Item 6, a statement by the Minister for Health and Social Services, an update on COVID-19. I call on the Minister for Health and Social Services, Eluned Morgan. 

Diolch yn fawr, Dirprwy Lywydd. Thank you very much for the opportunity to update the Chamber on the COVID situation and our plans to keep Wales safe during a difficult autumn and winter ahead.

Now, before I give my update, I'd like to acknowledge World Mental Health Day and thank the Deputy Minister for Mental Health and Well-being for her update on progress of our 'Together for Mental Health' delivery plan earlier today. Mental health is such an important agenda, and more so now than ever in the last 18 months. In what have been unprecedented times, I know how deeply the impact of the pandemic has been felt by so many. And I'd also like to extend my regards to the leader of the Tory party, and my respect for him to come out in the way that he has in terms of his situation. I'm fully committed to improving health and well-being in Wales and it's absolutely right for Wales to have a dedicated Deputy Minister for health and well-being driving these initiatives forward.

On Friday, the First Minister announced the outcome of the 21-day review, and though we remain in alert level 0, there are important protections that have been maintained and strengthened to keep us safe. Coronavirus is still very much with us; since my last update, cases had surged. We still have very high rates of coronavirus in our communities, but I'm pleased to say that in the last week, numbers have fluctuated at around 500 cases per 100,000 people and we've seen similar fluctuating trends in hospital admissions, although noticeably lower numbers than last month. We therefore consider the public health situation to be stable, though we're acutely aware that this could quickly change.

The NHS is still under intense pressure. Our health and care services are still experiencing resource pressures and we still need everyone to play their part and follow the guidance in place to enable Wales to remain open under the lowest level of restrictions. There are very high numbers of infections in younger people and we're monitoring the links between schools and community transmission. Last week, we published strengthened advice and guidance to learners in secondary schools and colleges. When a household member tests positive for COVID-19, in addition to the current advice to take a PCR test on days two and eight, they should in future undertake daily lateral flow tests for seven days. By finding and isolating positive cases, we can help stop onward transmission.

We've also started the vaccination programme for 12 to 15-year-olds. Our incredible vaccination programme has helped weaken the link between infection and serious illness. Vaccination is the best defence we have against coronavirus. Our new vaccination strategy published today sets out how the vaccination programme will continue to deliver effectively and at pace in the autumn and winter months. The strategy focuses on providing boosters for the most vulnerable, vaccinating children and young people and our principle of leaving nobody behind, including those people who are pregnant. Over the summer, we worked with health boards to plan this next phase. This has allowed them to move quickly when confirmation of the booster and vaccination of children was recently announced. This new phase brings us hope.

This week sees the introduction of the COVID pass. With the increase in numbers we saw last month, we continue looking at measures to mitigate the spread of COVID through our communities. None of us wants to see businesses having to shut again. We will of course keep these measures under review to ensure that they remain proportionate.

On Friday, we published an updated coronavirus control plan, setting out the main ways in which we will keep Wales safe. Essentially, these are: vaccination, test, trace and protect, and continuation of the basic measures that we can all do to protect ourselves. Our advice around testing is not changing. We still ask you take a PCR test if you develop symptoms of COVID-19, and self-isolate if your result is positive. We are closely monitoring the unprecedented numbers coming forward for tests in Wales. If this level continues, we may need to make choices. But for this review period, our advice remains the same. Testing is the best way to break transmission. 

Those basic measures we’ve all been doing throughout the pandemic are still important: washing hands, keeping your distance, wearing face coverings in indoor public places. These vital measures will keep us safer. The control plan sets out two planning scenarios for the pandemic over the winter. In the first, called COVID stable, Wales remains at alert level 0, with all businesses able to open. We expect this will be the scenario for the future, as we become used to living with coronavirus and as we gradually move out of the pandemic. Under this scenario, if case rates fall, measures could be relaxed, but if they rise, existing measures could be strengthened.

The second planning scenario, called COVID urgent, is designed to deal with sudden changes to the situation that would cause a rise in pandemic pressures, which could risk overwhelming our NHS. In this scenario, the alert level system and restrictions would be used proportionately, but as a last resort, to protect people’s health, control the spread of infections and protect the NHS. Dirprwy Lywydd, modelling work suggests that we appear to have passed this peak, but we cannot be complacent at this critical time. In coming months there will be threats from other respiratory infections, such as RSV and seasonal flu. We continue to focus on vaccination for these infections.

We all need to look after our health this winter. It is important that we take the small, achievable steps to keep ourselves healthy and avoid getting ill. This includes being physically active, eating a balanced diet, limiting our alcohol intake, quitting smoking, and of course looking after our mental health. We will work with vaccination centres, GP surgeries and pharmacies over the winter to raise awareness of these messages and signpost people to the support available across Wales.

I would like to end on a positive note. There are no substantial changes to the rules over the next three weeks, beyond those we'd already announced. Everyone has worked so hard to protect themselves and their loved ones, and it is working. We're changing the course of this pandemic together. We aren’t out of this pandemic yet, and the situation could change quickly. But together we can continue with measures in place to keep us on the right track, to protect our NHS and to protect each other. Thank you.

Conservative spokesperson, Russell George.

Thank you, Deputy Presiding Officer. Can I thank the Minister for her statement today, and can I also align myself to the Minister's comments in regard to mental health and the important agenda in that regard as well?

Minister, you mentioned your winter plan. I've mentioned a number of times previously that we need to include diagnosis centres, and I wonder if you could confirm whether that will be included in your plan next week. I wonder what efforts you're also making to ensure that investment and resource sharing is provided to primary care to release pressure from GPs and, ultimately, emergency services. How are you also addressing Healthcare Inspectorate Wales's report into ambulance services?

I will raise one area that is not mentioned in your statement, that is absent from the statement today, and this is the response to this Chamber about the UK Parliament Health and Social Care Committee's report into the handling of the COVID-19 pandemic. This report is almost exclusively centred around the UK Government's response, mentioning Wales only nine times, but it demonstrates, in my view, the urgency of the need for a Wales-specific inquiry. Throughout the pandemic, the First Minister has repeatedly said that Wales was doing things differently. You yourself mentioned the same today in respect of the very report I've just mentioned. So, I will ask: will you make a comment today to the Chamber about a Wales-specific inquiry in the context of what I've just said and this report today?

Your Government's decisions, good or bad, have decided the outcome of the pandemic. In relation to my next question, I'll raise a few points here. Wales has the highest death rate across the UK in terms of COVID-19 in terms of the population. The First Minister actually said that he saw no value in testing care homes a full two weeks after the UK Government significantly expanded their testing regime. The then health Minister said:

'I don’t understand the rationale in terms of how…it saves more lives for the way that the testing policy has been changed in England'.

The First Minister then said that face coverings were not a silver bullet, nearly two months after the UK Government introduced mandatory face masks. And finally, the previous health Minister was charged with reducing hospital-acquired infections going through our hospitals last winter, saying that lessons had been learned throughout, and we ended up with nearly a quarter of deaths from COVID picked up from infections in hospitals. These issues here are as a result of Wales doing things differently. There will be good, there will be bad things in terms of Wales doing things differently. But of the areas I've specifically mentioned that I have raised, do you think that they would be adequately addressed in a UK-wide public inquiry? 

Also, I think your Government needs to learn lessons from the pandemic, as indeed all Government across the UK, of course, need to do. But the Westminster committee raised a very pertinent but valid point, I think, for the Welsh Government, and I quote here:

'The fact that the UK approach reflected a consensus between official scientific advisers and the Government indicates a degree of groupthink that was present at the time which meant we were not as open to approaches being taken elsewhere as we should have been.'

So, not open to other opinions. We've heard again today from yourself and the First Minister that Wales was following the science. Was the Government wrong to take this approach? And the final—[Interruption.] Well, that's a question that is a valid question to be asked. This is a question that's put forward by a cross—[Interruption.] I can see the Minister laughing. I'm sorry, but this was a question raised by a Westminster inquiry of all parties. I think it's a valid question to ask. I'm not making a suggestion; I'm asking that question that I think need to be addressed today.

Finally, Minister, you also mentioned COVID passports. I've been contacted by the National Autistic Society, and they've raised quite important points regarding COVID passes. People with disabilities such as autism are at risk of being discriminated against is the charge that they make, due to being unable to be vaccinated or tested due to behavioural changes or sensory difficulties, and this can cause, of course, as you'll understand, stress if people in those groups think they're being excluded. Routine, of course, is very important for people particularly in that group as well. So, will there be exemptions for people who are unable to vaccinated or tested for medical reasons, as is the case in Scotland, and if not, how do you plan to cater for these specific groups of people, Minister? 

Diolch yn fawr iawn. Thank you for those questions. On the winter plan, I'm afraid you're going to have to wait for that to be published. So, good try, trying to get some information out of us, but we'll let you know when we're ready to publish that. You've only got a few more days to go. There is considerable pressure on GPs at the moment. That is undoubtedly the case. That's why we've got a huge programme of publicity going on at the moment, trying to inform the public on where they can go to get help. There are alternatives to GPs, and you heard the First Minister this morning—[Interruption.]

No interventions—[Inaudible.]

You heard the First Minister this morning talking about the fact that, actually, we need to wean ourselves off this assumption that you will always see a GP. There are people who are as good, as qualified, who can support us with our health needs who are alternatives to GPs, and we need to understand that.  

You mentioned very briefly ambulance services. It's impossible for me to go through all of the points that you made, but you're aware that we have a whole programme of work that we're undertaking in relation to ambulance, trying to improve the situation with ambulances. We've spent an additional £25 million in terms of recurrent funding, huge numbers of ambulance workers have been recruited, there's been the creation of urgent primary care centres—so, lots of things are ongoing to try and take the pressure off our ambulance services. 

Turning to the UK report, yes, you're absolutely right, it's a report that looks at the situation in the UK, but isn't it interesting that you come straight in here and try and throw the problems here at us in Wales? The fact is that they outline a situation like the fact that they should have taken a more cautious approach. Well, I think most people in Wales would understand that we have taken a more cautious approach than they have in the UK. The other thing, of course, is that we do have discussions in our Cabinet that I think are robust but are respectful, and we don't have groupthink. Part of the issue in the UK has been that there has been such an emphasis and such a focus on trying to keep the economy going that sometimes they've lost sight of the importance of public health. Getting that balance right, I think, has been something that we have tried to get right within the situation in Wales.

The other thing that they mention in this report is the fact that, actually, everything is too centralised. You've only got to look at the test, trace and protect system; the ridiculous amounts of money that they spent on that system in England, on private companies that have been completely ineffective when you compare them to us working in partnership with local government to drive a system that has been massively effective. I think it's very important that people understand that, actually, we are not in the same situation, as Wales. And you will be aware, also, that the First Minister has asked Michael Gove, in a letter, to set out, 'These are the things that we would like to see you address if there is going to be a public inquiry for the UK—we want these things to be set out.' Now, we're still waiting for an answer to that letter. I think it's absolutely clear that if there is a respect for looking at the kind of detail that the Welsh public will want to see, and we will want to see, then I think we will be able to go with the UK. If that doesn't happen, then of course we don't want to be a footnote in the UK public inquiry. I think that's enough on that one. Thank you.

Plaid Cymru spokesperson, Rhun ap Iorwerth.

Thank you very much, Deputy Llywydd.

Today is a pretty sobering day, isn't it, with the publication of that report by Members of the UK Parliament saying that the UK Government's response to the pandemic was one of the 'worst ever' public health failures. Those are pretty strong words. There's hardly a reference to Wales in that report—I'll get back to that in a second—but many of the questions around the response to the pandemic are just as relevant to Welsh Government, of course, including what happened in those very early days, and questions have been asked publicly today about that, both here in the Senedd by my colleague Adam Price, and also by journalists in the press conference earlier.

We have heard some contrasting responses about the pace of response here in Wales; the First Minister, during First Minister's questions, saying, 'We just didn't know how serious this was,' although I think we did, or the health Minister saying, 'We did know, but it was very difficult for Wales to act without England acting too.' Now, I'm not sure how you square those two responses, but the truth of the matter is, these questions have not been asked in depth. Members of Parliament at Westminster have had a go, as I say, in this report, which mentions Wales nine times, I think, isn't it, in 147 pages. But these are questions that the Welsh public expect to be looked at in depth, and the only way to do that, as has been proven again, I think, by this report today—. The way to do that in depth on these questions about the initial response, and so many of the questions about the response over the past 18 months, is to have a Wales-specific inquiry.

Now, I have met, on a number of occasions now, including once in person with representatives of the Covid-19 Bereaved Families for Justice campaign. I'm pleased that the First Minister has also met them now. And their central argument is this. It's very, very simple: decisions taken in Wales must be scrutinised in Wales. It's a very, very easy principle for me to get my head around. If I can get my head around it, I think most people can. Decisions taken in Wales need to be scrutinised in Wales. Now, perhaps the Minister can tell us now whether there has been a response now, or even an acknowledgement to the letter written by the First Minister to UK Government, seeking assurances about how Wales would somehow fit in and have enough focus on it as part of a UK inquiry. And can I ask, how long is Welsh Government prepared to wait for a response before deciding, 'You know what; we're going to have to do this ourselves and set up a Welsh inquiry'? It is the only answer. 

I'd like to focus, secondly, on one word that we heard a few times from the Minister today: 'stable'—the situation in Wales currently is stable. Can I suggest, actually, we need three categories, not just 'COVID-stable' and 'COVID-urgent' going into this winter? This is urgent. This is urgent today. We perhaps need a 'COVID-crisis' if things become even worse, but we are in an urgent position. And let me just remind people what 'stable' looks like. Wales currently: over 500 cases per 100,000 people over a seven-day period—that's worse than any other nation in the UK; it's three times, almost, the figure for Ireland, almost six times the case rate for the Netherlands, almost 12 times the case rate for France and 20 times the case rate for Spain. The case rate for under 25s in Wales is double the average for Wales at nearly 1,000. Seven counties in Wales, including the one that I represent, have case rates of over 1,000. If that is not urgent, I do not know what is.

So, perhaps I can just pose these questions in closing. When does current Welsh Government strategy envisage we'll get down to levels in France, in Spain, in Italy and in any other western European country you could mention? Is getting there as quickly as possible even a part of the strategy? Or is stable, steady-as-she-goes the way things are going to be approached from now on? For example, we suggested last week that we could strengthen the COVID pass system, perhaps, as a means to ramp things up. What evidence can the Minister point to to show or to even suggest that the Welsh Government is trying to do everything it can to get those case rates down to the levels of our western European partners, because— 

Can the Member conclude now?

—seeing the virus running riot in Welsh schools currently, and hearing from the parents who are scared and from the teachers who are scared about the continuing levels of the virus among young people and children in particular is something that we really need to continue to focus on?

Thanks very much. I'm not sure which press conference you were listening to, but I can assure you that I was very clear, I made it clear that it was a disease that we'd never seen before, none of us knew how it was going to impact, none of us knew how it was going to spread and none of us knew that you could spread this problem without showing any symptoms. 

We've been over this ground before in terms of a Welsh inquiry. You know our position. Our position is that we would like a very clear and comprehensive view of what has happened in Wales, but we want that to be seen in the context of the UK Government and what happened there. And the reason for that is, as this has demonstrated today with the publication of this report, is that actually, there is a huge amount of crossover between what was happening in the UK and what was happening in Wales. Now, the First Minister met with people who lost loved ones last week to coronavirus. It was, I'm sure, a very sensitive and difficult meeting and he gave them some assurances there that if the UK Government does not listen to the Welsh Government then, of course, he will think again about the situation in relation to a Welsh inquiry. But that's not where we're at. It would be less rude if we got an answer to a question and a letter to our First Minister, and clearly, that would be something that would be very helpful. So, if you've got any friends in the UK Government, ask them to speed it up, if you wouldn't mind.

You talk to me about urgency; let me tell you about urgency. The rates amongst young people—you're absolutely right—are incredibly high. Last week, you wanted to postpone and procrastinate because of a COVID pass, because you wanted to strengthen it. That's not urgent, that's taking your time. We wanted to move and thank goodness we were able to move. Let me be clear, the rates are starting to go down, but the responsibility here is also on the public to help us. They know what they need to do to keep themselves safe. We all know what our own responsibilities are here, but vaccination is one of our key methods of keeping people safe, that's why we've got the booster vaccine being given at the moment. We've got the 12- to 15-year-olds receiving their vaccination. And of course, then, we have a very comprehensive test, trace and protect mechanism in place to try and curtail the spread of the virus. So, we do have lots of mechanisms at our disposal that we are using very comprehensively to try and get a grip on the situation.

Minister, thank you for your statement. I reiterate what you say in your penultimate paragraph: everyone has worked hard to protect themselves and their loved ones, and it's working. We are changing the course of this pandemic together. It's important to say this because that reminder to people about how much they have done together and how much we have still got to do to get through this autumn and winter and next spring as well—.

I will be off to a venue this week for the first time since the pandemic has been had. I will be watching a show. I won't say which one because my fans will come there and mob me, I know. But, they are asking me to do a lateral flow test. It's not a problem at all. If they need to see my double vaccine certificate, that's not a problem as well. If that keeps that venue open through the winter and through the spring, and keeps the staff and the other audience members safe, then you know, that's a good job. That's part of my responsibility as well.

But, could I ask the Minister what she is doing across Government at the moment in terms of social and behavioural analysis? Not the technical things, not the direct measures, not the regulations and so on, but that analysis of what will help people do the right thing, and continue to do the right thing. The threat perception has changed, and that's partly because of the success of the vaccine roll-out. Social norms are shifting a little bit. But, there are ways in which this can be done because we have done it so well already. The messaging, the leadership, sometimes the penalties—

Can the Member conclude?

So, I'd ask the Minister what work she is doing on social and behavioural science to actually make sure that we can get through this all together safely.

Diolch yn fawr, Huw. Thank you for recognising that, because of the COVID passes, we are hopefully able to keep some of those venues open that may otherwise have faced closure. Certainly what we are very pleased to see is that, actually, there has been a considerable amount of social and behavioural science associated with our whole approach here. We have comprehensive research that has been done into what it is that nudges people into behaving in a different way.

We have a really active campaign that has been ongoing for a number of weeks now, 'Help Us Help You', trying to help people to direct them to the right places for support, in particular if they are ill, but also to make sure that they look after themselves this winter. We can all eat better. We can all get fitter. I think that it is really important that we understand our responsibilities in this as well. Also, we have a 'Keep Wales safe this winter' campaign. So, it's really important that people engage with that. When people are getting their booster vaccinations, I'm hoping that they will also be given some advice in terms of public health and how to protect themselves this winter.

Minister, you referenced in your statement that the NHS is still under intense pressure. Many residents in the Cynon valley have contacted me to raise concerns that the A&E local to them at the Prince Charles Hospital has been under extreme pressure during the pandemic. Even now as we speak, there is an average time of eight hours and 15 minutes for people to be seen there, and 70 patients waiting to be seen.

The situation has worsened since the closure of the minor injuries unit as Ysbyty Cwm Cynon since 8 September, which was due to staff shortages. Today, it has been reported to me that this temporary closure will now be permanent. Is the Minister able to confirm this report? And, if it is the case that the minor injuries unit is being permanently closed, what is the Minister's view of a health board downgrading local services permanently during a pandemic, and adding to the pressures on other services such as the A&E at the Prince Charles Hospital?

Diolch yn fawr, Heledd. Can I just make it clear that our NHS services are under intense pressure at the moment? It's not because they are not working hard. They are working incredibly hard, as they have done for 18 months. Frankly, these people are already exhausted. A lot of them are off sick. A lot of them have COVID. So, you have to understand that, every time that that happens, there is more pressure on the people who stay. So, I would ask the public in Wales to act sensibly and to be sensitive to the fact that the people on our front line are now really facing a very, very difficult winter.

I do think that we have to understand that that means that, sometimes, we are going to see the need for those services to be concentrated in some areas because of the staff pressures that are happening. So, I do feel that it's important that people understand that, as we’ve seen this week in south Wales, maternity units are having to really concentrate their efforts because of that staffing situation. So, I would ask people to really, just during this time, be understanding of the severe pressure on our systems at the moment.

Finally, Mabon ap Gwynfor.

Thank you, Deputy Presiding Officer. Minister, I think you and the Government are being slightly unfair in saying that no-one knew what was to come at the beginning of last year and that it's easy to use hindsight, as the First Minister mentioned earlier. I think we all saw the pictures coming from Italy at the beginning of the year, and from China too, and everyone had a pretty good idea of what we were facing. But, in addition to that, thanks to Dr Moosa Qureshi, we know that the UK Government held a thorough preparation for a coronavirus event, and that was five years ago, and it was called Exercise Alice. This apparently warned us of the need to stock PPE and the need for a thorough test and trace system, among many other things. And if the report in The Guardian is to be believed, the Welsh Government were witness to that exercise and accepted the recommendations. So, why didn't the Government take action on those recommendations, Minister?

Diolch yn fawr. I think it’s unfair to say that we knew lots about COVID when it arrived. The very fact that we didn’t know for a long time that people could carry COVID and they were asymptomatic—that was something that we learnt much later on, after it had arrived, just as one example of things that we’ve learned. If you read the report that’s come from the House of Commons today, one of the things that it does say is that the UK’s pandemic planning was too narrowly and inflexibly based on a flu model and failed to learn the lessons from SARS, MERS and Ebola. It doesn’t mention the report that you are talking about. So, I think it’ll be interesting to see why this committee didn’t pick up on the report that you’re talking about. So, that’s certainly something that I’ll go and look at after this question.

Diolch, Weinidog. It appears that the—. Ah, we have the Minister.