Questions now from the party leaders, and, first of all, the Plaid Cymru leader, Leanne Wood.

Diolch, Llywydd. First Minister, later today, your Government is making a statement on minimum alcohol pricing. Now, I’m aware of the public health arguments and the need to reduce deaths from cancer in particular. But public health policy should be looking at all problematic substance use. What assessment has your Government made of the impact of minimum alcohol pricing on the use of other substances, like illegal drugs?

Well, we know that there will be some people, of course, who have an addiction. It may be that there are some who then look at illegal drugs. But, for the vast majority of people, this will have two outcomes. Firstly, it will help to reduce the health issues that surround over-drinking. And, secondly, actually, it will help pubs, because it’s the pubs that suffer the most as a result of supermarket selling that undercuts pubs, which we know are important for our communities. So, there is actually a commercial aspect to this as well. But we make no apologies for wanting to ensure that we get rid of scenarios where very cheap alcohol is available to people, in a way that causes them to drink too much and therefore affects their health.

I have some sympathy with the arguments that you’ve just outlined. But from your answer it doesn’t appear as though any assessment has been made between that link, which I hope very much is an oversight, First Minister. We need to reduce drug-related deaths as well as alcohol-related deaths. Now, drug-related deaths have reached a record high in Wales and England. According to latest figures, drug-related deaths are up 44 per cent compared to 2012. For Wales-only figures, in the latest year on record, there was also an increase on the previous year—168 people lost their lives in 2015. Hospital admissions are also up, which means an increased cost to public services and to the NHS. And, anecdotally, we all know that some people are openly using drugs in public places, on our streets, in town centres, where it’s less safe both for them and for others. First Minister, can you explain how your substance misuse strategy is using devolved powers to reduce drug-related hospital admissions and drug-related deaths?

One of the problems that is faced at the moment is that the Misuse of Drugs Act 1971 has always found it difficult to keep up with new drugs as they appear onto the market Drugs like Spice—fairly new, causes people to become extremely violent. And the leader of Plaid Cymru is absolutely right—there is too much open use of drugs, and dealers who seem not to be too concerned about being caught. The first thing to do is to target the dealers. They need to be convicted and jailed—that’s where they belong, off the streets. Yes, it’s true to say that others may come forward, but it’s important to send that message.

Now, that’s not enough in itself; I understand that. How do we deal with people who misuse drugs? Well the substance misuse strategy is there to help to do that. It is a combination, to my mind, of medical intervention, but also being strong in terms of clamping down on people who supply the drugs.

Well, locking up the dealers hasn’t worked so far, and those powers are outwith your control. What you do have control over is health. Now, a harm-reduction approach has proven to be the most effective at reducing drug-related deaths. And, in your substance misuse strategy, you claim to be committed to a harm-reduction approach. We won’t know whether the actions that you’ve taken are sufficient until the new Welsh statistics come out this winter. But, of course, the Wales-and-England statistics that we’ve already seen don’t bode well.

If you were serious about reducing drug-related deaths, as well as reducing the wider social problems, you would be open to the solutions proposed by Plaid Cymru police and crime commissioner, Arfon Jones. Will you agree to meet Arfon Jones and provide the police and others with the support that they need to enable a suitably located pilot safe injecting facility, which would reduce harm to the public, as well as help to reduce unnecessary deaths from harmful drugs?

Well, there are already regular meetings that take place between the police and crime commissioners and Ministers in any event. It is absolutely right to say that there is very little point, nor would it be right, to see substance misuse as something that is a crime. There are people who have medical issues; the suppliers are different. But those people, of course, who are in a position where they misuse substances, the intervention for them has to be medical. And that means working with the police—that’s true; it’s what the substance misuse strategy is designed to do. She herself said we’re waiting for the Welsh figures, and we want to make sure those Welsh figures show that we are seeing a positive effect on substance misuse. But the challenge is always there: how do you deal with new drugs that appear, all the time, synthesised originally from drugs that didn’t exist in 1971? She’s right to mention heroin—right to mention heroin. But it’s hugely important that we work with the police and crime commissioners, as we do, and that we develop and give our substance misuse strategy the time to develop, and in that way I believe we will help more and more people to get off the substances they become addicted to.

The leader of the opposition, Andrew R.T. Davies.

Thank you, Presiding Officer. First Minister, there are pressures across the United Kingdom when it comes to the health service. In June 2015, your Government took in to special measures the north Wales health board, Betsi Cadwaladr, and, in March this year, you said that actually where deficits run out of control and problems exist in other health boards across Wales, you might well have to consider intervening in those health boards. What we’ve learnt in recent months is that the deficit has doubled in the north Wales health board, waiting times have gone up by 79 per cent—from 4,858 to 8,700—and the deficit is projected at the end of this year to be £100 million cumulatively over the three years: £50 million for this one financial year, and the previous two were £25 million. How can people have confidence that your Government is putting Betsi on the road to recovery and, importantly, that the concerns that are raised by the Member from Aberconwy are being addressed, when the statistics show that, on waiting times, on recruitment and deficit control and reduction you are missing all your own targets?

Well, this is simply wrong. First of all, to clarify his suggestion that there will be £100 million deficit, we do not expect any of the health boards to come in with a deficit by the end of this financial year, and that is a message that we make very plain to them.

Well, First Minister, with the greatest respect, in their own board papers, which I presume you have sight of and, obviously, help put together because it’s under your control, this health board, they are projecting a deficit in this financial year of £50 million. It’s not my calculation; it’s their calculation, and they say that unless there are mitigating measures and actions implemented to bring that deficit down, that deficit will exist. Here in Cardiff, you are saying that isn’t the case. Your own managers and directors in north Wales who are responsible for the day-to-day delivery of service are saying that there is this deficit. You can’t have the two working there. Perhaps it’s a cause for concern that you’re so disconnected from what is actually happening on the ground. I ask you again, First Minister, with waiting times going through the roof, with the deficit not in control and, above all, the inability to recruit and retain staff, either at GP level or within the hospitals, how, after nearly three years under your direct supervision and control, can the residents of north Wales have confidence that their health board is on the road to recovery?

They can have every confidence. As I’ve said, we do not expect the health board to be in deficit by the end of the financial year. If they identify an issue now, they must deal with it. That is their responsibility. He talks about waiting lists going through the roof and offers no evidence for that. He also says that there are problems with recruitment and retention. I can say to him that ‘Train. Work. Live.’ has been hugely successful in filling training places, particularly in terms of nursing applications as well. And, do you know, what GPs say to us—and I’ve had this from one consultant who said this to me a month ago—‘The reason why I wanted to come to Wales was I liked the recruitment campaign’, and two other words: Jeremy Hunt.

Why are waiting times that much better in the UK as opposed to what’s happening here in Wales?

Are they?

I used figures to—. Well, you say they’re not, First Minister. A&E—the 12-hour wait in England—there are 78 people waiting out of a population of 55 million people 12 hours or more in A&E. In Wales, the figure was 2,438 out of a population of 3 million. They’re not my figures; they’re your figures. What I’m just trying to seek from you, First Minister, is some ability to have confidence. I used the waiting times that your Government published last week that said that waiting times had doubled from 4,858 to 8,708. I used the deficit figures that the health board themselves have published in their board report. I’ve used the example that the health board say themselves that this deficit will exist at the end of the financial year unless mitigating actions are taken. So, everything I have quoted to you has come either from the health board or are statistics that have come from your own Government. I merely seek assurances from you, First Minister, after nearly two-and-a-half years of your Government being in direct control of the north Wales health board, that the health board is progressing to a situation where waiting times will come down, doctor vacancies will be filled and, above all, the deficit will come under control. On two occasions you have failed to give any assurances to date. I think that tells you more about your grip on reality than it does about anything else.

Well, all I can say to him is there’s been a complete abdication of responsibility towards the NHS in England. Every time a health board underperforms it’s never the fault of Jeremy Hunt, is it? Never the fault of the Conservative Government or Jeremy Hunt. Let me give him a figure that is correct so that he can mull over it: in England, the total waiting list is now the highest on record—the highest on record. That’s Tory stewardship of the NHS. There were 409,342 patients over the English target—that’s more than doubled over the last three years. More than doubled over the last three years. We know, in Wales, we’ve gone in the other direction. And he sits there and acquiesces a bung to Northern Ireland of £1.67 billion—some of it on health—and he did nothing to represent his country. [Interruption.] He did nothing to represent his country. What representations did he make to the UK Government and his colleagues to demand that Wales should get a Barnett equivalent of that money? Nothing; he’s too scared of them.

Leader of the UKIP group, Neil Hamilton.

Diolch yn fawr iawn, Llywydd. Returning to the theme mentioned by the leader of Plaid Cymru earlier on today—the Public Health (Minimum Price for Alcohol) (Wales) Bill—how can the First Minister possibly support a measure that is so regressive in the way it works? This is a measure that is explicitly designed, disproportionately, to target those drinks that are consumed in disproportionate measures by people on low incomes. It’s well known that low-income households buy fewer units of alcohol overall, but more of what they buy is priced at less than 40p per unit. Where’s the equity in a measure that leaves the champagne socialists of the posher suburbs of Cardiff unaffected, but target-bombs the beer drinkers of Blaenau Gwent?

Is he seriously saying that people on low incomes are proportionately bigger drinkers? That’s snobbery of an extent that I’ve never quite seen before, I have to say. And the consequence of his argument is that, in that case, we should reduce the tax on tobacco, because that’s disproportionately regressive as well, so let’s reduce the tax on tobacco as well. It’s exactly the same argument. What we want to do is make sure that alcohol does not get cheaper and cheaper, as it has done, so that people drink more and more, because they see it as cheap.

As I said earlier on, there’s also an issue here for the pubs. Pubs are being hammered year after year after year after year by cheap supermarket alcohol, and pubs are responsible places where people drink—they look after and don’t serve people who are drunk—and pubs are being lost at a rate of knots in our communities. You speak to any publican and they will say to you that part of the reason is that people are buying cheap supermarket alcohol, sold at below-cost price, quite often. Now, those people deserve fairness as well. So, yes, of course there’s a health aspect to this, but also, of course, as a side issue, we know that one of the consequences is that it will provide a far better level playing field for pubs as well.

I didn’t say that people on low incomes buy more alcohol; I said the opposite actually—that people on low incomes buy less alcohol overall than people on higher incomes, but more of the alcohol that they do drink is cheaper brands, not more expensive brands, so it’s going to have a disproportionately tough effect upon people on low incomes.

The Centre for Economics and Business Research said in 2009 that there’s substantial evidence, overall, that heavier drinkers are least responsive to price changes. So, the problem alcohol drinkers are the ones who’re least likely to respond to the measures that are now being proposed. What’s going to happen here is that the real problem drinkers will carry on drinking, and perhaps they’ll have less money to spend on things like food. So, in other dietary respects, their health is going to suffer. This will have no positive impact whatsoever. The only people who are really going to benefit from this are the supermarkets, because this is not a tax that is being imposed—it will just raise the price of a cheap product, and that will produce extra profits for the supermarkets. It certainly won’t produce extra profits for pubs.

Well, again, the same argument could be used for cigarettes. If he’s saying that the tax on cigarettes should be reduced because it’s regressive, let’s hear him say that. As far as alcohol is concerned, we know that alcohol has got proportionately cheaper, we know that it has encouraged people to drink more—there’s no question about that; if it’s cheaper it will do that. This is a way of ensuring that the balance is right between the price of alcohol and people’s health. I see nothing wrong with that, and it’s hugely important that we have a responsible attitude to alcohol, rather than one that says, ‘Buy one, get one free’, ‘Buy two, get one free’—and they’re not always on the cheapest brands; they’re quite often on brands that are proportionately quite expensive. That’s the way that people are encouraged to buy more and drink more. Surely, that’s not something that we want to encourage.

There is a problem with a relatively small number of people who overindulge. And, of course, we do want to target those. The problem with a measure of this kind is that it’s so scattergun in its approach that it actually penalises the many who are moderate drinkers whilst not actually having any measurable effect upon those whom we do want to help.

I don’t follow that logic. The same logic applies to cigarettes. He could stand up and he could say, ‘Well, it penalises the occasional smoker, and so the duty on tobacco should be reduced.’ The two things have the same kind of effect. Look, for me, it’s hugely important that, as a society, we don’t have alcohol being sold below cost price—and it happens in some of the offers we see in supermarkets—and we don’t have people being encouraged to buy more alcohol than they otherwise would want to buy. That encourages people who would otherwise be quite moderate drinkers to drink more than is good for them, and that is something that we’re keen to avoid.

As it happens, as a side effect, it also enables pubs to be able to compete on a level playing field with the supermarkets that have driven so many pubs out of business. Don’t talk to me, talk to publicans and they will tell you this. The difference in price, proportionally, between supermarket alcohol now and alcohol in pubs is far, far greater than ever it was before. We need to make sure that people have a place to go in villages where they live, through pubs, for example. This is not what the intention of the legislation is—the intention is that it’s legislation that deals with health. But there are, of course, wider effects that are identified.