We now turn to spokespersons' questions, and the first this afternoon is Plaid Cymru spokesperson, Rhun ap Iorwerth. 

Diolch, Dirprwy Lywydd. Some questions initially on preparations for an increased intensity of outbreak, and it's important to put those preparations in place. We know from international experience that critical care capacity could become very, very important here. I've been looking at some figures today that show that critical care beds per 100,000 people in the UK is low, compared with global standards, and in Wales it is certainly much lower than in England. Both I and Adam Price asked yesterday what has been done to ensure that we are increasing capacity. I'm not sure that we had the answers that we wanted yesterday, so I'll ask again: what is being done now to make sure that capacity is being increased as much as possible, because current capacity is not going to be enough? I accept that there may be a different nature to the kind of capacity that we will need compared with normal times, but I think it's very important that we have a description from Government of what exactly is being done to make sure that we increase capacity in this very, very important area. 

I recognise the broader point that's being made. The relative levels of critical care capacity across the UK are lower than other European countries; that's true. I don't think now is the time to try to get into any of the funding or other challenges that we might have in a normal period of politics; it's really what we can do now to improve the capacity that we have, for what we expect to be an influx of really sick people who are coming to our health service and need care. And, so, yes, we are already planning what is possible, both in terms of the staff that we have, the staff that we need to protect, in terms of their welfare and well-being, because if we do see significant absences across the economy and public services, that will affect the health service too. We're also needing to think about what else is possible, even if it isn't what we currently recognise as critical care in the way that we provide it, and what that means in terms of redeploying staff. That also means switching off other activity within the health service. So, this isn't a simple matter of flicking a switch and we automatically double our capacity; it's actually about how much we can change within the service; how much we can redeploy our staff, and then what we do to, as best as possible, meet those other healthcare needs. And, as I've said, that may mean treating people in their own home in the coming weeks or months, when we would today expect them to be admitted into a hospital.

Now, I'm not in a position to share direct and detailed plans. I'm working through the detail of those plans and the instructions we'll need to give the health service of what those plans would be. We've worked through them. I met medical directors from across Wales on Friday of last week. I met with royal colleges from across Wales last week as well, and so, we are deliberately drawing together people that need to be there to make those choices. As soon as we do have a decision to make, with the plan to go with it, we will, of course, share that information. And in the way that I have already briefed, not just the Plaid Cymru, but also the Conservative health spokesperson, we want to continue to make clear what those plans are, and the detail of them, and to be able to share information on a trusted basis, as well as being able to provide public information for everyone to see and hear. And that, of course, will involve not just members of the health committee, but all Members across this Chamber. I fully expect to be making weekly statements on the position in relation to coronavirus for the foreseeable future.

The Llywydd took the Chair.

Capacity will be needed in other areas too, below critical care. I fear the loss of community hospitals will be something that we rue, somewhat, in coming months. We will perhaps need to build capacity for isolation, for example, and I can relay to you the offer made by one hotel owner, for example, offering a hotel to be used, perhaps as somewhere where people can be isolated. Are there plans to create that kind of capacity within the system—perhaps turning to hotels, or other locations, or even to the army too. Because there is capacity that can be built within the military when it comes to isolation.

We're considering all options. And that's both part of our pandemic influenza planning that is being stepped up; it's also part of what local resilience fora are looking at, to consider what takes place in each of the four areas. And that involves not just devolved public services, it of course involves the regular relations we have together with non-devolved services. So, for example, the police are involved in each one of our four local resilience fora as a matter of course, in terms of that emergency planning and delivery response. We are also, of course, considering the potential role the army may have to play. But it comes back to what role is required, and who is best placed to serve that. So nothing is ruled out—certainly—in terms of the provision we have, and, as I said in answer to your first question, how that meets the need we expect to see coming through the health service and other public services, and where are the right places to try and increase that capacity, and, equally, the activities that we recognise will need to be delayed and put off for a period of time, and that, of course, depends on the length and severity of the outbreak.

And a short collection of questions, just to finish off. We know that Italy reached the point where they needed, or felt they needed, a nationwide lockdown. I'd appreciate just an idea of the kinds of plans that are being put in place, initially perhaps, for local lockdowns, and what preparations are being made for that.

Secondly, on 111, and the telephone triaging that is going on at the moment. I've contacted your office today with a specific concern about the parents of a constituent of mine who have returned from a cruise, contacted the triage centres on telephone—as they were instructed to do—were told, 'No, you're not in a risk category.' Others who were on the same cruise, I am told, have since been diagnosed as having COVID-19. You can imagine, therefore, the concern of my constituent and her parents. She can't visit her parents, because she suffers from pneumonia herself. So, again, it's a portrayal of the wider problems here. So how can we be sure that the telephone triaging isn't missing people who actually perhaps should be in a higher risk category? These people had said, 'Listen, we think we are at risk', and they were told that they were not, and they think that now they should be tested. I'll wait for a response from your office on that.

But also, we're still hearing from people who are saying they've tried to contact 111, and have been, for example, guided to a website, which tells them, '111 isn't available in your area.' Will you gather data on the use of 111, failure to connect to 111, and on how many people who do try to use the services—as they rightly should—are either not getting through, or are being sent to other websites, which are just not able to help them?

There are real, practical questions there, and I'm glad the Member managed to raise some of those with my office earlier today. And I would encourage any other Members, from any party, who have similar experience with constituents, where they're not sure about the advice they're being given, or they've been directed to the wrong part of the system, to raise those with my office. Because I want to make sure that they're resolved sooner rather than later, because we may well see more use of those services in the coming weeks. Some of that has come because people have been directed and gone to the wrong 111 service—so, the 111 service in England, where it says it's not available in your area. So, the 111 telephone advice service is available in every part of Wales. There is a symptom checker available on the NHS Wales Direct website. We want to try to ensure that people are using the service that we have set up and created and want to minimise the risk of people going to a different service over the border that may not direct them to the right path for their help and advice. But I don't want to lose sight of the experience that people do have of using the 111 service, and, as I say, I reiterate to them that I'd ask Members from all sides to contact me if they have the sort of experience you've described.

On the point about how and when people should be tested, it comes back to people following the advice and the guidance they're given. But I have asked again for some clarity to be reiterated, because we've seen some headline instances of people who are, for example, on cruise ships coming back, what happens to them, if people are symptomatic when they return, and to be clear, that the advice is consistent and isn't confusing for members of the public. So, I am taking the opportunity to do that, and will be able to reiterate that with the regular information that Public Health Wales provides and I'll also make sure that that advice is circulated specifically to Members.

But on the sorts of things that might happen, or might be required, I think we need to look at the circumstances in each country. We can learn, of course, from different countries' experience. And Italy, they're a European country we have links with, with a developed and modern healthcare system. There are parallels there for us to look at. Seriously, there are some differences, though. They have an older population than Wales does as well that may explain some of the challenges and the numbers they have coming through. But certainly the experience there of them finding that their health service is effectively overwhelmed now, well, part of that journey is how early and when we take action, because timing is really important, and that's been the advice from our own scientific advisers to all four Governments in the UK and indeed our four chief medical officers.

The danger is that if we act too early, it's the point that the First Minister made yesterday about the level of compliance if we ask people to act again. There's also a danger that we depress the peak of the coronavirus outbreak and we have a second peak later on, rather than being a wholly effective measure. There's also the risk that if we time it too late, then we could effectively bolt the stable door once the horse has bolted, because actually Italy is now in a position where it looks as if there's significant community transmission. And the value then of taking really restrictive measures, our scientific advice doesn't suggest that that's an effective measure at that point.

And it comes back to the difficulty that Ministers have to stand up to and recognise in making choices and advising the public, and that is about following the evidence and the best scientific advice about what we should do and the choices available to Ministers to make, rather than looking to have something that, from a communications point of view, may look as if we're making big and difficult choices and showing how seriously we're taking it, but may not actually be the right thing to do both to depress the peak of the coronavirus outbreak to allow services to recover and cope, but equally to make sure that we resolve and reduce, as far as possible, the potential mortality of the coronavirus outbreak.

And I would not want to be in a position where I've taken a series of actions that may look as if we're doing something that is gripping the situation from a public point of view, and subsequently find out that actually it was the wrong choice and our mortality rate may be higher at the end of it, and that is not a choice that I think I could live with. 

Conservatives spokesperson, Janet Finch-Saunders. 

Diolch Llywydd. Of course, spokespersons are to scrutinise and challenge you, Minister, and I've done my fair share of that over the past few years. But I would like to put on record my thanks to you, as our health Minister, for the hard work, obviously, going on behind the scenes and the plans that you are putting in place and also for keeping us, as Members, updated and keeping the public informed. I felt that that should go on record, thank you. 

Now, coronavirus is most significant amongst older people and people whose immune systems are already compromised. These people are to be found in greater concentrations in residential care, nursing homes and in the domiciliary homecare setting. The seriousness of the threat is clear when considering the care home near Seattle, where there have been more than a dozen deaths and all the home residents now are confined to their rooms.

Last week, the First Minister advised that the Welsh Government would do more to provide advice to the social care sector. Care home residents are worried, care home providers and those delivering domiciliary care are worried. There is talk of issuing guidance, encouraging friends and relatives not to visit people in care homes until the risk of contracting the disease is more manageable. What steps will you be taking to support care home residents and reduce the risk of them contracting the virus? 

I thank Janet Finch-Saunders for that question and she's absolutely right that older people, and older people with complex health needs, are at much greater risk. And so we want to do all we can to protect them as much as possible, and we are working very hard to do that. The director for social services and integration is taking the lead in the Welsh Government. We're liaising very closely with the local authorities, which are obviously very close to the care sector, and we have got a lead director appointed to look at this subject. The lead director is from Powys. We've set up a working group that is looking at all the sorts of issues that she raises. There has been guidance already issued to the social care sector. It's guidance that is joint with England. So, it is the same guidance, but we are looking to produce another set of guidance, which will be done by a working group with all the people involved.

Thank you. One in 17 adults in Wales work in the social care sector. The United Kingdom Homecare Association has advised that it is important for social workers to understand that home care visits could take much longer than the usual expected time whilst dealing with people who are unwell, and warn that the situation was potentially extremely serious, particularly with regard to having sufficient staff to support older and disabled people in community settings.

Similarly, I have received an e-mail that highlights concerns that one infected domiciliary care worker could potentially unknowingly carry the virus into the homes of countless vulnerable older residents. Therefore, will you explain what steps you are taking to assist our care workers to reduce the risk of contracting the virus? What emergency measures will be taken to protect vulnerable individuals receiving home visits, and state what support will be provided to social care providers to help them find replacement staff, should some employees have to self-isolate? And a question I have is: are all 15 cases of coronavirus that have been identified in Wales actually designated as COVID-19? [Interruption.] Well, coronavirus covers a—.

Yes, I believe they are, answering that last question, yes.

If you look at the social care sector, there's a wide variety of issues that arise: there are the people who are living in residential care or in nursing homes; there are those people who are receiving domiciliary care, and then these are the staff who are going in, who Janet Finch-Saunders has referred to. And it's obviously crucial that we address all of those issues, about what is to happen if anybody in any of those groups becomes infected and how we deal with the whole situation. So, for that reason, we have set up a social care planning and response group, which includes local government—because, as I said, we're working very closely with local government—it includes the Wales Council for Voluntary Action, because it’s absolutely crucial, I think, that we work very closely with the third sector in addressing all of these issues, because the third sector may be very close to some of the communities that we are talking about, but also the third sector does have many volunteers who work there and who I'm sure would be willing to help us in this situation, if it does escalate. And it also includes Care Forum Wales, which, again, is a very important body to work with. So, we are working with all those bodies and what we want to do is to come up with another set of guidance, which will address those very important issues that she has raised.

Thank you. I think my next question is more directed to the health Minister. Sadly, there is good reason to be concerned too about front-line health staff. I've received correspondence from a Welsh general practitioner who has highlighted a lack of personal protective equipment and masks for front-line staff, but also people such as receptionists, nurses and housekeeping staff. He has rightly explained that there are not enough of them to be able to self-isolate, if there may have been possible exposure, and to still cope with the amount of pressure on our health service. What urgent action will you take to ensure that every front-line member of staff receives and uses the personal protective equipment as directed?

Well, I think the health Minister did, in his earlier response, say that these were going to be provided. And certainly this is an issue that we have discussed within the Government, but it's obviously a very important point that we are taking very seriously.

The Brexit Party spokesperson, Caroline Jones.

Diolch, Llywydd. Minister, Dr Andrew Goodall told the Public Accounts Committee on Monday that he's very disappointed that three of Wales's seven local health boards are millions of pounds in deficit. Do you share his disappointment that Betsi Cadwaladr, Hywel Dda and Swansea Bay are forecasting a combined deficit of over £92 million for 2019 to 2020? Betsi Cadwaladr is predicted to be £41 million in the red; Hywel Dda not far behind with a £35 million deficit. My own health board, Swansea Bay, will be £16.3 million in deficit, and that's enough to employ around 465 radiographers. Minister, why can some health boards break even and others rack up massive deficits?

Well, the issues are different in different health boards, and of course I'm disappointed, not just at the failure to meet the target, but about the extent of that failure between different health boards themselves. In Hywel Dda, you'll know that we've undertaken a series of interventions and reports around their challenge and the opportunities for them to improve. It should, though, be said that on a performance end, Hywel Dda have made real improvements over the last few years. So, they are in a better place in performance terms, whereas in Betsi Cadwaladr, they haven't had the requisite grip and the control in terms of both performance and finance. So, whilst Hywel Dda health board can put their performance figures in a positive way, it's not quite the same story in north Wales, and you'll notice that both of the previous finance directors are now no longer in post. There's a recovery director who is having an impact on the financial discipline within the organisation, and, of course, there is now an interim chief executive following the change in leadership. And in terms of Swansea Bay, the disappointment is tempered with some optimism, based in reality about the future, and, again, the list of opportunities they have to improve the financial running.

There is one point that I think I need to make on a general level, and it is that if coronavirus is anything like as significant as we think it is, then the normal way of operating the health service will change significantly. So, the normal way that we want to hold organisations to account within the Government and within this place will have to change. I cannot expect the health service to behave in a radically different way in prioritising significant numbers of really sick people coming through the doors, if I'm then also saying, 'I want you not to lose any sort of progress on referral-to-treatment times, and I want you to try to make sure that money is being spent in a certain way.' Now, there'll be some points about financial discipline and opportunities to save money that will still exist in a way that doesn't harm the service, but there will need to be a sense check about what will really happen, and then what will be the longer term consequences if we do have a significant outbreak, on both resources, the overall pledges the Chancellor has made about the NHS having whatever resources it needs, and what that means in broader performance terms for the health service then to try to recover and catch up on.

Thank you for that answer, Minister. Of course we all have to live within our means, but we can't just cut funding to health boards without impacting upon patient care. Take the new medicines fund, for example: the Welsh Government funds novel treatments for the first 12 months, and then health boards have to find funding for future years. So, what assessment have you made of the impact that this is having on local health board finances? And we also have to account for known unknowns, as you've already said—the coronavirus. But also, for example, the impact winter pressures will have on services throughout the rest of the year. And this year we have the added unknown of the impact that COVID-19 will have on services both planned and unscheduled. So, Minister, how resilient are NHS finances, and what steps are your Government taking to ensure financial pressures do not impact patient outcomes? Thank you.

Well, I think there's a broader point here about financial improvement across the health service in the last three or four years. I took a particular choice, on taking on the Cabinet role, that I would make sure that whilst we make sure the bills are paid—so that patient care is not compromised, that staff don't have to worry about whether they're going to get paid in the last two months of the year—we would highlight the reality of performance of each organisation, so rather than trying to find a new way to inject money into the system towards the year, as we were often accused of doing, we've been really upfront about the financial performance of each organisation. That greater scrutiny and accountability, and some of the very direct conversations that I have had, and that the chief executive of NHS Wales has had, I think have seen a real improvement. Even at the start of this Assembly term compared to where we are now, we are definitely moving in the right direction, but there is still more to do than I would wish there to be.

But in terms of the new treatment fund that you referenced, it's been a great success. The reason that we introduced it was because there was inconsistency across Wales when new treatments were introduced and available. They're available at different points depending on which health board you were served by, and some of the challenge is not just the consistency but the timeliness of that—it could vary significantly across Wales. They were supposed to be introduced and available within 90 days, and some health boards were not able to do that on a regular basis. 

We knew that there was a particular problem in the first year of introducing new treatments, and the ability of health boards to have new treatments come onstream during the financial year and to plan effectively for them, and that was why they were introduced in such an inconsistent way. So, the new treatment fund has levelled that out so there is now a consistent service. And rather than being over three months, people expect new treatments to be available within about two weeks. So, there's a really significant intervention with, in health terms, a modest sum of money, but a really impressive and consistent outcome. I'm very proud of the action that this Government has taken to do so.

Question 3—Janet Finch-Saunders.

I think I've got—

Okay, you're not ready to ask your question.

Question 3 [OAQ55201] not asked.