Questions now from the party spokespeople. Plaid Cymru spokesperson, Rhun ap Iorwerth. 

Thank you, Llywydd. Minister, you will be aware that a group of organisations wrote to the UK Prime Minister on measures to protect health and care workers from the virus. They say that steps to reduce airborne transmission have been insufficient and they are calling for an improvement in ventilation and for changes in PPE guidance in order to protect the workforce. Will you work proactively in responding to those demands and recognise that our understanding of airborne transmission has changed considerably over the past 12 months and that public health messaging, as well as that protection guidance, should be amended to reflect that, including putting more emphasis on the importance of fresh air?

I'm happy to say that in regular Welsh Government messaging, we highlight the importance of good ventilation, and that's in not just press conferences and other events that I do, but from others—from the chief medical officer, the deputy chief medical officer and indeed the First Minister, who has highlighted this as well. I know that that's practically been taken on board. For example, we have made sure that my son has an extra layer of clothing because windows in his classroom were open when he returned to school. So, the message is being taken up on ventilation in a much more significant and sustained manner than, to be fair, it would have been at the start of the pandemic.

When it comes to the review of the adequacy of personal protective equipment, that's a matter where we do regularly undertake reviews. The lead for that is the deputy chief medical officer, Professor Chris Jones. He regularly engages with other colleagues across the UK to make sure that our guidance is up to date. I understand the concerns that some people have about whether the current version of the PPE is the right version of PPE, given that we have a more transmissible variant of the virus—the Kent variant—in place as the dominant variant in Wales, but the latest review shows that our current standards are appropriate, and, as ever, they're always under review.

Thank you. I want to turn now to the long-term impact of COVID-19. It's wonderful that the vaccination process is developing well, but many people will wait a long time before getting a vaccination, including young people, and they are also open to acute and serious risk, as we have seen in the most painful manner on Anglesey over the past few days in light of the deaths of two young men, Kevin Hughes and Huw Gethin Jones. I know that I speak on behalf of the whole of the Senedd as we send our condolences to their families today. But for those who will be fortunate enough not to develop serious illness, we are coming to understand more and more of the dangers of long COVID.

I met this week with the organisation Long Covid Wales and discussed the need for far more investment in long COVID care, which is different to post-COVID rehab. We need healthcare for the sufferers of long COVID. I note, today, that an additional £750,000 has been allocated in Scotland for long COVID care. Can we have a commitment of enhanced resources to provide this care and, crucially, to ensure that it's available in all parts of Wales? Because at the moment, you are far more likely to get care if you are living in the south-east of Wales. 

This is a matter that I do take seriously. I'll be writing imminently to the health committee in response to the Chair's letter on behalf of the committee on long COVID with a series of questions within that. We'll set out what we are doing and the work we are undertaking on the long COVID pathway we've agreed as well. I think it's really important to understand that, when we talk about long COVID, we're talking about a variety of impacts, because this is not a commonly experienced condition, in the sense that the symptoms may vary. You may have people who have never been to a hospital, but have never fully recovered and have recurrent symptoms that have an impact on their day-to-day activities. You may also have people suffering from a much more significant impact and there may be people with different organ damage, with longer term consequences as well. We're looking to have an approach that takes account of the different impacts on different people and we recognise that this will require a multidisciplinary approach.

It's part of the reason why we've worked with colleagues in primary care, as well as secondary care, in understanding how to put together a pathway and to make sure that primary care colleagues are equipped to refer people to the appropriate part of that pathway as well. That will be really important for the future, because the honest truth is that today we don't have enough understanding to set up a definitive treatment pathway that will do for everything and anything in the future. We will continue to learn, which is why we continue to invest in research around long COVID. It's why, whatever happens on the first Thursday in May, the next Government will continue to need to reassess the state of our knowledge and our understanding and will, again, need to return to the current pathway we have in place to make sure it's still appropriate and to understand as further advances in care and treatment are provided. So, this is a moving picture but one that we're committed to return to, because I recognise this is going to be one of the longer term impacts of COVID. It's a success story that so many people have recovered, but the nature of that recovery will be varying and there will be recurrent episodes for a number of people. 

There is still a lack of understanding on how hard long COVID can hit people. Even if they don't have to go to hospital, it can take many weeks for some people to recover from COVID and the symptoms of COVID. I've heard of one individual who was threatened with disciplinary action from her employer unless she returned to work within a fortnight. She, as it happens, has recovered now but it took her a month to recover from COVID. Now, most employers are being responsible, but with all sorts of stories to be heard about workers being requested to use annual leave to self-isolate or to ignore a request to self-isolate entirely, will you be entirely firm on this issue and press for prosecution if necessary—which could be as serious as corporate manslaughter in the most serious of cases—if there is clear evidence that employers or others are acting in a way that contributes towards the spread of this virus?

There are two distinct points there. The first is that Ministers don't make prosecution decisions. There's a clear separation of powers. It's probably a good thing for everyone that, as the health Minister, I'm not in a position to direct the criminal justice services to undertake prosecutions or not. However, when it comes to the law and our expectations, we do work alongside the Health and Safety Executive. It's a reserved body, but they're very clear about what requirements of the law are in place here in Wales and what that means in terms of businesses that are not compliant in following those rules, whether it's retail or other activities as well. The guidance we issue has a real bearing on making sure that workplaces are safe workplaces with an infectious condition that is in widespread circulation still around the country. I think that's the point the Member is really driving, about making sure there's a clear message from the Government about expected standards of behaviour from employers and not to hesitate in supporting action that is taken, whether it's by environmental health organisations, trading standards or, indeed, non-devolved areas, to ensure that workers are kept safe. 

We have these conversations on a regular basis, not just in the social partnership but also in the national health and safety forum that's been created as well. We are, I think, being very clear about our expectations for employers about how they need to keep their businesses safe and secure to keep their workers and their customers safe and secure. We'll need to return to this again, as our evidence, knowledge and understanding of COVID changes in the future. I hope that, as we do recover and get out of the pandemic crisis, we'll make sure there isn't a dropping of the guard when it comes to this. Because I also wouldn't want to see employers taking precipitative action against people who, in my former life, I would potentially have been taking discrimination action for if these are people with a material impact on their day-to-day activities with a recurring condition. That seems to me to describe a great deal of what long COVID actually means for people who have the condition and the likelihood of a future occurrence. I hope that all employers are taking a much more considerate approach, because these are matters where our understanding will continue to develop and we want people to return to work and contribute to the future of our economy. 

The Conservative spokesperson, Angela Burns. 

Good afternoon, Minister. When are you hoping to bring forward a national plan for dealing with the waiting list problem that we have here in Wales?

I expect to be in a position to publish an NHS recovery plan before the end of March. I have indicated this previously. We'll need to look at recovery in general terms, so not just planned care and elective services but more broadly as well. We need to describe the approach we're taking and what that will mean to give everyone some context about the scale of the task as it is and then to set out how we're already working to plan and then to be able to deliver it. The challenge will still be that, by the end of March, we're unlikely to have a definitive set of delivery plans because we still don't anticipate reopening all of our services within the national health service by that point, and that will affect the scale of the problem that any future Government will have to confront and resolve. But we do expect to provide a much clearer guide about what recovery will look like. 

You talk about recovery in a general way, and I appreciate that. I understand that you have to look at the NHS as a whole, but I am particularly concerned about the waiting-for-treatment times. We now have over 538,000 people—that's one in five of our population—waiting for some form of treatment. Granted, they're not all humongously urgent—although to the person involved, it may well be—but there are an awful lot of people, ranging from people waiting for diagnostic treatment to women waiting for gynaecological treatment, people needing treatment for their eyes so they don't lose their eyesight; these are all people whose quality of life and whose eventual outcomes could well be severely impacted by waiting for treatment. I understand the position we're in—we've been through hell on earth this last year and a half—but I am desperately seeking from the Welsh Government a real assurance that there's going to be a targeted plan specifically aimed at this.

The reason I ask you, Minister, is because I hear health boards telling me that they are going to take up to a decade to recover and get back to the places they were before the pandemic happened. I am aware that many health boards use other health boards to provide certain services. Unless there's a united national plan in place, it could be very difficult to get all the services to start coming up to the boil at the same time. For example, in Hywel Dda, there is no treatment for keratoconus; you have to go to the Princess of Wales in Bridgend. If that board does not decide to liven up that process in time, then people in Hywel Dda will continue to wait. Can you give us an assurance that you're going to specifically look at this, and can you give us some idea of how you're going to be able to address that problem? As I say, I totally understand it's a significant challenge, but we also need to be aware of funding and resources. Are you able to give us any indication?

When we do publish the NHS recovery plan, we will within it address the fact that there will be a resource requirement for this not just in a year, but over the course of the whole term. I've indicated previously that I think the recovery will take least a full Senedd term. That's the scale of the problem we have. It's probably not much comfort to people here in Wales, but you'll find a huge scale of challenge in every part of UK, because of the last year that we've all lived through. I recognise the point the Member makes about not just the increase in the volume and the backlog that's been built up, but the fact that that may mean that there is harm that is caused that may not be reversible. That is part of the difficulty in having to make choices through this pandemic and about weighing up and balancing the impact on different people.

I should say, though, that it isn't the case that one in five people in Wales are on a waiting list. A number of the people who are waiting will have appointments on different lists, and it's part of the challenge in having an accurate discussion about the scale. The numbers the Member quotes are the numbers of outstanding appointments in a variety of areas, as she's indicated, from out-patients to more urgent activity as well. That reinforces for me the importance of continuing to get on top of coronavirus and not letting the virus get out of control again, because it would just mean a further interruption and even more harm and an even bigger backlog. But yes, you can expect a plan that covers a range of different areas, including a balance between local, regional and national choices. I may not be the Minister who has to make those national choices, but whoever does return as the health Minister after the election in May will need to be prepared to make national choices to build upon the plan that will be published by the end of March, because this, as I say, is going to be a significant undertaking for the whole country.

To go back to those statistics, they did come from Government information, but I am happy to go back and review that, because it was quite clear it was one in five. One of the areas that's leapt astronomically in the last year is the area of gynaecological services. We had less than 1,000 women waiting for over 36 weeks; now we've got over 13,000 women waiting for some kind of treatment. That, of course, spins back to health inequalities, doesn't it? All of the parties will have received a letter in the last week from the Royal College of Physicians on behalf of 30-odd organisations talking about health inequalities. Will the Government be able to make any commitment that in this recovery plan is not just going to be a broad-brush approach, but that you will look at key health inequalities to ensure that groups such as women, who traditionally have suffered unequal health in a wide group of areas, are brought into the mix at the same time? Of course, it's not just women; there are a lot of ethnic minority groups that have particular health inequalities. Will you be listening very closely to the representations being made by the likes of the Royal College of Physicians to try to ensure that we don't allow this pandemic to broaden those health inequalities that we already have here in Wales?

If I deal with the point about the figures first, and then deal with your point about health inequalities, on the figures, the figures are accurate in terms of the number of appointments that are outstanding, but there isn't one fifth of people who have an outstanding appointment because some of those will be individuals on more than one list, and that's the point that I'm making. In terms of the number of people that are really waiting, it isn't actually one in five of the population. The figure you quote is an accurate figure for the number of individual appointments. I myself know that I could potentially be on two waiting lists, for the sake of argument, if I were a new patient with the two individual issues where the NHS regularly cares for me. So, that's the point that I'm making in having an accurate conversation about the scale of the challenge we face.

On your point about healthcare inequalities, we recognise the pandemic has exacerbated healthcare inequalities and made them even more stark than they were before. The level of harm, the different harm that has been meted out by coronavirus—. It is not a great leveller. It is the reality that harm is done in those communities, those families, those individuals who started this pandemic with the greatest number of health inequalities at the outset.

We have to make sure that the recovery does properly take account of that in how we prioritise people in the greatest clinical need, how we get to those people first, and how we make sure that our recovery doesn't exacerbate, yet again, the healthcare inequalities that there are. That means that it can't be about the sharpest elbows finding their way through a system. It's actually about how we deliberately design a recovery that does take account of all of those healthcare inequalities, and that will be difficult because of the scale of the challenge that we have. But I actually think that our prudent healthcare and value-based healthcare approach will help us to do that, to drive that into our system. This is all entirely consistent with the 'A Healthier Wales' approach that we have, where, of course, you'll recall from the outset of this term, from the parliamentary review to having 'A Healthier Wales', healthcare inequalities were very much at the heart of that plan, and they'll need to be at the heart of our recovery approach, too.