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

Thank you, Llywydd. Members will, of course, know that I have committed to keeping you informed about COVID-19 developments, and this is my latest statement to do just that. 

The challenge from coronavirus is far from over. We have been successful in ensuring that our NHS has not been overwhelmed, but we continue to operate in an uncertain environment, and that  will continue for some time to come. It's clear that the NHS and our social care systems must operate with COVID-19 as an ever-present challenge for the foreseeable future. So, we must remain vigilant and continue to use the best scientific evidence and advice to inform how we plan services moving forward. Today, I want to update Members on a number of important developments.

We have to take unprecedented steps to increase all aspects of NHS activity to cope with the onset of COVID-19. That's staff, beds, medicines, equipment and more to plan for the worst possible scenario to provide services to meet the needs of those who are affected by COVID-19. That, of course, meant that I had to take the first decision within the UK to pause a wide range of other elective NHS activity.

We've had to give careful consideration to how essential services can be provided during this time. Without that, there's a significant risk that indirect mortality and serious harm could increase dramatically. Difficult decisions have had to be made to balance those demands, and that, again, will continue for some time to come. Our ethical framework, though, will help to guide our decision making.

At the end of March, the World Health Organization issued interim operational guidance for maintaining essential health services during the outbreak. That guidance is informing our own approach to maintaining services now and in considering any changes that we will make as we move forward. The World Health Organization suggests that, in selecting such priorities, it should initially focus on the prevention of communicable diseases, particularly through vaccination; services related to care during pregnancy and childbirth, reproductive health and the care of vulnerable populations, such as young infants and older adults; the provision of medicines and supplies for the ongoing management of chronic diseases, including mental health conditions; and the continuity of critical in-patient therapy and the management of emergency and acute presentations that require time-sensitive intervention; and just as importantly, services such as diagnostic imaging, laboratory services and blood bank services.

This is obviously complex, but minimising harm and determining where care is time-sensitive are the key priorities. Innovative solutions are and will continue to be found, including the use of digital and IT to provide those answers, as well as considering regional solutions, for example for cancer treatment. There remains, though, a need to balance the risk and benefits of having treatment at this time, including, as I said, for example, people with cancer. That is something that needs to largely be determined on an individual level between the patient and their treating clinician.

We are acutely aware, and concerned, as I have expressed previously, about a fall in the use of urgent and emergency care services. There's a real risk of harm to people who may have serious illness but are not dialling 999 or presenting at emergency departments as they should, or indeed scheduled urgent care.

To date, in April 2020, we have seen a 29 per cent reduction in ambulances transporting patients to hospital compared to the same period in April 2019. Daily average attendances at our emergency departments have reduced by 50 per cent, and emergency admissions to hospital by 35 per cent in April compared to February this year, prior to the outbreak of COVID-19 in Wales. Clinicians in our emergency departments report an increase in people with anxiety or emotional distress upon presentation, and people who had indeed presented later than they should manifesting in additional health complications.

So, I urge people who are seriously ill and need urgent advice or treatment to use NHS Wales services, because our clinicians and health professionals are still there for you. People who are concerned about attending emergency departments should be reassured that they will be screened on arrival, and they will also be segregated from any patients with symptoms of COVID-19. There are now well-established protocols and pathways across the urgent and emergency care system to optimise safety and limit the spread of the virus.

The World Health Organization identifies the need to develop a road map for a progressive, phased reintroduction of services. This will be a further important consideration to inform local and national recovery plans. Any such plans will need to ensure that we can reintroduce surge capacity flexibly and quickly, as well as maintain essential services if faced with a further peak of virus transmission. These are, understandably, difficult scenarios to plan for, and I do want to thank again our NHS staff and those working in partner organisations who continue to rise to the extraordinary challenge of this once-in-a-century event.

Personal protective equipment remains my No. 1 priority to keep our staff safe across health and social care. I can confirm that from 9 March to 26 April, we have issued over 60 million items of PPE for the use of front-line health and social care staff, with over 12 million items delivered for the use of front-line staff specifically in social care settings. Last weekend, we received masks from China into our NHS shared services stores. PPE equipment for use in care homes and social care environments are being managed by local social services who know their own geographical area and can co-ordinate priority deliveries. Yesterday, as we know and from the pictures we saw, vital supplies of personal protective equipment for our front-line health and care workers in Wales arrived at Cardiff Airport. The flight into Wales carried 200,000 fluid-resistant gowns from Cambodia. In total, this week, we expect that 660,000 gowns will be flown into Cardiff Airport, from Phnom Penh in Cambodia yesterday, and on a later flight we expect later this week from Hangzhou in China.

As well as taking these initiatives on procuring PPE for Wales, we continue to work closely with other UK countries through mutual aid arrangements and to ensure an equitable share of UK-wide PPE procurement.

On testing, Members will be aware that testing is now also available to critical workers and members of their family if they have suspected COVID-19. The current daily capacity is now more than 2,000 tests a day, but we're working hard to increase that number and to make sure that all available tests are being taken up as far as possible.

In order to continue to expand our testing programme, we're opening up more mass drive-through testing centres in addition to the Cardiff and Newport centres and the community testing centres that are already in place. So, this week, from today, there are more testing centres in Llandudno, and from tomorrow we expect the Carmarthen centre to be open. A further centre will soon follow, and that is likely to be in the Merthyr area, and we're also looking at how we strengthen capacity in Ceredigion, Pembrokeshire and Powys. Our approach involves a hub-and-spoke model with mobile units operating to give greater reach and flexibility.

Now, as I've made clear on a number of occasions, care home staff and residents have always been and remain a priority for us, and we have already expanded testing in the care home sector. I want to be sure that we're doing everything that we need to to keep staff and residents safe. So, to that end, last week we announced that we will be testing those being discharged from hospital into care homes, whether they are symptomatic or not, further protecting our most vulnerable people, and, crucially, giving confidence to the care home sector to allow discharges to be made from hospital when it's no longer the appropriate place for the care and treatment of individual people.

We're working with our partners to monitor and respond to the prevalence of coronavirus in care homes and will further revise guidance to and for care homes based on the latest evidence. Now, of course, I'm aware of the UK plans announced last night to expand testing in a range of areas. As I have said on a number of occasions, we will continue to extend the number of tests available and to keep our testing strategy under review based upon the evidence. I've committed to providing further updates on a regular basis.

Sadly, we continue to see deaths on a daily basis. Every one is a tragic loss for families, friends and communities affected. Understanding and acknowledging the numbers of people who are dying is important to all of us, including Ministers. Yesterday, we published a report following the identification on 23 April of a significant number of deaths that had not been reported to Public Health Wales. The actions identified within the report that I published yesterday have already been put in place, and, of course, they were covered in earlier questions to the First Minister.

Yesterday, many of us stood in silence for a minute to remember workers who have lost their lives to coronavirus or work-related accidents or ill health. On Monday, I announced that families of NHS Wales and social care workers who die in service as a result of COVID-19 will be entitled to financial support with a payment of £60,000. That is in addition to any other existing pension arrangements. I know that our front-line workers are going above and beyond to care for vulnerable patients every day, and this scheme gives equal recognition to staff across health, social care and community pharmacy. It provides a safety net for eligible staff who have delivered front-line services and who may not, perhaps, have been eligible to join the pension scheme or decided not to because of affordability, but also to those already in a pension scheme. I hope this will be of some help during a difficult time, although, of course, I recognise that a lump sum payment does not recognise the loss of a life. 

I'll be making an oral statement on a regular basis so that Members are assured about the COVID-19 measures being taken across the health and care system, so in addition to the committee scrutiny, which is restarting, there'll be a regular point of not just information but opportunities to ask me questions. I continue to urge people everywhere to follow the guidance, to stay at home, stay safe, help protect our NHS, and to save lives. 

Thank you for your statement. However, you'll be aware that I've raised concerns since the middle of March regarding the number of deaths in our care homes here in Wales, and in particular in my own constituency of Aberconwy. I do recall the first death was recorded here in Aberconwy on 13 March.

Now, of the 302 deaths in Welsh care homes, 109 are registered as having passed away, sadly, to COVID-19. We know of the situation of the care home in Newport that lost 15 residents in just one month, whilst 14 had symptomatic coughs and high temperatures, only two were recorded on the death certificates as having COVID-19.

I welcome your statement and the mention that at some stage you would like to see all care home residents—testing made available to everyone, but could you state by when you expect testing to be made available to all asymptomatic care home residents? Whilst I've been live on here today, I've had a number of e-mails from worried relatives, worried care workers, because I'm afraid just testing people who are coming from hospital—which is a great plus, I must say; I've raised concerns on this—the testing of more residents and care homes is a must. It's a given, and if you speak to anyone in the social care sector, the surroundings of a care home are considerably different to a hospital setting, so it's quite a vulnerable set. Also, I would want to know—from a request by a care home, now—currently for COVID-19 tests to be undertaken, how long will it take for that test to be taken and for the results to be delivered back?

Some care homes have lost as many as 60 per cent of their residents for one reason or another and have bed occupancy as low as 20 per cent. The figures needed to be viable and sustainable—they must have 90 per cent occupancy. Some are resorting to—

Janet Finch-Saunders, you need to come to your final question.

Right, okay. In a written statement on the £40 million financial assistance for adult social care, you stated there was the potential to make further allocations. Will you act on this so that more finance can be accessed by homes that are facing closure?

Thank you for the series of questions. On the point about financial support, the position is as indicated in my initial statement: when providing £40 million-worth of support for adult social care, we'll continue to review provision. We're already having direct conversations between my officials, the Welsh Local Government Association and members of the independent care home sector about the sort of support that could be made available and the base upon which that could happen. It's not actually a straightforward matter, but obviously I'm concerned that care homes remain in business. It's not just a matter of sustaining part of the business sector—they're in a different position to other businesses, because these are businesses who are caring for some of our most vulnerable people.

On the rest of your range of questions largely about the care home sector, we already have regular reporting, a commitment to regular reporting, which I've confirmed earlier this week. That's work that we're doing both within the Welsh Government, with our chief statistician and with the Office for National Statistics. There'll be regular reporting in public each week about what we understand the position to be, and I think that's important in terms of assurance and making sure that we're open and transparent.

On asymptomatic testing: this was well covered in questions to the First Minister in his statement, so I just repeat again that if you simply test everyone and anyone in the care home sector, it does not provide the assurance that people may seek, because the same people could be symptomatic or asymptomatic but positive the day after having had a negative test, and we do need to understand the utility and the purpose of the testing regime that we implement.

There is, though, a question—and I've discussed this today with the chief medical officer—about whether or not we ought to revise our testing strategy approach, based not only on a developing evidence base, but the evidence around the utility of a test if someone in a care home does test COVID-19 positive, and whether we do then need to test other residents or staff, and if so, on what basis? In terms of the time it takes from referral to test, I'm really pleased to say that the evidence we've had both from local government and indeed the improving evidence from the independent care home sector is that they're being much quicker and that people are being referred and then tested on the same day as a matter of course. And I hope that's really helpful in terms of providing the assurance that the sector and the wider public need to hear, because, as I say, this is a matter of real priority for the Government and the national health service.

That was actually very reassuring. My second question is more to do with health. I have a number of constituents approaching me in desperate need of dentistry, some in quite severe pain. The dentists are wanting to carry out the treatment, however they simply do not have the necessary PPE to do this. So, what guidance—how are you helping those in our dentistry profession to actually be able to continue carrying out dentistry?

Well, on dentistry, we know that they've had to close down, apart from emergency procedures, but if they're undertaking NHS contract work then the PPE guidance should apply. If there are specific instances for me to address then I'd appreciate it if the Member, or others, could provide me with those details, because I haven't had a sector-wide issue across dentistry brought to me in the past. But, as ever, I'm always happy to look at the evidence of what is taking place on the ground and even on an individual level to see what we could and should do to resolve that. But, obviously, I'd expect that Members, in representing constituents, would first have contacted their local health board to understand how supplies of PPE are being managed right across the health sector.

I'll start with two brief questions on ventilation and oxygen. The Minister has confirmed that, of the 461 invasive ventilators that were due to come to Wales under UK arrangements, 46 have been delivered. On 9 April, I raised a concern with the Minister and the First Minister—brought to my attention by doctors, I should say—that ventilators earmarked for Wales had gone to field hospitals in England. Now, I was told that that's just not true. I know now we're being told now that we don't need those ventilators, but can the Minister tell us where all those Wales-destined ventilators went? Secondly, I first wrote to the Minister on 28 March advocating earlier intervention with oxygen for COVID-19 patients, rather than pursuing the protocols that are still in place, which are basically asking people to wait until they're very ill before presenting themselves, and for many it's already too late then, and international evidence is pretty strong now on the lifesaving benefits of early intervention. Can the Minister seek an urgent review of how many patients who've sadly lost their lives so far in Wales were offered early intervention, so that we can try to learn from that and help future patients?

On the final point made there, about the provision of oxygen treatment earlier in a patient pathway, it's a matter we've discussed. It's a matter where we've had clinical correspondence—not just letters from Mr ap Iorwerth—and it's a matter that our clinicians are actively considering. So, I'll discuss the matter again with our chief medical officer, about whether there is a need to undertake a review, but it should be that there's a need and a point and purpose to doing so. It's that learning and understanding of how we treat people effectively that matters to me, and I expect that that's exactly why Rhun ap Iorwerth is asking his questions.

On the point about ventilators, I issued a written statement today, providing some factual clarity about where we are. Just to reiterate, there are no missing ventilators. Ventilators have not been purloined from NHS Wales to be made available in other parts of the UK. We are receiving those over the course of the procurement exercise, but, if you'll recall, when we originally procured additional ventilators for use in NHS Wales, we were expecting a peak to take place in June, as opposed to the position that we are in now. We still expect to have use of those ventilators that we originally contracted for. We are, though, now in the very positive position that we haven't needed that ventilator capacity, and part of the policy objectives we're trying to pursue are how we not just look at an exit through lockdown, but continue to behave in such a way where we don't need to make the use of all of that capacity at the same time. That's because we as a country have been successful in social distancing measures and that's made a really big difference to the spread of the virus and the level of really sick people that we've seen come into our critical care capacity. So, I hope that's helpful in providing some reassurance that there are no missing ventilators as far as Wales is concerned.

Thank you for that response. I move to three brief and distinct questions around the area of testing. The Government's document, 'Leading Wales out of the coronavirus pandemic: a framework for recovery', quite rightly calls for effective case identification and contact tracing when we move to relaxing restrictions, but we still have no clear plan for achieving that effectiveness. Roughly how many tests per day will we need to be carrying out in Wales to be effective in this key element of battling coronavirus? Government may, of course, have a plan and it's not being communicated with us; briefings are very useful in that respect. Can the Minister tell us if it's true that the chair of Public Health Wales asked to be able to brief opposition party leaders, but that she was told she couldn't? And, finally, questions have been raised already in the session today about the decision not to broaden testing to all care home residents and staff. We've been told multiple times this afternoon that you don't believe, as a Government, that this is a good use of resources, but let me just remind you: by now, we were meant to be testing 9,000 a day. We have a capacity now, we're told by the First Minister, of 2,100 per day; yesterday, we tested 734. So, isn't the truth of the matter that (a) we still don't have the capacity and (b) we're still not identifying enough people to be tested in this war against coronavirus? 

I'll happily deal with those three areas. The first is probably the easiest. There is absolutely no instruction to the chair of Public Health Wales that she can't brief opposition party leaders. We're providing a huge amount of information on a daily basis and, indeed, there are regular briefings that I provide to the official opposition spokesperson and Rhun ap Iorwerth in his role for Plaid Cymru. So, we've been very open from the outset about what we're doing as a Government, including where there's disagreement about what we're doing. So, I'd be disappointed if anyone was trying to suggest there's been an attempt to try to prevent information being provided to elected representatives, when that is the very opposite of what we have been doing.

On testing in care homes, we're going through the issues that have been raised before. The point about our plan for the future is it's part of a broader plan about the testing strategy being part of the underpinning for what we do about recovery, moving out of lockdown. How do we get there? What does a proper public health surveillance system look like? We are working through that, and, of course, when I'm in a position to do so, I'd be happy to discuss that with Assembly Members.

The point about where we are on testing is, following the review that I ordered, I've been really upfront about the facts; I provide a weekly update on where we are in our testing capacity. I expect that to increase each week, and we then need to understand what does that mean in terms of the measures that we may want to take to move out of lockdown and the capacity we think we may need. It's important to see that as part of a whole, rather than having a plan for testing that isn't linked in to what we actually want to use that testing for, because our current capacity is enough for the current purpose of testing—for critical workers whilst we are in lockdown.

But, as I have said on a regular basis, we will need a bigger testing infrastructure, in terms of the ease of access for people to use that testing infrastructure, as we approach the end of lockdown, even if we're moving in those cautious steps that we've advocated, that we've said that we want to try to move forward with, and that remains the position. I'll continue to provide that weekly statement, that weekly update, and I'll continue to be happy to deal with Members' questions on where we are, and, when we're in a position to have that wider plan, then, of course, you'll hear about it.

Thank you for your statement, Minister. Yesterday, we observed a minute's silence for our heroes in social and health care who lost their lives to the scourge of COVID-19, and I want to once again put on record my thanks to our dedicated health and social care workforce, who are keeping us all safe, and offer condolences to those who have lost loved ones.

We still do not know enough about this virus, and, as we continue to flatten the curve, we must redouble efforts to understand this enemy. Minister, it appears that, on a per capita basis, south-east Wales is the hardest hit part of the UK. Cases per 100,000 people are at 441 in Newport and 436 in Cardiff, while the hardest hit part of England, Brent, has only 396 cases per 100,000—the same as Swansea. What assessment has the Welsh Government made of why we have such high incidences of infection?

Of course, these are just the hospital-confirmed rates, and, if we are to truly understand the infection rates, we need to ramp up serological testing. Minister, what progress has been made in developing plans for randomised antibody testing across Wales?

This pandemic has had a massive impact on mental ill health, and we have seen an increase in suicide rates. Minister, what plans does your Government have to increase the availability of remote talking therapies? Can you outline other measures the Welsh Government are taking to combat the impact of the virus on mental health?

One of the biggest risks facing us is a second outbreak coinciding with the flu season. What plans does the Welsh Government have to massively increase the flu vaccination programme, and will you consider giving free vaccines to everyone in Wales?

It is well established that measles wipes out the body's immune memory. Minister, will you ensure that all vaccination programmes continue and do all you can to ensure everyone eligible for vaccination receives it? Thank you once again for your continuing efforts. Diolch yn fawr.

Thank you for the series of questions. On your first point, about actual rates of coronavirus infection, of course, these are the recorded instances, and we always have a health warning in every part of not just Wales, but the rest of the UK, that the real figures are likely to be higher. So, I'm not going to be drawn on definitive comparisons of different parts of the UK, but we know that the south-east part of Wales has had the most significant impact. You can see that not just in the number of confirmed cases, but actually in the way that our hospitals have seen people come into them requiring care, and in particular the way that intensive care capacity has been used. That is just as good a marker, if you like, of the circulation of the virus in different parts of Wales.

So, of course, we take seriously and want to understand exactly how the virus behaves as its behaviour has changed during the course of the pandemic. So, there are lessons from other parts of the UK, and a need to learn lessons within and across Wales, and that is a regular feature of the work and the discussions that we are having within Government and indeed within the service.

In terms of your point about an antibody test, we're not yet at the point where we have a reliable antibody test we can roll out across the country. There's a range of work on that. There's testing of a range of potential tests that are in the market, and every now and again you may see on social media someone claiming to have a useable and effective antibody test. Well, we need to test whether those claims are real or not and whether we can actually provide an antibody test that provides the level of usefulness that it plainly could have. That's why it features in our strategy, because we understand how useful that could be in understanding both the spread of coronavirus and how we actually take measures in the future to protect the wider public.

On talking therapies and mental health generally, it's part of my concern and part of my concern that I've set out previously about the use of our services. I'm not just concerned about physical health, I am just as concerned about mental health, both of the public but also of our staff, who are—. Despite the fact that the impact of coronavirus to date has not been as significant as we thought it really could be a few weeks ago, our staff are still dealing with an extraordinary period of events and there's a very real strain on our staff in doing so. That's why I've increased the availability across health and social care of access to support for our staff in doing their work. We need to keep them well so they can help to protect us. 

On flu vaccine, I think the constant message is the take-up of the flu vaccine. So, people who have been advised to take further care and to especially pay regard to social distancing—the starting group is for people who get a flu vaccine on the basis of their medical conditions. And it's a constant struggle each year—despite a very high profile public campaign, many people still don't take up the option they do have to have a free NHS flu jab. I certainly hope that this year people take even more seriously not just the opportunity but the real value in making use of that NHS flu jab to keep themselves and their family safe.

And there's the broader point about vaccination programmes. It's one of the key points I made not just in my statement but in previous statements, about wanting to maintain various parts of our public health architecture, and vaccination programmes are obviously a crucial part of that. So, in particular for parents of young children, please make sure that your children do continue to attend and take up those vaccines, because it's important not just to keep them healthy from coronavirus, but actually in their general health. The last thing I'd want to see are those common illnesses that we know cause real harm make a reappearance because as a nation we don't make sure that our people get vaccinated when they could and should do.

Minister, we have some absolute heroics going on in the care sector at the moment—managers of care homes and front-line staff in domiciliary and residential care are going way beyond the call of duty. They're not just caring for our loved ones who are locked down and in isolation, but they're trying to adhere to physical distancing when working with residents with dementia and those who will wander. They're dealing with more frequent incidents of bereavement, and some care homes have been especially impacted, and all of this is being exacerbated by the difficulty of families and friends being isolated from the residents in life and in death. Our care workers are genuinely heroes. They always have been, of course, but it's now evident for all those who've not seen this before. So, Minister, what will the future look like for these heroes? When the public health battle against COVID-19 is won, will they be truly better valued in society? And crucially, Minister, will they be truly better paid and have better terms and conditions and a professional career path?

And on a related note, Minister, what does a far more integrated health and social care effort look like in Wales in future times of comparative calm and peace, having learned the lessons of how essential integrated working is in the heat of the battle against a pandemic?

Again, I think it's a really important point that Huw Irranca-Davies makes about people who've been isolated in life and death; that it's very, very hard, both for people who know they're nearing the end of their life, but also their families who may not be able to see them and derive a sort of comfort and closure that those of us who have suffered loss within our own family and friends would understand makes a really big difference to being able to move on.

In terms of the future for social care staff, whether in residential care or otherwise, I certainly haven't forgotten my commitment and a place where I want us to get as a nation. I hope that the current crisis, the extraordinary time we're living through, means that people won't just wander out every Thursday to applaud key workers, not just in our national health service but in social care and wider, and then forget about the conditions that they work under and the pay that they receive the month after the COVID-19 crisis is over. Because it does ask questions that we all need to ask about the sort of country we live in and how we value each other, because we've really seen the enormous value that a number of people, who are poorly paid, provide to the way that we all expect to be able to live our lives and, frankly, the way we expect our relatives to be cared for in a way that other countries, for example, have much greater familial care and provision. That's what we don't have here. So, I certainly want to see continued moves made forward on pay, on career progression, on terms and conditions. So, the work that was paused on the ministerial group on paying for social care that, at one point, you were the chair of during your time in Government, that has continued. It's been paused because we were about to publish a series of reports to start a national debate just before coronavirus became a much bigger issue. I don't want to let that work go, but I certainly hope that's not just a commitment from the parties in Government, but much broader afield across each and every party about how we properly reward people and recognise them. And that recognition is in our integrated system; we're in a better place because we've made steps along the path of integration here in Wales. I think far from undermining the plan in 'A Healthier Wales' for health and social care, it reinforces the need to make steps on that journey and to make them more quickly, because they provide a better benefit, not only for our staff, but for the public that we serve.

Minister, the infection rate known as 'R' is below 1 because of the lockdown and vigorous social distancing. It seems to me that the only way it remains below 1—and in Germany we're already seeing that is a formidable challenge—is if we can test and trace extensively. But we're still quite vague on what that system is going to look like. I know in England they're aiming to recruit 18,000 contact tracers; that would give us roughly 900 in Wales, if we needed a similar capacity. But lots of questions about what technology will be used and where these people will be recruited. Will they be more local authority based or health authority based? What's it going to look like? And how are we going to deal with the particular challenges of high-density housing, tower blocks and that, where lots of people don't know their neighbours, and yet the knowledge and passing the information on of who's been in contact with whom and how is really very important? Without that picture, it seems to me we can't move significantly out of lockdown. And can you give us a bit more detail on what that picture is going to look like in Wales?

I expect to be able to provide that within a fairly brief timescale. It's why, I think, having a testing target that isn't linked in to what we actually want to achieve doesn't actually make any sense. It's also the point that I made previously about having a testing target in isolation, where we're not in control of all the elements of it. The commitment to expand our testing capacity has not gone away. I'm certainly not trying to suggest to anyone, either here or any member of the public, that we're not concerned about expanding our testing capacity, because, as I have said repeatedly, we will need that in place for exactly the test-and-trace element of what recovery looks like. Because you are right to point to Germany, about the increasing rate of coronavirus. It's the lockdown and social distancing that have meant that we've not seen a further spread of coronavirus. That's what's meant that our hospital system has not been overwhelmed; that's why we don't have our field hospital capacity full. But it also reinforces why we shouldn't run the NHS hot and want to run it full and then go out of lockdown, because Germany is a really good example of that, about the challenges that you can have. As people mix more, then coronavirus will continue to be an issue.

So, I want to say more about that when there's a plan to talk to you about, rather than the outline conversations that we've had, but if you bear with us and our system, then we'll have much more detail to provide. And, again, I recognise that when that's available, there will be understandable scrutiny, not just from the press and the public, but I expect to be able to answer those questions in front of Members as well.

I'm glad to hear, Minister, that you're advocating better working conditions and salaries for nurses and care workers, because that strikes a very different tone to the one that you struck in answer to my questioning just some months ago, when I was raising concerns about proposed changes within Betsi Cadwaladr to nursing rotas in north Wales, which would have been, of course, to the detriment of the working conditions of nurses there. So, are you now saying that you will be backing the nurses and the unions, and not telling me that it's a matter for the board, and not a matter for Welsh Government?

Well, I think it's some jump to link the challenges over nurse rotas, where actually I played a part in getting the employer and trade unions back in the room to discuss matters and to resolve them, and to link the position now with the question on paying some of our poorest paid workers—a largely female workforce—in domiciliary care and residential care. I think that's just a leap too far.

I have always been committed to wanting to do the very best for our workforce in each part of the economy. It should be no surprise to you, not just as a Labour politician, but as a former shop steward myself who's been involved in pay negotiations, that I want to see people well paid. That's why the NHS continues to be a real living wage employer; it's why I made the moves I did on pay and terms and conditions where I am responsible for authorising and agreeing pay rates within the national health service. We have a commitment as a Government to want to see sectoral bargaining in other parts of our economy, and I think that would make a real difference in social care: it would provide some certainty.

We need to look at how that links into both commissioning at a national and local level, and we also need to do something about having the income to do so, because you know as well as I do that our ability to pay our staff properly does relate to the income that comes into our system. I think it's pretty difficult to have a much more sustained increase in the pay for social care staff without having more income coming in to do so, and that's why it's a very real consideration for us to use the powers that this national Parliament has, to use those in a way that would provide not just more money to go generally into social care, but what that means for our staff as well.

As I say, we were on the point of having that national conversation when the coronavirus pandemic struck, and all other forms of normal policy making had to take a backseat. So, the answer I gave to Huw Irranca-Davies remains, and my commitment through my whole entire political engagement remains to improving terms and conditions for workers right across the economy.

Can I press you again, Minister, on the number of testing centres? Yesterday, The Daily Telegraph reported figures from the Department of Health and Social Care that said there's only one testing venue in Wales. I've been in touch with the NHS Wales Informatics Service and they say that there are 21 testing centres. Can you tell me precisely how many testing venues there are that are up and running at the moment?

Can you also give some assurance about the NHS pneumococcal vaccine this winter and that there will be widespread availability, as it is helpful, I believe, for treating secondary respiratory infections?

Finally, on fertility clinics, when can we expect them to reopen? Will Wales be doing something different to England and can those receiving treatment at least have the option of pursuing treatment in private clinics, provided it's safe to do so?

On your final question about fertility treatments, I'd need to go through more of the detail. If you'd be happy to send me a note, I'll be happy to provide you with some more detail on the points that you raise.

In terms of people undertaking a variety of vaccination programmes, the point I made earlier stands, that we don't anticipate there being, at this point in time, a challenge with vaccine supply for other vaccines. The real challenge is getting the public to take up the vaccinations that are available, and to recognise the very real protection it provides to them and other people if they do so.

On your point about testing centres, it's not a surprise, but it's a constant source of frustration and disappointment to me that we have reports in other organs claiming to look at the UK-wide picture that don't accurately reflect where we are in Wales. We of course have more than one testing centre—we've got more than one drive-through centre—and the 21 that NWIS have provided you reflects not just the numbers of venues, but then there's something about the spread of those as well, because community testing involves people going out to people's homes. I've already said we're going to be at the point where we're going to have home testing available for people as well, and mobile units to go out and provide testing too. So this isn't just about getting people to a test centre; it's actually about getting the tests to people in a more convenient way. That isn't just an issue for rural Wales; it's an issue for large parts of urban Wales too, to make the testing programme as easy to access as possible. It's not just about the form-filling process, but then the practical access to the test itself, and we actually should then be in a world where we're able to move to a point where the test results themselves are sent directly to people by SMS if they have that. I think that texting response will remove yet another part of the challenge in the efficiency of the system. So, yes, NWIS are correct with their 21, but you need to see how those 21 different programmes and venues work in providing tests to people, and not just getting people to a different venue.

Minister, I'd just like to pick up on the question that David Melding asked you about testing and how we exit our lockdown. I understand that you haven't yet formulated all your plans and you need to work on them, and you want to put more meat on the bones, but I am concerned in respect of surveillance testing. You know the Welsh Conservatives have pushed for having a very clear departmental team in charge of making testing happen today, which we know it's not: 2,100 hospital tests can be done every day, and we're doing about 700, and it's nowhere near the ambition of 9,000. And we also want to make sure that that team has a really good idea moving forward of how we look at the whole surveillance issue.

Now, during last week's parliamentary Science and Technology Select Committee meeting at Westminster, the chief medical officer was asked about the plan for testing in Wales, and he basically intimated that there's a technical advisory group that takes details from SAGE and flexes them for a Welsh context. I just wondered if you could give us a little bit more detail on that. Who are these people? Are they from a science background, an NHS background? Are they actually modellers? What data, given that our data is not great in some areas, are they using to flex it for that Welsh context?

Yes, the technical advisory group is chaired by our chief scientific adviser on health. He co-chairs it. It does include a range of scientific expertise; it does include modellers; it includes people from public health backgrounds and others as well. So, it's a variety of people to try to understand the science and then to convert that into advice that is useful for our system and for Ministers. So, yes, we do have that expertise available to us, as do other Governments within the UK as well. You'll find similar arrangements, although they may have different names, in both Scotland and Northern Ireland too.

On your broader point at the outset about having a public health surveillance plan as part of the essentials that we'll need to move out of lockdown, which will include testing as part of it, that is work where there's a re-focus that's been undertaken. I'm still the Minister with responsibility, as you would expect, but we had a military planner who's done a review for us to look at where we are, and so we've looked at an internal reorganisation to give some internal leadership to that, so that the system we have, not just within the Government, but with our partners, can see more clearly how and where decisions will be made. Now, that doesn't make a particularly interesting press release, and we certainly can't turn it into a Twitter soundbite, but actually in terms of getting the system right, it's actually really important. So I'm expecting that grip and focus to be improved, and that should help us to get to where we all want to be, not just with a bigger programme with bigger capacity within it for testing, not just being part of that wider whole, but making sure that we actually get to use it in the way that we want to, with ease of access, ease of use, and that really should help us with the surveillance work we'll need to undertake as we exit lockdown, because as your colleague David Melding recognised, this isn't a simple or straightforward matter, and other countries that have gone first are finding this quite a difficult challenge to get through. It's been much easier to go into lockdown than to successfully come out of it.

This crisis has brought to the fore a fundamental problem at Ysbyty Gwynedd, Bangor in my constituency. For some weeks, I've been aware that a problem has arisen with the capacity of oxygen flow in Ysbyty Gwynedd and that, in turn, could restrict the ability of the hospital to deal with the COVID crisis. Resolving this is being given priority by the British Oxygen Company, and I'm grateful for the efforts made by local managers to ensure that that's the case. However, would you agree with me that we should have invested in this work over a period of time? It takes a crisis for this to happen. And do you agree that this is a clear sign that Ysbyty Gwynedd, Bangor is being downgraded quietly and through the back door?

Well, I'm pleased to hear the oxygen flow issues are being addressed and are being highlighted, and that's, of course, important. It's partly, though, because of the flexing up of critical care capacity and the much greater use of oxygen, and so the flow that's required has obviously increased. That's not a surprise when we think about what's happening. 

In terms of investing in that work over a period of time, well, as we learn lessons, not just at the end of this but all the way through this, we'll of course have questions to ask about what we have done but then more importantly what we choose to do in the future for our preparation, not just for a potential future pandemic, but actually for what we think of as normal business and what level of resilience we need. And that's quite a difficult debate, actually, because that is about how we use resources and how we spend money prospectively when, actually, we've gone through a period of more than a decade where, actually, it's been about a deliberate policy to take money out of public services, and we've all had to cope with a significantly reduced amount to do that with. 

On your final point about whether this means that Ysbyty Gwynedd is being downgraded, I simply don't agree with you. There is no secret plan to downgrade Ysbyty Gwynedd and to do it secretly and quietly through the back door, so I'm happy to reassure you that this isn't the plan of either myself or anyone else. The reconfiguration of health services right across the country is about how we design what works best within our health and care system and how we meet the challenge set for us by the parliamentary review that set out that, on some services, we could and should see a better service with better outcomes for people if we concentrate those highly specialist areas, but equally on others, they should move out of specialist centres either into local provision or, indeed, primary and community care. That is the basic plan that we have right across the country, and it's really important that we reflect that that is the best way to deliver the best possible care to each of us and that's the way we could and should organise our system.  

[Inaudible.] —being released daily. What can you do as Minister to make sure that last week's reported failure to keep north Wales's data accurate is properly rectified and not repeated?

Well, as I said, this has been dealt with in some detail by the First Minister, but I hope that the report that I published yesterday provides Jack Sargeant with the sort of certainty that he's understandably looking for. I think it is important to reflect that this wasn't simply a matter of people saying that it was the north Wales health board that got it all wrong. That isn't what happened. The issue that was identified came about when Public Health Wales published health board area data, and, at that point in time, Betsi Cadwaladr got in touch with Public Health Wales because they recognised that there was a problem with the figures that were being published. We now have a system where the recommendations of the report are being implemented, everyone is using the same system, and there's weekly contact between Public Health Wales and the health boards to provide the reassurance that all of us want, and that certainly includes Ministers as well as local Members in the different health board areas, because I want data that I can rely upon in the choices that I make for the whole country. 

Minister, I put a question to you in writing, and the response you gave me was simply,

'I will write to you and a copy of the letter will be placed on the internet.'

That was the answer there. I raise that point with you.

Secondly, I'd like to ask a question on behalf of Colin Brain and many others in the same situation in my region, because, in light of the statement made by you about not testing people without symptoms in care homes, he simply asks that, if his mother or others in the care home died due to a lack, in part, of testing, will you, the health Minister, take full responsibility for that and everything that that entails?

Well, as the Member has heard on a regular basis throughout not just this afternoon but on a number of other occasions, the evidence we currently have does not support general testing of people who are asymptomatic. If that evidence base changes and under specific circumstances or generally, then I'll be happy to shift the position of myself and the Government. And it's really important that we don't try to set out that there is a counsel of perfection that is available in one part of our system or another, because we'll continue to learn; we'll know more about coronavirus next week than we do this week. We'll have more evidence to base our choices on, and we may need to change the way that we deliver different services. I think if Ministers got ourselves into a position where we refuse to concede, refuse to acknowledge that there could be different, other evidence available in the future and we may make different choices, well, that would be doing entirely the wrong thing for the public.

So, I will continue to take responsibility for the whole system, for choices that I make, for the way that I give direction and the leadership that I give right across health and social care. If we do change what we are going to do, then I will expect not just to recognise that but to explain that, and to explain what we are doing and what the basis for that next choice is. And that, I think, is the sort of responsible leadership that all of us are entitled to expect not just from me, but from other people in their own leadership roles right across our health and social care sector. 

Minister, you'll be aware that the University of South Wales, based in Treforest, has been at the forefront of research about new ways of testing for coronavirus and that they produced a potentially game-changing rapid response test. It's part of an upsurge in local enterprise and innovation to produce personal protective equipment, and to develop new ways of testing that we've seen in Wales and which the First Minister commented on earlier. Now, I understand that the trials for Cwm Taf Morgannwg health board have gone well, and that the University of South Wales is now seeking support from Welsh Government for this important work. I wonder if you could update me on what the current situation is, whether there have been discussions between yourself and the University of South Wales, and on any progress that's been made in advancing this important project. 

I thank the Member for the question. This is an important and positive development in our growing evidence and research base about what we're able to do. The test that the University of South Wales have been involved in developing provides a rapid test result, and so we're looking to roll that out. It could be very helpful in both point-of-care testing but also home testing as well, and I'm happy to confirm that we have approved funding from our COVID-19 support mechanisms to allow that to carry on and carry forward to the next stage. And I'll continue to take an interest in the results of that. We're also doing some work with a business to progress the technology around this as well.

So, those offers, I understand, have gone out and they'll be aware that that support is being provided, and the funding support should lead us to a position where we understand if this is a technology to pursue and then to roll that out to provide the sort of rapid testing that will really change our ability to implement a different sort of testing regime and provide people with some real certainty in either their work places or, indeed, their homes. 

Finally, Delyth Jewell. 

Minister, ONS data suggests that COVID-19 deaths in care homes are substantially higher than is being recorded, and I've looked at the Aneurin Bevan data and it shows that there's an increase in deaths of non-COVID deaths in care homes this year. Now, that isn't what we'd expect moving from the winter into spring. Surely, the only explanation that's reasonable for that is that COVID-19 deaths are not being recorded as that on death certificates. 

Now, additionally to this, I've spoken to a number of care home managers who have told me that a lack of testing is leading to avoidable outbreaks in care homes, and this at a time when tests will be made available to residents and staff at care homes in England but not in Wales. Looking at all of this, Minister, are you ashamed that you said this morning that providing tests to residents and staff of care homes would not be the best use of resources? 

On the point about non-COVID-19 deaths rising, we need to understand what exactly that is, whether there is an issue in COVID-19 not being recorded—because, actually, the death certificate review is the most accurate review—whether there's a time lag and whether those figures are provided by the Office for National Statistics. It's also the point that I've made both in my statement and previously that some people are refusing to go to a hospital when they have urgent care needs, and I'm really concerned about avoidable harm and avoidable mortality. And rather than jumping to one conclusion, I want to understand what that full picture is.

And on the point you raise about the use of resources, I think it's important to quote people in context and fully so you don't give a misleading misrepresentation of what's actually been said. I've been really clear about the evidence and advice that we currently have, about whether having a general testing programme in care homes for people who aren't symptomatic is the right thing to do. I've also indicated that if the advice changes, then we could or should shift our position, based on the evidence and advice on the best way to use our resources. I think it's unfortunate to use such emotive language and the social media post that has been made, with yourself and your name on it, which contains a direct misrepresentation of what I said, is a work of fiction, and, if someone's going to be ashamed, I think you should look at what's being said in your name because it is simply is not true. 

Thank you, Minister. That brings us to the end of that statement and I will suspend proceedings now for 10 minutes. 

Plenary was suspended at 15:51.

The Assembly reconvened at 16:07, with the Deputy Presiding Officer in the Chair.