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

The next item on our agenda is the Welsh Conservatives’ debate, and I call on Angela Burns to move the motion.

Motion NDM6195 Paul Davies

To propose that the National Assembly for Wales:

1. Notes the Cabinet Secretary for Health, Wellbeing and Sport’s statement in November 2016 on winter preparedness.

2. Further notes the Royal College of Physicians’ response to the inquiry into winter preparedness 2016/17, which stated that: ‘The challenges facing health boards as they prepare for winter are complex. They reflect wider pressures on the NHS and social care’, and that; ‘Health boards are operating in an under-funded, under-doctored and overstretched context’.

3. Calls on the Welsh Government to provide a status report on how its 2016/17 planning, alongside those of Welsh Health Boards, is performing against the current situation across the Welsh NHS.

Motion moved.

Diolch, Lywydd. I’m pleased to have the opportunity to open this debate today. Of course, since tabling this motion, the issue of winter pressures has hit the headlines in both Wales and England. And, to be truthful, I would expect there are concerns across all home nations. We are seeking an update report from you, Cabinet Secretary, on how you think the Welsh health service is coping and how you have evidenced the views that you might have. I’m very conscious that, year after year, health boards promise that they are ready for winter pressures, yet, year after year, we have a situation where people are struggling to give and receive the correct and safe levels of service.

As I said yesterday, having a public debate in response to very public concerns—and you only have to look at the front page of today’s ‘Western Mail’ to understand the pressures staff feel they are having to operate under—. Having that public debate in no way casts a negative light on staff within the NHS. This winter, as in previous winters, many of them have gone over and above the call of duty. They have stood in for colleagues struck down with flu, they have dealt with worried parents of frightened young children suffering from bronchiolitis, a winter perennial, and they have held the line with our more elderly and vulnerable members of society for whom winter can be such a trial. I would like to thank all the excellent staff who work in our hospitals, surgeries, nursing homes and ambulances. You are all a credit to your profession, and the fact that we are debating this issue is by no means a reflection on your abilities or dedication to your jobs. You’re all working under immense pressure and, having been a reluctant but regular user of the NHS in recent years, I cannot speak highly enough of the work that you do.

Cabinet Secretary, the Royal College of Physicians were among a great many organisations, including the Royal College of General Practitioners, the Royal College of Emergency Medicine, the Royal College of Paediatrics and Child Health, the Royal College of Nursing—and I could go on with the list—who essentially raised the same concerns about readiness, about staffing levels, numbers of beds available, training and funding during written and oral evidence to the health committee. The Royal College of Physicians stated that:

The challenges facing health boards as they prepare for winter are complex. They reflect wider pressures on the NHS and social care.’

And they went on to say that:

Health boards are operating in an under-funded, under-doctored and overstretched context.’

Given the reports that we are receiving in our constituencies, the stories emerging in the media and concerns being raised by a multitude of healthcare professionals, I ask you, Cabinet Secretary, for an honest appraisal of how you feel that the Welsh NHS has, under your watch, performed so far this winter. How is it coping, and do you feel that it is in a healthy enough position to see out the rest of the winter season?

The British Medical Association, in evidence it gave to committee and in further briefings, states that too many hospital beds have closed over the last decade and the lack of investment and capacity in social care is increasingly impacting on the provision of healthcare, particularly during times of peak demand.’

Yet, in evidence you gave on 17 November, you said:

we don’t think that there is evidence that year-round capacity is overstretched in terms of our numbers. We’re always looking, though, at whether we have got the right level of bed capacity as part of the system.’

Do you still stand by these views, even though the BMA seemed to think differently?

Now, I do agree that many of these organisations say that the NHS is under this pressure year-round, however, the shape of that pressure changes in the winter, with far more of the individuals at either end of the spectrum being at risk—either the very young or the very elderly. Society has changed and Wales has now got an increasingly ageing and therefore more frail population, and this means there are more complex needs and an increase in the amount of visits to accident and emergency departments. Wales has the highest rate of long-term limiting illness in the UK. In the nine years between 2001-02 and 2010-11, the number of people with chronic or long-term conditions increased from 105,000 to 142,000, therefore placing more pressure on services.

And, finally, the college of paediatrics and child health have highlighted the increased demand on services by children and young people, and they go on to highlight that they feel the number of high dependency and intensive care unit beds are insufficient. Cabinet Secretary, yesterday, I asked you a number of questions during the urgent question, and there are a few I would like further clarification on. You accept that bed numbers have reduced, but said that beds are ring-fenced over winter months in case of extra demand. Can you tell me whether you feel that there are now enough beds available in the Welsh NHS and, more specifically, are they available in the correct locations—community and secondary? It is all very well having bed space for patients, but if they’re not located where we need them the most then they are wasted. Yesterday, I raised the issue of frail and elderly assessment units, which could be set up in A&Es during times of peak demand. Similar units are already deployed in hospitals in other parts of the UK. Could I get on record a commitment to consider this approach, which may help to alleviate the direct pressures on the front-facing parts of our health service and get patients treated more efficiently, a point made yesterday by the college of emergency medicine?

The Deputy Presiding Officer (Ann Jones) took the Chair.

I’m also interested, Cabinet Secretary, in the way that GPs are being consulted and when, when it comes to planning for peaks in demand for services. Do you encourage health boards to bring senior GPs onside at the planning stage, as they will have very different views on what constitutes pressure than hospital staff, because we need to ensure that all parts of our NHS are pulling in the same direction and following the same guidelines and recommendations? And, during the evidence we received, the GPs were very clear in saying they’d not been involved in preparations for winter.

We’ll be fully supporting both of Plaid Cymru’s amendments and, whilst we can support almost all of the Government’s amendments, I do not see the evidence for the statement that you’re investing record levels of funding into the NHS. Statistics that I have show that, this year, the funding is less than 2014-15 and years of underfunding have led to this situation. I am pleased that you are calling on yourselves to provide this status report, which the Welsh Conservatives have asked for because I do think it is only by you, Cabinet Secretary, keeping up the pressure on health boards that we will see any chance of adherence to the plans that so few of the professionals claimed they had part in. I look forward to hearing your response.

Thank you very much. I have selected the three amendments to the motion. Should amendment 1 be agreed, amendment 3 will be deselected. I call on the Cabinet Secretary for Health, Well-being and Sport to formally move amendment 1 tabled in the name of Jane Hutt.

Amendment 1—Jane Hutt

Delete all after ‘pressures on the NHS and social care’ in point 2 and replace with:

3. Recognises that the Welsh Government is investing record levels in the NHS to meet growing demand, particularly during winter months.

4. Puts on record its support to the NHS and social care staff who have worked incredibly hard over the winter period to ensure the best treatment and care for patients.

5. Calls on the Welsh Government to provide a status report on how Local Health Boards’ and the Welsh Ambulance Services NHS Trust’s 2016/17 planning is performing against the current situation across the Welsh NHS.

Amendment 1 moved.

Formally.

Thank you very much. I call on Dai Lloyd to move amendments 2 and 3 tabled in the name of Rhun ap Iorwerth.

Amendment 2—Rhun ap Iorwerth

After point 2, add as new point and renumber accordingly:

Notes that social care services are also operating in an under-funded and overstretched context, and these services also provide an important part of winter preparedness.

Amendment 3—Rhun ap Iorwerth

In point 3, after ‘Welsh Health Boards’ insert ‘and social care services’.

Amendments 2 and 3 moved.

Thank you very much, Deputy Presiding Officer. It’s a pleasure to take part in this important debate. Naturally, we’re talking about winter preparedness. As my fellow Members of the health committee will be aware, we have been continuing an inquiry over the past few weeks into this particular issue. Of course, it’s true to note, as we heard in evidence, that the health service in Wales is under huge pressure throughout the year, if truth be told, but there are some peaks during the winter months.

In the time that I have, I was going to note, following our amendment that notes the importance of the social care services in all of this, that there is a danger that those of us who work in the health service just to go on about the health service. But unless we get the social care services right, then it will undermine the efforts of the health service to get to grips with these particular issues. Specifically, therefore, we need to expand provision in the community in terms of our social care services in the first instance, to prevent some people from having to go to hospital in the first place. So, we need to improve care in the community. That’s down to our GPs and their teams, but it’s also down to social care in the community to enable people to remain in their homes. There’s excellent work going on, but we need more of that provision to prevent people from having to go to hospital in the first instance.

Then, the other issue: when people are ready to go home from hospital. We need to expand that provision as well in terms of social care to ensure that there is as little delay as possible in transfers of care into the home. So, I would like to see—and I’ve talked about this before—social workers in all GP surgeries and social workers on every ward in our hospitals. It would be their responsibility to arrange how that patient goes home promptly. There are different schemes in different places here in Wales. Projects in Caerphilly—I’ve heard of one where there’s collaboration and it encourages social workers to be located in our GP surgeries and our hospitals. It’s improving provision and improving patient experience of the health service as a whole, and that’s in terms of social care.

Having discussed the importance of social care services, what’s important in the winter months is that everyone who needs the flu vaccine does receive that vaccination. That includes everyone over 65 years of age, those with long-term conditions such as heart and lung conditions and diabetes and so on, and also the staff in the health service and social care. We received plenty of evidence that the average number of staff in the NHS that received the flu vaccine could be relatively low in some areas. So, we need to persuade those people because, ultimately, we want to keep our staff healthy as well.

My final point in the time that is available to me: I’m going to talk about, beds because the system is under pressure because of a lack of capacity. One of those is in terms of beds—yes, in our hospitals, but also beds in community settings and in residential homes and so on. I’ve been talking about a lack of beds for many years. People always accuse me of oversimplifying the problem because it’s about more than just about a bed. But ultimately, most of the time we just need a bed, don’t we? You can talk about what kind of bed that is, and who is going to staff that, but ultimately, we’ve seen an erosion in the number of beds available in our health service, and in terms of social care. There’s been a decrease in the number of beds available and yet there’s an increase in the number of patients. Well, that doesn’t add up, does it? David.

I thank the Member for the intervention. I accept and agree that the number of beds is decreasing—as I’m sure the Member will recognise, we’re often told that the more beds you have the more you fill them. But also there’s a serious question of staffing and the nursing requirements to make sure that beds are safely staffed. There’s an issue there we have to address as well, surely.

Yes, I’m entirely content to accept that point. We always accept that point, but sometimes we lose sight of the fact that we need more beds regardless. The system is at its most efficient when 85 per cent of bed capacity is full. We need some kind of give in the system, because when things remain full we don’t have that flexibility to be able to respond to different emergencies. Thank you.

Can I say that I do find it more than just a little ironic that it is the party in Government in Westminster bringing forward this motion on the back of challenges facing the Welsh NHS—the same party that has not just consistently cut funding to the Welsh Assembly but has overseen the biggest crisis facing the NHS and social care in England probably in our lifetime?

But here in Wales, of course, we do face challenges and it’s not just winter pressures that put a strain on the NHS and care services. Rising demand for services is a consequence of the success of the NHS and care sector in keeping people alive for longer. Coupled with an ageing population, we have patients presenting with more complex and serious and severe conditions. This unavoidable reality of rising demand and complexity of needs is a challenge to the health and care sector all year round and these constant pressures inevitably increase during winter months when the NHS also has to deal with higher levels of staff absence through illness. No one is saying either that there isn’t also a challenge here in Wales in recruiting more doctors and other professionals within the NHS—

Will the Member take an intervention?

Not at the moment, no. Many of the submissions to the Health, Social Care and Sport Committee identified workforce planning and staff shortages as a key issue for our care services all year round.

However, what we do have in Wales is a Government that is prepared to allocate additional funding and introduce legislation and initiatives to tackle the challenges facing us. Other common themes amongst the evidence that was submitted to the committee included the potential for pharmacists and other care staff to free up GP services and the need for greater integration of health and social care.

Now, in my constituency, Cwm Taf health board were part of a successful pilot scheme where GPs actively triaged patients to pharmacy where appropriate. The Welsh Government has committed to a further roll-out of the Choose Pharmacy scheme across other parts of Wales. I think it’s worth noting that this is in stark contrast to England where the Westminster Government announced a cut in funding available to pharmacies there. Significantly, we have £60 million being invested in the pioneering intermediate care fund, which those giving evidence to the committee identified as being vital to relieving the everyday pressures on our health services.

So, what we can evidence here in Wales are measures to tackle the issues that present real challenges to the NHS all year round but which are exacerbated during winter months. I’ve referred to some of those initiatives already but other measures include the nurse staffing levels Act; the extension of the bursaries for student nurses, midwives and allied health professionals, which, of course, has been scrapped by the Tories in England; investing in primary care with a primary care and workforce plan backed by £43 million; GP practices being offered access to a new support package; promoting the Choose Well campaign to try and alleviate the pressures on emergency services; an extra £50 million to deal with the increased demand in winter months; and ensuring health boards, local authorities and the Wales ambulance service have updated and integrated winter plans. All these initiatives are about longer-term solutions to the challenges faced by our health and care services, and are an integral part of the additional £50 million announced by the health Secretary to help deal with those winter pressures. We should always recognise, of course, that, with all of these initiatives, they would not produce the desired impact if they were not underpinned by the tremendous dedication of all those staff working in our health and care services—

Will the Member take an intervention now, please?

No, I haven’t got enough time.

So, while no-one underestimates the challenges that winter pressures place on our health and social care here in Wales, we have a Government that is working closely with all partners in the health and social care sector to deliver—long-term and sustainable—to avoid the sort of crisis currently faced by the NHS and care sector in England.

I would like to thank the Welsh Conservatives for bringing forward this debate today. So far, winter 2016-17 has been a mild one and apart from the north-east of Wales, there haven’t been any major outbreaks of influenza-type illnesses. However, this hasn’t reduced pressures on our NHS. According to the Royal College of Nursing, our hospitals are so full all year round that the system cannot cope with a seasonal spike in demand. I fear that if we do see a seasonal spike in demand this winter, our NHS may not be able to cope.

At this point, I would like to put on record my thanks to our dedicated health and social care staff who work incredibly hard all year round, but even more so at this time of year, to ensure that patients receive excellent care despite the pressures. In fact, if our health and social care staff weren’t so dedicated and hard-working, our healthcare system would have broken down a long time ago.

The NHS and the social care sector investment has not kept pace with the demands on the system, and has been made worse by poor strategic planning by successive governments. One of the worst decisions affecting the NHS has been the reduction of bed capacity over the last two decades and the closure of cottage hospitals. This has been compounded by a lack of investment in the social care sector. Traditionally, the solution to winter pressures has been to increase capacity by cancelling non-urgent operations. This is short-termism at its worst. It only leads to increased misery for those on waiting lists and only delays the problem, rather than fixing it. The investment put up by the Welsh Government to tackle winter pressures is welcome, but will only be a short-term fix unless we address the underfunding of social care and increase the capacity of our hospitals.

We have a growing and ageing population, so unless we take radical action now, the strain our NHS is under will reach breaking point. Diolch yn fawr.

It’s a self-evident truth that increased seasonal demand puts further strain on an already overstretched service, resulting in lengthy waits for patients. As the British Medical Association Cymru warned last October, the frail elderly and a rise in respiratory conditions lead to more and different admissions in winter. GPs report difficulties in arranging for patients to be assessed or admitted all year round. Such patients can end up being directed to the emergency departments where they join others waiting for a hospital bed to become available. Age Cymru’s public policy statement on fuel poverty last September said that fuel poverty is a significant problem for many older people in Wales—the group most likely to suffer from this—and is a significant cause of excess winter deaths. Ninety per cent of 16,000 excess winter deaths in Wales over the past decade involved people aged over 65, with the highest rate amongst those over 85, who constituted nearly 50 per cent of the total.

In 2012, almost 30 per cent of Welsh households were estimated to be in fuel poverty, spending 10 per cent or more of household income on fuel to maintain heat adequate enough to safeguard comfort and health. Increased household incomes and decreased fuel prices saw this fall to 23 per cent in 2016, but that still represents 291,000 households and 43,000 in severe fuel poverty. Welsh Government targets to eradicate fuel poverty amongst all vulnerable households by 2010 and social housing by 2012 were missed. There is no realistic prospect of achieving the 2018 target of eradicating fuel poverty in Wales, and, as Age Cymru state, many of the mechanisms and measures contained within the 2010 fuel poverty strategy are out of date, or no longer applicable. I think the time is right for the Welsh Government to refresh its fuel poverty strategy, with a clear programme and timescales, credible evidence base, and new fuel poverty targets, rooted in delivery rather than being a hostage to energy price movements.

As Fuel Poverty Coalition Cymru states, the Welsh Government must save lives by implementing the NICE guidelines on tackling excess winter deaths. And although fuel poverty is first and foremost a social justice issue, this First Minister has again given responsibility for reducing it to the Cabinet Secretary for Environment and Rural Affairs. It is therefore essential that the Welsh Government works with Fuel Poverty Coalition members to instead place fuel poverty at the heart of action to tackle poverty, with strong emphasis on all sectors taking responsibility together. We must put early intervention and prevention into practice, giving real meaning to person-centred and citizen-directed approaches.

Local affordable warmth schemes, spearheaded by the Flintshire affordable warmth partnership, should be expanded, working with local authorities, third sector organisations, and existing public and private sector energy efficiency schemes, to address specific fuel poverty and health issues prevalent in Wales. Independent advice services for people in fuel poverty must be supported, rescuing those in immediate crisis whose needs are not met by current provision. Energy Best Deal sessions, funded by energy suppliers, Ofgem, and Citizens Advice, must be embraced, as must energy company contributions, such as the charitable British Gas Energy Trust, offering advice and support for people struggling with energy bills, and Npower’s Health Through Warmth scheme, helping vulnerable people with cold-related illnesses to fund and install heating and insulation in their homes.

In March I’ll be sponsoring an event in the Senedd, promoting the continuation of National Energy Action Cymru’s Calor-sponsored rural Welsh energy advisorship programme, to assist fuel-poor households in off-grid rural communities across Wales. A written answer I received from the First Minister yesterday stated the Welsh Government’s key programme for tackling fuel poverty comprises its Warm Homes programme, including the Nest scheme. However, Fuel Poverty Coalition Cymru is concerned that the proposed new Welsh Government eligibility criteria will deny help for many households currently eligible, preventing interventions that save public money.

We must embrace co-productive preventative services, designed to operate throughout the year, to reduce winter pressures and enable health professionals to concentrate on meeting clinical needs, such as the British Red Cross support service, planned for Glan Clwyd Hospital, Bodelwyddan—their community navigates this pilot at Clarence House surgery in Rhyl and their welfare centre in Wrexham. The Joseph Rowntree Foundation and Bevan Foundation told the last Assembly that fuel poverty should be central to the Welsh Government’s tackling poverty action plan. We therefore need a revised fuel poverty strategy now.

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

Thank you, Deputy Presiding Officer, and I thank the Members who have taken part in today’s debate. And I’m sure that, not just yesterday and today, we will spend more time in this Chamber discussing the reality of winter pressures upon our health and social care services over the coming months.

We all know that there’s been very real pressure over recent weeks in health and social care services here in Wales, and right across the United Kingdom. And it is a testament to the commitment and skill of our staff that, despite these genuinely difficult and trying circumstances, the vast majority of patients continue to receive their care in a professional and timely manner, and the dedication of our staff should be a source of great national pride.

The winter plans of health and social care partners are being implemented in response to pressures that we all recognise. Parts of primary community care, for example, have reported an increase of 30 to 40 per cent in demand for GP appointments, and an indicative increase of 10 to 15 per cent demand in out-of-hours services. But we know, in terms of taking new measures, the 111 pathfinder in the Abertawe Bro Morgannwg University Local Health Board area also saw an increase in demand over Christmas—some days seeing over 350 more calls per day than the typical peak volume calls for the first few months of that pilot. But, crucially, that service also appears to be working well in providing care, but also in diverting people away from unnecessary journeys into a hospital. And, again, that is a testament both to the skill and the dedication of our staff, and the design and the delivery of the 111 service. I recognise comments made by a range of Members in this debate about GPs having a critical role to play, both in the design of winter plans, and in the delivery of healthcare throughout the winter. That’s why it is encouraging that primary and community care services are generally coping with recent increased activity. The Welsh Government, of course, are supporting a range of initiatives, including local examples of telephone triage, enhanced pharmacy services that are also helping to manage demand, and I’m pleased that Dawn Bowden managed to highlight a number of those initiatives there. They’re really making a difference to individual staff, but crucially to the patients they care for.

And, again, the Welsh ambulance service has experienced some huge spikes in demand. For example, on New Year’s Day, there were 46 per cent more red calls than the daily average in 2016, but the service, though, has been able to safely discharge up to 200 patients per day without transport to hospital—that’s using its enhanced clinical desk service, all by treating patients at the scene. So, this isn’t a comment of the NHS simply putting more money into the previous system that it’s always run—there is real change, reform and innovation taking place, and it’s led by our staff and informed by the very real evidence of what works on the ground.

Will you take an intervention?

Yes.

Thank you, Cabinet Secretary, for taking an intervention. I do take the point and support the point that there is excellence going on every day within the NHS, and in particular in our ambulance service. But would you respond to the reports today of a rugby player who broke his neck and had to wait two hours on a pitch before the ambulance arrived to pick him up to take him to hospital? Can you confirm that that is very much an isolated case and isn’t a situation that people are finding happening in other parts of Wales?

I’m only aware of the headline issues in the particular point that you raise, but I think it is an isolated case. And, in fact, the evidence of our statistical evidence of what happens when people make calls is that the great majority of people receive a much faster response, both in red and in the amber category. And that is part of the point where I think we should be proud of what our service is doing. The resilience of the ambulance service in particular, in this winter compared to the one before, and the one before that—I do not think you would have seen the sort of resilience that has generally been delivered by our staff. That is because of the staff, and that is because of a change in the model and the prioritisation of patients with the greatest level of need. And again, I’m really proud of what our ambulance service are delivering, in this, the most demanding time of the year. And management information also shows that attendances at major A&Es are up by as much as 5 per cent for the days following the new year compared to last year. So, demand is continuing to rise, and early in-hospital management data also show that emergency admissions peaked at a five-year high on 27 December.

Now, we are supporting health and social care with record levels of investment, including the additional £50 million support that I’ve previously announced. That’s in addition to the £43 million for the primary care fund, and £60 million for this year’s intermediate care fund, to help prevent unnecessary admissions and delayed discharges. And on delayed discharges of care, we again have a good story to tell in Wales. We’ve gone from a period of a high a few years ago to sustaining a level of reduction. There is always more to do, and that is absolutely the approach I take, in understanding and recognising the achievements and the improvement that is there, and again with what more we need to do to see further improvement, with different partners needing to be involved, engaged and having a stake in that improvement. All of this is being delivered against a backdrop of sustained austerity for public services, and that is an unavoidable reality for all of us in this Chamber, but, more importantly, for our staff and the general public.

We have made different choices to England, which, of course, has been in the news in the last week or so—different choices on planning and funding our health and social care system together. That’s why we chose not to make cuts to social care that Simon Stevens, and others in NHS England, are now saying are a very real problem for them. We were criticised for the approach that we took, in seeing health and social care together in the last term, but I say to people in this Chamber, who are now urging us for more money for social care and for the national health service, not just to look at yesterday, in the final budget, but at the additional £25 million announcement in the draft budget, and an extra £310 million on top of that in the final budget yesterday. We are funding social care to levels that are not seen in other parts of the UK, and we should all be proud of the choice we are making, but it does not come consequence free for other parts of our public services.

I said previously in the Health, Social Care and Sport Committee that we were better prepared for winter than ever before. We’ve learnt from our previous winters. And, in addition, there will, of course, be more learning to come from this winter and more improvements for the years ahead. But I say again that we will expect challenging days ahead, where the pressures will escalate and reduce again. Each of us in this Chamber should feel extremely grateful and fortunate that we are here and not facing those front-line pressures that our staff do.

We will continue to work with partners to deliver the very best possible care at the most demanding time of year, and that is only possible because of the staff we have in health and social care.

Thank you very much. I call Angela Burns to reply to the debate.

Thank you very much indeed for your response, Cabinet Secretary. I have to tell you that I was expecting something a little bit more forensic, given that we were asking for a status report—an update report. In fact, in your amendment, which you tabled to this motion, you said that you’d be providing a status report. What you’ve done is given us a whole series of opinions and also examples of good practice, which I utterly, utterly welcome, but what I don’t see—. This is my job: my job is to challenge you and to question you about what’s going on in the national health service. It’s your job to then hold to account the health boards. What we don’t see or feel, from the health boards, is that true liaison and collaboration with the general practitioners, who are one of the two main front doors to the health service, and who are under immense pressure, and A&E, the second main front door to the national health service, which is also under immense pressure, as the Royal College of Emergency Medicine said.

I don’t hear and didn’t hear any reference to liaison and collaboration with the domiciliary care sector and with care homes, because we need them to be fully functioning and ensure that those plans are in place. What I’m basically asking you for, Minister, is for you to convince us all that you have got those seven health boards at your fingertips. They have plans—. They said that they had plans in place to manage winter pressures and that you are measuring them—measuring their ability to deliver and measuring their outcomes. I look forward to the status report that you said in your amendment you would provide, because I think that you are the only one with the big enough stripes to really hold those health boards to account to ensure that our staff are not worked so hard that they can’t cope and that our public receive the care and support they need at a tricky time of the year.

Thank you very much. The proposal is to agree the motion. Does any Member object? [Objection.] Therefore, I’ll defer voting on this item until voting time.

Voting deferred until voting time.