So, we'll move on now to the statement by the Minister for Health and Social Services on long COVID—Eluned Morgan. 

Diolch yn fawr, Llywydd. I launched the Adferiad programme last June, a £5 million-package of services for people who are recovering from the long-term effects of COVID-19 in Wales, including long COVID. As part of that announcement, I said we would review the progress of the programme every six months. The first review has considered reports from each of the health boards and feedback from hundreds of people who have received care as part of the service from an all-Wales service evaluation, undertaken by Cedar research centre.

Before I turn to the results of the review, I want to say something about how services for people with long COVID are structured in Wales. We want care to meet people’s specific needs through services that are available as close to home as possible. If someone is struggling with the long-term effects of COVID-19, their first point of contact is their GP, who can quickly and easily refer them to local services, including rehabilitation services. Some people have also been referred into the system from other parts of the NHS. This includes people who have spent many weeks and even months in hospital being treated for COVID-19, although it's interesting to note that the majority of people being treated for long COVID were not admitted to hospital with their original COVID-19 illness.

The Adferiad programme has funded expanded and enhanced primary and community-based services in every health board, and we've developed a clear pathway to improve access and speed up referral to treatment where people need more specialist care. All services are provided in line with National Institute for Health and Care Excellence guidelines. I had the privilege of meeting some of the healthcare professionals providing services and some of the people receiving services when I visited the long COVID team at Swansea Bay University Health Board last week.

The information we have from health boards is that the average waiting time for people to be seen in long COVID services is 23 days. This compares to the current 15-week waiting time for access to the specialist long COVID clinics that have been set up in areas of England. Data from Digital Health and Care Wales show that, by January, just over 2,400 people had been diagnosed with long COVID by their GP or healthcare professional in Wales, and 2,226 people were referred into our long COVID rehabilitation services in the last year. This number is smaller than the self-reported Office for National Statistics estimates of the number of people with long COVID in Wales, and we don't know yet what the long-term impact of omicron, the variant that is currently very prevalent in our communities that has affected so many people, will be on the number of people experiencing long COVID symptoms.

The COVID recovery app, which supports people to manage their own symptoms, has been downloaded more than 10,000 times. It is possible many people have found the app is helping them to manage their symptoms on a day-to-day basis. However, we know that some people, particularly those who developed COVID-19 at the start of the pandemic and are living with the long-term effects of their initial illness, have struggled to access the support they needed. I would urge them to seek help if their symptoms are impacting on their quality of life.

Llywydd, I want to turn now to what the first review of the Adferiad programme is telling us. The evaluation suggests services are supporting those people who have been seen and are undergoing treatment to improve their health outcomes. The model of locally delivered, integrated and multi-professional rehabilitation appears to be meeting the needs of our population. But we are not complacent, and we will continue to monitor, learn and improve services, making sure that we react to feedback from people who need and who use these services.

Our long COVID services provide assessment and access to a wide range of health professionals, treatments and rehabilitation.

We know that, for a small number of people, COVID-19 has had a significant impact on their lives, and they need ongoing specialist assessment, investigations and treatment. The number of children with long COVID in Wales also remains low, thankfully. Health boards are treating each child in accordance with their specific needs. 

Our workforce is working extremely hard to support the recovery of the whole population effectively and equitably. They are collaborating with colleagues around the world to ensure that the latest evidence informs our decisions and responses.

Llywydd, in addition to the Adferiad service, the NHS in Wales is taking an active part in UK-wide long COVID research studies, which will help to increase our knowledge of both diagnosis and treatment. I'd like to thank all of those people in Wales who are also taking part in these very important research studies.

I have also set up the Wales COVID-19 Evidence Centre, through Health and Care Research Wales. Part of its work programme has a particular focus on addressing issues of relevance to those affected by long COVID and the health and social care sector.

Some people have experienced such severe or long-lasting long COVID symptoms that they had had an impact on their ability to work. I am pleased to say that NHS employers and trade unions have worked together to review employment policies and procedures to ensure that healthcare staff are supported as far as possible.

The NHS's long COVID recovery services include specific support for people in respect of their ability to work, although work-related benefits remain a UK Government responsibility. I have also asked the Bevan Commission to report on the potential to develop a register of people with long COVID here in Wales. Currently, I am considering the commission's report.

Health boards have told us that they believe that expanding and integrating the existing long COVID services into other community rehabilitation and long-term conditions services will provide the highest quality of treatment and clinical expertise for the longer term. 

I am now considering the priorities for the next six months, so that the NHS can continue to develop the expertise of our workforce, adapt services to meet the needs of our population and ensure that these services are embedded as part of our wider COVID recovery planning. Thank you.

Minister, can I thank you for your statement this afternoon? I'm interested in your claim in regard to the information that you have had from health boards—that the average waiting time for people to be seen in long COVID services is 23 days. You also go on to compare this to a 15-week waiting time for access to specialist long COVID clinics that have been set up in parts of England. Can I ask you: are the two comparisons that you make on a like-for-like basis, and if they are not, can you set out the differences?

A top story today, Minister, on the BBC, as I'm sure you would have seen, is the story of Sian Griffiths, a Welsh resident who has paid to see a consultant in Stoke-on-Trent instead of waiting 12 months—which is the claim in this case—on the Welsh NHS. So, can you perhaps explain the contrast of Sian's experience and story with the claim that the average waiting time for long COVID treatment is 23 days? I wonder what actions, in this regard, you would take, Minister, to ensure that Welsh patients don't have to travel long distances and travel to England in instances such as the one that has been set out in this particular story. 

Now, I'm not aware that the data that you mentioned from health boards is published, Minister, at all, so I wonder if you would agree to publishing this data so that we can examine this ourselves across the Senedd.

Of course, many people who have or are suffering from long COVID talk of their frustrations and their struggles, of having to go for several tests at different times and in different places. They talk about the experience being exhausting, which I'm sure that you and I can appreciate. People who are struggling in this regard argue themselves that specialist clinics are needed, because people are very unwell and they're not able to negotiate a complex system of referrals to different places. So, I wonder if you would agree that it is better for those struggling in these particular situations to go to one place to be treated.

I was interested in an initiative taking place in Essex for those struggling with long COVID and other lung conditions, where a mobile vehicle is available for support for at-risk patients—I'm assuming the mobile vehicle parks very near someone's home—because people are struggling to get to a GP or hospital themselves, and this detects, of course, various conditions, such as long COVID. It struck me that this might be a potential opportunity to introduce in areas of Wales, particularly rural areas, where people do have to travel a long time for hospital appointments and for GP services.

Specialist centres, of course—. One of the arguments that is used in support of specialist centres is that doctors can develop expertise through the pooling of minds and resources to better understand the condition. So, can I ask how specialist experience is being developed here in Wales, Minister?

In your statement, you say that some people have experienced such severe or long-lasting COVID symptoms that they've had an impact on their ability to work, and then you've gone on then to talk about that you're pleased that the NHS, employers and trade unions have worked together to review employment policies and procedures to ensure that healthcare staff are supported as much as possible. You mention, of course, healthcare staff there, but does this support extend to nurses in care homes that are not employed by the NHS?

And of course the other issue, Minister, which I'm sure you'll appreciate as well, is that long COVID, of course, is not fully understood, and unfortunately the definitions differ around the world. So, measures of how common it is, or symptoms are, of course vary greatly, and it can be difficult for GPs to provide the right care and advice for patients. So, can I ask what conversations you've had with healthcare professionals in defining the symptoms of long COVID so that GPs and healthcare professionals can be supported?

And finally, Minister, I'm aware that those that are suffering from long COVID are eligible for Department for Work and Pensions payments. Recipients will receive payments through personal independence payments that are designed to help those, of course, suffering from long-term conditions or a disability that affects their ability to carry out everyday tasks or move around. So, I wonder, finally: how is the Welsh Government ensuring that relevant bodies in Wales that are supporting people with long COVID are making people aware of these particular payments?

Diolch yn fawr, Russell. I think it is worth pointing out that access in Wales is quicker. What you will know is that they have gone a slightly different direction in England, unlike the way we've gone in Wales, Scotland and Northern Ireland. What that has meant is that, actually, whereas in Wales people are being seen quicker, there is a much longer wait for those clinics, those COVID clinics. Let's remember, I think there is about 90 of them, which is not that many, if you think about the size and the scale of England. So, I think what would matter to the patients is how quickly they're seen and making sure that they're having an assessment that then directs them to the right support. That's the system that we've set up in Wales, and there seem to be many people who are satisfied with that system.

I'm obviously reluctant to comment on any individual cases, but what I will say is that at the beginning of COVID, of course, we were all learning, we didn't know much at all about long COVID, and we're still learning about long COVID, but, obviously, the service that was available then is very, very different from the service that is available now, and that £5 million that only went into the system in July is already reaping the benefits. So, clearly, there are people who may have felt very frustrated because they were before this programme started, but, obviously, that is available to them as well.

I am very happy to publish the report, which of course is an independent assessment of what we have put forward.FootnoteLink I think we have to be really careful, because, obviously, we all hear anecdotal reports, but, actually, what's more important for me is listening to data that is broader, but, having said that, I think it is worth listening to direct experience from people. That's what I was able to do last week in Swansea, where I must say that the response from the people who were in receipt of the service was extremely positive.

The multiprofessional, multidisciplinary approach is one that we think is working very well here in Wales, and only around 3.5 per cent of the people who come into the system are referred on to secondary care. So, that's the danger with a kind of clinic approach, that you're actually getting people to go and see specialists who don't necessarily need to see that kind of specialist, and the question is what kind of specialist do they need to see. Because the symptoms for COVID are very, very different in every individual; some have problems with fatigue and they've lost their sense of smell, they have definitely breathing, difficulty concentrating, but some have much more complex issues around heart issues or lung issues that obviously need far more specialist services.

In terms of health and care staff, obviously, there's a very clear concentration on that because of the sense of responsibility particularly towards those who've maybe contracted COVID during their employment. I'm pleased to say that the unions and the NHS are working together to make sure.

And just in terms of defining symptoms, it is difficult, because the symptoms are very, very different for lots of people. We're still learning, but what we did do very early in the programme was to give training to GPs to make sure that they were aware in terms of what to look out for and then where they could refer on to.

Information further to Plenary

Thank you for the statement, Minister. Without doubt, many patients who are suffering these terrible symptoms can access support from their GPs, and, of course, the role of GPs is crucial in all of this, but we do know that some can't be referred; they return to their GPs time and time again and aren't getting the specialist support that they need.

You mentioned learning, and it has been a learning experience for the medical profession, but it is clear that the expertise isn't there and the support isn't there for some of these patients who do approach their GPs. So, what reviews will there be for those who have tried to access specialist support time and time again? And what about those, as we heard in the case of Sian Griffiths from Anglesey, who's been in the headlines today and has been forced to pay to go private? She, like many other NHS staff, has had to go private. Shouldn't they, quite simply, be reimbursed that cost? And what about those staff who work for the health service who face losing their salary now because they still can't work? They deserve for financial support to continue, and I hope you'd agree with me on that. But, as a central point, in light of your statement today, aren't we still short of the kind of specialist teams that could provide accurate diagnosis, could provide appropriate treatment, and also provide that support earlier than is the case at the moment for those patients suffering long COVID? Thank you.

Thank you very much. I think that there is, clearly, an important role for GPs. That's the front door for the way that we operate in terms of the health system here in Wales. And, of course, then, they are referred on to the services that are now available in every health board area in Wales. That is the feedback that we've received from this report.

So, I think it is important to ask when people have tried to access these services. If they tried to access them before July, it's important that they go back now because these services are now available, whereas they weren't available before last July, because we have learnt from these experiences. It's only in July that this £5 million was available. So, if there are some who haven't received support before then—. And it was interesting to meet a number of people in Swansea on Friday, a number had caught COVID in December 2020. Of course, the service wasn't available at that point, but they are content now that they have received the treatment since this programme has been up and running. So, it's important that people go back if they have tried to access the service, because the system has changed, clearly. 

What is happening is that there are expert teams. That is what is happening now. There are teams, the GPs refer to these expert teams, they refer people to ensure that—. Mental health support is available; there might be issues with regard to exhaustion. There are all kinds of factors and all of those experts help out. So, the treatment now is entirely different to what it was previously. And certainly, we weren't just willing to learn then, but we are eager to continue to learn, because, as I said, this is a new condition and we don't know yet how omicron is going to have an impact on long COVID either.

I'm grateful to the Minister for coming forward with this statement this afternoon. What I want to focus on is the impact this is having on people, on patients and families. I'd like to know what exactly are the services that the Minister is ensuring are going to be available in each one of our health boards. What are the Government's expectations for those services? Like her, I'm not persuaded that an under-resourced specialist unit is the best way of providing care, but I also want to be convinced that the current system is working well. What instructions has the Welsh Government given to health boards? What targets or objectives have been set for the delivery of those services?

And secondly, Presiding Officer, I want to think specifically of the NHS and front-line staff who, working throughout the pandemic, have put themselves at risk and who may now be suffering from long COVID themselves. People who contracted it whilst delivering services on behalf of us all are owed a fundamental duty of care by all of us, and it is the important role—fundamental role—of this Government to deliver that duty of care. Can we ensure, Minister, that all people in the NHS and associated services who find themselves with long COVID today are treated like people who have suffered an industrial injury and receive the duty of care that we all need to owe to them?

Diolch yn fawr. I can tell you some of the things that we have focused on in terms of what our expectations were. Certainly, we expect staff time, training, therapeutic and technical equipment to have been purchased, and a real emphasis on digital resources. I'm very pleased to say that 10,000 people have downloaded the self-help app. I downloaded it last night and had a good look. It's very, very easy to use and it's clear that a lot of people are getting that tailored support. So, the app is also giving tailored, individualised support.

The other requirement was that, actually, we expected individualised support. So, there is no one-size-fits-all; it's got to be responsive to the people that are walking into those services. Certainly, in terms of the people who have contracted COVID, in particular if they have been NHS workers, you're absolutely right, there is a duty of care. It was very interesting to hear from the Swansea health board in particular last week how they are very focused on supporting those people who have found it difficult going back to work, with occupational therapists specifically put in place and making sure that people are not pushed back to work before time. There's an understanding that, actually, in particular, that duty of care is something that needs to be understood and that, working with the trade unions, we're making sure that that respect is given to those people who, as you say, have really given their all during this pandemic and paid a significant price under certain circumstances.

The Deputy Presiding Officer (David Rees) took the Chair.

I thank you for your statement this afternoon, Minister. I think we've yet to fully comprehend the long-term impact that a COVID infection has on some people. What we do know is that, sadly, far too many people have been left debilitated long after the virus has left their system. Minister, emerging evidence has highlighted the similarity of brain scans in some COVID patients and those suffering some forms of Alzheimer's. What research has been undertaken in Wales to understand the causes and potential remedies for long COVID?

Rehabilitation is key to longer term recovery, so what assessment have you made of the capacity of such services in Wales, when considering allied health professionals—physios, OTs, speech and language therapists? How will the NHS in Wales manage referrals into those services? Some health boards such as my own, Betsi Cadwaladr, allow self-referrals, but others require GP interventions. So, what steps are you taking to avoid setting up a potential postcode lottery for care? And, with an estimated 2 per cent of the population believed to be suffering long COVID, what assessment has the Welsh Government made of the additional pressures that this could place on the social care sector in Wales? And finally, Minister, as we move from the pandemic to an endemic phase of this disease, what process will be put in place to monitor the longer term impacts of COVID infections on both the individual and our healthcare systems?

Thanks very much. I haven't seen that research that suggests that it's similar to Alzheimer's, so if you could send me a copy of that, that would be really useful. What we are trying to do is to learn about long COVID every day. We have invested considerable funding into research, as I set out in my statement, working on this specifically.

There are people in particular who are therapists, who you'll be very aware of, who can be very helpful in these circumstances, giving that support and renewing the confidence of people. That's what came across very clearly to me in meeting some of these people is that, actually, they were very pleased that there was an acknowledgement that there's a problem, and many of them felt that people who they knew—. Because many of them had also suffered COVID, but hadn't responded in that way, as you've heard, some people were told that they were lazy and, actually, that is so far from the truth. What was great is that these people were just so pleased to be listened to, to be heard, but also to be given, then, the practical support that they needed to rebuild their health and their lives.

And certainly, in terms of a postcode lottery, well, I'm really delighted to say that every health board now has this multidisciplinary service, so we shouldn't be seeing that. And obviously, the long-term impact is something that we just need to keep an eye on, which is why I have said that every six months, in relation to long COVID, I want a reassessment to check, 'Are we doing the right thing? What do we need to change? How do we need to re-evaluate the services that we're giving?'

And finally, Jack Sargeant.

Diolch yn fawr, Deputy Presiding Officer. I welcome the statement by the Minister and I also welcome the response to Alun Davies with regard to a duty of care for those who've caught coronavirus within the NHS and associated services. But I do feel that there is a piece of work there to fully understand who caught coronavirus when working within those services. I know that my colleague Sarah Murphy has a particular passion about that, and I think that there's an opportunity to work with our trade union colleagues on that. 

Also, Minister, I welcome the statement in particular, because I think it's important that we talk about helping people with long COVID. A couple of weeks ago, the Senedd Petitions Committee considered a petition for the second time calling for long COVID clinics—one-stop clinics. Now, it's important to patients across Wales who will be using these services that they'll have a role in shaping those services. Can you set out today, Minister, how the future delivery of long COVID services are being shaped, and how patients' voices can be heard in this delivery plan?

Thanks very much, Jack. And I know that there are many people who are very focused on this issue, and when you have an illness that is so debilitating, then clearly we need to respond. We have not gone down the route of long COVID clinics, but we're following the National Institute for Health and Care Excellence guidelines, and I'll read to you what the NICE guidelines actually say. They say that we should:

'Provide access to multidisciplinary services, if available...for assessing physical and mental health symptoms and carrying out further tests and investigations' and

'these could be "one-stop" clinics'.

Well, what we do is that we have access through the GP to this multidisciplinary team. When you call it whatever you call it, the fact is that we are following the NICE guidelines, and we're very confident that we're doing that. It is important, I think, that we continue to learn from and to listen to the voice of the people who are using the services, and that's why it is important, I think, that people who tried to use a service earlier on in the pandemic recognise that the service has changed significantly and fundamentally in the past six months. And it's really important, if people tried to get that care in the beginning and they didn't get it, that they know that it's available now and that they should go and seek that support.

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

Plenary was suspended at 15:22.

The Senedd reconvened at 15:32, with the Deputy Presiding Officer in the Chair.