Item 7 on our agenda this afternoon is a statement by the Cabinet Secretary for Health and Social Services on winter delivery planning, and I call on the Cabinet Secretary for Health and Social Services, Vaughan Gething. 

Thank you, Deputy Presiding Officer. I am pleased to update Members on how NHS Wales, local authorities and other partners are planning to deliver resilient services for the winter. Last winter was one of the most difficult that our health and care services have faced in several years and saw increased challenges for our front-line staff. This was not, however, unique to Wales as health services across the UK were put under immense strain. Significant snowfall, freezing conditions, increased demand for GP and emergency care services, increased admissions to hospitals for older people with complex conditions, and the largest number of flu cases since the pandemic of 2009 meant that our NHS and social care system was under unprecedented pressure. Despite these pressures, the majority of people accessing health and social care services during last winter received timely and safe care. This is testament to the thousands of committed staff working in often difficult circumstances, often going above and beyond what could reasonably be expected of them to deliver professional and compassionate care. 

Members will be aware that an evaluation of health and social care resilience over the last winter was published recently. Reflecting on learning from this evaluation, it was recognised that a co-ordinated and collaborative whole-system approach is essential. It also suggested that prioritising delivery of a small number of areas in a targeted way ahead of this winter would support better management of surges in demand and changes in patterns of demand.

As I stated in my written statement on 25 October, my officials have worked with national clinical leaders, leaders from the NHS Wales organisations and local authorities to develop five winter delivery priorities for this winter. These will increase focus on the management of patients in the community, make sure there is clinically focused hospital management to manage risk and peaks in demand, and to ensure that people are able to return home from hospital when they are ready.

While we recognise that pressures on the health and care system are a year-round reality, planning for winter remains a significant priority for our health and care system and national agencies. Preparations for this winter have been taking place throughout Wales and across organisational boundaries since last winter. Local health boards, the Welsh ambulance service, local authorities and other partners have been working over recent months to develop and finalise integrated winter delivery plans for their health and care communities, aligned to those five priorities. 

Integrated winter delivery plans have been received from every health board and they have been scrutinised by my officials, the NHS Wales delivery unit and the national programme for unscheduled care. Feedback has been provided to help improve their plans ahead of the winter. The Welsh Ambulance Services NHS Trust has developed a national plan that has been considered and agreed by the Emergency Ambulance Services Committee as well.

The local plans include an additional focus on providing telephone advice to people with urgent care needs, increasing access to services in the community over evenings and weekends, and collaborative working with the third sector to support people to leave hospital when they are ready.

To support the delivery plans, I announced a £20 million package for the NHS and social care partners in Wales ahead of this winter. Learning from previous years, I made the decision to allocate this funding earlier this year to ensure local health and care teams are as prepared as they can be for the winter to come. This funding is, of course, on top of the £5 million I announced on 17 October to help relieve pressure on critical care units and the £10 million I announced on 22 October to support sustainable social services through this winter. It will help people to access care closer to home, ensure there is sufficient available hospital capacity and help people to leave hospital for home when they are ready. Sixteen million pounds of that £20 million package will be allocated directly to local health boards to support delivery of actions featured in their plans, alongside their partners in the ambulance service, local authorities and the third sector.

I expect that funding to be used to support health boards’ delivery against milestones identified for this winter, as part of the adoption and adaptation of the primary care model for Wales. Delivery against these milestones will be monitored through monthly meetings with directors of primary and community care. We've made clear our expectations to health boards that this funding must be used to support delivery of actions outlined in their integrated winter plans, and that, again, will be evaluated as part of another review of winter resilience after this winter finishes.

The remaining £4 million of the £20 million package will fund nationally agreed priorities for the winter period, and these include increasing capacity in emergency departments to support patient flow, four high-impact Welsh ambulance service projects to manage patient demand in the community, and two pilots to extend primary care out-of-hours access.

The winter will also see NHS Wales work more closely with the third sector. For example, local health boards will work with the British Red Cross to support patients and staff in emergency departments, and transport relevant patients home, helping them to resettle and reconnect with community services. The Welsh ambulance service will also be working with St John Cymru Wales to scale up a project, trialled in south Wales last winter, to introduce a dedicated falls service, and I outlines this in my statement last week about the amber review. This will help avoid sending essential emergency ambulance resources to people who can safely be resettled without a clinical intervention.

Health boards have been asked to formulate operational plans for the crucial 18-day period between 21 December and 6 January. That's in recognition of the particular challenges that this period presents due to the number of bank holidays. This year’s Choose Well winter campaign that I launched recently places more of a focus on the role of community pharmacy and the wide range of other services that are available within the community. They're often closer to people’s homes and available at more convenient times for a range of people in the evenings and weekends.

I was pleased to launch the annual Beat Flu campaign on 3 October, and I had my flu jab in a community pharmacy in Cwmbran. The Beat Flu campaign encourages all those who are eligible for the free flu vaccination to get protected. This year, the vaccine will be more widely available than ever before, including for staff within the social care sector, paid for by the national health service.

But there is no reason to think that this winter will be any less challenging than previous years and, yet again, we will rely on the dedication of our staff at the most extreme times of pressure. However, the plans that we have across health and social care come from a partnership between our NHS, local authorities, the third sector and the Government. The combination of local and national plans should provide increased resilience against the inevitable pressures that will come over the winter months. As ever, it is our aim, and that of our dedicated staff, to make sure that patients continue to access the care they require, when they need it and where they need it. 

Cabinet Secretary, thank you for your statement today. One of the things that does seem to mark out the winter months is these winter pressures on the NHS and, obviously, over the Christmas period, as you alluded to in your statement. With the bank holidays and all the rest of it, it is a particularly challenging management time for the NHS, and we do pay tribute to the work of the NHS staff across the whole estate, because it needs everyone within that estate to work, as well as the voluntary sector, to meet those challenges. 

I will take a couple of points out of the statement, in particular around the capacity. You can talk about the extra money you've put in, which is very welcome, but is that extra money buying additional capacity, both in hospital beds and access to GP practices and primary locations, in particular? In the statement you talk about increasing access to services in the community over evenings and weekends. Well, if you talked to most people, they do have difficulties at the best of times trying to access appointments in the evenings within the GP sector, for example. So, what additional capacity will the resource that you're identifying buy over these coming months so that that will actually treat patients in the best location, which is the community itself?  

Here in Cardiff, for example, over the Christmas period last year, there was a certain period of time when there was no GP out-of-hours provision whatsoever because the health board was unable to attract any GPs to fill those rota slots. Can you give a commitment today that that situation will not happen this winter, given the preparedness that you've identified within your statement this afternoon? In particular, and I did raise it with the leader of the house, could you touch on staffing levels within the NHS, in particular in maternity services? You did indicate that you were going to come back to the Chamber to inform us about staffing levels within maternity services across Wales in light of the Royal Glamorgan Hospital situation and the staffing numbers there. If you could use, maybe, this statement to give us an assurance that your officials now have satisfied themselves and confirmed to you that staffing numbers are robust in the services that will be called upon for the winter months, I think that would be greatly appreciated.

The flu vaccination—obviously there's a widespread campaign around flu vaccine across the length and breadth of Wales. Only this morning I was hearing of issues in north Wales in particular, where there does seem to be a shortage, certainly in some GP surgeries, and patients unable to actually have the jab when they've presented themselves to have that vaccination. Can you confirm whether you are aware of such instances where patients are turned away when they present for the vaccination, and, if that isn't the case, are you able to give an assurance that, if constituents do want to have the flu vaccine, there is ample supply here in Wales for that programme to actually meet the goals that we want it to achieve?

Obviously, what's really important as well is to focus on the wider NHS estate. There is little or no point in having the hospital itself working if the car parks, for example, or the roadways into the car parks, are blocked up. Very often, these are the things that do tend to get overlooked. I can remember in Llandough hospital, some two years ago, the hospital itself was functioning very well but because the car parks were iced up and snowed under, basically they couldn't get any patients in or staff to assist in the changeovers that were required. So, when the hospitals and health boards look at their estate, they should look at the entire estate and the workings on that estate so that we don't find that sort of anomaly happening again that puts undue pressure on the hospital environment itself.

You also touched in your statement on the increase in community facilities that will be made available. Could you explain what increase you're looking at creating this winter that wasn't available last winter in the community, so that patients know where they need to go and present? It is important, as you quite rightly identified within your statement, to say that this is a multi-agency approach that's required, from the voluntary sector, from local authorities and the health service itself. If all walk in unison together, then we can have confidence in the plans that you've outlined today. But what we saw last winter was a breakdown in the service, regrettably, despite the best endeavours of many people across the length and breadth of Wales. I do point to that specific point that I touched on, where, in Cardiff for example, there was no out-of-hours provision whatsoever and so that only leaves the A&E department to take the brunt then of all that extra demand arriving at the doors of the hospital, which puts pressure on the hospital itself, and that pressure drives the service down. So, can you give us the commitment that the capacity will be in the community? Can you give us the commitment that health boards have got the staffing levels they require, and, above all, what new initiatives will you be bringing forward where you've learnt the lessons from last winter? 

Thank you for the wide range of questions. Some of your broader points were about capacity across the system—you started and ended on those points. On capacity within the beds part of the system, and not just within the hospital setting, but the ability to flex bed capacity, that requires staff, and that's the biggest limiting factor, rather than the physical beds and space themselves. But there are also beds in different parts of the system, so a focus on reablement beds, to get people out of hospital if they need an intermediate setting before going back to their own home wherever that may be, whether it's a private residence or if they're in the residential care sector.

There's always capacity to make better use of the capacity within the pharmacy sector too, which I've outlined in the statement. There are more services that pharmacies can provide than many people are aware of. We want to make the best possible use of that service. I've outlined in both the amber review and in today's statement some of where that extra capacity will be—for example, more clinicians available to service the clinical desk with the Welsh ambulance service, where lots of demand ends up being filtered through during this time of year, and, where the 111 service has been rolled out, there is more resilience in the out-of-hours service and not just people interacting with the emergency ambulance service as well. So, we will have more staff to help make that work. That partly follows on from the statement last week on the amber review. Today, for example, you know that, across the system, the successful pilot of advanced paramedic practitioners in north Wales is being rolled out through the service. So, that's extra capacity but not just numbers, but the sorts of people making use of the skill that those advanced paramedics have. Local health boards have decided with their local authority partners where best to deploy the skills of those advanced paramedics. So, yes, there are going to be more staff in and around our system, and we really are trying to learn lessons from the last winter. It should be a positive that that lesson learning takes place between professional staff and leaders of staff, so I'm not getting drawn into the operational detail of that because, actually, that's not where a politician should be. It's about the assurance that we are providing them with the resources they need to deal with the capacity and where they need that capacity to try and deliver a more resilient system through this winter.

But it would be foolish of any health Minister in any Government to try and provide an absolute guarantee that the system won't come under pressure or strain during the winter, and that includes our ability to provide out-of-hours services and how all parts of the system flex with each other. That's why we need to make better use of integrating the whole system together, because otherwise I recognise that that pressure goes into different areas. That's why we are looking to provide more capacity across the social care side of the system, because the dedication of our staff has to be in all of those sectors. If we achieve greater flow through the healthcare system, as we expect to do and as we want to do, that means that people will arrive in the social care sector more rapidly than before. We need capacity in that sector, not just in beds but in staff to do their job too.

On some of the specific points you made, on the operational plans that health boards are delivering, I do expect them to cover the estate within our hospitals so people can actually move around that estate—that's staff and patients and visitors too. On the assurances on the maternity services, we have received assurances, and I'll be providing a written note for Members to confirm that those assurances have been received about the staff members on maternity services around the country.

And then, on the flu vaccine, there was significant additional demand for the manufacture this year. Every year, public health organisations agree on the right strains of the flu vaccine to target. There's a slightly different vaccine available depending on different age groups and the efficacy of that. The manufacturer had some short-term supply issues at the start of the season. They're being resolved and the batches are being released across England, Wales and the rest of the UK as well. So, if anyone has not had the flu jab who wants it they should re-contact either their GP or their local community pharmacy and they can give them local information about when to have the jab and when it will be readily available in each area of the country. But we've actually got ahead this year in our flu campaign. We expect and want to vaccinate more of our staff and more of the public, and there should be more opportunities to do that in different locations around the country too.

I'd like to thank the Cabinet Secretary for his statement. I'll just start with a general issue. Cabinet Secretary, you quite rightly highlight at a number of points in your statement the huge pressure that there has been on staff. I think you said in a recent interview:

'Last winter was really difficult and meeting staff who were at the sharpest of sharp ends. Knowing they are committed, and knowing that they want you to do something for them. Sometimes that’s listening and there’s times people say "You can make this better for us".'

Cabinet Secretary, are you confident that the plans that you've outlined for us today will relieve the pressure on staff? Nobody could expect you to guarantee that there won't be additional pressure, because there always is at winter time, but are you confident that it will relieve pressure on staff and make this winter somewhat less stressful for them? I have to say that my inbox and my postbag suggest that there's a certain amount of scepticism out there about how much has changed, so perhaps you can take the opportunity this afternoon to further reassure staff.

Turning to the main content of your statement, you talk about the winter delivery priorities focusing on management of patients in their communities and ensuring that people are able to return from hospital when they are ready. Now, you'll be aware of concerns that have been raised consistently by the Royal College of Occupational Therapists about the lack of occupational therapists available both to take part in the assessment processes when people are ready to leave hospital and to assess their homes to make sure that the homes are appropriate to receive those patients returning home. Will the initial resources that you've announced today help increase the occupational therapy capacity where that's needed to facilitate people going home from hospital as quickly as possible?

With regard, then, to the winter delivery plans—and I'm sure we're all very pleased to know that they're in place—you refer in your statement to feedback having been provided to the care providers, to the local health boards, to improve those plans. Are you able to share with us a little bit more of the concerns that you did have about those plans, or that your officials had, and what steps you expect local health boards to have put in place to address them. I fully take on board what you say about detailed operational matters not being a matter for you, but given that you have highlighted that feedback was needed, I think it would be helpful for us to know what that feedback was in order to be assured that that was fully taken on board.

Like Andrew R.T. Davies, I welcome the £20 million package. Could you tell us, please, whether this is new funding for the health budget or whether this is funding that's been moved from another priority to this priority, and, in which case, where that funding has been moved from? I realise and appreciate how very tight the budget is and I am, as I've said, welcoming that additional resource, but it is important for us to understand where other pressures may arise if that funding has been moved.

I would very much welcome the references to some of the positive work with the third sector, and I'd just like you to tell us this afternoon what you propose to do to ensure that, where there is good project working in particular areas with the third sector, that that is learnt from and that those good uses of the third sector are extended nationally. Of course, there will be different third sector provisions in different parts of Wales and it may not be possible to do it everywhere, but where there is good practice, I'm sure that you would agree that it's best that that's shared and used.

One of the important parts, of course, is that your statement highlights the emergency care system—out-of-hours GP services and the 111 call centre. Now, given the extremely critical audit office report on out-of-hours care that came out last summer and the concerns that the Royal College of General Practitioners have raised today again about the number of general practitioners we have, the gaps, and general practice's capacity to cope, with 84 per cent of GPs saying they're concerned that their workload will negatively affect their ability to provide care for their patients this coming winter, can you assure us, and can you update us on the progress on implementing that report's recommendations so that out-of-hours care will be strengthened this winter and will be as robust as you are setting out for us that you hope that it will be?

Of course, finally, winter planning is not just about making sure that doctors and nurses are available in our hospitals. Hospitals, particularly, have a whole range of support staff to make sure that pharmacies are stocked and equipped, to make sure that porters are in place to help patients to move about and so on and so forth. Can you confirm that keeping these support services operational is also part of the key, particularly, holiday planning that you've expected the local health boards to make to prepare for the Christmas season?

The Llywydd took the Chair.

I tried to cover the final point in the series of questions in the statement. I tried to refer to the range of bank holidays that take place between 21 December and 6 January. We know that's partly about bank holidays and also about the additional surge that we tend to see both after Christmas and after new year when people have put off going to seek help and advice, and after each of those particular milestones we see a surge in demand coming into the whole health and care system, not just our hospital sector, but general practitioners certainly see that surge in demand as well.

On your—I'm trying to address the number and the range of questions that you asked—I think the plans will help to make sure that we have the best prospect of delivering the best possible service through winter, and I recognise there is always pressure and stress on staff. We're talking about the busiest end of the service, both in emergency departments, but even more so in primary care. The busiest part of our system is actually primary care. And I can't take away all of the stresses of the job. And there's something about honesty when you meet staff—being honest with them about what you can do and an understanding of the pressures that they're going through and recognising that the system really is busy all year. But what should give people some confidence isn't a group of politicians who sit down with a variety of officials in a room and decide to concoct plans that have no bearing on practice. The advice we get and the plans are drawn up by people leading and working in our system. For example, the clinical lead that we have for unscheduled care is actually an emergency department consultant who works in the Heath in a busy department, has been part of leading an improvement in that unit and has, frankly, buy-in from her colleagues around the country in a way that a politician or an official who has never done that job doesn't have. So, there's real confidence that it is possible to deliver improvement as well as understanding the specific nature of some of the workspaces and demand coming into different parts of the country.

On your particular point about occupational therapy, there's a challenge about the shorter term and the money may help with some of that shorter term capacity through winter, but there is, of course, a longer term challenge as well, and that's where we'll look at our training places and the numbers we invest. We've had a significant increase in occupational therapy training places over the last four to five years. The same goes for some of the points made by the Royal College of General Practitioners today. We're actually looking again at how we recruit and where we recruit GPs to and from. In the last two years—we overfilled our GP training place numbers the year before last; this year, we had a 98 per cent fill rate in GP training and Health Education and Improvement Wales will be looking again at both how we recruit, but also the numbers of training places again in this year.

On your point about out of hours, it's something that I recognise as a challenge. The 111 programme that I talked about is not just about a different way to deliver part of an out-of-hours service; it's actually reshaping the model of how we deliver out-of-hours services, and a broader range of healthcare professionals—GPs, pharmacists, nurses and therapists in particular—to make sure that a range of advice is available and to make sure that there is resilience across the whole system.

On your point about money, the £20 million that I announced weeks ago for the national health service, with partners—that's one-off money to make sure that we get through winter this year. The £10 million that you will have heard us put into the social care system—that's one-off money, but, of course, that will be followed by £13 million of recurrent investment into the social services system from the health budget for the next financial year. 

Finally, your point on the third sector. We have national partnerships in some areas. The examples I've given are St John Cymru and the Red Cross, but, equally, you will understand that there are more local third sector partners that deliver services, and that is absolutely part of the learning for this winter. And I expect we'll learn again at the end of this winter what has worked successfully and what we could do even more successfully in other parts of our system.

Thanks, Minister, for your statement today. Just a couple of points to raise. Vaccination has been mentioned a couple of times. You describe in your statement that you're now encouraging social care staff to get vaccinated, which is a good development. There was an issue a couple of years ago that there was actually a less than 50 per cent take-up of the flu vaccination from within the NHS staff. I guess a lot of this is due to actually publicising the availability. Are you confident that there's going to be a much better take-up this year?

You're right about encouraging people to not always see a doctor and that sometimes, they're better off going to see the local pharmacist, so you're directing people to try and see the pharmacist where possible, which is, again, a good development. Of course, it does raise the ongoing issue of the co-location, which was a recommendation of the health committee a couple of years ago after their inquiry. They wanted pharmacy services co-located within A&E departments. I wondered if you'd had further reflections on that.

And with the telephone advice, yes, there's obviously going to be a need for more telephone advice. Are more people being taken on to offer this advice and are they being trained well enough to give reliable advice? Because, obviously, that's what the public need to be convinced of. It's a very challenging job, so I'd be interested to hear how the training is going and how you're going to offer increased capacity this winter. Diolch yn fawr.

Thank you for those questions. To deal with your last point about reliable advice on the telephone, we'll either have staff who go through a series of options that is drawn up by a clinician to get to the right point about whether further advice is needed, but lots of our advice is actually directly with the clinician. If you ring up what would've been the NHS Direct Wales line—if you ring up 111, you will get to talk to a call handler, to then be screened and be put through to a relevant healthcare professional. So, yes, there is training available, and it's actually about making better use, in those telephony services, of skills that paramedics have as well. A successful pilot that I visited last winter in north Wales that has been rolled out is actually using the skills of advanced paramedics to screen calls and to give people advice to avoid actually having to send an ambulance when it's not necessary. We know, for example, that some of the big priorities for improving the Welsh ambulance service this year—we think that the ambulance service thinks that up to three quarters of chronic obstructive pulmonary disease admissions could be avoided if they got the right advice and support, and they could do that and deliver that over the telephone. And that is about the right person giving that advice.

I do think we'll see again an improvement in the uptake of the flu vaccine by NHS staff. We've seen that over the last couple of years and that isn't by accident—it's a deliberate attempt, both by health boards as employers but also, frankly, with some leadership from staff organisations as well. Both the Royal College of Nurses and Unison, I know, have been very consistent in encouraging their members to take up the flu vaccine and making sure that those opportunities are available in workplaces for that to take place. We've learnt from that by looking, this year, through community pharmacy, to deliver the flu vaccine service for residential care staff. By definition, residents in those areas are much more likely to be vulnerable. 

On your point about pharmacy, I would much rather see a pharmacy service where people recognise they can get it in the community. I reckon that there are challenges about having a pharmacy service located in A&E, but I want the message to be: 'Use your pharmacy in your community; it's at the most convenient place—you'll avoid needing to go on to a busy hospital site to go to an A&E, and try and get the support and advice that you could and should get there, rather than travelling unnecessarily to your hospital.' I think that will help the person, who doesn't need to go to hospital, as well as those that really do, to avoid additional traffic unnecessarily.

Can I thank the Cabinet Secretary for his statement this afternoon? It's important that we look at the issues facing us. One of the disadvantages of going after other speakers is that most of the questions get asked, while the advantage is that I don't spend so much of your time. But there are a couple of points I want to highlight and perhaps ask you questions on.

In the summer, ABMU, my health board, had a consultation on beds and capacity, and as a consequence reduced the number of beds, which it said it used as surge capacity last winter. Now, those beds are therefore gone, so the question I want to ask is: will you publish, perhaps, your analysis of the implementation plans for each health board, so that we can see that and be assured that the considerations for surge capacity and other matters have been reflected upon in those analyses? It's crucial that we ensure our constituents are able to be reassured that the beds in the hospitals, which have now been reduced—that that will not have an impact upon the availability during the winter period. Now, over the time that I've been a Member of this Assembly, I have seen the improvement in the winter preparedness plans. I have also seen a continuation of the challenges every winter presents to the health boards, and patients need that reassurance.

Can you also answer a question on capacity, as to what's in the community? Many district nurses in my area are struggling with the workloads they have, very often, and clearly your intention is to get people out of hospital as quickly as possible, back in the community, back under the care of the social care sector, or the district nurses, and yet we are seeing them challenged every day in that service. What analysis have you done of the capacity of district nurses within the health board regions to ensure that they can deliver on your intention of getting people back in the community as soon as possible? I fully appreciate we want to get them out, and we've got a problem with the flow through the hospitals, because we see the ambulances stacked up outside the front. We all focus on the front, but not focus on the back; we've got to get people in the community—but being cared for in the community is the crucial element here.

On that question, also we see people waiting in the hospitals; there are very many systems for discharge, but they can't get discharged because systems in the hospitals are slow. Will you also ensure that the systems in the preparedness of those health boards allow patients to be discharged quickly, and there's not some bureaucracy being kept? Gareth Bennett talked about pharmacies; how many patients wait in a hospital, in a bed, for hours, whilst they wait for a pharmacy to actually deliver the medication before they can be released? So, have you done an analysis of the systems within the health boards to ensure that this flow you want—we all want—is actually achievable?

Thank you for the questions. We could put up a series of the key actions from the local health board winter plans, but you'll know that, of course, every health board plans to flex its bed capacity during winter, because they know there will be a greater likelihood of needing to admit people, for the right reasons, and they're more likely to stay for longer, as I outlined earlier. But I'll certainly give some thought to publishing something in a useful way that would inform Members, rather than provide more fog, and will actually be helpful for Members to look at as well. 

On your point about the type of capacity needed, well, it reinforces the crucial partnership between the health service, local government, but also housing providers as well, to actually be able to plan and commission for the right capacity in the right place, because, often, it doesn't need to be a hospital bed; it could be a bed in the care sector, and it's often more appropriate for that person, and we'll definitely see that running through the winter plans that each partnership has provided.

And I recognise your consistent interest in district nurse capacity—not just for this winter, actually, but more broadly—and the chief nurse principles that have been introduced. It's one of the areas we're looking at with a potential extension on staffing numbers, to understand not just what we need, but how many people we need and where we want them to be. So, there'll work done not just by the chief nurse's office, but of course HEIW will take an interest in that as well.

On your challenge about discharge from hospital, it's one of the areas that I've regularly focused on, actually, about understanding what more could we get out of the pharmacy, in particular hospital pharmacy, where people have got their discharge advice and they're ready to go, and actually they need to be able to go home and to have medication to go with them. It is one of the areas where I think we'll be able to make greater progress soon in the next year, because I do think there's a greater role for community pharmacy. If they're prepared to step up, and they're able to deliver that service to patients in their own homes, those people can leave hospital more quickly than some of them are able to do now. I think there's a real gain to be made in delivering that greater flow, and, actually, for the person who wants to leave the hospital, to enable them to do so.

But two of the big five winter delivery priorities are a focus on getting people out of hospital when they're ready, but also looking at a discharge-to-assess model as well. We regularly talk about this: discharge someone to assess their need rather than keep them in hospital in an artificial environment to try and understand their need in their home environment. It reinforces the point about the role of therapists and, in particular, occupational therapists, to understand the need of that person. Again, that is a partnership between health and local government, and it goes back to where we launched the 'A Healthier Wales' plan. We went to Ynysybwl and we looked at the work that therapists had led to get someone out of hospital sooner, into their own home, to assess their need, and a package of care was provided. That's the genuine partnership that we're looking for between health, local government and, crucially, the citizen.

Thank you, Cabinet Secretary.

The next items are the Sustainable Drainage (Enforcement) (Wales) Order 2018 and the Sustainable Drainage (Appeals) (Wales) Regulations 2018. In accordance with Standing Order 12.24, I propose that the following two motions under items 8 and 9 are grouped for debate. Does any Member object the grouping?