The next item is a statement by the Minister for Health and Social Services—services supporting people to recover from COVID-19. Eluned Morgan.

Thank you very much, Llywydd. As we begin to focus on different aspects of recovery from the coronavirus pandemic, we must not forget those to whom the virus has caused lasting harm. For some individuals, even though they may have had a very mild or asymptomatic experience of the virus itself, we're aware that they may have been left with one or more symptoms, including breathlessness, brain fog, fatigue, joint pain and a number of other symptoms. There has also been an impact on the health and well-being of a significant number of people who did not contract the virus themselves. Our NHS in Wales is working extremely hard to ensure that the recovery supports the whole population equitably.

Long COVID is an outcome of the virus that we still don't completely understand. We don't yet know why some experience it and others do not. We don't know how long long COVID will last or why the range of symptoms is so wide, and it isn't possible at present either to prescribe a particular pill to improve the symptoms. And while we are supporting and monitoring research in these areas, we must help people to manage the symptoms of this condition and live as full a life as possible. That is why I am today announcing an investment worth £5 million to develop primary and community services to support these and other individuals who have additional needs as a result of the impacts of the pandemic. The funding will support a new patient pathway programme called Adferiad, or Recovery, and it will expand the provision in terms of diagnosis, treatment, rehabilitation and care for those suffering from the long-term effects of COVID-19, including long COVID in Wales.

And I'm very pleased to be making this announcement on the day that we publish our programme for government. During this term we have committed to supporting our NHS to recover, including pushing forward with our plans to bring together GP services with pharmacy, therapy, housing, social care, mental health, the community and the third sector.

This money for the Adferiad programme will be used to fund allied health professionals and rehabilitation staff to create primary and community infrastructure, including support for the development of community diagnostic hubs in primary care. It will also be used to provide training and digital resources that are of a high quality and that are evidence based, to help all health professionals to develop their expertise in diagnosing, investigating and treating long COVID and supporting people in their rehabilitation. It will also support investment in digital tools that will improve 'demand and capacity' modelling, and will ensure that the NHS helps people make the right decisions for their care and treatment.

In Wales, we aim to work together on the design of our services with those who use and deliver them. Our health professionals working with people who are experiencing these longer term impacts from COVID-19 are those best placed to understand people’s needs and what intervention will best meet those needs. Our health professionals are liaising closely with colleagues around the world to ensure that the latest evidence is informing our decisions and our responses. Additional resource and focus are currently required in primary and community care to ensure that we provide the right support and treatment to maximise people’s recovery. This also supports the strategic aim in 'A Healthier Wales' to provide appropriate and prudent care as close to home as possible.

I have spent time speaking with those experiencing long COVID, and one of the pieces of feedback—. And I was very pleased to meet with the newly established group at lunchtime today, the cross-party on long COVID. And the feedback I receive most often is that people don’t know how to access help, or, when they do ask, there's a possibility that the person that they're speaking with doesn't know what support may be available. So, in response to these concerns, alongside the Adferiad programme, we will this week launch the all-Wales guideline for the management of long COVID. This important guideline for health professionals offers the latest information for managing long COVID across the NHS in Wales, and is supported by a package of comprehensive education resources. This includes advice on the referral process into secondary care where needed and clear guidance on when to arrange diagnostics for people living with long COVID. Updates will be provided direct to users of the guidelines, and, when new evidence and changes to guidance emerge, so our guidelines will be updated. Most importantly, it will mean that across Wales health professionals will have access to the same information and treatment advice on this condition and will also have a clear guide on when and how to refer onwards for treatment and support. When people are referred onwards, it will be important to ensure, where necessary, that a co-ordinated response is put in place, giving the individual tailored support, ensuring multidisciplinary specialists are mobilised to support the individual, as is the model in the Aneurin Bevan health board.

For many people with long COVID, the symptoms they are experiencing can be managed at home, and some supportive advice and guidance is needed just to help individuals to understand how to help themselves and also give advice on how to monitor the progress they're making. That's why NHS Wales have launched the COVID recovery app, which has been downloaded around 6,000 times already, and is actively supporting people to manage their condition and monitor their progress of recovery.

I think it's worth being clear that this is not to replace professional advice, but rather to supplement it for those who do require the help of a professional, or allow people to help themselves and manage their own care where their symptoms are milder.

I want to reassure those experiencing ongoing symptoms who may be worried about the future that we haven't forgotten them. Professional advice and support is and continues to be available. As we start to relax our restrictions, it's important to remember that the effects of COVID-19 infection can be long lasting, and that's why it remains important that we work together to keep Wales safe. I have asked officials to revisit the Adferiad programme on a six-monthly basis to ensure that we're keeping abreast of the latest evidence and science. Diolch, Dirprwy Lywydd.

The Conservatives' spokesperson, Russell George.

Minister, can I thank you for your statement today? I certainly very much welcome what you've said, in terms of funding for diagnosis and support for long COVID. I, like many in this Chamber, I think, would have been shocked by the ONS figures that said as many as 50,000 people across Wales have been suffering from long COVID. I, myself, spoke to a constituent fairly recently about their experience—going to work, feeling fatigued, out of breath—and the impact it had on their work life and family life. Thankfully, the person I spoke to recently had a very understanding employer, but that's not always the case, and the effect on the family life with bringing up young children was huge in terms of how it affected them.

It's been about five months now since your predecessor announced the long COVID app, which you referred to in your statement today, and that app, of course, provides information about self-support for people. I'm pleased that you said in your statement this isn't a substitute, it's additional information. But can I ask what feedback you've received, or your officials, on whether this app has been successful in tracking systems and helping people with long COVID to recover? So, has the app been successful and how has it been successful, I suppose, is the question.

It's clear from your statement today, Minister, that you're looking to expand diagnosis and treatment for those suffering from long COVID, which of course is very much welcome. And Long Covid Wales has been, I know, calling for some time now for specific multidisciplinary clinics to help with rehabilitation, saying that the—. Well, what they said to the previous Health, Social Care and Sport Committee back in March was that one-stop-shop clinics are needed, because people have not got the energy or resources to go back and forth to their GP and be referred to different places; they need to go and get treatment from one place. That's what they told the previous committee. So, I'd be grateful, Minister, if you could confirm exactly how the £5 million is going to be used and whether there'll be physical or virtual long COVID clinics with multidisciplinary teams, as has been the case, as you know, in NHS England over the past seven months. I certainly think they should be physical clinics, and I was perhaps a bit disappointed that that wasn't mentioned in your statement today, but perhaps you can clarify. If there are physical clinics, then perhaps you could identify where those locations are going to be.

I see that you briefly referred to research on long COVID in your statement today, and I note the National Institute for Health Research announced in February that it was investing £18 million to fund four studies of long COVID and, in March, it launched another round of funding worth £20 million. The UK Biobank also plans to send self-testing kits to all its 500,000 patients so that those with COVID antibodies can be identified and invited for further study. So, in that context, can I ask what efforts the Welsh Government is making to feed into UK-wide and Welsh research into the effects of long COVID and what support you're providing the Welsh NHS with in this regard, so that we can use this research, of course, to diagnose and treat further and future long COVID sufferers effectively?

And lastly and quickly, you've put some emphasis on GPs being part of the diagnosis pathway, and they'll be issued with new guidance—you pointed that out in your statement today—so, I'd just like to ask, have you, and what discussions have you had with GP representatives on the guidance before making this announcement today? Thank you, Minister.

Yes, the figures from the ONS were truly very large, and that's why I think it is important that we take this very seriously. We're still learning, as I say, about this particular very debilitating illness. One of the key things that people have said to me is that they need to be believed. So, there are hundreds of thousands of people across Wales who have contracted COVID. Now, a lot of them recover and don't have these long-term illnesses, but the ones who don't need to be believed, and that is one of the key things that they're asking for: 'We need this to be validated, exactly what we're going through to be validated.' That is why I think it's so important for us as a Welsh Government to make sure that we are standing by these people, and by launching this Adferiad programme, we're doing precisely that.

There have been about 6,000 people who have downloaded the app. What we're trying to do is to feed back to make sure that we're updating and getting better information, so that the efficiency and the effectiveness of that app are constantly updated, and hopefully that will lead to a better and more successful model, and hopefully even the debate today will help people to recognise that that app is available.

We have always in Wales used the GP surgery as our gateway to secondary care. That's the way that we really make sure that we're getting people to the right place within secondary care. And part of the issue that we're trying to avoid, particularly when people have particularly complex care, so they may have a problem with their lungs if they've been on a ventilator, but they may also have a heart problem, so where do you send them? Do you send them to the heart specialist or the lung specialist? What's the route to do that? So, that's why it's actually quite difficult to get clinics that really specialise in everything. So, I do think that the model that is being developed in places like Aneurin Bevan, where they will wrap around the individual and make sure that there is a team really looking at every aspect of how the individual responds, looking at their mental health, looking at their diet, looking at the really specific issues that they may have and the need to see both a specialist in lung surgery and a specialist in heart. Those things, I think, offer a much better route to go down rather than the clinics, and that's why we've gone and we've taken advice from clinical experts in this, and that's certainly what they have recommended.

In terms of the money, the money will go towards helping healthcare workers and allied health professionals to develop the infrastructure to deliver the services. We'll provide high-quality evidence-based training and digital resources, so making sure that those GPs know exactly what to look out for, and we'll be investing in digital tools that are going to provide data about services, demand, capacity and modelling. So, that's where the money is going to.

And when it comes to research, we are certainly co-operating very closely with the UK Government. We're all in this boat together; we need to understand and learn from each other, and we are helping and participating in the UK study called the post-hospitalisation COVID-19 study. That's being funded by the National Institute for Health Research and Medical Research Council UK, and that's being led by the NIHR Leicester Biomedical Research Centre. We're pleased to be one of the highest recruiters, with sites across Wales for an urgent public health study that has been established. We've also got the inspiratory muscle training post COVID-19 study, and that's being led by Swansea University. And of course, we have already established the COVID-19 evidence centre, and that's a 24-month investment of £3 million. What we're trying to do is to make sure that we're not duplicating the work that's done elsewhere with the UK Government, but working together, and I think that is the important way for us to work moving forward.

Plaid Cymru spokesperson, Rhun ap Iorwerth.

Thank you very much, Deputy Llywydd. I will wear two hats, possibly, at this point—yes, as Plaid Cymru spokesperson on health and care, but also as joint chair, since earlier today, of a new cross-party group established here in the Senedd, which I jointly chair with the Member for Caerphilly. We could see that the scale of the problem was so great that we needed a platform within this Senedd to give full consideration to long COVID, and I'm pleased that the Minister was able to join us for a few minutes earlier today.

There is no doubt in my mind that the Government in Wales, for whatever reason, has been too slow in understanding what exactly we were discussing here. There are two different issues: people who have difficultly in getting over an acute illness, namely COVID, and problems after being in intensive care, for example. That's one problem that can be long term, but that's not what long COVID is. Long COVID can be something that happens to people who have been asymptomatic, as the Minister said.

So, I am pleased to hear the tone of the statement that we heard this afternoon, which without doubt, I think, recognises that we are discussing something where people deserve to know that they are believed; that there is a piece of work being done by Government that will take their concerns and symptoms seriously. Of course, what I'm looking forward to now is to see how this is to be implemented.

I've been keen to see specialist centres developed, and I share the frustration expressed already, and the jealousy, if that's the word, in seeing centres established over the border. Now, one of the benefits noted of that is that specialism is developed within these centres. The Minister has mentioned information sharing and this evidence centre, which will be gathering evidence, but I wonder what work the Government will do to ensure that good practice and lessons learned really are reflected in the treatments developed and provided across the health service in Wales. Because we are learning here, and we need to learn very quickly, but when lessons are learned it is very important that people benefit from that by seeing new treatments being developed.

One specific question I would like to ask the Minister: what's being done within the health service itself? I've already written to the Minister on this point, but I am aware of a number of health professionals who are on the front line, of course, and would have been more likely to have been infected. I see many people who have trouble getting support from their own employers within the health service to provide them with the treatment that they need so that they can return to the workplace. So, what work can the Government do to ensure that that support is provided to those health and care workers who were so selfless over the past 15 months, placing themselves in danger, who now find themselves not being supported—including one who's had to go private in England because she couldn't get the tests that she needed within the NHS in Wales?

I will leave it there for now, but I will say again that I welcome the tone, I welcome much of what we have heard, but the measure of success of these steps will be the real test. I look forward, within the cross-party group, to keeping a close eye through Long COVID Wales on how successful these steps will be, and I do hope that the Government will be willing to change direction if new evidence emerges and patient requirements are highlighted further in the coming months.

Thank you very much. Could I thank you and Hefin David for establishing the long COVID cross-party group? I was very pleased to be able to be there for at least a few minutes today, as you said. I am aware that we do need to listen, and I have been trying to make an effort in recent weeks to speak directly to people who have suffered from this. Long COVID is complex. It's not just one thing, and that's part of the problem; it's very difficult to wrap your arms around it. And that's why, I think, that the way into the system is through the GPs at a local level.

I agree with you that it's vital, particularly with a new condition, that we learn from each other and learn from good practice. I've received a list of what's being done across the different health boards, and it is interesting to see that people are dealing with this in different ways. But as we learn, I think it is worth us ensuring that that good practice is shared, and I do hope that it will create a model that we can follow for other complex conditions and illnesses. There are other illnesses where you need to see more than one specialist, so I do hope that we can think about changing the system. I do hope that we won't miss this opportunity to make changes during a period of great change.

In terms of those who are suffering from this within the health service, you'll see that within the Adferiad programme that there is a specific piece of work that recognises that and shows that we do understand that there are problems within the NHS, that we are very aware of this and that there are standards that need to be adhered to. I think there is more work to be done when it comes to other employers, and I'm looking forward to working with the unions, perhaps, to ensure that we do raise awareness among employers across Wales as well.

I warmly welcome this statement this afternoon from the Minister for Health and Social Services, and the recognition of the innovative work of Aneurin Bevan health board that was mentioned earlier. The Office for National Statistics has estimated that more than 1 million people in Britain have so far suffered from long COVID, and The Sunday Times only this week christened the UK as the long COVID capital of the world. The Welsh Government investment of a £5 million recovery programme to help patients living with this condition is to be very much welcomed. In Islwyn during the recent election campaign, I met many people who had experienced and survived acute COVID, only now to face their own battles with long COVID. One such Islwyn resident, Kate Alderson, has told me of the debilitating fatigue that still endures months later. So, Minister, as our scientific knowledge of acute and long COVID grows every day, will you commit to regularly updating this Senedd on the condition? And with the vast majority of health and social care workers being female and the typical long COVID sufferer being a working-age woman, what action can the Welsh Government take to ensure that women are not disproportionately damaged by the consequences of suffering from long COVID? Thank you. 

Thanks very much, Rhianon. I'm very sad to hear that you, of course, like everyone else here, have constituents who have been really affected by this really difficult and long affecting illness. I have made a commitment to ensure that we look at this Adferiad programme on a six-monthly basis, because this is such a novel disease and there's always new evidence. The point that Rhun made earlier about the need to learn from best practice I think is something that I hope we can learn from and build into reforming this programme as we go along. So, I can very much give that commitment. I'm sure that the health committee will be interested in receiving regular updates, and if they ask, I'm sure we can make sure that happens.  

I welcome the statement. Minister, can you inform us about the protocol for people who had their first AstraZeneca vaccination and developed complications like thrombosis and who are not listed to receive the second AstraZeneca vaccination? Should they have a booster using Pfizer? If so, when? Thank you.

Thank you, Altaf. I'm sure there's an opportunity to go into this in a bit more detail. It's not strictly speaking a long COVID issue. We are of course making sure that we follow the advice of the Joint Committee on Vaccination and Immunisation. That's the way that we determine who gets what vaccine. As the balance of risk is changing in the light of the delta variant, we'll be looking for that guidance to come out from the JCVI. You'll be aware that they did come up with a recommendation that AstraZeneca shouldn't be given to those in the younger cohort, but we're waiting to hear now whether they will want to update that advice in the light of the delta variant, which is moving very quickly, certainly in England, but increasing here in Wales as well.

I'd like to thank the Minister, as Rhun did, as co-chair of the cross-party group on long COVID, for your attendance today. I think it demonstrated your seriousness to tackle this issue. I think equally so has been the decision you've taken to make it one of your priorities as one of the first things you do as health Minister. So, it's very pleasing to see that. Some of the issues that were raised by long COVID sufferers in the cross-party group today were particularly the fact that they find it difficult to get past the GP, because of the multitude of symptoms that present, and also the fact that children, they are concerned, are also being affected by this and not being identified. With that in mind, I think a key question for you will be: how will you consider the patient voice in everything that you do, and how will the patient voice scrutinise the decisions you take? Just as an early example of that, one of the things that Long Covid Wales are saying is that they want dedicated long COVID clinics. How do you explain to them that that is the path you've not chosen? How will you explain that to them? And then how will you return to that discussion later down the line when we see, hopefully, the fruits of the actions that you're taking today?

Thanks very much, Hefin. Can I thank you also for establishing this long COVID cross-party group? We've heard that complaint also—that many have found it difficult to get past the GP. That's why, on 18 June, the all-Wales guideline for the management of long COVID is going to be launched, giving much clearer guidance to GPs on what they should be looking out for and when they should be referring on. So, all of that should be in place, and I'm hoping that people on that call today will be comforted that it will be put in place. I hope that proves that, actually, we have been listening to patients. I've made a point of listening to patients, of looking at what is being said on social media channels. But also I think it's incumbent upon me to listen to the clinical advice that I'm given, and the advice that I have been given, very clearly, is that the route that we want to follow in Wales, and the route that conforms with our approach, which is to give care as close to home as possible, actually makes sense for us, to make sure that that route is through the GP. What we need to do is to strengthen the understanding of people in primary care, and to make sure that then they are directing into secondary care if and when necessary.

The Llywydd took the Chair.

Just one short, single question. A few minutes ago, I received an e-mail from a constituent in north Wales, and I'd be grateful if you could answer their points, following on from your previous response:

'I was watching the news about the announcement of the money for long COVID. The trouble is there are not many staff with experience, and they won't listen to those of us who have the experience and are willing to talk.'

How can you assure that constituent and others like them that the staff who are charged with providing them with care will listen to them about the experience and are willing to talk to them about that experience, so that they can co-design the solutions together?

Thanks very much, Mark. If you follow the logic of that, it would suggest that, actually, GPs couldn't refer anyone on unless they'd experienced the illness themselves. We have to follow the fact that, actually, GPs and people in primary care follow guidance and they follow guidelines that we have set for them, which is generally based on NICE guidelines, which has all been clinically proven. That's why we're making sure that we're going via the primary care route. I think it's really important that we give that advice, that we train people up within the primary care communities and that they know where they can go for help. I can assure you that the patient voice is being heard. That's why we are going down this route, because what they've told us is, 'Not enough GPs understand what we're going through'. That's why we're strengthening these guidelines.

I thank the Minister.

The Health Protection (Coronavirus Restrictions) (No. 5) (Wales) (Amendment) (No. 11) Regulations 2021 and the Health Protection (Coronavirus Restrictions) (No. 5) (Wales) (Amendment) (No. 12) Regulations 2021 are next. In accordance with Standing Order 12.24, unless a Member objects, the two motions, under items 5 and 6, will be grouped for debate, with votes taken separately.