1. Will the Minister make a statement on the Grange University Hospital’s declaration of a black alert last night? TQ615

In the light of exceptional pressures and despite efforts to stabilise its services, Aneurin Bevan University Health Board declared a business continuity incident at the Grange University Hospital on the afternoon of 29 March. This is the highest level of escalation available, and clearly indicates the severe pressure being experienced by our health and care services. 

Thank you for your answer, Minister. For a major hospital to declare a black alert on a weekday evening, of course, indicates that the NHS in Wales is ill-prepared to support those who need it the most. I'm particularly concerned, of course, for the staff at the hospital, who are under significant pressure, and, I'm sure, will be feeling a sense of being let down themselves. I would like to know, Minister, the urgent assessment that you have made of the black alert at the Grange hospital's A&E department. The hospital was, of course, supposed to be the flagship hospital, and it was of course opened early. So, I would ask you for your assessment on whether it was correct to open the hospital early. Understaffing has been an ongoing and huge issue at the hospital since it opened. There have been sustained reports of understaffing since the hospital first opened. So, can I ask you, Minister, did you see this coming, and what support can you now offer? What is your plan to support the hospital and particularly support the workforce that are under so much pressure at the hospital?

Thanks very much. There is a difficult—an extremely difficult—situation that's confronting not just Aneurin Bevan health board but also health boards across the whole of Wales at the moment. We've always been open about the challenges that NHS Wales and emergency departments are under, and they're under pressure like they haven't seen during the whole of the pandemic. COVID rates have never been higher in our communities. We have 1,468 people in hospital with COVID. That's the highest number in a year. During the last six weeks, we've been at the highest level of bed occupancy in the NHS since the beginning of the pandemic. We have 900 more patients in hospital today than we did a year ago. Was it right to open the hospital early? Damn right it was, because imagine if we hadn't. We needed those beds. This is not a situation that is unique to Wales, but it's absolutely clear that this is a pressure that's facing people across the United Kingdom as well.

One of the issues that we are having to confront is the fact that there are very high numbers of patients who are ready to be discharged from hospital but they're unable to do so because of the fragility of our care services. I know that the Deputy Minister for Social Services is working incredibly hard on making sure that we get a better flow through our systems. The fact is that in Aneurin Bevan we have around 270 patients who are ready to leave, but it's been impossible for many of them to leave because 70 of our care homes in Aneurin Bevan were closed because of COVID. Can you prepare for those kinds of things? We have been trying to prepare, but we are in an extremely difficult situation at the moment and I think it is absolutely right for us to understand the kind of pressure that our staff is under. And on top of that, let's think about the staff, because actually, a lot of them are going down with COVID as well, which obviously increases the pressure even more on those who are left in the hospitals.

Thank you, Minister, for your responses so far.

During my numerous street surgeries throughout the region, a common complaint has been the service that patients have experienced at the Grange. This has been the case across the region. It seems people have difficulties in terms of site accessibility, the lack of adequate public transport, and the long waits to be seen when they eventually get there. Things have clearly come to a head in the last few days. Having a brand new facility is all well and good, but doesn't the brief history of the Grange hospital show that a new hospital is nothing without its staff? The NHS's greatest strength is its people, and we are in danger of forcing them out of the sector unless we improve their working conditions. We also risk the health of patients wherever crisis points like this are reached. What lessons have been learnt from the opening of the Grange, and what plans are in place to put the hospital on a healthier footing? This situation must be rectified as soon as possible, for the sake of patients and the staff. Diolch yn fawr.

Diolch yn fawr. Of course there were lessons to be learnt from the opening of the Grange. We opened it because, frankly, we were in the middle of a pandemic and we needed all the help that we could get. So, it was absolutely the right thing to do, but obviously it meant that we didn't have time to do the preparations that we would have done had we not been in that situation. I'm very pleased to say that the Royal College of Physicians made a visit to the Grange University Hospital a while ago. They were quite critical, frankly, of the services there, but they have now produced a follow-up review that's been published today, and they are actually endorsing a lot of the actions that have been undertaken by the health board. So, I'm very pleased to see that.

What else can we do to help? Well, frankly, we can all help in these circumstances. We are in a situation where we all need to see if there's anything more we can do as citizens. Our priority, of course, is to ensure the safe and efficient delivery of healthcare services to anyone, but I would appeal to members of the public: if you are able to help with the discharge of your family from hospital if they are ready to be discharged, then please help us out and come and help us to discharge them from hospital and give them that support, so that we can get more urgent cases into the hospital at this extreme time.

I'm grateful to you, Minister, for those responses. It's important that we recognise what is actually happening in the Grange, rather than simply listening to hearsay. There are some significant successes from the centralisation of services in the Grange, and I've spoken to constituents in the last week who have been through some excellent treatment and have received superb levels of care within the Grange. I think it's important that we recognise that and recognise the hard work that is going on in the Grange and the other hospitals in the Aneurin Bevan network.

The issues that I'm dealing with are the issues, Minister, that I've brought to your attention already in the last few weeks, which are about unscheduled care, which are about emergency access, and those issues are very real issues. There is an issue with the ability of the Grange to deal with the pressures it's under, and there is a significant issue where sometimes some very vulnerable patients have not received the treatment that they require urgently. I brought a constituent's situation to your attention last week, where she did not receive the treatment that she needed, and that was a very urgent cancer requirement. So, we need to look at the reality of what is happening in the Grange and deal with the real issues.

Minister, is it possible for the Welsh Government to provide the Aneurin Bevan health board with resources, or work with the health board, to enable them to overcome the issues that you've described that we're all familiar with, that will enable them to deal with the current pressures, to enable them to build the sort of sustainable services that we require in the hospital and in the network of hospitals, but also to ensure that we have the different health boards that provide services to people in Blaenau Gwent talking to each other, so that where a patient is taken, for example, to Prince Charles Hospital, that their treatment plans are recognised by staff in Prince Charles, and that they are able to receive the treatment that they require?

Like others in the Chamber this afternoon, I think we should all pay tribute to the hard work that is being done by members of staff in the Grange under the most extraordinary pressures that the Minister has already described. I think as politicians, what we need to do is to ensure that we put in place the structures that are required to support those staff, to support those services, and to deliver the treatment that people need and require at the time they need it.

Diolch yn fawr, Alun. I think you're absolutely right, it's important that we don't just act on hearsay, but there are lots of individual patient experiences that are frankly heartbreaking. I've received e-mails over the weekend with people just desperate, frankly, because they have been waiting for hours on end.

We are in an extreme situation at the moment. I'm confident that we won't continue to be in this situation, but that's where we're at at the moment. I think it's really important for people to understand that the NHS is still very much open for business. We're seeing 200,000 patients a month still, in terms of outpatients. I think it's important also to respond to the fact that actually, the RCP is saying that things are improving. It's just that we are in these intensely difficult situations at the moment.

The flow is part of the problem. How do people get access to A&E if all the beds are full? As you've heard, because of the situation in terms of getting people out of hospitals because those care homes are shut, that is creating a real problem for us. It's very difficult to know what do you do in those circumstances, and that's why we are appealing to people to come and fetch their loved ones from hospital and look after them if they can, because we can get them out of hospital, and we can help support other members of their family who may need more urgent treatment as well. 

We have given significant additional support to the ambulance service. We've recruited hundreds of new people in our service. We've given £250 million extra to relieve pressure last year. We're giving £170 million additional funding in the next financial year. And we are, actually—. Aneurin Bevan is being absolutely clear that, under these extreme circumstances, they are diverting patients and helping patients to go to other health boards that are perhaps not quite under the same pressure.

Back in the autumn when I was taken ill, I spent 22 hours in an A&E department, and I know the pressure full well that staff feel, but also the hopelessness that patients feel as well. I'd be most grateful to understand from the Minister the staffing ratios in the A&E department at the Grange, and if she hasn't got that information, could she provide that in a letter form that could be placed in the library? And importantly, on those staff ratios, how many are core staff and how many are bank? Because the one thing that became evident to me in the A&E department that I was in for a considerable period of time was that there were a lot of bank staff there that weren't familiar with the settings and the procedures that that department required to use on a day-to-day basis, and that caused a lot of problems in discharging and the flow of patients that the Minister's referred to. So, could she provide that information, accepting if she hasn't got that with her today, she could place it in the library and we could all see it?

Absolutely. And, no, I don't have the specific information, but, obviously, I'd be willing to look at that. There are always issues about pressures in hospital, and if people are off sick, obviously—and there are a lot of people off sick; we all know somebody who is suffering with COVID at the moment—clearly that is affecting hospital staff as well, which is why you then have to go to those bank staff.

What we're trying to do, and we have been doing for a long time now, is recruiting additional staff. We've recruited 53 per cent more staff than we did 20 years ago. That is a massive increase. You look at our recruitment and our training when it comes to nurses and midwives—significant increases: 73 per cent and 92 per cent; huge increases in the number of people that we're training. But it is difficult, and we've never seen pressure like this before.

Minister, since the Grange opened, it's been plagued with overcrowding and long waits, and, as we've been hearing, this isn't fair to patients or staff. The fact that there were 14-hour waits in A&E last night is indicative of a serious problem. I know, last October—you've been referring to the fact that there were reports of trainee doctors and consultants being scared to go into work, which the Royal College of Physicians was reporting. When other hospitals like the miners' hospital in Caerphilly closed, patients were promised that there would be no disruption to their care, but overcentralisation of services is leading to just that. So, we have staff who are, at times, near breaking point, and patients who aren't getting the care they need.

But, Minister, as well as what you're saying that the Government obviously will be doing to change this, you've just said that we all know someone who is suffering with COVID at the moment. Now, I'm asking this sincerely, I'm not asking this glibly at all: do you really think that now is the time to remove legal requirements over self-isolation and COVID mask wearing in retail and transport? Won't more COVID cases make a dire situation even worse? 

Thanks very much. Well, I would urge you—and you're quite right, there was some extreme criticism about what happened in the Grange by places like the Royal College of Physicians—to read the follow-up review, which does suggest that there have been many improvements since that initial inspection took place. I would also ask people to make use of the now all-Wales 111 telephone services, which provide access to out-of-hours and urgent primary care services, making sure that you get the right support at the right place at the right time. So, there are alternatives to A&E, and it's really important that people make use of those.

Also, you talked about the legal requirements. Well, let me tell you that your sister party in Scotland never had a legal requirement when it came to self-isolation, and it seems to have worked quite well for them. So, we're actually in a position now where we are giving responsibility back to the public. And I've got to tell you, in Wales, the public have been marvellous. They have followed our advice, and we are now trusting them to continue to do the good work that they know should be done. When they know rates are at the highest levels within their community, I'm sure they will continue to do the right thing, to wear face coverings when appropriate, to make sure that they're testing if appropriate and to make sure, also, that they're self-isolating if they catch COVID.

Finally, Jane Dodds.

Thank you, Llywydd, and thank you, Minister, and thank you to Russell for asking this question.

It's just a very short point. Many residents in south Powys attend Nevill Hall Hospital in Aneurin Bevan health board in Abergavenny. In the statement last night from Aneurin Bevan on the Grange, there was a recommendation that patients are diverted to other hospitals like Nevill Hall. I'm sure this has been considered, but could you just reassure us that additional support is being offered to hospitals like Nevill Hall that will be put under additional stress in the short term from the situation in the Grange? Diolch yn fawr iawn.

Thank you. Well, there is stress across the whole system. The Grange is experiencing it in particular, but this is a stress that is happening across the whole of Wales, indeed across the whole of the United Kingdom. And I'm informed by my officials that sites, for example, in England, also declared major incidents last night, including Hereford hospital and the Royal Shrewsbury Hospital, which led to handover delays of up to 20 hours for Welsh Ambulance Services NHS Trust vehicles conveying patients from Wales to those sites. So, it's not just in Wales that these pressures are happening, they are happening across the whole of the United Kingdom. Obviously, we will give as much support as we can to the system, but there are levels of escalation that the health boards know that they need to use and implement, and we're at a particular level of escalation in Aneurin Bevan, which is the highest level of escalation, and that means that they stop doing the routine work and they focus on their really urgent work. And I'm sure that you'll understand the need to do that.

I thank the Minister. The next question is to be answered by the Minister for Economy and is to be asked by Rhun ap Iorwerth.