1. Will the Minister make a statement on weekly COVID-19 testing for care home staff? TQ477

Thank you. I have today announced we will continue the current weekly testing regime for a further four weeks. If COVID-19 prevalence rates remain low, as they currently are, I expect to reduce care home testing to fortnightly from 10 August. I will continue to review and adapt our testing policy based on the latest evidence and advice. 

Thank you. Well, I'd like to start by thanking the Llywydd for addressing a serious affront to the Welsh Parliament: the health Minister choosing to make such an important statement outside this Chamber. Now, having considered the written statement, I welcome the fact that he has extended the weekly testing regime for a further four weeks, but I am alarmed that he may reduce care home testing from 10 August. I would like to remind the Minister that Care Inspectorate Wales have been notified of 3,382 adult care home resident deaths since 1 March. That's 74 per cent higher than deaths reported for the same time period last year. Seven hundred and thirty four care home residents have died with suspected or confirmed COVID-19, and the Older People's Commissioner for Wales has rightly described the situation in our care homes as a tragedy. More should and could have been done sooner to support residents and the staff, who do so much to care for them.

We, here in Wales, had to wait until 15 June for weekly care home testing of staff to commence, almost three months from the start of lockdown. Why? Why did the Welsh Government choose to state that the testing policy was under review instead of extending testing for staff immediately? Surely an extension was reasonable and obvious at a time when there continues to be a high number of adult care home residents dying of all causes—112 between 4 and 10 July. Moreover, it was and is perfectly feasible to extend weekly testing immediately and to maintain this beyond 10 August, when considering that testing in Wales is only still at around 20 per cent capacity. Bearing that in mind, do you agree with me that weekly testing should be extended to care home residents and other front-line social care staff like domiciliary care workers?

You know I have raised this with you, Minister. You know that you shared your concerns with me—

Quickly now, Janet—I've been very generous. 

Okay. Care Forum Wales have stated that their concerns centre around the turnaround time for results, as 46.5 per cent of test results authorised in NHS Wales laboratories were returned within a day, and 66 per cent within two days. That's down on last week. When are you going to get a grip on the test result waiting times? Thank you, acting Presiding Officer. 

There were quite a lot of points there, acting Deputy Presiding Officer, and I'll try to run through them as quickly as possible. I don't accept the accusation that the announcement today and the written statement amount to a serious affront to the Welsh Parliament. In fact, I only signed off the new testing strategy very late last night, and I'm very happy to answer Members' questions in a very busy day in Plenary. 

On the end point that Janet Finch-Saunders made on turnaround, as she'll have heard from the First Minister today, actually, it's not correct to say that this is about NHS Wales's laboratory seeing a reduction; we actually saw an increase over the last week in turnaround times. There was a specific issue, a technical issue, in the lighthouse lab in Manchester that serves north Wales, and that's had a material impact on our turnaround times. You'll see in the next week's testing figures that we had a significant increase in testing over the weekend, with over 22,000 test results over the weekend, the majority of them in lighthouse labs, and I expect us to make continued progress forward. I am certainly aware of the importance of quick turnaround times through our contact tracing service. 

On whether we should alarmed at the two-week proposal, no, we should not be alarmed. This is actually good news, and it's good news because it reflects the very low prevalence of coronavirus in our care homes. We're now at a rate where the range of positive results is well within the range for false positives—where positive results are returned but they're not necessarily true positive results. We're also in a position where, as the Member wanted to compare us with England, actually, it's less than 1 per cent prevalence within care homes staff—significantly less than 1 per cent—whereas in England it's 2.4 per cent; a material difference. And also, they haven't quite completed their care home testing programme within England. We're in a different position, and if we continue to see very low prevalence within our care homes, then we can safely reduce the frequency to a two-week, a fortnightly retesting, which is still a very regular programme of retesting within the care home environment for our staff. 

The evidence that will be published later today confirms that, on asymptomatic testing generally and the current antigen test, it's not a good way to make use of that test to simply test large groups of asymptomatic people. So, we won't be rolling it out to other groups in an unqualified way. We'll be looking, as the strategy sets out in the written statement I've issued today, at evidence for where we think it's the right thing to deploy test results for a wider and larger population. And it's worth Members bearing in mind the very clear statements from the Royal College of Pathologists about needing to have a testing programme that isn't simply obsessed about something that is done and counted; that isn't a marker of the success of our programme. Testing has to have a purpose. If you look at prevalence rates for coronavirus in Wales, we're in a very good position for a variety of reasons and the testing programme is part of that, but it's about how we use tests and how we continue to keep people here in Wales safe. 

Care homes have borne the brunt of the COVID-19 crisis, with care home residents accounting for around a third of all deaths. Now, the Welsh Government was allowing untested residents to enter care homes from hospital up until 23 April, which was an absolute scandal that Ministers will have to be held accountable for in an upcoming inquiry, even if they're not always keen to answer questions about it when asked by Members of the Senedd. It took months of pressure before the Welsh Government agreed to roll out a comprehensive weekly testing strategy for care homes, and, until pressure was exerted, there was no new strategy in place.

Now, I do welcome the fact that that has been announced today, but Care Forum Wales has said that there was no engagement at all with the sector about what was set to happen. Care homes were let down once again, and I think that that is utterly unacceptable. But can the Minister explain the reason for initially discontinuing these tests given that we had excess capacity, the reason why a replacement scheme was not ready to be implemented and announced immediately, and his justification for not engaging with the sector to explain this? Finally, do you accept, Minister, that this delay in letting the sector know what would happen until the last minute caused unnecessary distress? 

Again, there were a number of points there, acting Deputy Presiding Officer. When it comes to the vulnerability of residents in care homes and the significant number of excess deaths, we still don't have any evidence that discharge arrangements from hospitals are a material factor or, if they are, then how far in the number of excess deaths and, of course, it's never been the case that I've refused to answer Members' questions here in the Senedd. 

The Llywydd took the Chair.

When it comes to engagement with the care home sector, there was engagement with officials before I made a decision on signing off the testing strategy. I know that there was a direct conversation with the chief exec of Care Forum Wales before the strategy had been completed. That hasn't come from any media interviews or essays from politicians on any side of the Senedd; it's come because that's my expectation—that we do have conversations with the sector that's affected. And I don't think it is a reasonable accusation to make that people were left unaware and bereft while a decision was made.

We've just completed the four-week testing programme. I made a decision last night, announced today, about taking that programme forward. It's still on a weekly basis, and, as I say, it is good news for everyone that we have a very low prevalence of coronavirus in the country, and in particular in the care home sector. That comes from all the indications in the first four weeks of this programme, and we will be able to safely reduce the frequency of testing. That won't put residents at risk—we'll still have a frequent, regular retesting programme, and we'll continue to follow the evidence. And I think that, once that evidence is published, all Members will be interested in seeing that evidence about asymptomatic testing, because it does show that we need to understand the point and the purpose of testing, rather than seeing it as a good and an end in itself. It's a tool to help keep us safe, and it's important that we understand how it's to be applied, as it continues to help keep all of us safe here in Wales.

Minister, I notice you made a new statement today on how you will take the testing regime forward. Obviously, what's critical is replying to those tests and getting the results of the tests back to people who've undertaken the test. I heard your response to Janet Finch-Saunders, but it is a fact that, week on week, it's been a declining response rate, that nearly 20 per cent of test results are not being returned to the person within three days, and only 46 per cent of tests being returned within 24 hours, down from 49 per cent. So, accepting you've made an announcement around a new testing regime, how are you focusing your energies to make sure that, whatever testing regime is in place, the results get back to the recipient as quick as possible, so that they can either get back to work or take the necessary action to isolate and protect?

That is exactly the form of action that we're looking to undertake. A few weeks ago, we recognised that we needed to make further progress, and we weren't seeing the progress we wanted to, so we had to examine a range of different parts of the system. And this is set out in not just the written statement but in the strategy that's been published today. So, we look week to week—and it's a fairly small period of time—at what the figures are. We've looked at what we do in terms of the ease of people getting a test—that's now in a place where people can get a test quickly and easily. We then need to look at what happens from the point of testing to getting that test to the lab. We've already taken an example of NHS Wales labs, where we have increased the speed of that—we've changed the courier arrangements, as the First Minister indicated in answer to your question earlier.

And then when it comes to efficiency within the labs, it's an explanation not an excuse that the lab in particular in Manchester that serves large parts of north Wales had a technical issue that meant there was a slowdown. There are two points there. One is that, even though we're not in control of those labs, what we do need to understand is, if they do have that issue, that it's escalated to us much earlier on, so we don't find out at the end of a week that there's been a problem. We are now, though, in a position where we're getting that information from those lighthouse labs flowing directly into our system. So, as soon as the results are available, they're going to our local contact-tracing teams. So, actually contact tracing is still a very successful endeavour here in Wales, with over 90 per cent of contacts over the last three, four weeks being contacted and chased up successfully.

The final point is the programme of improvement we've got within the NHS Wales lab—it will have a more direct relationship with Public Health Wales, of course. And we're looking at improving the turnaround within those labs and what that will mean in terms of cost, in terms of the staffing model, and how we take that forward. Whilst we have very low prevalence rates, we need to get this right before we move into an autumn and a winter season, where we know that there'll be more tests undertaken because of the respiratory tract infections that are a common part of the autumn and winter seasons. So, good news that we have low prevalence. We are aware that there are issues that we need to resolve—we're honestly dealing with those, and we'll be open with the public and Members about that improvement action, and we'll continue to publish the figures to show how successful we are in improving those turnaround times.

First, may I say that it's a shame that it's only by the decision of the Llywydd to extend the time for a topical question that we're having time to discuss this strategy now? Because a statement should have been timetabled for this, because test and trace is so central to the fight against coronavirus, and the strategy over the next few months is so central to our success. It is still a failure in not using the capacity available. I accept entirely that we shouldn't be making ad hoc decisions on testing—we have to be strategic and we do have to test for a purpose, but, first, I do think that planning to reduce testing of care home staff, from the current weekly regime to a fortnightly regime from August, is an unnecessary and risky step at the moment, given the capacity available. 

And (2) I am disappointed that there is no reference to the need for asymptomatic testing of care workers going into people's homes. I have called for the extension of asymptomatic testing, certainly for those health and care workers who are at greatest risk, both for themselves and the people who they are in contact with, and surely, those people who go into the homes of others to provide care—many people within one day—have to come into that category. Yes, the number of cases has reduced and we take pride in that, but let's keep it that way and look out for the most vulnerable people. So, can we have a commitment on testing for those going into people's homes to provide care?

I think it's worth reflecting on the—. I referred earlier, acting Deputy Presiding Officer, to the comments made by the Royal College of Pathologists; it's worth reminding Members of what they said. This from the president of the Royal College of Pathologists: 

'Testing is not something that is just done and counted. It is a process with clinical purposes for individual patients, for those who care for them and for the population at large. It is a conscious and targeted use of valuable materials and skilled professionals within the context of a pathway and purpose.'

And I simply don't agree with the Member's conclusion that it is a risky measure to signal that care home testing will reduce in August, if we continue to see very low levels of prevalence. It's a mark of our success that we would still be maintaining a regular programme, but on a different cycle. And our ability then to still act, where we do have positive cases of coronavirus, will remain unchanged and we will be able to quickly and swiftly move to test whole cohorts, if we need to.

To be fair, though, I have had the advantage of seeing the technical advisory group's updated advice on asymptomatic testing, and I think, when the Member has an opportunity to read that, as it will be published today, he'll see that it isn't as straightforward as implementing asymptomatic testing for any and every individual as a way to keep the whole country safe. There are real challenges in particular in false positives that come from it, when we have such low prevalence. So, it's about testing for a point and a purpose and that's exactly what we've set out today and it's underpinned by the latest evidence and advice we have.

And when it comes to domiciliary care workers, I've already indicated that we will be looking to have domiciliary care workers in the next wave of antibody testing, to understand the surveillance, from a surveillance perspective, of where we are with coronavirus. So, we're thinking about what to do, how to keep workers safe and how to keep the people they care for safe, and that underpins the way in which we approach this, as we always have done, as we look to keep Wales safe and get ourselves ready for what, I'm afraid, is going to be an even more uncomfortable winter than we're used to.

Can I concur with the comments and questions that were posed by my colleague Janet Finch-Saunders at the opening of this topical questions session? Minister, a lot has been said about the importance of testing and tracking and the issues in the domiciliary care sector. I know that Aneurin Bevan University Health Board have put a particular emphasis recently on testing patients before they leave hospital to go either into a care home setting or back to their own home to a domiciliary care setting. That seems to be a pretty sensible practice. Is that widespread across Wales, and are you looking at ways that testing like this could be extended and other ways that the domiciliary care sector can be made as COVID-free as possible?

Thank you for the question. Well, actually, the reference that you made to Aneurin Bevan is a national approach in terms of hospital discharge, and it's part of a risk-based approach. When we changed testing policy on discharges out of hospital, that was largely about providing confidence to the residential care sector. The evidence and advice, at that point in time, did not support, on a science basis, testing everyone who was asymptomatic. It has always been the case that people with symptoms should have been tested before discharge from hospital. We then had a situation where we recognised that, actually, the sector was going to start declining referrals, which would have been particularly difficult for people, because harm is caused when people are ready to leave hospital and they're not able to. So, it was a practical choice about giving confidence and about keeping the whole service moving so people could return, in large part, to their own home, as opposed to new admissions from people who have not been in a care home environment before. 

When it comes to the risk-based approach, we are then looking at what the risk is in overall harms if that testing doesn't take place, and that's very different to an unevidenced approach where we don't understand the risks on a wider roll-out of asymptomatic testing, which I'm regularly urged to undertake by a range of people, including in the Chamber here today. The up-to-date evidence I think is something that is of genuine interest to Members of all sides, so I understand they're asking questions because they are concerned about their constituents and how we maintain the success we've seen, as a country, to get to the point where we have very low prevalence rates of coronavirus, as we want to successfully not just come out of lockdown, in the final stages, but actually to maintain that time out of lockdown. And that's why we're reconsidering how we rebalance the NHS with red and green zones. It's why we're thinking about a whole variety of things. The testing strategy is a part of that, and that's why I've set out the testing strategy today. And I'm in a position to answer these questions today because I signed off that strategy very late last night. I've been keen to get it right and then to make sure that we're able to provide that to Members and the public. And the statement that you have before you today, and the strategy, is part of that.

If the evidence changes, I'm sure Mr Ramsay and other Members would expect me to revise my position and to revise the way I expect the service to behave. But that's the very latest up-to-date evidence and advice, and I'm going to continue to act based upon the science. But ultimately they're my decisions, as the health Minister, about how we keep Wales safe. 

Like myself, the Minister is a student of history, and, obviously, while he was signing off these regs last night, he would have been watching that excellent S4C documentary on the Spanish flu of 1918, which revealed, obviously, there was a large first peak, then absolutely nothing happened for four months—no cases, no patients, no nothing—and then there was a huge second peak, with 10 times the deaths of the first peak. So, that's what history shows us. But, obviously, in terms of planning or mitigating any possible second wave, testing, tracing and protection is absolutely key. So, can the Minister guarantee now, with all the evidence we've garnered in the health committee over the last few months, the primacy of local public health teams? They're doing some excellent work here in Wales, and it's still basically a public service here. But can he also guarantee that as many—that the testing that's done in our laboratories here in Wales as well, in our hospitals and in our universities, as a public service, especially for the home-testing kits sent away by courier to private laboratories in England, which accounts for why you can't get the result back within 24 hours—. So, obviously, with regard to the contact tracing, getting the result back in 24 hours is absolutely key, which is why we need to ensure that we have the testing capacity here in our universities and our hospital laboratories. Can you guarantee that that's going to get—in terms of 100 per cent? Because that's how we're going to get the turnaround results in 24 hours, and also to involve GPs. The weakness of having a private overlay system linked into the UK is that GPs have no access to those results. We're absolutely cut off. People don't know, and obviously the private sector has no link to the NHS in terms of testing. So, there are weaknesses, and if they weren't written into your regulations, while you were studying last night and watching this documentary—I realise you had a lot on your plate—can you review that for any future regulations? Diolch yn fawr. 

[Inaudible.] Sorry, I've managed to be muted. It shouldn't come as a surprise to the Member or others to know that I wasn't watching the S4C documentary while I was working last night. I can multitask and cook, but I can't watch the tv and do the work that I need to do at the same time.

I've noted a range of the measures that we need to prepare for, and, in fact, the Academy of Medical Sciences report, commissioned for the UK Government about England, is, obviously, largely relevant for us here in Wales, as we look to prepare for the autumn and the winter. And I have made reference to the fact that we do need to make use of the time we have now in the summer to prepare for what may happen. We know there will be more respiratory tract infections and symptoms; we know there'll be more use made of our testing capacity here in Wales, which is why we've built it up now. We'll expect to use more of it when we need to make use of more of it, when there are many more symptomatic people who—as has been mentioned before—will either want to know they have coronavirus and need to continue self-isolating, or will be released by a positive result to go back about their business. So, we will definitely want to maximise the use of our NHS Wales laboratories, and that's why the work that's being done on improving the efficiency of that laboratory turnaround is so important.

We'll need to make some difficult choices, I think, because our budgets are incredibly strained and pressured, but we'll need to find a way to deliver a staffing model that allows a more significant staffing of our NHS Wales laboratories to maximise not just the capacity, practical daily capacity, but actually the ability to turn that around promptly, rather than being able to do that in a way that doesn't deliver the sort of speed that I recognise is important to have effective contact tracing. But we have a system that we've been proud to create as a public service, which is delivering very effective contact tracing with very high levels of success, and I'm very proud of the work that councils have done, together with the NHS, across the country to do so.

When it comes to your points about the lighthouse labs and the way they've been developed—that UK programme has managed to deliver significant extra capacity, and it is what we're using largely with the drive-through centres we've created in conversation with the UK Government, and that has meant that we now have significant extra capacity available to us, and we can protect that NHS capacity for, in particular, symptomatic people who we referred to in parts of the care system. Now, that does mean, though, we had a challenge—. And this is why we didn't go into the UK testing programme earlier, because we couldn't get the data, and your point about GPs being blind to that—well, actually we didn't know at all. We'd have known that people had had tests, but not known what the results were, and that was the position that other countries found themselves in earlier.

We are now in a position where we can both publish the number of tests—you have a unified publication every day of tests carried out in Wales—and we see the flow not just going to our contact tracing system from those lighthouse labs, but it goes through the limb system, which I'm sure you'll be familiar with, but other people who don't happen to work in the health service aren't. That means that it is going back into the patient record. Now, we didn't have that earlier. It is now available to us. So, people who provide care for individuals should see that on the individual patient record, and it will enable us to actually undertake proper contact tracing. So, we've not just got the numbers for the tests being undertaken, but, as the Royal College of Pathologists has advised all of us, it's testing for a purpose, and that purpose is part of how we keep Wales safe.

Finally, Mark Isherwood.

Diolch, Llywydd. Testing in care homes in Wales came too late for too many, and its effectiveness as a tool in the toolbox requires care homes to be operating on a sustainably resourced basis. Speaking in the virtual Welsh Parliament on 3 June, I referred to a nursing home who'd written stating that five residents had suffered COVID-19-related deaths, and that Betsi Cadwaladr University Health Board had so far contributed not a single penny towards the COVID-19 crisis. The problem was identified in the subsequent Care Forum Wales cheapskate awards that half of the bottom 10 local authorities in Wales for paying care home fees amongst the coronavirus crisis are in north Wales, with Flintshire the worst of these.

Betsi Cadwaladr University Health Board said on 15 June in correspondence that the health board is working closely with Care Forum Wales and other health boards across Wales to work with Welsh Government in securing a financial support plan for nursing care and care homes across Wales. But Care Forum Wales e-mailed me a week ago last Wednesday saying, 'Still no announcement, to our ever-increasing frustration.' When are you going to get this sorted, because the care homes are telling me they need this desperately?

Well, I think that question reveals the very sharp differences and divides in views from people on an individual and a local level and the conversations we have on a national level with stakeholder bodies. There is a regular conversation with people running residential care—both local authorities who still provide and commission large parts of the residential care sector, as well as the independent providers as well. And that includes regular conversations with Care Forum Wales. So, I simply don't accept that it's an accurate reflection that there is no conversation with the residential care sector. There are regular conversations between officials in the Government and local authorities and the care sector itself. And it's also a part of the challenge about the language that we use. I think the cheapskate awards were not Care Forum Wales's finest hour and not a helpful way to make use of the relationships we've deliberately built in Wales, where partners get to talk to each other and continue to have conversations that are challenging—they're not warm and cosy conversations between commissioners and providers, or indeed the Government and Care Forum Wales—and what we need to do is to have a relationship that has a robust and honest conversation. And that's what I think we do have. I don't accept it's been too late for too many in the way we've acted. We'll see the evidence, and I will have to take account of the evidence, once it's there, about the impact on that sector, about the choices we've made and what that's meant in terms of helping to save lives.

I would, though, remind Mr Isherwood that, when it comes to Betsi Cadwaladr, the idea that they've not contributed a penny towards the COVID crisis is simply not factually supportable, not just in terms of the work that they've done with care homes and the testing that's been provided, the way they've used NHS resources to support people, but the way in which Betsi Cadwaladr—as indeed every other part of our national health service here in Wales—has made a significant contribution to keeping people well, safe and alive, and the way that we will call on our health service to do that again through this next winter.

And, as we've heard, this is a sector that has been supported deliberately, our national health service, not just in people clapping outside their doors, but in the real appreciation of the extraordinary efforts that have been made in an extraordinary period of time. From the residential care sector's point of view, it's a matter of fact that there are tens of millions of items of personal protective equipment that have been provided at a cost of now more than £25 million for free to that sector; there's staffing support that's been provided by a variety of health boards to support that sector as well, as they've had staff in difficulties. And we'll carry on in that very practical way to help the sector, to look after some of our most vulnerable citizens, to keep as many people as well as possible, and to help keep people all across Wales, wherever they live—to keep all of us safe.

Thank you, Minister. The next item is the topical question to be answered by the Deputy Minister for Culture, Sport and Tourism, and the question is to be asked by Alun Davies.