We'll move now to the short debate, and I call on Gareth Davies to speak on the topic he has chosen.

Please, everyone leaving, be quiet, to let Gareth have his short debate.

Diolch yn fawr iawn, Deputy Llywydd, and it's me again. I've agreed to give a minute of my time to Samuel Kurtz tonight.

Over the past few months, I've been surveying my constituents in the Vale of Clwyd to ascertain their biggest concerns, as well as their key priorities for the Senedd as we emerge from the pandemic. One of the most startling themes to emerge was the sheer number of respondents who listed access to healthcare as their No. 1 issue.

The pandemic has certainly put our health and care systems under enormous pressure, but we knew access to healthcare was a problem before COVID. Well before the novel coronavirus made an appearance in the Wuhan region of China in early 2020, our citizens were struggling to see their GPs, driving hundreds of miles to get dental treatment, or waiting years to get a hip replacement. We became used to seeing lines of ambulances stacked up outside our hospitals. Winter pressures had become year-round pressures; we were as likely to see ambulances queuing outside emergency departments on August bank holiday as we were on New Year's Day.

As someone who worked on the front line of our NHS for over a decade, I can personally attest to the enormous strain our health and care systems have been under. And when a deadly virus has thrown into the mix, it's a sheer miracle that the system didn't break. But that’s only thanks to the dedication of my former colleagues in the NHS, not because of any leadership from the top.

The vast majority of the problems facing our NHS are down to an absence of leadership. The reason why my constituents and yours cannot see their GP, get an NHS dentist, or have had their surgery cancelled multiple times, is due to one simple fact: successive Governments have failed to do proper integrated workforce planning. The royal colleges and the professional bodies have been warning for at least the past decade that we are not training or recruiting enough front-line staff. And Welsh Government are very good at creating managers, bureaucrats and red tape, but are absolutely useless when it comes to creating doctors, nurses and healthcare professionals.

Things have improved somewhat—I do give credit where it's due—and, with the creation of Health Education and Improvement Wales, we now at least have a workforce plan, but I fear its too little too late. Just last week the Royal College of Nursing released their report on nursing staff levels, and it was a sobering read, because the sheer numbers of nurses leaving the profession should worry us all. There are at least 1,719 nursing vacancies across Welsh health boards, and, over the past five years, we've spent around £0.75 billion on agency staff. The RCN report shows how we are losing almost as many staff as we are recruiting, and last year the workforce only grew by 0.1 per cent. We gained a handful of nurses last year when we need thousands. We lost 6 per cent of the district nursing workforce between June 2020 and June 2021 and, in a survey of its members, the RCN highlights that a third of nurses are strongly considering leaving the profession early, all due to chronic workforce pressures. We are in real danger of creating a negative feedback loop—people leaving healthcare because of the pressures of not having enough staff. And it's not just nurses feeling this pressure; it perpetuates across the health and social care system. General practitioners are also leaving the profession in their droves. GPs are retiring early and some are even surrendering their medical licence, meaning that they can't be called out of retirement in times of crisis.

We were warned by the British Medical Association nearly 10 years ago that we needed to recruit around 200 GPs a year in Wales. For the majority of the intervening years we were lucky if we managed half of that. And because we failed to address the recruitment problems, we created a retention problem. In 2019, before the pandemic, nearly a quarter of practices surveyed were considering handing back their general medical services contracts. Since the pandemic, things have got much worse. GPs are warning that the strain could overwhelm the system, that pressures are putting people off the profession all together, and one in eight GP trainees say they do not intend to work in general practice after qualifying as doctors, according to a recent BMA poll.

All this is having a devastating effect on patients, many of whom are becoming sicker because of a lack of early intervention. My constituents tell me that it can take them weeks to get an appointment with their GP and practices cannot cope with the numbers of people on their lists. And when patients do manage to navigate their way through primary care, they face the same challenges in secondary care. Referral-to-treatment times were already astronomical prior to COVID and have skyrocketed since. The latest figures show that one in five of us are on a list awaiting NHS treatment, two thirds of a million people are waiting years for treatment to end their pain and suffering, and 691,000 Welsh citizens are left in limbo not knowing when their treatment will begin. How many of those one in five will die because they didn’t get a cancer treated soon enough? How many will be forced to give up work because their condition deteriorated to such an extreme that they are unable to function in the workplace?

These are the real impacts treatment delays are having on people's lives. Patients are dying, going blind and losing mobility because they can't be treated soon enough. And they can’t be treated early enough because we don’t have the staff. There are currently over 3,000 vacancies in our NHS and many in my health board, in Betsi Cadwaladr, in north Wales. We have 10,000 fewer beds than we did at the beginning of the century, yet we have frequently breached safe staffing levels over recent months. In recent weeks we saw accident and emergency departments with fewer than a third of the required staff, and if we are to recover adequately from this pandemic and be prepared for the next one, if we're unfortunate to have another one come around, we have to get to grips with the training, recruitment and retention of staff.

We need true integrated workforce planning that anticipates future service demands, and let’s not forget that the parliamentary review of health and social care warned us of the challenges we face as our demographics change. We aren’t planning to meet today’s needs, let alone to respond to future challenges. We need root and branch reform of our recruitment and retention policies, and it would help if we actually had retention policies in the first place.

We need to make working and staying in health and care a more attractive proposition. We need to encourage more young Welsh people to pursue careers in health and care. We need a workforce plan that looks at the whole picture, from science teaching to retirement planning and everything in between. It's time to join up the dots, and that requires leadership. It requires a Welsh Government that can plan for the future. I urge the Minister to grasp this nettle now and make workforce planning her No. 1 priority, otherwise my mailbag and yours will continue to overflow with complaints about not being able to get a face-to-face appointment with a GP, about not being able to see an NHS dentist, or about not being able to get a suitable care package for an elderly relative. We can’t afford to lose any more NHS staff, and my constituents can’t wait any longer for treatment. Diolch yn fawr.

I'm grateful to the Member from the Vale of Clwyd for bringing forward this short debate, and the Minister won't be surprised that I'm bringing forth the Argyle Medical Group and Argyle Street surgery as my example this evening. This is one of Wales's largest GP surgeries, with a patient ratio of approximately 2,506 patients per GP. This is a real burning issue in my mailbag, as constituents cannot get access to healthcare services. I understand the need to move away from just seeking GP services, and we can move away to looking at nurses, physiotherapists and pharmacists, but there are still real issues within this GP practice in Argyle Street. I do pay tribute to Judith Scourfield, the practice manager, and the staff of Argyle Street; they are working incredibly hard. But I do feel there needs to be something targeted here to really support them in what they're trying to deliver in my part of the constituency. Diolch, Dirprwy Lywydd.

I call on the Minister for Health and Social Services to reply to the debate—Eluned Morgan.

Diolch yn fawr. I'm grateful for the opportunity of this short debate today to discuss the important topic of access to health services. Now, under a Labour Government here in Wales there are now more doctors, nurses and other healthcare professionals working in the NHS in Wales than ever before: over 104,000 people and 89,000 full-time equivalents—3,600 more staff than at the same time last year. And far from being absolutely useless, since 2016 the number of medical and dental staff has increased by 21 per cent. We've got nursing, midwifery and health visiting staff up by 9 per cent, scientific, therapeutic and technical staff up by 24 per cent, and ambulance staff up by 39 per cent. We are training 69 per cent more nurses than we were before 2016, and last week I hope you noted that we recruited 400 new international nurses.

We're not, however, complacent, and it's not just numbers alone that are going to guarantee the success. It's about how health professionals collaborate and use their skills, including their Welsh language skills, in the most effective way for patients. We therefore have a programme for government commitment to deliver better access to doctors, nurses, dentists and other health professionals that builds on previous commitments. Action is centred around the primary care model for Wales, which is about people accessing the right care from the right professional or service for their specific needs, at or as close to home as possible. 

Now, this means increasingly people will only travel to hospitals for those services that should only be delivered in those settings. As the national clinical framework programme drives national clinical pathways, we'll make faster progress with rebalancing services, funding the workforce away from illness and hospitals towards wellness and care closer to home. 

Now, in the time I've got today, I can't do justice to the huge range of policy and activity through our national programmes for primary care, for planned care, for urgent and emergency care and for mental health to support this rebalancing of the system, so I'm going to highlight the action to improve access to those services that most people frequent and are most familiar with, and these are our primary and community services. 

To improve access to GPs, we've introduced a change through the general medical services contract to remove the bottleneck at the start of the day. I have provided extra funding of £4 million annually over the next three years to build capacity in GP practices. The primary care model is about increasing the range of services and health professionals accessible in the community. GPs and practice nurses are not always the right health professional for someone's needs, and as a physiotherapist, I'm sure you're well aware of that. For example, an optometrist is the right person to treat eye problems like red eye; community pharmacists offer an increasing range of services, from hay fever to emergency contraception; ear wax causing hearing loss is a common problem, and we're increasing the availability of community audiologists.

I'm very aware that one of the biggest areas of concern for people in terms of access is dentists. Managing the infection control requirements of COVID has meant a lot less capacity in dental practices. Reforming the dental contract is our main policy driver to deliver that better access, and we will create more capacity for new patients by moving away from the historic six-monthly checks for all to a service based on individual need and prevention. For many people whose oral health is good, they only need to have a check-up once every two years. We do need to communicate this better to the public, and I welcome Members' support in conveying that message.

Last month, I launched our new six goals for urgent and emergency care programme, and I'm supporting this with £25 million of investment. Key developments enabling better access are the eight new urgent primary care centres across Wales, with two more opening shortly. And our 111 telephone service is now available across the whole of Wales. The '111, press 2', directs people to mental health well-being support. Also in April, I published our programme for transforming and modernising planned hospital care and reducing waiting lists. Now, importantly, the plan also signals the transformation of community-based services to offer different options designed to support a person to do what matters to them. We are moving steadily into a new phase of the primary care model. This phase is about increasing the visibility and development of community services, where the focus of leadership and investment is on wellness, independence and the integration of health and care.

A recent King's Fund paper on what we could learn from the pandemic states that a successful and sustainable recovery is possible if there is investment in the resilience of communities and community-led approaches, with individuals and communities in the best possible health to cope with what comes next.

As part of the strategic programme for primary care, there is also a specific workstream on prevention and well-being. This workstream sets out a national primary proposal for mental health and well-being that will be the basis for planning and local provision. There are also other commitments under the programme for government for community services, and developing a national framework for social prescribing is one of them.

The new regional integration fund, which is worth £144.7 million, continues to move us closer to realising our vision in 'A Healthier Wales', a vision where Wales has one integrated health and care system, that concentrates on health and well-being and on preventing illness—a system that enables people to benefit easily from a wide range of services and facilities in their communities. 

To close, I think we can agree that a wide variety of measures are being developed to improve access to healthcare, but there is more yet to come. As well as improving access for individuals, I want to see these improvements making a positive difference to those who provide the services. Their commitment is constant, and it's important that we support individuals in their communities. And the support that they have provided to the public has been exceptional. Thank you very much.

I thank the Minister. That brings today's proceedings to a close. Thank you, everyone. 

The meeting ended at 19:05.