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

Thank you, Llywydd. We continue to see, as expected, an increase in the number of confirmed coronavirus cases in Wales. Sadly, we have also seen more deaths. My deepest sympathies go out to those families who have lost loved ones and my thoughts are with those who are still critically ill.

These are truly extraordinary times. However, the response from across our public services has also been truly extraordinary—extraordinary to help protect our communities and to save lives. People are working tirelessly to respond to this public health emergency. That work matters for today, tomorrow and our preparation for the weeks ahead. I am grateful for and genuinely humbled by the contribution of each and every one of those people to this national effort.

The Welsh Government, the NHS and social services organisations already have existing plans in place for a potential flu pandemic. That plan provides us with a solid base to build upon, and those plans are now being put rapidly in place. NHS organisations are working to increase the capacity of local services, beds and workforce availability. To put this into context and demonstrate the scale of this work, our health boards will have, in effect, created the equivalent of up to 7,000 additional beds with the plans they have in place for field hospitals or Nightingale hospitals—essentially, step-up and step-down care. That is, effectively, double the number of existing NHS beds. That is exceptional in any circumstances and it's been created over a number of days.

Significant announcements have been made over the last week, as Members are aware. For example, I approved £8 million to enable Cardiff and Vale University Health Board to work with partners, including the Welsh Rugby Union, to convert the Principality Stadium into a field hospital with up to 2,000 beds—that's twice the size of the University Hospital of Wales here in Cardiff. That is in addition to the extra capacity that is being created on the health board's hospital sites that exist.

Hywel Dda University Health Board has well-progressed plans on a range of sites, including Parc y Scarlets—as we saw on ITV Wales news last night—a range of leisure centres across Carmarthenshire, and Bluestone in Pembrokeshire. Swansea Bay University Health Board has, with its two local authorities, identified leisure centres and the Bay Studios in Llandarcy. These are all in addition to the 350 beds that will be available at the new Grange University Hospital from April. And we know that north Wales has already identified Venue Cymru as one of its sites, with more to be confirmed in the days ahead. So, all health boards are developing equivalent capacity plans and specifications for a distributed model of additional bed capacity across Wales.

On critical care, we have already more than doubled the number of beds in Wales to 313. As of yesterday, occupancy of critical care units was about 40 per cent. Sixty-nine per cent of those people occupying beds either have suspected or confirmed cases of COVID-19. We will continue with the rapid expansion of critical care bed numbers, which will be supported by the purchase of over 965 additional ventilators, with further options to purchase or manufacture ventilators being urgently explored.

I know that there are, quite understandably, continued concerns about the availability of personal protective equipment. Over the weekend, more than 600,000 additional FFP3 respirator masks were delivered to health boards for onward transmission to primary, community and hospital sites, as well as commissioned services, such as independent mental health hospitals and hospices. Further deliveries of PPE were also made on Monday and Tuesday of this week to the local authority joint community equipment stores for directors of social services to distribute within the social care sector. We have now deployed, from the Welsh Government pandemic stocks, more than five million pieces of PPE for use within our health and social care system.

The delivery to the joint stores is sufficient to enable each of Wales's 600-plus care homes to be provided with enough PPE to cover 200 individual interventions. A telephone and e-mail contact has been set up for the NHS and social services to use in an emergency if PPE supplies have been disrupted or there's been an unforeseen or unplanned surge in use. This is the point the First Minister referred to in questions earlier.

Whilst we face an unprecedented time and increasing demand on our health and care services, the response from our workforce has been humbling. We have and will continue to be innovative in meeting the demands placed upon us in the fight against COVID-19. A week ago, we asked our newly retired nurses and doctors to come back to the NHS and they have responded in their numbers. Already, over 1,300 health and social care professionals have responded to that call to return and serve the country.

Our students are also keen to support us. We're exploring ways to harness the energy and commitment of up to 3,760 medical, nursing, midwifery, allied health professional, paramedic and health scientist students as well. Working closely with NHS Wales Shared Services Partnership and Health Education and Improvement Wales, we've been able to make progress at this unprecedented time. And each of those students who undertake an offer will be paid in accordance with their time—it won't be a voluntary service we're looking for from those people. 

We have more than 1,200 GPs on our locum register in Wales, and we'll be asking all GPs to consider what further time and capacity they have to offer. That is why we're asking all locum GPs to consider a temporary contract with their health board. Their expertise can help in so many ways in community and primary care.

These are extraordinary times that have called for extraordinary measures, but our uniquely Welsh approach to working in partnership is helping us to make a difference. The COVID hub Wales will be released later this week to support our extended and evolving recruitment solutions across the health service.

To ensure that our primary care services remain as resilient as possible, through the increased demand upon them, we've made significant changes to the way that GPs and their multi-professional teams, pharmacy teams, dentists and optometrists provide care to patients across Wales. The changes that I have agreed are designed to respond to people with the most urgent needs, whether related to COVID-19 or not, and to of course minimise the spread of COVID-19. 

We are asking providers to work collectively in their communities to deal with this situation and I am pleased that our stakeholders are supporting this approach. I encourage everyone to follow the advice that has been issued on how to access services during this time. I am grateful to our primary care and social care providers for their continued efforts during this situation.

There are approximately 81,000 people in Wales identified as being at very high risk of severe illness from COVID-19. This week, each person will have been sent a letter from Wales's chief medical officer. It may not have arrived yet; we're waiting until the end of the week for all of those letters to have arrived. The letter includes clear advice to stay at home for at least 12 weeks. The Welsh Government is providing a further £15 million to ensure that people in Wales who are not able to leave their homes will get direct deliveries of food and other essential items to their door, and that was a point covered in the First Minister's statement and follow-up questions. 

My cabinet colleague, Lesley Griffiths, has led on our conversations with supermarkets and wholesale suppliers to agree both supply and delivery for this group of shielded people in a very short period of time. Julie James, as you would expect, is in daily contact with our local authorities. And I really am tremendously grateful to the local government family for the way that they have responded to both lead and co-ordinate community efforts to support people in their own homes. 

So, considerable progress has already been made across our health and care system. It would be easy to forget that all of this has been achieved within just a matter of weeks, and in some cases just days. The work of our public servants and our volunteers is, I believe, truly inspiring. It is vitally important that we use the weeks ahead to put further preparations in place. But these will only be as effective as they could and should be if each of us adheres to the social distancing measures that we have introduced. Stay home, protect our NHS, and save lives. 

Minister, thank you for your statement. In fact, I think that's a very good reminder right at the end. On 1 March, who had any idea that we would be in the situation we are today? Therefore, I really want to add my thanks and my congratulations for the 7,000 additional NHS beds that have been created. I think that's outstanding work on behalf of or by the NHS and by all those partner organisations, from the local authorities to the many organisations that have come behind and offered space. I think 7,000 is a really quick and easy number to say but, my goodness, when you think about the logistics behind that, I really do congratulate all of them for pulling that together. 

In your statement, Minister, you go on to talk about PPE, and I am going to have to return to this issue, because it is probably the issue that I have the most contact—or one of the most contacts—from people over. I do think that, in the initial days, there's been a lack of clear communication to people about when and who should use PPE, and I think that this situation has now got even muddier. I understand the scientific advice, which is that if you're dealing with somebody with COVID-19 symptoms then you wear PPE, and depending on where you are in the chain of people who are dealing with somebody who is ill with COVID-19 depends on that type of PPE that you will wear. 

But I think the issue, Minister, is really that this is a scary disease; that people are willingly putting themselves in harm's way to help the rest of us; that we know that 30 per cent of the people who have COVID-19 will not show any sign of having symptoms; and we know that about 80 per cent of the Welsh population will have COVID-19 at some point or other. So, I totally understand the concerns of the district nurses, of the midwives, of the morticians, as well as those of the people who are on the front line as we recognise the front line, in other words, on acute wards.

So, please can you perhaps come back and tell us how we're going to get this PPE? When is it going to be available? How clear a guidance are you going to be able to put out there so people understand who should use it? And do you actually foresee a situation where we accept that, if you are dealing with the public, you are going to need to have some form of PPE, whatever that is?

So, for example, a domiciliary care worker may be looking after 10 very vulnerable people and, on his or her travels through those 10 people, they could unwittingly be spreading the disease without knowing it, because we don't know how it manifests itself in everyone. So, I just think that, on the subject of PPE, this is an issue that we haven’t yet got to the heart of. Are you able to tell us how much PPE we need, how much PPE we've got, and whether or not you'll be able to source it at the appropriate times for this situation to move through?

I'd also like to raise two more questions, Llywydd. The first is: now we have a UK-wide approach to procurement, are you able to tell us what kind of data Welsh Government is needing to feed into the UK Government? Do you have a really good handle on the forecasted need for equipment such as ventilators, PPE and testing kits? And are you able to share the clear numbers of where we are now and where we need to be?

Finally, Minister, I understand that ethical guidelines are being drawn up to help doctors prioritise patients for hospital admission and treatment. I understand and have huge sympathy for those doctors, because these are tough decisions for doctors to make, working in stressful decisions, but they are decisions that need to be made fairly. Can you confirm, Minister, when those guidelines will be available? And can you confirm that the Welsh Government has heard the rights statement issued by the Older People's Commissioner for Wales, Age UK, Age Cymru, Age Northern Ireland, and the Commissioner for Older People for Northern Ireland, among other people?

Because I truly believe that the fact that someone is in need of care and support and is currently in a care home or in their own home should not be used as a proxy for their health status. Do you agree that to make such decisions without considering either older persons' needs or their capacity to benefit from hospital treatment would be discriminatory and unfair? And, Minister, will you ensure that vital end of life palliative care and do not resuscitate and do not attempt cardiopulmonary resuscitation conversations are undertaken in a respectful, compassionate and informed manner?

Will you undertake to provide guidance on this issue? Because I have been approached by many older people and disabled groups who are feeling under enormous pressure to sign up for things that they haven't had a conversation about and don't want to sign up to. Everybody has rights, and everybody wants to try to beat this awful disease.

Thank you for the questions. On the 7,000 extra beds, I'm delighted that the health service has been able to undertake this work in the most difficult of circumstances, and also the response from partners. I think it's entirely appropriate that Angela Burns has welcomed and recognised that too—the local authorities family, wider partners and, of course, the support that we've now been provided with by the army in recent days as well. So, it is a real national effort and it does show what our committed public servants are capable of in times of crisis.

I'll deal with your points on PPE. In terms of our stocks, we're releasing our pandemic stocks that we have built up. The need for the amount of resupply rather depends on the outbreak, and because we can't accurately forecast when the outbreak will end, we can't accurately forecast how much we'll need. But we know we'll need to resupply at several other points, and I've had conversations with the other Cabinet Ministers for health in the other three national UK Governments. We spoke on Friday and again yesterday, and we'll be talking again tomorrow. But at each point in time, each of us have made points about the need to have a UK mechanism to procure and bring in a supply of personal protective equipment into the UK and then for a properly equitable distribution to each of the four nations, and there's agreement on doing that. That's another point that myself, Jeane Freeman and Robin Swann have made and I'm pleased to say that Matt Hancock has confirmed that he agrees that is exactly what should happen.

On the guidance that you've mentioned, there's a real challenge here and I recognise the point you made over the fact people are worried. People are concerned whether they work in health and social care or not. There's an issue about the trust in the guidance as well. Part of our difficulty is there's been widespread demand for PPE in any and every setting, and the revised guidance that is being undertaken, there's a rapid review of the guidance, so all of the chief medical officers across the UK are sighted on it, there's been a range of—. All of the medical royal colleges have contributed and front-line staff too, and that's been important, because there appeared to be a loss of confidence in the guidance and in the way that guidance was being implemented. I expect that rapid review to be available imminently and, when it is, the important point for Governments is to be able to not just confirm what that guidance is to staff, but both who does need PPE and what form of PPE, but also for those people that don't need it. And it's really important that that guidance will deal not just with the settings and the tasks that people have for appropriate PPE, and that's the place it should be provided, rather than whoever happens to employ them, and it will then be our task to make sure that the supply actually matches that guidance.

On ventilation and testing kits, I've given some updated numbers in this statement. Again, we're taking part in UK-wide procurement mechanisms as well as some of our own procurement as well. And the challenge, again, about what do we need, that will be partly about the progress of the pandemic, but I'm happy to continue to give updates not just in the conversations I have with health spokespeople, but in public as well, and to the mini Senedd as it meets, and the people of Wales.

And your final point on ethical guidance, I agree with you that there has got to be a proper decision-making framework to help our staff to make really difficult choices, and it can't be telling people that you need to get out of the way because you're no longer valuable; that is exactly what should not happen. I am happy to say that, today, the Royal College of Physicians have published some guidance for doctors to look at and consider, and that's been done together with 14 other royal colleges and other medical faculties as well. So, that's been published publicly and we'll be re-providing that, making sure people have it, and I'll happily undertake to make sure that's circulated to all Members to see as well.

I'm grateful to the First Minister for confirming the identity of the company involved in the collapsed deal. I was wondering, Minister, if you'd respond to the statement, therefore, that Roche put out last night that it does not have and has never had a contract or agreement directly with Wales to supply testing for COVID-19. Is it your view, therefore, that that statement isn't true, they would have known it wasn't true, and they're effectively lying?

Now we know the 'who' in relation to this collapsed deal, but we're still a little bit unclear about the 'why', so I was wondering if you could say a little bit more about that, your understanding as to why the deal collapsed, and particularly this widely held suggestion that, effectively, it was scuppered by a parallel deal with Public Health England, which the company chose in precedence over the deal with the Welsh Government.

In relation to the new four-nation arrangement for testing procurement, there has been a reference to Wales receiving a population share of tests, I understand. But shouldn't that be higher given the particular demographics of Wales that you, Minister, have referred to previously, and also the epidemiology, the fact that Wales has 4.7 per cent of the UK population, but 8 per cent, I believe, of the current confirmed cases, therefore shouldn't we be getting 8 per cent of the tests?

Will you be publishing a daily figure for the number of tests undertaken as Scotland does, so we can track progress as we move forward? And also, the question that I put to the First Minister, I was wondering if you could address: has the Welsh Government approached the Welsh universities or have the universities approached Welsh Government to see if we can use the scientific expertise within our laboratories there to actually improve our own testing capacity in Wales? And do we have a figure—? We have a figure, I believe, for the number of tests that have been conducted with NHS staff. Do we have any figures about the degree of confirmed cases as a result of those tests? How does that compare with the general population?

Moving on to PPE, you refer to some of the numbers of items that have been sourced and supplied. Do you have, Minister, an idea of the number of total people that currently you're advising require PPE? It would be interesting to see, if you have figures, just to have some sense of that. I noticed that, just today, the Basque co-operative Mondragon has just announced a new production line to manufacture 0.5 million masks a day. Will you be approaching Welsh manufacturers to see whether we could manage the same here in Wales in order to improve our own level of supply?

Just finally, on the issue of local authorities that I touched on as well, I understand the advice to local authorities is not to procure their own PPE independently, but are they free to do so if they feel that that is necessary?

Okay, just to pick up on that final point first, there's no legal bar to a local authority going off and procuring an alternative source of PPE. We're trying, though, to have a co-ordinated approach to the acquisition of PPE and then its transfer across Wales.

In terms of manufacture and supply of not just PPE but other items that will be useful in the response, we've had a significant amount of inquiries, offers of help and interest, and that's now being channelled through a consistent team in the Welsh Government. There's co-operation between my officials and Ken Skates's officials to make sure that we're getting to the right people to support businesses in Wales, but also to understand the potential procurement issues. Now, part of that is actually about understanding the value of the offer that's been made, because you'll understand that whilst lots of people may make an offer of support that, on surface level, looks impressive, we need to make sure that people can deliver what they're saying they can deliver and that that's actually going to be effective.

In terms of your point about the requirements for PPE, well, that will really depend on the revised guidance as to the amount of PPE that we need. If the guidance changes, either about the type of PPE that is to be worn or the variety of settings and tasks for which it is to be worn, we'll need, obviously, to acquire more PPE. The acquisition of PPE will need to reflect what is in the guidance, as I said in response to Angela Burns.

In terms of the written agreement that we had, I just don't think it's at all helpful for me to get into a war of words with a company, when, actually, my job, I think, is to make sure that we are diversifying our supply and our capacity for testing, and making the maximum use of it to provide the maximum benefit. That's what I'm focused on, so I'm not going to get drawn into matters that I'm sure, in the months ahead, when we're past this, we'll want to look at in much more detail.

That's why I was able to announce on the weekend that we've diversified our capacity to increase it this week, and in the next two to three weeks, to get it up to about 5,000 tests here in Wales, not relying on any share from UK-wide arrangements. In that deliberate diversification of supply and capacity, we have, of course, been having conversations with universities for some time about where they may be able to help to provide that.

In terms of what is a fair share from the UK-wide picture, we signed up to arrangements, as indeed have the Scottish Government and the Northern Ireland Executive, to try to acquire the maximum amount of capacity possible across the UK. Now, we may start from a population share, but, actually, I think when you look at what is a fair share and what is capacity, I'm confident we'll flex that as it's required across the UK. Wales and our share and our need today may be very different in three weeks' time, when other parts of the UK may have greater need, and that's the point—how we have our ability across the UK to provide increased capacity and to meet the needs of people right across the UK, and to make sure that we get our fair share of that.

In terms of your broader point about updated numbers for testing and staff, we'll be providing updated numbers throughout the weeks on the numbers of our front-line staff who have been tested and those who have been able to come back to work, and those who are confirmed. I don't have the numbers with me, so I won't try to make them up for you, but we will be providing more clarity on what our testing regime has produced.

We're obviously in a better position than some other parts of the UK because we started testing front-line staff at an earlier point in time. So, there are already some of our front-line members of staff who have returned to work promptly because they had the right diagnosis, and we'll continue to do that. We'll be transparent with the public about the numbers of people doing that and what that means for our public services. 

Thank you for your statement, Minister. There has been much criticism about the lack of testing in Wales, and comparisons are being made with other countries. I won't rehash the arguments about the failed deal to secure additional testing for Wales, but what assurances have you received from the UK Government, and the other home nations, that we are not competing for the same limited supply?

South Korea is cited by the media as an example we should be following. South Korea did not start, though, from a standing start because they already had significant testing facilities prior to this outbreak due to ongoing issues with SARS. Minister, have you discussed with nations outside the UK, such as South Korea, the best way of ramping up our testing regime? Other nations, such as Germany, are also so far ahead because they have the lab capacity, which is why the test for this new coronavirus, developed in German laboratories, is being used around the globe. Minister, I accept that increasing testing is not just about buying a stock of reagents: we need personnel to collect samples; a vast logistical network to move the samples; trained lab technicians to conduct the test; and IT infrastructure to collate the results. We are far behind where we need to be. Minister, can you outline the discussions you have had with the pharmaceutical sector in Wales regarding their role in supporting the fight against coronavirus, and can you also outline the steps the Welsh Government are taking to ensure we can meet not just the immediate testing needs, but also for future demand? This is a global pandemic, and we are facing a new, mostly unknown, virus so we do need a global response. Can you outline how public health officials and researchers in Wales are working with other nations to tackle this new viral threat?

Minister, we have all received a letter from the British Medical Association regarding issues surrounding the vulnerable patients lists. Yesterday, I was contacted by a constituent who is vulnerable but not on the extremely vulnerable list, to their knowledge. This constituent has, for many years, relied upon deliveries of food and medicine, but is now unable to do so because they are not on the Welsh Government list. According to the BMA, GPs cannot assist patients as they do not have access to the lists of patients. So, Minister, what steps are you taking to ensure our constituents are not faced with a choice between starvation or possibly contracting the disease, which has a strong chance of being fatal because of their health conditions?

Hospitals are being erected in days and people are lining up to help in any way they can, but there has been some confusion regarding ways to volunteer in Wales following the publicity surrounding the GoodSAM launch in England. So, what steps are you taking to ensure that everyone in Wales who wants to help in the effort to combat this disease can do so?

Also, Minister, in the last few weeks, universities, industry, and the maker community have been developing novel methods to produce everything from face shields to ventilators, and new CPAP machines have been developed and automated bag valve masks have been trialled to ensure ventilators can be reserved for the more serious cases. So, what discussions have you had with industry and the higher education sector in Wales about increasing Wales's supply of ventilators? Diolch yn fawr.

I think, to be fair, Llywydd, that I've dealt with the point about ventilators, both in terms of supply and manufacture, in response to the questions that Adam Price asked, and also Angela Burns in terms of the collaboration between officials in my department, Ken Skates's department, and people making those and manufacturing them here in Wales.

In terms of the point about volunteering, we've had a really significant response from people in Wales, so whilst there’s been some confusion over the headline messages that are being played out, actually, lots of people in Wales have found a way to go to be able to volunteer within their local communities in either smaller groups that have been set up, but also through the national Volunteering Wales portal. So, we've got over 30,000 people registered as volunteers, and within the last week we've had a rate of 1,000 people a day registering to be volunteers to support people in their local community. Part of the challenge was that there was, I think, a misunderstanding in the way that the England-only scheme was launched. Some of our colleague elected representatives in Wales didn't understand that there was, simply, an England-only scheme and not a scheme that was designed and delivered by the four Governments across the UK. So, we've got a good response already, and that's being put to use, with the third sector and local government working together to do so.

In terms of GP access to the list of vulnerable people, we've been really open in developing both the lists and criteria for people on the shielded group of 81,000 people. So, we've worked together with the British Medical Association and the royal college of GPs, and, by the latest, from 2 o'clock today that list will have been available in the GP portal for every GP practice to review the groups of their patients on that list so they can exercise their judgment and knowledge of their group of patients if they believe there are other people who should be on that group of shielded people. We'll continue to develop our response in supporting the wider group of vulnerable people over the coming days, as I say, working together, I'm sure, with local government and the third sector.

And, in terms of your broader points about testing and learning with other countries, well, it is fair to say that South Korea, for example, is in a different place because of its experience of having been much harder hit by SARS in the past. Now, there'll be lessons for us to learn in the here and now, and Public Health Wales are in regular contact with public health organisations in countries in Europe and the wider world, on help and advice in the here and now.

So, for example, we've definitely learned lessons from Italy; that's why we've put so much energy and effort into creating field hospital capacity at such pace, because that's about getting people out of hospital when they no longer need to be there. And it's even more crucial now, because people who are delayed getting into a hospital are people who really may well need life-saving care. So, that's one of the lessons we've already learned, and we're talking about lessons as it emerges that some of the social distancing measures will start to be relaxed. That's really important for us about our response to the pandemic here in Wales and the rest of the UK. But, equally, that conversation will continue.

Public Health Wales are actually in a very good position in the global public health community, and certainly within the World Health Organization European region, in terms of the respect we have, the ability we have to share learning on a variety of different topics, and that will be really important—to look back about what's happened to learn lessons where we think we may have been able to make different and better choices during the period of this pandemic, but also for the future. And that will be a whole society-wide conversation, because, if we want to have extra capacity in place for a future pandemic, we need to fund that and create that capacity and have that ready and available. And that's a different sort of choice for us to make about the way that we support public services.

Some of my questions have been answered, but I did want to return to the issue of the shielded letters, because I think that is incredibly important. Because, for many people, that will unlock the support that will enable them to stay at home for three months. I've been advising people to contact their GP if they haven't had a letter and think they should be shielded. I welcome what the Minister's just said about everybody having access to that list today, but GPs are now telling me locally that they don't have the capacity to deal with the numbers of queries they anticipate getting from people who think that they should be shielded. So, I'd like to get the Minister's comments on that—what assurances can you offer that people who should be shielded will be able to get on that list in time to get the support that is available?

Similarly, also picking up issues with pharmacy as well, people who've always had their prescriptions delivered who aren't well, because they're not on the shielded list are now worrying they're not going to be able to get their prescriptions delivered. So, your response on that as well, if possible, please.

I know that you've dealt with the ventilator issue in relation to Angela Burns and Caroline Jones, but I have sent through a number of companies who have made offers of help to the Government. I understand that there's a process to be gone through, but can you just say a little bit more about how Welsh Government is dealing as quickly as possible with those offers of help from manufacturing companies in relation to ventilators?

[Inaudible.]—support. That may come up again in questions with Ken Skates, because his department, in terms of the business support for those people, is actually really important to make sure they're helped to manufacture. So, there's more than one potential opportunity to manufacture CPAP machines, which are a level down from invasive ventilation but can be helpful. The faculty of intensive care have actually produced some guidance about the increased use of those machines. So, we're supporting a range of companies and working alongside them to assist in the manufacture of those in the here and now. I know UK headlines are very excited about the Mercedes Formula 1 team being involved in doing something, but we have a range of examples here in Wales where we are manufacturing those machines as well.

So, it goes into a central team here in the Government to understand what's on offer, and then to understand the technical specifications of what's potentially on offer, and then, if there's business support need, that's where Ken's team comes in. We've got a centralised process, so it's not going to three or four different people, we understand which group of officials are supposed to be dealing with it, provide the support and also in a reasonable time frame.

On your point about shielded letters, to people who are to be shielded, the 81,000 people have been tightly drawn up on clinical criteria. Now, there is a wider group of people outside that who we've also advised should really be staying at home if at all possible—so, for example, women who are pregnant and people over the age of 70. Not every pregnant person, not every person over the age of 70 will have a shielded letter; they shouldn't expect to have one. I think there is some confusion within that, but it's important to be clear with our constituents that, if you're over the age of 70, that doesn't mean you will automatically get a shielded letter, and to have some patience and to ask people not to ring GPs, because otherwise they will be overwhelmed.

Now, the work we're continuing to do with the third sector and local authorities, and indeed the food supply sector, is initially about getting support to people in that most vulnerable group—the 81,000—who don't already have a mechanism to get supplies themselves, whether that's food or medicine or other goods, and it's then to work on support for that wider group of people. Now, some local authorities are already in a place to be able to do that. We're looking to be able to provide some clarity on a national basis about how that wider group of people are continuing to receive support to be able to stay at home. That's why the wider volunteer network is so important to us, to help the widest group of people possible.

On prescription delivery, I've tried to make it clear several times, and I'm happy to do so again, that if people can get their own scripts—if not them, if they're supposed to be staying at home, their friends, family or trusted people who can go and get the script for them—they should do so. If they rely on delivery and they have no other means of getting that, then their pharmacy should deliver. We had an incident last week where there were localised challenges with a well-known pharmaceutical company, and I had direct contact with that company in Wales on what's supposed to happen. That was unhelpful for people who were caught in a position where they didn't get the supplies delivered to their door as they should have expected, but it was helpful in the sense that it meant that that group went out and told all of their store managers the guidance they'd issued on making sure that, if people can't get their own scripts, then they should make sure that they're delivered, and there should not be delivery charges during all the time that we are facing the COVID-19 pandemic as well. I hope that's helpful.

Two very brief issues I just want to raise with you, Minister—first of all, I'm sure you'd have seen the concerns raised last night in the media by the Tenovus cancer charity, who are extremely worried that hundreds of cancer patients in Wales could die because of delays in treatment and screening as a result of the coronavirus outbreak. Of course, I fully understand the Government's need to tackle the spread of coronavirus head on. However, this will undoubtedly lead to a great deal of anxiety and frustration for many patients living with cancer and their families. Indeed, I've been contacted myself by constituents asking about cancer care during this crisis period. So, therefore, can you tell us, Minister, what the Welsh Government is specifically doing to support those living with cancer in Wales during the COVID-19 outbreak and will you be bringing forward a specific cancer strategy at this time?

Secondly, Minister, of course, we owe a great deal of gratitude to front-line staff, including Wales's community pharmacists, who you've referred to today. However, respecting social distancing is proving difficult in many pharmacies, due to their design up and down Wales. You basically can't keep 2m apart, for example, in many of our pharmacies. So, can you tell us what additional guidance and support the Welsh Government is giving to pharmacists to help them address some of the significant challenges that they're currently facing, and is the Government planning further guidance to pharmacists and their staff, given that they are feeling vulnerable in these circumstances?

Following on from Lynne Neagle's question, I understand that there has been some relaxation in the rules around dispensing repeat prescriptions, but this may have an impact on the supply of medicines. Therefore, what action are you and the Welsh Government taking to ensure that pharmacists are indeed able to access sufficient supplies at this time, and what discussions have you had with the pharmaceutical companies about the supply of medicines and treatments?

Okay. Thank you for the questions. On cancer care, I did see what Tenovus had to say yesterday, and our expectation is that we're able as far as possible to maintain urgent care across the health service. But our challenge is—and this is why, in all of the choices that our clinicians are making and are being supported to make—there really aren't a range of easy choices, and this is a good example of them. So, on some areas where it can make a difference between whether someone survives or not, we'd expect that treatment to go ahead if at all possible, but if we know, as we do, that more and more people will come into our hospital system, and we're talking about large numbers of people living or not living because of the choices we make across the whole system, we're having to balance each of those choices. But, for example, we're certainly not saying that people who have an urgent need for care, whether it's an emergency, or whether it's indeed cancer care or other long-term or life-threatening conditions—we're not saying that all of that treatment has to stop; far from it.

But we are seeing a public response to the way they use the health service. You'll recall from the conversation this morning that there's been a significant reduction in people presenting to our emergency departments, because people would otherwise be having a much higher attendance rate—I think three or four times what we're currently seeing. So, that public response is helpful to allow our capacity to be protected, and, as I mentioned in my opening statement, of all the people who are currently in intensive care beds, 69 per cent of them are COVID or suspected COVID. That means that over 30 per cent of those people aren't suspected of having COVID or don't have it. So, we already have a number of people in intensive care, so it does show that our system is continuing to treat other people. I'll continue to listen to what our clinicians are saying about their capacity to do their job, and we may then have to make some system-wide choices. If we do, I'll be happy to be upfront with the public and Members on any of those choices. 

On pharmacies, I recognise that, in the design of some of these, it's difficult, if not just not possible, for staff to maintain a 2m distance. Now, the advice we've given is as far as possible to maintain social distancing, but, given the critical role that pharmacies do play, we want community pharmacies to stay open to supply people and support people in managing the range of their healthcare conditions. It's important that the public behave in that way. We know that within the last few weeks we saw some unacceptable instances of behaviour directed towards our pharmacy staff, and that appears to have calmed down now. I've also made choices about the way that pharmacies operate to allow them to make sure they're in a position to continue providing a service to the wider public. My officials and I are of course happy to keep on listening to community pharmacy if there are more things we need to do to enable them to do their job at this hugely important time, but I've yet to hear a further bid from either the Royal Pharmaceutical Society or indeed Community Pharmacy Wales on further steps that we need to take to allow community pharmacists to undertake their role in supporting the public. 

And, in terms of medicine supply, it's a matter I discussed yesterday with Cabinet health Minister colleagues from across the UK, and we don't see at this point in time a medicine supply issue, but it's a matter of fact that the national health service across all four nations from time to time has to deal with supply issues. That's a regular challenge, and most people don't notice that it's happened. At this point in time, I'm not aware that there is a specific medicines resupply issue, but obviously that's something that we'll not just discuss across the four nations—we have well-run decision-making methods across the four nations, which is, if you like, a positive result from our 'no deal' Brexit preparations; we had to think of ways to deal with potential medicine supply issues. Those arrangements are still in place to ensure equity in supply across each of the four nations.

Minister, I'm seeing a disconnect here between the reality on the ground and what I'm hearing from you. The reality is that front-line nurses do not have protective equipment. The reality is that care companies do not have protective equipment. So, this weekend I've dealt with constituents, disabled constituents, showing symptoms, unable to be looked after and just left. I interviewed Ashley Morgan. He's a young man in Caerau, and he's got a 3D printer, and he's made his own masks to a very, very good specification, and he's now supplying the Heath hospital and other areas. There are queues of medical staff outside his property, almost. So, we have an army, almost, of people—literally some of them working in their own front rooms, own back rooms—producing good quality protective gear. Ashley can make thousands per week if he gets support. So, first of all, the first part of this is there's a reservoir of people out there ready and willing. I think that the large supply chains have failed us. What can we do to enable those people? Who can they contact? When can they contact them? And how and when can they be supported?

The second thing I want to talk about is testing. You received an e-mail on 19 March—so did the First Minister—offering testing kits, I'm advised already validated, and nobody responded to that company. Equally, Public Health Wales was then contacted afterwards, and not until I intervened was there any contact with that supplier. The contact, basically, stated—I saw the e-mail, it said they'd be contacted, maybe, as need arises. Well, the need is here. We're not following the World Health Organization advice, I know that, but I think we all agree that we need more testing anyway.

There are still medical staff, whose families have symptoms and who cannot be tested, sat in isolation needlessly. So, my question to you is: how and when are we going to enable people to be tested? We should be testing every person who is suspected of having the coronavirus. I think it's really essential that we realise the absolute emergency on the ground, where people are simply not safe doing their everyday work because they don't have the equipment.

And to go back to the carer, if a carer has the virus and is not showing any symptoms and they're visiting vulnerable people on a daily basis, they're going to give them the virus if they're not wearing protective equipment—gloves, masks. I just don't understand why the front line is lacking so much at the moment. So, my question, really, is: when, how and who do these people contact? 

Thank you for the questions. If I deal with your point about manufacturing, because that is exactly the same point that I dealt with in an earlier question. Whether they're ventilators or whether they're PPE manufacturers, the opportunities are there to be supported in the delivery of that. We've also got the ability to validate the quality of supplies with the facility that we have here in Wales.

I've also seen the Royal Mint, for example, producing visors for front-line staff who now need them. That's advancing the old guidance of what we expected for a flu pandemic, potentially. I'm expecting the new revised guidance to say more about protective eyewear and, actually, that's why we distributed a range of protective eyewear earlier than we would otherwise have expected.

I'm happy for whoever thinks that they have the ability to help produce something to a right specification to contact the Government. They can contact my ministerial address and I'll make sure it gets to the right place to be reviewed, as I explained earlier on the ventilator manufacturing point as well. 

For testing kits offers, actually, they are all being reviewed by Public Health Wales. Now, we've had a significant response with people coming in and making offers, and the point I made earlier in response to Adam Price was we need to understand the value of the offer that's being made, the efficacy of any of the potential testing routes that are being offered, and the value that they then provide. We've got to be able to do that, because otherwise we will potentially see ourselves burning up resources on kit that we don't find to be effective. Now, I don't want to get into individual cases because, as you'll know, I don't read every single e-mail that has my name on it, but I do make sure that those are dealt with and responded to. 

On your point about personal protective equipment, I've responded to questions not just today but in a wide variety of fora—when speaking to trade unions, when speaking to local authority leaders, when speaking to health board chairs and chief executives, when speaking to staff—and they all recognise that there are challenges in some parts of our system in PPE getting to people on the front line. It is not the case that all of our staff are being left without PPE; it is the case that some of our staff are now. If we provide the PPE to 98 per cent of our staff, that doesn't mean to say we don't worry about the 2 per cent that don't have it.

I'm genuinely concerned about front-line staff who need PPE not having adequate supplies of the right PPE for them to use. It's taken a huge amount of my time and energy, and that's why we've sent out so much PPE—as I said in my statement, over five million items. This is not a small or marginal undertaking, and the Government is absolutely aware of the scale of the emergency that we're facing. It's an emergency the like of which none of us have ever seen in our lives in public service and none of us expected to. 

So, we will continue to work in accordance with the guidance that I know is being reviewed, and you know is being reviewed from my earlier statement and in answers to all the questions, and we'll take on board our responsibilities to procure the right PPE in accordance with that revised guidance.

And finally, David Rees.

Diolch, Llywydd. Most of my questions have been answered by the Minister, and I'm very pleased to hear that the 965 extra capacity for ventilators is there and that the five-million-plus PPE items have been distributed. But I have to agree that there are still deep concerns over the number of PPE available, particularly for the front line in hospitals and also for those social care workers. I have many constituents who have expressed deep worries over carers coming into their homes, when they themselves are vulnerable or their partners are vulnerable, and maybe bringing the disease into their homes. So, I think there's an area we still have to get to grips with.

Now, I know you were talking about the new guidance, I remember you on the weekend saying that you expected that to be on Monday. Yesterday, at your press conference, you said that you hoped that it would be available yesterday. Today, you said it was rapidly evolving. I think it's important that we have a timescale as to when that new guidance will be in place, so we know what PPE is going to be appropriate for who and in what situation, so that we can ensure that the PPE gets to the right people in the right place at the right time. There’s huge concern, both in the professions themselves and from the constituents who are receiving the care, regarding the availability of PPE.

Can I also ask—? I support Paul Davies's question on cancer, because there are many constituents who are deeply worried about the delay. They've had appointments for surgery that have been cancelled because of the coronavirus situation. We all understand the demands upon the NHS, but when you're facing a situation where you have breast cancer and you have an appointment for surgery and then that is cancelled, there are clearly deep worries. So, we do need to look at health boards and how they are scheduling such surgery to ensure that people who have other life-threatening conditions are not going to be disadvantaged by not having the surgery as and when that surgery is required. So, can you look at that aspect and ensure that health boards are delivering those types of details to Welsh Government and to ourselves to know that?

On the field hospitals, it's come out today that NHS Nightingale may require 16,000 staff to deliver that. Now, if you have 7,000 extra beds, do you have the capacity to actually staff that type of extra number of beds? Because we already understand that there may be some reduction in capacity because staff themselves may get the virus. Where are we with making sure that, if we create these field hospitals, there will be sufficient staff and resources to deliver the care in those field hospitals?

And finally, you might be aware of a letter that was sent out by a GP practice, not in my constituency, but, actually, I've had constituents who've received that letter, asking them did they wish to be considered as 'do not resuscitate' if they got the virus. I will contact all health boards urgently to ensure that no such letter goes out again from another GP practice, because every patient's life is worth a huge amount. It is not something they should be asking: 'Do you want a do not resuscitate note put on your notes?' Can you imagine a patient getting that letter, saying, 'If you get the virus, stay at home. We'll look after you, but we won't put you down as needing resuscitation. We won't take you into hospital as an urgent patient'? It is not acceptable—I'm sure you agree with that. Will you ensure that all health boards tell their GP practices that that is not the way to move forward? Diolch.

Thank you. I now expect the PPE guidance to be provided tomorrow. I'm providing all of these time frames in good faith, but they're time frames that I'm not in control of, because the guidance is being provided by a range of different expert advisers—CMOs are working together and we're looking at what the scientific evidence is. I can honestly say, 'The sooner the better', though, because I know that I'll continue to face questions even after the guidance is produced. But once there's some more certainty and clarity about who needs PPE and who doesn't, that will help to improve the situation and then we'll be able to make sure that we procure that PPE in accordance with the guidance. So, I recognise the concern and frustration that you and other Members who are here and, no doubt, who will be watching the later recording of this will be stating, because that's a concern of front-line staff as well. 

On cancer and other life-threatening conditions, as I indicated to Paul Davies, we'll of course be looking at how the health service continues to provide care for those people. But you can't avoid the honest truth that the national health service can't pretend that it can carry on as normal in every other sphere of life with the significant challenge that COVID-19 provides. The way that I've already closed down significant parts of NHS activity to allow people to prepare for it will have some consequences for the way in which we provide other forms of treatment.

The important point is that people have conversations with their treating clinicians about what's happening and, if surgery is postponed or moved on, that they have a way in which to understand why that's happened and what that means. Because a number of our patients, for example, don't want to have treatment if there's the possibility of them going into a clinical area where there may or may not be people with COVID-19. So, some people are looking to defer their treatment in any event. I know that there are calls that are taking place between treating clinicians, their teams, and the people that they are looking after.

And that point about not carrying on as normal goes into your point about the 7,000 extra beds and the ability to staff them. That's why we are looking for people to return to service; it's why we are looking to recruit people into the service; it's also why we're managing to persuade some of those over 3,700 undergraduates who are undertaking medical and other health professional degrees to undertake work within the service.

It will be a different way of working and, as I've said many times before, the way that we currently work, or the way that we would have worked, say on 1 March, will be very different to the way that we will be working within the health service and providing care for a period of time ahead. But I understand, it's a matter that I raised today in my call with chief executives and chairs of the national health service organisations in Wales about making sure that the extra bed capacity we create aren't just beds in a room that are abandoned, but we can adequately staff them. So, I'll happily not just take that up but make sure that I can provide more assurance for members of the public on the staffing issue. 

And on the GP letter, I am aware of the issue. The constituency Member Huw Irranca-Davies notified me of the challenge and the conversations he was already having with the practice and the health board. And I've been assured, before this morning, that there'd been a conversation that had taken place about the letter itself; the GP practice is contacting people to try to recover that; and I know that they've issued an apology.

Having a conversation about a 'do not resuscitate' notice is difficult at any time, end of life care is difficult at all times in the public cycle, and it's a conversation that requires some sensitivity. I am confident that, after this incident, you won't find similar letters going out from general practices to their patients and there'll be a real sensitivity and dignity in the conversation between general practitioners and their patients. And, taking on board Angela Burns's point earlier about the way that people make really difficult choices, there will be an ethical framework for doing so to support our staff to take the best possible care of all people, regardless of what age they are, right across the country. 

Thank you to the Minister for his statement and his answers. As Members will have realised, I've considerably extended the time allocated for both previous statements in order to aid with scrutiny, but I will understand if Members or Ministers need to leave the meeting at any point now due to diary commitments.