We'll move on to a statement on COVID vaccination from that, and I'll call on the Minister to make the statement—Vaughan Gething.

Thank you, Llywydd. Last week was a week of real progress and highlights for our successful vaccination programme here in Wales. Members will be aware from my written statement on Saturday that we have now reached the 1 million total doses delivered mark, and this is an incredible achievement. We've reached this milestone in just 12 weeks. I'm tremendously proud of the team who have delivered this landmark. Data published earlier this afternoon shows that at least 933,485 people have now been recorded as having had their first dose of the vaccine and 111,716 have completed their course by having their second dose. That's a total of 1,045,201 vaccines administered by our fantastic vaccination teams across the country. As you can see, we're closing in on having delivered 1 million first doses of the vaccine to people in Wales.

The Deputy Presiding Officer (Ann Jones) took the Chair.

On Friday, we published an update to our national plan. While less than two months since we published the plan itself, a lot has happened with our programme. I want to reflect on progress and provide more information on our current and future priorities. In the updates, I confirmed that two key target dates have moved forward. The first is the target date for offering the vaccine to all those in the current priority groups—that's groups 5 to 9. I've said that our aim now is to do this by the middle of April. The bringing forward of some of our supply allocation now makes this possible. I've also confirmed that we plan to offer the vaccine to all eligible adults by the end of July instead of our original autumn deadline. As I've said all along, supply is the limiting factor. I have confidence in the pace and capacity of our delivery model and in the fantastic team of people who are doing the work. However, achieving these target dates remains subject to vaccine supply and the timeliness of that supply.

In the update, I've also confirmed our approach for phase 2 of our programme. As with the current phase, it will be on the basis of the advice of the independent, expert Joint Committee on Vaccination and Immunisation. Our approach in Wales is similar to all other UK countries and has the endorsement of the four chief medical officers from each UK nation. The JCVI has recommended continuing the roll-out on the basis of age. That is because age remains the most significant risk factor and because a model based on age will enable the fastest pace for the remaining vaccinations. In recommending an age-based approach, the JCVI noted the importance of other factors, specifically gender, ethnicity and socioeconomic status. We will take account of the need for clear, trusted and targeted information on these factors within our communications and deployment arrangements for phase 2.

Members will of course be aware there has been a lot of interest in prioritisation on the basis of occupation. Again, the JCVI did consider this. However, the independent, expert committee did not have sufficient evidence to persuade it to advise the four Governments of the UK to set specific occupations apart from the general population. It also commented on the operational complexity of such an approach, which would inevitably slow the pace of the roll-out.

We know that over half of key workers are aged over 40. Over half of our key workers will therefore either be offered vaccination as part of the current phase of the programme, or will be called for vaccination as part of the first priority group recommended by the JCVI for phase 2—those people aged between 40 and 49. I recognise there'll be some disappointment around this—those working in education, childcare and the police service, and in the transport sector, for example. I've also heard the case made for retail workers and postal workers, all of whom have worked through the height of the pandemic. But, put simply, the JCVI advise us that an age-based approach is the simplest, the quickest to operationalise and deliver, and the fairest approach to the population as a whole.

The update to our strategy also explained some of the emerging evidence on the effectiveness of vaccines. The research is very encouraging and really does give us greater cause for hope and positivity. But there is still a long way to go with our programme yet, with many, many more first and second doses to be delivered. We're very much on the right track, but there is a lot of work left to do. However, I hope that Members from all sides will recognise the fantastic achievement of our vaccination programme here in Wales to date. Thank you, Deputy Presiding Officer.

[Inaudible.]

Sorry, I saw you talking, Deputy Presiding Officer, but I didn't hear who you'd called to ask questions first. Unless there are, of course, no questions. 

The Llywydd took the Chair.

Sometimes it's difficult for me to unmute myself, even. I think there's a problem with Ann Jones's sound at this point. I haven't left the room, so I'm back chairing. Angela Burns. 

Thank you very much indeed, Llywydd. Thank you, Minister, for your update. It is incredibly cheerful news. I think a million doses is an enormous achievement and I give my heartfelt thanks and an absolute salute to you, to the health boards, to the volunteers, to everybody who's been involved in this programme. I also pay absolute credit to the UK Government for their vaccination procurement strategy. I think it was a master class getting Kate Bingham involved, and I think that we have been fleet of foot across all four nations, and the people of the UK are benefiting from it. I just want to say, absolutely, congratulations.

I agree with you that a successful vaccination strategy must be based on science and on simplicity. I think we have to be very careful about doing anything that will delay the roll-out. To be able to vaccinate every adult in Wales by the end of July would be an enormous achievement, and I would encourage you to hold fast to that ambition.

Having said that, I've got four questions. The positivity rate in Wales is now at 5.9 per cent, which is a key benchmark for level 3 restrictions. Additionally, case numbers per 100,000 sit at the benchmark of level 2 restrictions—excellent news, but do these figures now enable the Welsh Government to start lifting the blanket level 4 restrictions? Now, I'm not advocating you throw the baby out with the bath water and rush ahead gaily, but I do think we can start lifting some of these restrictions to help mitigate the incredible cost to individuals in terms of their mental and physical health, to businesses and to the people who own those businesses and run those businesses, which in Wales are very often smaller companies and private individuals who work incredibly hard to help support our economy. So, I'd be very interested to know if you feel that this success in the vaccine roll-out will enable you to lift these restrictions sooner rather than later to help mitigate these personal and financial costs.

My second question is: as the Welsh Government starts phase 2 of the vaccine programme, you obviously also need to ensure that dose 2 is implemented on time, so can you just update the Senedd, please, on the progress with developing partnerships with organisations such as Community Pharmacy Wales, because we're going to be relying on those organisations to help with this massive programme?

Thirdly, we know that uptake in some cohorts is very low. Can you just give us an update on how progress is coming on, how the communication strategy is developing? Are you getting positive feedback that it is working to persuade those who are reluctant to take the vaccine to do so?

And my fourth question is very, very small, but I have been approached by just a handful of people who are currently residing in Wales, almost all of them because they're either giving private care or they're giving individual but paid-for care to elderly people here and, in one instance, a disabled young person, but they're residents and their own personal GPs are in England. Are they still able to access the vaccine here, because it doesn't seem terribly suitable to send somebody who's looking after a vulnerable person, perhaps on the train, with multiple exposure to potential COVID, to get a vaccine and then come back and maybe bring that back?

So, that was just a bit of housekeeping. But I think it's very good news. Thank you. 

Thank you, and thank you for your words of thanks and appreciation. I know that the team across Wales would appreciate support from all sides of party politics for the work that is being done in every part of Wales. And, actually, across all four countries, the vaccination programmes are moving pretty quickly. Certainly, against other international comparators, we're doing very well in every nation of the UK, and in Wales in particular we are making sure that we're delivering the second doses. You'll recall some stakeholders were concerned that we wouldn't be able to deliver second doses in time. We're managing our stocks, in particular the Pfizer vaccine, to make sure we are delivering second doses. So, that's a key feature in our response. 

And you talked about partnerships with community pharmacy in particular and about the challenge of delivering second doses. Actually, we'll need community pharmacy to come on board not so much to deal with second doses but, actually, because we expect to see more supply come in, and that means that our current model of being general practice-led, together with mass vaccination centres, will need to have pharmacists and other injectors not just attending at mass vaccination centres, but we're likely to need more pharmacy on board. So, every health board over the next month will be bringing more community pharmacies on board to help deliver the programme as the scale expands outwards again to deliver the pace that we all want to see. 

Now, on your question about people living in Wales who aren't ordinarily registered here or aren't registered with a GP, we've been very clear that we'll vaccinate anyone who is in Wales, so students and others can be vaccinated. On your example of people delivering care, I've had this instance brought to me before, and the starting point should be that people should try to get themselves registered as a temporary resident with a local general practitioner, because part of the challenge to the health service is that if we don't know that someone is here, then we can't vaccinate them. Once we do know that they're here, then we'll provide a vaccine. There won't be any attempt to try to screen people out, and I've had the individual example you were giving raised with me. It's a relatively small number of people, but it's important that they're protected, and that would make a difference to the people that they're caring for as well.

In terms of comms for lower uptake groups, we can't really judge the success of that yet. I attended a meeting hosted by the constituency Members for Newport, Jayne Bryant and John Griffiths, with the health board and others last week. That had a good attendance from local faith leaders and members from local communities, and our challenge is that each step outwards that we make gets more people engaged and, actually, the feedback from people delivering the programme is that every time they engage with people who are reluctant, they have a very high success rate of people who are then prepared to take up the vaccine. And I really do think the work that lots of our doctors and other healthcare workers are doing, in going back to the communities that they come from so that there is that trusted professional face, is actually really helping to make a difference—Muslim Doctors Cymru being a very good example. There are others too. And that work is making a difference. It's also important to recognise that the role of faith in some of our communities is stronger than in others. So, having local imams and lots of church pastors, where lots of African and Afro-Caribbean communities attend to, having them being positive and on board makes a real difference in terms of people coming forward, just as, if those figures are expressing hesitancy or concern, it helps to move things in the other direction. So, I don't think just yet we can really judge the success or otherwise, but it is something that I am very keen to keep a watching eye over, because we're largely talking about groups who have a higher rate of mortality and harm from COVID as well.

On your broader questions about, really, the COVID control plan and where we're going to be able to go with our three-week reviews, it's always a balance, and, when we originally set out the COVID control plan, we were dealing with a situation pre the Kent variant. So, we now know that we have a variant that is dominant across Wales that is much more contagious, and that has an impact on the R figure of between 10 per cent and 50 or 60 per cent. So, we have to think of the current levels that we've got and the ability for that to increase further. That's why we've had this scientific evidence and public health advice that we have about schools opening on a phased basis. They continue to be our priority. But we also have some advice that says we have an extra element of headroom available, and we'll need to consider how to use that in a cautious manner to allow other areas of activity, whilst we are committed to phasing the re-opening of face-to-face learning in schools and colleges, but to do so in a way that doesn't compromise our ability for all learners to return to face-to-face school and college immediately after the Easter break, as you've heard the education Minister indicate is her preference, and indeed the preference of the Government. So, we're going to continue to set that information out in a way that makes sense, from myself, the First Minister and other Ministers, and you can expect a proper update at the end of the next three-week review, to give you and the rest of the country more certainty on the next steps out of lockdown.

The Deputy Presiding Officer took the Chair.

Thank you. We'll try again now, then. Rhun ap Iorwerth.

Thank you very much and welcome back, Deputy Llywydd. If I may ask for some clarity on two particular areas, the first is vaccination for unpaid carers. We got some clarity from the First Minister a little earlier—I was pleased to hear that—in terms of the process of deciding which carers will qualify for a vaccination in priority group 6. It's clear that those carers will have to make an application themselves through an online form to be considered for that. I note that the onus here is on the carers themselves to make that application, where other priority groups receive the vaccination automatically, and that's unfortunate, I think. I think that international experience suggests that the more people have to opt in then the lower the percentage that actually access the vaccination. So, could we have some more detail as to how that process is to work, and how swiftly do you think you can deal with appeals when people are rejected to be on that priority list?

The second issue—. I've lost this argument, it would appear. My argument is that people in public-facing roles should be prioritised along with others as the vaccination process deals with people on an age-based basis. I know that the older you are, the more likely you are to become very ill, but there is clarification here that the JCVI has considered a number of factors. Age is the most important, according to them. They've looked at gender, ethnicity, socioeconomic status, according to the statement. But there's another question here: where is the coverage for exposure, the likelihood of one actually catching COVID? I know that most people who are likely to become very ill or worse have already been vaccinated, but are you saying, therefore, that it doesn't matter if young people get COVID? I think it does matter, and that we should try and prevent young people in public-facing roles from catching COVID. Can you explain whether long COVID and the impact of that has been taken into account as part of the equation here? Also, of course, there is very encouraging research that suggests that the vaccination makes it less likely that you pass the virus on to others. Well, if so, then it makes sense, once again, for those people who are in public-facing roles to have received the vaccination earlier, even if they are a little younger. Thank you.

Yes, thank you for those questions. I'll deal with unpaid carers first. We published guidance last week on unpaid carers and I think that's brought a large amount of clarity, and the online form, which we have worked with national carers groups to agree, that should provide a more generous understanding of who an unpaid carer is than some of the initial guidance from the JCVI, which has subsequently been clarified, of course. We're not just dealing with people who have carer-related benefits, because, of course, unpaid carers aren't necessarily going to be in receipt of those benefits. We know that lots of unpaid carers don't want to make themselves known, despite the fact that, in the legislation we've passed, we've had a specific recommendation on carers' rights and their own right to an assessment. So, the information that local government will hold on who they've undertaken those carer assessments of gives us a good starting point, but, actually, in itself, wouldn't have been complete. We could have faced ourselves with the situation of having people already on a list and then excluding everyone else, and we know that that would have provided a significant injustice to a wide range of people. So, we've developed a process where people can go through that to then be placed on the list. Once they complete the online form, which will be available across Wales by Monday at the latest, that will then mean that their names will then go forward into the Welsh immunisation system and that will then generate appointments for them.

We have this challenge—. I understand the suggested point that asking people to opt in isn't the same as taking information from a list. Well, actually, part of our challenge is that the NHS doesn't know who every unpaid carer is. The NHS knows how old you are, but it tends not to know exactly what you do, whether for your paid employment or, indeed, for an unpaid caring activity. That's why we do need an opt-in process. And we are, of course, relying on people treating the process as they should do, with integrity. The form asks you to go through a series of questions about your caring role and responsibilities. It's possible that some people could try to navigate their way through that to push into priority. It would mean that they would have to be persistently dishonest in doing so. I think that the reality that some people may choose to do that should not mean that we take a more exclusionary approach that would otherwise exclude lots of unpaid carers from going into priority 6 to get their vaccines, and, as I say, we've worked through this with carers organisations.

On your point about the JCVI and the advice, we're doing what I think the public expects us to do, broadly, which is to follow the science and the evidence. And we've had this independent expert advice; we've followed it previously on all of our other immunisation and vaccination programmes, and it would be an odd thing to say that we've heard the science and the evidence, we've had the clear public health advice, but we decided not to follow it. Because the reality is that if we choose to prioritise different groups of workers, we have to deprioritise other people. So, it doesn't matter which group of workers you put to the top of the list for the next phase, you have to say to other people, 'Your turn is going to come later.' And the advice we have is very clearly based on how do we have the maximum impact on preventing significant ill health and potential mortality from COVID.

This isn't about saying that young people don't count, but it is about recognising the scale of the risk factors, which are set out very clearly in the scientific evidence and advice that we've had from the JCVI. And I guess it depends on whether you want to follow that evidence and advice or if you want to take an alternative approach. I'm very much committed to following the evidence and advice, and it is the case, as I said in my statement, that the JCVI did consider occupational exposure. That was considered and they still came out with what I think is very clear advice that we should take an age-based approach to roll-out, with the quickest way to protect people to complete the adult population programme. The danger, I think, is that if we chose, despite that advice, individual groups, it wouldn't just be throwing the science aside, we'd be making value judgments on which groups of essential workers are more important than others. Should we say that postal officers, postal workers, are not as important, or that retail workers aren't as important, when, actually, there isn't the evidence to say that those people shouldn't be prioritised? Should we take other key workers in but not take public-facing transport workers, who've had high levels of mortality from COVID? So, it's not as simple an issue as some of the campaigning suggests.

I understand why people campaign for people like them to have priority in the vaccination programme, but think of it this way: if you're a teacher and you're 25, and you're not in one of the groups with an underlying health condition that would put you into groups 4 or 6, then your risks are significantly less than a teacher who is 45 or a teacher who is 55. A 55-year-old teacher, and there are many of them, is already covered in groups 5 to 9. A 45-year-old teacher will come first in the next cohort, once we've completed groups 5 to 9. That doesn't mean that a 25-year-old doesn't matter, but it does mean their risks are less, and that's the point. On a population programme like this, we need to act on a basis that accounts for those risks across the population to reduce the amount of harm, to maximise the positive impact the vaccines will provide. That's what JCVI advice gives us the evidence for and that's the decision that I've made to help keep Wales safe.

I think people across Blaenau Gwent and elsewhere join you in thanking the national health service and the work of Welsh Government in ensuring that the vaccine programme is progressing so quickly, so efficiently and so effectively, both in terms of first doses and second doses; that's certainly our experience here in Blaenau Gwent.

There were two questions I had for you, Minister, first of all on unpaid carers and, secondly, in terms of those people who are housebound. In many ways, you've already answered the first question, so let me address the issue of patients who are housebound. The impact of the vaccination programme is being felt in all of our communities, and I'm seeing and talking to people here in Blaenau Gwent who have had their first dose, who are waiting and will receive their second dose, and that's having a real impact. But there is a group of people who are housebound, who are unable to reach either the GP's surgery or the mass vaccination centres. I'm hearing increasing concerns from families, mainly, of people who are waiting, who are in some cases quite elderly and quite frail, who have not received opportunities to have a dose yet because they're unable to reach either a surgery or a vaccination centre. Can you ensure, Minister, in your discussions with leaders of the vaccination programme, that we're able to reach everybody equally, so that people who are housebound and by their very nature are some of the frailest people in our communities are not inadvertently left behind?

Yes, I'm happy to address the Member's question, not just today, but I'll also undertake that I'll specifically cover it in next week's vaccination update statement. Because, for example, I took my mother to have her vaccine on the weekend. She would not have got to the vaccination centre without me is the reality of it, so I was happy to do it; I'm her son and I think that's part of what many sons and daughters across the country are doing. As we were leaving the vaccination centre, I saw someone who I assume was a daughter of someone who was then walking in with a very impressive animal-print walking stick going in to have her vaccine as well. So, it's not unusual, and that's an entirely reasonable reason for people to travel and to be with people they otherwise wouldn't be.

I do, though, recognise that, in rearranging my mother's appointment, there was a time to get through and to rearrange, but anyone who is offered an appointment at their GP surgery, or in an alternative local or mass vaccination centre and who can't get there, there is the opportunity to rearrange, and I want to reinforce that. If people can't get there, they shouldn't worry or not attend and think their opportunity has passed them by. We're definitely taking a leave no-one behind approach. So, if that appointment has passed and people do want to call to rearrange—them or a family member—they can do that and we will arrange a different opportunity.

We have teams of people undertaking vaccinations for housebound people. Next week, I'll make sure that I do give an update on the progress of those teams doing so, but also to reiterate how people can go about doing that if they are concerned. I think it's a fair point, and I want to reassure people who find themselves in the position that the Member for Blaenau Gwent has highlighted.

Minister, one of the other big impacts of the vaccination programme, which has been so successful here in Wales and across the UK, has been the falling number of people with COVID in our hospitals. I've noticed, though, that, on the latest sets of data that are available, it would seem that the proportion of hospital beds that are taken up by COVID-positive patients in Wales is still much more significant than they are in other parts of the NHS in England, Scotland and Northern Ireland. This would imply, potentially, a number of things. It could be that we just have people staying in hospital longer because they are older and frailer, or could have some more complex needs than the patients elsewhere in the UK. It could mean, of course, also that we have a problem with hospital-acquired infections. I don't know. I just wonder whether this is something that the Welsh Government has considered, and if you don't know the answer, whether that's something that you could provide some information to Members on in the future, given the fact that it doesn't look as though the number of patients in our hospitals with COVID is coming down at quite the same rate as other parts of the United Kingdom.

It's hard to give a definitive response to the Member's question because I haven't reviewed the data for other parts of the UK. And indeed, you'll see variation, in particular in England, because England is a big country, and we know there's significant variation within English regions. The south-west of England has still had the lowest impact of COVID throughout the pandemic; other regions of England have been hit much harder as well. So, I think we need to look at not just national data, but, for England in particular, the regions of England to understand what a comparison would look like. It's probably best to do that by asking our Government statisticians in knowledge and analytical services to look at something, and I'm sure that in a future publication they can publish something that does compare the picture.

In Wales, it's broadly good news that we see a reduction in hospital admissions. The significant number are people who are recovering from COVID, but still need acute care, and we still see 110 per cent of our critical care capacity being used. The percentage of those who are being treated for COVID has been reducing, which is very good news, but it does still show that our NHS is under significant pressure. So, we're not at the point where we can open up a pathway for renormalising lots of treatment, because we don't have the capacity to care for all those people. It is a broadly improving picture, but still, nevertheless, being just below 1,500 people in our hospitals being treated for COVID does show something of the significance of the impact and the scale of the capacity that is still taken away from the way that our NHS would normally function, even if we then had to go on to consider the additional infection prevention and control methods. But I'll take on board the point the Member makes seriously, and I'll see how we can provide a properly comparative view on this.

And finally, Mark Isherwood.

Diolch. With several constituents in places like Llangollen asking me, 'If the fall in vaccine supply the Minister referred to last week has been felt by all health boards, why is it that England and south Wales are seeing consistent and indeed increasing vaccination numbers as ours locally fall?', how do you respond to the constituent who stated, 'My wife falls within target group 6 and I fall within target group 7 for vaccination against COVID. Would you please ask the Welsh Government why, to date, 49,994 people within group 8 and 43,648 within group 9 have been vaccinated ahead of us?'

And now that unpaid carers who are eligible for a carers allowance, or those who are the sole or primary carer of an elderly or disabled person who is at an increased risk of COVID-19 mortality, and therefore clinically vulnerable, have been added to vaccination priority group 6, how do you respond to the constituent who asks, 'Can you get a register discussed from a medical perspective for the unpaid carers added to group 6, because given not all carers claim the allowance, either due to working, studying or they're unaware, there are a lot of people who will fall through the cracks?'

Okay. So, I just want to be absolutely clear that the fall in supply that we've transparently highlighted, that we're expecting to see resolved from the middle of this week onwards with increased supplies, has meant that we have allocated the vaccine supply available to us on a properly proportionate basis to every part of Wales. It is absolutely not the case that any one region of Wales has been preferred over another, it's absolutely not the case that any one region of Wales has somehow been treated less favourably. I do find it rather depressing that even at this stage in the pandemic there's still an appeal to a special treatment being provided to other areas of the country. It just simply isn't how we've approached all of the really difficult choices and challenges we've had through the pandemic. And I think that appeal to blaming bad people in different parts of the country and preferring their own as opposed to taking a national approach doesn't help any of us.

On the challenge of carers allowance and unpaid carers, I think I've dealt with how we're dealing with unpaid carers at some length today, with the guidance we've issued last week, with the online form that will be available across the country by Monday at the latest, and the fact that that is a generous approach, to understand who unpaid carers are. And once they're entered into the Welsh immunisation system, they will then have an appointment generated for them, including their second appointment.

We are in a different position on carers allowance recipients in this regard, and that is that, if you receive carers allowance, then that entitles you to receive the vaccine. The challenge we have, though—and this is a point of some irritation and frustration to me; I don't think it's an acceptable position—the challenge we have is that the Department for Work and Pensions are delivering, to colleagues in NHS England, their list of recipients of carers allowance first before providing the same information for Wales. I've made it clear that I don't think that's acceptable. The Department for Work and Pensions, in this instance, are not an English Government department; they're a UK Government department with similar responsibilities for every part of the union they administer for, and I don't think it's acceptable that people in Wales who receive carers allowance won't have their appointments generated because the Department for Work and Pensions have chosen not to deliver that information to Wales on the same timescale as England. The positive, though, is that I do think that, as soon as that information is available to us, we'll be able to generate those appointments very quickly. I understand that people who are in receipt of carers allowance may be frustrated at even a marginal delay of another few days more, but once that information is available from the Department for Work and Pensions, we will then generate those appointments for those people to make sure people get their vaccines swiftly and on time. And I think we're in good shape to complete priority groups 1 to 9, including all of the carers we've discussed today, by the middle of April. Thank you, Deputy Presiding Officer.

Thank you, Minister for Health and Social Services.