1. Will the Minister make a statement on a potential strike by nurses? TQ674

I've just heard that the required turnout threshold has been reached for the Royal College of Nursing members balloted in all NHS employer organisations in Wales, with the exception of Aneurin Bevan health board, and in each of these, a simple majority mandate for strike action has been achieved. So, just to be clear, in Wales, RCN member nurses have voted for strike action everywhere with the exception of the Aneurin Bevan health board.

As a Welsh Government, we recognise why so many nurses have voted the way that they have, due, in no doubt, to the Tory-inflicted cost-of-living crisis, and also, the increased work pressures that many nurses are facing. And can I be clear that we agree that nurses should be fairly rewarded for their important work, but there are limits as to how far we can go to address these concerns in Wales without additional funding from the Conservative Government at the UK level?

Thank you, Minister, for your response. We know that, in the last half an hour, as you've said, six health boards across Wales out of the seven have responded to the result of the RCN strike ballot, and strikes will take place in those health board areas.

I have to say, Minister, I'm disappointed by your response, trying to deflect away from your responsibility. This is a Labour-run NHS in Wales, this is your responsibility, and it's for you to solve this problem. And I'm disappointed by your answer this afternoon. We know that, in Wales, a fifth of the population are waiting on an NHS waiting list, 60,000 of those waiting for over two years, the longest ambulance red-calls responses on record, and the worst accident and emergency waiting times in Britain. So, the last thing that we need in Wales, and the people of Wales need, is for nurses to be striking. Now, I appreciate that solving this problem is difficult. I appreciate that—it is not easy. But it is your dispute to solve, Minister. It is the responsibility of this Labour Government here. I hope that every opportunity has been taken, every opportunity possible has been taken, to avoid getting to this point and stopping strike action. So, can I therefore ask you, Minister: can you tell me how many times you have met with the Royal College of Nursing to negotiate the proposed pay rise; what approach are you going to adopt to bring any strike action to a close; what effect do you believe that the strike action will have on those long waiting times for emergency and elective treatment, which I've just outlined; and, finally, what will the cost be, if any, in agency nurses to cover any striking action?

Thanks very much. Can I just be absolutely clear that, without additional funding from the UK Tory Government, it will be impossible, within the current health and social care budget, to provide the kind of inflation pay rise for the NHS without facing—

Please allow the Minister to answer so we can all hear.

—some extremely difficult cuts that would have to be made elsewhere in the health budget. And that is an extremely difficult—. If he wants to give me some ideas of exactly where he thinks we should cut to pay for this, I'm all ears.

Now, I want to make clear that, in Wales, we work in social partnership. I meet very regularly with the RCN. We have a conversation, which is ongoing. We of course will continue, now we know the results of the ballot, to discuss what contingency planning we will need to put in place. We will not be using agency nursing to cover any shortfalls, because we respect the right to strike in Wales, and we understand that the nurses have not taken this action lightly and we appreciate the strength of feeling amongst members. I think this is the first statutory ballot on industrial action across the UK in the 106-year history of the Royal College of Nursing. Can I make it clear also that we would expect and we will continue to have conversations with the Royal College of Nursing in terms of the derogations that would happen at the time of the strike? In other words, we would expect emergency and cancer care to continue, for example, and we will be having those conversations in the forthcoming weeks.

Can I first of all register my support for all RCN members and the way they voted? Nobody wants to see industrial action taking place, and that includes, more than everyone, the nurses themselves. But the fact that this ballot took place in the first place tells us all we need to know about how nurses feel. Now, in driving a decade and more of public service cuts and real-time cuts to nurses' pay, the UK Government created a crisis. We can recruit into nursing, because, thankfully, we have enough people who care, but we can't hold on to nurses, because they feel undervalued. And whilst that's not all about financial rewards—we're still waiting for the extension of section 25B of the safe staffing levels legislation, for example—we simply have to show, through nurses' pay packets, that they really are valued. So, the UK Conservative Government should not have created this crisis; they should have undone the damage they themselves caused. And the Labour Welsh Government should have taken the opportunity, if not when the sun was shining—because it hasn't shone for some time—but at least before it disappeared behind the darkest of dark economic clouds we now face, to address the cuts in pay that have built up over time, and those other elements that have contributed to the unsustainability of nursing in Wales.

Now, pay, as I say, is just the tip of the iceberg—there are so many issues that need to be addressed—but nurses have taken a pay cut for the last 10 years. I understand that the Minister is still refusing to meet and negotiate pay with the RCN, but, I'm sorry, the need to negotiate has to be non-negotiable. Now, if Scotland can take the first step to prioritising their nurses by increasing their pay there by 7 per cent, why can't we? I agree entirely with the Minister that the Conservatives in UK Government have to take the blame for driving those cuts in public services, but there are actions that Labour can take here in Wales. When are we going to take the action that the Scottish Government have taken in Scotland?

Thanks very much. Can I be clear that we have been recruiting to the workforce in Wales, in terms of nurses, for several years? We've seen a 69 per cent increase in the number of nurse training places in Wales since 2016. The challenge, as you mentioned, is retention, and we understand that. These nurses have been under incredible pressure, in particular during COVID. We understand that that pressure has been unrelenting, and we also understand that they're heading into a very difficult winter. Those conversations will continue.

We have conversations regularly with the Royal College of Nursing, but I've got to be absolutely clear that there is no money left in the NHS budget. So, if we're going to find this money, we would have to cut it from the services that we give to the public in Wales, and, as you've all pointed out, there are many people waiting for operations in Wales as we speak. So, we're going to have to make some pretty tough choices here.

I know that Plaid Cymru, for example, are very keen for us to honour the commitment to pay the real living wage to care workers. Again, we'll have to find that money from somewhere else. So, let's be absolutely clear that taking political decisions is about determining what your political priorities are. It's very, very difficult when you have a limited funding pot that has been brought about and is going to get substantially worse because of the chaos the Tory Government has inflicted on us in recent weeks.

What we need to see is the Welsh Government taking responsibility for nurses' pay and stop passing the buck onto Westminster whenever the going gets tough. You slice the pie at the end of the day, Minister, and you have full control over this matter. The Scottish Government have put forward a pay offer that will see nurses in the country given an uplift of £2,205, with the health Secretary, Humza Yousaf, saying that the new deal for the 2022-23 pay cycle would reflect the hard work of NHS staff and

'will go a long way to help them through the cost of living crisis.' 

Now, I don't agree with the political make-up of the Scottish Government, but at least what they have shown is some guts and some leadership in dealing with nurses' pay, which has prevented strike action by the RCN up in Scotland. Are you happy to stand here this afternoon as a Labour Minister, in the shadow of Nye Bevan, and preside over the first nursing strike this country has ever seen, all because this Government can't get its act together? We are heading into winter with all the associated pressures, and in a situation, for the first time ever, that our vital front-line NHS staff are likely to walk out. When are you going show some guts, take some responsibility and give our hard-working NHS workers the pay reward they deserve?

Russell George asked you in his question how many times you've met with the RCN, and you've refused to answer, health Minister. So, could you please answer that question on how many times you have met with the RCN? Thank you. 

Well, I won't be lectured by a Tory on how to deal with the NHS. I will not be lectured by a Tory. And the shadow of Nye Bevan—absolutely, I feel a real responsibility to make sure that we provide the best possible service for the people of Wales. And that does mean keeping our nursing friends and our colleagues safe in the NHS, and making sure that they are happy in their workplace. And we will continue to have those conversations. 

As I say, I meet regularly with the RCN, at least quarterly—at least quarterly—and, on top of that, at other times.

But can I just give you a little bit of background to how we've come here today, because this pay award that is on the table at the moment is implementing in full the NHS pay review body recommendations? And as part of the pay review body process, various parties, including the Welsh Government, but also including trade unions, have the ability to submit evidence for their consideration, and then the independent pay review board submits their proposal. And what we've done is to take on their recommendations, which has been the story for many, many years. If we step out of that, then we're opening up a whole new world that we need to consider what happens if that happens. So, we're not in that place, and, as I say, it's going to be very, very difficult for us to find any additional funding. 

Just a note to Gareth Davies—the pie has shrunk over the last 12 years, and that is why the whole of the public sector is struggling so badly in terms of its budgets, in terms of the resources it has to deliver the services. So, there is no more money, because the chances of the UK Government suddenly shaking this magic money tree and delivering us more money is absolutely infinitesimal. So, my question, Minister, is this: I appreciate that you've only just got this information, but what's really interesting about what you've just said is that Aneurin Bevan health board has not followed the other six health boards in voting for strike action, and I wondered if you've had any time to reflect on whether that is down to the fact that Aneurin Bevan is consistently sector-leading in the way it delivers services, and reshaping them to constantly being better able to meet people's needs, and whether this has enabled staff in Aneurin Bevan to not have such a stressful working existence, which has made them less likely to strike. 

Thanks very much, Jenny. Certainly, we're always keen to work in social partnership. Obviously, I haven't had a chance to digest what is happening in Aneurin Bevan and why they perhaps have taken a slightly different route. My understanding is that they didn't reach the threshold of the numbers of people to participate, but I haven't seen the exact breakdown, so I'll look forward to analysing those results and seeing what is going on there that's different from other areas. But, as I say, I am very keen to make sure that we continue the conversation with our trade union partners, and to make sure that, where we can, we can stand with the nurses, who certainly deserve a pay award. 

And, finally, Joyce Watson. 

Diolch, Dirprwy Lywydd. First of all, I want to declare the fact that a close family member is a member of the RCN, before I speak on this. We all know that nurses are under huge pressure. We also all know that nurses were at the front line and instrumental at the time of the pandemic, and that others went outside every Thursday evening to clap their endeavours to try and save us from the worst excesses and death rates, whilst, at the same time, putting themselves forward on the front line. The pay award, as the Minister has said, was delivered and agreed by the pay review body, and has been paid in full, but the point here is that that was done before the double act—Truss and Kwarteng—crashed the economy, and has now put huge strain on families and public services. We can't get away from that, and I can hear the silence over there now; they're not trying to.

So, I think what needs to happen here—. And we've got a statement coming forward, but it's being leaked and drip fed to us that the Tories intend to cut public expenditure. They've made that perfectly clear, and they're drip feeding. Now, if you're going to cut public expenditure, included in that, and maybe the Tories here need a lesson, will be the NHS. That includes it. [Interruption.] It isn't beside it; that is public service, that is public expenditure. So, what I hope the Tories will do here, because they're clearly, like all of us here, exercised by the fact that we want to reward our nurses and all other staff who work to protect us and deliver our services, what I hope that they will do is write to the UK Government before that budget cuts the public expenditure even further, so that we can deliver what we know we want to deliver to the people who are delivering those services for us. And I look forward to having copies of those letters, delivered by e-mail or on my desk; they can take their choice in which way they do that. Thank you.

Thanks very much. The cost-of-living crisis, as Joyce has pointed out, is hitting everybody, but it's hitting nurses as well as other people, and it's really depressing to hear of nurses going to foodbanks and other places. That is, really, a very difficult situation. And what we have seen, as you pointed out, is a huge increase in energy costs, a huge increase in food costs, and now, as you pointed out, thanks to Truss and Kwarteng, what we've got are increases in mortgages, and that's what's really challenging people. All of those nurses who own homes are now going to have to dig deeper, as a result of the chaos that Truss inflicted on our economy. And—can I just be clear—it's not just about this year, as Joyce has pointed out, we are expecting substantial cuts next year. Now, even if the NHS stays at the same level as it is at the moment, we know that, with an ageing population and with digital advances and things, we should be improving the NHS by about 2 per cent a year. That is going to be incredibly difficult in future. But, on top of that, what we're seeing is an erosion of the amount of money that is available for us to spend on the NHS. So, I've given you this example before, but I'm going to give it to you again: I had—

Can I ask Members to be quiet, please? I'd like to hear the answer from the Minister, and Members are getting rather loud in their backbench heckling.

I had £170 million to clear the backlog, and now I've had an additional bill for £207 million for the cost of energy. I've had a little bit of money to cover that from the UK Government, but nothing like what is needed. So, that means we have to find cuts from within the NHS. That is your doing. That is your doing, and you have not come to the rescue. Go and speak to your political masters up in London.

I thank the Minister.