Questions now from the party spokespeople. Conservative spokesperson, Russell George.

Diolch, Llywydd. Minister, do you feel it would be appropriate to apologise on behalf of the Welsh Government for its failure to contain hospital transmissions during the first and second waves of the pandemic?

Thanks very much, Russell. Of course, every death in this pandemic has been difficult, and for those who've caught COVID in hospital it's even more tragic. We are very aware of the difficulties of the situation. Of course, what we have to remember is that the people who are serving in those hospitals also belong to the community, and when transmissions were high in those communities, there was always a possibility that COVID could get in in that way. Also, we just heard, passionately, how Rhys ab Owen was keen to see his loved one; there are also people who wanted to see loved ones in hospital. That should demonstrate to you the difficult balance and the difficult calls we have to make in this situation. Every time you let somebody in, there is a risk. And that risk, in particular in a hospital—you're allowing people to go into one of the most difficult and sensitive areas, where, if people catch COVID, the problems could be catastrophic, and have been. So, I just think that this balance has been extremely difficult. Of course, if you're already in hospital, you are likely to be more vulnerable, and therefore if it gets into hospital, as it has, and as, I'm afraid, it will continue to—. But we have put all measures in place; we've set out very, very strict guidelines. We have tried to learn as we've gone along in this area, and, of course, with all of those infections, where we've had those incidents of patient safety, each case has been investigated thoroughly to see what we can learn.

Thank you for your answer, Minister. I appreciate what you've said. I think, from my perspective, we as Welsh Conservatives were raising deep concerns about the level of hospital-acquired infections in Wales from last summer onwards. There was a sense, I feel, that the Welsh Government was shrugging its shoulders at the time, with your predecessor saying that lessons had been learnt. [Interruption.] I can hear the former health Minister; he should be listening to what I'm saying rather than dismissing what I'm saying. But what I would say to you, Minister, is that there was a great focus last year on community transmission—and I wouldn't dismiss that; that is correct, there should be that focus—but there wasn't that focus last summer and last year in terms of infection in hospital settings. 

Now, we now know that one in four deaths across Wales were probably or definitely as a direct result of ward-to-ward transmission. In Hywel Dda itself, it's one in three deaths. That's significant, and I'm sure, Minister, you wouldn't disagree how significant those figures are. That's 1,000 people who have sadly died, with countless loved ones bereaved, when this could have been avoided to a large extent, or to some extent, if the Welsh Government had acted differently. Now, a group of 35 clinicians have also written to the Welsh Government calling for a Welsh public inquiry, and they believe that one of the questions for that investigation should be how healthcare organisations can be guided to reduce this death rate. This is a specific Wales issue, so will you and the First Minister heed the growing concerns and calls, and agree to a public inquiry into the handling of the COVID-19 pandemic in Wales? You yourself said in your answer that you're learning as you go along. That's the right approach, but that's surely a reason why we need a public inquiry to properly scrutinise the process. 

Thanks very much. I, too, would refute the implication that we haven't been taking seriously the nosocomial transmission in hospitals, this infection transmission in hospitals. We've been taking very careful steps, and anybody who's been to hospital will understand how strict they are in terms of who's allowed in and wearing PPE, and I absolutely refute that. As you say, we are investigating every case, and we are trying to learn as we go along. I know and I hear the calls for a public inquiry, and I have read carefully the letter that has been written, but I've got to tell you that we are still in the middle of a pandemic. We have all our hands at the pump at the moment, and this is not over. We know, if you look at the projections in particular in England, they're talking now of the possibility of two million cases a day. So, we've got to be really serious, and take this seriously and understand that this is not the time for us to get involved in a public inquiry, but we are learning as we go along.

I also refute the fact that this is a specific Welsh issue. Let's not pretend that there haven't been deaths in hospitals as a result of COVID in hospitals in England and that transmission in hospitals in England. That is simply not the case.

Well, I wasn't suggesting that is the case at all. That'll be the case in countries around the world, but I was suggesting it was to a greater extent in Wales and that lessons need to be learned from that specifically. Now, a Wales-only inquiry, and not being willing to bring that forward—. I was very careful in my question not to say an inquiry immediately now. I specifically asked about agreeing to a public inquiry—that's what I should add to that. But not agreeing to that, I suspect, I believe, shows a lack of transparency in terms of the Welsh Government's role in looking into how it has handled the pandemic. 

This leads me on to my final question, Minister, with regard to the confidence in a COVID-lite environment, and I would be very concerned—I know you are—about the over 4,000 people who have not turned up for cancer diagnosis treatment. I would suggest, is there any wonder that there's a concern about turning up into a hospital setting when we hear about the figures I've outlined and that we're aware of. Now, you and I will both know, and both agree, that it's going to be a real challenging situation where we've got coming forward now people with advanced cancer and more complex treatment, and the Welsh Government was again warned about this last summer by medical professionals, but we've not seen any significant work in terms of COVID-green sites or COVID-lite cancer hubs, which have been present in England for over a year. I would suggest, after the context of my earlier questions, that there's a greater need now to have COVID-lite hubs here in Wales. Sadly, these decisions will bring more pressure onto palliative care services as cancer becomes untreatable at later diagnosis, of course. So, can I ask finally, Minister, will you therefore tell us how many people your department has calculated are missing from diagnosis, and how long are the backlogs? Will you bring forward before this Senedd specific plans on tackling the backlog of cancer patients as well as telling us when the cancer quality statement implementation plan will be published? Thank you, Minister. 

Thanks very much. It's interesting that this has been presented as some big, sensational news story. It's not. We have been transparent about this the whole way through, about how many people are contracting COVID in hospitals. It's published on the Public Health Wales website on a regular basis. That is not done in England or elsewhere. So, if anybody wanted to see these, this is not new, it is not sensational, it has been there the whole time and you could have been tracking it. 

When it comes to the public inquiry, it is very difficult to disaggregate what was going on in the rest of the UK from what's going on here. If you just take PPE, there was a relationship there. In fact, the relationship, very interestingly, was us giving parts of England some PPE. On vaccines, we were dependent on the supply working together across the United Kingdom. So, it is really difficult to disaggregate this, and that's why I do think the right approach is to have a UK inquiry but with a kind of subsection for Wales, where there will be a need to look in detail at what we can learn. But I can tell you that we are trying to learn as we go along as well.

We are very concerned about the number of people who haven't turned up in relation to cancer diagnosis and the fewer people who have presented relative to other years. That's why we have undertaken a very comprehensive advertising campaign to try and encourage people to come forward. And, of course, cancer treatment has never been stopped. We've been making sure that that has been seen as an essential service throughout the pandemic.

When it comes to COVID-lite hubs, I absolutely don't object to this in principle. The problem we have is that the implication of that is that you have to separate them off from A&E and the kind of hot issues that are coming into hospitals. Now, Russell, you might want to go around closing A&E departments, but I don't. So, I just think we've got to be really careful about the practicalities of making that happen, but we are trying to look at what alternatives there are, and I'm pleased to say that health boards have come forward with some ideas and we're analysing those at the moment.

The Plaid Cymru spokesperson, Rhun ap Iorwerth. 

Thank you very much, Llywydd. I want to ask about the recovery of the health service too and reference a number of areas. I, too, will refer to this backlog in terms of cancer diagnosis, looking at a different aspect of that. It's a concern to think that thousands of people—over 4,000 people according to Macmillan—who haven't had a diagnosis. But it's a concern to me that what's happened over the past year is that we've exacerbated a problem that already existed, and one problem we had in cancer services was a shortage of workers to do that diagnostic work. I think the Royal College of Radiologists has mentioned that we we are 97 radiologists short here in Wales. You can't have an effective diagnosis and a swift diagnosis service without those staff in place. So, in looking to recovery, can you tell us what resources you will put in place to deliver specifically on resolving some of the workforce problems we have? 

Thank you very much. As it happens, I've just come from a call with HIW where we were talking about the problems specifically in relation to radiologists. Now, they have put a system in place where we do produce about 20 new radiologists every year, so that is quite a big increase from where we've been in the past. And of course, what's important is the quality of training that they receive, and I've asked them to also consider what else we can do. Is it possible, for example, for us to send some of the images that we get abroad so that they are analysed overseas?

So, I think that there is scope for us to be imaginative in terms of how we approach the issue of dealing with this backlog, particularly when it comes to cancer. But you'll be aware as well that we have provided £25 million in additional funding in order to ensure that the equipment is available, so that we can increase and accelerate that process, and that has already gone into some of our hospitals. 

If I could turn next to orthopaedic services, there are huge challenges facing you in building capacity. I and every other Member here, I'm sure, will have heard about far too many patients waiting far, far too long in pain. In April of this year, there were 88,000 people waiting for trauma and orthopaedic treatment, with 60 per cent waiting over 36 weeks. The figure back in 2019 was around 11 per cent. Over half now wait for longer than 12 months. Of course, these waiting lists, again, were too long prior to the pandemic, so what assurance can you give us that, in trying to deal with the acute problem of the backlog caused by the pandemic, you will do far more than just restore services to where they were previously? How will you now try to create services that are more sustainable for the longer term, because that is what we are looking for in coming out of this pandemic?

Well, I want to ensure that we don't miss this opportunity presented by the pandemic to change things. A lot has already changed, and we need to tie in what's good as regards the changes that have happened in terms of how the workforce operates, but also the systems that we use. I was pleased to be part of a conference over the weekend with an orthopaedic society from India. A lot of our orthopaedic surgeons in Wales come from India, and it was good to hear their ideas about how we should be accelerating the process. And, of course, that will include the possibility of having direct hubs or centres—these cold centres, the direct centres that I was talking about. So, we're just analysing how that could happen in practice and how that could be funded. But we're very eager to see how we can use this pandemic to deal with this problem and to get us to a different place in the medium term.

I want to finish, Llywydd, if I may, by turning to long COVID. It's a huge concern for me. I have huge concerns about young people, if truth be told, at the moment, as restrictions are relaxed. We'll have an opportunity to discuss that again. But I want to look specifically at the impact of long COVID on the health and care workforce. From my work as joint chair of the cross-party group on long COVID, I see that an incredible percentage of the people I speak to are people who have fallen ill as a result of their work in health and care. We need to look at this. We need to provide support to them, and I want to know what the Government will do to support them, because they deserve that support for the work that they have done and the fact that they put themselves in harm's way during this pandemic. But if we look at the recovery work, will the Minister tell us what she is going to do in order to push for assurances that these people get the support they need to return to the workplace, because we need to ensure that our workforce is fully staffed, and sufferers of long COVID within the health and care service want to return to work to do what they've been trained to do? We can't wait any longer for an assurance that treatment will be provided to the high number, I fear, of workers who are suffering in this way, and that they will be treated fairly.

Thank you very much. You'll be aware, in our publication on the new recovery plan, that we did give specific attention to those working in our health and care system who are suffering from long COVID, and we did ensure that guidance is available in order to give employers an idea as regards ensuring that they know how the health and care system should be responding to those suffering from long COVID. So, I would hope that that is clear in that report.