1. Will the First Minister provide an update on the Welsh Government's priorities for improving the health service over the coming year? OAQ54972

Llywydd, I thank the Member for that question.

Amongst our priorities for the coming year are the investment of record sums across our health and social care system, the training of record numbers of clinical professionals to create the workforce of the future and defending Wales against any attempts by the UK Government to put the NHS up for sale.

Well, First Minister, as you know, recent weeks have brought to the fore the current pressures that are facing the Welsh NHS—'winter pressures', as we like to term them, though the reality is that they are there for most of the year. Now, in the words of Dr Phil Banfield, the British Medical Association Cymru Wales consultant committee chair, he said 

'It is clear from the latest developments that things are getting worse not better.'

He also went on to state that

'Care will suffer if something isn't done about this now. This must be taken seriously. There is a real chance of lives being needlessly lost.'

First Minister, the BMA also go on to suggest, as many of us have in this Chamber suggested, the various things that need to be done to alleviate winter pressures and the kinds of areas that we need to look at, from increasing beds in hospitals, to increasing people's ability to come out of hospital and be supported in the community, to ensuring that only the people who need to go into hospital go into hospital. So, we're four years in, and this was a priority of the Welsh Government. Can you please tell us, in the remaining year that we have, whether or not you'll finally be able to address this very serious issue? And it is serious, because I want to end on this one note. Dr Banfield, who represents a great many people in the health NHS goes on to say that the staff pressures are intolerable, and that patients' lives are at risk. This is not an acceptable situation. 

Well, Llywydd, let me agree with something that the Member said at the start of her question, because nine of the last 11 months in the Welsh NHS have been the busiest months of that sort on record. So, she is right to say that the pressures in the Welsh NHS are relentless; that the demand grows all the time. But she then goes on simply to focus on the supply side, as though the answer to the health service is just continually to ratchet up the services that are provided, in pursuit of ever-growing demand. And that is not an answer to the health service. We do all of that. We go on every year. We have a record number of professionals working in the health service in Wales. We now have more people working in the NHS in Wales than in the whole of the British Army. More than 92,000 people are employed to provide the service that Angela Burns refers to. As a result of winter pressure planning, there will be 400 more beds, or bed-equivalent services, available in this winter than there otherwise would have been. 

The Member referred to the services that are there to keep people out of hospital. My understanding, from management information, is that we will have seen a fall in delayed transfers of care in December of last year because of the enormous efforts that are made by our local authorities to provide those services. But when you have a rising tide of people coming through the door; when those people are often elderly, where their needs are often complex, where they do need to be in hospital—. I agree completely with what Angela Burns said, but only somebody who needs to be in hospital should be in hospital. But the number of over-75-year-olds presenting at the front door of the Welsh NHS, who then need—and genuinely need—a hospital bed, has been at the highest it has ever been over this winter.

So, wherever we can, we need services that divert people from the highest level of intensity in the hospital sector, deescalating need, using community pharmacies before you go to the doctor, all of those things—they are all happening in the Welsh NHS, but they happen against a pattern of demand that means you have to run even faster simply to stand still. 

A fundamental challenge is to move towards a system that is truly preventative. We don't see that in terms of policy at the moment, and we don't see it in terms of how budgets are divvied up. So, will the First Minister realise that we need real prioritisation now? We need to find ways of moving towards a new kind of NHS, and of being able to invest in the preventative—including preventative infrastructure, sports resources, physical exercise resources, and resources for keep fit—or the NHS will be a bottomless pit. We need that transformation that we are not currently seeing.

Well, of course I agree, Llywydd. The things that we could do to prevent people from—. Sorry.

—to prevent people from needing access to the health service, that, of course, is a proper investment in the future; it's not an answer to the person aged over 75 who needs services in the here and now. The parliamentary review, in which parties across this Chamber participated, provides a bridge of that sort. It describes how you can incrementally—because that is the only way you can do it—shift the system so there is greater emphasis on prevention, and therefore a reduced need for people to seek help in the most intense part of the system. That doesn't help people whose needs for that sort of help are in the present day, and you can't not attend to those needs.

And prevention is not the responsibility of the national health service; prevention is something that you can only bring about where you have all public services invested in doing that and where you have a relationship with the user in which they too play their part. We talk often on the floor of the Assembly about co-production, and the need to capture the contribution that users make, and nowhere is that contribution more important to capture than if we are genuinely to have preventative services. Because most of all, that relies on what individuals can do to make sure that the harm that would otherwise happen in their own lives is avoided.

Minister, I see that a worldwide study has revealed that sepsis is now a bigger killer than cancer, and instances of it are increasing in England and Wales. What assessment has the Welsh Government made of this, and how is your Government going to ensure that the Welsh NHS is prepared for this over the coming year?

I thank the Member for that important supplementary question. I should just make it clear that sepsis numbers in Wales are falling and not rising, so the figures that were published are not Welsh figures—they have fallen in Wales since 2016. And that is because of some really groundbreaking work that has been done by clinicians here in Wales, led by some very far-sighted and committed clinicians, who have developed the early-warning signs system that we have for sepsis here in Wales, which is now being adopted in other parts of the health service more broadly, which makes sure that people are alert to those early signs that can easily enough be confused as a sign of something other than sepsis, to do the six steps that you need to take as a clinician to test for whether sepsis is what you're seeing in front of you, then to take rapid action. It's a really important issue, but I think we can genuinely claim that we have been in front of this debate in Wales, and that's why the figures in Wales have been falling.

First Minister, I've raised with yourself the situation in Cwm Taf Morgannwg University Health Board many times, in respect of ambulance handovers. And it's fair to say that, in recent years, they have developed an excellent model, where they receive the patients from the ambulance, to free up the ambulances. But of course it also requires that there is the investment at the other end in terms of those who are in beds being able to leave; that they have the right social service support, and so on. Now, it is clear that, this year, that has been working, but there are considerable pressures, so I've had a number of examples reported to me.

I think there are two issues, really, that I'd like to consider. To what extent has that model that was developed in Cwm Taf been rolled out amongst other health boards? But secondly, what evaluation is taking place of the pressures that clearly exist at the co-ordination with the social services side, so that beds—people are able to leave hospital when they're ready to do so, obviously freeing up space, and also then freeing up the ambulance service? And I suppose finally on that is really the recognition, I think, of the professionalism and dedication of our ambulance services. Because, at this time of year, their responses and their commitment are second to none.

Well, Llywydd, I'm very glad to put on record the appreciation of the Welsh Government for all those who work at the front line of our health services under the unremitting pressures that have been there, not just over the winter, but as Angela Burns said, over many months before that. There is a lot that other people can learn from the Cwm Taf experience of handover of people from ambulances into hospitals and that's why we have a national approach to the development of ambulance services.

Mick Antoniw is right, of course, to point to the pressures that are there in our social services, as well as the health service. I mentioned in my answer to Angela Burns that there are 400 bed or bed-equivalent services being produced over this winter in addition to the normal services. About 160 of those are actually in social care, providing places where people can be safely looked after in the community, either rapidly discharged from hospital or preventing admission in the first place.

But, as I've also said previously on the floor of the Assembly, what local authorities are facing, in some ways, is a consequence of the success that they have achieved in reducing the need for residential care here in Wales. I remember reading predictions at the start of devolution that told us there would be thousands more elderly people in residential care in Wales by today and that we needed to start preparing for that. In fact, what local authorities have done is to strengthen community services so that that explosion in the need for residential care hasn't happened.

But when you are looking after more people—more fragile people, people with higher levels of need and greater intensity of service in the community—then the challenge of keeping those people well, keeping them active, returning them to their homes when they have an acute episode of care, is a genuine challenge. Of course we track it; of course we talk through the regional partnership boards and with our colleagues, and we will learn the lessons from this winter, as we begin planning—as we soon will—for the winter of next year.