The following amendments have been selected: amendment 1 in the name of Rebecca Evans, amendment 2 in the names of Mark Reckless and Gareth Bennett, amendment 3 in the name of Caroline Jones, and amendment 4 in the name of Siân Gwenllian. If amendment 1 is agreed, amendments 2 and 3 will be deselected. If amendment 2 is agreed, amendment 3 will be deselected.

We now move on to the Welsh Conservative debate on NHS waiting times, and I call on Angela Burns to move the motion.

Motion NDM7626 Mark Isherwood

To propose that the Senedd:

1. Notes that 1 in 5 patients are on a waiting list and over 2,000 people have waited longer than two years for treatment.

2. Recognises that over the last five years 5 out of 7 health boards have been in special measures or targeted intervention.

3. Believes the Welsh Government has held back the Welsh NHS.

4. Calls on the Welsh Government to urgently publish a recovery plan for the Welsh NHS which will:

a) clear the backlog in treatment and ensure that no-one has to wait more than one year for treatment;

b) recruit at least 1,200 doctors and 2,000 nurses to reduce waiting times; and

c) transform mental health by treating it with the same urgency as physical health.

Motion moved.

Thank you, Deputy Presiding Officer. In moving this motion today, I wish to start by expressing how grateful we are to the staff of the NHS. From front-line medics to back-room managers, they've held the line and delivered care and support to many individuals and families during this dreadful time. Without doubt, the NHS has been put under immense pressure by COVID, but the truth is that the NHS was under immense pressure before the pandemic. There needs to be not only a route out of the current situation, but to look and to ensure that the Welsh NHS is both well resourced and truly enabled, because the NHS needs more trained professionals and the freedom to innovate, it needs investment in primary care, strengthened secondary care, better IT and a plan for social care and mental health, and we need to be able to slash those horrendous waiting times.

I don't underestimate the uphill battle this will be. Let us remember that the Welsh NHS was in a weak and vulnerable position before COVID-19, as a result of poor decision making over the last 20 years by a succession of moribund Labour and Labour-Liberal and Labour-Plaid Governments. One such area that was badly affected is recruitment. The workforce is the backbone of the NHS, but Welsh Government has relied on goodwill, overtime and agencies to plug staff shortages, rather than implement a proper workforce strategy. According to the Royal College of Nursing, there is an estimated absolute minimum of 1,612 nursing vacancies, let alone doctors, physios, speech and language therapists, occupational therapists and mental health specialists. In 2019, Welsh Government commissioned a health and social care workforce strategy, two years later, where is it? Nowhere. In order to fund an increase in workforce, the NHS must be properly funded. Yet, the Welsh Labour Government holds the dubious honour of being the only Government in the UK to ever cut the NHS budget in modern times by some £800 million. They've also underfunded the social care system and allowed an unforgivable fragility to develop in the sector. Welsh Government expects older people to pay twice for care by looking to introduce an age-related social care tax, both unfair and ageist.

And let's turn to waiting times, terrible before the pandemic, horrendous now. Before the pandemic, waiting times had trebled for those waiting more than 36 weeks for treatment. Before the pandemic, the Welsh Government failed to meet its own target times for treatment. Before the pandemic, the 95 per cent target for patients spending fewer than four hours in A&E had never been met. Before the pandemic, cancer waiting times had not been met for a decade. Before the pandemic, the target of patients waiting fewer than 26 weeks for treatment hadn't been met for 10 years. Before the pandemic, the target for patients waiting fewer than—.

Sorry, you've disappeared, Dirprwy Lywydd. I don't know if you've lost me. My apologies, the Deputy Presiding Officer disappeared, so I thought perhaps I had disappeared. You may wish I had, but unfortunately, Minister, I'm still here.

The Llywydd took the Chair.

Carry on. 

Before the pandemic, mental health services were struggling with a backlog of inquiries. Wales had the third highest rate out of English and Welsh regions for female suicide and the fourth highest rate for male suicide. And this is the problem, Minister; we have a health service in Wales that was already underfunded and struggling before COVID hit. 

During this Welsh Parliament term, five of the seven health boards have been under some kind of Government intervention, and Betsi, despite your recent announcement, is still struggling to show signs of real, long-term, sustainable improvement. And there were other areas over the past five years where you've promised much but failed to deliver, such as a mother and baby unit for south Wales and a gender identity clinic for Wales. So, we're calling on your Government to urgently publish a recovery plan for the Welsh NHS. It must include three key commitments: clear the backlog in treatment and ensure that no-one has to wait more than one year for treatment, going forward; recruit at least 1,200 doctors and 2,000 nurses to reduce waiting times; and transform mental health by treating it with the same urgency as physical health.

I am not convinced you can deliver this. The Welsh health service now needs new leadership, and I'm delighted with the plans that my party, the Welsh Conservatives, have to take things forward. A Welsh Conservative Government would have a COVID-19 management plan, which would appoint a dedicated COVID-19 recovery Minister in the Welsh Government to oversee all areas of coronavirus recovery, including the vaccine roll-out. We would support people experiencing the long-term effects of COVID-19 by establishing clinics dedicated to treating long COVID. We would urgently establish routes to support for people suffering with mental health problems from the pandemic, especially NHS staff and care workers, because they've been providing palliative care, and those who suffered bereavement who were not able to say goodbye to loved ones. We will address the chronic deterioration in waiting times over the last 12 months and begin to ease the recruitment crisis in the Welsh health service with our 'recruit, retain, retrain' policy. For too long, mental health services have also been the poor relation, and it is time that mental well-being was given the same prominence as physical health.

Minister, we want to build back better, we want to provide the Welsh NHS with the support that it needs and we don't want more of the same. I look forward to hearing the contributions to this debate today. I would urge Members of this Senedd to back this motion. Thank you. 

I have selected the four amendments to the motion. If amendment 1 is agreed, amendments 2 and 3 will be deselected. If amendment 2 is agreed, amendment 3 will be deselected. I call on the Minister for Health and Social Services to formally move amendment 1 tabled in the name of Rebecca Evans. 

Amendment 1—Rebecca Evans

Delete all after point 1 and replace with:

Recognises:

a) that despite this challenging time, through additional support, and dedicated NHS staff, four health boards have reduced their escalation status, and we now have one health board in special measures and one in targeted intervention;

b) the impact the pandemic has had on the health service in Wales and across the world;

c) and acknowledges the outstanding contribution of all health and care staff during the pandemic; and

d) the need for a clear recovery plan to include all areas of health services such as mental health, to ensure parity between physical and mental health.

Amendment 1 moved.

Formally, Llywydd. 

Thank you. I now call on Mark Reckless to move amendment 2 tabled in his name.

Amendment 2—Mark Reckless, Gareth Bennett

Delete all after point 2 and insert:

Believes that devolution has held back healthcare provision and outcomes in Wales.

Calls for an integrated UK-wide approach to healthcare with one National Health Service.

Amendment 2 moved.

I move our amendment formally. Diolch, Llywydd, for selecting our amendment, which we're grateful for. I reiterate what Angela Burns said around thanking the staff. On our amendment, we believe that it's devolution that's held back healthcare provision and outcomes in Wales. The Conservative motion refers to the Welsh Government having done so, but of course there only is a Welsh Government because of devolution. 

On waiting lists, yes it was a poor comparison before, and clearly there has been a huge increase in waiting lists due to COVID, and I think it'll take a while before the data and proper understanding of that shows the relative impact of that in Wales and England. I think one of the difficulties we have is it's become harder over the course of devolution to make fair comparisons between outcomes in England and Wales, but those that we have seen I don't believe read well for us. Although, overall, the level of spending is still somewhat higher, it is less so relative to the amount of spending we have with the spending floor and that greater degree of spending within that. The health service has been relatively de-emphasised, including that real-terms cut in spending. We would like to see an integrated, UK-wide approach to healthcare with one national health service. That vision of Aneurin Bevan initially when he created that service; it's now been balkanised and split apart.

We would like to have IT systems that are properly integrated, we would like doctors to be able to refer patients to hospitals or care in England on a fair and equal basis to how they can do so in Wales, simply looking at medical need. However, I don't pretend that that will be a panacea for what we have with the health service at the moment. I would say that the amendments and the motion we have today—even our own amendment—are at the margin compared to the crisis that we have in our health system because of COVID and because of the huge backlog of work that has developed, and I'm afraid it's still developing while we've been focused on COVID. In the motion, we are told by the Conservatives that the Welsh Government should urgently publish a recovery plan for the Welsh NHS that will clear the backlog in treatments. I'm afraid it is a very, very wide gap between the Welsh Government publishing a plan and clearing the backlog of treatment. I think that applies whether we're talking about the NHS in Wales or England or Scotland, despite their somewhat different structures. 

We welcome the change in the English NHS with the purchaser-provider split eroding, partly because we think it makes it easier to reintegrate the NHS on a UK—or at least an England and Wales—basis. But the amount of people who are now waiting and how long they are waiting and how that's still getting worse—that change is so large compared to where we were before. It is, I fear, not realistic to think that we are anytime soon going to erase that backlog of treatment, or that the mere publication of a plan for the Welsh Government would do so. I think one really serious challenge for the Welsh Government, as elsewhere in the UK, is linking up that strategy of what happens to the top level to actually trying to clear those backlogs and do so with decent outcomes at the front line. Whatever the structures we have within our NHS, how they work and link together I'm afraid will not necessarily be as it was before, given the huge scale of the challenge we face, which I fear will carry on for several years at a minimum. I think that will be the case whatever the changes we propose, however much we believe our own at the margin may improve things, and I recommend our amendment for that. The scale is absolutely huge.

I call on Caroline Jones to move amendment 3 tabled in her name. Caroline Jones.

Amendment 3—Caroline Jones

Delete all after point 2 and replace with:

Regrets the fact that more than 23,000 UK-domiciled applicants failed to gain nurse training places last year and that, since 2010, more than 54 per cent of UK-domiciled applicants to nursing courses have been rejected.

Believes the Welsh NHS has been held back by both the UK and Welsh Governments due to a complete lack of workforce planning over many decades.

Calls upon the Welsh Government to:

a) work with UK higher education providers to provide more medical training places to UK-domiciled students;

b) work with the royal colleges and professional bodies to assess the true staffing needs of the Welsh NHS;

c) recruit sufficient doctors, nurses and healthcare professionals to address the massive backlogs in treatment waiting times as well as diagnostic waits;

d) ensure that no one will wait more than 12 months for treatment;

e) transform mental health by ensuring it has equal footing with physical health.

Amendment 3 moved.

Diolch, Llywydd. I move the amendment tabled in my name. Before Christmas and for five weeks after, my husband was critically ill in hospital with coronavirus and he saw first-hand the stress on all NHS staff. We owe them a huge debt. We have discussed many times the need to recruit and train doctors and nurses from the local population, and here in Wales, this is doubly important, because of the need to increase the number of staff in the NHS who can speak Welsh. I was therefore dismayed to read the report by Migration Watch UK, which, using UCAS figures, uncovered the fact that 23,300 UK-domiciled students were rejected for nursing courses at the height of the pandemic. The report also highlighted the fact that over half of all UK-based applicants for nursing courses have been rejected in the past decade. Against this backdrop, both the Royal College of Nursing and the Nursing and Midwifery Council have been warning of nursing shortages and the impending disaster of an ageing workforce.

All of the royal colleges and medical professional bodies have warned Governments of staff shortages, but instead of addressing the issue by training and recruiting young people from the UK, successive Governments both here and at the other end of the M4 have relied upon training and recruiting from overseas. Not only is this lack of workforce planning short-sighted, it's also unfair to the developing world, as we are poaching their talent and their much-needed doctors and nurses. We are extremely fortunate in that we have the virus on the back foot, and should have our entire population vaccinated by summer. The rest of the world are not as fortunate. The Indian subcontinent and south-east Asia will need their medics more than we do as they continue to deal with COVID. Is it fair that we poach these staff? We have to become more self-reliant for our doctors and nurses. We must ascertain the true level of staffing needed by working with the royal colleges and professional bodies, and then train, domestically, sufficient staff to meet the demands of our ageing population. Otherwise, we will forever be at the mercy of winter pressures and woefully unprepared for any future pandemic. Diolch yn fawr. Thank you.

Rhun ap Iorwerth now to move the amendment in the name of Siân Gwenllian.

Amendment 4—Siân Gwenllian

Add as new point at end of motion: 

Believes transformation of health and care can only be secured through:

a) a new focus on preventative measures; and

b) seamless integration of health and social care through a new integrated national health and care service.

Amendment 4 moved.

Thank you very much, Llywydd. My contribution won't be very long to this debate. I want to take this opportunity once again to thank everyone who is working so very hard on our behalf across health and care services in all parts of Wales. The willingness of staff to go that extra mile time and time again over the past year is something that each and every one of us has appreciated, and I hope that it has provided a renewed focus on the challenge facing us.

So, to move to the motion. Although I am quite sure that the Conservative Party, who brought the motion forward, will bring a new series of very deep problems to the NHS if they ever get their hands on it, what we have in this motion is a description of an unsustainable health service—a health service that has been made unsustainable, I'm afraid, by the failure of a series of Labour Ministers to give the health and care landscape in Wales the kind of stability and support that it needs. Those committed staff that I referred to have had to carry more than the burden they should have carried due to that unsustainability and lack of support.

That hasn't always meant lack of financial support. There is no doubt that many years of cuts imposed by the UK Government have made public service budgets more vulnerable, but we still see what percentage of public expenditure in Wales is spent on the health service. However, there is more to it than simply the financial. What we have here, I think, is a failure to have transformed health and care, and the time has come, in my view, to do that. I look forward to seeing a Plaid Cymru Government grappling with this issue.

So, what is that transformation that we're seeking? I refer to the amendment tabled in the name of Siân Gwenllian, and I formally move that amendment. We must have nothing less than a revolution now in terms of preventative care. We have to create a society that is healthier. We have to create a regime that identifies diseases far sooner, and prevents them from developing. I want to be at a point where health funding can be used to build sports facilities. That's the kind of sustainability that I am looking for, ultimately, and we have to set that target for ourselves. I can see the Minister, Dafydd Elis-Thomas, shaking his head—he doesn't want to see funding spent on sports facilities and the preventative benefits that they bring. You'd be welcome to make an intervention to this debate, Deputy Minister.

We've also reached a point where we do have to see a real integration between health and social care, and our aim is to create an integrated national health and care service. It will be delivery at a local level. It won't mean huge structural change at a local level, but it will mean the introduction of clear frameworks for health and care, and how they interact. I appreciate the ambition by the Conservatives of employing 3,200 additional staff. We in Plaid Cymru have been talking for years about the need for an additional 6,000 doctors, nurses and other healthcare professionals. That's what we must introduce over the next few years in order to provide that sustainability.

Of course, that comes at a time of unprecedented challenge following a year of pandemic, and yes, that makes the challenge even greater, but the catching up now has to go hand in hand with transformation, and we can't at any stage decide to postpone the transformation that we need to see happening in health and care because of the pandemic. It means working smarter for years to come, because the point has now come where we need a real revolution in Wales. 

Across Aberconwy, we have a clear message: the sun will once again shine. Thanks to the work of NHS staff, we've had hope and light throughout the pandemic. Thank you all very much. 

Thank you. Of the 0.5 million patient pathways waiting to start treatment in December, 21 per cent are here in north Wales. Of the around 0.25 million pathways waiting over 36 weeks, over 51,000 are here in north Wales. That's up 347 per cent since the start of the pandemic. Clearly, Betsi Cadwaladr University Health Board is in desperate need of a recovery plan. In fact, I recently disclosed that one consultant has over 450 patients waiting for orthopaedic treatment.

However, the north Wales situation is unique. Not only do we need a recovery plan because of the devastating pressure caused by the pandemic, but one that takes us to a better position than ever before, as it is fact that since 2015 the board has remained under direct Welsh Government intervention. In June 2015, Mark Drakeford, the First Minister—he wasn't at the time, but he is now—placed the health board in special measures, reflecting serious concerns about the leadership, the governance, mental health services, reconnecting with the public and other areas. Last week, the Minister for Health and Social Services set out four key areas that require improvements: mental health, strategy planning and performance, leadership and engagement. So, five years and nine months on from the commencement of special measures, we are basically back at square one. 

Now, whilst I appreciate that the targeted intervention plan is backed by £297 million up to the end of 2023-24, how can we be confident that those improvements that have been identified as needed will, in fact, be secured? In 2019, I disclosed that the Welsh Government had spent £83 million on propping up this health board, but what was achieved? The interventions have failed to deliver for our staff and for our patients. In the interest of the recovery and improvement of our health board, I would ask that a plan is delivered that shares the huge long-standing treatment burden with other boards across the UK, champions schemes like the new post-anaesthesia care unit at Ysbyty Gwynedd, plants the seeds for improved giant beanstalk-size growth in recruitment through maximising the potential for a north Wales medical school, and sees a dedicated mental health worker teach GP practices across Wales. 

Llywydd, the new chief executive of the Betsi Cadwladr University Health Board is now in post, and I have great hopes going forward that she will be able to turn this board around. We've had several previous to her and we've had several promises, but one of the reasons that brought her to the board—and she makes no secret of this fact—was the fact that she herself was let down when there was an incident within her own family. So, she knows first hand how we have to get these things right. I would urge anybody going forward after May here, in particular in north Wales, that change is brought and it's brought quickly. That would at least bring some further light to the lives of staff and our patients here in north Wales. Diolch. 

I'll try and keep my contribution short, but I have to express my huge disappointment at Mark Reckless's contribution, once again trying to put the NHS back in the hands of Westminster and towards a Government that wants to privatise rather than serve the people of Wales. I'm also very disappointed in how Caroline Jones's efforts to comment upon these contributions from overseas workers and overseas health professionals seems to be more focused on sending them back home than actually helping them to help our people, and I think that's very critical. I want to also put on record my great thanks to the staff of the NHS who have been tireless in their commitment and dedication and compassion to our people who have been needing that service, particularly those who have been in hospital with severe conditions through COVID. We can never give enough thanks to them. I won't talk about the pay rise at this stage, but they deserve far more than actually they have been recognised for at this moment in time.

Llywydd, I have spoken many times on the topic, and I recognise that there is deep concern about these statistics that we are seeing and that we need to take action to support our health service increase services to both reduce the waiting lists but at the same time address the immediate needs of patients who present themselves in the future, because we are moving out of the pandemic and into a period where we have to catch up, but we also have to continue delivering to those who present themselves there and then. There is no doubt that in addition to the waiting lists that we are aware of—and that's the people who have already been placed on waiting lists—there are going to be many more who have failed to present themselves, whether that's because the pandemic has worried them about attending their GP or whether symptoms have been confused with the coronavirus. I, myself, before Christmas, presented myself with shortness of breath, was told to go and get a coronavirus test—negative—and I ended up actually having to go into hospital with blood clots on the lungs: a condition that needed to be addressed. There are many people out there who are perhaps more hesitant to present themselves, and they will come forward, and therefore our waiting lists are going to increase. That wave of people, I think, and the large number—I think it's a tsunami—of waiting list people has to be addressed.

Pre pandemic, we were making positive progress towards reducing waiting times in most areas. In 2019, we saw less than 1,000 people waiting over 24 weeks for nine out of 12 months in all diagnostic services. Now, the majority are waiting under eight weeks. The total figure in 2020, in December, had only increased by 14.5 per cent on the previous December, but what we saw was a greater shift from those who were waiting under 26 weeks to those who are now waiting over 36 weeks. So, a large shift and a change in the length of time that people are waiting. In fact, we saw a 748 per cent increase in that change. So, there's definitely a move from shorter waiting lists to longer waiting lists. Everyone on these waiting lists needs that treatment and our goal must be to challenge the Government to set out its plan to address these figures. COVID-19 unfortunately has made that even more difficult in how we manage those patients on the lists as required, because this is across the UK, and therefore some of the options and alternative available waiting list initiatives are taken away from us because hospitals in England, services across the UK, are going to be facing exactly the same challenges we are facing, and therefore the modelling of approaching the waiting lists has to be changed. We have to look at new models. Now, let's remember as well, please, our NHS staff are exhausted, and we must ensure they recover too, alongside the waiting times, so that we will be in a position to deliver a resumption to the full provision of health services, along with the preparations for additional waves that the viruses and—[Inaudible.]—will bring upon us in the years ahead.

Now, there is positive news. We have seen an increase in training places over recent years, and the take-up has been good, and we need HEIW to reflect the workforce needs to establish additional training places and work with health boards and GPs so that we get the places they can go into get their experiences. That's very important, because very often we talk about large numbers, but we forget: how can they be managed when they go into those work placements? Especially for nurses, we must make sure there is sufficient support there as well, and the staff have sufficient time to give that support. There's a lot of consideration to be given, and I welcome today's announcement from the Welsh Government that they are looking to add additional funding to the north Wales medical training aspect. So, there's a process, but there is still far more to be done on that. I ask the Welsh Government: please ensure that you increase the GP training places, you increase the doctor training places, you increase the nurse training places, and all the allied professions. I know it's difficult. I know there's an issue on funding. But we have to get these people in place. We—

I will have to ask you to draw to a close. Excellent, thank you.

I'll close there, Llywydd.

Thank you very much. Paul Davies.

Diolch, Llywydd. According to the Welsh Government's latest statistics, in December 2020, there were 25,182 people waiting over 36 weeks for treatment, compared with 726 people waiting for the same length of time in 2019 in the Hywel Dda University Health Board area. That's a snapshot of just one area of Wales, which shows an eye-watering increase in the number of people desperately waiting for NHS treatment. And as Members have already said, behind those figures are real people living anxiously and in some cases, in severe discomfort and pain. 

Now, during that time, the COVID pandemic has meant that the focus of the NHS has been to tackle the virus and its impact on our people and communities, and we all have to accept that the pandemic has had a very real impact on our health services and their ability to carry out elective surgeries and routine treatments. That's why there were calls last year for COVID-free hospitals to be established so that some progress, at least, could be made in tackling the increasing backlog in treatments across the country. However, we're now at a point where the vaccination programme is making significant progress in Wales, with more and more people vaccinated every day, and that's why it's crucial that the Welsh Government now publish a specific recovery plan for tackling waiting times on the Welsh NHS and provide people waiting for treatment with some hope that the backlog will be tackled and that they will finally receive the treatment that they need.

I'm certainly not alone in receiving correspondence from people desperate to hear when they're likely to receive the treatment that they need, and the lack of information that they've received whilst waiting for treatment has left people frustrated and anxious. Therefore, I hope that the Minister will reflect on that and at the very least, take back to local health boards that there needs to be better communication with people waiting for treatment to explain their position and the local circumstances.

There are also very serious concerns from charities and organisations such as the Wales Cancer Network regarding the capacity of the NHS to deal with backlogs. For example, Professor Tom Crosby of the Wales Cancer Network has warned that an unprecedented tsunami of demand for cancer services is coming. Indeed, we know that more than a third of patients with suspected cancer are waiting too long to start their first definitive treatment, according to the Welsh Government's first set of suspected cancer pathway figures published recently. And those are just the cases that we know about. The pandemic has meant that many patients with suspected cancer have not presented to their GPs, and so there could be further pressure on services as we emerge from the pandemic, as more people report potential symptoms to their GPs. Therefore, for services to be developed for the future to tackle the backlog in treatments, we must also factor the unseen challenges like this, which will have an impact on the future demands on our NHS services.

As the Welsh Government develops its recovery plan for the NHS, there are several issues that it needs to consider when planning the delivery of future services. Firstly, the Welsh Government needs to ensure that the NHS's diagnostic infrastructure is sufficient to meet the future demand as well as tackling the current NHS waiting lists, and the Minister and his officials must reflect on current models of delivery, particularly as things like clinical practice and technology continue to change.

And secondly, in light of the COVID-19 pandemic, I hope that the Minister and his officials are exploring ways in which we can better build resilience within the NHS so that we don't just fall back into the old ways of delivering health services. I believe that there may be scope to look at how we can use the additional capacity developed during the pandemic, such as the field hospital capacity, to help deliver services, particularly in the short and medium terms. And so, perhaps in responding to this debate, the Minister can tell us a bit more about the strategic discussions that he's having about how we deliver health services post pandemic.

So, in closing, Llywydd, it's vital that these issues are seriously considered as a recovery plan is developed for the Welsh NHS, and that a strategy is developed that balances the need to tackle the backlog and also provides enough resilience in the system to meet the challenges of the future. And I would therefore urge Members to support this Welsh Conservative motion. Diolch yn fawr.

The Minister for Health and Social Services, Vaughan Gething.

Thank you, Llywydd. Before the pandemic, we delivered on our commitment to improve access and had four years of continuous improvement in waiting times across Wales. Over that same period, we've worked with our NHS to ensure that health boards and trusts are able to work as high-performing organisations. Four years ago, we had five organisations in the top two escalation levels; now, we have two organisations in targeted intervention.

Like in all countries, the pandemic has made the last year incredibly challenging and held back further improvements in waiting times. We have, however, continued to make improvements in a range of areas, such as delivering between 30 per cent and 50 per cent of out-patient appointments virtually.

COVID-19 has affected, and continues to affect, our ability to treat all patients in as timely a manner as we would like. Many patients are waiting a long time—too long—and this picture is repeated in health services across the world, not just here in the UK. Sadly, I recognise that some patients will worsen in their condition whilst waiting. We are working actively with patients to mitigate, where possible, the impact of these waits. Measures to reduce the risk of harm, led by dedicated clinical leaders, are actively being undertaken.

I've set out previously why our priority must be to respond to the pandemic in a structured and measured way. This involves developing approaches to support patients most in need of planned treatment, whilst balancing resources to meet the needs of other services, like mental health. Indeed, Members have been discussing mental health earlier in today's business. While we have an agreed way forward at health board level to treat COVID-19 and maintain essential services such as cancer, our plans for recovery are being developed. In partnership with our NHS, as Members already know, we are producing a recovery plan, which I will publish before the end of this Senedd term.

The real challenge will be in the delivery of the plan, which will of course take years to achieve. Our NHS and social care are dealing with an unprecedented situation. There is no simple operational—and, indeed, no simple ethical—answer to the enormous challenge that faces us. Both, I believe, are responding magnificently to this once-in-a-century public health emergency. I remain incredibly grateful to our dedicated NHS and social care staff. They continue to demonstrate their professional commitment and compassion.

I will now address the majority of Conservative contributions to this debate. Paul Davies was, I thought, thoughtful, although I don't agree with everything that he had to say. The rest, I'm afraid to say, of the Tories were dripping with insincerity and inaccuracy. It seems to me that—and I believe that our staff know this—on our NHS, the Conservatives are wolves in wolves' clothing. If you really value our staff, then why is the Prime Minister lying about Labour voting against an NHS pay rise—an NHS pay rise that the Tories plan to rip up? The Tory plans to effectively cut NHS pay and starve us here in Wales of the cash to do any more are a kick in the teeth for our NHS heroes. Your actions tell our staff how much you truly value them, and I can tell you that they are angry, and they have good reason to be so.

Here in Wales, we'll continue to balance our recovery efforts and recognise that our staff need time to recover. Whilst we recognise that additional staff across all disciplines will be required, this too will take time. But, as a Government, we have a clear ambition to grow and train our staff, and have an excellent record on supporting health and care staff. We already have a joint workforce strategy for health and social care. We've invested nearly £230 million this year to support education and training for healthcare professionals—the seventh successive year where we have increased funding, and that includes an increase for medical training places. In the last seven years, nurse training places have increased by 109 per cent, midwifery places by 97 per cent, health visiting by 88 per cent, physiotherapists by 81 per cent, and radiographers an increase of 24 per cent. This Welsh Labour-led Government has a track record to be proud of in valuing our staff and investing in the future.

We will tackle the waiting list backlog. It will take time, but we will do it. We will lead a recovery for our whole health and social care system. We will rebalance social care, deliver a new settlement for our staff, delivering greater integration with healthcare in transforming the way that health and social care work together, and we will deliver a health recovery for physical and mental health. Welsh Labour values created the national health service, and it will be Welsh Labour values that will protect our NHS as we finally see the end of the pandemic and rebuild our national health service.

Two Members have indicated that they wish to make a brief intervention, and I will call on Caroline Jones first.

Diolch, Llywydd. I ask the public to listen to my contribution in its entirety, as David Rees has deliberately tried to misinterpret my contribution for his own political gain.

And Mark Reckless.

I'd also push back on David Rees's preposterous characterisation of the NHS in England currently as being one of accelerating privatisation. Clearly, in the late 1990s, the marketisation that we saw in England didn't develop in Wales with devolution, and, clearly, under Blair and Brown, there was quite a lot of marketisation within the NHS in England. But, in the 2010 Lansley reforms, there were some structural changes within the NHS and a legal framework that could have led to more privatisation, but the reality is those reforms were, on the ground, largely undone. Lansley was pushed out; the NHS worked together. There is a lot more co-operation, a lot less of the single market than has been seen before, and now it's proposed to change the law in England largely to remove that purchaser/provider split and make their NHS much more like ours is in Wales currently, which would it make it easier to integrate.    

And Darren Millar now to respond to the debate.

Diolch, Llywydd, and can I, first of all, start by thanking those NHS heroes and heroines across Wales who are working so hard at the moment during this pandemic, and have been caring for patients so well, and indeed have been doing so well in terms of rolling out the coronavirus vaccination programme? It's been a delight to see the NHS in action, with our staff stepping up to the plate and doing what we know they will always do in times of crisis.

I have to say that Angela Burns hit the nail on the head when she opened this debate in making it absolutely clear that the problems in the NHS here in Wales that we have at the moment are not a new phenomenon. These are long-rooted problems that have been with us for some time in terms of people waiting far too long for tests and treatment, with waiting-time targets not met for over a decade on almost every measure. And I think it's a bit rich, frankly, of the health Minister to take a pop at the Conservatives for pointing out the fact that it's your failure, as a Government, to get to grips with the recruitment crisis that we've had in our NHS. You've been in charge of it for 20 years, and we still have a shortage of nurses, a shortage of doctors, a shortage of all sorts of other health professionals.

You made reference to the UK Government's role. Well, I'll point out the fact to you, Mr Gething, that the UK Government has made billions available for our NHS, with huge spending commitments going forward over the next few years, more than sufficient to be able to address some of the challenges that you have outlined. And I will remind you and Members of this Senedd and the public once again: no Conservative Prime Minister has ever cut a national health service budget. Only the Labour Party, the Labour Government in Wales, has been responsible for cutting an NHS budget in the past. And not only was that supported by Labour Members of the Senedd, but of course it was also supported by their little helpers in Plaid Cymru and the Liberal Democrats at the time when it was imposed. And I would ask people to very carefully consider these facts when they head to the polls in May, because I'm afraid that, unless there is regime change in this nation for the sake of our national health service, it will continue to go backwards.

For political reasons, you withdrew the Betsi Cadwaladr University Health Board from special measures. But, as Janet Finch-Saunders quite rightly pointed out, the public in north Wales will not be hoodwinked. Basically, the same material problems are still prevalent in that health board, as identified in your targeted intervention statement just recently, that were there six years ago. So, there's been very, very little progress, and in fact the only bits of progress that have been made have been because tens of thousands of people marched on the streets in north Wales and signed petitions in order to overturn some of the decisions that were being made by the health board that had an adverse impact, or would have had an adverse impact, on patient care here in north Wales.

Now, we're in a very serious situation. We have over 0.5 million people in Wales—that's one in five of the adult population—that are currently on an NHS waiting list. We have to have a plan to put that right. Just weeks ago, Mr Gething, you said it was foolish to set out a recovery plan. 'Foolish' was the word that you used. Well, I'm sorry, it's not foolish to have a strategy in order to claw this situation back, for the sake of people across this country who are living in pain, some of whom are coming to harm, with irreversible damage being done to their health as a result of languishing on these waiting lists. And I would remind you that, in north Wales, even prior to the pandemic, the typical wait for somebody being referred in February of last year for an orthopaedic operation was two years until they were due their treatment. Now, unless you've got a plan to sort that situation out, because it's now approaching three years for many of them, then, I'm sorry, you don't deserve to get any support, frankly, in the forthcoming elections.

So, I would encourage Members of this Chamber today to support our motion, to reject, I'm afraid to say, Mark Reckless's amendment, which blames the failures of the Welsh NHS on devolution. They are not the failures of devolution, they are the failures of the Welsh Labour Party in terms of their management of our national health service and their stewardship in recent years, Mark Reckless.

I recognise very much the points that Caroline Jones made about recruitment, but we will not be, I'm afraid, supporting your amendment today, because, unfortunately, it deletes some other important parts of our motion.

And we will also not be supporting the points made by Rhun ap Iorwerth in terms of the need for a merger of the NHS and social care in Wales. The very last thing that our national health service needs at the moment is another reorganisation, and that's what Plaid Cymru is proposing. That would be a massive distraction in terms of trying to deal with some of these systemic problems. And I'm afraid that in the only part of the UK where we have got these merged boards, which, of course, is in Northern Ireland, the performance in many respects has been even worse than it has been in Wales. So, that's not the answer, and it's certainly not the answer to divert money that should be spent on hospitals and healthcare into sports halls.

So, I'm afraid we've set out our stall: we believe that you need to set out a clear recovery plan to clear that backlog, to recruit more health professionals and to transform mental health care here in Wales. I urge people to support our motion.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Yes, there are objections, and I will defer voting under this item until voting time.

Voting deferred until voting time.

And that brings us to voting time, and therefore I will suspend the meeting briefly to prepare for the vote.

Plenary was suspended at 17:27.

The Senedd reconvened at 17:30, with the Llywydd in the Chair.