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

Thank you, Llywydd. I am going to give Members an update on a range of issues related to our coronavirus response from across the health and social care system.

We continue to maintain supply of personal protective equipment to our front-line health and social care workers. We're working on a Wales and UK basis to secure more robust supply arrangements going forward. As you've heard earlier from the First Minister, as of last week we had issued more than 16.2 million items of PPE to the NHS and local authorities, for distribution in social care, from our pandemic NHS stores. That pandemic stock is part of the 48.3 million items of PPE we have issued in Wales since 9 March. Supplies have been distributed to hospitals, general practice, the Welsh ambulance service, pharmacies, and all local authorities for onwards transmission into social care. And I do want to recognise the significant work that has been undertaken to establish new structures to deliver PPE from our national supplies to our vital services, including our independent sector providers in social care. I’d like to extend my genuine thanks to all involved—our health and local authority partners, social care providers, and local resilience forum co-ordinators.

In any operation of this scale, there will be times where things don’t work exactly as we would like. And I am acutely conscious of the stress and anxiety felt by our front-line staff; they want to know that they are sure that vital equipment will be available when they need it. And trade unions have been key in identifying those issues in real time at workplace level, for employers to respond quickly to shortages, which enables us to improve and refine the process and what that means to allow our staff to do their work in caring for the public.

The worldwide demand for PPE is creating an insecure and unpredictable market. As we know, some countries have taken the decision to stop the export of PPE supplies, and other supply routes have experienced significant delays. And the recent very public example of the delay of an order for the UK from Turkey is perhaps the most obvious and most public example of that.

We are, though, taking a multifaceted approach here in Wales to ensure that we do manage to provide our ongoing supply of PPE in Wales, and that includes working with other home nations across the UK to pool and share our procurement efforts to bring in vital new stocks, our usual Welsh arrangements, the procurement of additional PPE supplies using the National Procurement Service, and our work with Welsh businesses to produce more PPE here in Wales.

In addition to working jointly with Northern Ireland, Scotland and England, we are actively mobilising industry in Wales to supplement back to those UK-wide supply routes through innovation and new manufacturing.

As you know, the First Minister recently called on Welsh businesses and manufacturers to help produce a Welsh supply of PPE to support our front-line health and social care staff. The Life Sciences Hub Wales is working with Welsh industry to develop, refine and deliver those ideas. And our approach intends to maximise all the opportunities that are available to us to recognise the scale of demand and the very challenging global market that we are operating and competing within. 

We have, though, had a tremendous response from Welsh companies so far. In North Wales, we have Brodwaith in Anglesey, who are making 2,000 scrubs a months. We also have Worksafe Workwear in Ruthin, who are producing over 2,000 scrubs a month.  One of those companies used to make pyjamas and the other used to make bags. They are good examples of how companies have adapted their processes in a matter of weeks to produce the equipment that we need—in this case, scrubs. 

We also have high-profile examples of the Royal Mint and the Rototherm Group, who are making face visors and shields that are being worn by healthcare staff. And the gin distillery In The Welsh Wind is making WHO-approved hand sanitiser. I really have been struck by the level of innovation and support that has come from all parts of Wales.

The demand for PPE will continue to be well above normal for the foreseeable future. The actions that we're taking in Wales are all directed at ensuring the supply of PPE to our staff who need it to continue to work and to care for the public safely. It is of course important that the guidelines on PPE are followed properly and that PPE, of course, is used in accordance with that guidance by the staff who need it.

On testing—I know there have been comments in the First Minister's statement and in questions—on 15 April, I commissioned a rapid review that focused on the key elements of our plan for testing critical workers. That included our testing capacity, access to testing, and the testing referral and results process. Following the review, I can confirm that our current testing capacity is now 1,800 tests a day. I have made £50 million of Welsh Government funding available to bring in further equipment, chemical reagents and other activity to increase our testing capacity. We do now have mass drive-in testing centres in operation in Cardiff and Newport and new testing infrastructure is planned for north and south Wales to be in place shortly—within the next fortnight, as I understand it today—to boost the existing testing arrangements already in place. We're piloting a web-based booking platform this week, and I've removed the ceiling on referrals per local authority, and I've also published a new critical worker policy that extends the number of groups that can now be tested. We're now testing all symptomatic care home residents and all care home residents who are returning from hospital. All symptomatic care home workers themselves can now also be referred for testing.

I remain confident, following discussions with our chief scientific adviser on health, that our plan sets out the right approach to ensure we are delivering the right testing, when and where it is needed, both in the short and the longer terms. So, I'm confident at this point in time that we're testing the right people.

On a different subject, I do understand that it's important that we recognise and then try to understand why, across the UK, we're seeing a disproportionate number of people from black, asian and minority ethnic community backgrounds who have become critically ill as a result of COVID-19.

Yesterday, I confirmed that we in Wales would be contributing to the review that is being led by Public Health England to explore the role of pre-existing medical conditions. Welsh Government officials will mobilise efforts to establish whether there are any identifiable factors that could help to inform decisions on whether we need to give different public advice regarding comorbidities, isolation, shielding and personal protective equipment in relation to people from black, asian and minority ethnic community backgrounds. We will be working with representatives from our black, asian and minority ethnic communities here in Wales to help shape that work going forward.

Now, on children’s social care and safeguarding, I know there are major concerns not just for the Welsh Government, but for other key stakeholders. We understand that services are under pressure, and, at the same time, we know that the emergency is placing a great strain on all those involved in the lives of vulnerable children. To support local authority social services departments and partners in addressing those challenges, I'm pleased to confirm that the Welsh Government has now published operational guidance for children’s social services. That's been developed through close working with stakeholders and it sets out measures that should be put in place to minimise the impact of the pandemic; to help local authorities and their partners to continue to provide effective support to vulnerable, at-risk and care-experienced children, whilst maintaining their statutory duties.

Safeguarding remains everyone’s responsibility. I am concerned about the reduction in referrals and reports of concern for adults and children at risk of harm, abuse or neglect during the coronavirus outbreak. So, I want to remind everyone that social services departments are operating as normal and are able to respond to concerns that people have. So, if you feel that anyone, whether an adult or a child, may be at risk of abuse, harm or neglect, you can report that by dialling 101 or contacting the local authority social services department. Help is available through the Live Fear Free helpline for anyone who has concerns regarding anyone who may be experiencing domestic abuse or sexual violence.

And, finally, I ask the public not to be complacent. We have significantly increased NHS capacity and taken extraordinary steps to change the way that we live our lives. That has undoubtedly stopped a much wider and more aggressive spread of coronavirus here in Wales. The action that we are all taking is saving lives. There is, however, much more for us all to do for some time to come.

Good afternoon, Minister. Thank you very much indeed for your statement. I would like to start by thanking not just all our health services and our community services, but everybody who's helping Wales to try to contain and deal with this dreadful situation that we're in. I'd also like to express my condolences to all the people who have lost those that they have loved so much over these last few awful weeks. I'd also like to put on record that I am grateful for our discussions on a regular basis, and I have found them very helpful in both understanding what's going on and in being able to scrutinise the Government. 

Turning to your statement, I'm delighted that you feel that there is improvement being made on the subject of personal protective equipment and getting it to the right place at the right time and to the right people. Can you please confirm, though, how much extra the Welsh Government is procuring outside of the four-nation buying strategy? I am completely of the same opinion that we should be in the four-nation buying strategy. There's obviously going to be a PPE-wide shortage in the world for many, many months to come, and it makes sense to have that consolidated buying power, but of course, there are many other strands that we can take advantage of. So, are you in a position to actually tell us a little bit more about the procurement of additional PPE supplies using the National Procurement Service that you've identified within your statement? 

I do also want to thank and welcome the great news that so many Welsh companies have turned their hand to helping us all in this very difficult time. 

Now, I'd like to turn to the testing part of your statement, Minister. I am concerned, deeply concerned, about the decision to drop the targets for testing. As the First Minister said in his contribution a little bit earlier on—his statement—we're in this for the long haul, and I think that this is such an important area. And I think you can tell it's an important area, because it's been raised today by so many other people. I think it is vital that if we are to emerge from lockdown with the chances of a second or third spike being really suppressed, we need to have a very strong testing regime.

I note your rapid review—I have a copy of it here, I've read it. To be frank, it doesn't say an awful lot more than we all knew and have known for these past few weeks, it's just taken time to produce it. I am disappointed that we're only up to 1,800 tests a day, down from the promised 9,000 when we first started all this. I do welcome the web-based booking platform, but I want to reiterate my call for there to be an identifiable lead who can deliver on a Wales testing programme, not just today, but in the months to come. Someone—and a team—with logistics and delivery success and experience, because we not only need point-of-care testing and regional testing centres, but we need those rapid results. In west Wales and north Wales, I'm still being told that those tests are coming back too late. We're going to be looking at at-home kits, we're going to need contact tracers, we're going to need to build software, we're going to have to look at the modelling that we’re going to need to do in order to get us out of lockdown, and that needs a dedicated team.

A couple of days ago, you said that testing was your No. 1 priority, the next day you said that PPE was your No. 1 priority. I absolutely recognise that you're being torn in all sorts of directions with competing priorities. I urge you, Minister, to considering giving this to a team that can really focus on it and deliver it, because it's going to be such a vital strategy for us to move forward.

I just want to deal with two other areas that I found regrettable were not in your statement. The first is around the fact that some three weeks ago, health trusts in England were given a reassurance that they could have their current debts written off to ensure that they could fully focus on fighting COVID-19. But here, there's no similar pledge, and I noticed the responses in yesterday's press conference when you were very keen to sort of say, 'Well, we don't really know what kind of money we're getting. We're not quite sure.' I can be clear—we’ve got £2 billion coming this year as a COVID fund; on top of that, we've got another £1.4 billion of consequentials. I noted in your written answer to my question, you said that you don't charge interest on the debt. Yes, absolutely, and you cite Cardiff and Vale as an example of a health board that's come out of debt, but let's be very clear, that board was under targeted intervention from Welsh Government for two and a half years, and it achieved that in pre-COVID times. We're in a different place now. We have health boards that, between them, owe £100 million of Welsh Government debt, and they still are also working on an assumption that all the work that they're doing now, Welsh Government will pick up the cost on. Will you please lay out, very clearly, the financial support that you intend to offer to these health boards?

My final set of questions, actually, is around the data that we're currently collecting. Data, of course, is always one of those things where you can interpret it in a great many ways, and different countries are measuring data in very different ways. But I am concerned that recent data sets that have come out show such enormous disparities, health Minister, between health boards in terms of numbers of people who have died in hospital, numbers of people who have died in care homes, in hospices, or even in their own homes. And I think that, without us really understanding that data, we cannot start to build up a significant picture of how the COVID-19 process is working; the kinds of people—when, where why, how—vital questions to understand anything to really get to grips with what's happened and what we need to do in future. So, will you please review how we're collectinig our data and how we're using it? So, one quick example: we're saying that, in Aneurin Bevan, only about 10 to 12 people died of COVID in care homes compared to the neighbouring health board where the number is almost three times higher. Now, it could be that they got it in a care home, they were taken to hospital, and that is, sadly, where they died. But that is very important data to understand, because then we know that the outbreak was actually in the care home and we can take those kinds of measures. So, will you please review that?

I obviously have a number of questions, but I can see that the Llywydd will want to hear other people, rightly, and so I'm going to stop there. Once again, I would like to say thank you very much for the information you do share on a regular basis.

On the final point that Angela Burns raised around data collection and uses, I'll happily review the data so we can be more certain about its accuracy and how it's then used to address areas of improvement and learning right across the system. I think it's always a fair point to think about how we review what we're doing and why and how information is used to enable us to improve.

On finance, I want to restate what I said yesterday: no local health board will be penalised for the action they have taken in responding to the once-in-a-century threat that coronavirus presents. I've spoken regularly with chairs and chief execs across the NHS family and it's not been raised with me at all that there are anxieties about how the finance will be reconciled at some point during the year, but it is just a point of accuracy that we aren't certain on the consequentials. From the headline statements that are made, we then have to translate what really arrives in Wales.

And the other point that none of us can avoid is the fact that we don't know the exact progress of coronavirus and the stress and the pressure that it will produce, not just in the significant additional resources we've put into creating a network of field hospitals, but, of course, the significant and ongoing pressure not just to provide PPE but, of course, the very real cost pressure that provides in itself and balancing that up against other activity that isn't taking place where costs aren't going but those staff are then largely redeployed. So, the financial movement around the system isn't certain, but to restate: no health board, no trust in Wales will be penalised for the activity that they are taking to keep all of us safe.

On testing, it is up to 1,800 tests today. Each Tuesday morning, I'll be publishing an update on the increase in testing and the forecast, and later today, I'll confirm a range of other figures. But in terms of the time frame for testing, my understanding is that I should be able to confirm when I've published matters today—and it's a matter of regret to me that I wasn't able to do this before today's session—that well over 90 per cent of people have their test results within two days of the test taking place. We've undertaken over 27,000 tests here in Wales, and on a per-head basis that means we're undertaking more testing than Scotland or England are. So, actually, our rate of activity compares with other UK nations. Our challenge is not just what we need in the here and now to make sure that critical workers including, of course, front-line health and social care staff, other emergency services and other partners receive that testing, but, obviously, the point that I've made repeatedly about the scale of the testing operation we need ahead of lockdown being withdrawn to make sure that we have a much more significant scale of testing and the spread and access to that testing as well.

On PPE, I just want to restate: we are far from complacent or sanguine about where we are. We know that we are running with a forecast of PPE coming in, but we're reliant on supplies coming in within each week to make sure that we're secure. The position on fluid resistant gowns we saw in England over the weekend is not something that we're taking any comfort in because we weren't in that position, because we do know that we need supplies coming in on a regular basis to make sure that we're not in that position where we have to reconsider what to do if the first source of PPE isn't available to us and to our staff. I can't give a running total of the amount of PPE that we've acquired outside of the four-nation purchasing routes, but we do continue to run through each of the opportunities that are presented to the National Procurement Service. We want to look at individual opportunities to work alongside other UK countries. And that is still taking place as well as our four-nation procurement. And what we've agreed to do is to be open with each other across the four Governments about how much we've got of each item. Because the mutual aid that the First Minister referred to that we provided to Northern Ireland, we may be looking for that mutual aid to be provided in the future, whether it's from England, Scotland or Northern Ireland. So, the openness we need is really important to make this work because the market that we're in is so competitive and so uncertain that an individual nation approach is not going to serve our staff or the public well. But I'll happily keep you updated in our regular conversations about where we are and the questions that I know you're asking in correspondence as well. I'm happy to do so.

May I thank the Minister for his update and for our regular conversations? I’m pleased to ask these questions in a public forum such as this one. May I also take this opportunity to thank all of those key workers in healthcare and other key areas who are working so very hard on behalf of us all at the moment?

Generally speaking, I think that there are a number of areas that stand out: shortage of testing; concerns about PPE, which is still a very real problem on the ground, and for those on the front line, of course. We're not testing enough. There are no plans in place to test enough, and services, particularly care services, don't have the confidence that I would like to see them having in supplies generally, as we look at the weeks ahead. 

Let me focus on a few of those key issues, then. There's still, I think, a lot of confusion on testing. I remain, as you know, Minister, unconvinced about the Welsh Government's stance on testing. We've been told again today that just over 20,000 people have been tested in Wales to date, but to put that in context: under original targets, we'd have tested 20,000 since Monday morning. Now, you wouldn't have picked the original targets—8,000 a day-plus by now—out of the air; they'd have been based on advice. We know the World Health Organization advice is that testing is really a key part of the battle against coronavirus, so can you explain what change there has been in the advice that you are given on the value of testing, because we've gone from that targeted 8,000 or 9,000 a day to around 1,000? You just said a minute ago that it was 1,800 today. Now, it's capacity of 1,800 today; it was fewer than 1,000 tests again yesterday, so we need to know what you are being told differently.

Yesterday, we were told that there's less spreading than we thought: yes, but that's because of lockdown, because of effective social distancing; it's working perhaps better than we had feared. It doesn't make the virus less contagious, so don't we need to have effective community testing in place before we can come out of lockdown? In fact, shouldn't we say that we can't leave lockdown? We cannot have substantial lifting of restrictions until we have community testing in place, and that's need a plan. We don't seem to have one, or I haven't been convinced that we have one, so can the Minister please square that anomaly for us? How can we build up our testing ready for relaxing lockdown rules without even having a trajectory to follow for increasing testing numbers?

And the First Minister said today we have no capacity problem. If we have no capacity problem, why are you, quite rightly, putting £50 million towards increasing capacity? The way I see it, we're just not reaching that capacity quickly enough. The First Minister said that it's a matter of not having enough people being put forward or coming forward for testing. Well, how about having a policy that encourages people to come forward, as a growing community-testing model, so that we are building up for the release of lockdown? We all want it to happen as soon as possible, but we can't do it until we know that the time is right.

Let me turn to PPE: real concern. Two things we need to know, of course: that we have enough PPE on the shelves now, and this week and next week for those that need them. I think from what I understand, we're sort of okay at the moment, which is good, although I'm still hearing of issues, especially in the care sector. In the longer term, though, the concerns I hear are that there's a lack of confidence in what is on its way in coming weeks, how much of it, and, crucially, what the delivery schedules are to make sure it gets out to where it's needed. Now, can we expect to have that kind of detailed plan? And with the military, as I understand, having assisted with the review of distribution, can the results of that review be shared as a means of giving people confidence?

I'm still also interested—and I've asked the Minister on a number of occasions—where we stand in terms of being able to source our own PPE internationally, as well as being part of your important pooled efforts across the UK. We know the background: suppliers in England refusing to sell PPE to care homes in Wales; flights full of PPE landing in Scotland, a major order on its way to Northern Ireland, but nothing quite like that happening here. So, if we are putting in those kinds of orders ourselves, and getting our own supplies—from China, for example—that's great; it's good news. Maybe I could ask you to share details of those orders today. But we're also hearing of UK Government telling other devolved administrations, 'You can no longer procure yourselves internationally.' Perhaps you can tell us if you've had such an instruction.

Third brief area for questioning: can I ask what work is being done on PPE for public use? I think there's growing evidence that wearing masks might well be useful to slow transmission when some social distancing regulations are released. So, on top of PPE for professional use, what plans are being put in place by Welsh Government for the procurement or production or distribution of public-use masks, because it may well be that we'll all need them soon?

And finally—also a question from me on data. We have the daily data on deaths related to COVID in hospital settings, with a lag because of death registration. We then wait to see COVID-linked deaths figures in the community too, which suggests, I think, that around a third more are dying directly of COVID in total than the official daily figures from hospitals show. But, on top of that, we have those tragic deaths occurring—non-COVID deaths, but deaths most likely that wouldn't have occurred were it not for the current restrictions: people not seeking timely treatment, not visiting the doctor and so on. The Office for National Statistics has also compared death rates now with the usual death rates, and found that the figure to be almost double what we would have usually expected across the UK for this time of year. That's 8,000 more in the first full week of April. So, are you able to tell us with any confidence what you think the current figures are for the number of deaths in total in Wales now, and are we able from that to assess through that data the steps that could be taken to save lives? 

Thank you for that long list of questions, comments and points. When it comes to the starting point about testing and whether we're testing enough—we've talked about this in our other meetings and in the response I've provided in public forum in the commentary and press questions. In terms of whether we're testing enough, we are having enough capacity, and it's about making use of that capacity. That's why the review I ordered needed to look not just at how fast we're growing the capacity, but the use we're making of it and the system we have to get people from referral to testing. I recognise that there were some challenges in our system, which is why there have been some immediate changes to improve that. We've already seen a much greater throughput in terms of the people from the care sector. We've heard from local government already; they're putting through much greater numbers of their staff and people in the independent sector. We've deliberately drawn Care Forum Wales into the work we're doing so that those in the independent sector have a much clearer line of sight into how they can get their members of staff referred, and to understand the policy changes that have been made that I referred to in my statement, and crucially, that the local resilience forums across Wales, which are having to co-ordinate the emergency response across Wales, and the range of services, also understand how they can refer their members of staff through as well, to get that commonality and consistency and efficiency in the process. So, our current capacity is what that is being used for, and I've had a direct conversation with the chief scientific adviser on health, and I've also spoken to the chief medical officer each day as well, and they are confident.

One of the points you raised with me was about what advice we're getting. Where we are will meet the sort of need we have in that sector of workers. But the point that I have regularly made, and I know you referred to it as well in terms of your comment around the value of testing—I've regularly made the point that we need to have a much bigger community infrastructure that is in place and ready to go. That doesn't mean that we're testing it for the first time on the first day and trying to phase our way out of lockdown, but that the capacity is increased steadily, progressively, and that we have it in place before we do come out of lockdown. That's a point I've made several times over the past week.

The reason, though, why we're not having to test 5,000 people a day and more is because of the social distancing that's been introduced, because of the measures we took to put the country into lockdown, because of public response, because we have intervened and flattened so successively the current rate of infection. But that doesn't mean that we can come out of lockdown today, for a range of reasons that I think Members here understand perfectly well. That's why I've made the point successively, and I'll keep on making it, that we need that bigger infrastructure ready and in place before testing comes out. And I don't think there's an anomaly there, because that is exactly what I've said pretty consistently when I've been asked about this for the last week and more.

On the point about the weekly update—in that weekly update that is being published on a Tuesday morning, moving forward I'll not provide an update but I'll give an indication of where we expect to be across the next week. That comes from the advice that we get from within our system and Public Health Wales and other actors on how we're increasing our capacity here, what the UK contracts are providing for us, to give that idea of where we're going to be next. Because I didn't pluck a figure out of thin air—it was based on the advice we had. And in the testing review I indicated the reasons why we weren't able to get that previous figure on tests: the change in behaviour across the rest of the world; the previous arrangements we had in place; the fact that other countries prevented equipment leaving their countries, including some chemical reagents and physical testing kits; and the fact that some of that equipment has been delayed. Those are all very real factors that are outside of our control. So, rather than setting a new target when I can't control a range of those factors, and neither can our own actors here in the health family in Wales, I've committed to providing a regular update on what we are doing and what we expect to do to get to the point where we have that much bigger infrastructure in place.

On PPE, a regular schedule is provided to local authorities and within our healthcare system, in terms of when they can expect deliveries. To be fair, the leadership at the Welsh Local Government Association have recognised that there has been improvement in the understanding of what's coming and the delivery of that. As I said, over 40 per cent of our pandemic national health service stock has been provided to local authorities for use in the care sector, including by those individual businesses as well who would normally source their own PPE but are now having that provided free of charge by us, through the national health service, whereas, actually, in some parts of England they're still paying for that stock despite its provision coming through the healthcare system.

On the review the military have undertaken, it has given us confidence in the logistics in our delivery system. It's given us some pointers for improvement, and we look several times a week at what is happening and our ability to have the right levels of PPE, and where we think that there are potential supply issues. We're also providing some technical briefings to people who really do need to know this in the system, on the trade union side and employers, so they've got confidence to provide to their members and their employees on what actually is happening.

On procurement, we continue to work not just individually to follow up leads that are provided to us, but we're also, as I've indicated, working with Northern Ireland and Scotland, as well as England, and we've also agreed to come together on a four-nation basis. It's not so much a matter of instruction, but it's how we've agreed to work in pursuing those opportunities.

In terms of masks for the wider public—again, I've answered several questions on this in a number of fora over the last week—the evidence base is being reviewed. At present, the advice we have is that the public don't need to wear masks. We know a number of people already are. The wearing of masks is about protecting other people so that you don't spread coronavirus to someone else, and that's most effective for people who may be asymptomatic, but it's worth reminding ourselves that people who are symptomatic and haven't had a test should be self-isolating. People who are COVID-positive should certainly be self-isolating.

We'll need to consider the impact of asking the public to wear masks and what that means, making sure it doesn't compromise the supply of surgical-grade masks, but that, equally, we understand what the evidence base is. If that evidence base changes, then I'll be very happy to shift the position and the advice that we give to the public. We don't know everything about coronavirus—we learn more each day and each week. It's part of the reason why some of the advice has changed throughout the progress of the pandemic. I expect that on a range of things we'll be doing things differently in months to come compared to where we are today. 

On non-COVID-related mortality—your final point—last week, of course, the chief executive of NHS Wales raised this point in his press conference. I've referred to it several times this week, including in yesterday's press conference, and I have asked the health service to do some work already to understand those areas of non-COVID-related mortality, to understand how much that need is being suppressed for people who do have urgent care needs. As I've mentioned in my statements previously, the NHS is open for business for people with urgent care needs. I don't want people to be so fearful of coming to the national health service for treatment that they potentially end up risking their own health and well-being. Sometimes that has led to potentially avoidable mortality. It's a matter I did manage to discuss with chief executives and chairs earlier today. I want to provide more focus on that in the week ahead, because public behaviour is a big part of why we've had a success story in preventing the spread of coronavirus, but it's also part of the challenge that you highlighted, and we've talked about before, on those non-COVID-related areas of mortality and how we continue to restart other parts of our national health service in the future. 

Thank you for your statement, Minister, and for your department's continuing efforts to help combat this disease—a disease that has killed nearly 200,000 people worldwide. Every one of those is someone's loved one, and my heart goes out to all those who have suffered loss at the hands of this invisible killer. Without the efforts of our NHS and social care heroes and volunteers, many, many more of us would be suffering from that loss.

Minister, in addition to our full-time social care staff, carers—both paid and unpaid—have a vital role to play during this crisis. Unfortunately, this vital role is not always recognised. One constituent who's been in touch with me has informed me that they're often forced to walk six miles home after caring for someone because public transport is reserved for key workers. Despite showing documents saying that she is a carer and a key worker, she has not been allowed very often on this transport.

Minister, do you accept that carers are key workers and will you work with the Minister for transport to ensure that our carers are rightly recognised as vital key workers, because without their efforts our health and care system would be overwhelmed?

Minister, the UK Government has also launched the CARE badge to enable the efforts of those working in social care to be recognised and rewarded. So, does the Welsh Government have similar plans?

I'm pleased to see that our care homes are getting supplies of PPE, although shortages still exist throughout the system. I accept that this is a world-wide issue. However, more needs to be done to ramp up domestic production and make it easier to ship in supplies. I have been contacted by freight companies concerned about the level of bureaucracy involved in shipping in PPE equipment. While I accept that checks have to be in place to ensure the efficacy of PPE, surely we can do more to streamline the processes during these times of crisis.

Minister, we also have to ensure that it is as simple as possible for companies and organisations to manufacture PPE. I have had contact with a wedding dress manufacturer locally who wishes to make gowns and masks for the NHS. So, Minister, what steps are you taking to make it easier for such companies to get involved, and will you consider what steps you can take to streamline the process, such as providing templates, et cetera, particularly for the face masks?

There is strong evidence to suggest that, when the lockdown is eventually lifted, the public on occasions, such as using public transport, will still be wearing face masks to help limit the spread of coronavirus. But we can't do that unless there are sufficient supplies of face masks to go around. So, Minister, do you have plans in place to increase these supplies?

And, finally, Minister, we have to plan, obviously, for the eventual relaxing of current lockdown measures, and I am grateful that the Welsh Government is recruiting people to help with contact tracing and have adopted the Symptom Tracker app. However, not everyone has a smartphone, so what plans do you have to improve symptom tracking for those without access to a smartphone?

Thank you, once again, Minister, for your continued efforts.

Thank you for that series of questions. We've actually worked alongside developers on the smartphone app and it's giving us a large amount of data in Wales to understand wider community activity and behaviour, but none of those systems are perfect and there are people who miss out—equally, not just on symptoms, on the data we're able to track about traffic movements and people movements as well to show the adherence to wider social distancing. 

So, we've got a range of surveillance efforts, not just on symptoms, on people reporting them, but also of course the numbers of people who contact our healthcare system if their symptoms give them enough cause for concern and they feel unwell.

So, there is a range of different areas to understand the challenges we face across systems and how we then address symptoms, particularly given the settings—that's why there's been so much concern about the care home sector. 

On face masks, I think it's again really important to reiterate that we don't want the public trying to acquire face masks that are medical grade to be used within our health or social care sector. It's about the evidence base that we have to understand whether or not masks would make a difference for the public, and, if so, what sort, and to make sure that they're manufactured in a very different way and to make it clear they're not in competition with those that front-line health and care workers need. Now, on the import of PP equipment, even if you take aside those matters that are reserved and we don't have control over, we certainly want to make sure that we test and understand the nature of the equipment that is being provided. I don't think anyone would want us to try to make that system any less properly rigorous. We want to know that people can have confidence in what they're being provided with. I know the economy Minister, through use of his local links, with the import of face masks that came in through a company in north Wales—we had to test that before having the assurance we could use it within our wider system. That's got to be the right thing to do. But every one of the leads we have is followed up and it's important to make that clear.

One of the frustrations that I have is that, for all of the well-meaning desire to help, some of those, of course, don't end up coming off, for reasons that I'm sure we could all understand. But my bigger frustration is the fact that, within all of the well-meaning and the positive things that do get taken forward, we still have to spend time working through what are fraudulent enquiries that are utterly mischievous, and that is a real sense of frustration. So many people in the world are behaving in an extraordinary manner to help their fellow citizen, but there are, sadly, some people who are looking to take advantage, and that is burning up lots of our precious time, energy and effort.

When it comes to recognition for carers, the economy Minister is going to be making a statement shortly, but we do need to think about the practical capacity of our transport network to take on additional need going into that, and it's a difficult balance. We regularly consider the role of carers, including unpaid carers and what they do, and many of us are, in fact, unpaid carers ourselves, when you think about friends and family who we care for. I'm certainly doing even more for my mother, as I'm sure many other people are with their parents and grandparents too, and that's really important to keep society going and to make sure that people who are living more restricted lives are able to do so well and to do so safely.

On the card issue that the UK Government have produced, that's actually—my understanding is it was a card for social care workers. What we've done in Wales is we've already provided a card—an electronic one, and there's a physical version going out—but that is so that our social care workers can be recognised as critical workers. That will help them with both assistance to practical restrictions in shops, when it is reserved for NHS and other critical workers, and to help them get practical assistance. We're also looking at rather more practical measures about how we recognise the significant efforts of our social care system, and a group of staff who we all recognise are relatively lowly paid, and we are reconsidering, quite rightly, the value they provide to our whole country.

Thank you, Minister, for your statement today. I'd like, first of all, to ask you if you could give us an update on the number of doctors and nurses who are previously retired and have returned to the NHS and perhaps also any student nurses and how they are able to plug those gaps.

My second question is around the announcement about GP online video consultations. Can you confirm that they are available across all of Wales now, and are there any plans to extend those to secondary care?

Yes, I'm happy to confirm that, when it comes to staff returning to the health service, there are over 10,000 staff who have now returned to the register that the NMC hold, and about 5 per cent of those are staff from Wales. That's a really good news story, because that's slightly more than our population share, and it does show a real willingness from recently retired staff to want to return. The NMC, as the regulator who holds the records, are writing out to people who have been retired from further back to see if they want to return. It's crucial we use those people in a way that is aligned with their skills, but also to recognise that some of them may need to be deployed away from front-line person-to-person care as well, so we make use of their skills without looking to compromise their own safety.

And it's the same picture with returning medics as well. There are a number of people who are retired who now have their own comorbidities where we need to make sure that we use them in a way that is entirely appropriate. I'll be able to give figures over the coming weeks on the number of undergraduates who have taken up the offer to come back to work and to be paid on 'Agenda for Change' conditions and to support the network that we have. And the need to scale that up is not what we thought it would be even a month ago, because of the fact that we haven't had the more significant upswing in coronavirus infections that we were planning and having to prepare for. So, that's a good news story—that we haven't needed to have all of those people working within our system. But it will matter as we move into not just restarting parts of our national health service, where we'll need to make use of that field hospital network; it will also matter about our ability to care for people who have urgent care needs. And, if we do see a further upswing in coronavirus, we'll need to be able to call on those people fairly rapidly, and I'm very grateful for the level of flexibility and commitment that all of those people have shown.

When it comes to the use of video-conferencing, I'm very pleased we've managed to roll this out across the country. There was a pilot in the Aneurin Bevan health board area. So, this was trialled in Gwent first and it was shown to be successful, and we've managed to roll that out much more rapidly than we would normally have done to a nationwide roll-out. It's part of my frustration in normal times that we aren't able to move more rapidly across the system. The real willingness of staff to make things happen and to remove barriers has been one of the really positive aspects of our response. That is available freely and comprehensively in primary care in general practice, and we are looking to roll that out further in secondary care as well, because some areas of that service already have a range of using digital technology and video-conferencing. I want to see that being a much more consistent part of the way we run our service. It's a point of necessity for the position that we're in, but, of course, it's a point of real advantage and opportunity for the future as we get used to different ways of working that make better use of everyone's time—both patients who need care, and our staff who provide it.

I've now called Members from each of the political groups. I will need more succinct questions and answers from now on to try and call as many of you as possible. We're already out of time for this statement. Janet Finch-Saunders.

[Inaudible.]—Llywydd. And, again, I would like to thank the Minister, Vaughan, for your statement and to acknowledge the considerable effort that you are trying to make to respond quickly to the ever-evolving COVID-19 crisis. Now, yesterday, you announced that Wales only had a few days of PPE stock available, and you'll recall that I wrote to you on 3 April, submitting a written Assembly question asking you to take urgent steps to ensure that adult and children's hospices have access to adequate personal protective equipment. Now, whilst I've still yet to receive a response, I do welcome the announcement that you've made of a three-month package of additional support worth up to £6.3 million for hospices in Wales, but can you clarify what steps you've also taken along those lines to ensure that, now that the funding's in place, they can actually access the PPE they require?

I appreciate that more than £62.2 million extra items of PPE have been sent to front-line workers, but I cannot overlook findings by the Royal College of Nursing that 54 per cent of those surveyed felt pressured to care for a COVID-19 patient without adequate protection and that 49 per cent of nursing staff treating COVID-19 patients not on ventilators said that they have not received training on what standard PPE to wear and when they should wear it. And I've also had that concern raised with me in the social care sector. I'm aware that the Welsh Government has been liaising with military planners regarding the demand for PPE, and, obviously, we hope this will assist in effective distribution, but will you clarify what steps are being taken to ensure that there's a fair distribution of PPE across the front line of health and social care in Wales?

You will be aware, Minister, that some companies have written to you and, notwithstanding what you've said about people fraudulently writing to you, people are offering up supplies, and they've had to approach me because they say that they haven't even received a response from you—so, a simple 'no', maybe. But leaving people in limbo when they read news reports that there's this panic on for PPE and when they're bothering to write to you and the finance Minister—to not receive a response isn't good enough.

Now, sadly, as of yesterday, it was estimated that 100 health and social care workers have died from COVID-19 in the UK. So, again, I would reiterate—I think it was Leanne Wood who asked about the families of the deceased here in Wales—whether grants will be available for those who have lost their lives to the global effort, in terms of funerals and things.

More worryingly, and this is really the thrust of all my questions, I've received a lot of concerns from the social care sector here about the non-testing of people leaving hospital, and social care homes being asked to take these people in. I have situations now where some social care providers are not prepared to do that for the lack of a test, because clearly, if they've got a COVID-free environment in a residential care home setting or nursing setting, that's how they want to keep it. But I would ask: how are these deaths being recorded? When you write to local authorities they say, 'We're not recording them. Care Inspectorate Wales are recording them.' You write to Care Inspectorate Wales and they say, 'We're not recording them.' So I would really like your clarity because the deaths in the social care sector across the UK have quadrupled, and it's a huge worry to those working in the social care sector, and it's a worry to me as a representative of those people and my constituents. I am being approached on social care matters very, very strongly at the moment.

So, I think I've asked you enough questions there, but I would like your comprehensive answers to those, which will provide me with some assurance. Thank you. Diolch.

Just to reiterate the point I made, I asked for succinct questions and succinct answers, so I'll need to ask the Minister as well to be succinct in his answers, and I would appreciate Members listening to what I say when I ask for succinct questions. Minister.

Thank you, Llywydd. I think there were eight separate points made. I indicated we had about a week's supply of fluid-resistant gowns, we expect to receive more this week, but I was trying to be open with people about the position, and indeed staff and the public.

On hospice care, I did announce extra money for the hospice sector. PPE guidance needs to be followed within that sector as well, and as I say, the equipment, the PPE that we're providing is for use across health and social care, and obviously used appropriately and where necessary within hospices.

On the RCN survey, the key point is that I expect people to take up those issues with employers. We have well-rehearsed social partnership meetings here in Wales, and pretty much an open-door approach. In fact, the RCN and other trade unions themselves take part in a weekly meeting with me so they can raise issues directly with me. It's important that those individual issues are taken up with employers in the first instance, and I expect those to be resolved.

I'm happy to confirm that distribution is fair across the country. No region is advantaged or disadvantaged about how we meet the need across the country, across both health and social care, and if people do have examples of concerns where companies say they haven't had a response, I'd be grateful if Members could provide the details so that I can follow them up.

On testing on residents due to return to the care home sector from hospital, that's a matter I've covered in both the testing review and, I'm sure you'll have heard, I covered it in my statement today.

When it comes to the recording of deaths in the community, including in the care home sector, we already have, through the Office for National Statistics, a regular report on those deaths and where they take place. There is a time lag between those, because they need to review all death certificates, of between seven and 14 days from the headline figures that are released each day by Public Health Wales. So, there is pretty clear and transparent reporting of all deaths across all sectors.

It's an inexcusable failure, Minister, that you've not carried out the 5,000 tests a day in Wales that you promised. The World Health Organization advises that the countries that are best coping with this pandemic are mass testing, they're tracing and quarantining. There must be, at the very least, weekly testing for all key workers, whether they work in the public or the private sector, and until we have that, we can't relax the lockdown. I'd ask if you would accept that point. You've said you're working towards mass testing, but you didn't say in response to questions from my colleague Rhun ap Iorwerth whether you accept that point—that, unless we have mass testing in place, we cannot relax the restrictions.

I've had concerning reports from care homes as well, where PPE is in supply, but the manager has locked it down because it's being rationed. The policy is for it to be used when residents or others are showing symptoms, but we all know that, by the time symptoms are showing, the virus may well have already been transmitted. So, will you urgently issue guidance to enhance the protective measures that care homes and other closed settings should follow? I know PPE is a precious resource, but it's not acceptable to expect these low-waged workers and those that they look after to be put at risk in the way that they are under the current policy, in my view.

Okay. On the starting point, I just don't accept the premise that there's an inexcusable failure not to deliver a larger amount of testing. I've explained on several occasions the reasons why we weren't able to do it, the factors that were outside our control and what that means, and the direct advice we've had from our chief medical officer and our chief scientific adviser on health on how we make the best use of our testing resources, and the fact that we have enough testing capacity to address our front-line workers. I've also been crystal clear, not just today but on several occasions in the past, about the fact that large-scale testing is a prerequisite to move out of lockdown. I didn't need to be asked a question about that, I've proactively made that clear in a number of public statements.

I don't accept the premise that we need weekly testing for critical workers. We're not doing testing for the sake of it, we're only testing in a way that makes sense and is in accordance with the plan that we've had signed off. And, actually, it's not a dissimilar approach to the approach being taken by all four Governments across the UK on how we want to deploy our resources and the rationale that underpins it.

On PPE, I want to restate we're following the guidance. We had a review of the guidance right across the UK; all four nations are looking to follow that guidance and, in Wales, we haven't had to depart from it. And that is the point about making sure that we don't set a run on PPE use because we're responding to large-scale fears that people have, but that we provide confidence that the guidance is appropriate and is being followed, and that underscores why providing adequate amounts of PPE really is the No. 1 priority for me and for the Government at this point in time. 

David Rees.

Diolch, Llywydd. I can always be succinct, as you know. 

Three areas. PPE: I will want to highlight PPE because, again, I do get concerns from care home providers and also domiciliary care providers regarding PPE. It's important, I think, that we ensure they have sufficient levels, and I do think the guidance can be strengthened by Public Health Wales, because if you're in a lockdown situation, a care home is likely to be seeing infections because of an asymptomatic member of staff coming in with the virus and passing it on, so they should actually be using PPE at all points in time, not just when a case occurs within that home. So perhaps you could strengthen PHW's advice and guidance on that. 

Also in care homes—. I appreciate the website coming through, which will make things easier, but can you also look at ensuring that it's easier now for care home providers to have referrals by simply asking the council to do it directly, rather than having to go through PHW, which is causing more concern for some of the care home providers when members of staff are symptomic and they want them tested? A direct referral to the council might help that. 

Finally, I very much appreciate what you said to Rhun ap Iorwerth in relation to your discussions with health boards as to the preparations to introduce other treatments relating to the provision for non-COVID issues, but I've also received information that cancer referrals from GPs in other parts of the UK, in some areas, have gone down by 75 per cent. Are we aware of what percentage of cancer referrals—urgent cancer referrals—from GPs have changed, and will you look into this matter? Because it could be that patients are not wanting to go to GPs at this point in time, or it could be because GPs are being advised that certain types of conditions need to be met and they are therefore hesitant to refer themselves. We need to ensure that those who receive that type of urgency are not delayed because of a fear of overburdening the health system at this point in time. 

Thank you for the questions. I want to reiterate, on PPE, the point about the guidance needing to be followed. The last thing that we need to do is to encourage people to use PPE in larger quantities outside the guidance, because whilst that might provide some people who don't need it with more confidence, it will take away the supply from our front-line staff who really do. What we need is to make sure that each one of our front-line settings, including residential and domiciliary care, where they need to use PPE, have access to it. That's why we've taken the extraordinary step of using our public resources to provide PPE to independent businesses. We would not normally do that. If, in normal times, we were providing free of charge PPE to those going concerns, then people would have an entirely different set of questions, but it demonstrates this once-in-a-century threat that we are confronted with and the way that we are responding. 

On the process of referrals, I'm happy to report that that has already improved. And, as I've said, we've heard directly from local government that a much larger number of referrals are being made of workers in the care sector. It's important to me those aren't just people employed by local authorities directly but people in the independent sector, as Dai Rees highlights. So we need to make sure that they have referrals that are speeded through, whether through the local authority or directly, to make sure that they're provided with the test and promptly. Again, the figures that we've published today should give some confidence that those results are then provided quickly.  

On the particular point on cancer referrals, I recognise Dai Rees's longstanding interest in the work of the country on improving cancer outcomes, and it's one of the things that I am concerned about to make sure that urgent referrals where urgent care is needed don't get put to one side. That's already one of the things I've asked the service to look into as part of my concern to understand accurately the picture, and then not just to present that picture but actually to do something about it; to encourage people to come forward to address their very real healthcare need because, as we know, late referral, late recognition of cancer often leads to much more radical treatment and actually compromises the best prospects of people having a good outcome. So, they're definitely points that I want to take up, and you'll hear more from me over the coming weeks on the work that is being done to do just that, and I hope that provides an answer to Dai's question. 

I think the reality, Minister, is that far too many people simply do not have PPE at the front line. Again, what I'm hearing this afternoon is almost a denial of the reality of the situation. So, my question is a very simple one: what did you do to ensure that PPE was ordered in January and February, and how much PPE was ordered for the Welsh NHS during that period? 

As Mr McEvoy will understand, I don't have those particular figures at my fingertips, but I can absolutely confirm there's been no complacency and no denial on the scale of the challenge that we face, and if he'd just listened to the statement and the questions that I've answered in public on a range of occasions, we've distributed millions of additional items across health and social care. The 16.2 million items that have already been distributed from our pandemic stocks represent a huge additional influx of PPE across our system, and the work is tireless from our staff and people in the sector outside of the Government. And I want to pay tribute to them for the extraordinary efforts they are making to make sure that our front-line staff are properly equipped with PPE in what is an unprecedented global situation. 

Thank you, Minister, for all the work you and your officials are doing at this time. Following the Welsh Government investment, the Grange University Hospital was due to partially open at the end of April. Although the extra 350 beds will be ready and available as planned, over the last few days it has been very welcome to know that the Aneurin Bevan University Health Board are unlikely to need to use the extra capacity. The health board have said that they will keep the situation under constant review in case evidence changes, and we must not be complacent. The health board, their dedicated staff and the community have been at the sharp end since early March, and I know that the additional staff recruited will be deployed to support the existing services. Can the Minister assure me that the experiences learned by Aneurin Bevan health board will be shared with others, and also what more can be done to urge members of the public that if they are having a heart attack or stroke, for example, to call 999 as critical beds are available?  

Yes, thank you. I think there are a couple of points I'd make briefly in response, and that is that it's a good news story that Aneurin Bevan don't need to make use of the capacity that is available at the Grange now. That demonstrates the impact of our social distancing measure, but the important message about not having complacency about what we're doing now so that people don't suddenly throw away the gains that we have made. But it is there available for future use because we do expect that as we release social distancing measures, we may find more need coming into our system, and the point is well made about suppressed need. For those people who are avoiding coming into our system because they're concerned about coming into a hospital environment now, despite the fact that they have urgent care needs themselves, I want to reiterate that message again: if you have an urgent care need, the NHS is still open for business; we want you to come forward with your urgent care need. In some cases, it really can be the difference between saving someone's life or not. 

And it's important to make the point about learning from what's being done, and I think absolutely across the system we're looking to learn from the expansion and the way that Aneurin Bevan have coped. I think it's the wrong time now to have a fully fledged public inquiry; that would be a massive unnecessary distraction. We need to learn as we move, learn as we do, and of course there'll be a time when there needs to be a much fuller backward look about what's been done and why. I'm sure that this Parliament will want to play its part in deciding how to do that. 

Finally, Jenny Rathbone. 

First, I'd just like to say that this was made by a couple of asylum seekers for me. It's obviously not suitable for healthcare workers, but it's beautifully made, and it's the sort of thing that we could get, for example, our design technology students making. So, perhaps you could pass that idea on to the education Minister. 

A couple of questions: one is around PPE. There is clearly a global bidding war going on, and care homes are simply too small and far too busy to be engaging in that. So, it really is the role of government, both local and national, to ensure that we have the PPE we need. I think we shouldn't be shooting the messenger when Sir Martin Evans says that it is astonishing that an advanced, industrial country like ourselves isn't able to source PPE from within our own country. And I don't mean that we need to be producing all items of PPE in Wales; I mean across the UK we should be able to be self-sufficient in PPE. And as this coronavirus pandemic is going to go on for many months, we really do need to ratchet up our ability to produce it for ourselves, otherwise there's absolutely no hope for developing countries. I just wanted to ask a question on that, which is what thought, if any, has been given to making it safe to reuse certain items of PPE, because that is what is happening anyway by people on the front line who fail to get certain items when they need them. So, is there any evidence that some of it could be reused rather than disposed of immediately after being used?

My second question is around testing, because you say that you're confident that all the right people have been tested. Well, some of my constituents who are care workers have had huge difficulty getting tested simply because they don't have a car. You cannot turn up to Cardiff City Stadium or these other drive-in facilities if you don't have a car, and putting them in a taxi doesn't meet the social distancing guidelines for someone with suspected COVID-19. But by not providing this testing, we are delaying the return to work of the individual who may not have COVID, and we are submitting their families to having to be self-isolated. And, so, as well as home testing—and I'd like a bit more information on the timescale for home testing—I wonder if you could tell us what possibility there is for mobile testing by the testers going to the care homes, and the prison, and other places where we know that people need to be tested in order to be able to make the work of care homes more manageable. 

Thank you for that final set of questions. On PPE, I just want to reiterate that we're taking an approach to pursue all leads and working constructively with other nations in the UK, because it's the responsible thing to do. And, in normal times, we'd be engaging in politics as normal. I think it's time to put all of that decisively to one side to get the right equipment for our staff. And this isn't about shooting the messenger when it comes to what Martin Evans said. It's not the view of Cardiff University that his judgment is one that applies to the work and the nature of our partnership with that university. It is a reality, though, of the fact that the global supply chains, which we have become used to having and delivering for us, have been interrupted significantly in a way that was not predictable even a short distance into the past. That's why so many Welsh manufacturers have responded to the call to change the way that they deliver goods to actually manufacture PPE and goods that we know that we need. And, of course, in terms of looking back and learning lessons, we need to look forward to understand what local supply chains we have to provide greater resilience for the supply of PPE across our health and social care system, and that is a point that is well understood within and outside the Government.

In terms of the reuse of PPE, it is possible that some PPE can be used, for example, in dentistry as a regular part of making use of some of the eye protectors that they wear. But that isn't a politically led choice or process; that's actually got to come on the basis of the evidence of what's safe, because if I decide and try to say now we should be reusing certain forms of PPE, that is not going to have the level of confidence that staff will understandably want, or indeed the public. Those are definite, professionally led conversations that are taking place about whether there is the potential for more reuse of PPE. 

And, on testing, we don't just have drive-in testing facilities as you know. So, for example, we do think we're getting closer to home testing. You'll have heard some of the publicity this week about home-testing kits that are being developed here in Wales. And that's certainly part of our plan, to want to be able to exploit those—that point-of-care testing—so we don't have to wait a long period of time to get from referral to test to result. But also community testing services that already exist across Wales do include people going to other people's places of work or, indeed, their homes. That's already taking place in the here and now, and that's part of the infrastructure we already have, and we're looking at trying to expand that again into the future.

I thank the Minister.