Questions now from party leaders. The leader of Plaid Cymru, Adam Price. 

Diolch, Llywydd. Your Government's targets for people waiting more than 12 hours for treatment in accident and emergency is zero. In Scotland, they have the same target and have managed to come within touching point of it. With a larger population, they achieved a figure of fewer than 200 with unacceptably long waits in the latest figures. But, in Wales, that same statistic has to be counted in thousands. In January 2014, the number was 1,277, and since then it has been getting steadily worse: 3,006 in 2015; 4,048 in 2017; 5,099 last year. In the latest figures, for January this year, it is worse again: 5,264—the second worst figure for Wales since records began. And I should point out that over 700 of these cases were at Wrexham Maelor, in your own constituency. So, my question is simple, Minister: do you accept that these almost unprecedented and unacceptably long waits at A&E now constitute a fully fledged crisis? I'd be grateful as well if, in your response, you could place on record the reason you are deputising for the First Minister today. 

The reason I am deputising for the First Minister today is he's in London representing Wales at an event there.

In relation to A&E waiting times, I am aware obviously of the number of cases in my own constituency. The problem is we have seen an unprecedented number of people attending accident and emergency, and I think we need to look at why that is. And I think there is more work to be done in relation to out-of-hours as well. But certainly we should also accept that we're seeing very high reported levels of satisfaction within the NHS and work is being done in emergency departments across Wales. I should say more than a million patients attended A&E departments across Wales last year. 

I know the First Minister has said he doesn't look forward to First Minister's questions, and he once reportedly stood up the Prime Minister to attend a party, but do you think it's in order for him to prioritise a reception in Buckingham Palace over answering questions here in the Senedd?

What I would have asked him, and now we'll ask you instead, is if you are running out of excuses for the crisis in A&E. For instance, on 12 February, the Minister for health, Vaughan Gething, told us that, over the past months, we've seen the highest number of flu cases in hospitals since 2009 pandemic, yet the Public Health Wales influenza surveillance report shows flu is circulating at medium levels below that for the year previously. Vaughan Gething also claimed that winter stomach bugs were putting an additional strain on the NHS. Well, we've researched this with FOI requests. Some local health boards told us this information for this winter wasn't available yet, but the ones that have provided us with data have shown that this year's numbers are not noticeably different from last year. Indeed, Betsi Cadwaladr, the worst performing health board for A&E, is treating fewer cases of winter stomach bugs this year than in the previous two years.

It cannot be claimed either that the NHS is being overwhelmed by patient numbers this winter. In his statement on 12 February Vaughan Gething said, 

'Hospitals have admitted fewer people over the age of 85 as emergencies this winter, compared with the previous two winters.'

So, when all these excuses are stripped away, surely there can be only one of two reasons for your failure to get to grips with worsening waiting times: one is that you simply have no idea what to do to tackle them; the other can only be that you know what to do but you're simply not doing it. Which is it?

So, to go back to the First Minister, I think everybody would want the First Minister to represent Wales in the way that he is doing. [Interruption.]

Last month was the busiest January on record for emergency department admissions. Emergency admissions in January 2019 were 9 per cent higher—[Interruption.]

Let's hear the Minister respond to the questions please. A bit of quiet from Plaid Cymru. Minister, carry on. 

Thank you, Presiding Officer. Emergency admissions in January 2019 were 9 per cent higher than in January 2015 in major emergency departments. There was also an increase of 16 per cent in attendances at major emergency departments when compared with January 2015. I have to say I unfortunately had to attend A&E in the Heath hospital about a month ago, and talking to the staff there I was very interested to know about admissions et cetera, and one of the consultants was telling me that, over the weekend, they'd had over 10 people who were near the age of 100—over 90 years of age, but nearer 100, and she was saying that was unprecedented. So, clearly, the ageing population is also having an impact.  

I have to say to the Minister—maybe we have different values, but I think that the priority for the First Minister is to be here to answer questions from the elected representatives of Wales. Surely, that's the purpose of having this Parliament in the first case.

Now, across the UK, the monthly target for people waiting more than four hours for treatment in A&E is 5 per cent. Again, the Scottish performance outstrips Wales and England as well—

Now I can't hear Plaid Cymru because everybody else is making a noise. So, Adam Price, please.   

In Scotland last December, just 10 per cent had to wait more than four hours. In England, it was significantly worse, with 24 per cent waiting more than four hours, but in Wales it was worse still. Our figure was 28 per cent. It is significant that colleagues of yours—Labour MPs at Westminster—consider the waiting times statistics for England in A&E so bad they have called for an independent inquiry. Given that the figures for Wales are even worse than in England, will you join with Jon Ashworth, Labour's shadow health Secretary at Westminster, and demand that an independent inquiry should be held in Wales as well? Would it not be hypocritical to fail to hold yourself to the same standard to which you are holding the British Government in opposition here at home in Wales, where the Government is you? 

I go back to some figures that I have in front of me. In January 2019, 14 of 24 emergency care facilities reported an improvement on January 2018, or the same level of performance. That includes seven of our 13 major emergency departments. Four of the seven health boards reported better performance in January 2019 compared with January 2018. I think we have to accept that the majority of people who access A&E are seen within the time, are receiving the best treatment. Some don't, and those are the people that we need to continue to support. 

Leader of the Opposition, Paul Davies. 

Diolch, Llywydd. Minister, what plans are in place in Wales to fund the recovery of substance misusers in residential treatment? 

Sorry, could you repeat that? 

What plans are in place in Wales to fund the recovery of substance misusers in residential treatment? 

I'm sorry; I don't have those details to hand. 

Well, let me give the Minister some figures, because figures from last year show that only a shockingly small percentage—13.5 per cent—of substance misusers who underwent treatment on the NHS were substance-free by the end of their course. Now, my visit to the excellent Brynawel rehab centre recently, the only centre of its kind in the country, showed me how desperately help is needed for some of the most vulnerable in our society from centres like this. Just last month, the Minister for Health and Social Services dismissed calls to address the need for residential care here in Wales, but despite pledging to ring-fence £50 million for health boards to back substance misuse services, centres similar to Brynawel have closed across the country. And, when tackled on the subject last month by a member of your own party, the Minister failed to commit to support what he described as merely a 'useful facility'. Can you therefore clarify here today, Minister, what specific resources are going to be available from the Welsh Government in the coming years to provide specialist residential care to help those in need to get their lives back, given that money has been ring-fenced for substance misuse services?   

Thank you. I too have attended Brynawel residential centre; I think it was with Huw Irranca-Davies's predecessor, Janice Gregory. I'm very well aware of the excellent work that is done there. I don't think the Minister for Health and Social Services dismissed the matter in the way that you addressed and certainly the funding—. You will be aware that we've increased our funding significantly for health and social services by nearly £0.5 billion in 2019-20, and that's an increase of around 7 per cent. And then health boards can obviously use that funding in the way that they wish. 

Well, I would ask the Minister to check the record and check last month's debate because, unfortunately, the health Minister did dismiss calls to address this particular issue. Let me remind you as well, Minister, that previous figures have shown that half of people referred for substance misuse rehabilitation in Wales are treated in England, and at Brynawel clients wait months for a space due to high demand, often at a time when their lives are in danger and they've turned to crime as a way to gather money or even to seek shelter in prison. Not for the first time on the topic of healthcare here in Wales, we are hearing that there is a postcode lottery across the country for people in need. Healthcare Inspectorate Wales reported last year that access to services across Wales is inconsistent and limited in rural areas; people found it difficult to get the treatment they needed because of long waiting times and a lack of capacity in services. And yet hundreds—hundreds—of people die every year from substance and alcohol misuse here in Wales. Minister, what is the Government doing to stop this postcode lottery and to stop people in need being put at risk of being forgotten, just because of where they live?

I think it's very important that we do address postcode lotteries, and you mentioned that half the people who need support and help are treated in England. You'll be aware that there are specialist centres that we don't have in Wales and vice versa. I know, representing a border constituency, certainly it's a two-way traffic between England and Wales in many of these areas.

You ask about substance misuse and also alcohol. You'll be aware that we've always said that minimum unit pricing for alcohol is part of our wider strategy and approach to reducing substance misuse and we will continue to use all available levers to reduce the harms that are caused by excessive consumption of alcohol and other substance misuse.

Leader of the UKIP group, Gareth Bennett.

Diolch, Lywydd. Minister, the Welsh Government is currently working on a new scheme of payments for Welsh farmers after Brexit. Obviously, you know a good deal about this in your ministerial capacity. Now, I'm glad that you've adopted an overall tone that there are opportunities that can be taken after Brexit, but, of course, we also have to be mindful not to try and bring about unnecessary change and unnecessary volatility in a climate in which we already have a fair amount of uncertainty.

There is a proposal from Welsh Government to move to a new payment system, where direct payments for farmers, as we currently know them, will disappear altogether. Now, without disagreeing with the need to develop other payment schemes, we do have to face up to the hard economic reality that, here in Wales, 80 per cent of farm incomes are derived, on average, from direct payments. Is there not a strong case that this is a valuable safety net for Welsh farmers that should be left in place at least for the foreseeable future?

No. I don't think the common agricultural policy does that. It certainly hasn't made our farmers more robust, more productive; it doesn't reward the active farmer either. You'll be aware that we had a lengthy consultation last summer. I've committed to bringing forward a White Paper before the summer agricultural shows, but I've been very clear that the basic payment scheme will go. It will be replaced by two other schemes, and we want everyone to work together to bring forward those schemes. But you mention—you know, 80 per cent of funding, on average, for farmers. I don't think that's something to be proud of, 80 per cent. I think it shows that CAP has not worked in the way that we would want it to.

Yes. I certainly don't disagree with you on that point, and I did state that we do need to move away from that scheme. I'm just flagging up the possibility that, in the short term, we may need to commit to some form of direct payment as part of payments to Welsh farmers in the interim, before we develop longer term schemes. And, of course, they must be robustly modelled—[Interruption.] They must be robustly modelled before we move to new schemes. So, clearly, if we are serious about going towards new schemes, we have to have a look at the modelling. There have been concerns about the pilot schemes that you are going to get, some of which are up and running. Now, do you think that these pilot schemes are moving quickly enough? Are they robust enough and are they in a wide enough area of Wales so that we can move ahead with your planned timetable to the new payment system?

Well, the Member knows more than me, because I don't think there are any pilot schemes up and running. We are looking at which farms will do it. There'll certainly be a geographical spread; there'll be different types of farms used. I think modelling and impact assessments and those pilot schemes will be very important in forming the direction that we take, but the worst thing for the agriculture sector at the moment is the uncertainty around leaving the European Union. You will have heard the farmers' union state that to leave with a 'no deal' would be catastrophic. I also should say that all the funding at the moment comes through the European Union and I cannot get any assurance out of the UK Government that that funding will be there post 2022.

Yes. I appreciate the factors that you mention; of course there is uncertainty. It seems to me that the very nature of the uncertainty may demonstrate the need to move towards a slower transition when we bring in a new payment scheme. Another issue that arises is that, under the Welsh Government's current proposals, the move from payments to active farmers to a broader category, which we are calling 'land managers', may also result in many thousands more people being eligible for payments from the Welsh Government. So, are you entirely confident, given also the uncertainty that you've mentioned today, that you will have enough resources to deal with the payment applications when they do start to come into your department?

I think you have to accept that the majority of land managers are farmers—I do prefer the word 'farmers'—and I don't think we will see these thousands of people applying for the funding. I've heard that people with allotments will be able to apply, for instance; that's completely incorrect. What I want to make sure is that UK Government gives us every penny that we would have had as a country from the European Union. That's what I'm holding them to, and then we can make our decisions following the White Paper consultation, and I've said all along the new schemes must be in place before we remove the basic payment scheme.