Questions now from the party leaders, and on behalf of the leader of the Welsh Conservatives, Paul Davies.

Llywydd, can I also associate myself with the comments made by the Member for Caerphilly? And our thoughts and prayers are with Jack Lis's family today.

First Minister, in your view, how long should an 85-year-old wait for an ambulance after suffering a stroke?

Well, Llywydd, I know the case to which the Member refers, and it's clearly not acceptable that someone was left to wait for as long as that individual was. The ambulance service, as the Member will know, is under enormous strain from the highest ever level of calls that it has experienced in its history; from staff sickness levels, which affect the number of people it's able to put into ambulances and on the road, and a significant amount of that is coronavirus-related itself; and from coronavirus conditions, which mean that ambulance staff have to get in and out of PPE between calls and ambulances delayed by the need to clean them between journeys, because of COVID conditions. All of that helps to explain some of the stress the system is under, but nobody is satisfied when individuals are left waiting too long for an ambulance to arrive.

Yes, First Minister, the reality was that David Evans waited for more than half a day for an ambulance, and that is simply not acceptable. I'm sure you'll be aware of the comments of Darren Panniers, the head of ambulance services in south-east Wales, who has said that

'Prolonged hospital handover delays, high call volume and staff absence have significantly hampered' the ambulance service's

'ability to get to patients quickly in recent weeks.'

He went on to say that as Mr Evans waited for help, more than 840 hours were lost at hospitals in south Wales alone. So, First Minister, will you now apologise to Mr Evans and his family for the unacceptable amount of time he had to wait for an ambulance? Will you now consider setting targets against all ambulance calls, regardless of their categorisation, and will you tell us what the Welsh Government is now doing specifically to ensure that people across Wales aren't having to wait more than half a day for an ambulance?

Llywydd, I have no difficulty at all in apologising to anybody who hasn't received the service that we would wish them to receive, and I know that the ambulance trust has already done that on behalf of the service directly. In terms of the explanations that the trust offered, I've already referred to the high volumes of calls and the staffing situation that the ambulance trust faces, but the third explanation is also a really important part of this picture: our hospitals are full of people who do not need to be there, but where it is simply impossible to discharge them safely to their own home or into the community, because of the enormous pressure that the social care system is also under at this time. And that does mean that when ambulances arrive at a hospital, they are coming into a system that itself is full of stresses and strains at this time. So, setting targets simply for the ambulance service doesn't result in the improvements that the Member would want to see and I would want to see as well. We have to be able to improve the flow of patients through the hospital so that there is greater capacity to receive people on arrival.

A huge amount of work is going on to try to respond to the stresses and strains that the health service is facing. At the Grange hospital and in Morriston Hospital, where some of these pressures have been greatest, new areas are being devised so that people can be safely taken from an ambulance and into the hospital, start their journey and allow that ambulance to get back on the road again. We are recruiting more people to the ambulance service itself—over 250 additional whole-time posts in the last two years. And there is an unremitting focus, through the ambulance trust and with their colleagues in the district general hospitals, to find ways of preventing the need for people to be transported to a hospital in the first place. All of that is going on all the time.

Despite the pressures that the system is under, Llywydd, in September, over 1,000 red calls were responded to within five minutes, over 2,000 red calls were responded to within eight minutes, and the median response time for a red call in Wales was seven and a half minutes. Despite the enormous pressures that the system is under, I just want to give the Member an assurance that, in all parts of the system, efforts go on every day to try and make sure that people get the service they need and get it in as timely a fashion as possible.

Of course, it's not just ambulance waiting times that need to be urgently prioritised, there's also a need to tackle referral-to-treatment times too. According to the latest figures, the number of patients waiting more than 36 weeks has grown from just under 26,000 in February last year to just under 244,000 by August this year. Indeed, the longest waits included around 56,000 people who need orthopaedic or trauma treatment, and, as a result, we've seen people choose to fly to countries like Lithuania because of the impact that waiting for treatment has had on their lives.

First Minister, you said earlier that people are in hospital who shouldn't be there, but the number of beds in hospitals has been cut by 30 per cent since 1999 under successive Labour and Labour-led Governments. And we also know that there's a staff recruitment crisis that currently means around 3,000 healthcare posts are unfilled. The problems of capacity have occurred on your watch, even before the pandemic. For over a year, we on these benches have been calling for the introduction of regional surgical hubs to help with waiting-list backlogs, and it's not just us saying that, the Royal College of Surgeons have also been calling for the very same thing.

So, First Minister, the Welsh Government's winter plan talks about the development of COVID-lite regional hubs for some settings, and so will you confirm today that surgical hubs will be established across Wales, and if so, when? Also, can you tell us what other urgent short-term measures the Welsh Government is taking to treat those who have been waiting on a list for months and months so that they don't have to travel to Lithuania for treatment in the future?

Well, Llywydd, there are more people working in the NHS today than at any time in its history, and that is true of clinical staff, nurses, doctors and other forms of specialists who help to keep our NHS the place that it is. And on the Member's comments on beds, I saw the material that the Conservative Party in Wales put out on beds, and it is so deeply mistaken that it's hard to imagine that they don't know that it's mistaken when they put it out. The fall in beds in Wales has been slower than it is in England under his Conservative Government in the last 10 years. Falls in bed numbers are characteristic of all advanced health services, as we aim to look after more people with learning disabilities in the community, more people with mental health conditions in the community, and more elderly people in their own homes than in hospital beds. As the length of stay for patients in a hospital bed reduces, the number of beds in the health service has fallen as well. It's fallen more slowly in Wales than under his Government in England over the last decade. And more beds are not the answer in the modern health service, albeit the fact, as I've noticed that his press releases never mentioned once, that there were 6,000 extra beds created in the health service last year in order to deal with the pandemic crisis.

As to future arrangements and the sorts of regional provision that could be put in place in order to help deal with the backlog, then, of course, the Welsh Government is working with the Royal College of Surgeons and others to make plans for that sort of provision here in Wales. We will be, as will every other part of the United Kingdom, looking for scarce resources in order to deal with the backlog. The whole of the United Kingdom has seen the sorts of rises in numbers waiting for treatment that the Member refers to here. There is no easy spare capacity waiting to be used for any part of the United Kingdom. We will create capacity here in Wales, we will reform some of the working practices that can result in greater productivity, and we'll work with others in other parts of the United Kingdom to learn from any experiments that are being mounted there in order to try to do what any Member of this Senedd would wish to see done: that people get the treatment they need as quickly as that is possible in the extraordinary circumstances of a continuing public health pandemic that the health service is dealing with here in Wales today.

Leader of Plaid Cymru, Adam Price.

Diolch, Llywydd. May I, first of all, also, on behalf of Plaid Cymru extend our deepest condolences to the family of Jack Lis? One can only begin to comprehend the grief that that family must be experiencing, and our thoughts and prayers are with them, with Jack's friends, with the community and with the staff of the school, who I know are also terribly affected by this awful tragedy.

First Minister, in the last week, a majority of Members of Parliament in the House of Commons voted to overturn the verdict of the Parliamentary Commissioner for Standards to protect a former Minister. Another former Minister, Lord Bethell, admitted to deleting WhatsApp messages in which he discussed the granting of COVID contracts, and the Conservative Government now stands accused of handing out not just contracts but seats in the House of Lords in return for political donations. We have seen accusations of political sleaze in the past, but given the scale and the scope of the current wave of cronyism, contracts running into hundreds of millions of pounds, and the blatant attempt to undermine the independent watchdogs that are the hallmarks of a functioning democracy, is Westminster as a political system, as even a former Conservative Prime Minister has argued, now plainly and simply corrupt?

Well, Llywydd, I heard the interview that Sir John Major gave at the weekend, and it was a very powerful indictment of the more recent developments at Westminster. If Members haven't had an opportunity to hear it, I think it's worth 20 minutes of anybody's time. The accumulating evidence of the way in which the current Conservative Government discharges its responsibilities, I think, would shock anybody who has the interests of a healthy, functioning democracy at heart. And it's not just in these areas. You'll remember that Sir John Major began his interview by saying that there was a whiff of this Government acting in a way that, 'We are the masters now.' In other words, 'We can do what we like, where we like, how we like.' And that is just as true of their treatment of the devolution settlement as it is of the issues to which the leader of Plaid Cymru has referred today. In the end, it risks bringing not just themselves into disrepute but the institutions on which we all rely into disrepute as well, and there is a great deal of recovery to be done if the events of the last 10 days are not to leave a lasting legacy.

Of course, this superiority complex that this current Westminster Government has is expressed not just in undermining the independence of the standards commissioner but also that of the Electoral Commission, the appointments commission, of all the independent checks and balances on its power. Our solution to that, of course, is to demonstrate what a healthy, modern, world-class democracy could look like in the twenty-first century by becoming our own independent nation. But, while we remain trapped in a Westminster system that is rotten to the core, what can we do to insulate ourselves from its most egregious consequences? Will you add your voice, Prif Weinidog, to those calling for the abolition of a House of Lords based on political patronage rather than merely its reform? And do you agree that the Metropolitan police should treat allegations of the sale of honours at least as seriously now as it has done under previous administrations?

Adam Price is quite right to say that, during the last Labour administration, Scotland Yard took allegations of the sale of honours so seriously that they sent very senior members of Scotland Yard into Downing Street without any notice of their arrival. It would be interesting to see whether they do indeed take the same approach with the current instances.

I have long believed in the abolition of the House of Lords. I believe in its replacement by an elected second chamber in which the position of the nations is protected—in some ways, as the Senate operates in the United States system. But, some of the things that we have heard recently are not simply to do with the House of Lords; they are to do with the extraordinary ways in which some Members of Parliament also appear to operate. The case of Geoffrey Cox that we have been reading about today defies belief—a man being paid nearly £0.5 million to work for a foreign Government that is under investigation for corruption by the UK Government and doing all of that when he appears to have a full-time job representing his own constituents. You could not make it up. 

I do think, in a way, Llywydd, that it is almost, for me, trumped by the news about another former Minister, Chris Grayling—a man, you'll remember, where the National Audit Office said that the cost of compensating people for the contracts that he had negotiated for ferries would be £56 million. You'll remember his deal with Seaborne Freight: £14 million to a company that didn't even own a ferry—not a single one—and £1 million paid to consultants in order to secure that contract. I lie awake at night wondering how you can pay £1 million to a consultant to land you with a contract with a company for ferry purposes that didn't even have a ferry. But, the good news is that Chris Grayling is now earning £100,000 over and above his salary as a consultant to a ports company. Well, he's a man with a lot of expertise to draw on, as we know. 

It says something—Geoffrey Cox is the former Attorney-General, isn't he? How low have they gone? As Westminster sinks deeper into the mire of its own corruption, what can we do here in this Senedd to uphold the highest levels of public integrity in our own democracy? This month, the Nolan committee, following on from the Boardman review, published new recommendations to strengthen public integrity, which includes some that we could enact independently. These include placing the independent adviser on the ministerial code, or its equivalent here, on a statutory basis and giving them the authority both to initiate and determine breaches of the code. This would strengthen public confidence in Wales's democratic institutions at a time of plummeting trust elsewhere. And, of course, when we devolve the criminal justice system, finally, we could go further in creating a new law of corruption in public office, as the Law Commission of England and Wales currently has proposed. If the Prime Minister refuses to explore these ideas, are you prepared to do so as Prif Weinidog instead?

I thank Adam Price for that. Could I begin by saying that I think that successive tests of public opinion carried out annually by Aberystwyth University show that the Welsh public holds this institution in a different place in their minds than they do Westminster? As I look around the Chamber, I see people who work very hard on behalf of their constituents, who have no other jobs that they do at the same time and where people discharge their responsibilities with a genuine sense of integrity and with the public interest at heart. And I think that is true in all parts of this Chamber. Is there more that we can do to make sure that we sustain that reputation, that we make sure that people in Wales go on having confidence that what happens in their name, in their Senedd, is conducted in a way that they would be willing to regard as consistent with the standards that they think would be right? Well, of course, if there are—and I'm interested in the reports of the Nolan review—more things that we can do to make sure that we continue to secure that reputation, then of course I think we should do them. But I think that we should have some confidence that the way in which successive terms post devolution have been conducted gives us a different platform and a different reputation in the minds of the Welsh public. We should jealously guard that and go on doing things to make sure we continue to secure it into the future.