Questions now from the party leaders. Plaid Cymru leader, Adam Price.

Diolch, Llywydd. First Minister, we will all, of course, naturally, have been encouraged by the glimmer of hope we saw yesterday, but, as you say yourself, a vaccine should not be regarded as a silver bullet, certainly at this stage in the pandemic. But nevertheless, the news was, I think, potentially a silver lining of what's been a dark and difficult year so far. Could you say a little bit more about the plans that you referred to in your answer earlier? Are you planning, at least on a contingency basis, if the necessary approvals are delivered, or is there potential for the vaccine to be rolled out initially next month? And could you say a little bit more about the logistical plans that you referred to? So, are you looking at, potentially, a network of mass-immunisation centres, drive-through centres that have been suggested, possibly roving immunisation teams and temporary pop-up facilities in general practitioner surgeries? Who is co-ordinating and leading this effort across Government? And in terms of the refrigeration question you referred to, of course, there was a discussion about refrigeration capacity in relation to a 'no deal' Brexit and medicines a year ago, and we may be in that position again. Are you satisfied that we have the capacity in the cold chain in order to deal with the virus, potentially?

Llywydd, can I thank Adam Price for those important questions? I think his description of it as a glimmer of hope is a good one, because I think that is what it is. It is hopeful and we need a bit of hope in these difficult times, but we mustn't exaggerate it either. It is the chief medical officer's office in Wales that is in charge of planning for any vaccine that becomes available to us. The chief medical officer was involved in this as far back as June, and was in correspondence with our health boards in July to make sure that plans are in place. 

On the storage issue, Llywydd, I think our current expectation is that if it were to be the Pfizer vaccine that was available first, with its need to be stored at below -75 degrees centigrade, then we would use the facilities available to the Welsh Blood Service, which does have facilities and in different parts of Wales that are able to keep things refrigerated at that temperature. But there are complications. My understanding of this vaccine is that it can only be taken out of refrigeration on four occasions before it's no longer capable of being used. So, there are some very real constraints with it. It has to be administered twice, as I know the Member will know, at a three-week interval, and it doesn't become effective until the first week after the second dose of the vaccine has been delivered. So, there's another set of difficult complications there. We don't yet know as to whether or not it will be effective in older people, and that's particularly a challenge at the moment because the Welsh plan, which is very similar to plans elsewhere in the United Kingdom, is to begin with priority groups and to begin with priority staff who are capable of administering the vaccine. So, our plan is that we would start with experienced vaccinators, people who do this all the time, and then we would expand beyond that. So, that's in terms of delivering the vaccine.

In terms of who will get the vaccine, until we're certain—more certain than we are now—as to which groups in the population this particular vaccine will be effective for, then we're likely to start with healthcare staff, social care staff, to make sure that front-line workers who are regularly in contact with people with coronavirus are vaccinated, and then, if it is effective with older people, then it will be care home residents and people in later stages of life that will get the next priority. So, it's a priority system; it will depend on how quickly the vaccine becomes available. We'll get a population share of it here in Wales, but there are a lot of questions that we will not yet know the answers to, and as those answers emerge, we will be able to firm up the programme that we will have for delivering the vaccine to those who need it the most first. 

Diolch. The Scottish Government has said that it's agreed for its vaccine quota, if you like, to be determined on a population-share basis because there's minimal difference between that and calculating on something more like a needs-based formula. You've said in the past, First Minister, that in the context of COVID Wales has a greater vulnerability because it's older, sicker and poorer than average. So, will you be making the case for our allocation to reflect a greater than population share on this basis?

And in terms of the prioritisation issue that you've just referred to and the interim order of prioritisation set out by the Joint Committee on Vaccination and Immunisation on 25 September, which you said that we would broadly be following, have you looked at alternative methods for prioritisation, for example the Oxford risk prediction tool, which stratifies the population according to a wider list of risk factors? In particular, will you be prioritising the roll-out of the vaccine in communities with demonstrably greater risk of infection, for, principally, areas of high socioeconomic deprivation, the black, Asian, minority ethnic communities and areas with higher levels of infection?

Llywydd, because of the speed at which we will need to move in the first instance, we've agreed a population share for Wales. That doesn't mean to say that we can't return to that, but in the first instance, getting our population share will allow us to get the programme going and we're likely to be guided in the first instance as well by the advice of the JCVI, which we've had a long history of engagement with and who do understand some of the particular challenges we face in relation to the Welsh population. None of that, however, means that, once we've got this vaccination programme under way, we are not able to fine-tune it, both by looking to see whether we have a case for additional volumes of vaccine coming to Wales and by making sure that the prioritisation that we agree is fine-tuned to meet the needs of the Welsh population. And I agree, of course, with Adam Price that there are particular groups in the population—the BAME community, certainly—who have a greater vulnerability to this virus and therefore, in a prioritisation system, you'd want to pay some proper attention to that.

While we await the roll-out of an effective vaccine, other methods of avoiding an over-reliance on lockdowns as a primary policy tool are important, of course, which is why the mass-testing programme being piloted in Liverpool and the example that we had in Slovakia are important. The latest available data shows the weekly rate of COVID in Liverpool is 300 per 100,000 population. The corresponding figures for Merthyr Tydfil, Rhondda Cynon Taf and Blaenau Gwent are all above 400 cases per 100,000 of the population. While bearing in mind the advice of the Scientific Advisory Group for Emergencies that mass testing should complement rather than replace track and trace, is there not a compelling case for the urgent roll-out of a similar mass-testing programme in these areas in Wales? I read today that England is talking about 66 local authorities being part of the next wave of the mass-testing programme. Can you confirm, First Minister, whether the Welsh Government is actively planning a similar programme in these areas in Wales and to do so at scale and at pace?

Llywydd, mass testing does have a potentially very important role to play. We will learn a great deal from the Liverpool experiment. It's not straightforward. If you go for whole-population testing, you're doing it on a voluntary basis. There are very significant logistical issues to consider, and the testing is only one part of it, because you have to have everything in place to deal with the additional number of people who you will undoubtedly discover as being positive with coronavirus if you test in that way.

We are engaged with the Liverpool pilot. We are purposefully planning for the way in which we could use mass population 'whole-town testing', as it's called, here in Wales. And I think that by learning from the very early lessons that are emerging already from the Liverpool experience, we will be able to mount a whole-town approach to testing in a way that will be more immediately effective, and I want to make sure that when the moment comes, we're able to do that here in Wales. We've done all the preparatory work so that it delivers for that local population.

Leader of the Conservatives, Paul Davies.

Diolch, Llywydd. First Minister, you will have seen the very worrying concerns from some health experts that as many as 2,000 people in Wales could die as a result of COVID-related delays. Professor Tom Crosby of the Wales Cancer Network has said that he fears an unprecedented tsunami of demand for cancer services is coming. What urgent action is the Welsh Government taking to address these very worrying concerns?

Obviously, Llywydd, the most urgent action we are taking lies in everything we are doing to turn back the tide of coronavirus, because the biggest threat to treatments for conditions other than coronavirus comes from our NHS not having the capacity to be able to go on offering those treatments, and we are still far too close to that position in Wales today. The firebreak period will, we hope, have given us the opportunity to go on in the Welsh NHS providing cancer care, providing coronary care, providing stroke care, and all those other really important things that the NHS does, but the most important action we can take, and the most important action that every single citizen in Wales can take, is to do everything to turn back the tide of coronavirus, because that will mean that our health service will be able to go on doing those other things and to do so increasingly, as it has built up its capacity to do so ever since April of this year.

Of course, and I very much agree with the First Minister. Our priority has to be tackling this virus, but, of course, we need to make sure as well that routine surgery and routine services are able to continue, because figures today have shown that around 49,000 patients in September had been waiting for more than a year for an NHS treatment in Wales, and that's a tenfold increase for all treatments compared to September last year—49,000 people, with many people across the country living in pain and discomfort waiting for treatment. And those same figures show that 18,000 people are waiting for some kind of treatment at Betsi Cadwaladr University Health Board—a health board, of course, that is directly under your control. Now, the health Minister has himself admitted that as a result there will be poorer outcomes, more people having avoidable disability and more people potentially losing their lives with non-COVID care. So, First Minister, can you tell us what discussions the Welsh Government is having with health boards across Wales about managing these waiting times, and the impact that this may have on the Welsh NHS in the medium and longer term? And given the pressing nature of this matter, will you now give serious consideration to perhaps establishing COVID-free hospitals across Wales, so that we can start addressing these worrying figures?

Well, Llywydd, of course we discuss these things all the time with our local health boards. The Member will see in their quarter 3 and quarter 4 plans all the actions that they are taking to try to provide for non-coronavirus care while dealing with the impact of the global pandemic. What health boards say to us is that their staff are exhausted by the experience of this year, and that we are going to be asking them again this winter to cope not just with the over 1,000—well, over 1,400—patients who are now in beds in Welsh hospitals suffering from coronavirus, but we are going to ask them to do all those other things as well. And our health boards report, as do organisations like the Royal Society of Medicine and so on, real concerns about the resilience of our workforce in everything that we are asking of them, and much of what we are doing is to try to make sure that we look after those staff so that they can go on doing all the things that Paul Davies has suggested. 

The idea of coronavirus-free hospitals in Wales is a difficult one, I think. Our health boards are preferring to have green zones and red zones inside existing hospitals. I'll give him the example that he will know the best. What would he like Withybush to be—a hospital devoted to coronavirus only, so that anybody with coronavirus ends up in Withybush, or anybody in the Withybush area who has coronavirus has to go somewhere else for their care, because Withybush has become a non-COVID hospital? And that's a difficult issue, as he will recognise, in every part of Wales, isn't it? Because we have rural communities with single hospitals, small often in scale, doing everything that is needed for that local population. And if you're in a very big metropolitan area, where you've got hospitals close by to one another, then maybe that is a viable possibility. I think it's much harder to make it fit the geography and the population distribution in Wales.

First Minister, of course, it is critical that the Welsh Government explores every opportunity to resume non-COVID care so that people can access vital treatments as soon as possible, and it's deeply worrying to hear the health Minister say it would be foolish to have a plan for backlogs before the pandemic is over. Now, it's also crucial that the Welsh Government considers how it also supports our NHS workers at this time, as the First Minister has just referred to. The Royal College of Nursing in Wales have made it clear that an increasing number of staff are actually accessing mental health support due to the pandemic, so it's absolutely critical that a strategy to support the NHS workforce is delivered to nurture and indeed support our front-line staff. So, can you tell us how is the Welsh Government responding to the concerns of the Royal College of Nursing, and indeed others, regarding the impact on NHS workers? And can you tell us what workforce planning is actually currently taking place, and, should there be further pressures on the NHS in the future, how will the Welsh Government protect and support our NHS workers in the face of those pressures?

Well, I do entirely agree, Llywydd, and said so myself in answer to Paul Davies's second question, that one of the real constraints we face this winter is in the finite number of staff that we have, the experience they have all gone through, the fact that, as front-line staff, they are particularly vulnerable themselves to contracting coronavirus, their recovery is no different to anybody else and is often a long and difficult one. So, I said to the leader of the opposition that the quarter 3 and quarter 4 plans from our NHS colleagues focus particularly on making sure that we can sustain our staff through this very difficult period. We've provided new services, available to whole breadth of NHS staff, in relation to mental health; we've provided further training to staff to be able to deal with a broader range of demands that will come their way. But, when we look forward to a winter in which coronavirus shows very little sign of going away, where we've yet to begin the flu season, where winter brings with it all the other things that we know happen when you have an older, sicker, more vulnerable population, as Adam Price says, then doing everything we can to support our colleagues in the health service is top of my agenda and that of the health Minister here.

Some of the things we were able to use earlier in the year are not so easily available to us. We were, as Paul Davies will know, back in April and May, able to recruit students who were just finishing their courses; they were ready to be deployed in clinical circumstances. That isn't the case in November and December. We recruited back into the service people who had recently retired and were willing to come back. We may well be looking to people to help us in that way again.

The good news is that, despite all of this, recruitment to the Welsh NHS does go on being very successful. We have filled our general practitioner training rotas, and overfilled them this year, compared to any other year, including in north Wales, which the Member mentioned. So, the longer term sustainability of our health service staff is based upon our ability to recruit into courses, into training schemes, and, on that score, despite the very bleak year we're in, we continue to do well in Wales.