5. Statement by the Minister for Health and Social Services: Coronavirus (COVID-2019) update

– in the Senedd at 2:31 pm on 10 March 2020.

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Photo of Elin Jones Elin Jones Plaid Cymru 2:31, 10 March 2020

(Translated)

Therefore, the next item is a statement by the Minister for Health and Social Services, a coronavirus update. I call on the Minister to make the statement—Vaughan Gething.

Photo of Vaughan Gething Vaughan Gething Labour

Thank you, Llywydd. The situation in Wales continues to evolve and we now have six confirmed cases. More cases will be diagnosed both here and elsewhere the UK in the coming days. In response to the changing situation, we have jointly developed an action plan with the UK Government and the other national devolved Governments. This builds on our experience of treating infectious diseases and our planning for an influenza pandemic.

The action plan deals with what we know currently about the virus and the diseases it causes; how we have planned for an infectious disease outbreak such as coronavirus; the actions we have taken so far in response to the current outbreak; what we're planning to do next, depending on the course that the current outbreak takes; and, of course, the role that the public can play in supporting this response, now and in the future.

I have asked the chief executive of NHS Wales to establish an NHS Wales and social services planning and response team to draw on appropriate expertise and to be in the best position to address response issues as we move through the phases of this outbreak. This team will provide ongoing support, co-ordination and integration of the health and social services response. They will co-ordinate their work with the wider remit of the Welsh Government emergency co-ordination centre. As an immediate action, assurance has been sought and confirmed from all health boards with acute hospitals that they are ready to accept patients into their isolation facilities.

This weekend, I authorised the supply of personal protective equipment to all GP practices across Wales. Supplies of personal protective equipment to community pharmacies will be sent out later this week. We are mobilising our pandemic stockpiles for health and social care, so that this stock is in a state of readiness to be pushed out as and when necessary. 

We are still taking action to detect early cases, to follow up close contacts, and to prevent the disease taking hold in this country for as long as is practically possible. If the disease becomes more established in the UK and in Wales, we will need to consider further measures to reduce the rate and extent of its spread.

We will therefore look to take new powers for Wales through the UK-wide coronavirus Bill to be introduced in the House of Commons, to be able to help systems and services work more effectively in tackling the outbreak. The Bill will strengthen quarantine and mass gathering powers, and will allow for the closure of schools and colleges, if necessary, to contain the spread of coronavirus. All four UK Governments across the UK have agreed on a single piece of UK-wide legislation as the right approach. However, I do want to reiterate the point that, in that single piece of UK-wide legislation, it is a clear expectation that all those powers that are currently devolved responsibilities will remain the responsibilities of Ministers in devolved national Governments. 

Photo of Vaughan Gething Vaughan Gething Labour 2:35, 10 March 2020

Our NHS will have to make some changes to how it operates. That includes care and advice by phone and information technology. I have decided on a new software system to be made available across Wales to enable video consultations for people with their GPs. We have already introduced an online symptom checker, hosted by our NHS Direct Wales website. There is, of course, the daily update on the Public Health Wales website too. This should help to reduce pressure on front-line staff, and better support people with information and advice.

We want to strike a balance between keeping people safe and minimising the social and economic impact. Our decisions will reflect the scientific evidence, and take into account the trade-offs involved. The actions we will consider include encouraging greater home working, not using public transport and other behavioural measures that people can voluntarily take to slow the spread of the disease. We will consider if those with more minor symptoms should self-isolate, but this will be informed by expert advice on the epidemiology of the outbreak, and we are not at that point today.

It is worth reminding ourselves and the public, though, that people with significant flu-like symptoms should not attend work, their GP, or an A&E department. That is not new advice—that is the current advice at all times of the year.

Some major public events, as we've seen, have been cancelled or postponed outside Wales, to limit the risk of transmitting coronavirus. A number of schools have closed in other countries for similar reasons. These are possible future options for us too. We are, however, not at that stage. Schools should remain open, and there is no rationale to cancel major sporting fixtures at this point.

But some of the most effective measures involve all of us—not just the Government or the NHS. For instance, simple personal hygiene procedures can significantly limit the spread of the virus, as can prudent self-isolation for those at particular risk. Employers can and should support their staff to take such action, without creating undue alarm. To mitigate the impact on businesses, the Welsh Government has registered COVID-19 as a notifiable disease. This will help companies seek compensation through their insurance policies in the event of any cancellations that they may have to make as a result of the spread of the virus.

We are moving towards enhanced monitoring arrangements at Cardiff international airport. This will mean that every aircraft that lands here from a region identified by the case definition will need to declare any symptomatic passengers to Public Health Wales's port health teams before disembarking.

Outside the UK, the risk changes daily. The Foreign and Commonwealth Office also updates its advice to travellers regularly. And people who intend to travel abroad should check the Foreign and Commonwealth Office website for the most up-to-date travel advice before they travel. The latest advice for returning travellers from the highest-risk parts of the world is to stay indoors, avoid contact with other people, and call 111. That is true even if they do not have symptoms. Those areas are: Iran, the Hubei province in China and Italy. For returning travellers from areas that are deemed lower risk, the advice is to stay indoors and avoid contact with other people only if you develop symptoms. This now includes all of Italy outside of the locked down areas I've already mentioned.

There is further advice available from Public Health Wales and the Welsh Government for people who have not travelled but are nonetheless concerned. That too will change as the pattern of the outbreak changes and as our understanding grows. But following such advice is always better than listening to often ill-informed rumour and speculation. In particular, I would urge people to check the advice that is available before presenting themselves for diagnosis, which, of course, risks wasting finite NHS resources. We are continuing to offer community testing to people in their own homes. In addition, 111 is now available across all areas of Wales for coronavirus advice.

The First Minister and I continue to attend COBRA meetings. We will continue to work with UK Ministers, the Scottish and Northern Irish Governments, our chief medical officers, and public health agencies, across all four nations.

No-one should be under any illusion about the threat that the coronavirus presents. There are plain and serious risks to people's health, including in particular people who are already vulnerable. And a large-scale outbreak also carries wider risks of social and economic disruption. 

This outbreak will not go away quickly and it will get worse before it gets better. But, at the same time, we have long been prepared for an outbreak like this, and we are learning more about this particular virus each day. That knowledge, combined with the dedication of our health professionals and others right across public services and the independent sector, allows us to reduce the risks as far as we possibly can. I will, of course, keep Members and the people of Wales fully informed of any steps that we take here in the Government. 

Photo of Angela Burns Angela Burns Conservative 2:40, 10 March 2020

Thank you very much for your statement, Minister, and for keeping me, on behalf of the Welsh Conservatives, so well briefed during this situation. Just going through your statement, I have a number of questions. Are you able to confirm to us the level of seniority that the members of the NHS Wales and social services planning and response teams will be—in other words, that they've got the stripes to make things happen out there in the NHS? Are you able to confirm to us how many isolation beds we currently have available throughout our whole NHS? Because I'm assuming that isolation is literally quite different from intensive care, because they're the ones within the walled glass environments, so I just wanted clarification on that.

I was very pleased to see the personal protective equipment going out to GP practices and pharmacies, and I wondered at what point you might consider issuing them to domiciliary care workers and to care workers in residential homes, and what advice you might be giving to owners of private homes as to what precautions that they should be taking.  

You were talking about the technology to underpin this, and I must say that the symptom checker is very good, because I tried it out, and I think it's very clear and I commend you for that. Of course, an awful lot of older people will not necessarily have access to IT or be able to use IT, and I wondered what you might be putting in place, or what instructions you will be giving to older persons who can't actually use a symptom checker and what they should do. I'm assuming you might say back to me '111', and, again, I just wanted to have some clarification on that, because I was up in Wrexham Maelor Hospital meeting staff last week, and I also met with a couple of GP practices, and they were quite confusing on their message back to me as to the efficiency of 111 in north Wales. There was talk about the 0845 number being on a divert and that they weren't convinced that actually 111 was universal. So, perhaps, you could just confirm that, so that we can move forward on that one. 

And, again, while we're on the subject of older people, I appreciate that this isn't for now, but in the weeks coming up, will you be talking to and have you had any discussions with organisations such as supermarket leaders, to perhaps put in place some kind of way for older people who have to stay at home because they've got severe health risks like chronic obstructive pulmonary disease, or because they're a higher risk population, to be able to phone in supermarket orders and get them delivered? Because, again, particularly I know that in my constituencies, there is a significant number of older people who simply do not have access to that IT equipment to be able to put an order out to one of our favourite supermarkets. 

I've got a specific question that I'd like to ask about the workforce. In a previous statement, you said that you planned to employ volunteers and staff who've recently left the NHS. So, they're going to be current. Could you confirm that locum doctors will be offered contracts that will cover them and their families in the event of serious ill-health or even death if they die in service because of this? Will you be looking at that going forward? Because it's one thing to ask a retired GP or a retired consultant perhaps or nurse to come back in and cover a shift and they've recently retired, we can get them a quick fitness to practice certificate—I understand all of that and that will, no doubt, be taking place—but we also need to cover them if the worst happens. So, can you just confirm that perhaps this will be an area that you would look at?

You've also talked about the opportunity of video consultations, which actually I think is a very important step forward, but, again, are you giving some thought to what plans might be in place for the areas where video connectivity, because of our IT infrastructure, simply isn't available, and I could give you quite a few notspots in my constituency where that really wouldn't happen?

There are lots of questions to ask on coronavirus, and I simply am not going to take up lots more of your time. My last question would be that, of course, South Korea believe that they've passed the peak, and that they're now coming down the other side; they're quietly confident. They've been very effective in how they've dealt with it. They have a different social structure, and a different culture, but one of the things that they did use was they used social media to help to track a coronavirus-identified patient. Obviously, I don't know—I assume that they had permission—but to track where they'd been, so that they could then try to use that kind of technology to find out who else might be at risk. Could you just tell us whether or not you've got any thoughts in the weeks ahead? As I say, not now—I appreciate it's not in place at this moment—but we all recognise that this virus is going to expand. The situation will get worse and the things I've mentioned are just things that we could do to help perhaps to chase down or to mitigate, and I just wondered if you'd been looking at somewhere like South Korea, who think they're through the worst of it, to learn what best practice we can to help us contain the situation, or at least manage the situation, in our country.

Photo of Vaughan Gething Vaughan Gething Labour 2:46, 10 March 2020

Thank you for the series of comments and questions. Your first point about the new team that I've referred to within the Government: the fact that I've instructed the chief exec of NHS Wales to set this up, there should be more than enough stripes, to use your terminology, within the NHS to make sure that people respond with an appropriate level of seniority. It's about co-ordinating the work within the Government as well as the interface together with the health service. And on your point about isolation measures, going back to some of the points the First Minister made in questions as well, this is actually about how we ought to flex up our capacity to meet people, but also we're going to need to treat people in different ways. People who would normally come in to a hospital setting for their care—we may need to treat teach more and more of those people in their own home in a different way. So, actually, I don't think we should get fixated on the number of beds we currently have but actually about our capacity across our whole system to be able to treat more people, and what that means, and the different treatment choices we'll need to make, and what we'll actually then need to do, for example, together with both regulators and royal colleges as well.

When it comes to the personal protective equipment for general practice and pharmacy, and what that might mean for other people who have direct contact with, in particular, at-risk groups of people—that goes into part of the conversation we're having, not just with the staff in domiciliary and residential care, but also one of your later points about the work with supermarkets. I've already instructed officials to have those conversations about providing goods to people who may be in their own homes for a longer period of time, but it's also about the work the local government in particular will need to do, both in planning for a change in the nature of the way in which services will be delivered, about the way they deliver services in people's homes already, either because they're directly providing that care, or they're commissioning care, and the way in which they'll need to plan for a different way to deliver services—again, potentially with fewer staff at some point, but also potentially with an increase in demand coming through their doors too.

On your point about IT access, the steps that we've taken to provide a consistent piece of software across the system is a real step forward, but that doesn't mean that it has universal coverage, because you're right to point out that there are some people who either don't have IT equipment or don't have access effectively to it for a number of reasons. So, there are also things—[Inaudible.]—other people as well. And again, that's a challenge that not just the health service faces, but a range of other public services too.

And on your point about access to the symptom checker, Public Health Wales have already provided a range of advice posters that talk about symptoms in there, so it's not just an online forum. I've seen in my recent trip to north Wales what that means, and at Cardiff Airport—where they're visible; I think they're very clear—but also a range of businesses have used exactly the same information posters. And that goes back to the points being made before about clear and consistent advice in using advice from a trusted source of information so I'm really encouraged by the way in which that very simple and clear advice is being used in a wide range of areas.

And I'm happy to reiterate the point about 111. It is an all-Wales service—an all-Wales service for coronavirus. So, if people are concerned, they can ring that number from any part of Wales to be provided with advice and guidance.

On the report about indemnity for people who are locums, I'm happy to explore that area further to see about whether we do need to change any of our current arrangements to make sure we have the right numbers of staff in the right place to provide care and treatment and also give people the assurance they may be looking for.

And on your final point about international learning, not just from South Korea, but from more broadly across the world—that was part of your discussion at COBRA this week. It's part of the discussions I've had on a regular basis with the chief medical officer, because what appears to be slightly different advice is being given in different parts of the world, but it's also learning from people in different stages of an outbreak as well. Actually, the work of the World Health Organization will be really important in this. But we certainly want to be linked in to the best possible advice, not just across the UK, but internationally too, about lessons we can learn—and we're slightly behind where other parts of the world are with this outbreak—to try and make sure we make better choices here, or we better understand the choices we are inevitably going to be faced with. So, yes, it's important in the here an now. It will also be important afterwards. So, once we're after the peak of the coronavirus outbreak in the UK and across the globe, it's how we learn from what's happened and understand what we'll better need to do in the future.

(Translated)

The Deputy Presiding Officer (Ann Jones) took the Chair.

Photo of Rhun ap Iorwerth Rhun ap Iorwerth Plaid Cymru 2:50, 10 March 2020

(Translated)

May I thank the Minister for the statement and thank him for the briefings provided both to me and to other party spokespeople at this time?

May I just tell you a story about a doctor who contacted my office to complain about the 111 line, because she dealt with a patient who'd had to pay £10 to call the 0845 number because 111 didn't work and the patient wasn't able to use a landline at that particular time? This particular patient and her husband had travelled back from Italy recently, where they'd been on holiday with friends. Having returned, those friends who lived in England were tested and tested negative for COVID-19. The patients in Wales then got a headache and a cold and phoned the 0845 number, but they were told that they were unlikely to be at risk and that they didn't need to be tested. But because their friends in Essex had been tested, they felt that they should take further steps themselves and they decided to drive to Ysbyty Gwynedd. They spoke to a nurse there who triaged them over the phone. The doctor then put an apron and gloves on and went out of the car to ensure that tests and diagnosis could be provided, and what I've heard is that there was a lack of understanding even among hospital staff in terms of out-of-hours medical care in terms of what exactly to do in cases such as this. This is a cause of concern, of course, if the front-line staff themselves don't feel that they have the appropriate advice to provide to people, or appropriate clothing to protect themselves, although I do note, and am thankful, from the statement that GP surgeries are to be provided with appropriate clothing now.

There are a number of questions arising from this for me. First of all, if people can't contact 111 for some reason, or perhaps can't afford to phone the 0845 number, is there a risk that we are missing some cases? What steps will be taken in order to strengthen that 111 provision further?

If staff in hospitals feel that they don't have the necessary equipment to safeguard themselves, is there an expectation that they should be provided with that clothing and equipment? Also, what steps are being taken to strengthen the provision in hospitals for those people who act contrary to the advice provided and go to hospital in any case? Because people are going to do that, unfortunately. I hope there'll be few cases, but it will happen. So, what will be done to ensure that hospitals are ready for that?

If I could also make an appeal for an update on the more intensive care capacity. It is crucial, I think, that we at this point in time do ensure that that capacity is in place for more intensive care beds to be provided in hospitals. I do think that it's fair to say that our experience from other nations in looking at what happens elsewhere tells us that the kind of care provided to people at that point where their illness becomes serious, whether the care is appropriate for them and good enough for them at that point, can make the difference as to whether those individuals survive this virus or not. So, what's being done now to ensure that that capacity is built for the needs that could arise over the next few weeks and months in terms of intensive care in hospitals?

Photo of Vaughan Gething Vaughan Gething Labour 2:55, 10 March 2020

I want to thank you for the comments and questions. I think your story of real experience in the recent past is important for all of us. On 0845, the old 0845 number, that is a cost that phone providers themselves charge and we're not in control of that. That's really frustrating, but we've taken the step to have an all-Wales 111 service so that it's a consistent number, so that we're not asking people in different parts of Wales to check which number they should use. I think it's really important, those points about clarity and consistency in the message that we have.

I'm really clear that if they need more resources, then we'll find more resources to give them more capacity to deal with people. There is something then about our whole NHS system understanding what to do, both about whether they need to use protective clothing or equipment, but also to make sure that people do themselves understand, in a simple and a clear way, how they should behave with members of the public. I think your point about the fact that they drove to a hospital site when that's exactly what we're asking people not to do, and our challenge about reinforcing for people to please follow the advice to keep them and other people safe—it's about keeping them safe, their family, their loved ones, but also people they may never have met. This is a really serious position.

The choices that we may well be faced with making will be choices that are imperfect, in the sense that we may be making choices about putting off activity within the health service to prioritise the most serious activity; we may be asking people to deliver treatment in a way that isn't what you'd expect to deliver in the here and now today, because of the capacity and because of the demand that we may see coming through our doors. The situation in Italy should tell us something about the choices we may face.

Italy is not a developing world country, they have a good developed world health system, and yet their healthcare system is over-topped at present. They've over-topped all of their intensive care capacity, including having scaled that up by redeploying their staff, and they're having to make some of the choices that the First Minister described as well. They're talking about treating people in hospitals not in the sort of position that they might otherwise have wanted those people to be in, in an intensive care bed, but they may not have those beds because they're full; they're talking about people who may need ventilation, they don't have that, they're thinking about alternatives. As I've said several times, we may be treating people in their own homes when today we would definitely be saying, 'That person should be in a hospital, in a bed with a certain level of escalation.' These are not trivial choices we are actively contemplating having to make.

Even if we flex all of our capacity, if we switch off other areas of activity, if we redeploy all of our staff, it is still possible that if we don't take steps, if we don't take effective measures, we could be over-topped. It is also possible that, doing everything humanly possible, a new condition that we don't have a vaccine for, we don't have effective anti-viral treatment for—it is possible when you look at the reasonable worst-case scenario that a range of our services could be over-topped. That's the challenge we're facing, so the seriousness of all the choices we make are real. As I say, the scale of what is happening in Italy now should reinforce that, not just the rise in the death toll numbers, but also the numbers of people that are seriously unwell at present today in Italy and they're having to care for.

So, I'll be happy to deal with all of those points as we come through and have to make choices, both about choices that we are making, about change in the way the health service works, but also about choices that we are saying we don't need to make. Again, we're asking the public to follow the advice that we're giving from trusted sources, the Government the national health service, and to make sure that we do follow that advice and not some of the alternative advice that exists from alternative commentators that are being giving a platform on social media and the broadcast news. I saw an interview Rory Stewart did—a former Cabinet Minister—and he was suggesting that the Government should ignore the scientific advice and take action early, in advance of what the science tells us. That is entirely the wrong thing to do. I was very disappointed because it's highly irresponsible, so this Government will make choices even if they seem counterintuitive. I re-provide the reassurance that we are definitely definitely listening to the four chief medical officers across the UK and we are definitely looking to the very best scientific advice we have to base our decisions upon.

Photo of Alun Davies Alun Davies Labour 3:00, 10 March 2020

I think the thoughts of all of us in this Chamber and elsewhere are with all those people who are currently suffering from this virus and those who believe that they might be but are maybe awaiting diagnosis, as well the families of those who have already died. I think this is one of the most terrifying threats to us as people and to our society that I've certainly seen in my lifetime. I can remember on no other occasion how a disease like this has spread across the globe and has infected so many people and caused so much suffering in societies across the whole of this world. 

I'm glad that the Welsh Government is listening to experts, and I'm glad that the Welsh Government is following the advice that our scientists and doctors are providing to us. It is absolutely essential that, in responding to this crisis, we follow the best advice and scientific analysis that we have available to us. I'm also very pleased to see that the Welsh Government is working closely with the other Governments across the United Kingdom to ensure that we do have the sort of holistic response that we require. I would say that I believe that the Welsh Government is the only administration, if you like, in this country capable of co-ordinating all of the responses required across all of our public services and across all of the different services that we will require as a country to come through this virus. I hope that the Minister—he hasn't mentioned this in his initial response, but I trust the Minister is working closely with his colleague sitting next to him, the Minister, I think, who is responsible for civil contingencies, and perhaps he would explain the structures that the Welsh Government are putting in place to ensure that we have the full, civil contingency response that we will require.

But I think the thoughts of many of us are with those people working in the national health service who will bear the brunt of this virus and the human consequences of this. Many of us have been seeing and hearing and reading of the impact that this is having on the medical service and the health service in Italy and the impact it is having on the people working within the health service in Italy who have to take life and death decisions, who are working long hours under extraordinary pressures to deal with the human impact of the virus. In my experience, one of the most difficult civil contingencies that we've dealt with across the United Kingdom was that in Salisbury, and the poisoning that took place there some years ago. One of the lessons learned there was the burnout and the impact that responding to these emergencies has on people over an extended period of time. Clearly, the incident in Salisbury was an isolated, single incident; this is something that is going to be happening in every community across the whole of this country over an extended period of time.

I hope that—. And perhaps the Minister will explain to us the sort of measures that the Government is putting in place to protect national health service workers and to ensure that we're able to support people working in the national health service to ensure that they have the support that they need, but to also look outside of the national health service to ensure that we have the care available for vulnerable people, people who may be living alone, people who might be living with life-limiting conditions at present, to ensure that they are kept safely in their homes and in their communities, but also support for small businesses as well. This is extending beyond, perhaps, this Minister's responsibilities, but it is easier for a multinational to withstand this than a corner shop, and we need to ensure that the small businesses of this country are protected as well. That takes us to ensuring that our public services have the support that they require as well. Local government, amongst others, amongst education and elsewhere, will be on the front line in dealing with much of the impact of this virus, and we need to ensure that our public services have the support and the co-ordination that they also require. 

Finally, Minister, in your statement, you outlined four-country legislation that is going to be passed by Westminster to provide Ministers here with the powers that you require in order to deal with this, and I very much welcome that, but can you assure us that the powers that you will be taking will be subject to sunset clauses so that these powers do not remain on the statute book at the end of this emergency, so that we don't, almost by accident, grant the Government enduring powers over our lives outside of this emergency? 

Photo of Vaughan Gething Vaughan Gething Labour 3:05, 10 March 2020

Thank you for the series of questions. I think I'll start with some of your early points—I'll try to take them in order. I don't always agree with Matt Hancock, and I certainly don't always agree with Boris Johnson, but, during our COBRA calls, there has been a genuinely serious and grown-up attempt to go through issues and to reach agreement on finding the best way through. In fact, the Prime Minister has said, and I agree with him on this, that the greatest risk of panic and the wrong response is often politically driven demands in contradiction of the science and the evidence. So, our response is based on the science and on the evidence.

In terms of the work we're doing across Government, I have already met with Julie James at the start of the now very regular COBRA meetings. We've had a conversation, and I've met with her lead official who co-ordinates much of the civil contingencies work. We've also formed, as the First Minister said, a core ministerial group—if you like, a COBRA Cymru group of Ministers—and we're meeting each week. I chaired the first meeting of that group last week. We're meeting again tomorrow, so there'll be regular conversations between Ministers so that Ministers are informed of different choices that are being made, but, equally, so Ministers can co-ordinate choices within their own portfolio areas, because every group of stakeholders working to every group of Ministers will be affected by this somewhere along the line, as you say.

And it's not only the choices that we make there, because your specific choices around small businesses, I think, are really important. Because there is a range of measures that Welsh Government could take, but, actually, on many more of those, there's action that the UK Government will need to take on a whole-UK basis. I hope that the budget tomorrow sets some of those out. That's why the finance Minister was in London at the start of the day to have that conversation. That, again, came from a previous COBRA meeting, where there was agreement that that meeting should take place with finance Ministers in all of the devolved national Governments.

We'll then need to see what measures are taken tomorrow, but as the outbreak develops to make sure there's a fleet-of-foot response from the Government across the UK as well. Obviously, the economy Minister has already asked his officials to look at the measures that we could take here to support small businesses in particular. That, potentially, could be as a consequence of the public health advice that we give. If we ask people to stay at home—if we ask more people to stay at home—that could have an impact on either the custom that goes out, but also people going to work themselves. A small business say with five employees—well, if two of those people are asked to stay at home, that can make a really big difference to the running of that business.

Your point about the human impact of this, I think, is also really important as well, because we're really talking with the Royal Colleges and regulators about the potential impacts of making different choices and holding people to standards at the time. But there is a human impact in, if people are seeing large numbers of very sick people, not making choices that they would otherwise make, and not feeling they're able to be in control as they would normally expect to be in delivering health and care, and that's something that we discovered both at the partnership forum, the NHS partnership forum, between the Government, the employers and trade unions on Thursday in north Wales, when I attended.

Again, we're trying to work through some consistent advice, so we don't see a wildly varying approach being taken between different NHS organisations here in Wales. There is a broader point there about public services too, because it won't just be NHS workers who will find themselves in a very difficult position, as you point out. That's a matter that I went through with social care cabinet colleagues from local government yesterday. So, across all parties, they recognise that they need to go and look at the way in which they run their services, and, obviously, the leaders of every local government organisation will need to think about that too.

I'm pleased you made the point about social isolation—if we're asking people to stay at home, what that means, regardless of the age profile. Given that we understand that social isolation and loneliness are a real challenge for lots of people, if we're then asking more of those people to not have that social interaction, again there's a choice for the Government, for the health service, but also for local government, about what form of social interaction can those people have to make sure that they're still being checked up on and not ignored, if we're asking them to avoid what would otherwise be normal social contact that helps people to stay well and healthy. So, it isn't a simple measure of, 'Take one step and that will keep everyone safe.'

The final point I'd make is just to give you some reassurance about the emergency powers Bill. All Ministers are cognisant of the fact that, in asking the legislatures across the UK to trust Ministers with powers, there should be some safeguards, and that definitely includes sunset clauses. So, any legislation, you'd expect to see sunset clauses in that about not just how powers are enacted but how powers get switched off again as well, because I recognise completely the point that the Member makes. 

Photo of Caroline Jones Caroline Jones UKIP 3:10, 10 March 2020

Thank you for your latest update, Minister, and I welcome the measures the Welsh Government, Public Health Wales and our excellent NHS staff are taking to protect us from the spread of the SARS COV-2 virus. Some of the measures, such as the new software to enable video consultations, will enhance our health service beyond this outbreak, and we must capitalise on this service, which, in this instance, replaces face-to-face contact and is absolutely necessary at this point.

At this point, it is important to reiterate to the public that we must all try to be as not panicked as possible, and while it is right that we prepare for all eventualities, there is no need for the public to change the way they go about their day-to-day activities, apart from taking precautions against respiratory illnesses, such as regular hand washing and never touching your face with unwashed hands. But this guidance should be normal practice, and we must note that influenza kills more than 0.5 billion people a year, so it's important to keep that in perspective.

It is also important to check the information that is readily available to the public and ensure that it is updated, and also to ensure that our most vulnerable in society have access to all of this information and our hard-to-reach communities are also made easier, so that they can interact regarding information on this virus.

So far, we have six people infected with SARS COV-2, and that's 0.0001 per cent of the population of Wales: six people out of 3.2 million. So, it is reassuring to note that, across the UK, there have been around 320 cases out of a total population of 70 million. It is important also to note that we keep our perspective, prepare but do not overreact, and the biggest threat in any viral outbreak is public panic. Rumour is currently our biggest enemy and social media is rife with fake cases and fake cures, and everything from drinking bleach to snorting cocaine. It has led to panic buying, resulting in short-term shortages as the supermarkets restock, further adding to the rumour mill.

So, Minister, what discussions have you had with the UK Government and have had with the social media platforms about the best way of tackling the spread of misinformation, and how to promote information from trusted sources such as Public Health Wales? I would once again like to thank you for the measured approach the Welsh Government is taking in preparing for the impacts of a COVID-19 outbreak.

I have just one or two questions relating to preparations here in Wales. Minister, last year the Welsh Government made preparations for a 'no deal' Brexit by securing warehouse space and stockpiling certain medicines. Minister, what role, if any, will those measures play in preparing for a wider scale outbreak?

And, finally, Minister, there have been reports that the SARS COV-2 virus will impact the availability of pharmaceutical ingredients coming out of India. This supply chain is vital to the generic medicines trade, so what discussions have you had with the pharmaceutical industry about the best ways to mitigate any threats this virus will have upon the supply of pharmaceutical products? Thank you.  

Photo of Vaughan Gething Vaughan Gething Labour 3:14, 10 March 2020

Thank you for the comments and questions. On your questions, there is already an NHS team that is taking—. There was an announcement—you might have seen publicity on it yesterday—in terms of some of the points about search engines and which terms are going to come to the top of those outcomes and results to make sure they're from trusted sources, but also in terms of trying to rebut on social media some of the more lively conspiracy theories but the range of information and misinformation that is in the public realm, and that is a real problem for us.

Our 'no deal' preparations will actually stand us in relatively good stead, both in terms of stakeholders who have a range of measures to deal with interruptions in their supply, but also the warehouse you mentioned. We actually purchased that, and so we do have some additional resilience. But the challenge comes, like you said in your question, about generic medication. We need to be upfront about what we can do, but also, if there are steps that we can't take, to be clear that we can't take those steps as well. So, we're looking for intelligence from the pharmaceutical industry itself, which manufactures and imports those medications, to understand if there are risks to supply and if there are alternatives or not.

And I think the final point I'd make is that, with the low-level flu that is relatively circulating here, with the low level of people who have coronavirus in Wales today, we expect that over the coming days more people will be diagnosed with coronavirus. So, the relatively low number of cases today should not be taken as a sign that this is nothing to worry about and there's no need to do anything about it. This is a real concern. There is already community transmission in some parts of England; that will take hold in other parts of the country.

So, we have to absolutely understand we will have more coronavirus cases in Wales; there will be people who will become unwell. What we can't anticipate exactly is how many people that will be and the impact that will have upon our services. This is not like another mild flu season taking place out of winter. We don't have a vaccine for coronavirus, COVID-19; we don't have effective antiviral treatment. So, if this circulates widely, it will have a real impact on the health of very many people who are already vulnerable. That is why we're taking it so seriously; that is why we're taking extraordinary steps; that is why there is so much co-operation between four Governments who would otherwise have plenty to disagree about at the top of their agenda.

Photo of Ann Jones Ann Jones Labour 3:16, 10 March 2020

Thank you very much, Minister.

Item 6: the Regulation and Inspection of Social Care (Wales) Act 2016 and Regulated Services (Miscellaneous Amendments) Regulations 2020, and item 7: the Social Care (Wales) (Specification and Social Care Workers) (Registration) (Amendment) Regulations 2020. I propose, unless any Member objects, in accordance with Standing Order 12.24, that the following two motions are grouped for debate.