Questions now from the party spokespeople and, first of all, the Conservative spokesperson, Angela Burns. 

Diolch, Presiding Officer. Thank you. Minister, your recently published COVID-19 forward plan, I think, is a very fair summary of the situation that we face in Wales today. I think it neatly outlines the challenges that are faced by health and social care. But I also feel it is very short on some key solutions that we need to be seeing. So, for example, could you please explain what specific plans you have in place to deal with the ever worsening waiting times crisis in elective surgery? 

Well, those plans and detail have been worked through with clinical leaders. I was very fortunate to have a really useful conversation with clinical leaders and the NHS chief exec last week, and we went through the deliberate ways we're trying to change where we are. So, when the plan talks about needing to change some of our ways of working, it recognises that we can't go back to trying to buy activity and just to have a deal with the independent sector. So, we're going to need to have some local answers, some regional answers and some nationally directed answers. There isn't a hard-and-fast operational delivery plan now. That comes on the back of the framework and that will come in the plans not just from health boards, but, as I say, needing to make sure that there are local and regional overlays on them. 

The other reason is that we're not out of the pandemic yet. So, actually, the lists are going to get bigger before we're at that point. That's partly because, as you'll know, we have a position where the NHS can't work to the same operational efficiency, because we still have additional measures in place, testing and PPE requirements, and we're also still in a position where we're not able to turn back on all of the elective activity that is still paused because—and, again, you'll know this because I know you look at the figures—our critical care units are still at more than 100 per cent. So, you can expect more operational plans to be delivered, whoever the next Government is, and that work will be done by clinical leaders, together with health boards, and whoever is the next health Minister will then have to decide how to get behind those and make choices about areas where health boards need to act on their own or together, and it will, I believe, require a necessary element of direction from whoever the next health Minister is.

You talk about the importance of operational plans, and I agree with you that it's very important to work with all the stakeholders to draft operational plans that are really deliverable. Of course, to make those operational plans really sound, you've got to have good data and really up-to-date coherent information and I'm really pleased that your COVID-19 forward plan does recognise that and, in fact, I think you have a whole chapter on how we can improve and use our data. Therefore, will you also listen to the calls of organisations, such as the Royal College of Surgeons, who are asking for not just modelling and publishing of projections on the numbers of people who need an operation in Wales—because they say that is not clear and we're not clear how many elective surgeries and other operations were postponed or completely cancelled because of the pandemic—but also asking for you to publish monthly planned surgery activity levels for the health boards in Wales to encourage the restoration of surgical activity and ensure equity of access to surgical services for patients? In other words, holding the health boards to account on this matter.

Well, the Royal College of Surgeons were at the meeting that I described with clinical leaders and actually the guidance that they've issued has been helpful in allowing some activity to continue in different parts of Wales, but it reflects the reality of where we are on the ground with, not just COVID, but with other harms that are coming in. Because I think part of this is, you're right about data and understanding what that data is, but it's also still then the judgments and the understanding of where people are on that waiting list. There'll be some people who are a higher clinical priority and it's the understanding of how that's taken through to deal with people to avoid the greatest amount of harm, and that will be different in different areas of the service. And, again, the Member will know that in some parts, delaying treatment can lead to irreversible harm, for example, on sight loss. In other areas, it can lead to discomfort and deterioration in that person's well-being, if you're waiting for a joint operation, for example. But that harm may be recovered. So, it's both understanding how to prioritise the waiting list and then to understand how you fairly judge the level of activity that each organisation is undertaking.

So, I'd be more than happy to continue the conversations that we already have with the Royal College of Surgeons on how we can be open and transparent about the levels of activity that are being restarted, but not to use as a simple, 'You're somewhere on a league table and you just have to get somewhere else', because, as I say, the pandemic isn't finished yet. When we move beyond the pandemic, then, yes, I think there'll be more and more data and more and more expectation in terms of my response to your first question: how have we managed to gear up different ways of working to deliver the required levels of activity whilst, of course, at the same time, taking care of our staff who will be exhausted when the pandemic is finally over?

I'm afraid this is where I have a slight difference with you, because everybody talks about 'when the pandemic is over', and I actually think we've gone past that—we've gone past the crisis. We're now in a situation where this is endemic. We're going to have a situation where we're going to be in this position for a long, long time to come. We can't keep saying, 'Oh, we're just in a crisis; we're just in a crisis—how do we handle that?' We've got to look beyond that.

I thought that the COVID-19 forward work programme did have some really good things in it, but it comes back to some of the issues that we really found out when we did the cross-party parliamentary group on how to deliver health and social care. There's a lot of, 'We know what the challenges are', but not a lot of, 'How are we going to solve them?' And you yourself have just mentioned our exhausted staff in the NHS and social care services. And I listened to the director of the Royal College of Nursing last night at the commemoration event, talking about how exhausted and traumatised so many of the staff in the health and social care sectors are. And I do worry, reading this COVID-19 forward plan—it talks about, 'We do have a workforce deficit'; well, it's more than just a small workforce deficit. How are we going to be able to manage that on top of creating that space to allow those who have been working so hard over this last year and who are so exhausted—how are we going to allow them the time to recover and get back and start picking up all of these elective surgeries? And there wasn't much talk about recruitment policies, retraining policies, retention policies. You know our plan, we've got a very strong recruit, retain, retrain policy. I didn't see much of that. Can you give us some overview of how you're going to be able to bolster that hard-working but shattered workforce?

With respect, I don't think we are at the point where COVID is now managed and endemic. I think that's where we will get to, but I don't think we're there yet. As I said, when critical care is still operating at over 100 per cent of its capacity, and we still have significant numbers of COVID-positive patients in our hospitals, we're not there yet. But I do think we're well on track to do so, and each easement that we unlock means that there's another area of activity that can be restored in wider life and it puts us further on the path to then being able to deal with a new normal situation for our health and care system. So, I think perhaps we're at different perspectives about when the point is when more normalised activity can restart, and, with respect, I don't think the figures bear out that we're at that point now.

I do know, though, that the reality of how we manage and look after our staff is hugely important. So, you will see comments about that in the recovery plan. In terms of the detail of that, I think that's for manifestos for the election. We've got a really good track record, though, on the numbers of staff that we have recruited, trained and retained over this last term and beyond. We've managed to increase the NHS headcount by more than 10,000 over this Welsh Parliament term. That shows the benefit of consistent recruitment, retention and training. So, I think people can trust our record, because it's a strong one.

But, even with that, and even with the benefit of the future investment that I expect you will see in our manifesto, we still have a really significant task in caring for our staff and not setting unrealistic expectations about how quickly the huge backlog that exists here will be eaten into and moved away. I think this will take a full Welsh Parliament term. That's the honesty that I think the people of Wales need to hear. That's the honesty that I think our staff need to hear as well, that we're not going to expect them to suddenly wipe away all of the huge backlog that has built up necessarily to prevent people from losing their lives in this last year, and you'll hear more from us, from Welsh Labour, when it comes to the manifesto launch, and I think you'll hear plenty about future recruitment and retention for our staff that will be funded and entirely deliverable.

Plaid Cymru spokesperson, Rhun ap Iorwerth.

Thank you, Llywydd. Well, in the final health and care question session in this Senedd, may I take this opportunity to thank the Minister and his officials for their collaboration over the years? We haven't always seen eye to eye, but whilst I've been very willing to support the Government when I think they've got things right over the past 12 months, I know that the Minister will understand the importance of scrutiny and will appreciate the role of an opposition party in trying to influence policy and changing direction when we need to do that. That's why, when the Minister said there was no case for a medical school for north Wales, we were determined to continue to campaign on that, and we're pleased to see the change of mind there.

To COVID now, the situation in Wales is improving, and that's positive. There are problems in Merthyr Tydfil and in my constituency, as it happens, and we need to support those areas now. There was a strong team of volunteers out in Holyhead this morning providing COVID tests, going from house to house. I was one of them, as it happens, but it's a cause of concern for me that the process is overly reliant on volunteers and places a huge strain on the staffing resources of the local authority. Would the Minister agree that we need to look at means of providing greater support to councils as they undertake tasks such as this one, because if there are interventions like this required in various communities, then I fear that that's going to be difficult to deliver?

Well, I think there are lots of lessons to learn, not just from what we're having to do today and in the days ahead around Holyhead—not the whole of the county of Anglesey, but around Holyhead, and the same in parts of Merthyr. We also have learning to take from the pilot that was undertaken with the three local authorities across Cwm Taf Morgannwg with a greater amount of community testing, and you will have seen, I'm sure, the really positive review of that community testing programme. And, actually, within that, we've managed to have a more successful engagement of the public in that community-wide testing than the pilots in Liverpool and Glasgow, I believe. That's really good news. We managed to highlight that, because of that, we think we'd identified more cases and prevented more admissions, including, the likely prevention of a number of deaths.

That does mean, though, that we need to learn about how we need to support local authorities. Some of that is about mutual aid, some of that is about the ongoing discussion we have between health, local government and the Welsh Government about how we support them. And I can honestly say that I've found local government leaders regardless of their party to be constructive and honest, and we have not always agreed at every point, but we have come to what I believe have been sensible answers to carry matters forward, and as ever, we're still learning as we go through. The good news is, though, that the spikes in Holyhead and in parts of Merthyr appear to be evening out with a fall in the case rate in Merthyr in the figures today in particular. That's good news, not just for everyone with the potential of opening up with more travel around Wales, but good news for those communities in those areas that are looking forward to the next stage in our path out of lockdown.

This week is a week of commemoration and reflection exactly a year since that first lockdown. The UK Prime Minister's admitted that he made some wrong decisions in dealing with the pandemic, but I'm not going to ask that question of the Minister. What I want the Minister to do is to look back at the 20 years and more of Labour control of the NHS leading up to the pandemic. One lesson that we've learnt is that health and care services in Wales aren't resilient enough to deal with the pandemic. Does the Minister accept that no other Government can afford to leave crucial services in such a vulnerable position again?

At the start of the pandemic, health and care and wider public services were still recovering from a decade of austerity and you'll recall the very difficult choices that the Government and Members in supporting budgets have had to make in moving money around. The prioritisation of the health service I believe was the right thing, but that caused real difficulties for local government in every part of the country as it meant a reduction in local government income. Just because the cuts that they had to deal with weren't of the scale that colleagues in England had to face, they were still nevertheless incredibly difficult and left our public service partners in a less-than-even-handed manner than you'd want them to; the resilience they had was less than it should have been. The same with the police, of course, who have been key partners in the pandemic response with a significant reduction in the workforce and front-line policing as well.

So yes, we were more vulnerable than I would have wanted us to be at the start of this pandemic. Despite that, what we have seen from local public service leaders is a real willingness to work together and it's a real plus that it's drawn health and local government together with other partners because of the necessity, and I believe that's good ground for those people to work together.

We disagree on whether there should be a significant reorganisation of health and social care responsibilities. My view is that's the wrong thing to do—with an unfinished pandemic—to have a big reorganisation. But I do think that there are good grounds to not just praise the response of health and local government together, but to want to build on that in the sort of joint working that we have frankly found not as easy as we'd wanted to on the scale and the pace we want to see for the transformation that is still needed to make sure that health and social care are a genuinely sustainable system working with each other.

You have to remember that the health and care sector in Wales went into a decade of austerity off the back of decades of neglect by successive Labour and Conservative Governments in Cardiff and at Westminster. It's clear to me that health and care services in Wales were not prepared for this pandemic. Public health and the care sector in particular had been neglected. Pandemic planning, we know, was woefully short of where it should have been right across health and care. There was far too much dependence, I think, on the sheer dedication of staff who'd always be prepared to go the extra mile to care for patients, but were overworked and undersupported. That's why COVID recovery now can't be about bringing us back to where we were before. I don't want reorganisation, either; I want a new focus and it's why Plaid Cymru wants to lead transformation of health and care in Wales and after 20 years and more of the failure to bring about the transformation that health and care in Wales needed before COVID, will the Minister agree that there is no reason for people to believe that Labour can lead that transformation after COVID either?

I think it's a rather foolish attempt to try to rewrite history on what's happened with the health service and funding and public services. I remember as a young man growing up with 18 years of the Conservatives in Government in the UK. I remember the creation of devolution, I remember the significant injection of public funds into health and other public services that came about with the return of a Labour Government in 1997. This institution benefited from a very different approach to public expenditure and investing in public services because there was a Labour Government across the United Kingdom, and there's no point in trying to claim that wasn't the case—it's factual, and that's why we saw a significant investment in public services, just as it's factual that we've seen a decade of austerity with a Conservative Prime Minister and Chancellor. Those are just the facts.

When it comes to pandemic planning, our planning was geared up towards something more like a flu pandemic, which was in the top handful of risks to the United Kingdom. We then found something that didn't behave quite as the flu has done, so we've all had to learn—not just here, but right across Europe—and I think the attempt to try to have a uniquely critical view on pandemic planning here in Wales is somewhat misplaced, but there are views for the public to make their choices on within that. We have seen a tremendous response across public services and from the public themselves, and the private sector, who have supported our national health service. I think that the people do broadly trust and appreciate the leadership that this Government has provided for Wales through the pandemic, and, when it comes to who you trust to complete the unfinished task of seeing us through this pandemic, I'm confident the people of Wales will recognise the role Welsh Labour has had in doing that, and renew their faith and their trust in us to lead our country forward and to have real ambition for how we can rebuild a better Wales. 

I've enjoyed our conversations across this particular forum. I don't know if you have a supplementary question later on, but we have not always agreed, and I look forward to the people of Wales making their own judgment on who should serve in this role and others after the election in early May.