Part of the debate – in the Senedd at 3:32 pm on 12 February 2019.
Turning to your final point first, I've been very clear that Betsi Cadwaladr need to do substantially better on both unscheduled care and planned care as well. They make up about half of the numbers of people waiting more than they should do for 36 weeks. Their 26-week percentage isn't where it should be either. The revised plans they've provided me with, with new scrutiny from the chair and the reinvigorated board, give me some greater confidence, but I have made it clear that they will need to deliver the performance improvement they set out before I will come here and give the sort of assurance that you and other Members will look for. And making that difference in north Wales will make a difference to the people of north Wales and the picture across Wales as well. And the same in unscheduled care as well.
And it's about the appropriate balance between support and challenge, because I think, as I said previously, the easiest thing for me to do is to say it is somebody else's fault and I expect them to do better, when, actually, those staff need to be supported as well. And that's why the peer leadership and the clinical leadership really matters, and why the whole system support and engagement matters as well. I want to see people stay within the system, and, actually, I have some more cause for optimism about the next few months and where we'll get to after that, but I'm looking for that to be made real. And I fully expect to have questions to answer about that, not just through the winter, but through the rest of the year, whilst performance figures remain as they are.
On your broader points about the level of detail, well, we always make a choice about what's in statements. If I'd provided particular statistical figures through the statement that are linked to it, then I'd have been spewing out a range of figures and not giving analysis. There is a balance, and, in an answer to a question from Helen Mary, I gave some more figures, and I have to tell you that, in terms of the length of stay for emergency admissions, there has been a 3 per cent reduction this winter compared to last winter, and, on emergency admissions for over 85s, there has been a 7 per cent reduction—so, a real and material reduction in percentage terms. The challenge is to sustain that, not just through the winter but through the rest of our year, and to do what I said in response to Helen Mary about making sure that we actually deliver on having the adequate resource within primary care and social care to deliver more care closer to home and keep people out of hospital when they don't need to be there. There is more to do in the way we engage professions in doing that, and, actually, the pharmacy pilot is a really important part of this year, not just in the community provision, and actually asking people to go the pharmacy first, but in having pharmacists within the emergency department, because, as we regularly rehearse—and David Melding regularly does when he talks about community pharmacy, and others—a significant number of hospital admissions are about medication errors. So, the more we can do in having appropriate pharmacy support, the better for the whole system.
And, on your point about ambulance waits, well, I start with the recognition that too many people still wait too long—not just an hour, but there are some waits that are still just too long in any event, on an individual level. But the 30 per cent improvement is real, and it includes Betsi Cadwaladr as well—they have made real improvements in reducing the number of, if you like, lost ambulance hours too. That's part of the challenge about our system, that we're doing better on the ambulance end in a sustained way—that isn't transferring through the whole system, though. There is still more to do, but, again, we should not lose sight of the fact that this is the fortieth consecutive month that the Welsh ambulance service has met its target for red calls, despite there being a larger number than ever of the life-threatening red calls as well. And that is a significant tribute to the ambulance service trust.
And, on your final point about the level of demand that comes in and what that might be, well, actually, this isn't simply about numbers. The portion of numbers changes. We categorise patients who come into emergency departments as either minor, in terms of minor injuries and minor ailments, or major, where they're really significantly ill. And, actually, it's the case that, in winter, we tend to see more people in the major category; they tend to be older. Actually, this winter, the percentage of our major patients, so the people who are most ill, has shifted again. So, we're actually seeing even more people who are actually very, very unwell, and need to be in a hospital for treatment. And, actually, more and more of those are getting there themselves—they actually are either walk-ups or people who are being driven there by friends and relatives—as well as the record numbers that are being transferred by the ambulance service. There is more to do about how we're able to cope with that changing picture in demand. That's the context for us to deliver, but I recognise Members will expect me to be accountable for the whole system, and for the whole system to be able to recognise and address the pressures that exist within our population.