Questions now from the party leaders. The Plaid Cymru leader, Leanne Wood.

Diolch, Llywydd. First Minister, leaked documents suggest that the Hywel Dda Local Health Board is considering the future of hospitals in its area. Now, it's only been around three years since the last reconfiguration, which was meant to offer a long-term and sustainable solution, yet people now face more proposals, including closures. Was the health board being honest about its last reconfiguration?

Well, the health board itself could answer that. I see no reason why they were not being honest. There are always challenges. The parliamentary review, which all parties that have signed up to, have said that there will be difficult decisions in the future. Now, as a Government, we have no view on this. This is not our policy. These are options that the health board has taken forward. What's hugely important is that whatever the health board considers is taken forward with full public consultation.

Well, First Minister, you have to ultimately be responsible and accountable for health. Health is fully devolved and responsible to you. Now, the health board are indicating that they want people treated closer to their homes and in the community, but that's not what the proposals in the leaked document appear to be about. One aspect that could complement existing hospital services is the creation of community hubs with beds, or perhaps more accurately, 'I can't believe it's not a community hospital'. Shutting down community hospitals was once a Labour Government's policy, and it has led to a reduction in beds, and it has been a big mistake. Community services should not be used as an excuse to close district general hospitals. With bed occupancy across the NHS over the safe level of 85 per cent for the last seven years, do you accept that the NHS needs more beds in order to enable it to cope with the additional winter pressures?

I think we need to focus not just on the issue of beds, but on the issue of getting people out of hospital as quickly as possible. That means that, if you look at delayed transfers of care, our figures are greatly improved month on month, and greatly improved from last year. We don't want people staying in hospital for longer than they have to.

But, of course, the other point that we have to understand is that we need an NHS that's sustainable. All parties signed up to that as part of the parliamentary review. It's massively important that, yes, of course, we agree with the principle that people should be treated as close to home as possible, but we also need to make sure that services are sustainable in the future. Now, the proposals that have been put forward by Hywel Dda are for Hywel Dda to consider at this stage, to engage in full public consultation. It's true to say that there may come a point when there will need to be a decision by Government, but that point has not yet been reached.

The point is, First Minister, that people need an integrated health system and community services that complement district general hospitals, not replace them. People in the west are still going to need emergency treatment. They will still need operations, they will still need overnight stays and accident and emergency within a reasonable distance of their homes. Now, a Plaid Cymru government will keep these essential services for our rural communities. That means A&E for Bronglais and Glangwili, and keeping Withybush open.

Now, Plaid Cymru has been warning you for a number of years now about the need to train more doctors. Will you work with Swansea medical school on its proposals to expand the number of doctors in the Hywel Dda health board area? Can you assure people out there, and Members here today, that you will not sign off any decision to remove A&E from Bronglais or Glangwili? Will you also confirm that the Labour Government will not sign off any decision to close Withybush or to remove A&E services from that hospital?

It seems to me that it's pointless having any kind of consultation. Now, we have no view on this at this stage, and there are reasons for that. [Interruption.] Simon Thomas knows this full well: the reason why we cannot take a view at this stage is because there's an open consultation. We can't shut down the consultation at this stage. There are legal issues surrounding that, for a start.

It's true to say there will come a point, or there may come a point, where Ministers have to take a decision, and that is the point at which Ministers no doubt will be questioned as to why that decision was taken. But you cannot on the one hand say, 'We've signed up to a parliamentary review looking at creating an NHS that's sustainable' and then say, 'Options are going to be—' [Interruption.] No, no, no. And then say, 'There are some options that will always be ruled out completely'. That is not the way these things operate. Last week, the parliamentary review was being supported by all parties in this Chamber. The question is: are those parties now running away from that review? That is a question that I think needs to be answered.

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

Thank you, Presiding Officer. First Minister, do you still believe that the Welsh Government's preferred black route option for the M4 will come in nowhere near £1 billion and will be way below the figure that you prophesised back in 2015?

Well, the figure has certainly risen because there's been more of a delay than expected. But we intend to make sure that the issue of congestion on the M4 is dealt with. I wonder what his party's view is.

First Minister, this is First Minister's questions, and that's why we ask you questions and we look for answers from you. We don't seem to get many answers on a week-by-week basis.

But, last week, in the Economy, Infrastructure and Skills Committee, the senior civil servant who was dealing with this in the Cabinet Secretary's department indicated that the project cost was somewhere near £1.4 billion to £1.5 billion. The actual figures that have been lodged with the inquiry are £1.3 billion to £1.4 billion. They're actually lodged with the inquiry, those figures are. Only two years ago, you were stating that it was going to be nowhere near £1 billion and would be considerably less than that figure. One hundred and sixty civil servants at that time, as given to us by the Minister, were tied up with this particular project. I ask you again: what has gone wrong? This is the key infrastructure project that the Welsh Government is challenging to deliver. The project costs, if your estimations at that time were to be believed, have nearly doubled, by the civil service's own figures that they put to the inquiry and also identified by the Cabinet Secretary in that committee.

Well, first of all, inflation—that makes a difference to the figures; and, secondly, the UK Government is charging VAT. The UK Government is charging VAT. Here's a challenge for him: why doesn't he go back to his party and say, 'Don't charge VAT for this project'? That would save us hundreds of millions of pounds. 

That is awful, First Minister. This is your biggest infrastructure project. The negotiations around VAT are still ongoing. Without VAT—and these are the words of your own civil servant in that committee—the costs of this project are in the region of £1.3 billion to £1.4 billion. Only two years ago, you were trying to convince people that this project was going to come in at £800 million. I asked you to let us see that information so we could have confidence that you were building a project on sound finances. All this has been undone. Can you commit now today that there is an upper limit where this project is viable, and if there isn't that upper limit, will you be whipping your backbenchers and having Cabinet responsibility to vote this project through, whatever the cost?  

He didn't know about the VAT, did he? That was one of the issues that's blind-sided him.

Those discussions are ongoing.

I'm surprised that the leader of the opposition isn't aware of the VAT issue, and has not said anything publicly to support the Welsh Government and the Welsh taxpayer. It's one thing to say that negotiations are ongoing, but why isn't he standing up and saying to the Conservative Party—a Conservative Party that took funding away from electrification of the railways to spend outside of Wales; a Conservative Party that is trying to increase the price of the M4 project; a Conservative Party that claimed it was reducing the tolls on the Severn bridge when all it was doing was removing VAT that it wasn't legally able to charge in the first place. I mean, we talk about spinning, but what we have here is a whirling dervish. We will deliver transport projects for the people of Wales in the teeth of opposition from the Conservatives. 

Leader of the UKIP group, Neil Hamilton. 

Diolch yn fawr iawn, Llywydd. Emergency hospital consultants in Wales have recently written to the First Minister claiming that safety is being compromised to an unacceptable degree. The Royal College of Emergency Medicines has described accident and emergency units as battlefields. Dr Tim Rogerson, a consultant in emergency medicine at the Royal Gwent Hospital has said about the picture across Wales, 

'We're on our knees as far as emergency care [is concerned]. We have patients coming into emergency departments that are already full.'

The consultants have asked the First Minister to review as a matter of urgency the number of beds available for acute care, and for a significant increase in funding for social care. Is he going to accede to that request?  

First of all, I'm aware of the pressures there have been on emergency staff, and I thank them for what they have done. It has been very difficult, given intense spikes in demand—unpredicatble spikes in demand at certain days in the course of the holiday period. We would be delighted—delighted—to spend more on health and social care if the brakes were taken off by the Chancellor of the Exchequer. The Cabinet Secretary for Finance only last week outlined that we could be up to £4 billion better off if previous trends had been followed. That is a significant investment we could make in the health service. 

So, yes, we agree with the consultants that we want to spend more money on health and social care. Where are we going to take it from? Schools? Because that's the only place we can go. Put the council tax up? Because that's what will happen if we take money away from local government. We need to make sure the UK Government—. Boris Johnson today, saying there should be £100 million a week available for the NHS in England. That would mean £300 million more available in Wales. On that, if nothing else, I support Boris Johnson. 

I'm delighted to hear that, because as a result of leaving the European Union there will be more money to spend on the health service. [Interruption.] In answer to the leader of Plaid Cymru—. It's the way you tell them. In answer to the leader of Plaid Cymru earlier on, he said that beds don't really matter; it's how quickly you move people out of them. But the truth of the matter is there's been a very substantial cut in the number of beds available in hospitals throughout Wales in the last seven years—roughly 20 per cent to 25 per cent depending on the health board—but the occupancy rate of those beds has barely moved, and it is higher and has been, as the leader of Plaid Cymru pointed out, above the safe level of 85 per cent now for seven years. Surely, within the priorities of the health service for which the First Minister is responsible, not Boris Johnson, there should be some kind of change to ensure that hospital safety is actually taken very seriously by this Government.

It's a matter for health boards to ensure they have sufficient beds available. It's not right to say that I said beds weren't important: I said they were only part of the picture. If you look, for example, in England, where spending on social care has been hammered, England is now reaping what it has sown. We have made sure through, for example, the integrated care fund, that more people can leave hospital when they are ready. We're seeing delayed transfers of care dropping, whereas in England, of course, social care is on the verge of collapse. If you don't believe me, listen to council leaders—Conservative council leaders—in England, who are saying just that.

Sorry, I wasn't aware that the First Minister had finished as there was so much noise coming from other parts of the Chamber. The whole point of my question was not about social care, but about beds in hospitals and hospital care. The consultants who wrote to the First Minister last week said that emergency departments in Wales were, in some ways, worse than in England. Staff are arriving for work to find patients in the emergency department who were there the previous day, and multiple staff are in tears because they feel they cannot deliver the care that patients need. The consultants also claim that the four-hour target figures for best performing hospitals in Wales were similar to some of the worst performing hospitals in England. Surely, that is an indictment of 20 years of Labour Government in Wales.

There are question marks over England's figures for a start. That doesn't diminish, of course, the pressures there have been on emergency services in Wales and I certainly don't seek to belittle that in any way, shape or form. But the question is this: should you divorce the issue of health and social care, as he's trying to do with his third question? The answer is, 'No, you cannot.' The two are integrated, the two are the same, they're integrated in terms of the service they seek to deliver to people and we have put money into that through the integrated care fund, making sure that people are able to leave hospital when they are able.

What England did was to try to spend money on health and starve social care of money, effectively taking away from social care and putting into health, and now England is reaping the whirlwind of that. We always took the view that health and social care had to be seen in the round and that one was strongly linked to the other.

If we look, for example, just beyond that to the Additional Learning Needs and Education Tribunal (Wales) Bill; that looks at bringing together education and health provision for young people as well. So, we've made sure, when it comes to spending, that spending in Wales is higher per head than in England on health and on social care to make sure that we don't let our people down just like the Government has done in England.