The following amendment has been selected: amendment 1 in the name of Simon Thomas.

We’ll move on to the next item on our agenda today, which is the Welsh Conservatives’ debate: the NHS workforce. I call on Angela Burns to move the motion.

Motion NDM6084 Paul Davies

To propose that the National Assembly for Wales:

1. Notes that the retention of the frontline workforce is a major challenge facing the NHS in Wales.

2. Believes that the Welsh Government must outline its response to recent increases in the number of vacancies for doctors in the Welsh NHS.

3. Recognises, with concern, that stress-related illnesses are increasingly responsible for ambulance service staff being absent from work, and the impact this could have on the longer-term recruitment and retention of staff.

4. Calls on the Welsh Government to implement a clear, comprehensive strategy which outlines how the Welsh Government will prioritise frontline staff recruitment and retention and tackle issues pertaining to low staff morale during the course of the fifth Assembly.

Motion moved.

Thank you, Deputy Presiding Officer. I’m pleased to move the Welsh Conservative debate motion tabled in the name of my colleague, Paul Davies, in which we ask the National Assembly to note that the retention of the front-line workforce is a major challenge facing the NHS in Wales. We ask the Welsh Government to outline its response to the recent increases in the number of vacancies for doctors in the Welsh NHS, and to implement a clear, comprehensive strategy that outlines how the Welsh Government will prioritise front-line staff recruitment and retention.

We also ask that the National Assembly recognises that stress-related illnesses are increasingly responsible for ambulance service staff being absent from work, and the impact this could have on the longer term recruitment and retention of staff. Additionally, given the stark figures on stress-related illness within the ambulance service, we would like to understand how the Welsh Government will address the issues pertaining to low staff morale during the course of the fifth Assembly. Front-line services, especially general practice, are facing a perfect storm. A combination of events, decisions and circumstance, each individually manageable, are combining to create an unprecedented situation where the service is struggling to deliver timely and comprehensive care to the public in a great number of areas. The rising tide of ill health bearing down upon front-line services is creating an enormous tension in general practice. There has been a substantial increase in the numbers of people seeking treatment.

The Welsh health survey, published in June, showed that 51 per cent of people in Wales are battling an illness, incidences of high blood pressure have risen to 20 per cent of the population, respiratory illness to 14 per cent, and mental ill health to just over 4 per cent— all of which place an increasing strain on general practice. Worryingly, people’s perception of their health has also dipped, with one in five people considering themselves in poor health. We must also bear in mind, when discussing extra pressures, that Wales has a far greater proportion of people aged 85 plus, compared to the rest of the UK. With people living longer we are seeing an increase in the rates of age-related illnesses such as dementia and some forms of cancer.

A case in point would be the rise in cancer diagnosis. Cancer cases, as a whole, were up by 14 per cent over the last 10 years, with the biggest rise being seen among women aged 65 to 69. Lung cancer incidences in women alone have risen by 57 per cent. Another example would be diabetes. Since 1996 the number of people living with diabetes has doubled in Wales: 8 per cent of the population now have either type 1 or type 2 diabetes, and estimates show that a staggering 540,000 people in Wales are at risk of getting type 2 diabetes. Furthermore, it is estimated that diabetes accounts for 10 per cent of the annual NHS Wales budget, but 80 per cent of that funding is spent on managing complications, most of which could be prevented.

As a nation, our rates of physical activity should also be considered in any discussion on our collective health. Physically inactive individuals spend, on average, 38 per cent more days in hospital; they make 5.5 per cent more GP visits, access 13 per cent more specialist services, and make 12 per cent more nurse visits than active individuals. Inactivity is a hidden killer, contributing to one in six deaths in the UK—the same level as smoking. However, more than one in three people in Wales are inactive, failing to be active for more than 30 minutes a week.

There also needs to be a far greater acceptance that many of the causes of ill health are social rather than medical in origin. I use the word ‘acceptance’ very carefully because I think there is a recognition that much of that which ails people stems from social causes; however, acceptance that it is the job of a system based on a medical model to deal with perceived social ills is not embraced in all quarters.

To illustrate my point, in a recent meeting with practising doctors, one said that listening to socially inept women crying because their boyfriends had left was creating pressures on their time. If we can accept that crying people might be there because they are depressed and need counselling, and we can put them in touch with counsellors, then I would argue that that is primary care at its best and how we need to shape it. Primary care has the opportunity to halt sadness from becoming depression; from becoming despair; becoming too much drink or drugs; and becoming long-term ill health and incapacity. Whether it’s social or medical, the increase in people seeking help compounds the pressures on general practices that are already struggling with the growing change in the demographic of doctors within general practice. Granted, the headcount for GPs—

Will you take an intervention?

Of course.

I thank you for taking the intervention, and I don’t wish to distract from the issues about GP recruitment, which I’m sure you will come on to in a short while. But, from what you have discussed so far, the Choose Well strategy that the Welsh Government proposed last year, or last session, and prudent healthcare is actually the right way to tackle some of the issues that you have just talked about.

Some of it is, and as you listen to the rest of the debate, I think you may be slightly cheered. Granted, the headcount for GPs remains fairly stable. However, there is little recognition that many of those heads are not full time. Not only has the GP’s role changed, but the way patients wish to access their GP has also changed. Patients still wish to see a named GP, and to be able to see him or her within a short space of time. To quote one doctor, who encapsulates neatly the views of many: ‘Patients want immediacy, but immediacy with the doctor of their choice at the time of their choice, and that is a gold standard. We’d all like that, but there seems to be little understanding among patients that that isn’t actually possible.’

There is also a recognition that recent years have seen a decrease in self-care, with patients no longer seeing the GP as the final call when they are showing signs of illness, but the first. Figures also show that, although appointment times have been increasing, the UK still has one of the shortest appointment times, and a total of 73 per cent of all UK GPs said they were dissatisfied with the time they were able to spend with each patient. A recent Welsh BMA survey, in February this year, clearly demonstrates that: 57 per cent of GP practices reported the quality of service had dropped in the last 12 months; and, 64 per cent said their workload was either unmanageable a lot of the time or all of the time. Many of these issues could be tackled with better workforce planning, greater education and signposting. We really need to understand the picture we have before us. Cabinet Secretary, will you undertake to review the collation and sharing of data within the primary care sector, so that we can form a clear picture and share that knowledge base with all decision makers?

I have noted that in your document, ‘A Planned Primary Care Workforce for Wales’, there is a desire to encourage primary care clusters to assess local need and match resources. However, comprehensive workforce planning needs to take into account the availability and training requirements for all the other primary care workforce, such as physiotherapists, nurses, optometrists, pharmacists, occupational therapists, speech and language therapists, healthcare support workers and clinical psychologists. We already know from committee inquiries, such as those into looked-after children, adoption, and child and adolescent mental health services, that we are facing a Wales-wide shortfall in speech and language therapists, eating disorder clinics, behavioural and social care support workers, and that timely access to mental health services is very difficult to receive.

Today’s GP is less a general doctor and more a complex care practitioner. She or he is being asked to front-line an extraordinarily diverse range of illnesses. They are being encouraged to manage as much as they can in order to take the pressure off the secondary care sector. However, in order to achieve that objective, they must be secure in the knowledge that there are a plethora of trained professionals that they can refer to. Unfortunately, there are not, which is why, Cabinet Secretary, I would ask that workforce planning is comprehensively undertaken throughout all areas of the primary sector, and that it looks at hours rather than heads, and future needs and training requirements rather than the status quo.

Training and encouraging people into primary care is absolutely key to strengthening and planning for workforce management in front-line services. The BMA has highlighted that, despite commitments from successive Labour-led Welsh Governments, the overall training places for GPs in Wales remain static. They also state that investment not only needs to be made into high-quality undergraduate and postgraduate training in Wales, but also continuing professional development. We need to look for a national medical workforce. We need to have a compulsion for junior doctors training in Wales to undertake GP rotation as part of their training. I've had this message reinforced to me by local GPs who also raise concerns over whether the medical schools really grasp the importance of rotations as a means of ensuring that general practice is not perceived as the cinderella division of the medical profession. Add to this the view that trainees don't see becoming a GP as a desirable career due to increased costs surrounding indemnities, the ageing state of the buildings, you know, increased work pressures—people are just not wanting to enter into a very necessary and valuable part of the NHS workforce.

Finally, I'd like to quickly turn to the Plaid amendment, which we will be abstaining on. Now, I totally accept that there’s empirical evidence that clearly suggests that medical students often stay in the area where they are trained, and I recognise that this amendment mirrors the call by the Royal College of Physicians. However, such is the shortage of doctors, I would suggest that if a Scot, an Italian or a Welsh-domiciled person were to train in our medical schools, then we should embrace them with open arms and seek to retain them in the country where they have trained. I would also like to understand better how many Welsh-domiciled students are refused training or choose to train away because they cannot get the place locally. Hence an abstention, because I can be persuaded if you can show us the evidence. I think that a stronger argument, which my colleague will develop, is that we should increase the number of training places available and broaden the geographical research.

Cabinet Secretary, this is a crisis that is enveloping general practice. So, in summation, we would like to see a recruitment programme that encapsulates the needs of partners and families, comprehensive workforce planning undertaken that includes all the strata of primary health care in order to ensure that general practice has the ability to refer patients across the piece in a timely manner, that there are changes made to the training of junior doctors in order to ensure that rotations into general practice are as routine and valued as rotations into cardiology or acute medicine, that a review is undertaken into the financial pressures in general practice from capital expenditure to indemnity insurance, that a comprehensive package is worked out with health boards and the ambulance trust to better understand the causes of the high levels of stress-related illnesses the services experience and that an accessible programme of intervention for individuals to access is put in place, and that the voice of general practice is strengthened and put front and centre in health board and Government planning. If you achieve this, Cabinet Secretary, you will avert the storm building in front-line services, and we, the Welsh Conservatives, will support you in this endeavour. Thank you.

Thank you very much. I have selected the amendment to the motion and therefore I call on Rhun ap Iorwerth to move amendment 1, tabled in the name of Simon Thomas.

Amendment 1—Simon Thomas

Add as new point at end of motion:

Believes that a recruitment and retention strategy must include a commitment to increase the number of Welsh-domiciled students studying in Welsh medical schools.

Amendment 1 moved.

Thank you, Deputy Presiding Officer. I’m very pleased to move this amendment and to speak in this debate. I do believe that workforce planning and responding to the problem of a staff shortage, or the crisis of a staff shortage in some areas of the service, are some of the most important matters that face us as we try to plan an NHS that truly answers the needs of the people of Wales. I welcome the opportunity once again to outline the positive vision of Plaid Cymru for recruitment within the NHS—we are the only party, I believe, that has consistently been underlining the need for additional doctors specifically, but also other health practitioners.

This debate is a very timely one, too, because it comes as the BMA has warned again about a recruitment crisis amongst GPs, with 20 practices having been returned to the care of health boards in the past year alone. And the facts speak for themselves: Wales has the lowest number of doctors per head of population of any UK nation. And, yes, we’ve heard the Government mention an increase in the number of GPs, but what we’ve seen is more working part-time—a greater headcount, perhaps, as we heard from the Conservatives, but not more full-time GP posts. That’s decreasing and that’s entirely clear.

There’s a concern, of course, about what will come in coming years, with over 23 per cent of the workforce aged over 55, and that figure increasing to a frightening level of 50 per cent in areas such as the south Wales Valleys. The Wales Deanery has noted that the target for recruitment for GP training is lower in Wales than it is in the rest of the UK nations, and that target was set a decade ago. So, perhaps we shouldn’t be surprised to see some of these problems that we’re facing today.

This is happening, of course, at a time when surgeries—nine out of 10 of them, according to BMA research—say that demand for their appointments is increasing. This isn’t sustainable, and I hope that everyone here in the Chamber today is agreed on that.

Let us also look at district nurses. According to the RCN, if the current decline in numbers continues then we won’t have any district nurses in as little as five years’ time. The number of district nurses has decreased from 876 to 519 full-time posts in a period of five years.

We’ll move on from primary care. Recruitment problems are one of the main causes of loss of services in general hospitals over the past few years. According to BMA figures, again, we believe that over 10 per cent of specialists in Wales are locums. We know what the cost of that is, too, as well as the uncertainty caused. That figure of 10 per cent is over double the level in England. We need to recruit, we need to be innovative in doing so, we need to offer incentives, financial and otherwise, and we also need to look at questions such as medical indemnity.

I will make my last comments on what we specifically call for in our amendment today.

Mae ein gwelliant heddiw yn ymwneud â’r angen hirdymor i hyfforddi cenhedlaeth newydd o feddygon a nyrsys. Nid yw hynny’n golygu, wrth gwrs, nad oes mesurau tymor byr y dymunwn eu gweld yn cael eu rhoi ar waith yn awr. Mae recriwtio o’r tu allan i Gymru i hyfforddiant meddygol yn hanfodol wrth gwrs, ond mae’n rhaid i ni hyfforddi mwy o feddygon a nyrsys o Gymru yng Nghymru. Nid ni’n unig sy’n dweud hyn; mae’r arbenigwyr yn y maes yn ei ddweud. Mae angen i ni wneud hynny yn ein canolfannau hyfforddi presennol a chanolfan newydd ym Mangor hefyd. Mae meddygon sy’n hyfforddi yng Nghymru yn fwy tebygol o aros yng Nghymru. Mae meddygon o Gymru sy’n hyfforddi yng Nghymru yn bendant yn llawer mwy tebygol o aros yng Nghymru. Edrychwch ar y ffigurau gan Goleg Brenhinol y Meddygon, sy’n cytuno’n llwyr â ni ar yr angen am hyfforddiant meddygol yma yng Nghymru: dim ond 30 y cant o fyfyrwyr mewn ysgolion meddygol yng Nghymru sy’n dod o Gymru, o gymharu â 55 y cant yn yr Alban, 80 y cant yn Lloegr ac 85 y cant yng Ngogledd Iwerddon. A byddem yn cefnogi system gwota. Mae cwotâu wedi gweithio’n dda wrth gynyddu recriwtio i ardaloedd gwledig mewn llawer o wledydd, gan gynnwys Awstralia. Mae cangen meddygon teulu Deoniaeth Cymru a llawer o academyddion sydd eisoes yn gweithio yn ein hysgolion meddygol yn cefnogi cwotâu, ac rydym am gyrraedd y pwynt lle gall unrhyw fyfyriwr o Gymru sydd â’r graddau academaidd gofynnol astudio meddygaeth yng Nghymru os yw’n dymuno. Fe ildiaf.

I’ll be generous. Go on.

Thank you.

I’m nearly done.

Just very quickly, do you have the evidence that says that Welsh students are being turned away from being able to train in Welsh medical schools because they’re already full with other people? If you have that evidence, I’d like to hear it.

There is of course a lot of anecdotal evidence. This is a piece of work that is being done. I believe it’s already under way now. This is a piece of work that is vital. We know from anecdotal evidence that this is happening. We need that empirical evidence, absolutely. I am totally convinced that that is the case. I could also mention, of course, the need to do this and to ensure that we have adequate Welsh-language staff within the NHS—not because it’s a nice thing, but because it is vital for, for example, dementia patients. And of course we need to make medicine an attractive proposition for young people again, so we reverse that decline in the numbers of students making applications. So, let’s have a more proactive approach to workforce planning. I look forward to hearing what the Cabinet Secretary has to say.

Front-line capacity in the NHS is on the verge of turning from a weakness into being a threat to the sustainability of the service as it’s modelled today. While that threat might be manifesting itself across the UK to varying degrees, it’s mattering most here in Wales now. This debate is not tabled just to have go at Welsh Government, although we do invite you to be frank here. This Assembly’s concerns about workforce planning, the deanery and the slothful approach to horizon scanning for gaps in clinical provision aren’t new. So, we do hold you to account for your unwillingness to change tack when previous forays into this haven’t worked and we do hold you to account that unprecedented cuts to the health budget in the last Assembly made the Welsh NHS a less attractive place to work.

While I’m sure you’ll want to divert attention in your response, Cabinet Secretary, we don’t really care that much about your views on the NHS in England; we care an awful lot about your plans for the NHS in Wales. So, this debate is primarily tabled with a benign purpose and that is to help you flush out the challenges, some new ideas from all parties—you’ve heard from us and from Plaid—and the priority actions on which we might be glad to support you. Let this Assembly help you. Just be aware that, as representatives of the people of Wales, we cannot accept a same-old, same-old strategy presented by you in the hope that this problem will go away.

The Welsh Conservatives are asking you for a comprehensive strategy. That means it must include, or at least be drawn up in parallel with, a strategy to reduce demand on the NHS in the first place. That means enabling, encouraging and maybe even insisting in some cases that we take more responsibility for our own health. So you shouldn’t dismiss ideas such as charging for missed appointments or informing patients of the cost of their prescribed drugs just because the Welsh Conservatives came up with those ideas. Please consider variations on those that are more palatable to you. Don’t dismiss the voluntary at-home assessments and the at-home wardens just because they’re Welsh Conservatives commitments. At heart, these are sound proposals for helping prevent those with degenerative conditions, age-related or otherwise, manage and control their own lives without early resort to the medical profession.

And don’t be afraid to take the Welsh Government badge off the public health messages. I’m not going to stop buying doughnuts because the Cabinet Secretary tells me—in sporadic advertising campaigns—that they’re bad for me, but I might if they weren’t used as loss-leaders in supermarkets or if I were repeatedly exposed to sugar and fat warnings on them or pictures of clogged-up hearts on the box. Stick a sign to the lift saying you could have used 20 calories using the stairs, but don’t stick a Welsh Government logo on it. With public health, legislate or get others to fire your strategic bullets for you.

Your key assets in reducing demand on the NHS are the value and power of other services. Angela mentioned a few, but I’m including here social services, bodies like housing associations, the third sector, of course, or society itself. Our young people should be growing up seeing responsibility for others as a natural part of life, even if it’s just that understanding that you get social and emotional support by being a member of some sort of community. So much of our good health could be supported from outside the NHS by nudging our culture away from ‘a pill for every ill’, just as Angela said. Good continuity of social care, for example, where the individual’s views are completely material to what that care looks like, can help older people maintain confidence at home if every point of contact, in or outside the NHS, has reinforced the information about, say, preventing falls, what help you might get at a pharmacy, and how technology helps you stay in touch with the people who matter to you.

The Presiding Officer took the Chair.

None of this is instead of a robust front-line professional well-trained NHS workforce. But we will not stop inappropriate arrivals at A&E—choosing well will mean nothing—until people can get hold of a GP or a specialist nurse when they’re anxious about their health, however many helplines we have. We won’t stop people reaching mental health crises until we have more psychologists, as well as psychiatrists, in the health service. But early intervention, whether that’s through the NHS or not, is part of reducing the often crippling pressure, I’d say, of demand on those who we think of as front-line staff. That, in itself, makes the Welsh NHS a little more attractive as a place to train and stay. Thank you.

I’m grateful for the opportunity to contribute to this debate and pay tribute to the diversity and dedication of our Welsh NHS workforce that work hard, day in, day out, in the face of many challenges, some of which are acute: a workforce that all too often not only finds itself at the sharp end, but also has the collateral damage of what can feel to them like constant criticism, unfortunately, in public discourse. Unsurprisingly, a lot of the debate today and much of time focuses on the front-line staff that we’re most familiar with—the doctors, the nurses, the paramedics. I’d just like to take a moment to mention the many staff that I’ve had the privilege of working on behalf prior to being elected to this Assembly earlier in the year—the range of those who not only make up the front line but also the backbone of our NHS, and keep it functioning: the clinicians, the scientists, the health visitors, the physiotherapists, the porters, the estate and maintenance staff, and many more—staff for whom the financial pressures faced by the NHS are all-too real but who also recognise the positive—well, most of the time they’re positive, because, like all relationships, it has its ups and downs—partnership working between trade unions and employees of Government in Wales. Whilst I know from my own experience that negotiations might not always deliver everything that is demanded, the door is always open for discussion here in Wales, which is actually, unfortunately, in stark contrast to over the border, where trade union colleagues often see the door firmly shut in their face. It’s not a simple coincidence that industrial action is happening in England while it’s not in Wales. As a result of this relationship, directly employed staff in the NHS are now paid a living wage, and I’m proud to have played just a tiny part in making sure this happened by playing my small part in the partnership discussions and working to make sure not only did this happen, but that there are also better terms and conditions for NHS Wales employees.

Yes, as people have said, there are challenges in the NHS and there are always ways in which we can improve. I know first-hand, as I’m sure many in this room do, and the Minister does himself, that those on the coalface are always only too happy to offer their advice and ideas and, indeed, those on the shop floor, as we say, are often best placed to tell politicians not how it is, but also how it could be done in the future, going forward. Whilst that might not bring us a radical revolution within the NHS, those many incremental ideas could bring about positive change in the future.

Would you take an intervention?

Sure.

Thank you. I would just like to make the point that much of my speech has been predicated on the discussions that I’ve had with GPs and with the Royal College of Physicians and with the British Medical Association. So, we are listening to what they have to say. Many of these ideas are their ideas and we would like the Welsh Government to listen to what they say.

Absolutely, and you’ve just almost summed up what I was going to say in conclusion that, as I said, going forward, I’d urge the Government and others to make sure the whole of the workforce, through their various professional bodies and trade unions, are a part of shaping a world-class NHS and one that everybody can be proud to be part of.

I welcome the opportunity to speak in the debate this afternoon. It’s an opportunity to look at an issue that affects all health services across the whole of the United Kingdom, and indeed across the whole of the western world, about creating a modern staffing environment and the multidisciplinary teams that form the backbone of the health service in whatever western country you happen to live in. But, Wales does seem to have had a perennial problem in attracting and, importantly, retaining staff to make sure that those multidisciplinary teams can continue to work and deliver the service. Very often, there’s little or no point in having 90 per cent of that team intact when the one important component, the 10 per cent, is away, because the whole team falls down then.

I really did learn that when we were in the third Assembly, when the health committee then did an inquiry into stroke services, and Dai Lloyd came along with me to the Cardiff Royal Infirmary stroke unit, which I think we’re all very pleased has been replaced, because the facilities there were very antiquated—it’s been moved up to Llandough now. Just by witnessing how that team interacted with each other, we saw if you just took one cog out of that multidisciplinary team, then the bulk of the rehabilitation that was on offer to the patients who presented basically was just put on hold and the patient was just left in limbo, through no fault of the team, but through maybe illness, absence or just an inability to attract that key worker, such as that key speech therapist, as Suzy Davies touched on—that key individual who can drive forward the rehabilitation and the reinvigoration of that individual’s life.

This debate today, which was opened by Angela Burns, really is looking now to the Cabinet Secretary for health to try to map out, with a five-year plan, what he wants to achieve by addressing some of the demons—let’s call them that—that have really blighted the health service here in Wales, about the attraction that the health service needs to have to retain people in a very stressful environment that has people working at the top of their game, rolling up their sleeves and delivering for the public good, but who ultimately are feeling that, year on year, week on week, day in, day out, that pressure is getting more and more like a pressure cooker environment. They’re either walking away from that environment or they’re having to take long bouts of time off for sickness and they’re not getting the support that would allow them to function at the top of their game. I do believe that this is an opportunity now, with the election behind us and we’re in the early stages of this Government, for some of these real tough nuts that haven’t been cracked over successive governments to be addressed. The important thing here is to make sure that we create an environment that people can have confidence in to look after their long term interest, create an ability to progress their careers, but, above all, respond to the ever increasing demands that the health service faces day in, day out today here in Wales and, indeed, across the United Kingdom.

It was in yesterday’s Plenary session that Julie Morgan touched upon the fact that the population of Cardiff each year is expanding by between 10,000 and 15,000 people. That is a huge increase in just one area—in an area that can most probably reach out and attract new people. But, when you spread that out across the rest of Wales and, in particular, into some of the more rural areas of Wales there is a real issue about getting people to travel to the furthest parts of west Wales, for example. Withybush hospital, as my colleagues, Paul Davies and Angela Burns, have championed here, is finding it difficult to fill those rotas and fill those rosters. It just cannot be good enough that services are temporarily suspended for another couple of months because this issue has reared its head again. There must be a solution that can be put in place by the Government who do have the mandate to deliver a functioning NHS here in Wales that people want to work in.

It was only yesterday that we actually had the figures that, regrettably, show that there’s been a 15 per cent decline in students going forward into medicine here in Wales. That decline has been across the United Kingdom, I accept that, but here in Wales that decline is more marked than other parts of the United Kingdom. That must be a source of great concern when you think over the last five or 10 years the various initiatives that have come forward to try and make medicine a more attractive profession, a more attractive way of bringing people into Wales—we’re not doing that. We’re not seeing that happening on the ground by those very figures. But, importantly as well, whilst it’s important to reflect on attracting staff, retention is a really, really important part of, surely, what a modern workforce should be about. We invest and the Government invest and the health boards invest a huge amount of money in developing the skills and talents of individuals in a highly complex environment and, yet, very often through poor management and neglect, those individuals walk away from that career, and a career that very often is only 50 per cent the way through or maybe even three quarters of the way through what potentially could offer so much more back. So, I hope the Cabinet Secretary will use the opportunity to respond to the genuine points that have been put forward, because he does have a new mandate. He has a mandate to deliver and I do hope that he will engage in giving us some feeling of how he will take forward the proposals of the new Government in addressing some of these long-term structural problems that have been at the very heart of providing a modern twenty-first century health service here in Wales.

I would like to thank the Welsh Conservatives for bringing forward this debate. It’s very welcome. Also, I’d like to commend the NHS staff for the work that they do, often under very difficult circumstances. Problems with the recruitment and retention of front-line staff, clinicians in particular, have been well documented in recent years. Staff shortages have led to increased workloads, which have become unmanageable for many frontline staff. Unmanageable workloads have affected staff morale, led to an increase in stress-related illness and forced many clinicians to leave the field altogether. Nowhere is this more evident than in general practice. Some GPs have seen their caseloads double in recent years with practices unable to recruit GPs. A GP seeing 80 patients during a consultation is now not unheard of. These unmanageable workloads have led many GPs to quit general practice altogether, thus compounding the problem. The Royal College of General Practitioners states that we need to recruit an additional 400 GPs over the next four years as we are failing to fill the training places we already have.

The Welsh Government must be more creative when it comes to recruiting clinicians. We must incentivise clinicians to train and work in Wales. The recruitment of Welsh-speaking staff is also important to cope with patients who can only speak Welsh and perhaps are suffering, as Rhun said, from dementia. Above all, we must incentivise clinicians to stay in Wales. According to the Royal College of Physicians there is a distinct lack of research undertaken to understand the drivers for recruitment and retention.

Decisions on future medical recruitment strategies are not based on robust evidence. It is therefore imperative that we collect more data to assist us with future recruitment campaigns. But we mustn’t only focus on front-line staff, as important as it is. The NHS is Wales’s biggest employer with around 72,000 people working in it. There are just under 6,000 hospital clinicians and 2,000 GPs working in NHS Wales. Without the vast number of nurses, scientific, therapeutic and technical staff, patients could not be treated. Without the administration and support staff our hospitals and GP surgeries wouldn’t be able to function. So, we cannot recruit more clinicians without ensuring that there are sufficient staff to make the appointments, conduct the diagnostic tests, transport patients and nurse patients back to health. They need to ensure that there are sufficient staff across the NHS to cope with the increasing demands on services.

So, future workforce planning in the NHS has not—and the Welsh Government has to ensure that there are sufficient resources put into workforce planning otherwise we will be having the same discussion in another five years.

UKIP will be supporting the motion today because there is a crisis in GP recruitment and we could soon be facing a crisis in other clinical fields.

We also ask about the possibility—because when people go to be trained as a doctor they have to have eight A* GCSEs and at the moment we are asking that—when we’ve spoken to some doctors who are currently, say, in their forties or fifties, many have said that they would struggle to achieve these grades. So, we’re wondering if the emphasis could be put perhaps on the A –level grades as opposed to the eight A*s. This doesn’t mean putting down, but just ensuring that Welsh universities in their pursuit of attracting the brightest students in the world don’t put Welsh students at a disadvantage. Cardiff are asking for eight A*s, and GCSE results, we feel, shouldn’t have as much bearing as long as the student has the requisite A-levels. Perhaps Cardiff could re-envisage this qualification. I look forward to the Cabinet Secretary’s reply and his plans for tackling NHS recruitment. Thank you.

Thank you, Madam Presiding Officer. Health is the first law of the land, therefore we all want to see the NHS in Wales delivering high-quality healthcare. To achieve this, we need a well-resourced and high-performing workforce. However, it is clear that the recruitment and retention of front-line staff has become a major challenge facing the NHS in Wales today.

We all know that NHS staff are working tirelessly to meet the demands of patient healthcare. But doctors in both primary and secondary care are reporting increasing and unmanageable workloads.

Presiding Officer, since 2009-10, demand on our hospitals has risen by 2.5 per cent—22,000 more consultant episodes took place in 2014-15. A recent survey by the British Medical Association found that 30 per cent of junior doctors said their workload was unsustainable and unmanageable. These pressures are reflected in increasing stress-related illnesses among NHS staff. A third of NHS staff in Wales report having suffered work-related stress or illnesses due to stress in the past year. Last year, stress-related illnesses concerning anxiety, depression and other conditions resulted in 13,400 days lost by ambulance service staff only.

Recruiting staff to ease these pressures has proved a problem. Health boards face difficulty in filling these vacancies. Just under 17 per cent of all junior doctor positions are unfilled in Wales. This equates to a shortage of 3,000—sorry, 331 doctors are actually short at the moment in Wales. In September last year, 1,240 positions were unfilled in Wales. The highest number of vacancies was in my own area, Nye Bevan health board—260 positions were unfilled. This failure to recruit has had serious financial consequences: more than £60 million has been spent on agency nursing staff in the last five years. Although it is vital that gaps in nursing coverage should be plugged, this is not sustainable in the long term, and strategies need to be changed.

Evidence exists that the problem of staff shortages is likely to grow. The BMA reports that an increasing number of doctors are planning or have considered early retirement. An ageing workforce, combined with difficulty in recruiting trainees demonstrates the need to address these challenges as a matter of urgency. We need to train more new doctors in primary care in Wales. According to BMA, the overall number of training places for GPs in Wales remains static. GPs and practice nurses are at the heart of service delivery. Recruitment and retention of these staff must be a priority for this Government. We need a clear strategy from the Welsh Government for future workforce planning. Closer cross-border working and effective incentives must be used to fill geographical and specialist gaps in our health service.

We must provide the skills to adopt the modern healthcare needs that we want in Wales. Traditional models of care are becoming increasingly unsuitable for today’s healthcare needs. The delivery of healthcare is a fast-changing world. Education and research are driving forward innovation. We must ensure the skills of the existing workforce are updated continuously to deliver real change. We must shift the emphasis in the training and education budget to fund continual professional development in Wales, and we must monitor it.

We need effective public health initiatives also to relieve the burden on NHS finances and release money for front-line core services. Presiding Officer, I know two doctors. Their parents had Pakistani, poor backgrounds. One was a market trader, another, who died, was also selling clothes door to door. Both are young doctors. I meet them virtually week after week. One said, ‘Uncle, I’m working in a hospital, but, believe me, my family life is shattered’, because he’s too tired to go home and look after his family. There are a lot of things we can discuss about these doctors’ problems also that haven’t been considered in this Chamber yet.

Presiding Officer, the Welsh Government must bring forward a clear strategy, address the problem of recruitment and retention of NHS staff—all, right from carers to the consultants. This is vital if we are to create the well-resourced and high-performing NHS that the people of Wales need and deserve here. Thank you.

Many speakers today have talked about the remarkable work carried out by health workers in Wales, and who hasn’t heard about the extreme sensitivity used by some of our palliative care nurses with people in their dying moments? Who hasn’t heard about those incredible stories of how surgeons have saved the lives of a dying child and how that’s transformed and given meaning back to the life of those parents? Who hasn’t marvelled at the ability of GPs to see a patient every 10 minutes without being totally frazzled, and I know, because I live with one?

I’m not sure where Caroline Jones got her figures from in terms of the 10 A*s. I was going to have to go back and whip my son into gear, because we are so desperate for GPs, I think we all need to make a contribution here. He’s never going to get 10 As the way he’s going now. But, fortunately, you need a B in maths, a B in English and three As and a B in a science, so we may be lucky there.

But the key thing, I think, we have to understand is that, as Hannah has pointed out, it’s not just the people who are working on the front line we must remember. We must remember those people, the unsung heroes, who are just as important—those cleaners who are making sure that we don’t have C. difficile and we have attacked the issue of MRSA in our hospitals.

We know that almost all NHS workers are under extreme pressure, and that’s partly because we now have an ageing population. Our NHS is also under extreme pressure because we have to finance these new expensive technological developments and new medicines that are demanded by patients. Angela Burns is absolutely right to point out that the expectations of patients today are things that are very difficult to meet.

Proportionately, the fact is that we spend less in percentage terms in this country on health than Portugal, France and the Netherlands. Of course, whilst there’s room for improved efficiency, I think there will come a point where we have to have an honest conversation with the public—that they will have to understand that if they want more, they will have to pay more, or we will have to cut back in other services in order to pay for that help. We all seem terrified to have that honest debate with the public, and at some point we will have to do that.

The NHS in Wales is coping remarkably well under the circumstances. We have got an older and a sicker population, and yet our NHS is no worse, according to the Organisation for Economic Co-operation and Development than any other part of the UK. With that ageing population, we are likely to see more complex care needs develop—care that doesn’t necessarily need a hospital stay but will require that extensive nursing. A 44 per cent rise in the over-65-year-olds has been predicted by the Office for National Statistics over the next 25 years. A 44 per cent rise. If you think about the over-80s, by 2040 we will have over 30,000 people who are over 80 living in Wales. That’s the whole of Llanelli—every single person in Llanelli over 80. Are we ready for that? Are we prepared for it? No way. We don’t have the kind of plan or strategy that will be required. We need to think about that, and we need to understand that that pressure on the health service is not just about health, it’s about our care services—that cinderella service that we always forget about. It’s important that we understand that it’s financed in a different way and that we need to understand the relationship. The Government has understood that relationship. We have the intermediate care plan. It’s beginning to kick in. We will need more of that, without question. If we want to avoid treating patients on trolleys in the hospitals of the future, we need to know that we can release people back to their homes and to their communities.

That cinderella service, I think, we have to change. We have to change our attitudes, we have to appreciate this vital service that we’re all going to need in some way or another, and we have to have a serious conversation about how on earth we’re going to pay for it. Care workers are poorly paid, they’re poorly qualified and they need increased support. We need to work out how we incentivise people to attract them to that important service, and we need to keep people in that sector for the demands of the future.

I think it’s also worth asking how we can look at different models. If you look at the Solva Care model, which is a very interesting model, we have volunteers from the community doing some of the care work that obviously doesn’t require nurse training but that can relieve some of that pressure on our care services as well. Until we address that care service issue we will see more delayed transfers of care, we will see an increase in emergency admissions, putting further pressure on the NHS workforce. At some point, we will need that honest debate with the public about how we fund this.

It’s entirely apparent from all the contributions in the Chamber today that we need a strategy as a matter of urgency to train more doctors in Wales. I will make a case that this strategy will have to be one that is pan Wales. We do have two medical schools—one in Swansea and one in Cardiff—but we have nothing whatsoever in north Wales or in mid Wales. If we are going to start to fill these gaps in terms of doctors and GPs in north Wales, then we do have to provide that training in north Wales. As we have heard on a number of occasions, students do tend to remain in the areas where they train to become doctors. And if we don’t train them in north Wales, then there is no hope of retaining them, clearly, and it becomes very difficult, then, to retain people in the area, because you have nothing in place in the first place. There is a report by Professor Longley from the University of South Wales that demonstrates that 95 per cent of doctors who are trained in Wales do remain in Wales, which is excellent, but what we want is more doctors remaining in Wales, and certainly there is a need for more doctors moving to north Wales, or the problem will simply become critical—even more critical than it is at present.

I’m very pleased to hear that there is some momentum behind this concept of a medical school in Bangor. I’m very pleased that a business case has been drawn up at last by the Welsh Government, and I look forward to seeing that. The people I’ve spoken to—Bangor University, the north Wales health board, the Coleg Cymraeg Cenedlaethol, the medical association—everyone is in favour of this principle, and therefore it makes sense to move ahead with it. There are a number of very specific reasons as to why we need to take this seriously now. The university in Bangor and the health board are working in partnership already. Bangor University is already providing a wide range of medical health-related education and social care education. It’s a natural step, therefore, to reinforce Bangor’s position as an internationally important research centre. The health board and the university would benefit as entities. Both would be strengthened in retaining the best staff and the best students in the area, and in turn that would strengthen the local economy, with two institutions being major local employers.

We could establish a medical training centre through the medium of Welsh in Bangor. That would be the natural place for that to happen, bearing in mind the strength of the Welsh language in that area. That, in turn, would enhance the supply of bilingual doctors that are needed. In order to achieve your own Government’s strategies, such as the ‘More than just words…’ strategy, we need those bilingual doctors, and there simply aren’t enough of them at present. A medical school with an emphasis on rural medicine would be unique, not only to Wales, but it could also provide innovative solutions and attract students from across the world who are interested in providing care to an ageing population in a rural context. That is relevant in other parts of the world too, of course. But, more than anything, a medical school in north Wales would enhance the service that the people of Wales are provided with. There is no doubt about that. North Wales does feel that it is often forgotten. You will be aware of that. There is a feeling that we are being left behind. This is a very real opportunity for the Welsh Government to show support for north Wales and for our rural areas. So, why not be ambitious? Why not move ahead with this proposal, and, who knows, a medical school, in turn, could lead to other training in north Wales—dentistry, pharmacy, physiotherapy, and so on? Therefore, there is a clear case here. A series called ‘Doctoriaid Yfory ‘—doctors of the future—has just started on S4C, and I was watching it last night. There is so much talent here, and we now need to provide opportunities for more young people, such as the ones we see in that programme, to be trained here in Wales and in north Wales specifically. That, ultimately, will improve the health service for all.

I call on the Cabinet Secretary for Health, Well-being and Sport, Vaughan Gething.

Thank you, Llywydd. I’m grateful to the Conservative Party for tabling today’s debate, and the opportunity it provides to set out the significant work being done in this area by health boards, trusts and the Welsh Government. There are, of course, challenges for recruitment and retention in Wales, across the NHS family in the UK and further afield in most western healthcare systems. I can confirm that the Government will support both the motion and the amendment today. We have already had some successes here in Wales, and we should recognise that. But this is not an exercise in complacency by the Government. We do, as I say, recognise that there are challenges, and we are in the process of taking action.

It’s fair to say that, in Wales, our retention and recruitment rates have remained consistent, with staff, for example, leaving in fewer numbers when compared to those in England. However, there are areas where there are real difficulties. We know there are particular roles that are in high demand and have a comparatively high turnover.

And part of our challenge is the way in which we do talk about NHS Wales. We know it has a real impact on morale and recruitment, and a range of the criticism that is regularly meted out is not fair and objectively accurate. Paramedics, for example, regularly described this to me over the last period of the year or two. For example, Ceri Phillips mentioned it this week when talking about the ability to encourage people to consider careers in medicine and allied professions. But I’m actually encouraged by the manner—the constructive manner—both of the opening of the debate and the contribution of Members around the Chamber. The way that we talk constructively about the service can make a difference to having a real and searching debate about the health service, but doing it in such a way that we do not reach for headline-grabbing and unsupportable calls.

I recognise that retention is a key area of focus, and significant work is already under way, with health boards currently considering the broader aspect of staff engagement, such as appraisal and development, so staff feel supported and valued throughout their careers. An NHS staff survey is already under way, with the support of trade unions, to help us to understand the issues faced by our staff, and the results of that will feed into the changes that we wish to make to help aid retention. Of course, where turnover and vacancies exist, we need to recruit on a regular basis, and health boards already take a range of measures to try and fill those vacancies. They include European and international recruitment drives, promotion and the extension of return-to-practice schemes, local marketing and recruitment activity, to name but a few.

Whilst today’s discussion has focused on recruitment and retention challenges, it is a fact that there are now more front-line NHS staff working in Wales than ever before. Full-time equivalent staff numbers have increased by more than 2,200 in the last year. That’s an increase of 3.1 per cent, and an increase of double on the previous year. It is a fact that the numbers of consultants, other doctors, nurses and midwives have reached record highs. That means that the NHS workforce in Wales continues to grow in the face of continuing austerity, and yet, despite those record staff numbers, we know that we still face a challenging recruitment market, and that’s why the Government is already taking action to support health boards to recruit and train additional doctors. We’re building on last year’s campaign by launching a major national and international campaign to market Wales as a great place for doctors to train, work and live. The campaign will launch in October and has been developed to support health board and trust activity consistently, under the banner of NHS Wales. Its initial focus will be on doctors, but it will then extend to take into account the wider NHS workforce, and I’m pleased to hear a range of speakers in the Chamber today mention the fact that the NHS is not just doctors, not just nurses, but a whole range of different professional and supportive groups. I will be making a fuller statement on that campaign in the Chamber next week.

Will you take an intervention, Minister?

Yes, a couple of seconds.

Has that campaign been discussed and tested with the professions, such as the Royal College of Nursing and the BMA, to see that the input that they could give at this early stage could be beneficial in the roll-out of that campaign? So, has that discussion taken place?

I’m very pleased to say that discussion is taking place. At the ministerial task group that I set up—I chaired it a few weeks ago—it is part of our ongoing and engaging discussion. Indeed, in the early months of my time in this particular post, I’ve met those particular stakeholders, and they are continuing to work with the Government on designing and delivering our campaign. I’m actually positive about the constructive and generally positive way that they are engaging with us, and they are supportive of the direction that we are taking.

I’ve previously said in this Chamber that we are committed to developing a 10-year workforce plan for the NHS. It should be a clear vision, with priority areas of work for the Government, for NHS Wales, and for our partners, to address the challenges that we face now and in the future. The plan must take account of the full range of professionals working in the NHS and be based on new models of care, and not plugging gaps in existing services—this, again, has been mentioned in other Members’ contributions, including in the opening from Angela Burns—because we know that we need to change how we provide health and care to continue to meet the rising levels of complexity and demand that we face. Simply trying to increase capacity will not be enough to deliver the health and care services that we need.

In the summer recess, I jointly met the deans of both medical schools in Wales, and they identified the importance of reviewing the activities already in place to encourage Welsh students to aspire to a career in medicine and to encourage them to consider starting their education for that career here in Wales. We’ve looked to identify barriers or obstacles that might exist or disadvantage candidates from Wales.

Turning to the ambulance trust mentioned in the motion, in fact, sickness absence in the ambulance service has reduced over the last year, but we recognise that it is still too high. Support for staff has been raised with me by the staff trade unions, in my conversations with them, for the stressful environment they do already work in. I’m pleased to say that the ambulance trust is investing significantly in their own health and well-being services. That includes a new employee assistance programme with direct 24/7 access to counsellors and fully tailored packages of counselling.

It’s also important to note that the Welsh Ambulance Services NHS Trust is an improving organisation, albeit certainly not perfect, not only in response times, but in the highly competitive world of paramedic recruitment. Staff are now positively coming to Wales for their careers in paramedicine, and we expect to be at or near full head count this year. Given the position that the ambulance trust was in even 18 months ago, that is a remarkable improvement and a real success story that I hope will be recognised and welcomed across this Chamber.

Our vision is for a high-quality and compassionate national health service here in Wales with improving outcomes with and for our citizens. Staff recruitment and retention are of course undeniably significant challenges here in Wales to be met to achieve that vision. We will continue to act with partners to recruit the staff that we need to deliver and improve upon the high-quality compassionate care that I’m proud to say that NHS Wales delivers with and for communities right across Wales as a regular experience that we already have.

I call on Darren Millar to reply to the debate.

Diolch, Lywydd. I have to say I’m very encouraged to hear the Minister’s response to the motion that we’ve tabled today. I think it’s good that the Welsh Government is at least recognising now that the workforce planning of the past, and the way in which the workforce planning has been undertaken, has been inadequate and that there is a need to engage more widely with the stakeholders that are out there that are willing to engage and want to contribute to make Wales a place in which clinicians and other professionals that want to work in the health field want to come to, and actually work in our NHS here.

I was also pleased, I have to say, during First Minister’s questions yesterday, that the First Minister recognised the importance of selling Wales to the wider family and not just the clinicians themselves, as part of that international recruitment exercise that the Welsh Government is about to embark upon. So, a very encouraging start indeed, and I do hope that further work is done to ensure that everybody can work together in order to deliver what we all know we need, which is a workforce that is fit for the twenty-first century NHS that we all want.

I was pleased also to hear the recognition that we don’t just need to increase the capacity of the existing workforce, but that we also need to deal with demands—sometimes unrealistic demands—that are being placed upon the workforce and the NHS by patients. I have to say that we’ve been big supporters of the Welsh Government’s prudent healthcare agenda, and we will continue to be, and I would very much hope, and it certainly sounds like it, that the Welsh Government is getting onto our page in terms of patients accepting more responsibility themselves for the way in which they use the NHS and the resources of the NHS. I was pleased to hear a number of speakers during the debate make reference to the importance of public health and, indeed, the social care system and the way that that can also help to prevent unnecessary demand being pushed on to the doorstep of the national health service.

The Minister didn’t respond in this debate to the amendment that had been tabled specifically by Plaid Cymru. I know he said that he would be supporting it. But nor did he respond to the need to establish a medical school in north Wales. Whilst I know that there’s been some ongoing work, shall we say, looking at the feasibility of the establishment of a medical school up there, I think it is extremely important that we make sure that there are training rotations in north Wales that will attract people to work in that area in the future. I wonder, Minister—there’s a little bit of time left—whether you might be able to give us an update on any work that is being done to develop training rotations between the north-west of England and north Wales as well, which traditionally has helped to ensure that there is an adequate supply of GPs and other medical professionals in that region.

Are you able to provide any sort of update? If you’re not, I appreciate that we’re out of time. Perhaps he could write to Members just to give us some confidence that that is actually going to take place, given the previous Minister’s commitments in the past. Thank you.

The proposal is to agree the motion without amendment. Does any Member object? No, so the motion without amendment is therefore agreed in accordance with Standing Order 12.36.

Motion agreed in accordance with Standing Order 12.36.