4. What assessment has the Minister made of the number of people with COVID-19 in hospitals in Wales? OQ55796

The number of COVID-19 patients in hospitals continues to rise here in Wales. As of 3 November, the number of COVID-related patients in hospital beds was 1,344. That is 21 per cent higher than the same day last week. This is the highest number of COVID-related patients in a bed since 25 April, and we are approaching the April peak in bed occupancy.

Thank you, Minister. Yesterday, Andrew Goodall issued a stark warning that demand for critical care beds for people with coronavirus is expected to increase over the coming days and weeks. How are the Welsh Government preparing for this eventuality, and crucially, what could be the knock-on impact on other service areas within our hospitals in Wales?

I think that's a really important question, again, to remind ourselves in the Parliament, but also the public that we serve, that the impact isn't just about COVID-related harm. The reason why we introduced the firebreak was to interrupt the rise in admissions and the rise in harm that we are now seeing, that we thought we would see when we introduced the firebreak. And that's because, when you see infection rates go up, there's then a lag from those infections to people going into hospitals. It's why I plan to publish openly the data on over-60s infection rates as well—that's an even more reliable indicator of harm that we're likely to see in hospitals, and I'm afraid also the harm that we will see in, ultimately, the death figures.

The critical care capacity—about a third of our critical care beds are now taken up with treating COVID patients. And COVID patients actually spend a longer period of time in those critical care beds, so it isn't just a number, it's a fact they're likely to be there for longer, and that impacts on our ability to undertake other areas of service, because at this point in the year, we're getting used to the fact that critical care would normally be pretty full because of the fact we see more people who are seriously unwell at this point in the year. And as I said earlier, it will hamper our ability to treat non-COVID patients.

The positive news is, though, that even though we're opening up our field hospitals at present, we're seeing people flow into those and out. There are about three dozen people in the Cwm Taf field hospital, Ysbyty'r Seren, at present. There are people going in and out of there, and I want to pay tribute to all of those people treating people in our mainstream hospitals and in our field hospitals. That recovery and rehabilitation journey is often thanks to nursing staff and working together with therapists. And it's perhaps appropriate at this point to recognise that it's Occupational Therapy Week, for us to recognise the job that they do in keeping us healthy and well, and in particular on the journey to recovery and rehabilitation. 

Minister, I listened to your answer to Vikki Howells with interest. You will know that I have expressed my concerns about the accuracy and reliability of data collection surrounding hospitalisations due to COVID many times already this year, because it's vital for our understanding of the disease that we really get to grips with who has COVID and then subsequently dies from COVID, and who, unfortunately, dies and COVID is not the primary cause of death.

I wondered if you were doing—. You talked to Vikki Howells earlier about doing analysis as to the types of people who might get COVID, but are you actually doing analysis of people who've been admitted to hospital and whether that admittance to hospital is because of COVID or they happen to have it when they come in because they have, for example, broken their leg or they're undergoing cancer treatment? And subsequently, when somebody passes away, have you given further thought to the calls by the Royal College of Pathologists to have more postmortems so that we can verify the figures between those who die of COVID and those who die with COVID, because that skews the data immensely? 

Those are fair concerns, and to be fair, the Member has regularly asked questions in this area. So, when we talk about COVID-related patients, we talk about all those people with confirmed COVID as well as suspected. The reason for that is it changes the way the health service needs to treat those people once they know that they're a suspected case. That has an impact on the number of staff and on the equipment that people do and don't use.

We're treating everyone who's admitted—we're testing everyone who's admitted, rather, and we're finding that the levels of positive cases from people admitted very neatly tracks community transmission positivity rates. So, we're seeing some people come in with symptoms who are being admitted because we think they might have COVID and we're also seeing other people who we're picking up in that testing programme when people are admitted.

We're also doing some work—and, again, the ONS work is helpful in this—on understanding the numbers of people where the primary cause is COVID, and those where COVID is an underlying cause or a potential one. I'll take on board and I'll go back and I'll consult with the chief medical officer about the value of the suggestion from the Royal College of Pathologists, not in terms of understanding whether it's a useful thing to do, but understanding the real-world impact of doing that in the way that our staff would be deployed in potentially undertaking an extra amount of activity because all of these things have to be balanced in turn. We have a much better line of sight now, thanks to a much bigger testing programme, on the levels of community prevalence, the ability to understand who's coming into our hospitals and our ability to plan and deliver non-COVID care as well. What I wouldn't want to do is to undermine our approach to be able to deal with those issues by undertaking an extra area of activity that wouldn't deliver that wider benefit, and, again, it's another neat example of balancing all of the potential benefits together with the potential harms from any course of action.

Minister, having heard what you've said to others about the difficulty of creating COVID-free areas or COVID-free hospitals, I've had some correspondence this week from constituents who were worried about going into Prince Philip Hospital in Llanelli for non-COVID-related treatments because they're concerned about the possibility of contracting COVID there. What further reassurance can you give those patients, working with the local health board, that they are able to undertake those non-COVID treatments safely? Because I very much associate myself with what you've said about how important it is that people do carry on getting non-COVID treatments at this time. 

I think there are two points to make. The first is that our health service is now in a different position to where it was in March and April. Our ability to test everyone who is coming in, regardless of the reason, is there now and that is being applied consistently across the service, so people can have that extra reassurance that an extra check is being undertaken, and this is all about minimising the risks, the way that PPE provision now works. All of these different things and the way in which we've organised our service to have zones that are COVID light, as well as COVID positive and COVID-suspected areas, to try to have that separation of patients, and, indeed, the way that we're looking to have some separation in the way that staff groups work as well—. So, all those measures are being taken to try to reduce the risk of harm to anyone who comes into an NHS hospital, or indeed into primary care as well; primary care has still been extraordinarily busy throughout the pandemic as well.

The second essential point I'd make is—and it goes back to comments that were made earlier in these questions—there's real harm in either stopping or not attending non-COVID activity. In the first half of the pandemic, we saw a significant fall in emergency admissions in our emergency departments, and also, very visibly for me, as well as the impact on cancer care, with people opting out of that, we saw a significant drop-off in emergency admissions for stroke. Now, that wasn't because the public suddenly became much healthier overnight; it was because people were so worried about going into an NHS hospital that they opted out, and that would have meant there would have been poorer outcomes for those people, including potentially avoidable mortality. So, it's really important that people recognise the NHS is open for business. It is there to serve you and protect you, and we are taking every reasonable measure to reduce the risk—as low as possible—to protect people from harm from COVID.