Questions now from the party spokespeople. Conservatives’ spokesperson, Suzy Davies.

Diolch yn fawr. Minister, phase 2 of the Regulation and Inspection of Social Care (Wales) Act 2016 is due to bite in April, and we heard in the cross-party group on nursing and midwifery last night that both commissioners and providers need to plan for this, and it will actually need some planning. We also heard that, while there had been stakeholder engagement, plans to dilute the presence of qualified nurses in nursing homes had not been shared with the public, who may now find themselves paying for a care arrangement that is not what they had expected. Can you commit today to publishing, by the end of this month, a road map—a sort of timetable of steps that you will be taking between now and April—so that commissioners and providers have some clarity? And will that include information on when you will be launching a public information campaign?

I thank you for that question, and I would be happy to provide the Assembly with a written statement in the coming weeks on the road map and the particular timescales that we have for the implementation of this part of the Act.

Well, thank you for that answer. ‘Coming weeks’ can mean anything, so I’m hoping that it will be very few weeks before you are able to do that.

As you know, the stakeholder consultation raised grave concerns about the effective removal of 24-hour nursing presence in nursing homes and moving to a remote supervision of nursing care by a responsible person, who would be a nurse, who could be covering any number of homes. In particular, we were told that it would result in increased demand on district nurses and out-of-hours provision locally if the responsible person was some distance away when the nursing need arose. I’m sure you’d agree that early nursing intervention avoids escalation of a need into something even more distressing for the individual and more expensive for the NHS. Can you tell me about any assessment that you or the Cabinet Secretary may have done of this displaced demand, and what modelling has been done to establish whether there’s any capacity for our diminishing number of district nurses and out-of-hours cover to meet that displaced demand?

I thank you for that question. We certainly were proposing to remove that 24-hour nurse requirement within the regulations because it was very stringent and very strict, and actually didn’t give residential homes the flexibility that they actually need—that we believe they need—to meet the needs of the people they care for in the most appropriate way. So, in future, the statement of purpose that care homes will provide will be absolutely critical in terms of setting out the care that they provide for the types of conditions that people will have and will require. So, I think that that is a more appropriate way of taking forward the staffing structure within the care homes. I understand that there is some nervousness about it; of course, I do. I recently went on a visit organised by David Rees to a care home within his own constituency, which was organised alongside the Royal College of Nursing. So, we were able to tease out some of these specific issues and specific concerns that the nursing profession have raised. We certainly will be taking all of those on board when deciding on the next steps forward.

That’s useful to know. That’s taking some evidence, but we haven’t gone quite the full way to an assessment of the likely impact on district nurses, which I think is perhaps something you may want to consider. But you did allude then to the staffing needs of any given nursing home, and the make-up of any team in a nursing home is critical to the success of the care it offers. The removal of a nurse on site is one pressure on that team, but another is the replacement of skills, which may be lost as people leave.

Developing the skills of existing staff, whether they are nursing assistants or healthcare support workers, is good for retention levels and personal development, but there are practical difficulties in finding time to train staff, both in nursing homes and for at-home care. This applies particularly when an individual needs to apply judgment and understand the implications of an intervention rather than being able to mechanically perform a task, if you like. How can you assure us that quality and standards are not compromised when continuing professional development is patchy due to these pressures? And how will this inconsistency in the acquisition of skills create inconsistency in individuals concluding exactly when they are now qualified enough to register?

I thank you for that question. Developing the workforce and providing public assurance are two of my personal key priorities, but they’re also priorities of Social Care Wales, which, as you’ll be aware, came into existence in April of this year. And those two issues, I think, are very much front and centre as well of their strategic plan for the next five years. And they’re very much focused on what qualifications we’ll be asking people working in the sector to have in future. There’s a consultation ongoing at the moment, or I think it’s just been launched this week or next, in terms of what qualifications we’ll be asking people in the domiciliary care sector to be having in future, because we want to have qualifications when people are registered that are relevant, and that will give the public confidence, but also we need to make sure that we maintain those soft skills, which we have so much of in the domiciliary care sector as well. People have been working in that sector for many, many years, and they have experience and they’re compassionate. They deliver good quality care; they understand the individuals. Those things are quite hard to measure, so we need to have that balance in terms of the softer skills and the attitudes and the aptitudes for the work, as well as the more formal qualifications, as we seek to professionalise the workforce in order to make the work more attractive to people in future and to give the kind of kudos and respect and career structure that we would like to see in the workforce as well.

Plaid Cymru spokesperson, Rhun ap Iorwerth.

Diolch, Llywydd. Now, too many patients are still experiencing excessive waiting times for treatment, and I’d like to focus firstly on orthopaedic waiting times in Betsi Cadwaladr health board. I have a constituent who’s been clinically prioritised as needing urgent orthopaedic surgery. He has currently waited 66 weeks for this urgent treatment and isn’t expecting treatment until March next year. In a letter I received recently from the health board, I was told that some patients were having to wait over 100 weeks. And this is not acceptable by any measure. Your predecessor was faced with a similar problem in the south of Wales regarding cardiac surgery, and took the decision at that time to outsource surgery to bring those waiting lists down. Will you do the same for people in the north of Wales to address this crisis now?

I recognise that some people do wait unacceptably long times, and there’s a real challenge in long waiters in particular in north Wales, and the ability of the health board to have the appropriate capacity, including the intensive therapy unit capacity for those people who are more complex in terms of their needs. So, it is not an acceptable position. It is a matter that I have taken up directly, obviously, with the chair; I’m in regular contact now with the chair and the chief executive. I expect the orthopaedic plan that the health board are bringing to address matters this year, and not simply to look ahead to future years when they say that the issue should be resolved. If that plan is not judged to be adequate, and I will take advice from officials here as well, then, yes, I will have to consider other measures. But that must be on the basis of what the plan is, whether it’s really credible, because I expect people in north Wales to have access to good quality and timely care, and I recognise that there are some people where that is absolutely not the case.

You described there what you’d like to see happening in time, and you’re waiting for reports; you’ll consider reports. This is happening now, people waiting over 100 weeks, and my question specifically related to what could be done now in order to speed up the waits for people who have been waiting in pain, leading to further problems with their health. You often claim that waiting times are getting better. Some of them are. If you compare with 2014 rather than 2011, the long-term trend of ever-lengthening waiting times is quite clear. You sometimes announce money for initiatives to tackle problem areas, but workforce planning failures undermine their sustainability. A year last August, you’ll remember you launched a thrombectomy service in Cardiff to treat stroke victims—the highest quality of care. In May this year, the service was stopped because of staffing problems, meaning 500 patients a year won’t now get the best treatment available. Why are other parts of the UK getting this right, but Labour-led Welsh NHS can’t?

There’s more than one part to the comments and questions that have been made, and, actually, in terms of improvement this year, I expect improvement to be made this year. I’m expecting the orthopaedic plan from the north Wales health board to be provided within the next month. That’s what I expect, and I expect that to be properly judged then as to when it will deliver action. The additional moneys that have been available are to make improvements within this year for people waiting in the here and now. That does include commissioning capacity outside of north Wales as well. It would be wrong for me to get ahead of actually seeing their plan and understanding how effective it is likely to be and giving a commitment when the issue may be resolved, but what I will say again is: if I don’t have confidence that that issue will be resolved, then I’ll need to have a different discussion about how to actually deliver improvements for people in north Wales.

On your point about thrombectomy, this is a relatively new treatment that is available and it has a potentially significant impact for people suffering from stroke. The service was commissioned in Cardiff and became active with three consultants working together as a team—that was assessed to be the right number of people for the needs of people in the whole south Wales area. Unfortunately, two out of those three consultants have now left, due to circumstances that are generally beyond the health board. The challenge has been recruiting people to fill those posts. One person has been recruited and is starting this month. However, they’ll be undertaking a period of supervision for the first four months, which is entirely normal. I do then expect further steps to be taken to make sure the service is back up to capacity. That does mean that, at this point in time, we’re commissioning additional capacity from within the English system.

It is also worth pointing out that, actually, every other part of the United Kingdom system has a challenge in meeting the need for this new service. You’ll note that, in the piece this weekend, it noted there are significant parts of England that similarly have challenges in having a fully staffed and functioning service, and, in addition, the same can be said of Scotland as well. So, this is about how we get back to a relatively new form of treatment, to commission it properly and on a sustainable basis moving forward. This, of course, is a serious priority for myself and the service.

Again, this is a message we hear time and time again, that this isn’t a specifically Welsh issue, this is a problem throughout the UK, whether it be recruitment or retention or whatever else, but we know that this is a service that is being provided in other parts of the UK. In fact, the North Bristol NHS Trust stroke lead has said that the failure to get a grip on things in Cardiff and in Wales, in particular, means that Wales is becoming the laughing stock of the international neurovascular community. I don’t, and patients and staff don’t, want people talking about our NHS in that way. Can’t you see that there is a big, big mismatch between what you and Welsh Government say, the expectations you like to create, and the reality for NHS staff and patients, who, frankly, deserve better?

You may not like to hear it, Rhun, but it’s the honest truth about where we are compared to other parts of the United Kingdom as well. You’ll note, from The Guardian piece that you quoted from, that, actually, it does set out that there are significant challenges in other parts of England as well. It is not the case to say that Wales is uniquely bad in this case. I have to say that, the comment made by the consultant in Bristol, I felt that that was particularly offensive and short-sighted. To comment on services provided by other commissions within the four nations of the United Kingdom in that way I felt was, as I say, offensive. This is a challenge that is beyond—. This is not something where the health board have caused a problem in two people leaving in a very short order; the challenge is how we actually get back, and, actually, we rely on good relationships within the Welsh system, but also with colleagues in England, and vice versa too.

There’s a challenge here about how we create a proper network to service the needs of people within Wales and we do need to work with colleagues in England to understand how we could and should do that in a way that’s sustainable for all parts of the United Kingdom. So, I look forward to a more grown-up conversation between colleagues in Wales and in England about how this developing treatment, which could have a significant impact on improving mortality and avoidable disability for people who suffer a stroke, is delivered on a generally sustainable basis. It doesn’t really matter to me whether you’re frustrated about having an honest answer about where we are, but I think the honesty matters, because, otherwise, we’re not going to have the sort of healthcare system that we want to have and the people of Wales deserve to have.

UKIP spokesperson, Caroline Jones.

Diolch, Llywydd. Cabinet Secretary, October is breast cancer awareness month and to mark the occasion Breast Cancer Now have published a new report looking at the breast cancer patient pathway, and makes recommendations to improve patient outcomes. We’re now making progress in improving breast cancer survival rates. Both one-year and five-year survival rates have increased by 1.7 per cent over the last decade. We are getting better at detecting breast cancer, but we are not always treating the cancer early enough. Referral-to-treatment cancer targets for both urgent and non-urgent routes have not been met in the last 12 months. Breast Cancer Now are calling for you to closely monitor performance against waiting times and to take remedial action. Cabinet Secretary, will you accept this recommendation and outline the steps that you are taking to meet referral-to-treatment targets?

I thank the Member for the question. This is an issue where there is genuine concern across the Chamber and within and outside political parties. Actually, the achievement in cancer services is a marker of the success we’ve had within the NHS but also of the unmet challenge that still exists. I’m pleased that you noted there’s been a significant move forward in one-year and five-year survivorship within Wales. We’re statistically in the same place as the other four nations in the UK. We also see more people being referred and more people treated, and treated within time. And that’s on the back of a 40 per cent increase in referrals in the last four years.

But the unavoidable truth is that, within the United Kingdom, all four nations are still at the bottom end of the outcomes league table with other European nations. There’s much more for us to do. Now, I don’t accept everything the Breast Cancer Now survey says, but, when it comes to the need to try and do something about screening—because, unfortunately, the screening results on breast cancer have gone down; we’re not having the same numbers of women come through—there’s a challenge for us about making sure that the message is clearly understood that early screening will help to save lives. Also about the challenges in our diagnostic capacity as well—and that is absolutely part of what we are looking to do, not just with the immediate performance moneys in this year but on a longer term and sustainable basis. And I certainly do closely monitor performance.

Referral-to-treatment and cancer are issues that every chair expects to have to discuss with me and, indeed, when services go backwards then there is extra attention provided. A good example of this has been Cardiff and Vale health board. Not that long ago, against the 62-day target, there were figures in the 70 per cents—wholly unacceptable. They’ve resolved and looked at those issues and they’re now in a much better place in over 90 per cent. The challenge for the rest of Wales is how to have the same level of understanding of their challenges and then achievement and to do that on a sustainable basis in the face of ever-increasing demand.

Thank you for your answer, Cabinet Secretary. One of the biggest improvements we can make to breast cancer care—and the whole purpose of the awareness month—is to make the public aware of the signs and symptoms of breast cancer. Detecting breast cancer early improves your chances of survival, as I know from personal experience. I’m now in my tenth year following breast cancer and I owe my life to the fact that I noticed not a lump but a dent, and the excellent staff at Neath Port Talbot hospital gave me first-class care.

Cabinet Secretary, breast cancer can present itself in many ways, so it is vital that the public are aware of the signs and symptoms. Many men don’t realise that breast cancer can affect them—54 per cent of men in the UK have never checked themselves for symptoms. What plans does your Government have to run public information campaigns on breast cancer, targeting both men and women?

I’ll check, but I’m not aware there is a particular Welsh Government plan to run a targeted campaign at men, but we do recognise that the third sector are particularly active in promoting awareness. I actually think the biggest thing that we know, because there’s evidence about this being effective on a population-screening basis, is actually to make sure that the breast cancer screening service is taken up in higher numbers in the future. We do have a challenge with men and their awareness of breast cancer—actually, men generally and their own health awareness on a whole range of issues. There is a broader challenge about not just understanding if there is a problem, but I think the bigger gain to be made is actually in primary prevention and understanding those behaviours—through diet, exercise, alcohol and smoking—where we are more likely to become unwell, including to suffer a range of cancers, and to take more ownership and control of the things we can do for ourselves.

Thank you, Cabinet Secretary. We all know that prevention is better than cure. While we can and are taking action to tackle some of the risk factors associated with breast cancer, Breast Cancer Now highlight the fact that we can’t tackle the biggest risk factors: being a woman and getting older. We can, however, take action to reduce the risk of breast cancer spreading to other parts of the body. Breast Cancer Now are calling upon the Welsh Government to improve access to preventative medicines, such as bisphosphonates. Cabinet Secretary, what is your Government doing to improve access to off-patent medicines for Welsh breast cancer patients?

Interestingly, the Member was in the room when I had a meeting on exactly this subject about six weeks ago with the Member for Torfaen and her parliamentary colleague. These are areas that we’re actively considering. We’re beginning to see that there’s more that we can do to have an evidence-led approach to making sure that the most effective and proportionate treatments are available within our service.

Question 3 (OAQ51130) has been withdrawn. Question 4, Lee Waters.