1. Will the Minister make a statement on NHS winter pressures, on services and waiting times for diagnosis and treatment? TQ525

Thank you. Wherever feasible, the NHS will strive to continue to deliver essential services for both diagnostics and treatments, based on clinical priority and timeliness. Our NHS will continue to risk assess patients on an active treatment list, to ensure that those with the greatest clinical need are seen as a priority in line with national clinical guidance.

Thank you. I'd like to make a plea on behalf of two organisations in response to your statement last week on NHS COVID pressures and new frameworks being put in place to deal with those pressures. The fear from Cancer Research UK is that the Welsh Government has issued a framework here that allows for local health boards to downgrade some key services, including elective cancer surgery and non-urgent, but hugely important, diagnostics. And remember, they've consistently argued for the stepping up of services to address the cancer backlog, a key recommendation made by the cross-party group on cancer last month too. They're concerned that lessons from the first pandemic wave haven't been applied.

The Royal College of Nursing make a call that, on the face of it, could almost be seen to contradict that, but it really doesn't. What it does is highlight the complexity of the situation we face, as you well know, and the need for very clear Government guidance to get us through that complexity. What the RCN said in a public letter to you is that severe workforce pressures, the overstretching and sheer exhaustion of staff and the simple reality of there being a lack of registered nurses available to work in some parts of Wales now means the pausing of non-urgent elective care may once again be necessary, just as in the first wave, and they say so with a heavy heart.

What both Cancer Research UK and the RCN very much have in common here is a view that there has to be absolute clarity from Welsh Government on the context in which decisions are taken by our health boards. Now, local options, as spelt out in the framework, are all very well, but can the Minister ensure with urgency that there's clarity on when the limiting of non-elective work should be triggered, for example, so there's consistency across the NHS, and what services, including in cancer diagnosis and treatment, we simply cannot allow to slip in this very serious second wave?

I thank the Member for his question. I think, with respect, we have already addressed that in what we've said. I understand the fears of different service and interest groups, and I understand very well the position the RCN have taken. They're right that they and all of us should be concerned about the reality of staff absences. I've just come from a call with health boards and local government leaders from across the broad south Wales area, and the Aneurin Bevan health board have just confirmed that they have a staff absence rate of 11 per cent. Now, that has a significant impact on our ability to provide services, and if you're having that sort of staff absence, then you can't carry on providing all services.

It also means that it isn't an option for that health board or for others who are facing up to similar challenges to continue opening extra provision with the staff that they have, and so, there are very real challenges. And, again, if you were talking to local government leaders, they'd also be describing the sort of pressures they have with staff absences too, and we know that police and crime commissioners and chief constables are facing similar pressures too. So, that's why we've introduced the framework of action.

It isn't just about individual health boards making a choice for themselves and ignoring other services, because we know that mutual aid is already taking place. Cardiff and Vale health board, for example, are already assisting Cwm Taf Morgannwg health board to manage some of their pressures. We know that cancer services often take place on a regional footprint. There are a range of other specialist services that take place across health board boundaries, and the message that I've been giving and health boards have been reflecting back is that, within the choices they are making to manage local pressures, they are already sighted on the challenges for regional services. Regional services have yet to be affected by any of those choices, but health board chief execs talk regularly about this. There was a conversation yesterday at the NHS board, chaired by the NHS Wales chief executive. There are regular means for people to have those conversations across the services.

I should say, for people to understand the concern about cancer services, cancer services are being maintained where it is safe to do so. It's that point about the safety of the service. So, cancer services are not being downgraded. We are having to manage against the real pressures that we face, and it is entirely possible that, in the near future, I may need to make a national decision about how services are managed. We do know, though, that the position in Hywel Dda is rising, the position is different in Powys, because they commission their secondary care, and we know that the position is slightly different in north Wales too. So, if I were to make a national choice at this point, that might affect people in north Wales, in particular, who might be able to manage some of those services for an extended period of time. But I'm afraid that if coronavirus rates continue to rise in the manner they do, then we will see a time when we may need to go back to where we were on 13 March with a national choice on services. We're not there at this point in time, but I take on board the Member's constructive points. We should not lose sight of the fact that local choices have to be considered within a wider context.   

Thank you for the answers so far, Minister. Could you update us on the state of the health boards that have not so far suspended elective surgery? We know that two in Wales, Aneurin Bevan and Swansea Bay health boards, have both cancelled elective surgery. You alluded in your previous answer that you'd just come from a meeting about staff sickness within the NHS, so could you please give us the most up-to-date position? Because obviously the suspension of elective surgery in any health board has a dramatic impact on services provided to patients who have obviously had the expectation to be seen.

The two health boards that I indicated earlier in the week have made public their choices to restrict some services—not just elective surgery but a range of out-patient appointments and others as well. I think it is entirely possible that we will see other health boards needing to do the same. And I refer to 'needing' to do the same—not wanting to but needing to—because of the very real service pressures. So, as I indicated in my answer to the Plaid Cymru spokesperson, we've already seen Cardiff and Vale assisting Cwm Taf Morgannwg with some of the pressures that they're facing, and it's important that mutual aid does exist across our national health service.

I think it goes to the heart of the first question about making sure that health boards don't operate in an isolated fashion where they only think in a very narrow way, but to understand the broader impact. And that, too, has to be a consideration for the impact on the Welsh ambulance service as well, because the way that pressures are managed will have an impact on the ability to get to people in the community, to manage the emergency calls that they are taking and then to move those people to the right place for their care to continue. 

So, as I've indicated, the up-to-date position is that Aneurin Bevan are reporting an 11 per cent staff absence. I'll want to provide more figures to Members and the public on staff absences. I don't have a list to give you exactly on each and every health board, but people should not be surprised to see rising staff absences across each health board, in line with community transmission that we know is taking place. The R rate is going up across Wales, the threat level is rising across Wales; that's why the First Minister made the announcements that he did today.

On elective care and other planned care, I recognise that there is harm caused when that is delayed. There is nothing pleasant about putting off treatment, which will cause anxiety for people, even if they understand and support why it's being done. If you're living with discomfort, then it may not be of much comfort to you that there is someone else in even greater need. But that is why our NHS is making these choices. That is why, as health Minister, I've endorsed the NHS having a framework to help guide those choices. Because the need is so great and we have people who will need care that could be the difference between long-term disability or the difference between surviving and not, and those are the choices that we are engaged in making. So, that's why I'm supporting and have endorsed that framework of action, and I'm afraid that there are more of those choices to come in the weeks and months ahead. 

Can I just start by saying that I'm not in any way criticising the NHS staff in the Grange hospital in my South Wales East constituency? They are doing an incredible job under extreme pressures at the moment. But I've had doctors, GPs, contacting me from the catchment area for the Grange hospital saying they are terrified for their patients they are sending there as they deem the Grange to be unsafe and unfit for purpose. As well as us obviously seeing now patients waiting in car parks for 17 hours with life-threatening illnesses, and people waiting in ambulances for extraordinary amounts of time, what is also apparent, from not just the COVID cases rising, is that the infrastructure at the Grange hospital is not ready. It is not coping. There are not enough beds, there are not enough staff, the internal phone systems are not working properly, and also the hospital is not set up to receive cars. And when there was an entire fleet of ambulances outside the hospital last weekend, it needs to be set up for cars, it needs to be ready. These systems, these internal processes are clearly not ready. So, what urgent action are you taking, Minister, to ensure that the Grange hospital is fit for purpose?

With respect, I disagree with most of what the Member has said. I think there's a misunderstanding of the mission of this hospital, there's a misunderstanding of the severity of the threat that the health board faces and the choices that they are having to make with other partners to make sure they are prioritising the interests of patients in the greatest need. The Grange University Hospital was never set up to receive essentially what the health service would call 'walk-ins'—people who deliver themselves to an emergency department. It is set up to receive our sickest patients; it is not set up to receive people who want to drive themselves there. It is not like a normal local district general hospital in that sense; it was never set up to be that like that. As other Members from the Gwent area, I'm sure, will recognise, that was not the Clinical Futures plan and not the mission of this hospital. So, I think with respect, the criticism is misplaced.

There have been some teething problems—there was a problem with the telephony system—but more broadly, the reality is that the hospital is facing an unprecedented tide. This is a once-in-a-century event. The additional pressures that we are seeing are what has led to the extraordinary choices that mean that treatment is being interrupted or withdrawn in a range of areas to protect the interests of people in much, much greater need—people whose lives could be lost otherwise. The hospital is as fully staffed as it can be with an 11 per cent absence rate across the health board. That, with respect, isn't the issue; the issue is can we keep enough of our staff fit and well and able to attend, so service choices are not driven by a rising tide of staff absence. I'm sure the Member will have engaged with the direct briefings that the health board I know has provided to Members from the Gwent area to set out all of the detail of what lies behind this. I hope the Member will engage in that in the way that we continue to engage within this Parliament so that all Members are operating from the best available information.

The Minister actually has covered a large part of the area I was going to ask about in his answer to Laura Anne Jones. I've also had similar concerns represented to me, Minister, not about the Grange university being unfit for purpose or not suited to the role that it's designed to carry out—I think, as you've just said, it's built for a specific purpose, and at the moment, it's having to deal with an extraordinary situation. However, there are some concerns about the number of COVID cases there and the fact that it's had to respond very quickly to a changing situation without, possibly, the capacity that a hospital that had been there for a long time might have been able to develop very quickly. So, will you confirm that you are going to keep the situation under review, that you will liaise with the health board, and if the COVID situation does deteriorate over the next few weeks, that that hospital and the health board will be able to cope with the situation?

To be fair to the Member, the hospital is actually in his constituency, although it's in Torfaen local authority. The reality is that there is a bigger critical care unit within the new Grange University Hospital, and the health board are looking to surge and provide extra provision around critical care. The key limiting factor is staff, and we come back to this difficult conundrum; if you have need at the greatest level and you have reducing staff cohorts, you can't produce more staff immediately, and then you have to decide where to deploy those staff to address the greatest level of need. And that means that you need to move staff from other areas. Those are the difficult choices that not just the Aneurin Bevan University Health Board are facing, but health boards right across Wales, and indeed in another parts of the UK. So, that is what the health board are considering doing.

I can give the Member the assurance that the health board will continue to take all of those professional judgments about how and where to deploy staff to the greatest effect, given the significant need that exists. I will continue to work with not just the Aneurin Bevan University Health Board, but health boards across the country as they face those choices, and if there is a need for me to make national choices as a Minister, then I will not shirk in my duty to do so. But I think it's really important that all of us continue to take a constructive evidence-led approach, and I certainly do hope that Members across the political divide are engaging with their local NHS as they offer regular briefings to Senedd Members to understand what the picture is locally and how that is leading to them needing to make significant choices to help keep Wales safe.

Thank you, Minister.