4. What is the Welsh Government doing to train and recruit medical consultants for hospitals? OAQ55057

I thank the Member for that question, Llywydd. Through additional investment in our workforce, health boards and trusts in Wales employ more NHS consultants than at any time previously. The overall hospital consultant workforce has grown by more than 10 per cent over the last five years.

We all know about the consultants shortage, but the local ratio locally of 15,000 people to one consultant is more than twice as bad as the UK average of 7,000, and, First Minister, those figures are not wrong, because those figures were being quoted just last night in a public meeting by health board officials. This gets to the very heart of the question at the Royal Glamorgan Hospital, which looks set to lose 24-hour consultant-led services. So, at a packed meeting that Plaid Cymru organised in Porth last night, the anger and frustration from people were palpable. False assurances have been given in the past about hospital services. Just eight months ago, in June of last year, I asked you to give guarantees about the future of A&E at the Royal Glamorgan Hospital and the recruitment of unfilled posts, and, in reply to me, you said, and I quote,

'where people move on, and people do get new jobs and go further in their careers, those posts will be replaced. They will be replaced, we hope, by substantive posts, and a number of expressions of interest for vacancies at the Royal Glamorgan have already been received and are being considered by the health board. If we have to fill those posts on a temporary basis by locum appointments, then that's what we will do. That is the future for that emergency department, and I'm very glad to have had the opportunity to put that on the record here this afternoon.'

Can you, First Minister, tell the people in the Rhondda what has changed since last June? Can you tell me why you were prepared to give those assurances then, but you're now advising local politicians to stay out of the discussion about the future of the Royal Glamorgan's A&E department? 

Well, Llywydd, let me repeat what I said earlier: my advice to local politicians is that they should play an active and engaged part in the debate that will now be carried out by the local health board. I know my colleague Mick Antoniw and others have been holding meetings with their constituents, and that is exactly the role that local politicians should play—making sure that the views, the possibilities, that people might be able to contribute to the discussion, that all of that is well known and properly debated.

When I spoke in June of last year, I said what I said because it was the position at the time that the local health board were attempting to recruit substantively to vacancies; if they weren't able to recruit substantively, that they would aim to recruit locum consultants in their place. That is what the health board was doing then; it's what the health board has done in the interim. There comes a point when local clinicians believe that continuing the current service is not viable, would not be safe for patients, and they wanted to discuss alternatives with their local population. I hope that the health board will take every step to make sure that it engages directly with local representatives and local patients as part of that. But, given that that is the conclusion they have reached, they are surely right to have that conversation.

The Member for Rhondda rightly raises the amount of, or numbers of, patients that each consultant has to deal with, but, of course, another issue is about the spread of consultants across specialisms. If we're looking to be effective in outcomes and effective in the deployment of money, one of the things we must ensure is that, when a patient comes into hospital, they do not then submit to the revolving-door syndrome, where they leave because something is fixed, but actually, they had a number of things wrong with them, a number of conditions, or a mental health issue, and then, just a month later, or a few months later, they are readmitted again under a different consultant. This is partly driven by the fact that so many consultants are very specialism driven.

First Minister, can you please tell me what HEIW might be doing to ensure that we look at patients in a more holistic way, by employing more general medical consultants in hospital and more orthogeriatricians, for example? Elderly people, they go in because they've broken a hip, but they actually then develop pneumonia, or they have mental health issues, or dementia that's not picked up—bang, they're back in again. It doesn't help the NHS; it doesn't help the person to stay at home. If, while we had them there, we dealt with them in an effective way instead of just focusing on one issue, I believe that we could transform some elements of our services within hospitals. I'd be interested to hear your opinion.

Thank you. Llywydd, I had hoped not to take time up putting this on the record, but it's the third time these figures have been mentioned, so I feel that I must. The ratio of consultants to patients in England is derived by dividing the number of people attending major accident and emergency departments by the number of consultants. The figure quoted for Wales is derived by dividing the number of consultants into the people who attend all accident and emergency departments and minor injury units as well, and given that thousands and thousands of people attend minor injury units it is no surprise that, if you divide consultants into a different sort of total, you come up with a different sort of result.

So, I didn't want to have to go into all of that, but that's why I said in answer to Adam Price that the figure he quoted was not to be relied upon, because it is comparing apples and pears. As I said, it wasn't for me the central point of what he said, but given that it's been twice repeated since, I just want to make sure that people understand the basis of the figures that have been quoted and why they're not a reliable comparison in any way.

To the substantive point that Angela Burns makes, which I think is a very important one, when I was the health Minister, I worked with UK health Ministers on a report that the UK Minister had commissioned from the vice-chancellor of Sheffield university, as I recall, which proposed a new cadre of generalist consultants working with older people. Now, in many parts of what the health service does, the trend over the last 20 years to have ever greater sub-speciality is in the interest of patients. If you are going for an orthopaedic operation, you'd rather have it from somebody who is a specialist in the particular procedure rather than somebody who has a go at everything.

But when it comes to older people, in the way that Angela Burns said, people present with a whole variety of different conditions that have an impact upon one another, and what you don't want, I believe, is that patient being handed from one slice of speciality to another. You need a doctor trained as part of that new cadre of generalists.

I think the truth is that that effort—which I say her Government had a leading hand in generating—didn't make the traction that we had hoped, and that's largely because the thrust of general colleges is in the opposite direction. We have to do more to persuade the profession as well that the nature of medicine for older people needs a different sort of response than the one that has been the dominant trend for nearly 20 years.