The following amendments have been selected: amendment 1 in the name of Rebecca Evans, amendment 2 in the name of Caroline Jones, and amendments 3, 4 and 5 in the name of Darren Millar. If amendment 1 is agreed amendments 2, 3 and 4 will be deselected.

So, we're going to move on now to item 10, which is the Plaid Cymru debate on access to health services, and I call on Helen Mary Jones to move the motion. Helen.

Motion NDM7178 Rhun ap Iorwerth

To propose that the National Assembly for Wales:

1. Expresses concern with the lack of access to basic medical services, including GPs and NHS dentistry, in many parts of Wales.

2. Calls for the recruitment and retention of additional medical staff to ensure appropriate access to health services across Wales.

Motion moved.

Thank you very much, Deputy Presiding Officer. We want to focus in this debate—I'm pleased to move the motion, tabled in the name of Rhun ap Iorwerth—we want to focus in this debate on access to community care services, community health services.

Now, I don't feel I have to spend terribly long in this Chamber setting out the fact that we have a real problem. The number of GPs, for example, has fallen since 2010 from 1,991 to 1,964 at a time when demand has gone up. We know that when it comes to access to the dentistry service—and I know my colleague Siân Gwenllian will have more to say to this later in the debate—only one in six dentists in Wales are taking on new national health patients at the moment.

When the health committee recently reported on community nursing, we were shocked to discover that we, in fact, don't know how many district nurses we've got. We don't know what the state of community nursing is in Wales, because the data isn't there. And we all know, in this Chamber, from our constituency and regional postbags, and many of us from our personal experience, of people waiting weeks and weeks to see a GP or to access other services in community services and GP surgeries for non-urgent appointments. And we also know that there are huge disparities in services across Wales, and that poorer communities are disproportionately badly served—

Will you give way?

I will happily give way, yes.

I hope I didn't intervene too early, but, actually, I agree with the point you just made, which is that one of the issues is the lack of uniformity, because I've got patches in my constituency that are exceptionally well provided for in terms of primary care, but also that engagement with community healthcare teams. There's some amazing work going on. But then I have issues in some areas with dentistry accessibility, and there doesn't seem to be no rhyme nor reason.

I think that's a very valid point that Huw Irranca-Davies makes, which is that in a country the size of Wales, 3.5 million people, we should be able to achieve some consistency. I don't know if it's the case in his constituency, but it's certainly the national experience that the poorer the community, the more poorly it is likely to be served. It's not always the case, and we get excellent practice serving some of our poorer communities, but it's not good enough.

We had a discussion recently in First Minister's questions, raised by my colleague Adam Price, about the broken manifesto pledge to require GP surgeries to open at evenings and weekends. We were told that there was no demand for it. I find that incredibly hard to believe. But also we know—be that as it may—that in 2018, only 74 per cent of practices were open in what are called the core hours, between 8 a.m. and 6 p.m., and during those core hours they don't even have to be seeing patients. So, almost 30 per cent of them are not meeting that target, and that target isn't very effective anyway. I could go on, and I'm sure many of you across the Chamber could contribute as well.

So, why are we in this situation? Now, I'm sure the Minister, in his contribution, will talk about the Tory Westminster Government and austerity, and of course there's an element of truth in that. We don't have a magic money tree, as somebody once said. You can't produce resources from nowhere. But let me remind him, Deputy Presiding Officer, that his party has been in charge of the health service in Wales for 20 years, and for the first 10 of those years, from 1999 to 2010, times were relatively healthy in terms of public budgets.

I'd like to draw the Chamber's attention to some manifesto commitments from the Labour Party in the 2003 election. They began with a fairly open and honest contribution about what they hadn't done.

'We have not met...our targets to reduce waiting, but the solution in these areas is not to change direction or scale back on investment, reform and capacity building—it is to go faster and further'.

Well, fair enough. So, they then went on to say:

'In our second term we will ensure no-one waits more than 24 hours to see a member of their Primary Care Team, while at the same time widening the range of services provided at a local level.'

That would have been an excellent plan. They also went on to say:

'In our second term we will recruit 3,010 extra nurses and 410 extra doctors.'

Now, I must remind the Chamber that this was at a time when resources were not tight, and it didn't happen.

So, let's roll forward to the present day, and evidence from Health Improvement Wales and Social Care Wales that will be placed before the health committee tomorrow. It's written evidence, so it's already in the public domain. The evidence states

'The overriding aim of the strategy will be to ensure that, by 2030:

'We will have the right workforce to be able to deliver flexible and agile health and social care that meets the needs of the people of Wales.

'We will have a workforce that is reflective of the population’s diversity,' and that

'We will have a workforce that feels valued.'

By 2030. Thirty-one years after the Minister's party took control of the health and care services in Wales.

I don't pretend that I know all the answers—I don't suppose anybody knows all the answers—but we do know that there are other big institutions, for example, multinational companies, with complex needs, varying markets, varying levels of demand, that plan their workforce to meet needs and they succeed in doing that years in advance. We might not want to follow their example, of course—there may be some ruthless practices that we wouldn't want to go within 100 miles of—but it does prove that it is possible to effectively plan the workforce that you need in a complex situation. We know we need competent management, we know we need proper resources, and we know we need people who are experts in workforce planning.

Now, the Minister will say that we have all this, but I would submit to this Chamber that that simply cannot be the case. Because, otherwise, we would have effective services in the places they were needed when people needed them. We know how important it is—and the Minister has said this frequently himself—that we strengthen our services in the community, because that is not only better for patients, but it also keeps patients out of secondary care, which is so much more expensive. Nobody wants to be in hospital—good primary care can make sure that that's not where people end up.

So, something is really wrong. And I'm sure that we will get the usual complacent response from the Minister saying that everything will be fine. Well, perhaps I'm a sceptic, Deputy Presiding Officer, but after 20 years, I'm beginning to doubt it. I think that the best chance of us sorting this out is a change of Government. Meantime, the Minister must show leadership and give direction and challenge. And above all, he must not be complacent about those communities that Huw Irranca-Davies has highlighted, which are not receiving the community services they deserve. We have waited as a nation long enough for the community health services that we need, and Labour in Wales has run out of excuses.

I have selected the five amendments to the motion. If amendment 1 is agreed, amendments 2, 3 and 4 will be deselected. Can I ask the Minister for Health and Social Services to move formally amendment 1 tabled in the name of Rebecca Evans.

Amendment 1—Rebecca Evans

Delete all and replace with:

To propose that the National Assembly for Wales:

1. Notes the positive action underway through the Primary Care Model for Wales to improve people’s access, day and night, to the right professional and service for their particular needs.

2. Notes the marked improvement in the recruitment of doctors to the GP speciality training programme this year.

Amendment 1 moved.

Formally.

Thank you. I call on Caroline Jones to move amendment 2, tabled in her own name. Caroline.

Amendment 2—Caroline Jones

Add as new point after point 1 and renumber accordingly:

Regrets that over 119,000 patients in Wales are covered by GP practices at risk and calls upon the Welsh Government to ensure that primary care is adequately funded by receiving at least 10 per cent of the overall NHS budget.

Amendment 2 moved.

Formally. Diolch, Dirprwy Lywydd. I thank Plaid Cymru for tabling this debate today. For those who didn't attend the BMA's briefing on the current state of general practice in Wales, let's just say that the message was dire.

As alluded to in my amendment to this motion, nearly 120,000 GP patients are covered by practices at risk. The BMA produced a heat map covering all health boards, highlighting practices that have closed and those under threat of closure. Aneurin Bevan has 32 practices with an uncertain future.

GPs at the event expressed concern that general practice might never recover from the damage being done by underinvestment and mismanagement by local health boards. Practices are simply handing back their contracts because they cannot cope. GPs are being asked to do much more with a lot less. We are spending more than ever on healthcare, yet the share given to primary care has continued to shrink. Despite 90 per cent of all contacts with the NHS occurring in primary care, primary care receives around 7 per cent of NHS funding. On top of this, practices are being stung by enormous service charges and directives that do allow for strategic planning or expansion of premises.

We have to do all that we can to protect general practice in Wales, and we have to start by ensuring fair funding for GPs. Primary care should receive at least 10 per cent of the NHS budget. The share of the budget has been falling year on year, and anything under 10 per cent is simply unsustainable. We also have to address the enormous service charges imposed on GP practices by health boards.

The independent contractor model for primary care has served Welsh patients well for decades, but it is now facing an existential threat. If we lose these GP practices, then we lose primary care for good. Health boards have proved they cannot manage practices as well as our independent GPs. Local health board-managed practices cost as much as 30 per cent more to run.

General practice is the front line of our health service, and it's time that the Welsh Government recognised this and did all it can to adequately fund and provision it. Diolch yn fawr.

Thank you. I call on Angela Burns to move amendments 3, 4 and 5, tabled in the name of Darren Millar.

Amendment 3—Darren Millar

Add as new point after point 1 and renumber accordingly:

Notes the ongoing concerns of the British Medical Association Cymru regarding the future sustainability of primary care services and the publication of the latest Welsh GP practice heat Map.

Amendment 4—Darren Millar

In point 2, after 'staff' insert 'and other health professionals'.

Amendment 5—Darren Millar

Add as new point at end of motion:

Further calls on the Welsh Government to undertake a root and branch review of workforce planning within the Welsh NHS.

Amendments 3, 4 and 5 moved.

Thank you very much, Deputy Presiding Officer. I formally so move those amendments. I'd like to thank Helen Mary Jones for opening this debate, and I think the word or numbers '2030' will forever be emblazoned on my heart after today's series of debates, what with hepatitis C and the diagnosis targets, because you mention about the fact that we need our workforce in place, and the concern we have is the fact that the workforce is so out of kilter with the ever-growing needs of the population. Our cancer survival rates still lag behind other countries, and it's a recognised fact that early diagnosis is key to ensure that patients have a better chance of survival.

Now, Welsh Government have brought forward fresh thinking with the single cancer pathway and the rapid diagnostic clinics, but, according to Cancer Research UK, this work is at risk of being undermined by gaps in the workforce. Patient demand is increasing, the number of confirmed cases of cancer will increase to an annual total of 25,000 a year by 2035, up from the current 19,000. So, we must ensure that our diagnostic workforce keeps pace with that.

Again, for example, the demand for imaging services has risen by 10 per cent per year over the last five years, and yet the radiology workforce has only risen by 1 per cent. I see it in my health board of Hywel Dda, and I'm sure that other Members see it in the health boards that they have to deal with on a day-to-day basis. Most worryingly, all bar one health board are struggling to recruit and retain radiographers, and this last year, Welsh radiology departments spent an estimated £8.8 million on outsourcing, overtime, and insourcing extra staff—up by almost £4 million. If we had that £8.8 million that we could actually spend on training—because you need the training places and then recruiting the radiologist to our health boards—we would have a better use of that funding. Yes, Huw.

Thank you for giving way. I'm always interested in these debates to hear ideas of how we can resolve some of these quite complex situations. A number of members of my family are involved in radiography—some as clinical tutors within radiography as well—and we are training a lot of people, and yet, we still have parts of Wales, including places like Powys and Ceredigion and so on, where those trainees are choosing not to go and work where there are vacancies in those hospitals to work. So, we're training the people but they're choosing to go to Cardiff or to Bridgend or to wherever. So, I'm interested in the practical ideas about how we can resolve this, because we're doing the training in a number of these specialisms, but we're unable to recruit them into the areas that we need them.

And, of course, one of the ways of doing that is how we place our medical training places, where we put them and what we tie people into, because it's a recognised fact that if you start to train in a particular area, and you develop your social life there, your network there, you're far more likely to stay. I'm really sorry, I didn't realise I only had three minutes on this.

I shall be generous because you've taken an intervention, but it is three minutes normally.

Thank you. There are similar shortages, obviously, with endoscopy nurses.

I did want to just touch on Caroline Jones's amendment, because we will be abstaining on it. Not because we don't support it, because we absolutely do, but the fundamental issue that we have with access to primary care services is that everything that this Government has done—the parliamentary review, the vision for health—is predicated on us taking our potential patients and seeing them at home, in the community, before they go anywhere else and do anything else. And primary care, I suspect from the numbers that I'm running, needs substantially more than 10 per cent in order to be able to meet the ambitions that we've all cleaved to as parties across this place on the parliamentary review to try to move that emphasis away from hospitals and into—[Inaudible.] So, it's a good amendment, but we can't support it because you put a number to it.

Perhaps this might just be the time to gently remind Members that in a half-hour debate, Members get three minutes to move amendments, three minutes to speak. The Government response gets six minutes, and the mover and the closer get a total of eight minutes between them. In moving and seconding I will be generous, but for the next debate, I will not be generous, because you've now been told. So, there we go. Siân Gwenllian.

Thank you very much. It’s encouraging news that 186 training places for GPs have been filled this year, which is an increase on the 136 available in 2017, which happens to be the same figure exactly as the one in 2010. It’s vital that this momentum is maintained and accelerated, as we heard from Helen Mary, in order to develop the vital workforce for the future, so that we can provide better access to services to patients. It’s important that this increase happens in different parts of Wales, and we need to plan in detail, with 23 per cent of GPs likely to retire in five years' time.

Members will be aware of the difficulties arising in my constituency, as GPs retire and a surgeries fail to attract new GPs, particularly those who can provide services through the medium of Welsh.

And some of you will also remember that I have been arguing the case for having a medical school in north Wales, at Bangor University. And after a great deal of persuasion and discussion here, the Government yielded, and by now, the first cohort of medical students are studying medicine in Bangor and the work continues there.

The Minister was loath to introduce this at the beginning, but he did see that the argument that we put forth was a very sound one, namely that there is evidence from all part of the world that shows that medical students remain close to the place where they are trained. And I am of the belief that some of this first cohort in Bangor today will start to plug some of the gaps in our surgeries and our hospitals, thus improving patient care across north Wales. But we need more training places, including those in Bangor, and I'm sure that a full medical school will come to Bangor soon.

Thank you very much. It is wonderful to see the medical school there, or the medical education there developing, at least. Would you agree with me that what I currently see in my constituency, in the Holyhead area—where there are two surgeries that, because of failures to recruit GPs, have had to transfer to the management of the health board, and that causes a crisis in terms of primary care in Holyhead—is proof yet again of the need for us to move towards training far more doctors, which won't help us today, but will certainly make things easier in future years?

Certainly, yes. This long-term planning is vital to avoid situations such as that in the future. And that’s why I’m so pleased—if truth be told, I went to visit the 18 students in Bangor being trained at the moment, and it’s wonderful to see that, but we need that to increase and to accelerate as well.

There's a lack of dentists as well, which is creating problems in terms of access to dentistry services in the same way. And in my constituency, this means that people have to travel very far to receive treatment on the NHS. And certainly, we need more dentists in that area. And the way that the dental contract caps the numbers of NHS patients is also decreasing access to dentist services.

I see that time is against me. It’s vital that patients in Wales, who need to see a GP or a dentist, can have equal access across Wales to these services—equal in terms of geography, and equal in terms of income and also in terms of age.

I agree with those who have already said that primary care needs to get more resources, because we have to remember that 97 per cent of people never go anywhere near a hospital. So, I wouldn't disagree with what Angela Burns said, that we probably need to have it as more than 10 per cent, but it's good to see the Brexit Party supporting a 10 per cent target. It will be interesting to hear what the Minister has got to say on that.

Primary care is the last open access service. Often, primary care is dealing with issues such as debt or domestic violence, which of course have a serious detrimental impact on people's health, but aren't issues that necessarily couldn't be dealt with by other agencies. So, we have to get better at ensuring that we've got that multidisciplinary support for people who are turning up in primary care who could be seen by a debt counsellor or could be seen by a social worker, who can help them dig themselves out of very difficult situations.

I think one of the frustrations for my constituents is the inconsistency of access to primary care. So, we have some GP surgeries where you're able to book an appointment online, and others where you can't. I think it's quite difficult for patients to understand why that is. I note the uptake of a digital booking system has gone up from about 220,000 to 350,000, but that's well short of the target of over 870,000, and it would be interesting to hear from the Minister as to whether doctors' surgeries are simply refusing to engage with the way in which the world has moved on, technically. People expect that, if they can buy a book online, a ticket to a match, or a piece of clothing, they feel they ought to be able to book a doctor's appointment online, rather than having the frustration of holding onto the phone at 8 o'clock in the morning in the hope that they will get answered before all the places have been booked. 

I raised in the Assembly a couple of weeks ago the fact that people who need to get their ears syringed were instead being told by GP surgeries that this was no longer in the general medical services contract and they were being diverted to other agencies who were charging up to £95. So that needs sorting out, because these are pretty basic pieces of primary care intervention, just the same as foot care for older people, who can become crippled if they don't have somebody to cut their toenails, if they can no longer reach down and cut them themselves. 

So I think these are really important things. I acknowledge completely that we've boosted Choose Pharmacy to enable simple primary care tasks to be done on a walk-in basis by the pharmacist, who is a highly trained individual and much underused. But I think that we have to acknowledge that there's much that's going on that's very good.

There are some existential threats to the health service arising out of Brexit. The first one is just that we've got over 1,300 NHS workers from Europe employed by the NHS in Wales, including 7 per cent of our doctors. Are we going to be able to retain them if Brexit goes ahead? People might feel they're no longer welcome here and they're certainly able to vote with their feet. These are highly employable anywhere in the world. 

Are you winding up, please?

I think that the biggest thing, I'd like to say, the biggest existential threat, is over potential US trade talks, which could lead to a massive increase in drug prices, if Donald Trump has anything to do with it, and particularly a lack of access to generic drugs, which are really, really important in keeping the budget for drugs down. And there are some pretty terrifying things going on in terms of identifying that this could actually nearly triple in price. So that's something that it's difficult for us to guard against, as drug purchases are not a devolved matter. 

Thank you. Can I now call the Minister for Health and Social Services to reply—no, not to reply to the debate, to add to the debate? Vaughan Gething. 

Thank you, Deputy Presiding Officer. I'd like to thank Members who've contributed to this debate. Of course, access to primary care services is a key part of the Government strategy 'Prosperity for All'. Medical services are a vital part of primary care for people across Wales and valued by us all. It's a real positive that, in the latest national survey, 93 per cent of people were positive about their most recent experience in primary care. However, we're all aware of the challenges that Wales and every country within the UK faces.

The old way of delivering primary medical and dental services is not sustainable, so we need to move on and rise to the challenge, as Members have recognised. 'A Healthier Wales' sets out our joint vision, across health and social care, for a whole-system transformation. Our vision is that everyone has a longer, healthier and happier life, is better able to remain active and independent in their own homes as long as possible. To do that, to deliver that transformation, we recognise the need to develop and diversify our workforce, to change the way that we work and signpost people to the most appropriate local service, to deliver the right care, at the right time and in the right place. 

So, our health boards do have an ambitious work programme, with a focus on delivering a 24/7 model for primary care, that's both in hours and out of hours, with the roll-out of our 111 service. And, of course, to help move forward on the transformation of primary care, I've already invested £89 million in the transformation fund. Every single health board area in Wales is trialling a new and a better way of working. There are, of course, always going to be specific challenges that need to be addressed within local communities. I recognise the comments made by Huw Irranca. 

Will you give way, Minister? 

I can. 

I thank the Minister for giving way, and the reason I ask him to give way is to ask him to join with me in welcoming something that he stood here in the debate with me previously, which is the issue of primary care provision in Llanharan. I hope he'll join with me in applauding Pencoed Medical Centre who have actually made the decision now, working with the local health board, finding some money available, to extend back into Llanharan and Brynna to provide 4.5 days a week of outreach surgeries into those communities, and he knows the impact it had on those communities. So, there are ways through this with the will and with a bit of clever funding put in the right direction. 

And that's a good example of the sort of progress we need to make to deliver real access to primary care. And I remember meeting the Member together with his local constituent to discuss the issues. I do get to go out and about and to hear directly from staff and residents. For example, I recently returned to Bryntirion with Hefin David to meet the team in a managed practice to hear about their challenge that happened when GP partners retired. They now have an occupational therapist, a clinical pharmacist, a physiotherapist, health support workers and access to paramedics as part of that team, and they're now planning for the future and much more optimistic. The primary school in Ely I visited to see the Designed to Smile initiative, a significantly effective programme shown to have achieved a 13.4 per cent reduction in the levels of dental decay in five-year-olds since 2008. And, of course, in Taff's Well, that practice is able to operate a GP triage system, and routine appointments are being delivered in one to two days. And that's now across the cluster; they're using funding to help provide patient information and signpost to wider services. There are the points that other people have made about investing in wider primary care services, in Choose Pharmacy and optometry, for example. 

It was at Taff's Well, of course, that I announced the access standards for general medical services. I set out clearly what I and the people of Wales expect in providing real access. It's backed by £15 million of investment in the GP contract for access, including new digital telephony to help make it easier for patients to contact practices and access the services they need. 

I will take one more intervention then I will need to make more progress—

I'm just really grateful, and I'm glad to hear all that good news; it is supremely positive. But I do want to point out that we have 29 practices at risk which have submitted sustainability applications, and another 29 at risk which are in the pre-application process. So, how does all that good news tie to the fact that we've got practices that are on the verge of closure or are under real problems of sustainability?

As I've said many times in this Chamber, we will need to change the way that we deliver primary care. Single and double-handed practices, their ability to deliver the sort of range of services that we need, that's part of the reason we introduced clusters to help GP practices to work together with the wider primary care team to deliver a more sustainable way of delivering care.

Primary care will change and it should do to meet the legitimate expectations of the public and, actually, the agenda for health and care provided in the parliamentary review and in 'A Healthier Wales', and it includes dentistry, of course. More than 40,000 NHS patients regularly receive NHS dental care compared to five years ago. We're witnessing the highest ever level of child access to general dental practice, and that does not yet include children accessing the community dental services. We've also seen a reduction in children having general anaesthetics. Our reform agenda should help further to improve access, as we've previously discussed in this Chamber.

But it's not all, of course, about money or systems—it's about people and making sure we have the workforce to meet our needs. So, I'm delighted that this year we have once again overfilled our GP training places against an increased target. I increased the quota for GP training places from 136 to 160, but we have 186 places filled, the highest number of recruits into GP training ever in the history of Wales, and every single GP training scheme in every part of the country has been filled. That's part of our 'Train. Work. Live.' initiative.

While GP training incentives have helped us to meet our recruitment targets, it is an area where some of that recruitment has been historically difficult. There are, of course, challenges, and there will always be specific local issues to address. However, we do know what those challenges are. We have a vision for what we want to do, and we have a plan to achieve it. And more than that, we're taking action. We should be proud of the progress that we are making and delivering.  

For my part, I recognise that there is always more to do and I am far from complacent about the challenges that face us, but this is a Government that is determined to keep our promises to meet the challenges that we face, in improving access to primary care, and I look forward to having more good news to report to the Chamber exactly on that in the next 18 months. 

Thank you. Can I call on Helen Mary Jones to reply to the debate?

I'm grateful to the Deputy Presiding Officer and to all Members who have contributed to this debate. I have very little time. The Deputy Presiding Officer has been kind enough to say she'll be generous, but I know better than to push my luck.

I'm grateful to Angela Burns for her support and we will be supporting her amendments 3, 4 and 5. She rightly highlights the increased demand, but that increased demand is not entirely unpredictable. We need to be able to look at the likely demand and to plan, and we're not doing that effectively yet.

Caroline Jones was right to highlight what the BMA have told us. I don't share her view that directly managed practices can't be successful. They're often more expensive because they're serving poorer areas with higher levels of need, but she's absolutely right to say that the current model isn't sustainable and that action is urgently needed. We won't be supporting her amendment 2, more or less for the same reasons as Angela Burns gave, because 10 per cent may or may not be the right figure. It may not be enough. It may be that we need more. It may be that at some point we can spend less. But I fully accept that the amendment is offered in the right spirit.

Siân Gwenllian rightly highlights particular concerns in her own area and talks about equal access, equal access not only geographically, but as we heard in my exchanges with Huw Irranca-Davies, around the need for the right services for people who find it more difficult, for poorer communities. It's very interesting she mentions the final arrival of the clinical school in the north, which was, of course, another thing that was promised in Labour's 2003 manifesto. I don't think we would have it by now if it hadn't been for the pressure from Siân and her colleagues, and we're still waiting for the clinical school in Gwent—a challenge we might offer to those Members who represent that area. 

Jenny Rathbone is absolutely right to talk about the issues of inconsistency of access and I share some of the concerns she raises about Brexit. Also, some of the comments she made were similar to those of Huw Irranca-Davies, and, in that context, I look forward to them supporting the motion and rejecting the amendment because the amendment is, I'm afraid, the usual self-congratulatory nonsense from the Government. Why will they not just oppose our motions if they don't agree with them? The Minister says things like he is not complacent, and then he speaks as if he is. He talks about there being specific challenges and that we will recognise them and meet them. Well, Deputy Presiding Officer, we've been waiting 20 years for his party to meet them and his manifesto of 2003 identifies those challenges, sets out things that should have been done to sort them out, and he cannot wash his hands and pretend that it isn't a matter for him. His party has had this time. He says he's not complacent; well, that isn't how it feels from where we're standing, and I notice that there are some of his colleagues on his own backbenches who may not be very happy either.

In the end, this is not about problems in one or two places. This is not about problems of access in certain communities. It is something that all of us across this Chamber—and Labour Members have mentioned it today—recognise is affecting their constituencies. Twenty years on, it isn't good enough. He should either get on with it or get out of the way.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Object. Therefore, we defer voting under this item until voting time. 

Voting deferred until voting time.