Questions now from the party spokespeople. UKIP spokesperson, Caroline Jones.

Diolch, Llywydd. Minister, whilst in Bridgend last week, I was contacted—spoken to—by a constituent whose neighbour was released from hospital just days after suffering from a stroke, yet they didn't have, again, any care plan in place. The individual concerned had no family nearby and was left to fend for themselves. Unfortunately, this constituent's situation is far from unique, as five weeks ago, I reported on someone who had a triple heart bypass in the same situation at the age of 83. I have been made aware of many, many instances where patients are discharged from hospital without the appropriate care plan and ongoing care in place, forced to rely on the kindness of their neighbours because the state has let them down. Minister, what steps is the Welsh Government taking to ensure that all vulnerable discharged patients from hospitals have a care plan in place?

Well, thank you for that question. Can I say, first of all, the individual items of that case, if you want to bring them to my attention, either write to me, or, if you want to meet with me, I'm more than happy to discuss them, and see what can be done in that individual case?

One of the biggest factors in front of us is the issue of delayed transfers of care, of course. I don't know whether that was a material factor in this particular instance, but, certainly, we are aware that, in the ABMU area, in particular, the significant increase recently was a result of delayed transfers of care, and I wonder if that hit on to the impacts. But I'll have a look at the individual instance you refer to, and we'll see what can be done.

Thank you for your answer, Minister. Of course, the Social Services and Well-being (Wales) Act 2014 is supposed to transform the way social care is delivered, and ensure everyone who needs care gets care. Unfortunately, this isn't always the case. Not only are we seeing patients sent home without anyone to help meet their care needs, but we also have large numbers of patients in hospital far longer than they need to be, because they have no ongoing care package. The latest delayed transfer of care statistics show 462 people in hospital far longer than they need to be. The majority of these patients spend around a month longer in hospital because there is no community care available, or there is lack of care home spaces. Minister, it is a well-known fact that the longer these patients spend in hospital, the longer their recovery will take.

What is your Government doing to eliminate delayed transfers of care?

Well, again, I thank you for that further question. And it is a real issue, and it's an issue that we're investing both expertise and competence but also funding in, and working with health boards and local authorities on the ground. We have seen an increase in the August period, and it's an increase that we hadn't seen in the previous 18 months. And two of those areas were ABMU—Abertawe Bro Morgannwg—and also Hywel Dda. So, we're directly supporting local authorities in their efforts to secure additional service capacity, and to make, I have to say, more effective use of the provision that is already available. And part of this is joined-up working in those regions.

We do expect health boards and local authorities to continue to work in close collaboration, making the best possible use of the intermediate care funding that we've made available, to ensure that improvement is sustained, and that capacity issues are addressed ahead of, as we all know, the forthcoming season of winter pressures. There is some optimism here, however, because we do have some areas that are doing well in this area of delayed transfers. So, in the Powys health board region, for example, delayed transfers of care continue to be lower than historical levels, and there have been issues before, despite periodic fluctuation. And the latest published figures, in September, show a 31 per cent reduction in delays in comparison with the previous months. So, it does show, within the existing capacity on the ground, things can be made to work, but it takes some joined-up thinking.

Thank you for your answer, Minister. We are well aware that social care is facing increasing demand. Unfortunately, we are not meeting that demand. This is highlighted all too clearly by Age Cymru's recent 'Care in Crisis' report. Age Cymru found that older people in some parts of Wales were not getting the required carers assessments, and that there was huge variation between local authorities. The social services Act was supposed to end the postcode lottery of care, but we are still finding that some local authorities are better than others in delivering this package.

Minister, what more can your Government do to ensure that local authorities fulfil their duties under the Act, and ensure that budget cuts do not impact upon their ability to fulfil these duties? And I would also like to say that, whilst monitoring this situation across my region, I have noticed within the region different standards of care being given to elderly patients, and I'd like to speak to you at some time about it.

Thank you.

Thank you, again, for that supplementary question. And, as we discussed in committee earlier this morning, there is a great deal we can do within existing resources by acting more cleverly. And that includes the use of regional partnership working to jointly commission services, it includes the use of pooled budgets, so that we can share what the priorities are across a region rather than trying to do it on a piecemeal basis, and there are many other things, including the ICT fund, that can be used to do these things. But, ultimately—as I was in the committee this morning, and the Cabinet Secretary was—we have to be quite frank as well: there is no new pot of money. We work within the constraints that we have, and I know that, by the end of 2019-20, the Welsh resource budget will be 7 per cent smaller. It will be a £1 billion smaller than it was in 2010, and, of course, the capital spending is 7 per cent smaller. That's the reality in which local authorities, other providers on the ground and ourselves have to work, but that doesn't mean we shouldn't give up on working cleverer with regional partnerships, pooled funds, in order to make a difference to people's lives. 

Plaid Cymru spokesperson, Rhun ap Iorwerth.

Diolch yn fawr iawn. Plaid Cymru has long put the case for training and recruiting 1,000 extra doctors in Wales, but, given British Medical Association estimates on the numbers of just GPs that we need in the coming years, maybe we've underestimated the figure. Do you think it's time for Plaid Cymru to look at that 1,000 doctors figure and review it upwards, and what is your Government's assessment of the number of doctors we'll need over the next, say, 10 years, and how many of those we'll need to train in Wales?

I thank the Member for the question. We will continue to discuss not just doctor recruitment and doctor numbers, but all of our healthcare professionals and how they work together. I think it's a mistake to simply look at one group of professionals in isolation to others, as we progressively talk—[Interruption.]—as we progressively talk about, for example, changing the way in which hospital services work, moving more care to become local, as work progresses within local healthcare clusters, as we have GPs working in different numbers with different groups of professionals. So, we need to constantly look at and review the numbers of people we wish to train and recruit within our healthcare system, and, of course, doctors play a hugely important role within our healthcare system. 

The creation of Health Education and Improvement Wales has been a deliberate choice that we have made, based on a well-understood review, to bring more intelligence to the numbers of different healthcare professionals we need to recruit and we need to train. That is why Health Education and Improvement Wales will come into being in April of next year, and I look forward to having a more rounded conversation about all of the different healthcare professionals we will need to continue to have in a well-functioning and high-quality compassionate national health service. 

Okay. I didn't hear a number there. We're sitting quite close to each other; I'd have thought you would have heard that I asked specifically about doctors, not other health professionals, in this particular question. And thank you very much for pointing out the fact that doctors do play an important role within the NHS. If it is the case that you don't know how many additional doctors specifically we're going to need, it's no wonder that we are facing such a workforce planning crisis here in Wales. I was prepared to admit perhaps we'd got it wrong and that we need far more than 1,000 doctors. We need a minimum of 1,000. We need a minimum of 5,000 nurses. We have shortages, you're quite right, across the workforce. That's why we need to increase student numbers across the NHS workforce, why we need a new centre for medical training in Bangor, why dentists and pharmacists, incidentally, are saying to me 'Can we have some more training places in the north too, because we need them?' Figures published by the BBC last month showed that in this financial year we're seeing more people leave the NHS than are joining, leaving us with around 150—250, excuse me—fewer staff. Will you admit that we're going backwards?

We have real and significant challenges, and it's pointless to pretend that we don't. I regularly say that, both in this Chamber, in private conversations with healthcare professionals, with Assembly Members, and in arenas where I give speeches and answer questions. And I think it's really important to be consistent and to be mature about this in the way I approach my job. That's why I won't engage in an artificial search for numbers, because we have to understand what we are going to expect from our healthcare system and how we expect it to behave. The parliamentary review, for example, will help us and set challenges for us about the future way in which we expect health and care to be delivered. Obviously, then, the choices that we make in the Government about the future health and care strategy moving forward will affect the numbers of healthcare professionals that we need. And that's why I don't want to get tied down into one single group of professionals as opposed to others. And I deliberately answered your question in that way. We could have a bit of back and fore and look at the semantics between us if we wanted to. I don't think that's particularly useful. I'm much more interested in having a proper, grown-up conversation about the future of the national health service, it's intertwined relationship with social care and other partners as well. And that must be the right way to behave, not just in the Chamber, but in the way that I go about my business.

And when we think about, for example, the way in which we are making real progress with the range of recruitment challenges, we're investing more than ever before in nurse recruitment, more midwives are being recruited, and we have an at least 91 per cent fill rate in our GPs. And the First Minister indicated yesterday that I will update this place on the continued progress we've made in that area in the coming days. So, there is real progress being made, but there are real challenges. I would much rather be honest about that rather than engage in banter in the Chamber and a search for numbers that may not exist in the robust way in which they could and should do if we're serious about the future of the health service.

Llywydd, earlier you challenged a colleague of mine to come to a question; perhaps you could challenge the Minister to come to an answer.

Let's try one perhaps on which we can agree. Another worry for staffing is our departure from the European Union. A British Medical Association survey suggests that 45 per cent of EU doctors working in the UK are considering leaving—another reason perhaps to upgrade our 1,000 doctors figure. But, with this threat to the NHS workforce, I would imagine that you would want as much of a say as possible on the terms of leaving the European Union. Now, in the Houses of Parliament last night, all bar one of Labour's MPs failed to back a Plaid Cymru amendment calling for the Assembly and other devolved Parliaments to have a say in the European Union (Withdrawal) Bill. Do you share my bitter disappointment at that and do you share my fear that that doesn't bode well for getting the right, for example, to have our own NHS work permit system here in Wales in order to address our own NHS workforce needs?

We've set out the position of this Government in relation to Brexit; we've set out the position that this Government takes in relation to wanting to have a more grown-up conversation with the United Kingdom Government about the realities of Brexit and the damage that it could do if it's pursued in its current shambolic form by the UK Government. I make no apologies for sticking to the policy of this Government and highlighting the concerns that we do have, not just on the national health service, but on a wide range of sectors of public life, public service and the economy.

The General Medical Council and the Nursing and Midwifery Council have both indicated the number of reductions in people going onto the register from the European Union in the nursing workforce and well-founded fears about the doctor workforce, about people actively considering their future. I'm determined to make the case, with the rest of this Government, for a rather more sensible approach to Brexit, and I sincerely hope the United Kingdom Government finally listens and recognises reality.

Conservative spokeperson, Suzy Davies.

Diolch yn fawr, Llywydd. Cabinet Secretary, your retained responsibilities after the reshuffle include research and development in health and social care, despite having a social care Minister who oversees the work of Social Care Wales. In assessing your budget priorities, you've elected to cut the money available for that research. What current and future research is likely to be compromised by this decision? Is there an effect on Social Care Wales, who were keen to do some research, and will any of your current research partners' own funding be compromised as result of reduced funding from here?

There are two things that I'll say. The first is that we think that we can manage some of the reduction without impacting on current research activity. It will affect some of our relationships within the United Kingdom architecture around health and care research, but we think that we can manage. But it means that there are things that we may not otherwise be able to do. The challenge, though, comes back to my second point, which we made in committee today. There is no consequence-free choice to make in having trade-offs within departmental budgets and across departments as well. The reality of a significant and continuing reduction in the real-terms budget available to this place means that budget reductions are being made in areas we'd much rather not do. So, this is just one of those areas. It was not a pleasant choice, not a choice that I enjoyed making, but that is the reality of being a Minister in the Government at a time of continuing austerity. I sincerely hope that your colleague at No. 11 Downing Street sets out a different course for public expenditure for the sake of every single part of the United Kingdom, but I do not hold out significant hope for an alternative view for the future.

I must admit I was sincerely hoping for an answer as to what exactly you are going to cut in terms of research—not necessarily the amount, but which forms of research are now going to lose out. What exactly are we going to not see being done? Which partners are possibly going to lose their funding as a result of our decision? And just one example would have been fine for that.

I'll just move on now to the proposals to move health services in the county borough of Bridgend from Abertawe Bro Morgannwg University Local Health Board to Cwm Taf Local Health Board. That would naturally affect social care provision. The Western Bay health and social care programme is currently made up of ABMU, as you know, and the three local authorities in the same footprint.

Cwm Taf already provides some mental health cover for ABMU patients, but I think it's pretty unlikely that the whole of Cwm Taf is going to end up in the Western Bay programme. So, what preliminary thoughts have been aired about the relationship between Cwm Taf and the Western Bay partnership, particularly on the imminent question of pooled budgets, which of course have to be decided by April next year?

Indeed. On pooled budgets, I indicated in health committee today that we need to take a pragmatic view about Bridgend's place in pooled budget arrangements. It would not be sensible for us to require Bridgend to become involved in a pooled budget relationship with Neath Port Talbot and Swansea councils and the ABMU health board. At the same time, we are consulting on moving them into the broader Cwm Taf footprint. That is the one area where I will need to take that decision, given the constituency interest of the Minister, but it will affect the way in which we now expect Bridgend to be an eastward-facing authority.

There will be a formal consultation process that will start next month. That was agreed with the then Cabinet Secretary for Finance and Local Government, and my colleague the new local government Secretary and I still expect that consultation to go ahead next month, as we continue to take practical steps for the move to be made in the Bridgend area.

We'll need to think about what stays exactly the same, and patient flows, and we'll need to think what needs to change in the way that Bridgend will become more part of a partnership with Cwm Taf authority when it comes to social care. So, there are changes to be made. We think this is the right thing to do, and that's why we've said we're minded to do it, and I look forward to the 12-week consultation and hearing more broadly from the public and of course staff in all of the organisations affected.

Thank you for that answer. Of course, I understand the rationale behind it. I'm hoping at some point that you'll be able to give perhaps some guidance to Bridgend County Borough Council in this sort of hiatus to ensure that progress on social care isn't jeopardised in any way, because they have been making progress there.

Just finally, we're all aware, of course, of the pressures on the numbers, because of the number of GPs that we don't have in Wales. Earlier this month, the out-of-hours service in Bridgend was closed for certain periods over two nights because there was no local GP to offer the service. During that period, 33 patients from Bridgend contacted the service and had to be referred to the Morriston helpline instead, which ended up advising four admissions to an accident and emergency department. How much of an issue is it for GPs that they're having to provide out-of-hours cover locally as well as doing their day job? Does it affect where they choose to practice?

As you will recall, in the mid 2000s, a change was made to the way the out-of-hours service was structured. So, GPs now opt in and are not required as part of their contract with the national health service to undertake the out-of-hours function. Part of our challenge is understanding how many GPs we need to make the service more stable and secure, and there are challenges across different parts of Wales and the UK in having an adequate number of GPs undertake that service, together with, as we more and more understand, other healthcare professionals.

So, the roll-out of the 111 service across the ABMU area and now into Carmarthen as well is actually really helpful in use and in understanding the different numbers of people who we expect to be there—having the clinical leadership of GPs, of pharmacists, nurse practitioners, and, indeed, the advice that call handlers can give. So, we have understood the need to change our out-of-hours services to make them more robust, to make them more appropriate for people requiring help and support, and I expect the 111 project to roll out across the country, the pace of which is something that I'll need to determine based on the evaluation of the earlier pilot. But I do expect that will give more stability to out-of-hours services not just in Bridgend, but a footprint and a way of working for the rest of the country too.