Questions now from the party leaders. Leader of the opposition, Paul Davies. 

First Minister, your party colleague and MP for Wigan, Lisa Nandy, made it clear that she believes that people in north Wales do not feel that devolution is working for them. First Minister, is she right?

Well, Llywydd, I had the advantage of the Member in being in the room when that question was answered. Had he wished to be there, we would no doubt have found a ticket for him, provided he was willing to pay for it.

What Lisa Nandy, the MP for Wigan, was saying was this: that people throughout the United Kingdom, when they live at a geographical distance from where decisions are made, can feel disconnected from that decision. She was pointing to people who live in Wigan compared to decisions made in London, and she was saying that people who live in other parts of Wales can feel disconnected from decisions made here. And I don't disagree with her; I think geography does matter. I think when people live further away from decisions, it's harder for them to feel connected to them. I think that is true anywhere in the United Kingdom, and anywhere where distance is at play. And in that leadership hustings, I was very encouraged to hear a whole range of ideas as to how we can reconnect citizens with the important decisions that are made in their lives—ideas we can use here in Wales; ideas that Governments elsewhere in the United Kingdom should also be attending to.

Well, Lisa Nandy might think that devolution isn't working, First Minister, but we all know that it's not devolution that's the problem, it's the party running the Welsh Government that's the real problem, and that's why we need change. Now, First Minister, the people of north Wales feel rightly let down by your Government and frustrated at the lack of progress being made to tackle the issues that matter most to them, particularly when it comes to health services. It should be a great source of embarrassment and concern that Betsi Cadwaladr University Health Board is the worst-performing health board when it comes to accident and emergency waiting times, with just 66.8 per cent of patients being seen within the critical four-hour period.

Indeed, Dr Mark Payne, the clinical director of Betsi Cadwaladr University Health Board, told staff in an e-mail that 20 January was the worst start to a day he had seen in 13 years working at Ysbyty Gwynedd. First Minister, do you accept that the A&E waiting times at Betsi Cadwaladr University Health Board are a cause for concern? And can you tell us what urgent action your Government is now taking to turn around this poor performance, given that you are directly in charge of this health board?

Well, Llywydd, accident and emergency departments across the United Kingdom have been under pressure over this winter, and Betsi Cadwaladr performs a great deal better than many A&E departments under the control of his party across the border in England—[Interruption.] I know they don't like it when you tell them the facts of the matter, but that is the fact. You quote Betsi Cadwaladr's figures to me as though there was a direct connection between a political party and those results. If that's the case, how come where his party is in charge results are far worse in many places?

The system is under pressure; it's under pressure everywhere. Things in Betsi Cadwaladr have been resilient over this winter to those pressures. There are days when the pressures are greater than they have ever been, and that is true in Betsi Cadwaladr as in other parts of the country. What I think is remarkable is the resilience of the staff to that; the resilience of those staff to the criticisms that they constantly hear from his party. But they go on providing that service to patients across north Wales in accident and emergency departments, in elective care, in primary care and in the work of the ambulance service. Yes, the pressures are real; the response to them is real as well.

I know, First Minister, that you don't want to talk about your own failures, but you are directly responsible for running the health service in north Wales, and clearly, you are failing to do so. Now, last week, you said that we want a culture in the NHS in Wales where, when things go wrong, people feel empowered to speak up. But yet, whenever anyone raises an issue or scrutinises your record, like today, you tell us we're dragging the NHS through the mud. And let me remind you of the recent 'Psychological Therapies Review in North Wales' report that showed significant unwarranted variation in provision, access, teamworking practices and culture amongst the multidisciplinary workforce at all levels; unacceptably long waits in some areas; and a lack of strategic clarity and oversight at health board and divisional levels. It really doesn't get any more damning than that, First Minister.

Now, we know that Betsi Cadwaladr University Health Board is set to post a deficit of £35 million in this financial year. That is £10 million above the target set by your own Government, and that's in spite of almost £83 million that has already been spent on intervention and improvement support. First Minister, given that the health board has been in special measures since June 2015 and is under your direct control, how exactly now will you turn around the unacceptably high waiting times for A&E services in north Wales? How will you address the lack of improvement in mental health following the serious failings identified in the psychological therapies review? And what urgent action will you now take to address the current leadership and the ongoing special measures arrangements to actually deliver the service improvements that the people of north Wales actually deserve?

Llywydd, I'm aware of the psychological therapies report, because it was a report commissioned by the health board. When I said last week that I want a culture in the NHS where people feel willing to speak out and are willing to talk openly about the challenges they face, organising that report by the board itself is an example of what I was talking about. It is the board itself recognising that there is a challenge, it is the board commissioning a report, it is the board learning from its staff about things that need to be better for the future. And I think that is a good sign of the board being willing to work with its staff to learn from them and to find a plan to make improvements, alongside other improvements in mental health.

The Member paid not a moment's heed to the work that has gone on in Betsi Cadwaladr to improve mental health services, which have been improved in many different aspects. Psychological therapies is one aspect. You choose one aspect and you've never got a good word to say for it when there was an opportunity for you to do so, when you could have recognised the work that has gone on by clinicians to improve aspects of mental health services. You've never got a generous word to say about everything they do and everything that is done for patients. And Llywydd, I will give patients in north Wales this assurance: whereas his party continuously criticises us for providing the funding to that health board to go on providing services to patients in north Wales, while we expect and while we work with the health board to bear down on the deficit that it has run up, and while we are disappointed that it hasn't been able to make all the progress we wanted to see made this year, this Government always steps in to make sure that the impact of that is not felt by patients; that they are not disadvantaged by that. We find the money—we find the money from within our budget here. We will do it again this year, and that is a symbol of our determination to go on providing a service for patients in north Wales. 

The Leader of Plaid Cymru, Adam Price.

Who is responsible for making the accident and emergency service at the Royal Glamorgan Hospital unsafe?

Services at the Royal Glamorgan Hospital are the responsibility of the local health board, and it is the local health board that is taking action with its local population, with those people who represent people in that locality— [Interruption.]

Darren Millar, I'm sorry to name you, but you seem to be the most vocal person in this Chamber this afternoon. Please allow the First Minister to respond to Plaid Cymru. I did allow you to carry on with your vocalisation during questions by your own leader, but I won't allow it to carry on during questions from another party's leader. Adam Price—sorry, the First Minister was answering.

I'll finish the sentence, Llywydd. The health board is responsible for those services. It must work with its local politicians, its local population and its local clinicians to make a plan for that service for the future.

The health Minister's responsibilities are listed on your own Government's website as having 'oversight of NHS delivery and performance'. Therefore, there can be no doubt as to who is responsible for allowing the situation at the Royal Glamorgan Hospital to deteriorate. Staffing levels at all three of Cwm Taf Morgannwg's A&E units are well below UK-wide standards. The UK average is 7,000 people to every one consultant—it's 15,000 to one in Cwm Taf Morgannwg health board.

The Royal College of Emergency Medicine recommends that a hospital about the size of the Royal Glamorgan should have around 10 consultants. Why have you allowed it to get to this stage? During the recent general election, Labour's shadow health Secretary, Jonathan Ashworth, highlighted the 'extreme' and 'catastrophic' risk as a result of losing some 24-hour services in the north-east of England. His answer:

'We pledge that within the first 100 days of a Labour Government we will get on top of this.'

You've been in charge in Wales not for 100 days, but for 20 years. Where have you been?

Llywydd, the figures that the Member quoted at the start of his supplementary question are entirely wrong. He's dividing the wrong thing by the wrong thing. In a way, it's not the issue, but I think he ought to look carefully, so that when he does quote figures he tries to get them accurate, because he is very inaccurate in what he has said. 

The real issue, though, is this: the Welsh Government funds the national health service at record levels, we have more consultants working in the national health service in Wales than ever before, we have more A&E consultants working in the health service than ever before and we have a pipeline of A&E consultants of the future being produced in the Welsh NHS with the training systems that we have. Right across the United Kingdom, there is a shortage of consultants to work in accident and emergency departments. The Welsh Government works every day to try to put that right here in Wales.

In creating the NHS in 1948, Aneurin Bevan won an argument around the Cabinet table, against the likes of Herbert Morrison, that regional boards within the NHS had to be accountable to, and working under the direction of, a health Minister, otherwise it would not be a national health service, hence the famous apocryphal quote about dropped bedpans in Tredegar reverberating around the corridors of Whitehall.

Your argument yesterday that the decision as to whether to downgrade A&E services at the Royal Glamorgan Hospital is primarily a matter for clinicians not politicians is against the founding principles of the NHS, it's against the founding principles of this Senedd and it's even against the core values of your own party, which is why so many of your own Members are joining with Plaid Cymru and others in ignoring your advice to protest against these changes. Aren't the people of the Rhondda, the central Valleys and, indeed, the rest of Wales entitled to expect a First Minister who will intervene on their behalf, instead of simply saying, 'Nothing to do with me'?

Well, the people of the Rhondda and the people who use the Royal Glamorgan Hospital are absolutely entitled to make sure that their views are known; that, through their local representatives, they engage with the health board and they make sure that the health board provides them with information; and that they feed ideas to the health board. Of course they are right to have that engaged relationship with the decision making.

The point I made yesterday, and I make it again this afternoon, is that when a decision has to be made as to whether a service is safe, whether it is of the right quality and whether it is sustainable into the future, then the right people to ask about that when the decision comes to be made, not while the decision is in preparation, are the people who are experts in the service that is being provided. I think that is a really important principle—that if you want to know whether a cardiac service is safe and sustainable, then you'd be better off getting your advice from people who are experts in cardiac surgery.

Leader of the Brexit Party, Mark Reckless.

Now we have left the EU, could I ask you, First Minister, about how the Welsh Government should be consulted on future trade agreements and what your priorities are? Of course, if the UK Government had listened to you before, when you said tariffs would devastate the UK car industry by causing it to relocate to the EU, they might be surprised by this week's news. Groupe PSA, who make Peugeot, Citroën and Vauxhall marks, said they would respond to tariffs within the EU by stepping up the company's presence in the UK at Ellesmere Port, where, of course, many in north-east Wales work. Meanwhile, Nissan plan to shut EU plants and relocate production to the UK, aiming to quintuple their share of the market from 4 per cent to 20 per cent, displacing EU imports. Despite this, are you as First Minister saying that the UK Government should have to agree its trade policy with you—in effect, a veto?

Llywydd, we left the European Union on Friday of last week. I think it's a little early by Tuesday of this week to have already decided what its impacts will be, particularly as there are no tariffs and there are no non-tariff barriers at the moment, because we are still in the transition period. So, I think he will have to let a little more time go before he can tell whether his rosy view of the future will turn out to be delivered.

My view of the right relationship between the UK Government and devolved administrations across the United Kingdom is that, when the UK Government comes to frame its negotiating mandate and its negotiating position with other countries, whether that is the EU or with other, third countries, the UK Government's hand would be strengthened if it was able to say to those who it is negotiating with that what it says represents not just the views of the UK Government, but of other Governments across the United Kingdom, and that therefore structures should be put in place to allow that to be attempted, and that the attempt should be made honestly and genuinely by all parties concerned. I think that will be right for Wales; I think it'll be right for the United Kingdom as well.    

Thank you. Of course, it's not me who's saying these things, but the car companies, as reported in the Financial Times. But it should not be a surprise that, when the EU sells £265 billion-worth of goods to us and we only sell £170 billion-worth of goods to them, if you make trade more expensive through tariffs, that production would relocate on a net basis from the EU to the UK in light of those tariffs. I would prefer to see free trade and I would also support, I think, broadly what the First Minister has just said; I think there had been suggestions before of UK Government having to agree its approach, but to the extent the First Minister was just talking about—consultation—I support him in that, and agree that the UK Government's hand would be strengthened if there was wide support for its negotiating stance.

I would, however, caution the First Minister against assuming he'd have support in Wales for confronting the UK Government on this issue. We're reminded today that support for abolishing this place is greater than support for independence, yet your Minister, Ken Skates, has just written to Members of Parliament to tell them to change rail devolution—and I quote—to

'address...concerns being raised by the growing independence movements in both Scotland and Wales.'

First Minister, surely it's preposterous to pressurise the UK Government as if you're Cardiff's Nicola Sturgeon. 

Well, Llywydd, I have no policy of confrontation with the UK Government, or with the Scottish or with the Northern Irish Governments either. The Welsh Government comes to the door in all the discussions that we have looking to be a positive contributing member of those inter-governmental discussions. Where I differ from him, however, is this: when our interests are different to those of the UK Government, of course, we will always speak up for them and nothing will stop us from making sure that, when we think that something is in the interests of Wales, whether that is in car manufacturing, whether that is in the way that rail funding is organised across the United Kingdom, then we will do our job. We will stand up to that responsibility and we will never leave them in any doubt—not because we are looking for confrontation, but because we have a job of work to do that means that this Senedd is here to represent people's views in Wales, and we must do that without fear of any contradiction by others.