We'll now turn to leaders' questions, and the first leader this afternoon is the leader of Plaid Cymru, Adam Price.

Diolch, Dirprwy Lywydd. First Minister, I'd like to start by raising with you the case of Peter Connelly, who died in what the Welsh ambulance service trust described as 'difficult and unacceptable...circumstances'. There had been an eight-hour delay in admitting Mr Connelly to Wrexham Maelor Hospital. Following his death, the senior coroner for north Wales issued a regulation 28 report on the prevention of unnecessary deaths. It was the thirteenth such report since 2014 that highlighted long waits outside hospitals in north Wales. The coroner concluded that, unless working practices changed within the NHS in north Wales, it was inevitable that future deaths would occur that might otherwise have been preventable. That report was issued at the end of last year. This year already, a further report—making it the fourteenth in six years—into the death of Samantha Brousas identified failings in the transfer of care at Wrexham Maelor. Despite suspected sepsis and being critically ill, she was held outside the hospital in an ambulance for over two hours. As a consequence of the concerns raised by the coroner about Betsi Cadwaladr and the Wales ambulance trust, will the First Minister undertake an urgent investigation to ensure that lives are not put at risk any further?

Well, Llywydd, any coroner's letter about the avoidance of future deaths is taken very seriously in the health service, and certainly the ambulance trust will have responded to previous such advice and is currently responding to the example that Adam Price referred to. The problem is not one that is soluble in the hands of the ambulance service alone, as those letters always make clear. It is a whole-systems issue, in which we have to be able to clear people through the whole system so that, when the system comes under pressure, as it has over the last few weeks, there is room at the front door. Because the emergency reception of patients is linked into the way that the whole system, inside the hospital and outside the hospital too, is operating. Nobody wants to see people waiting in ambulances when they could be admitted into our accident and emergency departments and treated there. That is absolutely the view of the Welsh ambulance trust. They work very closely with health boards. The health Minister works with them both to try to create the conditions in which those sorts of delays can be avoided. 

I'm sure that it's right to say that there are systemic reasons for the problems that have been highlighted, but would the First Minister accept that there have been so many cases in north Wales that there must be specific reasons, which would suggest that the kinds of general factors that exist elsewhere have caused a large number of tragic cases?

Part of the issue, of course, is a lack of capacity. You mention every winter the unprecedented levels of pressures, so let's look in more detail at that. In 2018, one reason given for the additional pressures at that time was norovirus, but in reality there had been a reduction of 11 per cent in the number of cases as compared to the previous year at that point. Last year, flu was to blame according to you, but flu had been categorised as a low-intensity problem for the large part of that year. Now, in 2020, in a relatively warm year, what will be the reason this year?

Well, there are a number of reasons, of course, Dirprwy Lywydd, and I don't agree at all if the Member was suggesting that the problems are causing this in north Wales more than in other places, because we know that that is happening in every area.

The Member, I think, misunderstands the nature of some of the challenges, norovirus in particular. It's not a matter of the overall level of norovirus; it is the fact that norovirus tends to be concentrated in particular places and then ends up—as it has in Glangwili Hospital this year, for example—with the closure of whole wards and an inability, therefore, to admit patients. There may be a low level of norovirus overall, but it attacks particular places and causes particular impacts where it does. This year, there has been an early onset of flu; it may not be the most virulent strain of flu that we have faced in the last five years, but the fact that it has started early means that there has been an earlier influx into emergency departments of people with flu-like symptoms.

Particularly this year, we face the fact that a number of very frail elderly people coming into emergency departments have required a higher level of admission to emergency departments than previously, and this is partly, Dirprwy Llywydd, a reflection of the success of the way that things have been done in Wales. We have large numbers of elderly people still living in their own homes with very intensive packages of care from local authorities, who in previous years would have been in residential care. When they come into hospital, it isn't a simple matter of simply plugging in one small extra service to allow them to go home; they are already receiving a very significant level of domiciliary care, and putting a new package of care ready for them is something that is complex and demanding amongst a whole range of services.

And finally, we are still seeing this winter the impact of the changes to tax and pensions that has affected the ability of doctors to fill rotas and to carry out additional sessions. Two thousand sessions in Wales were cancelled in the run up to the Christmas period, 15,000 patients were affected by it, and that is still to be resolved. Nevertheless, Dirprwy Lywydd—and it's really important to say this, isn't it—over the whole of the Christmas period, when there were 15,000 attendances every week at emergency departments, 10,000 calls to the ambulance service in Wales, 4,000 emergency admissions every week into our hospitals in Wales, despite all those pressures, the health service goes on day in and day out responding to clinical need here in Wales, and patients in every part of Wales are grateful for the service that they get.

If I understand the First Minister correctly, you were arguing that your failure, in a way, is a reflection of your success. For the eighth year on the bounce, it is again true to say that over 85 per cent of the beds are occupied, which is above the safe threshold that you have set. Some 125 patients were healthy enough to leave one hospital last week, but there was no social care available for them, which is very different to the picture that you have just painted.

Whilst you were health Minister seven years ago, you said that the front door problems—to use the term that you've just used—of the health service were way worse because patients remained in hospital although they were healthy enough to leave. Having highlighted that problem in a previous post, why have you failed to get the Government that you now lead to resolve it in your current post?

Well, we have resolved the problem, Dirprwy Lywydd, and the situation is much better than it was when I started as health Minister.

The two best years since figures have been recorded for delayed transfers of care in the Welsh health service were 2017 and 2018. So, we had fewer delayed transfers of care in those two years than at any time since those figures have been recorded, and that is a huge tribute to the effort that our colleagues in social services departments have made, with extra funding through the ICF, with the work that's been done in the regional partnership boards.

And yes, it is a struggle for social services departments, as well as the health service, to deal with a sudden surge in demand, but last week, when Hywel Dda was under the pressure that it was under, it was because of the help that they received from social services departments in those areas that they were able to recover the position so that, by the end of last week, things were in a much better position.

I was very grateful, Llywydd, that I was in Carmarthenshire on Thursday with social services staff and able to thank them, and the Plaid Cymru leader of that council, for the enormous efforts that they had made that week to assist the health service and to make sure that, as much as possible, people who were fit to be discharged from hospital were being assisted by those local authority services.

Thank you. I change to the leader of the opposition, Paul Davies.

Thank you, Deputy Presiding Officer. First Minister, the Welsh Government's own latest figures have shown that more than 11,000 young people received counselling in 2017-18. Indeed, more worryingly, figures from the charity Barnardo's Cymru have confirmed that the number of children it helped in the past year rose by 56 per cent. In light of these very serious figures, can you tell us what immediate steps the Welsh Government is taking to address this problem and what new early intervention measures will be introduced to help reduce the number of children needing mental health support here in Wales?

I thank the Member for that important question. He will have seen that, in the draft budget published on 16 December, there is a doubling of the budget for mental health support in our schools in Wales; partly a response to the report of the health committee published earlier in this Assembly term. We want to make sure not only that we strengthen the counselling services that we currently provide, but we extend the age range of them as well and we extend their availability down the age range so that it's available to young people earlier in their school career, and when it may be possible to intervene in a way that will prevent problems from developing into the future. I think I managed to quote some figures last week in the Chamber that showed that 87 per cent of those young people who received school counselling didn't require any further intervention, and I think that is a real endorsement of the strategy that, right round this Chamber, Members have advocated in relation to children's mental health; that we get in early, we aim to prevent, and we don't draw young people into the more serious part of the system when we're able to provide more mainstream everyday services to which there is less stigma attached and more effect in their lives.

I appreciate that response, First Minister, because as you know poor mental health can, of course, affect anyone from any background and at any age. Indeed, one of the less discussed facets of mental health is in relation to the farming sector in Wales. Sadly, agriculture carries one of the highest rates of suicide, and the remoteness of many farming communities mean they are often geographically distant from mainstream health services, which may limit their access to support.

Now, you may be aware of the outstanding work done by the DPJ Foundation based in my own constituency, which is supporting those in rural communities by helping to break down that stigma you were just talking about attached to mental health. And as well as doing that, they are also running a project called Share the Load, a 24-hour telephone and counselling service. Therefore, in light of the good work done by the DPJ Foundation, and indeed others, can you tell us what your Government is doing to support the delivery of more local, tailored mental health support networks across the country?

I thank the Member for that supplementary question, again dealing with a very important aspect of mental health. I was very pleased to meet the founder of the DPJ Foundation at the Pembrokeshire show, where I saw other colleagues as well, and Lesley Griffiths and I were able to open their office there at the Pembrokeshire show and to hear from them about the fantastic work that they do. The Welsh Government has been pleased to support their work financially as well, because of course Paul Davies is right, there are particular vulnerabilities in the farming sector at different times. We've had dedicated mental health helplines to assist the farming community going back as far as the foot and mouth epidemic at the very start of devolution. So, we continue to work and to invest in those specialist services that are relevant in rural Wales.

But, Paul Davies is also right, there are other aspects of mental health where there are particular needs—veterans services, for example, where we know that we have to provide a mental health service that, as well as being available to everybody, is skilled and able to respond to the particular sorts of mental health conditions that people who served in the armed forces are especially vulnerable to experiencing.

First Minister, of course, it's not just children and young people, or indeed farmers, who are struggling to access appropriate mental health services. We also know that depression is more common in older people than in any other age group, and sometimes they are not being recognised as they should and therefore not being provided with the support that they need. It is deeply worrying that people are not receiving some of the support that they need. The Welsh Government, of course, needs to ensure that individual departments aren't actually working in silos, either, but rather under one co-ordinated umbrella.

Moving forward, what assurances can you offer the people of Wales that these services will indeed be made available to anyone who needs them, regardless of age, geography or background, and when will you be confident that we'll actually start to see these figures improve in the field of mental health support in Wales?

Llywydd, can I just say to the Member that there is a complexity, isn't there, in the figures in that we want people to come forward, we encourage people not to feel stigma, we encourage people to declare that they need help with a mental health condition, and then the figures sometimes look as though demand has risen and is not being met? But in fact, it is partly a reflection of the success of the campaigns that have been led around this Chamber over many years to try to make sure that people who need help with a mental health condition feel confident about presenting themselves for it. It's partly why in this Assembly, in the third term, the Mental Health (Wales) Measure was put on the statute book with the new primary care mental health service, and I think that has been a tremendous success and a tribute to the work that was done in this Assembly, because that is somewhere where— . We know that older people are more likely than any other part of the population to be in touch with their family doctor, and therefore the primary care mental health service ought to be the way in which older people who are suffering from loneliness, isolation and where that shades into a mental health condition like depression—that is where that is first recognised and a front-line service is able to be provided for them.

The number of people getting help from the primary care mental health service has grown every single year and is now at its most successful, and yet, waiting times for that service have been kept down through the extra investment that's been made in mental health. It would be completely wrong for anybody to think of an older person who is depressed, that this is just something that older people have to put up with because it's part of the condition of ageing. Those people need to feel as confident as anybody else that the services that are there are available to them, too.

The leader of the Brexit Party, Mark Reckless.

First Minister, GDP declined by 0.3 per cent in November, and I know that you like to blame Brexit for any weakness in the economy. However, isn't it revealing that we've had some much stronger data since the election? For instance, the Halifax have reported that house prices rose by 4 per cent in December. Deloitte, who surveyed companies' chief financial officers between 13 December, which was, of course, the day after the election, and 6 January, saw their business optimism balance rising from -35 per cent to +45 per cent. They say this constituted, and I quote,

'an unprecedented rise in business sentiment'.

First Minister, isn't it now evident that what was holding the economy back was not the prospect of Brexit, but the prospect of Corbyn?

I don't think that's true for a moment, Llywydd. I want the UK economy to be a success, because the Welsh economy will be a success alongside it. So where there are signs that the economy is strengthening and recovering, then of course those are to be welcomed. But the signs are by no means all in one direction. Not only did GDP data show the UK economy growing by just 0.1 per cent, it showed a 0.3 per cent fall in both manufacturing and in services.

So the data on the UK economy is mixed. Where there are good signs, let's welcome them, and hope that they can be used to go on creating a successful economy, but it's far, far too early to draw any conclusions about whether the signs that are there of things strengthening will turn out to be the long-term trend, or the trend that we saw in GDP data yesterday—which some serious economists are suggesting are likely to see a formal recession in the UK economy in 2020—whether that turns out to be the truth.

I thank the First Minister for his considered and thoughtful response. First Minister, when I first asked you about the fall in stamp duty commercial receipts following the introduction of land transaction tax, you said it was too early to draw any conclusions. We now have the definitive data in the 'Welsh taxes outlook' from the Office for Budget Responsibility, and they say that your pre-announcing rates and thresholds for LTT created challenges for their LTT forecasts, in particular with your 6 per cent supertax on commercial transactions over £1 million. They conclude that the final quarter's outturn for commercial stamp duty land tax paid to the UK Government in Q1 2018 was £20 million, or 25 per cent higher than they'd expected, as transactions were brought forward to avoid Welsh LTT. They also say that, in the first quarter of 2108, property transactions generally rose by 50 per cent relative to the first quarter of 2017, since forestalling was evident prior to the introduction of LTT. This included for higher value residential properties. Do you accept that pre-announcing those tax hikes was a mistake, as it brought forward property purchases, since people prefer to pay lower taxes to the UK Government than higher taxes to the Welsh Government?

No, I don't accept for a moment that it was a mistake, Llywydd, it was done for very good reasons, and it was done particularly on the advice of the sector, who needed to be able to plan for the changes, needed to be able to plan for the fact that these were taxes that were now being discharged here in Wales, needed to make sure that they had plenty of time to be alert to any changes that this National Assembly would put on the statue book. Forestalling was always going to be a phenomenon of moving from one system to another; it was absolutely a phenomenon of the Scottish experience.

There is a problem. The solution was not to delay announcing what we announced—the solution is for the UK Government to repay to us the windfall that they have now received, and we're in discussions with them about that, because the rules of the fiscal framework are clear that, if there are unexpected shifts of this sort and they can be attributed in the way that I agree—the Member is right in his attribution—then that money should be paid back to the Welsh coffers because that's where it belongs.