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

Thank you, Presiding Officer. First Minister, I would just like to inform you that we do have six regional Members and one constituency Member who do run in parallel with the M4, so we do have a vested interest, and that's an increase in the number of Members who came back after the 2021 elections.

What I would like to ask you, First Minister, is: after the waiting time figures that came out last Thursday, one of the big issues that many people struggle with is to get a general practitioner appointment. I've seen that, in other parts of the UK, commitments have been made that if someone requires a GP appointment, they will get it within two days. Are you prepared to make a similar commitment here in Wales?

Llywydd, it's important to get the facts right, and I'm happy to correct the fact that the Welsh Conservative Party did win one constituency seat across the whole length of the M4 in south Wales.

As far as GP appointments are concerned, let us be clear that there is no guarantee whatsoever that that promise will be delivered. I've heard it made by Conservative health Ministers repeatedly over more than a decade. They've never managed to make it happen so far; they're certainly not going to make it happen this time either.

The Member will be aware that only last week, the Care Quality Commission published its report on the state of healthcare and adult social care in England. It described a system, as they say, in gridlock: only two people in five able to leave hospital when they are ready to do so because the state of social care and primary care in England means that those people cannot leave hospital. People in England in the health service and social care, Llywydd, are working as hard as they possibly can. I make absolutely no criticism of them. It's just that they are facing, as we do, very, very significant headwinds in being able to provide the service to everybody in the way that we would wish to do so. I spent Friday morning in a GP practice here in Wales, hearing from GPs and the wider primary care team about all the extraordinary efforts they make to be able to provide appointments for the population that they serve, and they know that every day, they're not able to do the job in the way that they would like that job to be done, but it's absolutely not because they are not doing everything they can to make that happen, and they have the full support of the Welsh Government in doing so. 

Well, it's interesting that that commitment was made by the Labour health spokesperson at the Labour Party conference in Liverpool, so I'm sure that you'll pick up the phone and tell him that that commitment can't be made, considering that they're looking to Wales each time to see what can be delivered at a Westminster level. That was an interesting comment that you made, First Minister, there.

What about two-year waits? In particular, here in Wales we have just under 60,000 people waiting two years or more to have their procedure undertaken on the NHS. In other parts of the United Kingdom, in England, those two-year waits have been wiped out, and in Scotland, they've virtually been wiped out. Will you give us a timeline when that will happen here in Wales, and when the 59,000 that are two years or more on a waiting list can expect the same level of service here in Wales?

Llywydd, in the figures to which the Member referred last week, it showed that those long waits continue to fall. They've now fallen for five months in a row. They fell again in July, and provided that the system is able to continue in that way, then of course those long waits will be eliminated. 

What the figures also showed is the extent to which the health service in Wales, despite the huge pressures that it faces, has now been able to recover activity levels. Out-patient activity in July was at 102 per cent of pre-pandemic levels. In other words, not only is the system delivering everything it did before the pandemic hit, but still operating in a condition where over 500 patients are occupying a bed in the Welsh NHS today with COVID, where over 1,000 are not in work because of COVID—the system is delivering out-patient appointments over and above what it was able to do before the pandemic hit. And operations, elective in-patient care, have recovered to 92 per cent of the level that they were at before the pandemic. That's the highest level we've seen since the pandemic struck, and all of this while the system continues to do everything else we asked of it. This week, we have gone above 500,000 COVID vaccinations carried out over this autumn period. Who is involved in doing all of that? Well, it's the GPs that the Member mentioned in his first question, and all those other staff who turn up at weekends and run the clinics that mean that we've seen that extraordinary success.

So, while the health service works hard every day to recover the ground that was lost during COVID, to respond to the emergencies that people present, to do the other things we ask of them in vaccination not only for COVID, but for flu as well, we are seeing those long waits continuing to fall.

In my first question, First Minister, I asked you to support a commitment that the Labour health spokesperson in Westminster said that Labour would deliver, and you said that was undeliverable. In the second question, I asked you to give a commitment and a road map to wiping out the two-year waits here in the NHS. I've been contacted by a constituent this week, Richard Cooper, who got told that, to have his hip operations on the NHS here in Wales—because he required both hips to be done—he could expect a four to five-year wait for those procedures to be undertaken. He had to access his own private savings to go to a clinic in Poland to have the procedure undertaken. Now, I can't get a commitment out on GP response times, I can't get a commitment on two-year waits out of you; what is the advice I should tell my constituents, like Richard Cooper, who are having to access their own savings, their pension pots, because you can't deliver a health service that can meet the needs of the people of Wales?

On those three points, Llywydd, first of all, as soon as there is a Labour Government, we will be able to implement the Labour promises. I've explained to you—[Interruption.] I've explained to you why, under your Government, with budgets falling year by year, and now another era of austerity facing us all, the promises that your health Secretary made in England will not be met. With a Labour Government, then those things will be different and then of course we will see things improve, as we did under the last Labour Government. And I explained to you that long waits in the NHS continue to fall, despite everything else that the health service is doing, and everything else the health service is doing extends to trying to make sure that we have a sustainable orthopaedic service here in Wales. That is a challenge, Llywydd. We have an ageing population. We have more work that needs to be done. We have operating theatres still not able to complete the volume of activity that they were before the pandemic, and yet, as I said, in August alone there were 24,000 operations carried out in the Welsh NHS, and 230,000 out-patient appointments. While I regret anybody who is waiting too long for the operation they need, what I say to them is the system is working as hard as it can, it is gaining ground not losing ground, and we will continue to invest both financially but also in the staff that we need to make sure that our NHS continues to provide the treatment it does at that industrial volume that I've just described to you from the month of August alone. 

Leader of Plaid Cymru, Adam Price. 

Diolch, Llywydd. First Minister, you quite rightly complained that the last Tory Prime Minister failed to pick up the phone to you, and indeed treated yours and the other devolved Governments with contempt. How do you intend to approach relations with the latest Prime Minister? Will you perhaps decide to change tack and try and pick up the phone to him, as leaders of other national Governments are set to do over the next few days? If you do speak, you will no doubt want to congratulate him on being the first British Asian to be elected as Prime Minister, which is indeed a historic event and all the more fitting that it's on Diwali. But will you also want to underline that the one thing he must not do in his Halloween budget is to usher in a new era of austerity and plunge the economy into recession, people into poverty and our public services, including the NHS, into yet a deeper crisis? 

Llywydd, I hope of course that the new Prime Minister will take a different approach to relations with the devolved Governments across the United Kingdom. I see a series of Welsh Conservative MPs today calling on the new Prime Minister to take that initiative, and it is the initiative for the Prime Minister to take. So, I hope very much that there will be early contact from the latest administration, and, if there is, then you can be sure that I will want to have a constructive relationship with the new Prime Minister. If I have an opportunity, there will be a series of things that I will want to put early on his list of priorities. The future of the United Kingdom itself—I'll remind him, no doubt, that the Welsh Government is the only other unambiguously unionist Government with which he will have contact, and I would want to work with him to make sure that there is a successful future for the United Kingdom. 

I want to talk to him about some very important individual issues that are important here in Wales—the future of Tata Steel, for example. When I wrote to the Prime Minister but one ago earlier in the summer, he replied to me acknowledging the seriousness of the position of Tata Steel, but saying that it would be for the next Prime Minister to make the decisions about the level of support that could be offered to the company; well, that latest Prime Minister came and went and no decision of that sort was made. So, if I have the opportunity, I will certainly be saying to the new Prime Minister that attending to that very important issue, as far as Wales is concerned, should be high on his list of priorities. And, of course, Llywydd, I will say as well that the very last thing people in Wales or across the United Kingdom need is a further dose of Tory austerity.

You've been calling for a general election, and there is an unanswerable case for having one, given now we've had two Prime Ministers without a democratic mandate. The truth is that Prime Minister Sunak is free to ignore that, as he is free to ignore you. The UK's unwritten constitution concentrates huge power in the hands of the PM, which explains the mess we're in. Now, the doctrine of Westminster supremacy means the new Prime Minister is free to repeal any Act of this Senedd and revoke any power, even though he has no mandate to do so, certainly not here in Wales. Now, the political pendulum may swing at the next election, whenever it comes, but how can we stop being in exactly the same position in years to come, when the pendulum swings back? How do you propose an incoming Labour Government would entrench our Welsh democracy in a political system where Westminster reigns supreme?

Llywydd, I agree that there is an unanswerable case for an election, and I don't think that the Prime Minister is in quite the unassailable position that the leader of Plaid Cymru has suggested. The deep divisions inside the Conservative Party may be papered over for a few weeks yet. We may see Conservative Members of Parliament playing football against one another on the green outside Parliament in some form of Christmas truce, but, once Christmas is out of the way, then I'm afraid the incoming Prime Minister will face the very, very deep divisions inside the Conservative Party, as the last four predecessors have done as well. And I'm not in quite the same position as the leader of Plaid Cymru in thinking that a general election won't be coming our way sooner rather than later. After that election, there will be an opportunity, I hope, for an incoming Labour Government to do exactly what Adam Price has said: to entrench devolution, so that it cannot be rolled back in the way that we have seen since 2019. I think there are a series of practical ways in which that can be done, and, when the Gordon Brown report into the future arrangements of the United Kingdom is published, I think we will see a number of those practical ideas. I'm not going to rehearse them this afternoon necessarily, Llywydd, but they are there. They are there in ways that would guarantee that the things that have been endorsed in two referendums by people in Wales can be organised in a way that those preferences can be delivered without the risk that they're always under pressure of being rolled back.

When you were in Ireland recently, you reiterated your view that the United Kingdom represents, for Wales, a great insurance policy, but how is that policy working for us when the contract can constantly be changed over our heads, against our wishes and against our interests? You talked about the pooling of risk through the union, but surely the events of the last few weeks have demonstrated that the union actually exposes us in Wales to risk, to uncertainty and to avoidable harm. Now, you've said you would never ever support an independent Wales, but would you accept that there are some circumstances at least—another Tory Government elected against our wishes in Wales, or a Scottish 'yes' vote in an independence referendum—where independence might become, for Wales, and even for your party, the more progressive option? I understand that you prefer a continuing union, but isn't saying 'never' to independence simply wedding ourselves to a future that will be never our own to decide?

Llywydd, the issue of whether Wales should be independent is a matter for people in Wales, and I've always said that if a party were to put that as a prospect in a manifesto and they were to win a majority of seats here in the Senedd, then, of course, if people choose that course of action, then that is the democratic will of people in Wales. Their voice is the important one—not mine, whether I think it's right or wrong. Where I will agree with the leader of Plaid Cymru is this: that if the political geometry of the United Kingdom were to alter, if one of its constituent parts were to choose a different future, that doesn't leave what remains untouched. You would have to have a very serious set of discussions about how Wales's future could best be designed in those different circumstances, and it's why, as the leader of Plaid Cymru knows, we have established our own constitutional commission to help us to think about what choices there would be available to Wales in those circumstances. Independence could be one of them, as it has been ever since his party was established and ever since it's put that prospect in front of the people of Wales. So far, people have not been persuaded of that, and there will be alternative futures that others of us would rather advocate. But that's the right place for these decisions to be debated; they're not for me as First Minister or even for political parties here to make that determination. Just as the leader of Plaid Cymru said there was an unanswerable case for a general election to determine the future economic direction of the United Kingdom, so it would be an unanswerable need for such decisions of the sort that he's outlined this afternoon to be made by the people who put us here.