We move to item 5, which is a debate on the Health, Social Care and Sport Committee report on the impact of the COVID-19 outbreak, and its management, on health and social care in Wales, and I call the chair of the committee to move the motion. Dai Lloyd.

Motion NDM7401 Dai Lloyd

To propose that the Senedd:

Notes the report of the Health, Social Care and Sport Committee:  Inquiry into the impact of the Covid-19 outbreak, and its management, on health and social care in Wales, which was laid in the Table Office on 8 July 2020.

Motion moved.

Thank you very much, acting Deputy Llywydd. I'm very pleased to open this debate on the Health, Social Care and Sport Committee's report on the COVID-19 outbreak.

Before I turn to our findings, I'd like to pay tribute to the commitment and dedication of everyone who has contributed to the work of keeping our front-line services operating in the most difficult of circumstances. Whilst our thoughts turn automatically to the health and social care sector, we must also recognise the tireless efforts of so many other sectors and professions, often behind the scenes.

The public has also made huge sacrifices, and we need to recognise that. Families and friends were separated, and the most vulnerable were isolated from their wider support networks. Their collective efforts in adhering to the lockdown rules significantly suppressed the spread of the virus. Sadly, we now face similar challenges, and we are asking the Welsh public to show the same collective spirit to help curb this insidious virus once again.

When the first case of coronavirus in Wales was confirmed in March 2020, very few of us, I imagine, realised that the virus would have such a devastating and long-lasting impact on us all. It's been cruel and ruthless and it's stolen the lives of friends and loved ones. As a committee, we felt that it was important to consider the impact of coronavirus, and its management, on health and social care services in Wales. We have considered the response of the Welsh Government and relevant public bodies, as well as the impact on staff, patients and others receiving care or treatment in clinical settings or in the community. Our purpose in undertaking this work was to seek to identify what worked well and what didn't work so well, in order to learn lessons and to apply them quickly to any rise in infection rates.

We've taken evidence from a wide range of professionals in health and social care, public bodies and stakeholders, and we continue to do so. We carried out a survey of front-line staff, patients, carers, and those receiving care or treatment, to understand the impact of the pandemic on them. We also issued an open invitation to anyone who wished to share their experiences with us. I'd like to thank everyone who took the time to contribute to our work.

Our recommendations include 28 recommendations, and 21 have been accepted in full, and I'd like to thank the Minister for his detailed response. I won't have time to address every recommendation, but I will try to cover some of the key messages, turning first to personal protective equipment. Now, in the early days of the pandemic, a great deal of coverage focused on concerns regarding the adequate and continuous supply of PPE. Much of the early evidence we received reflected the fears and concerns of front-line staff about the availability of appropriate PPE. According to a survey carried out by the British Medical Association, 67 per cent of doctors in Wales did not feel fully protected from COVID-19 at work, and 60 per cent had had to purchase items of PPE directly, or had received supplies as a donation, because the NHS had not been able to procure adequate supplies.

The Royal College of Nursing also reported that many of their members, particularly community nursing teams, had called because they were distressed at being unable to access PPE. It said that 74 per cent of nursing staff had raised concerns about shortages of PPE, with over half having felt pressurised to care for a patient without adequate protection. Indeed, the Minister for health told us that the situation was a very real concern for Government at the time.

This position has improved, and we welcome this, but we cannot afford to be complacent. We need assurance on the continuity of PPE supplies, particularly in light of the recent rise in infection rates. We therefore made the following recommendations: the Welsh Government must, as a matter of urgency, publish a strategy for securing a resilient supply of PPE; stockpile sufficient quantities of appropriate PPE for any future outbreak; keep under review the PPE that it has stockpiled to ensure that it remains of adequate quality and is fit for purpose; publish a strategy for ensuring the resilience of distribution arrangements; work with partners to ensure that guidance on PPE is kept up to date in light of the most recent scientific advice, and communicate this advice clearly to staff. That's recommendation 1. I am very pleased to say that this recommendation was accepted and that a strategic plan for the procurement of PPE for health and social care is being developed.

Given that Wales has traditionally been reliant on supplies from China and other Asian countries, it is vital that we support manufacturers in Wales to develop our own homegrown supply. We therefore recommended that the Welsh Government review its own systems to ensure that the mechanisms are in place to enable manufacturers in Wales to respond quickly in supplying appropriate PPE in the event of any future outbreaks. That's recommendation 2. In accepting this recommendation, the Minister acknowledged the important role of Welsh businesses in strengthening our resilience to withstand a second peak of COVID-19, and said that the PPE procurement plan for health and social care will blend local manufacture and international supply.

Now, in turning to care homes, testing in care homes proved to be a controversial issue, with both the UK and Welsh Governments coming under criticism, as we know, for lack of testing in care settings. The Office for National Statistics figures show that there had been 663 COVID-19 deaths in Welsh cares homes.

According to Care Forum Wales, the practice of discharging hospital patients to care homes played a major role in enabling the infection to spread at such an alarming rate in care homes. The Older People's Commissioner for Wales said that she had concerns that older people’s rights may not have been sufficiently protected. The number of COVID-related deaths in care homes was a source of great concern to us. We believe that the Welsh Government’s initial attitude in terms of testing in care homes was deficient at the outset and their response was too slow thereafter. As a result, the number of deaths in care homes accounted for 28 per cent of all coronavirus-related deaths in Wales.

Recommendation 9 in our report called for the Welsh Government to ensure that all patients being discharged from hospital directly into a care home have been tested, in accordance with latest best practice, in order to ensure that residents and staff have maximum protection. This recommendation was accepted in principle. The Minister said that there had to be test results available before patients could be discharged from hospitals. I'd like to thank the Minister for this reassurance and for accepting our recommendation.

In turning to test, trace and protect finally, before I finish this first part, I'd like to talk about the test, trace and protect strategy—the contact tracing system of the Welsh Government. The test and trace programme under the strategy has a number of key purposes, including: diagnosing the disease; population health surveillance; contact tracing; and business continuity, enabling key workers to return to work more quickly and more safely.

A number of witnesses have highlighted the importance of the timely return of test results to secure the success of the TTP strategy. As Sir David King, a member of Independent SAGE told us,

'the turnaround time after testing is critically important. If you get the test result five days after the test is made, and that person is still wandering around in their community, imagine the number of people infected during that period.'

We agree that the speed of testing, the turnaround of testing results, and the accuracy of those results will be critical to the success of the TTP strategy. The longer the end-to-end turnaround time, from sample collection to the reporting of results to individuals, the greater the delay at the point when the disease is most infectious, or the greater the likelihood of—[Inaudible.]—.

[Inaudible.]—recommend therefore that the Welsh Government, working with Public Health Wales, should seek to ensure that every test result is returned within 24 hours. That is recommendation 19, and that recommendation was also accepted in principle.

We also heard that public support would be crucial to the success of the strategy. People must be willing to be honest in sharing details about their movements and their contacts, and to self-isolate if they are at risk for the benefit of the wider community. We recommended, therefore, that the Government, working with its partners, should ensure that they present clear public messaging and to rehearse those consistently at a local and national level, highlighting individual's responsibility to self-isolate, if they have symptoms, and the importance of seeking a test immediately. That's recommendation 25, and that was accepted.

Of course, if contact tracing is successful, people could be asked to self-isolate multiple times and this is a particular worry for people in low-paid employment who cannot afford to take time off work. According to the current guidance, anyone who is self-isolating is entitled to statutory sick pay, which is £95 a week, but this is not a sustainable wage or a living wage. The temptation to ignore symptoms and advice and to attend work is therefore a very real concern, and it's an area that requires urgent attention from the Welsh Government, particularly given that arrangements for statutory sick pay are not devolved. We've therefore called on the Welsh Government, as a matter of urgency, to pursue with the UK Government the arrangements for statutory sick pay for social care workers and others in Wales who do have to self-isolate. I welcome the fact that the Minister has accepted this recommendation and his assurance that he continues to raise concerns with UK Ministers about the financial impact of self-isolation. 

In closing, I would like to acknowledge that the scale of the challenge facing Governments and their partners in dealing with the effects of COVID-19 has been unprecedented. Enormous efforts have been made across the board, resulting in many significant achievements. Unfortunately, infection rates are on the rise once again. We must use the experience that we have and everything that we learnt in battling the first wave of the disease to ensure that any new measures introduced to control the virus are effective, timely and proportionate. Thank you very much.

I welcome the opportunity to contribute in this debate today. I appreciate I wasn't on the committee at the time of this review that was undertaken, or this inquiry that was undertaken, but I'd just like to pay tribute to my predecessor, Angela Burns, for the work that she did in her time on the committee, and also the Chair of the committee, the staff and the other Members who have produced a very detailed and concise piece of work, with some key recommendations, to say the least on it. And the Government, by and large, has engaged with those recommendations, although, as a politician of some 13 years standing, you're always a bit reticent when you hear 'agreed in principle' because, regrettably, that very often doesn't get delivered, and many, if not all of these recommendations, if taken in their entirety, would add hugely to an improved offer, an improved response, now that some months after this report was published we're seeing what many would call the second wave of COVID hitting many of our towns and cities and communities the length and breadth of Wales.

I think, in the report, as almost like a third person coming to it, reading it from cover to cover, the index of dates at the back is a timely reminder of how quick we've travelled in this year, from January right the way through to when this report was published in July, and the level, the volume, and the complete transformation in services, the way Government responds—I mean, you only need to look at our work here today and yesterday, how COVID has consumed everything that we do because it is all-encompassing.

Reading some of the comments around PPE and the recommendations around PPE, it was a timely reminder of the real challenges that the sectors face, both health and the care sector in particular. And reading it, it emphasised the point how health and the care sector need to be taken as equal partners, rather than one sector getting the provision of PPE in the first instance and then maybe the care sector getting what was left over and maybe playing catch-up. That does need to be rectified, if that situation of constraint of supply does happen again. And I'm pleased to hear the assurances of the Minister, saying that the supply of PPE has been greatly enhanced since the beginning of the outbreak, but it is really important that that parity of esteem is listened to and understood. In particular, if the Minister in his response could highlight what progress has been made in relation to the work that the Government have commissioned from Deloitte about the demand mapping around PPE, again, that would be good to understand how, if that squeeze comes on in the winter months, there will be equity across Wales in the supply chain of PPE.

Testing, as we hear much about these days, and the concerns around testing—in the absence of a vaccine, testing is really our only defence to be on top of this virus and to understand where the prevalence of the virus is and, ultimately, how it is tracking through our communities. Reading some of the recommendations that have been put in place, and, importantly, how they'll be deployed is of critical importance, in particular when you think of ramping up the volume of tests that will be available. It is a little discouraging to see that, in July of this year, the Welsh Government's own testing capacity was at 15,000; here, some two months later, in September, it's still on 15,000, and the comments that the First Minister himself made—I applaud him for his honesty—that maybe we'd be able to deal with that on a day basis, but it wouldn't be sustainable over any long-term period of time to use that full capacity. And so, working united across the United Kingdom, despite the problems of the lighthouse labs, will be the only solution to bring a real volume of testing here into Wales, and indeed other parts of the United Kingdom. It would be my sincere hope that many of the glitches that have hit the system can be ironed out.

I hope the Minister can give us an up-to-date position on how the testing numbers are being deployed, because, very often, as politicians, as the report highlights, we fixate on capacity, but it's the ability for the whole system to work, from the capacity through to the number of tests that are done, to the response rate, as the Chair highlighted, and the importance of getting that response back within 24 hours. Any effective testing system has to get at least 90 per cent of its results back within 24 hours. If it fails to do that, then we're really missing the goal of achieving that best effect from the testing regime.

I appreciate that my five minutes are nearly up on the clock. TTP: the scale of test, track and protect is enormous, as the report highlights, and the BMA's evidence in particular spoke of this enormous programme that will be required from between 7,500 to 8,000 contacts in a day, up to 0.5 million people at any one time being in the system. That gives a sense of the scale of operation that we're talking about, and if at the start of this year people said to politicians, 'What do you think are going to be your top-five challenges?', I don't think anyone would have touched on a COVID outbreak and the all-encapsulating nature of it.

So, I do commend the report to the public at large and I do commend the activity of the committee in undertaking this report, and I look forward to continuing the work of the committee when it revisits some of the recommendations to see that they've been implemented in the future. Thank you, Deputy Presiding Officer.

Once again, our Chair has given a very thorough and strong introduction to the report in his contribution this afternoon, and I wish to join him in paying tribute to all the NHS staff and social care workers across Wales for what they did during the pandemic at its peak, since then and are continuing to do now, and I'm sure that they will be doing through all of the winter. We clapped them every week at that time, but they deserve so much more than that. Their commitment is undying and unquestionable.

I think we need to remind ourselves, also, why we put the report in, because it was about the impact of the virus and what lessons we would learn from that. There are still so many families that have been devastated by that virus and the loss of loved ones, others who have suffered severe health conditions as a consequence of contracting the virus and spending a long time in hospital, and we must never forget those people in everything we do.

But we have come a long way since the start of the pandemic, and, hopefully, we have learnt a lot. There is much to learn, because if we look at the report and some of the issues that are raised, and I'm repeating some of the comments that Dai Lloyd introduced, but if you look at them, they are still relevant today, they haven't gone away. The PPE question: I'm very pleased that we do now have sufficient PPE, but when this came out, we didn't. No matter how much we thought we had, we didn't. I'm very pleased, also, that local businesses are now using opportunities to create and develop PPE—I've got one in my own constituency, Rototherm, which has transformed itself. Fantastic work is being done to ensure that Wales has a supply of locally based businesses that are producing the PPE.

But also, let's not forget what wearing the PPE does for staff, because if we read our survey of the staff, and some of the comments they made, they found it very difficult to work in those circumstances, and it took its toll on them. Sometimes we need to reflect upon that, so that we ensure that we protect our staff as well, and that we get this PPE right. We don't want to put people in a position where they are facing life-threatening positions when they are going to care for people because we haven't got the PPE for them. We must get that right. I know the Minister will say that we're doing that; we've got larger numbers now, and I very much appreciate that. But I also want to ask him, perhaps—because halfway during the pandemic, the guidelines for PPE were changed, and I want to ask whether there are more changes to come in those guidelines because of the lessons learnt during that pandemic, and people's ability—. Because paramedics are saying that sometimes they go into a situation wearing simply an apron and gloves, which is not sufficient on occasions. We need to make sure our staff are protected.

Can I also raise the issue of care homes? We know full well that, during the initial stages, they were vulnerable, and the residents, who are vulnerable themselves, became, unfortunately, victims of the virus. We saw many, many residents hospitalised, and some of those unfortunately did not survive. Dai has highlighted that there were over 600 of them. We are in a position now where we have put better protection in place, but we did ask for testing to be done on a regular basis. I know that's being done, and I'm very pleased about that, and we must make sure it continues, but I'm still concerned on the home testing agenda and the quality of training given to people to do that. There are too many false negatives and false positives coming through the testing system, and we have to minimise those. One of the ways of minimising that is by following recommendation 10, bullet point 2, which says, 'Ensure it's done by a suitably qualified individual'. There are many nurses already employed in care homes, and there could be others being used in those that don't have them, so I don't think it's something that the Government should have rejected. I think that the Government should have accepted that and made sure that there were appropriately qualified people taking those tests to minimise the possibilities of false negatives and false positives, because that does give misleading information, and it does give misleading confidence on occasions, so we need to address that.

The other issue, obviously, is testing—people have talked about testing—in general, and we raised this question about testing and getting ready. In fact, we actually said, I think in recommendation 8, that we need to prepare for a second wave, and that we should work with partners to take steps for sufficient capacity. Yet we're still talking about capacity. We're still talking about whether we're using lighthouse labs or not. There's a question there still being raised. I appreciate the Minister's already had this many times, but I hope he takes on board the fact that testing is not going to be something that will go away—it is something that is going to drive the agenda forward, and we must ensure that we address the capacity issue, both of the ability to take the test, but the ability to analyse the tests as well. Because that's where people are getting confused; they think, 'Oh, I can have a test', but don't forget it's got to be analysed and the results have got to be provided. We said at that point in time that we want more within 24 hours, and we're still not seeing some of those figures increasing. We need to address that point.

I'll close by saying I want to give huge thanks to the committee staff. Many people don't always appreciate it, but committee staff worked unstintingly throughout the period, and over the summer period, to ensure that we had the evidence we needed to provide this report. We must give thanks to them and to the witnesses that gave us the evidence. Those witnesses represent the people on the front line, and we can't forget that, either. So, thank you very much. And please, Minister, I appreciate we have come a long way, and I appreciate we are not where we were back in March, but let's make sure the lessons are learnt and that the advice is followed. Thank you.

I just have one more speaker before I call the Minister, and that's Rhun ap Iorwerth.

Thank you, Chair. I'd like to echo the thanks to the amazing work of the committee team, the clerks and the research team and so forth, who have worked so tirelessly through this period. I've been very pleased to be able to be part of this inquiry, which is ongoing, of course, and will continue for some time. It's the first report in a series, focusing on a number of specific areas. I'll go through those. One of the major elements that we looked at was testing, which is such a key part of the battle against the virus. We know that the system isn't as robust as it should be. There are a great number of my constituents who have contacted my office—people not being able to have tests at home and having to travel a long way to testing centres; people failing to have tests because they don't have an e-mail address or a mobile phone—not everyone has those—and some people having trouble driving to certain test centres. We have to ensure that this aspect is strengthened. 

I am pleased that the Government has accepted recommendation 8, namely that they should assess carefully the likely demand for tests in the future and ensure that there is enough capacity to test in the future so that anyone who needs a test can access one quickly and easily. But the truth is that there is a failure to meet current demand, let alone the demand over the winter. We need to differentiate between capacity and how much testing is happening in practice. The First Minister talked about 15,000 capacity, whereas actually very often it was only 2,000 or 3,000 tests that were being done.

I know that the problems of having tests have come to the surface as schools have opened, and capacity has been short when it was needed. I would have expected there to have been more preparation for that and more robustness in planning or building for the start of the school term. And despite the pledges that things will be better in a few weeks in terms of the lighthouse labs, it doesn't give much confidence in terms of winter robustness, as the second wave continues to grow.

I'm pleased that the Welsh Government has accepted recommendation 7 in terms of developing a clear plan for regular and repeated testing of health and social care staff, including asymptomatic staff. I have been calling for that consistently, and there are still too many people on the front line who are nervous. I hear stories about community nurses, for example, who don't get offered tests and are very concerned about passing the virus on to patients. We need to expand the scope of asymptomatic testing at home, for example. 

Another issue is the financial implications on local government during this pandemic. I do welcome the recognition that the Government needs to confirm as a priority the support package for local authorities to support the work of employing tracing professionals, as they've been doing. And that's recommendation 24. That's something I raised with the finance Minister in July. There were volunteers in local authorities and workers who had been pulled from other departments into the tracing teams, and I think that it is obvious that, even though the number of tracing staff has grown, as we heard in the committee this morning, there will be further support needed by our councils on this front. 

Further work that local government has been leading on is helping people to shield. And you've seen a great number of references in the report in terms of supporting people who have been shielding and ensuring that people are being fed, and so forth. And on that point, I was disappointed with the response I had to a letter from me asking for support for local authorities to be able to plan for providing food and so forth for vulnerable people during the second wave. There was a great partnership in Anglesey, being led by the council, with Menter Môn and local businesses, and Dylan's restaurant, and so forth, ensuring that food packages were being distributed. And Dylan's were very eager to see that preparations were in place to be able to respond quickly to a second wave. The response was very quick in Anglesey the first time, but of course we need to learn as we go. We have the background information now, and we need to ensure that there is better preparation, and I didn't hear that in that letter. So, I'd like to have an assurance that planning work is being done. 

And finally, I echo the recommendation in terms of adequate PPE during this pandemic. We've heard the word 'thanks' being said time after time to health workers and care workers but, of course, what they need is information now and in the future that the resources will be there to allow them to do their work properly. 

Diolch yn fawr. I call the Minister for Health and Social Services, Vaughan Gething. 

Thank you, acting Deputy Presiding Officer. May I first begin by thanking the committee for their time in considering this important topic, and what is an interim report? The scrutiny continues; I had the pleasure of more than two hours in the company of the committee today answering questions about the continuing work that we do on how we keep Wales safe, and the response of our health and social care system. I want to put on record my thanks to the staff across our health and social care sector, not only for their incredible hard work and dedication to care for people with COVID-19 and their incredible compassion and resilience—they really are a credit to each and every one of us—but also the work that they have done with others in addressing urgent health and care needs to protect those who are the most vulnerable within our community. 

I support and accept or accept in principle the majority of the recommendations from the committee. Our national winter protection plan has now been published and this is an overarching plan that sets out our expectations for health and social care, and informs engagement with wider partners and stakeholders. This ambitious plan will seek to embed our learning from the report to strengthen our approach over the forthcoming winter period.

On testing, the testing strategy published on 15 July outlines our plan for testing health and social care staff, and I've recently provided a written statement on the priorities for testing at the start of this week. Our strategy is based upon the latest evidence. As ever, it is subject to change as the evidence base may change during the course of the pandemic. And I would gently say to the committee that they will hear and they'll continue to hear anecdotal demand for asymptomatic testing. The committee can't demand a broadly evidence-based approach and demand fidelity to the scientific and medical evidence to help keep Wales safe, and then choose when to cherry pick and amplify demands that are made to overturn the evidence that we rely on to help keep Wales safe. 

We've openly set out the evidence base from the technical advisory group, and the committee have had the opportunity to hear evidence from the co-chairs of TAC, including the chief scientific adviser on health as well as access to the chief medical officer. We're continuing to openly publish that evidence and to make choices based upon it. 

We are acutely aware of the challenges posed by delays in the testing from lighthouse labs; that's been highlighted again today in the questions from Andrew R.T. Davies highlighting the delay of 2,000 results from lighthouse labs to flow into our system, and that's an important factor. In the overall lighthouse labs testing programme, those 2,000 tests aren't a significant amount but, actually, in terms of the overall numbers for Wales they could make a material difference about our understanding of disease prevalence in communities across Wales. So, I do recognise that that is a real challenge for us and, as I say, it's something we're looking to work constructively with different officials and, indeed, different Ministers and I'll continue to have those discussions not just with the UK Secretary of State for health, but also ministerial colleagues in Scotland and Northern Ireland. 

We were, at the point that I gave evidence to the committee, expecting to have the lighthouse lab in Newport open over the summer; that's now delayed and expected to open in October. That should help us in improving the volume of tests available, but there's also something about the robustness and access to the largest population base in Wales. So, that should be a positive step forward for us. But Welsh lab capacity is already being used for rapid deployment of outbreaks and incidents, and for NHS Wales. We continue to work urgently with Public Health Wales and our NHS to build on the work that is already taking place to supplement capacity from lighthouse labs with those that are operated by Public Health Wales.

Again, I was able to run through some of this with the committee this morning, with the update, for example, on the increased testing availability we'll have in north Wales, where this week we expect to increase the testing capacity by some 40 per cent. That is largely because of our deployment of Public Health Wales lab tests. We'll utilise and prioritise Welsh lab capacity as we see pressure and demand rising across the UK and, of course, to deal with hotspots here in Wales. I recognise that turnaround times are critically important to the effective functioning of our test, trace, protect system. And test, trace, protect is a successful Welsh innovation and delivery, designed and delivered between health and local government in partnership, across all the different geographies and politics of local government, working with their local and national health service. I recently announced additional funding of £32 million to increase capacity to process tests at Public Health Wales laboratories. That includes six new hot labs that are due to open in the month of November, and extending regional labs to operate on a 24-hour basis should take place before the end of October. And in the most recent week that we've been able to publish figures for, 94 per cent of new cases were successfully traced by our test, trace, protect service, and 86 per cent of their contacts.

I recognise the comments made by committee members about support for self-isolation. Our test, trace, protect service does contact people who are isolating. It's how they understand how successfully people are or aren't isolating. I've had feedback from my own constituents and others about the difference that call has made to them successfully continuing with self-isolation. But I recognise the issues raised by not just the King's Fund report, but also by SAGE and others about the concern over people not successfully self-isolating. So, it was welcome when Michael Gove, in a call with First Ministers across the UK, confirmed there should be new money available to match the policy offer that had already been announced in England—of a £500 additional payment on top of statutory sick pay for low-paid workers. We now expect the UK Treasury to honour that commitment, so the First Minister has been in a position to confirm that we will introduce that payment to make sure that people can successfully self-isolate.

Care home providers, as well as people living and working in care homes, have faced an unprecedented challenge this year, and my sympathies are with those who have faced months of separation from family and friends, and especially to those who have lost loved ones. We supported the sector through this exceptionally difficult period, and we'll continue to do so. We'll be publishing our care home action plan that the Deputy Minister has committed to. That will set out the actions we're taking to ensure that the care home sector is well supported ahead of the challenges of the winter period.

We have been challenged—we heard it again today—about the approach we took in discharging people from hospital to care homes during the initial phase of the pandemic. And if I can take this opportunity to draw the committee's attention to recent research undertaken by Public Health Wales in partnership with Swansea University. That research found no evidence that hospital discharges were in fact associated with a significant risk of a new outbreak in a care home. However, the size of a care home was found to be associated with this risk. Research investigating into how other factors, including policies around staff and visitors, might affect risk continues to be prioritised in support of our efforts to reduce or eliminate care home outbreaks.

Restricting visits to care homes has been exceptionally difficult and, in fact, heartbreaking, and we heard this again today in the committee. But it has been one of the necessary measures that we have had to take at various stages in the pandemic to reduce the risk of infection to care homes. We've worked collaboratively with the sector to produce guidance to support providers to reintroduce visits safely as lockdown restrictions were eased over the summer. That work continues, and I know that the group met again this week to consider how the guidance is working in practice, and, again, the understanding that there should be not be an entire blanket policy—there should always be an individual circumstance where the care needs of that individual could or should be met by visits.

Recent local restrictions mean that local authorities have again had to make some very difficult choices about care home visits, striking a balance between people's continued well-being and the risk presented by increased community transmission. And I again encourage our local authority partners to engage with Public Health Wales, working with their local incident management teams in reaching those decisions. I expect restrictions to be temporary, to be as least restrictive as is safe, and to be kept under review. A rapid response system is in place for local health boards to deploy mobile testing units to those care homes where there is a positive case, and a dedicated care home testing portal is available for ongoing testing of care home staff.

It is worth pointing out on PPE, which the chair spent time on in introducing, that since 9 March, NHS Wales Shared Services Partnership have issued 342.3 million items across our health and social care system, and 167 million items have been issued to social care—that's 48 per cent of the total of items. And we're still issuing around about 13 million items a week. The scale of activity is still significant, and since the very early days of the pandemic, we have provided that free of charge to care home providers. It is the legal responsibility of employers to provide PPE for their workforce. The NHS Wales Shared Services Partnership stepped in because otherwise we would have had an unacceptable risk of harm to staff and the people they care for, and I'm pleased to see that England have recently announced they will follow the lead that we have taken in making that provision of PPE freely available to the care home sector.

We've also been able to provide mutual aid to other UK countries, we have a healthy supply chain of future orders and we are in a much more robust position and we are stockpiling for the winter ahead and for future provision. In fact, I think our system stood up well to the extraordinary pressures and the very sharp tightening in the international market that we saw. That's both in ordering and delivering more PPE into the country, and, in fact, we've provided some assistance in terms of the conversations with England where they've had to reconstruct a central purchasing and procurement operation that was lost in the Lansley reforms. But more than that, we've also, as Dai Rees mentioned, seen Welsh businesses and manufacturers respond significantly to the challenge of creating more PPE. And in the future we'll need to have a different balance in what we procure from other countries and what we continue to provide from manufacturers here in Wales. There may be an additional cost per item to that, but it's the right thing to do to make sure that we have a more robust system in place.

Minister, you've now taken 11 minutes. We're not pressed—[Interruption.] Hold on. We're not pressed for time and this is an important debate, so if you take a minute or two to conclude, that's fine, but we do have to pay some attention anyway to the time limits.

Thank you. I'm fortunately drawing to the conclusion of my remarks, and that is that we have learned from the initial six months. We've learned about working closely with local authorities and public health experts on all of the local restriction measures. We've met with local authority leaders regardless of geography and political leadership, and that's a real strength of the position that we've taken here in Wales, in contrast with some of the choices where leaders have found that out in other parts of the UK, especially in England.

But we all have a part to play to keep Wales safe: the Government, health, social care, public services, businesses and, crucially, us as individual members of our families and communities. The rules are in place for all of us, they apply to all of us, they're for the benefit of all of us, and if we all play our part, then together we can keep Wales safe. Thank you.

I call on Dai Lloyd to reply to the debate.

Diolch, Dirprwy Lywydd. I'm conscious of the time. Can I thank everybody who has contributed, first of all, to this debate? Excellent contributions all around, making a variety of points that come from our analysis in what was our first report as a health committee into COVID-19, fulfilling our scrutiny role as a committee and as committee members. There are other reports to follow.

Now, it's fair to say, obviously, that it's been a completely and totally devastating year. There was real fear on our hospital wards during those early days in February, March—real fear—and obviously we've heard about the challenges as well, outlined by colleagues, Andrew R.T. Davies, David Rees and Rhun ap Iorwerth: challenges around testing in those early days and we still have those challenges on testing, and similarly with PPE, although the situation appears far healthier as regards PPE.

We've taken a lot of evidence about social care and how as a society we view social care. And if this pandemic emergency had done nothing else, surely it must crystallise our view that we need to do something about how we organise and view social care generally. If we totally view it as having parity of esteem with the health service, should we not look to reorganise care along the same lines as we organise health? Mental health issues have been prominent as well in a lot of the evidence we took, and it's not surprising and it will be the basis of the next report from the health committee.

But in closing, can I pay a huge tribute, as I did at the start and as others have done, to the massive, heroic and epic response to this pandemic, not just in the health and social care sector, but also, as we've heard from Rhun, local authorities really came good during this—local authorities have shone, absolutely shone indeed. As well as thousands of volunteers in the background who have been doing everything from delivering food, medicines, sewing gowns, sewing masks, and also to the thousands of unpaid carers who really have felt the strain of the last six months. It's been a horrific time for many, and some who have recovered are debilitated by long COVID now, as we speak—chronic, debilitating and still suffering. Rehabilitation services are going to be key as time goes on, and that'll be the basis of another further report from this health committee. My thanks also go to clerks and researchers and legal support, and everyone that makes this health committee function so very well indeed. It's an excellent report, as I've heard many say, and a lot of that is due to excellent research and excellent clerking response.

So, in closing we say: stand firm and do the basics in terms of social distancing, in terms of hand washing, in terms of wearing a mask and in terms of decreasing social contacts—that's what we need to carry on doing—and support the motion. Diolch yn fawr.

Diolch yn fawr, Dai. The proposal is to note the committee report. Does any Member object? The motion is therefore agreed in accordance with Standing Order 12.36.

Motion agreed in accordance with Standing Order 12.36.