Questions now from party leaders. Leader of the Welsh Conservatives, Andrew R.T. Davies.

Thank you, Presiding Officer. First Minister, last week I challenged you on your inability to bring forward a COVID inquiry, and there is a difference between the view that I take and you take, and I accept that, and that's a political difference. However, Covid-19 Bereaved Families for Justice Cymru do want that independent inquiry. During your answers to me, you indicated that they'd 'moved on'. Do you accept that it is still their goal to achieve an independent Wales-wide COVID inquiry?

Llywydd, I think it is better that I quote the words of the bereaved families themselves, so that there is no ambiguity in what I am saying. So, here is—. I'm quoting now directly from the press release that they issued on Tuesday of last week. They say that they firmly believe that a Wales-wide inquiry would be the best way to,

'achieve the scrutiny that Wales deserves'.

That has always been their view. I have rehearsed it and discussed it with them in five separate meetings. They go on to say that, despite those meetings, the First Minister,

'remains unconvinced that this is the right way ahead'.

That's a very fair summary of my position. And that I believe that,

'all decisions made by the Welsh Government must be seen in the context of those made by the UK Government'.

Again, an absolutely fair representation of my view. They then say,

'CBFJC have therefore shifted their focus to ensuring that Wales is fully scrutinised in the UK Covid-19 Inquiry'.

I think it's easier that I put their words onto the record rather than trying to gloss them myself.

I accept the point that you've made, First Minister, but last week, you did try and make the point that they had 'moved on', when in fact your opening remarks directing us to their press release last week clearly show that they do want a Wales-wide independent inquiry. But the record will speak and people will make their judgment accordingly. 

I'd like to raise with you, First Minister, my constituent's e-mail to me last night. Ross highlighted the experience that his grandmother had in the accident and emergency department in the Heath hospital, Cardiff. I appreciate that you cannot respond on individual cases, but this was a particularly poignant e-mail that came, and I'm sure that many Members in this Chamber get these e-mails. His 86-year-old grandmother went to the A&E department, not transported by an ambulance, but by a taxi, with a suspected stroke, because she was told that it would take several hours, if not a day, to get an ambulance to her. When she arrived at the hospital, she waited 20 hours to see a doctor—20 hours. Her assessment now is that she will never go back to a hospital, and all she wishes for is that she has a painless death. 

Now, in June, Healthcare Inspectorate Wales undertook an unannounced inspection of the A&E department at the Heath hospital. I hope, as a constituency Member here in Cardiff, you are familiar with the outcomes of their recommendations and the situation they found. Last week, you said to me that I highlighted the impotency of opposition. Could you show me the potency of your Government in addressing the Healthcare Inspectorate Wales report on the A&E department, and in particular, address the concerns that Ross's grandmother has, that she will never go to an A&E department again and wishes for a painless death?

Well, those concerns of the individual need to be taken up with the clinicians who are responsible for her care, because what the leader of the opposition has said would clearly be unacceptable, and those who were responsible need to be able to discuss with her how she now feels and what they can do to put that right.

I am of course familiar, Llywydd, with the Healthcare Inspectorate Wales report into the emergency department at University Hospital Wales. It's important to emphasise, isn't it, that the report found that the majority of patients reported being treated with dignity and respect and that they were receiving good emergency care. That's what the report says. But the report also says that there were numerous environmental factors impacting on the ability of staff to provide dignified care. And let me be clear this afternoon, Llywydd; it is absolutely unacceptable to me to read a report that says that an emergency department is dirty, that an emergency department doesn't have enough chairs for people to sit on, and that an emergency department is unable to provide access to water for people who are waiting.

Look, I understand the system is under huge pressure, with unprecedented numbers of people presenting, and staff who are under the most huge pressures for everything they've gone through in recent years. That does not excuse a health board for failing to deliver on those very basic environmental standards. Now, today, the health Minister has announced a further £2 million to help health boards across Wales with those small, basic things that make such a difference to the patient experience and to staff experience as well. It's hard enough working in the accident and emergency department at the Heath hospital without feeling that the physical conditions in which you are working are dirty and unacceptable. So, the Member asks 'What can the Welsh Government do?' Well, we will find another sum of money that we will provide to those emergency departments, and then I absolutely look to the people who are paid to manage those organisations to make sure that those basic standards are properly observed and that the physical conditions in which staff have to work and patients have to present themselves are not of the sort that were described in that report. 

One of the examples that was used in that report, First Minister, was children turning up with severe burns and, because equipment was not available, staff were having to put children into sinks to cool their burns or use the showers in the staff changing rooms. That's the level of the challenge in that A&E department, and indeed A&E departments across the whole of Wales.

What I would also suggest is one of the big pressure points on A&E departments is obviously the waiting times that people are finding when they have to go on to the lists and they're not getting their procedures undertaken. That's putting pressure on A&E departments, with people turning up with complications because of the waits that have grown over time. Now, the health Minister, on Sunday Supplement said that she has not given up yet on waiting times—a direct quote from Sunday Supplement. The one waiting time that she was challenged to say whether the Government would meet was the first target of having all out-patient appointments undertaken by the end of the year for those who have been waiting 12 months or more. Will you say now whether that particular target will be met in a little over two and a half months' time?

Well, what I will say, Llywydd, is that long waits in the NHS in Wales have come down for four months in a row, and people across the system are doing their very best to make sure that they meet the targets that the health service has signed up to. The leader of the opposition is right, accident and emergency departments end up dealing with failures in other parts of the system—less, I think, the failure that he pointed to. But, we know, when people feel that they might not get an appointment elsewhere in the system, they know they can turn up in an A&E department and in the end you will be seen. You may have to wait longer than you wanted to and the conditions that you might have to wait in would not be what you would expect, but in the end you will be seen. And that's why people default to it if they don't have confidence that they will get the timely care they need in other parts of the system. That is part of the explanation of the pressures that A&E departments are facing in every part of the United Kingdom.

Staff are working as hard as they possibly can in the very difficult circumstances they face. Every week, I report—I'm very seldom asked, but every week I report on the impact of coronavirus in the Welsh NHS. At the end of last week, the number of patients in a bed in a hospital in Wales with coronavirus went up by more than 100 in a single week, back over 500 on Friday. The number of staff off because of COVID-19 went back over 1,000 last week. All of that, every time that happens, that makes it more difficult for staff trying to clear the backlog of people waiting for planned care. And yet, every single day, they do everything they can to try to make sure that people in Wales get the quality care and the sustained interventions that we know they need. 

The leader of Plaid Cymru, Adam Price. 

Diolch, Llywydd. This winter's cost-of-living crisis is coming on top of years of austerity, in which workers' pay has fallen behind year on year. People are working more hours for less money, and working people in increasing numbers are saying that enough is enough. Only a few weeks ago, at the Labour conference, a motion was unanimously backed from Unison for inflation-proof pay rises. Led by the National Union of Rail, Maritime and Transport Workers, Unite, the Public and Commercial Services Union, the Communication Workers Union and other unions, hundreds of thousands of workers are already striking for pay.

Now, the Westminster Government hides behind arm's-length employers and independent pay review bodies in shirking its responsibilities, but, where large parts of the public sector in Wales are concerned, it's you and your Government that will decide. Nurses and teachers are balloting for strike action in Wales because of your proposals for a real-terms cut to their wages. So, First Minister, is it a policy of your Government that public service workers should be entitled to pay settlements that at least keep pace with inflation?

Well, Llywydd, the leader of Plaid Cymru drew attention to the resolution passed at the Labour Party conference. That is the policy of my party, and it is a policy this Government dearly wish that we were in a position to implement. He will know that every 1 per cent rise in the pay bill across the public service in Wales costs another £100 million. Every 1 per cent costs £100 million. If he can tell me where that money is to be found, then I'm happy to enter into dialogue with him. If all he has to offer me are pious aspirations and accusations that somehow other people are not as holy as he is, then I'm afraid that debate is hardly likely to prosper.

I have to say to the First Minister: look, awful politics in Westminster is not an excuse for poor politics here in Wales. These disputes are not just about pay; they're about the survival of our essential public services. In healthcare, we have a workforce crisis, with more and more people leaving by the day. There are 3,000 nursing vacancies in Wales, a rise of more than 1,200 on last year. Ever-increasing sums are being spent on agency nurses that plug gaps in rotas.

The figures for social care are worse, with 5,500 vacancies. Last week, speaking about the struggle to recruit social care workers, Deputy Minister Julie Morgan said that social care couldn't compete with the hospitality sector. To defend the public services that you're responsible for, you have to do something about the crisis of low pay, of nurses—the hard-working nurses you referred to—having to use food banks, of care workers that would be better paid in supermarkets. You referred to the Labour Party motion that committed you to pay increases at least in line with inflation, but it said not just Westminster—. I quote: the motion urged

'Government at all levels to take seriously their responsibility to fund public services properly and deliver a fair wage to those who provide them'.

Why are you not prepared to do that here in Wales?

Llywydd, it is the emptiest of contributions to offer us further and further iterations of the problem, without a single sentence that helps us to find a solution. This Government pays the real living wage to social care workers; the first time that's ever been done in the history of devolution. But I just put to the leader of Plaid Cymru the points I made earlier this afternoon: our budget in Wales next year is already cut by over £1 billion. We know that, because the UK Government has said in terms that it will not increase funding for public services, and the impact of inflation on our budget is that it is worth over £1 billion less than it was when the Conservative Government set that budget in November of last year.

On top of that, we are going to face huge further reductions. Let him tell me where the money to do what he asks me this week, let alone the money to do what he asked me to do last week, and the money to do what he asked me the week before—where is all that money going to be found in a time when we don't have more money to invest in our public services, we have less money than at any time during the history of devolution.

So, you agree with me, First Minister, about levels of pay, but you say your hands are tied by Westminster. Well, isn't it time, then, to take matters into our own hands? And no, I don't mean—. I'm not referring to independence or the devolution of welfare; that is a matter for another day. I mean in the here and now. In response to Alun Davies, you said you were committed to using all the powers that you had to defend the people of Wales from this Tory onslaught. Well, use all the powers that you have. We have the ability to use our tax powers to keep the 20p basic rate of tax in Wales and to be more progressive by putting a penny on the higher and additional rate. We argued for those powers, we campaigned for them, for situations precisely raise like this. Doing as we propose would raise close to £250 million and go some way, at least, to tackling the crisis in pay and morale in our public services, as well as in the wider crisis of liveability. It would protect our public services and save lives. Isn't that the Welsh way of solidarity, of community, of chwarae teg, for which this place was precisely created?

Llywydd, both I and the finance Minister have said that we will make decisions on the fiscal powers available to the Welsh Government in the way that we always do them, as part of the budget-setting process, when we have the full information we need in order to be able to do so. Now, he has made a case this afternoon; that case will be powerfully considered within the Welsh Government, but it will be done in the way that we always do it, in an orderly way, in the budget-setting process, as the Finance Committee would expect us to do, and when we are aware of all the decisions that will have an impact on our ability to fund public services next year.