The next item is a statement by the Minister for Health and Social Services on the health and social care winter plan 2021-22. I call on the Minister, Eluned Morgan. 

Diolch yn fawr, Dirprwy Lywydd. Every year, the NHS develops a plan for how it's going to manage with the increased demands over the winter, and this year is no exception. The preparations have been taking place already for many months. We are making this statement today in order to give an opportunity for Senedd Members to discuss our plans before the formal publication of the report on Thursday. I think it is important for Members to note that, generally, the winter plan is an instruction to the NHS and is normally an internal document, although we understand the political interest in the plan this year as we see challenges to our health and care services this year, the likes of which we have never seen in the history of the NHS.

We are going into this winter where we still have very high rates of COVID, where we are expecting significant additional pressures from winter flu, and we are trying to keep up the pace on addressing the backlog of treatments that has developed during the pandemic. This will be happening at a time when the NHS and care workers are exhausted, when the flow through our hospitals is restricted because of challenges in terms of discharging patients when they are ready to leave, and an increase in demands on our GP surgeries and massive pressure on our ambulance services.

That's the backdrop to the publication of this winter plan. At the heart of the winter plan is a determination to work together with the NHS, local government and, ideally, the public, in asking us all to play our part to relieve as much pressure on the system as possible. There will be a comprehensive programme to direct the public to the appropriate place for care, which will not always be the GP in primary care or accident and emergency in secondary care. COVID is not over, and a central part of our plan is to ensure that we are vaccinating and continuing our test, trace and protect programme through the winter months. We'll be revising our Adferiad long COVID programme, as promised, to keep up with the latest data and information.

Mental health will be central to the support that we will be providing over the winter months. It will remain an essential service, irrespective of the pressures that we are likely to face. In terms of primary care, including GP services, there will be a real focus on respiratory illness, making sure that patients are able to access primary care when they need it. It's important to note that this could be via a virtual appointment, although face-to-face appointments will be available if necessary. We will be asking community pharmacies to step up, once again, as they've continued to do throughout the pandemic.

On planned care, we will be honest with the public, and will explain that it will be tough to work through the high numbers on our waiting lists over the winter. We may even need to flex the system and reduce the numbers receiving planned care if the pressure on the system continues to mount. However, we will ensure that health boards keep in touch with people waiting, and will offer them the support and pain relief that they may need during this difficult time. In the meantime, we will work up further how we intend to drive forward with reforms in order to make significant inroads into the waiting lists, and we will give further detail on these plans at our planned care summit in November.

The Senedd will be aware that the pressures on our urgent and emergency care system are huge. We have a very clear plan set out on how to address this issue, including the national roll-out of 111, the use of the military for support, an increased focus on timely ambulance patient handover, and the triage of patients in emergency departments. One of the areas that we will really focus on is the importance of standing by and supporting our care services. We will give further details on this later this week, but I cannot emphasise enough how much we need to support our care services and our care workers during this challenging time. If we want to discharge people from hospital, we need to know that they will be supported in the community, and we will continue to work with our local authorities to deliver this.

Finally, we cannot do any of this without our incredible care and health workforce. We will stand by them and support them as they enter the toughest time in their history. The health service will be pushed to its limits this winter, and we ask the public to use these services wisely, prudently, and to play their part to get us through this winter together. Thank you very much.

The Conservative spokesperson, Russell George.

Diolch, Deputy Presiding Officer. Minister, can I thank you for your update you've given us today on the health and care plan for the winter? But that's what it is, of course, today—it's an update and not the plan itself. I think Members across this Chamber, and the Welsh public, will be disappointed that they've had to see a further delay just before we go into the Senedd recess. And I do note in your opening remarks today, Minister, that you said that this is a statement in order to allow the opportunity for Senedd Members to discuss the plans before they're formally published on Thursday. But if they're not publicly published, then it's very difficult for us to scrutinise those plans, of course. I will say thank you, Minister, for your call this morning; I appreciate greatly the technical briefing that you gave me and other Members of this Chamber this morning, from your officials. That was greatly appreciated.

I do have to say, though, I don't accept your points within your statement that it is usually an internal document for the NHS—and I'll stand to be corrected if that's wrong. But if that is the case, then I would say: what did your predecessor publish on 15 September 2020 in his winter protection plan? This included a framework about essential and routine services, urgent and emergency care, the vaccination programme, primary and community care, social care, care homes—I could go on. But it also mentioned allocations from the Welsh Government to support the NHS over winter. It even mentioned in its purpose the Welsh Government's overarching plan, which describes the broad context and priorities for health and social care until March 2021. So, can I ask the Minister for an explanation on a number of issues there? Why wasn't the plan published earlier in September? Why have we got a further delay before the public can see this plan? And perhaps you could also clarify why you say this plan is usually an internal document, given what I've just said.

It's taken a long time for the Welsh Government to get together its framework document, and it appears, over the last month, that communications between Ministers and NHS Wales haven't been entirely clear. I'll give some examples in that regard: in response to the leader of the opposition in September about the publication of winter pressure plans, the First Minister avoided this entirely, referring to the regular updating of the coronavirus control plan. But, just two days earlier, and after you'd mentioned to the Health and Social Care Committee that you'd been preparing for winter earlier than ever before, the chief executive assured the committee that a very clear winter plan will be visible and will be published during October. Minister, can you give some assurances to the Senedd today that you and the Welsh Government are clearly communicating with NHS Wales and local authorities over your overarching aims for easing winter pressures? I would say, Minister, it's absolutely crucial that, at this time of extreme pressure on the Welsh NHS, we have direction from the Welsh Government. We have record-breaking A&E waiting times, record-breaking numbers of people on waiting lists, and one in four people are waiting for more than 12 months for treatment. So, it's crucial that we have a clear plan from the Welsh Government.

Turning to your statement itself, you mention that a central part of the plan will be vaccination, and your statement in September said that you had started the COVID booster programme. We're yet to see any uptake figures on how successful, or not, this programme is so far. Your 'progress against strategy' document, published within the last hour, also gives no indication as to how many have taken up the booster. I have had some reports from colleagues that in other parts of Wales there have been those who have yet to receive information—those who are over 50—on when they will receive the booster. I've also received reports of people waiting up to an hour outside vaccination centres in order to get their booster that they've been timetabled in for. I am particularly concerned about that, given that this is an older age group, and given that we're coming in to a period of more severe weather—if people have to wait outside in order to receive their booster as well. So, perhaps you could provide some information in that regard. 

Can you also provide a timeline on booster uptake figures that are available to the general public? And what exactly do you mean by the majority of people being offered the boosters by 31 December in your COVID vaccination statement today? That could be 51 per cent. Perhaps you can give a little bit more detail in that regard. You also mentioned planned care— 

Can the Member conclude? 

I'll ask my last question in that case, Deputy Presiding Officer. You also mentioned planned care, and I note that you're leaving a formal plan until the planned care summit in November. Meanwhile, both England and Scotland have been doing their utmost to ease those waiting times with community diagnosis centres, and we've heard about surgical hubs and the use of independent healthcare to support NHS waiting lists. So, can I ask you for a little bit more information in that regard? Because you'll be aware I've been asking you for about four months in regard to surgical hubs, health Minister. 

I think it's really important that there is an understanding that there was always a plan for us to publish this report at a winter learning event, which is going to take place on Thursday, so that we're engaging with the NHS directly. The only way this plan is going to be implemented is if it's really taken up and taken seriously by the NHS and by our care workforce. So, it is important that we're speaking to the right audience, and that's what this plan is supposed to be. It's an instruction to them, and that's why we were always planning to do that on Thursday. 

We have, however, already been doing a huge amount of work in relation to preparing for winter. We've been doing it for a very long time, we've had the NHS planning framework that sets out expectations for health boards and trusts for a very long time. There are weekly meetings that are happening between us, health boards and local authorities to provide a forum for taking further action in terms of preparing for winter. We've got a COVID planning and response structure, of course, which all has fed into this plan. So, it's not as if we're starting from nothing here, we're building on what was already there. And of course, the local options framework is something that health boards are already aware of, and we're making sure that that's being updated in relation to the COVID pressures, and they understand where there are opportunities to flex as we enter the winter.

You ask about the planned care situation, and I think it is important that people understand that we've already given quite a lot of money to the system, £250 million already has been announced, and that communication, as I say, has already been happening.

In relation to the vaccination plans, I can assure the Member that around 30 per cent of people from 12 to 15 years old now have received their first dose, and we will be able to give an update in terms of the booster uptake on Thursday this week, so I hope you can be a little bit patient and wait for us to get those statistics checked before we announce those. We set out in that vaccination plan that the over-50s would be offered their booster doses before the new year. Now, there was another group of people, as you mentioned, who would be offered the vaccination booster before that, that included people like care workers, people in care homes, NHS workers, and so we are on target to be delivering against that vaccination plan that I set out last week.

And then, just finally on planned care that you asked about, as I said, we've already announced £250 million. The health boards have come back to us now and have suggested how they would like to spend that money, so we're just making sure now that we have all our ducks in a row in terms of making sure we have a co-ordinated approach and, hopefully, we'll be able to give more information on exactly how that's going to be spent in that planned care summit later.

Plaid Cymru spokesperson, Rhun ap Iorwerth.

Thank you very much. This is an interesting debate, a first opportunity to scrutinise the winter plan. Unfortunately, we have no winter plan to scrutinise as of yet. I do appreciate the short briefing that was made available earlier today to members of the health committee on some of the principles underpinning the plan. I appreciate having a preview from the Minister today of some of those principles, but, in a way, this session is posing more questions than it's answering. There is talk about access to primary care and making mental health central to services, but the question we want answers to is how is that going to be done, that's what we'd hope for in the report itself and hope for in the report on Thursday.

There are many principles and elements that I welcome, some of them that I outlined as things that I would want to see in a session a fortnight ago, asking for improved signposting so that people get the right care in the right place, and the Minister has said that that is going to be a priority. I know that the BMA today has highlighted some research that suggests that only around 10 per cent of people were aware of the Government's Choose Well programme in 2018, so, obviously, we need a lot more investment in that kind of work. And again, I'm looking forward to having more detail on that on Thursday, hopefully, and I would appeal to the Minister to ensure that time is made available in Government time after half term so that we can scrutinise and ask questions in light of the publication of the report itself.

There are questions that I can pose today, particularly around the fact that, as the Minister said, COVID and the pandemic are the context to this winter still. I was critical last week in hearing the Minister say that we are in a period of stability in terms of the pandemic. There is a risk, of course, that 'stability' is seen as being something positive, but the figures are frighteningly high in Wales, as the Minister will know, and we need to bring those figures down. Amongst schoolchildren, there is huge concern being voiced to me by people from all parts of Wales, and I would like to hear from the Minister this afternoon what urgent steps are being taken now to try to bring cases down within schools. 

And, following on from the question from the Conservative spokesperson, I do think we need more information as to the strategy of the booster programme. We heard the Minister say that we'll get more figures on Thursday, but will we have an update on a change of strategy or a gear-shift, perhaps? Because we might be suffering here from having had an early and successful vaccination programme, so the period of a decline in the effectiveness of the vaccination is hitting more swiftly than it is in the rest of Europe. And that means that we need to rush forward with the booster programme. So, an update on that would be useful. And also, in the past few hours, we've heard of a possible new variant related to the delta variant, and that that might be responsible for as many as 6 per cent of new cases now. So, an update from the Minister on what the implications of that could be would be appreciated and what's being done to monitor that in Wales. 

I want to take this opportunity, too, to ask one specific question on a problem that we could face over the winter in terms of providing diagnoses, that there is a great shortage in terms of test tubes for blood tests. This is causing great problems across the NHS, with doctors having to make very difficult decisions as to which patients should have those blood tests because of the shortage of these vials. So, when is this problem going to be resolved, because it's been a problem for many weeks now, and there are very real concerns across health services that this is holding diagnosis and treatment back?

And finally, very briefly, we heard the First Minister today saying that he had been satisfied by the Prime Minister yesterday in terms of his pledges on giving Wales a voice within the UK-wide COVID inquiry, but the campaigners are angry, the campaigners are disappointed with the First Minister's response, following his conversation with the Prime Minister yesterday. We've seen nothing in black and white. Why should we trust Boris Johnson on this when he's been undermining Wales in so many other ways recently?

Well, thank you very much, Rhun. One of the reasons why we were eager to ensure that there was an opportunity to give that briefing to some of you this morning was to ensure that you saw or had some kind of idea before half term, because we are aware that some will be away and we didn't want to leave it too long before we had an opportunity to share our ideas with you. And, of course, there will be more detail in the report itself. 

Now, there is a programme in terms of sharing information with the public on where they can go to get additional help. That's already under way; that's already started. And it is important that we continue with that over the winter. So, that programme has already commenced. And you're right that COVID is the context for preparations for this winter. And I do think it is important that we underline that this is one of the most challenging winters in the history of the NHS. And when you say that it is a stable period, well, everything's relative, isn't it? And so I do think that what we're talking about here is a time when there isn't a variant of concern at the moment. So, that's part of the reason why we're talking about being in a stable period, where we know that the majority of the population has received some kind of safeguard because they've had the opportunity to have the vaccine. 

In terms of our schools, we are aware that the numbers are very high in our schools, but we're also aware that we don't want our children to lose more time spent in school. So, that's why the machines to monitor the air in our schools will be distributed during the coming weeks. 

And in terms of a change of strategy, well, it's only last week that I announced the new strategy on the vaccine and the booster for the winter, so no, we're not going to introduce a new programme after we announced one last week. But of course we are always vigilant in terms of looking out for a new variant. That's why we're so concerned about the fact that the United Kingdom Government is taking away so many of the safeguards in terms of international travel into the UK. We need to keep these variants out of the UK, and that is of concern, but that's very difficult for us because the border is so open, and that the majority of people who travel abroad travel through England.

In terms of the issues with a lack of blood testing equipment, that has been an issue, as you said, for several weeks; it's an international problem. We know that when these vials are received, there'll be huge pressure on GPs once again to have to restart the work that they usually do. So, we are concerned about that pressure, but of course, work is being done worldwide to try to produce more of these vials.

And with regard to the independent COVID inquiry: well, I was on the call with the Prime Minister when I heard Boris Johnson saying clearly that he would be willing to speak and consult with Wales about what the scope of the way that we evaluate this COVID inquiry will be, and that he would be taking the situation in Wales into account.

Thank you, Minister, for your statement today. I welcome your comments about ensuring people are signposted to the appropriate source of medical support and advice, and community pharmacies obviously have a key role to play, as you acknowledge. But how can we make sure that people know they are there and that people have a good knowledge of the common ailments scheme and how it can be used? In addition, extra pressure in my constituency could be caused by the temporary closure of the minor injuries unit at Ysbyty Cwm Cynon, and while I appreciate the comments from Cwm Taf Morgannwg that this is being done to make the service sustainable while staff are being upskilled to run the unit, how is the Welsh Government working with the health board to make sure a consistent provision will be in place as soon as possible?

And finally, I'm starting to pick up a larger volume of casework from people affected by delayed transfers of care, and that's despite the excellent work that's already been carried out by Rhondda Cynon Taf County Borough Council, and I know Welsh Ministers have supported innovative responses, for example the Stay Well@Home scheme funded by the intermediate care fund. I note your comments that further details will be released this week, but how will you work with colleagues and other stakeholders to take that holistic approach to ensure, for example, that homes are fit for people to be discharged to?

Thanks very much, Vikki, and you're absolutely right that it's really important that we alleviate the pressure on the places that people traditionally go for support, and that's why we have a very active campaign, 'Help Us Help You', which is ongoing at the moment, and of course, that will be able to help people and point people in the direction of community pharmacies and other places where they can go for support. Also of course, we'll be encouraging people to use the 111 telephone and online advice that is available to them, and that also manages to take pressure off people.

I am obviously keeping an eye on the situation in Cwm Cynon in relation to the health centre there. One of the reasons, of course, you'll be aware, is because there's a shortage of staff; COVID is affecting everybody, and it's affecting our public services. And so in order to make sure that they're sustainable, and we can give a sustainable service, in the longer term, we have to consolidate so that staff can work together at times. I have been given an assurance that the situation there will be changed in the new year, but I think it's really important that we scotch the rumours that I understand have been going around the community that it will be permanently closed. I can assure you that is not the case and it is important that people understand that this is simply part of what we're going to have to do to get through this winter together.

And in terms of the delayed transfer of care, I'm spending a huge amount of time with my colleague Julie Morgan on the issue of care at the moment. We're having weekly meetings with, I'm pleased to say, Andrew Morgan, who is the leader of Rhondda Cynon Taf council, taking a huge interest, and really trying to underline the fact that, actually, we can't solve the problem in terms of our hospitals until we address the problems in our care services. So, getting people around the table together from our local authorities and our health boards on a weekly basis to come up with any innovative ideas for how we can get through this winter has been an important exercise, and we're still taking weekly actions on that. As I say, there'll be more information on that when we publish the report properly on Thursday.

Thank you for your statement this afternoon, Minister, and for providing officials to brief members of the Health and Social Care Committee ahead of this statement. I look forward to scrutinising your plans in detail, but, ahead of their release, I would be grateful if you could answer a couple of questions relating to the care side of preparations. Care Forum Wales have warned that the sector is facing its worst crisis in living memory. With this in mind, and given the impact issues in social care have on hospital capacity, how will the Welsh Government ensure sufficient capacity in social care over the next few months?

Staff working in the care sector are as vulnerable to illness as everyone else. How, then, does the Welsh Government plan to address the thousands of care home workers who are not fully vaccinated against COVID-19? And finally, Minister, all the experts are warning that this winter will see one of the worst flu seasons in living memory. Why, then, do care home workers, unlike their colleagues in the NHS, have to seek a flu jab from their community pharmacy? In some areas we are seeing long waits for flu vaccines. Surely those working in care should have priority. Diolch yn fawr iawn.

Thanks very much, Gareth. Can I assure you that we are speaking very regularly to representatives from the independent care sector as well? We're very aware of the kind of pressures that they're working under at the moment.

I think it probably is worth underlining here once again the fact that, actually, part of the reason for the pressure that we're under at the moment is because so many of our social care workers were EU nationals and they've gone home. So, for example—. The numbers don't sound very good if you take it as a percentage—about 6 or 7 per cent of them were European citizens—but actually that amounts to around 2,000 to 3,000 care workers, which, if you think about that, is a huge number of people that we're now missing from our system. So, I do think that we can't get away from the fact that, actually, Brexit has been a large part of the issue here.

Now, when you talk about care workers not being vaccinated, I'm really delighted to report that, actually, there are very few care workers in Wales who haven't been vaccinated, and the numbers are incredibly high in Wales. If there are people who haven't been vaccinated, it's usually because there's actually a flow through the system—they've either just come in, or they're just about to leave, so they've had their first jab and then they've left. So, there is quite a big turnover, as you're aware, in the care system, and that goes some way to explaining those very few care workers who haven't been vaccinated, which is why we haven't had to go down the route that they've gone down in England, putting even more pressure on their care services.

In relation to flu, of course those people who are vulnerable who work in those care sectors, they will be eligible for that flu jab as well.

Finally, Joyce Watson.

Diolch, Dirprwy Lywydd. I want to welcome your statement, and of course the briefing that I attended this morning with Dr Andrew Goodall. I'm particularly pleased to see that this is a joint plan. It's not just about health; it's about health and social care and working with partners to help deliver a service that ultimately needs support from local health boards, local authorities and care providers. You know, Minister, that Hywel Dda have launched a bridging scheme, where they're working to ease that passage from hospital to home or whichever setting; it's much needed, and it offers an opportunity in two ways: (1) to get people out of a care setting, but also another opportunity to bring people into the care setting, and also offers them—

You need to ask your question now.

—an opportunity for career progression. So, my question is this, Minister: will you look at the outcomes of that bridging scheme and see if it can be replicated across Wales? 

Thanks very much, Joyce, and the one thing that I have learnt since being appointed to this role is the absolute interrelationship between health and care. And it is really important that we understand that part of the reason for the fact that we have ambulances lining up at our front door is because we can't get people out through the back door because of the fragility of our care system, which is why we've had a huge recruitment campaign to try and get more people interested in what is a very important role, a very responsible role and a very rewarding role. And we will be launching another recruitment campaign fairly shortly as well. 

In relation to the bridging scheme in Hywel Dda, I was very pleased to see that being developed, and Swansea also has a very innovative action plan in relation to that kind of bridging that needs to be done, and taking people from hospital to home. But I do think it's important that we underline the fact that the statutory responsibility in relation to care remains with the local authorities, and what's important is that we honour our commitment that we made in the manifesto and we pay the living wage to those workers in the care sector. We're working very hard with the trade unions at the moment to work out how exactly we can do that. So, that'll be part of the focus that we'll be really concentrating on, once we have a much better view of what the budget looks like from the UK Government as well. 

I thank the Minister. We will now suspend proceedings to allow changeovers in the Siambr. If you are leaving the Siambr, please do so promptly. The bell will be rung two minutes before proceedings restart, and any Members who are arriving after a changeover should wait until then before entering the Siambr. 

Plenary was suspended at 16:07.

The Senedd reconvened at 16:17, with the Llywydd in the Chair.