The following amendments have been selected: amendments 1, 2, 3, 4 and 5 in the name of Rebecca Evans, and amendment 6 in the name of Siân Gwenllian.

Okay. So, we reconvene with item 8 on our agenda, which is the Welsh Conservatives' debate: the impact of COVID-19 on health services. And I call on Andrew R.T. Davies to move the motion.

Motion NDM7489 Darren Millar

To propose that the Senedd:

1. Notes the BBC Wales Investigates report that showed a ten-fold increase in patients waiting for all treatments in the Welsh NHS compared to September 2019.

2. Further notes the warning from leading cancer experts and charities that 2,000 people could die because of COVID-related delays in the Welsh NHS.

3. Recognises the hard work, dedication and commitment of staff in the healthcare sector supporting patients not just with coronavirus but with a variety of conditions.

4. Regrets that the Minister for Health and Social Services has estimated that it would take a full parliamentary term to resume normal services and that it would be foolish to have a plan in place to tackle the waiting list backlog.

5. Calls on the Welsh Government to:

a) immediately boost the use of COVID-free hospitals, as recommended by the Royal College of Surgeons and the Royal College of Emergency Medicine;

b) conduct an urgent review into how hospital patients in Wales are being discharged during the pandemic and implement those findings to tackle bottlenecks in hospitals, as recommended by the Royal College of Physicians;

c) significantly improve its testing regime to ramp up capacity and ensure that COVID-19 is isolated and kept out of Welsh hospitals;

d) introduce a cancer recovery plan, as seen elsewhere across the UK, and increase investment in the roll-out of rapid diagnostic centres across Wales; and

e) implement a nationwide campaign to ensure that people who suspect they have cancer, or need to go to hospital in an emergency, continue to do so.

Motion moved.

Thank you, Deputy Presiding Officer, and I welcome the opportunity to move the motion in the name of Darren Millar on the order paper this afternoon. For those who are not aware of the tabling arrangements of the National Assembly for Wales, or the Welsh Parliament as I should call it now, those people might wonder why we haven't put the waiting times that were published last Thursday in the motion. But, as people who know the tabling arrangements would know, they have to be in on the Wednesday afternoon.

So, I do think it is worth us reflecting on what those figures did tell us last Thursday. And these are figures across the UK as well—we do accept the point that all NHSs across the UK have seen a massive increase in the waiting times—but here, in Wales, the 36-week-plus waiting times went up by 597 per cent to 168,000 people, and 26 to 36 weeks went up by 250 per cent, from 54,000 people to 116,000. That's the scale of the challenge that we face here in Wales, irrespective of whatever Government forms after May next year. That's in excess of 0.5 million people who are on a waiting list here in Wales: 517,000 people are now on a waiting list. And, of course, that's for treatment.

When you look at the diagnostic and therapies waiting times as well, there's been a substantial jump in those waiting times, which have seen a spike of between 30,000 and 35,000 people between March and October. There are now 143,000 people waiting for diagnostic and therapy appointments in the Welsh NHS. And interestingly, on those sort of numbers, those numbers have grown significantly since June and July of this year. There was an actual decline in some of those numbers in the early part of the pandemic, because people weren't progressing through the health service to get those initial appointments.

So, that's the scale of the challenge we face, and that's why we've tabled the motion this afternoon, so that hopefully we can have a debate, discussion, and a sense of what the current Welsh Government are proposing to do to tackle these waiting times. It would be easy to spend the whole debate talking about numbers and percentage increases and actually just getting lost in those numbers, but it is important when we focus on the numbers that each and every one of those percentage points that I was talking about is an individual, an individual sitting on a waiting list that regrettably hasn't managed to progress through the system.

It is vital that we don't end up with a health service that ultimately just becomes a COVID service. It has to be the national health service that we treasure and love so much. And at this point, I think it is worthy for us all to pay tribute to the dedication and commitment and professionalism of the staff within our health service here in Wales, who have gone above and beyond the call of duty through the pandemic, and who themselves want to get back to the day job of treating people in the health discipline that they've trained for for so long, to achieve a community sense that the health service is delivering for every man, woman and child within the country of Wales, and that we are making progress in the waiting times.

It would be also wrong of me not to deal with the amendments that were tabled to the motion, because I had hoped that we could have got broader support for the motion that's before us, but I do welcome the point that there haven't been any 'delete all' amendments tabled this afternoon to the motion. But regrettably, we won't be able to accept amendment 1, tabled in the name of Rebecca Evans, because we do believe that point 1, which talks about the waiting times and the tenfold increase that BBC Wales highlighted, is a fact. It is a fact that there's been a tenfold increase in those waiting times, and we believe that needs to be at the front and centre of the motion.

Amendment 2, which again is tabled in the name of Rebecca Evans, seeks to delete point 4, and it is a fact that, regrettably, the health Minister did say that it would be foolish to have a plan in place to tackle the waiting list backlog. Well, as I've highlighted in the statistics that I've put in before us today, there is a desperate need for a plan to deal with the waiting times. I accept the point that we are still in the middle of the pandemic and the pandemic has many months, regrettably—even maybe years—for it to pan out, but we do need to plan and we do need to make sure that the NHS has the confidence, along with the care sector, that the centre is supporting the NHS in any part of Wales to make sure that services are turned back on and we can start to get on top of these waiting times.

It is important that we get COVID-lite hospitals up and running, and in a secure and safe environment, surgeries can ultimately progress within the Welsh NHS, and that's why we are unable to support amendment 3 that seeks to delete that point from the motion this afternoon.

And above all, then, we do believe that there does need to be a cancer recovery plan, which other parts of the United Kingdom have made available to their NHS, so that there can be a clear route for cancer services here in Wales to progress and get back on that even keel. Because one thing we do know about cancer is that timely intervention is critical—is critical—to making a successful outcome for that cancer patient, to have the right result from the treatment they received. Macmillan's own evidence and news reports, recently, have highlighted that there's been about 2,900 people walking around with cancer today because they've gone undiagnosed, and up to 2,000 people regrettably will die prematurely because they haven't been able to get the treatment and get into the system to get that diagnosis and get on top of the condition that they might be facing. That in itself requires urgent action from the health Minister, and so that's why we will not be supporting amendment 4 in the name of the Government that seeks to delete point (d) of our motion.

We will be supporting the Plaid amendment, because we do think it adds to the motion and we do welcome that analysis of 10-year waiting times and the ability to understand what we need to do going forward to enhance the capability of the NHS to get on top of the waiting times that I've highlighted in my opening remarks. But it is about commissioning more capacity; it is about looking at new ways of working; it is about getting COVID-lite hospitals into place; and it is about making greater use of community services, rather than moving people into the acute sector, where we can address the issue at the earliest possible stage by increasing the community spend of health resources here in Wales.

There is always a debate and discussion to be had about what money is available for the NHS, and we do know that considerable consequentials—. And I accept those consequentials have come not because we're a special case and we're deserving, but because of spend that has gone on in other parts of the United Kingdom that has activated the Barnett formula. There's £1.6 billion worth of money sitting in the Welsh budget already, unspent and unallocated. And today, with the comprehensive spending review, additional moneys will be arriving in the finance Minister's hands, which, I hope, will be passed to the health Minister, so that extra capacity can be commissioned and can be created, and these new ways of working can be ingrained in the NHS to start addressing the terrible wait that many people across Wales face—the 0.5 million people across Wales that are on an NHS waiting list today. It is important that where that allocation is made, sufficient support staff support is put in place to make sure that the staff, whatever level they are within the NHS, whether they're the porters, the cleaners or the consultants and the neurologists, are there and thought of, because without the staff, you will not have an NHS that delivers. And what we want to see is an NHS that hasn't just been turned into a COVID recovery NHS and is an NHS for us all, whatever part of Wales we live in.

It is a fact that the recent Royal College of Nursing staff survey highlighted that 34 per cent of staff—nurses in particular—felt undervalued by the Welsh Government. That was the highest figure of any Government in the United Kingdom, I might add. And 75 per cent of staff believed that they'd seen an increase in the stress levels. So, a staff strategy to make sure that the retention of staff is at the heart of what our health boards do will be critical to making sure that we deliver a staffing structure that can respond to the COVID crisis, as well as the reopening and re-engineering of services across the whole of the Wales NHS. And building on that staff support, we need to make sure that we have the testing resources in place to make sure that where hospital infections—. Sadly, my own regional area, where the Cwm Taf health board covers, has seen a massive spike in hospital-acquired infections. We need a greater energy behind the testing regimes within our hospitals and with our care settings, so that we can get back to a functioning environment within those hospitals and within the care homes. And with the rapid testing that is now available, this really does seem to be a game changer in what we can be doing. I would urge the Minister to make sure that those tests are made available to the Welsh NHS.

But, above all, the central leadership that the Welsh Government can provide, with the civil service here in Cardiff, and the access to resource, has to be driven and engineered to make sure that the health boards are driven in their planning to make sure that the services are re-engineered and reopened. And it is only that central resource—that capacity of that central resource—that will allow this to happen. We need to make sure we have a strong public health messaging campaign so that people know that the NHS is open and ready for you should you need it. Because with the messaging and what we've gone through in the last six to seven months, it is a fact that many people are—to put it bluntly—frightened to engage with services, and that shouldn't be the case. We need to be constantly repeating the message that the NHS is there for you, to get that diagnosis, get that treatment and, ultimately, get back to a normal way of life. Regrettably, Macmillan have pointed out that, on cancer services, for example, other than a brief campaign in June, there hasn't been a joined-up and co-ordinated campaign here in Wales, unlike in other parts of the United Kingdom, when it comes to cancer services. So, there is work to be done in that particular area. Above all, what I'd also like to see is a cancer delivery plan delivered by the Welsh Government, which, regrettably, they've declined to do, according to a written answer to me. We do know that the current cancer plan is coming to an end at the end of December this year, and the answer that I received yesterday indicated that there's still not the formatting of its successor plan to be put in place.

So, when we're looking at developing a more central model to, ultimately, support the NHS here in Wales to deliver on waiting times, deliver on support staff support, deliver on resources, and then we look at one critical part of the health service—the cancer departments within our hospitals—their own delivery plan will be coming to an end in December, and there is no successor plan in place at the moment from the Welsh Government. The Government do need to step up to the plate and get on top of this, because, as I said, when it comes to cancer services, we know for a fact that time is of the essence. And that is why I call for support this afternoon for the motion as tabled. It is a fact that all parts of the NHS, in any part of the United Kingdom, are facing long waiting times. We are not disputing that, and we don't blame the Government for a moment for suspending those services back in March. But, reactivating those services has been slower here in Wales than in other parts of the United Kingdom, and it is that slowness that has exacerbated the waiting times, which the figures that I mentioned at the beginning of this debate have highlighted graphically—first of all last week, when they were first published, and again by repeating them here in the debate this afternoon. I hope that Members will be able to support the motion as tabled, unamended, so that it has the most potency and ultimately drives home the seriousness of the challenge that we face. Thank you very much, Deputy Presiding Officer.

I have selected six amendments to the motion. Can I call on Vaughan Gething to move formally amendments 1 to 5, tabled in the name of Rebecca Evans?

Amendment 1—Rebecca Evans

Delete point 1 and replace with:

Notes that the Welsh statistics published on 19 November show an 11 per cent increase in the total numbers waiting for treatment from September 2019 to September 2020, and it is the growth of waits over the national target 36 weeks that have increased ninefold, a trend which has been seen in all areas of the UK.

Amendment 2—Rebecca Evans

Delete point 4 and replace with:

Regrets that Wales, the UK, and the world will be living with the effects of COVID-19 for many years.

Notes that whilst COVID remains in our community, NHS plans are focussed on balancing the safe delivery of COVID and non-COVID services.

Amendment 3—Rebecca Evans

Delete sub-point 5(a) and replace with:

Work with local clinicians to develop models of delivery which maximise all resources to deliver safe, quality care for both COVID and non-COVID pathways to local communities.

Amendment 4—Rebecca Evans

Delete sub-point 5(d) and replace with:

Continue to work with the cancer network and NHS to ensure cancer services are able to meet new and current demand, and agree how to deploy future investment to deliver on the agreed commitment for rapid diagnostic testing.

Amendment 5—Rebecca Evans

In sub-point 5(e), delete 'implement a' and replace with 'continue our'.

Amendments 1, 2, 3, 4 and 5 moved.

Formally moved, Deputy Presiding Officer.

I call on Rhun ap Iorwerth to move amendment 6, tabled in the name of Siân Gwenllian—Rhun.

Amendment 6—Siân Gwenllian

Add as new sub-points at end of point 5:

'conduct a review of performance against waiting time targets over the past decade to ensure that lessons are learned about management of waiting lists;

consider using the Nightingale hospitals where possible to provide extra capacity for patients recovering from surgery to help increase flow through the system.'

Amendment 6 moved.

Thank you very much, Deputy Presiding Officer. I'm pleased to have an opportunity to respond to this motion. It's a motion that we in Plaid Cymru agree with in general terms. I disagree with the wording in certain areas—COVID-lite areas rather than COVID-free are what the Royal College of Surgeons is calling for, and it's an important issue. We certainly agree with the underlying intention of the motion in general terms. We will be voting against the original motion to allow a vote on our own amendment, of course.

Long before the pandemic, we were concerned about lengthy waiting lists. As health spokesperson, it has been one of the hot topics of the past few years. As a constituency representative, I know of I don't know how many constituents who have been told that they will have to wait for way over 12 months for urgent treatment. It will be an experience common to each and every one of us in this Senedd, I'm sure.

The impact on patients is great—not only the direct impact of having to live with illness, often in pain or in discomfort, with the anxiety that the long waiting time is actually making things worse and that the treatment will ultimately be less successful—but also because the waiting itself leads to problems. We had a valuable report from the health councils back in 2018, 'Our lives on hold', looking at the impact of waiting times on quality of life. The title said it all, if truth be told. We are talking about the impact of the waiting, not only on physical health, but also on mental health, on isolation, on mobility, on the loss of dignity and the impact on family life, where older people have childcare responsibilities and can't undertake those responsibilities.

In that respect, I think that the Government has been a little disingenuous in its amendments. The Government needs to recognise that waiting times in Wales were far too long before this crisis. They shouldn't, in any way, try to avoid the reality of the situation—that performance against waiting time targets has been a long-term problem. But, the pandemic, of course, has exacerbated the situation. For many people who had been waiting before the beginning of this troubled year, things came to a stop. When some elective treatments restarted, we heard concerns of inconsistencies across Wales in terms of access to surgical services.

But, do bear in mind that it's not just waiting times for treatment that have been recognised as a problem. We have also seen great delays—and the complete suspension at times—in the diagnostic services that are so crucially important. In addition to that, of course, many people have chosen not to seek medical assistance because of nervousness about catching the virus or because they don't want to be a burden on our health service at a time of crisis.

The upshot of all of this? We have heard cancer organisations such as Macmillan tell us that they think that up to 3,000 people in Wales could be living with undiagnosed cancer because of the impact of coronavirus. So, it is crucial that the Welsh Government does look at how they deal with the backlogs in the system, and deal with the fact that many people feel that they have been forgotten. It's important not only for the sake of the patients, but also for our committed staff, and we once again have an opportunity to thank them for their service.

We need the COVID-lite sites as a matter of urgency, with regular testing for staff and patients and sufficient stocks of PPE to keep the elective capacity going through the crucial next few months. I use the term 'COVID-lite' deliberately, rather than 'COVID-free', as the Royal College of Surgeons does, because in reality you can give no guarantee that you can eradicate the virus entirely from sites. Regular testing is crucial in order to maintain surgical services, workforce planning, and safeguarding the COVID-lite sites is important. Staff must be tested regularly, even when they are asymptomatic.

We have tabled our amendment in the spirit of making progress, and in passing that, as I've suggested, we will be supporting the motion itself. We do think that we need a review of performance targets—

We appear to have lost Rhun. We've not got the Member back, and as he was running out of time anyway, I think I'll draw his conclusions to a close for him and I'll call Janet Finch-Saunders.

Thank you, Deputy Presiding Officer. Just in starting this debate, I'd like to put on record again, myself, and on behalf of us as Welsh Conservatives, the immense thanks to all staff in the healthcare sector for the hard work, dedication and commitment that they continue to show to Welsh patients. Now, let's be honest, the health service here in Wales under this Welsh Labour Government did not enter the pandemic on its best footing. The 95 per cent target for patients spending less than four hours in A&E had never been met. Cancer waiting times had not been met for 10 years. Forty-two per cent of people in Wales had an unmet need for physiotherapy compared to 30 per cent in England, and Betsi Cadwaladr, my own health board, had some horrendous waiting times in February: 508 patient pathways waiting over 36 weeks to start ENT treatment, 903 for urology, and 3,192 for trauma and orthopaedic treatment. As Andrew R.T. Davies has quite correctly said, these are individuals. Their lives are being impacted daily. Sadly, despite these tireless efforts of our front-line workers, the impact of the pandemic on these individuals is devastating. Waiting times for those waiting more than 36 weeks have increased by eight times; 168,944 people have been waiting more than 36 weeks for treatment. In fact, the overall number of patient pathways waiting to start treatment by the end of September 2020 had topped 0.5 million people.

Now, as the Minister knows, I have written to him on several occasions with constituents who are now on record as having waited years for some orthopaedic surgery, and we must note the BBC Wales report, which shows a tenfold increase in patients waiting for all treatments in the Welsh NHS compared to September 2019. Now, these are not new findings, and we're not dismissing the impact of COVID-19, but in fact, warnings of backlogs were made during the first lockdown. The Royal College of General Practitioners commented that in 2009, during the flu epidemic in the UK, there was a significant increase in deaths from strokes. So, there is a risk that the obvious emphasis on COVID patients will result in treatment for other health conditions being delayed if patients are not allowed to present in primary care. Asthma UK and the British Lung Foundation highlighted severe concerns about people with chronic lung disease being at greater risk of preventable exacerbation and worsening of health.

The British Heart Foundation indicated that the drop of 20 per cent in the number of people seen in hospitals across Wales with a suspected heart attack since lockdown may partly explain the increase in deaths that are not currently attributable to COVID-19. Now, while I agree that many treatments were closed at the start of lockdown, obviously, to ensure the safety of patients, urgent action is needed now to resume some of these services. Unlike the Minister, I think it would be sensible to put a plan in place to tackle the waiting list backlog. You should immediately boost the use of COVID-free hospitals. As recommended by the Royal College of Surgeons and the Royal College of Emergency Medicine, across the UK, setting up COVID-19-free hospital areas could prevent 6,000 unnecessary COVID-19-related deaths—this is after cancer surgery—over the next year.

On 31 July, NHS England published the third phase of its COVID-19 response, which had a particular focus on the capacity available to ensure the return of near normal levels of non-COVID health services. But in comparison here, we've seen the Welsh Government struggle to act quickly. So, by 28 August, no general and acute beds were available in field hospitals. This was the case for nearly two months until 15 October, when 115 beds had been made available. That's less than half of the capacity seen at the peak of the pandemic. That failure to not use the independent and field hospital capacity consistently, before the second wave, has driven pressure on to our existing hospitals during the second wave. The seriousness of this situation is clear, when considering that 2,000 people could die because of COVID-related delays in the Welsh NHS. Scotland and England have had cancer recovery plans in place for several months, yet not here. So, I wholeheartedly support the calls for a plan and a nationwide campaign to ensure that people who suspect that they have cancer and need to go to hospital do so. Even Macmillan Cancer Support recommended last month that you must commit a clear plan and resources to support the delivery of surge capacity.

I will close by noting that the urgent action that we are requesting is feasible. This is constructive opposition. Not only is it supported by health organisations, but we can feasibly boost the use of COVID-free hospitals across Wales by ensuring that health boards have clear policies on addressing testing requirements and frequency for staff and patients; adequate PPE and surgical supplies and clear policies on when and how to use them; local co-ordination to ensure that patients' care pathways are appropriately managed; the use of hospitals from the independent sector to boost capacity; and Nightingale hospitals to remain in operation. Please, Minister, let us all work together now across the board and deal with the situation that faces us now with COVID, but let normal hospital treatments that are required by the Welsh public continue and let them have their much-needed treatment. Thank you. Diolch.

I welcome, Dirprwy Lywydd, the constructive and serious way in which the Conservatives have approached this debate today. I'll say to those Members on the opposition benches that when a debate is approached in this way, it puts the pressure on the backbench Members of the Government benches to justify, then, supporting the Government amendments. And it's that much more important that we put forward a strong argument when a debate is conducted in this way, and it's a good way to conduct scrutiny.

But I have to say that at the very heart of this debate is the need to control the virus and to prevent the spread of the virus into hospital settings, which, clearly, the SAGE advice given to UK Government and devolved Governments prior to the firebreak lockdown that took place at the beginning of November, was for that purpose. Looking at point No. 4 in the motion, mentioning the health Minister's very clear and honest answer about the problem facing waiting lists as a result of COVID, the purpose of that advice from SAGE to introduce a firebreak lockdown was to tackle exactly that problem. And I think the Conservatives would recognise that now, with hindsight, they were mistaken not to support that firebreak lockdown at the time, because, as we saw in England, a longer and harsher lockdown was introduced in order to tackle that problem. And this is at the heart of this debate—taking those measures and taking those strategies that will allow the control of the virus. And I'm sorry to Andrew R.T. Davies, if I was allowed to let you intervene, I would—you know I would—but the rules aren't allowing it at the moment.

So, in looking at the situation, what has the Welsh Government done? Well, just last week, we had a written statement from the health Minister about the single cancer pathway that was introduced in November 2018. And what it does is make sure that all patients, regardless of the degree of suspicion, all patients who are presenting with potential cancer cases are dealt with on a single cancer pathway. It's therefore, as the health Minister said in his statement,

'a much more accurate way of measuring the times to treatment our patients are experiencing in the health system.'

But one of the things he said in his statement was that,

'The Single Cancer Pathway will enable us to tackle variation, improve outcomes and deliver better experience for patients.'

I think it's the duty now on the health Minister to elaborate on that and to provide us with more information on how those things are being achieved, and that's a key point that I'd like the health Minister to address.

And with regard to cancer support and treatment, I have to say, in 2016, when I was first elected, I met with the chief executive of the Aneurin Bevan health board, and her ambition was to introduce a breast cancer centre of excellence at Ysbyty Ystrad Fawr. I'm very pleased to say now that we are going to see that open next year, and that in itself—this centre of excellence—will provide evidence-based services, providing the best clinical outcomes, comprising of dedicated diagnostic treatment and counselling rooms that will enable faster diagnosis. And, indeed, the business case put together by Aneurin Bevan health board says the new centre will increase the range of breast surgery that can be performed as day cases from 30 per cent to 70 per cent. That's happening in Ysbyty Ystrad Fawr—they're having to extend the hospital to do it. That's Welsh Government funding that's supporting those patients with breast cancer. And, I think, therefore, I'd like to dedicate my contribution today to a constituent, Dawn Wilson.

Dawn Wilson lived in Ystrad Mynach and was diagnosed with terminal breast cancer in 2017. Dawn passed away at the beginning of Breast Cancer Awareness Month on 1 October this year, and she spent the years in which she was diagnosed as terminal campaigning for others to avoid them getting in her position. In support, I'm wearing my pink tie today. She took the Know Your Lemons campaign, which originated from the work of Corrine Beaumont in America—she took that campaign as an awareness campaign and brought it to Wales. The idea is, there's a poster with a series of lemons and you can look at the lemons and they show the kind of breast cancer that may be diagnosed from looking at the shape of the lemon. And it's a very clear visual guide. Dawn got the Welsh NHS to pick that up. It was Dawn's campaigning in the last years of her life that got the Welsh NHS to pick up that campaign, and it was the Welsh Government that launched that campaign because of Dawn Wilson. Therefore, to close my remarks, I'd like us to recognise that contribution she made, and what selfless contribution too, in the last years of her life. I met her here in the Senedd two years ago, and I went to her house in Ystrad Mynach to talk to her about that campaign. So, it's a pleasure to dedicate this contribution to her today.

The pandemic has highlighted many things about our NHS—the resilience of our staff, their commitment to patients in the many additional hours that they have worked, and the flexibility that so many staff have demonstrated to help put in place the response to the pandemic. The pandemic has also highlighted some weaknesses of a system that has been creaking for some time. In her contribution, Janet Finch-Saunders said that waiting lists were on the rise before this public health crisis started, and we know that the backlog is now so big that it will take action for years to get it back to normal. In fact, the chief executive of NHS Wales admitted that point last week.

I'm concerned that, as we approach winter, waiting lists will inexorably grow longer, as they always do at this time of year, particularly as the NHS focuses on COVID-19 and winter pressures. Nowhere is this more stark than in my area in south-east Wales. The people will now need to know when they can expect treatment for not just routine matters but also access to life-saving treatments. In September this year, there were 26,974 people waiting for more than 36 weeks to start their treatment in south-east Wales, when the target is zero, compared to only 1,313 a year ago. This is clearly a colossal increase. The Royal College of Surgeons, in their recent evidence to the inquiry undertaken by the Health, Social Care and Sport Committee, outlined that a significant elective surgery backlog existed in Wales, prior to the COVID-19 pandemic, and that this will only have increased. In January 2020, the last waiting-time statistics before the pandemic showed nearly half a million people waiting to start treatment, with 76,862 waiting more than 26 weeks. The risk is that many patients will require complex surgery if their treatment doesn't occur in a timely fashion, resulting, as we know, too often in worsening symptoms and deterioration in their condition.

Dirprwy Lywydd, I have, on several occasions in this Chamber, welcomed the building and the recent opening of the new Grange University Hospital in Cwmbran. We should all be ambitious about reforming the delivery of services to better suit patient needs, with new facilities, a focus on innovative models of care and the latest in technology and equipment. That project has been in development now for well over 10 years—I think, before I was elected to this place, I remember taking part in the Gwent clinical futures meetings then—and we finally have that excellent facility. But if new facilities are to be effective, they have to be properly resourced with the right level of staff. Any risk of shortages needs to be avoided, and people need to know that the hospital is accessible by both car and public transport, because these issues have been raised with me in recent weeks. The problem is, welcoming new capacity is too rare, and the problem of waiting times and growing waiting lists is the opposite—it's not rare, and something that the Welsh Government have had to respond to in the past.

In the second Assembly, the then health Minister introduced the second-offer scheme to bring the waiting list and waiting times down by offering treatment elsewhere in the NHS and outside Wales in the independent sector. At that point, many people were then treated more quickly. In fact, between April and September 2005, a total of 495 people from Gwent were offered alternative hospitals in the private sector to get their operations done. In all fairness to the Government at that time, it demonstrated a willingness to look beyond narrow political standpoints about treating people outside of Wales and outside the NHS, and secured a workable solution for patients at that time. In light of the fact that theatre capacity across Wales has been below optimal for some time, has the Welsh Government explored the option of increasing short-term capacity, perhaps working with providers outside Wales who might have capacity to address this?

Whilst all NHS bodies across the UK will be managing the response to the pandemic, I would ask that the Minister sets out whether capacity exists elsewhere and, if it is possible, to perhaps scope out some kind of second second-offer scheme—a phase 2, if you like—to address this important crisis. If not, then what else can be done to examine the flexing up of the previous surge capacity that was introduced during the UK-wide lockdown to protect the NHS in case the COVID-19 numbers start to really undermine the NHS capacity? Additional capacity is now needed to address the consequences of the pandemic for thousands of people whose need of NHS care is equally important as it has been in the past.

The COVID pandemic has had an absolutely cataclysmic effect on very many people. Lives have been lost from COVID and for non-COVID reasons, and other lives have been changed forever, touched by grief, loss and tragedy. Others continue to suffer the debilitating effect of long COVID, and all this applies, yes, to patients and people everywhere, but also to NHS and care staff. Some staff have lost their lives by going to work.

The motion recognises the hard work, dedication and commitment of staff in the healthcare sector, but, sometimes, these words just slip out without pausing. The reality that is COVID: the terror on the wards in the early days with inadequate PPE and inadequate testing and just not knowing, fear stalked wards, staff felt exposed and in danger. We had an already overstretched health service going above and beyond, an exhausted workforce trying to catch up on routine demand during the so-called quiet summer months, before being stretched again now as the case numbers rise, hospital occupancy rises and beds in intensive care become full again. This time, both COVID and non-COVID cases are being dealt with, but the capacity is not there. Asymptomatic viral transfer means striving for COVID-free wards, but COVID-free wards are a huge ask and currently probably unachievable. COVID-lite is as good as it gets. Courtesy of changing all the PPE kit all the time, between every patient, the throughput of patients has taken a huge hit now.

So, there is a long list of things to do, and the various royal colleges are telling us what to do. We still need to get on top of COVID, and many doctors still have huge concerns about the UK Government's privatised test and trace service, with some doctors calling it a lethal mistake. Creating a testing and tracing system from scratch using private companies, none with any public health experience, in the middle of a pandemic, separate from the existing public health NHS testing and tracing system—I mean, what could possibly go wrong?

A highly efficient contact system is vital, and supported isolation is key. Paying people £800 to isolate, contacting people in isolation regularly every day, arranging hotel accommodation where appropriate—it works in other countries. This isolation has to be supported and enabled for the good of us all. Local NHS and public health testing and contact tracing works brilliantly well. We need to strive to only do that, and phase out the private UK system dogged by delays, inaccuracies and failure, resulting in only around 20 to 30 per cent of people that are contacts, that should be isolating, actually isolating. The rest are merrily spreading the virus around without knowing. We need to redirect resources to our public health NHS and GPs, testing and contact tracing as we've always done for any other notifiable infectious disease down the years—TB, malaria, salmonella, measles and so on and so on. Involve GPs in testing and tracing, supply pulse oximeters to people and primary care. Community COVID can be tackled safely outside hospitals, testing and tracing is here for the long term, so let's plan properly long term.

Finally, the calamitous effect of COVID is common to all health services. We know the lengthening waiting times here in Wales. Over the border, the situation in Conservative-run England is no better—worse, if anything. The number of people in England waiting more than 52 weeks for elective treatment reached 139,545 in September 2020. That is not 10 times more than the previous year, not 20 times more than the previous year, not 50 times more than the previous year, but 107 times more than the number in September 2019.

Vaccines are a superb discovery, absolutely game changing, but not here yet. We still have a winter illness season and a rampant COVID pandemic to tackle first, with exhausted overstretched staff everywhere. We can all do our bit. Welsh Government needs to sort out testing and tracing contacts now, and get supported isolation up and running as soon as possible.

Although I'm receiving a high volume of e-mails regarding COVID-related delays in the Welsh NHS, all recognise the hard work, dedication and commitment of staff in the healthcare sector. The Labour Welsh Government describes the increase in patients waiting for all treatments in the Welsh NHS compared to September 2019 as a trend that has been seen in all areas of the UK. This is of course both true and inevitable. However, despite the magnificent job done by the Welsh NHS in caring for people who have contracted COVID-19, the pandemic has shone a spotlight on issues within our Welsh NHS resulting from over two decades of Labour Welsh Government policies.

Neurology was already chronically underfunded in Wales before the pandemic, with large gaps in service provision resulting in delays to diagnosis of months and sometimes years, lack of follow-up and community support, as well as low levels of access to specialist and end-of-life care. In terms of access to services and treatments, an MS Society survey in 2019 showed that Wales was already lagging behind the rest of the UK before the pandemic, with 42 per cent of people in Wales having unmet need for physiotherapy compared to 30 per cent in England, and 70 per cent of people in Wales living with MS not having received any emotional or psychological support, compared to 13 per cent across the UK. The Wales Neurological Alliance survey on the impact of the coronavirus pandemic revealed that it had had major ramifications on the provision of health and social care services for people living with neurological conditions, with services and treatment delayed or stopped. After I asked the First Minister when essential surgery will resume for highly vulnerable children or adults with epilepsy earlier this month he wrote stating that epilepsy surgery has not stopped. However, hospital episode statistics show far lower numbers and longer waits for both respective surgery and vagus nerve stimulation surgery in Wales, compared to England. I am advised that there have been no adult VNS surgeries, either new implantations or battery replacements, since the pandemic started in March, resulting in people not getting the essential surgery and therapy they need.

In August, I met campaigners from Macmillan Cancer Support online to discuss their lived experience of the worrying impact the coronavirus pandemic is having on cancer services in Wales. Macmillan Cancer Support has noted that England's backlog of cancer patients will take less time to get through than in Wales, where the median waiting time for patients waiting to start treatment at the end of September in England was less than half that of Wales. By 29 April, 21 COVID-free cancer hubs were set up in England, run by cancer alliances. The Scottish and Northern Irish NHS have also used independent hospital capacity to set up COVID-free cancer hubs. However, as Macmillan Cancer Support stated, Wales is lagging behind England when it comes to setting up COVID-19-free hubs to treat cancer patients in Wales. 

Both Scotland and England have had plans in place for several months to ensure that cancer patients are seen and operated on swiftly. However, as Macmillan Cancer Support stated, we need the Welsh Government to put in place a fully fledged COVID-19 recovery plan for cancer services and to tackle a cancer care backlog that will only continue to grow with every disruption in Wales to cancer services caused by this pandemic. Their research shows an estimated 2,900 people in Wales could be living with undiagnosed cancer because of the pandemic. As they said, it is a wholly inappropriate for the Welsh Government to suggest that a plan for clearing the already substantial cancer backlog would be, quote, 'foolish'. Cancer, they said, cannot wait for the pandemic to end, and Macmillan wants to make sure cancer is not the forgotten 'c' of the pandemic. 

Cancer Research Wales has warned that many of the people who did not receive their invitation due to the pause in cancer screening services, who put off seeing their GP for fear of COVID-19 or concern about adding to NHS pressures, could have cancer. They said that, unless it is addressed quickly, the outcomes for patients in Wales will be less positive, that Wales already had a low reputation for cancer outcomes, and this will experience significant damage in the coming years and that it is through a COVID-19 recovery plan for cancer services that Wales will be able to understand the scale of the challenge and be able to coherently draw all approaches from across Wales together. As our motion, therefore, states, Wales needs a cancer recovery plan, as seen elsewhere across the UK. 

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

Thank you, Deputy Presiding Officer. I'd like to thank Members for their contributions to today's debate and deal with the Government amendments and comments made during the debate. It's a fact that, before the COVID pandemic, we had made four years of continuous improvement in waiting times across Wales. The last year, the pace of improvement scaled as a direct result of the tax and pension issues across the UK. Like all countries, the pandemic has impacted and continues to impact upon our ability to treat all patients as efficiently as we would like—points that were well recognised and noted in the contribution by Dai Lloyd. 

As the September statistics show, many patients are now waiting much longer. Those statistics show that the over-36-week waits have increased sixfold from February to September within this year. Like other parts of the UK, we will see further increases as we respond to coronavirus during this public health emergency. I should, perhaps, at this point address some of the comments about capacity in England or the independent sector. We already have arrangements in place with the independent sector through the pandemic. We already make use, from time to time, of independent sector activity to deal with waiting list initiatives. There's nothing new in that. However, the capacity that is regularly made use of in the English system is unlikely to be available to us because of the significant scale of the backlog that they will have to deal with. 

Sadly, as was recently highlighted in the community health council report yesterday, the condition of some patients will worsen whilst they are waiting. This reinforces the need to control the spread of coronavirus and to increase the number of planned operations as safely and as quickly as possible. Coronavirus has affected almost every aspect of healthcare, from learning how to treat and care for people who are seriously ill with COVID, the long COVID treatment—we're still learning more about the condition—to making physical changes to clinics, surgeries and operating theatres to both protect staff and patients from the risk of contracting this highly infectious virus. And I remain incredibly grateful to our dedicated NHS and social care staff for their commitment and their compassion during these unprecedented times. 

In the recent BBC Wales Investigates interview, I clearly described why our priority must be to respond to the pandemic in a structured and measured way. This involves developing approaches to support patients most in need of planned treatment, and I also indicated that we are already looking at broader steps to plan for the future. We do have an agreed way forward at health board level to treat COVID-19 and maintain essential services such as cancer, which is certainly not the forgotten 'c' during this pandemic. Those expectations are set out in the quarterly planning framework that we discussed again in the Health, Social Care and Sport Committee today. There's detailed guidance within that on cancer and other related services, such as endoscopy. So, health boards have plans in place in response to this, and we continue to work closely with them as we understand and monitor delivery. 

The pandemic has, though, had a heartbreaking impact on services that care for people with cancer and other life-affecting treatments, and our chief medical officer has been very clear that there are several ways that the pandemic will cause harm, both directly and indirectly. And I should at this point note Hefin David's comments about his constituent, Dawn Wilson. I met Dawn before endorsing and supporting the Know Your Lemons campaign, and I recognise the impact that she had, and it was an entirely selfless act on her part to take up the end of her life to campaign for others. A key message in our forthcoming national communication will be to continue to highlight and to reinforce the need for patients to contact our NHS with any signs or symptoms of cancer. This will continue in the new campaign, Help us, Help You. We're working with a range of partners, such as the Football Association of Wales and the Wales Rugby Union to support our messages, with focus videos, including some from football figures and real NHS staff. 

Health boards are having to deal with an unprecedented situation, and there are no simple operational or ethical answers to this. Everything that can be done is being done. Everything that can be provided is being provided. And we're still learning and needing to adapt as our evidence base changes, as our knowledge changes. So, the Government does remain focused on addressing this important area. My officials continue to work with clinicians on identifying options for how additional moneys recently announced by the UK Government can help us to address the significant challenges that delayed treatment will present, not just for the next few months, but for an entire Welsh Parliament term. Our priority will be to reduce risk from delay and to support clinical prioritisation. As the chief executive of NHS Wales highlighted last week, additional safety measures are necessary to protect patients and staff, and they remain a priority as the number of patients presenting with COVID remains high in all of our healthcare settings in primary and secondary care. This affects both the type and the volume of services available to treat other patients. So, we continue to explore ways to maximise the flow of patients in and out of treatment. That includes reviewing safe discharge arrangements and how best to use our hospital and primary care estate, including field hospitals.

I want to deal with the option of green hospitals, or, as the motion says—a different phrase—COVID-free hospitals. It sounds an attractive idea, but it's not easy to do, and I agree with Dai Lloyd that I don't think it's actually a practical answer. For example, we need to know what impact this would have on local access to emergency services, including minor injury services, travel times and strain on ambulance resources during winter. The so-called COVID-free hospitals that the Tories advocate—. And if they're serious about doing so, we need to be clear about what that means: so, which hospital in north Wales would no longer have an A&E department? Would Withybush or Glangwili no longer have A&E or minor injuries, or emergency surgery, and how would maternity access be organised? Because, in all of these areas, they're not compatible with a COVID-free hospital. I'm afraid that the slogan of 'COVID free' isn't actually a serious and practical answer for NHS Wales now, and, actually, the Royal College of Surgeons in Wales have made clear that they're interested in COVID-lite zones within our estate as a practical answer, as Richard Johnson recently set out. And I should make it clear of course that, in terms of Dr Lloyd's comments about contact tracing, TTP in Wales is public and is delivering to a high standard.

Our field hospitals have a role to play in supporting capacity and flow, but it's not possible to deliver elective pathways in a field hospital. And I think remarks on this area from Janet Finch-Saunders didn't perhaps take in and fully understand the role that they can play and will play in this phase of the pandemic. For example, many treatments require post-surgical care and additional back-up facilities, including intensive care. Operating theatres are, of course, not available in field hospital environments.

The NHS has responded magnificently to this major and unprecedented public health emergency. Our staff have shown tremendous adaptability to deliver services, to both COVID and non-COVID patients. And I believe that our NHS staff and their colleagues across the public sector deserve a proper pay rise to reflect this. That means teachers, teaching assistants, cleaners, cooks, environmental health officers, and their colleagues across local government, the police, and the armed forces, who have helped so much in our COVID response here in Wales and across the UK. All of these public servants, and their colleagues, deserve so much better than the kick in the teeth they got today from the Chancellor. We here in Wales will continue to work with and to value our NHS and their partners, as we continue to face the unprecedented challenges of this pandemic, in the months ahead, and in the years ahead, and the recovery that will take place once the pandemic is finally over.

Thank you. I now intend to call those Members who have requested to make an intervention. Rhun ap Iorwerth, I notice that you're back with us now; do you want to do a minute's worth of your intervention?

Thank you very much. It's incredible that it's taken seven or eight months to lose electricity in the house at some point during a Senedd session, but I'm pleased to be able to return.

All I had left as my contribution was to refer to what we were seeking to achieve through our amendment. We do think that we need to review the targets used to see how they encourage behavioural change in the health boards, and whether they are measuring the right things. I also wanted to say that we also believe that, as we do have the Nightingale hospitals to provide capacity, we should use that to increase flow through the system. And just to make the point in conclusion that COVID is a crisis in and of itself, but it's created another crisis from the pressures that already existed in the system. And that's something that we need to see more urgency on and a more meaningful response to. But, Deputy Presiding Officer, thank you for the opportunity to conclude my contribution in that way.

Thank you. And Andrew R.T. Davies.

Thank you, Deputy Presiding Officer. I just wanted to reiterate that I think the Conservative position on the firebreak lockdown was a consistent position, and if that vote came today, we would stand by that vote and vote the same way. Because SAGE's advice at the end of September also pointed to the fact that the effectiveness and outcomes of such a firebreak, or lockdown—call it what you will—were unknown, and actually those harms are far greater. We do support restrictions to suppress the virus—we're not saying there shouldn't be restrictions; we do support that. And we support the localised restrictions, which would have a greater effect than some of the measures the Welsh Government have brought to date. So I just wanted to put that on the record, because sadly our terms of engagement don't allow the intervention. [Interruption.]

No, you cannot, I'm afraid; nobody can respond to any intervention, I'm afraid. I'm going to call Angela Burns to reply to the debate. Angela.

Diolch, Deputy Presiding Officer. I do not have very much time, so I'm not going to be able to touch on everybody's individual contributions. I would just like to say that I'm very grateful for the tone in which most of this debate was mostly conducted—sadly not all of it.

This isn't about having a knock at the NHS and the people who work so incredibly hard in it, or the doctors and the nurses. In fact, it's not even particularly a knock at the Government, because, let's be clear, this pandemic was something that none of us ever saw coming, and many people in many organisations, both public and private, have stepped up to the plate in a way that is unprecedented. And to each and every one of them, I say an enormous 'thank you'.

But the real concern behind all of this is we don't just have COVID in our lives, we have many other illnesses, many other diseases. And we don't seem to have a plan, and that's what we're calling for, and we've called for very clearly in our amendment today. Different health boards have different ways of dealing with their bit. Patients aren't clear. So, I just want to, very quickly, run through why I think we need a plan.

We need a plan to give hope to patients. Too many people are writing to too many of us, too often, to say they can't get access to treatment, they're really worried, they can't get the diagnoses they need, they've been told that they could conceivably have cancer, their heart's not in great shape, they had a bowel test a year ago and they're supposed to have a follow-up. People are frightened, they need to know that the Government has got a clear plan.

We need to have a plan to support the dedicated and, frankly, exhausted staff. They need to know that there's a way forward, that it's not just going to be COVID, COVID, COVID. We need to have a plan to ensure that all the health boards are in the right place at the right time—that we don't have a postcode lottery. Some health boards have performed extremely well during this pandemic, others have done less so. A clear plan on how we're going to catch up with these waiting times, with this backlog, will really help to bring everybody up and level that playing field. We need a plan to maximise the skills and the commitment of the specialist teams, to give confidence to the professionals.

We need a plan to answer the concerns and the fears of the many organisations. I can't run through them all, but we've got the Wales Cancer Alliance, we've got the Royal College of General Practitioners, Asthma UK, the British Lung Foundation, the Chartered Society of Physiotherapy, the British Heart Foundation, the Royal College of Surgeons, the Multiple Sclerosis Society and the Royal College of Psychiatrists. These guys know their business, and they are raising concerns about the lack of plan.

We need to have a plan to keep pace with other home nations. And we need a plan to ensure that the regional collaboration really works effectively—that if you can't get your treatment in Hywel Dda, you can go just up the road. If you can't get your treatment in Betsi Cadwaladr, you can go to another health board. And even more importantly, Minister, if you can't get your treatment in Wales, your gatekeepers will stand down and will allow you to go to other nations where some of this specialist treatment may still be available.

I've run out of time, Minister, as my timer—which you can probably all hear, and I can't work out how to switch off—is saying. I just want to say, this is not about saying to the NHS, 'You aren't doing it well.' You've been phenomenal. But it is about saying, 'It is now our duty to not just keep our eyes on the big fire that is COVID', because if we don't look at all the other small fires that are continuing to burn, then they will be the ones that will eventually burn down our building, and we cannot afford that, and our citizens do not deserve that. So, I ask you, please support the motion today.

Thank you very much. The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Thank you. I heard that, thank you. I defer voting under this item until voting time. And in accordance with Standing Order 12.18, I will suspend the meeting for five minutes before proceeding to voting time, during which time IT support will be on hand to help with any issues.

Plenary was suspended at 18:23.

The Senedd reconvened at 18:29, with the Deputy Presiding Officer in the Chair.