The following amendments have been selected: amendment 1 in the name of Jane Hutt, and amendments 2 and 3 in the name of Neil Hamilton. If amendment 1 is agreed, amendment 2 will be deselected.

The next item is the Plaid Cymru debate on overseas workers in the Welsh NHS, and I call on Rhun ap Iorwerth to move the motion.

Motion NDM6145 Rhun ap Iorwerth

To propose that the National Assembly for Wales:

1. Recognises the significant contribution made by workers from overseas to the care and treatment of patients within the NHS.

2. Calls on the Welsh Government, through negotiation with the UK Government, to secure powers to issue work permits for overseas nationals to work in the Welsh NHS.

Motion moved.

Thank you, Llywydd. I move the motion and ask for your support to that motion tabled in my name.

The future of NHS staff who have been trained abroad has come under the spotlight this year following the change in the political climate since the referendum on membership of the European Union. NHS staff trained overseas face uncertainty because of two main factors. One is the likelihood that we will see more strict immigration rules as a result of that change in the political climate, particularly the rhetoric of the type that we heard in relation to doctors at the Conservatives’ conference. This will also have an impact on those who may continue to have a right to remain here, working personally, but that may not be the case for their husbands, wives or other members of the family. The uncertainty exists because of a second factor, namely the increasing enmity towards migrants that makes Britain, it would appear, a less attractive place to work.

We are using this debate today to tackle that first factor that I mentioned, and we call on the Welsh Government to try and secure the powers so that they can issue work permits for foreign nationals who could work in the Welsh NHS.

We already know how dependent the NHS is on foreign nationals. Some 30 per cent of doctors in Wales were trained overseas—over 2,500, with one in six of those from other EU nations. We know that high numbers of nurses come from abroad to work here, and we know of recruitment campaigns in Spain, for example. We don’t in reality know how many overseas nationals work in social care, because many are working in the private sector, but we do know that that figure has increased substantially and that the sector is already saying how difficult it is to find staff. We know that we will have an ageing population, and that will mean that we will need more care workers, more nurses and more doctors, and we can’t rely on the training placements available in Wales to meet those needs, at the moment at least.

This is not just a matter of those specific difficulties in terms of obtaining work permits for foreign nationals. Other changes to the immigration system are also likely to add to these problems. I’m talking about the decline in foreign students, perhaps, and that would perhaps restrict the ability of our education sector to make provision for Welsh students, as that would lead to the loss of a significant income stream for our universities. So, why are we calling for Wales to have the power to issue work permits?

Pam rydym yn galw am gael cyhoeddi trwyddedau gwaith yma yng Nghymru yn hytrach na’i adael i swyddogion yn Llundain? Mae’n debygol y bydd y ffaith nad yw Cymru yn gallu pennu ei hanghenion gweithlu ei hun, nifer y meddygon a nifer y nyrsys sydd eu hangen arnom, sy’n debygol o orfod dod o wledydd eraill, ac unrhyw system fewnfudo newydd sy’n datblygu yn y DU nad yw’n ystyried anghenion Cymru, yn rhoi ein GIG mewn perygl.

Bydd gan Gymru anghenion gwahanol i wledydd eraill y DU. Mae gennym boblogaeth hŷn, sy’n fwy tebygol o fod angen triniaeth ar gyfer cyflyrau cronig, yn gysylltiedig, yn rhannol o leiaf, â’n gorffennol diwydiannol. Ar hyn o bryd mae gennym broblemau eithaf dybryd o ran prinder meddygon teulu, problemau’n ymwneud â gwledigrwydd a phrinder meddygon ysbyty mewn arbenigeddau penodol, ym maes damweiniau ac achosion brys a phediatreg ac yn y blaen. Mae gennym brinder nyrsys mewn meysydd penodol eraill. Mae gan rannau eraill o’r DU eu problemau eu hunain gyda phrinder. Dyna pam na allwn dderbyn y gwelliannau a gyflwynwyd. Mae’n ymddangos yn rhyfedd i mi fod Llywodraeth Lafur Cymru yn teimlo bod Llywodraeth Geidwadol y DU yn gwybod beth yw anghenion gweithlu Cymru yn well na hi, a’i bod, felly, yn hapus i ymddiried ynddynt.

Nid yw gwelliannau UKIP yn ei gwneud yn ofynnol i Lywodraeth Cymru wneud dim—o leiaf mae gwelliant y Llywodraeth yn caniatáu ar gyfer archwilio opsiynau—ac roeddwn o dan yr argraff mai holl bwynt y blaid honno oedd adfer rheolaeth. Rydym angen rheolaeth ar ein gweithlu yma yng Nghymru, wrth gwrs.

Yn amlwg, mae angen i ni hyfforddi mwy o staff yma—mwy o staff o Gymru. Rydym bob amser wedi bod o blaid hyfforddi mwy o feddygon o Gymru, i ddatrys ein hargyfwng recriwtio, er enghraifft. Cymru sydd â’r nifer isaf o feddygon o gymharu â’r boblogaeth yn y DU. A dweud y gwir, mae prinderau’n arwain at wasanaethau’n cau mewn mannau, ond ni allwch sicrhau bod meddygon o Gymru yn cymryd lle meddygon eraill dros nos. Mae’n cymryd amser. Os yw gofal claf yn dioddef yn awr oherwydd prinderau, yna mae angen i ni weithredu yn awr i ddiogelu’r dyfodol. Nid wyf am i bobl gymryd yn ganiataol fod hyn yn ymwneud â meddygon yn unig—fel rwy’n dweud, mae’n ymwneud â’r ystod gyfan o weithwyr gofal iechyd proffesiynol, gan gynnwys gofalwyr yn y sector cymdeithasol ac mewn nyrsio, wrth gwrs.

Oes, mae angen i ni ddatblygu ein rhaglenni hyfforddi i gynyddu capasiti hyfforddi yng Nghymru, ond mae’n rhaid i ni wneud ein GIG yn GIG croesawgar i staff o’r tu allan i Gymru a’r DU, ac yn groesawgar i’r rhai sydd eisoes yn gweithio yn y GIG yn awr a’r rhai y buasem yn hoffi iddynt ystyried dod yma yn y dyfodol. Gwyddom y buasai ein GIG yn chwalu hebddynt. Buasai Llywodraeth Cymru â phwerau i gyhoeddi ei thrwyddedau gwaith ei hun yn gam mawr ymlaen tuag at roi’r sicrwydd sydd ei angen arnom ynglŷn â’r gweithlu. Felly, gofynnaf i chi gefnogi’r cynnig hwn.

I have selected the three amendments to the motion. If amendment 1 is agreed, amendment 2 will be deselected. I call on the Cabinet Secretary for health to formally move amendment 1 tabled in the name of Jane Hutt.

Amendment 1—Jane Hutt

Delete point 2 and replace with:

Calls on the UK Government to ensure the Welsh NHS remains able to recruit qualified healthcare workers born and trained overseas, if and when necessary, after the UK leaves the EU, and to explore all options to facilitate that.

Amendment 1 moved.

Formally.

I call on Neil Hamilton to move amendments 2 and 3 tabled in his name. Neil Hamilton.

Formally.

You can speak to your amendments.

Amendment 2—Neil Hamilton

Delete point 2.

Amendment 3—Neil Hamilton

Add as new point at end of motion:

Calls on the Welsh Government to support sensible UK immigration controls, including a work-permit and visa regime to fill skills gaps in the Welsh NHS.

Amendments 2 and 3 moved.

Diolch yn fawr iawn, Lywydd. Well, I do regret the way in which Rhun ap Iorwerth introduced this debate, referring to uncertainly for existing NHS staff and their family as a result of Brexit, because we all know that the Government has given a commitment that anybody who is here lawfully will be allowed to remain. That is the position under the Government’s treaty obligation. [Interruption.] Yes we do, yes we do—because it is the treaty obligation of Her Majesty’s Government. The second thing in particular that—

Will you give way on that point?

In a 30-minute debate, where I’ve only got a couple of minutes to speak, I don’t think I can give way, I’m sorry. But I’m quite happy to see the Member outside afterwards.

But that will not be on the record.

I also very much regret the reference to increasing enmity towards immigrants. Apart from a very small minority of reprehensible individual, there is no enmity towards immigrants amongst the British people at all, particularly towards those who work in the NHS.

About 5 per cent of the staff of the NHS throughout the UK are from overseas and are EU citizens. They do play an extremely important part in the delivery of health services, and that, no doubt, will continue. Nobody is asking to build a wall down the middle of the English channel and stop movement either way. What we want is sensible controls. These controls are already in existence as regards the rest of the world. There are a very large number of people employed in the national health service who come from the Indian sub-continent—India, Pakistan and other places—and who are already subject to visa controls. So, we’re asking for nothing that is very remarkable in relation to EU citizens.

No-one can deny the growing alarm on the part of very large numbers of people as a result of the uncontrolled immigration that has taken place within the EU since, particularly, 2004. In 2001, there were 59.1 million people in the UK. By 2015, that had gone up to 65 million, and estimates for 2026 are 70 million people, on current population trends. These are very, very rapid increases in population and they are having an enormous impact upon certain communities in different parts of the country. It is that popular concern that has given rise to the Brexit result. I have no doubt of that whatsoever.

We’ve no difficulty in acknowledging the contribution that immigrants do make to this country. All that is being asked for by millions of people—. Seventeen million people voted for Brexit—they’re not all bigots and racists. Only a tiny minority may be bigots or racists and they are not worthy of our consideration in the context of this debate. All that we’re asking is that immigration should be controlled. Every country in the world controls its immigration to a greater or lesser extent. We’re only talking about a question of degree, not a question of principle. The motion, in a sense, ignores the important role that is played by those who come from other parts of the world outside of the European Union. As a result of introducing controls on unskilled immigration from the European Union, we’ll be able, perhaps, to be more generous towards other countries in the visa regime that we apply to them. It’ll be for the British Government to take these decisions and not the European Union, and that, I believe, is an important democratic gain.

I do have some sympathy with the Plaid Cymru position that the Welsh Government should have a role in this, but we have a UK and a UK immigration policy and the correct way in which the Welsh Government feeds into that is in the normal relations that exist between Cardiff and Westminster.

So, I believe that the future of those who work inside the NHS who are people who are citizens of other countries is assured under the current arrangements and that will continue, and that we will have the flexibility in a regime for visas and work permits, which can be introduced in due course, to provide for whatever needs there are as a result of skills gaps in the NHS. So, whilst deprecating any form of bigotry or racism, I think we should, nevertheless, accept the concerns of millions and millions of people that immigration should be controlled and that there is no necessary contradiction between wanting to have plenty of skilled people to fill the gaps that exist, not just in the health service, but in all other forms of economic activity, and yet, on the other hand, control the numbers that are creating so many difficulties for so many people in different parts of the country.

Can I thank Plaid Cymru for bringing this debate before us? Because it is a very important issue that we need to be dealing with at this moment and it’s very immediate, of course. In my previous life as Unison’s head of health here in Wales, I had a high level of engagement with the Welsh NHS as an employer, and my experience in that position made me acutely aware of how crucial to the NHS overseas workers employed across the whole of our health service actually are.

As an aside, as Rhun ap Iorwerth has already said, it is worth mentioning that, whilst this debate is about NHS workers, we shouldn’t forget that it’s not just our health service that relies on overseas workers; many more are employed in social care services, which play an increasingly integrated role in the delivery of healthcare.

According to the most recent figures, almost 31 per cent of doctors in Wales were trained overseas, and about 6 per cent of those were trained in EU countries. That equates to about 518 doctors here in Wales trained overseas, not just in the EU. Of nearly 26,000 registered nurses in Wales, 262 qualified in another EU country—just over 1 per cent—with a further 6.5 per cent qualifying in non-EU countries. As recruitment from the EU in particular has been a key component in addressing current staff shortages, it’s probably likely that that figure is now slightly higher. But I don’t think this debate is really about statistics. I don’t believe any of us could fail to be aware of the tremendous contribution that staff from the EU, the EEA and many other parts of the world make to our NHS, working alongside Welsh and UK workers. We know that the health service would struggle without them.

In this Chamber, we’ve unfortunately had to express, on a number of occasions, our outrage and despair at the rise in incidents of racism being reported since the vote to leave the EU on 23 June. If that were not enough to raise concerns amongst these staff over their future in this country, there will be many who will now be fearful about what leaving the EU will mean for them when that finally happens—just one more reason why it’s particularly unhelpful that, despite what Neil Hamilton says, the UK Government is unable or unwilling to provide any clarity over its negotiating position in respect of the free movement of workers. There’s no doubt that the NHS will not just be reliant on the EU and overseas workers it currently employs, but, if the targets for overcoming shortages are to be met, there will be a reliance on bringing in more overseas workers in the years to come.

As I said at the outset, I am grateful to Plaid for bringing forward this motion. But I’m afraid, as often is the case, I think they risk not achieving the desired aims by turning this into an issue around an argument for more powers—something, I think, that can be a long-term objective, but, on this issue, it’s something we need to deal with fairly quickly. So, the amendment from Jane Hutt, on the other hand, maintains the thrust of the motion, which aims to ensure that we can secure the EU overseas workforce and develop our workforce into the future, but without getting ourselves embroiled in technical or legal issues around further devolved powers.

I certainly don’t intend to dwell on the fairly predictable amendment that we’ve seen from UKIP. We all know the scale of the current challenges we face with staffing in the Welsh NHS, so why anyone would want to introduce a work permit and visa scheme, which could only serve to act as a deterrent to future recruitment from overseas, is really beyond my comprehension. It’s our duty to ensure that our NHS can continue to benefit from the skills and experience provided by overseas workers, and Welsh Government should do everything it can to make sure that there is no impediment to making that happen.

I’m grateful for the motion before us today, because it reminds us all of the immense contribution made to our NHS by many workers from overseas. I’d like to take this opportunity to send them a clear message of thanks and gratitude for all that they have done for our country and continue to do so. There are already some huge shortages in certain staff areas. Between 2013 and 2015, there has been a 50 per cent increase in nursing vacancies. For doctors, there’s been a 60 per cent increase in vacancies full stop. We need to recognise that we simply cannot train enough people to keep up with the growing number of posts and the growing specialisations. The BMA, for example, says it takes around 15 years for a medical student to become a consultant, so, therefore, that makes workforce planning extremely difficult.

And, of course, the pressures on the NHS are changing. We have a growing population that is older and has more complex needs. So, we’re lucky to be able to recruit workers from abroad, and they add far more value to our NHS than just a pair of hands or technical skill. The rapport with patients, the bedside manner, of some overseas workers is wonderful to behold and really adds value to our NHS and adds value to our practice, particularly in the areas of social care and nursing.

The vote to exit the European Union did change the playing field, but it is my sincere belief that the vast majority of Wales’s people, despite voting to leave, would not want to see an end to doctors and nurses from overseas continuing to practice here in Wales. We cannot close the door to foreign workers. I admit that we must respect that the majority of those who voted for Brexit did so for a multiplicity of reasons, but predominantly because they wish to see some form of reduction in the freedom of movement and less immigration from the European Union into the United Kingdom. But that is why I think that we, as Welsh Conservatives, would absolutely support the Welsh Government amendment, because we think that we need to ask the Welsh Government to explore all the available options on the table with the United Kingdom Government so that we can continue to recruit these outstanding people to support us, our communities, our national health service and our social care.

Donna Kinnair, the director of nursing policy and practice at the Royal College of Nursing, has said:

‘Nurses trained in other countries have contributed to the NHS since its inception.

‘The health service would not cope without their contribution, and with the future supply of nurses looking uncertain this situation will not change any time soon.’

Let me just say that little bit again:

‘Nurses trained in other countries have contributed to the NHS since its inception.’

I, for one, have no intention of turning my back on them now.

Galwaf on Cabinet yr Secretary for Health, Vaughan Gething.

Thank you, Presiding Officer, and I’m pleased to speak in today’s debate and recognise the contributions made by other Members on the invaluable contribution that our NHS workforce makes to the health of our nation. Staff are at the heart of our NHS, and our priority is to ensure that the Welsh NHS has the right workforce it needs for the longer term. We will not discriminate against those born or trained elsewhere, but welcome them as the valued assets to our NHS workforce and wider communities they have always proved to be. I am particularly pleased to recognise the points made by Rhun ap Iorwerth and Dawn Bowden about the wider social care workforce as well.

Now, we’ve heard many times before that consultant, GP, nurse and overall staff numbers in NHS Wales are at their highest levels ever. We do, though, still face recruitment challenges, competing to attract doctors at a time when other countries also face shortages in particular medical specialities, but also across a wide range of other specialities within the health service too. I believe, however, that the debate around the NHS workforce, training and recruitment should only be about how we can continue to provide the best possible care for people in the face of rising demand and increasing complexity of care.

More than £350 million a year is invested in the education and training of health professionals, supporting more than 15,000 students, trainees and staff. We will continue to invest in education and training opportunities for a wide range of healthcare professionals. This September, for example, saw the highest level of nurse training places commissioned in Wales since devolution—a 10 per cent increase in the number of nurse training places commissioned last year, which is in addition to the 22 per cent increase in 2015-16. We do not want to see controls introduced that would harm the Welsh economy or Welsh public services, including the NHS. We will participate constructively in discussions with the UK Government and other devolved Governments on this subject, as well as engaging widely with stakeholders and people across Wales.

At the same time, we make no apology for saying yet again we will not stand for any form of racism or xenophobia in the NHS, in Wales, or in wider public life or private life. We will tackle any unacceptable behaviour and comments head on. It is essential for us as a Government that we remain outward-looking, internationalist, open for business and proud of our public service values and ethos. Our commitment to fairness and opportunity for all is clear and undiminished.

Part of what has bound us together in the four different countries that make up the NHS family since 1948 is a collective understanding that people from different parts of the world working in the NHS make a huge contribution. This is in stark contrast to the current approach being taken by the Conservative UK Government, who believe that foreign doctors and NHS staff are only welcome here whilst they’re needed. That approach is damaging to the reputation and functioning of the NHS in all four countries at a critical time, and I’m happy to recognise the very different tone and approach struck by Angela Burns in this Chamber compared to the approach taken in the UK Government.

Just to deal with Neil Hamilton’s point about India and Pakistan and different visa controls that exist, well, those visa controls do not help the national health service in Wales or any other part of the United Kingdom. Those controls have nothing to do with looking after the best interests of the NHS and the public that it serves. Protecting the rights of citizens of other EU countries and beyond who currently live and work in Wales is a critical issue, and we have seen a rise in intolerance since the Brexit debate. Regardless of what side you were on in the Brexit vote, we should not ignore or try to minimise the real harm and damage being done to Welsh citizens since that particular vote. This Government will not treat valued members of our NHS as bargaining chips in the fallout of the EU referendum.

So, this Welsh Government makes it clear that we remain committed to exploring all options to facilitate recruitment and retention of the NHS workforce from the EU and beyond the UK, and those who leave the EU. However, we do move our amendment as there are no specific arrangements in place for leaving the EU, particularly not known by the Government—they don’t appear to know where they are going—so we want to have a more open arrangement as opposed to tying ourselves into a specific mechanism for achieving our objectives. It should of course be no surprise that we oppose the UKIP amendments. This Government is proud of our NHS staff and will continue to value them, wherever they have come from, for the contribution that they will continue to make to life within and outside our national health service.

I call on Rhun ap Iorwerth to reply to the debate.

Thank you very much, and thanks to everyone who participated in this afternoon’s debate.

Gadewch i mi ymateb yn syth i’r sylwadau a wnaeth cynrychiolydd UKIP. Rydym i gyd yn gwybod y dywedir wrthym nad oes unrhyw broblem gyda phobl sydd yn y DU ar hyn o bryd yn aros. Dyna’r math o sylw difeddwl, diystyr a oedd yn nodweddu’r ddadl Ewropeaidd. Mae’n ymddangos bod UKIP wedi gwneud arferiad o gyhoeddi gwarantau ffug nad oes ganddynt awdurdod o gwbl i’w gwneud. Yn ystod y cwestiynau i’r Prif Weinidog yn San Steffan heddiw, gofynnodd Alberto Costa, yr Aelod Seneddol Ceidwadol, am beidio â chael ei roi mewn sefyllfa byth lle y byddai gofyn iddo bleidleisio ar y posibilrwydd o allgludo’i rieni, sydd wedi bod yn y DU ers 50 mlynedd. Ymatebodd Theresa May drwy ddweud y buasai’n hoffi gallu gwarantu hynny, wrth gwrs, ond nid yw hi, hyd yn oed, yn gallu gwarantu hynny ar hyn o bryd. Felly, rwy’n anwybyddu’r sylwadau a wnaed unwaith eto gan UKIP.

Rwy’n croesawu’r sylwadau a wnaed gan Dawn Bowden. Mae llawer o’r sylwadau yma yn dangos bod gennym amcan ar y cyd, y rhan fwyaf ohonom yn y Siambr hon, i sicrhau ein bod yn gwneud GIG Cymru yn GIG Cymru croesawgar.

Dywedodd Dawn Bowden ei bod yn ofni bod Plaid Cymru mewn perygl o fethu â chyrraedd ein nod drwy ddadlau am fwy o bwerau, ond fel rydym yn ei ddatgan yma mor aml, mae’n ymwneud â chael pwerau pwrpasol. Fy ofn yw, wrth roi ffydd yn Llywodraeth y DU, y mae hyd yn oed Angela Burns ar feinciau’r Ceidwadwyr yma wedi dweud nad oes ganddi lawer o ffydd ynddi mewn perthynas â staffio’r GIG, a rhai o’r synau rydym wedi eu clywed gan wleidyddion Ceidwadol y DU, mae angen i ni wneud yn siŵr fod gennym yr arfau gorau posibl yn ein harfogaeth yma yng Nghymru i amddiffyn ein hunain wrth i ni symud ymlaen.

Heddiw, er bod y pleidiau eraill yn dweud nad ydynt yn gallu ymrwymo iddo ar hyn o bryd, rwy’n meddwl ac yn gobeithio ein bod wedi hau had syniad y gallwn barhau i ddadlau’r achos drosto fel ffordd o gael y sicrwydd mewn perthynas â’r gweithlu y bydd ei angen arnom yn y dyfodol. Rydych wedi dangos eich ffydd heddiw—eich ymddiriedaeth—yn Llywodraeth y DU. Rwyf wedi cyrraedd y pwynt lle nad oes gennyf ffydd o’r fath yn Llywodraeth y DU i roi’r camau angenrheidiol ar waith er mwyn diogelu gweithlu ein GIG yn y dyfodol. Mae hwn yn syniad y byddwn yn ei godi eto, hyd yn oed os nad yw’n cael eich cefnogaeth heddiw, oherwydd rydym am i Lywodraeth Cymru allu gwneud yr hyn y mae angen iddi ei wneud er mwyn sicrhau bod gennym GIG sy’n addas ar gyfer pobl Cymru yn y dyfodol.

The proposal is to agree the motion. Does any Member object? [Objection.] I will defer all voting under this item until voting time.

Voting deferred until voting time.