The following amendment has been selected: amendment 1 in the name of Lesley Griffiths.

Item 11 is a Plaid Cymru debate on national health service winter pressures, and I call on Rhun ap Iorwerth to move the motion. 

Motion NDM7792 Siân Gwenllian

To propose that the Senedd:

Calls on the Welsh Government to publish a winter plan to tackle the pressures faced by the NHS during the winter months.

Motion moved.

Thank you very much, Dirprwy Lywydd.

This is a debate that has been inspired by the passage of time, the passage of time with problems intensifying within our health and care services. With winter approaching, indeed the feeling that winter pressures are here already, and yet we haven't seen a plan from the Welsh Government for the winter this year. They managed to publish it in September of last year, in a very timely way, after the exceptionally challenging months during the pandemic. The truth is that patients need the confidence that a plan is in place and the staff need to know that steps are in place to at least try to shoulder some of the pressures on their behalf over the winter. No matter how often we pay tributes to the staff, I will say the words once again: for their commitment, their sacrifice, and their work over the past period, words aren't enough.

I know that staff need support. Since we introduced this motion, I'm pleased that the Government have said that the plan is on the way. They will publish their winter plan on 18 October. We will be waiting almost another fortnight, and I know that there is confusion and disappointment that it has taken so long, but what we can do now, with a fortnight left to go, is we can try to influence that plan, and what we want to do is try to outline some of those areas that stakeholders have told us that they want to see as priorities. We've summarised that input from different organisations and bodies across health and care into five areas that we believe are entirely vital to get right in the winter plan, and I'm very grateful to those who have contributed to this work.

This five-point programme that we have follows the journey of the patient through health and care services, because we need to look at the entire system. First of all, we need to focus on the preventative measures—I hope that the Minister would agree with that—and signposting people to the right places to receive care. Things as simple as pavement gritting programmes can be very valuable in preventing accidents, even; ensuring that people are warm in their homes is important to prevent many health problems. Of course when people do become poorly, as is inevitable for many, we need to ensure that the messages on how to access services are entirely clear, encouraging people not to call an ambulance or go to an A&E department unless they genuinely need to do so, for example, and ensuring that the alternative methods of receiving care are supported correctly.

The second point is to do with that first point of access to health care through primary care. We have to find ways of releasing the time of health and care staff to see patients. Amongst the key steps there is accelerating the shift towards the introduction of new technology—a debate that we've had here recently—including e-prescribing and so on. Measures could include bringing additional staff such as GPs in from retirement over the winter; that could be something that could be considered as a matter of urgency. I also think that ensuring access for older people to primary care is vital, and I do refer the Minister to the new report by the Bevan Foundation in collaboration with Age Alliance Wales, 'Access to GP services by older people'. That's a very important document.

The third point is to strengthen diagnostic and referral work. We need to see a continuation, for example, of screening programmes through the winter. There is a genuine risk that cancer survival rates could slip back for the first time in decades, and the winter without doubt does cause additional challenges in that regard. We do need to ensure that cancer services are safeguarded this winter, that patients receive prompt diagnosis and treatment, and this needs to be put in the wider longer term context, namely the need for a national cancer plan. Workforce issues in general are more long-term issues too, but we need to somehow prioritise that element of strengthening the workforce that needs attention now, straight away, in this winter time.

The fourth theme, the challenge of increasing capacity: I look forward to hearing the Government's statement a week on Monday, and I hope that there will be a commitment to create robust COVID-lite hubs as part of that.

And finally, this winter's arrangements in terms of ensuring patient flow through the health system and on to social care are more important than ever before. We'll be hearing more about that from my fellow Member in a moment. We have heard about people's experiences with the ambulance service, for example. In one letter that I received this week, somebody waited almost 24 hours for an ambulance. The flow of people through the system is the problem in that regard, and we've all heard of similar experiences.

We can't hide from the challenge this winter. We'll need significant resources, but we will need innovative ideas too. So, I look forward to hearing the contributions this afternoon.

I have selected the amendment to the motion. I call on the Minister for Health and Social Services, Eluned Morgan, 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:

Notes that the Welsh Government will publish a health and social care winter plan in the week commencing 18 October 2021.

Amendment 1 moved.

Formally.

Can I thank Plaid Cymru for bringing forward this second important debate this afternoon? As Welsh Conservatives, we wholeheartedly support Plaid's motion, so we'll be supporting that today. Of course, we as Welsh Conservatives have been calling for a winter pressure plan for some considerable time, so there's no doubt that it's absolutely vital to get that plan to show this Parliament, to show the people of Wales and healthcare professionals, the Minister's direction to our health boards, at a time when we know that staffing is over-stretched and when infection control and prevention become more difficult to contain. 

Tragically, last winter we saw people die because of ward-to-ward transmission of COVID-19 in places that should be safe and secure for patients, so we can't afford to allow this to happen again, as it did last year. We know that waiting lists are still very high: one in four are still waiting for over a year for treatment and, in comparison, in England that figure is one in 16. So, Welsh patients who have been waiting for more than a year cannot afford to wait any longer for essential treatment, because we know the reasons for that.

Like Rhun did in his opening, I welcome, of course, the Government announcing that they will publish their plan on 18 October. What I would say is that this is a month later than it was published by the Minister's predecessor last year, in 2020, and of course the plan comes after that sustained pressure from opposition parties over the last few weeks as well.

Now, as part of that plan, we need to see action, I think, in a number of areas. We need an update to this Welsh Parliament on the Minister's progress on the plans local health boards have submitted on COVID-lite hubs; we need an update to this Welsh Parliament on creating community diagnosis centres, so that those with potential cancer and other conditions can be found quickly; we need an update to this Senedd as part of that plan on the progress of the COVID booster and flu programme, and how this will be implemented throughout the autumn and winter; we need an update on how hospitals are planning for enhanced infection control and prevention throughout the winter period; and we need an update to this Welsh Parliament on plans for emergency care this winter, of course, as well.

NHS staff, hospital patients and Welsh patients in general need, I think, reassurance that the Welsh Government have a plan to keep them safe this winter, so as Welsh Conservatives we'll be supporting this motion today. Diolch, Dirprwy Lywydd.

I guess we're all familiar with the usual winter pressures that come with the flu season, and the general strain on health during the winter, and the impact that has on our GP surgeries and our hospitals. This time around, of course, with COVID and the backlog of treatments that have built up, those pressures are likely to be even greater than usual. 

For me, as a representative of Newport East at the moment, Dirprwy Lywydd, what I'm getting in my postbag is a lot of concern about access to GP services, around basics like the telephone system and being able to access those face-to-face appointments when appropriate. Some of the problems obviously predated the pandemic, but they've certainly got worse, and I think the community health council, for example, have evidenced that in their work.

It's a basic problem, really, of people ringing continually and not being able to get through on the telephone within the designated period during which they can book an appointment that day. When they get through, it's too late to book an appointment that day and they're told to ring tomorrow, and then they go through the same experience again and, obviously, despair of ever getting the face-to-face appointment that they want. Of course, I do think that leads to extra pressure on A&E unscheduled care at the hospitals, because some people will then go to the A&E when they shouldn't. There are further problems there in terms of discharging from the hospitals around available staff for homecare and care homes. 

There's such a cocktail of problems at the moment, which, to some extent, existed before the pandemic, but it has certainly worsened as a result of COVID-19. I'm wondering, really, what the Minister can say today in terms of Welsh Government action on this. To what extent is there an assessment of these problems, working with the local health boards, to understand which GP services are having particular problems, for example, with their telephone systems, what upgrading is taking place of those telephone systems to deal with the problems, which GP surgeries are having particular problems with providing the necessary flexibility around face-to-face appointments, and what is being done to address that? And how is the Welsh Government working with the community health council to understand the evidence and the experience that people are having? 

There is a need for flexibility, Dirprwy Lywydd, I know. Some people actually want to use the new technologies to access services, but there are some that want those face-to-face services, and, when they're appropriate, obviously they need to be delivered. So, I would be grateful for some responses from the Welsh Government to those particular issues. 

Older people are a large and important part of my portfolio for Plaid Cymru. During the past week, I've had an opportunity to have a webinar with the older people's commissioner. It was an online session that launched the state of the nation report produced by the commissioner. One of the main points made during the webinar was the significant decline in the physical and mental health of older people because of the pandemic. The report also noted that older people have had difficulty in accessing services in the community, particularly health and care services, over the past 18 months. 

One statistic in the report stood out for me, namely that fewer than a quarter of older people found it easy to access online health services. Given that we are living in an increasingly digital age with many services that were once provided face-to-face going online, this means that older people are being deprived more and more and pushed to the periphery of society. We can't allow this to continue, and I'd like to hear how the Government intends to address this increasing problem. 

One aspect of health that is more likely to affect older people, but can also strike at any age, is cancer services. There's room for improvement in these services if we are to achieve the best outcome for patients. It would be useful to have an update on the next steps for the quality statement for cancer. We need to see strong leadership for cancer in Wales, and clear plans should include ambitious targets and mechanisms for tracking progress towards the longer term. Plaid Cymru also want to see more investment for staff, equipment and infrastructure if we are going to improve cancer survival rates. 

The gaps in the NHS workforce remain a major worry that hamper meeting the growing demand, reducing waiting times and improving outcomes. There should be investment in our NHS workforce as a matter of urgency. We know that winter comes every year, yet it always seems to catch out successive Governments. There must be a way of breaking this cycle of winter crisis after winter crisis. I believe there is much more opportunity to carry out preventative measures, like a more rigorous and comprehensive gritting programme for pavements. Many people in A&E every winter are there because they have broken bones after slipping on icy pavements. Many councils will not grit pavements and major walkways unless there is prolonged snow or ice; they don't have the resources to do so.

I know from my experience as a community councillor that the lack of resources is the most common reason for refusal from a local authority when we request on behalf of residents. We should look after our pavements as well as after our roads. It's not acceptable to simply ask people to stay at home during the cold weather due to lack of resources. By being proactive on this and giving local authorities the resources and guidance to act on this, we will allow people to live their lives throughout the winter, as well as ease the burden on the NHS. I hope this Government can support that.

You are right; every year we have a winter. A winter protection plan is a reasonable ask, and as colleagues have observed this afternoon, the Welsh Government has routinely set out its objectives for our health and care system to respond to the pressures of increased seasonal demand whilst attempting to deliver planned care and surgery. In fact, there was such a plan covering the most recent period of 2020-21. Whilst it was published during the pandemic and largely in response to that, it did demonstrate that the Government has a role in guiding and supporting our health and care services during a challenging time. My view is that we need a plan, a complete well-resourced target, targeted at those measures that our officials should know are going to work in ensuring that health and care can work more closely together in responding.

We know there is a higher risk of patients with flu needing to be hospitalised. The flu season last year would have been weaker because of the measures implemented to deal with COVID, such as social venues closed and people largely unable or restricted in mixing in each other's homes. So, whilst the incidence of flu would have been less, the level of immunity will also have been lower because of the reduced opportunities to mix with family, friends and work colleagues. The risk, therefore, of a greater number of people becoming ill this year, and with a greater intensity, will be somewhat higher than in previous years, and needs to be planned for.

I also want the Government to be open and honest about the numbers of people over the winter contracting flu and being hospitalised. In supporting our health and care system, I believe the Government ought to consider a range of actions. No. 1: assessing the capacity in primary care and whether we need short-term improvements in the range of multidisciplinary teams to help get us through the winter period. Many people will present at primary care, including out of hours, so ensuring that right capacity and skills mix is essential. No. 2: we need also to be sure that there is support for improvement to early hospital discharging measures to reduce the length of hospital stays at acute and community hospitals, to reduce the stress on bed management. No. 3: we need to identify capacity within our hospitals for those most elderly people who will sadly need to be admitted in response to flu. In the absence of a specific plan, assuming the Minister will this afternoon dismiss these calls, I will want assurance that the Government is examining a range of measures, fully sighted on the possible size of the challenge over the next few months. People have been warning about this for some time; the time to act is now. Thank you.

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

Thank you very much, Dirprwy Lywydd, and thank you very much for the debate. I'm afraid I can't go into detail on all of the points that have been raised—many of them very valid ones, I think—over the coming four minutes, but I hope that we will have an opportunity once the winter plan is published over the next couple of weeks.

This year, the pressure on the health and social care system has been absolutely relentless. The direct and indirect impact of the COVID-19 pandemic has made it extremely difficult for dedicated front-line staff. And this winter may, again, be the most challenging in the history of the NHS, with the ongoing demands of the pandemic and increased demands for other health services—the impact of winter respiratory viruses, as Altaf Hussain has just mentioned, the fragility in our social care system that many have mentioned, the need to continue with infection prevention control, and NHS staff who are exhausted, with some of them off sick with COVID.

Our approach to managing the pandemic is outlined in the coronavirus control plan, which is revised and reissued as the situation changes. We also issued a looking-forward document in March, demonstrating how we would rebuild the NHS. In the light of increasing pressures, we recently reviewed and reissued our local choices framework to support local decision making to protect patients and staff. And planning expectations are communicated annually to NHS organisations through our planning framework. We asked organisations across Wales to work in partnership to develop plans to safely meet the health and social care requirements of the people of Wales. The fluctuations in COVID-19 case rates add to the complexity of planning services, and we need to remain ready to respond to rapidly changing circumstances.

Later this month, as you're aware, we're going to be publishing our comprehensive winter plan for health and social care, setting out our priorities in response to expected and exceptional winter pressures. These priorities are already well known, and some are already being delivered at a local, regional and national level, with a focus on reducing the risk of people needing hospital treatment and keeping people safe and well. I'm pleased to say that many of the points that certainly Rhun ap Iorwerth talked about in terms of the need to look at prevention, making sure that we direct people to the right places—a lot of that is already happening. We have the Help Us to Help You campaign addressing the issues that John Griffiths asked about: how do we tell people where to go? How do we get people to access the right services? So, a lot of that is already being done, and we know that we need to keep that focus on reducing the risk of people needing hospital treatment and keeping people safe and well.

The Llywydd took the Chair.

These priorities will be supported by our investment of £140 million for recovery and £48 million for social care. I would like to take this opportunity to thank from the bottom of my heart the health and social care staff in all parts of Wales. They have worked tirelessly, with commitment and compassion, to provide services throughout the pandemic. Safeguarding the health and well-being of our staff is one of our major priorities this winter. I look forward to providing detailed information when we publish our winter plan soon.

Rhun ap Iorwerth to reply to the debate.

Thank you very much, and thank you for Members' contributions and the Minister's reply to the debate. We've heard references to very familiar problems that will be familiar to each and every one of us here in the Senedd, and we've heard a number of ideas from across all parties, to be fair, in terms of the responses that could be put in place. In terms of the Minister, I don't think that we would expect more just a fortnight before the plan itself is published than an outline of some of the principles that will be adhered to, and we look forward to seeing the publication of that report, even if I do have to add the words 'at last' at the end of that particular sentence. 

We can't come out of this winter in a worse position than we enter into it, and that is because of the terrible state of some services because of the pressures that there have been on them. And, in addition to that, the service will have to deal with the additional winter pressures—and it's another COVID winter, of course—and emerge from it with clear signs that the general situation of health and care services and the prognosis for those services is improved, and that is certainly the challenge that we face. 

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] I defer this item until the vote, which will take place during voting time.

Voting deferred until voting time.

Before we hold the vote, we will take a short break to ensure that the technology and everything else is ready.

Plenary was suspended at 17:30.

The Senedd reconvened at 17:34, with the Llywydd in the Chair.