The following amendment has been selected: amendment 1 in the name of Lesley Griffiths.

We move now to item 6, the Welsh Conservatives debate on NHS waiting lists. I call on Russell George to move the motion.

Motion NDM7997 Darren Millar

To propose that the Senedd:

1. Believes that the Welsh Government does not have an adequate plan to tackle NHS waiting list backlogs in Wales.

Motion moved.

Diolch, Dirprwy Lywydd. Foolish—that is what the then health Minister said to having a plan to tackle the NHS backlogs in Wales before the pandemic is over. And what has that led to? As it stands now, Wales is experiencing its worst accident and emergency waits, longest waiting times for treatment, and second slowest ambulance response times on record. The number of people waiting over two years is now over 60,000, and one in four Welsh patients are waiting over a year for treatment. We, of course, as Welsh Conservatives, have long been raising the increasing NHS backlogs, and it is frustrating, when we voice concerns for the need for a recovery plan, to be told that's foolish. I of course fully accept that the pandemic has caused huge pressures on our Welsh NHS, but we can't get away from the fact that there were deep-rooted issues, including workforce gaps, bed shortages and a creaking NHS estate, and that happened well before the pandemic. Unfortunately, all this was happening well before the pandemic hit us. 

As it stands now, even before the pandemic struck, thousands were waiting over a year for treatment. In fact, that doubled in the year before the pandemic. A&E and ambulance services were already feeling the strain each winter, and the NHS workforce was already facing significant challenges and shortages. So, unfortunately, now, we've got the equivalent of one in five of the Welsh population on a waiting list. In emergency care, a record-breaking one in three patients are expected to wait more than four hours to be seen in A&E, and ambulance response time targets have not been met for nearly two years. These are, of course, harrowing statistics, but behind every stat are, of course, real people, who desperately need the Government's latest recovery plan to work, and I hope it does. It's important, as an opposition, that we highlight the Government's failures, but that we also come forward with solutions ourselves, and that's what I will do later in this debate today.

One of the big issues that urgently needs addressing is the issue around delayed transfers of care. No doubt, of course, this has all been exacerbated by the pandemic, but there were long-standing problems that existed well before that pandemic hit. Delayed transfers of care are not just again stats; behind every delayed transfer of care is a person who has not received the care and support they need to enable them to return home or to move into appropriate accommodation. Family members and unpaid carers are being put in the impossible position of leaving their loved ones in hospital longer than is necessary, or taking on further caring responsibilities that they may not necessarily be equipped to cope with, often at the detriment to their own health and well-being. For there to be 1,000 people in hospital beds, when they could have been discharged, is totally unacceptable.

Of course, it's well documented that remaining in hospital longer than is necessary is detrimental to the patient, particularly older patients, and being discharged without the appropriate support in place places unreasonable demands on families and presents risks to the safety of the individual, increasing the likelihood of readmission—so, not breaking that cycle. We've got unprecedented pressures, of course, on the health and social care workers, and unpaid carers as well, and I think, of course, they should be thanked for all that they have done and they continue to do. Another issue, though, here as well is the poor communication, the lack of integration and joined-up working, amongst some of the other issues that have to be tackled if we want to see improvements in patient flow through our hospitals in Wales. 

Shockingly, national performance against the 62-day cancer waiting times target remains significantly below where it should be, and, prior to the pandemic, Wales already had poor waiting times for routine treatments. It's worrying to know that cancer waiting times have not been met since 2008. Furthermore, waiting times for key cancer diagnosis targets are still substantially large, despite progress in recent months, and the Welsh Government targets that patients wait a maximum of eight weeks for diagnosis remain unmet. 

There are some areas that I do welcome some progress from the Government on. I welcome the fact that the Government has started on regional surgical hubs, something I've long called for, of course. I also welcome the fact that we had the recovery plan in April. But, so far—I hope the Minister can tell me I'm wrong on this—we've only seen details for those surgical hubs rolled out in south Wales. So, can I ask the Minister to give us a timetable on when we're going to see those surgical hubs rolled out across the rest of Wales? When are they going to be fully mobilised? It's really important, of course, for those suffering with other conditions and long COVID, and, of course, again, it will free up the pressure from hospitals.

I said I'd provide some solutions myself also. Certainly we need to improve access to primary care appointments and change current guidance on telephone triage. This will reduce the number of patients presenting themselves to A&E. We need to redouble efforts on rapid recruitment of paramedics. I appreciate the Welsh Government has announced 136 new recruits, and the Welsh Ambulance Services NHS Trust is committed to recruiting a further 127 this year. However, it's got to be key that the Welsh Government provides support for rapid recruitment to cover any potential gaps. Mobilise members of the public and former healthcare professionals to join their local NHS team as part-time reservists to support the NHS during periods of high demand. Establish routes of support for NHS staff and care workers and families who have experienced trauma through the pandemic. Set a plan and timetable to raise wages of care workers. This will provide, of course, care workers with the security they need, and will also potentially keep more workers within the sector to help with hospital discharge. That's a key element that needs to be addressed. Also, clear and regular communications with patients on waiting lists, as well as available mental health support and a public health campaign to ensure cancer diagnoses are caught earlier.

We can't just look to the short term. This is why I'd suggest plans for the long term, which would include focusing on the time for treatment, so ambulances and hospitals work closer to deliver timely care. I'd also suggest developing a clear, clinically led plan for Welsh NHS to clear the waiting list backlog, and utilising cross-border and independent facilities as well. And not forgetting COVID-19, we should aim to establish long-COVID clinics to support people experiencing the long-term effects of COVID-19. I also think we need to build upon the 10-year health and social care workforce plan by introducing a recruit, train and retain plan across the whole of the health and social care sector. We need to significantly increase the number of doctors and nurses and care workers, through, for example, a nursing apprenticeship scheme also. That's how we do that. 

But the Labour Government here needs to get a grip, I think, on the NHS, stop breaking all the wrong rules and the wrong records, and I would suggest that the Labour Government concentrate on making sure that the right records are not broken and get a grip, really, on the NHS, as we go forward. I'm hoping that we'll have some solutions from the Minister today, but I move the motion in the name of my colleague Darren Millar.

I have selected the amendment to the motion. I call on the Minister for Health and Social Services to formally move amendment 1, tabled in the name of Lesley Griffiths.

Amendment 1—Lesley Griffiths

Delete all and replace with:

To propose that the Senedd:

1. Notes that the Welsh Government’s planned care recovery plan published on 26 April was developed in partnership with clinicians to ensure targets were challenging but achievable.

2. Further notes that further operational detail on how the ambitions in the plan will be delivered will be set out in the NHS integrated medium term plans, which are currently being reviewed.

Amendment 1 moved.

Formally.

There's quite a simple motion before us today. Myself and my colleagues on these benches agree that the Welsh Government doesn't have an adequate plan to tackle NHS waiting lists in Wales and the backlogs in Wales. We've seen the plan, over the last few weeks, and there are, of course, positive elements. One, that we have a plan at last, having waited far too long for it, and there are plans in place in certain areas that will assist, there's no doubt about that, and, importantly, we have targets that enable us to measure success or otherwise in terms of the Government's actions, although there are some gaps in those targets too, and we'll return to that in due time. 

For far too long, the NHS in Wales has been locked into some sort of vicious circle where it's creaking under the pressure from day to day, and Minister after Minister failing to ensure that the right steps are put in place to reduce those pressures, first of all through a number of preventative measures, and then, secondly, to ensure the sustainability of the service and how it works in terms of the workforce, more than anything else, perhaps. So, the pressures grow and the unsustainability increases.

If there's one point that is truly important and should be made at the beginning of my contribution, that point is that all of this was true before the pandemic struck, a little over two years ago. What the pandemic has done is to highlight more than ever before that lack of sustainability, and highlight in a more graphic way than ever the inequalities that drive these huge pressures on health services. The upshot, of course, is that waiting lists now are longer than they have ever been before. Almost 25 per cent of the population, nearly 700,000 people, are on waiting lists—60 per cent of those are waiting for their first appointment as an outpatient.

This delay at an early stage in the journey through the health system, the delays in diagnostic appointments and surgical appointments has had a catastrophic impact on so many of those who are waiting. We know how many more are discovering cancer later on now, and are being given a diagnosis having gone to A&E, rather than having been diagnosed as an early stage as part of the kind of cancer pathway that we need. The survival hopes are so reduced in finding that cancer late.

Back to that figure of 700,000 people on waiting lists—yes it's an increase of 50 per cent since pre the pandemic, because of the pandemic, but it was 450,000 before the pandemic, so we can't think of any Government strategy as something that will take us back to where we were two years ago. The Government says that its plan is ambitious, but I fear that there are many elements here that raise very serious questions as to how ambitious it is in reality. First of all, a plan would have to persuade me that the Government is going to transform its attitude towards the preventative agenda in order to take pressures off our hospitals.

Yes, the Government says it wants to push the preventative agenda, and I do believe that, but I don't see that in its plans. I need to be persuaded that there is a new attitude and a gear change like we've never seen before in terms of training—training and retaining health staff. But I don't see that gear shift, although I don't doubt that the Minister wants to see that, and I should say 'health and care' here, of course.

Neither do I see in the Government's plans that crucial commitment to make integrating health and care a central part of the solution to these backlogs. Yes, there is work happening at the moment in creating a national care service. I'm confident that the work that's happening in the light of the co-operation agreement will bear fruit ultimately, but a lack of adequate reference to care in the Government's plan that was recently published is something that concerns me greatly.

And in terms of the targets, well, time is against us. As I've said here recently, I am very concerned that these new targets are going to exempt some areas of specialism. Orthopaedics, as we know, is so problematic, as we know. What we also know is that the orthopaedic workforce in Wales has provided a plan for the Welsh Government, and that that plan isn't included in the plan published by the Government. Listen to those on the front line in health in Wales; then, perhaps, we will have plans that can ultimately bear fruit.

The COVID-19 pandemic has proved beyond doubt that good health is the cornerstone to our society. COVID has caused so much grief and loss and no aspect of our lives remain untouched. Like I’ve said before, the NHS is an organisation we can all be proud of. But the Welsh Government is failing to produce a plan that targets the ever growing waiting lists in Wales. The Welsh Government spends £2,402 per head, more than England and Scotland, but has the third worst performance figures. One in four patients are waiting over 52 weeks for treatment, and 64,000 have been waiting two years. Something must be seriously wrong. As a result of this, pressure is growing on NHS staff and patient care is suffering, and there is a sense the NHS is losing the battle to deliver the standard of care people deserve. 

Three weeks after I had my COVID vaccination in February 2021, I began suffering with severe anterior chest pain. After speaking to 999, I was advised to take four aspirin whilst waiting for the paramedics. After a period of time, my wife phoned, again, 999, and the paramedics arrived 40 minutes later. I was taken to the Heath hospital where I received excellent care for five days. After returning home for three weeks, I again began experiencing severe abdominal pain, which was when I was taken to the hospital, and I spent another 10 days in the intensive care units. I was fortunate enough to make a full recovery, and the kind of treatment and care I was fortunate enough to receive in the Princess of Wales Hospital and the Heath should be given to everybody. Unfortunately, this is not the case, and many others will have dire experiences.

After another recent stay in hospital, I, like many others, have experienced the challenge facing NHS Wales. The surgery I went through this time should have been performed in six months; instead, it took six more months after postponing four times, twice after admission and once on the day I was supposed to be going to the theatre—instead I was discharged home. These cancellations can and will have consequences for patients' well-being.

There is a sense that the NHS is fighting a losing battle to deliver the standard of care patients deserve. The widespread view is that the NHS is in a sorry state. However, this is not always based on personal experience, as I had. During my stay, I witnessed people on trolleys and chairs because of a lack of capacity in assessment wards, staff talking to patients with little regard or compassion and, all too often, patients had little idea who they were talking to. We obviously have a long way to go to achieve the high standards we strive to meet.

In A&E it is well documented that patient waiting times are extraordinary. Only 65 per cent of patients are seen within the target of four hours—the lowest on record. Due to a service that lacks the capacity to meet demand, some have waited days to receive treatment in a chair due to no beds being available. Some have experienced communication difficulties, with staff members who appear to ignore their concerns and medical history, which is vital to their treatment and prognosis. They all call themselves practitioners. In addition, some staff with dark blue uniform, and they look and act like a sheriff or a marshal, who remind people to behave, or else. These staff obviously forget their ethics and the patient's human rights. 

After a serious fall whilst exercising during the pandemic, a lady needed treatment at the Princess of Wales Hospital in Bridgend. She had broken several bones. In obvious pain, she waited six hours with limited pain relief, and was then sent home as there was no doctor available. We all know this is a difficult time for our NHS, but even before the pandemic, NHS Wales had been struggling. There has been little progress over 20 years, since the Welsh Government came into being. Change is long overdue and is vital to make NHS Wales fit for purpose. [Interruption.] I'm sorry. It will take me—. It's been 70 years; history can talk. Give me one or two minutes more, sir.

I'm sorry, you have your allocated time, and you know that. So, you will have to conclude now, please.

Let me finish, then. The current state of the NHS demands urgency for corrective measures. We are still unable to identify the basic problems in the NHS, and that is why our corrective measures never seem to bear fruit. Let me have the last word, sir. As the health and care system moves forward, and the focus shifts to re-establishing services and supporting the ongoing health and well-being of people, who have been waiting, and in isolation, there will be opportunities for further learning and innovations, and we must continue to rebuild our way back to health. Thank you.

The experience of Altaf Hussain is, I'm sure, repeated, and I know it's repeated, amongst many of my constituents, but that doesn't really get us very far, in the sense that we can acknowledge that the service is under huge strain at the moment, not least the pent-up demand from two years of lockdown, but also the reduced capacity of hospitals caused by the additional public health measures needed. It is no use operating on somebody for a particular complaint and then they get COVID during that intervention, because, obviously, the health outcomes from that are unlikely to be very good. And it's also the case that health staff catch COVID too, and we definitely don't want them coming into work when they've got COVID, and that reduces the capacity of professional staff. And these are not people we can just pick off the supermarket floor and get to come in and do the job in the hospital instead; these are trained people who need years of training in order to be able to do their jobs. 

So, I think we have to acknowledge the pain that everybody's going through, and the health Minister does that regularly, but we have to come up with solutions that are coherent and that are also doable. Because it is just two weeks and one day since the health Minister announced the recovery plan from COVID, and it's a little bit early at the moment to say, 'What's happening, and why isn't it working?' So, I think that we need to have a little bit more critical use of our faculties to work out what we need to be doing and how we're going to get there.

Certainly, we had a broken system before. If we've got somewhere between 20 per cent and 25 per cent of the population waiting for a hospital appointment—and it was a bit unclear from Russell's contribution which it is, but it doesn't really matter, let's just say it's one in five—that is just a staggering figure. And we just have to tackle the cause of the problem, as well as treat the symptoms, so we have to get on with the prevention agenda. And my colleague Lynne Neagle is sitting next to me; nobody could be a better Deputy Minister for public health than Lynne Neagle, and we are definitely getting on with the business of supporting people with their mental health, of tackling the obesity crisis that we have and also tackling smoking, which is obviously a major cause of cancer and many other problems, as well as obesity. These causes of ill health undoubtedly cause huge problems for the individual and for the health service system. And the best time to intervene on that, in terms of a response to Rhun ap Iorwerth, is at the beginning of the journey, which is when women are pregnant. That's when they want to change, that's when they'll give up smoking, that's when they'll change their diet. And we have to ensure that people are picking up the money that they can get when they're pregnant to ensure that they eat a healthy diet. So, there are many, many things that we need to do on that, but we can't not do it, because it's completely unsustainable to just go on the way that we are going at the moment.

One of the things we've got is—. It's no use asking for more beds—that's really not where it's at; if you've got beds, people will fill them. We need to do interventions differently, more effectively, with more skill, just like the north Wales orthopaedic surgeons who do day surgery of knee operations, enlisting the patient and their family in preparing for that operation to ensure its maximum outcome.

Thanks, Jenny. I agree with your comments in regards to prevention. I think we do need more beds, but I do agree with you on the general principle, though, because we've already got, as I said in my contribution, 1,000 beds with people who don't need to be in them. So, the big, big problem is the delayed transfer to care. If we can tackle that, that will answer a large part of the issues that we've got.

I agree. And that was on my little list. [Laughter.]

So, the Welsh Government is investing £43 million in social care, which is the main cause of delayed transfer of care, by offering the real living wage to make it more attractive to go into social care and also by having the wraparound care that's available through the neighbourhood nursing schemes. These are definitely things that need rolling out. But we also need to develop an equitable service and the Minister's plans to bring services closer to home. Because, remember, 90 per cent of the population don't go anywhere near a hospital; it's a much smaller number who actually need to be in hospital. But we also need to acknowledge that we have problems with staffing levels and that these are not going to be easily resolved. That's why we had the closure of two midwifery-led birthing units announced in Aneurin Bevan, which means that we're having to concentrate hospitals on a smaller number of units that are further away from where people are living, and that causes additional problems. But the problem is also exacerbated by Brexit. Those of you who think that Brexit was a good idea, let me just tell you that one health board—

The Member needs to conclude now, please.

—had a Greek ophthalmologist—. A Greek othalmologist was—. An appropriate person was offered the job by this health board, and, when the Home Office told them they couldn't allow their family to come with them, guess what? They decided they didn't want to take that job. So, that problem is exacerbated for all the other health professionals who we have, in the previous iteration, allowed to come from other European countries to come and support our services.

Jenny, you need to finish, please.

So, we absolutely have to change, and I think that the recovery plan is a coherent plan for change. But doing things the way they have always been done is definitely not an option.

Let's not beat about the bush: COVID-19 has not caused this waiting list crisis. Yes, it has exacerbated problems, but those were issues already present within the Welsh NHS under the remit of this Welsh Labour Government.

As of January 2020—2020—12,428 treatment pathways were waiting over 36 weeks for treatment in north Wales. That already horrific figure has now reached 58,988 in February 2022. It's the highest number on record and is 250 per cent higher than the low of 17 in May 2012. Clearly, the staggering worsening delays we are encountering in the Betsi Cadwaladr University Health Board form part of over a decade of decline and overcentralisation in three major hospitals—Ysbyty Maelor Wrecsam, Glan Clwyd and Gwynedd. Look at Llandudno hospital: prior to the pandemic, it already had empty wards, and then the management team at the board went and closed the ambulatory care unit—ACU—in 2021, a newly opened unit to actually reduce pressure on Ysbyty Glan Clwyd, Ysbyty Gwynedd and even Wrexham Maelor. Despite having an excellent minor injuries unit, which saw 98.4 per cent of patients spend less than the four-hour target time in the emergency department, its responsibilities now have decreased to around nine injury categories. And this—. We were told, once the A&E department went, that we would have an all-singing, all-dancing minor injuries unit, and, again, one that would take pressure off the three major hospitals. And yet, as we speak, the services there are being reduced. Consequently, even residents living in the town opt to go now straight to Glan Clwyd or Gwynedd out of fear that the MIU will simply refer them there. This is compounding the pressure in the worst-performing A&E in the nation. At Ysbyty Glan Clwyd, less than one in two patients are seen within four hours, and one in four patients wait over 12 hours.

Now, I've been leading my own campaign to try and reduce pressure on the three major hospitals. The health board is undertaking a six-month bridging service—and, Minister, this is where you've got people in beds in those three major hospitals who really should be in the social care system. So, you know, because I think you've welcomed it, this bridging service—. But the costs of it, it's only going to be open for six months. We need that to be a longer functioning service. These are people who are medically fit to be discharged and have a suitable care package in place, and these are being transferred to the specially configured Aberconwy ward in Llandudno. But no initiative can be judged on its merit on a six-month basis.

I hope you will agree that increasing the role of our smaller hospitals is a key lever at our disposal. And I will always continue to stand up and fight hard to see services integrated at Llandudno hospital, because you've promised me, as have previous chief executives of the health board, and previous Ministers, that Llandudno General Hospital does have an integral part to play. So, you know, actions speak better than words.

At present, the Welsh Government management of the Welsh NHS has caused a situation in which the Stroke Association are warning that delayed transfers of care are causing a number of problems in emergency care for stroke patients. Cancer Research UK has stated that the quality statement lacks detail and accountability. It does not set the vision needed to support services to recover from the impact of the pandemic whilst improving cancer survival. We certainly have a crisis with mental health services in north Wales. Despite the Deputy Minister claiming that mental health for children and young people would be a top priority, only 38.1 receive their local primary mental health support services assessment in north Wales within 28 days, and that was in December. Compare that to Cardiff, however, where the figure is 91.3.

And it gets worse. The Nant y Glyn community mental health team in Colwyn Bay is failing our residents. I have constituents who are in mental health crisis, and, when they reach out to this Nant y Glyn clinic, they can't get through to the centre on the phone, let alone access any specific support. I've asked Fleur Evans now to meet me with Mr Kenny Burns, the manager of that centre, because it is not good enough. People are coming into my office seeking urgent mental health support, people are also coming into my office threatening suicide because they cannot access this support. I've raised this year after year after year here, and you can turn around, Minister, with all due respect—and I do have a lot of respect for you; I just feel that we come here week after week, we raise the same concerns, you listen and you respond, but it's not words I want, it's action for my residents—

On that point, you have used your time.

Gosh, right. [Laughter.] We have at least 100 consultants across Wales—of shortages. There has been no increase to the advertised 309 medical school places at Cardiff University. I could go on—

No, you will not.

—but I'm not allowed, but this is a really serious subject, and I thank my own group and Darren Millar and Russell George for bringing this. We will bring these debates week after week, month after month—I hope not year after year. Please listen to us, Minister, but please improve the health service in Wales.

I too would like to thank Darren Millar for submitting today's vitally important debate and, of course, Russell George for opening today's debate on NHS waiting lists. I'd like to start today by firstly putting on record my gratitude and thanks to all those wonderful and dedicated people who work in our health service, who go above and beyond in the work that they carry out. As someone who has both a brother and a sister who are nurses in the NHS, I understand first-hand the work and dedication carried out by so many—[Interruption.] An important phone call, I'm sure.

Nevertheless, Deputy Presiding Officer, it's this Welsh Government who continues to fail our health service here in Wales, and, of course, this is an issue that was evident, as already described eloquently by so many, long before the COVID-19 pandemic started. This has been a responsibility for Government here in Wales for 23 years now, and, with all due respect to Jenny Rathbone's contribution, I hear what was said, but 23 years to fix many of the issues that have been raised here and I too will raise in a moment—.

We constantly see, of course, a significant portion of taxpayers' money in Wales, over half of Welsh Government's budget, being spent on health, and we have to ensure we see value for money.

Will you take an intervention?

Certainly.

Thank you. We've talked about—. Over the last 10 years, we've had cuts in public service funding, which has impacted on the money that's been available to social care through the councils. We've talked about not being able to move people on—[Interruption.] No, the UK Tory Government have cut public service funding under 10 years of austerity, which has impacted—

Can you let the Member make the intervention, please?

—which is what has impacted on not only social care services, but services that are able to be provided through local authorities, preventative services, all sorts of things and help to people. Do you not agree with that, Sam Rowlands?

Well, you make a point in terms of the budget allocation here in Wales, the responsibility of the Government of Wales, but you have to ask the question: pressures across the United Kingdom in terms of budgets and dealing with debts that Government has to deal with, but we still see the worst waiting times in Wales than anywhere else in the United Kingdom—. Darren Millar wants to intervene.

Yes, I'm grateful to you for taking the intervention. It's a matter of fact that no Conservative Prime Minister has ever cut an NHS budget. The only Government in the United Kingdom that's ever cut an NHS budget is the Welsh Labour Government. It's your party, Carolyn Thomas—it's your party, Carolyn—that have actually cut the budget. 

Can I remind the Member that an intervention is directed towards the speaker and not somebody else?

I appreciate the Member's intervention and I took that to come to me directly there. 

It was directly to you.

Thank you very much. So, in my contribution, if I may continue, Deputy Presiding Officer, I'd like to focus on emergency waiting times initially and how, quite frankly, we see this area continuing to fail. The statistics are shocking. As already outlined today, we see one in five on a waiting list; one in four in Wales waiting over 52 weeks for an appointment; and, in addition to this, since just August we've seen those waiting over two years more than treble across Wales.

Now, in looking at my region in north Wales, the health board in north Wales has more people on waiting lists than any other health board in Wales, and I'm afraid these statistics continue to get worse when looking at those in accident and emergency units. Within four hours, we see some of the worst waiting times in accident and emergency units—within four hours—in Wales than anywhere else across Britain. They are deeply concerning statistics. Again, coming back to my region in north Wales, for example in Ysbyty Glan Clwyd, one of the main hospitals in north Wales, one in four patients had to wait in accident and emergency for over 12 hours. Looking at ambulance response times, north Wales has one of the worst response times in Wales. I've stood up here before and talked about this north-south divide, and, again, in terms of health outcomes and health performances, we see a north-south divide. Health is not performing anywhere near as well in north Wales as it is across in other places in Wales. I come back to this point: 23 years to solve some of these issues. We do forget sometimes, sadly, that people are paying for this service. People are paying through their taxes to sit in accident and emergency for over 12 hours; people are paying to wait for hours and hours and hours for an ambulance to turn up to help them out. This really isn't acceptable.

The second area to focus on, I believe, is the cancer waiting times. Staggeringly, prior to the pandemic, the target for cancer waiting times had not been met since 2008. In addition to this, the Welsh cancer intelligence unit's data sadly shows that Wales has the lowest survival rates for six cancers and the second lowest for three cancers in all of the UK. Of course, deeply concerning for patients and families up and down Wales. It's clear to me that the plans that the Welsh Government have are not working.

When looking at some of the most up-to-date statistics, we can see that the Welsh Government is still failing on cancer targets. In February this year, just 59 per cent of patients newly diagnosed with cancer started their first definitive treatment within 62 days of first being suspected of cancer—well below the 75 per cent target. Again, it's worrying for patients and families across Wales that these targets are being missed. I mentioned it in my contribution earlier, Minister, in terms of the question. My worry for much of this—and we'll stand here and we'll highlight these issues—is the trust that this erodes in the health service and in the targets and the actions that the Government are looking to take to improve the health service. If that trust goes, then we're really, really struggling to bring our residents along with us. 

The Member needs to conclude now.

I will wrap up, Deputy Presiding Officer. Now, of course, is a time for Welsh Government to take these issues seriously. People's lives are on the line, which I know we're all aware of. I believe that Welsh Government needs to urgently rebuild the trust of residents across Wales by improving our health service, hitting the targets that it sets, and improving our health service for all. In light of this, I call on all Members to support our motion and reject the Welsh Government's amendment. Diolch yn fawr iawn.

I call on the Minister for Health and Social Services, Eluned Morgan.

Diolch yn fawr, Dirprwy Lywydd. I'd like to start by, I hope, speaking on behalf of the whole Chamber, just to say that I'm glad to see Altaf Hussain back in his place. I'm really pleased that he's had good treatment from the NHS, along with 200,000 other Welsh people per month who are receiving treatments in the NHS. I think we've got to start with that. Can we please recognise that the NHS is not broken, that 200,000 people per month, despite the pandemic, are still being seen and are getting good treatment?

I want to thank you, Dirprwy Lywydd, for allowing me to respond to this debate. I published the report on planned care on 26 April. That, of course, was developed in collaboration with our clinicians, so this is not a civil-servant-created plan; this is one that's been developed with clinicians, with our NHS. And what we wanted to do was to make sure we had something that was both challenging and achievable. So, you can say, 'We're going to clear the whole backlog within a year', but it's unrealistic to think that's going to happen, and my predecessor was very clear that it's going to take the whole of this Senedd term to clear that backlog that has developed.

You know that we've promised to invest £1 billion in clearing the backlog. I'm glad to see the finance Minister's here to hear me saying that. And I guess, if we had more, we could do more, but, actually, we are restricted because of the money we get from Westminster. And let me tell you that if you put together health and care—and you've all talked about how important that relationship is today—then we're spending 4 per cent more than they are in England on health and care here in Wales. And I must say that, in terms of Plaid Cymru, this is one of our priorities, but this was not one of the priorities that you set out in the partnership agreement. So, we have to deal with the money that we have here.

Now, I know, through meeting our dedicated NHS staff, that despite what they've gone through over the past two years, they are up for the challenge. I've spoken to surgeons and anaesthetists who've told me of their frustrations in not being able to operate at the rates that they need to for their patients. And you're right, Rhun, you hear the Royal College of Surgeons saying, 'do this', but then you speak to the Royal College of Physicians, and they say something different. So, let's be clear that there is not a one view from the NHS in terms of how to tackle this backlog. And it is absolutely clear that the pandemic has had a massive impact on our health and care services. It's stretched the NHS to its limit and, prior to the pandemic, in 2019, we had no more than 9,000 people waiting for 36 weeks for treatment.

North Wales—lots of you talked about north Wales—it needs some attention, and I'm giving it lots of attention. I can assure you that I've been to the north Wales health board more than any other health board, but, actually, can we start to talk up what's good about north Wales as well? Cancer treatments are better than anywhere else in Wales. Now, we're not hitting the targets and we've got further to go, but let's give praise to all those NHS workers who are really working hard to clear that backlog. I think it's really important we're really careful about talking down Betsi all the time because, frankly, it's making it more difficult to attract and recruit people. So, can we please be sensitive in the way we talk about it? Of course you can hold me to account, of course we need to hold the health board to account, but just understand that there is a consequence to this constant criticism.

We're acutely aware, Minister, of the importance of praising the good, but shining a light on the bad. We have to have honest discussions, and that means calling out when the health board is failing. And certain aspects, unfortunately, of service in north Wales are failing, and that's what you've heard referred to today. We adore the hard-working staff in our NHS in north Wales. We're constantly praising them. As local Members of the Senedd, I know that we visit local surgeries and hospitals all of the time and have lots of interaction with our health board, but you can't expect us to have a gagging order from you about not calling out bad practice—

I'm not—. I was very careful in what I said then.

—because it's important that we do so that you can get to grips with it.

I can assure you there is no gagging order from me.

Thank you.

Can I just make it clear also that we heard loud and clear when the UK Government published their planned care plan that they didn't have a workforce plan alongside it? Well, we are very aware that we can't deliver this without a very active workforce, and we have recruited 8,000 more staff into the NHS than we had in September 2019. That's about a 54 per cent increase in staff to the NHS in the past 20 years. That is a significant increase. Not enough, there's still more to go. But we're not starting from scratch here. We will need more staff in clinical and administrative posts, we'll need to use the staff we have effectively, and we're going to make much broader and better use of the skills and expertise of our staff, including our nursing staff and our allied health professionals, to support people while they're waiting for their appointments. [Interruption.] If you don't mind—. Go on, Altaf.

I just want to speak about a very small thing. What you said about the clinical staff, nurses, everybody, is fantastic. But I have written this paragraph: managers have been appointed without a job description, or at best a job description of managerial description. They have become the embodiment of self-focus, self-development, self-progression, self-preservation, self-extension, self-propagation to the exclusion of the broader interests of the NHS. This tendency can fundamentally subordinate and undermine our NHS. That needs to be looked into, please.

Altaf, let me tell you what I do and what I don't do. What I don't do is I don't manage the NHS. That is not my job.

Someone needs to.

Wait a minute—that is not my job as a politician. That is not my job. That is the job of the NHS health boards, and it's my job to hold them to account, and it's my job to set them targets and to hold their feet to the fire for those targets and those outcomes, and that's what I'm doing. But I will not be getting involved in writing contracts for people, and I think it's really important that we understand where the lines are here.

Lots of people have pointed to the need to do something about the delayed transfers of care, and it is a really difficult situation we're in here. Let me tell you that, at this point in time, about 43 per cent of our care homes are closed in Wales as a result of COVID. This is not something we've created. These are the circumstances we're in at the moment. Now, I can't take full responsibility for that. One in 25 people in Wales have COVID at the moment, so these are pressures that we're having to deal with. We could have published our plan a year ago, but what would the point of that have been? Because there is no way you can respond if you know that, actually, you're going to have wave after wave of COVID, where you can't actually see the movement and progress that we want to see.

So, I think it's really important that we understand that COVID is still with us. There are 700,000 open pathways, and we're very aware of that, and I can tell you it keeps me awake every single night, but they're pathways—they're not all individual people. There are lots of people who have more than one pathway that they are on. I was clear that it would take the full Senedd term and a lot of hard work to recover from the impact of the pandemic, and I was interested—. Rhun and Jenny always talk about the importance of the prevention agenda. This was very much a planned care programme, and I can tell you that I am not taking my eyes off the planned care agenda, because, frankly, they will just keep coming into the system unless we do something on the prevention agenda. I've been meeting with the World Health Organization this morning, who are very interested in our prevention agenda, and it's really important that we don't take our foot off the pedal on that. If you were in the Chamber yesterday, you'll have heard about our outcomes framework, which is all really geared to the preventative agenda.

It is important now that we increase the capacity of the health service, that we prioritise diagnosis and treatment, that we transform the way that we provide elective care, and it's also important that we provide better information and support for people. We have allocated additional millions of pounds to ensure that we see theatres and additional resources for endoscopy, and that is already making a difference. So, our recovery plan does acknowledge that the whole system needs to work together to achieve the aims of this plan, from the primary care sector working very differently with the secondary care sector, services to support patients to manage their health in their own homes and we need to decrease the need for care in hospitals. It's important that the care sector and the social sector work together to ensure that patients are released from our hospitals safely. I'm sure that we're all going to work together to recover from the pandemic.

I call on James Evans to reply to the debate.

Diolch, Deputy Llywydd. I want to start this by thanking everybody in this Chamber who has contributed to this very important debate today. This debate is of vital importance to the people of Wales. I know personally about this waiting list, because my mother had been waiting four years for a hip operation, in excruciating pain, but I'm pleased to say that she has now been treated.

As my colleagues Russell George, Rhun ap Iorwerth, Janet Finch-Saunders and others have said, NHS waiting lists now are longer than ever before. One in five people are on a waiting list. This affects people of all ages and all backgrounds and they're all being hugely, negatively affected by these backlogs. As Rhun said, the NHS was creaking under pressure before the pandemic began. Early delays, which were mentioned, have caused problems in the wider NHS and it has made pre-existing health conditions an awful lot worse, especially around cancer diagnosis. 

I was very pleased to see more investment going into the NHS. However, we do need to be assured that that additional investment will be spent on the front-line NHS and not lost in bureaucracy. We don't need anymore managers; what we need is more doctors, nurses and front-line health professionals to deal with the problem. More money goes into the NHS in Wales than in England. So, it's not the money that's the problem, it's the way that the NHS is managed. It was great to hear Altaf Hussain's very powerful contribution to this debate. I'm sure that everybody in this Chamber knows of your experience, Altaf, and you're very well respected, not just here, but across the world for your experience in the NHS and what you have done.

In my own constituency, residents face lengthy delay times. They don't have access generally to a district general hospital. We are seeing community support being reduced. Knighton Hospital in my community has seen the services cut back. We're seeing local wards close. Janet Finch-Saunders made the point about local community health, and if we are to sort the delayed transfers of care out, we need to make sure there are beds in our community hospitals for people to be transferred into.

We have previously discussed the damning report 'Waiting well?', which stated the impact of the waiting times backlog. It called for robust plans to be put in place. Whilst the Minister has announced a series of measures to tackle this, and I and many others welcome that statement that there are commitments in place, it's vitally important that the Government and this Senedd and relevant committees can scrutinise health boards to make sure they are delivering on their targets and that people aren't let off the hook.

Jenny Rathbone did say that this plan has only been in place for two weeks. But, I would just like to remind you that this Government has been in place for over 20 years, and it was creaking before, so you cannot blame the pandemic for everything. Things were going backwards before, so I'd like to ask the Minister to reflect on that and not blame everything on the pandemic. Yes, Jenny, I'll take an intervention.

Yes, it has only been there for two weeks. What is it that's not adequate about this now? You said it's not an adequate plan, so what would make it adequate in your view?

What we want to see is timescales. We're not seeing adequate timescales for delivery on these things. We're seeing the surgical hubs some of us don't have; we're not seeing when surgical hubs are going to be delivered right the way across Wales. There's no time frame for that—it's in the plan. We're not seeing where all this money is actually going to be invested. We want to see that so that we can scrutinise it properly. 

Because we do welcome surgical hubs, Minister. That's something that you and I, and Russell George and my party, have been calling for for many years, because we want to see the number of people going into the NHS increasing. But when those people go in, we need to ensure there is adequate staff there to make sure that people are getting seen. I've said to you, and I'll say it again: I do think we need to have a radical look at how we get people into the NHS, whether that's through degree apprenticeships or having a radical overhaul of how people become nurses or doctors.

A lot of people have mentioned in this Chamber—[Interruption.] I'll make a bit of progress, Carolyn, and I will come back to you. Prevention is better than cure. Many people have said that. And I do respect the Deputy Minister's position here of trying to address that, but we need to push this faster, quicker, to make sure it's delivered. We don't want to see people who are suffering with obesity on waiting lists, because that puts pressure on the NHS in terms of delays in discharge. Public health needs to be prioritised and that means closer integration with our local authorities. 

I do want to talk about discharge. Social care and the health sector working together isn't working at the moment. We have seen too many people sat in hospitals bed blocking, and the link between the health boards and our councils needs to be more integrated. I know, Minister, you will say that we now have the regional partnership boards in place to help deliver that, but with 1,000 people still waiting in beds, as Russell George has said, I'm not sure if that integration is working. And something I'd like to push you on is to make sure the regional partnership boards are delivering that.

Minister, I don't want you to see this motion as an attack. I think emotions got very high earlier around this. Russell George, my colleague, put in some very good points on how we would like to see things improve across Wales, and that's what I want us to do here. The NHS isn't Labour's, it's not the Conservatives', it's not Plaid's, it's not the Liberal Democrats', it's the public's NHS. They pay their taxes, they expect a decent service, and that's why we as Welsh Conservatives will hold the Government to account on this. That is what we are here for, and that is why I urge all Members to support this motion in front of them today. 

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Yes. I will defer voting on the motion until voting time. 

Voting deferred until voting time.