1. Will the Minister provide an update on waiting times in Welsh hospital emergency departments? OAQ54596

Yes. This year has been the busiest on record for Welsh emergency care services. Last month was the busiest September on record for emergency department attendances and for the most urgent ambulance calls. Despite the 7 per cent rise in emergency department attendances compared to last September, we actually saw, treated or discharged more people within four hours, and the median wait was two hours and 35 minutes.

I thank the Minister for that reply, but can I supply a translation for the benefit of the Assembly of what he's just said? The figures released last Friday showed that waiting times in Welsh A&E departments are the worst on record. That is, more people than ever before are waiting longer than the target waiting time set by the Welsh NHS. Twenty-five per cent of admissions to A&E spent more than four hours waiting; the target was 5 per cent. Over 6 per cent of admissions spent more than 12 hours waiting; the target for that is zero. And that was in September, which is, of course, not going to be the biggest challenge in the winter. The Minister has said before that there are real people behind the figures, and he suggested that it was one of the things that keeps him awake at night. Can I suggest that one way to improve his sleep pattern, perhaps, is to resign his office and let somebody else have a go at improving things?

Well, that's a fairly predictable and not at all helpful way to try and address a very problem that exists as we face into winter. There are challenges right across the UK system. I'm responsible for the challenges here in Wales. There are a range of measures that are already being taken—for example, work being taken in two boards with a particular challenge, both the Aneurin Bevan University Health Board, and Swansea, who are making use of GP services to assist with some of triage so those people who don't need to be in an emergency department aren't there, and, equally, that people aren't waiting longer than they'd want to be. So, I have an understanding of the very real challenges that our staff face in my regular engagement with them, and an understanding of the very real challenges that members of the public face in getting the care and the treatment and the dignity they deserve. I'm determined to do all I could and should do as a health Minister to improve the position as we face what will inevitably be a difficult winter.

Well, perhaps, Minister, part of the answer to this lies in what's happening in the minor injury units, and I look forward to a statement on that fairly shortly. But, in the meantime, I recently visited Bridgend's Princess of Wales Hospital to find out more about why the average time it takes an ambulance to hand over a patient is significantly longer than in other parts of Cwm Taf, and you may remember me raising this with you. Two things came to my attention—the first is that, while the patient may not be in the ambulance, they still remain in the charge of paramedics, in which case those patients are not added to the A&E waiting times, disguising the actual figures, and the second is—and I'm sure this is true of other hospitals—it's sometimes impossible to move patients to a ward elsewhere because there are medically fit people waiting to be discharged occupying acute beds while waiting for a care package, and that means that those individuals are waiting in A&E for follow-up medical treatment when they shouldn't be there. That's tying up A&E beds, and that means that the increasing number, as you say, of walk-in arrivals have to wait longer. The root of the problem still seems to be delayed transfer of care. You've invested in better working between health and social care so why aren't we feeling the benefits in A&E?

Actually, on delayed transfers of care, we're at historic lows. When I became the Deputy Minister more than five years ago now, one of the subjects that I did address at that time was the challenge that we had in delayed transfers of care, and that was about bringing health and social care together, about recognising there is a shared challenge, not meeting them separately, and we have seen some sustained improvement. We're starting to see that creep back up, so there's work that I and the Deputy Minister will be doing with health boards and their partners. It is a whole health and social care system issue. That's why, of the £30 million that I made available across the health and social care system this winter, some of it went direct to health boards; £17 million of it, though, went to regional partnership boards to decide together how it should be used across the system. Because every time I visit a hospital and look at the front door, the reality is that I know—and I regularly raise it with each of the hospital directors; I ask how many medically fit patients there are and the challenge of moving them on. Sometimes, that is to the social care system. That is a big part of our challenge. But, equally, there are times when it's within another part of the national health service. So, it's about seeing the whole system, about understanding what more we can do to get people to the right point for the next stage of their care.

The other honest challenge is that we do genuinely have more people who are coming to our emergency departments who are seriously unwell, and, if you had a conversation with each of the health boards about the people coming into their emergency departments, they themselves would say that. They'd also tell you there are more people making their own way to emergency departments; you're having walk-ins who are significantly unwell. It's the challenge we have and it's our ability to keep on extending our ability to meet that right across the whole system that really matters.

Minister, I appreciate your answers to Suzy Davies, particularly on delayed transfers of care, but also the answer you said to Neil Hamilton in relation to the type of individuals who are going there. But we have a problem, because we are having people who are going to A&E because the out-of-hours service is not delivering for them or they can't get a GP appointment or they now feel, in fact, that it's easier. Because I've been on the phone 45 minutes waiting to get hold of a GP just for an appointment for a five-year-old child. Now, this is causing people to go into A&E. So, the Choose Well agenda you had as to who you should go to is great, but the problem is that you can't get to them—they're not available. Can you therefore look at the actions taken to ensure that, if we are going to choose well, they are available to choose to go to, because that is the big problem?

We’ve got a variety of challenges to try and address, and something we are deliberately doing is exactly that on our Choose Well message, and to better equip the wider primary care team to do so, whether that’s the steps we’re taking on eye care, with the emergency eye care service we have, which they don’t have across the border—it’s widely recognised as being a positive—whether that’s about making better use of pharmacy, and the roll-out of Choose Pharmacy, and the minor ailments service is an important part of that. We’re diverting more and more people not just away from GPs and from the emergency department, but to somewhere that is actually appropriate for them to receive the right care and support. And also, as we continue to roll out 111, in each of the areas where the 111 roll-out has taken place, there is a more robust primary care system in hours and out of hours as a result. It is still, as I say, about our ability to constantly keep pace. So, yes, it is something that I look at. It is something that I will look at as I will be meeting a number of the health board and local government departments with the most significant pressures within their systems to understand what is taking place earlier on within the system and how the additional moneys we’ve made available are actually addressing the very real challenges that I know that you’ve set out.