Item 5 this afternoon is a statement by the Minister for Health and Social Services: planned care recovery plan. I call on the Minister, Eluned Morgan.

Dirprwy Lywydd, thank you for the opportunity to outline how we plan to transform and modernise the way the NHS provides planned care here in Wales. I am today publishing a plan that will help to reduce the long waiting times that have unfortunately built up during the pandemic. It will ensure that people get the right treatment the first time and make sure that they are cared for as close to home as possible, with fewer visits to hospital.

The pandemic has had a massive impact on our health and care services. It has stretched the NHS to its limits, not just here in Wales but across the UK. The NHS has been fantastic in the way it has responded to the pandemic. It's provided incredible care under extraordinarily difficult circumstances and, on top of that, it's delivered the life-saving COVID-19 vaccination programme. We've seen the very best of the NHS and its staff during the pandemic. They've worked tirelessly to keep as many services going as possible. They are the reason we came out on our doorsteps to clap every week at the start of the pandemic.

But the pandemic has brought many changes to the NHS. At the very beginning of the pandemic, we made the difficult decision to cancel planned appointments and treatments to enable staff to focus on caring for all those very sick people with COVID-19. Each subsequent wave of infections has meant that the NHS has had to focus on COVID-19 instead of being able to provide the full and normal mixture of out-patient appointments and planned operations. Services have also had to adapt to the great many infection control procedures and practices, all necessary measures to help keep patients and staff safe. These have also limited how many people can be seen and can receive treatment at any one time.

As we start to move beyond the emergency response to the pandemic, the NHS is providing more planned care than at any point during the pandemic. But, even today, there are almost 1,400 COVID-19 related patients in hospital beds, although only around 16 per cent of these are being actively treated for COVID. At this level, these pandemic pressures continue to affect the amount and type of planned care that the NHS can provide.

Before the pandemic, waiting times were steadily falling across Wales. Today, unfortunately, too many people are waiting far too long for treatment, and this is the same situation in every part of the United Kingdom. There are nearly 700,000 open pathways, with many people waiting for more than 52 weeks. These numbers will keep on growing as people rightly continue to come forward to see their GP. It will take a full Senedd term and a lot of hard work to recover from the impact of the pandemic. This is now my priority and it is the health service’s priority.

The planned care recovery plan is backed by an additional £170 million a year of Welsh Government funding. It will reset and transform planned care services and it's been developed with clinicians. It sets out a wide range of actions to redesign services and, in many cases, redesign what people can expect from the NHS when they are referred by their GP or another healthcare professional for planned treatment. For those who are already waiting, we'll ensure there is support in place. For those coming into the system, we will help them to manage their own condition and, wherever appropriate, we'll provide more treatment alternatives so that surgery isn't the only option available. We'll also do more to address inequalities in care.

I am today making four commitments to people, to help them access the advice and services they need in a timely manner. We'll increase the capacity of the health services. There will be better access to doctors, nurses, dentists and other healthcare professionals closer to home, so people receive the right care from the right person. We'll prioritise diagnosis and treatment. There'll be faster access to treatments and diagnostic procedures. We'll prioritise people with suspected cancer and other urgent conditions and we'll prioritise children. Clinicians will work with people to make sure treatment options are the best for them.

We will transform the way that we provide planned care. There will be more care and support available from a wider range of local services and professionals to help people to stay well and to stay at home. We will set up dedicated surgical facilities and will separate planned care from urgent and emergency care, where we can. We will provide better information and support to people, especially those waiting for treatment.

I've also set some very clear and ambitious targets to reduce waiting times. By the end of 2022, this year, no-one will wait longer than a year for their first out-patient appointment. By the spring of 2024, we will have increased the speed of diagnostic tests and reporting to eight weeks and to 14 weeks for therapy interventions. By the spring of 2025, no-one will wait more than a year for an operation in most specialties. By 2026, 80 per cent of people who receive a cancer diagnosis should start first definitive treatment within 62 days from the first point when cancer was suspected. We will make sure that those with the greatest need are seen first. But, let me be clear, the task in front of us is huge.

Our NHS faces unrelenting pressures as a result of the pandemic and winter pressures. Our NHS staff are tired from working under enormous pressure over the last two years. In the past 20 years, we've increased the number of staff working in the health service in Wales 54 per cent and more, but we need more. We've already committed to doing that through funding worth £0.25 billion to train more specialists. We will support the NHS as we ask it to deliver this plan. We will continue to recruit highly skilled staff to join the workforce and we will continue to train the next generation of healthcare workers.

Primary care will have a vital role to play in the success of this plan. We have introduced an e-advice service for GPs, to help them to seek early advice from specialist teams to support decision making and to manage patient care. We will also make broader and better use of the skills and expertise of our dedicated nursing staff and allied health professionals to support people while they wait for their appointments and as they recover from surgery. There are no quick-fix solutions to reducing long waiting times. This will take hard work, it will take the support of people throughout Wales and the NHS, and it will take time to see real and lasting results. Together, we will recover from the pandemic. Thank you.

Conservative spokesperson, Russell George.

Thank you, Deputy Presiding Officer. Can I attach myself to the Minister's comments in regard to the NHS workforce and what tremendous work they've done? We can't reiterate that enough, can we, our thanks for all their work over the past two years.

Can I thank the Minister for her statement today, alongside publishing the plan to reduce waiting times, and also thank the Minister, of course, for the technical briefings that she's provided as well? That's very much appreciated. I'll start by very much welcoming this plan. I do really welcome the fact that this plan has got targets. That's absolutely crucial, and that's a positive element to what I've read through today. I am deeply concerned about setting a target that no-one waits more than a year as far away as 2025. That is, of course, going to be of little comfort to those who are waiting, often in pain and discomfort. We're in 2022 now, and they look and see the year 2025—that's going to be difficult for them to accept. I'm also concerned that the target of 80 per cent for cancer diagnosis and treatment within 62 days by 2026 is just not ambitious enough. There are already people, of course, as it stands now, that are turning to private care.

How and when, Minister, will you ensure that Wales's health boards are effectively communicating with the hundreds and thousands of those waiting for support on waiting lists—those whose, perhaps, physical and mental health is deteriorating in that time as well? How are you going to ensure that health boards are communicating effectively with these people who are waiting for information? Because they're being told they have to wait several years before they are treated. How will these targets be monitored? Will there be an annual report? I know, Minister, that you are going to be holding your officials to account on many of these targets that you've brought forward; how are we in this Senedd going to hold you to account? How can we do that? Are you going to have an annual report? Tell us a little bit more about how we can monitor progress. 

I do welcome the use of technology to address some of the pressures on the NHS workforce, but it's been four years since the former health Minister proposed similar plans, and since then we've only just seen the outline plans for e-prescriptions, which could really have lifted much of the bureaucratic burden from doctors and pharmacists. Technology is useful, of course it is, but it's not going to address how an already stretched and strained NHS workforce will be coping, nor will it provide a complete vision for a more flexible and engaged NHS. How will your plan be focusing on retention? What targets are you putting in place for recruitment? How do you think virtual appointments will help someone who needs a hip operation who has been waiting for several years in pain, or somebody who has been losing their sight? How will your online services help those who are unable to access the internet? How will you ensure that face-to-face appointments with doctors are an option?

Being fair, Minister, there are some very positive, high ambitions within your plan. I don't doubt that for a moment. There are some challenging targets that you have put in your plan, in some aspects. But, on first reading, for me, I would like some reassurance that this plan is more than just a sticking plaster. It doesn't address some of the long-term outstanding problems that we've faced within the Welsh NHS. I'm sure you would agree that we want to build back better, don't we, in Wales, after the pandemic. We don't want to just get back to where we were before the pandemic started, we want to be in a better position. So, how is your plan going to do that? Just give us some reassurance that it's not just a sticking plaster on current problems.

Yes, COVID, of course, has impacted on our services. I know you started your statement today, Minister, by saying that you've published your plan to help reduce the long waiting times that have unfortunately built up during the pandemic. That is factually correct. But, what it is also important to say is that we were in a very difficult position before the pandemic started. The number of people on the waiting lists had doubled even before the pandemic hit Wales. We had double the number of people waiting for over a year than in the whole of England in March 2020. That's a pretty staggering statistic considering the size of Wales compared to England's population. 

The Member needs to conclude now, because we have quite a few speakers. 

Thank you, Deputy Presiding Officer. I'll run through quickly, then.

Can I ask, Minister, about COVID-lite regional hubs? I've gone on about this—I know I've gone on about this, and my predecessor in this position did as well. Tell us when they're going to happen. Tell us when they're going to be in position, because I would really like to know the answer to that today, Minister. 

And finally, Deputy Presiding Officer, we've got one in five people in Wales on a waiting list, and a quarter of those are waiting for more than a year for treatment. We've got average waiting times that are 10 times higher than those in England. We've got the worst A&E waiting time records that we've ever seen in Wales, and we've got the second-worst figures just announced on ambulance response times ever. These are all significant records that are being broken in the wrong direction. So, can I ask you, Minister, when the Labour Government will get a grip on some of these issues and stop breaking all the wrong targets and make sure that your plan is actually delivering for the people of Wales?

Thank you, Russell, for your contribution. I'm pleased that you agree that it was important to have targets. You're absolutely right that our targets are clear that nobody should wait more than a year by 2025, but there is an interim target, and that is that we should eliminate the number waiting for longer than two years in most specialities by March 2023. So, that's a way you can hold us to account this time next year, and I ask you to hold me to account in the sense that I'll be holding my officials to account, and we'll be holding health boards to account. I think it's absolutely clear. We've built these targets alongside the health boards. They are telling us that they can hit these targets. It's really important now that we hold their feet to the fire on that.

You asked about a communication strategy. You'll know that there has been a very active communication strategy already, particularly with those who are waiting the longest. Your committee has written a very interesting report, and you'll know from that that the Living Well programme gives advice to people in terms of how they can live well while they're waiting for their operations. Obviously we'll be interested to see if and when other health boards will pick up on that. I will be requiring monthly briefings from my team, but I'm sure that they will be monitoring in real time what's been going on. If there are facilities that are not being used—in particular 9 a.m. to 5 p.m. full-time, all of the time—I'll want to know why, and I'm sure you'll be interested to know why as well. There is a target you can hold me to at the end of this year, in fact, as well, where we're saying that people should have their first appointment by the end of this year. We know that many—around 50 per cent, if not more—are waiting for that first initial appointment. So, hopefully, that will help us out.

When it comes to e-prescribing, you know my frustrations, Russell, in relation to this. You'll know that I've put money on the table, but I can assure you that I'm on it. I had a meeting just yesterday to go through how we can speed up the process, because, as you know, I'm not satisfied with waiting for three years for that to happen, and I do think that that could potentially make a big difference in terms of people's time. 

You're quite right to focus on not just recruitment, because I think we do have pipelines of recruitment ongoing. We have about 78 per cent more nurses in training than we've had before. We've got about 97 per cent more midwives in training than we've had before. The real issue for me is retention—how do we keep people in the system. In order to do that, we need to incentivise, we need to make sure that there are opportunities for them to make more money, perhaps, through working longer hours. So, all of those things are opportunities for them.

You're quite right to ask what help can a virtual consultation give. What it can do is the preparation work. Obviously, it's not going to help for the operation itself, but there's a lot of pre-op work that can be done virtually, and I think it's really important that that is done. But also, I think we've got to get people to understand that surgery is not always the only option and always the best option. I'm looking at your colleague behind who is an expert in this area, so I'm always very aware of the way I'm speaking when I have such an expert in the Chamber. I was speaking to somebody just this week who was told initially that he may need surgery on his shoulder, and now, actually, some intensive physio has corrected the problem. I think we do need to get people to understand that there are alternatives to surgery.

When you talk about building back better, I was waiting for your surgical hubs, I was waiting for your question around what we're doing in terms of COVID-lite hubs, and I can tell you that, actually, some of these are already up and running. In Cardiff, for example, we have a cataract theatre where, between Cardiff and Swansea, we'll be seeing 600 people per month. That is already up and running. We are going to be seeing a new trauma and orthopaedic centre being developed in Aneurin Bevan in the Royal Gwent. That's going have £1 million, and that's going to see around 3,650 people regularly. There's going to be a new orthopaedic and spinal surgical unit in Swansea and Hywel Dda. That's going to be a green area, that's going to be separate, so it won't be knocked out by urgent care that comes in through the door. I know that's something that surgeons have been asking for. We're going to try and make sure that we separate these paths out as much as possible. It is quite difficult when all the beds are full. It is important that we try and maintain that flow through the system, but also that we have reserve beds, if we can, for surgery to be able to continue.

Then, just in terms of waiting lists, obviously, the pandemic has knocked all of our plans out. We were actually improving as we went into the pandemic. In 2019 there were only 9,000 people waiting for 36 weeks. And I would ask you, Russell, to stop comparing apples and pears. The way that we count in Wales is very, very different from the way they count in England. First of all, it's not all about the numbers of people. So, when we see 700,000 people—

Deliberately different.

It is very different.

Deliberately so.

It's not deliberately so. We want—[Interruption.]

You don't need to answer someone from a sedentary position.

We need to be transparent with the public. We think, for example, that it's important to include things like diagnostics and therapies in our waiting list times because, actually, there are thousands of people who are waiting for those. Those are not included in the English figures, so I would ask you to stop comparing apples and pears.

Plaid Cymru spokesperson, Rhun ap Iorwerth.

Thank you very much, Deputy Llywydd, and thank you to the Minister for her statement. The first thing I'll say is that I don't think it's possible for me to ask every question that I'd like to ask today, and to be fair, it's not possible for the Minister to provide all of the responses this afternoon. But today is the start of a process in holding the Government to account on the most important task that the Government is currently facing.

Another important thing to say at the outset, in response to this long-awaited plan, is that the problems that we are talking about now are the same problems as those that existed prior to the pandemic. Yes, they are worse, and the figures are so much worse—the waiting times are longer and the waiting lists are longer—but these are the same problems. As the Royal College of Surgeons said in a statement today: 

the pandemic has simply exacerbated the problem that we were already facing. 

That's the reality of the situation, and that tells us so much about the failure of one Minister after another to put the health and care services of Wales on the sustainable foundations that we need. What the pandemic has done is to show just how unsustainable things were. If it is the Minister's intention to take us back to how things were prior to the pandemic, well, God help us.

I will go through some of the elements of the statement today. I'm pleased that we have had this statement and that this plan is in place. I agree with much of the narrative that we've heard from the Minister—the need to provide the right treatment in the first instance; the need to provide care as close to home as possible—but there are many questions arising as to how, exactly, some of these pledges are to be delivered.

If we're talking about prioritising increasing capacity within the health service, it is a major concern of mine that we are not talking about increasing capacity within health and care services here, because we have to think of these are two halves of the same walnut. One chief executive of a health board told me during the pandemic, when the Minister was making some funding available to the health service, that he would prefer to see the money going to care services because that's where the problem is. We do have to think about the process of recovery post pandemic as a challenge for health and care services.

In terms of prioritising diagnosis and treatment and introducing some new targets, I welcome the fact that there are targets. I am very disappointed with the level of ambition in terms of cancer targets. To be fair, it does reflect the situation that we are in, but we have never reached that target of 75 per cent to start treatment within 62 days. All that's happening is that's being increased from 75 to 80 per cent, and I can't understand how the Minister will be able to achieve that target either without having a cancer plan, which everyone other than the Welsh Government seems to be calling for. 

In terms of the broader targets—

I've received some comments today from Cymru Versus Arthritis, worried about the targets that are in relation to cutting waiting times for most specialities, rather than all. Given how long orthopaedic waiting times are, this is one heck of a get-out clause for Welsh Government: 'We'll sort waiting times except those people who are waiting the longest'. I would appreciate an undertaking to publish targets for all specialities, but recognising that the challenge is greater for some specialities, but, again, it's about knowing where we need to go.

Technology, very briefly—I was going to urge you to talk about technology and the use of technology. I'm pleased to see the commitments to develop the portal so that patients can know where they are within the system. Just a few questions arising as a result of that. When will this portal be ready? Will you be using front-line staff to help develop that proposal? And also, will it allow communication between primary care and secondary care, because we do have to have that seamless communication between the different parts of the health service?

I am aware that my time is swiftly running out, so I'll leave it there, because, as I said, this is the beginning of the process of holding the Government to account. And I've quoted them once, and I will do so again, the Royal College of Surgeons—there are good ideas here, but what isn't clear is how these ideas will be delivered, including on something as fundamental as workforce planning. We've heard of the need to plan the workforce; well, we know that, but what we want to know is how that work is going to be done. There's a huge challenge facing the Government.

Thank you very much, Rhun. Certainly, things have changed since the pandemic hit. The fact that we are all using technology in an entirely different way as compared to how we were using it before the pandemic means that there are possibilities now that weren't in place before the pandemic. We want to take advantage of those opportunities to transform the system going forward. But you're right, what we need is to develop sustainable services in the long term and that's why what we intend to do here is to increase capacity. And you talk about transformation; well, that's what we're trying to do, to transform, but the public needs to come with us on this too, to understand that we do have to do things differently and that the way that we have done things in the past—people just taking it for granted that they would be receiving care in a hospital, for example—will change. We want the care to be taking place closer to the people, we want the diagnostics to happen in the community, and that they'll only attend hospital if they generally have to do so. So, we have a priority in terms of diagnosis and treatment, and that is important, because there are many people waiting for their initial diagnosis. We need to know who is waiting, to find out whether that is going to be a serious problem or not, and that's why we are focusing on that during the first few months.

As you know, major funding has gone into the care service. There will be a need for more, certainly, but as you are aware, for the first time we are paying the real living wage to those people who work in this sector. And that's the greatest challenge, I believe, in terms of care, namely to pay people a fair wage, because it's in that way that we will attract more people into the system. But we are working with Plaid Cymru to come up with a programme on how we will go about looking at care in the longer term.

What we've tried to do here is to put in place measures and targets that are realistic, but that also give people hope, and that is vital. At the moment, people don't know what to expect, but with these targets, I hope that they will get a better idea. And it's really important, and I want to make it clear, particularly with regard to orthopaedics, for example—we have to be aware that we are still in a crisis situation. You only need to go to A&E on a Friday evening, as I did last Friday, just to see the pressure on them, and you can see why people are cancelling operations, because there is so much pressure at the back door. And so having beds is vital if you're going to continue and go forward.

So, in terms of orthopaedics, for example, what we'll be doing is changing the way that we do this, to ensure that there are organisations and services provided where we see a great many cataract procedures done swiftly; the same with orthopaedics, as we intend to develop, for example, a centre in Swansea for that. But it's also important that people understand that the median wait at the moment is 42 weeks. So, even though some people are waiting very long, the median wait is 42 weeks. So, it is important that people do understand that too.

Technology and the way that the systems communicate with each other—once, again, we've been discussing that this week. Again, it's difficult to switch that on overnight, but there are plans in place, and I've tried to apply pressure to see whether we can move more swiftly with regard to those systems.

And in terms of workforce planning, you'll be aware that we have a programme, but what's important is that there is an action plan associated with that programme. That's why we're working with HEIW. And part of what we're going to be putting in place here is to ensure that we are entirely clear in terms of the workforce that we need to have in place. And I'm sure that the committee will be interested in seeing what we intend to do in that field. 

Members will be aware that we've already gone beyond the allocated time. I ask all remaining Members—I will call you—to keep your contributions succinct and within the time allocation, and for the Minister to also be succinct in her answers, please. Jenny Rathbone.

Thank you. I congratulate you on not trying to fix a broken system, but instead to have a whole-system change. So, I fully support the work you outline in your plan.

Cataracts, hips and knees are the biggest issues that I find it very difficult how to advise constituents on, because they're obviously things that need to be done by specialists. I'm aware, for example, that a consultant orthopaedic surgeon up in north Wales has pioneered day-care knee surgery. How well is that pioneering work travelling to ensure that other people are also doing that sort of knee surgery, which involves, obviously, a multidisciplinary team of nurses and others, to ensure that people, including the patient's family, know how to do the exercises to enable all that to happen?

We need to change the way we think about things ourselves. I heard Peter Fox earlier decrying the fact that his constituent's children had only been able to see the hygienist, when, unless they've got special needs, the hygienist is the best person to check a child and give them a routine check.

Similarly, the optometrist providing an enhanced service is surely going to help us ensure that those who most urgently need to see the ophthalmologist will get seen. But it does require the ophthalmologist to look at the images that the optometrist is sending them. I know that this happens in Swansea Bay health board, which is why they have such a low level of waiting times. How are you going to get that sort of good practice embedded across the system so that people, those who really do need urgent cataract treatment, are going to the top of the list?

Thanks very much, Jenny. And, certainly, cataracts is an area that we are very much focused on, because, as you say, there are literally thousands of people waiting. We are trying to make sure that we deal with them in a system of priority, so those who are more likely to lose their sight go to the front of the queue. I actually had an eye test this morning and my optician was thrilled to hear that we're going to be changing the law to make sure that they can do far more than just eye tests. And we hope, through changing the law, we will be able to reduce the waiting lists by around a third. So, there are experts that we are not using to their full capacity at the moment, and that's what we intend to do.

And you're absolutely right to point out, I'm afraid, to Mr Fox that, actually, we are going to be doing things differently. You may not see a dentist in the future. It may be that you'll be seeing someone different who is just as capable of finding out whether you need more expert treatment or not. This is about a really different change, a different approach, and I'm glad to see that you've recognised that. So, we will be doing things differently.

Just in terms of day care, you're absolutely right. I spent a very interesting day in Ysbyty Glan Clwyd last week with the clinical head there—very interesting in terms of what they're doing, day care. [Interruption.] And also the kind of—. What's important for me, if you don't mind stopping chuntering at the side there—. What's important to me is that we—[Interruption.] Can you please stop, Darren?

Minister—. Darren, it is fair. We are already out of time. I want to hear the answers and I want other speakers to be able to give their questions.

I'm more than happy to answer you, Darren. Just let's do it in a formal way. 

For me, the important thing is that we look at efficiencies but also the costs. So, Cwm Taf can do hip replacements really cheaply compared to some of the other areas, so we've got to learn from those and some of those are about day care. So, certainly, that would avoid the problem in terms of the beds issue, which is the constraint on the system. So, lots to learn and that's what we'll be driving the system to do in the next few years.

I've got three questions and I'll make them very quick. Minister, you talk about recruitment. Dentists and nurses are extremely hard to recruit, especially in places like Brecon and Radnorshire, so do you think that the NHS degree apprenticeships are something that you would bring in to actually try and get more people into the NHS? I'd like to have a comment on that, please. The additional money going into mental health support is welcome, but I'd like to know what specific areas that money is going into to make sure that it's actually not being swallowed up in bureaucracy and going to the front line to support people who are suffering. And finally, you did mention about developing an orthopaedic surgical hub in Swansea, and I'd just like to know how quickly that's being developed and where we are, as of today, with getting that set up. Diolch, Deputy Llywydd.

Thanks. That's the way to ask questions, James. Thanks very much. [Laughter.] I'll see if I can answer in just as efficient a way. First of all, on dentists, look, we're already on it in terms of apprenticeships. So, Health Education and Improvement Wales, we're asking them to really look at what more we can do in that area, where we're using technicians rather than dentists. On mental health, I know that my colleague Lynne is very keen on making sure that we put the emphasis on prevention, stopping the problem from developing in the first place. That's why we're doing it in schools, making sure that there's early intervention and making sure that we have more things like social prescribing to help us out there. And in terms of orthopaedic hubs, I know that Swansea is very much on it in terms of developing their orthopaedic hub and they will be doing that as a result of the £250 million that we invested last year, and I know that they're very much keen to develop that, I think in the Neath area, because it's away from A&E.

Minister, I think he actually asked about degree nurses, rather than degree apprenticeships in dentistry.

It doesn't matter. [Laughter.] Let's move on—[Inaudible.]

Heledd Fychan.

Diolch, Dirprwy Lywydd. Minister, as we discussed in this Chamber during endometriosis month, the disease has a devastating impact on sufferers. A constituent of mine has contacted me saying that she was told by her consultant at the Royal Glamorgan Hospital yesterday that the NHS aren't doing any operations at all for women with endometriosis—so, no diagnostic laparoscopies, no excision, no thermal ablation. She was due to have an operation a week before the first lockdown in 2020 and six months ago had a call from the medical secretary asking if she would be prepared to go to the Spire for treatment paid for by the NHS, to which she said, 'Yes, of course.' But yesterday she was told to give up any hope of getting surgery—no timescales at all. She has to have an injection every month to chemically induce the menopause and will be put on hormone replacement therapy, something that she's very concerned about because of all the press reports about the shortages with HRT at present, and also because she received this treatment 15 years ago and was made very ill from this treatment. She told me, 'I feel completely invisible.' How do we ensure that she and others like her do not feel invisible?

Thanks very much. Can I tell you that endometriosis is an area that I have really tried to focus on, because I think it's an area that's been neglected for far too long? And that's one of the reasons why, by the end of this term, I will be producing a women's health plan, because I do think that it's really important that we focus on women's health. There are so many areas where we need to understand. What is diabetes in women? How does that affect women? Asthma in women, autism in women, all of these different areas—we need to have a women's lens put on all of these different conditions. But endometriosis is an area where we already have the women's implementation group, which has been set up for a number of years, and they've actually started to deliver. So, I'm really pleased that we already, now, have experts in terms of endometriosis nurses in every health board. Of course we need more surgeons who are able to deal with this, but this is all part of a plan. We can't switch it on overnight, but those nurses are in place. I've been to hear them and been to presentations with them, explaining and describing how to tell patients to manage pain. I'm really delighted that we've already appointed two national clinical leads for pain management, one in Aneurin Bevan and one in Powys, and I hope that those people living with endometriosis will be able to access those as well. So, there's a lot more work to be done on endometriosis, but I'm very pleased with the progress that we're already making.

Finally, Huw Irranca-Davies.

Diolch, Dirprwy Lywydd, and I will keep my question very brief indeed. First of all, I do welcome the plan, because it does give hope, particularly with the targets, but those now have to be not only achievable but delivered as well. Because a lot of us who believe strongly to our dying day in the NHS know that we've got to give confidence back that the system isn't broken. It's bowed, but we can actually fix this and we can get it back onto its feet. And my two questions related to this are these: first of all—and it reflects on the past 10 years—we put the money into the NHS that we are able to that comes through Barnett consequentials. Rigorous analysis that has been done has shown that, over the average 10 years leading up to the start of the pandemic, the increase was around 1.4 per cent per year compared to 3.7 per cent. It was missing, Dirprwy Lywydd, £37 billion. So, is the quantum sufficient that we now have going forward? And secondly, how are the staff ready to deliver this? After coming out of a pandemic, in all the brutal conditions that staff have encountered, now to do this turnaround—. Can it be done? What support will we give to the staff to do it, and is there enough money in the system now to do it as well? But I welcome the fact that nothing's been ruled out of this. You've thrown the kitchen sink at it.

Well, we certainly are trying to throw the kitchen sink at that, and I can tell you that I don't think the system is broken. A system that actually sees 200,000 people a month I don't think is a system that is broken. And I do think that we should appreciate the incredible work that is being done on a weekly basis by the heroes who are in our system, and I think it's really important that we don't talk down the system too much. We know that there are a lot of people waiting, but let's actually also praise the system for the incredible things that they've been able to achieve.

In terms of the budget, what I can tell you is that we are spending around £10 billion a year on the NHS, which makes up more than half of the Welsh budget. So, it is a lot of money, and what I can tell you is that if you look at the amount we're spending on health and care, then we're spending more than England. For me, the important thing now is not about how much we're spending but are we spending it well. We've absolutely got to start making sure that it's not about just chucking money at it; it's absolutely, 'Is it making a difference?' It's got to be about efficiency. And part of what I intend to do is to make sure that we drive efficiency through this programme and make a huge change in terms of really getting the biggest bang for our buck.

I thank the Minister.