The next item, therefore, is the debate on the Health and Social Care Committee's report, 'Waiting well? The impact of the waiting times backlog on people in Wales'. I call on the Chair of the committee to move the motion. Russell George.

Motion NDM8039 Russell George

To propose that the Senedd:

Notes the Health and Social Care Committee report: 'Waiting well? The impact of the waiting times backlog on people in Wales’, laid in the Table Office on 7 April 2022.

Motion moved.

Diolch, Llywydd. I’m pleased this afternoon to debate the Health and Social Care Committee’s report on the impact of the waiting times backlog. I move the motion in my name.

What is important to say is that before the pandemic, people were already waiting far too long for diagnosis, care and treatment. COVID has of course made the situation worse across all specialities and all stages of patient pathways. It is frequently said that the equivalent of one in five people in Wales are on a waiting list for diagnosis or treatment. Behind those numbers are of course individuals whose daily lives and potentially those of their families, friends and carers are being affected by delayed diagnosis or care. Alongside written and oral evidence, the powerful case studies collected by the Senedd engagement team captured the experiences of people waiting for diagnosis or treatment themselves or for someone they care for, and we're grateful to everyone who was willing to share their experiences with us as a committee.

The Deputy Presiding Officer (David Rees) took the Chair.

We heard about people who are in pain, discomfort or experiencing anxiety. And we heard about people whose needs are becoming more complex, which puts more pressure on health services and on unpaid carers, who may be asked to take on more complex caring responsibilities. We also heard about people who are less able to work, study or undertake their usual caring responsibilities, and whose costs of living have increased, of course, as a result of their condition. We also heard about the pressures facing the health service, and by the health and social care workforce, as they tackle the pandemic and the waiting times backlog. And, of course, we thank the social care workforce, including unpaid carers and volunteers, for all the work that they have done and continue to do. Without a sustainable, engaged and supported workforce—we must remember that the workforce is far broader than just doctors and nurses—we simply will not have the transformation in our health and care services that we need to see. 

Our report focused on the impact of the waiting times backlog, and what can be done to help people wait well. We are pleased that the Welsh Government accepted 26 of our recommendations in full, and the remaining one recommendation in principle. The vehicle for addressing many of our recommendations is the Welsh Government’s plan for transformation and modernisation in planned care and in reducing waiting lists in Wales. In recent weeks, we have gathered views on the plan in writing, and earlier today, actually, we as a committee, as members, met with stakeholders here at the Senedd. Stakeholders broadly welcome the plan; they want to see it succeed, as, of course, do I, but they also have concerns about whether the plan is sufficiently detailed, whether it provides a clear enough vision for the transformation of our health services, and whether there is enough capacity to deliver it. And that's a key message, actually, from the group of stakeholders I spoke with this morning. The key message was that the plan is great, the plan is ambitious, but they were concerned there is not enough capacity to deliver the plan. 

We all know it will take time to bring waiting times down. Audit Wales, in its recent report on planned care, estimates that it could take seven years or more to return waiting lists to pre-pandemic levels. It is vital, therefore, that people are supported to wait well. That's part of our recommendation 1. So, we strongly welcome the inclusion in the Welsh Government’s plan of a commitment to improve the information and support available to people while they wait for diagnosis and care.

However, while we welcome the developments such as the commitment to improving patient communication, particularly coming across this morning with stakeholders as well, they've told us that more information is needed about the time frame for delivery, how the power and experience of the third sector will be harnessed and how risks of digital exclusion will be managed. Some information and communications will need to be personalised and tailored to individuals’ needs to make sure that they have the right information for their circumstances. I heard a shocking experience this morning about how a template letter can sometimes have to go through 20 stages before it's finally agreed. However, stakeholders told us this morning that time, resource and expertise will be required for communication to be effective and accessible, and I would welcome further clarity from the Minister about what the Welsh Government can do to ensure that sufficient resource is available, and how a balance will be struck in national co-ordination to provide consistency of messaging and avoid duplication.

Health inequalities is a key priority for us, and we asked the Minister to explain how support would be targeted to people living in more deprived areas. We welcome the indication that a national group is being established to develop solutions to support local populations and identify how inequality gaps in prevention and planned care will be closed. We look forward to hearing more about the work of this important group in due course. However, in the meantime, stakeholders, including the Royal College of Physicians, and Macmillan Cancer Support, have told us that they are concerned that the Welsh Government’s plan lacks detail on how it will take account of and tackle health inequality. So, I would be grateful if the Minister could say something today about the work of the national group and how that will inform the implementation of the Welsh Government's plan to transform and modernise planned care.

Our report calls for the routine publication of waiting times data, disaggregated by specialty and hospital. The availability, transparency and detail of data was a real key issue that was raised by stakeholders this morning. Like us, they want to see more detail about the types of treatments people are waiting for, and that data broken down further. The Minister accepted our recommendation, but said that she is still considering her approach, including what information will be useful and meaningful. Stakeholders also told us that better data was needed about the health and social care workforce, warning us this morning as well that the age profile of staff in some specialties represents a cliff edge in terms of workforce capacity. It would be helpful if the Minister could tell us more this afternoon about the timescales for improving the availability of data in relation to waiting times and the workforce.

Reducing waiting times will require leadership and national direction. Stakeholders have told us that they broadly support the plan’s ambition, but that further detail is needed on the leadership arrangements and how change will be delivered, including how health, social care and third sector partners will be engaged and involved. Key issues raised include the role of the new NHS executive and regional partnership boards, and the need for greater clarity about how overall accountability for delivery is distributed between different local, regional and national planning programmes, project groups and networks. We also heard concerns about whether the plan does enough to recognise the impact of challenges in social care.

In her response to our recommendation 26, the Minister explained that she would hold health boards to account against their integrated medium-term plans, and that a new national director of planned care, improvement and recovery has been appointed to work with the NHS to ensure that local improvement plans meet the Welsh Government’s commitments and ambitions. However, I would welcome the Minister’s views this afternoon on stakeholders’ suggestions that an annual progress report should be laid before the Senedd, and that more needs to be done to encourage health boards to work together and increase the pace of developing regional models.

Finally, in our report, we explored the different ways in which the waiting times backlog is affecting different physical and mental health conditions and services. Stakeholders have told us that it isn’t clear to them whether all specialties are covered by the Welsh Government’s plan. For example, Cymru Versus Arthritis notes that it isn’t clear whether orthopaedics is included, and Mind Cymru has called for urgent clarification of whether the recovery targets apply to mental health services, particularly as delays to the mental health core data set mean that detailed waiting times for many mental health services are not available. I would be grateful if the Minister could clarify whether orthopaedics and mental health services are included within the scope of the recovery targets in the Welsh Government's plan. I look forward to contributions from Members this afternoon.

First of all, may I thank my fellow committee members for having collaborated with you on this report? I'd like to thank the clerking team and the wider support team and the research team, and everyone who shared with us as a committee their experiences and their expertise as we tried to better understand the impact of long waiting times for treatment. 

We're at risk at the moment of almost accepting that people are going to have to wait a long time for treatment. It's endemic. One could start to think that it's inevitable, but it isn't. And this report, I think, makes it clear in a number of recommendations that we can't accept the status quo, and that we can't accept that we will return to the pre-pandemic stage, as the Chair said.

The report makes a number of recommendations you could place under a broad heading of reducing waiting lists. We've looked at commissioning higher capacity to strengthen the workforce, to encouraging early diagnosis, to tackle health inequalities—those things that will make a different in the longer term—but I think it was timely to do a piece of work on dealing with the long waiting times we currently have and how they impact people. The statistics are frightening, with something like 0.75 million people in Wales on some kind of waiting list. And it's very important to always bear in mind that these are real people, not statistics, and that many of them are in pain, they're anxious, they see their health declining even further, they can't live their lives as they should, they perhaps can't work, and therefore we need to think of their well-being always as they wait. We make recommendations as to how to support patients as they wait, on investment in helping patients to manage pain, where there's been huge underinvestment. We need to inform people about alternative support that they can access in their communities whilst they wait, support through pharmacists and so on, and there are specific recommendations on those areas. 

It became very apparent to us that there are very fundamental weaknesses in the communication with patients. How many times have we as Senedd Members worked on behalf of a constituent who's reached the end of their tether because they simply don't know where they are on their journey through the health service, or how many times we have listened to someone whilst they explain their physical pain or their anxiety? Recommendation 19 relates to using technology as part of the communications work. I'm wearing another hat as the chair of the cross-party group on a digital Wales, and I will remind you of the words of the Deputy Minister Lee Waters in the Senedd, comparing the kind of service that we have in ordering something online, knowing exactly where your parcel is on its journey—comparing that with what we should expect in the twenty-first century in our health and care service, surely. You know that your Christmas shopping will reach you at 3.30 next Tuesday afternoon, but if you want to know when you'll get something far more important, such as a new hip, well, yes, you can knock on the door of your Senedd representative, but, as a rule, you would go to your GP, who would write to the health board, and they would write back—it produces work. It's ineffective and it leaves patients in the dark. It adds to that emotional strain faced by patients very often as they wait for treatment.

Dirprwy Lywydd, tackling waiting lists in the health service does have to be one of the great priorities of the Welsh Government, if not the priority, and holding them to account on the work that they do in tackling the problem does have to be a priority for us as a Senedd. That is why this report is so important. I'm pleased that the Government has accepted 26 of our 27 recommendations, and accepted the other partially, but we can't be content with that. And very often, in accepting a recommendation, what the Government says is that, 'Well, we're already doing this.' But this is a mountain to climb, and our message as a committee is clear: the Government is not doing enough as things stand, and the people of Wales are suffering as a result of that.

Can I start also by thanking the Health and Social Care Committee, along with Russell George's chairmanship, for bringing forward today's debate and report, 'Waiting well? The impact of the waiting times backlog on people in Wales'. As someone who isn't a member of the committee, I found this report extremely important, as the current waiting times across Wales impact everyone, and sadly impact my region of North Wales probably the most. In contributing to today's committee report debate, I'd like to highlight just three particular areas that the committee have looked into, which I think are key.

Firstly, as stated in the report, are the statistics regarding the waiting times and the data that should be made available. And as already outlined, around one in five people in Wales are on a waiting list—certainly not good enough, as I'm sure the Minister accepts. And behind these numbers, as Rhun ap Iorwerth has already said, are real people suffering day in and day out. And certainly, when looking at my region of North Wales, earlier this year in January 2022, which, of course, is going to be a peak time for a health board, but, nonetheless, there were around 148,000 patient pathways, people waiting to start treatment—148,000 people in a population of around 700,000 is quite a stark number. Of course, these numbers are repeated in other health boards, but I have a parochial interest as a North Wales regional Member, and want to see this number reduced as quickly as possible. Of course, it's not right that people are paying their taxes and national insurance for these health services, and yet, they're having to wait such a long time to be seen, and during that time waiting to be seen, they are, of course, having a difficult time and sadly are suffering. So, the first area is around the data and reporting the data and those statistics being readily available so they can be analysed quickly and easily.

The second area when looking at the impact of waiting times, and that the report highlights as a long-standing issue, is around the recruitment and retention of staff. As we know, the retention of existing staff is a huge problem for health services at the moment, meaning that the sector continues to struggle and maintain current staffing levels, let alone increase them, and it's certainly an issue in the region I represent in north Wales. Of course, if we want to attract more nurses and doctors and other healthcare workers to come in and work in the NHS, we certainly need to see some action to make the service more appealing and highlight the opportunities that come with it. And I certainly want to see our health boards performing well so we can see more people coming into the health service and taking those important jobs and we can retain them in those positions as well.

Finally, the third area, which has already been outlined in today's report and mentioned by the Chairman a little earlier on, is the need for really clear leadership and a clear plan to effectively deal with the waiting times backlog in Wales. Because, as we know, the problem, yes, was certainly exacerbated by the COVID-19 pandemic, but was certainly there before COVID-19 was upon us. And regretfully, whenever we see any waiting list statistics, it's the people of north Wales who continue to suffer the most. So, we urgently need clear leadership to take responsibility for a plan of action to rectify this and ensure that the people I represent are not forgotten about. And in this plan, there need to be effective measures to modernise the health service—again, as has already been mentioned by previous Members—with a renewed focus on innovation and digital, and moving forward with these innovative ideas, which will make the work of our front-line workers so much easier.

So, in closing, I would again like to thank the committee for their efforts and this piece of work. Also, I appreciate that the Welsh Government and the Minister have accepted 26 of the committee's recommendations in full and the other in principle, of course. Because the current situation is simply not good enough and it cannot continue; we can't afford for it to continue, for the sake of our people here in Wales. So, putting into action the committee's report could see real improvements to tackle this extremely concerning waiting list backlog in Wales, which we so desperately need. Diolch yn fawr iawn.

Thank you to members of the Health and Social Care Committee for your report and for the opportunity to discuss waiting times on the Senedd floor today.

We know that the pandemic has had a profound effect on our health service, with waiting times proving a real problem. I welcome the announcement made by the health Minister earlier this year, ensuring that by 2025 no-one will be waiting more than a year for treatment in most specialities. And I agree wholeheartedly with the recommendations in the report to raise awareness of cancer symptoms, but we need to see more urgent action on cancer waiting times. A constituent contacted my office this month. They were told they had an urgent cancer referral following a visit to their GP, only to find out that urgent referrals are now 16 weeks or more. The worry and angst caused over these four months has an astronomically detrimental effect, not only to the individuals but their families and friends too. In your response to this debate, will the Minister please commit to making a statement on how Welsh Government will reduce the number of weeks and months people are waiting for cancer referrals?

Gareth Davies.

Thank you, Deputy Llywydd, for the chance to contribute to this debate today. As a member of the Health and Social Care Committee, I've been moved by the contributions and testimonies of those affected by waiting times crises here in Wales. The frustration that my colleagues in the NHS express isn't just the frustration at them being unable to do their jobs and, indeed, the jobs that they love; my colleagues feel that they are letting their patients down, leaving them in pain and agony, yet despite their best efforts and hard work in many cases, there is nothing that they can do. And after 11 years working in the NHS for Betsi Cadwaladr University Health Board, I know exactly how they feel. But whilst the Government wants to squarely and only blame the COVID-19 pandemic, I will remind this Chamber, as other colleagues have done, that waiting times in Wales doubled in the year before the pandemic struck. On behalf of those who work in the Welsh NHS, I urge the Minister to properly listen to the committee's recommendations, and I must emphasise that this waiting time disaster needs addressing and fast.

Each one of the one in five people in Wales sitting on a waiting list, the 148,884 people under the Betsi Cadwaladr University Health Board awaiting the start of their treatment, are indeed somebody's loved one, a loved one who is suffering during these delays. And with respect to emergency care, only 54.5 per cent of responses to immediately life-threatening calls arrived within eight minutes, down from 60.6 per cent in May 2021, and a staggering 58.3 per cent of amber calls to patients, which includes those suffering from strokes, took over an hour to reach. This Government can blame ambulance shortages, staffing gaps or the pandemic, but these issues and this backlog were here before COVID, particularly so in north Wales, as Sam Rowlands alluded to in his speech. And other UK nations facing the same challenges are faring better on this issue, with the median waiting time of 12.6 weeks as compared to 22.5 in Wales—sorry, the 12.6 weeks was in reference to the rates in England. It was beyond disappointing to me and many others when the previous health Minister said it was foolish to try and tackle these issues earlier on. However, what my constituents and NHS colleagues want, regardless of the cause of the backlogs, is this Welsh Government needs to get on with the solution.

Minister, it is positive that you have accepted the 26 out of the 27 of the committee's recommendations, and the last in principle, but I'm disappointed that you didn't provide sufficient detail on the implementation in your response, and this is not only my view but also the view of many key stakeholders, some of whom I was lucky to meet this morning in the health committee. And it's also frustrating that the reason given for your partial acceptance of the other recommendation, which is recommendation 23, was because it would be complicated. Knowing the Minister, I know there's nothing too complicated for you to tackle and resolve, and I hope that you will take another look at that. To highlight the importance of the initial recommendation of this committee's report, asking that

'In addition to setting out how the waiting times backlog will be addressed, the Minister for Health and Social Services must ensure that the Welsh Government’s planned care recovery plan includes a focus on supporting patients to wait well.'

And I'd just like to share with you the plight of my constituent, who is Miss Isolde Williams. She is just one of the many people who are suffering due to the treatment delays and has been waiting since her initial appointment in 2017 for specialist treatment and a replacement for her knee. And she shared this with me, and I quote:

'My quality of life continues to deteriorate. I am totally reliant on my car to get out, and I am scared of how bad I am going to get before I get this treatment. This delay has led to further problems in my leg and hip, and I just wonder when all this is going to end. I am losing faith in our health service.'

Unquote. In conclusion, Minister, what assurances can you give Isolde and so many others across Wales in her position that they will receive the treatment that they need as swiftly as possible and that no-one should have to go through these drawn-out delays without adequate support in the future? Thank you.

May I begin by thanking the committee for their work on this important report? I think that it's very difficult to read, but it reflects the casework that we all receive, and I think it's very important that we remind ourselves very often that there are people behind every statistic, and, although we see that there is a plan in operation, that doesn't make it easier for those people who are living in pain or in a situation that does endanger their lives.

I had a question specifically with regard to section 3 of the report about those who are paying to go private at present, and this idea that came across very clearly of a two-tier system, and the shocking fact, if truth be told, that we're seeing one of the consultants in hospital considering, when they look at a patient, 'Well, is this person going to be able to afford to go private or not?' and that that goes through their minds. That echoes something that I've heard with my casework, with people telling me that they're being encouraged to go private, and perhaps they look as if they can afford to go private, but the truth is that they can't afford to do so.

One of the things that angered them recently—perhaps people in the Chamber have seen the BBC Wales investigates programme about the NHS, and the interview with the chief executive of the NHS in Wales, where she denied that the health service is in crisis. The question asked to me by a constituent at that time was, 'Well, why isn't somebody willing to acknowledge the scale of the crisis? If people were to acknowledge and recognise that there is a crisis and an emergency, at least they would then acknowledge the size of the problem and the size of the pain that we're facing.' I think there is something in that, that we need to be honest with people instead of trying to hide behind different plans and schemes. One of the things that the same constituent asked me was, 'Well, am I meant to just accept that my life is less important, because the health service can't provide the treatment that I need for two years?' She knows that doctors have said that she needs treatment as soon as possible, that she could die, but she has to wait for two years before receiving that treatment, and she can't afford to do so.

So, Minister, what would you share as a message to those people who are in similar situations today? And are you willing to do what the chief executive of the NHS failed to do and acknowledge today that there is a crisis and that we should come together as a Senedd to ensure that we come through that crisis and ensure that things do improve for people in these crisis situations?

Can I start by thanking, firstly, the committee, Russell George in his chairing, and participants for their work in bringing this report forward? It's a really important report. Thank you so much. And can I welcome the Government's planned care programme and response to the report as well, published earlier this year?

Firstly, I want to draw attention specifically to Powys Teaching Health Board, within the region I represent. I understand that Powys is actually the exception to growing waiting lists and has managed to decrease its waiting list backlog over the last two years by around 5,000 individuals awaiting treatment. But that does stand in contrast to other health boards, whose waiting lists are, on average, around 26 times longer than Powys's. So, I would like to commend Powys there.

In June 2022, we had a new record of over 700,000 people in Wales awaiting diagnosis or treatment, and, as you will know, Minister, this is around one in five people waiting for treatment. This doesn't include what we guesstimate to be around 550,000 potentially missing referrals, identified in a Wales audit report, that are likely to come forward in the coming months, which, of course, we welcome, and we want to encourage those people to come forward.

According to this report, the current waiting list is yet to peak, and will only return to pre-pandemic levels by 2029 if the Government's objectives are achieved. I am concerned that the five ambitions outlined in the programme do not reflect the real capacity pressures and limitations on capital funding of the NHS, but I want to emphasise that we know, from the committee report, that it isn't all about finances, and it isn't all about money. With the anticipated increase in the number of patients waiting for treatment, and an already exhausted workforce, and our NHS bursting at the seams, may I ask you what steps have already been taken and will be taken in the next five months for this objective to be achieved? 

Another issue I would like to raise, which I know has already been raised, is carers' mental health. As the committee report demonstrated, the long waiting times severely affect patients and carers' health conditions and financial security. I fully support the Government's financial resilience plan for carers, outlined in a response to the report, but I do worry that carers have not been given full consideration by the Government. Carers have to face the uncertainty about whether their loved ones will receive the urgently needed treatment soon enough. They're not being communicated the expected waiting time for the treatment, nor any assistance available to them, which leaves them feeling isolated and abandoned, which my colleague Heledd Fychan touched on as well. They're often forced to leave their employment or education, and become an almost professionalised workforce, administering medication, perhaps with no regular medical and health support. As Mind Cymru stresses, it is essential that the Government does not leave our carers without consistent access to clinical, emotional and well-being support throughout this period.

So, to summarise, I wonder if you could respond to the following. Beyond the additional financial support, how will you ensure sufficient support for carers to also 'wait well'? What steps are being taken to identify individuals who should be formally recognised as carers, so that they do receive the support that they are entitled to? The goal of no-one waiting longer than a year for an out-patient appointment by the end of 2022 is a tall order, and I wonder how the Government has progressed towards this target. And, finally, Minister, NHS Wales, as I understand it, has had to return to Welsh Government almost £13 million in March. What changes are being made in the type and scope of funding being made available to health boards to ensure that they have the right resources to deliver against the plan? Diolch yn fawr iawn. 

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

Diolch, Dirprwy Lywydd. Thank you for allowing me the opportunity to reply to this important debate around the 'Waiting well?' report and waiting times. I'm very pleased that we were able to accept almost all of the recommendations, 26 out of 27. Obviously, we haven't gone into the detail in the response, but obviously there's a lot more detail in the planned care plan. Now, I published our plan to modernise and transform planned care services in April. And I'm sure the committee was pleased to see that many of the actions in that plan reflect the committee's findings and recommendations. Now, we're already making good progress against this plan, although it was only published in April, and the statistics we have are from April, so, obviously it will take a little bit of time to get up to speed. What we are doing is to focus on what we're doing to support people while they're waiting to be seen. 

Now, I am intensely aware, as health Minister, that every one of those thousands of people who are waiting for treatment are individuals. They're often waiting in pain, in anxiety, their families are concerned about them, and it's of course our duty to make sure that health boards are supporting people while they wait. Now, we know that planned care recovery won't happen overnight. It will take time, and, as you are aware, I've set some very clear, but ambitious milestones to recover and to reduce those long waiting lists, but, as I've said before, this is not going to be easy.

In response to Heledd Fychan, look—. Are we in a crisis? Look, it's not great, but I don't think we're in a crisis, and I'll tell you why. Because we are seeing 315,000 people in secondary care alone every month. That's not including GPs. Three hundred and fifteen thousand. That's not a system that's broken. That's a system that's working very well. And all those thousands of people working in the NHS, I think, would accept that, yes, it's under massive pressure. My God, they are working for those 315,000 people they are seeing on a monthly basis.

And, in terms of funding, well, over the term of this Senedd term, we've said we're going to spend £1 billion. I've made £680 million available so far—£170 million for every year, plus £15 million each year to support planned care transformation projects and £20 million to support value-based pathways. Now, our plan has been developed in collaboration with NHS staff to ensure it's focusing upon the things that are going to make a difference to people and the staff, and they're key partners in implementing the plan. That's why it was important that we built it with them. I'm clear that we must support and continue to build our workforce across both health and social care over the coming years. They've worked incredibly hard over the last few years, and we need to continue to invest and support their well-being. I understand and I hear what you're saying in terms of concerns around capacity to deliver, that that's what you heard from the stakeholders. Now, we are going to be producing a workforce delivery plan to support the recovery plan, and that's going to be ready later this summer, where we're going to set out our approach to support staff. I do worry; I worry every single day about the hundreds of thousands of people who are literally just waiting for their appointments, and it is important that we let people know that we haven't forgotten them, that we are going to reach out to them and support them whilst they are waiting.

We are making great progress—a new service, the wellness improvement service at Cwm Taf Morgannwg University Health Board I think is really exciting. The programme supports patients to manage their conditions through an evidence-based lifestyle approach to improve their mental and physical well-being, and we're evaluating the advantages of a number of different models to support patients while they wait, including the Red Cross pilot across three health boards. 

Now, the removal of COVID restrictions in May means that we can now start to see and treat even more patients, but COVID is still with us and there are pretty high rates in our communities at the moment. I'm sure we all know somebody at the moment who's got COVID, and that's going to impact on health workers. So, we've just got to bear in mind that we're still living with a pandemic, and that's going to have an impact on our ability to deliver. On 27 June, there were over 600 COVID patients in hospital. Luckily, there were only eight in critical care.

Now, I know that waiting times are nowhere near where they should be. At the end of April, there were 707,000 open pathways. We're starting now, thank goodness, to see some improvements, and April data showed for the first time that the number of pathways waiting for over two years is now falling. Now, we are, as anticipated and as we predicted, starting to see more people requiring and being referred to secondary care, and the problem we have, of course, is that they keep on coming on to the lists. So, we've seen the demand increase—compared to two years ago, up 13 per cent. So, the January to April figures are 13 per cent more than what we were seeing at the same period last year. So, reducing waiting times and supporting patients while they're waiting is my priority; it's the health service's priority.

We have established a committed team. The national recovery director will lead the health service to ensure that our recovery programme is delivered. Every health board has been given additional funding to be used to help them to transform and to deliver locally, and some of that funding will be used to support patients on waiting lists.

Now, in the eight weeks since we launched the plan, there has been significant progress made. I just want to give you a few examples. Capacity for surgery has increased in Hywel Dda—they've bought temporary theatres for the Prince Philip Hospital—and there are two new theatres established for cataract care in Cardiff and the Vale, meaning that it will be possible to have 4,000 more surgeries in a year.

Buffy Williams was asking me about cancer care, and you'll be aware that there are new rapid diagnostic centres now in every health board. The Cardiff one will be coming online later this year. Seventy-five million pounds has been provided to upgrade diagnostic capacity, including new MRI and CT equipment. Twelve million pounds has been invested for linear accelerators in Betsi Cadwaladr and Swansea Bay, and, with the Welsh Government, Aneurin Bevan and Cardiff, we are investing £16 million extra in terms of endoscopy.

There are so many issues that you touched on: communication with people, the data, monthly updates. I'm getting monthly updates, so I'm keeping an eye on how we're progressing every step of the way, and then I can put a bit of heat on people. So, I was really disappointed, if I'm honest, with the cancer rates in April, and I was able to go straight to the health boards and say, 'Look, you need to step up here.' So, those monthly assurance meetings, for me, are going to be critical. I can assure you that our orthopaedics are in the targets.

And prevention, you know, you can't put everything into the planned care plan, but, of course, prevention is key. If you want to stop cancer, then you need to stop people smoking, you need to make sure that they eat well—all of these things—but you can't put it all into the planned care plan. We've got lots of other areas where we're doing that. The same thing with care. I spend a lot of my time working with my colleague Julie Morgan just trying to address the care issue that is so integral to our ability to tackle this issue.

We've introduced electronic systems for patient referral and advice across Wales. And, as a result, almost 15 per cent of referrals are now managed by advising patients rather than through new appointments for in-patients. Each of these steps will begin to tackle issues that have been raised in this important report. Some people will still, I'm afraid, have to wait for too long for some time. But I look forward to continuing to report on the work that's being done across our system to reduce waiting times and make things easier for people. Thank you very much to the committee once again for all of its work.

I call on Russell George to reply to the debate.

Diolch, Deputy Presiding Officer. Can I thank Members for taking part in this debate today? Can I also add my thanks, really, to the clerking team and the research team at the Senedd, who support us very ably and do so much work behind the scenes? So, thank you very much, diolch yn fawr iawn for your work supporting us as Members.

I think Gareth Davies pointed out in his contribution, of course, that people were waiting far too long for treatment and diagnosis well before the pandemic started, so we've got to keep that in mind at all times.

I think one of the themes that came across in the contribution today was communication. I think it was Rhun ap Iorwerth and Heledd Fychan who talked about the level of correspondence to their offices, and I have the same, and I'm sure we all do, in terms of people contacting us where that really, of course, shouldn't be happening, should it? We do need to have better communication with patients who are waiting and to support them waiting well. We heard this morning in the stakeholder meeting how, often, inappropriate letters can be sent out and inappropriately worded letters can be sent out. So, I think it's worth looking at our health boards and supporting health boards in terms of their communication—how they word and relay their messages to patients who are waiting. And, of course, those letters being sent in a timely manner as well. I think I relayed in my opening comments how one stakeholder mentioned there were 20 drafts for a letter to go through a process. Like I say, I'm grateful the Minister's looking at and querying that, and I think it's worth querying that process, because that then puts in a delay. You might want to get the letter right, but it puts in a delay in actually getting the letter out to patients.

Another theme coming across quite strongly this afternoon was, of course, the workforce and the retention of staff. This isn't just about recruiting staff; it's about the retention of staff. I think it was mentioned by Buffy Williams and Sam Rowlands, and again it's about perhaps those improved working conditions. But, all the time, the issue of capacity kept coming up throughout our work, and again at the stakeholder meeting this morning. And, again, the question really is: is there sufficient capacity to deliver the plan that you want to see? So, stakeholders are saying, 'Yes, I'm efficient'—

Russell, will you take an intervention from Altaf Hussain?

Yes. Absolutely, yes.

Thank you very much. I just wanted to ask the Minister, but it is good that I can ask the Chair about whether you have considered, going into these concerns, the human rights of the patients at any time. Thank you.

Thank you, Altaf, for your intervention. I think it's not something we specifically looked into in our committee report, but I think, from our perspective, what's important to us is that the backlog comes down. We know, we’ve heard from other Members’ contributions this afternoon, that we can talk about statistics, but it's about the real impact on people's lives. Again, the Senedd research team did a great job in actually demonstrating some of the very issues that people were dealing with, and their families, in terms of being on a waiting list.

But I think one of the other issues—. I think Jane Dodds mentioned the issue about funding being returned, interestingly, to Welsh Government, and Audit Wales pointed this out as well, of course. But the question is: why is that? Why? Because they can’t spend the money. Why can’t they spend the money? Is that a capacity issue? They don’t have the sufficient capacity to perhaps deliver that.

But arguably, I think, the greatest challenge of this Senedd is bringing back down that waiting backlog. It’s the Government’s responsibility and it’s this Senedd’s responsibility to hold the Government to account in that regard. I heard the Minister’s contribution—a few examples of specific examples within health boards. But what I think you didn’t say too much on, Minister, was perhaps on what could be done at a more regional level, perhaps, as well. So, we can see that there are individual examples within health boards, but there is that issue of health boards working together, and what could be done in terms of bringing forward that best practice, but regional health boards working collaboratively across each other as well.

But I do appreciate your sincerity, Minister. I appreciate your honesty in terms of the disappointing cancer rate figures. Keep on being honest with us, Minister, about the position, and I think that is helpful in that regard. But I think what is important is that we can’t simply aim to return to where we were back in March 2020. We’ve got to use this opportunity to reset, and we need to see sustainable investment in services, the workforce, the estate and infrastructure, a renewed focus on innovation, genuine and sustainable service transformation, and progress on prevention and tackling health inequalities to make sure that no-one is left behind. Diolch yn fawr iawn.

The proposal is to note the committee’s report. Does any Member object? There is no objection, therefore the motion is agreed in accordance with Standing Order 12.36.

Motion agreed in accordance with Standing Order 12.36.