The next item is a statement by the Minister for Health and Social Services, an update on COVID-19, and I call on the Minister to make the statement. Eluned Morgan. There you are, Minister.

Thank you, Llywydd, for this opportunity to update Members on the situation with COVID. 

Thank you for the opportunity to update Members on the COVID situation, during what is already proving to be a very challenging autumn. Now, in my last update I was able to report cases decreasing and plateauing, indicating we were potentially passing the peak of this wave. In the last three weeks, the situation in Wales deteriorated, recording our highest ever case rates during October—over 700 cases per 100,000. We know that mistakes at a private laboratory in England resulted in thousands of people wrongly being given negative test results, which may have contributed to this rise. We have also identified around 2,000 cases of a new variant in Wales, which we are closely monitoring.

It's clear that the pandemic is far from over and we must continue our efforts to follow the measures we've put in place to keep us, our families and our communities safe. The problem isn't simply the rising number of cases; it's the pressures they create on our NHS and social care services. We have urgent and emergency pressures related to non-COVID issues comparable to what we normally see in the depths of winter, and the rising number of COVID-19 cases is leading to greater occupancy of hospital beds and intensive care units. All of our health boards are facing this increased demand for services.

We've planned, and we've worked with our health and care partners, to develop our health and social care winter plan for 2021-22, which was published on 21 October. At the heart of this plan is a focus on patient safety and well-being. Through preventive activities to try and keep people well, we want to reduce the need for urgent and emergency care, which will, in turn, reduce pressures on the NHS. The plan calls for each region to develop an integrated health and social care winter plan through the mechanisms of the regional partnership boards. This supports a joined-up approach to winter planning, covering what is delivered by local authorities and what is delivered by health boards. Regional partnership boards are now working on addressing the seven priorities in the winter plan. The aim is to protect those in greatest need while also protecting essential services, our dedicated workforce and the public. I expect to see the plans developed by the regional partnership boards later this month, and we will review them to ensure that they are robust. 

A hundred and forty million pounds has been allocated to health boards and NHS trusts through the recovery fund to support delivery of safe services over the remainder of the year, which will include a very difficult winter period, and this is to treat the backlog of patients that has been built up over the past 18 months. This is on top of the £100 million that we allocated in May. A further £48 million has been allocated to support social care in Wales. A total of £9.8 million has been distributed across all RPBs—regional partnership boards—to support the delivery of the winter plan.

Now, I’d like to move on to the outcome of the 21-day review, which the First Minister announced last week. We're very aware of the harms that could be caused by the COVID restrictions that we were forced to put in place previously, and none of us wants to return to those measures. However, given the seriousness of the situation we’re in, we had to consider very carefully whether we needed to return to some stricter measures.

We have agreed that the best option now is to strengthen some of the current measures we already have in place. These include vaccination, and specifically a speed-up of the roll-out of booster vaccinations, and vaccines for those between 12 and 15 years of age. We have already offered boosters to all eligible care homes residents and staff. As always, I want to thank everyone involved in our incredible vaccination programme for all the work that they've done. Vaccination and boosters continue to be our best defence against the virus. Without this programme, the public health situation would be significantly worse. Vaccines have weakened the link between infection and serious illness and continue to do so.

We know that part of the rise in numbers is being driven by high infections in young people. This week we are publishing a toolkit to support headteachers in dealing with the high number of cases in their schools and to quickly introduce additional protections. We are also increasing our efforts to encourage staff and secondary school students to take up the opportunity of a twice weekly lateral flow test. Regular testing, together with the protective measures, will help keep coronavirus out of our schools.

In my last update, I explained the reasoning behind the introduction of a COVID pass. Having been in place for three weeks, we will now seek to extend its use to theatres, cinemas and concert halls. These are settings where large numbers of people gather indoors for long periods, often without face coverings.

Finally, we are reintroducing the requirement for people to self-isolate if someone in their household has symptoms or tests positive for COVID-19, regardless of their vaccination status. This is because infections between close contacts have also been partly responsible for the large rise in cases. Household contacts will now need to self-isolate until they receive a negative PCR test. This system is in place in Scotland, where the case rates peaked in September and are now much lower than in Wales.

Llywydd, we all want to keep Wales safe and open, but if the public health situation continues to deteriorate, at the next review we will be considering raising the alert level and reintroducing restrictions. The next three weeks are therefore critical. I call on everyone to please follow the measures in place, as well as remembering those basic principles which can protect you and others—hand washing, social distancing, wearing face coverings and following the testing regime. Most importantly, and I can’t stress this enough, please get your vaccination and booster when you are called for it. It saves lives. This is a fast-moving public health situation, and, in the same way as it deteriorated quickly, we can also turn this around and improve our situation here in Wales. Everyone is working hard to protect themselves and their loved ones. Let’s continue to do this together. Thank you.

Minister, can I thank you for the update today you've given us on COVID-19? Now, you say in your statement, Minister, that there is a rising number of COVID cases leading to greater occupancy of hospital beds and ICUs, and I would agree with you that is a cause for concern. The Government cut 224 beds in the NHS during the first year of the pandemic, so I'd suggest that bed capacity needs to increase not decrease. So, if you agree with that assessment, can you inform the Chamber today what you are doing to reverse this cut and increase bed capacity?

You also say in your statement that vaccines continue to be the best defence against the virus. I firmly agree with you in that regard, and I think it's welcome news, isn't it, that the vaccine programme has been a great success across the UK and indeed here in Wales. I think we should thank, again, all our key workers who have tirelessly worked to roll out this life-saving vaccine, or vaccines, I should say. Many people in Wales are now eligible for a third jab, but they need some reassurance in this regard. The guidance in Wales says that you will be contacted by the health board when you are eligible for a booster vaccine, but evidence is showing from different parts of Wales that that is not the case and health boards—not just one, but numerous health boards—are not yet contacting people who are eligible in that regard. Now, if you're in England, you can get a booster dose from a walk-in site if it's been at least six months since your second dose and that you're over 50 or over 16 with a health condition that puts you at higher risk from COVID-19. So, can I ask, will the Welsh Government be adopting the same approach and, if so, when? Certainly, my suggestion would be that the Government should take that approach with urgency as well.

Now, evidence also is suggesting that more people are ignoring restrictions. I think that is concerning. I think, whether you agree with the restrictions or not, you should follow the restrictions. So, my question is not in that regard, but I think there is a concern here. There was a CoMix survey last week that showed that mask wearing in Wales has decreased sharply over the last month compared with England and Scotland. So, how are restrictions such as mask wearing and working from home going to be enforced if data is suggesting that people are ignoring the restrictions? So, I'd be interested in your conversations in Cabinet around this. Clearly, when you're considering further restrictions, there's got to be a discussion about the Welsh public's appetite for the willingness to follow restrictions. So, I'd be grateful if you could give some further detail in that regard as well.

Now, clearly, if people are being asked to isolate, we do need some clarity as well. In your statement today you referred to PCR testing. Can I ask, Minister, do the household have to keep taking regular PCR tests until the infected individual is recovered and has tested negative? The reason I ask that question is to understand the logic here. I appreciate you said this is being done in Scotland, so I'm sure you can explain the logic. But, if somebody tests positive and then the household have to obtain a PCR test, if that result comes back in one or two days and that person can then go back out again and leave the household, then clearly that person in the household is still infectious. So, I wonder if you could explain the logic in that regard. 

Can you also let us know whether this is a legal requirement or is it guidance? I think that's quite important. I've had people specifically ask this question myself. And in that regard as well, it might be useful if you could inform the Chamber in regard to all the additional requirements that were announced on Friday. Can you clarify whether these are guidance or these are legal requirements? I think that's quite important, if you are able to set that out.

I feel that the COVID pass needs some further clarity, Minister, given that we're now being asked to vote on its extension next week. I won't rehearse the arguments from my position; those have already been debated. But in order to be classed as fully vaccinated here in the UK, we need to have two jabs. In Israel, you need proof of two vaccinations plus a booster after six months of receiving your second dose or you're not considered to be fully vaccinated. Does the Welsh Government have plans to update the system to provide the booster vaccine for proof of the vaccine pass system?

I've also been contacted with regard to the use of the COVID pass. Some have described the process as confusing and feel that a step-by-step guide is needed. I appreciate there are people of all ages and abilities that will be trying to obtain a COVID pass. Can I ask whether the Welsh Government is doing anything to improve the functionality of the COVID pass system, particularly to help the elderly and vulnerable with access to COVID passes? And I say that in regard to some of the information that's required, such as passport details, driving licence details, mobile phone, because there are some groups of people that don't have any of those items, and there is clearly an obvious discrimination issue in that regard. So, I'd be grateful if you could perhaps outline what you're doing to ensure that there's no unintentional discrimination between people who don't have any of those particular documentations.  

Thanks very much, Russell, for many, many questions there. I'm not sure I'll get through them all but I'll give them a go. First of all, on the beds in Wales, and the number of beds in hospitals, my understanding is that the number of beds that have been quoted did not include, for example, the field hospital beds and, of course, doesn't take into account the fact that the situation is different compared to the past, because we have to take into account the social distancing that needs to be taken into consideration because of COVID. On top of that, you need to understand that the average length of stay is significantly reduced compared to what has happened in the past, and there is a rolling closure of wards for cleaning purposes. So, all of those things mean that the situation is different compared to the past. But I do think that it's important for us to remember that, actually, keeping people out of hospital is what should be our intention, and getting them out of hospital as soon as we can because of the kind of infections that you can catch in hospital, and because, frankly, you're more likely to get the kind of rehabilitation that you need in your community. 

On boosters, I'm pleased to say that we're doing very well in Wales, and we're following the same priorities as we did in the first round, and that is making sure that we actually do it in line with the vulnerability of people. So, we have people over the age of 50 within those categories of one to nine, but we're working through them in a very systematic way so that, obviously, care home residents have been some of the first to have been offered. I'm pleased to say that about 68 per cent of care home residents have already had their booster jabs, as have about 54 per cent of care home workers and NHS workers. So, these are the first categories that we're looking at. We're not going to be opening it up to a free-for-all in the way that they have in England. We'll be more systematic than that, following the kind of advice that the Joint Committee on Vaccination and Immunisation gave in the first round. 

When it comes to face coverings, I am very saddened to see that people are not taking this seriously. This is certainly not a common situation throughout Wales. The majority, I think, are still abiding by our laws. And let's underline that—it is actually a law to wear a face covering in certain public places in Wales, and we did, of course, have many robust discussions within Cabinet about this, in particular about how we enforce it. And I'm pleased to say that Ministers Lesley Griffiths and Vaughan Gething have been meeting with supermarkets to talk to them about their responsibility of enforcing face coverings. It is a legal requirement and we expect them to enforce that.

In terms of household isolation, this is something now that we are strongly advising people to do. If somebody in your house has COVID, then we're asking you to self-isolate. And if children, for example, have a PCR test and it comes back negative, there is still an expectation on them to take a lateral flow test for seven days, so that we shore up that potential of them developing it later, so that we are clearer about trying to keep it out of our schools.

In relation to COVID passes, I must say that what we've seen is that they have been quite successful. Certainly, when it comes to the rugby on the weekend, the kind of spot-check implementation that we saw did seem to work quite effectively. People got to the stadium about half an hour before they usually would. So, the Welsh Rugby Union certainly seemed quite satisfied with the way things worked out there.

The situation is still very, very serious in Wales. There is grave concern out there still. Yes, things are moving in the right direction, hopefully, but we are moving there from a frighteningly high peak in terms of the number of cases. And—let's be quite open about this—we're among the worst in the world in terms of numbers of cases. So many have been in touch with me expressing concerns that the basics aren't being done properly anymore. We heard the Minister say that she was confident that most people are still adhering to the requirement to wear face coverings, but that's not the experience that many people have. In the last few days I've had people working in pharmacies, in shops, restaurants, people who are concerned about what they see in their daily lives on public transport. We need to do something different now in order to reinforce that message and to ensure that the legislation is being implemented, because it is clear that the legislation, in and of itself, isn't enough. So, I would be grateful to understand from the Minister what kind of innovative thinking is being done around that communication. My professional background is communications; perhaps I'm more interested than most in that, but it is crucial. I asked four people who were closest to me on the train this morning, just as a point of interest:

'Why have you decided today not to wear a mask?' 'Oh, I don't know, there are not many people on this train.'

That's what one person said.

'I'll put one on if you'd like me to.'

Well, that's not what's important here. The message has been lost. That was the case with the four people on the train, as with so many others.

We are agreed, certainly, on the importance of vaccination. I'm very grateful to all of the teams implementing the booster vaccination programme. I am concerned that there are people who have had to wait longer than six months since their last vaccination and have not only not had the booster but haven't heard anything either. Again, we need to get that clear communication in place. I hope that you are right that we are ahead in terms of our booster vaccination programme, but people need to know where they are in the process so that they can have confidence that they will be protected when the time comes. And the same is true of children between the ages of 12 and 15. We are behind in that age group, and parents are seeking assurances that things are to gather pace. And just one question as to the pace of things. You admitted in the statement that we need to move forward more quickly with the booster programme. Details on what the plans to accelerate things are would be very useful indeed.

In terms of COVID passes, the last time we discussed this, I and Plaid Cymru made the case for stronger measures—vaccination passports, perhaps. That's not what was supported by the Senedd, which settled for the COVID passes ultimately—something that the First Minister at the time admitted was a compromise. But that's what we have in place in Wales at the moment, so in that context I'm sure myself and the group will support the extension of those passes, because it's clear that we need to do more. I certainly don't want to see another lockdown; I don't think anyone wants to see another lockdown. So, we must put measures in place to keep people safe as they go about their daily lives in as normal a way as possible. And in considering where we can extend those COVID passes further, it's worth pausing for thought and considering the fact that passes had been in place in the stadium on Saturday, but not in pubs around the stadium, which were full of people not wearing masks and not having to show any proof of their safety in being there.

Can I appeal to the Government to communicate clearly how they will support any businesses or organisations that have to implement COVID passes? May I also ask specifically today what work has been done to seek new ways of avoiding the problems that can arise from the fact that lateral flow tests are being self registered by individuals? The First Minister said in response to a question from Adam Price some weeks ago now:

'if it becomes possible, through technology, to move lateral flow devices beyond self-certification'—

and that was our great concern—

'then I agree that that would certainly be an important step forward.'

Is there any update on that? It is true to say that we are at a crossroads now; people are becoming concerned about another COVID Christmas and now is the time to see the Government doing things to keep things tight—not just for the sake of Christmas, but it is a reminder of the need to take action.

Thank you very much, Rhun. We are doing a lot now to try and reinforce the system—that is what our discussion was during recent weeks, particularly with Transport for Wales. So, those discussions have been ongoing with Transport for Wales to ensure that they see it as part of their responsibility to police this. As I said, we have also reached out to some of the shops, particularly the major shops. But, the fact is, we have to bring the public with us and we need to ensure that the the public understands that this is a responsibility on them as well; it is legislation. And, of course, there is a communication programme, which is very broad-ranging, which is already in place. Of course, we will do our best to ensure that people do hear those messages.

In terms of the vaccination booster programme, as I explained, what we're trying to do is ensure that people accept the call to have the booster in the correct order. We understand that that, sometimes, is longer than six months after the last injection. But, unfortunately, we were ready to give the booster sooner than we had the opportunity to start the process, because we had to wait for the JCVI—that's why we're in the situation where we were ready. But, of course, capacity is something that we have to work on, and we have to remember that there are still people in certain communities who still haven't had the first vaccine and we don't want to leave anyone behind. So, the vaccination system is quite complex, and so the messages are more complex still, but I do accept what you say in terms of the fact that people need to know when they are likely to receive this. They need some kind of expectation management—that's very important.

In terms of 12 to 15-year-olds, I think that about 45 per cent by now have been vaccinated. There are some restrictions in terms of why we haven't been able to go further with that, partly because many children have suffered from COVID and they can't have the vaccine within 28 days of having had COVID. So, we have to leave some time to pass. We will be reinforcing those messages.

In terms of the COVID passes, we made it clear that it was a compromise; we have to get this balance right. This is not a perfect science and I am pleased to hear that you will be supporting us in terms of, hopefully, going further with the COVID passes. In terms of going further into other areas—in terms of pubs—when I saw the crowds in Cardiff at the weekend, I was also somewhat concerned about what the pubs would look like. What we've said is if the situation doesn't improve, then we will have to consider passes in pubs and so forth, but we have to ensure that we work with the sector to ensure that whatever we do introduce is practical.

In terms of the technology, I'm not aware that the technology has improved yet, but I am very concerned about what Christmas will look like if we see the kind of scenes that we saw in Cardiff on the weekend everywhere in Wales, in terms of people mixing when COVID is still peaking.

First of all, could I ask the Minister to pass on my thanks to Transport for Wales and transport police in south Wales for a very effective response to my raising concerns about the decreasing use of face masks on local journeys by rail from Ogmore into Cardiff? They've implemented a series of measures and they're showing some progress now, actually, with transport users, but we'll keep an eye on it as the weeks go by.

Simplicity and clarity of message are key, as we've always known throughout this pandemic. So, on that basis, Minister, could I ask you something that my constituents have asked? It builds on what Rhun has just said. Are you giving active consideration, if it is necessary, to the expansion of the use of COVID passes to other hospitality and licensed venues, and retail outlets, but also to expanding once again, as we had before, the use of face masks in close-contact indoor settings?

The reason this has been put to me by businesspeople as well as constituents—local residents—is because they feel that that would help with clarity for people. It's not unmanageable or unreasonable, and, do you know, if it keeps us having the hope of a decent Christmas, not only for socialising but for workers in our health and social care settings as well, then it's worthy of consideration.

Diolch yn fawr, Huw. I will try to make sure that I pass on your thanks to Transport for Wales, and thank you for raising it directly with them. We're obviously continuing those conversations with Transport for Wales, but, clearly, it does make a difference when people do raise these issues with them.

You're absolutely right about clarity of message. It is difficult to maintain that clarity when things are changing all of the time, and people forget: 'Now, are we in that phase or that phase? What level are we at?'—all of those things. It does get quite complex, so we are very aware that we do need to try to keep those messages as simple as possible, which is why the overall message remains the same and has remained the same the whole time, which is, 'Keep your distance, wash your hands and try to remain outdoors'—all of the things that we know are better. So, those are the kinds of broad messages that we have to continue with.

When it comes to whether we will expand further, we've made it very clear that if the rates continue to go up, then we will have to introduce this in hospitality. Obviously, we're hoping that that won't happen, because the rates are starting to come down, but this has given us so many surprises. What I'm very reluctant to do is to go into the Christmas period with rates so high without any kind of forward plan. This is why we thought it was really important to give that kind of forward warning to hospitality, in case we're in a situation where we do have to introduce these passes quickly.

In terms of face masks with close contact, well, I think some of that should be in place already, Huw, so, clearly, we need to get some better messaging on close contact. I'll look at that again.

Thank you very much, Minister, for your statement this afternoon, as well as for allowing Dr Atherton to brief members of the health committee at lunchtime today, which we're really grateful for. Minister, it's quite clear that we will never be able to stop the spread of COVID. After all, we have the toughest control measures in the UK, but have the highest infection and death rates. We have to focus efforts on protecting the vulnerable. With that in mind, Minister, what additional protections are you introducing to protect those in the care sector? Do you plan to update the guidance to care homes, and do you agree with me that the best way to protect the vulnerable is to ensure that all care home staff and residents are fully vaccinated? Therefore, how do you plan to incentivise staff to take up the COVID and flu vaccines? And, finally, could you possibly answer my colleague Russell George’s question on whether the changes announced on Friday, with the changes to PCR tests, are actually guidance or legal requirements? I think that’s very important for this Senedd and the Welsh public to know that. Thank you.

Thanks very much, Gareth. We clearly have to be very careful about protecting the vulnerable at this stage. The best way to protect the vulnerable is to make sure that they have been vaccinated, and that’s why we’re very keen to make sure that we prioritise the booster vaccination for those vulnerable people, for those people in care homes and, as I say, we’re doing remarkably well with our targets on that—already, 68 per cent have received their vaccination.

I’ve been listening to lots of podcasts recently in relation to health and what we can learn about the virus and what we’ve learnt internationally. One of the things that we’ve learnt internationally is that you can’t seal off care homes and think that they work independently from society. They are a part of communities. They have people going in and out of them as part of communities. The care workers are a part of communities. So, you can’t seal them off, and that is the international experience. And, therefore, what we’ve done is to make sure our guidance is very clear that people do need to take lateral flow tests if they are going to go visit people within care homes.

When it comes to care staff, actually, the rates of care staff are incredibly high—they’re in their 90s—and the small numbers who haven’t, some of them are, perhaps, new into this sector or just leaving the sector. There is a lot of movement within that sector, and that would go to explain why some people—. And, of course, there are some who, clinically, are not able to. So, we have had very active campaigns to make sure that we can get as many people in care homes as possible vaccinated.

In relation to the question on PCR tests and what happens if somebody in your household—. This would be guidance rather than a legal requirement.

A number of people living in the South Wales Central region have been in touch with me who have family members who have autism and who are refusing to have a vaccine for all sorts of reasons, including being too concerned about visiting a vaccination centre because of inexperienced staff not dealing sensitively with their needs. Many too either can't or won't take a lateral flow test. And they're concerned about the impact of expanding the COVID pass to include more settings. In England, it's possible for those with autism to still get a COVID pass on the basis of a medical exemption. Can you confirm whether this is also the case in Wales, as the guidelines for this are not clear on the Welsh Government website in relation to the COVID passes? Confirming this would be a source of great relief to people with autism, and their families.

Thank you very much for that question. I'm willing to look into that to see whether there's anything that we can do in this area.

Thank you, Minister. Well, I'm expressing the views of constituents here, and many others, in saying that they've totally lost track of your strategy in dealing with coronavirus, I'm sorry to say. You introduced the COVID pass and, in the debate in this place some weeks ago, all the debate centred around the need for a COVID pass because of nightclubs, and that young people were going to nightclubs. But at that time the evidence showed that the infection was spreading in our schools, and it's been rampant in our schools for over two months. It's taken two and a half months for you to come to this Chamber and to say that you are going to take action in schools. So, I'm grateful for your contribution in mentioning schools today, but people have lost confidence, and therefore it's crucially important that you communicate clearly with parents as to what the expectations on them are when children are found to be COVID positive, or teachers and staff in schools.

You mentioned that the WRU were happy with the COVID passes. That might be the case, but tens of thousands of people came off buses and trains and went into pubs, were singing and shouting, and none of them were wearing a face mask. I was here in Cardiff and I didn't see a single face mask, which suggests that you perhaps haven't learnt the lessons since last year's six nations, and shows why we need an independent inquiry into COVID here in Wales. So, will you commit to extending the passes to be a meaningful passport?

And you also mentioned self-isolation—one final question: when you expect people to isolate, what financial support will you provide for them and their families as they have to stop working for perhaps up to a fortnight? Thank you.

Thank you very much, Mabon. Just in terms of infection in schools: the infection framework has been in place for some time. The extent to which people were using that depended on the rates within their communities. Of course, we've tightened up our perspective and our position in terms of trying to have people within the same household to have a test if somebody else within the household is suffering from COVID. One of the reasons that I was eager to keep children in schools was the fact that they'd lost so much school already, and they're paying a very high price, those children. But, evidently, when the levels are so high, we needed to tighten up the system.

In terms of the escalation of this to passports: I think we have to strike a balance, and we have to consider that balance. It is a political call. So, the final question asked me about people with autism. Now, they wouldn't be able to have a passport. So, you have to be very careful about what you're asking here, if you go down the path of passports only.

And in terms of—we've already talked about the need to tighten up the rules on our trains and so on, and ensure that people intervene when people don't wear masks and so forth.

I thank the Minister, and that concludes that item. We will now take a short break to make some changeovers in the Chamber. A short break.

Plenary was suspended at 15:23.

The Senedd reconvened at 15:33 with the Deputy Presiding Officer (David Rees) in the Chair.