We have one item of business remaining, which is the short debate, and I call on Jayne Bryant to speak to the topic that she has chosen. Jayne Bryant. 

Diolch, Llywydd. I've agreed to give a minute of my time today to Jack Sargeant. 

The Deputy Presiding Officer took the Chair.

It's nearly 11 months since the first COVID patient was identified here in Wales. Since then, in a year like no other, our NHS and social care workforce have strived to do all they can to keep us safe. They have faced unimaginable challenges and pressures, and for many, those stresses have been taking their toll on them personally and on their families. I wanted to use my time today to bring their experiences of this pandemic into the Senedd Chamber. We have a duty to understand the reality of the situation that our laws create, and the impact that it's having on the health and well-being of those who are doing all they can to look after us. Many of our NHS front-line staff have, after finishing their shifts, used their position to let many of us know what their experiences are, challenging misinformation and perceptions. Hearing from those on the front line is essential.

Two of those who've done so much are intensive therapy unit consultant Dr Ami Jones and theatre operator Glenn Dene. They have recently published a photo book, Behind the Mask: The NHS Family and the Fight with COVID-19. All proceeds are going to NHS charities. Many of you will have seen the images taken by Glenn in the news recently. The book details the heartbreaking reality inside Nevill Hall and the Grange University Hospital, capturing the light and the dark, both the harrowing struggle and the glimmers of hope, showing us the real truth and tragedy of this crisis. Some photographs show moments of positivity, such as staff tenderly supporting each other through difficult moments and babies being born. But more harrowing images include COVID patients on ventilators and a body on a mortuary trolley. I had hoped to be able to show the photos while I spoke this evening, but we're unfortunately unable to do this. I will, however, show some of them via my social media. In her own words, Dr Ami Jones states:

'This is probably one of the worst—and also best—times in the history of the NHS. The way that teams have come together to adapt and overcome is very positive—but it's clearly a dark time in the NHS. So sadness and happiness when you look back at the photos, really.'

Back in the spring last year, the arrival of COVID-19 saw many processes done in the NHS that would normally have taken years to implement undertaken in weeks. This is the same for staff. They have adjusted, trained and taken on new responsibilities. They have risen without question to the challenges COVID has brought. New starters have had 10 years' experience in six months. Dr Ami Jones describes the start of the pandemic response like this:

'The hospital moved swiftly. Wards were reorganised and spaces identified that could be turned into new ITUs. The hospital was divided into an area where COVID patients could be treated and areas where other patients would continue to receive medical care. Despite elective operations and routine clinical appointments being cancelled and COVID seeming to be all-encompassing, people were still going to need emergency surgery, and women still had babies to deliver. What was odd about most of these patients was that they were so young and fit compared to our usual ITU population, but we soon learned that no-one is really safe from COVID.

'Patients were quite rightly scared at the thought of going onto a ventilator, and we've always tried to make time for the patient to ring or video call home and speak to loved ones before we took them to ITU. Sadly, we know that approximately 50 per cent of patients entering ITU due to COVID won't leave again, so a precious few moments for the patient to speak to or even maybe see their families was vital, if possible. Without relatives being allowed into the hospital, having to do this over the phone is heartbreaking, and probably the cruellest twist of all. But the patient will not die alone. The nurses will always be there, holding their hands and talking to them until the end.

'The nurses have probably had the toughest time throughout this pandemic. Or, more correctly, the healthcare professionals doing the usual jobs of ITU nurses. For even if we can find more bed space, buy more ventilators, more drug pumps, we still can't buy more of the thing that sick ITU patients need the most, an ITU nurse. We have had to adapt and overcome to fill the potential gap in numbers if the surge happens. We asked our ITU staff who had left for other jobs to come back. We asked nurses who have never worked in ITU but had transferrable skills to come and help us. We asked theatre assistants and healthcare assistants from the wards to come and help us, and no-one refused; everyone wanted to help, even though they probably felt like they were putting themselves on the front line. They were the nurses who spent time speaking to the relatives over the phone or a video call, showing them their loved one asleep on a breathing machine, and holding a patient's hand if the worst happened. Sometimes these shifts broke them emotionally, sometimes the gruelling hours in PPE broke them physically, but they never lost their humour, their morale, or their professionalism.'

Other extracts and quotes from the book include Ian Brooks, operating department practitioner. Ian said, 'Thirty-one years ago, I started working in theatre. The virus is indiscriminate, ruthless and silent. The fear I felt every day was like a death sentence. I sat with my 21-year-old daughter one morning, and she asked how I was doing. I burst into tears and I just didn't know why.'

Louise, ITU nurse, 'A feeling of responsibility I've never faced before; holding a patient's hand and willing them to live for the sake of their poor family who can't be with them will live for ever with me.'

Andrew Edwards, theatre assistant, 'Nothing could prepare me for COVID. Walking into ITU was like walking into a horror movie, only this was very real. There were wires, pumps, flashing lights and alarms going off everywhere, but everyone kept their cool. It made me feel safe in the knowledge that the ITU staff had my back and we were in this together.'

Jessica Scurr, operating department practitioner, 'In my role, it's a real privilege to be there for the patients in the moments that they need us the most. We utilise our years of training and our specialised skills to provide the support they need, and do everything in our power to keep them safe and well. However, during this unique time, I've felt a compassion and empathy completely incomparable to anything I've every felt before. I try to channel those overwhelming emotions into being as kind and comforting as possible. I make sure patients have a hand to hold, I listen to what they have to say, and I hope my eyes show it. I hope they know I'm smiling behind my mask. In the darkest of moments, light has been found in encouragement and support of all my work colleagues. They have been shoulders to cry on and a reason to smile. We hold each other up through the highs and the lows, and it's a true honour to work alongside such incredible people.'

These were the experiences of the first wave in the spring. Sadly, we know that the winter has been harder. Rates are much higher than at any other point during the pandemic, and more people have died. ITU is seeing much sicker patients in this second wave, and they're seeing people in their thirties, forties and fifties. The staff continue to be incredible, but many will have not recovered from the spring. Many have been isolated from their own families to keep them safe, many are facing horrendous shifts after horrendous shifts, and tragically, many colleagues have been lost. Even if they're trained and experienced, they will not mentally and physically be prepared to go through this. Experienced staff from cleaners, porters, consultants and nurses have never seen anything like this over a sustained period of time. They're all tired and many of them have got what they've coined 'COVID fatigue'.

Sadly, it isn't just in our hospitals that staff are struggling. Our paramedics and ambulance service have been under immense pressure and they tragically lost their second member of staff to COVID on New Year's Day. The chief executive of the ambulance service trust Jason Killens has stated that at one point in December, 12 per cent of the service staff were either sick or having to self-isolate because of COVID. They've been under its highest level of alert, described as extreme pressure, since early December. This means that the staff have faced increased pressure through the normal volume of calls and workload, and then having COVID on top of that. Dr Catherine Goodwin, who is a consultant clinical psychologist, has told me, 'I think the biggest message we're hearing from staff at the moment is fear; fear for themselves, their families, and our patients, and the uncertainty that comes with the unknown.'

I believe that some staff are genuinely scared to go to work. Moral injury is certainly a risk and not being able to respond as quickly as they would like to patients or to hand over patients to hospital staff is having a toll on both our crews and call handlers and dispatchers. They feel that they're not doing their job. The increases in staff who are having to self-isolate or unwell or with long COVID, as well as stress-related difficulties, means it's increasing pressure on staff who are in work. I suspect we'll see an increase in mental ill health and physical difficulties once the pressures ease as people start to feel they're able to consider and even notice themselves, rather than keep going just to ensure the service can keep going.

We're also seeing frustration, confusion and sadness when witnessing some of the scenes that the media report of people at large gatherings or not socially distancing after the first lockdown ended, and then, more recently, as many people appear to continue to mix. And sadness that they're not able to take relatives with poorly patients as they would in the past. This is what every member of staff I've spoken to over these past months tells me: the emotional impact on them is immense. One paramedic described the pressure he and his colleagues were under. He said that at one point an incident caused him to question whether he wanted to continue working. He said, 'During the peak of the pandemic last year, I was assaulted by a member of the public when I was spat on in the face, and that's really the only time that I've stopped and gone, "Is this for me?" However, the vast majority of the public', he said, 'have been absolutely fantastic', adding, 'we've had people waving at us and buying us coffee.'

Our social care staff have also been operating under the toughest of conditions. They've seen the people they care for day in, day out pass away in devastating numbers, and without the time to grieve. The impact on them has been huge. They have strived to do their work in the most difficult of times. The fragility of the service and the pressure on staffing has been starker than ever. We've seen numerous examples of whole care homes isolating themselves like islands, separating themselves from family for weeks to protect the residents. The impact on all those in our care family—from carers to cleaners to cooks—must not be forgotten.

We've also seen front-line NHS staff speak about the reality of fighting the pandemic. Respected consultants in Aneurin Bevan health board, such as Ami Jones, David Hepburn and Tim Rogerson, have all voiced their experience and described the pressure they and their colleagues are facing day in, day out. The way that some people have chosen to abuse those people who have simply tried to tell the truth is shocking and deplorable. It deflates the staff who've come off their shift exhausted only to be treated with so little respect. Although these voices are small, the majority of us must do all we can to make sure they're heard and supported. Our front-line staff did not sign up for this, and they deserve so much better.

The COVID pandemic has underlined the challenges that the health and social care workforce face, particular those who are on the front line. Across the system, we have seen first-hand the incredible sacrifices so many have made to protect, help and support the vulnerable, not just on hospital wards, but also in the community. The full impact of this is still unknown, however recent research in England showed that nearly half of intensive care staff reported symptoms of post-traumatic stress disorder, severe depression or anxiety. Having a healthy, motivated and supported workforce is in all of our interests, but as we enter the eleventh month of COVID pressures, the NHS is facing one of the most difficult times in its history. Staff across the system are feeling exhausted and fatigued.

The impact of this will be felt by those on the front line for many years to come. It's likely to leave a legacy of long-term COVID-induced mental health issues, and people questioning whether they still want to or are able to stay in the job because of burnout. I know many of those services already have support in place, such as occupational health and well-being services who are able to listen, run drop-in sessions, workshops and signpost to additional help. However, more must be done, and more support must be given by the Government, and the recognition must come with more than warm words and our gratitude. They deserve that. All our health and social care staff have gone into work day in, day out, and worked tirelessly, caring for our loved ones with little respite from this virus. We must do all we can to support them to ensure we look after those who continue to look after us. Extensive support must be put in place to help them both now and in years to come, and as has been said many times, not all heroes wear capes, but we know where many of them work. Diolch.

Can I start by commending our colleague Jayne Bryant for bringing this topic to the Senedd? I think the way she has just delivered her speech today clearly shows the importance of this issue, and we say 'thanks' to our wonderful NHS staff and care workers.

It is impossible to say when and how post-traumatic stress disorder hits, but when it does, it can be debilitating and devastating. I say this from my own personal experience and struggles. At the moment, our NHS and social care staff and volunteers are being stretched beyond what we could reasonably expect from them, and even what we could possibly imagine. But they carry on, and they carry on for the sake of the nation.

Anxiety, tiredness and perhaps even a sense of hopelessness could be a real issue, but the future could hold an even greater risk as trauma-inflicted side effects could happen at any time. Now, this should not take the Government by surprise, and we should be planning for it now. Significant support will be needed as these mental health problems are predictable and will impact on everyone.

Deputy Llywydd, I'll finish in the words of Jayne Bryant: not all heroes wear capes, but we do know where they work, and we as Governments and as individuals need to support the heroes that have supported us and continue to support us. Thank you.

Thank you. I call the Minister for Mental Health, Well-being and Welsh Language to reply to the debate, Eluned Morgan.

Thanks very much, and I'd like to thank Jayne Bryant for giving us this opportunity to have this very crucial and timely debate. I think we've all seen the images of staff and hospital wards that can leave us in absolutely no doubt that the health and social care workforce will be changed by the experiences that they've been through, and I'd like to thank Jayne in particular for painting those very vivid images for us this evening, really demonstrating the very moving and difficult circumstances that NHS staff find themselves in. I also thank Jack, who always has demonstrated real sensitivity and understanding on this issue.

I'm sure I speak on behalf of all Senedd Members when I pay tribute to the unyielding hard work and the dedication of the incredible health and social care workforce. They are the life force of the service in peacetime, but especially now in our battle with this terrible, unforgiving virus. As Jayne illustrated, the last 11 months have been absolutely relentless for them. The pandemic continues to have a significant impact on patients and staff, and I fully recognise the extra physical and emotional demands that this places on the workforce. Many health and social care staff working on Wales's front line have spoken both online and to the media about their experiences of delivering care from the centre of the response to the virus. And I think their stories are a stark reminder of the gruelling reality of the daily fight to manage the virus, to care for our patients and to keep our people safe.

Now, we take the health and well-being of our health and social care workforce extremely seriously, and support employers to provide a range of extra support during this pandemic. Since March of last year, the Welsh Government has made a number of significant financial investments for mental health support for our health and social care workforce. The Welsh Government has built on its well-established social partnership mechanisms to work closely with the NHS, employers and health and social care unions to make available a multi-layered well-being offer for health and social care workers, because I think we have to recognise that individuals will be affected differently by the pandemic, and they might want different levels of intensity and styles of intervention, which is why the offer we've developed must include a lighter-touch listening service, as well as that in-depth therapy and even physical health service that some may need, on top of the practical and financial advice that some may need. 

There are a number of apps available free of charge that provide support and guidance in dealing with anxiety, improving sleep and meditation processes to help people to clear their minds. We've extended the SilverCloud provision, which is an online service, so that all health and social care workers in all parts of Wales can access a variety of programmes provided at any given time, wherever they may be. And these programmes are based on cognitive behavioural therapy, CBT, which can provide people with the skills to manage their own psychological well-being, to be more confident. 

To recognise the extensive strain and trauma that NHS staff have faced, more than £1 million in addition was invested by the Welsh Government in April to extend the healthcare service for health professionals in Wales. This service was available already to those working in medicine and dentistry in Wales, but there is now more provision available because of this additional funding. The service now provides an even better level of support and advice to all health professionals, including doctors, nurses, healthcare students, paramedics, pharmacists, therapists, dentists and medical volunteers working in Wales. By now, the service is also offered to administrative and clerical staff who are also facing great stresses. 

The aim of the service is to provide support for those with acute symptoms—individuals who feel that they can no longer cope, who are anxious or are having difficulty in managing the various challenges posed by the pandemic, individuals who are starting to feel the symptoms of anxiety and depression, individuals who have problems with alcohol, for example, as well as those who are suffering PTSD. We are sure to see an increase in demand for such support when we move out of this pandemic. People will slow down and think back on their experiences, as was explained by the Royal College of Physicians in Wales just last week.

During the symposium for health professionals in December, it was explained how necessary and vital this programme is, and this is particularly true because the burden of responding to COVID-19 is ongoing and will extend into the long term. The Welsh Government will continue to work with Cardiff University, who run the service, to ensure that it is fit for purpose and that it can adapt depending on changes in demand. And I'm pleased to say that we are working well with Cardiff University at the moment to draw up a model that supports the social care workforce as well as those working in health. Information about these resources and how to access them is available on mental health pages of the Health Education and Improvement Wales website.

In the autumn, we circulated a Welsh health circular to NHS organisations, noting how they were expected to support the health and well-being of their staff during the pandemic. The circular is a means of reminding employers, and sends a clear message to our workforce, restating our commitment and the employer's commitment to support their health and well-being.

Since the beginning of the pandemic, Social Care Wales have been maintaining a well-being network, which considers the use of the services already available and how it can be advertised more widely.

Following a review of occupational health services across Wales, commissioned by health boards, we'll be working with partners to consider an appropriate occupational health solution for Wales, based on the review recommendations. I understand that a partnership group has been established to look at this work, including representation from unions, employers and the Welsh Government. We're also funding an employee assistance programme, which has been procured and managed by Social Care Wales. This is going to provide longer term well-being support for people within the social care workforce, who are not yet covered by the scheme.

Now, we're not done in our fight against this unrelenting virus. The roll-out of the vaccination programme and the publication of our vaccination plan last week offers us a glimmer of hope and a path out of this pandemic, but we know that ongoing physical and mental health impacts for patients, staff and the public will be immense, and we must continue to work together, to be prepared and to be able to support our workforce to carry on supporting our patients as we navigate our way forward out of this pandemic. So, thank you, Jayne, once again, for bringing the attention of the Senedd to this really important subject.

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

The meeting ended at 17:12.