Questions now from the party spokespeople to the Cabinet Secretary. The Conservative spokesperson, Suzy Davies.

Thank you again, Llywydd.

Gweinidog, diolch yn fawr iawn am eich datganiad ar gyllid gofal cymdeithasol a gyhoeddwyd y bore yma. Yn wyneb y £2 biliwn ychwanegol a ddaeth gan Lywodraeth Geidwadol y DU ar gyfer hyn, rwy’n credu ei bod yn bwysig eich bod wedi gwneud datganiad cynnar yn nodi eich bod yn barod i ymrwymo arian rydym wedi’i gaffael drwy gyllid canlyniadol Barnett ar gyfer yr un pwrpas, ac felly rwy’n croesawu hynny. Rydych eisoes wedi cyhoeddi arian ychwanegol, wedi’i anelu, rwy’n credu—mae’n ymddangos i mi, beth bynnag—bron yn gyfan gwbl tuag at y gost ychwanegol o ddarparu’r cyflog byw cenedlaethol; yn amlwg, rwy’n cefnogi hynny. Ond mae’r £9 miliwn newydd o gyllid canlyniadol Barnett rydych wedi’i gyhoeddi heddiw i’w weld wedi’i anelu at yr un diben yn union. A yw hynny oherwydd bod eich dyraniad gwreiddiol yn annigonol, neu a oes gennych ffigurau newydd sydd wedi dangos bod y costau hyn yn uwch nag a ragwelwyd gennych?

I thank you very much for the question and for the warm welcome that you have given to our additional funding and additional investment in social care in Wales. And, just for the benefit of Members, the additional funding that I announced today did include that extra £9 million to help meet the pressures of the national living wage within the sector, but also a further £8 million to support work to prevent children from entering care and improve outcomes for those who are in care, and also £3 million to local authorities to support respite for carers, given the crucial role that we know that carers play as well. The domiciliary and residential care workforce has a crucial role in society and we have been concerned at the level of turnover within that sector, which is around 30 per cent in some areas at the moment. So, the aim of the funding is to allow local authorities to invest, and providers to invest, in their workforce—to raise the pay, obviously, that their workforce receives at the moment, but also to look at what more we can do to keep people in the sector as well. So, it’s investing in skills and investing in the individuals more widely as well, ensuring that people don’t have to pay for the clothes that they wear to undertake their role, and so on.

So, the additional funding was made because we’re able to do it because of the extra money that we had through the consequential funding, and it’s welcomed by local authorities. I’d add as well that we have written to local authorities because this is grant funding in this first year. So, we’ve set out quite clearly to local authorities what we will be expecting them to achieve for the sector through the additional funding that we’ve made available today.

I’m very grateful to you, particularly for the last part of your answer there. As I say, I’m more than happy to welcome everything that’s in the statement, but, obviously, I’m going to be scrutinising you on how well you are watching how that is spent. The £3 million given to local authorities for respite, obviously, and particularly in view of what we were talking about here yesterday, is very important. It’s an area where provision is particularly weak, and I’m very keen to know what you’re going to do to make sure that that is spent on front-line respite provision and that it doesn’t get eaten up in procurement or commissioning processes, which do have a tendency to eat up money, particularly when it comes to respite for social care, where we need every single penny.

I prioritised respite for carers because this is one of the areas that carers repeatedly tell us that they need more support in, and we need to look after our carers to ensure that they’re able to continue to look after the people who they care for in return. So, I will be working up the specific details in terms of what we will be requiring from local authorities with regard to the funding for respite care particularly, and, again, that will go out through grant funding, with specific requirements on local authorities as to what we would expect them to see for that money, and for support for carers locally as well, because we absolutely are clear that this has to make a difference for carers on the front line, who will be in receipt of respite, to, as I say, enable them to continue the important role that they do.

Well, for that very reason, I’m very pleased it hasn’t gone into the revenue support grant, so I do thank you for that. Could I ask you: do you welcome the Prime Minister’s announcement of a statutory right for leave for those with caring responsibilities?

When you initially see that there’s a right for carers to have statutory leave, fantastic, and then you see it’s an unpaid year off work, and then you realise that that is going to be completely out of the reach of most people who are carers, unfortunately. I don’t know many carers who can afford to take a year off work, and it just seems again that it’s a Conservative policy from the UK Government that is an empty promise, but which also benefits those who have, and so benefits the few, not the many, in the sense that only the highest-earning people and those who are in families that are already wealthy are going to realistically be able to take a full year off work completely unpaid. So, in that sense, I don’t think it will be taken up by huge amounts of people in Wales. So, what we do need to do is ensure that the respite care, and the things that are in our gift in the Assembly to deliver, really do meet the needs of carers right across Wales. And, actually, we know as well that carers find it very difficult to find employment anyway, so many carers are out of work because of the nature of the caring responsibilities they have. So, there’s a role for us as well to look at what we can do to make employers in Wales more carer-friendly, more flexible, to allow carers to return to work. And we’re also looking at interesting projects to see how we can perhaps look at whether or not carers are able to access some kind of accreditation for the caring work that they do. So, it might be that, at a point in the future, they’re able to use the experience and expertise that they’ve gained as carers to take that step, then, into paid employment in the caring field.

UKIP spokesperson, Caroline Jones.

Diolch, Llywydd. Cabinet Secretary, I welcome the nurse recruitment campaign and the news that the Welsh Government is to retain the student nursing bursaries for another year. We need to do all we can to encourage people from all walks of life in Wales to consider a career in nursing. What plans does your Government have to extend the nursing bursaries in the future to ensure that Welsh residents considering a career change can afford to train as nurses?

I welcome the support provided for the NHS bursary, provided not just for nurses, but a range of other allied health professionals, to help them through their training. We recognise, given that the average age of a nurse in training is in their late 20s, that they’re likely to have ties to a local area and they’re likely to have responsibilities. Taking away the financial support, as has been done by the United Kingdom Government across our border for those people training in England, has a serious and significant effect. We’ve seen a significant drop—24 per cent—in the people applying for nurse training across the border as a direct result. We made a choice, based on the evidence, to support people undertaking healthcare courses, including nurses, and it was very well received when I attended the Royal College of Nursing congress in Liverpool on Sunday and Monday. This Government will provide not just the direction of travel that we’ve been very clear about recently, but a fuller and more comprehensive long-term approach to supporting people undertaking healthcare education, when we announce our full and final response to the Diamond review in due course.

Thank you for that answer, Cabinet Secretary. While the nursing recruitment campaign can help address short-term staffing issues, we need to think about the longer term and how we can encourage more Welsh people, particularly Welsh speakers, into nursing. UKIP would like to see the reintroduction of the equivalent of the state enrolled nurse, which would allow healthcare assistants and others to train as nurses without requiring a degree. What consideration has your Government given to the reintroduction of some form of enrolled nurse into the Welsh NHS?

Well, I welcome the recognition that the ‘Train. Work. Live.’ campaign is a positive step forward for nursing in Wales. It’s had an incredibly positive response at the outset from the current nursing workforce, who are very proud to see themselves being highlighted and featured—the four individual named and photographed people are nurses with different career routes, and that’s been very much welcomed by the current nursing workforce. They recognise the focus of attention and, if you like, some hope for the future and a deliberately different approach here in Wales.

This Government does not support a return to a state enrolled nurse role, partly because we have spent significant time and effort working with the nursing family to develop a career path and a development path for healthcare support workers. In fact, the Member for Merthyr Tydfil and Rhymney behind you was part of the conversation in her previous role about developing that career path and development. We also see a number of healthcare support workers undertaking training from their current role into nursing, so they’re still undertaking work as well. That’s part of the flexibility we’ve provided, to make sure that that can take place so that those people who are in work with responsibilities can still carry on working whilst undertaking their nursing qualification. There is no support from representatives of the nursing workforce for us to remove the status and the requirement for nursing to be a graduate career, and I’m happy to listen to those people about how we develop the very best nursing care from the whole nursing family, and we do properly value and support the role of healthcare support workers.

Thank you, Cabinet Secretary. Finally, we not only have to recruit more nurses, but we also must ensure that we retain our existing nurses. According to the RCN, nurses in Wales often do not feel valued by the NHS or the Government. There has been a 14 per cent real-terms fall in nursing pay since 2010, and 69 per cent of nurses work overtime at least once a week. What plans does your Government have to improve nurses’ pay, terms and conditions and ensure that they have access to continuous professional development in order to reflect how we, as a nation, value the profession?

I recognise the points that are made about the feelings of a number of people within the nursing workforce. Part of what we’re doing to retain people, of course—those people that are training—is not just support with the bursary, but also the fact that that comes with the expectation that people will take up the offer of two years of employment here in Wales, so people will continue to work within Wales as well. We actually have pretty good retention rates, as well, for people who actually complete their courses.

On the broader point about the 14 per cent fall in the real terms of nurses’ pay since the Conservatives came in to lead the UK Government, the reality is that the direct imposition of a public sector pay cap is a real barrier not just for nurses, but a whole range of public sector workers. I would dearly love to be in a position where we had a different approach taken. You will recognise, of course, that there are different manifesto pledges being made outside of this place ahead of the general election, and my party on a UK level has to pledge to break the public sector pay cap if we return to the UK Government. That is good news for nurses. We would be able to properly value them and recognise in their pay the real support the public have for them.

But, in terms of your point about nurses not being valued by the Government, I can confirm there is a radically different approach and understanding for nurses here in Wales compared to across our border, and that point was made plain to me on a number of occasions forcefully, clearly and politely by nurses, both in Wales and in England, who I met at the recent Royal College of Nursing congress in Liverpool. So, a good story for us in Wales. There’s more that we could do if only we had a UK Government on the side of Wales.

The Plaid Cymru spokesperson, Rhun ap Iorwerth.

Diolch, Llywydd. Now, last week was Mental Health Awareness Week, and, though that’s been and gone, we’ve got to keep the issue’s prominence, of course, on our agenda.

Last week, I raised the issue of mental health services in the north of Wales with the First Minister, in particular the number of mental health patients who had been sent out of north Wales, hundreds of miles away from their families, including children. The First Minister’s response was that he didn’t accept the figures. Do you accept the figures?

We know that there are a number of people who are being sent out of area. We’ve seen a significant improvement in the number of people going out of area for treatment. Some of those people will go out of area because they require specialist support that is not available in Wales—we don’t have the number or the ability to commission and provide that care directly in Wales. Some people are still, though, going inappropriately out of area, but we’ve made significant progress on this issue over this year. So, for example, there are now single-digit numbers of children going out of area for placements. I accept that, for each person where there’s long travel to go to an appropriate placement, that would be a real issue for them, their family and their loved ones. The point is, though, there is real progress that has been made over this last year, and we expect further progress to be made in the years to come.

So you keep telling us. Some of the figures that the First Minister didn’t accept this week were that waiting times for CAMHS haven’t improved. He claimed things had moved on significantly. We all know that if you want to demonstrate improvement, you simply take the month where figures were at their worst as your starting point and compare with more recent ones and, unless the performance is worse, the maths will show an improvement. That’s what the First Minister did yesterday. In reality, an honest look at CAMHS waiting times shows that, prior to July 2013, the percentage of children waiting over 26 weeks never went above 10 per cent. Then, waiting times skyrocketed to 36 per cent waiting over 26 weeks in September 2015, before, yes, recovering to the current level of 20.5 per cent in February this year, which is when we have the most recent figures. An improvement in a period of time, but not overall. Do you accept that this is a more accurate reflection of the performance of CAMHS, and when will you accept that the First Minister or yourself simply standing there saying that targets are being met is a long way from the reality faced by desperate staff and desperate patients who share with us as Assembly Members their experiences?

Well, I would hope that we could have a searching but reflective conversation about this, and I’m disappointed by the tone that is struck. I don’t try to avoid scrutiny at all, but the reality is that, when looking at the period over the last few years, we’ve seen a significant rise in the number of referrals and the ability of our system to cope. There was a time when people were waiting significantly longer than they should have done, and some people do still wait too long—we have a backlog to clear—but we have made undeniable, real and significant progress. The investment decisions made over the last couple of years have made a real difference for families entering into the CAMHS system. There’s additional focus on the support that should be available outside of the CAMHS network, as well—the progress of Together for Children and Young People. There is real progress being made, and I don’t deny your right to scrutinise me, I don’t deny your right to ask difficult and awkward questions, but I do wish they could be a more reflective and a more accurate picture of the progress that really is being made. And when we see—. We’ll have figures out tomorrow across a whole range of NHS services, but NHS health boards have committed to meeting the waiting time standard for people who should be seen within 28 days of referral. They say they are confident that they will meet that standard, and I look forward to seeing the figures published, to see if they have done that. I will certainly hold them to account. There will be no lessening in scrutiny or expectation from Ministers in this Government, to make sure that people are seen appropriately and by the right service.

But people aren’t stupid; they know when people are being selective with figures. There’s clearly a shortage of staff in mental health, and I hope that you would agree with that. Another area of health workforce where we have shortages is among GPs. It’s a Wales-wide problem. It’s one of the reasons to support Plaid Cymru’s pledge to train and recruit 1,000 extra doctors. Now, patients in Burry Port are the latest to hear that they have to leave the area to see a GP, due to the closure of a surgery. The Member for Llanelli has been typically lively on the backbenches today. I do understand that local Labour politicians are protesting against this. Will you be joining them, I wonder, in their protest, as I seem to recall the former education Minister doing, against the closure of a school in his constituency? Or will you own up to the fact that it’s Labour’s, Welsh Government’s failings in workforce planning that has led to this shortage of GPs?

The honest and mature approach that I thought we would have to discussing healthcare in the future, which was taken by the parliamentary review, of course, doesn’t exist when it comes to ministerial questions. The reality is we are recruiting more GPs. We are training more GPs in Wales. We’ll have a more successful approach in the future. The Train, Work, Live campaign has been significantly successful in us actually having more GPs coming into Wales. I expect to see, as we make commissioning decisions in the future, that we will properly take account of the workforce planning that we need to do, in a much more joined-up way. There has been real improvement in this area.

Now, when you then talk about 1,000 extra doctors as the answer, well, that’s what we’d politely call an aspirational target—not a real or an achievable one. In this position, in the Government, you have to commit to things that will make a difference. That’s what I’m doing in this, and I’m proud of the fact that we are making a real difference for people right across the medical workforce here in Wales. And I say that every Member is entitled to stand up for their local community and ask awkward questions of health boards and me. That includes the Member for Llanelli, who is standing up for his community and asking what arrangements will be in place for the future of primary care. I don’t complain about that from any Member in this place, and nor should I. That’s people doing their job. I just wish we could have a much more honest and grown-up conversation between ourselves in this Chamber, as well as outside of it.