1. Will the Minister make a statement on waiting times for out-patient appointments and treatments within the Swansea Bay University Health Board area? OQ55772

Yes. The Welsh Government is working closely with all health boards to ensure that, when services can be delivered, the most urgent patients are seen first. During the pandemic, the available capacity has been reduced to enable appropriate social distancing and improved infection prevention and control measures to be implemented.

Plainly, the COVID pandemic has clearly had a very significant impact on waiting times, for both out-patient appointments and planned treatments. The number of patients waiting more than 36 weeks for treatment within Swansea bay health board stood at 22,453 at the end of August this year, compared to 3,263 at the same time last year. Now, we know that the health board has made some use of out-patient and theatre capacity at Swansea's Sancta Maria Hospital, but this is not a sustainable option long term. So, could I ask what additional actions are you taking, Minister, to address this issue? And do you agree that you need to do more in terms of developing not just COVID-lite pathways but COVID-lite hospitals or stand-alone units within the Swansea bay health board area in order to significantly increase capacity to tackle this backlog?

I think there are a couple of points to make. The Member correctly highlights the significant difference in the number of people waiting a long time, and that is one of the harms that we specifically recognise in needing to balance in all of the action we're taking during the course of the pandemic. There are a number of things that we have done to enable appointments to go ahead, in primary care, which the Member will know something about, in the way that video consultations are taking place, but also there are times when people need person-to-person contact for effective treatment options to be run through.

In terms of what we are doing, there is activity that is taking place, but we know we're going to have a significant backlog at the end of the pandemic. So, as well as the quarter 3 and quarter 4 operating frameworks that the health service is working to, we're already having to forecast and look forward to the significant recovery that we need. Because the Member's right that Sancta Maria is not a sustainable, long-term answer to that. In having, if you like, COVID-lite and COVID-free areas, which the service is planning for and so we are doing much more non-COVID activity because our NHS has organised itself in a way to try to do that, the big challenge is, with community transmission as it is, keeping coronavirus out of a site, even if we designated it as a non-COVID site, is actually really challenging and difficult. And the way that our hospitals sites are set up, they're not currently set up, if you like, into 'hot' and 'cold' sites, where you have planned care on one hospital site totally and unscheduled care on another.

So, this is a much bigger reform than I think we're going to be able to deliver within the coming days and weeks. But we do have designated zones, and that's why the infection prevention and control measures are so important, but it's also why the messages to the public are so important—if community transmission continues as it is, then we're unlikely to be able to see coronavirus kept out of all of our hospitals, regardless of the designation we provide to them.

Minister, I think I'd be grateful if you could bring some influence to bear on the restoration of a minor injuries unit at Singleton Hospital in Swansea. It's been closed for some time now. But in the meantime, I wonder if you could tell us what out-patient activity is happening in the community since March. It's been part of Welsh Government policy for a while to try and bring some appropriate out-patient activity back out of general hospitals. And could you also say whether that activity has decreased since we've started to see some COVID deaths, actually, within some of our community hospitals, as opposed to our general hospitals? I think Members may be aware of the sad deaths within Maesteg Community Hospital, which is obviously in a different part of my region.

Okay. So, I can say that, in terms of the increase in out-patient activity, from April, when, of course, we made the choice—which I think was the right choice—to end lots of activity within our healthcare system, and elective care and out-patients in particular, lots of those were paused to allow us time to prepare for the wave that we knew was coming, and we then had—. Lots of members of the public opted out of treatment as well, even in essential services. So, we have this big backlog that's built up and a really significant drop in activity. Since April to September, elective activity within Swansea bay has increased 147 per cent and there's been a 60 per cent increase over the same timescale in out-patients. We are now seeing a receding back in some of those areas of activity because of the extra wave of COVID patients coming into our hospitals.

And that, again, is part of the point I was trying to make in answer to the first question from Dr Lloyd, and that is that, as we see a rise in coronavirus in our communities, as we see more beds taken up with COVID patients, it will affect the other activity we can undertake, and that's why the message with the public is so important, as we look to the end of the firebreak, not to let the hard-won gains go.  Because we know that, even if we go through this winter without needing to have another firebreak, there is a big challenge coming in the future to deal with the backlog that's been built up. So, yes, we're having to make choices about ending some forms of elective and out-patient activity to manage our COVID patients. What we don't want to do is see that disappear altogether, because that in itself would be a real cause of harm for people that you and I represent, and others, all across our country. 

Minister, with Swansea bay still having to impose infection control measures at Morriston Hospital, the number of people waiting for treatment will continue to rise, compounding an already dire situation with regard to excessive waits for treatment. Before the pandemic, there were already nearly 6,500 people waiting more than 36 weeks for treatment. So, with the suspension of routine treatments during the pandemic, that number has skyrocketed. Minister, will you be recruiting additional doctors, nurses and other staff in order to address the backlog? 

Well, Dr Lloyd accurately set out the challenge in the rise in people waiting that we acknowledge is a direct consequence of the action we've had to take to keep people alive during the pandemic. And that difficult balance in the choices we make and the different harms that are caused is very much in the minds of myself and other ministerial colleagues in all of the choices we make. I've also said before that we're going to need to look after our staff not just through the rest of the course of this pandemic, but in the future, because there is a very real mental health toll on our staff, from the treatment they've had to provide and the circumstances in which they've had to do that to keep our people well and alive. So, in the future, I think we'll see a drop-off in staff as we need to deal with and address some of the longer term challenges that will come from that, and that's why the investment choices we've already made are so important, in our training numbers and in the progress we've made, for example, on recruiting more people into general practice and secondary care.

So, yes, we'll look again to maximise our opportunities to recruit and to retain more staff, but we should never forget that the workforce of the future is already here in substantial numbers. The people who we'll have serving our communities in the national health service for the next five years are almost all here already. So, we'll look after our staff for the future, when they're going to join the national health service, and crucially take care of all of our staff in primary and secondary care who are here right now, serving each and every one of us. 

Minister, you've highlighted, and correctly highlighted, the challenges facing the health board, and I would love to see a COVID-lite hospital, but we cannot guarantee any site would ever be COVID free, because that is one of the challenges facing us. I've had many constituents who have actually been in touch with me to say they were referred as an urgent patient, prior to the pandemic, and whilst, when you answered Dai Lloyd first, you indicated that they were telling you that prioritisation would take place, clearly there's something going wrong with the system when patients who are seeking urgent care and have been referred as urgent patients are still waiting. Now, I've been in touch with the health board on particular cases, but will you look at it and ask your officials to speak with the health boards to ensure that prioritisation is done on a clinical need and that some people are not being let through the system because they're not simply shouting loud enough? 

Well, it's absolutely the case that clinical need should be what leads to how people are prioritised at all times, and especially so now, because we know that some people will have waited for longer because services were postponed, and others will have opted out of the service. But, actually, for some of those people, their needs will be even greater now. So, yes, that's a very clear message from the Government and from the chief exec of NHS Wales to our whole system. If the Member has particular instances where he's concerned that that clinical prioritisation may not have taken place, obviously, I know he'll raise it first with the health board, but he's free to write to me if he wants matters investigated further as well. But it's a very clear message: clinical prioritisation for all people waiting is exactly what every part of our health service should be doing.