The next item is the statement by the Minister for Health and Social Services on an update on COVID and winter pressures. And I call on the Minister now to make her statement. Eluned Morgan.

Thank you very much, Llywydd.

We're approaching what is likely to be a very challenging winter period for the people in Wales as we face a cost-of-living and energy crisis and, of course, ongoing pressures within our health and care systems. Our planning for winter for the health and care system has been developed over the past few months within our existing planning arrangements. Our planned care plan, developed in conjunction with clinicians, contains a number of challenging but achievable ambitions, and is supported by £170 million of recurrent funding. Health boards’ and partners’ plans to support resilient, urgent and emergency care services this winter will build on local six goals for urgent and emergency care programme plans. Priorities will focus on increasing emergency ambulance capacity, opening new urgent primary care centres, introducing seven-day same-day emergency care services, and increasing available community capacity to support timely patient discharge. I will shortly provide a further written statement on these plans.

We're also preparing for a third winter of living with COVID. However, the situation regarding respiratory viruses is more uncertain than in previous years, as seasonal patterns have been significantly disrupted due to the pandemic. We could experience spikes in both COVID-19 and flu, and we must ensure that our communities and health social care systems are as prepared as they can be, particularly in the context of the current cost-of-living crisis. Today, I will update Members on the current situation regarding COVID-19 and the approach we are taking to prepare for a potential spike in respiratory illnesses in the coming months.

After an increase in COVID-19 cases over the summer, driven by the BA.4 and BA.5 omicron wave, community prevalence, thankfully, has continued to decrease, which has meant that pressure on our healthcare system associated with COVID-19 has also decreased, although other pressures remain. According to the latest Office for National Statistics coronavirus infection survey, the proportion of people in Wales testing positive for COVID-19 has once again decreased to one in 110 people, from one in 95 the previous week.

This decreasing prevalence, combined with the protection provided by other interventions such as vaccination, has allowed us to reduce testing, including a pause on regular asymptomatic testing from 8 September. In line with our long-term COVID-19 transition plan and our objective to protect the most vulnerable, we'll continue to provide symptomatic testing for patients, those eligible for COVID-19 treatments, health and care staff, care home residents and prisoners. And, we'll continue to test patients on discharge from hospitals to care homes.

While we are currently in a stable position, we know that seasonal flu and COVID-19 viruses have the potential to add substantially to the winter pressures faced by the NHS, particularly if infection waves from both viruses coincide. Therefore, we are adopting a joined-up approach across Welsh Government and Public Health Wales in our approach to respiratory viruses that will provide guidance to support health and social care colleagues and to our communities on preparedness and actions that can be taken.

Vaccination continues to offer the best protection from COVID-19 and flu, and our winter respiratory vaccination programme, launched on 1 September, integrates the COVID-19 and flu vaccination programmes this year to maximise uptake of both vaccines. ONS antibody data indicates that the 2022 spring booster has successfully maintained high antibody levels in vulnerable, older populations. So, we go on encouraging all those who are eligible to come forward for their vaccinations to do so. Invitations for a COVID-19 vaccine will be issued to all eligible individuals by the end of November, and the flu vaccine will be offered by the end of December. A national winter respiratory vaccination communications campaign will be launched next week.

As I mentioned earlier, our testing and contact tracing teams are now focusing on targeting those who are most vulnerable to harm in our society. People who are at high risk of becoming severely ill due to COVID-19 are eligible for treatment with antiviral or antibody therapies. If those people who are eligible for treatment test positive for COVID-19 and report their lateral flow test result, they will usually be contacted by text or telephone call by the national antiviral service within 48 hours, and they will be offered treatment. We are also using multiplex PCR tests for our most vulnerable, including care home residents and others, and these tests test for other respiratory viruses alongside COVID-19 and can support treatment and manage outbreaks.

This winter, we will be strengthening our surveillance system to identify any deterioration in the situation, such as from new, harmful variants of concern and other respiratory viruses. A major purpose of the surveillance system will be to determine whether Wales has moved from a COVID-stable to a COVID-urgent state, either through the epidemiological—it's difficult to say that word, isn't it? Epidemiological indicators. Was that okay? Or from genomic surveillance indicating the presence of a more severe variant.

During this autumn and winter, we're focusing on enhancing and establishing more robust community and hospital surveillance systems that will further enhance the information we receive from the Office for National Statistics survey, as well as the wastewater analysis and other intelligence. The continual assessment of these data sources contributes to our ongoing surveillance.

Despite all of our plans around vaccination, testing, treatment and surveillance, we know that COVID-19 has placed sustained pressure on the NHS in Wales, both from people being treated directly for COVID-19 and people testing positive but being treated for other reasons, along with staff absence due to infection, the requirement to self-isolate or family illness. Given the exceptional nature or scale of some of the potential risks faced this winter, particularly in relation to COVID and other respiratory viruses, and the system's capacity and capability to respond to demand, additional winter operational planning guidance is being developed for NHS organisations. These NHS organisations will need to ensure that robust and resilient plans are in place, including joint action through regional partnership boards.

We are also acutely aware of the significant challenges faced by our communities this winter as a result of the cost-of-living crisis. We will be developing practical advice and guidance to support individuals and communities to keep well this winter. For example, we know that maintaining key protective behaviours—and we have all become familiar with them by now—can have significant benefits that go beyond COVID-19. Continuing with these behaviours will help to reduce impact of future waves of infection, and will also reduce the impacts from other respiratory infections. However, in the context of the cost-of-living crisis and fuel poverty, we recognise that these will be more challenging this winter and when we have cold weather. So, the key message to protect yourself, your family and others is to ensure that you are vaccinated and stay up to date with any COVID-19 booster vaccinations. Thank you, Llywydd.

Thank you, Minister, for your statement and update today. That's appreciated. I was pleased to see this agenda item added today. I was, though, expecting a statement today detailing your health and social care winter plan, but that's not it today. What I would ask today, Minister, is when are we going to get that plan, given the fact that, last year, the plan was significantly late. In fact, we were already substantially into the winter. Also, I suppose, as well, just to ask for clarity on who is delivering that plan. I think, last year, it was the regional partnership boards who prepared the winter plans. In previous years, it was health boards. So, can I just ask for that confirmation that it is the regional partnership boards that will be delivering that plan that you will be publishing?

Also on that, it would also be useful to understand how the NHS Wales delivery unit is included in the plans as well. Now, we know, or we expect, routine procedures to be highly likely to be put on hold in certain parts of the winter. That might be unfair and I'd appreciate your view on that. That would be my assessment. To help reduce the backlog in England, the English NHS is proposing to use technology to combat lengthy waiting lists, including an option on the NHS app to find hospitals who have capacity for specific treatments. Now, of course, we're still using fax machines and we're still waiting for e-prescriptions to be fully rolled out, and we have no live NHS app. So, can you tell me, Minister, how you're using technology to alleviate winter pressures, leading to helping to reduce the need to cancel routine procedures?

A few questions around the workforce, Minister, which you've mentioned in your statement today. There is, of course, a threat of strikes by nurses—that's going to ballot shortly. I'm aware that 6.2 per cent of staff in the NHS are currently off though illness. That's usually 5 per cent, in pre-COVID times, so keep that in mind. There are five health boards in Wales who have spent nearly £200 million on agency staff in just one financial year. So, a number of workforce issues in that regard. What are your plans to increase capacity in the NHS workforce so that health provision is, of course, delivered as it should be over the winter period?

I would also raise, Minister, alongside this, that the Welsh NHS Confederation has expressed concern about the capacity needed to deliver the Welsh Government's vaccine strategy for this winter, which includes the rolling out, of course, of both the flu and COVID vaccinations across a wide range of groups. So, in your assessment, is there capacity to deliver the vaccination strategy, and what challenges, Minister, do you foresee, given also the other workforce challenges that I've also outlined?

We also know that, of course, many people sadly died from COVID after actually going into hospital with another illness. And we know that that happened to a greater extent in Wales than in other parts of the UK. So, you've outlined some statements today in your contribution, but can I ask what lessons have been learned in terms of what will be done differently to ensure that hospital-acquired infections are kept to a minimum? They can't be entirely eliminated, but what is being done to keep that to a minimum?

And finally, Minister, we saw restrictions on people's lives introduced last Christmas due to the omicron variant. I wonder what lessons were learned from the Welsh Government's reaction to that new variant last year. What would you do differently this winter in a similar position? And effectively, what are your trigger points for introducing any restrictions this winter?

Great. Thank you very much, Russell. I think I need to be absolutely clear that we have given very clear guidance to NHS boards that actually the winter planning has to be done early. So, we've asked them to do it as part of their normal planning, because if you leave it until now it's too late; you already need things in place. So, we've given them the money, they needed to build that into their programme. Their integrated medium-term plans have all considered what next winter will look like. And of course we've already given, for example, £25 million to roll out the six priorities for emergency and urgent care. So, all of that's gone, because if we'd waited until now, as you said, it would have been difficult for us to have rolled things out. So, they've known what was coming, we've given them very clear guidance in terms of what we expect as a result of that. 

We still have a lot of issues in relation to delayed transfers of care. So, that is probably one of my biggest headaches at the moment: how do we get people out of hospitals when they are ready to be discharged, because there is considerable pressure because of those issues in building that community care capacity. So, we've got an initiative that the NHS has been working on with local government over the whole of the summer, where we're building that community care capacity. I can give you a bit more detail on that at a later date, but those are very advanced programmes, very detailed, and people have been working on that intensively over the summer. 

In terms of hospital capacity, I'm very clear that I don't want a let-up in relation to planned care, which is why I have been asking, for example, in relation to orthopaedics, that we have reserved beds, because there is always going to be pressure. The pressure is not going to go away, but we need to get through those waiting lists. And when it comes to digital, I can assure you that this is one of the issues that is very much at the top of my agenda. I have almost weekly meetings on the various aspects of digital that we need to use to transform the way we deliver services in Wales. And there'll be some interesting news for you on the NHS app very shortly. So, I'm hoping that we won't have to cancel too many routine procedures this winter, but of course it does depend on what that wave may or may not look like. Staff sickness is obviously something we're very concerned about, which is why getting those rates down significantly lower than the rest of the four nations is a good place to be, but we know it's an undulating pattern, so we've got to keep an eye on that.

In terms of increasing capacity in the NHS workforce, you will be aware, Russell, that we have already undertaken significant recruitment during the pandemic. When it comes to the ambulance service, for example, over the past couple of years we've recruited at least another 200. There are going to be some changes to the ambulance roster soon, which is going to release an equivalent of about 72 additional people. So, I'm confident we've got a very clear plan in terms of what we need to do in relation to urgent and emergency care.

So, in terms of winter planning, then, we've set out a framework that sets out our expectations for health boards to work with partners to build on that six-goals programme, and some of those priorities include a national communications campaign to raise awareness of NHS 111, to optimise the role of the third-sector services, to recruit 100 new ambulance clinicians, and to make sure that we are reducing those long ambulance handover delays, because we know that if that pressure is heavy now, it's going to get more difficult later. Fixing that now is critical to us. So, building that community care capacity still remains very much at the top of my agenda.

Thank you very much to the Minister. Thank you for the statement. In parliamentary terms, we're setting some sort of baseline today, I suppose. This statement comes at the very beginning of the term, at a time when we're in transition between summer and winter, or moving to summer pressures and winter pressures, because it has become more and more apparent that the NHS is unsustainable at all times of the year, and that the summer can be just as exceptional as the winter. I know from personal experience this summer what it's like to wait 10 hours for treatment in A&E. I can't criticise the staff, who were working so very hard and doing their very best, but it's not acceptable, and I thank and wish the committed staff across the NHS in Wales well, as they face the winter pressures.

Where are we today? Where is the Welsh NHS? We have a statement here that refers to an ongoing pandemic, of course, but where COVID pressures are reducing. The Minister said that we're in a stable position, but we do see an emerging picture of the threat that we face as COVID and flu and other respiratory viruses all come together. Additional guidance for the winter is being prepared, according to the Minister, and NHS institutions will need to ensure that robust and resilient plans are in place.

We need to ensure robust and resilient plans are in place, the Minister tells us. I agree with the Member for the Conservatives saying that those plans should already be in place. How on earth has Welsh Government left it until late September before being able to publish those assurances? Maybe the Minister can address that further.

But I would like to focus, if I can, on the worrying findings of a report published earlier this month and in print this week by the New Scientist, telling us that there have been well over 20,000—22,500—more deaths than we would expect in the UK between April and August this year, around 10 per cent more than the five-year average. It's thought that COVID has contributed to that directly, with figures suggesting there were twice as many deaths involving COVID-19 directly this summer compared with the summer of last year. But that only accounts for perhaps half of the excess deaths. For the rest, it is thought that indirect impacts of the pandemic could be at play here, and, in fact, that they are likely to be. We have a disrupted healthcare system. The cancer tests and treatment delays of lockdown are being felt now in the latter stages of 2022. Delays, of course, cost lives, which is why there was so much anger at treatments and appointments that were due to take place yesterday being cancelled.

Two questions arise from this. Those figures on excess deaths do detail the situation in Scotland and in Northern Ireland, but we don't have figures for Wales. Will the Minister commit to investigating how many excess deaths occurred in Wales? Because she surely will need that kind of data before being able to assess what led to what appears to be a significant surge in deaths. Don't those figures for the summer, assuming—and I think we can—that Wales will follow a similar pattern to Scotland and Northern Ireland, but coupled with the warnings that we've heard from the Minister herself today, tell us that we really cannot wait a day longer for that robust plan for this winter? It's already late in the day, and those figures in the New Scientist suggest to me that the usual winter pressures could be compounded this year by a general pattern of increased deaths already in place. That, I'm sure the Minister will agree, is a matter of some concern.

Diolch yn fawr. There is a huge pressure on our services at the moment. I'll just give you a sense of the difficulty we have, in particular in relation to delayed transfers of care. We're at a point now where we have around 1,200 people ready to leave our hospitals. Because of the difficulty of getting them out because the support system is not quite there in the communities, we have around 1,200 people waiting, which is quite a high proportion. So, it is a very difficult system, when it's clearly difficult to recruit to our care service despite the fact that we in Wales are paying the real living wage. Robust plans are in place already for winter, we have those within the IMTPs, and those I have signed off, so we have those plans already.

You asked about excess deaths, and, obviously, one death is too many when it comes to excess deaths when we weren't expecting it. My understanding is that our knowledge and analytics team have looked at the excess deaths in terms of ONS. These may be slightly older figures than you have, but certainly in England, it suggested excess deaths were at 14.5, and in Wales 11.7, so there's a slight difference there. Whereas in England deaths per 100,000 were at 217, per 100,000 in Wales it was 212. So, there's a slight difference. When people come and talk about these statistics, there is a standardised mortality figure that is usually used, so you do have to go into the detail of what exactly they are suggesting here.

I think the thing to bear in mind is the fact that Wales does have an older and sicker population. We've had some interesting evidence recently to suggest that, in terms of numbers of people who contracted the virus, we were significantly lower than other parts of England, but when it came to hospitalisation, our figures were higher. So, I think we need to just be aware that, actually, if that older, sicker population contract the virus, they are in deeper trouble. That's what we know about this virus: that it really hones in on those most vulnerable people.

I thank the Minister.