Questions now from the party spokespeople, and the Conservative spokesperson, Angela Burns.

Minister, I'm sure you're aware of the eye disease keratoconus, which can lead to patients completely losing their sight. Can you please explain why the recognised treatment for this disease is not available on the Welsh NHS?

I've had correspondence with a number of Members on this in different parts of the country, and about some of the challenges. It is about our skill mix and ability to deliver the right treatment as recommended by the National Institute for Health and Care Excellence. It is something that we are deliberately working through and I've had correspondence with Members, as I say, in different parties on it. It's about the capacity and ability of our system to deliver all that we would wish to.

Minister, for £2,000 you can nip down to the Princess of Wales Hospital in Bridgend—which, the last time I looked, was an NHS hospital—and you can pay an NHS surgeon, in his spare time, for £2,000, to actually give you the treatment that saves the sight in your eye. I fail to see that that's to do with capacity; I think it's to do with will. Will you undertake to look at this process? It's called cross-linking: for those who do not know, your cornea, instead of being a smooth curve like the planet, becomes like a mountain range. The use of this LED light helps to flatten it—not always, but sometimes it does come back. But my goodness me, if you can get another six months, one year, or two years more sight for £2,000, I fail to understand why we're not doing it. Will you please look at this?

I'd be happy to look at it, but it's not a matter of will. It is always about how we use the resources we have. And it's not just about money, it's about people. And we're going to have a debate later today about eye-care measures, and the determination we do have as a Government, together with the health service, to save the sight of more people, and have measures that promote that activity, to make sure we actually address sight loss before it actually takes place.

Minister, it's entirely about money and about resources. And, as I've said, you've got the resources there—I can pop you in my car, drive you down there, and show you them. The money is not very great. I totally understand that if you're talking about a very, very expensive treatment, then you might look at the cost-benefit analysis. I can totally understand that, if you're talking about an illness where there are a number of different solutions, and this just happens to be one in the mix, and one we choose not to support for whatever reason. But this is the only treatment. Once you've gone blind, you then have to go onto a waiting list for a corneal transplant—they're not easy. So, my constituent, who's 19 years old, and is a student, went and borrowed £2,000 off his employer, because nobody told him about the IPF. He borrowed £2,000, and went and had one of his eyes done; he's now scoping for the other £2,000 to have the other eye done. He's 19 years old—he doesn't want to go blind, he's got his whole life ahead of him. And the question he asked me to ask you is: 'Why, for the cost of £2,000, are the Welsh NHS happy to see me lose my sight?'

The Welsh NHS is not happy to see people lose their sight. I think that's a very unfortunate way to end the contribution. Because this is about resource and capacity, it is about people who can undertake the work, and it's about having a system that can deliver in a way that is properly equitable. I'm more than happy to engage in correspondence with the Member, to address the issues that she raises, and the broader point about how the whole healthcare system addresses that.FootnoteLink Because the NHS is an organisation that delivers great volume and great benefits to the public, but there is always room for improvement. And I hope that we can recognise that in all of our interactions, within and outside the Chamber.

Information further to Plenary

The Plaid Cymru spokesperson, Helen Mary Jones.

Diolch, Llywydd. Minister, the latest figures show that the median response time for amber calls has more than doubled, from around 12 minutes to around 26 minutes, over the last three years. Do you think that matters?

Yes, it matters. But the challenge that we have set out for our ambulance system is to prioritise those with the greatest need, where the fastest response will make the biggest difference. That's why—before, admittedly, you came into the Chamber in this incarnation—the clinical review process was undertaken, to understand which conditions should have an eight-minute response time, and which should not, but would still have a blue light response. And the evidence does tell us that those that are in the eight-minute category—the red category—it does make a difference if there's a really fast response. Those in the amber category do have an urgent care need, and will receive a blue light response, but it is less urgent, and will make less of a difference. And, actually—and I've reiterated this many times over when we talk about ambulance response times—the approach that we have led on and taken here in Wales has been copied across the United Kingdom. The SNP Government in Scotland have taken a broadly similar approach. Even the Conservatives in England have borrowed our approach, although you won't hear a Conservative Minister stand up and say they're doing that.

I don't think my concern is about the overall approach, but my concern is about the knock-on effects for particular conditions. A freedom of information request from my office showed 4,038 patients waiting longer than an hour for an ambulance to arrive when they had a stroke, between January 2018 and March this year. Strokes are a life-threatening emergency; when they're not life-threatening, they can absolutely devastate people's lives. Is it acceptable that we have over 4,000 people waiting for longer than an hour for this very distressing, and, in many cases, life-threatening medical emergency?

No, which is why I set out and instigated the amber review process that took place—again led by clinicians working in the service. I gave a statement on this within the last few months—on setting out the reform and improvement programme that has taken place. I've directed the Chief Ambulance Services Commissioner for Wales and the emergency ambulance services committee to undertake that programme of work to deliver the improvement that is required and possible. So, this is not an area of complacency—far from it. We made a real healthcare gain within our system by changing the way we measure and drive performance within the ambulance system. We've had a review to look at the amber category and what further progress we can make. That's what I'm determined to do and it's what I spent some time on my feet responding to questions on within the last few weeks and months.

Indeed you did, Minister, and I suspect you will carry on needing to respond to those questions until we've got answers that our constituents are wholly satisfied with.

You know how devastating, I know—there's no need for me to tell you how devastating the after-effects off stroke can be. You also know how important it is that that whole pathway, from the emergency call to the actual treatment, is done in a timely manner. There are costs to that, but also there are potentially huge cost savings, because if the treatment is given quickly enough, we're going to have patients who will fully recover, whereas otherwise, they might be permanently dependent on health and social care.

Now the Stroke Association has called on you to set targets from the time of that emergency call to the treatment being delivered. That is being done elsewhere. I'm very pleased to hear you say, and I know it's true, that other Governments are learning from some good things that we're doing here in Wales on healthcare. Is this an example of where you might need to learn from somewhere else? You are prepared to set binding targets for some aspects of services, which is absolutely correct. Will you reconsider your decision not to set, at this point, a binding target for that treatment time, from the emergency call to the actual treatment being delivered, for patients suffering from stroke?

I understand the call that's been made by the Stroke Association; I understand the reason why they made the call. But, again, we've just had a clinically led review of the amber category and it did consider this. The Stroke Association are part of the work that is being done to take that forward. And, again, if the evidence changes, then I'm more than prepared to look again at that evidence and whether it's still the right decision. But at this point in time, it would just be dishonest for me to say that I'm going to look again at a recent review that's taken place when, in the last few months, I've reported to this Chamber on the work that I've already outlined. That does not mean that that is a decision for now and evermore; it means that, at this point, the evidence doesn't support the call that's been made by the Stroke Association. But, as ever, we should be prepared to learn and recognise, when evidence changes, to shift decisions to make sure that we're delivering the right service for people right across the country. 

Brexit Party spokesperson, Caroline Jones.

Diolch, Llywydd. Minister, the outgoing chair of the Swansea Bay University Health Board has said that the LHB's officials are forced to take part in three or four conference calls a day with Welsh Government. He accuses you of micromanaging the health board and getting in the way of sorting out the problems facing the health board. Minister, do you agree with this analysis that your Government is holding the health board back from making improvements to the NHS in my region?

No, I don't share the view of the outgoing chair of the Swansea Bay University Health Board. I think it's important that there is a link, and Members in this place and in committees regularly encourage, if not demand, that I and my officials, take an even greater role in holding parts of the health service to account and intervene on an even more granular level than we do presently. But certainly through the winter, there are regular conference calls with every health board about performance, particularly in the unscheduled care system. There is always going to be a balance about where you intervene and where you ask and where you scrutinise and where you leave trusted parts of the system to progress. It's part of the reason we have an escalation framework that sets out the level of confidence in different parts of our system. But on some of those big key touchstone areas of activity, where it's recognised there are real issues for patients, we do have regular conversations with the health boards, and I don't apologise for that. 

But I would say, though, as we're talking about the outgoing chair of Swansea Bay University Health Board, that during the time of his period in office as a chair, they've had some real challenges to address within the health board and he has been a part of making sure that they do address those challenges. And there is a real improvement trajectory now for Swansea Bay University Health Board and Andrew Davies has real credit to claim for having been part of doing that. We won't always see eye to eye, just as we didn't when he was rather more active in elected politics, but that's part of the business of doing a job like this—not everyone agrees with you, including people who you even share the same party with, as we all know.

Thank you, Minister. Until April of this year, residents of Bridgend fell under that health board. They're now covered by Cwm Taf, which, while still under joint escalation and intervention arrangements, aren't as bad as the former ABMULHB. However, that's not helping patients in Bridgend. Last week, one of my elderly constituents, also a friend, had a stroke and was injured as a result. He waited nearly three hours for an ambulance and he also waited nine hours at the accident and emergency department at the Royal Glamorgan, as the Princess of Wales was full. He's 85 years of age. So, Minister, when can patients living in Bridgend expect to see improvements to the NHS under Cwm Taf?

Cwm Taf Morgannwg, as the new health board, is now responsible for the operation of the health service within Bridgend, and I expect to see phased improvement across every part of our service and not just the Cwm Taf Morgannwg area. Again, if we look at the regular experience of people within our healthcare system, they are seen promptly and compassionately. I was reflecting on a number of events today about where healthcare goes wrong, it has a huge impact on people's lives, both the experience of healthcare and when technically the healthcare goes wrong as well. But also, our healthcare system is a high-quality system and it's part of the reason why, when it doesn't go right, it's thrown into such sharp relief. If the Member wants to write to me, or indeed directly to the health board, to have an investigation into the individual circumstances, I'd be happy to look at it. But I'm of course interested in how we improve the whole system to make sure that fewer and fewer people have the experience that she described and more and more people have the standard experience of high-quality, timely and compassionate care.

Question 3 [OAQ54183] was withdrawn. Question 4—John Griffiths.