Questions now from the party spokespeople. The Welsh Conservative spokesperson, Angela Burns.

Thank you, Presiding Officer. Cabinet Secretary, storm Emma passed through our area nearly a couple of weeks ago now, and I'd like to use this opportunity to put on record my thanks, and I'm sure the thanks of every Assembly Member, to the NHS staff who were so brilliant at getting in, in very difficult conditions, who were prepared to stay and work a lot of extra hours to make up for colleagues who couldn't come in. We owe them an enormous debt of gratitude because it was pretty tough. I know that, for three days, I couldn't get out of my house, and yet there were people who were staffing our local hospitals. I also know, Cabinet Secretary, that you are aware that there was a lot of speculation in the press from staff who'd said that when they had stayed over in order to help us through this difficult time, they had been charged for accommodation. I think you were quite robust in saying—and I don't believe I'm putting words in your mouth—that that shouldn't happen. Could you reassure us that, in fact, any staff who did go out of their way to help us haven't incurred extra costs, and that we are able to defray any costs that people did incur in any way whatsoever, and that health boards haven't charged people?

Yes. And, again, I welcome the recognition that you start off with about our national health service staff and other emergency service workers, local government workers, the third sector, and citizen volunteers, who made sure that the work continued. The range of stories of people who helped health service workers get in to do their job is really uplifting. 

On your specific point, I'm happy to give the reassurance sought. At the time, I indicated that this is not what I would expect should happen. Every health board came out robustly and indicated that they have systems in place both to make sure that accommodation is provided for free for staff who come in in these circumstances, above and beyond what would normally be expected, and that any staff who had made their own arrangements, either because arrangements weren't available, or, indeed, if a mistake had been made, should be able to have those costs refunded by the health board. And, again, I've also had a conversation with the Royal College of Nursing about the matter, and if they reveal any additional issues that I'm not aware of, then I will happily look at them and see them addressed. 

Thank you. I'm really grateful to you for that answer, and I'm quite sure that NHS staff across Wales will be as well. 

I'd like to address my second two questions to the issue of mental health. I was delighted the Welsh Government supported the Welsh Conservatives' debate on mental health of a few weeks ago. You did make a couple of comments during that debate that I would just like to pick up on. I was saying that spotting signs of mental ill health is incredibly important, both in the workplace and in schools—wherever it might be—and that all of us have a role to play in actually being able to get alongside somebody to spot the fact that they may be going into some kind of crisis, and then for there to be a direction of travel for us to be able to access support services for that individual. And you said that you felt there were some plans afoot on that. I just wondered if you could perhaps tells us a little bit more now about what the Government's doing to ensure that the tools and resources are available to all of us to help us understand what mental health is, what the signs are and where we might go in order to help another person. 

Well, this is about making our services as accessible as possible. I'm sure, within this building, you'll have seen the range of posters in a variety of locations highlighting that sometimes all you need to do is listen to someone who wants to talk. Part of the challenge is that not everyone wants to talk and not everyone recognises the challenge that they themselves have. The more that people do talk and are open, it helps others then to be able to do so as well. There is then the point that you're making, which is about how, if you think someone is struggling, you can actually get alongside that person to help them. And there are, sometimes, relationships that exist that allow you to do that and equally people that you are close to who, even if you think there's a challenge, may not react well to somebody saying, 'Can I help?'

Part of our challenge is to recognise that within workplaces and placing a high value on mental health and broader support. That's why mental health is one of the cross-Government themes within our 'Prosperity for All' programme, and it's also why I have a particular focus within that on mental health in workplaces. So, the Healthy Working Wales programme, which covers about a third of employees in the country already, looks at physical and mental health in the workplace as well, and tools to help equip employers to better support their employees. We're looking to improve and increase it. That's why it's part of the economic contract as well. So, we're looking to have employers who are going to have support from the Government to have a business here, who want to be good employers in all aspects, including looking after their workers' physical and mental health in the workplace. 

I'm delighted to hear that, because I do think there's still so much stigma attached to the whole area of mental health and how we recognise it, how we pick it up and how we help people who might be going into crisis to be able to access the support that they need.

I spent a couple of hours this morning in Pontardawe looking at Hafal's new facility, and I know you've been there, because you opened it, and it's a great facility. And my goodness me, isn't it how mental health services should be provided? It's an old building that's had a whole new lease of life. It hasn't had millions and millions and millions spent on it, but it's funky, it's modern, it feels like a hotel and you're treated as a guest not a patient or a leper, which can sometimes come across in some of our old ways of dealing with people with mental health issues. They have 16 beds there, but only four are taken up, and that's the maximum occupancy they've had since they've been open, because there is still this reluctance from health services to engage with this kind of provision. It's a great step up, and, if anybody wants to go and visit it, I really recommend it, because it enables people to understand how they can live a life independent and be well and it stops that awful revolving-door scenario. 

What do you think you, as the Cabinet Secretary, can do to ensure that a facility like that doesn't actually wither on the vine, but is used really well, because it really is a foreshadow of what mental health services should be—that parity, that equality and that absolute respect? 

I recognise what you said at the start of your third question about stigma. There's still an unfinished journey in tackling stigma, both in the way people see themselves and mental health, as well as the way other people see mental health challenges, and in how we normalise the conversation about mental health in exactly the same way as we do with physical health challenges.

I remember and recognise the Gellinudd Recovery Centre opening. It was a very enjoyable day with an enormous cake, I seem to recall, and I actually went through some of the rooms that they were looking to open. And there was a conversation there about making sure that health service commissioners and others were aware of the spaces they had. And I looked at the layout, and it does look like somewhere you would choose to stay as opposed to somewhere where people are hidden away and that's a really important part about the feel of the place when you go in, and this really is all about recovery and that's the point; they refer to it as the Gellinudd Recovery Centre, because they want to look at how people are helped in that journey as well. It is a journey; there isn't a simple point at which you say a specified period of time will resolve all ills. We recognise that that isn't the case. So, there’s something about how we continue to look at what people commission, about the help and support that is there, and then making sure that, if there was a challenge in that work not being commissioned, that we would bring people together in exactly the same way we have done with other facilities as well. We bring commissioners together to look at the services that are already there to make sure they're properly aware of it and to think about how they are otherwise meeting the needs of their population, because that is the point: how does the health board, together with their duties with local authorities, plan together to understand people's needs and then do something to meet the needs that they identify?

UKIP spokesperson, Caroline Jones.

Diolch, Llywydd. Cabinet Secretary, according to Cancer Research UK's position paper on the diagnostic workforce in Wales, shortages in the diagnostic workforce are, in part, responsible for Wales failing to achieve waiting time targets for cancer patients since 2008. Do you agree with this analysis, Cabinet Secretary, and do you have any plans to address shortages in the diagnostic workforce in the short term?

There are a couple of points that I would mention. I recognise that, of course, the diagnostic workforce are crucial not just to cancer, but a range of other services, in making sure that people are appropriately diagnosed and put on the road to either the certainty that they don't have the potential condition, or indeed have the opportunity to start treatment at an appropriate point in time. So, there's no avoiding the diagnostic workforce and they're important to being able to achieve real and meaningful targets.

I would again just point out that if we had the English targets of 85 days and 62 days then we would almost certainly achieve that on a regular basis. I'm actually looking, as I've indicated in this place and in other places as well, to look again at the current targets we have on cancers and to look in particular at whether some waits are not revealed by our current waiting times target. If we are to move to a single cancer pathway, as I wish us to do, that will require further investment in the diagnostic workforce, not just for cancer, but to make sure that other services are not compromised by an additional focus on delivering a single cancer pathway, so these matters are in my mind and I expect to have more to say towards the end of this year.

Thank you for that answer, Cabinet Secretary. Staying with the Cancer Research UK report, they highlight the patchy information available on the diagnostic workforce, which is making it difficult for local health boards to make well-informed decisions about workforce planning. We know that there is a 13 per cent vacancy rate in diagnostic radiotherapy and have now information about shortages in endoscopy. In December, there were over 2,000 patients waiting more than 14 weeks for an endoscopy and a handful waiting more than 40 weeks. Cancer Research UK predict a 40 per cent increase in demand for endoscopy in two years' time. What is the Welsh Government doing to improve workforce planning for diagnostic staff and how do you plan to cut waiting times for endoscopy services in the interim?

There are a couple of different points there. The first is that, of course, we've invested more than ever before on the future education and training of the non-medical workforce—£107 million that I announced—and, at a time of falling public resource, to continue to invest even more in the workforce and their future training is a significant choice to make. There is something about understanding not just about the numbers of the workforce that we need, but about how we wish them to work and a more effective way of working. The staff themselves are involved in redesigning the ways of delivering care as well as, of course, the equipment that they will need and the numbers and type of staff that we will need together as well.

In terms of the information on the workforce point that you mentioned, well, health boards themselves, as the employers, I would expect them to have the information. There's a challenge about them understanding their own information systems to understand the workforce they currently have, as well as looking to plan for the future workforce, but the introduction of Health Education and Improvement Wales has been deliberately designed to help improve workforce planning in a more integrated way and to have a national view on those areas where we need to invest in more staff.

Thank you, Cabinet Secretary. One of the recommendations of the Cancer Research UK report is to explore the use of artificial intelligence for diagnostic tests. In January, the Reform group published a report on AI in the NHS, which highlights the potential for AI to narrow gaps in health provision. Whilst the Reform report focuses on NHS England, there are lessons for us here in Wales. In addition, last week, Microsoft announced a new platform for helping healthcare providers to harness the power of AI and the cloud. Cabinet Secretary, have you or your officials considered the Reform report, and are you looking at utilising artificial intelligence to assist clinicians in NHS Wales? 

There are two brief points I'd make, Llywydd. The first is that, even without Lee Waters in the room, I recognise that artificial intelligence is absolutely part of the future. It's part of today and it'll become more and more a planned part of the way in which we deliver health and care services. It should help us in assisting clinicians to make choices; it should make our pathways more efficient for the citizen as well. I think it has real potential to save resources to be reinvested within the service. So, there's no doubt about artificial intelligence having a larger part to play in the future of health and social care.

The second point I'd make is that we are already looking at partnerships with technology firms on a small basis to a larger basis. In the last few months, I have announced a significant partnership with Intel, who are looking to invest and have a partnership with Wales because of the way in which we've designed our system. It's an attractive place for technology businesses to want to work with the healthcare sector. I'm sure that my officials have looked at the report that you referred to in England—I won't pretend that I've read it—but I am very clear about the future role of partnerships with technology firms and the national health service that don't compromise our values, but should help us to deliver a better service now and in the future.

Plaid Cymru spokesperson, Rhun ap Iorwerth.

Diolch, Llywydd. I'd like to begin, if I could, by correcting some comments made yesterday by the leader of the Conservatives, who claimed the ambulance waiting times in Wales were improving. In fact, the median response times to red calls are worse this winter than last winter—fewer are arriving within the target eight minutes. When it comes to amber calls, almost half are now taking longer than 30 minutes to arrive—almost twice as bad as last winter. And our excellent paramedics tell me that they're really, really losing heart. Why are ambulances taking longer to arrive now, in emergency and in urgent, amber call cases, than in previous years?

Well, the system was one that we introduced about two years ago, and, when you look at where we were at the start of the new response model to where we are now, there's been a real and significant improvement over that time. Comparing this winter to last winter, there has been a fall in performance of a couple of percentage points, but we're still meeting our targets.

The challenge, though, is: how do we understand, from a system point of view, the pressures that we have had this winter, how much of that is genuinely exceptional? And, on some days, as you'll be aware, we've had pressures that I genuinely do not think that any service could have planned for. But there is a broader point about the increasing demand we expect to see delivered in our system, and it's our ability to cope with that, and it's not just about the ambulances; it is a whole-system response. So, it is about continuing to improve on delayed transfers and make sure that people move through the hospital system. It is about continuing to improve on the work that is already being done to try and make sure people don't unnecessarily go into hospital as well.

I recognise, too, that there is a long tail on amber calls, which is not something that the Government is looking at and saying, 'That isn't a problem'. There's work already being done by the emergency ambulance services committee, together with the Welsh ambulance services and health boards, to look at that and to look at what further we'll need to do. And there'll be choices for the health service to make, and potentially choices for the Government, to help the whole service to improve.

I agree entirely that we need a whole-service approach. I'm saying that the whole system is broken and it's the ambulances and paramedics and call centre staff who are having to bear the brunt. And you say you're meeting targets; there are no targets for amber calls and that's a part of the problem. 

Behind the statistics, though, we must remember are some truly shocking stories. Let me recount two recent very distressing cases, I'm told, both on Anglesey, both the same day. I can't imagine the distress caused to paramedics dealing with these cases, let alone to those people's families. First, chest pains—red call, surely. An ambulance turns up after an hour and five minutes. The patient has died. Suspected stroke—amber call. An ambulance arrives 10.5 hours later. The patient, again, was dead. The same day.

Let me focus on that second case. It may be the case that whether an ambulance turns up to a suspected stroke patient in eight minutes or 10 minutes doesn't make a difference to the outcome, but surely you agree that waiting hours for such a potentially serious condition to be addressed is unacceptable. Do you accept that removal of any time target for amber calls has forced under-pressure ambulance staff to treat those calls as less of a priority, and patients therefore have been put at risk?

I have to say I'm incredibly disappointed with the remarks made at the start, claiming the whole system is broken. That simply is not true, and you should be embarrassed to say such a thing.

You should be embarrassed. You should be embarrassed. How dare you? How dare you?

I don't hide—[Interruption.] I don't hide from the challenges for our staff or citizens. To use such deliberately inflammatory language about our healthcare system I think really does not reflect well on you, Rhun ap Iorwerth. I don't hide from the individual challenges. On either of the points you make, I obviously can't comment on what happened in individual cases, but I will remind you again about the reason and the rationale for introducing the clinical response model—not simply clinical opinion, but the evidence about how we run our ambulance system and whether or not we're getting the help to people in the most urgent and life-threatening emergency cases. And the previous system—there's a lot of evidence, accepted by people across this Chamber and outside—did not serve the interests of the patient well. We had a number of categories for an eight-minute response that simply did not make sense. We reviewed the evidence and it showed that—no surprise—a 40-year-old system was out of date. We then had clinical evidence and advice on an improved system to prioritise people in the greatest need. That was supported by front-line paramedic staff. It was supported by leadership within the ambulance service and the wider health service. That's the model we've implemented.

We have also, though, had an independent review of the new system and that review was looking at the categorisation of calls. So, rather than politicians arguing with each other about which particular condition should be in which particular category, we're again looking at a proper evaluation and a proper basis upon which to make that choice. That must be the right way to proceed, not to have a campaign-led approach to which condition should be in which category, but to have proper evidence and clinical advice on what to do and then to do the right thing—[Interruption.] And then to do the right thing by staff within the whole system and by the people of Wales we are supposed to be here to serve.

How dare you say that I should be embarrassed? How dare you say that I should be embarrassed for suggesting that your system is broken? It is NHS staff on the front line, be it in ambulances or in accident and emergency units, who are telling me that the system is broken. You're in charge of the system, and we want a better system for the patients that deserve that, frankly, here in Wales.

It's deeply upsetting for ambulance staff, whether in control centres, or paramedics on the road, to witness and deal with cases where they wanted to and could have made a difference but they were unable to because they were parked, because of the system, outside hospitals. It's perhaps no surprise that ambulance staff have the highest rates of staff sickness out of all NHS staff. I want that to change, and one thing we have to be doing here is involving the staff much more in debates about the future of our service. It's the staff on the front line who themselves know how the service can be improved. So, will you give an undertaking to engage much more—[Interruption.]—to engage much more with staff on the front line—maybe you don't care; I do—

I do care, Rhun, and they are involved, all the time.

—and listen to their demands? Both paramedics on the road and control room staff, they need to be engaged with, they've got ideas, they're the ones on the front line, they deserve to be listened to.

Well, I make no apology for saying the NHS is not broken. I make no apology for being offended by the way you have approached this issue. I've met—[Interruption.] I've met—[Interruption.] I have met paramedics through the worst of times. When I was appointed as a Deputy Minister for Health at that time and meeting paramedics at that time, they were angry and they were despondent. They wanted the system to change. They recognised they were in a mad rush to meet a target they did not believe in, they did not believe served the patient well or them as members of staff well. They were directly engaged in helping to change that system. We listened to what paramedics were saying to us at the time, and we continue to listen. I have spent a large amount of my time in this office going out and directly listening to staff in their workplaces. I was with paramedics last week within north Wales. I was listening to them about the work they're doing to improve our healthcare system, the work on a trial being run in north Wales that I think is likely to be rolled out across the rest of the country, using advanced paramedics to improve out-of-hospital care to avoid unnecessary admissions. And we will continue to listen to our staff. We will continue to see them engage, as they already are, as individuals in their workplaces, within their trade unions and their representatives, because this is a system that is looking to improve and to learn. And I think that if you spent more time with representatives in our system to look at the improvements that have taken place within these last few years, and to look at the further improvements we are planning and trialing, I think you might take a slightly different perspective.