The following amendments have been selected: amendment 1 in the name of Rebecca Evans, amendment 2 in the name of Siân Gwenllian, amendment 3 in the name of Neil McEvoy, and amendment 4 in the names of Mick Antoniw, Dawn Bowden, Huw Irranca-Davies and Vikki Howells. 

The next item is the Welsh Conservatives' debate on emergency departments in the NHS, and I call on Angela Burns to move the motion—Angela Burns. 

Motion NDM7266 Darren Millar

To propose that the National Assembly for Wales:

1. Notes the concerns expressed by patients and clinicians across Wales regarding the performance and future of NHS emergency departments.

2. Rejects proposals by Cwm Taf Morgannwg University Health Board which could lead to an end to 24-hour consultant-led services at the Royal Glamorgan Hospital's emergency department.

3. Calls upon the Welsh Government to intervene to prevent any downgrading or closures of emergency departments in Wales during this Assembly.

Motion moved.

Llywydd, thank you. I formally move the motion before us, tabled today in the name of the Welsh Conservatives by Darren Millar.

You will see that we ask that the Welsh Assembly

'Notes the concerns expressed by patients and clinicians across Wales regarding the performance and future of NHS emergency departments.

'Rejects proposals by Cwm Taf Morgannwg University Health Board which could lead to an end to 24-hour consultant-led services at the Royal Glamorgan Hospital's emergency department.' and we're calling upon the Welsh Government

'to intervene to prevent any downgrading or closures of emergency departments in Wales during this Assembly.'

Now, before I start, I do want to make it clear that the numerical information within my contribution has been taken directly from StatsWales, the Nuffield Trust, the Welsh Government itself or the Royal College of Emergency Medicine. And this is an important point to make, because we must not allow the Welsh Government to be in denial over the situation we are seeing and that staff and patients are experiencing across Wales's emergency departments. Nor can we allow Labour and the Welsh Government to continue to blame austerity or finances, the Conservatives down the M4 corridor, or untold, unknown and unexplained pressures or, indeed, the statistics they don't like, because the concerns expressed by patients and clinicians are at an all-time high. 

Yesterday, I heard the First Minister repeat the mantra that the NHS satisfaction survey reported a 93 per cent satisfaction rate, but you know, Minister, and I know that this is a use of quantitative statistics at its worst, because it pays no heed to the deeper analysis required. People are grateful for the service they've got, but when you ask them how the service performed they will tell you about the waits, they will tell you about the lost records and the moving around the hospitals. And let me quote directly from some of the responses to the big NHS survey that the Welsh Conservatives are currently running across social media platforms. Here's one:

'In the main, quite  happy with my treatment with the exception of A&E where, due to understaffing, due to too much money spent of management who don't appear to understand what a hospital's supposed to do, they work their socks off despite being under-resourced'.

Or another:

'I called an ambulance for my 87-year-old unconscious relative. It took over an hour and a half to arrive. They took her to Wrexham hospital. After eight hours, they'd done nothing. Fantastic staff are working reliably. A&E waiting times are not good enough. My relative wouldn't be here today if it wasn't for the doctors and nurses, but the system was appalling.'

So, of course, they are 93 per cent satisfied that their relative is still there, but the experience was horrendous. And clinicians tell us that winter 2019-20 has been difficult, with the lowest percentage of patients being admitted, transferred or discharged within four hours since records began—and let me repeat that—since records began. In December 2019, only 66.4 per cent of patients were seen within four hours—sounds good? Well, let's flip that around. That's 33.6 per cent of patients who are not seen within four hours. Let me repeat that: that's one third of patients who waited longer than four hours to be seen at an A&E in Wales. 

But Members, the number of attendees in December 2019 is not a shocker. This is an average of 55,560 patients turning up to our emergency departments each month so far this winter, compared with 67,490 last winter, and 65,629 the winter before that. So, let me repeat that: fewer patients are turning up at our A&Es this winter than last year and the year before, but the performance has gone down. And given that a third of patients were not seen within four hours, then it is only logical that the number of patients waiting more than eight and 12 hours is increasing every winter—StatsWales, your information. 

Will you take an intervention?

I will in a moment, Jenny. In fact, winter 2019-20 represents the highest number of patients and the result is that patient safety is being compromised, staff morale is at an all-time low. While money for winter pressures, Minister, is welcome, ad hoc cash injections are simply a temporary solution. What the NHS needs is a substantial increase in resources, which should be deployed to ensure that there's measurable increase in available staff and acute beds.

Thankfully, the UK Conservative Government has committed to boost Welsh NHS funding by £1.9 billion over the next three years. This is a significant sum that could and should be used for the betterment of our NHS. Before the Labour backbenchers leap to their feet, I would make the point that no Conservative Prime Minister has ever cut an NHS budget. So, shame on Mark Drakeford and your Welsh Labour Cabinet for cutting yours. Between 2010-11 and 2015-16—[Interruption.] I most certainly will for you, First Minister.

Thank you. Considering that you decided that you would name me—

Well, you are the First Minister.

—name me the year in which I was in Government in which the NHS budget in this Assembly was cut. Given that you named me specifically, give me the year.

You've cut it year on year and we can give you the statistics, First Minister. 

Absolutely untrue.

And, First Minister, you are responsible for the Welsh Labour Government.

You can't answer the question because what you've said is not true.

Between—. I'm giving you the years. Between 2010-11 and 2015-16—

When I was in Government, I asked you.

First Minister, you were the special adviser to the—. You are now in Government, you were the health Minister, you were the finance Minister and now you're the First Minister. 

And you'll never find a year.

Maybe I should call you First Minister Pontius Pilate. 

The Welsh Conservatives do recognise that winter pressures are no longer exclusive to winter months. Poor performance is now a year-round reality and whilst there are particular issues experienced in winter, overall performance continues to decline, which in and of itself, Llywydd, must bring a ferocious level of stress and exhaustion to the front-line staff tasked with delivering services. And to them I give my heartfelt thanks. This debate is not about trying to hammer them into the floor, but to give them the support and resources they need to lift them up so that they can do the job they love; they can have the training and career they wanted; and the work-life balance that we all need for our health and our mental well-being. 

I challenge totally the notion that untold, unknown and unexplained pressures are to blame for the situation across our emergency departments. It is a fact that attendance at emergency departments has only grown by 7.4 per cent, yet in the same time period, eight-hour waits have gone up by 254 per cent. And, Welsh Government's data has come up trumps because we know that since 2013, when data collection for 12-hour performance began, the number of people waiting for 12 hours or more has gone up by a staggering 318 per cent. We know that longer waits in emergency departments are almost always associated with poor patient flow through hospitals, congestion in hospital wards and inadequate social care provision in the community. This is certainly true when we consider the number of hospital beds available. 

I think it was Andrew who might have mentioned hospital beds earlier—somebody did—and occupancy rates. Data from the Royal College of Emergency Medicine demonstrates that the correlation between bed occupancy and the ability to meet the four-hour target is strong. In short, fellow Assembly Members, it's simple: additional bed capacity would mean a significant improvement in patient waiting time. The Royal College of Emergency Medicine strongly believes that we need 226 beds. Those extra beds would achieve a safe bed occupancy of 85 per cent. So, this pressure we see on our A&Es could be alleviated by having just under 250 extra beds.

The whole-system problem that we are seeing here will be exacerbated by the desire of Welsh Government to cut and to centralise their provision of emergency care services. Please don't roll out the recent mantra that it's up to the clinicians to decide. I think, Leanne Wood, you put your case very clearly earlier on: clinicians are saying, 'Keep our emergency services', and it's health boards, Governments, the south Wales programme, the Marcus Longley report that's all about centralisation, centralisation, centralisation.

I'm going to quickly turn to the amendments because I can see my time is running out. I do despair to see the Welsh Government has done yet another 'delete all' to stifle debate. I acknowledge that the Labour and Plaid backbenchers have signed a statement concerning the Royal Glamorgan Hospital, but point 2 of the Government's amendment is the usual hand-wringing promises that health boards will ask you for your views and then do what they've always planned to do anyway. This comes after years of uncertainty for the hospital's A&E services since the publishment of the south Wales programme consultation document in 2013.

Staffing at the hospitals is hitting dangerously low levels. Not only are all major A&E units in Cwm Taf staffed well below UK-wide standards, but on Christmas Day and Boxing Day 2019, ambulances had to be diverted from the hospital to Prince Charles because of a lack of doctors. The proposals by the health board have met with significant opposition from surrounding communities. Concerns revolve around the safety of patients who will now have to travel further to receive emergency care as well as vastly increasing the pressure on other A&E departments at a time when the other hospitals serving Cwm Taf did not even reach the Welsh average four-hour waiting times in December 2019.

I will support Plaid Cymru's amendment, which highlights the importance of workforce planning throughout the country, not just in the areas traditionally easiest to staff, such as south-east Wales, because it is only right that staff shortages should never be used to justify closures and service changes.

I also agree with Neil McEvoy's very clear amendment and the amendment from the Labour backbenches, because this Welsh Labour Government must reject proposals by Cwm Taf Morgannwg health board to end 24-hour consultant-led accident and emergency services at the Royal Glamorgan. And I would go further and say that the Welsh Government must review the Marcus Longley case for change report of 2012 and the south Wales programme, both of which are no longer current, both of which set a direction of travel that may no longer suit Wales, and, to be frank, both of which seem to promote services that are ever further away from the public that the health boards, the Minister and the NHS are there to serve.

I trust that the Labour backbenchers will support our motion and that by presenting a united front across all political parties, we can send a loud and clear message to the health boards across Wales. Listen to the people: do not close, cut or downgrade our emergency departments. I commend this motion to the Chamber.

I have selected the four amendments to the motion, and I call on the Minister for health to move formally amendment 1, tabled in the name of Rebecca Evans. 

Amendment 1—Rebecca Evans

Delete all and replace with:

1. Recognises the cross party statement on the Future of Safe Emergency Care in Cwm Taf Morgannwg.

2. Recognises the need for openness and transparency from the health board in their engagement with the public, clinicians, the community health council, elected representatives, staff and their unions to inform their decision on the future provision of all types of unscheduled care, including emergency services.

3. Recognises that any unscheduled care provision must be robust, safe and sustainable.

Amendment 1 moved.

Formally.

I now call on Leanne Wood to move amendment 2, tabled in the name of Siân Gwenllian. Leanne Wood. 

Amendment 2—Siân Gwenllian

Add as new point at end of motion:

Calls on the Welsh Government to adopt a comprehensive plan for increasing the clinical workforce, with specific focus on specialities and geographical areas that are hard to recruit to, such as within emergency departments, so that staff shortages can never be used to justify closures and service changes.

Amendment 2 moved.

Diolch, Llywydd. There have been many references from many Members in this Chamber to the inverse care law, that, essentially, the section of the population most in need of care services often face the most barriers to accessing them. We've also noted on several occasions that people in the poorest areas also face the greatest burden of disease. This is due to a combination of the industrial legacy and the neglect of those people in those communities when they were de-industrialised.

We've also noted that the dismissive attitude of senior management in the NHS when it came to dealing with complaints that led to the maternity services scandal in Cwm Taf, and noted that it probably wouldn't have happened to people in a more wealthy area. But, again, lessons are not learned, as this Labour Government presides over a policy of closing A&E in one of the most deprived areas in Wales. This is despite the University of Sheffield study in 2007 finding that a 10 km increase in distance is associated with around a one per cent absolute increase in mortality, and that relationship is greater for patients with respiratory conditions. And this has been confirmed by at least two other studies for asthma patients.

Now, the board cites staff shortages for this, and it is, of course, trivially true to say that a unit without doctors is going to be dangerous. But we have to ask why. How have we got to this place?

The figures I quoted yesterday to the First Minister demonstrate that in those areas with A&E units that are not under threat, consultant numbers have increased significantly. Those areas where reconfigured proposals were agreed did not. It's a self-fulfilling prophecy. Nobody chooses to work in a place that is under threat, when management rely on agency staff instead of advertising for long-term vacancies. My office has heard from a number of doctors who want full-time posts in the Royal Glamorgan and would take them if they were offered a little bit of flexibility in the hours.

So, what are the immediate short-term actions that need to be taken now? First of all, make a public commitment to the long-term future of the A&E department in the Royal Glamorgan Hospital. This alone will help recruitment and retention. Offer the existing agency staff full-time employment, making adjustments to the hours if needed. We know that there are many people who would accept this offer. Actually advertise some posts, using some financial incentives, like Cardiff has recently done, if that's necessary for the difficult-to-recruit positions. And, importantly, make the expectations to management clear—they have been operating with the opposite expectations and a belief that the unit should close ever since the south Wales programme was agreed.

In the longer term, Plaid Cymru has well-considered and costed policies for the training and recruitment of an extra 1,000 doctors, and that includes investment in the targeting of local recruits and the expansion of training places for doctors. These policies can and should be put in place for the benefit of all NHS services in Wales now.

I want to turn briefly to tackling some myths. First of all, the Tories need to reflect upon the fact that this process has happened in England. Jeremy Hunt made it clear that he wanted centralisation and he gave the go-ahead for this to happen back when he was health Secretary. Coincidentally, this was the date the performance in the English NHS started to decline, and that decline continues to this day. So, the Tories don't have a good track record in delivering a different model of service configuration.

Secondly, to those who want to abolish the Assembly, they need to consider what would happen if the NHS senior management had no political oversight at all. Some senior managers have been heard privately saying that they want centralisation to go far further. If they had their way, we could end up with A&E units in just Cardiff, Swansea and maybe one or two others. It's only because Labour know that they can't get away with agreeing to that that prevents this process from getting worse. But that also highlights another unavoidable truth: that the health Minister could stop these proposals right now, but he chooses not to.

I want to finish with this: we in Plaid Cymru will do everything we can to stop them closing or reducing those hours in our A&E department at the Royal Glamorgan, and we intend to win this battle. If we do, a future Plaid Cymru Government pledges to keep our A&E for the long term. But if we don't win, then we will pledge to restore it. Diolch.

I call on Neil McEvoy to move amendment 3 tabled in his name.

Amendment 3—Neil McEvoy

Add as new point at end of motion:

Supports a permanent and fully resourced accident and emergency department at the Royal Glamorgan Hospital.

Amendment 3 moved.

Thank you, Llywydd. As leader of the Welsh National Party, I say that we have to save the A&E department at the Royal Glamorgan Hospital.

I'm stood here as leader of the Welsh National Party, saying that we need to save the accident and emergency department at the Royal Glamorgan Hospital. The public message to us is very, very clear. I attended a public meeting, I listened intently outside. They want us to work together.

I support the motion. I cannot support amendment 1, because amendment 1 essentially wrecks the motion. I support amendment 2. I support amendment 4. My amendment is very, very simple—the message is simple. It says that this Assembly—us here, every Assembly Member—supports a permanent—and that is the key word here; it's not in any other amendment or any other motion—a permanent and fully resourced accident and emergency department at the Royal Glamorgan Hospital. We can all support that, and we can all support each other's amendments so we can listen to the public today and actually hear what they told us outside, and support the motion and support each other's amendments, with the exception of amendment 1.

The health of the NHS in Wales is in crisis. Staff deserve better. The public deserves better. We heard outside, Minister—and I hope you listen—that the doctors at the Royal Glamorgan, as my colleague across the way said, want the department to remain open, consultant-led, 24 hours a day. My daughter was born at the Royal Glamorgan Hospital, and they did a tremendous job back in those days. My dad is being looked after at this moment by brilliant NHS staff at the Heath, but I was in A&E on Friday, and I was appalled at what I saw. Staff told me that it was a quiet night, and on other nights, the night before, people were sat on the floor. We have declared, or the Government has declared, a climate emergency. I feel we need to declare a health emergency. Let's vote for these different amendments, let's listen to the public, let's listen to the doctors and let's give the message out that this Assembly wants to save the accident and emergency department at the Royal Glamorgan Hospital on a permanent—the key word—permanent basis. Diolch yn fawr. 

I call on Mick Antoniw to move amendment 4, tabled in his name. 

Amendment 4—Mick Antoniw, Dawn Bowden, Huw Irranca-Davies, Vikki Howells

Add as new point at end of motion:

Rejects proposals by Cwm Taf Morgannwg Health Board to end 24-hour consultant-led accident and emergency services at the Royal Glamorgan hospital and calls on the Health Board to:

a) rule out the closure of the accident and emergency service at the Royal Glamorgan Hospital or the replacing of the existing accident and emergency service with a 24 hour minor injuries unit;

b) reinstate the option of maintaining a full consultant-led accident and emergency service at the Royal Glamorgan, Prince Charles and Princess of Wales hospitals;

c) bring forward other proposals for community health services, including improvements in the out-of-hours GP service and extending the opening hours of the minor injuries unit at Ysbyty Cwm Rhondda and Ysbyty Cwm Cynon, which may alleviate the pressure on all three accident and emergency departments.

Amendment 4 moved.

Thank you, Llywydd. I move this amendment with the support of my colleagues Dawn Bowden, AM for Merthyr Tydfil and Rhymney, Vikki Howells, AM for Cynon Valley, and Huw Irranca-Davies, the Assembly Member for Ogmore. I'm pleased to have the support of the Royal Glamorgan Hospital trade unions, who are behind this amendment. 

Llywydd, Aneurin Bevan said that

'Society becomes more wholesome, more serene, and spiritually healthier, if it knows that its citizens have at the back of their consciousness the knowledge that not only themselves, but all their fellows, have access, when ill, to the best that medical skill can provide.'

That is what this amendment is about. The establishment of the NHS is one of Labour's greatest achievements. Indeed, it is one of the Valleys's greatest achievements, since its founding principles were based on the values of our Valleys communities. In Wales we are defending the NHS, its principles, its people and its funding, from the forces of privatisation and austerity. But that is not enough. The great strength of the NHS is that it is owned by the people of Wales, and we are merely the custodians of the NHS and Nye Bevan’s legacy. To that extent we are accountable to the people who have elected us to this Welsh Parliament.

The Royal Glamorgan Hospital accident and emergency service is a vital and essential service for the people of the Pontypridd constituency who I represent, and to those in the Rhondda, Cynon Valley, Merthyr and Ogmore valleys. It is a life or death service and it is a service that none of us want to use but one we take comfort from in the knowledge that it is there for us when we need it.

It's clear to us that for six years the sword of Damocles has hung over the A&E department and has increasingly undermined the ability of Cwm Taf Morgannwg University Health Board to recruit the necessary consultants. Last week I and my Westminster colleague Alex Davies-Jones addressed a packed public meeting in Llantrisant. Thousands more watched online, and it was clear from the health board’s contribution that recruitment is the root cause of this crisis. Indeed, many were left wondering if there would be a need for a review if the health board’s recruitment strategy had been more effective. So, whilst it is right that the health board is facing up to this emerging crisis, its starting point must be how a full, consultant-led A&E service can by guaranteed now and into the future, not what is the least painful way of closing it down.

There are five key facts emerging. The south Wales programme is massively out of date and increasingly irrelevant to the needs of the people of Rhondda Cynon Taf. Prince Charles Merthyr and Princess of Wales Bridgend do not have the capacity to safely absorb the A&E provision currently provided in Llantrisant. There is massive housing and population growth in the Taff Ely area that was never taken into account, and which will in the future only exacerbate this dilemma. Closing the department and replacing it with a minor injuries unit is just not viable. And the health board's recruitment crisis is the fundamental issue, not the hospital’s location, nor its staff, nor its funding.

The only viable options are, I believe, to rule out the option of closure of Royal Glamorgan A&E; for Cwm Taf Morgannwg LHB to reinstate the option of retaining a permanent, fully-staffed 24-hour A&E unit in the Royal Glamorgan; to bring forward additional proposals for the expansion of out-of-hours GP services and extending the opening hours of minor injuries units at Ysbyty Cwm Rhondda and Ysbyty Cwm Cynon to alleviate the pressures on all three emergency departments; and to pursue a rigorous, comprehensive recruitment campaign across all three hospitals.

Nye Bevan also said—famously said—that:

'The NHS will last as long as there are folk left with the faith to fight for it.' 

And, I think, in moving this amendment, I can assure Members that the people of the south Wales Valleys who so contributed to the establishment of the NHS have the faith to fight for the NHS and the retention of A&E services in the Royal Glamorgan Hospital. Thank you, Llywydd. 

Back in September, I was told, on a visit, that many of the posts in the Princess of Wales were interim and subject to service-level agreements that expire later this year. Cwm Taf Morgannwg does not yet have full control over some aspects of health delivery at Princess of Wales, and, furthermore, the maternity scandal and the loss of the chief executive has delayed certain decisions. This is a heath board, a new health board, which is simply not fully separate nor fully stable— absolutely not ready to be making this kind of huge strategic change at the Royal Glamorgan. 

Members—and Mick has just done it very well now—have spoken about the demand at the Royal Glam. If it loses its consultant leads, more serious emergencies will be diverted to Bridgend, Merthyr, and even beyond. So, let's have a look at the welcome patients will get in Bridgend. The first thing to say is that they will meet warm and caring staff who work their socks off, as Angela Burns just said, who provide first-class medical and nursing care. There is no question about that. But they may have to wait 16 hours before they can be discharged by the ambulance crew into the hands of the A&E team. And they may also have to wait 72 hours for a bed to become available for them on a ward. Every inch of space in the department is utilised. Once all the bays are full, and the trolleys or chairs placed in front of the reception desk and in front of the cupboards and in the space for the Christmas tree are all full, and the corridors are full of patients in the care of ambulance crew, patients who are fit enough are asked to go and sit in the cafe. Sometimes, people who should have been transferred to wards end up having all their treatment in A&E, they’re there so long.

And all this is after the initial triage, when some patients will already have been sent to the minor injury unit section, co-located with A&E, or back out of the hospital to their GP or to the MIU in Baglan. There can be 70 people in that A&E space, which is really tiny, at any one time. And the reason for this is not lack of consultants or first-class staff. It is the inability to move patients through the hospital due to delayed transfers of care. And, as a result, there is not an inch of space for new demand displaced from the Royal Glamorgan.

Now, this is your responsibility, Minister. Whoever started this conversation, this health board is trying to squeeze a quart into a pint pot, and the reason this is a pint pot is because you have not shown leadership on bedblocking. You are the Minister for Health and Social Services. Between you, both you and the now First Minister have been responsible for six years, yet my constituents with emergency needs have to sit in a chair where the Christmas tree usually goes because there is no space for them elsewhere in the hospital.

I want to move on to two points specifically on the south Wales programme, and the first is this: I went to the Princess of Wales to try and find out why their ambulance handover times were so long, whereas, in the Prince Charles Hospital, it could be as little as 15 minutes. And the answer was: a difference of opinion—a difference of medical opinion about what is safer for patients.

Minister, you and your predecessor said time after time in 2014—and you've said it again today—that you rely on medical opinion as to what constitutes a safe service. There will always be more than one medical opinion—and we've heard today from Leanne Wood that medical opinion has already changed. Your job at the time was to challenge and scrutinise, use all your lawyerly wiles to find the weaknesses in arguments put to you, as well as their strengths. What has not changed is the view of my constituents.

I don't think you did that scrutiny, Minister, hence the views of the consultants we heard earlier, and hence my second point. If you accepted in 2014, after such probing, that a safe A&E service could only be provided at two sites in what is now the CTM footprint, why is the Royal Glamorgan A&E still open? That it has become, as the argument now goes, unsafe is down to you. It is you who has allowed the department to exist—under that sword of Damocles, Mick. It cannot have been unsafe in 2014, or you'd have insisted on shutting it. But, instead of rejecting the south Wales programme, as you should have done in 2014, and allowing Cwm Taf to challenge for those consultants, to compete for them on a level playing field, you have allowed that field to tilt more and more by not challenging the board, until we are where we are now.

I am fed up, Minister, of hearing you say what you expect health boards to do. You're not the Minister for expectations—you are the Minister for Health and Social Services. So, let's see you lead like a Minister for Health and Social Services and halt these proposals now.

I thank the Welsh Conservatives for tabling this important debate. Our NHS emergency departments are unable to cope and have just experienced the worst waiting times performance on record. In my region, 40 per cent of patients waited more than four hours in the Swansea Bay LHB, and almost 5,000 patients in Cwm Taf Morgannwg, which is why plans to completely or partially close the emergency department at the Royal Glamorgan Hospital are so perverse.

While the Royal Glamorgan is not in my region, these plans will have a significant and lasting impact upon my constituents. Residents in the Bridgend county borough came under Cwm Taf Morgannwg health board last April, as did the Princess of Wales Hospital in Bridgend. I believe that the Cwm Taf Morgannwg University Health Board's plans to either close the A&E department at the Royal Glamorgan altogether, or to operate it only during daylight hours, will have serious repercussions for the Princess of Wales Hospital. The Royal Glamorgan emergency department saw nearly 5,500 patients during December. Should the department closure go ahead, these patients would have to go to neighbouring hospitals, with the Princess of Wales in Bridgend being the closest.

The Princess of Wales is also struggling with demand. It too saw nearly 5,000 patients in December, and only around 60 per cent of those were seen within the four-hour target. The increased demand from the closure of the Royal Glamorgan emergency department could totally overwhelm the department at the Princess of Wales. And Cwm Taf say they are pressing ahead with these plans on safety grounds. However, these proposals make the service less safe, not more. My constituents are paying the price for the abject failure by the Welsh Government and the local health boards to properly plan for future demand.

While these proposals will have the greatest impact on Cwm Taf patients, their effect will be felt across Wales. And, if local health boards are allowed to concentrate services around a handful of hospitals, then we are going to need a much bigger fleet of ambulances. Are the Welsh Government recruiting more paramedics, training more ambulance staff? No, they are not—in much the same way that they did not have any integrated workforce plans, which has led us to a shortage of A&E doctors and nurses.

And it has also been suggested that politicians should not meddle in decisions about the Royal Glamorgan. But, as it puts people's lives at risk, I am proud to be standing shoulder to shoulder with our constituents for something that, if implemented, has disastrous consequences for staff and patients alike. It is pleasing that there have been Members from all parties speaking out against the closure plans, and I wholeheartedly support Mick Antoniw's amendment, and I urge others to do so. And supporting this motion and amendments 2, 3 and 4 sends out a clear message that all parties have Members who oppose the downgrading of A&E services. 

And I repeat, as Mick Antoniw said, Nye Bevan said the NHS will last as long as there are people willing to fight for it, and fight we will. 

I'm pleased to contribute to today's important debate. I think an important point to be made at the start of this debate is that nobody—certainly nobody in this Chamber—denies that the NHS needs to change and to change in a transformative way that makes it fit for the twenty-first century, not just the twentieth-century, for which it was originally designed. It is, of course, the type of change that is in question. Is that change progressive? And, most importantly, does it carry the public with it? Too often, we see that it doesn't. 

Point 1 of our motion draws attention to the concerns of patients and clinicians regarding the performance and future of NHS emergency departments. The arguments against the downgrading of services in rural Wales are well-versed. Withybush hospital in Pembrokeshire is often discussed in this Chamber; today, we have the discussion surrounding the Royal Glamorgan. The loss of vital services, including paediatrics and accident and emergency, leaves patients having to travel much greater distances for their treatment.

Now, I know, from this debate and questions earlier, and indeed previous debates that the health Minister has taken part in, that he will argue that it is the quality of the healthcare on offer that matters, and its long-term sustainability, its safety, not the distance travelled for it. But the point is that the public are clearly not convinced about this and are not being carried along with the argument in the way that they should be. So, something is clearly going wrong with the proposals before us and the Government's way of consulting. 

Now, to be fair to the Welsh Government, it's not a universally gloomy picture across Wales. The reconfiguration of services in my area, in south-east Wales, as result, primarily, of the Gwent Clinical Futures programme, which I know Lynne Neagle, Member for Torfaen, has been involved in along with me over the years as well, has, by and large, met with support from local people. There have, however, been recent concerns about the extent of the loss of services, particularly A&E from Nevill Hall, to the new Grange university hospital in Cwmbran. There is a moral here—that people support change, but can only take so much in one go, and it has to be sold to them, they have to be part of that change, engaged in it, consulted on it and action it. 

A&E is a very sensitive issue, perhaps one of the most sensitive issues in the health service. Out-patients want to be reassured that those services are going to be available where and when they need them. The term 'minor injuries unit'— and I think it was Mick Antoniw in his excellent speech who mentioned minor injuries units—whilst it may work well on paper, when people are planning the layout and the division of new services, the sad thing is that, when you're out there, on the ground, talking to people, the term 'minor injuries unit' simply does not wash. It does not cut it with the patients and it does not cut it with the clinicians. It is no substitute for an accident and emergency unit, certainly not along the lines of what we've been used to previously. 

As I say, the reconfiguration in Gwent has largely been supported and accepted, but that is certainly not the case in other parts of Wales—certainly Hywel Dda. The proposals to end 24-hour consultant-led services at the Royal Glamorgan Hospital's emergency department have, of course, caused major concerns and those have been raised in this debate. There are choices here. Yes, the NHS requires massive resourcing. Modern treatments cost money. Money has been tight. Resources are tight. But, as previous Members have said, the Welsh Government can give a steer. It can intervene, if appropriate, and it can stand up for local people and local services if it wants to, if it believes that those priorities are the priorities of the Government and of the people, and, let's face it, this is what most people want. 

I think we need to recognise that there are no easy solutions here. There are structural problems that have built up over many, many years in the NHS—prior to devolution, in fact—and problems that are not easy to resolve. Simply saying 'We will downgrade services in one area and beef up services in another'—if you're lucky—just doesn't wash in the current climate. Transformative change needs to be accompanied by a vision, a vision that carries the public and clinicians with it, that truly does what the Welsh Government often in debates in this Chamber says that it wants to do: puts the patient at the centre of the process. How often do we talk about co-production, putting the patient at the centre, putting the recipient at the centre? Yes, a great idea on paper, but it hasn't happened hitherto in debates such as this, and that is what needs to happen.

In the absence of that vision, I believe, along with other Members, that downgrades of services should at least be put on hold, that they should at least be reconsidered, and that there should be a reassessment of restructuring across Wales where it is blatantly obvious that that restructuring is not supported. And the patient really should be put at the centre of the process.

Today's debate is the chance to send a strong message of support in favour of retaining A&E at Royal Glamorgan Hospital; to show just how many people will be affected by these health board proposals; to show just how important it is that the health board thinks again and instead brings to the table strong, safe and sustainable solutions.

I have co-submitted amendment 4 to put on the record my opposition to the closure of the A&E unit at the Royal Glamorgan. For my constituents living in Cilfynydd, Glyncoch and Ynysybwl, patient flows are towards the Royal Glamorgan. Closure of its A&E would have a clear and incontrovertible impact on their ability to access emergency healthcare.

From the number of people sending e-mails, joining social media groups, signing up to the statement of support for the Royal Glamorgan Hospital A&E issued jointly by Labour and Plaid Cymru politicians and a range of trade unions, people attending public meetings across the health board footprint, rallying outside the Senedd earlier today, we can clearly see the passionate attachment that members of the local community have to retaining the service, to making sure the people who need to use that service can access a consultant-led A&E service within their own local community.

Closure also simply doesn't make sense. For example, during 2019, the A&E service at the Royal Glamorgan was attended by nearly 64,000 people. That's over 2,000 more than Prince Charles Hospital, and 4,500 more than the Princess of Wales. While it would be iniquitous to pit one hospital against another, it is only fair to recognise that the Royal Glamorgan has the busiest A&E department in Cwm Taf Morgannwg, and it also performs extremely well. Using four, eight and 12-hour indicators, the Royal Glamorgan Hospital's A&E consistently records the highest percentage of patients being seen within less than the target waiting times. Its figures are also above the all-Wales averages for treating patients. Moreover, closure of A&E services there would increase pressure on other A&E departments, not just in Cwm Taf Morgannwg, but potentially further afield. I mentioned the A&E department in the Royal Glamorgan seeing 64,000 people in 2019. Well, let's break that down. That's over 5,000 people a month, or 166 people a day.

The health board is proposing that these people are to be seen in its other district general hospitals, but do they have the capacity to see this spike in patient numbers, especially when we consider additional house building in the area in the future will add around 20,000 additional properties just in the immediate vicinity of the Royal Glamorgan Hospital itself? No figures have been brought forward by the health board to suggest that either the Princess of Wales Hospital or the Prince Charles Hospital can absorb those extra flows. 

Such plans also ignore the geography that makes the south Wales Valleys such wonderful places to live. Distances and journey times to access the proposed alternatives are further and longer. That means more risk of missing the all-important golden hour for treatment. And when we factor in the age profile of the areas concerned, and the high levels of underlying health conditions, this is all the more serious. Indeed, the most powerful testimony in support of retaining A&E at the Royal Glamorgan is from family members attesting how accessing the service saved the lives of their loved ones.

I hope that today's debate and the united show of support from residents and representatives will encourage the health board to think again. It is already possible to see extra effort finally being put into the recruitment of much-needed consultants. So, I want to place on the record my thanks to the health board for that. But it is also a chance for us to reconsider how we make current provision even better to relieve some of the pressure from front-line A&E services. Let's re-examine the role of minor injuries units in community hospitals; they can relieve pressure from A&E units and do so much more than their name suggests—treating broken bones, for example. I believe it is frankly ludicrous that the minor injuries unit in Ysbyty Cwm Cynon isn't a walk-in clinic but rather an appointment-only service. These things need to be looked at again, and I hope that can be part of the health board's proposals.

The strength of feeling that this has aroused is clear, so I would urge colleagues to send a strong message today and to back amendment 4.

I rise to speak to the motion today because of the solidarity I want to show with those people who are campaigning for their hospital services in south Wales at the moment, particularly in terms of the emergency department at the Royal Glamorgan Hospital. I've been there, I've done that, I've got the T-shirt, and I've got the scars to show it: for the campaign, which was a cross-party campaign, that we had to have in order to save our maternity services in north Wales. 

The tall and short of the lesson that I learned in that campaign was that you only ever get the right result when Ministers actually intervene, because that was the situation for us. We were told that services were unsafe and unstable; they had been made unsafe and unstable because of the uncertainty surrounding the future of those services, which is exactly the same case as the situation at the Royal Glamorgan's emergency department right now. The situation was so unstable, we were told that the service would have to close, and there were plans, of course, then to change those services and remove the consultant-led maternity services from Glan Clwyd Hospital, as was the case at the time. 

It took thousands of people marching on the streets—tens of thousands; it took tens of thousands of people signing letters and signing petitions in order to make their voice heard; and it took politicians putting their party politics aside, embracing one another and standing shoulder to shoulder in order to campaign for those services to be retained. Because of that action, that concerted action on a cross-party basis, the then First Minister did actually decide to intervene. And we look to you today as health Minister here in Wales, Vaughan Gething, and we plead with you to be brave enough to challenge the information that's been put before you and to listen to the chorus of voices that was chanting outside of the Senedd earlier on this afternoon, calling for the sitaution to be resolved through your intervention, because I don't believe that it will be resolved without it. 

I want to talk just for a few moments about the fragility of emergency departments, not just in south Wales at the Royal Glamorgan, but of course elsewhere in the country. We know that we have a 95 per cent target for people to be in and out of emergency departments within four hours. Regrettably, that target has never been met. In fact, the situation in terms of the worst performance against that target is, unfortunately, in north Wales. The poorest performing hospital in north Wales at the moment is Wrexham Maelor, which has been breaking records across the whole of the NHS, UK wide. You've got just a one in two chance of getting out of that emergency department within that four-hour target at the moment in Wrexham Maelor Hospital, and a slightly better chance at Glan Clwyd, but still one in two. Two out of 10 people at Glan Clwyd Hospital will wait more than 12 hours—two out of 10. One in five people who walks through the door in an emergency situation will not be discharged for at least 12 hours. 

Now, we know that it's a combination of things that gives rise to these appalling performance statistics. One of them, as has already been referred to, is the number of beds in a hospital. We've seen, over the past decade, certainly in north Wales, one in four beds have been axed from our hospitals. That's bound to have pressure at the front door, which is the emergency department, because if you can't discharge a person from the emergency department into a hospital bed when they need one, then unfortunately they're going to clog the front end of the hospital.

Of course, that leads on to problems then with our ambulance services, because ambulances arrive, they want to discharge patients into the emergency department so that they can get off to respond to the next call, and they're unable to do so. As a result of that, unfortunately, we've seen patients dying while waiting for ambulances, and sometimes facing the indignity of dying in car parks in the back of ambulances outside of our hospital front doors, when the assistance they need is just yards away. It is absolutely frightening.

So, we need extra resources in our national health service, more beds in our hospitals, and we need you, Minister, to intervene in this situation in the Royal Glamorgan Hospital and stand shoulder to shoulder with your colleagues on the backbenches—and I take my hat off to each and every one of them today for challenging your Government over this. We will continue to campaign with those people who were marching outside the Senedd today until we know that the future of these services is secure.

The Royal Glamorgan Hospital needs its emergency department.

The Royal Glamorgan Hospital needs its A&E, and it needs it to be consultant led to be able to deal 24/7 with acute medical emergencies and significant trauma. Of course, major traumas—burns and so on—are better treated in specialist centres, but lives will be lost and pressure will become unbearable on other accident and emergency units within the health board and beyond if the downgrade or closure were to take place. I'm sure Ministers are aware that, as well as the consultants at the Royal Glamorgan saying today that they want to keep their A&E, doctors at the University Hospital of Wales in Cardiff are screaming, 'Please don't close the A&E at the Royal Glam, because we'll be overwhelmed.' Centralisation and the potential pitfalls of that has been a decade-long theme in Welsh politics. It's happening now with the disastrous removal of vascular services from Ysbyty Gwynedd. We're seeing it again at the Royal Glamorgan with A&E.

We have plenty of studies that suggest this isn't the right thing to do. There was a University of Sheffield study in 2007 analysing over 10,000 emergency calls that found a relationship between distance to hospital and mortality. It found that a 10 km increase in distance is associated with around 1 per cent absolute increase in mortality. There are other studies too: a study finding that an increase in journey time of 10 minutes has a 7 per cent increase in the relative risk of death. In this case—with this hospital, that geography, the weather as it can be, and traffic as it can be—10 minutes isn't close to what people would have to travel in addition if this A&E were to close. So, on balance, apart from those major trauma issues and so on that I mentioned, we are convinced here that we need to keep this A&E for the sake of patient safety.

On recruitment, consultants at the Royal Glamorgan are confident that the right medics can be recruited, not least by raising the threat of the closure of the department itself or the downgrading of it. I remember the plan to remove consultant-led maternity services from Ysbyty Gwynedd. We, the community, protested and the decision was overturned. And do you know what? Suddenly, recruitment was no problem and staffing levels were brought up to what was needed in terms of patient safety. So, let's build a future for A&E at the Royal Glamorgan as we seek to build a sustainable and locally focused Welsh NHS as a whole, and let's do it for the sake of the communities and the people that it serves.

I call on the Minister for Health and Social Services, Vaughan Gething.

Thank you, Llywydd. Before I deal with the wider issues raised by Members in today's debate, I want to start by thanking our staff, because the quality and the compassion of our staff is always the focus for praise when people contact me. It helps to explain why, despite the continuing pressures our NHS faces, we continue to see such extraordinarily high levels of public satisfaction across NHS Wales. As the First Minister reminded Members yesterday, when the public are asked, 93 per cent of people are happy with their own experience of local or hospital-based care. The importance of our NHS and the public attachment to it has been reflected on the Senedd steps and in today's debate, as it has been on so many occasions before. So many of us, including me, have good reason to be grateful for our national health service. The safety of our NHS now and in the future is of paramount importance.

Many of the questions that I have faced in this Chamber as the health Minister over the last year have focused upon where the safety and transparency of the service were not the first and overriding priority. I will not, and I'm sure that Members across the Chamber do not seriously expect me to intervene by directing or attempting to direct any health board or trust to try to run an unsafe service as long as it is local. The professional judgment call on the future immediate safety of the A&E service at the Royal Glamorgan has been made, as it should be, by the medical director, the senior doctor in the health board.

Will you take an intervention? 

But that, however, is plainly not the end of the matter. The health board, in considering any possible change of this nature, has to be open and transparent about the following matters as a minimum—

Will you take an intervention?

I'm going to deal with this, because I've got lots to deal with.

The immediate and longer term reasons behind any potential service change; the options that it is considering; and the impact of any of those options, including the impacts of doing nothing. And the impacts of options for change should, of course, include the impact on quality, safety and access in terms of time and geography. And the information on demand and need for current and future services should be openly shared with the public. The health board should set out how it will listen to and engage with the public and its staff. 

All of these matters should be shared with elected representatives and, of course, the local community health council. And that staff and trade union engagement is essential to current and any future provision. I really do understand that people have very real concerns and fears about the future service at the Royal Glamorgan Hospital and what it will mean for their families and community. I fully expect elected representatives to represent the concerns of their constituents and to press for alternatives, and that includes the impact of any proposals on community services on Ysbyty Cwm Cynon and the future of Ysbyty Cwm Rhondda, as well as Prince Charles Hospital, the Princess of Wales Hospital and Cardiff. 

It may be helpful to respond to the concerns that some Members have expressed today, both within and outside the Chamber, about other services. The health board set out yesterday that they will not be closing other services—no theatres and no intensive therapy units closing, and there will not be job losses if service change proceeds.

The Government amendment notes the joint cross-party statement about the future of emergency services in Cwm Taf Morgannwg. Within that statement, a range of information is requested from the health board about the evidence underpinning proposals for change and their impact. I expect that information to be made publicly available or an explanation of why not.

And I hear what Members have said today and before about the south Wales programme. Now, this wasn't determined centrally by the Welsh Government; it came from engaging over 500 front-line clinicians who live, work in and serve communities across south Wales. The final agreed position of the south Wales programme six years ago was for a 24-hour minor injury unit at the Royal Glamorgan. It's already developed and been at the leading edge across Wales at the Royal Glamorgan of acute medical care that would have previously gone to A&E. It's already developing, of course, the £6 million diagnostic hub we've heard so much about in reference to its impact upon cancer services.

However, I recognise that the health board are already reconsidering the 24-hour MIU plan, and they have set out possible options for consultant-led care to continue on the site. In considering a way forward, I understand that the health board are indeed reflecting upon the outcome of the south Wales programme, the changes made since then to the delivery of healthcare and the healthcare needs of current and the future population in the area and, of course, the unavoidable reality of staff recruitment. As Members across the Chamber know, simply calling for the south Wales programme to end doesn't answer the problem; it avoids the problem.

I've discussed at length and on a number of occasions the challenges of attracting and retaining emergency medicine consultants in what is a shortage profession across the UK, and indeed a highly competitive international field of recruitment. The immediacy of the current position in Cwm Taf Morgannwg has arisen because of immediate staff shortages that will arise at the end of March. It would not be honest or realistic for any Government to sign up to the wording of the Plaid Cymru amendment. It isn't a credible plan to simply instruct staff from Merthyr or Bridgend to work nights at a different hospital, and we all know from our own experience that staff shortages have led to service change because otherwise the service would be unsafe.

But we are not standing by and doing nothing. We are already developing a joint health and social care workforce strategy. Four doctors in training are expected to complete their certificate of completion training in emergency medicine this summer and to take up posts as consultants across Wales. Between 2021 and 2025, a further 62 doctors are expected to complete their certificate of completion of training for emergency medicine as well. The national unscheduled care board has been established and has reviewed workforce requirements for emergency medicine and further expansion of the consultant workforce, which is supported by Health Education and Improvement Wales. However, that in itself isn't an answer to all the concerns of Members and the public. The truth is that there are no quick or easy fixes.

The Government will vote against the motion to ensure that we reach the Government amendment that balances our expectations on how the health board makes a decision with the legal responsibility of Ministers. As Members across the Chamber know, Ministers, myself in particular, could ultimately have to determine a final service decision. The Government will, therefore, abstain on amendments 3 and 4.

I know that people care deeply about the future of our NHS. I do too. I expect all of our decision makers in our national health service to listen to what the public and their elected representatives have to say, and to be open, honest and transparent with the public and their staff. I expect our NHS to make choices that deliver a robust and safe service. It's what I expect for my family and I expect nothing less for the country.

I call on Andrew R.T. Davies to reply to the debate. Andrew R.T. Davies.

Thank you, Presiding Officer. In the time afforded to me, I'll do my best to sum up, which is about two minutes and 40 seconds.

I have to say that on that performance, Minister, I can fully understand how Jo Coburn on Daily Politics began her interview with you some months ago by saying, 'What is it like to be the worst health Minister in the United Kingdom?' You did not respond at all to a single point that various Members in this institution made to you, from the Government benches, from the opposition benches, and you failed to take a single intervention. That shows the weakness of the ground that you're on, Minister.

Also, the latter part of the statement that you made, where you said that you ultimately might have to make a decision on some of these service changes, that shows that you are responsible, and the Welsh Government are responsible, for the strategic direction of the health service. We need a decision from you to the health board to make sure that this A&E provision is kept in place. If you're not prepared to do that, at least make sure that the electorate have a chance to do that as this motion has to be put before the next Assembly election.

I would implore colleagues across this Chamber to support this motion unamended because, ultimately, it satisfies all the concerns that have been raised, from Vikki Howells's point that the Royal Glamorgan A&E department deals with 64,000 patients on an annual basis. Your own Government bench did not even respond to that, about how that service provision would be taken care of at the other two hospitals. If they're not prepared to engage with you, engage with this motion and vote for this unamended motion today because, ultimately, it'll show the Assembly speaking with one voice and calling on the Government, the only organisation that can make sure that this proposal is taken off the table.

From the Plaid Cymru benches, it was well made, the point, that if you're labouring under the south Wales programme, is it any wonder that no doctors or very few doctors have looked at this as a career opportunity, when they know that at any time soon the department is going to close down? 

Mick Antoniw, the Member for Pontypridd, touched on the point about development, and other Members touched on the point about development across the area. Twenty thousand new houses are going into this area. This is a district general hospital that is serving a growing population and, actually, to deal with proposals that were first put on the table some six years ago is completely out of synch with what is the requirement for this particular area, an area I know exceptionally well, because I've lived and breathed in that area for many, many years, and I know the people who rely on that service.

And I can see you shaking your head. Come and challenge me, then, Minister. If you want to intervene on me, intervene on me, because I'll take your intervention. You have the ability to intervene here and change the direction of these proposals, and I thank each and every one of the protesters who came before the Senedd today to show their frustration and their anger. Many of those faces, I recognise, had taken days off work because they're so concerned about these proposals that they came to the home of Welsh democracy. This motion has been put down today to respond to those concerns, and the Senedd can speak with one voice—one clear voice, as Darren Millar pointed out in his contribution. When, actually, the senior figures of Government intervene, things start to happen, as in maternity services in north Wales. So, I call on the Senedd to support this motion that's before the Chamber. Instead of just the words, start the action: press that green button and support this motion unamended today.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] I will defer voting under this item until voting time.

Voting deferred until voting time.