1. What guidance does the Welsh Government give to local health boards on the prevention of COVID-19 outbreaks in hospital settings? OQ55951

Throughout the pandemic, the Welsh Government has issued a range of comprehensive guidance to support health boards in preventing COVID-19 outbreaks from occurring in hospital, and limiting the spread and severity of outbreaks when they do occur.

In late July, I was contacted by a constituent whose husband with a non-COVID condition had been told by nurses that three COVID patients had been diagnosed on his ward at Wrexham Maelor Hospital. Only after my intervention was he moved to an adjacent, single-bed side ward. He did not catch COVID-19. Last month, I was contacted by a constituent stating that his father, who had a non-COVID condition, had been placed on the same ward for three and a half days, that, unknown to his father and family, some patients on the ward had COVID-19, and that is father was then transferred to the Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, where he had a positive COVID-19 test result and had developed a worsening cough that was causing concern. How do you therefore respond to the son, who asked, 'Why would you place an elderly man with orthopaedic issues on a ward with known COVID-19 patients? Why didn't they isolate him to prevent the risk of exporting the virus to a neighbouring hospital in Shropshire, and why, despite the front-line staff performing miracles, the backroom of the health board still cannot control cross-contamination, health and hygiene, but also the safety and management of patients within their safekeeping?'

Well, unfortunately, as the Member knows, I'm not familiar with the individual circumstances, or indeed, as I understand from what he said, as the constituent tested positive in the Robert Jones and Agnes Hunt hospital, I'm not sure when the infection can be traced to. But there's a broader point here that the Member is trying to make, and that is about how successfully our hospitals are managing those patients who are positive, and it's why, when we publish information about COVID patients and COVID care, we have a confirmed recovery where they have tested positive, we have a suspected category, because even though we haven't got a confirmed test at that point in time, it matters how they're treated and managed to try to prevent the risk of infection to people who are COVID negative, and then we also have a category of people who are in recovery as well. 

The reason why our nosocomial transmission group—and that's transmission between healthcare staff and others—has met and is led by our chief nursing officer and deputy chief medical officer is because we recognise the risks that exist. And if Members do have examples of where they're concerned that that hasn't been implemented properly, they should of course take that up with their local health board, and if they don't get a satisfactory answer, they should provide the details to me and I will happily investigate. 

I'm hearing some real concerns about some staffing difficulties in hospitals in my region, including Prince Philip Hospital and particular problems in Glangwili in Carmarthen. I'm told—and this is anecdotal, Minister, so I can't be sure that this is the case—that there are nurses and doctors becoming ill with coronavirus and members of the public concerned as to whether they're contracting that in the hospital, whether they're becoming ill in the hospital, or whether they're contracting that in the community. I'm sure that you'll agree with me that our staff are working incredibly hard; they've done such amazing work so far. Is there anything more that you feel needs to be done to ensure that staff are not exposed to infections in hospital settings—obviously, it's not within your or the health board's control as to whether they become infected in the community—and is there any further support or guidance that you can provide the health boards in that particular area of concern with regard to staff sickness?

On the last point, there is further, specific guidance the Government needs to give to the Hywel Dda health board. They're aware of the quite detailed advice that's been provided on a number of occasions. The most recent guidance that came out from that nosocomial transmission group went out on 6 November. But these are really difficult challenges to manage. In the overall picture, about 3 per cent of confirmed coronavirus cases come from transmission within healthcare. The challenge, though, is that we know this is a vulnerable group of the population, where people are there for in-patient treatment. So, the numbers are low, but the impact is significant, and it's the same when we look at transmission in other closed settings like care homes and prisons in particular. Again, the prisoner population and residents in care homes are a less healthy group within the population overall. And this is part of our challenge—about the difference between community transmission and staff who live in those communities also potentially being subject to transmission in those communities and then bringing the virus in, potentially, as well as nosocomial transmission. 

I am, though, hoping to confirm where we're going to be with further testing for staff, not just in the targeted testing we've done around outbreaks, which is still part of our approach, but whether we can have a more general approach to testing, and I'm hoping to be able to make that announcement within the next few days. And there's a meeting between my officials and leads from across health boards tomorrow, and I want to be in a position to update the public and the Senedd in the next few days after that. 

Minister, the roll-out of a vaccine within days, as we're told, is obviously going to be very significant in terms of controlling the virus in the hospital environment. One of the aspects of this particular vaccine is that it has to be kept at -70 degrees centigrade, which means that managing it and containing the vaccine is going to be an extremely difficult technical task. Is it likely that vaccination in hospitals is going to be one of the high priorities when it is possible to roll-out the vaccine within Wales? Can you give us any more information on this? 

Yes. The vaccine roll-out will certainly help in preventing some forms of nosocomial transmission. It would also help with residents in care homes in terms of our ability to protect staff going to those care homes and those residents who are mobile. The Joint Committee on Vaccination and Immunisation has provided advice that all four chief medical officers have endorsed, and health Ministers met this morning in an early morning call, with colleagues from Scotland, Northern Ireland and England, and we've agreed, again, to follow the advice that the JCVI have provided on prioritisation. Within that, care home residents and really vulnerable people are at the top, the next group are people over the age of 80 and front-line staff in health and social care.

In the written statement that I have issued today, I have indicated that, because of the particular characteristics of the Pfizer vaccine, we don't think we're going to be able to safely take it to care homes. That means we're going to have a smaller number of vaccination centres we'll need to bring people to. Now, in practical terms, some care home residents therefore won't be within the first few weeks of delivery of that vaccine. We need to understand the safety data of moving that vaccine around in real time in more venues before we could potentially look at taking it elsewhere. Now, that is a challenge, and that means that care home residents, who are right at the top of the vulnerability list, we're not going to be able to deliver the vaccine to them. They'll get some protection though from us in our ability to prioritise staff who work in those environments, as well as our front-line healthcare staff. So, I'm still optimistic that this vaccine will make a real difference. But it's why I've been on the record and I say again that the Oxford vaccine gives us a much greater ability to take it out because that is a vaccine you can, essentially, store in a fridge, so with significantly fewer logistical challenges to deliver.