Item 4 on the agenda is a statement by the Minister for Health and Social Services on the winter protection plan. I call on the Minister for Health and Social Services—Vaughan Gething.

Thank you, Deputy Presiding Officer. Members will be aware that I announced our intention to develop a winter protection plan for Wales over the summer. I'm pleased to confirm we have now published that plan, following our work with stakeholders. The events from the last week have reinforced why this is needed. Despite all of the good progress made over the summer, the position remains precarious. The COVID-19 pandemic is not over, and as we have been reminded again, the virus can spread quickly with significant local outbreaks.

We all know that winter is always a challenging time of year for our health and social service staff. Let me be clear: the challenges this winter will be truly extraordinary. In addition to the normal winter pressures, we will need to respond to the unfinished COVID pandemic. The resurgence of the virus in recent weeks will not be the end of our challenges. The next days and weeks will determine whether we need to introduce even more significant measures to control the virus. So, we must be prepared for the worst. The winter protection plan is intended to bring together the main health and social care contributions that protect the public, help support delivery and engagement with our key partners and stakeholders, and we will work together to keep Wales safe.

We have heard from community health councils about the things that will matter most to individuals and communities. Engagement with professional groups and partners across health and social care has been helpful to ensure that the context for the winter protection plan is clear. Our NHS and care expectations will be more specifically set out in the NHS operational framework for quarters 3 and 4, which will be issued next week. The winter protection plan will be supported by the £800 million NHS stabilisation package that we recently announced, together with the additional funding being provided to local authorities and the care sector.

The plan highlights a number of now familiar areas, but ones that are crucial to controlling the virus, keeping communities safe and well and to reduce demand on our NHS and care services. For example, a key element of the local prevention and response plans is the test, trace and protect service. This provides a key defence against widespread transmission that relies heavily on public co-operation, honesty and compliance with that advice. The plan identifies the need for the public to support an expanded and comprehensive flu vaccination campaign this autumn. This should help to reduce the seasonal demands that flu places on our NHS. There is no easy way to tackle COVID-19, it requires everyone to play their part in supporting this national effort.

Scientific evidence informs our decisions and will continue to do so. I recognise it has been very difficult and challenging for us as individuals and communities. Working together as a nation has made a huge difference, with people and organisations across Wales playing their part in helping to limit the impact of the virus. The reduction over the summer made some people relax and become complacent about the continuing threat. There has also been a minority of people that have deliberately not followed the rules and may have thought that COVID-19 had gone away. It has not and cases are rising.

Despite the huge efforts of the majority of people, some areas are experiencing much higher numbers of cases that are likely to result in vulnerable people being admitted to hospital in the coming weeks. So, let me be absolutely clear: if we are to avoid further local or national lockdowns, our behaviour must change and change quickly. We are in a similar position now to early February this year—a matter of weeks ahead of the national lockdown choice made in March by each UK nation.

We have seen significant rises in cases in the Caerphilly borough area, Merthyr Tydfil, the Rhondda and in Newport. Members will know that local actions have had to be taken and are under constant review. Limiting people's movements and placing restrictions on daily life is never something the Welsh Government has taken lightly. However, we will make those difficult decisions to help to save lives and reduce the risks to our most vulnerable people.

The significance of the rise in cases in the last week means we have a very narrow window of opportunity in which to act and avoid more radical intervention. None of us want to see more restrictions, but I cannot stress enough that if we do not start to see a reduction in cases, and that can only come through changes in our behaviour, then lives will be lost. I do not want to see a national lockdown, but if the choice is that or more harm, including deaths, then we will do what is necessary to keep Wales safe.

Health and social care staff, together with other key workers and colleagues in the third sector, work tirelessly to provide services and care for us and our loved ones. We in turn must all do our bit to fight the virus and help keep Wales safe, whether that is adhering to the rules, maintaining social distancing or practising good hand hygiene. We will continue to live with the virus in many aspects of our daily lives for some time to come. We must remain vigilant for ourselves, our families and communities.

The winter protection plan is not a panacea, and it will take time for us all to recover from this pandemic. However, the plan demonstrates our continued commitment to the people of Wales throughout this exceptional public health emergency. We all have our part to play to do the right thing. We can all make choices to help keep Wales safe.

Minister, thank you for your statement this afternoon. Can I put on record my sincere thanks to all the staff that make up the health and social care family in Wales for what they've done so far since the COVID outbreak was officially declared in March, and, indeed, to you as Minister, and the Government as well? Because I'm sure the pressure on all of you as individuals has been as great a challenge as anything you've faced in your political if not in your entire lives. But I would like to ask a series of questions about the plan that you have tabled before the Assembly today.

It's important that such plans do maintain confidence, and confidence is a critical component, not just from the staff who will be delivering this plan, but obviously the public who have to buy into it. Yesterday, we had the breach from Public Health Wales around the testing and the data that was put up on public display. This afternoon we've heard from the First Minister that he didn't know anything about that breach of data until 2 o'clock yesterday afternoon, when Public Health Wales put that up on display. I'm led to believe that Welsh Government were informed on 2 September of this data breach, and you as Minister were informed on 3 September. Can you inform the Assembly today of the timeline when this information was made available to you, and why did you retain that information rather than share it with other colleagues in Government? Or is it the case that you did share it with other colleagues in Government, but not the First Minister? I think it is really important that we understand how Government is working when such anomalies—and it is an anomaly, I accept, the data breach, but it's a serious anomaly of 18,000 names appearing on a public website, and it's vital that we keep confidence.

Secondly, could you highlight how this plan will start to address the issue of tackling the waiting lists that have built up through the summer months? Because it is critically important that we do make progress in that particular area. I agree entirely with you when you say about the issue of it being a real troubling time when you've got COVID and waiting times and normal winter pressures, but it's important that the public can have confidence that some of these waiting times will be eaten into.

Thirdly, on the flu vaccine programme, can you identify that there are enough doses available to meet the requirements of the flu vaccine programme that you've put before us? Because a new cohort of individuals has been brought into the scheme, and as I understand it, there are still negotiations pending with the pharmaceutical companies to secure enough dosage to make sure that there's enough flu vaccine available in the country.

Fourthly, it is vital that we understand the support that the staff require, both in social and in health settings. Are you confident that this plan that you've put before us today to meet winter pressures will meet the needs of staff both in social care and healthcare settings, so that ultimately they can feel supported, whether it be in PPE or making sure that they can make the decisions that they require to meet the circumstances that face them in their own localities?

Finally, could you highlight to me in particular—because it's a concern that I've had raised with me around dental services—how this plan will address the chronic problems that the dental service in this country is facing at the moment, getting back to as near normal as possible, albeit the new normal that we face with the COVID regulations?

Thank you for that series of questions, which I'll try to address as quickly as time allows.

You're correct; my understanding is that officials were informed on 2 September, and I was informed with a serious incident alert on 3 September. That's entirely normal. Public Health Wales had already informed the Information Commissioner, as they should do, of the breach. They had identified what had happened, and as I say, we don't believe that anyone has come to harm, but it is a serious breach and it needs to be treated seriously. That's why there is an independent investigation. That investigation will be taken through the board accountability and governance processes, so you can expect there to be a published report into that investigation once it's been received. And as you know, the chief executive of Public Health Wales issued a proactive press release and gave a series of interviews yesterday setting out what had happened, and indeed apologising for the serious breach. There is no attempt to cover over the fact that this was a serious breach that took place, and it was reported as a serious incident, as indeed all serious incidents are between the health service and the Government.

In terms of addressing waiting lists, I'm afraid I don't share the Member's optimism about the ability to significantly eat into waiting lists over the winter period. It's a reality in every nation of the UK that the significant increase in activity that has built up during the first period of lockdown, where we both ended NHS services—. You'll recall that on 13 March I was the first UK health Minister to make the decision to pause most forms of elective activity. We've seen a significant build-up as a result of that, and then, even as services have restarted, there's been some reluctance from members of the public to access services that are now available. In common with every other Minister in every one of the four nations, I'd say that most of the next term, a full Senedd term, will be likely to be needed to catch up with the activity we're seeing, partly because of the activity that's built up, but also because we're not able to see people in the numbers we'd otherwise do. That's about the need to screen people, between COVID secure and those where they are suspected or COVID-positive. It's also the reality that our staff can't undertake as many procedures with the additional PPE requirements. So, it isn't realistic for us to expect there to be a significant eating into waiting lists through this period of time. It will need prioritisation for people with the greatest need, and that means that it's going to be difficult because some people will need to wait longer. But, as I said, that is not a situation unique to Wales. You may have seen the commentary from the King's Fund and others about the scale of challenge that we're going to face right across our national health service, and we'll talk more and more about the reasons for that, including our staff. And I was pleased to hear you mention our staff, because our staff haven't really had a break, across our health and social care system, since the start of the pandemic, and that gives me great concern about not just the potential for a second wave, but the longer term future. 

We have introduced more support—occupational health support, health and well-being support—and I have had very regular conversations with representatives from employers and trade unions. There's been even more conversation between those parts of the workplace relationship than even we would have had in normal times. That's because what our staff have had to do will have an impact on them, for more support, practically, to keep them in the workplace, but we also know that there is an effect that takes some time to manifest itself when people have been through particularly difficult or traumatic events. So, through the next term, we'll need to deal with the reality that staff in health and social care will need more support, and some staff will need to come out of the workplace to recover and some staff may leave prematurely.

So, actually we have had a really big challenge building up with more activity that we can't undertake now and we'll face a challenge in our staff. But I can say, though, on the positive side: you mentioned challenges around PPE to support staff; we're in a much better position than at the start of the pandemic, where we found that we had stores that we had in use, and once we'd used the pandemic stores, our normal plans would have been to have contracts in place, but other countries then didn't honour them because they had their own challenges and, as we've rehearsed many times, the world market in PPE tightened significantly. We've rebuilt and stocked up our stores, we've been very successful within the family of UK nations in doing so, and we've helped other UK nations through mutual aid with PPE requirements. We've also managed to continue to supply PPE to our social care sector as well. So, we have a much better situation on stock than the position that I faced when going through the pandemic in April and May of this year. 

On the flu vaccine, the UK Government procure for all four nations. That's an agreed process. So, we're optimistic that we'll have more flu vaccine in place for every UK nation, including, of course, Wales. We're looking to prioritise the most vulnerable. There's a section in the winter protection plan on what we're looking to do to both have a higher rate of uptake in our most vulnerable populations and if we still have enough vaccine to then go out and have people over the age of 50 receiving the flu vaccine as well, as well as our in-any-event plan to have more pre-school and primary school-age children undertaking and receiving the vaccine as well. 

On dentistry, we expect more data to be provided in the NHS operational framework that I mentioned. This has been a real challenge because, of course, dentistry is a high-risk profession—it's pretty impossible to undertake socially distanced dentistry work, there's the proximity you often need to be able to do the work and, indeed, the aerosol-generating procedures. We can expect there to be more detail through the operational framework and the advice from our chief dental officer. 

Thank you for the statement, Minister. I'll begin with that assertion of yours that we're in a position very similar to that which we were in in February. I know why you're saying it, because this is the same virus, it's as potentially dangerous as it was back then and I fully concur with your view that it's up to all of us to face our own responsibilities in terms of adhering to guidance and so on, but we should be, of course, in a much, much better place than we were in February. We have track and trace, we know a bit more about treatments—a lot more about treatments—we do have, finally, now, the wearing of face coverings, keeping people safe, and so on. What we need to know now, going into the winter, is that lessons have been learned and some of, perhaps, the bad decisions made early on—understandable, given that this was new, if not entirely forgivable, but understandable—we need to make sure that they aren't happening again. And whilst you spent a lot of that statement saying how important it is that people take their own responsibilities, it's about what the Government can do and, on testing and tracing, it's not people who are flouting rules who are finding it difficult to get tests in my constituency and throughout Wales at the moment—it's people who can't get tests because they aren't available now. Can you explain to us what will be done ahead of this winter to make sure that the over-reliance that you decided to put on the lighthouse labs won't become a problem in coming weeks and months? This is something that independent SAGE warned against; I'm concerned about it too. We're looking for assurances from you. 

I wrote to you about the problems in getting tests last week. I also in that letter asked: please, can we move towards the asymptomatic testing of domiciliary carers and community nurses, and others who have to visit people's homes? Because there are fears that those tests that have been made available in residential homes still aren't there for people who need them just as much because of the vulnerability of people that they come across. Please can you assure us that that is something that you will look at introducing as we approach the winter, or do so immediately?

I'm concerned that there's no mention, whilst you look at the flu, of other chronic health conditions. In particular, I'm thinking of cancer. There's no reference to that in your statement. It's vital that you keep the NHS running, of course, for other health conditions as much as possible, and I dread to think what the survival rates for cancer will be next year if we have a winter without screening or testing. So, it's about what Government can show us at the onset of winter that they have learned that actually makes now very different to February in terms of our potential to certainly get a better outcome than we did in those early days of the pandemic here in Wales. 

Thank you for that series of questions I'll run through. I think it's important to recognise what I am saying about the comparison with February. Of course, we're in a better position in terms of our preparation and understanding, with the practical experience and learning from the last six months or so. That's not the point that I'm making; I think the Member knows that isn't the point that I'm making, but in terms of the position in February about the profile and the rise in cases, so without action where we could end up find ourselves. In terms of learning from where we were, I think it's fair to say that with the knowledge we have now and the same facts, we would act differently. So, that's why I'm saying it's really important that people take account of their own choices, because otherwise the Government may have different choices to make where we may need to make choices earlier than the time period in which we did in the first wave. And that is the learning that I think Members are urging us to take on board. The Government will meet its responsibilities, but I think it is really important that people don't forget their own personal responsibility as well. That's what saw us come out of lockdown through the summer and suppress the virus, and it's what's been the most significant factor in seeing a rise in case numbers as well.

It may be helpful if I re-set out what's happened with the lighthouse labs, the UK testing programme. You'll recall that most of the criticism at the early stage was that Wales didn't take part early enough in the lighthouse labs testing programme, and that was because we couldn't see and understand the data flowing through it. Scotland and Northern Ireland took part earlier; we waited until we could understand the data, and that's now regularly flowing through to our test, trace and protect teams. They've always been able to see data from the lighthouse labs and NHS Wales labs, and that's put us in a very good position for our highly successful contact tracing service. 

The challenges we've seen are that the lighthouse labs process was working well until about three weeks ago, to be fair. We've all seen the well-advertised challenges, and that's really because not so much that they can't undertake the sampling, but they're unable to deliver the testing of those samples to get the results back to people, and that's the problem that we see. And Matt Hancock today has acknowledged in the House of Commons that it'll take a matter of weeks for that to be resolved. That was a discussion we had in meetings of health Ministers of all four nations on Friday. We then saw the challenges in the testing programme with reductions over the weekend. And again, to be fair to Matt Hancock, after myself and other health Ministers contacted him, there was an improvement over the weekend, and we then mobilised some of our own resources as well. 

As well as us thinking about how we redeploy NHS Wales resources, which we are doing, and I'll have more to say over the next week or so on what we're doing, especially around mobile testing units, we also need the UK programme to get back on an even keel because it's a UK-funded and delivered programme of testing in each one of the four nations. There isn't an additional consequential of extra money or extra staff that are waiting to be found to come and deliver additional tests aside from this. And the successful return to the level of predictability and testing turnaround we saw through most of the summer would benefit all four nations. That is what we are looking to see happen.

When it comes to the use of NHS Wales resources, we built them up to be able to deal with extra pressures that we know we're going face through the autumn and the winter. So, it's a collaborative effort of the Welsh programme that we've taken Welsh Government resources to fund, and indeed the lighthouse programme as well, and seeing that come back to the levels of performance we saw up until about three weeks ago.

On the challenge about COVID tests in asymptomatic populations in domiciliary care and residential care, we've carried on with a regular testing programme now from the first weekly programme to every two weeks. Typically for staff in residential care, we've increased the frequency again in Caerphilly, and we're looking to do so again in RCT because of the challenges there about an increase in community transmission.

So, we are looking to deliver a regular programme, and, again, the challenges that you allude to in terms of that testing programme for our staff are again part of the lighthouse lab challenges that we're seeing, and that's again about the turnaround in those tests and, again, there's been a lot of commentary across the UK about that. We're again looking at whether we can use NHS Wales resources in areas of highest transmission and to try to—[Inaudible.]—faster and more predicable turnaround for a limited period of time.

On the domiciliary and residential care, they are again a priority—those staff—for the flu vaccination programme, because they are, by definition, working with groups of vulnerable people. And when it comes to non-COVID treatment and harm, it's one of the four harms we recognise in our national approach, and it's again set out very clearly in the winter protection plans. So, again, we've set out in the plan what we're doing to see that continue as much as possible throughout the period of the winter and, indeed, the message that myself and the NHS chief exec have given about the need to not just to restart those, but to see further plans for those in the quarter 3 and quarter 4 framework. Because I recognise that the harm that comes from a national lockdown—it's not just the economic harm, which almost always has a health consequence as well, but it's potentially the harm to those other forms of non-COVID treatment that may not go ahead and take place, either because we have to pause those, because we're seeing more people coming to hospitals with COVID, or, indeed, because the public, as they have done in the first wave, choose not to take part because they're more concerned about acquiring coronavirus.

So, there aren't simple and straightforward answers here. The plan we set out today talks about how we'll balance those priorities and, again, look to make and deliver further improvement. And you can expect to hear more from the Government over the winter about what we have and have not managed to do successfully in our unfinished fight with coronavirus.

Thank you. We are two thirds of the way through this time-wise, and I still have a number of speakers, so I'm going to have to ask for some brevity, both of questions and of answers. Mandy Jones.

Diolch, Deputy Llywydd. Minister, thank you for your statement today and the opportunity for me to contribute. The sense of dread after everything the health service and the public have been through this year, I send my best wishes and—[Inaudible.]—all of the challenges and dangers that brings, especially to those who are vulnerable. I've heard your winter protection plan and I'm very concerned that its main focus appears to be a look back at lockdown, a response to a second winter wave of COVID. As we head into the winter and the predictable number of illnesses and, sadly, deaths—many of these of the respiratory system—question 1: how will the public and the medical professionals differentiate between the usual winter-type illnesses and COVID-19, when the symptoms are very similar to each other?

Minister, we had an exchange in July when I referred to the effects of lockdown on non-COVID-related illnesses, and you mentioned the need to balance different harms like you've done again today. One of the biggest worries has to be suspected cancer. Minister—[Inaudible.]—modelling shows that, across the UK, there could be around 35,000 extra cancer deaths as a result of COVID-19. In Wales, between March and June, there were around 1,600 fewer urgent cancer referrals. There is clearly a huge backlog of patients, as you've mentioned, who will need diagnostic testing for suspected cancers who aren't in the system at all yet. When these patients do present, this will no doubt cause capacity constraint in diagnostic services, and we're all acutely aware that delays for patients could cause a late diagnosis of cancer, fewer treatment options and less chance of survival. I do see consideration of this in your plan, so can you tell the Chamber what the Welsh Government is doing to make sure diagnostic services are completely ready and what arrangements are being made for follow-on treatment and surgeries, all of this in the context of winter pressures? While we couldn't foresee the demands of the Welsh NHS of COVID-19 in the early days, the curve was flattened and, of course, you are keeping a close eye on the numbers of cases now and using the levers available to counter any rises in numbers. Surely, though, you must agree with me that the NHS in Wales cannot remain in a state of suspended animation, as it currently appears to be, and waiting lists for elective surgery need to get started again. Can you inform the Chamber how the lockdown has impaired waiting lists—sorry, has impacted waiting lists—and what your plan is for addressing this? A hip replacement or a cataract removal becomes an emergency when the former causes a fall and the latter causes blindness.

Finally, lockdown, job losses, working from home and a different reality to get used to has the potential to affect the nation's mental health, as we've previously said—what capacity has the Welsh NHS got to deal with this? 

And in closing, Minister, can I tell you that, despite what you say about the NHS being open for business, there appears to be a real disjoint between what you say and what constituents are experiencing, where simple and necessary procedures are not taking place? Appointments are impossible to get. With the winter pressures coming, I fear that nothing will change anytime soon and I hope you'll—[Inaudible.]

I thank the Member for the series of questions. I think I largely addressed challenges about elective care and waiting lists in response to Andrew R.T. Davies's first set of questions, in acknowledging both that we have a significant challenge to address over a significant period of time, but the fact that the NHS has been progressively opening itself for more work; there is elective care taking place in every single health board. Our challenge is the fact that, in having COVID-secure arrangements for people who come in for elective care, that means we can't do as much activity as we would have done in the past, and, again, the need to prioritise. That goes for a wide range of services, not just cancer, but broader diagnostics. You'll see more detail in our operational framework, but, of course, on cancer, we have already seen the restart of a range of cancer screening programmes, so we are doing that work and we know there is ground to recover. I'm certainly not sanguine or unconcerned about the backlog in not just elective care but in other conditions where significant health harm can be caused, including, of course, some conditions that, left untreated, may prove fatal.

When it comes to the challenges about the flu season in particular, I think it's worth reflecting that an average flu season across the UK causes 8,000 to 10,000 deaths, so it's something that we get used to, but, actually, flu does take the lives of lots of people every single year: it reiterates why the flu vaccine programme is so important. In terms of people who may come to harm from flu, of course, they are potentially more vulnerable to COVID as well, so it reinforces the need to get yourself tested and protected against flu, take the jab, but also it's why some of the rapid point-of-care tests are really useful for us, because a range of those will be able to test people for strains of flu as well as COVID. So, there are a range of things in the plan that we've already published today as well as more detail to come in the statements I expect to continue to make to the Senedd through the winter and indeed in the operational framework I've referenced in my opening statement. 

Thank you. Alun Davies.

I'm grateful to you, Deputy Presiding Officer, and thank you very much for the statement this afternoon, Minister. I think many of us will welcome a more localised approach to these matters. The local approach that's being taken in Caerphilly and a voluntary approach that's being taken elsewhere are ones where I think many of us will watch with a great deal of interest. It is important that the Government continues to be agile and is able to respond to some very different issues in different parts of the country.

But one area that I've seen, in the last few weeks, rise in salience has been that of testing. You've been asked repeatedly on it this afternoon, Minister, and the First Minister was earlier today as well, and I think that reflects the amount of concern that is felt on all sides of the Chamber and in all parts of the country at the moment. You will be aware that I've never felt that I have the confidence in the UK Government to do the right thing—to do the right thing for the people we represent, and to certainly do the right thing for Wales—and, over the last few weeks, we've seen the UK systems break down again. The UK systems have broken down week after week and month after month as this crisis has developed over the year, and I feel it is time, that we need, and that you need as a Welsh Government, to establish our own systems here in Wales, working with local government, working with the health board, working with Public Health Wales to ensure that we do have robust testing processes in place. We've seen the failure of contact tracing across the border in England and we've seen the impact that has had. We've seen in Wales how contact tracing—you made a statement on it last week, Minister—has been a great success, and I think it is one of the key ways in which we continue to deal with the coronavirus over the coming weeks and months that we get testing in the same place as where the wider contact-tracing strategy is, and that means a Welsh system, rooted in our communities, where people can walk in, have the test and get the results, because I'm not convinced that the UK systems are delivering for us.

I thank the Member, and, of course, we do set out some of the challenges he sets out at the start, in terms of taking local action in preference to national action, in our coronavirus control plan and, as the First Minister has reminded Members today, our test, trace, protect service works, effectively, as a smart lockdown. If people are honest and upfront about their contacts, we'll get to people quickly, because our contact tracing service isn't just highly effective in reaching contacts overall, but actually gets to people very quickly, in the information that we published in the last week. That allows people to follow that advice on self-isolation and avoid wider community measures, and I think that's really valuable and important for all of us.

The challenges on lighthouse lab testing are undeniably disappointing, and it's not just me saying that—every health Minister in the UK who will be asked questions about this will have the same issues to say and, as I say, Matt Hancock today in the House of Commons has acknowledged it will take a matter of weeks for those issues to be resolved. But it is in all of our interests for those issues to be resolved, because, until a few weeks ago, it was actually a pretty good performance of lighthouse labs, and that's not a point of criticism; that's what was happening. What we need to do, though, is to be able to see how we're going to be able to switch our resources in Wales to deal with the challenge we have for that next few weeks, because the challenge that the lighthouse labs are facing comes at a considerably difficult period of time. Schools have gone back, universities will have gone back within three weeks, and so we know we're likely to see more pressure on the system, and I recognise the deep frustration of not just the Members' constituents, but across the country, if they can't get ready access to a test in the way we were used to getting through the summer. So, rest assured, it isn't just the contact I've had on the Friday or the Saturday morning with other health Ministers; it's a regular feature of concern. That's why I wrote jointly, with the Scottish health Minister, to Matt Hancock yesterday, seeking to understand more about the challenges, so we can actually make sure we're deploying our own resources as we need to to provide the sort of testing system that all of us want to see for all of our communities.

Thank you. We have had one speaker from each of the parties, and can I just make a plea again? I have four speakers and it's entirely up to the three speakers ahead of the last person to actually just stick to the minute—including the Minister on his answers—and then the fourth person will be called and, if the fourth person can't be called, then I'm sorry; the fourth person had better take it up with those of you who were ahead of them. Vikki Howells.

Diolch, Dirprwy Lywydd. Minister, thank you for your statement today, which I've read with great interest. One key part of ensuring our hospitals are able to cope with demand through normal winters, let alone this coming one, is the ability to discharge in-patients in a safe and timely manner to avoid bedblocking. I know that RCT council and Cwm Taf Morgannwg University Health Board have worked closely with the Welsh Government's integrated care fund in past years to develop innovative community-based initiatives, which have assisted very many patients in achieving a safe and timely discharge from hospital, releasing those beds for those who need them most. So, I welcome the fact that, on 24 August, you announced a 12-month extension to the integrated care fund. It's clearly a central pillar of our response to winter pressures, so what work is Welsh Government doing to ensure that all local authorities and health boards are fully aware of the benefits of the integrated care fund and have the resources in place to exploit its potential fully this coming winter?

Thank you. I think it's a really important question, because delayed transfers of care cause real harm within our system. People that don't need to be in hospital almost always end up suffering harm. If you're immobile and in a bed, rather than being up and around, that's a challenge and a problem for that person. Many of the people we're talking about are vulnerable and, in particular, older people who are in hospital, and it's the wrong place for them to be. As well as the integrated care fund, which local authorities and regional partnership boards all lobbied for the continuation of, because they recognise the value it's provided, we have a twin challenge of making sure we don't just see the value from that, but we understand how that's spread to other authorities as well. And that deliberate shared learning is something that we can't lose sight of through the COVID pandemic. It also, of course, includes some of the work that we've funded with the transformation fund that accompanied 'A Healthier Wales'. The Member will recall that, in Ynysybwl, when we launched that, we took account of the work that the health board had done successfully with the council on getting people into their own homes, supporting them there—that was a benefit for those individuals and a benefit for the health service and the council in getting to the right place to receive their ongoing care and treatment. So, I'm very happy to continue making the case for work between health and local government; it benefits the citizen and it benefits the whole service.

Minister, firstly to say thank you very much for the work that you and the leader of RCT council did recently when we were failed by the UK Government in respect of the testing capacity. I don't think people will realise that, as I understand it, you both ended up almost virtually working around the clock, through the night, in order to try and alleviate and increase that capacity, and I think that is very much appreciated by those who were then able to get tested. Can I just ask about, though, elective surgery, hips and knees? Because these things do affect people's lives very, very considerably, and I think we all understand the impact that COVID has had on the capacity within our health assets, and I'm just wondering to what extent we can actually get information out to people, explain to them what the situation is, and give some indication of what is happening, with a view to, I suppose, a timetable of trying to restore and increase the amount of elective surgery that can actually take place. People are reasonable, people do understand, and sometimes it is the most reasonable people who are the ones who suffer silently, and I think we have an obligation to at least, I think, be as transparent as possible with them with the challenges we face. 

It's a completely fair point the Member makes, and others have alluded to as well in earlier questions, about elective care and doing as much as we possibly can do, and how we transparently set that out. You will see plans, when we publish the operational framework and quarter 3 and quarter 4 plans that I expect to come back in for us to be able to publish through October, for how we want to maintain elective activity, the sort of elective activity work we'll be able to do, and then health boards working transparently with their staff and the patients they're serving to try to explain how they're working through that. But, as I say, it's important to recognise that I don't think we're going to be able to keep up with the demand that is there. In normal times, we'd see a different position. And, actually through the first three, four years of this term, we actually made significant and material moves forward every year in the time that people waited, in doing more elective activity and the transformation of that. We're going to a significant step backwards because of the way the pandemic has interrupted not just a period of time elective activity didn't take place, but the way our service operates. 

And, finally, to say thank you for the recognition of the work that was done, not just by myself, but Andrew Morgan, the leader of RCT, who I think has been highly impressive throughout not just the pandemic, but in dealing with this particular situation over the weekend, but, in particular, the team at Public Health Wales, Cwm Taf Morgannwg and the Welsh ambulance service, who, from a challenge that we knew about late on Friday evening, by 10 o'clock the next day, had a Welsh solution in place to make sure that testing was protected. It involved work late at night and through Saturday—not always popular with families, as I can attest to myself—but it meant that the public had a service they could rely on that next day.

Minister, thank you for your statement, and I want to put on record my thanks to all those health and care social workers who have gone above and beyond in the last six months, and will go above and beyond in the next six months as well. I agree with my colleague Alun Davies from Blaenau Gwent in regard to testing, but you've answered that, so I won't push that agenda at this point.

But you mentioned just now the ambulance service, and one of the issues I'm concerned about, and I'm getting messages from my constituents, is they are now facing increased pressure once again, and we're seeing five-, six-, seven-hour waits for ambulances to attend at the point of need. A person falling down, an older person falling down on a path in the summer being told, 'Don't move them'—on a nice day like this, you could get away with it; come the winter, that is not acceptable. We need to address the issue on the emergency ambulance services and getting people out. I've had ambulances waiting at Morriston, again, for hours. Will you look at this to make sure the ambulance service has sufficient resources to be able to actually go to these urgent cases, to ensure people don't have to wait these long times for the care? And, another point, we've also questioned on the health visitors issue and the safeguarding of children; some health visitors have not been able to go, during the coronavirus pandemic, to ensure that the children are safeguarded. That's a very serious question that we have to address during the next winter months as well. I'm conscious of the time, Deputy Presiding Officer. 

Thank you. Minister.

Thank you. On testing, I recognise the point that the Member has made. To be fair, as well as in the Chamber, a number of Members have approached me directly, in their capacity of representing their constituencies and regions, about the issue.

On Welsh ambulance response times, we're seeing both the return of more normal activity, as well as the backlog of activity that built up in emergencies, where people would otherwise have called and sought help, whether that's from the out-of-hours service or the ambulance service, and they're now returning in much larger numbers, bringing very, very high volumes of activity. It's putting pressure on the service while we are also, in some areas, seeing a rise in COVID cases. So, it's a very uncomfortable period of time. So, again, where people don't need an emergency ambulance, they should look for other options.

But, I'd also reiterate, I think, the need to transform emergency care. I have made announcements recently, and there will be more to come in the next week or two, about the money that we are putting into transforming emergency care, the resource that comes with it, and also some of the telephone-first and triage approaches being taken not just in Cardiff and Vale, but also Aneurin Bevan, which is looking to trial some of them as well, to provide people with an appropriate service to make sure that people get to the right point to have their care needs met.

I recognise the point that the Member makes about health visitors too. It's one of our concerns that there were challenges about staff going into a number of different houses when there's community transmission of COVID, but also those families not wanting to see someone who has maybe been in three or four different houses in the same day. So, there are some challenges here.

Also, for me, it reiterates the importance of keeping schools open. When you have a whole community of children going to that place, it's a protective environment, and we are able to understand and support children and their families in a way that we haven't been able to during full lockdown. So, I recognise the issue that the Member raises, and I am sure I will carry on the conversations that I have had not just with him, but also with my Deputy Minister and also the education Minister as well.

Thank you. Finally, Huw Irranca-Davies.

Diolch, Dirprwy Lywydd. Minister, could I turn straight away to the NHS COVID-19 app? Could I ask first of all: are there similarities with the system being used in Scotland, where, for example, the QR codes are on every table and every counter and every bar in every restaurant? It is very easy, very convenient to use, and I have to say that everybody that I observed when I was there recently was using it.

What proportion of the population need to actually update this and use this for it to be effective, and how can you promote that uptake, not least among the young and those who are big data sceptics? And, can you confirm that this is in addition to—not replacing—the old-school, tried and tested, localised test, trace and protect taking place in Wales? Finally, what's your very simple message to the people of Wales about why they should use this app? If you can't answer all of these in detail now, just write out to Members and we'll pass it on to our constituents. Thank you, Minister.

Thank you to the Member for the questions. I'm happy to confirm that the NHS COVID app is now done on a local, not a central, basis. That was one of the concerns about privacy, so it should be largely resolved.

So, this is the second round of running an app. While Scotland and Northern Ireland have a proximity app that tells you how close you've been to other people, the app that England and Wales are going to launch and use together actually provides a bit more functionality than that. Actually, it made more sense, if the app worked in England, for us to have the same system, because of the transfers between England and Wales and the very porous border, so actually having a similar system has real practical advantages to it as well.

Interestingly, as well as a proximity app, it also has a diary function in it as well. So, if you have downloaded the app and you've been using it to check into places, you don't need to remember what you've done because there will be a function on your phone to allow you to do that. So, there are real advantages and we've encouraged businesses to download QR readers to make sure that people can check in and check out as they are going around into different venues and businesses.

It's particularly important that it's going to launch for 24 September—that's the plan—because we want to have this in place, ideally, before university students return. They're one of the key target groups who are likely to use and download the app, and somewhere where, actually, the challenges about people being mobile—. It will be much easier to do that, particularly when people are moving to a potentially new environment.

In terms of your question about this being an add-on, it is an add-on. So, contact tracing is still effective in Wales—highly effective. In 98 per cent of our index cases, people with a new COVID case get successfully contacted. Overall, since 21 June, 94 per cent of their close contacts have been contacted as well. So, a very high success rate, and all credit to our staff. So, it's an add-on to that, but it will be a useful add-on, and I would encourage people to download the app. We will be providing more information to Members and the public as we move into the phase of finally implementing this across England and Wales.

Thank you very much, Minister. There will now be a short break, just so people can re-clean the seats for change over. Thank you.

Plenary was suspended at 17:05.

The Senedd reconvened at 17:11, with the Llywydd in the Chair.