Questions now from the party leaders. And on behalf of the Welsh Conservatives today, Paul Davies.

Thank you, Llywydd. Before I move to questions to the First Minister, I would like to echo your comments in wishing a very happy birthday to the Urdd, who have and continue to make a huge contribution to our language, our heritage, our young people and to our daily life. So, a very happy birthday.

First Minister, around 20 per cent of people in Wales are on a waiting list for non-urgent treatment, of which 1 in 4 of those patients have been waiting over a year for treatment, and more than 42,000 people have now been waiting for treatment since November 2019. Now, last week, the health Minister warned that figures are likely to get worse before they get better. Therefore, in light of the health Minister's remarks a few days ago, can you tell us what modelling the Welsh Government has done in relation to waiting time figures? Because it's vital that, as a Government, you look at the worst-case scenarios so that health boards are able to plan the delivery of services in their regions more effectively. And is the health Minister right that waiting times are likely to get worse?

Llywydd, I think the health Minister is right that, in the short run, we're yet to see in the figures published so far the impact of the omicron wave and the need to divert health service resources to the vaccination programme carried out during December. So, I think the health Minister, through the modelling that is carried out, was simply warning people that the difficult position that will be facing the NHS is going to get worse before it gets better. But the Member Paul Davies will have seen the British Medical Association in Wales saying that, even in the figures published last week, there are the first signs of recovery, and that is underpinned by modelling, modelling carried out by health boards, modelling carried out across specialities, backed up very often by national arrangements, for example in orthopaedics, to make sure that we are trying our best to match new capacity to deal with the pent-up demand that has grown over the last 20 months. And there are a series of ways in which health boards will be planning to do that—maximising their own capacity, carrying out more lists at weekends, looking to co-operate across borders with other health boards and across the border into England, for those counties and health boards that sit along that border, and then to be able to see the tide turn on the lists that have built up over the last COVID-dominated period.

First Minister, the health Minister has said that we are still in a situation where there are very real restrictions within our hospitals because of COVID, and so your own comments last week that we are past the peak, and the situation has improved significantly, should mean that, following the December figures, waiting times should start to come down. In the meantime it's vital that patients attending NHS sites are not at risk of contracting COVID-19. You'll have seen the damning hospital inspection report into Prince Charles Hospital last month, which found that the arrangements for the prevention and control of infection within the emergency department and clinical decisions unit did not protect patients, members of the public and staff. That report also found significant failings in adhering to local and national guidelines, and staff themselves made it clear that they were worried about contracting COVID-19 and concerned about their patients. So, First Minister, what urgent steps is the Welsh Government taking to address the issues highlighted in that report? And more widely, can you tell us what is being done to ensure that arrangements for the prevention and control of infection in all hospitals actually protect patients and staff?

Llywydd, what Paul Davies said at the beginning points to the whole dilemma here, doesn't it? Hospitals continue to have to deal with very significant numbers of patients who have contracted coronavirus—over 1,000 beds still in the NHS are in that position—with hospitals having to divide themselves into red zones and green zones, with staff still having to wear personal protective equipment, with all the time that that takes and the impact that it has on productivity, the need for deep cleaning of sites and operating theatres between patients, particularly if you're operating where COVID is known to be part of that patient's condition. The health service isn't in a quick way going to be able to carry on as though none of that were happening. There's going to be a long tail of impact on the health service, and I'm afraid that the actions that the health board are taking that would slow down productivity inevitably are exactly the ones that Paul Davies points to, which protect from transmission of coronavirus within the hospital environment.

Now, I saw the report into the Merthyr position, and it was an issue that was raised by members of staff themselves. And where the Healthcare Inspectorate Wales report says that the plans by the local health board to improve that position came into them in a way that gave confidence that those things would now improve.

You can be sure that, right across the NHS, staff work tirelessly to try to prevent COVID from circulating within the hospital. The single biggest contribution we can make to that is to go on driving down rates in the community, because this is a virus that finds its way into vulnerable settings wherever those settings are to be found, and the more coronavirus circulates in the community, the harder it is to prevent that virus from moving in, whether it's into a prison setting, a care home setting, a hospital setting. Closed settings are where the virus thrives, and the biggest contribution we can all make to preventing the virus from circulating in the hospital is to reduce its circulation in the community.

First Minister, clearly this report is another reason why a Wales-wide COVID inquiry is needed, so that issues like this can be scrutinised fully and questions answered over how these failings came to be. Patients have the right to feel safe in a hospital setting, and yet, as this report shows, there are risks of cross-infections, and in some cases patients were at risk. According to recent figures, nearly a quarter of people who died from coronavirus in Wales were infected in hospital, and despite Ministers consistently telling us they were learning lessons and implementing stronger protocols, the Prince Charles report shows that patients are still being put at risk. It's now come to light, thanks to the COVID-19 Bereaved Families for Justice Group—Cymru, that there was a Welsh Government 'lessons learned' report following the SARS outbreak in 2004, where the Welsh Government committed to an audit and allocation of funding to rectify the lack of isolation facilities. So, First Minister, did that audit happen, and did Welsh hospitals receive the right support to modernise their settings to fight airborne viruses between 2004 and the start of the COVID pandemic? If that is the case, then why are some health boards telling families that a lack of isolation facilities compromised their ability to keep patients safe? And given the calls now for a Wales-wide inquiry from organisations, from politicians and from families across Wales, what will it finally take for the Welsh Government to agree to a Wales-wide inquiry, so that families can get justice and we can finally get answers in relation to decisions taken here in Wales by your Government?

Well, Llywydd, I've answered this question from Members from the Conservative Party time and time and time again, and I'm not intending to just repeat what I've said to them on those many occasions. What would it take for us to have a Wales-wide inquiry would be for me to lose faith, as he clearly has already, in the Prime Minister's ability to deliver the inquiry that he has promised. Now, if I come to his lack of confidence in the Prime Minister's willingness to do that, then I would have to think again about arrangements here in Wales. So far, as I've also explained many times in the past, the Welsh Government has had an opportunity to be involved in the appointment of the judge, Judge Hallett, who will lead the independent UK-wide inquiry, and I was satisfied with that appointment. I'm very glad that she is someone who has a very strong understanding of the devolved context and will bring an ability to ensure that that inquiry does focus on experiences here in Wales.

There is another hurdle to pass in the next few days, when I hope that we will see the draft terms of reference. They're with the judge still at the moment. Welsh Government, through our officials, have contributed to the development of those terms of reference. The Prime Minister has promised there will be a more formal opportunity for us to comment on them once Judge Hallett has completed her consideration. I will want to see that those terms of reference guarantee that the experience here in Wales will be properly and fully explored by that inquiry. And then there will be a further set of issues that I will need to be satisfied about, about the way in which the inquiry itself will go about its business. I will expect the inquiry to have access to expertise about Wales. I will expect it to have hearings here, directly in Wales, to make sure that it can collect the experiences, the views and the questions of people in Wales who will want that inquiry to be able to make the best sense it can of the experience of families, patients, staff here in Wales during the pandemic. They will only get those answers, I believe, when they are able to explore what happened here in Wales within that wider and sometimes shaping UK context. That is why I believe that that remains the best way of getting answers that people will wish to see from an inquiry about what happened here in Wales. And no doubt that will include the other questions that the Member has raised this afternoon. 

The Plaid Cymru leader, Adam Price.

Llywydd, may I also congratulate Urdd Gobaith Cymru on behalf of Plaid Cymru as they reach their centenary, and also on their success with the two world records? And I'd like to thank them for their incredible contribution to Welsh life over the past century, and also thank them for giving you an excuse to show your musical talents here this afternoon. But, on to scrutiny. 

First Minister, there has been much discussion recently about living with COVID. It's important to remember, when we hear that phrase, of course, that according to the Office for National Statistics, almost 60,000 in Wales are living with long COVID. Long COVID or post-COVID-19 syndrome involves a wide range of symptoms, but the most consistent feature, as we know, is a form of severe persistent fatigue that can be completely debilitating. The three occupational groups that are most affected, according to official statistics, are social care, teaching and healthcare—people who have put themselves on the front line to serve others and are now paying the price for their diligence. Does the First Minister agree with me that COVID-19 should now be classified as an occupational disease, as it already has been in eight European countries, as well as in Canada and South Africa, and that those who have contracted long COVID as a chronic disease through exposure at work should be entitled to compensation? 

Well, Llywydd, that would not be a matter for Ministers, I think, to take such a decision without the advice they would need, and I've seen no advice directly of that sort. But I do agree with what Adam Price has said about the importance of long COVID. The Office for National Statistics figures that I think he was relying on do indeed show 58,000 people living in private households in Wales experiencing the symptoms of COVID four weeks after first contracting the disease, and in nearly a third of those, or around a third of those, people still experiencing those symptoms a year after having had the acute episode.

So, one of the reasons why I feel so frustrated when I hear primarily Conservative politicians talk glibly about living with coronavirus, as though it were some sort of trivial matter, is that we know that the more people who contract coronavirus in the community, even when it may be mild for most people, a proportion of them will end up living with long COVID, and the more people who are contracting the disease, the more people with long COVID there will be. And that is not something to be set aside as though it simply didn't count for anything.  

Specialist clinics for long COVID-19 have so far been established in Canada, the United States, England, Germany, Belgium, France, Spain, Norway, and, in Italy, the national institute of health there has recently recommended the creation of post-COVID out-patient clinics in their country too. The consistent view among patients is that it's unfair to expect GPs to provide the necessary support for a condition that requires specialist intervention and whose treatment requires a strong link to translational research that can only be provided by dedicated clinics, the absence of which is forcing many people currently to go private. That would be wrong in any case, but it's especially wrong when Office for National Statistics figures show that long COVID is twice as prevalent amongst the most deprived. Is the Welsh Government prepared to rethink its approach and set up specialist clinics that patients and medical experts internationally are increasingly calling for?  

Well, I think there are many downsides to that strategy. I don't have the evidence that the Member refers to; I don't know what he means by many people going private, and I certainly don't recognise the view that it is generally held by patients that GPs are not the right people to provide the help that they need. The English centres are now so overwhelmed by referrals that there are waiting lists as long as long COVID. So, simply setting up a centre is by no means guaranteed to provide the solution that patients need. And I've always believed that if you are suffering from long COVID—. Adam Price was right when he said that 51 per cent of those people report that really debilitating fatigue is the primary symptom. Now, if you've got really debilitating fatigue and you're told that, in order to get treatment, you have to make a long journey from where you live to a specialist centre far away, I'm not certain that that is the best answer to your condition. 

So, the approach we have in Wales is that we want to make sure that our primary care clinicians are as well equipped as they can be to respond to as many people successfully close to their own homes, because of the nature of the condition, and then, where there are people who need a more specialist form of treatment, to be able to provide that through the NHS as well. I'm just not yet convinced that the idea of centres is the right answer for Wales. 

I think the consensus view, certainly amongst the international experts that I've been reading, is shifting towards a complementary strategy, which obviously has a role for primary care, but complements that with these specialist clinics in a condition where knowledge is fast developing. Now, estimates around the world suggest that between 10 per cent and 20 per cent of children who contract COVID-19 develop paediatric long COVID, and, using ONS figures, it is possible to estimate that well over 5,000 children in Wales currently are suffering this condition. If the Welsh Government is not prepared to set up specialist clinics for adults, for the reasons the First Minister has outlined, is it at least prepared to do so for children whose entire lives risk being scarred if they do not get the fastest possible diagnosis, the best medical advice and the most effective treatment, based on the latest knowledge? Surely, after what this generation of young people have already gone through, they deserve nothing less.

Let me begin, Llywydd, by agreeing with something that Adam Price said, because I don't think—. I didn't meant to characterise this discussion as though the Welsh Government's mind was closed on all of this, because he is right that knowledge is developing all the time. Research studies are reporting all the time. There are 19 high-quality COVID studies currently under way, and Wales is involved in quite a lot of them. So, we are continuing to follow the outcome of that debate, and if there are different forms of provision that the developing knowledge suggests that we ought to provide here in Wales, then of course that is what we will think of doing. I was reflecting, and I still do reflect, that the current state of knowledge does not lead me to believe that putting our major focus on specialist centres is the best way of getting the best help to most people. Now, as far as children are concerned, one of the problems here is that there still is no agreed definition—no agreed clinical definition—amongst the royal colleges and others who are responsible for that of what long COVID in children is meant to be. How would you make a diagnosis? How would you identify somebody? It's difficult when the definition itself is not agreed.

Now, we remain in close contact with the Royal College of Paediatrics and Child Health on this matter. The numbers that we know of, that are reported, of children with long COVID in Wales remain low. And you can extrapolate numbers in the way that the leader of Plaid Cymru did, but the number of children actually in the system identified as suffering from long COVID is not as high as that extrapolation would suggest. Health boards are treating those children in accordance with their specific needs. Now, we have a long COVID expert group here in Wales, and it now has a sub-group, looking specifically at how we treat children with long COVID, and there's a seminar that has been organised for 7 February for clinicians who are involved in the treatment of children to come together and to share experiences and to help us to develop our approach to providing services for them. Just as Adam Price said, Llywydd, our state of knowledge and understanding is developing, generally, all the time in relation to long COVID. I think that is particularly true of children, where knowledge and understanding probably still has quite a lot of ground to make up before we can be certain about the best ways in which those young people's needs can be met.