Cynulliad Cenedlaethol Cymru

Bore da. I'd like to welcome all Members and the public to the meeting of the Health and Social Care Committee. The public items of the meeting are going to be broadcast live on Senedd.tv, and a record of proceedings will be published as usual. This meeting is bilingual, and simultaneous translation from Welsh to English is available. Are there any declarations of interest from Members? I can see that we've received no declarations. We've also received apologies from Nigel Williams for our meeting today.

I'd also like to welcome Phil Berrington, the Welsh Government's preferred candidate for the position of chair of the Welsh Ambulance Services University NHS Trust. You're very welcome, Phil, and Members know that you've been through a long process before getting here, but you'll know that we do have a few questions for you today. So, we appreciate you coming in this morning. So, I'll just make a start and just open up by asking why you think you're well suited to the role, and how you'll draw on your skills and experience to ensure that the Welsh ambulance service is an organisation with strong governance, accountability and financial management.

In terms of why I think I'm well suited to this particular role, I think there are three primary reasons, supported by a fourth in terms of personal development, but the three primary reasons are: leading complex organisations, the second is in terms of my experience around governance and accountability, and the third is system performance.

So, if I take the first, in terms of leading complex organisations, you'll see from my pre-appointment questionnaire that I'm currently the deputy chair, and have been the acting chair, of a group of NHS English hospitals—so, Portsmouth and the Isle of Wight. The complexity is that they are very different in nature. So, the Isle of Wight was originally, when I started as a non-exec, a fully integrated trust. So, it covered community, mental health, ambulance and acute services. It serves a population of 140,000 people, with some very deprived areas. If I look at Portsmouth, a larger district general hospital, it has a medical school, a research facility, but serves a population of 650,000 as well. So, I had a period as acting chair between the current chair and the previous chair, so I've already operated at chair level. I would support that with the experience that I've got from the commercial world in terms of transformation and innovation—so, a long track record, particularly with IBM. So, that's the first reason in terms of leading complex organisations.

The second, in terms of governance and accountability—certainly, if I look at the accountability element, there has been a push from NHS England to make boards more accountable for the performance and the strategy of the organisation. So, I've had a lot of experience of getting board assurances in relation to things like submissions and compliance with planning guidance for the medium-term plans, for route-maps for the end of year, for example, in terms of quality and safety—so, recently, the Fuller recommendations.

In terms of governance, I was involved in the development of the new group structure between Portsmouth and the Isle of Wight, after we transferred the responsibilities for community and mental health to Southern Health NHS Foundation Trust. If I look at system leadership, I've touched on an element just then in terms of the transfer of responsibilities, but I was involved in the committee in common. I was the appointed non-exec from the Isle of Wight to the committee in common between Portsmouth and the island. I was involved in conversations with Southern Health about the due diligence and transfer of responsibility of community and mental health, and importantly, I think, for this role, involved in conversations with South Central Ambulance Service around the adoption of 'release to respond', or handover 45 in a Welsh context, and the consequences of that.

So, those are the three primary reasons. And in terms of me as an individual, I'd like to think I'm one of life's learners. I was recently on the NHS England Aspiring Chair Talent programme, which I completed back in March. I think that's important, because what you can see, actually, is a strong connect between not only the business experience, but the personal experience and personal development and the strategic objectives of WAST.

Brilliant, thank you. And just I'm trying to get a bit more information about the knowledge and experience you have of the health and social care system in Wales, and how you'll apply that in your role as chair.

So, I think—. You indicated earlier or at the outset that it's been a long process. So, I've had experience of reviewing material from Aneurin Bevan University Health Board. I was involved in that process, one of two appointable candidates. So, I'm quite familiar with the operation in terms of the preparation for that process. I also prepared for the process in terms of the shared services partnership as well, and, clearly, prepared for the Welsh ambulance service. So, whilst I don't have practical involvement in the Welsh healthcare system, I am familiar with the workings of the Welsh healthcare system from the standpoint of preparation. And I think there are many similarities between the healthcare system in England and in Wales. And of course, clearly, I'm also a patient in Wales as well, given that I live in Llangattock.

Brilliant. Diolch, Phil. So, we'll now move on to some questions from Members, so we'll start with a question from Becca Martin.

Diolch. Thank you so much for coming in today. Really, I just want to ask if you've got any other appointments that you think could give rise to potential conflicts of interest, or even perceived conflicts of interest, and, if so, how do you propose to manage those. And how would you manage anything that perhaps comes up in the future as well?

Right. So, the only appointment that I have at the moment is as deputy chair of the group for Portsmouth and the Isle of Wight, and my tenure in that role completes on 18 October. I've already started working with the executives and non-executives of the Welsh ambulance service, and I don't foresee any problems at all between now and the middle of October in terms of any conflict between the Welsh ambulance service role and the outstanding commitments I've got with Portsmouth and the Isle of Wight. If there was a particular problem, I would make the Welsh ambulance service a priority. It is not my intention to take on any other role. So, I would prefer to focus on the Welsh ambulance service, as opposed to taking on any other non-executive roles.

Thank you.

Thank you. A question now from Natasha Asghar. 

Thank you, Chair. Good morning. 

Good morning.

I'd just like to know, and I'm sure the committee would like to know: with the plethora of experience that you come to the role with, what's your long-term and short-term strategic plan for the Welsh ambulance service?

So, I think, clearly, there's a strategy, a long-term strategy, in place at the moment. And one of the things that I would want to do is to get to the point where we've got a refreshed long-term strategy. But I think, really, from my perspective, it comes down to three things. One is better outcomes for patients and the communities in Wales. I think this is a tremendous opportunity to lead on a national basis as opposed to my experience at a local or a regional level, and that will be driven through things like the ambulance performance framework and the clinical transformation, with a particular focus on things like our 'orange: now' performance. If I look at things like better system performance, one of my values is around collaboration, and I think the only way for the Welsh ambulance service to be successful on a sustainable basis is to be collaborating with other parties in the healthcare system, whether they’re health boards, trusts, communities, and better organisational leadership from the standpoint of board and board development.

So, those are the sorts of long-term ambitions I've got. In terms of short term, it's a step on—you know, the steps need to be put in place to deliver that on a long-term basis. I've already had conversations with the chief executive about the residual ministerial priorities, and then the objectives that are underpinning those previous ministerial priorities, and the performance.

Okay, thank you for your answer. I've been around here for a little while now, as have some of my other colleagues in the room, and I know that a lot of Members here have probably seen, over the last few winters, lines and lines of ambulances outside hospitals, particularly—and I hate to sound very Game of Thrones, but winter is indeed coming. We know it's upon us. So, based on your experience, do you feel that you're properly equipped to deal with the winter pressures that are going to be coming very, very soon? Or is there anything further the Welsh Government can indeed do to help and support you in this new role? 

Well, I’d say—. Let's start with the experience. I've had experience of operating in two environments between ambulance and acute. So, if I take the Isle of Wight, although it's the smallest ambulance service in England, the Isle of Wight is an integrated trust between acute services and ambulance services. So, that's one example.

If I take Portsmouth, the ambulance services are provided by South Central Ambulance Service. Back in 2024, we made the decision as a board to move to 'release to respond', or handover at 45. And what that did was to remove the ambulances from, effectively, the parking lot of the acute hospital. But we recognised that, actually, what that does is to transfer the risk into the acute environment, so consequently corridor care has increased in the acute environment. But what I can tell you is, looking at recent performance of both trusts, the Isle of Wight ambulance service is handing over patients in an average of 17 minutes; in the Portsmouth acute trust, patients are being handed over in 14 minutes, which is a very different situation than in Wales. But what it does is take collaboration between—. As I indicated earlier, it's collaboration between all parties in the pathway. And the reason, interestingly, why, if we take the Isle of Wight, it's an integrated trust but has a higher average time, is because there's a problem in flow—so, the inability to actually discharge patients at the right point.

So, we've got to collaborate across the entire healthcare system. And if I think about what more can be done from a Welsh Government perspective, clearly funding is a challenge, and also not just from the NHS perspective, but from the care perspective. Because, obviously, if we can get to the point where there is capacity and funding available from a care perspective, then patients can be taken from an acute setting into a domiciliary or care setting.

Okay. Thank you, Chair. 

Diolch. A question now from Safa Elhassan. Safa.

Hello. So, as a practising clinician, I know staff and patients often see risk early, but they don't always feel that they can speak up. As a chair, what will you do to make sure the ambulance crew, the call handlers, clinicians, patients and families can raise their concerns safely, and that they can see that those concerns lead to action?

I know that there have been some challenges for the ambulance service in terms of complaints and speaking up, and those are being addressed. I think, certainly, there's an element around the tone that's set at the top, because that's clearly important from the standpoint of creating the right culture. I'd want to also look at evidence, to see where there are problems around patients not being able to get the treatment that they deserve, but equally, from a speaking-up perspective, from a staff standpoint. So, that's the way I would tackle or work with the executive to look at those particular problems.

With your experience as a Freedom to Speak Up lead non-executive, what practical lessons from that role will you bring to the Welsh ambulance service?

It's an interesting one, because if we look at the experience when I was the Freedom to Speak Up lead non-exec, the service was an in-house service; we've now moved to an outsourced service. So, I think there's a question around a perception of confidentiality. If you're doing it internally, and you wish to speak up, there's a perception of, 'Is the conversation going to be confidential?' Whereas individuals are more comfortable with speaking to an external party and data being anonymised. So, I think that would be one area that could be of consideration—as in the learnings that I would take from my experience in Portsmouth and the Isle of Wight.

Diolch, Safa. A question now from Gareth Thomas. 

Hi. My interest is mental health, actually. I was interested in the mental health part that you did. But the question: what approach will you take to ensure the organisation has a vision, structure and culture that all staff will be fully engaged with and will ensure that morale stays high within your staff?

I think what you're describing there is—. That's the essence of what a board should be doing in terms of strategy, culture and oversight of performance. I understand, from reading material and talking to the executives and non-executives, that the strategy needs to be refreshed. Culture is clearly a connection with leadership. 

I think you'll identify, in my pre-appointment questionnaire, that I like to see myself as quite a visible leader, and that means getting out and about and having frank and open conversations with staff and with patients. And if I look at it from a patient perspective, there's a clear requirement to get patient input into the strategy, the long-term strategy, from the standpoint of effectively co-designing, as opposed to having a strategy that's developed internally and delivered to the patients and communities in Wales.

Diolch, Gareth. Now over to Matthew Jones.

Diolch. My questions are related to working relationships with the board and staff. So, firstly, how would you lead, develop and support the board of the Welsh ambulance service to ensure it has the required skills, works together effectively and performs to a high standard?

Well, if I make the comparison of Portsmouth and the Isle of Wight with the Welsh ambulance service, the Welsh ambulance service I think is in a better starting position from the perspective of me starting as chair than Portsmouth and the Isle of Wight. The reason I make that comment is that the Good Governance Institute has recently undertaken a review of the Welsh ambulance service and has already indicated that, in their assessment, the board is a good board but has the potential to be an exceptional board. To my mind, there's a connection between the ability of the board to operate and the operational performance. Generally, in terms of the operational performance, if I look at the new ambulance performance framework, it's still to be tested, but from the standpoint of the academic research it's generally in a good position. There's more to be done, but I would see a connection between the board functioning as a board and also the operational performance. What I've already started to do is have conversations with the governance team about the recommendations from the Good Governance Institute in terms of the timing and sequencing of those recommendations and the implementation of those recommendations.

Brilliant, thank you. What specific skills and experience do you have to enable you to develop a strong working relationship between the board and the chief executive and the staff of the Welsh ambulance trust, while also providing constructive challenge, monitoring the performance and supporting the achievement of the organisation's goals?

What you've described there is effectively the role of a non-executive, to not only support but provide challenge, as well as getting the right balance between those two responsibilities. I mentioned earlier on that I was acting chair for three months in the group. It's a large group. It's £1.1 billion and 12,500 staff. During that period, I had to undertake the evaluation of the chief executive and also the performance evaluation of all non-executive directors. So, I understand and have experience of holding people to account through the formal mechanisms, but also collaboratively working with executives and non-executives. As an example, having regular contact with the chief executive, whether that was on a weekly basis or bi-weekly basis, to review performance, but also to not just look at it from a short-term perspective, but from a long-term perspective.

Okay, Matthew? We'll move on now to questions from Sara Crowley.

Thank you for putting yourself through this process and for getting this far. My question is going to cover relationships with stakeholders and the public. I wanted to ask: what role will you play in building and maintaining effective relationships with stakeholders and partners within and outside of the NHS at national, community and local authority level?

It's a similar response to one of the earlier ones about—. It's critical to have engagement of the stakeholder communities that you've identified, particularly from the standpoint of a long-term strategy. That needs to be developed. What I would be seeking to do is to look at the engagement approach, so how do we engage, whether it's with third-sector patients or local authorities, in that process. I've had some experience of doing that with leading the strategy refresh on the Isle of Wight, as an example. So, I think those are the key things from a strategy perspective. But also, there'll be requirements on a more immediate operational level to build those relationships with local authorities, with other health boards and with patients, because the ambulance service is just one small component of the overall service delivery. Ideally, what I would want to do is to see an improved urgent and emergency care pathway across NHS Wales, as opposed to optimising the Welsh ambulance service, and take a broader view, and that can only be done through engagement.

Thank you. My final question to you—and I ask this as somebody who needed an ambulance as a child—is: how would you represent the organisation and engage with people of all ages to instil confidence in the Welsh ambulance service?

I think part of it will be about getting out and about and being visible and being approachable. And I'd like to think that I'm somebody who is approachable, and from my experience with Portsmouth and the Isle of Wight, I've spent time with patients, I've witnessed operations, with patients of different ages. But also, I think one of the important points, if we look at board activity, is getting patient stories in place—sorry, let me rephrase that—getting the right patient stories being presented. So, it's getting the balance between positive things and confirming what the service is delivering, but also recognising that some patient stories don't have as good an outcome as you'd want, and therefore it's what are we going to do as a consequence. So, I think it's getting that sort of balance.

Diolch yn fawr.

Thank you. We'll just go back to Safa again.

The ambulance service is there for everyone, but people can't always experience service equally. What will you do, as a chair, to make sure that equality, diversity and the Welsh language are built into the Welsh ambulance service to support staff and deliver care to patients, rather than being treated as a separate corporate exercise?

Sorry, that's the end of that—[Laughter.] As part of what feels already like my first 100 days, I've had time with the Welsh language services manager and taken a look at the Welsh language standards report. Clearly, in terms of the assurance levels, it's very positive, and that's a good starting point. There is more to be done in terms of attracting individuals with Welsh language skills. And in the conversations with the Welsh language services manager, it's more than policy and compliance, it's about what you can do to create the right culture, and hence why I'm starting the process of learning Welsh, and I'm committed to learning Welsh. I live in Llangattock, as I indicated earlier.

So, there's a lot to unpack in terms of the question that you've posed. I've had a lot of experience in my commercial time, or commercial world, with IBM, of dealing with individuals and assembling teams of individuals from different nationalities—large teams from India and the Philippines, as an example. So, I understand the need to adapt approaches, and, clearly, that's also something to consider for the Welsh ambulance service.

But one of the areas that does particularly interest me is addressing health inequalities, and what I can see is an example from Portsmouth and the Isle of Wight. The Isle of Wight is clearly separated from the mainland by the Solent, and patients and communities there suffer as a consequence of not being connected to the mainland. What I've done is supported executives to go through governance processes around business cases, whether that's around lung screening programmes or breast cancer, in order to, effectively, equalise the opportunity for patients and the population on the island. I would seek to take that same mentality into my role as the chair of the Welsh ambulance service. Now, clearly, I recognise, in terms of where I live, that it's a rural area so that presents its own challenges in terms of  access to the services that the trust provides.

Brilliant. Thank you, Safa. Finally, a question from Claire Archibald. Claire.

Thank you, Chair. Welcome, Phil, and congratulations. So, my question is on a couple of things. Could you give the committee three specific and measurable outcomes that you would expect the Welsh ambulance service to have achieved in your first year as chair? For example, I just heard you say about the 14 and 17-minute handover times. I'm really interested in that; I did see that in there. Obviously, I'm from rural Pembrokeshire and handover times are quite poor. So, you're saying that the 15 minutes are quite the norm, so would that be one of your achievable outcomes in the first year?

I would love to be able to wave a magic wand and deliver that—

I'd love that. That's what I wanted to ask. I did read it and I thought it was really interesting.

The reason I make that point is that it is possible to deliver, right, but it's a change in mindset and a change in culture that are required, and those don't happen quickly unless— 

So, my next question was: what are the barriers that you would find to achieving such a great thing? What would be the barriers? 

There are a lots of barriers. Funding would help, but, obviously, that's a barrier. The reason that that's important is—. I made the point earlier on about funding into social care, and then, if you think about flow from the standpoint of right across the urgent and emergency care pathway, ultimately, you want to avoid admitting people and you want people in for the shortest length of stay in an acute environment as possible and to be discharged when there are no criteria for them to reside in an acute setting. So, I would say that the constraints are ever-increasing demand, having to rethink and transform the processes and pathways to address that, but also to make sure that patients are being treated in the right place at the right point in time. 

Thank you. Are there any actual numbers or a target on one of those specific things that you'd like us to come back to in a year? 

Probably the best thing for me to—. You're trying to push me to a number, and I'm not going to give you a—

I'm just asking.

One, I'm not in role yet. 

I know, I know. 

Two, I would need to deliver that or get that delivered through executive responsibilities, and it would clearly require a significant change in the relationship between the acute or the health boards and the ambulance service. 

Thank you. 

Thank you. I did say 'finally', but we've got a question from Natasha again. Natasha.

I'm so sorry. There was a question that came to my mind, and I've been listening intently to everything you've said to all the Members. You've touched upon finances, you've touched upon social care, all elements that we know are really important when it comes to ambulance services. But I'd just like to know one thing that you haven't touched upon, and I'd really like even a 'yes' or 'no' answer, or if you want to be more detailed, that's absolutely fine. Do you think that more beds in hospitals would actually be more helpful to the ambulance service in the long term? You can give me a 'yes' or 'no', or you can give me a detailed answer. It's entirely up to you.

Well, if there were more beds in hospital, then, arguably, you could discharge more patients to be taken into the hospital. But, clearly, more beds require more funding. And when you think that the healthcare system, I think, accounts for almost half of the budget of the Welsh Government, I think a different approach is, 'How can we look to do better with the funding that we've got?' But it does require cultural change in terms of where risk is being taken. So, is it better to have patients in an ambulance at the back of an emergency department, or to transfer that risk to an acute setting and corridor care, but allow the ambulances, then, to go and meet unmet demand in the community? But what we've also got to do is make sure that we're not admitting patients who, frankly, shouldn't be admitted. What should happen is that those patients are treated in the community.

Okay. Thank you, Chair. 

Brilliant. Diolch. Thank you very much for joining us this morning. We really appreciate your time. You will receive a copy of the transcript, and you'll also receive a copy of the committee's report under embargo next week. So, diolch yn fawr, Mr Berrington. We really appreciate your time. Thank you for joining us this morning.

Diolch.

We'll now move on to the next item on our agenda, which is papers to note. Members will see that there are two papers to note, which are published in the pack. Are Members content to note those papers? I see that Members are. 

So, we will now move into private session. I propose, in accordance with Standing Order 17.42(vi) and (ix), that the committee resolves to exclude the public from the remainder of today's meeting. Are Members content? I see that Members are content, so we will now proceed to meet in private.