Questions now from the party leaders. On behalf of the Conservatives, Paul Davies.

Diolch, Llywydd. First Minister, last Sunday was World Mental Health Day, and before I go on to ask my questions, I'm sure that you and everyone in this Chamber will join me in sending our very best wishes to our colleague Andrew R.T. Davies as he takes some time now to focus on his own health.

I appreciate that the Welsh Government has provided some additional funding to reprioritise mental health in light of the COVID-19 pandemic. However, the fact remains that some people have been without face-to-face appointments for several months now, and some have been unable to access specialist support. I appreciate that there will be a statement later today on the 'Together For Mental Health' delivery plan, but can you tell us what targeted action the Welsh Government is now taking to ensure that those who need support and assistance can access services wherever they live in Wales?

I thank Paul Davies for that question, and of course I very much associate myself with what he said in sending our very best wishes on behalf of the Welsh Government and the Labour Party to the leader of the opposition. I hope to see him back in his place in the Chamber as swiftly as he feels able to do that.

The general point that Paul Davies raises is an important one: it was World Mental Health Day, as he said, at the weekend. Mental health remains the single largest budget line in the whole of the NHS in Wales, and our health boards generally overspend the amount of money that is allocated to them for that purpose. What we tried to do during the pandemic was to strengthen those no-referral services, those primary and preventative services that people can get to without having to go through a gatekeeper in the first place, and to get help when they first feel the need to do so. We're particularly focused on that with young people, as the Member will know, in our increased investment in school counselling, in the work that we've done with the youth service to make sure workers there are as prepared as they can be to respond to the needs of young people, and in our commitment to the whole-school approach.

The demand for mental health services has risen significantly during the pandemic and the ability to provide those services face to face has to take into account the clinical conditions in which the service operates. But I believe that throughout Wales, there are very dedicated and determined people who work in the service trying to do exactly what Paul Davies has suggested.

First Minister, as you will be aware, as well as struggling to access mental health services, there are also people across Wales who are really struggling to access their GP, as mentioned earlier on in this session. The pandemic has exposed the fact that there are not enough doctors and staff in primary care. Whilst I understand that there has been recruitment activity taking place, that's of little comfort to those patients waiting day in, day out to book an appointment to see their GP. I accept what you said earlier, that the picture is mixed, but many are left waiting for up to an hour or even longer on the phone to speak to someone, and when they finally get through they are often told there are no available appointments, and to call back the following day.

We know that there has been a reduction in the number of GPs; according to the Welsh Government's own data, between 2018 and 2020, there has been a reduction in the number of GPs per 10,000 of population in three out of seven of our health boards—in Betsi Cadwaladr, Powys and Aneurin Bevan health boards. So, First Minister, with the population numbers in those areas growing over the same period, what assessment have you made of the impact the reduction of GPs in those areas has had on patient care?

The assessment that the Welsh Government makes is that the future of primary care cannot depend on GPs alone. The nature of the GP population is changing. The sorts of contracts that people emerging into the world of primary care wish to take up are changing, and we have to change with it. We have to change with it primarily by expanding the range of professional voices who are able to provide primary care services. A focus exclusively on GPs will not give us the sustainable future for primary care that we need here in Wales.

GPs remain fundamental to that primary care team—leading it, responsible for clinical standards, making sure that they see those people who only a GP can see. But at the same time, they will oversee broader teams involving physiotherapists, pharmacists, advanced practice nurses and paramedic professionals, all of whom are able to provide a clinically effective service to people who need a primary care contact. That is the way in which we will find a future for primary care that meets the needs of the Welsh population and that, through that mix of professionals who will be at the front line, can make sure that the right sort of help is available to the patient far quicker than if we were simply to be relying on the model that has served us well up until now, but that is reaching the end of its exclusive usefulness.

First Minister, there is a serious issue here for patients trying to get access to their GPs. Mair Hopkin from the Royal College of General Practitioners has said that the crisis in GP surgeries actually predated COVID, with a lot of patients finding it difficult to get an appointment before the pandemic, and having to wait several weeks for an appointment. We've heard from Dr Phil White, chairman of the BMA's Welsh GP committee—he's said that problems were developing before COVID, with more GPs being lost to early retirement. And doctors themselves have highlighted the impact that this has on the whole system—doctors like Dr Oelmann, a GP at Clark Avenue surgery in Cwmbran, who has made it clear that it's not just GPs, it's right through the system. There are backlogs in secondary care, the ambulance service, social care. He's right to say that everything is interlinked, and that none of it can be viewed in isolation. It goes around in a circle and becomes more and more difficult for staff, and indeed for patients. Therefore, First Minister, do you accept the view of the Royal College of GPs that the crisis in GP surgeries predates COVID? And, given the impact the pandemic has had, what urgent steps will your Government take to specifically address the development of primary care in this parliamentary term? Given that one of your Government aims set out in the 'A Healthier Wales' review was to improve the experience and quality of care for individuals and families, how will you achieve this if the number of GPs continues to decline, and our population continues to grow?

I agree with what the Member says about the pressures that there are on the system, and they are in all parts of the system. Many GPs have chosen to take early retirement because of the changes in their pension arrangements that his Government at Westminster introduced, which meant that it was simply financially not sensible for them to continue in the jobs that they had done. We have urged the UK Government many times to remove the perverse incentives that have led to some people taking themselves out of the workforce earlier than they otherwise would have done.

The future of GP services—GPs in that narrow sense—lies in our ability to recruit more people into the profession, and to train here in Wales. He'll be well aware of the very healthy figures that we have achieved in recent times in reaching and overreaching the targets that we had set for GP trainees in Wales. I think in an answer to a question last week I explained how the number of GP trainees in north Wales was to be raised again next year. GPs by themselves are not the whole answer to primary care, in the way that I've described already, Llywydd, and what we will do as a Government is to invest in that wider set of professionals, changing the nature of primary care, bringing it into line with the way in which people who work in it see their futures as professional workers here in Wales, providing them with the twenty-first century surgeries that we are committed to in our manifesto, and continuing to celebrate the efforts that day in, day out see thousands and thousands of people successfully treated by primary care clinicians in Wales every single day.

Plaid Cymru leader, Adam Price. 

Thank you, Llywydd. Can I at the outset on behalf of my party also send our messages of support to Andrew R.T. Davies? Many people will have taken courage and inspiration from him speaking openly about the challenges that he's facing with his own mental and emotional well-being, something, of course, that many of us will face at different times in our life.

First Minister, MPs at Westminster have today described the UK's pandemic response as one of the worst public health failures in UK history. I agree with that damning assessment. First Minister, do you? 

I've not had an opportunity to read the report published today. I've seen newspaper accounts of it. It is clearly a report that merits proper consideration, and I plan to do that. I'm not in a position to endorse or deny any verdicts that Members of Parliament came to until I've had an opportunity to study what they've had to say in more detail than I've had an opportunity to do so far. 

First Minister, among the report's many findings is its conclusion that the decision by both the UK and the Welsh Government to abandon community testing against World Health Organization advice on 12 March 2020 was a fatal error that cost many lives. Notwithstanding the fact that you haven't had the opportunity to study the report, do you acknowledge that general criticism? Do you accept that it would have been better during that early phase of the pandemic to have followed your own policy in Wales, independent of Westminster, in relation to this, as you did indeed do on so many other matters in the later stages with considerable success? 

I thank Adam Price for that. Llywydd, I've been asked the question many times, 'Were there things that you would have done differently had you known then what you know now?' I think that that question is particularly pertinent to those very early stages of coronavirus, when so many things that we have learned since we simply weren't aware of in the way that we are now, whether that is community testing or whether it's the example I've most often given, which is: had we understood the extent to which coronavirus was already seeded through the United Kingdom, and had we understood the rapidity with which this virus would spread to other parts and to other communities, we would have acted earlier to introduce some of the measures that were only introduced in the second half of March. But we didn't know those things then. We were following the advice that we had at the time. As our knowledge grew and as we were able to make our own independent decisions because we had the knowledge base that allowed us to do so, as Adam Price says, the Welsh Government has not hesitated to take our own decisions where we thought that that was in the best interests of Wales. But at each point, I think it is fair for people to think about: what did we know then, what do we know now, and in the light of circumstances at the time, did we make the best decisions that we were able to?

I, of course, understand the point about hindsight, but I suppose the crux of the matter here was that the WHO had the foresight at the time to emphasise the importance of community testing. Indeed, I remember our party criticising the Welsh Government's decision to abandon community testing at the time, on that basis, because there was advice there that actually has been borne out in terms of its importance. In the entire 147-page report, ostensibly about the UK as a whole, Wales is mentioned I think just nine times, and the majority of those references are in the footnotes. Doesn't that make the case for Wales to have its own inquiry, because without it, if we delegate to Westminster, the experiences of the bereaved families that you met last week, First Minister, will simply be forgotten, and the lessons for Wales that should be learnt will be lost?

Well, Llywydd, as I've said, I've not had a proper opportunity to study the report, but even from the newspaper account that I have seen, it seemed to me to strengthen the argument for the Welsh experience to be properly investigated within the wider UK context. This report, as I understand it, was never meant to be about the experience in Scotland, Wales, or Northern Ireland, but it does set out very clearly the decisions that were made at a UK level, and without understanding that, you cannot understand the way in which decisions were made here in Wales. But let me repeat, because I know the Member has heard me say this before, that I have been very clear with the UK Government that the Welsh Government's decisions, and those taken by other relevant bodies in Wales, have to be scrutinised within a UK-wide inquiry in a full and comprehensive manner. Wales cannot and must not be an afterthought or a footnote in any UK-wide inquiry. I set out, as he knows, in my letter to Michael Gove on 10 September, a series of tests that we would apply to give us the confidence, or otherwise, that the Welsh experience was being given the attention within a UK inquiry that it needs and deserves, so that those families get the best possible answers.

Now, there are a number of tests coming up for the UK Government in this regard. I am yet to receive a reply to that letter, and I will look very carefully at it when it arrives. I'm hoping to have a face-to-face meeting with the Prime Minister within the next coming days, and I plan to use that opportunity to make these points directly to him. He has promised bereaved families that the lead of the inquiry—the judge, as I hope it will be—to oversee the inquiry, will be appointed before Christmas. I would expect Scotland, Wales and Northern Ireland to be properly involved in that appointment—not to read about it in a press release. So, there are a number of ways in which, over the weeks ahead, the UK Government can demonstrate that this is to be an inquiry that sets out the actions that were taken at a UK level, therefore providing the proper context to understand what happened in Wales, but has a focus on the Welsh experience, which will give confidence to people who will look to it that the actions of the Welsh Government and of others have been fully and properly scrutinised and the answers to questions that people have properly addressed in the process.