1. Will the Cabinet Secretary make a statement on the expansion of medical education and training in north Wales, following the announcement made earlier this week? 203

Thank you for the question. Earlier this week, I was happy to announce an immediate increase in medical school places in Wales. These 40 additional places will bring benefits to the whole of Wales, including west and north Wales, with 20 places in Swansea medical school and 20 places in Cardiff medical school, to be delivered in collaboration with Bangor University in north Wales. Cardiff and Bangor universities are collaborating on plans that will allow students to undertake all of their medical education in north Wales in the near future.  

I find this a really useful announcement, because in Wales we're facing the same challenges as the rest of the UK to train and recruit medical practitioners, and I'm pleased that this scheme will help to deliver and to promote that. I understand that there's lots of work and detail that will follow, and I look forward to the updates. I support a pragmatic approach to delivering maximum benefit from a restricted budget, and the fact that not all of the money will be spent on a capital investment.  

Increasing the numbers in Swansea and also Aberystwyth University will, I believe and I hope, give wider and more diverse opportunities to the people who live in those areas. We all know, and it's well documented, that west Wales in particular faces major recruitment challenges, and I look forward to this increase, or any other increase for that matter, delivering for the people of west Wales, who need, quite clearly, to gain from medical practitioners in an ever-changing environment.  

Thank you. It's important to note that this is keeping the pledge that we made to come back with a decision, and the indication that I gave that we thought we'd be able to do something on expanding them—expanding opportunities in different parts of Wales—in previous questions. I've always been keen to talk about the fact that this is good news both for north Wales but also west Wales, because, as you correctly point out, there are recruitment challenges in west Wales as well as the north. There is a small amount of capital that we'll need to deploy to make this happen, but doing this this way, in collaboration between four universities, will mean that we're able to make faster progress on increasing numbers and increasing opportunities in different parts of Wales, because there's lots of evidence we're more likely to have people stay in west Wales and north Wales if they undertake large amounts of their training there.

It does come on the back of an agreement we reached on how we use some money with Plaid Cymru in the budget, but that two-year amount won't be enough to train someone over the course of a whole medical degree. So, we've made the choice within Government to support this whole programme of study and to have a permanent increase in the additional numbers of medical training places. So, it goes beyond the agreement we reached about exploring this issue with Plaid Cymru. It is a permanent addition, and I look forward to understanding more about not just when people can undertake all of their study in north and west Wales, but also our ability to then see what more we can do to have the right sort of medical and fellow health and care professionals here in the service in Wales.

I do welcome the expansion of medical school places, although I do regret that you didn't choose to announce that expansion here when this has been a topic that has exercised so many of us on so many occasions. We do have a shortage of doctors, as you're well aware, in certain disciplines such as general practice, paediatrics and rheumatology. Are you able, through these places, to seek to massage the workforce planning going forward and to ensure that we have people who might then be able to follow those kinds of specialisms? And given the shortage of doctors, I would be very interested to know how you evaluated that 40 additional places is what we need. Do we need more? Was that all the money you had available, or do you think that 40 is it, and that will suffice going forward?

I noted in your written statement that you published earlier this week the intent that trainees will be able to undertake the totality of their medical training in north Wales, and their postgraduate training. Whilst further collaboration between Cardiff and Bangor is absolutely key in making that happen, what discussions, if any, have taken place with providers in the north-west of England, especially the hospitals that may be able to produce or to allow rotational work to be undertaken as part of that postgrad training? I'd be really interested to know whether or not you believe that we can do all of our postgrad training within north Wales itself, because we heard in our previous inquiry to the health and social care committee about some of the difficulties of producing or of being able to do some of that training, because we don't have all of those specialisms within our current structure up there in north Wales. Thank you.

Thank you for the questions. I think it's a useful point about distinguishing between the medical degree and then speciality training post medical degree. Of course, there are ongoing conversations with colleagues in the north-west deanery in England about how we might arrange different courses of study, as well as what we can do within Wales as well. I want there to be a practical conversation that is led by actually making a difference for the quality of training and the scope of training that can be provided, as opposed to an England-versus-Wales conversation. There will, of course, be times when politicians disagree, but this is actually about training doctors to give them a career within our national health service, serving our communities.

On the point on the medical degree and the practical choice about places and mone, they are practical choices about our ability to expand, if we want to fund that expansion, because, as I say, you can't do that on a limited agreement over two or three years, because the degree takes longer and it would be a pretty unusual thing if we decided to expand a degree course of study for one cohort and then at the end of that we would withdraw the funding. There would be no way to plan and properly expand the numbers we would want to see within our medical workforce. It won't take away our need to continue to recruit from within the nations of the UK as well as outside the UK, in Europe and further afield, but this is us making a practical choice with the resource we have to make a difference in the area that we can make with our current two medical schools, to deliver against some of the challenges in different parts of the country.

That will also be the case for speciality training as well, because, every year, we look at our speciality training numbers and we need to understand how and where we fill those places. So, actually, that is even more important in terms of the links with the rest of Wales and, indeed, the deanery across our border where different training places are available for those speciality places. So, we have some of the same challenges as the rest of the United Kingdom and some rather more unique ones. This is part of the answer, as opposed to a silver bullet for all the challenges that you and I will continue to discuss now and in the future.

In May of last year, this report was published by the Member of Parliament for Arfon, Hywel Williams, and me, setting out the case for a medical school for north Wales. Your announcement on expanding medical education in north Wales is a significant and important step in the right direction, and is the result of a strong local campaign in Arfon.

In your statement you say this:

'these new arrangements will provide more opportunities for Welsh speakers to undertake their studies in Welsh.'

Can you expand upon that and how exactly that will happen?

Thank you for the question. It is important that we see opportunities for people to utilise the skills they have to be doctors, including the ability to use the Welsh language. Part of our challenge, and I've made this point several times over in the past, is that Welsh language needs are not preferences, they are genuine care needs in a range of our communities and with individuals and their families. Part of our challenge has been how we have enough health and care professionals to be able to deliver against that, and I'd still like to see us be able to make more successful efforts to attract people back to Wales who have undertaken part of their medical or other healthcare professional training within England. That requires us to have an attractive offer for them to work here in Wales, as opposed to simply saying that they have a sense of national responsibility to return to make their careers anew.

But I do fully expect that in the programmes of study that exist already, that will be real and possible. We're making deliberate efforts to try and encourage people who speak Welsh to come into medical education as a potential career for them. I spoke, for example, on a programme of study we have to look to get a number of 16 to 18-year-olds in Valleys communities and other parts of Wales to come and consider a career in medicine. So, we are deliberately going out to look to try and make sure that it's an attractive career for different people to come into, as well as the place of study itself, as—[Inaudible.]—course of study, and the medium of the language that that is delivered in.

I'm pleased to reiterate that this decision that I have made is a result of us keeping our word about the decision that we would consider, the timescale we'd make it in, and our ambition to expand opportunities to undertake more medical education and training, and our ambition to make sure people come and undertake their whole period of study within Wales as well. 

I've supported the concept of a Bangor medical school since the previous vice-chancellor, Merfyn Jones, first raised it with me a decade or more ago, and this, of course, has been raised in previous Assemblies also. But given that the north Wales local medical committee—many of whom themselves studied at Liverpool medical school, or Manchester medical school, some of whom came from north Wales, some who chose to build their lives and careers in north Wales—have called for this model to incorporate and restore direct connections with Liverpool, and possibly Manchester medical school, not just beyond, across the border, but specifically there, given the historic links, how do you respond to that call by the north Wales local medical committee, made up of local general practitioners, and what dialogue have you had with them regarding that?

I've made an announcement that is building on our two medical schools and provision and partnership with universities in different parts of Wales. I don't think it would be at all helpful for me to try and interrupt that, having just announced it within a week, and to then say that I expect them to remake different links with different medical schools. We of course want opportunities for people to study medicine and to be able to acquire skills to deliver the full programme of study to become doctors and actually to keep them here in Wales. I will always look for opportunities for our health and care system here in Wales to attract people to come here, and to keep people here, and to work with other partners across our border to do so as well. That will be the focus. It will be about making the partnerships that we've agreed, to make them work, and the partnership and collaboration that has real investment and time for people in both Swansea and Cardiff medical schools, and I'm really pleased to say, within Aberystwyth and Bangor universities too. 

And finally, Rhun ap Iorwerth.

Thank you very much, Llywydd. May I welcome this statement today, which has taken far too long to come, of course? I am thinking back to a very early meeting I had, after I was elected, with Professor Dean Williams, from Bangor University and Ysbyty Gwynedd, who seeded this idea, and the realisation I very quickly had that it was obvious that we needed to move ahead with medical education in Bangor, as people like Dr Dai Lloyd realised the need for the introduction of medical education in Swansea University, and there is a now a full medical school in Swansea. I am thinking of all those doctors and those who would wish to be doctors, young people and parents, former doctors and nurses—people who see the benefit of developing medical education in Bangor, and I thank them today for supporting those of us who have campaigned so hard for this, in order to turn this into a reality.

Let us remember why this is taking place. This has to take place because of a lack of doctors in parts of west Wales and north Wales. This will be a help, I believe, in recruiting and filling the gaps. It is happening because there are too few doctors being trained in Wales, and too few of those coming from Wales. So, this opens the door, I hope, to a greater number of our young people being able to undertake a career in medicine.

To the Conservatives, if I may say: on a day when we are celebrating having a medical college, to all intents and purposes, in Wales, you decide to concentrate on asking about the linkages with north-west England. Well, listen: of course those linkages are important, but let us also today concentrate on what we can do here in Wales in order to increase the capacity of medical education for ourselves.

To you, Cabinet Secretary, I have simple questions to ask: can you confirm that this is only the beginning of a growth in medical education in Wales, and can you also confirm that you will share my desire to see this new medical college in Bangor developing to be a centre of excellence, not only in teaching medicine through the medium of Welsh, but also in the provision of rural healthcare? Today is an important step forward.

In making this announcement, we've been clear with our university partners and the two medical schools that we want to continue to see more people from Wales have opportunities to train to become doctors as part of this. We want to see excellence, of course, but I don't think that you need to dumb down on standards, frankly, to give more people from Wales opportunities to—

Who's talking about dumbing down on standards?

That's exactly my point. You don't need to dumb down on standards to give more opportunities to people in Wales.

That's not been suggested. Why do you bring that up? That's terrible.

The reason I bring that up is that it is something that is mentioned outside this place from time to time about saying, 'Actually you need to change standards.' [Interruption.] I think you're misunderstanding—[Interruption.] With respect, I think you're misunderstanding the point I'm making. The point I'm making is that there are plenty of young people from Wales who have the ability to become doctors. This is about making sure that our universities don't operate a system of understanding who will then be offered those places that excludes young people from those places. I want to see more people from Wales be given opportunities to study medicine in Wales, and the expansion in numbers has to be accompanied with an expansion in opportunities for people from Wales to take up those places. Because I believe there is plenty of talent available within Wales who will want to do so. And that's actually why, in answer to earlier questions, there are the efforts that we're making to make sure that more people are encouraged to consider a career in medicine. So, that work will have to continue, rather than simply say, 'Expand the places and the people will come.' The people need to come from within Wales as well.

I'm more than happy to indicate that I want to have a continuing conversation about the numbers of people that we have within the medical profession, about how and where they're trained. We will always need to have a practical conversation about that, to understand the resources that we have available, and the ability of our medical schools, in partnership with their universities, to do so. But at this point in time, I think the collaboration that has gone into this, and the work that has gone into this, from four universities, gives us good reason to think they could actually train more people. The challenge is our ability to finance that training, and to make sure that we make a success of the current expansion that I have already announced.

And of course I want to see the new partnerships that we have announced deliver genuine excellence, in health and care, including rural healthcare. There is a real opportunity for us to deliver real excellence in healthcare, because a number of doctors want to work in a city context, a number of doctors want to work in a Valleys context, and there are lots of people who want to be doctors in rural medicine as well, and this is a real opportunity to give those people more opportunities to do so.

I thank the Cabinet Secretary.