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

The next item is the Plaid Cymru debate on NHS performance. And I call on Rhun ap Iorwerth to move the motion.

Motion NDM7244 Siân Gwenllian

To propose that the National Assembly for Wales:

1. Notes the latest NHS performance statistics and regrets the continued failure to achieve performance targets across a range of specialities and services.

2. Regrets the cancellation of planned operations to deal with winter pressures and believes it is possible to plan for dealing with winter pressures whilst ensuring routine procedures continue.

3. Believes that staff in the NHS and social care should be congratulated for their performance under difficult circumstances.

4. Believes that improvements in the NHS can only be sustained in the long run if:

a) social care services have parity of esteem with the NHS, and regrets that social care services have been under-funded at the expense of the NHS;

b) substantial investment in services that prevent ill health takes place;

c) improvements to working conditions and workforce planning take place to improve recruitment and retention of NHS and social care staff.

Motion moved.

Thank you very much. It's a pleasure to formally move the motion in the name of Siân Gwenllian. It was a great temptation here today to rehash an old speech for this debate, because even though I have been away from this health portfolio for a year and a half now, far too many things, I'm afraid, haven't changed in my absence.

Too many things, on return to the health portfolio after a brief absence, remain the same. The poor performance of the NHS I think has been the equivalent of a chronic condition for the current Government. It's debilitating, causing Government problems in planning for the long term, but still, we're not seeing the kind of drastic changes that we'd like to see. In many other countries facing a similar context, I think we'd have seen the removal, surely, or the change of a Minister. It is a concern that any accountability that does exist within the NHS in Wales doesn't seem to include accountability by the health Minister himself. And, if I may say, it is a matter of some regret that the Minister isn't able to be here today to be held to account in this debate of ours; it is a Deputy Minister that will be responding to that debate. It's not good enough. 

I see from Government amendments that the central premise of our motion, the regrets about poor performance and 

'the cancellation of planned operations to deal with winter pressures' has not been amended this time. Maybe we are finally moving away from stage one denial at last now, and that's good. But instead, we're seeing blame being placed on the UK Government for austerity, which at least suggests an acknowledgement that things should be better and, of course, I agree that ideologically driven austerity has been hugely damaging to the provision of public services in Wales, but the problem is that this from Welsh Government today is rather misleading on many performance measures.

Wales has been staggeringly falling behind Scotland and, to a lesser extent, England for most of the past decade, despite austerity affecting all services across the UK. Indeed, Labour themselves were trumpeting the fact that they've been spending more on health and social care, to which we simply ask the question: why haven't things been getting better in that context? Because the truth is we've had a decade where Welsh Government has repeatedly bailed out poor performance in the NHS, often at the expense of local government services, and we know how damaging that can be. There's been little or no strategic vision or control over where additional money, where it was able to be found, actually went. And I think that's more true, looking forward to the coming financial year, than it has been even over the past decade.

Despite claiming to want more services in the community, for example, claiming to want to shift the focus towards prevention of ill health, the vast majority of money has still been going into firefighting in secondary care, being haemorrhaged to external management consultants, to agencies supplying NHS staff who would have stayed directly employed had conditions been better. Indeed, the health board that Welsh Government has had the most control over, Betsi Cadwaladr University Health Board, is the one where relations between management and staff are at all-time lows due to the now-dropped proposals on nurses' break times. This is also the health board with the worst waiting times for both planned treatment and accident and emergency, and the health board, of course, as is well publicised, that instead of investing in front-line services, has squandered hundreds of thousands of pounds on external management consultants working from home in Marbella. Clearly, austerity hasn't hit them. 

It's not all about money, although, of course, as I say, austerity has hit hard across the board, not just in health. Looking at those areas where we know performance is poor, we can only judge on performance measures that are publicly available. There are far too many measures that we would like to have and we simply don't have performance measures for them, where we can, for example, quantify the anecdotal evidence of long waiting times for GP appointments; the non-existent out-of-hours care; the failures of social care to keep people in their homes. There's so much data missing, and I don't think that data, were it available, would be telling a story any better to the data that we actually have. 

All the performance measures that are regularly published refer, it seems, to secondary care, even though their failings there in secondary care very, very often reflect failures in primary care, failure to invest in social care. And let's imagine how the conversation would change if as well as monthly reporting on the failure to hit waiting time targets, we also had monthly reporting on the impact that cuts to local services and local authority funding is having on the ability to adapt people's homes on time, or to put care packages in place on time. So, when we reflect on the long waiting times published every month, unacceptable as they are, of course, let's be clear, what we are seeing is just one visible sign of a system failure that is deep-rooted and is failing to be transformed. And it's that transformation that we are still waiting for and that we are seeing little signs of.

Turning to the Conservative amendments, we've got a minor quibble with the first one. Our view is that poor long-term workforce planning is to blame for the problems we saw reported recently. We would rather the focus was on that. But it's amendment 3, I think, that demonstrates how unfit the Conservatives are to run health services in Wales. I thought, from previous exchanges in here, that—

Will you take an intervention? 

Of course.

Just before you decide to try to elucidate us on what you think I might say, I'd be delighted—. When we speak about amendment 3, I will be telling you exactly why we have removed that and substituted it with two others, and I hope that that will answer your concerns. 

Okay. But it's clear, is it not, that where we have the Conservatives suggesting somehow that we can't be focusing on the damage caused by lack of investment in social care, we've only got to look to England to see what Conservative Governments there did in starving local authorities of funding and the devastating impact that that had on hospitals, especially accident and emergency, in England? It raises very, very clear doubts in my mind and I'm sure in the minds of many others about how seriously the Conservatives take this need to build an integrated system where you have to have sustainability across social care as well as our hospitals. And the Conservatives, the only place we can judge them, from governing in England, have made a complete hash of that ability to bring together sustained social care in order to support our hospitals. 

We will support amendment 4, but we will be rejecting amendment 5. The block grant may well be rising in the coming financial year in real terms, but it is far from being the real funding level that Wales should be seeing. For example, it doesn't reflect the money Wales should be getting from schemes like HS2, which is sucking in so much UK Government funding, and Wales is not getting its fair share of it, so we can't be supporting that. 

But we need to focus now on improving performance and getting better value for money for what we are spending. And, still, today, we give the Deputy Minister—not the Minister—an opportunity to give us just a whiff of where this Government is refocusing on transforming the health service that we have today into the health service that we will need in future. We need to build in the kinds of changes, the kinds of transformation funds that can take us to that destination, because, currently, managing, or, sadly, mismanaging the NHS means that we remain in this rut, that, whoever will be health spokespeople for opposition parties, as long as Labour remain in Government, it seems, it'll be the same speech time and time again, because there is no sign at all of the transformation our NHS needs. 

I have selected the five amendments to the motion. If amendment 2 is agreed, amendments 3 and 4 will be deselected. I call on Angela Burns to move amendments 1, 3, 4 and 5, tabled in the name of Darren Millar. Angela Burns.

Amendment 1—Darren Millar

Add as new point after point 2 and renumber accordingly:

Regrets that some Welsh health boards are delaying recruitment due to financial pressures which is exacerbating poor performance and pressure on frontline staff.

Amendment 3—Darren Millar

In point 4 (a) delete ', and regrets that social care services have been under-funded at the expense of the NHS'.

Amendment 4—Darren Millar

Insert as new sub-point at end of point 4:

'the artificial barriers between mental and physical health are removed.'

Amendment 5—Darren Millar

Add as new point at end of motion:

Welcomes the opportunities to invest additional resources into the Welsh NHS and social care services to boost performance as a result of real terms increases in the Welsh block grant.

Amendments 1, 3, 4 and 5 moved.

Diolch, Llywydd. I'd like to formally move the amendments tabled in the name of my colleague Darren Millar. I'd like to thank Helen Mary Jones for being able to agree and disagree with her so well in the health portfolio over the last few years—I shall miss you. And welcome back, Rhun. It is groundhog day, but good to see you. And, of course, it is groundhog day in many other ways, and I do understand your sense of déjà vu, because in your brief absence from the health portfolio, very little has improved, very little has changed, and that is a great, great concern.

That's why the motion tabled by Plaid is not one that we fundamentally disagree with; it states fact and expresses concerns about the performance of the Welsh NHS. However, we do feel that the motion could be much stronger, and this is why we will be opposing the motion in order to seek support for our amendments, which I'm going to touch on in my contribution.

What we certainly do not agree with, Deputy Minister, is the Welsh Government's amendment 2, which, as usual, devolves all responsibility for everything that happens here in Wales to absolutely anybody and everybody else you can possibly think of when, in fact, your party, your Government, with the aid of Plaid Cymru, have been running the Welsh NHS for the past 20 years. And we see from your amendment exactly why we are in the position we are today. The NHS in Wales is failing in part because of the decisions taken by its leadership and the lack of leadership that it does receive from the highest level. Your amendment seeks to not only blame others, but it does not address why you've taken the decisions that you have since the devolution settlement was agreed.

Now, one thing I want to make very clear—and I think probably all of us would want to chime in with this—is that, in any debate that we have on this matter, I'm always conscious of the damage that can be inflicted on the morale of the front-line workforce who are treating patients day in, day out, having to deal with the consequence of decisions that politicians and senior managers have taken. I want to again place on record my gratitude to those staff, to the dedication, their willingness to go above and beyond to work those extra hours, often without pay. And my message to those who work in the Welsh NHS and in social care is, to be frank: you deserve better. And by highlighting the issues that we do in our debates that we bring forward here, or amendments that we make to debates, it is our intention, the intention of my party, to try and put pressure on the Welsh Government and the health board management to facilitate the change we need to see.

Turning to our amendments—and I apologise for this—I'd like to just do them in slightly reverse order. Amendment 5: we do welcome the boost to the block grant that the Chancellor announced in his autumn spending review back in September, and I would like to remind the Assembly that the Minister for Finance described this addition to the block grant as a 'pre-election distraction'. And I would respectfully point out that if it was not for her party's mismanagement of the economy throughout the UK, the reduction in spending that was required to get the economy back on track would not have had to have taken place. So, it's not ideologically driven—

Will you take an intervention?

I will in a moment, Mick. I will just finish my point.

It's not ideologically driven, Rhun ap Iorwerth; it was absolutely necessary. And I would urge the Deputy Minister to talk to the Minister for health and ask him to use his department's proportion of the extra funding in a strategic way to look at where the extra money will make a real difference. Because all too often, this Government thinks they can affect real change by just chucking money at the same old thing, the same old thing. If it ain't working, you've got to do something about it. Sorry—I will take the intervention.

Thank you for taking it. Obviously, we will have expressions of our views during this motion, but repeating the fallacy that the austerity post 2010, post the financial collapse, was the result of spending by the Labour Government is economically disproven; it is factually incorrect. At the time, just before the financial crash, borrowing was 35.7 per cent of GDP, which was 0.1 per cent above that when Labour took office in 1997. Now, you can put your arguments, but it is factually incorrect. The financial crash was not the result of the Labour Government, and I think it's a misrepresentation, and it's unfair for you to continue to repeat that.

I think you want to speak later on in the debate, Mick Antoniw. That was a pretty long intervention, and you may need to take a bit of time off your intervention later on.

And I won't bother to address your intervention because I'm sure you can talk about it in your bit. I do want to address, though, amendments 3 and 4 because, actually, let me be really clear: the reason why we've changed those amendments is because we think that too often there is an artificial barrier between health and social care, and in the same way that there's an artificial barrier between health of the physical variety and mental health. Now, Rhun ap Iorwerth, you've sat with me on many a committee when we talked about the totality of well-being and the integration of the human. We believe that the whole of our health service needs to just shift focus and look at people when they go into hospital, when they go into primary care, when they access social services in a holistic way, because one of the big areas where we lose money and we do not deliver is we just fix a thing without looking at the whole person, their social care needs, their housing needs, their physical needs, their mental health needs, and putting them back together so they can go back out into society and live whatever is left of their lives as well as they possibly can. And that's our intention there, to put more money—we already take in health and social care £8 billion, and Wales needs money in other areas. So, that £8 billion needs to be redeployed in a much more clever and authentic way where we look at that whole person, and that's the change we're trying to drive through with amendments 3 and 4.

I'm really sorry, I know that I've run out of time, but I did want to just quickly add in that we're talking about recruitment due to financial pressures because we do think that there's a massive recruitment pressure, not just with doctors and nurses, but we forget about the backroom staff. We always talk about the front line, but if you're a consultant and you've got to send a load of results out to somebody and you haven't got a secretary who can type up that letter to get it out to that person and call them back in for further treatment, it's a massive problem. I'll leave it there, I do appreciate I've run out of time. Thank you very much for your additional moments, but I do commend our amendments to the Chamber.

I call on the Deputy Minister for health to move formally amendment 2 tabled in the name of Rebecca Evans.

Amendment 2—Rebecca Evans

Delete point 4 and replace with:

Recognises the impact a decade of unjust UK driven austerity has on the resources available to fund public services including health and social care and believes that improvements in the NHS can only be sustained in the long run if:

a) NHS and social care work together as equal partners;

b) investment continues across both systems to support people to stay well and out of hospital;

c) there remains a focus on the recruitment, retention and wellbeing of our health and care workforce supported by the joint health and social care workforce strategy.

Amendment 2 moved.

Formally.

Many of us are, of course, painfully aware that in June Betsi Cadwaladr health board will reach a very sorry milestone in terms of the fact that it will have been in special measures for five years. Now, that is the length of an Assembly term—a full Assembly term in special measures, which I think highlights how grave the situation is. And one does find oneself asking, 'Well, what have special measures delivered in terms of Betsi Cadwaladr?' What is the point of these special measures unless, after five years, we see the progress that one would hope to see and that one would feel is fair for us to expect to see? Indeed, special measures has become a kind of norm for Betsi Cadwaladr health board now, and some, with tongue in cheek, ask, 'Are there any extra-special measures that we could place the board in?' The Government, of course, although during that period have had direct control over the health board, have been far too willing to deny any sort of responsibility for the situation, and that is not acceptable either.

So, what difference have those five years made? Well, I'll tell you. During the period when the Government, to all intents and purposes, has had oversight of the board, we have seen attempts to privatise dialysis services in Wrexham and in Oswestry; we have seen attempts to privatise pharmacies in hospitals; we have certainly seen efforts to change the shifts of 4,000 nurses across north Wales, forcing them, to all intents and purposes, to work an additional extra shift without pay, which destroyed the morale of the nurses entirely. And I'm so pleased that the proposal as tabled by Plaid Cymru does recognise the excellent work and congratulates the workforce in health and social care on what they delivered despite the failings of management and the Welsh Government, in this particular case—and managers who, by the way, are clearly not doing their work in north Wales, because, as we've heard, they have to bring in dozens of management consultants on huge fees when the board is carrying debts of around £40 million. It's spending tens of millions of pounds on private agency staff, whilst many of us in this Assembly have been calling for many years for more effective and substantial steps to be taken in training and recruiting additional staff.

We see dozens of mental health patients sent to inappropriate locations, hundreds of miles from their families, in England. We've seen arguments about payments for contracts with hospitals in England, which mean that hospitals such as the Countess of Chester have refused to take Welsh patients. We've seen the loss of almost an additional 100 beds from north Wales hospitals during the period of special measures, never mind the loss of beds and community hospitals at the same time—29 beds gone in Glan Clwyd; another 29 in Maelor in Wrexham—and that leading, of course, to the delayed transfers of care that we hear so much about so regularly. The worst waiting lists in Wales; the worst A&E waiting lists in Wales at Wrexham Maelor, where barely half the patients are seen within four hours. And I have a personal story that I could tell you of waiting 12 hours to be seen in an A&E department. Now, of course, that means—[Interruption.] No, I won't take an intervention, I'm sorry; I have a lot to cover.

We see ambulances queuing outside hospitals because of the flow of patients, and we've heard about what's happened in places such as Gwersyllt, Rhosllanerchrugog and Fairbourne, when patients have had to wait many hours for an ambulance, and the results can be very grave and serious indeed.

Just yesterday, Adam Price highlighted the fact that almost half of all the incidents that led to deaths in Welsh hospitals were in the Betsi Cadwaladr health board area, and there's a question remaining as to the safety of mental health patients in north Wales. Another report was saying today that the north Wales mental health counselling service is not appropriate. Things are not improving as we would hope to see. Indeed, in some aspects, I have to say, the situation is worse now than it was five years ago.

So, what have special measures delivered? It's the current First Minister who was the health Minister who was forced to take Betsi Cadwaladr into special measures, and it was the current health Minister, when he was a Deputy Minister at that time, who was given specific responsibility for the situation at Betsi Cadwaladr University Health Board. It's about time, in my view, that the chief executive of the board stepped down. He's had more than enough time for us to see more substantial progress than we have seen. I can't believe, if truth be told, that he is still in post. I want to hear from the Deputy Minister what discussions there have been between the Welsh Government and the board on the future of the current First Minister—the current chief executive. The debate on the future of the First Minister is for another time, perhaps. But, more seriously too, we do have a situation where, given the record of the current health Minister, as I've outlined, during this whole period of special measures and direct control from the Welsh Government, in my view there is no doubt that the Minister should go too.

I think we should take seriously what Angela Burns says about the impact that our debates on this subject have on the workforce. So, although earlier we heard about the problems being faced by the Royal Glamorgan Hospital with the impending retirement of its only substantive emergency consultant, and Llyr has just been speaking about the ongoing problems at Betsi Cadwaladr, and I don't wish to in any way decry them, but you do have to think about what impact continually reminding people of the challenges ahead without providing solutions has. I think that we have to look at what we can do and what we are doing about this.

So, I wanted to address what’s in amendment 2 because I think it’s very important to recognise that improvements in the NHS can only be sustained in the long run if the NHS staff and the social care workforce are working together as equal partners. Because the First Minister highlighted recently that the 2019 figures are the best recorded figures for delayed transfers of care compared to the two previous years, but it’s had quite a considerable impact on the social care workforce who've been picking up the pieces as a result of us being very keen, naturally, to get people out of hospital when they no longer need hospital care.

I've just been reading the draft plan that has arisen out of 'A Healthier Wales', which has been written by the social care workforce as well as HEIW, which encompasses the deanery, the education and development services, and the pharmacists. So, I think it's very important that we have a workforce programme that really is going to join up the dots between these two services, and I think—. They outline very clearly there that we need to transform traditional roles and ways of working to support new models of care, and that they are already being developed through the regional partnership boards, as well as in primary care and through support at home plans.

It emphasises the importance of building a culture of compassionate and inclusive leadership, and it's really, really important that anybody who works in the health and social care services has to be looking at the individual in front of them and listening to them, rather than just saying, 'Well, you're going to get this' and 'You're going to get that'. We have to reiterate the principles set out in 'Prudent Healthcare' and 'Sustainable Social Services', which are about the partnership between the citizen and the service provider.

The second point that's made in amendment 2 is the investment to support people to stay well and out of hospital. Now, of course, in the long term, we need to get people eating clean, fresh food and walking or cycling rather than relying on the bus or car for short journeys, but I appreciate that that is not going to happen overnight. So, in the short term, I think it's important to address the Welsh NHS Confederation saying that as many as one in five of those coming to A&E could in fact be treated somewhere else. And if we still have that problem, we really do need to continue to work on that. And Choose Well is obviously a way of encouraging the citizen not to go to the emergency department unless they really do need emergency services. The NHS Confederation offers a checklist of what people can do to stay well over the winter, and all of us will be familiar with the sorts of things that are involved there—making sure that people are putting on the sorts of clothes and having the sort of furniture arrangement that encourages them not to fall over.

But I think a more holistic approach is needed for many people who don't read checklists and just simply don't operate like that—they're probably living in considerable isolation, a lot of them—and so I want to just commend a couple of things that Cardiff and the Vale health board is doing: (1) it's got something called a citizen-driven health programme, where they're working with Cadwyn Housing Association, with both staff and volunteers, who go into people's homes, getting to know older people, capturing their needs and aspirations and finding out what they'd like to contribute in the way of skills and interests. And I think that is really capturing what we mean by holistic care—with the older person, and empowering them to do things, what they can do for themselves, and putting them in touch with services that will combat loneliness and help them to feel better about their lives.

Equally, there's another initiative called Wellbeing 4U, which they've commissioned from United Welsh Housing Association, who are operating with primary care funding to deliver in GP practices in areas of deprivation to tackle isolation, anxiety, depression and high levels of alcohol consumption, which we know (a) leads to people falling over, and (b) leads to cirrhosis of the liver. 

You now need to bring your contribution—I've been very generous already—to an end.

Thank you. I'm sorry. Just to say that it's been very effective, and it's decreased the—. People are feeling physically and mentally better and are making a lot fewer GP appointments.

The mismanagement and poor performance highlighted by my colleagues in the north of Wales is indeed shocking, but I can't help but feel that this is also something that my own constituents may be facing, so I want to talk about the issues facing people in the Cwm Taf health board, as the range of special measures continues to become the new normal. Whilst waiting times may not be as bad as in the north, the performance remains poor, with a litany of missed targets. 

There has been an acceptance that it's okay for people to wait for a long time for treatment, but it really isn't okay, it isn't acceptable. Debates around waiting times can sometimes be a little dry, but there are people behind the numbers. I have a case example, which, unfortunately, I don't think is unique. This person has been waiting for over 16 months for treatment, and he writes about the wait, I quote, 'This has had a very restricting effect on my quality of life. Up until my diagnosis, I considered myself to be a very active man. I played golf three times a week and also enjoyed gardening on my allotment. I feel that at my age it's vitally important to stay active, and this interminable wait for this operation is making me feel very depressed as I'm conscious of the fact that I'm not getting any younger and would like to be in a position to enjoy the remaining years of my life, instead of waiting in limbo. I was told I would have the operation before Christmas, and then it was sometime in January. These deadlines seem to just come and go, and as they do my depression deepens.'

If we are serious about preventing ill health, managing chronic conditions in the community and supporting people to maintain a healthy lifestyle, then ensuring prompt treatment when it's required just has to be part of that. And, if it is, why are we being told that continuation with our emergency services is not possible?

Well, it is possible to have good services in primary care that prevent ill health and help people stay well—as well as possible—and also have hospital services for when they are needed. There will always be occasions when people need emergency treatment promptly. We may be able to reduce the numbers of people having heart attacks, strokes and so on through better public health, but nobody believes that all of the risks would be eliminated. Hospitals and emergency medicine will always be needed and, as such, services need to be provided within reasonable distances for all people in all parts of Wales. 

And reasonable distance must reflect the reality of travel times in adverse weather, it must reflect the lack of car ownership in deprived communities, and it should be planned in a way that tackles the inverse care law, which means hospitals to serve the local populations throughout the Valleys. But, as we've seen, the current Government has been content to allow the Royal Glamorgan Hospital to decline and deteriorate in what seems to be an ideological obsession with having fewer specialist units for the Valleys. 

The health Minister is responsible for the strategic direction of the health service in Wales. It has been run down since the south Wales programme was agreed back in 2014. Why would anyone want to go and work in a department that is being run down? The ratio of consultants is shocking. While the UK average is 7,000 people to every one consultant, when it should stand closer to 4,000, it is 15,000:1 in our local health board. That is a scandal. 

And it has happened because numerous health Ministers have put their fingers in their ears and refused to be more innovative when it comes to recruitment. It is possible to recruit. I understand that Cardiff are recruiting by offering retention bonuses. A recent conversation with an ex-consultant at the Royal Glamorgan Hospital revealed to me that the Royal Glamorgan is an attractive place for consultants to work. The Minister has the power to intervene here.

Deputy Minister, you have listened to the views of Members representing the surrounding constituencies—this is not just a Rhondda and a Pontypridd issue. It'll have a knock-on effect to people in Cynon, Merthyr, Bridgend, Cardiff and further afield. Will you urge the Minister to intervene? Give us one last chance to save this service that so many people are seriously worried about losing. 

I thank Plaid Cymru for tabling this important debate today. At the start of a new decade, when our thoughts turn to the future, our NHS is once again beset by the problems of the past. Welsh A&E departments have just experienced their worst ever waiting times. The waiting times figures for last month show only 72 per cent spent less than four hours in A&E waiting to be treated, transferred or discharged, compared to the target of 95 per cent. These figures are significantly worse than last year and we have to reflect and ask ourselves why that is.

More patients than ever waited over 12 hours—well over 6,500—when the target is that nobody should wait that long. The ambulance service failed to meet its target for responding to immediately life-threatening calls for the second time since the target was introduced five years ago. And, despite a mild winter, our NHS has once again been stretched to breaking point. We have a situation where our NHS cannot cope with normal pressures, and, if we have to deal with an influx of patients suffering from seasonal flu, or from this emerging threat from China, I'm afraid our healthcare system will melt down. This is despite the Welsh Government allocating an extra £30 million plus an extra £10 million last week.

The solutions to our problems do not require simply putting more cash in, which is why I urge Members to reject the Government's amendment. We have to ask ourselves why, despite spending significantly more per head on health than they do in England or Scotland, our outcomes are poorer, our waiting times are longer and our access is worse. We therefore have to question how the £7.5 billion we allocate to health each year is being spent. This isn't some abstract accountancy question on budgets; this is a fundamental question about people's health. And we are seeing Welsh citizens go blind waiting for treatment, Welsh citizens unable to function because they spend their days in agony, and we see Welsh citizens die from cancer because we fail to diagnose it sooner.

Our NHS is held together by the stellar efforts of its doctors, nurses and healthcare professionals, but that can't last, and things are already at breaking point. We must ensure that the significant amount of money we are spending on health is spent effectively. We need to focus our efforts and not simply throw cash at the problems hoping they will go away—that just won't happen. We need also to invest in social care. And bedblocking remains a significant problem. One consultant at Morriston Hospital stated that he knew of 106 medically fit patients who were still in hospital because there was simply no care package available. And yet, at the same time, here we are cancelling operations, leaving people in pain, potentially hampering their recovery and increasing the cost of treatment.

Will you take an intervention?

Yes, certainly.

Did he also say how many were not being let out of hospital or weren't able to go home because the pharmacy wasn't ready to give them their medication? And how many were fit enough to go home, but a consultant hadn't come around to let them go?

I do understand, Mike, that the pharmacy is an issue in a lot of hospitals, because they can't dispense the medication at a suitable time for people to go home, and a lot eventually comes at evening time and people are kept in longer than they need. So, that definitely needs to be looked into, and, thank you, Mike, for bringing that up.

Successive Governments have failed to plan for the future, hence a large portion of our budget goes on agency staff. And there has been woefully little workforce planning, which has left our NHS unable to cope with a growing and ageing population, and a lack of planning, which has resulted in us having the worst cancer survival rates in western Europe. So, we need a new approach to healthcare in Wales and this means ensuring that our primary care sector is properly funded. We have a national workforce plan and we prioritise health prevention. We also have to ensure that our social care sector is properly funded. Our NHS can't afford another five years of this mismanagement and I urge colleagues to support this motion.

There are many, many challenges with our health service. We see these in Wales, the UK, Europe and around the world, and I'm not going to go through those analyses. What I do want to do, though, is to talk about the importance of the hospital that is only really a few minutes from where I live and that's the Royal Glamorgan, and performance there and the importance of that particular hospital to the local community, and why there is a need to look at the figures and to review what is a six-year out-of-date programme.

The Royal Glamorgan, in December 2019, in accident and emergency had 5,152 attendees; the Princess of Wales, 4,800; and Prince Charles, 4,947. In the 12-hour performance figures, the Royal Glamorgan was at 95 per cent and the other two hospitals were at 90 per cent respectively. The four-hour wait performance in Royal Glamorgan was again ahead of both of the two other hospitals. I think that underlines that, when we start trying to draw comparisons, it is not just about the figures, but the Royal Glamorgan is in a position of importance and is delivering to a higher degree, in one way or another, and is really important, and important in an area where there is a massive expansion of housing: 20,000 homes in the Taff Ely area over the next decade. So, the growth there and the issues of access are fundamentally important.

But what I do want to say is this: finance and money is, of course, important and it is actually fundamental in many ways. For example, over the past decade, the impact of austerity in terms of the freeze on public sector workers' wages has been really significant in terms of morale and in terms of retention, and that has been a massive factor. The other factor has been the underfunding or the lack of funds available to fund the NHS as should have happened. When Labour won the election in 1997 and said, 'You've got 24 hours to save the NHS', they were actually right. And, in actual fact, that Labour Government did save the NHS. In actual fact, from 1997 to 2010—sorry, 2009—the Labour Government increased in real terms the NHS funds available by 6 per cent in real terms every single year of that particular Government. That made an absolutely massive difference and it did save the NHS. When the Conservative-Lib Dem Government came in, the funding was 1.1 per cent. With Cameron and May, in their Conservative Governments from 2014-19, it was only 1.6 per cent. When people complain about the Labour manifesto—[Interruption.]—the Labour manifesto being profligate, the Labour proposal—.

Will you take an intervention?

Yes, I will take an intervention, but let me just finish this. The Labour proposal was 4.3 per cent in real terms. Yes, I'll take an intervention.

I'm grateful for the Member taking the intervention and we can argue about the figures and we have many times. The key thing, as I said in the urgent question to the health Minister this afternoon, is that he is responsible for the strategic direction of the NHS in Wales. He could instruct the health board to keep that A&E department open and devise a business case to make sure that happens. Do you support that and do you support the action that the health Minister should take to keep that department open?

I think you heard my speech earlier when I said that I think the programme is now out of date and there should be a review of that programme before any further proposals are actually considered. I was absolutely clear in the things that I said earlier, which were things that I said very many years earlier when we effectively saved the accident and emergency in the Royal Glamorgan.

But what you cannot get away from is that 10 years of Tory austerity have deprived us of enormous sums of funding: £4 billion. And then when we talk also—[Interruption.] When we also talk about the impact on local government services—I know they don't like to hear these figures—in England, social services have been cut in real terms by 25 per cent; in Wales, they've been cut by 8 per cent. This is the consequence of Tory austerity. In any assessment of performance, you have to look at the environment that we're in and there is absolutely no doubt that Tory austerity has been one of the major contributions to the ability to deal with the pressures the NHS has in England and in Wales as well.

Well, we've just heard the usual fantasy economics tirade from the Labour Party as though the financial—[Interruption.] Well, I think I should get to at least five sentences before we have an intervention. [Interruption.] I now need to make some progress.

It is for the Member to decide whether he's taking an intervention.

It's as though the financial crisis of 2010-11 had never happened. In one sense, Members are right, of course, that the NHS is underfunded everywhere. It does have to compete, given that it is a nationalised monolith, every year, when there's the budget and Government spending round. It has to compete with all the other spending priorities that Governments have. Therefore, it is bound to be underfunded to all eternity, compared with the needs that it has to deal with. What really matters is how well you use the money that you have got. And I'm afraid that, if we are to judge devolution by its results, we have to conclude that devolution has failed.

Will you take an intervention?

No, I want to make this point first before I give way. I will give way, but I want to make this point first.

Yes, Wales does badly out of the Barnett formula. I fully accept that. And if it were based on needs, Wales would have a lot more money and we'd have more money to put into the health service. But the idea that a Tory Government at Westminster is ever going to give more money to a Labour Government in Wales is, of course, moonshine. And given that, overwhelmingly over my lifetime, Wales has elected a preponderance of left-wing Members of Parliament, there is a systemic difficulty here that can't be removed, so long as we have the devolution settlement that we've got.

I'll give way to Mick Antoniw.

It's really just to get clarity on this one point. Do you consider that the £4 billion that we've effectively lost since there's been a Tory Government has actually had an impact on the quality of services that we are able to provide within Wales, and indeed within England?

Well, obviously, if we had more money then we'd be able to do more things. Of course, I fully accept that. But the idea that the UK Government could just ignore the financial inheritance that it had from the Labour Government in 2010 is absurd. Just look at the figures. Since Gordon Brown took the brakes off public spending in 2001, everything went haywire. The Labour Government failed to mend the roof whilst the sun was shining. In 2001—[Interruption.] Because in the first Labour Government—[Interruption.] No, I won't because I'm answering—I've got to finish answering this intervention before I accept another one.

The first Labour Government of Tony Blair of course followed Kenneth Clarke's spending plans, and actually public spending fell during that Labour Government as a percentage of gross domestic product. And then from 2001 it rose relentlessly, from 27 per cent in 2001 to 50 per cent of GDP by the time the financial crisis hit. So, the room for manoeuvre for dealing with the financial crisis was therefore substantially reduced. And Government spending, as a proportion of GDP, rose from 35 per cent in 2000 to 40 per cent in 2009, to 45 per cent to 2012. The idea that this could simply be ignored and there wouldn't have to be some kind of tightening of the belt because of the overspending earlier on is just wholly unrealistic.

So, the big problem that we've got here is, yes, there isn't enough money, but how are we going to get more money? The only way we'll get more money is by harbouring the resources that we've got and diverting from some spending priorities to others. If the Government spends £150 million, nearly, on a planning inquiry on the M4, which then doesn't take place, that is a waste of money, and there are all sorts of other wastes of money that we could name as well. [Interruption.] I haven't got much time, but I will give way.

I just wondered if you also think it's a complete waste of money that the UK Government changed the pension tax allowances without considering the perverse consequences that has led to 27,000 patients not getting the service they need?

I'm not here to defend the Conservative Government. I'm not a Conservative Member of this Assembly.

I want to stick to the health service. Health absorbs half the Welsh Government budget, and it's growing, and it's bound to grow because the needs are growing faster than the means of dealing with them, and that's true of the population as a whole throughout the United Kingdom. So, we have to grow up when we're talking about funding the health service. This idea that because parts of the health service have been so-called privatised—Llyr Gruffydd mentioned some in north Wales in the course of his speech. This, I think, is an inevitability to a great extent. What is wrong with contracting out certain services if you can perform those functions more cost-effectively, and therefore it leaves you with more money to use on the other parts of the service that remain in the public sector?

Other countries in Europe have mixed health systems and they don't have this primitive debate that we have in this country between private and public. They recognise that, in order to solve the complex health needs and the even more complex, perhaps, financial complications behind the funding of it, we do need to have a more flexible system that is capable of getting more money in. People have to be persuaded to spend more of their own money, if the Government can't tax it from them; that, ultimately, is the way to have better health services.

The Deputy Minister for Health and Social Services, Julie Morgan.

Thank you, Presiding Officer. First of all, I'd like to tell the Chamber that the health Minister is at a COBRA meeting about the coronavirus, so that's why I'm taking his place.

At the outset, I'd like to reiterate my thanks to staff across NHS Wales, social care and all the other partners, who continue to work every day to provide care to the people of Wales. Their dedication to continuing to deliver high-quality services in the busiest, most difficult and pressured environments on record is extraordinary, and I know we all want to acknowledge that.

In the Minister's written statement on unscheduled care pressures he said that over winter this year, more than any other, we've seen relentless demand across the whole system, and I think that relentless demand has been echoed across the whole of the UK. I'll start off with the ambulance service. Of course, we are disappointed that the Welsh ambulance service has been unable to achieve the national target for a second month, but it is important to remember that this is from a background of achievement over the previous 48 months, While the target was not achieved in percentage terms, more people received a response within the eight-minute target when compared to December 2018, and this is because of the increased numbers. The Minister has recently announced a number of actions to improve ambulance availability, and this will include the establishment of a ministerial ambulance availability taskforce. This approach will focus not only on ambulance responsiveness, but also on the need for wider, whole-system improvements to reflect and respond to the changing environment. This taskforce is expected to provide early views by the end of March 2020, and the Minister will keep Members updated on those developments.

There have been additional factors outside of unscheduled care that have had a real impact upon performance. One such area is the UK Government tax and pension changes, and these continue to significantly affect the availability of medical staff to deliver on previously agreed scheduled care plans. Over the last three years, on planned care, we have seen significant improvements in the reduction of long waits, with a 20 per cent reduction from our high point, which was in 2015. However, because of the tax and pension changes, our latest information is that between April and December 2019 around 3,200 sessions have been lost, affecting nearly 27,000 patients in planned care. And we've also lost sessions in unscheduled care and GP out of hours for the same reasons. The Minister has called repeatedly on the UK Government to resolve this matter urgently. The problem is the direct result of UK Government tax rules, and the harm to our NHS is actually felt across the whole of the UK. We are very worried about losing the goodwill of a generation of staff.

Long waiting times are not what we want, and we continue to invest money to support improvements. However, this is not unique to Wales, with other parts of the United Kingdom also being affected. The latest figures from NHS England show their worst performance in terms of A&E four-hour performance, the highest number of 12-hour waits, the lowest 18-week referral-to-treatment performance, and they haven't met their urgent cancer targets since December 2015. Performance in Scotland has also struggled, with A&E four-hour performance being 6 percentage points lower than it was compared to the same period last year, and the lowest it's been since December 2017. So, I'm making the point to say that this is something that is affecting the whole of the UK, and it is affected by a huge increase in demand.

In the case of cancer performance, we continue to treat more patients within the target each year. In the 12 months ending in November 2019, nearly 8,200 people started definitive treatment on the urgent suspected cancer route, 3 per cent higher than the previous year, and 18 per cent more people started definitive treatment within target time than five years ago. The single cancer pathway will supersede the old measures in due course with a more useful, accurate and honest measure.

Unscheduled care pressures have also impacted on elective surgery. However, health boards mitigated the impact on elective care by deliberately reducing planned activity in the first two weeks of January to support the demand for urgent emergency admissions. Each patient is assessed based on their clinical need. If necessary, planned admissions may have to be postponed—and we know that they have been postponed—but care is provided at a later date. Any postponements are a last resort to ensure that patient safety is maintained and prioritised. And despite unscheduled care pressures, planned care activity continued across Wales in the early days of January 2020, with around 70 per cent of the planned activity undertaken while still meeting the emergency demand.

Planning for winter 2019-20 began early in 2019, informed by the review of health and social care resilience over winter 2018-19. As Members have mentioned in the Chamber today, the Minister made £30 million available to health boards and local authorities—earlier in the year than ever before, at their request—to support plans for the winter. And for the first time, we chose to allocate a significant part of the funding to regional partnership boards. This was intended to ensure health boards and local authority partners work together with other partners to collaboratively plan services across the health and social care community. That does echo some of the comments made in the Chamber here today with Angela Burns talking about the artificial barrier between health and social care, and Jenny Rathbone also referring to many of the projects that are used to tackle that issue. I think this is a very important point: we do have to tackle this issue. Our transformation funds are intended to bring health and social care together and to try to treat the whole system in a more holistic way.

The Minister also allocated an additional £10 million last week to add capacity across the system and to help relieve pressures on services to improve flow through hospitals and into social care. And as with the £30 million, this has been funded through RPBs to encourage joint working across health and social care. I have spoken to many of those people who are participating in the RPBs, and they tell me that the partnership working is developing and is becoming much stronger, and I think this is where we're going to see the transformation that we do need in our services. The winter plans agreed between health and social care partners acknowledge the importance of prevention and the need for effective partnership working. I think the investment through regional partnerships makes clear that we do see health and social care as genuine partners.

Health Education and Improvement Wales and Social Care Wales were commissioned to produce a workforce strategy for health and social care in Wales. That strategy was signed off by both boards in December last year and submitted to Welsh Government, and we are now considering the strategy and its subsequent implementation. Health boards' recruitment remains an operational matter, and they've been clear on ensuring actions taken do not affect patient care or quality of service. Recruitment for nursing and medical staff continues as required to deliver safe services.

The Welsh Government has invested over £0.5 billion extra in the NHS this year. We've seen the underlying NHS deficit reduced by 35 per cent between 2016-17 and 2018-19, and we expect there to be further improvements in this year, demonstrating better financial management. I have listened to all the comments that individual Members have made in this debate and have taken careful note of them. I can assure you that we want to be very clear that our force—the people who work in our health and social care force—are aware of our commitment and gratitude to them. Thank you.

The Deputy Presiding Officer took the Chair.

Thank you. Can I call on Rhun ap Iorwerth to reply to the debate?

Thank you very much, Deputy Presiding Officer. Thank you to everyone who's taken part in the debate. Thank you for the response of the Deputy Minister. I feel for you, in many ways, having to defend the indefensible in this place. A series of excuses and spin, that's what I heard, I'm afraid, from the Government, going through the targets that she claims are being met, and the challenges that arise over the winter. Of course there are winter pressures but build those into the system, include the capacity to respond to those pressures during the winter. As a health committee over the years we’ve been recommending to the Government to build in that capacity and that time of the year. Perhaps things have been worse than usual this Christmas. I hear evidence, perhaps, that it ha been. Well, we need that flexibility in our system or we don’t have a system that is sustainable. We know that it isn’t sustainable.

Thank you for the individual contributions. The spokesperson for the Conservatives, yes, it is groundhog day here. I’m surprised to see you denying the impact of austerity. We’ve had cuts over the past years under the leadership of the Conservative Party, and that has to have an impact.

But on amendment 3—if I can return to amendment 3—you’re deleting from our motion the part that says that it

'regrets that social care has been under-funded'

But don't we agree that social care has been underfunded? Perhaps you're embarrassed as a party about the impact the decisions made by Conservative Governments in Westminster have had on the health service because of cuts to social care services in England.

Thank you for taking the intervention. Let me be very clear, you say

'regrets that social care services have been under-funded at the expense of the NHS' and I tried to make it quite clear that, in our view, it is about ensuring that NHS, social care, mental health, all of it is seen in the round, and that's what we went on to make in amendment 4; we're trying to strengthen it. It's very difficult. There's £8 billion already going into the NHS/social care services in Wales. It's about redeploying that money in a far more effective manner so that we stop the revolving door syndrome.

But the point I make is that we have to aim towards redeploying that money from health to social care; that's the rebalancing that we need to work towards.

Thank you to Llyr for the comments with regard to the state of the service in north Wales, and for focusing on that. What’s striking, of course, is that this is the board where the Welsh Government has the responsibility and the greatest influence, indeed.

I agree entirely with the Member for Cardiff Central about the need to look at what we can do, and that’s why we’re focusing on different aspects, such as the need to raise standards of management within the health service and to consider seriously how we can fund the transformation agenda.

Thank you to those who’ve made comments about the situation in the Royal Glamorgan Hospital at the moment—a situation that has had a great deal of attention because decisions are being made now that were taken once back in 2014—correct, they weren’t implemented. You say, Mick Antoniw, that Labour had safeguarded and had prevented the closure of A&E there. Well, the decision was made to downgrade A&E, but it wasn’t implemented. The threat has continued there, and I think that this is another example of the failure to think strategically and to either look at that hospital or any part of that hospital, or any part of the health service, and to think seriously about what role this particular element plays within the wider health service in Wales.

To conclude, the debate that we’ve heard between the Labour and Conservative parties here about decisions made in Whitehall back in 2008 and 2010 speaks volumes, I think. Yes, there is a wider context of where funding comes from, and, yes, I do condemn the depths of the cuts in public expenditure over the past decade, but because it’s not just money—that’s not what the root cause of this problem is alone. I also condemn the lack of management of the Labour Party of the health service here in Wales and I don’t see signs of where this Government is going to realise, 'Do you know what? We are failing. We do need to admit that we are failing on the NHS in Wales.' We can’t put a Government into special measures, but we can change Government. Labour can’t run the health service in Wales. We know from experience in England that the Conservatives have destroyed the NHS in that place. Do let Plaid Cymru have the opportunity to run the NHS and let us put the NHS in Wales on a firmer foundation and a more sustainable foundation, so that the staff in the NHS and patients in the NHS in Wales receive the support they deserve. 

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

Voting deferred until voting time.