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

Diolch yn fawr, Dirprwy Lywydd. Thank you for the opportunity to update Members with the latest information about the very fast-moving omicron variant, its impact on Wales and the public health situation here. In my last statement to Members, I said it was only a matter of time until omicron arrived in Wales, and sadly, that has proved to be the case. The first case in Wales was confirmed just days later and, as of today, 32 cases have been confirmed. The numbers are growing every day, and we must be prepared for them to rise rapidly and sharply.

The doubling time for omicron is currently two to three days. The UK Health Security Agency has estimated that if the variant continues to grow at the present rate, it will become the dominant strain, accounting for more than 50 per cent of all COVID-19 infections in the UK by mid December. If current trends continue unchecked, there will be more than a million omicron infections in the UK by the end of December. Both the Prime Minister and the First Minister of Scotland have warned of a tidal wave of cases on its way. The situation is very serious.

We are still dealing with the delta variant in Wales at the moment, but there is worrying evidence that omicron already has a foothold in our communities. Cases have now been confirmed in every health board area. It arrived in the UK through international travel and the initial cases were connected to travel. There is now widespread and sustained community transmission in many parts of England and in Scotland too. The majority of cases in Wales are not linked to travel. When I spoke to you last about omicron, there was a lot we did not know. Thanks to the work of experts and researchers around the world, we are learning more every day. We now know that omicron has a growth advantage over delta, and this might be due to immune evasion or transmissibility, but it could be due to both.

Omicron is at least as transmissible as delta. It’s feasible that it's more transmissible. We are awaiting further evidence, but if it is, it has the potential to infect large numbers of people, which could translate into an increase in hospital admissions. We are moving into the most difficult period of the year for our health and care services. The NHS is already incredibly busy as a result of winter pressures and catching up with treatments that were delayed earlier in the pandemic. Even a small increase in COVID-19 admissions would put even more pressure on already stretched services and a tired and, frankly, drained workforce.

We also know that omicron displays a reduction in immune protection against infection and we still don't have enough information to know whether it will cause a more severe form of illness. How the variant behaves in different populations with different rates of vaccination and different demographic profiles is the focus of intense study around the world. Over the weekend, emerging data revealed that two doses of the vaccine are simply not enough to protect us against omicron. The booster dose is vital for increasing our protection.

More than 1.1 million people have already had their booster in Wales. We were already increasing the pace and roll-out of the vaccination programme as these new findings emerged, but we will now go further and we'll go faster. Our aim is to offer all eligible adults a booster appointment by the end of December. This is a huge undertaking. It will be the priority for the NHS and it will mean refocusing as much non-urgent activity as possible over the coming weeks towards the vaccination programme so that we can maximise protection. We'll be asking all NHS staff who can to work in our vaccine centres. We will be extending vaccine centres to their maximum capacity, extending opening hours and providing a hybrid model of walk-in and prearranged appointments.

I encourage everyone to take up the offer of the vaccine. Please make this your priority. It is one of the most important things that you can do to protect yourself.

Dirprwy Lywydd, this is an incredibly fast-moving and worrying situation. However, at the moment, the number of confirmed cases of omicron in Wales remains low and we continue to respond to the delta wave. But we must be prepared to act swiftly to protect people’s health. At the most recent three-week review of the coronavirus regulations, the Cabinet considered what protections are needed now to respond to the current delta wave and steps we need put in place to prepare and protect against an increase in cases caused by the omicron variant. We have decided to move to a weekly review cycle so that we can closely monitor the public health situation. For the time being we will remain at alert level 0, but we have built on the measures that we have introduced in the last two weeks relating to self-isolation and international travel.

We are now strongly advising people to take a lateral flow test before they go out to any busy places or to any events, and also before travelling or before visiting friends and family. We have issued guidance for students preparing to leave college and universities for Christmas regarding testing before they travel. If the test is positive, then stay at home. You need to isolate and arrange a PCR test. We have made some minor changes to the regulations to clarify that face coverings must be worn in cinemas and theatres and during professional driving lessons or practical driving tests. We also strongly advise people to wear a face covering in pubs and restaurants when they are not at the table or not eating or drinking. We have had to make some technical changes to the COVID pass. Lateral flow tests should be taken within 24 hours, rather than the previous advice of 48 hours. And also with regard to the COVID pass, we are removing proof of natural immunity from that COVID pass, in line with changes being made in England, as the UK Government introduces its plan B in response to omicron. We are considering how to support safer visiting in care homes and hospitals to ensure that we protect the most vulnerable.

Dirprwy Lywydd, this is a worrying and uncertain time for all of us. We have faced challenges together before. We all need to work together, to look out for each other and to keep each other and Wales safe. Thank you very much.

The Llywydd took the Chair.

Minister, can I thank you for your statement and the advance copy today, and also for the briefing that you provided to Health and Social Care Committee Members with your officials? That was helpful this morning as well. I agree with you, Minister; there's huge concern here, because there's so much uncertainty and we know that omicron is fast becoming the dominant strain across the UK and in Wales. Of course, I agree that increasing the vaccination programme has to be the priority and the vaccination programme has to be rapidly expanded.

Can I just ask you a few questions about your measures to increase take-up? Can I just ask about messaging, first of all? Because the First Minister, in his statement yesterday evening and today—the message is, 'Get your booster, and make that your priority'. But for many people across Wales, that's not particularly the issue, because they're ready; they're ready to get their booster. I think the question is how they can do that. For many people, despite the messaging that it's a priority, it's a case of sit and wait until you get your invite. That's the reality here. So, that's some of the messaging issues that I just wanted to raise with you around that. Because I'd imagine anyone in this virtual Senedd today feels the same way. I'm ready to drop everything to get my booster jab. I just want to know how I'm going to find out where I'm going to get it, when I'm going to know, what I should do and by what date if I haven't had my invite. So, if those are the questions of myself and Members in this virtual Chamber this afternoon, those are going to be the questions from people across Wales. I think that's the important element here in terms of meeting the targets that you've set out—the ambitious targets that you've set out to get all adults being offered the invite by the end of the year.

In terms of other measures on take-up as well, in your briefing today, you talked about plans for increasing opening hours. You spoke about that in your statement today, but I don't think you mentioned the times. I think in the briefing today, if I'm right, you mentioned increasing opening times from 9 a.m. to 8 p.m. Can I suggest that for many people, they can attend before 9 a.m. if that's appropriate? Many people can attend beyond 8 p.m. So, can I ask you to perhaps reconsider longer opening times? Because I would suggest that it's very difficult to meet your target if the opening times aren't extended any further.

Hand in hand with that question, of course, is volunteers as well. You've talked about working with the third sector, which I welcome. Can you now launch a Wales-wide recruitment campaign for volunteers? Because surely that needs to happen with some urgency. Can I ask you what your plans are in terms of filling gaps when people don't turn up, sadly, for appointments? It's very frustrating, I know. But when people don't turn up, what are the plans for filling in those appointments with a shorter time span?

You said in your statement that emerging data has revealed that two doses of the vaccine are not enough to protect us against omicron. Can you just clarify whether this is only related to AstraZeneca, or both vaccinations? And how much of a role does time since having a jab play in defending yourself against this new variant? Can I also ask about what plans you have in terms of cancelling planned operations? You spoke a little about that today as well. I'm just concerned because one in five people across Wales are already on a waiting list, so what efforts are you making to prevent waiting lists spiralling further in this regard, and what progress is being made on surgical hubs, as I've outlined previously?

And finally, there seems to be some positive data, early data, showing that death rates in South Africa have significantly fallen in the last few days, so I wonder what assessment has been made from other areas of the world where the new variant is significantly advanced that brings some hope and encouragement that can be drawn from that data.

Diolch yn fawr, Russell. Vaccination is absolutely the priority now, and if we do want to protect our NHS going into January in particular, then now is the time to do that work, and that's why we have really put a turbo charger up our system, to make sure that that vaccination programme can actually just be rolled out much quicker, but not in the chaotic way that we've seen in England. In Wales, we do things differently. We try and line things up before making an announcement. You saw those scenes in England on the weekend—thousands of people rolling up to vaccination centres, no plan, and GPs hadn't even been told. We do things very differently here in Wales. We have a conversation first, we line it all up, and then we make an announcement. That's precisely what we've been doing.

There are still some t's to be crossed and i's to be dotted. As you can imagine, this is a Herculean task that we'll be facing. What will happen is, when it's time for your vaccination, you'll be texted or you'll be phoned, so it is important that people have given their contact details to their GP so that we have your most up-to-date contact details. We will then get to a point where we'll let you know publicly if you should have been in the group of people that should have been called. So, we are sticking to the JCVI's suggestion that we should vaccinate people in order of priority in terms of their vulnerability, really—so it's an age-related and an illness-related approach, as recommended by the JCVI. We're going to be sticking to that.

It is possible that we'll be extending the opening times beyond 8 o'clock, so that is something that is just being worked out now. That is likely to happen, certainly in some of our larger centres. The recruitment campaign has already started. We have told people that they can sign up and help us out in terms of volunteering, so that's already been done, and there's a separate process for volunteers who are health professionals. We're also waiting for a response from the Ministry of Defence to our request for support from the military as well.

In terms of the gaps, we are really disappointed. In some areas we are seeing lots of people not turn up for their vaccination, and that is a really, really troubling situation that is arising, which is why we need to underline the fact that this is a vital opportunity for people to undertake and get that booster jab. So, what we're doing is we've always had a system of over-booking, and we'll be over-booking again to make sure that we don't have those gaps.

It's true that two doses of AstraZeneca is certainly not enough, but it's also true that it's not enough of Pfizer as well. That's why we are really driving this with a real sense of urgency. We follow the JCVI advice when it comes to the interval between doses. They have agreed that it is possible to reduce the time between doses—the second dose and the booster dose—from six months to three months, so we are simply following the scientific advice on that.

In terms of cancelling planned operations, I just want to underline that this is a three-week burst that we're talking about—it's a three-week burst of activity, and then hopefully we'll be able to go back to whatever normality looks like these days. So, it is important for people to understand that.

Just on the situation in terms of fatality rates in South Africa, I've been trying to read up about this this afternoon. What is clear is that the experts are warning that the South Africa experience may not be a reliable indicator in terms of omicron in other countries. So, 72 per cent of that population had experienced previous COVID infection. That is not the same situation as here in the UK. We have a different demographic, we have an older population here, we have different vulnerabilities to disease, and I think it is important that we understand that, because the system is different in South Africa, we're seeing hospitalisation rates that the—. I think the sensible thing to do is err on the side of caution, prepare for the worst and hope for the best.

Thank you, Llywydd. I certainly agree with the Minister that the situation is very serious, and I thank in advance all of those healthcare workers, vaccination services and test and trace services, and so on, who are going to be under a huge amount of pressure in the coming period, and that would have been a time of great pressure anyway, regardless of omicron. 

To add a more positive note, I hope that the early evidence that we've seen is going to play out and that we are moving into a less dangerous time. But, we don't know that for sure at the moment, and we do need to realise that large numbers are going to catch the virus now. Even if the proportion of people who become very ill is lower, it is going to lead to a huge amount of pressure on our health services because of those numbers. 

I, of course, support the principle of accelerating the booster process, but the danger now is that people's expectations are very, very high, and I haven't yet seen a plan in place that will give confidence that the programme is ready to go. The work is certainly building a head of steam, and I'm grateful for the updates that we've received from the Minister today and in an earlier statement. But whilst she's talking about chaos in England—and I saw the same pictures—I hear about chaos here in Wales, with people turning up to vaccination centres and being turned away because they had received an appointment in January, whilst other people who had not yet received an appointment, because they were less of a priority, were allowed to walk in and receive the booster. That doesn't make a great deal of sense.

We need clarity on what happens to key workers who aren't health and care workers—police and teachers. Can they receive the vaccination sooner? Where are the robust plans to deal with home vaccination, those who are too vulnerable and have mobility issues, which means they can't access those vaccination centres? Communication always needs to be clear with patients, yes, but also with colleagues within the health service. It makes no sense to me when one surgery says that they heard on Facebook that there would be a walk-in vaccination centre in their area. This needs to be tightened up, and the questions are multiple, aren't they? When will the walk-in vaccination centres be opening? Will there be such centres in all parts of Wales? Will people be allowed to travel from one area to another between counties, between health board areas, even to London if they've heard that there's a vaccination centre open there, as one suggested to me earlier on? These are the kinds of issues that we need clarity on.

I know how much of a challenge the Government, the health boards and the vaccination teams are facing, and I am very grateful for everybody's dedication, and I wish them all well in the coming period, but these messages need to be entirely clear, because people are not demanding that they should receive the booster today or tomorrow, but they just want to know what exactly is ahead of them. They are happy to hear that all will be well next week or the following week, and what should happen if they don't receive an appointment by then.

Turning to the pressure on the NHS as vaccination is prioritised, yes, it is inevitable in the situation that we are facing that there will be some postponement in terms of treatments that would otherwise have happened. It's insufficient, I'm afraid, to hear that the Minister is hopeful that things will return to normal after that. No, we need a clear plan to restore services. We hope that this process will be over in a couple of weeks, but the plan in terms of how to get back on track needs to be clear for the following period. So, clarity on that plan would be good.

And finally, I very much hope that we won't need to introduce more stringent restrictions this side of Christmas for reasons of people's well-being and welfare, and for social and economic reasons. We would certainly need to hear about financial support for businesses, and so on, if further  restrictions were needed after that. But, I do welcome the announcement today about the strengthening of some fundamental elements, now—such as wearing masks in more places, and advising people more strongly, as well—because even though I, like everyone, I'm sure, hope that we can avoid those further restrictions for now, things can't carry on as they were, and all of us have a part to play in our response to this new threat.

Thank you very much, Rhun. I think you're right that very high numbers are going to catch this new variant, and I accept that people's expectations are very high, but I would like to ask the public to wait until they are called so that we can maintain order. Some 26,000 people were vaccinated yesterday, so we've already increased the capacity hugely over the past few days. In terms of people who are vaccinated at home, we have provided additional encouragement for GPs to help to increase the numbers of those who will be vaccinated at home. We will have walk-in centres, but they won't be the same as they have in England, because we are determined to ensure that young people, for example, who are fit, who are 20 years of age, for example, don't receive the vaccine before those who are at high risk and who are, say, 64 years of age. So, yes, walk-ins will be available, but they will be available to a specific cohort of people, and so we will be doing things slightly differently to the way that they're being done in England.

In terms of restoring services and keeping services on track, well, Rhun, if you know what January will look like in the NHS, then you're doing better than me, because I think that the situation will be very difficult in January. We don't know how omicron is going to impact the NHS. We don't know how many staff will be off sick as a result of omicron. So, clearly, it is very difficult for us to forecast what January is going to look like. So, we do have a plan for the next three weeks. We always have a winter plan for the NHS. That is already in place. But, clearly, we will perhaps have to adapt that plan in the face of the fact that this variant is going to put increased pressure on the sector. 

The Cabinet will, obviously, meet later on in the week to decide whether we will need additional measures to keep us safe over the Christmas period.

Thank you, Minister, for your statement, and also thank you to our vaccine NHS champions. Minister, we know that the omicron variant effectively reduces immunity achieved by two doses of vaccine to virtually nothing in the case of Oxford-AstraZeneca and to minimal protection from infection in the case of Pfizer, but that is not to say that the double doses will not dramatically help people fight off severe illness as a consequence of being infected with COVID-19. So, Minister, will you join with me and ask for people to 'flow before they go' and also call for the people of Islwyn to get boosted this Christmas, to keep themselves safe, keep their families safe, and to keep Wales safe? And when people ask, 'Why get the booster shot after two doses?', is it not correct that the booster will increase immunity levels to over 70 per cent, and, as one correspondent put it, the first dose is the primary school education for your body, the second dose is comparable to sending your body to secondary school, and the booster is akin to university, deepening and broadening our body's own ability to fight this vicious virus?

Finally, Minister, outside of the priority groups, when will you be looking at opening walk-in lanes and centres for the people of Islwyn, as well as dramatically extending opening hours of vaccination centres? Diolch.

Thanks, Rhianon. You're absolutely right; the double dose is not enough. But the last thing I want to do is to put off people who haven't had any doses at all. They're the ones I'm still most concerned about—people who have had no protection whatsoever. Our ICU departments are really under a huge amount of pressure, and some of that is because there are people in there who have had no vaccinations at all, and it's putting pressure on our ICU system unnecessarily. I do really plead with people to think about how their actions are really having an impact on other people, in the sense that they may be taking up a hospital bed that somebody else could be taking for an emergency that is not of their making. And I think it's really important that we get people to understand their responsibility to the wider community and wider society here. Because none of us know how we're going to respond if we contract coronavirus, so we just need to really underline that.

We will be, as I emphasised, doing walk-in centres, but they won't be on a free-for-all basis; they will be in specific cohorts. So, all of those things are being worked out in the next few days. But literally—what day are we today? Tuesday—we've been working all weekend on this and, obviously, there is a huge amount to put in place to really ramp up this programme. It has already been ramped up, but we need to double what we're already doing, so huge amounts of work still to be done. And I do hope that we can all stand together and thank our NHS workforce for the incredible work that they have done, but, more than anything, we are now asking them to go the extra mile once again; at a sensitive time of year, when they do want to be with their families, we're asking them to cancel their leave—all of these things. It's another huge ask of the people who've given so much of themselves already.

Thank you, Minister, for your statement this afternoon, as well as addressing and allowing your officials to brief members of the health committee earlier this afternoon. 

Minister, while it's important that we react to the developing picture of omicron, it's vital that we don't overreact—this would create more harm than good. I welcome the fact that no new non-pharmacological interventions were introduced on Friday, but we need to focus on protecting the vulnerable, so, with that in mind, Minister, the guidance to care homes was updated on Friday, but it doesn't specifically mention the omicron variant. Will you be updating the guidance to reflect the potential impact of the new variant? And in particular, Minister, early indications of the transmissibility of omicron show that it may be more aerosolised than other variants, so, with that in mind, Minister, will you be issuing care home staff with better PPE, such as FFP3 masks? Of course, the best way to protect care home staff and residents is the boosters. So, Minister, when can we expect all care home staff and residents to receive their booster jabs, because, as it stands, one in three staff and 16 per cent of residents are yet to be boosted?

Finally, Minister, with the strain on the NHS over the coming months, there will be enormous pressure to move patients from hospitals and into the care system. So, what steps are you taking to ensure that this does not become a vector in transmission of COVID into the care sector? Thank you.

Thanks very much, Gareth. I've got to tell you that overreaction is something that, obviously, we're very aware of. We know that the situation is not all about health; it's about economic consequences, social consequences, mental health consequences; we have to balance all of these things out against the potential of our NHS being overwhelmed. So, all of these things are things that we put into the mix before we think about introducing any new protections.

In terms of the guidance being updated for care homes, we have been working with the sector, having conversations with the sector—so, we don't impose on them; we talk to them about what's possible, what's practical and what will work. So, we're working with the sector. And I think we're very aware that things will change very quickly. So, you talked about not overreacting. We have 30 cases in Wales. Things are going to change very quickly and we will probably have to just adapt how we monitor our guidance in relation to care homes.

On the PPE side of things, we have had more work done in relation to FFP3 masks and, again, our clinicians are looking at this, seeing if this is something that needs to be introduced. I think you've got to be very aware that it's a big ask to ask people to wear FFP3 masks all day long; it's something that they, sometimes, are reluctant to do as well. So, we just need to make sure that we land this in the right place; those conversations are still ongoing.

In relation to boosters for residents and care home workers—care home residents, we are up to about 85 per cent already. So, I think that's a pretty high level. So, we're pleased with that, but we've still got a little bit of a way to go to get to the 97 per cent who've received the complete primary course. Some of that, it's not because they have not been offered it; it's because there are different circumstances and reasons why that should happen. Care home workers—we're up to 67 per cent of care home workers who've had the booster dose. So, clearly, we're anxious to see if we can get that up higher. Our evidence suggests that it wasn't the release of people from hospital that was carrying infections into care homes, it was actually—. Some of it was because we had a situation where care home workers were going from care home to care home and, when it's in the community, it's really, really hard to keep it out of anywhere else. International studies have shown that. Trying to build a wall around these places is almost impossible. So, that's what the international evidence has shown us. So, we'll do all that we can, and that's why there is a need to make sure that we test and test and test again, when it comes to care homes.

We've received a very clear message from you today, Minister, for people to wait for an appointment. But I have received a number of calls and messages from people today asking when walk-ins will be available in my region, and have seen that there are health boards that are promoting this. So, I am concerned that there is a panic taking place out there, and I think that these messages, which perhaps are conflicting, won't be helping at the moment, in hearing that some areas do have walk-ins and some don't. So, having clarity on that is vitally important.

I'm sorry as well to sound like a stuck record, but I did hope to hear today, as part of your statement, an update with regard to the COVID pass, with regard to those people who can't be vaccinated for some reason. I've raised this with you on a number of occasions since 2 November. On the Welsh Government's website, it still says that the system is being developed to ensure that people can receive a COVID pass if they have an exemption, or they can't receive a vaccine, or they can't take an LFT test for medical reasons and so on.

So, could we have an update in terms of when this system will be available please? Because people do remain concerned, and they can't access access shows, or attend cinemas, and are concerned that people with autism and so on are being excluded from such activities at the moment because this system is so slow in being implemented, as compared to what we've seen in England. Thank you very much. 

Thank you, Heledd. I think it is really important that people understand that our system in Wales is different to that in England. We're not going to have walk-ins as they are seeing in England. It's not going to be a free-for-all here. We will go in order. So, I don't know where people are getting that idea that we are doing this in the same way as in England. We're not. We're going to adopt a system where we will go according to age and how vulnerable people are.

I know that people are perhaps uncomfortable with that, but that is what we've decided to do. We're following the guidance that we have received from the JCVI. So, there will be walk-ins, but they will be walk-ins for specific cohorts—for clinical at-risk groups, for example. They will receive a message, 'Today is the day for your walk-in.' Or those people who are between 55 and 59—that cohort will find out which day they can go in. It's not a free-for-all as is seen in England.

We don't want to see people shivering outside in the middle of winter, as is happening in England. What's happening there is survival of the fittest; those people who are fit, who can queue outside, can access the booster. So, we do have to operate by safeguarding those people who are most vulnerable. We're not going to apologise for that.

In terms of those people who can't be vaccinated, there has been a great deal of work on this, Heledd. We have analysed how many people can't be vaccinated and can't take an LFT test. We think that it's only between 100 and 500 people who are in that situation. So, if people are in that situation, they need to contact their doctor. That will be inputted on a system, and that will then be placed on the pass on the individual's behalf, so they will be able then to receive the COVID pass. We haven't done that yet. The reason why that that's been paused is because we have been focusing on the vaccination process; it's the same people who are undertaking all of this work. But a great deal of preparatory work has been done. We know who the people are, more or less. The work has been done, but we need to get the systems speaking to each other. So, we know who the individuals are. There are only between 100 and 500 people. So, when people go to rugby games and say, 'I'm exempt', they won't be able to do that anymore, because it will all be noted on a COVID pass; it will state clearly—if you're exempt, it will show up automatically.

Thank you very much to the Minister.