4. What contingency plans does the Welsh Government have in place to support the Welsh ambulance service during unexpectedly busy periods? OQ56926

Thanks. The Welsh Government continues to support the Welsh ambulance service to deliver responsive emergency services. I have asked the chief ambulance services commissioner to work with health boards, the Welsh ambulance service and partners to develop more robust whole-system escalation plans and to enable greater operational grip over the winter period.

Thank you, Minister. It was glaringly apparent from our debate last week and from the fact that our post boxes are full of worrying constituents' cases about this that there is a dire need to do something very quickly about this situation. But what I want to ask you today, Minister, is specifically about GPs and supporting face-to-face appointments, as opposed to the online ones, because if we tackle that, then that will obviously help the ambulance service by bringing down the numbers presenting at A&E, as what is becoming apparent more and more from the cases I'm receiving is that symptoms are being missed, and those people are then presenting themselves to A&E and contributing to the A&Es being clogged up and the adverse effect that that's having. 

So, Minister, how are we collating the data centrally? Because, from what I'm aware of, there's no central collection of data on this, and it seems to be really important that we do collect that data in order to make the informed decisions on a Wales-wide basis on this, because those people do need to see doctors face to face now, because things are being missed. But we have to contact the surgeries to get that information, wherever we go. We need that data centrally collected. So, what are you doing about that, Minister, please? Thank you. 

Thanks very much. Well, I think we've got to be straight with the public: we are not going back to the way we were pre-pandemic. We have introduced new digital services and, frankly, a lot of the public like them. A lot of people like e-prescribing, and certainly that is the response that we are getting in the many surveys that we're carrying out. Of course, there will always be a time when some patients need to be seen face to face, and that is a clinical judgment that our GPs are making every day. And I think it's absolutely right for them to be the people making that clinical judgment. So, what I won't do is what Sajid Javid has done and to just say, 'You've got to see these patients face to face'. We're not in that space. We are not going to be going back to that; we are going to allow our GPs to make that clinical judgment of what's right, and they will determine whether it's right to see people face to face.

And we do have to make sure that people in Wales understand that there are alternatives—that you can go to your pharmacy, that there are other places that people can go, and that they can give you some great advice. You can go directly to see a physiotherapist; you don't always have to go through the GP as a gatekeeper. What we're trying to do is to make sure that we train people up—receptionists—to make sure that they have a better understanding of where to point people.

But certainly, in terms of the information, you'll be aware, I'm sure, that there is a system where we effectively pay bonuses to GPs in terms of access, and about 76 per cent of GP surgeries actually were able to get that bonus last year because the access was actually almost better than it's ever been. Now, it may not have been face-to-face access, but we are keeping tabs on that, and I can certainly send you details of that breakdown if that would be helpful to you.

Ambulance waiting times in the south-east are a matter of great concern, Minister, and this is compounded by A&E waiting times. Figures released this week show that the Grange hospital in Cwmbran has regrettably had the worst performance on record of any hospital in Wales, with only four in 10 patients being seen within four hours there. Many communities in the Rhymney valley have been without an A&E since the miners' hospital closed, and Ysbyty Ystrad Fawr in Ystrad Mynach opened without an A&E. With longer ambulance waiting times, the British Medical Association has warned that patients in Wales are having to use taxis or be at the mercy of their GPs having to drive them to A&E, and this will be worse in the south-east, and the Rhymney valley especially, where people have to travel further to get to their A&E than they would have done when the miners' was open. So, Minister, will the Government open talks with the health board to reinstate an A&E in the Rhymney valley in Ysbyty Ystrad Fawr?

I think we've got to be clear with people that accident and emergency and calling an ambulance have to be an emergency, and too many people are calling ambulances when they're not an emergency. Now, that's not to say that there are lots of people being missed at the moment when it is an emergency, and the reason for that, as I've explained, is because there's a huge increase in demand. Part of the reason for this, of course, is because we're having difficulty getting people outside, taking people out of hospital; people who are ready to be discharged can't be discharged because of the fragility of our care sector at the moment. That's why I'm spending a huge amount of my time working with my colleague Julie Morgan at the moment, trying to see what we can do to address the system in relation to care so we can improve that flow through the hospitals so we won't be getting people waiting outside hospitals in ambulances. But we won't be able to fix that unless we fix the back door of the hospitals, and so that's where my attention is focused at the moment.

In relation to particular opening of A&E, A&E is not just something you can magic up. There are huge amounts of resources that you have to place around that, and don't forget that, actually, when you put an A&E in a particular place, what it means is that if something else comes in, your planned care gets knocked out, and I'm very aware that 20 per cent of the population of Wales are also waiting for operations at the moment. So, if anything, we need to keep the division between those hot and cold areas in relation to health so that we can continue with the planned care where necessary, and opening additional A&E does not necessarily help us with our planned care. All of these things are interconnected, so I will take advice from the clinicians on where best to open A&E facilities.