5. What further steps will the Welsh Government take to prevent and treat respiratory illness? OAQ52222

Thank you for the question. Our approach to tacking respiratory ill health is set out in the respiratory health delivery plan for Wales, which was updated and republished this January. We continue to invest in respiratory care, and, in Wales, spending has risen from £338 million in 2009-10 to £432 million in 2016-17.

Cabinet Secretary, the Asthma UK survey 2017 found over 300,000 people in Wales living with asthma, thousands of annual emergency admissions and 62 deaths in 2016. Two thirds of the deaths are thought to be preventable with better basic care, and standards of basic care are said to be achieved in over 48 per cent of cases in Northern Ireland but, at the other end of the scale, only 26.1 per cent in Wales. So, what further steps will Welsh Government take to drive up standards in Wales?

I'm happy to recommit ourselves to driving up standards right across respiratory conditions. We'll have more to say on that in the coming months. There's an interesting project led by a number of people about the possibility for a respiratory innovation centre, which I'm particularly excited about. There could be economic benefits as well as healthcare benefits to that. On asthma, the thing about the report provided by Asthma UK is that, given the size of the sample, I wouldn't quite agree with all of the assertions they make about the comparative nature of care being provided within different nations in the UK, but they are broadly right that we could and should improve on healthcare, both at primary care level as well as at specialist level.

We're actually in a position where virtually every general practice participates in the clinical audit for primary care for asthma and COPD. That gives us a good picture of the quality of care delivered locally and areas for improvement. And this is a key area where we're actually improving value, because a number of clinicians have actually looked at the treatments available and they choose what they think is the best value product, which isn't always the highest priced product as well. So, we'll get better value for care, and, of course, in asthma care, we've seen some of the new drugs and treatments available being made available faster here through the new treatment fund, delivering on our manifesto pledge to the people of Wales. So, we recognise we have more to go, but we have a real commitment, and I think really good reasons to be positive about our prospect of improving care outcomes here in Wales in the future.

Cabinet Secretary, we in the Welsh Conservatives launched our urban strategy last week, and we put in place some measures to improve air quality, such as the requirement on all schools and nurseries to have air quality monitoring on their premises. I wonder what sort of conversations you're having with your Cabinet colleagues, particularly the Cabinet Secretary for the environment, to start tackling the blight of poor air quality in Wales in a multifaceted way, as the future generations Act, of course, requires you to do.

I'm happy to confirm that there are conversations that do take place across Government, not just with the Cabinet Secretary, but with the Minister, who leads on the clean air plan for Wales. There's something here about understanding the contribution of the national health service and what we can do both to improve the quality of air, but the way the national health service itself operates. It's the biggest employer in the country; we were talking earlier about the fact that it's the only public service to have an expanding number of staff, and more than 90,000 people are employed by the national health service. So, how people get to work, how we make it easier for them to get to work and how we actually then improve the running of significant parts of the NHS estate are part of what we can do, as well, of course, as thinking about the consequences of poor air quality in terms of health service need.

I visited a fantastic example of looking at the way in which we reduce our footprint in actually having a smaller number of movements on and around hospital sites recently in St Woolos, looking at the new Sterimelt innovation, which is actually converting some of the equipment used in hospital theatres and converting it into larger blocks that can then actually be used for 3D printer filament. So, that's actually a really good way to have put a waste product, that was previously going to a landfill with lots of lorry movements on and off, previous to that technology—reducing the number of lorry movements needed to do that. Now we actually have that product turning into a different, useful product. And the good thing is it's been developed by a company in Wales, still based in Wales—I should say, Presiding Officer, within my constituency—but we actually have a real opportunity to see that go into a more useful product to be delivered again through the national health service.

6. Will the Cabinet Secretary make a statement on GP services in Pembrokeshire? OAQ52209

Thank you for the question. GP services are a core component of primary care and the delivery of a sustainable health system. Our drive for continued improvement is backed by the nearly £43 million primary care fund that is driving change and innovation across Wales, including, of course, Pembrokeshire, and £4.69 million of the fund in 2018-19 has been allocated to Hywel Dda for their plans for service sustainability, better access, and to deliver more services locally.

Cabinet Secretary, Hywel Dda university health board has recently approved the application to close St Clement's surgery in Neyland in my constituency, which will have a huge impact on patients at the surgery who will now have to travel to Pembroke Dock for treatment and incur financial costs due to travelling over the Cleddau bridge. In light of these circumstances, can you tell us what discussions you've had with your colleague the Cabinet Secretary for Economy and Transport—who's in his place at the moment—given that the Welsh Government has committed to abolishing the tolls on the Cleddau bridge, so that patients in my constituency will not have to incur financial costs for accessing vital GP services?

I'm sure the Cabinet Secretary for Economy and Transport will be happy to outline the progress this Government is making on the Cleddau bridge in due course. In terms of general practitioner and primary care services within Neyland, I recognise the point that the Member makes, and there are ongoing conversations to consider which services can still be provided within that area to reduce the need to travel to other parts of the health board area for further treatment. So, we'll continue to work alongside the health board, as required, to help them, but this is actually a choice that the group itself has made about closing a branch surgery, and that's within the rules in which general practice operates with this significant independent contractor. But I'm confident we'll still be able to deliver a significant range of local healthcare services within the Neyland area to reduce the need for anyone to travel to Pembroke Dock, including before the time when we make further progress on the tolls.

Well, I'm afraid the vision that you've set out is not the reality in Pembrokeshire for access to GPs. In the last two months, I've had constant updates from Hywel Dda health board about the lack of availability of GPs over the weekend. Only last week, a Narberth constituent contacted me after having phoned her GP surgery 82 times before she got an appointment. My discussions with my constituents about the Hywel Dda health reorganisation proposals have really turned around the fact that there's an informal rationing system for GP access now in both Pembrokeshire and Carmarthenshire that relates to making it blinking impossible to get hold of a GP and to get an appointment. When will you actually do some strategic work to ensure there is sufficient GPs in Pembrokeshire, but more than that, that we have a proper out-of-hours service provided by GPs so people don't turn up at A&E and report inappropriately to that area?

There are two points there, aren't there? There's the point about access in hours and the work that's being done in making sure people get to see the right healthcare professional. Sometimes that will be a GP, other times it will be a physiotherapist, an occupational therapist, or a nurse, or a pharmacist, or a different healthcare professional. I'm pleased to see that in both the north and the south Pembrokeshire clusters, they're investing in those different staff to provide that wider service.

I don't recognise the point you're making about deliberate rationing to make it impossible for people to see a healthcare professional. I do recognise, though, there are localised challenges that really do exist in different parts of the country where access is difficult; I recognise that exists around the country. There are also parts where access isn't a challenge. It's part of the negotiation we're actually having with the British Medical Association on changing the contract for the future, because they too recognise that access is a real cause for concern, with doctors themselves recognising the unhappiness of staff who are placed in that position.

In terms of out-of-hours, we're actually rolling out the 111 service; it's across part of the health board area already, in Carmarthenshire, and that will help us to have a more robust and sustainable model of out-of-hours provision. But I do recognise there are challenges in this area too, and actually, what hasn't happened, of course, is the taxation changes made that the Member for Llanelli has raised on more than one occasion, and that is actually putting people off. Conversely, though, of course, the steps that we have made, and will continue to make, on GP indemnity insurance will help to provide more people to work in the out-of-hours service, because actually, not resolving that issue is a bar to people working in both out-of-hours and in-hours. So, there are good reasons to be positive, although not complacent, about the future.