We now turn to the short debate, and I call on Caroline Jones to speak to the topic that she has chosen. Caroline Jones.

Diolch, Dirprwy Lywydd. As a new decade dawned in Wales, our NHS was once again struggling with winter pressures. January 2020 was not unusual. Every winter for the past several years, our NHS ground to a halt as it struggled to cope with cold and flu season. Non-emergency treatments were curtailed as the NHS ran out of bed space once more. Welsh accident and emergency departments experienced their worst ever waiting times. Only 72 per cent of patients spent less than four hours in A&E, waiting to be treated, transferred or discharged, compared with the target of 95 per cent. These figures were significantly worse than previous years. More patients than ever waited over 12 hours—well over 6,500—when the target is that nobody should wait that long. The ambulance service failed to meet its target for responding to immediately life-threatening calls for the second time since that target was introduced. So, despite a mild winter, our NHS was once again stretched to breaking point. 

Then, a new, severe, acute respiratory syndrome emerged in one of China's eastern provinces. It wasn't long before the SARS-CoV-2 virus spread around the globe, and people in Wales succumbed to COVID-19—the acute respiratory and vascular disease caused by the virus. As cases rose and our hospitals started to fill with coronavirus cases, all non-emergency treatments were once again halted. What was different this time was that screening services were also stopped. And as I've said in this Chamber many, many times, screening saves lives, and it's one of the most important services offered by the NHS. The fact that these services have only now restarted is deeply regrettable. As a survivor of cancer, I know only too well that early diagnosis is the key to survival, and without the screening services, how many cancers have now gone undetected? Some estimates have the number of people with undiagnosed cancers in Wales as high as 3,000. The Minister said last week that cancer referrals have returned to almost normal levels, but how many people have had their chances of survival diminish as a result of the intervening months? According to the director of the Wales Cancer Network, Professor Tom Crosby, as many as 2,000 people could die because of COVID-related delays in the Welsh NHS. This week, the BBC highlighted the case of one of Wales's disabled athletes, who had an MRI scan for a brain tumour delayed by two months, and sadly that individual's tumour is now inoperable. Had he received the scan on time, perhaps his fast-growing cancer could have been treated. This devastating case is far from unique, and my mailbag has been full of letters from constituents whose treatment has been postponed while the health service deals with the pandemic.

Swansea University researchers have been tracking the anonymised health records of the entire population of Wales during the pandemic. Their findings show that, in April, surgery across Wales dropped to less than a quarter of its usual output.

Overall, during the first lockdown, around 62,000 fewer patients were operated on in Wales, compared with the same period the previous year—62,000 people left in pain and suffering with no end in sight. And people haven't stopped getting sick. Heart disease, dementia and cancer just haven't gone away. COVID-19 isn't Wales's biggest killer. In fact, it's, ironically, the nineteenth most common cause of death in Wales. So, this pandemic will result in a lot of indirect deaths because our health service is not running at the capacity it should. Estimates put NHS services running at around half of their previous capacity overall, and that before this winter, which is likely to be a very bad one, given that south Wales is home to some of the highest COVID-19 infection rates in the UK.

This pandemic has highlighted the fragility of our NHS. We went into lockdown in March in order to build up our capacity in the health service, yet, eight months later, we have just come out of another lockdown, but our NHS is still in danger of being overwhelmed, according to the Welsh Government. At the start of this pandemic, field hospitals were set up to expand NHS bed capacity, and in total nearly 10,000 additional beds were created—almost the exact number of beds our NHS has lost since 1990.

Before this pandemic hit our shores, the NHS was operating at a bed occupancy rate of almost 90 per cent. We had no spare capacity, which is why we went into lockdown and why all non-emergency treatment was halted. What I find bizarre, however, was that the Welsh Government opted to close half of the field hospital beds at the end of the summer, because the additional capacity was barely used. It was barely used, because the NHS stopped all routine treatment, screening services halted and health prevention measures ceased. We knew, back in April, early May, that we had dodged a bullet, mostly because this coronavirus doesn't spread as well outdoors, and we were warned that autumn and winter would be much, much worse as people moved activity indoors. So, why, then, did we close nearly 5,000 hospital beds—beds that were set up to deal with COVID patients, beds that should have freed up hospitals to deal with the tens of thousands of patients desperate for treatment? But routine treatments didn't start, in many cases, until mid September, and this meant the extra capacity was largely unused, leading Welsh Government to conclude that it was unneeded. It is needed. It's badly needed.

So, we need to continue non-emergency treatment now, before it becomes an emergency. The field hospitals should be dedicated to treating patients who test positive for infection with the SARS-CoV-2 virus, leaving the rest of the NHS free to deal with non-COVID treatments, and working to reduce the backlog of treatments also—a backlog that continues to grow as the pandemic persists. These are not just numbers on a spreadsheet; these are people who continue to wait, living in pain, discomfort—patients whose conditions will continue to deteriorate. Perhaps they will worsen to such an extent that they require ongoing treatment—additional cost to the NHS, but, more importantly, impacting the lives and livelihoods of those patients and their families.

So, we were caught unawares by coronavirus in the beginning, but we have had some time to prepare. And the virus is not going away any time soon, but we can't let it decimate our health and social care services. We can't allow people to die because they aren't getting treated due to resources being focused on the pandemic. We can't add to the suffering of patients because of the threat of COVID-19. Our citizens deserve better. Our NHS can't continually be put on hold because of the pandemic. We have to continue treating Welsh patients throughout this second wave, taking steps to tackle the backlog of treatments. We need to expand the field hospitals once more, dedicating them to treating COVID-positive patients, and ramp up testing to ensure same-day turnaround and the ability to test all those needing treatment. That way, we have a real firebreak in place to allow NHS treatments to continue, saving lives and ending suffering by tackling waiting times for treatment. Diolch yn fawr.

Thank you. Can I now call the Minister for Health and Social Services to reply to the debate? Vaughan Gething.

Thank you, Deputy Presiding Officer, and thank you to the Member for her speech and choice of debate tonight.

Timely access to NHS services has been and continues to be a priority for this Government. From 2015, we made significant additional annual investment in planned care. This resulted in four years of sustained reduction in the number of patients waiting over 36 weeks to start treatment. By March 2019, compared to March 2015, over 36 weeks had improved by 53 per cent, eight-week diagnostic times had improved by 75 per cent, and 14-week therapy times had improved by 100 per cent. Total urgent suspected cancers treated in the year September 2019 to August 2020 was 16 per cent higher than five years ago.

Our NHS Wales plans for 2019-20 were to continue those annual improvements. However, the undeniable impact of the changes imposed by the UK Government on the tax and pensions of NHS staff resulted in NHS plans not being deliverable. The initial impact of COVID in March of this year, combined with the tax and pension debacle, resulted in over 28,000 people waiting over 36 weeks—that is three times higher than in March 2019.

In the early months of 2020, the COVID-19 pandemic was starting to have an impact across global public health systems. Learning from the lessons seen in Europe, our strategic priority was to support our NHS to help save lives here in Wales. On 13 March, I took the very difficult decision to suspend non-urgent planned care. This decision was supported by clinical advice and it aimed to protect our NHS so that it could better help to save lives. Shortly after our bold decision here in Wales, the rest of the UK followed suit. Delivery of emergency and urgent non-COVID care, including for cancers, where it was clinically safe to do so, continued throughout the summer. In recent months, where possible and appropriate, some routine activity has also started to be delivered.

In-patient elective activity from March of this year to July of this year was down 55 per cent in Wales, compared to March to July in 2019. Management information has shown that in-patient and day-case planned care activity has increased by 56 per cent from June 2020 to September 2020. Within the Government, I have recognised that we have to balance the risk of harm from four areas, and this underpins our broad approach across the Government: direct harm from COVID itself, harm from an overwhelmed NHS and social care system, harm from reductions in non-COVID activity, and harm from wider societal actions, including lockdowns. Our decision to suspend routine activity in March to reduce harm from COVID itself has resulted in raising the risk of harm from reductions in non-COVID activity. This has resulted in an unprecedented growth in the planned care waiting list.

The significant number waiting in August 2020 is also seen in NHS England, but also in Scotland and Northern Ireland too. At the end of August 2020, NHS England recorded their largest number ever of patients waiting over 18, 36 and 52 weeks. Without doubt, the condition of some of these patients will be worsening and they will be coming to harm in some cases. This reinforces the need to maintain control of the spread of coronavirus. If the virus takes off again, non-COVID services will be interrupted and more harm will be caused—both directly from COVID, but also in indirect harm from reducing non-COVID activity. I cannot overstate the importance of changing the way that we all live our lives. We must not throw away the hard-won gains from the firebreak and go back to the way things were before we began the last two-and-a-half-week period.

We have, however, prioritised cancer patients and other urgent care patients. I'm pleased to say that, in August 2020, we treated 623 patients on the urgent suspected cancer pathway. This is a 13 per cent reduction on the same period in 2019, but it's also a 13 per cent improvement from five years ago. From June of this year, as part of the quarter 2 plans, the NHS has started to deliver more planned care activity. This has been a challenge to implement alongside COVID care, as there has been a need to redesign services and redeploy staff to operate within protected zones.

The additional safety measures necessary to protect patients and staff remain a priority for me, as the number of patients presenting with COVID continues to rise once again in our communities. This affects both the type and volume of services that are available. Where operating lists, pre COVID, planned to undertake, for example, four operations, the health and safety requirements involving PPE and social distancing have reduced productivity to two. Delivery of face-to-face reviews in our out-patient departments, the hub of many hospitals, has reduced by 40 per cent to 50 per cent of the activity previously undertaken. I am pleased to note, however, that some of this lost activity has been replaced by virtual activity. Around 36 per cent of out-patient activity now is virtual. It is due to the continued dedication of our staff, who have been able to increase our routine activity in recent months, and I remain incredibly grateful to our NHS and social care staff. They have continued to demonstrate their professional commitment and compassion throughout these unprecedented times.

We have implemented new ways of working for supporting patients in different ways. They alone, however, will not be sufficient to stop the continued growth in our waiting times. We will recommence publishing our national NHS waiting times again, beginning on 19 November. This will provide a stark picture of the reality that we face. As I said before, this is not unique to Wales; it is a UK and, in fact, a worldwide problem.

It is important that we as a Government, and the public, realise the size of the challenge. We will need to work together, and each of us—Government, NHS and the public—all have a role to play. The NHS will support the public through education and tools on how to play a greater part in their own care and self-management. But there is no quick fix. It will take years for each UK country to get waiting times back to where they were, and, here in Wales, to continue back on our improvement trajectory. Now, this position is not where the NHS, the Government, myself or anyone in Wales would want to be. We are fully aware of the effect that this is having on individuals who are waiting even longer for their treatment. My officials are working with clinicians across our NHS to understand what more support could be provided to patients while they wait.

Our national rehabilitation framework recognises the key role that rehabilitation can play in supporting people to stay well while they wait. Health boards are starting to develop prehabilitation services to support patients, while they wait on waiting lists, to remain healthy. While in some cases this may actually reduce the requirement for surgery, in others, surgery will still be required. I am clear that this Government remains focused on addressing this important area. My officials will continue to work closely with clinicians to understand the options that we need to consider to address the impact that we see. The options will need to be significant to address the size of the problem. But, together with all nations across the world and here in the UK, we'll be living with the legacy of the effects of COVID for many years, even after we have the virus under control. We all face a significant task ahead. Thank you, Deputy Presiding Officer.

Thank you very much, Minister, and that brings today's proceedings to a close. Thank you.

The meeting ended at 19:49.