I now move to the party spokespeople to question the Cabinet Secretary for Health, Well-being and Sport. First this week is UKIP spokesperson Caroline Jones.

Diolch, Lywydd. Cabinet Secretary, the recruitment and retention of doctors in both primary and secondary care has been described by many, including many of the royal colleges, as a ticking time bomb. In primary care, we have the dual problem of failing to recruit enough GPs and, due to an ageing population, an increasing number of GPs retiring. The Royal College of General Practitioners told me that we need to recruit 400 full-time equivalent GPs, yet, last year, we recruited under 140. What is your Government doing to ensure that we train more GPs in Wales?

I thank the Member for the question. I’ll start with the one point of disagreement, which is that I don’t think there’s any real evidence that the ageing population is leading to early retirements in our GP workforce. There are a range of pressures upon primary care and secondary care, which are felt right across the UK, and that includes GP recruitment and a range of specialities in secondary care too. I really do recognise that that is the case.

We currently fill 75 per cent of our training vacancies. That is a better fill rate than in Northern Ireland, Scotland or England. So, our challenge is not to set a target that we can’t actually achieve. If I set a target of 400 extra GPs, there’s no real basis for thinking we could fill that number of GPs. I think the first thing is to make sure that we complete all the places that we have available, that we fill those, and then we reset our ambitions and we understand exactly who and what we want from our workforce. That’s why the commitment we’ve given is to look at the GP workforce and to come forward with proposals to improve GP training and, at the same time, the broader primary care team. Because the model of care could, should, and will change in the future. So, it’s about being sensible about what we can do. But I’m really pleased to say we’ve got the buy-in of stakeholders in proceeding on this basis.

Thank you for that answer, Cabinet Secretary. Perhaps we can move on to the retention of doctors. Hugely increased workloads and the stress of managing in an overloaded primary care system have been blamed by many GPs as the reason behind their decision to move overseas or to retire from general practice altogether. What is your Government doing to reduce the workload of our GPs to ensure they are not overworked and to ensure that we can retain our GPs?

I thank the Member for her second question. This is one of our challenges: how do we retain professionals within the workforce? Some of this is about making it easier to stay on different terms, some of it is about making it easier to return to the workforce as well. So, that’s part of the work that is already ongoing with stakeholders, in particular the British Medical Association’s GP committee, and also the Royal College of General Practitioners. But it’s also part of understanding that we need to have a broader primary care team, because, to take workload away from GPs, we need to send them to an appropriate extra place. That’s why advanced nurse practitioners, pharmacists—both clinical pharmacists and community pharmacy—as well as the therapists, like physiotherapists, are part of the answer. So, GPs do what they should do, and we transfer other people who don’t need to see a GP but have a healthcare need to be met in primary care, and have the appropriate professionals to go to for that advice, support and treatment.

Thank you, Cabinet Secretary. I would like to touch upon the training of our doctors. According to the BMA, it costs over £0.75 million to train a registrar, and over £500,000 to train a GP—a significant investment from the Welsh NHS. What consideration has the Welsh Government given to asking for a minimum term of service in the NHS before those doctors are able to enter private practice or move overseas?

I thank the Member for her question, which is topical. It’s part of our ongoing conversation about what sorts of incentives we provide for people: so, the additional support that we provide for people in training, and what we can then expect back. So, that is part of the work that we’re taking through with those stakeholders to understand whether that sort of bonded arrangement could be successful in keeping doctors here in Wales. But it’s only got to be part of the answer, because we want to make Wales a really attractive place to live and work and train. So, this is part of the conversation that we are having about the profile of training to make sure that GP training opportunities are a much bigger part of what doctors get before they make their speciality choices. So, there are a whole range of different measures that we are actively considering with our partners, and I expect to have more to say about this in the coming months.

Plaid Cymru spokesperson, Rhun ap Iorwerth.

Diolch yn fawr iawn. And I’m sure recruitment and retention in the NHS isn’t helped by UKIP-style rhetoric on migration.

Mi ydym ni’n gytûn, gobeithio, Ysgrifennydd, bod yn rhaid sicrhau hawl dinasyddion yr Undeb Ewropeaidd i aros yn y Deyrnas Unedig yn y dyfodol. Ac mae’r Prif Weinidog, yn sicr, wedi crybwyll yn barod bwysigrwydd meddygon, nyrsus ac eraill o dramor i’r NHS. A all yr Ysgrifennydd Cabinet ddweud a ydy o a’i adran wedi cymryd unrhyw gamau penodol yn y mis diwethaf i gysuro y staff allweddol hynny, i roi sicrwydd iddyn nhw bod croeso iddyn nhw yng Nghymru a’n bod ni am iddyn nhw aros?

Thank you. I fully support the point that’s being made. I’m pleased to see that Parliament actually passed a motion confirming that they want EU citizens’ status here to be retained and safeguarded. Here within the NHS in Wales, and across every single Government department, we’ve been keen, over the last few weeks since the Brexit vote, to make very clear in our public statements, when seeing staff, and when standing on platforms—that we do make very, very clear that this Government values the contribution of EU citizens, and from around the rest of the world, who are feeling uncertain about their place in our country. We value the contribution they make to the service they provide, but also to the communities of which they are a part, and I look forward to them being a part of Wales, not just at present, but also as a key part of our future as an outward-looking country.

It doesn’t sound as if a specific assessment has been made; I’m a little surprised about that. The uncertainty we’re facing is in danger of undermining the NHS, and we can’t afford to wait for the Government to take action. We will not go over the problems that Wales is facing now in terms of attracting and retaining doctors, but I will turn towards terms and conditions of the NHS staff. The Welsh Government, of course, has pledged not to copy what Jeremy Hunt has done in adopting a new contract for doctors. Does the Cabinet Secretary see it likely that we will see an end to pay discussions on a UK level in the next few years for all NHS staff, and what preparations is the Secretary undertaking to ensure that we have a specifically Welsh attitude towards pay and conditions that reflects the value of NHS staff, the need to retain experienced staff, and, of course, that shows young people that they can and they should be aiming for careers within the NHS in Wales.

I thank the Member for the question. We have regular conversations with our stakeholders in the trade unions about their position on a range of different parts of terms and conditions, including the negotiations we have had in the past with them about pay. And so we need to make sure the conversation is rounded between what the representatives of the workforce actually want to achieve and what we’re able to do as a Government as well.

In terms of junior doctors, given the comment that you made about imposition by the UK Government, I want to make it really clear again: this Government will not be imposing a junior doctors contract. Any changes that are made to junior doctors contracts’ terms and conditions will be done by agreement, on a basis of respect, and I’m looking forward to meeting the British Medical Association, following my invitation to meet with them here in Wales, to discuss the position here in Wales and how we take that forward on that shared and respectful basis.

And I would urge the Ysgrifennydd to look at the real opportunities that would open up to us from following a Welsh path. Doing things differently, as we’ve seen with junior doctors, really can mean doing things better. I think it’s quite clear that Wales is going to need more doctors and more nurses, more occupational therapists, physiotherapists—you name it—over the next few decades. In fact, I doubt that there is a profession in the NHS that won’t require more staff. We’ve heard about GPs, and, if not 400, what is it? Three hundred, 200, 100—you tell us: you bring up a target that you want to aim for. But we’ve been calling for proper workforce planning for several years and still don’t have a national workforce plan. Will there be a plan that reflects on the issues that I’ve touched upon here, and when can we expect to see it?

We’re committed to a 10-year workforce strategy; we’re working through that with our partners and stakeholders. We’ve had the Jenkins review and I expect to see advice on that in the near future. We’ve also had the review undertaken by Robin Williams, the former vice-chancellor of Swansea University, on education and training. So, we’re properly considering where we are, and what we want to do in the future. It has to take account of the health service we have and the health service we want to have as well. And this is a really big challenge for us, regardless of our political shades and colours, because you made the point that you expect there will be more NHS staff in virtually every single grade and profession. That is the demand, and that is the expectation, at a time of austerity. So, it means that there are really difficult choices for the health service, let alone for every other part of the public service, in the way in which we spend Government money. So, we have to have an honest discussion about what we can do and the budget choices that we make, and in the discussions each party will have an involvement around our budget, and then what we actually can do with the resource that we have. But I’m confident that, in the way that we are currently working, we will be able to provide a workforce strategy that our partners will buy into and support. You only need to look over the border again to see what happens when you don’t have that level of agreement. But I won’t pretend to you or anyone else in this Chamber that, by producing a workforce strategy, everything will be easy, because it will not. We have very real challenges; some of them are across every health system in the UK, but I’m certain that we will be able to match our ambition with our ability to recruit staff at the right grade and at the right point to deliver the sort of quality of care that everyone has the right to expect here in Wales.

The Welsh Conservatives’ spokesperson to ask her questions to the Minister for Social Services and Public Health—Suzy Davies.

Diolch, Lywydd. I think it’s my first chance to congratulate you on your post; I know it’s the last day of term, virtually.

Six years ago, the Scottish Government introduced the short-breaks fund to provide respite for carers and replacement care for those they care for. Labour pledged in its ‘Healthy & Active’ manifesto to:

‘Investigate the benefits of establishing a national carers respite scheme in Wales’.

The benefits would be 60,000 hours of replacement care for just over £1 million, with all the related savings to the public purse in terms of hospital admission, drugs, mental health interventions and even unemployment. Can you tell us when the Welsh Government will introduce such a scheme here?

I thank you very much for that question and I’m acutely aware of the important role that carers play in supporting the people—the loved ones—whom they care for, but also the economic benefit that they offer to our country as well, as you’ve just outlined for us. In reflection of that, the Social Services and Well-being (Wales) Act 2014 gives, for the first time, carers the same rights as the people whom they care for, which I think is a big step forward in terms of our support and our commitment to carers. But you’re absolutely right that our Welsh Labour manifesto identifies respite care as an important service for carers. In fact, when I meet with carers and carers’ organisations, and when my officials do so, respite really does come up as the No. 1 ask for carers, whether it’s a few hours a week or a week or two a year. So, I think we need to take a flexible approach to that. So, I’ll be ensuring that respite care and alternative care are very much a key priority when we deliver on another one of our commitments, which is to refresh our carers strategy. That will be happening later this year. I know that this particular approach is supported by our stakeholders as well. We’ll be having further discussions with health, with local authorities, and the third sector in terms of how our respite offer will look for carers in future.

Thank you for that response. I’m not quite sure if it’s quite said that there will be a fund introduced as a result of the carers strategy, but I’ll watch out and hope for the best on that for now.

Moving on, some good news from the Princess of Wales Hospital in my region and, indeed, from the Betsi Cadwaladr University Local Health Board as well: as a matter of course, they’re now taking a common-sense approach to the role of carers when consulting, treating and sharing information about patients with dementia. I think it comes to something when carers are being asked routinely to produce copies of powers of attorney before a carer can be given vital information when it’s clear that the patient themselves doesn’t have the mental capacity to understand what they’re being told. Can you give us an indication of the arguments that you’ll be putting to the Cabinet Sectary for health about the rights and responsibilities of carers, which will need to be reflected in the new dementia strategy?

I thank you again for that question and you’re absolutely right in identifying that carers play a crucial role in supporting people with dementia. Our dementia vision in Wales is very much about supporting people with dementia to stay at home for as long as possible and to play a full part in the community. Obviously, carers have an absolutely key role to play in that. As you know, we’ll be refreshing our dementia vision. Again, this happens this year, and, on our task and finish group for that, we’ll have the Wales Carers Alliance, so they’ll play very much a key role in advising Government on our future provision for people with dementia and the role that carers can play.

I think it’s extremely important that health and social care are able to share data so that people don’t have to tell their story three times to three different professionals and go over the same data over and over again. So this is something that we’re trying to make some real progress on as well.

Many carers are dementia champions—they play an important role in our Welsh Government support through the Alzheimer’s Society for creating dementia-friendly communities with a view to creating a dementia-friendly Wales. We have 2,000 of those champions at the moment, making a real difference at a very local level, and it’s worth reflecting on my attendance recently at the British-Irish Council, where we had a special discussion on the role of carers particularly. Our administrations identified older carers and carers who support older people as a particular area on which we would like to focus across our administrations in terms of sharing best practice and working together to improve things for the carers and the cared for as well. So, I hope to have some progress made there as well.

Well, thank you for that answer as well. If I am hearing you correctly, there will be a sort of cross-over between the dementia strategy and the carers strategy, in terms of the input that goes into both from the Carers Alliance, for example. I know that what I’m going to ask you next is something that is of great importance to everybody here in the Assembly, and that’s the fact that, in recent years, we’ve seen the amount that local authorities are willing or able to pay for the cost of care services and care providers. I hope that we would all agree that the very least that care worker could expect is a living wage; payment for travel between visits, if they are working in people’s homes; reasonable hours for work; and time to care properly for the people that they are looking after. I know that the social services Act envisages different models for delivering social care, but costs are still going to rise, regardless of the model, as the needs of the population grow, not least, of course, through us all living longer. What work are you doing now to plan for the medium- and long-term financial sustainability of paying for social care, regardless of which model is adopted in any given part of Wales?

Thank you. You’re right to identify that paying for social care and coming to a sustainable, secure long-term future for social care is critically important, given the pressures that you have identified on public services and the aging population, and people’s quite rightly ever-increasing expectations of the kind of social care that they will be able to receive as well. So, I am very alive to this issue, particularly the issue that you mention of differentials in pay as well. Local authority staff do tend to be paid well above the statutory minimum, but they do tend to be paid better than those in the voluntary sector, who in turn tend to be paid better than those in the private sector, who tend to be at the minimum as well. So, there’s a differential there, and there’s important work that we need to do in terms of raising the status of people who work in the care sector in Wales as well, and making it an attractive field for people to come into as well. We need to have career progression, and so on. Care work needs to be valued, because there’s no more important job, really, than caring for the most vulnerable people in our society.

The responsibility for setting pay levels resides with the providers themselves, but we do have some levers in Welsh Government that we can use to try and deal with this. They include a two-tier code, which I’m happy to write to the Member with some more information about. That does ensure that local authorities, when they outsource services to an independent sector, can’t lower the kinds of terms and conditions that the people who are employed can expect. We’re also currently consulting on proposals, using powers under the new Regulation and Inspection of Social Care (Wales) Act 2016, to increase transparency on pay and reinforce compliance with statutory requirements. That includes paying for members of staff travelling between seeing clients as well.