Questions now from party spokespeople. The Conservative spokesperson first—Andrew R.T. Davies. 

Thank you, Presiding Officer. According to Macmillan, Minister, nearly 3,000 people in Wales could be living with cancer undiagnosed as a result of the pandemic. What is your plan to tackle this vicious storm heading towards the NHS in Wales?

We are working with our clinicians and our services to restart a range of cancer services. You'll be aware that we've restarted screening services. You'll be aware that referrals in cancer are up to normal levels. The challenges we have are that we are now seeing more people presenting even later than before, and, pre-pandemic, part of our concern was that people, particularly in our less well-off communities, were more likely to present with cancers later, and to need more radical treatment options and to have less likely positive outcomes. 

When we do publish the information that I've indicated we will do, we'll continue to publish, for example, the single cancer pathway that we are introducing, and that will become, in the new year, the single measure that we use, as opposed to the older and less accurate measures that we currently have. And that will give people an honest appraisal of both where we are, and, indeed, as we need to plan for the resumption of services after the pandemic. And key to what we're saying here today, and on every day as we come back to this, will be the need to consider how we all behave to both reduce the harm from coronavirus and to recognise that if coronavirus gets out of control again, then we will find a direct impact on non-COVID care, and that will obviously affect cancer services, just as it is, I'm afraid to say, across our border too. 

Since the start of the pandemic, Minister, in Wales, female deaths from dementia and Alzheimer's disease in the home have gone up by 92 per cent against the five-year average. Male deaths from heart disease at home in Wales have gone up by 22 per cent above the five-year average. Excess deaths at home were mostly due to deaths not involving COVID-19. What is your plan to tackle these excess deaths?

Well, as the Member will know, the Office for National Statistics published their latest weekly report last week, and it indicates that the excess deaths in each country of the UK, but certainly the detail on England and Wales, pretty neatly matches the number of COVID-related deaths we're seeing. And, so, it does show the significant impact that COVID is having across all areas. So, dealing with the COVID pandemic is hugely important in managing excess deaths in all areas.

Again, as the Member will know, we have a critical care base of 152 beds. About a third of our current capacity, and we're over that already, is taken up with coronavirus patients. Now, that means we're already seeing a high number of people with non-COVID causes. We want to maintain that activity through the winter, to make sure that we minimise any harm that is caused by the necessary choices that we need to make to keep control of the pandemic. And again, I'd appeal to everyone in every part of Wales to continue to think about what we should do to reduce harm from COVID, both direct harm as well as the indirect harm that COVID will cause. 

In 2019, Minister, the Welsh NHS carried out 35,700 orthopaedic operations. Data up until the end of August show that there have only just been over 8,000 operations in Wales. At the same time last year, there were 24,000 operations performed by the NHS in Wales. What's your plan to tackle this public health bomb that will come and break the NHS?

As I've indicated, we have to deal with the coronavirus pandemic, because not dealing with it, not taking effective action, will undermine our ability to treat effectively people with non-COVID health conditions. The plan is to make sure that we have an operating framework that allows us to carry on treating non-COVID patients. I don't want to see our national health service turned into a COVID service and nothing else when it comes to hospital activity. That would indicate that our system is at the point of being overwhelmed and we know that that would translate into real harm for people in every single one of the communities that we have the privilege of representing in the Welsh Parliament.

The future is about the future plan for recovery, so it's a twin approach: managing the position now, maintaining non-COVID activity, as our operating framework sets out, wanting to continue to, if possible, increase the level of non-COVID activity, but certainly trying to protect the activity that we've restarted. And then, when we are through the pandemic, we will need to be able to finalise the plan that is already being worked on to recover from where we have got to in all areas of activity that have come under extraordinary pressure in these extraordinary times that we're living through.

Plaid Cymru spokesperson, Rhun ap Iorwerth.

Diolch yn fawr iawn. In the written statement today, Minister, you say that asymptomatic testing of care home staff will now be undertaken through the UK organisations portal and the lighthouse laboratories, rather than testing being allowed through Public Health Wales laboratories. Given the problems with lighthouse, many people will find that a disappointing and a rather strange decision. You're not even saying that the lighthouse problems have been resolved yet. Your statement says that issues are being addressed. Do you recognise that you're in danger of undermining confidence in this testing system for a sector that we all know is still very, very vulnerable?

I've taken seriously the evidence from the whole sector—from the Welsh Local Government Association, as both providers and commissioners, as well as providers themselves. We've also had engagement with trade union representatives too. So, this is a considered position, having worked with the sector in advance of it.

We're moving to a position where lighthouse labs, when it comes to their operation around care homes, are actually improving the turnaround. There are bigger challenges still with in-person testing. We've seen some improvement; we want to see it improve further. And this provides a consistency of provision, because I fully expect that local partners will, as we see high prevalence rates at present, want to move to the more regular weekly testing rather than the fortnightly testing we were able to move to when we had low transmission and prevalence rates in the summer. That then means that our Public Health Wales capacity can be deployed to support community transmission outbreaks, which we know have increased and we know we are likely to need to deal with as we go through the winter.

I just remind every Member that we're in a position where we have a joint programme where we have Public Health Wales tests and a significant infrastructure created through a UK paid for and led programme. We're not in a position to simply opt out of that programme and then replace all of that capacity ourselves. It's about money, it's about equipment, it's about people, it's our ability to deliver a system that will work for each of us as best as possible. So, I'm not being complacent about challenges in the lighthouse lab programme, but I recognise and I think that this is the right choice to make to provide some certainty. And indeed, it comes on the back of an improving picture in the way that lighthouse labs are dealing with care home tests.

Improving, you say, and moving to a situation where they can deliver a decent service, you say, but I'd rather wait until they can prove that they can deliver that service that we need. And I'm not saying, don't use lighthouse at all—I think lighthouse can be hugely important and will be hugely important—but surely, we should be having as much control over what is, possibly, within Welsh Government control.

We know from answers to written questions I submitted in recent weeks that your policy is to leave things largely to UK Government when it comes to vaccination too. There is growing optimism about the prospect of a much-needed coronavirus vaccine becoming available in the near future. Can you tell me what your latest thinking is on this and what Welsh Government's role will be in acquiring and running a vaccination programme in Wales?

I think it's a slight miscasting of the way that the system is actually working to say that we're leaving it to the UK Government. There are a couple of things to run through in terms of clarity. So, the first is that the UK Government, as it does with a range of other programmes, including, for example, the seasonal flu, procures the vaccine on behalf of the whole of the UK. We then take our population shares of that. So we will get the vaccines that are available when they're available, at the same time and in, if you like, the appropriate portion, as with every other part of the UK. 

In terms of the advice we get about how to deliver the vaccine, we have a UK-wide mechanism that will give advice on vaccinations, on approval and, in particular, the point about prioritising people. Because whenever a vaccine is available, we'll need to, as the First Minister said yesterday, consider how we deliver that to the most vulnerable population first—people who would gain the biggest benefit. That will, though, also be subject to the important caveat that we need to understand the characteristics of that vaccine. Some vaccines may be more or less effective for people with different health conditions, age ranges, and we need to make sure that the vaccine is actually effective for the group of people that we're looking to offer it to.

We are already planning our own programme for how we would deliver a vaccination programme here within Wales, and if we did have an early vaccine available before the end of the calendar year, then our plans are in such a position that we could deploy that for the limited group of people that we think a vaccine might be available for. So this is about planning, being able to deal with an early vaccine, if we get one, and also dealing with the more realistic prospect of a greater number of vaccines becoming available to every country in the UK at the same time at some point in the new year. But I can't give people the sort of certainties that they and I would like about when those vaccines will become available.  

I admire your trust in the UK Government. My fear, just like with testing and various other elements of what we've experienced over the past seven or eight months, including PPE and so on, is that you're afraid of taking as much control as you possibly could. I've praised you in the past, and I'll do it again, saying the Welsh Government has, in many ways, been at its best when it has decided, 'Listen, for this thing, we need to get it done properly by doing it ourselves', with absolutely the appropriate elements of and levels of co-operation and sharing ideas, and so on. Now, there's a danger that Wales, by not taking the bull by the horns as much as you possibly could, might be in a position where you can't press ahead with a programme as quickly as other parts of the UK. It was good to read in the GPs' magazine Pulse yesterday, for example, about plans for a roll-out in England before Christmas, which would be great. And with trust—and I'll finish here—being so vital for take-up, with Welsh Government trusted more than the UK Government over this issue—you could argue that that doesn't say much—won't a very, very clear and explicit strategy, clear and explicit communication from Welsh Government be a valuable weapon in building up trust and encouraging take-up, which we will need in the coming months?

There are two things that I'd say to that. The first is that we're taking the same approach that every nation in the UK is on the procurement and supply of a vaccine. There's nothing unusual in doing that. And actually, whilst I can and will continue, no doubt, to be sharply critical of the UK Government where I disagree with them, on the issue of the procurement and supply of vaccines, I just don't think there are grounds to suggest that the UK Government would somehow advantage one part of the UK over another. It's why not just this Welsh Labour-led Government is part of a UK-wide procurement programme; it's why the Northern Ireland Executive, led by a combination of unionists and republicans, and the Scottish nationalist Government are also part of those same arrangements for the procurement and supply of a vaccine. 

The arrangements for the delivery of that vaccine are down to each of the four nations. And, as I said, we already have plans that are being developed and worked through here for the delivery of a vaccine, and that would include the possible delivery of a vaccination programme within this calendar year, if a vaccine is available. And if we are going to do that, and if we do have a vaccine that is available to enable us to do so, you can certainly expect there will be direct and clear communications from the Government and from our national health service about what we are doing and why, which groups of the public we expect to benefit from that, and how we propose to deliver that in practical terms. In many ways, the delivery of the seasonal flu campaign is a helpful precursor to doing so, and I'm very please to say that we've actually had a greater uptake at this point in the year than last year, and that should provide population protection and coverage. I really hope that is a longer lasting impact of this pandemic—that people will undertake their own seasonal flu protection in greater numbers in the future.