Questions now from party spokespeople. Conservative spokesperson, Gareth Davies.

Diolch yn fawr iawn, Llywydd, and good afternoon, Deputy Minister. Last week, the First Minister told this Chamber that there was no need for an independent inquiry into children’s social services in Wales, despite similar inquiries taking place in the other UK home nations and despite calls from many of the experts in the sector. The First Minister pointed to the wealth of advice and reports received by your Government, such as the 2018 'Care Crisis Review' and the 2019 'Born into care: newborns and infants in care proceedings in Wales' report by the Nuffield Family Justice Observatory. The First Minister said you didn't need any more advice. Could you therefore explain why in 2022 two experts in the field are saying that children’s social care in Wales is in a crisis and are calling for a independent review?

Thank you very much for that question and I am thoroughly in agreement with what the First Minister said last week. I don’t think we need another inquiry in Wales at the moment. I think we can learn from the inquiries that have taken place and certainly we’re studying the English inquiry. And I think there are lots of points in the English inquiry that are very similar to the sort of things that we are planning to do here. What we feel is that what we need is action, not another inquiry. I think we know that social care does need reforming. We are convinced it needs reforming and we are planning to reform it and we have a whole list of reforms that we are going to carry out. So, we really feel that we need action and we see no point in having another inquiry at this stage. But as I’ve said, we will look very carefully at the recommendations from the English inquiry that has just come out and we’ll certainly learn from those recommendations, but we have a plan for reform that we are getting on with.

Well, I'm disappointed by that answer, Deputy Minister, and we'll have to agree to disagree on the need for that review. And we have a duty, an obligation, to protect our children from harm, to protect them from adverse experiences. There are still far too many children being treated for alcohol or drug addiction. The number of people being treated for foetal alcohol syndrome are not held centrally, so we don't know the whole picture. Deputy Minister, you have rejected our calls to adopt the WAVE Trust's 70/30 target, because it doesn't go far enough, but what are you doing to eliminate adverse childhood experiences here in Wales?

Thank you for that question. Yes, we’ve rejected the WAVE recommendations, because we don’t think you can say you’ll only help 70 per cent of children and 30 per cent you don’t help—we want to help 100 per cent of children. So, I’m sure that the intentions behind the WAVE recommendations, I’m sure, are very good, but you can’t say you reject 30 per cent of the children—you can’t help. And so that’s behind our reasons for not accepting the WAVE Trust.

And, yes, we do have a duty to protect our children and that's why we are putting record amounts of money into social care, into social services, in order to support families to bring up their children and to support them in a wide variety of ways, because it’s absolutely crucial that we do what we can to support families and to support children to stay in families because I think we would all agree that the best place for children is in their families, and there are far too many children who are looked after by the state in Wales and we want to see those numbers reduced. And so we are putting in more help to protect children in families.

Thank you for that answer, Deputy Minister. I think the aspiration is what we need. Of course we want to protect 100 per cent of children in Wales, but going to 70 per cent and adopting a policy that's accepted in other UK nations would be step in the right direction, and I strongly recommend that the Welsh Government do reconsider this. Many of your colleagues, here and at Westminster, support obtaining a 70 per cent reduction to the levels of children who currently undergo ACEs by 2030, which, by the way, is the absolute minimum that the trust are calling for, rather than the maximum. In fact, a majority of your colleagues in the Labour Party support the target. Every Labour Member of the Scottish Parliament stood on a manifesto that committed them to 70/30. Why the disparity between the different parts of your party? You're split on devolution, you're split on the media, you're split on the constitution, ACEs—the list goes on, Deputy Minister, and we can't sit idly by and accept this. Will you therefore agree to a meeting with me, the WAVE Trust and one of their Welsh ambassadors, a survivor of adverse childhood experiences themselves and someone who can share their lived experience?

Thank you very much. I can only speak for what our policy is here, and our policy here is not to adopt the WAVE Trust's proposals. I have met with the WAVE Trust, I had a lengthy meeting with the WAVE Trust, I have discussed with them in detail why we don't support their proposals. I think they understood why, because we are ambitious, and we don't think we can write off 30 per cent of our children. And in terms of ACEs, I'm sure you're aware of the large amount of money that the Welsh Government puts in to ACEs, in order to try to prevent adverse childhood experiences. That has been one of the key ground stones of our policies. And we've also been putting in a lot more money in terms of grass-roots community resources, where adverse childhood experiences can be prevented by the support of a community. So, our work on ACEs has moved, and, really, we're one of the leading countries in terms of work on ACEs. So, I think, really, continuing to go on about wanting to sign up to the WAVE Trust—what we want to do is improve things here for children in Wales. I'm happy to listen to the WAVE Trust, I've met them, I know what they say, and we are continuing to try to do our best for the children in Wales.

Plaid Cymru spokesperson, Rhun ap Iorwerth.

Thank you very much, Llywydd. A question first of all that I’d intended to ask before realising that we as a health committee were publishing today our report on patient flow through the health and care system. The recommendations, I think, are powerful, they are important, and they relate to the need to strengthen the social care system, to attract and support staff. It’s a sector that has been ignored for far, far too long. But may I suggest that there is another elephant in the room when it comes to ensuring that patients can be released in a timely manner from our acute hospitals? There are some 10,500 hospital beds in Wales; 30 years ago, there were over 15,000. We’ve lost one in three beds. And many of the beds lost were community based, they were step-down beds, where people could go and thereby create more capacity in the acute hospitals. Does the Minister agree that the loss of that capacity, under the watch of one Labour Minister after another, of course, has helped to create the current crisis, and what are her plans to restore that community capacity?

Thank you very much, and thank you also to the committee for the recommendations. I will be taking time to go through those recommendations, and I’m sure there’ll be a lot of ideas contained in them. It’s not something that we’ve been ignoring, it’s something that we’ve been paying a great deal of attention to. But as the committee now understands, it is a very complex system, where you have to aim to make improvement on every level of the system, including the care system, which we’ve been discussing this morning.

With regard to the number of beds in Wales, of course, what we have to remember is that, ideally, what we want to see is patients going in, being treated and then returning home. We want to see more care in the home for patients. And certainly, that’s where my focus is—to try to get people discharged from hospital as soon as possible. And what that means, if truth be told, is that you want fewer beds because you want them to be discharged and at home. What we want to do is to strengthen the care in those communities, as you say, and that’s what I want to see. It's interesting that the Nuffield Trust, for example, last week, had stated in their report that there are 

270 beds per 100,000 in Wales compared to 170 beds per 100,000 in England. So, if you compare our figures, in terms of beds here in Wales compared to England, then we come out much better than they do. 

And politicians in England can criticise the English Government for what they're doing on the loss of community beds too. The problem is that you are putting unsustainable pressure on the care sector, because of the loss of that step-down facility. Resolving the issue, I think, of patient flow will be a major contributor to the work of dealing with the backlog in the health service—the waiting times. But we also need to build in new capacity there and new ideas.

Now, when the Minister announced plans to cut waiting lists and waiting times recently, we were told that some specialisms may be excluded. Incredibly, it was suggested that this could even include orthopaedics, where waiting times are so, so long, but we have a plan for orthopaedics. It's called the national clinical strategy for orthopaedic surgery. I was given a presentation today by the two consultants and the manager who've drawn it up, and it is brilliant. Exactly the kind of expert-led, in-depth, data-driven work that we need. They propose three new build stand-alone elective orthopaedic hubs, they want a national multidisciplinary workforce review, and they want to see the establishment of a Welsh orthopaedic network with the delegated powers necessary to drive this forward. Will the Minister assure us that she will do everything in her power to deliver that? 

Well, certainly you've misunderstood, if you think that we somehow excluded orthopaedics from our planned care strategy. That is the place where I have most concerns, because the waiting lists are really quite hefty, and that's why we're actually paying a lot of attention to it and focusing on it. And I've made it absolutely clear, as the Member knows, that I'm very keen to see regional hubs being developed, and we are seeing, for example in Hywel Dda, precisely what you're suggesting being developed.

This could supersede it.

And I think it's really important, of course, that we listen to clinicians. We're the people who've asked these people to come up with their ideas. The restriction on us is capital, so that is the problem that we have. Can we actually set up these establishments? We'll need to, I think, adapt what we have, rather than build new facilities, but you won't get any objection to us here from doing that. And, of course, the other issue is it's not just about surgeons, it's actually about all of the teams around them, and that's certainly the message that I heard very loudly and clearly from the Welsh Surgical Society on Friday.