completely different kind of approach to understanding health.

These two models are not new, but, for the decades that I've been working with the NHS, we have a tension and a conflict between these. We need to be much more in the primary care space. Within Hywel Dda, it's a fragile, non-resilient service. It needs to have greater resilience, needs to have a greater structure behind how it's being delivered. And then we have a secondary care service that absorbs vast amounts of the resource that goes into health services. And then we have an insatiable demand for more services. In many senses, it feels as if it is a perfect storm.

There's a question about not being able—. You know, would it be the case that we had more money to plough into this, one would argue whether that's absolutely the thing we should be doing. Because, actually, we need to work within a resource base that enables others to be able to be resourced and be part of this journey as well. So, I think part of the challenge is it isn't just the complexity of the health service, it's recognising that it doesn't operate in isolation—it works with local government, it works with communities, it works with other providers inside this space, all of whom need to come together in a model that is much more collaborative and shared in terms of creating a healthy population. I'm not sure if that's answered your question or if I've wandered off a bit.

No, not at all. My question is trying to get your take, really, on how you see things. My colleagues will delve a little bit more into what do we do about all of that, what's the strategy. My last question to you is going to be whether you have any other appointments that could have potential conflicts of interest or perceived conflicts of interest and how you propose to manage those conflicts or perceptions if that is the case.

I've mentioned I'm the chair of the Wales Council for Voluntary Action, which is very close to my heart, because it's working with a large voluntary community base across Wales, which I think has an essential role in this current work. So, I think that's really important. I'm also a non-executive director on the board of the Scottish Government, which I will probably resign from in relation to being endorsed by the committee, if that's what you choose to do, because I think it will just be too much to do. I think my focus needs to be on the health board. The other role I have is I'm a civil service commissioner. So, I'm responsible for the appointment of senior officials to the civil service—specifically in Wales, but also with a wider brief across England and Scotland.

To go to the second part of your question, Sarah, I don't anticipate that they will be problematic, and if they are, then clearly I would identify and declare an interest and recuse myself in those circumstances.

Thank you very much. Thank you, Chair.

Thank you. In terms of the appointment you mentioned in regard to the Scottish Government, did you think that may be a conflict of interest and you would stand down from that role if you were appointed? Just to clarify.

I wouldn't anticipate it to be a conflict of interest. In Scotland, you pair up in a coaching role, and I'm working with the chief executive of the NHS in Scotland. I don't think it's particularly problematic, Chair. I think my decision to resign from the role is really one of giving priority to this role as the chair. I don't think they're both manageable. And because of my association with west Wales and my passion for health, this comes first. 

Understood. Thank you, Neil, for that. Mark Drakeford. 

Thank you, Chair. Good morning, Neil. Three questions from me about the strategic aspects of the role. The first one: I think a reasonable person might fairly describe Hywel Dda as an organisation in trouble. The entire organisation is currently in targeted intervention. It has never once in its whole history lived within its means, and that's a problem that appears to be getting worse, rather than getting better. So, what would you see in your early days as chair of the board as the contribution you can make to gripping those difficulties and getting the organisation to focus on making them better, rather than allowing them to get worse?

Thank you for your question, Mark. Initially, I'm not a big receiver of conventional wisdom. So, until I'm satisfied that I fully understand a picture, then I'm inclined to stay very focused around, frankly, challenging what I hear or what I see inside that space. I agree with everything you've said. I think it's a massive challenge and, arguably, it's suboptimal and underperforming. For me, the real question is to look to see why that's happening at the current time and, indeed, why it's grown up over a period, and then to, frankly, put some challenge and provocation into the system.

I don't want to do that in a way that's not informed. So, my initial activity is to get under the surface of the organisation, understand the way in which it's being led, understand the data and what the data is telling me, understand the nature of some of those fragilities and how they work. Some of them I understand, because, frankly, when I was the workforce and organisational development director for NHS Wales, there was always an issue with Hywel Dda, even at that time, and largely around issues of recruitment and resourcing, the considerable cost that sometimes the health board had to bear as a result of bringing people into west Wales to work in that part of the world. All of those issues, for me, seem to require further scrutiny, and I think that would be my role initially, partly to content myself that I fully understand the picture and the complexity of it. 

So, my initial thoughts on this are that we need to fundamentally change this model. It hasn't grown up immediately, everybody is not doing the worst job that they can. They're trying to do the best job they can in the system and the way they're delivering it, but it feels to me as if something is wrong fundamentally with this model. It's just suboptimal. And I think that's about working differently with neighbouring health boards, to understand how those services could be configured differently or integrated more. I'm interested in a care plan for west Wales, which would start to think about how we could work in a much more integrated way with social care providers and the NHS. I'm interested in third-party involvement in the planning and delivery of some of those services. 

I do see some priorities. You're right on the current status of the board—it's in special measures, it needs to target its work. I don't think you can have a plan unless it's balanced. So, for me, there's something about working much more closely to understand how we can reduce what is a considerable deficit and planned overspend over the course of the year. Even if we think the underlying funding position is poor, we still have to work, in my view, towards a path to balance inside this space, and as yet, I'm not convinced I've seen that.

Thank you. Neil, I was interested in what you said earlier about your experience of working with communities, and here is a board that has an enormous range of different communities within it, from the industrial history of Llanelli, and its surrounding areas, to north of Aberystwyth. And the communities that Hywel Dda serves are fiercely attached to the services that they know and have become used to over so many years. What can the board do to turn that fierce attachment to a health service into an asset on the necessary journey of change rather than a barrier to it?

If I can say, that's a very good question, because I think that's been in my head for a while, partly because I am part of that community, so I understand on one level how individuals work, because I am part of the community, but the other bit of me thinks, everything's got to change and we've got to go through this period of having to realign people's ambition and aspiration for health with a different model.

I have always been of the view that communities should be self-healing places. I think they should be self-educating, self-caring. That doesn't mean that there is no role for wider organisational intervention, but I think the heart of communities should be engaged in caring for themselves, and I think we could do that a lot more, frankly, than we do. I see lots of signs of that in west Wales—very informal levels of care and support across communities—but I think that that is an asset that we have to optimise. But there is a real sense that the people have learned their behaviour around how they want their health service to be. So, for me, there is something about the fact that people often have a very approximated or localised sense of where their service should be and how that should be delivered.

On your point, Mark, if you lived where I live, which is on Cardigan bay, when I access services, I have to think much more differently about those services than if I lived in Carmarthen or if I lived in Llanelli. So, for me, my relationship with those health services is very different, as it would be to someone living north of Aberystwyth or in parts of south Pembrokeshire. So, there is something about how we have a dialogue with people—an open and honest and transparent dialogue—that says, 'This is how we must all work together to deliver a change in the way in which those health services will be provided in the future.' And we all have to play a part in that, and our parts are not passive—they are active and they are proactive. And on one level, NHS services has to abdicate some of the responsibility for being all those things to everybody else, and allow communities to take some of that responsibility and some of the authority that comes with that process as well.

So, I think if there was an easy answer to shifting across to a much more focused primary care, community-based service that engaged communities in different kinds of ways, I think we would have got there before now, because I know that a lot of people are really passionate about wanting to make that change happen. For me, I'm interested in coming to this from a community perspective. So, I'm interested in just the power and capacity and the capability of communities to become much more instrumental, if heard and given the voice and given the opportunity to do that. And I'm not saying for a moment that there won't be conflict and distrust and anxiety about some of those changes, but I think we just have to have open, adult, grown-up conversations about what can be possible in the future and where our interests lie. And I think we are all seeking the same thing; I just think we have different ideas on how that gets delivered.

Thanks. My final question is about the strategic relationship between Hywel Dda health board and its neighbouring health boards. Because here you are with a board that, along its long eastern edge, has a very close primary care relationship with Powys; by the time you get north of Aberystwyth, some of the secondary care services are shared with Betsi Cadwaladr; and the key relationship for tertiary services is with Swansea bay. So, how much of your energy and how much of your prioritising the time you will have, and the effort you will make, do you think needs to be devoted to making sure that Hywel Dda sees itself not as an island on its own, but absolutely linked into those strategic relationships with its neighbours?

So, notwithstanding what I've just said about where my priorities would lie in joining and my desire to scrutinise the board, I would see much of my role to be about building stronger relationships with those neighbouring boards and those populations.

I think one of the challenges for Hywel Dda is that it can dig a hole and it can dig it really deep, and that, actually, it's kind of in that space, in that hole, trying to find a solution single-handedly to the kinds of issues it's facing. And I think, if we think about west Wales as a health economy, so we think about it more about how health flows across that economy and how people flow across that economy, then, actually, we've got to stand back from just thinking of ourselves as a single health board, but think of ourselves as part of a community of delivering across that space. And that will involve Swansea, so I think a much greater strengthened relationship in terms of the services that can be integrated and delivered across that area, because you're absolutely right: it kind of connects and feeds into west Wales, but also Betsi Cadwaladr and Powys as well, so it's understanding all those borders.

So, I have a real sense that if we work in a kind of inter partes way, a kind of among-equals way, we'd have a much stronger sense of how we're doing this. And actually, if we look beyond just the nature of transaction—so, I think a lot of those relationships are governed by a transactional kind of basis to delivering them—and if we think much more about the art or potential for transforming things through those relationships, then I’m hoping that we will see the benefit, mutual benefit, that can be delivered by Hywel Dda having a much more outward-looking focus. But I think that will take time and that's about building trust and delivering well in relation to some of those other organisations.

But I absolutely feel that's a priority. I am not really prepared to leave stones unturned on this journey towards rethinking, to actually optimising the work of the board in future. I would not want to come back in several years’ time and say, 'Ah, you've missed that.' Because actually, I think this is part of the solution.

Thank you, Neil. I'm just conscious of time. We've got three other question sections, so if I could just ask Members to bear that in mind, and Neil—sorry to have to ask—if you could be pointed in your answers as well, that would be helpful. And if you don't mind, Neil, as well, some Members may want to politely interrupt you if they want to get to the second question, if that's all right with you. Thank you very much.

Absolutely.

Joyce Watson.

Good morning, Neil, and I live in this area and I was interested in your response so far. But the big issue here, in trying to move Hywel Dda forward, is taking staff with you, and preventing the anxiety that often runs alongside change. So, what approach would you take to make sure that there is a vision and a structure and a culture that keeps the staff on board?

Thank you. I generally work from the position that people don't resist change; they resist being changed. So, for me, there is something about how you intrinsically get people to come with you on the journey, as opposed to kind of telling them or exhort them they need to take this space. And that only happens with quite a lot of time and investment in those communities, and a culture that people feel allows them to be instrumental, as opposed to just passive, in terms of the way that services are designed and delivered. So, I think there's something for me about making sure that the leadership that is shown in the board, which casts a long shadow or sunshine across the organisation, exemplifies those kinds of behaviours and the ways things have to work.

There are 13,500 people, so it's 13,500 opportunities, technically, to be able to deliver what the board needs to deliver. There'll be people who will come with us on the journey and be on the journey, there'll be people who will be ahead of the journey, who will have frustrations because they can see how things need to be better or different, and then there will be people who will struggle enormously with those changes, for whom it won't be, it will be for people coming in, or the workforce changing, or the workforce developing. I am a firm believer that we have to be very clear in our vision and our intention, and people have to be invited to join that. If that's not something that they want to engage in or do, then I think we should help them understand that this is the journey we're on, and, actually, there should be something else that perhaps they should be doing.

So, I don't know if that's answered your question, Joyce, but for me there's something very real about pulling in these 13,500 people, giving them more clarity around what we're trying to achieve, not presuming that they're on board with that, but working to build that sense of community within the board and focusing on that work. I suspect some of that will start around a refresh of the primary care and community strategy, which I think will take place over the next few months, but, generally, more transparency and more engagement.

Thank you, Joyce. Sam Rowlands.

Thanks, Chair. Good morning, Neil. Thanks for your time this morning. I just want to touch on your role as chair of the board in relating to the board, whether it's day to day or it's, perhaps, those more significant board meetings. I just wondered how you see your role as chair in ensuring the right skills and that the competence of the board is up to scratch.

Great, thank you. It's a unitary board. In that sense, there's that coming together of execs and non-execs. I am quite keen to initially meet with everybody to understand the scope of their ambition, their skill base, their profile and where they sit in relation to what we're trying to deliver as part of the board. For me, that's quite important, building that, strengthening that relationship, and also setting the template for how I want to operate as the chair. So, it's very much a scrutinous role, but it's a grown-up, adult role, so we should be able to challenge and engage with each other and have a sense of being collegiate amongst the community, but I also want everybody to understand that I expect the very best of them in these circumstances, and they can expect the best of me.

On that, Neil, as you said, it's a unitary board and there's that relationship as chair, relating at that level, but also holding especially the executives to account and challenging them on performance. I'm just wondering how you think you'll be able to best deliver on getting that balance right, maintaining a healthy day-to-day relationship whilst also properly challenging perhaps poor performance, as we've heard from earlier questions, about issues around special measures.

Personally, much of my experience as a leader, both working within a non-executive and executive capacity, is to have very open conversations, respectful, open conversations that have got enough bandwidth to allow a challenge to be made, but not for individuals to see that as a personal threat, an insult or as an offence inside that space. So, I think there's something about being able to challenge without judgment, so people don't feel diminished by the challenge, they just feel that they can answer the question and respond appropriately. The thing we need inside this space is honesty, lots of honesty. I don't want anything hidden, disguised or articulated as something else. I want that honesty, and I think you'll only get that honesty when people feel safe, trusted and valued. But that doesn't mean you can't have a hard or difficult conversation. As a chief people officer, I can't tell you how many times I've had to have those kinds of conversations with individuals. So, there is a blend of being respectful, but also being challenging inside that space, and I'd like to think I've worked that one out.

Okay, thanks, Neil. I absolutely agree with you, and I guess the challenge is, as chair, to drive that culture in such a large organisation. And then, also, aside from the very specific role as chair of the board, you mentioned working with neighbouring health boards, and there are also local authorities and other important partners that you'll be looking to work with. I just, perhaps, want to hear a bit about how you would expect to be able to build and maintain those good working relationships, and not just maintain them as they are today, but progress them to something better than they are today as well, and how you, personally, as chair of the health board, would carry out that role. What would you expect to do?

Great. So, I think there is something about deepening and strengthening the relationship with local authorities, elected members, third sector organisations and representative organisations, and I think—. So, for me, there's something about—I mentioned it earlier—not just engaging at the point at which it's just a transaction, so not just engaging in a meeting or a conversation because I need something or they need something and we're going to have a conversation about how best we can deliver to each other's needs, but I think it's about having a conversation with individuals and working with them in an environment that doesn't require me to have something from them or for them to take something from me, but just helps to build and substantiate the relationship.

So, as an example, slightly premature, but the chair of Pembrokeshire local authority contacted me and said, 'Would you do this with me? Will you come and see this event that's happening in the next week? Would you come and see and we can have a conversation?', and I kind of thought that that's exactly the kind of conversation I want. It's not about only coming to see you because I've got something to tell you or you've got something to tell me, it's having a conversation where we can be open about ambition, about what we might want to achieve in the future, where I can value some of the things that he's doing and he's engaged in in Pembrokeshire, but then, also, he can understand where I think some of the challenges are going to be when we move forward in the future. And I think the more conversations we can have in that space, the better it will be. I think the stronger those conversations—because, when it comes to circumstances where it gets really difficult and tough and a bit dark and dangerous, you need to be able to recall and recount those conversations when, actually, you worked well together.

Thanks, Neil. Perhaps just one last little point before colleagues come in. In that partnership landscape, I'm just wondering if you see any risk in getting lost within the complexity of it and then getting distracted by other areas that aren't necessarily fundamental to your role as chair of the board, or do you see it all integrated and all equally important?

No, I think there's enormous risk in that. I think there's enormous risk. There are high-value outcomes that we need to be working towards and there are low-value issues, which I think we've got to avoid. I think it's easy to become distracted and get tripped up and drawn into something that, frankly, looks a bit transactional, so 'If we can tick that box, wouldn't we all have done well?' I think it's trying to stay focused on the hard and difficult stuff around those relationships and about how we change the pattern of what we're trying to deliver, whether it's the local authority or it's Hywel Dda. You know, that's where the real difficulty lies when we're changing people's thoughts and behaviours. So, I think it's a real risk; I think you're right to raise it. For me, it's kind of being self-aware around where that risk is and when I can feel that happening.

Thanks, Neil. Thanks, Chair.

Thank you, Sam. Mabon ap Gwynfor.

Thank you. A great question. Much of my professional experience has been around promoting diversity and inclusion, and kind of trying to find ways in which we can improve the way in which we include others inside our organisations or the benefits that we can offer as part of society.

I was struck, a few years ago, when I was talking to a colleague in London, and she said, 'I work here, but I don't belong.' So, she had a real sense that she worked inside an organisation, but because of her diversity and difference she didn't think she belonged to it, culturally or otherwise. And I think I've dedicated quite a lot of time since thinking, 'How do you create organisations in which people feel that they absolutely belong, so their cultural differences are valued or respected in the same way as others?' So, I think there's something about the cultural base, or what I think of as the cultural genome of an organisation, to make sure it's wide, inclusive and open enough to accommodate, recognise and value different cultures. And then, I think, people will come. So, there is something about the fact that I wouldn't really want to work inside an organisation that I felt didn't reflect the values that I hold; I definitely wouldn't. So, I wonder whether other people won't as well. So, I think there's something about building that cultural base to encourage more people forward.

I think there's something about working with communities, also, to understand how do we grow this appreciation for working for the NHS, long before it happens at 16 or 17 or 21 years of age. How do we start off with that deep level of ambition, 'I want to work for the health service', and build that, because I think that would address some of the recruitment and resourcing challenges the health service are experiencing, certainly in west Wales? But I think it would also encourage people to feel as if the NHS is theirs and they're not just joining an external organisation; it's something that they feel part of.

Outside of that it's making sure that all the filters that usually happen when we recruit people inside an organisation are set at the lowest point of resistance as possible, so making sure that we aren't asking for anything that would either discriminate or disadvantage particular communities, making sure that all the biases that sometimes I see in my work in London and wider, that people exercise when they think about recruiting, are minimised as much as possible, and that people are given the opportunity inside that space to be the very best they can be, so we can attract the best possible people to the health board.

Thank you. I started learning Welsh when I was 11 years of age, when I went to secondary school in Pembroke, and over the course of my fairly lengthy career, I've continued at various points to practise, learn and refresh my Welsh. And one of the greatest things about having moved back to this part of the world two years ago was just the level of Welsh that people use, and you can practise with and you can speak to, and how authentic that is in terms of people's experience, and, frankly, it makes for a much more interesting, diverse community. I find it personally challenging, but that challenge has also been a really enjoyable one, where I think I've learned more about language and me and other people as a consequence of people speaking Welsh. So, I absolutely think it's important. And my personal journey is to become fluent in Welsh as quickly as possible and to encourage others as well. And to that end, I am part of lots of local Welsh-speaking groups that practise and improve their Welsh on a weekly, monthly and annual basis. I think that's really important.

So, for all the reasons you've just given, I think we have to make sure that people can access those services in the language in which they are most comfortable, especially—especially—when they're looking to access health services, because that's usually a point of significant vulnerability. And language can help to restore people's sense of confidence and address any of those vulnerabilities that can occur once you go into a big system and perhaps you have a significant illness or a factor relating to you health. So, for me, I suppose I would give you an assurance, personally and professionally, that I think it has to be absolutely bilingual in the way in which it operates its services at Hywel Dda and rejoice in that—not see that as a hardship or a challenge, but see that as a really important way in which we reflect the community and allow the community to flow through the health board.

Thank you, Mabon. Neil I just wanted to—. We're out of time, but I just wanted to ask very, very quickly, and perhaps I can ask you for some bullet-point answers on this—in your first year, what are your priorities, and then beyond that first year, for the rest of your term, what would you see as your priorities then? I'm particularly just wanting very short, pointed responses to that, if that's okay.

Okay, so first year, very much the plan—ensuring the annual plan and that all of the aspirations in that plan are delivered; that, for me. Secondly, building relationships both inside the health board, but beyond that with other health boards, for other local authorities inside that space, so seeing a growth in health boards. Thirdly, refreshing where we're going strategically. For me, that's quite important. For a healthier mid and west Wales, I think what we need to do is start thinking, 'It's five years old, let's just refresh that and get a sense of what we could do inside that space, post COVID.' So, three bullet points.

That's very good. Thank you. I appreciate that, Neil. And just in terms of that response, what are the barriers, do you believe, to achieving those in your first year? What are the barriers that exist to achieving the objectives that you just set out?

So, I think the plan is significantly challenging. I'm not convinced it contains all the challenges that the board needs to address over this period. So, there's something about the plan itself. And I think it will require a great deal of hard work and innovation and courage to deliver that. And I think those can be barriers, Chair, where people are not prepared to do that.

I think building those relationships within the board and beyond it is about making sure that time is dedicated sufficiently to be able to do that, and, actually, that we get beyond just, 'This is my organisation; this is your organisation', and we start to build solid, grown-up adult relationships. So, I think the barriers are about people often conflicting or coming to them with different views or thoughts, or people not being on the same page or having the same level of understanding, so that that would be the case. In relation to the strategy, I think a barrier could be people saying, 'Well, we're too busy, and isn't the strategy okay?'

And you think you'll be able to overcome the barriers.

I certainly intend to try.

Yes, there we are. Okay, well, thank you, Neil, for being with us today. Diolch yn fawr iawn. We'll seek to publish the committee's view by the end of the day, Monday. But we thank you for coming to the meeting this morning and also for your prior information before the meeting as well. So, thank you, Neil. Thank you for being with us. Diolch yn fawr iawn.

Diolch yn fawr.

That concludes the public part of our meeting today and we'll now proceed into private.