Questions now from the party spokespeople. I call first on the Conservative spokesperson, Angela Burns.

Diolch, Presiding Officer. Cabinet Secretary, in 2009, the Welsh Government supported the national inflammatory bowel disease standards, which recommended a minimum of one and a half whole, or full-time equivalent, inflammatory bowel disease nurses per 250,000 of the population. Could you please tell me how you're getting on in meeting this target?

You have me at a disadvantage, and I won't pretend to have the figures off-hand.

Well, if nothing else, I praise you for your honesty. Now, according to figures obtained from Crohn's & Colitis UK, in 2016, there were only 16 full-time equivalent specialist IBD nurses working across Wales. My own health board of Hywel Dda only has one IBD nurse and Betsi Cadwaladr has only got two and they have to cover a vast region. What are you going to be able to do to address this geographical deficit, which leads to patients often having to travel outside of their health boards to obtain treatment? 

I'd like to come back to how we have the most appropriate service possible. I actually spoke at an event organised on IBD in London in the past, which was organised with a range of people from across the UK to look at what we're doing, and I recognise that I do know that we don't have the number of specialist nurses that we would ideally wish to. But it's still about understanding how many specialists we could, should and will get, what that means in terms of workforce consequences in other places, and even if we can't have the number of specialist nurses we would ideally want to, how do we still, nevertheless, provide the very best possible care. I'm more than happy to undertake to come back to the Member directly about the current position and what improvement plans are in place within the service as well.FootnoteLink 

Information further to Plenary

Thank you for that. I think it's really important, because you as a Government have agreed to meet a certain set of standards and, some years on—let's be frank, it's eight years on—those standards are nowhere near being met. Rather than having 16 full-time nurses, we should actually have 30 of those full-time nurses. Inflammatory bowel disease is a horrible set of conditions. It taxes people, it makes them very, very ill and they've struggled to know how to cope, because it's very visible—or they feel it's very visible—it's very embarrassing and it's one of the diseases nobody ever likes to talk about. If we can look at how we can drive specialist help for those people—one nurse for every 0.25 million people—it doesn't seem too much to ask. I'd be very grateful to you if you had a good look at this and provided us with an update, as 2009—that was a promise made a long time ago. 

If I may, in providing a response, I'll look not just at specialist nurses, but more broadly at how we help people to manage their condition, to understand not just at the nursing end but a range of other issues like, for example, diet support we do give to people. It's a relatively common condition actually and a number of people suffer at various points in their life, including staff within our health service who will be managing it. You're right: lots of people don't want to talk about it, as they feel stigmatised and embarrassed about the condition. So, it is something that I recognise as an issue for our service and how we appropriately meet the needs of people who do have the condition. So, I'll be more than happy to come back to you on the whole service, where we are and what our expectations and aspirations are for the future.   

UKIP spokesperson, Caroline Jones. 

Diolch, Llywydd. 

Cabinet Secretary, despite just over 3 million people living in Wales, our accident and emergency departments were visited more than 1 million times in the past 12 months. There has been an increase of around two thirds in the numbers of people waiting more than four hours in A&E, and the media have reported that one senior doctor saw examples of people waiting for 80 hours. Difficulties accessing primary care services is often the reason for A&E attendance. Cabinet Secretary, what is your Government doing to improve access to out-of-hours GPs and what consideration have you given to using digital technology to improve access to primary care? 

I'm happy that Caroline Jones recognised this as a whole-system issue. This is not simply about saying that accident and emergency departments need to either run quicker or faster or more efficiently and that it's just about a hospital issue. It's actually about flow all the way through our healthcare system. So, it's about how we prevent people going unnecessarily into hospital, whether it's a minor injuries unit or a major department. It's about whether people do need to be there, about how quickly they're able to either be seen, treated and discharged, or, if they do need to be monitored, about that taking place, but also the flow through the hospital.

In terms of our use of information technology, well, actually we've just had a soft launch of A&E Waiting Times Live—a pilot done last year in north Wales. It was particularly helpful about helping people to direct themselves to the most appropriate point in the system and to give an indication of likely waiting times at different places. But, more than that, there is the work that is already ongoing at looking at how we anticipate care needs throughout the whole year—not just in winter—in trying to direct people at the most appropriate service. It isn't just about the out-of-hours primary care service; it's still about the regular hours service as well. But I'm also particularly interested in the learning we'll take from 111, with a relatively successful pilot in Abertawe Bro Morgannwg and Carmarthenshire, because that is partly about out-of-hours but also a much wider suite of issues and equally a constant challenge to try and inform and empower the public to make different choices about how they wish to access care and the most appropriate place for that care to take place.

Thank you for that answer, Cabinet Secretary. In just over 10 days, the NHS will once again experience the miracle of Christmas, where the wards are empty on Christmas eve but fill up again on Boxing Day. If we are to avoid the scenes witnessed in previous years that saw ambulances queued up outside A&E, we have to reduce demand on our urgent care system over the festive period. Cabinet Secretary, how can we further highlight the Choose Well campaign and encourage the public to utilise community pharmacies for minor ailments, and how can we ensure that local health boards publish information about availability of pharmacy services over the Christmas period?

Thank you for the questions. Again, part of our challenge regularly is how we reduce demand and redirect demand. There's a significant amount of work that is already ongoing, and not just the seasonal Choose Well campaign. Part of that this year is looking at My Winter Health Plan for those people who are particularly vulnerable and more likely to appear in our accident and emergency departments throughout the winter. So, actually, Age Cymru have been particularly helpful, and a range of others, in promoting the idea of having a plan for that person and their care and to understand what their care needs are. That's already proving popular in terms of people understanding how they can help people to understand their care needs in order to keep them in their normal place, but if they do need to go into a hospital setting for their care, how much more quickly they could expect to be turned around and for people to understand the information about them.

I recognise and I'm pleased to highlight the additional services we're providing through pharmacies in Wales. We made a deliberate choice on the £0.75 million in developing the Choose Well pharmacy platform—not just the common ailment scheme, but a range of others—and now over 60 per cent of pharmacies in Wales are available on the Choose Pharmacy system. Health boards are, on a regular basis, putting out information about the services available in pharmacies. The challenge always is that, in a sea of information for people to choose and understand and to make those different choices in terms of services, there won't be a single, one-off campaign to resolve all of this; it will require a constant level of information and, actually, word of mouth as people use a service successfully themselves.

Thank you once again, Cabinet Secretary. Choosing well requires having the right information to hand. NHS Direct and the 111 service have a role to play in providing such information to patients, helping them to make informed decisions and signposting them to the most appropriate service. My local health board was the pilot area for the 111 service, so could you provide an update on the pilot, Cabinet Secretary, and give a timescale for its wider roll-out over Wales?

I made a statement on the 111 service some months ago and I'd indicated that, through the winter, I would expect not just more about the evaluation of the 111 service in ABM and Carmarthenshire, which has been broadly positive, but to make choices through the spring about roll-out through the rest of the country. So, I will have an evaluation and have already committed to providing another public statement and update to Members and the wider public on how and when that will take place and indeed the scheduling around the country for the roll-out of the service.

Plaid Cymru spokesperson, Rhun ap Iorwerth.

Thank you very much. Cabinet Secretary, last week, you made a statement on funding training places for health professionals over the next year, and I certainly welcome much of what was said in that statement: a 10 per cent increase in the number of training places for nurses, physiotherapists and occupational therapists, and an increase in the number of training places for health visitors and so on and so forth. Given that training budgets in England have been cut, what structures will the Government put in place to ensure that those trained in Wales at the expense of Wales remain in Wales?

Thank you for the question. This goes back to the policy intent of this Government, which I've already indicated, to maintain the NHS bursary. It's not just a bursary for nursing students; there is a range of health and care professionals who receive the bursary. The continuation of the bursary in direct contrast to England—this Welsh Labour Government decided to continue with that support—has been particularly important for mature students to stay in the system on the basis that there'll be an expectation that people then work for NHS Wales for two years after their training has been completed. I believe that's a fair settlement of something for something. We recognise that most people who are starting as mature students already have ties to a local area, and so whilst their qualifications mean they're mobile, they already have ties that will keep them in their community in any event. I look forward to reporting back on the practical success of the bursary in the next few years, as people complete their training.

There are other parts of the announcement I certainly agree with: maintaining the 40 per cent increase in midwifery training places that happened this year, maintaining investment in training places for other key parts of the workforce— healthcare, scientists, paramedics, dental hygienists, therapists and radiographers—all very good news. I was unable, though, to find the bit about increasing undergraduate medicine study places or training places for GPs. Was that a deliberate omission or a mistake?

No, it's simply that we make these announcements at different points in time, as I'm sure you've noticed. We'll make different announcements about doctors and training places in the GP field. We've just announced, of course, the final fill rate for this year—we actually overfilled our GP training places. With the creation of Health Education and Improvement Wales, we'll have a different system to understand how many doctor training places and other health and care professional places—. At the appropriate time in the year, we'll make the next announcement about that. But you will of course know that in 'Train. Work. Live.' we have announced another incentive within the field of doctors for our psychologists. We recognise there's been a significant gap right across the UK—so additional help and support to hopefully get more people to undertake their training places here in Wales.

I'm glad you're engaging on the issue of doctors today. It seemed, quite often recently, that you've wanted to direct me away from talking about doctors to talk about other parts of the health service, but we know that all health professionals within the health service are dependent on each other, and doctors are very important too.

I cannot emphasise too much, though, the need to come forward with definitive figures and a vision of how many doctors we need to train in Wales over the coming years. I've seen some figures recently that should frighten all of us here, really. The figures I saw suggested that, of all the young people in Wales who decide they want to go into medicine, 75 per cent of them end up working in the NHS in England. Now, apart from the fact that we need doctors and more doctors from Wales to stay in Wales, as well as recruiting from elsewhere, it is a frightening brain drain from Wales in general terms. These are bright young people who, for all sorts of reasons, we need to keep within our community. Will you not recognise that a decision is needed quickly, and a positive decision, on increasing the opportunities for young people to study medicine in Wales in order for us to try to address that brain drain?

This Government has never tried to put a halt on young people from Wales having opportunities in Wales to study medicine. Our challenge has been something for something with our medical schools and our capacity to do so. So, we already have a slight increase in the number of Welsh domiciled students acquiring places in both Cardiff and Swansea. I've been clear, as indeed has the Cabinet Secretary for Education, that if we're going to invest more in training doctors here in Wales, then we need to see a greater return in terms of Welsh domiciled students. We also need to be better, frankly, at reacquiring young people from Wales who go to study medicine in different parts of the UK. I would not criticise a young person from Anglesey, Cardiff, St Davids or Newtown who decided they wanted to study medicine in Liverpool, Manchester, London or somewhere else. Our challenge is how we actually persuade those people to come back to Wales to undertake national health service work on a longer-term basis.

We're actually seeing some success in having more people, particularly with 'Train. Work. Live.', choosing, after undertaking some of their career within England, to actually come back to Wales as well. So, as ever, there is not one simple answer. There is a range of different things that we need to get right to have the best prospect of having the greatest number of Welsh domiciled students undertaking medical education and training here within Wales, as well as reacquiring people from Wales who have undertaken their medical education training in other parts of the UK in particular.