Questions now from party spokespeople. Plaid Cymru spokesperson, Rhun ap Iorwerth.

Thank you, Llywydd, and I'll pick up on the important questions about flu vaccination. I draw your attention to a recent study in Italy that has noted a relationship between flu vaccination rates and the severity of coronavirus symptoms and survival rates. In regions where more people over 65 had taken up the flu vaccine last year, there were fewer deaths or people having to go to hospital because of coronavirus this year. We can only guess, at this point, at the reason for that, but because we're very eager to restrict the spread of the flu anyway, it strikes me that ensuring that the flu vaccine is available for everyone who wants it, and not just the target groups, would be a very valuable investment, not only in tackling the usual winter pressures on the NHS, but also in reducing the impact of the coronavirus. So, as well as the commitment to encourage more people to get the vaccine, would you be willing to commit to extending it to everyone because that could be a good investment?

Well, first, to plan and to deliver an effective seasonal flu campaign, and this will be our largest ever seasonal flu campaign—we expect to deliver more flu vaccines than ever before to the people of Wales this winter—we need to make choices in advance of the season to be able to do that, and we have chosen to target and to increase significantly the amount of flu vaccine that we procure for the people of Wales and that we then deliver.

The question about whether we should have whole-population coverage in terms of the NHS campaign is rather out of the scope of where we are at present, but it's something that we can consider in the future. It's not currently supported by the joint committee that advises the Welsh Government and all UK Governments on the delivery of vaccination programmes. But, as ever, as the evidence base changes, then we're of course prepared to shift and to change our position, because the objective here is how we protect as many lives as possible, and avoid as much harm as possible, whether that's from COVID, the flu or indeed a range of other infectious diseases and conditions that we know are a regular challenge for how we live our lives today.

Thank you. I'll move on. As more restrictions are imposed on people across Wales, it's very important to show that we have learned lessons from the full original lockdown. And I've seen one report that says that as many as 50 per cent of people just didn't want to see professional health workers in terms of medical conditions during that lockdown because, very simply, they didn't want to bother the NHS. But even though the Health, Social Care and Sport Committee this morning did hear that the number of visits to doctors and A&E departments, and so on, have risen—that's a good thing—Tenovus Cancer Care estimates that there may be 2,000 people who are living with cancer without diagnosis, and still haven't visited a GP because of the pandemic. So what assurance can you give to those people—people who do feel more nervous now, as the new restrictions come into force—that the NHS is still open to everyone, and to encourage those patients who are lost in the system to look for medical advice?

Well I think we've been very clear and consistent about the concern we had for the harm that is caused as a result of non-COVID conditions. That's both the harm that could have been caused if our health and social care system was overwhelmed—and it wasn't; it was under significant pressure in different parts of Wales, but it wasn't overwhelmed—and also the harm caused by non-COVID conditions because people are not undertaking treatment, either because they're opting out of treatment because of the concerns they have, and we definitely saw that, or indeed because it isn't possible because of the system being overwhelmed.

You'll have heard me say on a number of occasions over the past months the concerns we had about the fall in emergency admissions. That's partly because some people didn't really need and don't need—and we discuss this every year—to go into an emergency department, there are other routes for their care, but the much bigger concern was that there are people who really do need emergency care who weren't coming into our health service. And that's not just cancer; stroke, we know that there was a significant fall in people attending the national health service with stroke conditions. Now, I don't believe and there's no evidence to support the view that that meant that, suddenly, there was a significant reduction in the incidence of stroke across Wales. It's about how people were behaving, and their concerns.

We have definitely learnt from the first six months. And so we now have streaming in terms of COVID-light or COVID-green zones, and COVID-red, COVID-positive or COVID-possible zones. That's important to give people confidence, and the way that we manage patients who are coming into our health service through either one of those routes, primarily for hospitals, but also we've had to change the way that primary care has worked. So the ability to consult and to see people virtually, to speak to people on the phone, there's been a significant increase, and that should give people more confidence. But the message from me, and from our whole national healthcare system, is we're open for business, we've learnt from the first six months, and if you have a serious healthcare condition, you should continue to come forward, you should continue to seek advice, support and treatment, whether via primary care or indeed hospital care, because the NHS has certainly not closed up and we look forward to people returning in larger numbers. The case for reform in our healthcare system will be remade about the need to change the way that we work, but that does mean people need to present at the earliest opportunity to allow us to intervene in the least invasive way possible.

But there are people though who are already in the system and who've faced a journey that's much, much longer than it would have been. And you'll have heard me make repeated calls about the need to structure services in a way that will allow treatments to resume, diagnosis services to resume, and so on, at a much faster rate than they are currently. Again this week I've heard concerns from surgeons—one of the royal colleges—that this isn't happening still to the extent that it's needed.

It might be understandable that the publication of referral-to-treatment data was suspended at the beginning of the pandemic, but here we are now on the last day of September and the last available data was published in March, and those were figures for January. RTT data provides a crucial insight into how long people are in the system, how long they're waiting, across all health boards, all specialities. And with elective services across Wales, we know, decimated by the outbreak, without the data we have no way of knowing the scale of the backlog problems we're facing within NHS Wales. And every statistic is a patient, waiting in pain, quite often. So, now that we're over six months into the pandemic, will you urgently make this data publicly available?

In health committee this morning, I and the chief executive of NHS Wales, Dr Goodall, provided a range of information about the scale of the backlog that has built up and the range of that backlog. I'll certainly look to see how and when we release information to provide more detail on that. I think returning to publishing RTT figures and percentages would be incredibly unhelpful, because it would give the impression that the NHS is somehow failing, when actually it is about how we're managing to cope with the demand that is coming through and a very different way of working. We're not in a position where we're going to be able to eat into that backlog through the winter. We're still in the mode of surviving the pandemic and maintaining as much activity as possible, but I've been very upfront about the fact that that means that we won't undertake the same level of activity. It would be wholly unrealistic, and set an impossibly unfair task for the NHS, to demand that it both prepares for and manages the pandemic, which is not finished, and eats into the waiting times that have built up. That's not just the picture here in Wales; it's right across the UK, and I'm sure you'll have noticed comments from the Royal College of Surgeons in response to the NHS Confederation report about England and the challenges they face, where they've been sharply critical of an attempt to eat into the backlog when actually their staff haven't had a rest following the first phase of the pandemic.

So, I still believe it will take pretty much a full Welsh Parliament term to get back on top of the activity that has not taken place, about the fact that people wearing additional PPE cannot undertake the same amount of activity as we would have expected in February this year. So, I'll happily go away and look again at how we provide information to inform people about the scale of where we are, not just people who want to read the transcript from this morning's evidence session with the committee, but to see how we do that in a way that is regular and reliable for members of the public and, indeed, of course, elected representatives. 

The Conservative spokesperson, Andrew R.T. Davies. 

Thank you, Presiding Officer. Minister, in the news today we've seen the outbreak at the Royal Glamorgan Hospital, and tragically eight people have been reported as losing their lives. We send our condolences to the families of the ones who have lost their lives. There are 83 cases of COVID at that hospital. Earlier in the year, we had an outbreak at Wrexham Maelor Hospital. Both hospitals have major accident and emergency departments for their particular areas, of which we have 13 across Wales. Can you highlight today if there are any similarities between the two outbreaks and, if there are similarities, how will you ensure that this doesn't occur in other A&E receiving hospitals? Because as we go into the winter months, obviously we know what winter pressures do, but with the disruption an outbreak like this causes, as well as the tragedy of loss of life and the general upset that it causes, this is something that we want to avoid at the other hospitals across Wales. 

I think there are differences as well as similarities. So, we picked up the issues in Wrexham Maelor, and we definitely learnt from what happened in Wrexham Maelor, about the need for clear executive leadership and for buy-in across the staff group for the measures that would need to be taken, about prompt isolation and reinforcing enhanced infection prevention and control measures. So, our whole system learnt a lot from what happened within Wrexham Maelor, and those lessons are being applied within the Royal Glamorgan. That is why we are, for example, testing staff who work on that site, it's why a number of wards have been closed, it's why there's an early diversion of activity away from that hospital, to allow the hospital to manage and to recover, and it's why there's been a reinforcement of the need to test patients on admission, whether emergency or elective.

It's also the case that some of the transmission in the Royal Glamorgan, as with Wrexham Maelor, came from transmission within the hospital, whether between patients or staff. What is different, though, about the Royal Glamorgan is that we have a higher reservoir of coronavirus within the surrounding community. So, a number of people have come into the hospital and needed treatment because of coronavirus, and we also know that some transmission has taken place within the hospital itself. There are risks for every hospital and closed environment if coronavirus takes hold within the staff or the group of people who are either being cared for or living within that environment. It's why we continue with our testing programme in care homes. I expect that we'll not just have more information from the health board, but there'll be a continued focus on whether the infection rate peaks, as it did in the Maelor, and recovers, and how long that will last for. So, I'm expecting to have regular updates from the health board themselves about the picture within the Royal Glamorgan each day. And I know that the chief executive of the health board is expecting to make further statements to the press about the measures that have been taken and the action, including, as I said, the diversion of patients away from that site. 

Thank you for that answer, Minister. As you highlighted, the reservoir in the local community is obviously one issue that does need to be understood, and the transmission into the hospital as well as in the hospital itself. Just this afternoon, we've had information from Public Health Wales that they've become aware of 2,000 test results that they were completely unaware of, and, obviously, when you're trying to understand local data, being able to understand the test results is a critical component of being able to track the virus in communities. Today, I welcome the news, obviously, that Rhondda, for example, and Merthyr have got their own local maps now that show the level of infection rates in those communities—something that I've been calling on you to bring forward for the rest of Wales. So, clearly you have that information. There are two parts to this, if I may seek assurances from you: can you enlighten us more as to these 2,000 results that Public Health Wales have been made aware of, as to why the system didn't alert Public Health Wales to the outcome of those test results, given their importance; and secondly, will you commit to making that data available that Merthyr are highlighting today and Rhondda are highlighting today about infection rates in local communities so that people can understand the prevalence of the virus within their communities?

On the second point, I have already indicated that I am looking to see how we can regularise the provision of that information so that it's not just ad hoc. And we're looking at what Public Health Wales already publish to give people the understanding of what is taking place on a local level. And it's not just the Rhondda area; it's actually the whole of Rhondda Cynon Taf where I think they're producing maps showing the rates that exist, together with Merthyr. I think it would be useful to provide that information on a regular and predictable basis. So, I am already looking at how we do that and to see what is already provided by Public Health Wales.

On your first point, unfortunately this has been a data glitch with lighthouse labs. The data haven't come in to NHS Wales Informatics Service to provide to Public Health Wales, and so Public Health Wales have alerted us to the fact they're awaiting those some 2,000 lighthouse lab test results. It's a matter that has been taken up through our normal management and information arrangements with colleagues in the UK testing programme. As soon as those figures are available, we'll need to make sure we understand where they are and how far back those test results go as well, because we have had some improvement in the turnaround delays in lighthouse lab test results, and so I'll want to understand how that tracks back and changes our understanding of the shifting picture of positive coronavirus cases across Wales. So, it's certainly not ideal, but, as I say, I expect us to resolve that with the people responsible for the lighthouse lab testing programme. 

Earlier in the response to my questions, you highlighted, and I highlighted to you, the disruption that's been caused by the outbreak at the Royal Glamorgan Hospital to services, and today in the news we're hearing that a million breast cancer screening appointments have been lost because of the COVID outbreak across the whole of the United Kingdom. What's really important is when GPs, obviously, have concerns and refer patients into the health system, people get the diagnostic tests that they require and then the treatment within the NHS. In Neath Port Talbot, there is already a rapid diagnostic centre that is available for such a service, but obviously we need such centres across the rest of Wales. Can you commit today to the rapid expansion of the rapid diagnostic centres, so that GPs do have that option and so that when patients are suspected of having further inquiries required when it comes to cancer procedures, they can get into the system, have the diagnosis and either get the all-clear or progress within the health service, in whatever part of Wales they live? Because we all know that, when it comes to cancer, time is of the essence, and if we do have disruption in the service, as we do because of COVID, then we need to use the best practice that's available to us, and I would suggest that rapid diagnostic centres are one of those avenues that need to be opened up. 

Two points: the first is that we have already restarted screening services, as I've previously reported back to Members. The second is: you may not have picked this up, but Tom Crosby has confirmed that there has been agreement within NHS Wales to roll out a national programme of diagnostic centres, following the trials that have been undertaken in Neath Port Talbot and, actually, at the Royal Glamorgan, at the diagnostic hub there as well. So, I will be providing proper detail to Members on the detail of that roll-out programme, but it's a good opportunity to say that the trial that we've been running in Wales has been successful, and we expect that to take place in a national roll-out. So, I think perhaps we're already half a step ahead of the question that's been asked today.