The following amendments have been selected: amendment 1 in the name of Lesley Griffiths, and amendment 2 in the name of Siân Gwenllian. If amendment 1 is agreed, amendment 2 will be deselected.

The next item is item 6, the Welsh Conservatives' debate on ambulance response times. I call on Russell George to move the motion.

Motion NDM7779 Darren Millar

To propose that the Senedd:

1. Notes that just over half of red ambulance calls met the Welsh Government’s target of eight minutes in July 2021.

2. Further notes the immense pressure the Welsh Ambulance Service is under with increasing transfer-of-care times of up to 18 hours.

3. Recognises the hard work and dedication of Welsh Ambulance Service staff in such challenging circumstances.

4. Acknowledges the pressures in social and primary care and the knock-on effects on the ambulance service.

5. Calls on the Welsh Government to:

a) declare an emergency in the Welsh Ambulance Service.

b) bring forward a comprehensive plan to improve ambulance response times, including action to:

i) ensure an adequate social care workforce; 

ii) improve access to face-to-face primary care appointments; and

iii) increase hospital bed capacity.   

c) set out a clear plan and timetable for raising the wage of care workers across Wales.

d) consider engaging the support of Her Majesty’s Armed Forces to assist with increasing ambulance response capacity.

e) redouble efforts for the rapid recruitment of paramedics.

Motion moved.

Diolch, Deputy Llywydd. I move the motion this afternoon in the name of my colleague Darren Millar. Can I, at the outset of this debate, first of all thank paramedics and ambulance staff for their work, especially during the course of the pandemic? I know that I speak on behalf of all my Conservative colleagues, but I know that Members from across the Chamber will agree that we thank sincerely our ambulance staff and paramedics for all the work they do in very difficult and challenging circumstances.

Our debate today is couched in that way. It's about support for the ambulance service and making sure that they receive the support that they need from the Welsh Government. But, be in no doubt: the ambulance service is in crisis. It's not just in near-crisis. It's in crisis now, and it has been in crisis for some months. We need immediate action from the Welsh Government to support the ambulance service and also to ensure that the people of Wales get the ambulance service that they deserve and need.

Now, I think that the Government first of all need to accept that the ambulance service is in crisis. You can't resolve a problem unless you accept that there is a problem. Now, I hope that this Chamber will know that I am not somebody who throws around statements and words easily; I choose my words carefully. So, I stand by that: the ambulance service is in a crisis.

In my own case, in a constituency issue, recently, a constituent was asked by the ambulance service themselves to take their family member with a suspected heart attack to hospital themselves. Now, I say that we've been in crisis not just now, but for some months, and I stand by that. Because we know that, in July of this year, 400 people across Wales were waiting for more than 12 hours for an ambulance—hundreds of people waiting for more than 12 hours for an ambulance. In the past, in this Chamber, we may have raised cases with Ministers, and Ministers may have said, 'Send me the examples.' We've gone beyond that. These are examples that are happening every single day throughout Wales, sadly.

Now, I was only speaking to the Stroke Association earlier today, and they were discussing the latest figures from the sentinel stroke national audit programme. Scotland's not a member of the programme, so there's no comparison there. We know how critical it is, don't we—we know how crucial it is—to make sure that, from the onset of stroke symptoms, you get to hospital. Now, the latest figures tell us—. And this is from the onset of symptoms to not just getting to the hospital, but getting to the right facility, so this is not just about the ambulance service; this takes into account some of the wider issues. From the onset of symptoms to getting to the appropriate place in hospital, in England, the latest figures say that the time is three hours, 25 minutes; in Northern Ireland, it's three hours, 23 minutes; and, in Wales, it's five hours, 17 minutes. Now, I welcome the Government's stroke quality statement today. However, the Government's own statement today emphasises the need for rapid treatment for stroke—but it's not happening.

My colleague Paul Davies was outlining in First Minister's questions yesterday his concerns about proposed cover being reduced in Pembrokeshire for ambulance services. Reducing cover for the ambulance service is not something that should be being discussed or debated at this time. That's not appropriate, not when we're in the position that we're in. Now, the First Minister dismissed Paul Davies's comments yesterday, but Paul Davies was relaying comments that were raised to him by constituents, by ambulance service staff on the front line.

Now, in terms of the amendments today, we will support the amendment from Plaid. We agree, of course, that the integration of services is important, and we of course agree with the additional staff that are required within the NHS. We won't, of course, be supporting the Government's amendment today. I'm disappointed. Disappointingly, it's a 'delete all' motion.

Now, our motion today sets out our thanks for our paramedics and ambulance staff, and it sets out a number of factual positions of where we are at, which I don't think that the Government will deny—if so, let's hear them today. So, why is it that the Government could not have supported our motion as tabled today?

As an opposition party, we do want to bring forward some constructive suggestions today to the Government. We've done so in our motion. There are short- and long-term issues that need to be addressed. So, first of all, the use of Her Majesty's armed forces to help support the ambulance service—I am pleased that we suggested this in our motion last week, and that's been brought forward. The Government have made that request, so I'm pleased that that is the position. But I don't think that anyone should be in any doubt that this action will resolve the issues that we’re facing in the ambulance service, because, of course, it won’t. There are other actions that are needed as well. First of all, we need to improve access to primary care appointments and change the current guidance to telephone triage. Secondly, we need to redouble our efforts for rapid recruitment of paramedics, and I know that Welsh Government has announced 136 new recruits for this financial year, and the Welsh Ambulance Services NHS Trust has committed to a further 127 this year also. However, in the light of the looming winter pressures, and we haven’t had a statement yet on winter pressures, the Welsh Government needs to provide support for rapid recruitment to cover any potential gaps. Thirdly, we need to mobilise members of the public and former healthcare professionals to join their local NHS teams. Fourthly, we need to establish routes of support for NHS staff, care workers and families who have experienced the trauma of the pandemic. And fifthly, we need to set out a plan and timetable to raise the wages of care workers, as we called for also in our manifesto earlier this year.

Then there are a number of medium- and long-term plans that need to be addressed also: we need to focus on the time-to-treatment for patients, we need to develop a clear plan for the Welsh NHS to clear the waiting list backlog, which has deteriorated during the pandemic, utilising cross-border and independent facilities as well as COVID-lite hubs to speed up treatment. We need to establish long COVID clinics to support people experiencing long-term effects of COVID, and we need to build upon the 10-year plan and social care workforce plan to introduce a plan across the whole of the health and social care sector. We need to expand the role of occupational therapists as part of the wraparound care to maintain patient independence. We need to promote independent living, offering online self-assessments to support the early identification of support needs, and we need to establish a fund for care innovation to promote joint working between the NHS and social care.

I commend our plan to the Senedd today, and I very much call on all Senedd Members to support our motion today as tabled. Diolch yn fawr.

I have selected the two amendments to the motion. If amendment 1 is agreed, amendment 2 will be deselected.

I call on the Minister for Health and Social Services to formally move amendment 1, tabled in the name of Lesley Griffiths.

Amendment 1—Lesley Griffiths

Delete all and replace with:

To propose that the Senedd:

1. Notes that in the context of record levels of demand, just over half of red ambulance calls met the Welsh Government’s target in July 2021

2. Further notes the immense pressure on all health and care services in Wales including the Welsh Ambulance Service and the range of national and local challenges that impact patient flow

3. Recognises the hard work and dedication of Welsh Ambulance Service staff and all health and care service staff in such challenging circumstances

4. Calls on the Welsh Government to:

a) ensure the actions identified in the Emergency Ambulance Service Committee delivery plan are delivered with pace and purpose;

b) support a range of initiatives to drive recruitment and retention within the social care sector and provide support to social care employers;

c) improve access to face-to-face primary care appointments where clinically appropriate;

d) deliver on its Programme for Government commitment to pay care workers the real living wage;

e) continue engagement with Her Majesty’s Armed Forces to assist with increasing ambulance response capacity; and

f) redouble efforts for the rapid recruitment of ambulance clinicians.

Amendment 1 moved.

Formally.

I call on Mabon ap Gwynfor to move amendment 2, tabled in the name of Siân Gwenllian.

Amendment 2—Siân Gwenllian

Add as new sub-points at end of point 5:

Genuinely integrate health and care services nationally;

Train and recruit 6,000 additional staff into the NHS, including doctors, nurses and other allied health professionals.

Amendment 2 moved.

Thank you very much, Deputy Presiding Officer. I formally move the amendment in the name of Siân Gwenllian. I’m sure that all of our inboxes include a number of examples of people suffering in their communities because they have to wait for an ambulance. For example, a constituent of mine in Abererch had to wait for 15 hours for an ambulance and she was in distress and her family were concerned for her life. And look at the staff, who often have to travel great distances the length and breadth of the country because there isn’t an ambulance available nearby. In addition to this, there are concerns that there are cuts to ambulance services in some areas, for example, Aberystwyth and Cardigan, as we’ve heard recently.

But why is this happening? Well, certainly it’s not the fault of the staff of the ambulance service, who are stretched beyond all reason. Indeed it is a symptom of a deep-seated problem. Let’s follow the journey of the patient. The patient goes into the ambulance, having waited for many hours, queues outside a hospital for hours, often behind a dozen or more other ambulances, and then, after a period in hospital, having made a sufficient recovery to return to the community, rather than being returned to the community, they can’t release the patient because there isn’t a community bed available or there is no social carer available for them. It is one crisis on top of another, emerging from the fact that there has been a historic shortage in terms of recruitment, retention and fair pay for health service staff. Of course, it would be wonderful to see more ambulances and paramedics available to respond on the front line, but I fear that all this would do would be to add to the queues of ambulances outside accident and emergency departments, because we need to look further up the system to see why it is overwhelmed.

Back in 2012, we saw a number of significant changes to health services the length and breadth of Wales. In north Wales, a programme called 'Healthcare in North Wales is Changing' was sanctioned by the then Labour Government, and that led in turn to the closure of a number of community hospitals, such as Blaenau Ffestiniog, Llangollen and Flint, centralising and downgrading some services, with a pledge that there would be more care available in the community. Yes, health services in north Wales and across Wales changed, but not always for the better. This discussion here today is the upshot of all of those changes.

In order to maintain an effective and sustainable health service, you need spare capacity in terms of beds. It's not me saying this but the specialists in this area. This is what the BMA told the Health, Social Care and Sport Committee in 2016, and I will quote in English:

'Once you go above 85 per cent bed occupancy, you can predict that you can’t cope with fluctuations. You need about a 20 per cent surplus of beds to cope with the kind of fluctuations that we’re talking about. When you’ve got bed occupancies running at 86 or 87 per cent, you start getting...delays...[in] the discharge of patients as well.'

And this is what we're seeing today.

Back in 1989, there were almost 20,000 hospital beds in Wales working at a capacity of around 77 per cent. By today, the numbers have halved to around 10,000 beds and are working to a capacity of 87 per cent, and that's been the case consistently over the past 10 years. And this pandemic, of course, has exacerbated the problems. Many of our community hospitals were closed because of a failure to maintain the beds with the required number of nurses, which brings us back to that fundamental weakness in our secondary healthcare system: a shortage of staff leads to a system that is struggling, as we are seeing today. With an ageing population, a tired workforce and delays in diagnostics and treatments because of the pandemic, we need more professional health workers more than ever.

So, what can we do? The first solution, of course, is to invest in preventative services to keep people healthy and out of our hospitals in the first instance. But the main issues that led us to introduce this amendment and that will strengthen the foundations of our healthcare system is the need to integrate health and care services and to train and recruit 6,000 additional staff. And I thank Russell George for stating that his party will support our amendment.

In terms of the health and care service, we need to take steps to plan the workforce, including attracting and keeping practitioners and paying social care staff health service wages. We should launch a national review to establish statutory care standards in care homes, and we need a commitment to plan immediately to scrap social care charges. We need to recruit 6,000 additional staff, as I mentioned, and we need to develop a five-year plan, which includes incentives for GPs, the creation of more GP roles, the creation of a recruitment and retention strategy for nurses, and investment in our medical schools.

It's fair to say that we all appreciate our health and care services more than ever before. We have seen for ourselves the selflessness of the staff who have travelled that extra mile day after day to keep us all safe, to save lives and to care for the most vulnerable in our communities. But we are also seeing the fragility and the inability of those services, the lack of investment that's led to an overreliance—

Please come to a conclusion now.

—on goodwill and the full commitment of our health and care workforce. It's a duty, therefore, on us all to alleviate those pressures and to repay them for their commitment in their hour of need. And when I say that, I mean more than standing in front of cameras and clapping. In doing this, it'll have a positive impact, seen in all parts of our health and care services, including the ambulance services that are so crucially important. Thank you.

I thank the Conservatives for bringing this debate today. As Members who were present in the last Senedd know, I rarely spoke in health debates. Fortunately, for the first time since I was elected, we have a health Minister who I am confident will address the problems.

I also recognise the hard work and dedication of the Welsh ambulance staff in very, very challenging circumstances. I also accept the immense pressure the Welsh ambulance service is under, with increasing transfer-of-care times. I, like many Members, have been contacted by angry relatives when ambulances have failed to attend. One constituent with a suspected heart attack was told to get a taxi. Another constituent, at a pub quiz, had a suspected stroke. There was no ambulance available; the pub landlady took him to A&E. I mean, is it bad luck that the two health providers that have provided the worst service over several years are the Welsh ambulance service and Betsi Cadwaladr, which are, geographically, the two biggest direct providers?

Providing more ambulances or getting the army involved, as proposed, what that will do is increase the number of patients waiting outside. I mean, you then have five more ambulances, you have five more ambulances waiting outside. The visible bottleneck in the system is A&E, and ambulances queuing outside is a symptom of this, not the cause.

Too many people go to A&E when their medical need is neither an accident or an emergency. Why do they do this? Because it's the only place you can guarantee to see a doctor. So, after several days of failing to see their GP, patients go to A&E for the long queue, but knowing at the end of that long queue, a doctor will see them. Also, doctors in A&E are risk averse, and rather than sending patients home and telling them to seek medical help if they get worse, they keep them in for 24 hours of observation. One of the problems with beds being used up is that people are being kept in, observed and released. How many patients have actually spent 24 hours in observation and then been sent home?

A proposal I put privately to the Minister previously is out-of-hours GPs being installed in every A&E department to help the—

Will the Member take an intervention?

Certainly.

Thank you, Mike. Would you not agree with me that there's also a crisis in our social care, whereby there aren't the number of social care beds, so beds are being occupied by people really now who are desperately wanting to either get home or actually facilitate appropriate social care, and that's making the condition worse?

I agree with you entirely. I've only got five minutes, so I will not be addressing social care; I'm just sticking with hospitals and A&E and health. But, yes, I agree entirely. 

To help deal with patients who attend, the GP out-of-hours service should be given the job of assessing patients upon arrival, deciding in what order they should be treated and dealing with non-medical emergencies. And this, by the way, is not a complaint about GPs in general. Most of them work incredibly hard and are seeing more and more patients. They are at capacity in many areas. The problem is that the first person who a patient contacts in their GP surgery is the receptionist, who normally lacks any medical training whatsoever, and just collects patients' requests and books them to a doctor's slot until all slots are full. One GP estimated that 10 per cent of their appointments per day were for advice and treatment for common ailments; another noted that practice GPs are concerned that they spend a significant portion of their time treating common ailments and conditions such as cold and flu. A further suggestion I made to the Minister previously is to train receptionists to the level of paramedics. They could then triage patients to the local pharmacy, the GP urgently, GP non-urgently or to A&E. I think it really is important that people don't have a sort of good luck or bad luck on phoning the GP: 'You were forty-first. You might be seriously ill, but the GP cannot see you.' That's got nothing to do with GPs; they are sat in there waiting to deal with people, but if you're the forty-first you don't get seen, if you're the fortieth you do, and the fortieth person might just have a cold or a cough or something that could easily be dealt with by the pharmacy. We don't use pharmacies enough.

Mike, will you take an intervention from Mark Isherwood?

Certainly. But it's the last intervention I will take.

Thank you. I welcome your comments, but do you share the concern of the senior clinician who also works as a GP, who wrote to me saying:

'Waiting times at Wrexham Maelor A&E department have got to atrocious levels. I've been discussing this with one of our junior doctors who does locum in the department. He confirmed that waiting times are indeed extremely long and said the issue was that there is no space to see patients'?

He said that there are commonly several doctors sitting around doing nothing because there is nowhere to see the patients, and surely physical space should be one of the easiest things to solve.

I agree it should be one of the easiest things to solve. I can't talk about Wrexham Maelor, but I can talk about Morriston Hospital, and the thing that causes the problem there is the physical number of people. They haven't got doctors sitting around doing nothing in Morriston, but if Wrexham Maelor would like to send some of their doctors down to Morriston, we'd very much welcome them. We haven't got people sitting around doing nothing; what we've just got is a huge queue. You can have 50 or 60 people there. Some are seriously ill, they've had a stroke, they've had a heart attack, they've had a serious accident, they need to be checked whether they've broken their neck or not, and others have turned up who are not feeling very well and they just can't see a doctor.

I sent this to the Minister regarding one of my constituents—and I was talking to the health board—who had a growth on his neck, which kept on getting bigger and bigger. He spent four days failing to see his GP, because he was forty-first or forty-second in line. We cannot have this sort of, 'You join a queue and you're either lucky or unlucky.'

Finally, the Welsh ambulance service is not working effectively. I believe, to get the best out of the ambulance service, it should be split up and run by the individual health boards, like it used to be, so the health board has ownership of the ambulance service. It's their fault, not somebody else's.

I just want to put on record that our ambulance crews and NHS workers are doing a fantastic job in the extremely difficult circumstances facing the NHS, and I want to thank every single one of them for the amazing work that they do. Last week, I raised the issue of poor ambulance response times in this Chamber. I was joined by a number of my Conservative colleagues and others, who are also facing a similar situation across their constituencies. I have personally received large volumes of correspondence from constituents and our NHS staff who are extremely concerned about the current situation. There is clearly an issue here that is not getting addressed. Yet when I asked the Welsh Government to tackle this issue last week, their heads seemed to be buried in the sand.

This seems to be an issue not just affecting Wales, but other parts of the United Kingdom. The Scottish Government have had to call in the army to support their NHS with the unprecedented pressure that they are under. I am pleased that the Welsh Government has acknowledged a request from the Welsh ambulance service and will now send the request on to the Ministry of Defence for assistance from the army.

I speak to paramedics in Brecon and Radnorshire and across Wales, and they have informed me that it's not due to a lack of ambulances that there is a problem, but any additional help is welcomed; it is the fact that they can't get patients from the ambulances into A&E and onto the wards, due to the lack of beds and problems in our social care sector. Someone somewhere in Government has got to take responsibility for this, because at the moment all everybody across Government seems to be saying is that throwing more money at the problem is the only way to solve the situation.

But we have seen significant increases in the NHS budget since the pandemic began, and things aren't getting any better. Can I ask the Minister to tell me, after the Welsh Government has received £8.6 billion to combat COVID-19, £2.9 billion announced in the 2021 budget making its way to to Wales and £1.9 billion over three years, a Barnett consequential from the English NHS, where has this money been spent to improve bed capacity and access to A&E treatments? Minister, are you going to take responsibility for this? Are you going to accept the fact that this needs to be addressed? The Welsh Government must now step up to the task and deal with this unacceptable situation. Lives are at risk, and people waiting for 12 hours plus is just not acceptable. We would not let animals suffer like this, so why are we letting the people of Wales suffer?

With power comes great responsibility, and we must all play our part to support those working in our NHS and the Welsh ambulance service. We now face a winter of NHS pressures, and you have been found wanting. No plan, no strategy to address those pending problems. However, it is not too late. Take this opportunity to reassure this Senedd and the Welsh public that you accept the circumstances our ambulance service and NHS are facing, and set out plans to improve the services that our public are entitled to receive. Let us explore opening up the Nightingale field hospitals to free up space in our current hospitals. Will you look to reopen currently closed wards so that people can go back into their community hospitals? Let's have a comprehensive plan for recruiting more social care staff, paying them a proper wage and doing more to support our front-line NHS staff.

The time for excuses is over. The time for blaming others is over. The time for action is now. For years you have campaigned for greater powers, you now have those powers; it's time for you to use them wisely and in the interests of the people of Wales. Minister, over to you, the public are watching. Diolch.

Can I firstly thank Russell George for bringing forward this very important debate? I know as well as he does about the long-standing challenges faced by the residents of Montgomeryshire in accessing health services. Thank you. Diolch yn fawr iawn. Like other speakers, I would also like to record my thanks and my appreciation and gratitude to all of our health workers, ambulance drivers, volunteers, care workers across Wales. During these past 18 months, they have worked relentlessly throughout this COVID time. As we're heading into winter, with COVID cases sadly starting to rise, we need to really address this issue together. 

It's no wonder that we hear so often now that some in the ambulance service are saying that morale is at rock bottom. From my understanding, this is a perfect storm of ambulance waiting times, patients needing to stay in hospital due to the lack of social care, increased use of our health services because of COVID and other issues that have been waiting for the health services to open up, and our health and social care workers being stressed and exhausted and taking time off sick. 

My frustration is that this isn't a new problem. In the region of Mid and West Wales, all three of the local health boards now fall short of the Government's target for ambulance response times, according to the most recently published figures. It's clear that there needs to be long-term reform. We cannot wait another decade to see change. The health Minister helpfully said earlier this month that it would take significant time to introduce the reforms necessary for the NHS and social care system, but this needs to be about people. And I would just appeal to us all to work together to develop a plan and support that plan that clearly addresses this health and social care crisis. Thank you. Diolch yn fawr iawn. 

I stand and wish to place on record my formal and utmost thanks and gratitude to our ambulance staff and crew, our switchboard operators, and those nursing staff waiting at the other side of the A&E doors who are collectively attempting to combat the handover waiting times. We all know that handovers from ambulance to our A&E staff are crucial to ensuring that patients receive the emergency care they need, including appropriate equipment and beds for recovery and treatment. 

Over recent weeks, I have witnessed the aftermath of a lady who fell backwards on a moving escalator in a local store, who was then waiting for several hours injured and bleeding from the head. After intervening with the Welsh Ambulance Service NHS Trust myself, such was my concern, I was so relieved to see paramedics arrive, only to find that they then had to wait themselves for an ambulance because they were unable to offer the appropriate treatment required.

Another of my constituents was left in considerable pain and unable to move for approximately five hours whilst awaiting an ambulance, having fractured their hip at a well-known local adventure park. They had to close the ride for all that time, and she was stuck on this ride. 

Another of my elderly constituents, 96 years old, fell at approximately 10 o'clock in the morning, but was waiting until 6 o'clock for an ambulance to arrive, only then to be stuck outside A&E for a further six hours, due to the practice of ambulance stacking. And another lady was left injured in a rural lane after badly falling off a horse at 11 o'clock in the morning, only to have to wait until 4.30 p.m. for the ambulance to arrive, and then endured a further five and a half hours outside Ysbyty Glan Clwyd.

This isn't rumour or conjecture, these are real-life scenarios and situations that are now being caused by a lack of Welsh Government intervention and support for this much-valued emergency service. 

During the first six months of 2021, a staggering 47,871 hours were lost by ambulance crews waiting more than 15 hours to hand over to A&E staff. In my own health board, Betsi Cadwaladr, 16,937 hours were lost between January and June 2021. This Welsh Government's so-called NHS recovery plan leaves much of the detail up to local health boards and clinicians to deliver. With winter pressures already appearing to bite in September, Minister, what steps are you taking to review this plan so that a renewed focus can be placed on the stacking-up issue of ambulances?

In terms of the service itself, with 8.4 per cent of the workforce being absent due to sickness between January and March 2021, and a high staff turnover—is it any wonder that there is a high staff turnover with, as has been mentioned, morale being so low—a comprehensive workforce plan is now required, and this is actually endorsed by Healthcare Inspectorate Wales. So, Minister, what inroads are you making—tell us today, please—to bring forward such a plan? This is needed now. As noted by my colleague Peter Fox yesterday, the lack of ambulance support is now having a horrific impact on the ability of our education facilities—

Would the Member give way?

Yes.

Thanks, Janet. On that, it's completely clear from what you said, and other Members of this Chamber today, that we are in a crisis and it's not a crisis you can hide from, Minister. But you're right to address the wider impact of this and it also needs to be addressed, and I'd like the Minister to address it later on and tell us what the Government are going to do on the wider impacts. Peter Fox quite rightly highlighted yesterday in the Chamber that the impact on education is a concern, as a chief executive highlighted to both of us that he was seriously considering stopping all practical courses within all our colleges because of the length of the ambulance waiting times. That is an impact that we need to address as it has a severe impact on education throughout Wales, and it's something that you could look into, Minister. Thank you very much for giving way.

Thank you, Laura Anne Jones, for making those very valid points.

Lack of bed capacity, staff shortages and an increase in the number of patients turning to the ambulance service due to trouble accessing a face-to-face appointment with a GP are all contributing to this issue. Welsh Labour's guidance for GP surgeries to continue using online or telephone services is placing further pressure on our emergency services, as is the current advice in my constituency on people presenting with mental health concerns told to go straight to A&E, instead of there being local access to such much-needed specialised support. So, Minister, what conversations have you had with the GP sector to ensure that the number of telephone, video and face-to-face appointments is being monitored so that the trend is moving in the right direction?

Finally, we as Welsh Conservatives welcome the ambulance service's asking the army for assistance. It is a sign that circumstances have moved well beyond normal levels of difficulty, and I hope that this will be the start of getting the help required by these essential front-line teams. Wales needs action on these points now, so that our ambulance services can be empowered to work, their reputation restored and those patients most in need get the care and treatment they so deserve. Diolch. 

I'm grateful for the opportunity to contribute to today's debate. We have excellent ambulance services here in the UK. I have a lot to speak, but I don't have time. Ambulance response times are an indicator of system failure, and that our staff, who are exceptionally capable, are now being let down by a health and care system that is badly configured, where patient care is being compromised by long waits to be connected, long waits in our ambulances outside the hospital, and long waits in the A&E department to be assessed.

Much of this is sadly not new, and the fact that we are here yet again debating ambulance response times tells us that the Government has not resolved the problem. COVID-19 has slowed us down, and it has shown us our weaknesses in how we structure and plan our health and care system. I will focus my contribution to those actions that the Government could consider, addressing some areas that would affect our ambulance provisions, specifically (1) improvements to out-of-hours services and operations of A&E departments; (2) measures to lower the rate of bed occupancy; and (3) ambulance staff recruitment.

Firstly, we know that out-of-hours services can be effective, but they are hampered by not being able to access on-site diagnostic tests. Instead of referring a patient further up the line to establish the nature of the problem, why can't the Government examine the resources available at out-of-hours to improve their effectiveness? Addressing this capacity outside of A&E departments would be beneficial. Equally, the operation of A&E departments requires attention, and so too do waiting times. We need additional space, more trained casualty doctors, and observation wards. Well-trained accident and emergency consultants should be in charge on the floor and the number of doctors has to be increased to eliminate the inhuman waiting times in the departments. It will also allow an effective ambulance service.

There are also concerns about 'hospital by night', which, in many hospitals, has created a lot of problems, both for junior staff in the delivery of healthcare and to the people in emergencies. The service is delivered by medical staff who may have no experience in that field. If this service must be continued, then it should be delivered directly by the consultants of different specialities in the A&E department. Otherwise, in the interests of the delivery of patient care, it should be stopped immediately. 

In addressing the problem of capacity in A&E, it is time that the Government considers how the NHS responds to flu. We have this debate every year—winter pressures and what to do about it. In my view, those with flu should never have to be dealt with in an A&E department; they should have a separate door to the medical department to go to. It is like a road traffic accident; when the road is blocked, the police find a diversion. At the time when cases of flu return, the A&E department should not have to cope with this extra surge in patients because the plan should have been made knowing that this was going to happen—it always does in winter. I would like to ask the Minister what assessment can she offer of the likely number of people requiring hospitalisation this year because of flu, and the anticipated impact on the ambulance services. I hope she will address this point, because I want assurance that the Government has a plan.

Deputy Presiding Officer, this brings me to my second point, and that is the difficulty in helping people to leave hospital when they are fit to do so, and how we can free up beds, which will have a positive effect on the ambulance service. We know that around 100 patients are in hospital waiting to be discharged because of the brittle state of the care sector, as said by the Minister. Many people waiting to be discharged will need residential or nursing care—

The Member has to come to a conclusion now.

Ambulances should be in the community, looking after people. Ambulances are not hospital A&E department cubicles, but that is what they are being made by the Government here in Wales. Thank you very much.

I call on the Minister for Health and Social Services, Eluned Morgan.

Diolch yn fawr, Dirprwy Lywydd. Can I thank Members for their contributions this afternoon? I absolutely understand the strength of feeling in the Chamber in the light of the immense pressures that we're facing in the Welsh ambulance service, but also in the wider NHS and care service at the moment. I'd like to add my thanks for the incredible efforts of those people who are battling away on the front line as they have been doing month after month after month. I hope that everybody in the Chamber will stand with me in thanking them for their incredible efforts over so many months.

I can assure Members that I'm not hiding, I'm not ducking. I am absolutely taking responsibility and I understand that it is my responsibility to drive change in the system at this time of unprecedented pressure. I think it is worth underlining the fact that we have never seen anything like this before. COVID was bad, everybody understood COVID, but everybody in the service at the moment is telling me that this pressure at the moment is worse than anything we've seen hitherto. So, we need to understand the pressure that the system is under at the moment, and it's not something where you can just flick a switch and expect things to change. We've heard everybody this afternoon talk about the way the whole system is integrated, that one part affects the other, and so we're trying to manage all of those systems to understand and to make better those connections, and to make sure that we can see that flow and understand that complicated set of arrangements that exist. 

I think it is important for us to understand that the Welsh ambulance service trust has reported a significant increase in calls of between about 20 to 30 per cent compared to this time last year, and I think it's worth noting that 18 per cent of 999 ambulance calls are COVID-related. So, it's not just about the pressures in the system—COVID is still a major issue here. And it's also worth pointing out that this is not an issue that is unique to Wales. We've seen recent announcements in England, in Scotland, and there is a need to explore all of the possible avenues of support to maintain safe delivery of care and health services. 

Now, these system-wide flow challenges manifest in different ways across all parts of the system. Of particular concern is the significant impact on ambulance capacity caused by ambulance patient handover delays that so many people have talked about this afternoon. And that is compounded by increasing demand on services as well as workforce, and resource constraints due to the continued impact of the pandemic. So, we do need a genuinely system-wide response to address these system-wide challenges which, by their very nature, can't be viewed in isolation or solved by any single part of the system.

So, we need cohesive actions to take place at local, regional and national level, and despite significant investment and accelerated recruitment to the Welsh ambulance services, staff resourcing has continued to be significantly impacted, as some have pointed out, by staff absence, and that's through a combination of staff sickness, which grew by 10 per cent [Correction: to 10 per cent] FootnoteLink in June 2021, self-isolation—they are affected of course by COVID as well—shielding, annual leave—which was delayed, of course, for so many staff as a result of the emergency response to the pandemic. We've got to accept the fact that a lot of these people are reaching burnout and they need a break. 

Welsh ambulance staff have been working to their limit, and often going beyond what could be reasonably expected of them over the course of the pandemic. And of course, that is impacting on staff morale and well-being. There's also been a reduced uptake of overtime, which has prompted the trust to consider options to incentivise overtime in order to make it more appealing to staff to fill gaps, and increase capacity over the forthcoming months.

Now, practical requirements, including the need to don personal protective equipment and deep cleaning of equipment and vehicles for each ambulance response. Don't forget, we're working in a COVID environment; it changes what they do usually to something more difficult and more sophisticated. And that also impacts therefore on ambulance availability and responsiveness at times of peak demand. 

Now, these capacity-limiting factors have been accentuated by difficulties in timely discharge of patients from hospital, which, again, so many Members alluded to, and this reduces available hospital beds and causes delays for the transfer of patients from ambulance crews to the emergency department staff. Despite all of these challenges, almost 60 per cent of immediately life-threatened patients received a response within eight minutes in July. Almost a third of these patients received a response within five minutes.

Now, over recent weeks there have been a number of occasions when the Welsh ambulance service trust has experienced pressures that have forced it to escalate, through its demand management plan, to a level at which it has not been possible to send an ambulance for certain categories of calls. Now, the demand management plan enables the trust to dynamically react to situations where the demand for services is greater than the available resources, and it's designed to optimise the safety and outcomes of all patients, and to prioritise those patients in the greatest need of an immediate response based on the resources available.

Now, I don't think it would be appropriate for the Welsh Government to declare an emergency in the Welsh ambulance service, but of course we accept there is a problem here that needs to be resolved. The trust is taking actions to transition from the recovery phase of its COVID-19 effort back to the response phase, the monitoring position, in response to the current and anticipated pressures. Now, this places the trust on a similar footing to when we were at the height of the pandemic, so I'm underlining the point that the problem now is as great as it was at the point of the greatest risk in terms of the pandemic. That gives a stark perspective on the level of the pressure the service continues to experience.

The Welsh ambulance service has been considering a number of options to supplement existing capacity, including exploring options with a number of national agencies. So, the trust has already contracted St John Ambulance Cymru to support additional support over the busy winter months, and the trust has also been working with military planners as part of the MACA, or the military aid to the civil authorities process, which the First Minister explained in the Chamber yesterday. The Welsh Government received the MACA from the trust earlier today, and both the First Minister and I have now agreed that that should now be passed on as a formal request.

We haven't been waiting for things to happen. In fact, in July, I called an extraordinary meeting of the emergency ambulance services committee, because we saw that there might be a problem. I requested the development of a delivery plan. I think somebody was asking for a delivery plan; we've got one and that sets out a range of time-bound actions to be delivered between now and the end of March 2022. The key actions in that plan—as Janet-Finch Saunders, I think, wanted me to tell her what was in the delivery plan—were: improved forecasting to better understand and plan for actual demand and match resourcing accordingly; continued implementation of recommendations from independent demand and capacity review; ensuring we're able to control the demand on our services whilst ensuring patients are safe and receive the care they need in the place that they need it; health board clinicians directly managing ambulance patients and redirecting them to clinically safe alternatives; and using ambulance staff to safely cohort multiple patients, allowing ambulances to return to community response.

Clarification by the Minister for Health and Social Services

Minister, you need to conclude now.

Well, I think the key thing to emphasise is that it's not just about the ambulance service, though. It's also about trying to make sure we address the issue of getting people out of the back door of hospitals once they have been seen. That's why we are hosting a weekly meeting now with the WLGA, with health boards, to address this issue of how we can give more support to get people out of hospital so we can get people through the front door of hospitals, because at the moment there is undoubtedly a blockage at the back door. That is absolutely the priority that I'm working on at the moment. All of these are integrated, but I really am grateful to people for bringing this issue to the attention of the people of Wales, because they need to understand the seriousness of the situation that we are facing at the moment. Diolch.

I call on Gareth Davies to reply to the debate. 

Thank you very much, Deputy Llywydd, and I'd like to thank everyone who has taken part in this debate this afternoon, and I really mean that. It's the first time, as a relatively new Member and in my short time, that you can actually hear a pin drop in this Chamber this afternoon, and I think that goes to show the seriousness of what we're talking about today. I would also like to take this opportunity to thank our amazing ambulance staff. They are having to work under unimaginable stress, and it's only thanks to their dedication and professionalism that Wales is not facing an even bigger crisis in emergency care.

As the many contributions to this afternoon's proceedings rightly point, Welsh ambulance services are at crisis point. Like many parts of our health and care services, the arrival of COVID-19 has deeply impacted Welsh ambulance services. However, the crisis in emergency and unplanned care predates the coronavirus pandemic. Long-term policy failings by Welsh Government and a fundamental lack of integrated workforce planning have led us to where we are today: an emergency in emergency care.

We will now likely see members of Her Majesty's armed forces having to operate on domestic soil to provide ambulance services in Wales. As my colleague Russell George pointed out in opening the debate, ambulance services are the canary in the mine. If patients are unable to go into hospital at times of urgent need, then there is clearly a wider problem and the health service is at risk of collapse. How many times have we dodged a bullet solely thanks to our amazing health and care staff, staff who are overworked and overstressed, yet pull out all the stops to ensure that health and care services don't grind to a halt? We know full well that the crisis in emergency care does lie with the Welsh ambulance service as a result of issues elsewhere in the system.

Ambulance crews are losing tens of thousands of hours waiting to hand over those in their care. Sadly, a load of ambulances stacked up outside our A&E departments is a common occurrence. While those crews are waiting outside emergency departments, they are not able to respond to emergency calls. Patients can't be handed over because there are no available beds. Often, there are no available beds in our hospitals because patients can't be discharged due to bottlenecks in social care. The health Minister admitted recently that patients are unable to be discharged, due—[Interruption.] I will give way, Mike, yes.

I can only talk about Morriston, but it's not the lack of beds that's causing the problem, it's the lack of rooms in accident and emergency. Accident and emergency, the whole of that area, including the places where people are being taken, is full, and that's where the problem is. It's not—. If they had 100 extra beds, it would not deal with the problem in A&E. The A&E problem is that there are just too many people there.

Well, thank you very much for your intervention, Mike, and I do agree that high numbers in A&E is commonplace. I think Mark Isherwood mentioned earlier about room being a factor, and in other contributions, and the possibility of Nightingale hospitals and other facilities being used. And that is, perhaps, something that can be addressed in the future.

The health Minister—

Will the Member take another intervention? It's your choice.

Sure.

You raise a very important point, which I was going to say, really. We have always talked about ambulances and we've talked always about the patients. But no health board so far has come up—. How many people in the A&E department are working at a given time? It is not more than one or two people, and they are the most junior people, they are not well versed with the A&E department. And as we talked about, at hospitals by night, you can go and ear, nose and throat people will see the orthopaedics, medical people will see surgical patients and there's chaos. So, always when we're talking about ambulance times, I would urge the Minister to tell us how many doctors are working in a given time in the A&E department, and you will see for yourself that it is not the ambulance services, it is the department of health that is failing us and it is making it a scapegoat, this 'Ambulance, ambulance'. Thank you.

Can I remind Members that interventions are not opportunities to make further speeches, as well? [Laughter.]

Thank you very much for the intervention, Altaf. I agree with what you said in your part of the debate when you mentioned about on-site diagnostics and better training. I think that's something that's definitely worth looking at in the future.

The health Minister admitted recently that patients are unable to be discharged due to the brittle nature of the care sector. We know that there are at least 1,000 people in hospital who should be at home or in a care facility, but are unable to move on due to capacity issues. We are today debating a crisis in emergency care, but that crisis is as a direct result of a crisis in social care. We need thousands of extra care staff today to ensure that the sector is adequately funded. In addition to massive staff shortages, our care sector is short of hundreds of millions of pounds, yet Welsh Government have no plans to address the shortfalls. Without a properly resourced care sector, our hospitals will remain above capacity, which will lead to the horror stories that we heard today.

James Evans spoke about poor ambulance response times, NHS staff concerns, Scottish Government having to bring in the army, and Welsh Government responsibility, which is really key. Mabon ap Gwynfor noted some of the problems historically in north Wales, and some of the intricate details leading up to some of those problems, which he's quite right to say.

Janet Finch-Saunders gave some personal accounts of witnessing people in her constituency in Aberconwy having to wait too many hours for vital healthcare treatment. As a former employee of Llandudno hospital, I've seen that first hand on the front line in the NHS. Laura Anne Jones mentioned some of the wider impacts on education, as Peter Fox rightly brought up in yesterday's Plenary. And, as I mentioned, Altaf mentioned some on-site diagnostics and training and some of the COVID-19 consequentials that we've seen during the course of the pandemic that have been really pertinent over the last 18 months or so.  

So, I once again pay tribute to our outstanding Welsh ambulance service staff, and I ask Members to reward their dedication to their duty and their Herculean efforts to maintain emergency care by supporting the motion and rejecting the Welsh Government's amendment. Unless we take the actions outlined in our motion, the crisis in emergency care will become a catastrophe. Diolch yn fawr iawn.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Yes. I will therefore defer voting on the motion until voting time.

Voting deferred until voting time.