1. 1. Questions to the First Minister – in the Senedd at 1:37 pm on 18 October 2016.
I now call for questions from the party leaders and, first of all this week, the leader of the UKIP group, Neil Hamilton.
Diolch, Lywydd. As the First Minister will know, Wales has the lowest number of GPs per 1,000 patients of any part of the UK—the number being 0.6 GPs per 1,000 in 2014. He’ll know also that training places are currently not being filled, that increasing numbers of GPs are retiring early, and there’s a growing crisis in recruitment and retention. Can he tell the Assembly what plans the Government has, with a concrete timeline, to train a greater proportion of UK doctors in Wales?
Well, it’s not realistic to think that we will be able to train every doctor that practises in Wales. Five per cent of our medical staff are made up of doctors who trained elsewhere in the EU; a substantial number are made up of doctors who trained elsewhere. That is true of every health service, everywhere in the developed world. That said, we want to make sure that we train more doctors—that much is true. I do not accept what he says, that there is a crisis in GP recruitment; there are challenges, that’s correct, but those challenges are not restricted to Wales. He asked what we’re doing about it. On 20 October, we will, of course, be launching our GP recruitment campaign in order to make sure that we attract more students and, indeed, practitioners to Wales.
Well, I thank the First Minister for his reply. As he will know, since 2004, the percentage of NHS funding in Wales that has been spent on GPs has gone down from over 10 per cent to just over 7.5 per cent. In the same time, consultation rates have increased by more than 20 per cent, so GPs are being more hard pressed in their daily work. Does he agree with me that the independent contractor model for GPs is the one that offers best value for money for the NHS overall? And does he realise that, for every half hour of patient contact that GPs do, they have another half hour in patient-centred work, and another half hour again on top of that in administration, and, if that were to be done as employed persons—employed by local health boards—we would likely get less bang for every buck that we spend?
Well, there are two points there. First of all, there are more GPs now than there were a decade ago—that’s worth emphasising. And, also, we should be wary of referring people constantly or pushing people in the direction constantly of GPs. Through our Choose Well campaign, we are looking to advise people that, for many conditions, they should go to a pharmacist first, a practice nurse first, rather than going straight to a GP, by default, and increasing that GP’s workload. It’s a matter for GPs as to the way they organise themselves. It is true, however, that more and more newly qualified GPs are not attracted by the independent contractor model. They must have the choice as to whether to be salaried GPs or independent contractors. It’s a matter for the profession how it organises itself, but I don’t hold to the view that the independent contractor model is necessarily the only model that can be adhered to in the future. The model will vary according to the preferences of those who deliver the service.
I agree with some of what the First Minister said, but I’d like to reiterate some of the points that have already been made by other questioners today in relation to the autism Bill. Does he understand the widespread anger and, indeed, incomprehension amongst the public at large that Labour AMs were whipped last week to vote against the motion for an autism Bill, which wasn’t actually a legislative proposal in itself but an expression of opinion of this Assembly on a matter that goes to the very heart of the suffering of tens and tens of thousands of people in Wales?
In Haverfordwest on Thursday I was asked this question by members of the public and I understood their position. I understand the great pressure that autism places on families. I’ve dealt with autism through casework over many, many years and seen some very difficult cases indeed. What I asked them though was what a law would deliver for them, and they were unclear on that. Perhaps, it was an unfair question to ask members of the public. What’s important is that we work with the National Autistic Society in order to identify with them what aspects of the draft Bill actually can be delivered in other ways. Why wait years for a Bill if there are better ways to deliver a better service now. From our perspective, a law is what is required when every other means of delivering a service has shown itself not to be effective. So, the Minister will work with the society in order to make sure that we can deliver what we can with what we have already and also examine whether there is a need for legislation in the future.
The leader of Plaid Cymru, Leanne Wood.
Diolch, Lywydd. Four bidders have expressed an interest in running the Wales and the borders franchise and the associated metro system. One area needing further scrutiny is the franchise map or the actual routes that will be operated. We know that the UK Government’s Department for Transport wanted to remove certain routes from the franchise and in particular those routes that serve destinations in England. Your Cabinet Secretary has indicated that the UK Government wants the map broadly unchanged. Do the four bidders know which routes they are bidding for and can you tell us when passengers across Wales will be given sight of the next franchise map?
There are several issues that arise as a result of the franchise. First of all, at this moment in time the Welsh Government, unlike the Scottish Government, is prevented from running a franchise and having that franchise run by a public body or public agency for reasons that are not fathomable in logic, but that’s what the current Wales Bill actually says. We’ve made strong representations to the UK Government saying that if it’s right for Scotland, therefore it’s also right for Wales. As far as the franchise is concerned in terms of the destinations, our view is that the franchise map should stay as it is. Otherwise, of course, there will be no service between Merthyr Tydfil and the Conwy valley railway that is run by the Welsh Government or through the Welsh franchise. Every service along the north Wales main line will be run from England, except the Conwy valley line wouldn’t be. The central Wales line—the Heart of Wales line—and the Cambrian coast line will all be run outside of the Welsh franchise. That is frankly a ludicrous situation and something that we are continuing to tell the UK Government in those exact terms.
The renewal of the franchise gives us an opportunity to address the issue of capacity, and there’s a significant issue with capacity on the Valleys lines. As you will be aware, every day commuters face issues of overcrowding and delays. Frequency is an issue as well. On the Treherbert line, for example—one that I’m particularly familiar with—there are only two passing points on that line and we need to go from a single line to a dual line. In the budget today, the Treherbert line is mentioned. Can you say more about that train line and, in particular, can you tell us when we can expect to see a plan for the re-dualling of the Treherbert train line please?
First of all, it’s absolutely right that we want to see better frequency by the services, a better quality of rolling stock on all the Valleys lines—none of those criteria are satisfied at the moment—and proper signalling, of course, on the lines to make sure that more trains can run on those lines and possibly more passing loops. The question as to whether the entire line should be re-dualled and whether that would actually add anything beyond improvements short of that is an open question. The one thing I can say to the leader of Plaid Cymru is we are absolutely committed, via the metro system, to deliver better frequency and better trains for the people of the Rhondda Fawr on all the Valleys lines.
I welcome that statement, First Minister, because when the franchise was last awarded, there was no provision for a growth in passenger numbers, and there was no capacity within that franchise to increase the rolling stock. So, I wonder if you can explain to us how you will make sure that that point is addressed in the next franchise. People travelling on those Valleys lines are sick and tired of travelling on decades-old second-hand rolling stock. When you travel elsewhere, there are excellent trains. Do you think train travellers in Wales deserve the service that we currently have to put up with?
No, it should be far better. We have seen some improvements around Queen Street and the points of access into Queen Street station, but I know full well that the quality of the trains is poor. They lack air conditioning, they’re not pleasant trains to travel on, the frequency is not good, the capacity is not good, and people often have to suffer overcrowding to the extent where some trains have to pass through some stations in order to avoid the overcrowding. These will be addressed as a result of the franchise negotiations. The franchise will transfer in the autumn of next year, but we’re absolutely determined to make sure that there’s better capacity, better trains and better frequency on all Valleys lines services. It’s an intrinsic part of the metro to make sure that people enjoy a far better service than they enjoy now.
The leader of the Welsh Conservatives, Andrew R.T. Davies.
Thank you, Presiding Officer. First Minister, there was a report out last week that highlighted the extra cost that your childcare policy could potentially end up costing the Welsh Government at the end of the five-year Assembly—a potential deficit of about £120 million over what you costed for your manifesto. Do you recognise the figures within that report, and if you do recognise the figures in that report, how are you making the allowances to be able to meet that increased demand? We all recognise childcare is an important part of the balance that many families face on a day-to-day basis.
There were some assumptions in that report about how we would implement the childcare policy, but the figures that we came out with were based on providing childcare for those who were working 16 hours a week or more, and they were figures that were provided to us by an independent survey, and not by ourselves—by an independent body.
I do take it from your answer that you do accept that there’s potential for this massive overspend, especially if the scheme is, hopefully, a rip-roaring success, in fairness, First Minister, because as I said, all parties recognised going into the election that childcare was a huge issue. Your offer is the offer that will be implemented because you’re in Government, and there is this potential overspend of £110 million. That’s not small change in the money that you have available as a Government. What allowances are you making to make sure that resources are available so that the scheme can be implemented and its full capacity and potential reached at the end of this Assembly?
We don’t accept that those figures are correct. We are confident in the figures that we have; we believe that they are robust. They were figures that were provided to us as a result of work that we commissioned, and those figures we believe are correct in terms of the money that will be needed to implement the policy.
Thank you for that answer, First Minister. So, you do take it, then, that those figures aren’t correct and that your figures of £90 million are the costings of that scheme. But, if you look at your wider commitments in the first five months of this Assembly, you have the backing for the black route, which is the most expensive M4 relief option, you have the pupil premium agreed with the education Secretary, and you have the potential for an overspend in your childcare policy. We know from the report last week that there is a deficit opening up in NHS funding to the potential tune of £700 million. In fairness to you when you were on the campaign trail, you said that for every commitment there will have to be a cut. Where will the cuts fall within your programme to deliver on those commitments that I’ve just outlined?
That will become apparent during the course of the draft budget statement. On the M4 relief road, that, of course, will be financed through borrowing and not through our own capital budgets. We are more than content with the figures we provided back in May and that they will help us to deliver the manifesto promises that we made. Indeed, that’s exactly what we did in 2011—we kept the promises then and we’ll keep those promises in 2016.