We move on to the next item on our agenda, which is a statement by the Cabinet Secretary for Health, Well-being and Sport on winter preparedness, and I call Vaughan Gething to make the statement.

Thank you, Deputy Presiding Officer. I’m pleased to update Members on how NHS Wales, local authorities and other partners are planning to deliver resilient services to citizens for the coming winter period.

Last winter, urgent and emergency services experienced days where there were significant surges in demand, especially from patients with increasingly complex care needs. On some days, these peaks were above what could be realistically anticipated for emergency ambulances, primary care out-of-hours and, indeed, emergency admissions to hospital through accident and emergency departments. For example, at the turn of the year, the number of ambulance arrivals at A&E departments reached a peak of 22 per cent higher than the January 2015 average, and A&E attendances were up to 23 per cent higher than the January 2015 average.

Pressure on the care system is now recognised as a year-round reality, and yet the overwhelming experience is that our front-line staff continue to provide care with professionalism and compassion. I am sure everyone in the Chamber will join me in expressing appreciation for our dedicated staff, who help people when they need it the most.

This year, we instructed NHS Wales and local authorities to develop integrated plans earlier than before to jointly design their response to the challenges that winter will inevitably bring. The NHS and partners held a series of national planning events where key staff scrutinised plans to share learning from previous winters and examples of best practice.

In recent years, we’ve seen an increase in the resilience of our system by developing a whole-system approach, so planning and organisations together have built upon the plans and experiences of the last year to prepare for this winter. There are, of course, a range of positive actions planned to further improve resilience, including an increase in bed capacity, given the likely rise in the number of patients with multiple conditions who will require admission to a hospital. We’ll see strengthening of emergency ambulatory care services to enable patients with specific conditions to be treated without needing to stay in hospital overnight, wherever possible. And we’ve seen an overall downward trend in delayed transfers of care, and regional partnerships are actively working to achieve further improvements.

Maintaining good patient flow across the whole system is key, and there’s a strong focus on expediting discharge by maximizing our capacity through collaboration. Other areas to strengthen in readiness for this winter include additional step-up and step-down services across Wales to provide short-stay beds for people coming out of hospital who are medically fit, but not ready yet to return home. And those beds will also be used as a step-up for people in the community to avoid a hospital admission. All health boards plan to increase consultant cover over the challenging weekend periods, and that will include focusing the presence of senior decision makers over the weekend, for example, at the front door or on in-patient wards to help support the timely discharge of patients. There will be additional support for primary care out-of-hours services and improved use of social workers in hospital to expedite assessment and discharge, to name but a few.

But we also expect to learn from the past, and I am keen for new models of care to be implemented widely to support the needs of patients. I have been impressed by a wide range of innovative approaches, for example, the award-winning ‘bridging the gap’ initiative, which is an integrated approach in the Cardiff area, focusing on supporting patients who regularly attend A&E or call an ambulance, to help improve outcomes and reduce demand; the Môn enhanced care model in Anglesey, which delivers intensive care in the home for acutely ill elderly patients through community resource team working, the key partners being social care, advanced nurse practitioners and GPs; and the western bay community services programme in Swansea, which is a multi-disciplinary team again, aimed at improving access to intermediate care services and keeping people well and independent. Finally, I’m really pleased to say that the 111 pathfinder pilot commenced in the Abertawe Bro Morgannwg University Local Health Board in October and it provides a real opportunity to signpost patients to the right service.

We’ve supported our health and social care services to deliver safe and timely services over the winter and beyond with significant investment, and we have made tangible improvements. Of course, on 3 November, I announced that this Government has provided an extra £50 million for NHS Wales to help manage demand over the winter and support NHS performance. That is in addition to £3.8 million to support a national programme of pathfinders and pacesetter projects to test new and innovative ways of planning, organising and delivering primary care services, and £10 million comes from the national primary care fund to support the development of primary care clusters. That means an extra 250 additional primary care posts, including GPs, nursing posts, physiotherapists, occupational therapists and pharmacists to name but a few. We’ve also made £60 million available through the intermediate care fund for this year to help prevent unnecessary hospital admissions and delays in discharge. All of these Welsh Government initiatives are making tangible improvements to the delivery of services for people.

Importantly, thinking back to last year, our ambulance service this year is in a much better position heading into the winter, following a sustained improvement in performance over the last year. The latest information shows the average response time to immediately life-threatened patients is just four minutes and 38 seconds.

For the first time in a single year, we’ve seen over 1 million A&E attendances and this demand, combined with our ageing population and an increase in patients with complex needs, presents a real pressure within our system. Similar pressures are seen right across the NHS family within the UK. There is, of course, much more to be done to deliver the improvements that we want to see, but we have seen general improvements in performance against key emergency care access targets over the last six months. Of course, we can all play our part as citizens to help the NHS through increasing the take-up of free flu vaccines for those eligible and carefully considering whether a pharmacist is the best option when we do feel under the weather.

Finally, of course, we are urging people to ‘Choose Well’ this winter by keeping themselves warm. That will help prevent colds, flu or more serious health conditions such as heart attacks, strokes, pneumonia or depression. All of us recognise that winter is a challenging time for health and social care. We’ve seen successive years of rising demand that will continue to challenge the entire system, and that reinforces the need for a whole-system approach. No-one should pretend that winter will be easy, but I firmly believe the extensive local and national preparation will deliver robust, resilient services so that people have access to the care they require when they need it.

I thank the Cabinet Secretary for the statement today. As it happens, the health committee here at the Assembly is having an inquiry into winter preparedness in the NHS. We’re looking forward to the evidence session with the Cabinet Secretary in the next few days. Yes, there is evidence that has been heard as part of our inquiry so far that does show elements of additional pressure—paediatrics is a specific one that has emerged. But what does come to the surface most is that, if the health service had the general capacity to cope throughout the year, it would have the capacity to deal with any temporary increase that happened, whether in the winter or at any other time of the year, for example, in the summer, when A&E departments are busiest. What we have in this statement today is an outline of a number of things that the Government is doing to try and respond to the challenges of the winter, but I do believe that that does ignore those broader factors. He mentions trying to reduce access to A&E departments and overnight stays, but he doesn’t mention much about social care apart from saying that social workers are going to be in hospitals in order to accelerate the process of getting people discharged. And we know, of course, that there is a lack of integration in the system as it stands.

Pedwar cwestiwn cyflym os caf i: mae’r datganiad yn cydnabod bod y pwysau ar y system drwy gydol y flwyddyn, fel y dywedais. A yw Ysgrifennydd y Cabinet yn hapus y gall capasiti cyffredinol y system ymdopi â'r pwysau y mae bob tymor yn ei chyflwyno? A chofiwn fod y gaeaf yn dod bob blwyddyn. Yn ail, gwelyau ychwanegol: efallai y gallech roi ychydig mwy o fanylion i ni am y math o welyau ychwanegol yr ydych chi’n eu gweld yn cael eu cyflwyno. Yn drydydd, cwestiwn penodol ynglŷn â chadw cleifion draw oddi wrth eu meddyg teulu: mae GIG Lloegr wedi cael llawer iawn o gyhoeddusrwydd ynghylch ei gynllun i adael i fferyllwyr weld pobl â dolur gwddf er mwyn penderfynu a yw'r haint yn firaol neu’n facteriol. A yw GIG Cymru yn ystyried hynny yn benodol? Ac, yn olaf, gan ei droi wyneb i waered i ryw raddau, ymddengys bod llawer o ymdrechion y Llywodraeth, yn canolbwyntio ar gyflymu’r broses o ryddhau cleifion, ond gwyddom am waith ymchwil sy'n dangos peryglon i rai cleifion o gael eu rhyddhau’n rhy gynnar. Beth y mae'r Llywodraeth yn ei wneud i sicrhau bod ysbytai yn rhoi cymaint o sylw i gadw pobl yn yr ysbyty, os mai dyna'r penderfyniad clinigol cywir, beth bynnag fo pwysau’r gaeaf, fel na chaiff y broses o ryddhau cleifion fyth ei chymell gan y pwysau yn y tymor byr i greu lle?

Thank you for the comments and questions. In terms of your opening comments, I don’t accept your assessment that there’s not much mention of social care. Social care is crucial to the whole system working. It isn’t just about social workers within hospitals—when you think about the ICF and the way that works, that’s got to be a partnership with social care. And, in your own constituency, the specific example I mentioned of the Ynys Môn enhanced care only works because you’ve got social care, advanced nurse practitioners and GPs working together. And, in fact, consultants in Ysbyty Gwynedd are very, very positive about the scheme, because they recognise the real benefits it brings. There are similar schemes around the country that only work because you have that whole-system partnership taking place, and that’s what we need to see more of throughout the year, as well as, of course, at the heightened demand point of winter.

To deal with your point about summer and winter demand and whether we’ve got the right capacity, well, the demand profile is different. There are more numbers in the summer, but, actually, the profile of patients coming in in the winter means that, actually, they’re more likely to take up space in a hospital, because it’s more likely to be the right choice for them, and they’re more likely to stay for longer as well, because we do know they’re more likely to be older people who are sicker and who have a more complex basket of conditions to be addressed. So, that’s why we know the pressure is entirely different in winter, even though the numbers themselves are reduced. So, that’s why we look at surge capacity within the acute care system. That’s a sensible thing to plan for in the way you have the balance between unscheduled and planned care in the winter as well: the balance changes. But also it’s why I made mention of the step-up and step-down facility. Some of this is about using our suite of community hospitals, but it’s also about more intelligent commissioning capacity within the residential care sector. We could and should do more progressively with the independent sector to look at what capacity exists and to make sure it works for both health and social care, and about how we spend that public money, as it may be a more appropriate place for someone to recover outside of a hospital if they’re medically fit for discharge.

That brings me to your final point—I’ll jump back to pharmacy—about keeping people in if it’s the right clinical choice. I don’t have very many instances at all where people write to me and they say, ‘My relative or I should have stayed longer in a hospital bed: that was the right place for me’. It’s almost always people saying, ‘I wanted to go, I was ready to go, but I needed more support to enable me to do that’. And we actually think the biggest problem in delayed transfers of care is patient choice, where people don’t want to leave because the place they want to go isn’t available. That means, of course, they’re occupying a hospital bed where someone with a much greater need isn’t able to access it. There are difficult challenges here, but I don’t think there’s a system-wide challenge for people to be taken out of a hospital before they’re ready. Of course, if that did happen, that would be a concern, but our big system challenge is actually helping to get people out when they’re ready to leave to move to a more appropriate part of the care system, either to have care at home, with support or without, or to have care in a different setting.

Finally, because I won’t ignore the point about pharmacy, we’re not just interested in sore throats. The common ailments scheme that we have is much broader than that, and I expect this winter a rolling-out of the common ailments scheme, of course, enabled by the investment we’ve made in IT infrastructure and the sharing of the GP record.

Minister, thank you very much for your statement today. The first point I would like to concur with you on is to show appreciation to the staff who help maintain our NHS services during the winter, when, I think we all recognise, there do seem to be extraordinary pressures, and I would like to pay my tribute to them as well.

This is a pretty upbeat statement, and I’m quite sure it reflects extremely your hopes for us dealing with the winter pressures, but I have to tell you, Minister, it does not reflect the evidence that we’ve been hearing throughout our committee sessions. So, a couple of key points I’d like to ask you about: you talk about having a range of positive actions planned to improve further resilience. Have you been utterly satisfied that the health boards have put this in place? Because when we’ve talked to GPs and we’ve talked to various A&E clinicians, the royal colleges, et cetera, they are less convinced that there has been a fully integrated discussion about how we can handle winter pressures. So, I’d like to be assured that you are reassured that our health boards have really got this taped, because, as I say, it does not reflect what we’ve been hearing.

I’m interested to understand, Cabinet Secretary, where the staff are coming from, where these extra beds are coming from. You talk about more beds in hospitals perhaps being opened up for the winter pressures, you talk about community beds, but there’s been a real slide in the number of beds in both hospitals and within the community, and I would like to understand how that is going to be rectified in such a short space of time, given that winter is just about here. An example I would give you is that there’s been a 30 per cent decline in the number of district nurses. So, how are we going to be able to keep people in the community and out of hospital, being looked after by GPs and being looked after by other services?

You talk about an overall downward trend in delayed transfers of care, but, Minister, every month, there are about 450 people waiting in hospitals for social care packages to be put into place so that they can escape a hospital confine and continue with their lives. How do you square that number we’ve already got in July, August, September, October—and that’s before we get into winter pressures—when, as you’ve acknowledged yourself, the case mix changes quite dramatically and we have far more older, more frail, and more vulnerable people and, of course, a lot more young children entering into hospital with acute needs?

Could you please, perhaps, explain how we’re going to be able to catch up with that shortfall, given that there’s also a social worker shortage? Because everything in your statement sounds absolutely great, but we all know that we are struggling to get enough staff into the health system, and I just can’t quite see how they suddenly managed to pull the rabbit out of the hat and this is going to work brilliantly well for the next three or four months.

May I also ask you if you have tasked the health boards with looking at developing more the idea of having acute clinicians in charge of specific departments such as orthopaedics, such as paediatrics, able to divert people from A&E to take the pressure off? Because the evidence appears to show that we can divert about 30 per cent of people away from A&E into GP out-of-hours—but, again, all of these services only function if they have the social workers on call, if they have the physiotherapists, if they’ve got the mental health workers to support.

So, great statement, very positive and upbeat, I appreciate you’ve had the discussions with the health boards, but I really find it hard to swallow that there’s been this massive change in the hospital regimes and the community services that we have available, with the shortages of staff we have, that’s going to enable us to cruise through the winter in a way that I fear the health boards may hope that they can do. After all, we’ve been here every single year, talking about winter pressures. Experience is beginning to outweigh hope on this, and we do want to come up with some solutions that are utterly sustainable for the future. Thank you.

Thank you for the comments and questions. I think I can be upbeat and ambitious about where we could and should be and talk about a resilient service, but, as I’ve said several times in my statement, winter will be a challenge; it always is. We know that the demand profile changes in winter. We know that when we talk about the service under pressure, we're talking about our staff, and I'm very pleased that you’ve paid tribute to NHS staff. Staff in the NHS and in social care have an extremely difficult job to do, and, actually, the NHS system keeps going because of the additional efforts made by social care staff, to make sure that they can get people out of hospital acute settings and into social care settings. So, the improvements we've seen in the last few years in keeping packages of care open, for example, has been crucial to keeping flow work within the whole system. Of course, that was one of the points that you made about the investment in community services, in that every health board has a slightly varying setting, but they’ve made that investment in community services, not only thinking about—I know there's a challenge with district nurse numbers, but, actually, community-based nurse numbers have increased over the last six years, but also, the partnership with a variety of people in the third sector and in housing as well, and they've been crucial to make sure that community support mechanism actually exists to enable them to go back to their own home or to a different care setting out of an acute hospital bed.

I am, of course, looking forward to attending committee and, yes, I look forward to answering all the additional questions you don't get a chance to ask today. But, you know, there is a range of things as well I do want to point out. In terms of that thing about flow in and out of a hospital as well, about keeping people out of hospital when it's not the right place—points raised by Rhun ap Iorwerth—but, on delayed transfers of care, it's a significant achievement to have levelled off and levelled down the numbers of delayed transfers, and there's no pretending from me or anyone else that this is not going to be a pressure through the winter. We saw last winter a rise in delayed transfers of care at the toughest points in the winter, and you would expect that to be the case; it would be unrealistic to think otherwise. But, the system in Wales has seen a downward trend over a number of years compared to record rises and record levels of delayed transfers—they call them delayed discharges—in England, and also similar problems in Northern Ireland and in Scotland. So, actually, we stand out against that picture by having seen a fall-off, but our ambition is to see more, rather than just be satisfied with where we are.

And in terms of the points made about hospital flow, within the hospital system, we recognise there’s a challenge. I'm not sure how bluntly the Royal College of Emergency Medicine put it, but we know that there’s sometimes a feeling that, at the front door, where lots of pressure is concentrated, there's both a need for more decision makers, as I’ve said in my statement, as each hospital system recognises, but also to think about how the responsibility at the front door doesn't just start and end at the front door either. What that means is I want to see a push into our hospitals, but also a pull through the system as well, and that's part of the challenge in pretty much every hospital across Wales, to make sure there is that shared responsibility for different departments, and not just leaving the emergency department to fend for itself, essentially.

Now, just in terms of closing off, you asked me whether I'm utterly satisfied with the position as it is. It would be a brave, if not a foolish person in my position who said they were utterly satisfied with where we are. We recognise that we have in improving picture on planning and preparing for winter and it's important to set that out. We're in a better position now than we were last winter or the winter before. But, as I say, no-one should pretend that winter will be easy or that it will be perfect; we expect there will be challenging points in time and there will be more learning to take from this winter as well, but I expect the system to be resilient. Unlike some parts of England last winter and the winter before, I expect the doors to be kept open, unless there really is truly, extraordinary, over and above what we could reasonably expect. And that's what I'm aiming for: safe, compassionate care, and delivered with dignity for people who really need it, and then to learn again and to improve again for next winter, too.

Cabinet Secretary, I agree with you; we all want to strive for safe and compassionate care for all our constituents and people in Wales, and I therefore welcome the statement that you’ve given today, particularly on the attempts to ensure that we get that during the winter pressure months. Can I also join you in praising the professionalism and dedication of our staff? I declare an interest in that my wife is one of those members of the front-line staff. But, it is important that they actually are recognised for the hard work that they put in, and I join Angela Burns in a couple of points. I am concerned about the workforce levels, particularly, sometimes, when we see sickness levels increased as a consequence of the pressure that puts on the remaining staff, and I would like to have, perhaps, consideration of how that will be tackled, particularly also in relation to district nurses, because district nurses—as you identified, there are more in the community, but there is a shortage of district nurses across the areas and, as a consequence, I have seen directly that there are sometimes difficulties in getting district nurses to come out and support individuals, because of the pressures upon them.

On your statement, a couple of points: you were talking about the extra beds. I am going to ask the same question about the staffing levels and the resource levels for those extra beds, because what I don’t want—. I’m often told by the health boards, ‘More beds and we’ll fill them quickly’. I don’t want to see more beds being filled up and then just being stagnant, because delays in transfer of care sometimes in my patch are not as good, perhaps, as they are across Wales. It’s important that we put the staffing levels in to ensure that those are used effectively.

You talk about an improved use of social workers, not more social workers. Are we going to be looking at more social workers based in hospitals so we can get those care packages rather than an improved use of social workers? You mentioned additional step-up, step-down services in your statement, and that the beds are also used as a step up for people in the community to avoid hospital admission, but who’s going to actually admit them into those units? Who’s going to make the decision as to whether they go into those units? Will that be a GP? Will that be a nurse? Will it be the individual? Who is actually going to be deciding whether they go into those particular units and those particular beds?

I also want to perhaps ask questions about the elective surgery we often see postponed or cancelled. Last year in my own health board area they cancelled several elective surgery cases. For a couple of months, as a consequence, we saw patients having further delays and experiencing further pain and anguish whilst they waited for the next surgery to come through. What sort of indication has been given by the health boards that they are taking those matters into consideration and that patients will not be experiencing those lengthy delays? We often see them going up to 36 weeks, and sometimes beyond the 36-week target, but I don’t want to see these patients going beyond simply because they haven’t considered how they will tackle elective surgery during that winter period.

Thank you for the points—a number of similar points to Angela Burns, and some novel ones as well. In terms of the workforce challenge, as I say, we recognise it. In every statement that I make in this Chamber, every set of questions, I expect to get asked about the workforce challenges. These are challenges that are not unique to Wales, but we have a responsibility to help navigate our way through. I recognise the challenge about district nurses, even though other forms of community nurses have increased in number, and the challenge always is: how do we provide the right service so it is available for citizens so they can get good quality care, advice and support? Actually, nurses are really important keeping people out of hospital as well as caring for them where they are. We’re making better and better use of the skills of the nursing profession both to triage and to support people and to keep them in their own homes for longer, with more independence.

Actually, nursing staff are crucial, of course, to making extra beds work within an acute setting. There’s always a challenge about how and what you flex. Some of the staff within the system are prepared to work longer hours, but for a period of time. You can’t expect that level of activity to go on through the whole year in addition to the potential to have proper contract and agency arrangements as well. Now, the challenge always is about understanding the financial demand that brings as well, but there is a need—if you need extra beds and extra surge capacity around how you staff, that has to be part of the planning process. That’s why we expect every health board, with their local authority and service partners, to understand what they’re doing in the whole plan.

I have to confirm that, with social workers, we’re seeing more social workers placed in hospitals as part of the team. It isn’t simply about organising and taking people in different parts of the system. We know there’s a challenge with the social workforce about our numbers, but actually there’s a recognition that it’s a better place to have more social workers there as part of that team to help support people to return to the community. In terms of admission to any facility, it will have to be the clinician or the team of clinicians that makes that choice. It won’t be driven by points of view abut finance; it will be driven by what is clinically the appropriate place for someone to receive and take part in care.

Finally, I want to deal with perhaps the main new point you make, about elective admissions and elective activity. We know that, in the winter, we actually see a significant amount of elective activity take place. It isn’t true to say that no elective activity takes place in the winter. There are compromises with unscheduled care when there’s an increase in bed capacity taken up though unscheduled care, but elective activity still takes place. In fact, last winter, comparing January to March in 2016 with January to March in 2015, we saw more than 4,000 additional elective procedures take place within NHS Wales, so there’s a real need to continue to see more activity take place to make sure that people don’t wait unacceptable lengths of time.

I don’t want to stray into an entirely different point, but I recognise the challenge and pressure of elective activity in the winter, and some of the £15 million of resource we’ve given out will go into supporting elective activity through the winter.

Finally, Dawn Bowden.

Thank you, Deputy Presiding Officer. Can I thank the Cabinet Secretary for his comprehensive statement, which is very welcome? I do think it shows that the Government has given much thought and consideration to the issue, because it is evident. There are a whole variety of factors that impact on the preparedness of health and social services to cope with those additional winter pressures, and all of those have been well rehearsed time and time again. But this statement does give me some hope that the issues taken in evidence have been considered and that that has been done without complacency, and it gives me confidence that what can be done, I think, will be done. I think that we will be looking forward to a better winter in health and social services in Wales than, unfortunately, our colleagues in England.

So, I just want to ask two very simple questions, Cabinet Secretary, if I may: one that I’ve raised in the past, and is in relation to the Choose Well campaign and its contribution to ambulance response times and making people think twice before attending accident and emergency departments; and also on staff take-up of flu vaccinations. I note, Cabinet Secretary, you referred in your statement to the Choose Well campaign, but I wonder if you could say specifically how you believe that the campaign can contribute to the Government’s strategy. It’s kind of mentioned there in passing, but how can that contribute to the strategy to alleviate those spikes, particularly in hospital admissions?

Could you also tell us what more you think can be done to encourage NHS staff to take advantage of flu vaccinations, therefore not only reducing the risk of cross-infections but helping to address reduced staffing levels through sickness absence caused by people going off with flu during this critical period?

Cabinet Secretary.

Hello. Sorry?

[Inaudible.]—to answer.

Sorry. Thank you for the comments and questions—said with the authority of a former head of health for Unison, of course. I think, actually, that the point you made early at the start about the English system—. Part of our challenge in Wales is to recognise the challenges that the more disjointed system in England has delivered for their staff and citizens, but also to make real the theoretical advantages and to see those made real in practice by having an integrated and planned system here in Wales—that’s really to be more and more progressive through each winter but also through elective and unscheduled activity in the rest of the year.

I’m pleased you mentioned Choose Well. It was fronted again this year by Andrew Goodall, the chief executive of NHS Wales. There’s something here about the citizen being engaged in their own healthcare choices and actually helping the system. In doing that, there’s a real benefit for the individual. It depend on which set of figures you listen to, but between 9 per cent and 30 per cent, depending on who you talk to, of people who turn up at an emergency department don’t need any form of healthcare intervention. Some people could be dealt with in a different healthcare setting. Again, you need to think about the authors of those different figures, but there is a significant number of people who turn up at emergency departments who don’t need to be there at all, either because they don’t need healthcare intervention or because they could get it somewhere else, either within the community, in a pharmacy or somewhere else. So, that’s a really important part of it.

The challenge is how we engage the public in making those choices, because if you turn up in an emergency department and you wait a period of time for a fairly simple intervention that you could get on a high street, that’s your own time you’ve taken up as well as, potentially, diverting decision makers and people giving care in that setting from people who have really serious needs and really are in an emergency or an accident department because of a serious accident or a genuine emergency. So, there’s something here about getting people to engage and actually make it easy for their own friends and loved ones who could be in that position of needing that extra care to access it more rapidly.

We will, of course, be looking to evaluate the Choose Well campaign. I’ve already asked, for the end of this winter period, to have a proper evaluation to understand the impact that it has already had to give us real lessons for the future. I think that’s important, too.

On the flu vaccine—I’m really pleased you mentioned this, because I’m delighted with the work that Rebecca Evans has been leading on on this year’s flu vaccination campaign. There’s a need to understand the balance between pharmacies and GPs in delivering the flu vaccine, but also, in particular, to think about people who work in social care or the health service to make sure that they actually take up the flu vaccine themselves. By definition, those people are working with vulnerable people, and the challenge is that if they don’t take up the flu vaccine, there’s a point there about the continuity of health and social care in being able to deliver and practise themselves anyway, but also the potential for some of those vulnerable people to make them more ill and raise the chance of them acquiring the flu in the first place.

So, I am looking forward to a positive outcome from this year’s campaign. We will learn from this year’s campaign, whatever the results are, to see further progress and improvement for the next year as well. But I do think there’s a real challenge here for the independent sector of social care in particular to make sure that they take up the opportunities around business continuity about how we deliver this in a real, embedded manner, potentially in commissioning, and the Minister may have more to say about that in committee this week.

Thank you, Cabinet Secretary.