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

Diolch, Llywydd. Cabinet Secretary, two weeks ago, the former head of the NHS counter fraud service warned that not enough was being done to tackle fraud in our NHS, and that as much as £200 million a year, or 3 per cent of the budget, is being lost because of fraud. The scale is appalling when you consider that, each year, we lose the equivalent of two and a half times the total new treatment fund. What is your Government doing to combat this fraud, given the staggering amount of loss?

Well, we start from a point of basic disagreement, because the research undertaken in Portsmouth is not something that we recognise—or indeed NHS England recognise—in terms of the scale of NHS fraud, and there are a number of suppositions within the research. So, it just isn't a figure that we recognise. We do, though, take seriously challenges about NHS fraud activity. We have a counter fraud unit that works not only in Wales but works with colleagues in England too. Part of what the research was talking about were things that you wouldn't necessarily consider to be fraud. You think about the commercial abuse of some relationships, which is part of what they were thinking about, and, actually, we have a range of legal actions, together with other jurisdictions within the UK, about infringements of patents and about abusing market positions. The Counsel General has to look at some of these issues as well about our position on legal action ongoing, but at present, of course, we're able to do that most effectively because we're able to make the best use of European Union regulations. That, of course, will become more difficult should we leave the European Union in due course.

Thank you for that answer, Cabinet Secretary. I welcome the fact that there is zero tolerance to fraud within the NHS in Wales. Last month, two former employees of a GP surgery in Newport were convicted of fraudulently filing prescriptions and ordered to pay back thousands of pounds to the NHS. Cabinet Secretary, what further steps can be taken to prevent this type of fraud, which costs the NHS millions of pounds? Have you explored whether technology can offer a solution on prescription fraud?

The answer to that is a simple 'yes'. Of course, we take a zero tolerance approach to fraud, but, actually, better use of technology will help to minimise the risks for fraud. In particular, we're looking at e-prescribing, making it easier to prescribe, actually saving people's time, and actually being able to track effectively what's being done by healthcare professionals at various points within the system. Our ability to do that does depend on our continued investment in not just the healthcare records, but actually the ability for healthcare professionals to access that record and be tracked in doing so. That was part of the barrier that prevented our earlier access to Choose Pharmacy. When I chose to invest in Choose Pharmacy, we'd reached a position where both the British Medical Association and community pharmacy themselves agreed on the investment, and they agreed on a method in which the healthcare professionals could be tracked on entering the GP record itself as well. So, actually it's improved our ability to audit and that should help us in our attempts to counter fraud within the NHS.

I'm pleased to hear that, Cabinet Secretary. I have in the past raised the issue of European health insurance card fraud, and at the time you said you didn't believe it affected our NHS. However, journalists working for national newspapers revealed how easy it was to obtain a card in someone else's name. Cards were obtained in the name of Theresa May, Jeremy Hunt and Donald Trump. According to a whistleblower at the NHS Business Services Authority in England, as many as one in five applications are fraudulent. As the card is often all that is needed to obtain treatment, it is believed that this fraud has cost the NHS hundreds of millions of pounds. Cabinet Secretary, how can we be sure that this type of fraud is not affecting our NHS in Wales?

That's an utterly speculative accusation to make—that there are hundreds of millions of pounds being siphoned off—by an unnamed national newspaper looking at a wholly anecdotal exercise. If we want to get stirred and stoked up into this, we can all follow where this leads. I am not at all interested in diverting attention away from the NHS doing its job to properly service the needs of the public and, yes, to properly think about dealing with fraud where it exists, but I'm not going to be led by the nose by a right-wing campaign that is all about our relationship with Europe. Our NHS relies on its relationship with Europe, not just for staff, but the way that we share knowledge, the way we share regulation, medical devices—our exit from the European Union on the terms that are potentially available at present with the chaos in the UK Government would do great and lasting damage to our national health service. That is the biggest barrier, the biggest challenge, to our national health service and our continued relationship with Europe.

Plaid Cymru spokesperson, Rhun ap Iorwerth. 

Diolch, Llywydd. At the end of last month, Cabinet Secretary, you wrote to all Assembly Members explaining that the party opposite's claim of falling nurse numbers at Betsi Cadwaladr, a claim based on freedom of information data, was wrong. You instead claimed that Betsi, like the rest of Wales, had seen an increase in qualified nurse numbers. Now, we've looked into the Stats Wales figures, and do you know what? Those figures do show that between September 2015 and 2017 Betsi has seen a small increase in qualified nurses, midwives and health visitors. Now, a cynic would say that you deliberately chose September 2015 as your starting point. If we chose September 2014 as the starting point, then the same Stats Wales figures show a decline in the number of full-time equivalent nurses in Betsi Cadwaladr compared with September 2017. Will you accept that things aren't really quite as rosy as you suggested in that letter last month?

My letter was factually accurate, unlike the claims made by the Conservatives. It's interesting that Plaid ride to the rescue of the Tories and look to make common cause with them. The undeniable truth is that we have more registered nurses in our national health service here in Wales than ever before. We invest more in our staff than ever before. I am proud of the record that we have here in Wales. You see a real difference in values between ourselves and the party opposite, and, obviously, in the investment choices we make, in which we choose to support people as well. I'll never pretend that it is an easy exercise to get all the staff that we want, in particular in the times of the twin clouds of Brexit and austerity. But I say to the Member behind me: this Government will remain committed not just to the values of the national health service, but to the need to have the right numbers of staff, and we will do so in these most challenged of financial circumstances.

Let me turn to figures from the Nursing and Midwifery Council. Incidentally, they show EU nurses leaving the UK in droves because of concerns over Brexit—hugely worrying, but that's for another day. The general Welsh data shows over 300 fewer nurses in Wales since 2012-13. Now, cynics might say that what I did there was to pick a starting point to suit my narrative. Its data actually does show a slight increase on last year. But let's take your narrative and my narrative out of it and turn for a more balanced view to the Royal College of Nursing, who say that:

'Overall numbers of employed NHS nurses are static. This does not reflect increased patient numbers, higher patient dependency and higher bed occupancy. The overall numbers can also obscure very sharp shortages of registered nurses and nursing in some specific fields, e.g.

Neonatal nursing and childrens nursing in the community.'

Do you accept that that is a far more accurate picture of nursing in Wales than the complacency that I think you showed in that letter of April 2018?

I'm certainly not going to apologise for taking on Tory misrepresentations of the truth within the national health service. A claim was made in leaders' questions that simply was not true. It is absolutely right that we stand up for the health service and correct the Tories when they get the facts wrong. I'm still staggered that Rhun chooses to align himself with that point of view. It is a fact that we have more registered nurses in NHS Wales than ever before. It is also true that we have a number of areas where there are vacancies and there are challenges, and I've never tried to hide—the idea that I'm complacent about the challenges affecting the future of the national health service is absolutely farcical. All of these challenges require us to be honest and grown up. They also require us to do all that we can in a time when you recognise, as I do, that because of eight years of Tory austerity we have less resource right across public services than we have ever had before. Despite that, this Welsh Labour Government has continued to invest in the national health service—the only public service where we have more staff now than at the start of austerity. That is a measure of our commitment and I will not apologise for the actions of this Government in living our values and protecting the future of the national health service.

It's a damning indictment of your Government, as I say, that, if you are continuing to spend more, we're getting less results in terms of full-time equivalent nursing numbers, as I have factually stated, based on your Stats Wales figures. I am merely aligning myself with those facts as your statisticians put them forward. Now, we also know that the Welsh NHS continues to demonstrate a heavy reliance on nurses working overtime—71 per cent of nurses working overtime at least once a week. That's 16,000 nurses having to go over and above the call of duty every week because of understaffing. Just recently, we heard those BBC figures, based on FOI, that Betsi Cadwaladr lost over 77,000 days to staff experiencing stress and anxiety, which illustrates the problem of overworked staff in understaffed environments. Now, three options for you: you can either send a letter to the BBC saying that they've got their figures wrong, you can repeat what you said earlier that it's not about stress but about better reporting of stress, or you can accept that in recent years Wales has been substantially understaffed with full-time fully qualified nurses, and that as a result the nurses that we have are under unreasonable pressure and patients haven't received the very care your Government admitted could only be achieved through safe staffing levels.

Well, it's a very strange pitch that the Member makes, but I'm happy to say again: we have more registered nurses than ever before in the national health service in Wales. And your comments about overtime and bank arrangements—some people choose to undertake those arrangements. We also know some people are working together in a range of different circumstances. We have a range of measures in place to think about the accuracy and the efficiency of bank arrangements. We're taking on ideas put forward to us by the Royal College of Nursing on having an all-Wales bank. We're taking up the opportunities for e-rostering, because they are better arrangements for people who have their own needs about how they wish to live their lives, but also at meeting the needs of the health service. We are actively recruiting nurses. The 'Train. Work. Live.' campaign is actively going out and selling Wales successfully as a destination for people to come.

I'll tell you—I was in Belfast at the Royal College of Nursing congress, the only UK health Minister to be there with the Royal College of Nursing at their congress, and the welcome that we had, not just from nurses in Wales, but from right across the United Kingdom and Ireland, was significant. They recognised that, in Wales, we do value nurses, we are serious about recruiting and retaining nurses. They also recognised we're serious about promoting reform and making the very best use of people within the nursing family. You could not understate the enthusiasm of Welsh nurses for the environment they work in, their pride in the service, and the fact that they know they have a Government that is on their side. You would not find anything like the same feeling from nurses working in England.

Conservative spokesperson, Suzy Davies.

Diolch, Llywydd. Minister, first of all, congratulations on the new responsibility added to your already very busy portfolio. At the launch of the older people's commissioner's latest impact and reach report, you said that the human rights of older people will be put at the heart of public services in Wales. As some councils are looking at closing care homes or day facilities, are you confident that older people are being appropriately consulted? Because I'm not sure that they are. But then older people don't have the right to be consulted about change that affects their lives in the same way that children do under the United Nations Convention on the Rights of the Child. It's a Welsh Conservative policy to further enshrine the rights of older people within Welsh law by placing that due-regard duty on public bodies, not just Welsh Government, and we'd do the same for children's rights as well. Will you be prepared to adopt those policies?

Thank you, Suzy, for that question. I'm delighted to take on explicitly those new responsibilities for older people. It was great to be at that legacy event last week with the older persons' commissioner. My officials, in fact, have met with her, I think, on three occasions over the last month, working forward on a set of proposals to, as she put it, and as I will reiterate here, 'make those rights real'—those high-level rights that we already have enshrined in our legislation, making them real.

I think that's the focus, rather than a grand new shiny piece of legislation. I love bringing legislation forward, but sometimes there's a better, more immediate way to do it. Just to reiterate some of the ways, because some of these are in statutory areas and some in non-statutory—. So, for example, advocacy is key—absolutely critical—to older people. How much does an older person—? If you went out to the middle of Carmarthenshire and said, 'What do you know about advocacy?', I think most people would say, 'What the heck is that? What right is it that I have to that?' So, getting the awareness out there, but also getting the advocacy, both informal and professional, right—. So, we will revisit Part 10 of the code of practice on advocacy, with a view to developing real practical guidance, making those rights real for people and demonstrating due regard to the high principles.

We will, on commissioning, develop a national framework for independent advocacy services for adults in Wales. We will consider introducing a stewardship function for advocacy in line with recommendations from the Public Policy Institute for Wales. There are many more areas, such as looking to the regulations under Part 9 of the Social Services and Well-being (Wales) Act 2014 and how we can update those—the guidance that flows from that—to have due regard to the UN principles and, again, making the rights real.

But, I will ask the new commissioner as well, as she comes in, to chair a working group. It's up to the new commissioner what programmes of work they take forward, but I hope the new commissioner would be open to chairing a working group on taking this work forward and making those rights real for older people without the necessity for a grand flagship Bill, but actually making them bite.

I think my response to that is that if you want to make rights real, you enshrine them in legislation and make them enforceable by the courts.

I'll ask you something else now, though. Local authorities are currently in the process of submitting their annual reports setting out how they've used Welsh Government funds to help with respite for carers in their areas, which I think we'd all agree is very important.

These reports, of course, could hold very important information on best practice and good ideas that would run well in different parts of Wales. No-one has a monopoly on good ideas, as both our parties are inclined to say. Can you confirm that these annual reports will be publicly available, to help share good ideas not just between local authorities but with other providers as well? Can you confirm whether the reports will be specific as to the source of money used for providing that respite care, whether it's from the RSG, direct grant funding from Welsh Government, shared budgets with the NHS or any other partnership funding? Following the money in this policy area is pretty difficult, and I'm looking to you, Minister, to help with a little bit of transparency on this.

Indeed. I will check on whether those reports are going to be made publicly available, and I'll write to you and to other Members who are interested on that. On the issue of the traceability of the funding, I'm not sure that they'll actually say whether this has come from information and communications technology—the £3 million being set aside of the £50 million of ICT funding—whether it is from other sorts of funding that are already within the RSG funding, or whether they are within other tranches of funding that are being brought into this. One of the things that we've done for local authorities—at their request, I have to say—is we've given them the flexibility around this in order to actually focus on the outcomes for respite care. In fact, the older people's commissioner made very clear in her 'Rethinking Respite' report that there wasn't sufficient flexibility; it was too hidebound with traditional approaches to respite. Both she and local authorities have said, 'Give us the flexibility—give us the funding, but give us the flexibility'. 

So, I think the thing we need to be measuring is not so much which piece of which funding goes into it, but whether they've actually delivered the outcomes—that there are co-produced packages of respite care flexible enough to cater to each individual that have been delivered. There's the real outcome, as opposed to where the particular tranche of funding came from to deliver that outcome. But, I will write to you on the issue of whether those reports will actually be publicly available.

Thank you for that. On the issue of outcomes, I don't think anyone here would disagree that that's the most important thing, and, in fact, the integrated care fund has had a lot of praise from a number of people I've spoken to. But I don't think the Welsh Government can take its foot off the pedal in helping on transparency so that we can actually understand the budgets that you bring forward every year. To try to move away from that as being unimportant, I think, is not impressive, I'm afraid to say.

What I would like to welcome is your planned establishment, through Carers Wales, of a Wales hub for Employers for Carers, something that, obviously, England's had for 10 years now, and I'm really pleased it's coming here. From some of the discussions I've had with people involved in caring at different levels, it seems to be pretty clear that many businesses don't really understand what the role of a carer is, what their rights are and what kind of support could be offered, as it varies, of course, greatly from business to business and carer to carer, sometimes even within single departments in bigger companies. Welsh Conservatives, as you probably know, would like to introduce a financial incentive for young adult carers to stay in post-16 education or apprenticeships so that they don't lose out on career progression, but we recognise—and I wonder if you agree with this—that some employers offering apprenticeships may be deterred from offering them to young adult carers because of those caring responsibilities. If so, how do you think your hub might help employers see beyond those responsibilities to the highly motivated young person who really wants that apprenticeship? 

I think you're absolutely right; if we are genuinely interested, with the demands in front of us of a diverse workforce, in utilising the skills of every person of all different ages, including those with caring responsibilities as well, then there is a real job of awareness raising and support for employers to actually identify the needs of those individual carers, respond to them, and to enable them to enter the workplace along with caring responsibilities. Now, if a carer is a young adult carer, for example, aged between 16 and 25, as part of their assessment in transitioning forward, it must include an assessment of, for example, current or future transitions that that carer is likely to make into further or higher education, or to training, or to employment, and it must have due regard to what that young adult carer wishes to participate in. So, part of this is working with the individual carer on their individual plans, and then it's also working with employers. There is a big job of work to be done here with employers, particularly small and medium-sized employers, to open up the world of work then for carers, and to work with them on that. But we will take that forward, and I look forward to the work now of the ministerial advisory group on carers as well on taking forward all of the work streams that, Suzy, you referred to there, and feeding back to me as a Minister.