I call on the party spokespeople now. The Conservative spokesperson, Suzy Davies.

Diolch yn fawr, Llywydd. Minister, Social Care Wales has been leading the way in producing a new set of qualifications for care workers. And as well as simplifying the system, this is an opportunity to respond to some new issues that aren't reflected in existing qualifications. There's more public awareness, for example, about sepsis, and while care workers are likely to receive some training about recognising the signs of a stroke, they don't get that training for signs of sepsis at the moment, generally speaking. Bearing in mind that some people with comorbidities are more likely to develop sepsis than others, and that the signs can be confused with other conditions, would you ask Social Care Wales to consider including sepsis awareness training as part of the curriculum for the qualifications for care workers?

Suzy, thank you very much for raising this important point. As well as raising this point, it would be worth mentioning the work of the cross-party group on sepsis, which has raised the importance of this, particularly across social care training as well, and I look forward to responding to that after discussion with my officials.

We're all very aware now of the heightened awareness of sepsis and the importance of early diagnosis as well as early treatment. It is noticeable that even with the rise in awareness and the rise in the number of people presenting with sepsis, particularly over the last year as well, and, of course, an increase in the number of our older population who are presenting with this, the number of deaths through sepsis is declining, and it may be part of the fact of the increasing awareness, the increase in training right across the board that we are doing on this. We know that not every death through sepsis is preventable, but we know that some are. So, that early diagnosis and treatment is absolutely vital.

Now, it's hard to draw firm conclusions at the moment from year-on-year figures. It seems to suggest that we are indeed doing something right in Wales with our training and with our approach. But I look forward to responding to the comments that have been made today, but also the work of the all-party group on sepsis, because we need to make sure it's working, not only across the health sphere, but across social work as well, so that we can make sure that, at every point, there is an opportunity to do very early diagnosis and have the early treatment, and continue the good work that we're doing. 

Thank you for that answer. That was my point, really, because I'm aware, of course, that hospital workers get this training, but social care workers don't necessarily. And that's why I'd like to see it mainstreamed in the curriculum for the qualifications.

Moving on to something else now, the Cabinet Secretary confirmed to me in a written answer—last year it was—that the money that Welsh Government put towards the social care workforce development programme is match funded by local authorities. However, you went on to say in the same response that for every £1 spend by Welsh Government, 44p is spent by local Government. I have to say that that doesn't quite sound like match funding to me. While I accept that councils are strapped for cash, I do remember that your predecessor made available additional moneys for councils conditional on evidence that it was being spend on social care improvement objectives. [Interruption.] I'm afraid, yes, you did. I have the questions and the answers to prove it. As the fund is now overseen by Social Care Wales, do they have the power to ask local authorities for greater contributions to the fund and do they have a remit letter from you about the outcomes that you might expect from it, not least whether Social Care Wales is to perhaps limit its own administration costs when administering that fund? 

Thank you very much. Just to be clear, the figures that I have on the element of match funding are not the same. It certainly isn't 44 per cent. Of the £7.15 million funding to the regions to deliver social care training by Social Care Wales, I'm informed that 25 per cent of that—so, a quarter of that—is match funded by local authorities. But I'll go away and look at that figure of 44 per cent, because that certainly isn't anything that has been brought to my attention. So, yes, indeed, if the Member could send that to me I'll have a look at it. But, as she knows, within that, the priorities this year have included care and support at home, they've included recruitment and retention, career development and the implementation of the Social Services and Well-being (Wales) Act 2014.

I'm grateful as well to the Member for raising those important issues of the work that we have to do on workforce training, because actually getting people to see that this is not only a valuable profession but a profession in which they are valued means we put the investment into the training, and it is a shared ownership of this. It is a shared partnership in this through local authorities and Welsh Government. We are putting the money in. There is an expectation with the match funding that local authorities will also step up to the mark. But, of course, we'll keep this under review as well. But there is a significant portfolio of work now going on in this area, and I am constantly, whenever I visit front-line social care workers, stressing to them the importance of the work, but also the necessity of us as Assembly Members, of us as Welsh Government, and also local authorities and everybody else, to really value and speak out about the value of this work, because we know it is truly the coalface in terms of our interface with some very vulnerable individuals. 

Thank you for that answer. You'll be aware, of course, that the Public Accounts Committee was talking a little bit about this on Monday. They heard evidence about how the average working life of a social worker is less than eight years, while, by comparison, a nurse could be expected to work for 16 years and a doctor 25. While that means that new social workers are constantly needing to be trained, it also means that there is a real shortage of experience that can be passed on generationally, if you like, to trainees and newly-qualified social workers.

Bearing in mind what you've just said about the workforce fund, how do you expect to improve the numbers attracted to social work and stay in social work, more critically? Do you think that the new qualifications are material to that? Who determines the key performance indicators that Social Care Wales should be looking at in order to ensure progress on both those fronts? 

There two things. One is that there is no one answer to this—there are a multiplicity of ways in which we take this work forward—and secondly to say it won't be overnight. But you are absolutely right in saying that some of the issues that you've raised already are important. We are working with social care workers themselves to try and devise the right package of incentives that shows actually that this is a valued career path, not simply a job. Those observations that were made in the PAC committee last week are very telling in that if you go into nursing or other areas you could be two or three times as long, seeing that as career progression.

We know also that some social workers are moving from social work into other career paths as well. You look particularly at things such as domiciliary care workers within social care. So, doing things such as extending the register, as we are now doing—it's a tricky ask, I realise, for domiciliary care providers, but extending the register to domiciliary care workers on a voluntary basis from 2018, ahead of mandatory registration from 2020, is part of it. It's an essential part, because it's an essential part of the professionalisation of the workforce to ensure that we have social care workers that are appropriately qualified to deliver qualified care to the vulnerable in our society. 

It is also working with Social Care Wales, with Qualifications Wales and other key stakeholders to develop clear career pathways—not a job that you go into and there's a dead end to it, or a job you go into and drop out of early, as those figures showed, but there's a proper career pathway here, that people can see that they can develop over a long time within this career, such a valuable career that it is, with continuing education and learning that enable those social care workers to progress through their careers. And also, I have to say—I mentioned the role that I have as a Minister in doing this, and I'm sure that every Assembly Member has as well, in speaking up for the profession right across—that it's also about working with Social Care Wales to develop a marketing and a recruitment and retention campaign to publicise that positive image of what social care workers do.

One final point: we've also provided £19 million this year of recurrent funding for local authorities to work with service providers to help manage the impact of implementing the national living wage. The national living wage itself is part of this multiplicity of ways in which we say that this is a valuable profession, with valued people working in it, and we want to see more people coming into it and staying in it longer. We'll do that and we'll work with all the partners out there to make sure that this is seen as a worthwhile career for the long term.

The Plaid Cymru spokesperson, Dai Lloyd.

Thank you very much, Llywydd. May I ask the Minister what assessment the Welsh Government has made of the implications for Wales of the research from the British Medical Journal recently that links cuts in social care budgets to far higher rates of death in England?

The observation is well made and we know the continuing times we are in with stretched budget pressures, and there's no point ignoring this place and stand on my feet and say that we can do remarkable miracles—we're working within the constraints that we have. What we do have in Wales, I have to say, is a very different approach to what we're doing within social care and with health, not least in the approach that's been taken with the apolitical, cross-party support that there has been for the health and social care review, if you look at what we're doing with the intermediate care fund, in that way of joined-up working. So, we're not looking for additional funding, although I'd love to have some, Dai—I really would. But it's also to do with how we use the funding that we currently have in a clever way.

I've come this morning from a visit in Cardiff, with my colleague Julie Morgan, looking at the independent living centre, which does exactly that. It uses the intermediate care funding, into which we've put £60 million over the last year, to look at the ways in which health and social care join up to provide that seamless care and allows people to stay in their homes or closer to their homes for longer, for better, and to not then wash up into later, more expensive forms of treatment and care.

So, Dai, I recognise the point that's been made in that report, because it shows that we have to continue thinking how we make the most of the money that we have. He will know, of course, as well, that amongst the four proposals discussed and put out for consultation by the Finance Secretary and my colleague, Mark Drakeford, was a discussion on a social care levy. I think it's pertinent that that is now out there for discussion because you and I and our families and our constituents will have to seriously consider, in the longer term, as we look at the trends that we've identified in the indicators that the Welsh Government has brought forward as national indicators of the strain that the system will be under, how we rise to that. Part of it is through working more cleverly and part of it is by finding the money. I would love to think that, in the next Treasury statement from the UK Government, they'd open the cheque book and say, 'Let's actually put something here', so that we can have the consequentials, but we wait.

Thank you very much for that response. Of course, the BMJ research does show that 22,000 additional deaths are caused annually in England because of cuts in social care budgets in England. That’s 22,000 people dying because of cuts to the budget. That’s what the policy of austerity is leading to. In addition to that, because the Government in England safeguarded, or ring-fenced, expenditure on health in England, the funding for social care took a massive hit as a result. That is why we see those 22,000 deaths: because of those cuts and because there isn’t enough money in the system.

Now, people always say it’s not always about the money, but, in the case of social care, money is the fundamental issue because there are people in hospitals when they shouldn’t be there. That is the outcome of the lack of social care. We will be talking about deaths in Ysbyty Glan Clwyd later on. Why are those people still in hospital? Because they can’t be discharged and go back to their own homes because of a lack of social services and a lack of funding.

As you’ve mentioned, in light of the parliamentary review into health and social care by Dr Ruth Hussey and the central importance of social care and the demand for transformation, are you, essentially, going to be calling for an increase in expenditure on social care, because that's what we need to do—not do more with funding that we don't have, but call for an increase in expenditure and an increase in the budget of the integrated care fund?

Thank you, Dai. A couple of things here: one is that, as you know, in stark contrast to what has happened over the border—I don't want to compare with what's happened over the border—what we have done is, in health and social care combined, which is the approach that we're taking, based on the Social Services and Well-being (Wales) Act 2014 and other legislation here, about that idea of integration. Similarly with the funding, there is more going into health and social care here in Wales than there is across the border. But we still know the strains on the system.

In addition to that, I have to say, these ideas of how we make that money go further—well, I've had repeated meetings, and very productive meetings, I have to say, over the last few months that I've been in post with, for example, the regional partnerships. The idea that we should do more joint commissioning—how do we actually make a bigger bang for our buck, so that we can say, 'Well, we've identified what the care accommodation needs are for the elderly'? We could apply this to other areas of thinking as well. How do we collectively say, 'We'll look at what we've got together'? How do we, on a regional footprint, provide for that and get bigger delivery—deliver more care homes and deliver more places and better outcomes for people?

One important thing with that is, I have to say, as tricky as it is, the issue of pooling budgets. This is tricky, because we're all elected Members—we have the mindset of an elected Member as well as sitting here thinking about policy in a highly strategic way. We know how difficult it is for people to say, 'Well, pooling budgets—doesn't that mean that we have to give up a little?' In some ways, yes, but if it delivers the right outcomes in terms of social care then we should be looking at that.

There are things in Wales that we can do more cleverly, more sharply and differently, and we should be doing that. But, ultimately, Dai, I agree with you—there is the bigger challenge going forward, both in health and social care, which is in the thrust of the health and social care review, which is looking at them together. That seamlessness of the pathway for somebody who is a constituent or a patient of yours—that they don't have to think about who's dealing with them or what authority is doing it, but that it feels like a wraparound. I'm convinced, as we look at some of the models with ICF funding, that that is absolutely the way that we should be going.

Thank you, once again. My final question relates to the fact that the BMJ research also discovered that one of the other things that would help in preventing deaths, in addition to further funding, is the presence of registered nurses in social care settings. That's what the research has demonstrated. Of course, as we discussed the Social Care and Well-being (Wales) Bill in the last Assembly, your Government voted against amendments that would have enabled local authorities to employ registered nurses in social care settings. Bu, there are other ways of resolving that problem. So, in accordance with the evidence, what plans do you, as a Government, have to increase the number of nurses in social care settings as part of any plan to mitigate the fatal effects of austerity coming from Westminster?

Well, Dai, thank you for raising that point. As you know, through not only the consultation that preceded this, which was quite extensive, but the bringing forward of the regulations—a wide range of regulations—part of this is also what we do with the nursing requirement, particularly in accommodation care settings. The traditional approach has been to say, in effect, 'If you can provide a nurse within a care home, then it's all hunky-dory and you're done', when, actually, what we know is that, in some care settings, you will require more than that. In other care settings, you may require nursing through the night; in others, you'll need, actually, more during the daytime or vice versa. So, within the proposals that we've taken forward, we have given more flexibility, but it doesn't take away the requirement, Dai, to make sure that the needs of those within care home settings are provided for; it gives more flexibility to do it according to the needs of those individuals.

Now, that requires, I have to say, that those care homes, and the wider monitoring of those, need to make sure that they are assessing accurately the needs of their residents and then providing for them. If that means more than one nurse, it should be more than one nurse. If it means more than one at night time, it means that, because we know that it's got to be based on the individual needs there and the collective needs within that care setting.

So, it has moved to a more flexible approach, and I realise that that has caused some people to say, 'Well, does that mean we don't need one in every home?' Well, what it needs is the right level of nursing for every single care home setting, and that's what we're committed to making sure is provided. 

The UKIP spokesperson, Caroline Jones. 

Diolch, Llywydd. Minister, last week a widespread failure in the NHS IT systems caused chaos for GP practices and hospitals across the country, with many GPs reporting that they were unable to access patient records. One GP described the situation as very frustrating and rather dangerous. Hospitals were unable to access test results and one patient was told he would have to wait another month for the results of a biopsy due to the backlog caused by the systems failure. I hope you will agree with me that this is totally unacceptable. Cabinet Secretary, can you update us further on the reasons for this outage, and what lessons, if any, have been learnt?   

Yes, I recognise the inconvenience caused to staff and patients in the national health service following the incident last week. It's not thought that it was a cyber incident, on the positive, and, indeed, that it was a technical issue, although widespread. All affected systems were returned to normal by 8 o'clock on the same day. There's a challenge about having caught up with any potential delays and backlogs. Further work has been done today to provide a new firewall, and my understanding is that our systems are in a fit and proper place to move forward. But there is, of course, a broader question about investing in IT to deliver more in the here and now and in the future.    

Thank you for that answer, Cabinet Secretary. NHS Wales Informatics Service have just announced that the new contract for the GP clinical systems and services will be awarded to Vision Health Ltd and Microtest Ltd. This has caused concern for many GP practices that use systems provided by EMIS Health Ltd. GP practices have been told that EMIS Health Ltd did not meet a number of the necessary tender evaluation criteria and that EMIS practices will need to choose an alternative system. Cabinet Secretary, can you expand upon the reasons that EMIS Health Ltd was not successful at the tender stage? Is it related to the news that NHS Digital have imposed significant penalties in the order of millions of pounds for failing to meet contractual requirements of the GP Systems of Choice contract in England? 

I should start by saying it was remiss of me not to thank NWIS staff who worked hard to resolve the technical issue last week and to make sure the disruption was not more widespread, and, indeed, as I say, it was resolved within the day. 

On EMIS and the issue of systems to support GPs, I recognise it's a challenge because a significant number of GPs currently use one of those systems. I can't go into the full reasons for it because there's a period of legal challenge and so I can't make a full statement until that point in time. But Members, I'm sure, will be interested to know that the British Medical Association have issued a very brief statement, because the general practitioners committee of the BMA were engaged in the discussions about the future tendering, and they themselves have said that they recognise that, whilst it's difficult, they think the right choice has been made because minimum standards have to be met within the contract process. But I think it will be towards the end of next week or the start of the week thereafter when the legal challenge process will be over and, if there is no challenge, a fuller statement can be made.    

Thank you, Cabinet Secretary. Whatever the reasons for the decision against EMIS Health Ltd, this affects many GP practices across Wales who have been using the EMIS system for many years. The Royal College of General Practitioners are concerned that this will have a detrimental impact on both GPs and patients due to the scale of the changes needed to move to a new system. There are fears that this could risk pushing older GPs to an earlier retirement. Cabinet Secretary, how do you plan to address the concerns that an already overstretched profession does not have the time or resources to move to a new IT system, and are you confident that the new systems provided by Vision and Microtest are robust enough to prevent failures like we saw last Wednesday? 

I think that the issues are different, with respect. The issues about the data centres I don't think are the same as the software and support that we're talking about to support GPs to work in their practices. And I go back to the statement made by David Bailey, the chair of the BMA Welsh council, who is also a GP himself, and his practice actually uses EMIS systems. He's recognised that it will be a practical problem for GPs in migrating to a new system, and that's why conversations have already taken place about the required training and support to help migrate practices into a new software that meets our requirements for the system that we have to run here in Wales. And that's the point: we have to have a system that supports the aims and objectives of the way we want to run our system here, not our system being driven by the demands of an external software supplier.

I do recognise the practical challenges about whether, if GPs don't feel supported in doing this, some may make a choice to leave the profession earlier than we would of course want them to. That's why the continuing nature of our conversation with both the British Medical Association and the Royal College of General Practitioners really does matter. I want them to be assured that there is a real will and commitment from the Government and the wider health service to support them in doing so and to continue to provide excellent, high-quality care to every community in Wales.