Questions now from the party spokespeople. Conservative spokesperson, Gareth Davies, to be answered by the Deputy Minister for Social Services. 

Diolch yn fawr iawn, Llywydd. I'd like to start by wishing the health Minister a very happy birthday. I didn't know until the Member for South Wales Central mentioned it earlier. So, I wish you a very happy twenty-first birthday. [Laughter.]

But my questions are directed to the Deputy Minister for Social Services, so I'll start by asking the Deputy Minister: what does the integration of health and social care look like to you?

I thank Gareth Davies for that question. The integration of health and social care is something that we are working very hard to reach. Our regional partnership boards are where we are putting this into practice, where we have the health authorities and the local government authorities working together to come up with proposals that are totally integrated. It's also very important to remember that when we talk about an integrated service, there are other services that are very important as well. For example, on the RPBs, we have housing represented, and we have citizens represented, and unpaid carers represented. My vision of an integrated health and social care service is where you can move seamlessly between the two services, and where there are organisations like the regional partnership boards that are able to plan on an integrated basis.

I'm grateful for that answer, Deputy Minister. I agree to some level that, in an ideal world, that would be the case, but sadly, we've still got a long way to go. Perhaps the prime reason to integrate health and care is to ensure the best health and well-being outcomes for Welsh citizens, because at the moment we are totally failing at that aim. We are all too painfully aware of this crisis in social care and the impact it's having on not just the care sector but right across health and care. DTOCs, or delayed transfers of care, mean that there are fewer beds for new patients, putting strain on an already overburdened system. As evidence to the health committee has highlighted, this is sadly leading to deaths. According to the Royal College of Emergency Medicine, delays over eight hours in A&E could have contributed to as many as 2,000 unnecessary deaths. How do you plan to ensure that an integrated approach to discharge happens on every hospital ward across Wales?

Gareth Davies highlights a crucial point. There is no way that the health service will flourish unless the social care system is operating to its maximum. The reason why over 1,000 people who are medically fit to be discharged are not able to be discharged is, to a large extent, because there is not the domiciliary support in their own homes for them to manage at home, and there aren't enough spaces in care homes, where there aren't enough staff to look after them. Because of that, they're totally interlinked, and that's why we are working so closely together, the Minister for Health and Social Services and myself as the Deputy Minister for social care—because these two elements are totally linked, and what happens in the social care service impacts in the hospitals. 

We've been meeting every week in an action committee, with the local health boards and with the local authorities, and we've come up with a huge range of proposals in order to get people home more quickly, to try to ensure that they receive the support in some way or another when they do go home. We've also made, as you know from the announcement I made yesterday, big efforts in order to increase the social care workforce. So, we are working very hard to ensure that there is an improvement, and he makes an important point on how linked these two areas of service are. 

Thank you again, Deputy Minister. Of course, if we're truly to get to grips with discharges, we need to get on top of DTOCs. We not only have to get health and housing all pulling in the same direction, we first have to truly understand the scale of the problem, and the data is spotty at best. It was before the pandemic, and has got even worse. Different departments in the same hospital can use different criteria for what constitutes a DTOC. We know from the Minister that NHS Wales believes that around 1,000 patients are medically fit for discharge, yet are confined to an acute hospital bed, but we don't truly know if that's just the tip of the iceberg. Deputy Minister, how do you plan to get health and social care working together to ensure we have up-to-date accurate data on DTOCs and the reasons for delayed discharges?

We are developing our services' data and we are analysing why those over 1,000 people are detained in hospital when they shouldn't be there. In the vast majority, the reason for it is because they haven't got the help from the social care services, but there are other reasons as well. For example, communications is a big issue. There are delays sometimes for things like medication. There are lots of delays, and we are in the process of analysing that data. But, again, I think Gareth Davies makes an important point that we do need that information in order to plan in a productive way. 

Plaid Cymru spokesperson, Rhun ap Iorwerth. 

Thank you very much, Llywydd. I have become disheartened once again looking today at waiting times for health appointments. It was CAMHS appointments that I saw today, showing that only 22 per cent receive an appointment within four weeks, the lowest level ever, when it was 75 per cent a year ago. Tomorrow, we're expecting broader health statistics, including ambulance waiting times, which show more than anything perhaps how patient flow through the health and care system has almost come to a stop. The target for the ambulance service of reaching the most at risk patients within eight minutes in 65 per cent of cases has been missed for a year and a half. When does the Minister expect the ambulance service to reach the target? Because every day, every week, every month of failing to reach a target puts lives at risk. 

Thank you very much, Rhun. I hoped you'd be kind to me today on my birthday, but that is a fair question. It is a difficult question to answer, and it's a question I'm very concerned about. The waiting times for ambulances are far too long, and that's why I had a meeting yesterday with the ambulance services trust. I'm having a meeting today with the head of the emergency ambulance services committee, which is responsible for ensuring that the work between the ambulance service and the health board and the care sector is co-ordinated, because we have to understand that this is one system. So, we've allocated a great deal of funding towards the ambulance service. We've provided them with many more resources. They've come forward and they've recruited far more people. It has made a difference. We've seen that around 11 per cent of people now aren't taken to hospital as a result of the better triage that happens.

But it isn't enough, and the waiting times are unforgivable. That is why I have been asking today and yesterday about what more we can do. Because if we just allocate more funding to the ambulance service what we we will see perhaps is more ambulances outside our hospitals. It might help us to reach people in our communities, but it doesn't help up with the flow of patients. So, we have to get the health boards to take their responsibility seriously. They have said that they want to see people coming out of ambulances within four hours. That isn't happening, so we need to put a greater pressure on them. What we're trying to see now is what more exactly we can do to provide that incentive or something so that we don't continue with this situation, because the waiting times are far too long. 

Certainly, they are, and there are people behind every statistic. I, and others on these benches, have been gathering evidence about the impact of the ambulance crisis. 

The stories that we hear are frightening: an 89-year-old woman collapsed and lying on the floor for six hours; a farming accident with no ambulance being available at all, so the patient is taken by car with a broken back; a wheelchair-dependent patient suffering a fracture being told to wait three days because it's non-urgent; a woman whose symptoms were deemed to require an emergency response waiting nine hours and an ambulance arriving as her heart stopped. Now, as the Minister says, this is not perhaps an ambulance crisis; it's a whole-system crisis, it's a system that is clogged up, and nobody is angrier about the situation that paramedics and ambulance staff, and our thanks to them is immeasurable. But, let me tell you what I was told by a senior GP recently. They said, 'If I had a family member who required urgent care, I wouldn't even think of calling 999, they'd be straight in the car. If we wanted an ambulance in Wales tonight, there probably wouldn't be one. This doesn't seem like a developed country'. What kind of country are we and when will the penny drop about the need to sort it out if even GPs are saying that we can't help those in most serious need of help?

I accept that there is a problem. The demand on the service has been enormous. The increase in demand on the service is more than anything we've seen before, so obviously there is a demand aspect to this that also needs to be looked at. I think also we've got to understand that actually over half of people are seen within the time frame, so it's not all bad, but of course we're not reaching anything like the targets that we should be reaching. One of the things that's happened this week is that there was a national risk summit to look at what harms are happening as a consequence of this, so that people start to understand this is not something where there are no consequences; there are serious consequences and therefore people need to understand that they need to step up and take more responsibility. So, that happened this week, as well. There will be outcomes as a result of that summit, so I'm just waiting to hear exactly what's happening. So, of course the situation needs some focus, which is why I'm giving it that focus. We've invested £5 million. An extra 127 front-line ambulance staff will become available in the coming months. They're all being trained up now, they'll be going on the front line and, of course, there are more people helping with that triaging in the call centres as well.