Questions now from the party spokespeople. Plaid Cymru spokesperson, Dai Lloyd.

Thank you, Llywydd. Minister, are you content with the quality of the information that you have about the NHS workforce?

I don't think the current workforce data that we have allows us to have the most robust means to plan for the future. That's part of what we're considering. In fact, I had a discussion on this very point earlier this week. 

Thank you for that. As you know, in the recent report of the health committee on community and district nursing services, we received evidence that predicted—and I quote: that despite recognising the key contribution of our community and district nurses in the provision of healthcare for the future, we don't know much about this invisible service, as it’s described. We don't have a detailed picture at a national level of the number or the skills mix within the nursing teams or the level of illness of the patients receiving care in their own homes. Now, naturally, this will have an impact on workforce planning efficiency.

That’s what the evidence tells us. In addition, we received direct evidence from community nurses being overworked, facing stress, overextending themselves to meet demand, whilst the heads of health boards predicted a far rosier picture of a service achieving its targets. We don't have full data either on the number of physiotherapists or occupational therapists in the community either. So, how can you plan to move more healthcare into the community in future when you don't know the number or the skills level of the healthcare staff working there at the moment?

Well, I wouldn't say it's a blank piece of paper and we don't know anything about the current workforce or indeed the current nature of demand. The Member will know that, in terms of our agenda for moving more care closer to home, it does involve continued investment in primary and community care. It involves the new models of care that are being trialled, both within the transformation fund and outside it as well. That's not just anecdotal evidence about particular parts of the country, it's actually a part of our system-wide reform. We've deliberately chosen to take a path where only those projects that have the ability to scale up will be supported through the transformation fund. So, of course, the evidence that we'll have from our cluster plans as well—where they'll have to plan at cluster level—will inform our medium-term planning process and health boards, in addition to the workforce strategy that is being developed by Health Education and Improvement Wales. So, you have a range of different sources of intelligence on what is currently happening, and what we need to do more of in the future.

But the Member will know, both from his time within this place, and the career that he regularly doesn't mention before he got elected, which he still carries on at various points as well, that this is never a static point in time. And our ability to reform as rapidly as we would like in this place often grinds up against reality. But I do think that the agenda we set out in 'A Healthier Wales' is one that we have commitment across the board for, and we'll continue to make investment choices to support that.

The same kind of pressures of work and gaps in rotas, stress and the terrible tiredness that emerges from overworking because of staff shortages also impact on doctors in our hospitals—exhaustion, huge responsibilities for life-and-death issues, no rest periods, an intensity of work without a break, the dangers of driving having finished and all-night shift, and the feeling of a lack of support and a lack of recognition of the huge commitment to their patients, and also the feeling that hospital administrators don’t take regard of this and are insensitive on occasion. So, what are you, Minister, doing to promote the well-being of our hospital doctors?

Well, we're taking a broad approach. On the one hand, when you look at the quadruple aim, staff are one of the four pillars within that quadruple aim. Specifically, when it comes to the medical side of the workforce, we have engaged already with the British Medical Association on the fatigue charter. I spoke with the BMA in the last few weeks—and that work is ongoing—to try to make sure we deal with some of the points that the Member raises about the incredible pressure and commitment that our medical workforce face. And it's only because of that commitment, not just our medical workforce, but the wider workforce, that the health service continues to provide the quality, breadth and compassion of care that is there. But we don't take that for granted. That's why we've had those discussions with the BMA, and we've have those discussions with other workforce representatives too, because I would not pretend that everything is rosy and everything is fine. Our challenge is how, with the additional demands we see coming in to our system, with all of the other issues outside the health service that both drive demand and affect our workforce, we do still do all that we can and should do to make sure that we are a good employer, and that we do properly take account of staff well-being at all levels.

Conservative spokesperson, Janet Finch-Saunders.

Diolch, Llywydd. Deputy Minister, you'll be aware, of course, that Care Inspectorate Wales have the key role for inspecting and taking action to improve the quality and safety of services for the well-being of the people of Wales. Now, according to the chief inspector's annual report 2018-19, 2,499 inspections were undertaken. That is 456 fewer than the year before. There were fewer services regulated also. Now, this decline in regulatory and inspection activity comes despite staff costs having increased by almost £150,000, and the percentage of that budget representing inspection and regulation activity having increased. So, how do you, Deputy Minister, justify the increase in staffing costs, whilst there has actually been a significant fall in the number of inspections, and what steps will you take to reverse the decline?

Well, obviously, the work that CIW does is absolutely crucial. It looks after the standards that are in our care homes in particular, and it's absolutely important that all the inspections they carry out are done to a sufficient depth, and are done in a very considered way. And I think what they are doing is doing very considered inspections, and I have every confidence in them.

Well, Deputy Minister, thank you for that response, but I have to tell you, here and now, that I do not share your confidence in them currently. According to strategic priority 2, in CIW's strategic plan 2017-20, the organisation is striving to be a great place to work. However, there are serious allegations of bullying and harassment within the organisation, and intense pressure on the inspectors themselves. In fact, I know of an inspector who raised concerns, triggering a so-called investigation. And this is how the senior manager responsible for the investigation responded:

'It has been concluded that, as your grievance focused on the breakdown in relationships between your line manager and senior manager, and as you took the decision to resign from your position as an adult inspector in CIW, that these professional relationships will no longer be present, as you are no longer an employee of CIW and Welsh Government'— so, you can see the very close-knit comment there, about CIW and Welsh Government—

'therefore, it has been considered that it serves no useful purpose to continue this investigation.'

So, it is alarming that the investigation was abandoned just because the person concerned resigned from CIW. And, technically, being as they themselves—the senior manager—said 'CIW and Welsh Government', technically the buck stops somewhere with Welsh Government. So, I ask you, Deputy Minister, will you commit to undertake an independent investigation into staff treatment, the intense pressures that are burdening them, and also how they actually go about carrying out investigations when somebody has actually been a whistleblower, and brought to their attention concerns about the lack of correct procedure in the carrying out of inspections within a care home establishment?

I can reassure the Member that I have regular meetings with the head of CIW, when we discuss all aspects of CIW's work. Obviously, the job that staff in CIW carry out is a very pressurised job, because they are looking at how our most vulnerable adults are looked after. And they take any evidence of any poor care that they see very, very seriously. And I can assure the Member that, in situations where they've had to intervene—I absolutely accept that they are very stressful situations—they take the job extremely seriously, whistleblowing is taken very seriously, and I can assure you that there is a good relationship between the Welsh Government and CIW, but that they do act independently.

Thank you, again, Deputy Minister, but we also know too that there have been some documented articles on the Y Byd ar Bedwar programme about their concerns—CIW—and about their ability to actually carry out robust inspections that do protect our most vulnerable in those situations.

Now, finally, I have reason to believe, from a reliable source, that these internal difficulties are negatively impacting on social care service users too. For example, it has been alleged to me that even though concerns about providers appear on a radar within the organisation, and despite inspectors allegedly flagging this up to managers, some situations can allegedly go ignored for weeks. In fact, one concern raised about a particular establishment—it took six months for the organisation to take any action whatsoever—six months—where it was felt that vulnerable people were potentially put at risk.

Deputy Minister, the fact that such serious concerns about a regulatory body, designed to protect the most vulnerable, have been raised with me, brought to my door, in the way it has been, as an elected Member of this establishment, I would ask that you take these—[Interruption.] Well, it is a Parliament, you're right. So, as an elected Member of this Parliament, I am asking you, Deputy Minister: please, will you consider a review into the fundamental workings of CIW? Will you look to the issues I've raised about allegations of staff bullying, intense pressures? But, more importantly, will you look at CIW, with a view, independently, to look whether it is actually doing what it's intended to do—to protect our most vulnerable? Thank you.

I would ask the Member, if she has got any very serious concerns about any way that any vulnerable people are being treated, that she should write to me about those individual situations. And it's not possible to respond to 'a reliable source'—it's not possible to respond to those sorts of incidents. And if you have serious concerns, please would you write to me?

The Brexit Party spokesperson, Caroline Jones.

Diolch, Llywydd. Minister, our NHS buildings are in a bad state of repair, and some are falling down. There is a £0.25 billion backlog of works deemed to pose high or significant risk. Thirteen per cent of the estate is not safety compliant. Of the Welsh Ambulance Services NHS Trust buildings, only a little over a third of them are deemed to be functionally suitable. Minister, you have committed around £370 million in health capital projects this year—how much of that will be spent ensuring NHS buildings are safe for patients and staff?

The significant chunk of NHS capital, as the Member will know, has been spent on the creation and completion, which is on time and on budget, of the Grange university hospital. I have already published a range of other statements setting out, for example, our capital programme in primary care. And NHS organisations have discretionary capital to try and undertake their backlog maintenance. So, I recognise the challenges that do exist, but this is part of what health boards themselves need to address within their allocations.

Thank you for that answer, Minister. There is at least a £0.5 billion backlog in building maintenance. I say 'at least' because most local health boards cannot even afford to do the assessments necessary to determine the extent of maintenance issues—maintenance issues that are impacting upon patient care. BBC Wales heard from staff at the University Hospital of Wales who stated that there were infection risks because hospital waste had to be transported in patient lifts. Minister, what is your Government doing to assess the risks to patient safety due to poor maintenance, and what will you do in future years to eliminate the repair backlog, which has been growing year on year?

Well, the Member mentioned the £370 million figure available and, of that, £80 million is available for health boards and trusts to undertake exactly this sort of maintenance work. It's within their discretionary capital allocation. And it's part of the job of health boards and trusts to properly understand the estate they have and to understand the risks they have. It is, though, the case that, where there have been immediate issues, for example the immediate collapse of a roof in a facility in Wrexham within the last financial year, the Welsh Government provided additional assistance to make sure that alternate facilities were available while the health board planned to properly replace that facility that had a significant impact on endoscopy capacity on the site. So, the Government gets alongside health boards when we can and should do, but this is part of the job that they have to do in properly managing and running the estate of the national health service.