Questions now from party leaders. The leader of the Welsh Conservatives, Andrew R.T. Davies.  

Thank you, Presiding Officer. First Minister, when I was going round Wales over the last couple of weeks, which was far more profitable for you than me as it turned out last Thursday—[Laughter.]—there were many things that were raised with me as I went round Wales, but one of the key themes that came across in all parts of Wales was access to GPs and the ability to get appointments in GP surgeries. And the recent announcement from the Welsh Government over the workforce planning and the money that's going to be made available talks of funding 160 places per year, but, according to the BMA, to meet the demand requirement, we're going to need to be funding close to 200 places to make sure that we're replacing people who are retiring or leaving the workforce or reducing their hours.

Another point that is being made by the BMA is that just over two thirds of doctors here in Wales only work full-time hours, so nearly a third are on part-time hours, and equally we have a higher number of GPs who are over 60—23 per cent of GPs in Wales are currently over 60. That's creating, I hope you will agree with me, real pressure in shaping the service for the future. So, do you agree with me that there is an issue about ramping up the number of training places for GP provision here in Wales, and also making sure that we create a service that is fit for the future and able to be accessed by patients wherever you live in Wales? 

I thank the Member for those important points. He is right to say that we have to train the GP workforce that we need for the future. We have a record number of GP trainees in Wales. We had a period not that long ago when we struggled to fill the number of training places that we had available. Now we're oversubscribed for training places, and that, of course, is being taken into account by the body that plans workforce provision for the health service here in Wales in the future. I hope the Member will have seen the latest number of GPs that we have in Wales, which rose again in the figures published just around Christmas time. Whereas the number of GPs in the English health service has been falling, in Wales we are managing to sustain the number we have and to increase it as well.

The nature of the GP workforce is changing, Llywydd. People are choosing to work part-time hours, and that reflects the nature of people who are being recruited into it. The old patterns—the old patterns—of people buying a stake in a business, thinking of themselves being there for 30 or 40 years, many young people who are becoming GPs don't see their futures in that way, and we have to craft futures for them that means that Wales continues to attract the people that we need. I make one other point, which I make every time this is raised with me: primary care is more than GPs. And while GPs are fundamental, they oversee the system, they have a level of expertise that means that they are responsible for the wider team, the future is at least as much about making sure we have all those other components of the team—the practice nurses, the paramedics, the physiotherapists—all those people that will work alongside GPs to make sure that people in Wales get the primary care service they need.

Thank you for the answer, First Minister. It is a fact that there are more GPs in Wales, but it is a fact, obviously, that many are part-time, as I said in my opening remarks to you. Nearly a third of the workforce is on a part-time basis when it comes to GP practices. Importantly, as I said to you, I recognise that there's an increased number of GPs being trained, but the actual figures show that the Government is funding training places to about 160 a year, when the actual demand is 200 places. So, what I'm looking for from you today, First Minister, and I'm sure those connected with primary medical care here in Wales will look for as well, is a commitment from the Welsh Government to actually meet the demand that the requirement needs, which is to put another 40 places on the table so that we can get to 200 training places here in Wales to meet what the workforce of 2030 will need to look like in the primary sector. I agree entirely with the remarks you make that the primary sector is broader than just GP practices—pharmacists in particular offer a very, very important role in supporting GPs in the work they do—but it is a fact that, underpinning entry into the NHS, you need a robust and sustainable GP workforce and, as I said, the modelling shows that we need to be training 200 GPs a year rather than the 160 we are at the moment. Will you commit to that?

Llywydd, there's little that I disagree with in what the leader of the opposition has said, and I certainly agree with him about the importance of pharmacists and the part that they play. They're playing a particularly significant part at the moment when there are, for a variety of reasons, shortages of a number of very important medicines that pharmacists have to manage. There are different ways in which you can model the need for GPs in the future. We ask the body that we have set up, Health Education and Improvement Wales, to do that on our behalf. They will take into account the views of the profession, of course, but they will have other sources of evidence available to them. This Labour Government has never failed to fund an expansion in the numbers of GP training places when that is the advice that we have had from those who are in the position to carry out that analysis. If they come to us and they seek a further increase—remember, 160 is a significant increase on the figures that we used to have—if they come to us and make that case, then, of course, that will be very properly considered by us.

Thank you for that answer, First Minister. I very much hope that those in the medical fraternity such as the British Medical Association do come and make that powerful case to you, because I detected a commitment to achieve those extra funded places if that case is presented to you. But what we also know in the acute sector, i.e. the hospitals, is that regular data is not provided on vacancy rates. It was welcome that the nurse staffing measure was put in place some time ago that protected certain positions within the hospital settings, but what we do know from the freedom of information replies that organisations have had is that, in some health boards, only 52 per cent of consultant positions are permanent—48 per cent are filled by temporary consultants. That clearly isn't sustainable in developing a workforce to meet the backlog of the pandemic, but also a workforce that is sustainable going forward. Will you commit to making sure that regular data on vacancies within the acute sector, i.e. our hospitals, is published by the Welsh Government so that we can see how much progress the Welsh Government is making in fulfilling the vacancies that are on our hospital sheets at the moment so that ward rounds can be covered and we can make real progress in eating into the waiting lists that have built up through the pandemic?

Llywydd, I'm happy to look at the issue that the Member raises. We publish a great deal of data on the Welsh workforce. If there are gaps in it that can sensibly be filled, then of course I'm happy to look at the point the Member has raised.

Leader of Plaid Cymru, Adam Price.

First Minister, some might think that it was a curious choice for us to choose to announce the terms of our agreement on strengthening Welsh democracy on the same day as the state opening of that other Parliament on the banks of the Thames. I think it was serendipitous, because it allows us to draw a contrast, doesn't it, with that creaking Westminster system, with all the pomp and ceremony, with elected MPs—I used to be among them—summoned by Black Rod to the unelected House of Lords packed to the rafters with Boris Johnson's cronies. Now, beyond the detail of what we have announced today, isn't what lies at the heart of it a desire to build, here in Wales, a modern democracy, abolishing the unfair first-past-the-post system, a fully gender-balanced, working Parliament committed to making a difference in people's lives, not the gentleman's club-cum-pantomime Parliament of Westminster?

Well, Llywydd, I do think today is a very significant day in the development of this institution. I brought with me my copy of the Richard commission, and as I was thinking of coming down here this afternoon, I remembered vividly standing alongside the then First Minister, Rhodri Morgan, when he made a telephone call to Lord Richard asking him to chair that commission. And here we are, 20 years beyond its proposal for an expansion in the number of elected Members here in Wales, finally able to bring the capacity of the Senedd to a point where it is able to discharge the responsibilities that fall on the shoulders of people who are elected to be here. And that's the purpose of the reform, isn't it? It's to make sure that decisions that are made here in Wales on behalf of people in Wales are carried out by an institution that's properly equipped to do that.

I've looked back recently, Llywydd, at the many proposals to create a Parliament here in Wales. Not a single one of them, other than the one that got onto the statute book, proposed a number as small as 60. The Kilbrandon report, set up in the 1960s, proposed 100 members for the Welsh parliament that it proposed. You can go back as far as Emlyn Hooson's St David's day government of Wales Bill in 1967 to see a proposal for 88 members of the parliament that was proposed then, and that was a body without many of the responsibilities that have to be exercised here. So, the purpose of the reforms and the fact that we have been able to reach an agreement, after what will by then be 25 years of trying to achieve reform, will be the creation of a parliament here in Wales that reflects the people of Wales in its diversity, and properly equipped to discharge the responsibilities that this Senedd is charged to carry out on behalf of Welsh people.

Of course, the Conservative Party, predictably once again, are saying that the people of Wales don't want any more politicians. They're almost right, of course, because what the people of Wales don't want is any more Tory politicians, as we saw clearly demonstrated on Thursday. You and I, First Minister—[Interruption]. You and I, First Minister—[Interruption]. You and I, First Minister, have a different vision for the constitutional future of Wales. Now, what we are trying to build here, of course, is not a—. What we're trying to build here, of course, is not a stepping stone to any one future for Wales, not a half-way house, but a firm foundation upon which the people of Wales can decide their own future—a futureproofed democracy, ready for more powers fit for the twenty-first century. And isn't that the central question—whether this Senedd should just be a mere symbol of our democracy, or should it be a Parliament with the powers, the time, the skills, the tools and the personnel to do the job that the people of Wales have asked us to do, not just in one referendum, but in two, and in every election that each one of us have stood in in the intervening period?

Llywydd, I too am not surprised at the opposition of the Welsh Conservatives to the further development of democracy here in Wales. All the arguments that I hear deployed are exactly the arguments that they deployed in opposing devolution in the first place. This is an entirely unreconstructed party when it comes to these matters. We don't need to pour salt in open wounds here, I'm sure, but people around the Chamber will know that, on Thursday of last week, in Scotland, 23 per cent of Conservative councillors were lost at the election; in England, 25 per cent of Conservative councillors failed to be re-elected; and in Wales the number went down by 44 per cent. That just has to tell you something. It tells you something about the way in which the continuing reactionary positions taken by the Welsh Conservatives just do not chime with the way in which people in Wales want to see their democracy develop. People want to see a Chamber here that is properly equipped to do the job that we are asked to do. Report after report and commission after commission,have demonstrated that, with its current membership and the level of responsibilities that are discharged here, you cannot do the job in the way that people in Wales have a right to expect it to be done. The reforms that we've agreed on will put that right, and will put it right not just for the next 10 years but I think for the foreseeable future.

One of the ways to confirm that you're right, of course, is knowing that the Conservative Party disagrees with you, because they've been on the wrong side of history on virtually every major question in 300 years of human progress.

One of the most exciting things about the reform plans is the pledge to legislate to have equality in terms of men and women in our main democratic body. Whilst statutory gender quotas are central to our main proposals published today, and are crucial to delivering our aims, and work for the benefit of everyone in Wales, does the First Minister agree that we should take advantage of the opportunity that the reform provides to present a broader range of steps to ensure that the Senedd is inclusive, including job share by Members and other steps to ensure the representation of people of colour and minority ethnic groups in the Senedd? And beyond the fundamental issues that we have made a statement on today, don't we need to be clear that we are starting the debate for the Senedd, for public life, and for everyone who wants to see Wales improved, so that they can participate in that improvement?

Llywydd, a Bill will come before the Senedd, and there'll be an opportunity for every Member here to try to take the opportunities in the Bill to do more to create a Senedd that reflects the people who live here in Wales. We've succeeded in doing some things over the years, particularly in the Labour Party, but there is more to do. The things that we have agreed today will put that into practice, but there will be more detail to discuss to create a Senedd where those people who haven't been part of the story here over the past decade can then see a Senedd where they can see opportunities for them to stand as candidates, and to stand where we are standing today. That is exciting, I agree. When we were discussing this issue in Llandudno in the Labour conference, people came on-stage to say time and time again that they wanted to take these opportunities to create a future where people of all backgrounds in Wales can look to the Senedd and think, 'Well, I can be there, too.'

Can I make a point of order, Presiding Officer?

Yes, you can.

I'd be grateful if you could clarify your determination when it comes to the co-operation agreement. I think they were very reasonable points that the leader of Plaid Cymru was raising there, and the First Minister's perfectly entitled to respond to them, but you have determined in a letter that you sent when the co-operation agreement was brought into effect that questions to the First Minister by the leader of Plaid Cymru should steer off the co-operation agreement. As I understand it, the press release that followed the announcement last night specifically referred to the co-operation agreement, and the line of response that the First Minister indicated was reflective of the co-operation agreement. Surely that is a breach of your determination as to how questions should be undertaken at First Minister's questions.

Thank you for raising the point of order, and thank you for suggesting it during the question to alert me to the questions that were being asked by the leader of Plaid Cymru. I consider on reflection that you're correct, and that it did probably go beyond the guidance that I've issued in that case. I'll take it as an exception to the rule today. I won't expect it to be repeated again, but the leader of Plaid Cymru has the right to ask questions of scrutiny of the First Minister that don't lead to it seeming as if it is a platform for policies of that co-operation agreement. I'll live and learn from what's taken place today and we'll reflect on that for the future. I suspect that we will be returning to this matter on a number of occasions over the next few weeks, months, if not years—hopefully not years, possibly, at that point. 

Question 3, Rhun ap Iorwerth.