The following amendments have been selected: amendment 1 in the name of Lesley Griffiths and amendment 2 in the name of Darren Millar.

The next item is item 9, and it's the Plaid Cymru debate on nurses' pay, and I call on Rhun ap Iorwerth to move the motion.

Motion NDM8140 Siân Gwenllian

To propose that the Senedd:

1. Believes that Welsh nurses deserve fair remuneration for their essential work in keeping our communities safe and healthy.

2. Calls on the Welsh Government to utilise every devolved lever at its disposal to make an improved pay offer for NHS nurses in Wales.

Motion moved.

The Llywydd took the Chair.

Thank you, Chair. We're today asking the Welsh Government to support Welsh nurses. We're asking the Senedd to support our statement that nurses deserve fair pay for their work, and we ask Ministers to use all levers possible in order to make an improved pay offer to nurses.

We are facing a nurses' strike for the very first time. Nurses, who are carers by nature as well as by profession, have made the most difficult decision possible to take industrial action because they feel that they have no other option. We are asking the whole Senedd to support the motion. We will support the second amendment, calling on the Government to come back to the table for discussion. The First Minister said last week:

'All strike action ends in the end in negotiation', but how about trying to end the strike action through negotiation? Even UK Government has negotiated, to no avail, but why on earth will the Labour Welsh health Minister not bring everyone back around the table through the Welsh partnership forum that's there for this exact purpose? I pointed out last week that Welsh Government hadn't even responded to the correspondence sent by the Royal College of Nursing on 25 October, asking for those negotiations to take place. As if by magic, the Minister has responded in the last few minutes, I understand—the first correspondence since that strike ballot result. But yet, there is no commitment to meet for new pay negotiations. What I'm seeing is a Government preparing for the nurses' strike action, when we should have a Government trying to avert that strike action in the first place. 

It's not all about pay—it's important to remember that. Nurses also want to know that they're being supported, given time for professional development and training, that staffing levels aren't putting them or their patients in danger, that there's a workforce plan aimed at bringing down the 3,000 or so nursing vacancies in Wales. But pay is a key part of being able to show nurses that they are valued. For too long, pay has been squeezed. For too long, the UK Tory Government has given us cuts, cuts and cuts; their economic incompetence compounding what was already a public spending crisis. But for too long, Welsh Government has used that as a reason to shy away from its responsibilities. Whatever the context, governing is always about prioritising. I’ll be told again today, as will my colleagues, ‘Where would you find the money?’ And I and colleagues have been open. We've urged you to look at how you can use all the levers at your disposal—taxation, reserves, reallocation. But I’m not in Government. Governing is a privilege. It’s a huge responsibility. And in this case, it’s the responsibility to avert an even deeper crisis in the NHS than the one that we already face.

There are 3,000 vacant nursing posts in the NHS in Wales. Nurses are leaving the profession. The failure to retain staff is a crisis. And unless these questions around salary are addressed, we will lose more—the crisis will deepen. More and more have been turning to agency work, contributing to the huge agency bill of some £130 million per annum now—a bill that we simply cannot afford, and a bill that would pay for the salaries of almost 5,000 new nurses.

Thank goodness we haven't faced a shortage of people wanting to become nurses, to come into the profession. We've actually seen an increase, a positive increase, in nursing student places in Wales in every year bar one, I think, of the past decade. On its own, that is great news, but it's a leaking dam. Yes, we've more coming into nursing, but numbers leaving are undoing that, and the exodus shows no sign of slowing down.

With an underpaid workforce that's also overworked, it's a recipe for even more attrition. Every week, nurses give the NHS in Wales an additional 67,000 hours of work. That's equivalent to 1,800 nurses. This isn't sustainable. So, yes, retention is perhaps a greater challenge than recruitment, but, of course, bringing in new nurses remains crucial. Let me ask the Minister one specific question around that. A few years ago, Welsh Government did consider removing the bursary, which is such an important element of being able to attract people into nursing. We, in opposition, and the RCN, and all those who saw the value of the bursary, succeeded in persuading the Minister at the time not to scrap it, and that was to be welcomed. Can this current Minister confirm unequivocally now that there is no plan to remove or undermine that bursary, that this payment will continue to play an important part in attracting and supporting nurses through their training? Without it, the crisis deepens even further.

I hope that I have painted a clear picture for you this afternoon as to why we must reach a settlement on the question of wages and support for nurses. But let me make it even more clear through the words and experiences of nurses and their families, speaking directly. A mother from Anglesey who has two nurses as daughters, one in Wales, and the other in Australia, unfortunately. The one in Australia is paid twice as much as the daughter working here in Wales. She would like to return to nurse here, but how can she as things stand? A third of a nurse's salary here can be spent on childcare for just one child, the mother says. She asks the Government to pay them a fair wage. 

Tony, a retired child and adolescent mental health nurse, came out of retirement to help during the pandemic, and thank goodness he did. Now on a nurse bank, he says, 'The situation was bad before I retired, but, on returning to work, I was met with excellent nurses describing feeling sick with anxiety before going to work in the morning, and crying when they finished work because they felt that they had failed to give patients the standard of care that they wanted to.'

Sarah says that she voted to strike because, after nearly 40 years of nursing, she's fed up of being taken for granted when it comes to pay:  'We've repeatedly been neglected and have not fought back', she says. 'But this time we've had enough.' This neglect has contributed to a reduced number of student nurses, and the early retirement of thousands, causing a severe staffing shortage.

Tom, a community nurse, says that the cost-of-living crisis is crippling him and other nurses. He said, 'I didn't come into the NHS to be rich'—none of them did; it comes from the heart—but he adds, 'We're hitting a crisis. We're looking after really vulnerable people, and no matter how hard we work, there's so much pressure and the resources aren't there.'

And Katherine, finally, an RCN member, says, 'Professionally employed people should not be forced to use foodbanks or sleep in their cars between shifts because they can't afford petrol.'

There are so many more nurses' stories I could share with you.

Llywydd, it's a word I've used a number of times today: crisis. The NHS is already in crisis. It was pre COVID; it's always important to bear that in mind. But, of course, the pandemic has exacerbated the situation. But the situation could get even more critical. We now have nurses preparing to leave wards in a dispute over wages, while simultaneously more and more are preparing to leave the profession entirely, and wage levels play an important part in that. We must stop this, and, although it's not the only solution, securing a deserved pay settlement must be a major part of the solution. The Government cannot delay any longer. 

I have selected the two amendments to the motion, and I call on the Minister for health first of all to move formally amendment 1. 

Amendment 1—Lesley Griffiths

Delete point 2.

Amendment 1 moved.

Formally.

Amendment 1 has been moved. Now amendment 2 to be moved, in the name of Darren Millar, by Russell George.

Amendment 2—Darren Millar

Add new point at end of motion

Calls on the Welsh Government to meet with the Royal College of Nursing Wales to discuss its campaign for fair pay and safe staffing to avoid strike action this winter.

Amendment 2 moved.

Diolch, Presiding Officer. Can I thank Plaid Cymru for bringing forward this debate today? A quite proper use of debating time in the Chamber this afternoon. 

A strike will have devastating consequences for patients, and we know six of the seven health boards have voted in favour of strike action. I think that just shows how desperate nurses are for the Welsh Government to listen to them. I'll say to the Minister: Minister, you must do everything in your power to avert a nursing strike as well as stemming the workforce pressures. 

To speak to the amendments today, we'll be supporting Plaid's motion fully today. I'm very disappointed at the Government's deleting point 2 of the Plaid motion. We've added an amendment of our own, which calls on the Welsh Government to meet with the Royal College of Nursing Wales to discuss its campaign for fair pay and safe staffing to avoid strike action this winter. To be really clear on this, the Minister has not met with the RCN to discuss their campaign for fair pay, and has only just responded to the request that they made last month. As Rhun ap Iorwerth has pointed out, the Minister still has no plans to meet with the RCN, and what frustrates me is that the Minister seeks to deflect, when this question is put to her, and then responds to a different point. Yes, you may be meeting the RCN to discuss other matters, and you may be meeting with unions, but you have not met with the RCN to discuss their fair pay campaign. And that is our amendment to the motion this afternoon, Minister. I hope you will confirm that you will be meeting with the RCN and supporting our amendment today.

Now, as Rhun ap Iorwerth has pointed out, it's not just about pay, of course, as well. Other areas need to be examined—key conditions, such as mental health support, retention, upskilling and tackling the mammoth staffing gaps in the NHS. They've got to be tackled urgently as well, so that the NHS workforce is fully supported. And whilst I'm on that point, I note Rhun did ask you to guarantee, in his opening comments, but I would reiterate that myself, Minister: can you give that guarantee that the nurses' tuition fee bursary will be safeguarded into the future in your remarks this afternoon?

Minister, you responded to one of my colleagues last week in the Chamber that you were fed up; you were fed up of some of the questions being put to you. [Interruption.] You did say that, Minister; you did say you were fed up of some of the questions being put to you. Well, can I say that I'm fed up, I'm frustrated, when Ministers don't take responsibility for what is in their power here? So, the Welsh Government has been responsible for the Welsh NHS for 20 years, and you, Minister—[Interruption.] I'll come on to that now, don't worry, Deputy Minister. But the Welsh Government is also responsible for nurses' pay and conditions as well. So, I'm fed up when you point your finger—it's health boards' responsibility, it's Westminster's responsibility, you want more money—all the time deflecting away from the responsibility here. 

The autumn statement has just been announced. The Welsh Government will receive an additional £1.2 billion in consequentials. You, Minister, can cut your cloth as you choose to do here. I could name a whole raft of areas where I believe the Welsh Government has spent money inappropriately, or wasted money. So, you have the responsibility here to cut your own cloth. I could talk about the different views in this Chamber about the £100 million that's about to be spent on 30 new Senedd Members. That's a debate for another day, but that's equivalent to 4,000 newly-qualified nurses. That debate will happen again, I'm sure. But the point is that these are decisions made here by you, Minister. I and my colleagues are wholeheartedly supporting our NHS nurses, and we think that they should be supported in the profession that they love. And it is disappointing that the Welsh Government has still failed to produce a retention plan for nursing over two years on from the NHS workforce plan in 2022. 

We face another winter of severe pressures on the NHS, and the Welsh Government should be doing everything in its hands and in its toolbox to avert strike action and avert pressure being put on the NHS across Wales. Minister, I would call on you this afternoon and call on the Welsh Government to meet with the Royal College of Nursing to discuss its campaign for fair pay and safe staffing to avoid a winter of industrial action in the coming months ahead. Diolch yn fawr. 

As was referenced by Rhun ap Iorwerth, we do welcome the fact that the Welsh Government has increased the number of nursing student places in Wales, with the exception of 2019-20, where the number remained static. It is very much welcome. But, unfortunately, the exodus of nurses leaving the NHS shows no sign of slowing down, and clearly seems to be increasing, as many nurses are leaving the profession earlier in their careers. In fact, when I recently met with the RCN, I heard directly from staff that students are even taking the decision not to seek work with the NHS because of what they've witnessed and experienced during placements, and the stress they have been under because of what they consider to be unsafe staffing levels. 

Experiences of the pandemic only reinforced what was already known about the NHS and the nursing workforce here in Wales. It is a workforce suffering from staff shortages, low pay and low morale, and yet it is incredibly needed and valued. But the reality is that nurses are operating in an environment deprived of investment and resources, which is why it should be of no surprise that the biggest threat to the workforce is its sustainability, with far more nurses leaving the NHS than can be matched by newly-qualified nurses or internationally-recruited nurses.

Research has shown that, where there are fewer nurses, patients are 26 per cent more likely to die, and this rises to 29 per cent following complicated hospital stays. Health boards acknowledge that nursing retention is an issue, and in many reports, discussed at countless meetings, they frequently highlight the absence of a national strategy in terms of retention. We need a national solution to a national problem, yet it appears that there is no incentive or performance management scrutiny from the Welsh Government in terms of the issue of staff retention. There is clearly a staffing crisis, and the Welsh Government must take action to tackle the issue of retention if we are to see improvements.

As has already been referenced, there are various strategies to address the high vacancy rates, such as the all-Wales national approach, and there are effective procurement initiatives and support for international nurses in place. However, in terms of both retention and recruitment, we already know what would make a difference to nurses, because they have told us, and that is uplifting nurses' pay and making sure staffing levels are safe. We know that, with the coming winter pressures as well as the cost-of-living crisis, the deeply concerning situation within NHS Wales will only worsen. And the current risk posed to patients because of a shortage in nursing staff and a struggling, exhausted workforce will increase.

We believe that our nurses and the public deserve appropriate and sufficient care. The only way to attract and retain nursing staff is to reward them, and to reward them well for their skills and commitment, and this must start with an above-inflation pay rise. This isn't my solution nor Plaid Cymru's—it's what nurses have told us needs to happen. This is something I have been told when I've met with them in hospitals, and heard directly from them about the very real challenges they are facing, and why some people feel they have no option but to leave a profession that they really, truly care about.

During the pandemic, we showed our appreciation for the NHS by standing on our doorsteps and clapping, but saying 'diolch' is no longer enough, and actions do speak louder than words, and I would ask all Members of the Senedd to support our motion and support our nurses today.

I recently visited Glyndŵr University in Wrexham, which has expanded to now offer nursing and a variety of allied health degrees, plus retraining, in fantastic new spaces with the latest technology. The bursary in Wales for training also makes a huge difference. Nursing and other staff get such a hard time and morale is low, so we need to promote nursing and health as a career, and we need to ensure that both Governments invest in people when looking at rebuilding the economy, not just construction and the private sector. We also need to create career pathways for specialist services, such as mental health nurses. We need to build back our public services and ensure there is adequate funding from the UK Treasury to give decent wages and employ more front-line staff, so that we can retain those we have on decent hours without pushing them to exhaustion. Not only nurses, but also care workers, allied health professionals, porters, administrators, advisory services, housing officers, teachers—all these impact on health and desperately need funding. And the pot is being cut, eaten up by inflationary pressures, not just caused by the war, but also Brexit, 12 years of austerity and terrible decisions made by the recent Conservative Prime Minister, creating a £30 billion pressure and rising inflation. I understand that the NHS energy bill black hole this financial year is £100 million. Councils are still facing an £802 million budget black hole, and the delayed transition to care is a huge issue, and it's a delicate funding balance. One cannot be addressed without impacting on the other. We simply need more funding from the UK Government for public services to cover all the inflationary rises.

But in terms of what the Welsh Government can do, I'd also like to know what consideration has been given to reducing NHS reliance on agency staff, in turn allowing them to improve pay for NHS workers and address the recruitment crisis, so we have more directly employed nurses. I believe the total spend on agency nursing for 2021-22 was £133.4 million, which has increased by 41 per cent from the previous financial year. At present, agencies are offering substantial hourly rates. For example, adverts are currently live for an agency nurse in Wrexham Maelor Hospital offering between £23 and £48 per hour, so even at the lower end of this offer, the pay is considerably higher than what an NHS nurse would receive; I think it's about £16 an hour. Earlier this year, I met with the Royal College of Nursing regarding NHS nurses' pay and conditions, and it was raised with me that, if health boards stopped paying to bring in agency staff to fill the gaps and instead directly employed nurses on improved pay and working patterns, there would be no need to pay the high cost to agencies in the first place. Because I was wondering how this cycle could be broken, and if it's not quite so clear, maybe we could just pass that information on to nurses as well, so they understand.

So, Minister, in your response, I'd like to know what the Welsh Government is doing to break the cycle of reliance on agency nurses, to ensure money goes directly into employing NHS nurses rather than relying on the expensive agency route. And if it's not that simple, please can you let me know why it's happening? Thank you.

For my contribution this afternoon, I'd like to focus on the impact that the crisis in nursing in Wales is having on hospices, and in particular on the two children's hospices in Wales—Tŷ Hafan and Tŷ Gobaith. Both hospices are sanctuaries to some of the most vulnerable children in Wales and their families. Neither hospice can work to full capacity, however, due to growing staffing costs and financial limitations to maintain a competitive employment choice for nurses. This means that the hospices are unable to provide all the support they can to the people who need it the most.

Having campaigned hard with the hospices to improve the funding settlement provided by the state to hospices, it is incredibly disappointing that hospices cannot currently work at full capacity. It seems that the recent uplift provided by the Welsh Government, which was the first in over a decade and still lags way behind the support provided by the SNP Government to children’s hospices in Scotland, has not kept pace with the rapidly changing circumstances. Not only are prevailing conditions and the economic outlook affecting the charities' ability to raise funds, but there has also been little recognition of how rising costs and inflation have essentially engulfed the bulk of the funding made available. Also, with nursing resource costs set to increase further, the gap between funding received and the effect on services delivered become larger.

Research shows that the need for hospice-based services, end-of-life care, symptom management and crisis-driven respite care is only going to increase. Yet, shockingly, these needs are increasingly not being met. Having visited Tŷ Hafan and seen first-hand the difference they make to children facing the bleakest of futures, this is truly heartbreaking. The outlook is that things will only get worse. An upcoming prevalence study, sponsored by Welsh Government, will show that a vast number of families with life-limited children, who are amongst the most vulnerable in our society, are not presently in receipt of hospice support.

Resourcing beds has not always been straightforward, specifically for Tŷ Hafan, where the exhausted pipeline for qualified children's nurses has led to recruitment challenges. This recruitment challenge reflects the current nursing shortage, and sustainable funding is vital to secure the provision of these essential services in line with current need. The connection between great care and experienced nurses is well known, and yet the current shortage of nursing staff in Wales is severely affecting a hospice's ability to deliver the level of care and support they would like to as many families as possible. If the current rate of attrition continues, it is conceivable that the hospices will not be able to operate. In line with their stated aim to be a compassionate country, the Welsh Government should support the hospice sector, specifically those nurses who are its building blocks, and this support must begin with an above-inflation pay rise. Diolch yn fawr.

I'm grateful for the opportunity to contribute to today's debate, and I thank Plaid Cymru for tabling it. Like other speakers, I wish to start my contribution by paying tribute to all those front-line workers within our NHS. They have led us in the fight against coronavirus, from treating people in hospitals to administering vaccines as part of the UK's world-leading vaccination effort.

I want to take the opportunity to specifically look at nursing conditions in my local health board, Hywel Dda. Figures from the Royal College of Nursing showed that the number of nursing vacancies in my health board—in our health board, Minister—increased from 408 full-time-equivalent positions in May 2021 to 539.2 full-time-equivalent positions in July of this year. This is leading to a much heavier reliance on agency staff, which is reflected in staggering spending, highlighted by further figures obtained by the RCN. Over the course of the 2021-22 financial year, spend on agency nurses for the health board was between £28.9 million and £34.3 million. Why can't I give an accurate spend? Because the figures provided by the health board, via a freedom of information request, were £5.4 million lower than the figures obtained by another absolutely identical FOI request sent to the Welsh Government. How on earth can such a vast discrepancy in accounting exists between Welsh Government and health board figures? And while this discrepancy is deeply troubling, we should not let it deflect away from the sheer amount of money that this health board is spending over the course of a year on agency nursing—money that, with better management and, most importantly, better guidance from the top, could be spent on retaining nurses and paying them a higher salary.

But this debate today is not just about the remuneration that nurses receive, but also about the respect that the Welsh Government shows to them. You've not met with the RCN to discuss the pay dispute. Both the Westminster and Scottish health Ministers have. And having listened to the Minister's response to the Petition's Committee report on safe staffing levels on 28 September, I know she will stand in response to this debate and point the finger at the Westminster Government. But can I ask the Minister, with genuine seriousness, to pause and reflect on her current strategy of deflection? Is it really the best course of action to treat our nursing workforce, a workforce of intelligent, articulate and determined people, with a lack of respect by trying to pull the wool over their eyes? It is the Welsh Government that has been in charge of the NHS in Wales for over 23 years now—a period of time where the Welsh Labour Party have always had their hands on the levers of power. I know this, the Minister knows this and, most importantly, the nurses know this.

Minister, none of us want to see our nurses strike. As a Welsh Conservative, industrial action is something that does not sit comfortably with me. In recent months, I have visited Glangwili General Hospital and had frank conversations with nurses. From these conversations and following discussions with the RCN, I can see why they are so frustrated. So, I beg you, Minister, I plead with you, to sit down around the table with the RCN to specifically talk about pay and the strike action. Deflecting your responsibility as health Minister, when after the pandemic the understanding of where health decisions are made in Wales is at an all-time high, does a disservice to the workforce who so valiantly serve us. My constituents deserve better. Our nurses in Wales deserve better. Please, Minister, take responsibility for your Government's actions. Establish a constructive way forward to avert industrial action, and recognise the contribution that our nurses make in Wales. Diolch.

How many of us have been grateful for the care that a relative has received when they are ill? I'm certainly grateful for the care that two of my grandparents received during COVID. That care that we rely on wouldn't be possible, and the quality of the care wouldn't be as good, without nurses—nurses who are asked every shift to go the extra mile, who were asked to take an extra shift during the pandemic. The reality is that more than half of Wales's nurses are demoralised.

Leanne Lewis, a nurse in my region, a fellow Pencoed resident, has said publicly and to me how there is a genuine staffing crisis. She said staff are leaving in their droves. Leanne tells us that there is lots of staff sickness through burnout and post-COVID complications, and there is not the right skills mix on the wards. Like the majority of nurses—and that's 78 per cent of them, by the way—Leanne felt that patient care was being compromised.

It's one of the reasons why we've called for an extension to section 25B of the Nurse Staffing Levels (Wales) Act 2016. Previously, the Minister has said that section 25B is based on evidence, and that being grounded in evidence is what gives the Act its credibility, and that any call to extend section 25B neglects the foundation of the Act. Well, I would say that the evidence is there. It's overwhelming. It's there today in what nurses across the Welsh NHS are telling us. Hell, it was in the Tawel Fan report, back in September 2014. All of this has highlighted the seriousness of the situation. Our nurses are doing everything they can to mitigate the issues, but, like everyone, they can't be everywhere at once, no matter how much they want to be. 

What it comes down to is the need for better recruitment and retention. I come back to Leanne. She tells us that nurses are absolutely traumatised and fed up of not being able to give their patients the care they want to give, and the care that they deserve. 'It's heart-breaking', she tells us,

'to have colleagues phoning me after a shift in tears because they feel they haven't been able to provide the care they wish they could have due to not having the staff.'

Tawel Fan should have been a wake-up call for the Government, but the problems have persisted and worsened, and, as a result of the Government's inaction, the people who pay the price are staff and their patients. I would welcome in your response, Minister, if the Government is ready to extend section 25B.

Now, there have been repetitive calls on the Welsh Government to commit to valuing our nursing workforce. In June 2021, 16 organisations wrote to the First Minister to urge the Government to ensure safe nurse staffing and expand section 25B to mental health in-patient wards and community settings. In October 2021, health boards asked for more funding, resources and nurses in preparation for the extension to paediatric wards. And there were also fewer patient incidents in 2021, where nursing has been considered a factor on wards covered by section 25B, compared to 2019.

Strike action has come as a last resort, as it always does. No matter what industry you're in, nobody wants to strike. But Government inaction to address the situation has left RCN members feeling like they have no other option, for the first time in their over 100-year history. A recent YouGov poll in Wales showed that 85 per cent of the public support a pay rise for nurses. All of those people are potentially NHS Wales patients. Without a nursing workforce, the NHS cannot function. Without an above-inflation pay rise, improvements in service for patients will not be possible. So, I urge the Welsh Government to have open discussions with the RCN and to commit genuinely to raising nurses' pay.

Thank you to Plaid Cymru for this debate today.

It is a really serious situation that we face, and it's good that we're able to really debate this here in the Senedd. I do want to say that I know the Minister has had many, many things on her plate and it has been a very pressurised time, but, right now, to think that we might face a nurses' strike is really very challenging for us as a society here in Wales. To think that many of the lowest paid who care most directly and work so hard for the patients in their care might be considering going on strike—. Now, put yourself in the head of somebody who has devoted themselves to caring for vulnerable people in need, and think, 'The only way I can get better conditions, better pay, is actually to strike.' They have not made that decision lightly. 

I want to just focus on two areas, briefly. One of those has been covered to Luke Fletcher, in relation to section 25B. I would seek confirmation that there is no commitment at all to row back on this, because I am concerned, actually, that that might be happening. The RCN actually cite very clearly that section 25B retains nurses—that nurses working in wards where that is the case actually want to stay. So, it's imperative that we retain it and extend it. I'm bound to say, of course, that this Bill was brought in by Kirsty Williams and the Welsh Liberal Democrats. In fact, it's the only private Member's Bill in 23 years to actually go through the Senedd, showing, I think, the degree of support and commitment that there was across parties to making sure that we had those safe nurse staffing levels. I would welcome as well an update from you, Minister, on whether you plan to extend the Act, as you've heard from Luke Fletcher, in order to address the staffing retention crisis in many other areas of our NHS. 

The final issue I just wanted to touch on is, it seems, the Welsh Government's refusal to use the levers at its disposal to actually award better pay for nurses. Before I go on to that, I think it's important that we don't get lost in the language of 'pay rise', because in the dire economic circumstances we find ourselves in, not least that the retail price index measure of inflation is running at 11 per cent, any pay award that the Welsh Government offer nurses below that level is actually a real-terms pay cut, and that's why I implore you to do everything in your power to deliver on a real pay rise for our nurses, to address the recruitment and retention crisis in the Welsh NHS. That's why I'll be supporting the motion today. Because I do know that the Welsh Government has in its power the ability to pay our nurses, and that is that we can look at how we use the powers here to raise taxes. I've said this time and time again: we have the ability here in Wales now—we have the ability to put on a penny in the pound. Now, I'm sure that many people around Wales wouldn't begrudge that; in fact, I think they'd commit to that, for our valued NHS workers and our valued social care workers. Let's be bold, let's be brave, let's see a commitment to that part of our society that cares for our most vulnerable. Thank you. Diolch yn fawr iawn. 

It's a pleasure to take part in this debate this afternoon on a subject I'm fairly passionate about, with my experience in the NHS. As mentioned earlier in the debate, the UK Conservative Government has provided Wales with £1.2 billion in Barnett consequentials after announcements made in last week's autumn statement, and that's in direct contradiction to the health Minister's claims that her funding would be cut. The Labour Government only has to look at themselves for the blame, and the health Minister should be putting that case to her Cabinet. I'll give you a few examples of some of the money that's been wasted by the Welsh Government that could be, arguably, ploughed into nurses and front-line NHS workers. So, £66.2 million on loans to prop up Cardiff Airport; £110 million on overspends and delays to the A465 Heads of the Valleys road; £157 million on the M4 relief road, which never got built; £14 million on the Llanbedr bypass in Gwynedd, which was halted when Lee Waters decided to halt road building; £4.25 million on Gilestone Farm in Powys; and £20 million on the universal basic income pilot. Let's not forget, as Russell George mentioned as well, that the Labour Party are very happy to spend £100 million on potentially 36 new Members of the Senedd, which would equate to around 4,000 newly qualified nurses, as Russell George also mentioned. The Royal College of Nursing Cymru has estimated that vacancy rates have almost doubled in the last year, with 2,900 vacancies in the nursing workforce compared with 1,719 in 2021. Wales is indeed the only country in the UK not to fully publish its vacancy data.

Just to briefly outline why I'm passionate about nursing staff levels and nurses getting a fair pay deal, obviously, it's because I worked for Betsi Cadwaladr and the NHS for 11 years, and I worked very closely with nurses across a very broad range of disciplines. It's really non-exhaustive what nurses do. They cover so many different areas—general health, mental health, the prison service. The list is endless. They specialise in other areas, so the skill set of nurses is very wide. Let's not forget as well that they have to indeed make a lot of sacrifices in order to qualify as nurses. Let's not forget that it's three years of education in university, £9,000 a year tuition fees, so you're looking at about £27,000-worth of debt before they've even started their careers. And their list of duties is non-exhaustive. They work 12-hour shifts, they work nights, they work weekends, they work all the unsociable hours—Christmas Day, you name it. So, they certainly put a shift in, to coin a phrase, and they're very hard-working and have a lot of responsibility for the public's health, and I think that should be fairly rewarded within the NHS service.

So, I'll just conclude by urging the Minister to get around the table with the RCN to thrash a deal out and prevent nurses' strike action, particularly as well as we're heading into winter—well, we are in winter; we're not heading into winter, we are here. We obviously know the consequential pressures of the winter, so, timing-wise, it's not the best time of year if strikes were to happen. So, please, Minister, please take some responsibility, get around the table with the RCN and let's do a deal. Thank you.

The Minister for health now to contribute to the debate—Eluned Morgan.

Diolch yn fawr, Llywydd. I want to say at the start that we absolutely recognise why so many nurses have voted for industrial action for the first time in the RCN's history. We believe that nurses, together with other hard-working NHS and public sector workers, should be fairly awarded for their work. Nurses, healthcare professionals, cleaners, porters, paramedics and many other professions that make up the NHS staff are on the same NHS terms and conditions as their colleagues across the UK—the 'Agenda for Change' contracts. So, Members should be aware that singling out one group of staff or prioritising one group over another when it comes to pay has significant consequences. All of our NHS staff are vitally important, and without them—all of them—we couldn't provide NHS services.

Now, we understand the concerns and anger of our workforce about how their standards of living are being eroded, but, before I turn to finances and financing, I want to cover the process that I followed this year in making the pay award. Now, as in previous years, we asked the independent pay review bodies to provide their independent advice, and when we asked for that advice, we specifically asked them to consider the cost-of-living crisis. The pay review body reviews evidence from all parties, including Government, trade unions and employers, prior to making independent recommendations. It's a mechanism that we and trade unions have agreed to follow when it comes to pay negotiations for NHS workers on 'Agenda for Change' contracts. So, RCN are part of the 'Agenda for Change' contractual negotiations. So, after careful consideration, I accepted their recommendations, and I also agreed to pay the £1,400 uplift on top of the temporary real living wage uplift, which I announced in March 2022, which means that the lowest paid NHS staff will see that substantive salary increase by 10.8 per cent.

Before announcing the pay award, I met with trade union colleagues to discuss the current financial pressures and explained that we could not increase the pay award without making extremely difficult decisions about cuts to other areas of the health budget, which would, inevitably, cut the services available to the public and make it even harder to clear the waiting lists. Now, I greatly value the regular contact that I have trade unions, and whilst these are not pay negotiations—I've just explained the process that we use for that—they are about issues that greatly impact on the NHS workforce, such as staff welfare and well-being, and I look forward to my next meeting with the NHS Wales business committee trade unions, which includes the RCN, on Monday.

Llywydd, I am saddened that, in the midst of a cost-of-living crisis, we are unable to give nurses, our NHS staff and our wider public sector staff an inflation-matching pay award, because our funding settlement falls far short of what is needed to meet these significant pressures that they and we face. Last week, the Chancellor presented his autumn statement, and we believe this was a missed opportunity to provide nurses, NHS staff and public sector workers with a pay rise. Now, there was some additional funding for Wales—£1.2 billion over the next two years. That's for the whole of everything we do in Government—two years—but this falls far short of what's needed to fill the holes in our budget, let alone meet the pay calls being made by staff and unions in all parts of the public sector. And there was worse news for this year. There is no extra funding for this year, despite the huge inflationary pressures, and this Plaid Cymru motion calls for us to use every lever possible to give nurses a pay rise. We've heard suggestions that we should use reserves or unallocated funds. Well, I'm afraid the figures we've heard quoted this week, in terms of unallocated funds, are very out of date. You're using June figures. That was before we knew about the £207 million extra bill for energy just for the NHS. So, every penny of our budget is needed to meet the inflationary pressures on public services.

Will the Minister give way?

Yes, I'm happy to give way.

Thank you for giving way. I specifically asked if you could update us on the current figure. So, can you tell us what is the current figure for unallocated spending and what is the current figure for the Welsh reserve?

Well, just to be absolutely clear, the pressures are way above that. This is no underspend this year. Wake up and smell the roses. I'll tell you how much extra I've had to find in terms of cuts this year in the NHS budget. It's cuts. We're way overspent.

Yes, well, will you tell us what—? Do you have the figures for unallocated spending currently and for the reserve? And can you share them with us?

No, I can tell you there is no unallocated funding. I can't go further than that. I can tell you how much over—. I think we can get that information to you.

Just to be clear, you're saying—

No, I'm not going to give way again.

The Minister isn't giving way. The Minister can continue.

The supplementary budget is going to be coming out very shortly, and you'll get all the detail in there. You will see the impact of the inflationary pressures, and they are way over anything that was in unallocated funding that you looked at in June. Every penny of our budget is needed. But even if we did have underspends, let's be clear that this could not be used to fund pay awards. This is time-limited and non-recurring funding. Reserves can't be used for everyday spending. They can only be used once, and they're held for emergencies. Responsible government also means preparing for the unexpected—for floods, for new COVID strains, for the cost-of-living crisis.

We've heard suggestions that we should cut back also on agency spend. I know there's a lot more we can do, and we must do, to drive down costs in this area, and we are working on it. But switching off the use of agency staff would have serious consequences if we did it very quickly in the Welsh NHS. We—

Will the Minister give way?

Sure. 

I do hear what you're saying, and I think there's a valid point on this going too rapidly on agency staff. But I think there is an issue here on the reliance on agency. You often speak to front-line NHS workers who will say, 'If some of that proportion of what's been spent in additional agency was actually spent on mild enhancements to encourage us to come back in or stay after shift'. Can we do that over time?

I can assure you that my officials are working on this as we speak. There's a lot of work being done. I do think people need to understand that we do have a legal requirement in terms of safe staffing levels. If you're saying, 'Don't use agency staff', what that will mean is that we'll have to close wards. There will be accident and emergency services that will have to stop. That's the consequence of doing it too quickly. We know we have to do more, but we can't do it overnight. 

It's true that we do have choices. We've heard calls today to increase Welsh rates of income tax to pay nurses. I explained earlier that prioritising one group of public sector staff over another has significant consequences. We would want to consider giving all public sector workers an inflation-matching pay rise, but that is going to be extremely difficult. We'd need to raise at least an extra £900 million. To raise that through the Welsh rates of income tax, we'd need to raise the basic rate not by a penny, but by 4.5p. Such a rise could generate about £900 million. So, we could cover it, but imagine what that would mean. It would mean that, in Wales, one of the poorest parts of the UK, we would have some of the highest tax rates. It would have to become permanent, and let me just give you an example of what that means in practice. Somebody earning £20,000 in Wales would be paying an extra £424 a year in tax, and someone earning £30,000 in Wales would be paying £784 more in tax. And don't forget that nurses would be covered by that. So, if they're earning £35,000, even nurses would have to pay an extra £1,009 in tax. 

Another lever available to us would be to make deep cuts into existing and future health and social care budgets. That would mean job cuts and cuts to services. It would mean longer waiting times and fewer new medicines. Of course, that is possible. The Scottish Government have decided to do that, and what they've done is massive cuts to budgets to front-line services. That's the reality of what you need to do. If we were to do the same, it would—

Would you take a short intervention?

No, I'm not doing any more interventions, if you don't mind, because I know the Llywydd is going to call me to order very soon. 

You're perfectly within your rights to decide on interventions.

Thank you. I want to give you an assurance that the nurse bursary will remain. I'd like to emphasise that what we need is a fair funding settlement from the UK Government, which recognises the hard work of all of our NHS staff and other public sector workers and provides them with a fair reward for the jobs that they do. 

I take this opportunity again to implore the UK Government to consider the significant impact industrial action will have on the delivery of services, and to provide additional funding for a fair pay award for staff to avoid industrial action and the impact that that will have on patient care. Diolch yn fawr. 

I call on Rhun ap Iorwerth now to reply to the debate. 

Thank you very much, and thank you for everybody's contributions to this debate this afternoon. We've heard from Member after Member why we appreciate nurses so much. Yes, we've thanked them on our doorsteps, as we've thanked all staff in the health and care service for their tireless work, but the point comes where we do have to show true appreciation, and that has to include through pay packets.

The Minister has explained to us today why she feels that her hands are tied by the financial settlement of the UK Government. Of course, I agree entirely with her about the impact of the ideology underlying the cuts by one Conservative Government after another. It's a choice to cut the budgets of public services. And a word of advice to the Conservatives: don't draw too much attention to the pitiful increase given to public funding in Wales by your Conservative Government in Westminster, and say that £1.2 billion over two years is anything more than the crumbs that it represents. And another word of advice: don't use a debate like this one to attack devolution and the work that is being done to develop our democracy here in Wales through making up figures about the cost of the reforms that are taking place here in the Welsh Parliament.

But there is a more bitter taste, of course, now, to the economic deficiencies of the Conservatives in Westminster, because we're all paying the price for their inability, and our nurses are paying the price for that inability. But the Welsh Government still has a role to look at their priorities. There are no excuses for the lack of action. We were challenged as an opposition to find the funding. The First Minister, like the Minister today, was critical last week of the Scottish Government saying that they had pulled money out of the NHS to make a better pay offer, as if the nurses themselves aren't one of the most important elements that the NHS can pay for. At the moment, we are seriously asking nurses themselves to fund the NHS that they themselves work for. How can that be justified or acceptable?

We had a promise that the bursary is forever. It's not that unequivocal promise that the bursary won't be downgraded. I am happy to receive an intervention from the Minister if she wants to give us any assurance that there won't be any change to the bursary. She chooses not to make that intervention. We'll leave it there—[Interruption.] No, I was asking that there wouldn't be any downgrading of the bursary either. We've heard that it is remaining, but I look forward to hearing those further promises, because it is so important.

I did say that retention is perhaps more challenging than recruitment, but we have to ensure that we maintain all the tools needed to bring nurses into the profession, and remember many come not straight from school, but perhaps a little later in life and having to give up another job. They need the backing of that bursary at the current level.

On the pay negotiations, Government has to come to the table, and it has to persuade us that it's left no stone unturned. They clearly haven't done that to date, and they clearly haven't done that this afternoon. It's in the Government's interests to do this. Low pay is pushing nurses out of the profession. It's pushing nurses into agency working. I'm grateful for the comments from Huw Irranca-Davies on the impact of agency working, and Carolyn Thomas too. We all want to cut that agency bill. But the pay level currently and the level of morale within the health service is pushing nurses into working agency shifts. The bill has rocketed some 41 per cent in the last year alone, to £133 million in one year. The nursing workforce is effectively being privatised under Labour's watch.

The Labour Government's amendment today takes out our demand that the Welsh Government utilises every devolved lever at its disposal to make an improved pay offer. It's not one single lever; it's all the levers brought together, bringing together all the options at the Government's disposal. I look forward to further comments from the Finance Minister on the fact that there is zero money, apparently, unallocated, and zero in reserves. Perhaps we could have an explanation of whether that really is the case. In tabling that amendment, Labour is refusing to use the levers at their disposal, even though they could. They're turning down opportunities to try to avert this strike. If the Government's amendment passes, then of course we'll support all that's left, a mere statement that nurses deserve fair remuneration. But those words are only words unless Government shows it's ready to take action. 

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] There is objection. I will therefore defer voting until voting time. 

Voting deferred until voting time.

Before we move on to the vote, Natasha Asghar asked me earlier to reflect on the appropriateness of the use of the term 'hysterical' in response to her by the Deputy Minister for Climate Change during questions this afternoon. There is a very, very long history of the term 'hysteria' being used by men to demean women, especially women in public life, and I apologise to Natasha Asghar for not having noticed it at the time it was said. 'Hysterical' is an inappropriate word to describe any contribution by any woman in this Chamber. It may have been naively used by the Deputy Minister at the time, but I don't expect to hear it again. 

Now, we will go on to the vote, unless I have three Members who wish for the bell to be rung.