2. Will the Minister make a statement on the increase of cases of group A streptococcus in schools? TQ695

Strep A infections cause a number of common childhood illnesses. It's not unusual to see cases associated with nurseries and schools. Nurseries and schools have received guidance from Public Health Wales, and parents of unwell children are being advised to seek medical advice for diagnosis and treatment.

Thank you, and a massive thank you to the Presiding Officer and Deputy Presiding Officer for allowing this topical question today, and thank you for an initial response, Minister, and thank you for the written statement last night, although I know many across this Chamber were disappointed that there was no oral statement yesterday, so that Members across the Chamber would have the opportunity to ask questions on this. Of course, it's important that it was brought to the floor today, so thank you again. And, of course, it's crucially important that concerned parents and carers across Wales are kept up with current developments. There has been some obvious concern, with the sad deaths of nine children across the UK, one of which was in Wales, and our thoughts go out to those families for the loss of their child. And I believe it's just been announced in breaking news that there's been an outbreak in Carmarthenshire, with two seriously children and 24 cases reported of scarlet fever in the primary school there.

Minister, it's obviously, of course, crucial that we don't cause any sort of panic, but it is important that schools and nurseries are extra vigilant and that there is a universal awareness of what to do and what steps to take. And on that, I’d like to ask you how you’re working with the UK Government and Public Health Wales to ensure that schools are acutely aware of what to do and what steps to take to minimise the spread of strep A, and what the protocol is for them when this happens; it would be useful to know.

There was, of course, some concern also over the amounts of antibiotics available, and I believe that you’re working with the UK Government on that, so an update would be fantastic. I also understand the reason why antibiotics will be given to whole schools if there is a certified case, but there is some understandable concern from the medical profession about giving potentially healthy children antibiotics, because, of course, we want to prevent healthy children from having antibiotics and ensure that's kept to a minimum when they’re younger so that they don’t get immunity to them.

My colleague Altaf Hussain has also said that perhaps it would be a good idea for schools that are affected in the way that I’ve just announced to have access to a paediatrician straight away to confirm the diagnosis and whether they actually do need to have those antibiotics, rather than a blanket approach. But I’d appreciate your thoughts on that, because I understand, obviously, why parents particularly would probably like their children to have them. But, practically, would that be even possible due to the number of paediatricians we have in Wales, of course?

I just wanted to ask one more question: whether, now, if anyone presents in A&E with strep A symptoms, they'll have immediate access to paediatricians rather than having to wait the usual times in A&E. Thank you, and thanks again for bringing this to the floor.

Diolch yn fawr. Can I add my expressions of condolence to, in particular, the family who've recently lost a child? I think we all understand the real concern that many parents are suffering today because of the increase that we are seeing in strep A in our communities.

Public Health Wales issued advice to schools and nurseries at the end of November. Staff should be aware of the possibility of this infection in children who become ill with a fever, sore throat or rash. So, already that advice has gone out. Parents of unwell children are being advised to seek medical advice for diagnosis and treatment.

A child who's got scarlet fever will be asked to withdraw from the setting for 24 hours after the commencement of appropriate antibiotic treatment. Where there are two or more cases of scarlet fever in a setting within the same 10-day period, schools and nurseries have been asked to notify the local health protection team for further guidance. It is at that point that they will take a judgment as to whether you do need to give out antibiotics to the entire class or just to people who've been in close contact. Obviously, they'll make an assessment of whether there's a need for a paediatrician at that point.

So, I think it's really important for us to understand that there are degrees here and, obviously, it's only when it becomes very complex that the real danger kicks in. It's when you get invasive strep A that we really need to be concerned. But, obviously, taking those antibiotics at an appropriate time means that people can be helped.

In terms of the shortage of antibiotics, the good news is that all of the relatively mild illnesses caused by strep A can be treated with common antibiotics. Obviously now we have seen an increase in demand for antibiotics to treat those suspected cases of strep A, and that has led to some pharmacies in Wales experiencing shortages of stock. Now, we're confident that suppliers are working to address any supply issues, and, if people find difficulty obtaining a prescription locally, they may need to visit a different pharmacy, and, if they're still not able to, then they can go back to the GP and they can prescribe an alternative treatment. So, we are working with the UK Government medicine supply team and other partners to make sure that pharmacies in Wales have the supplies that they need.  

Thank you for that response from the Minister. I also wanted to ask about the shortage of antibiotics. I think we've had quite a comprehensive response there from the Minister. Two other questions from me, again on communication. I was pleased to see the statement coming last night. I've shared that on my social media, in my constituency, and I'm sure other Members are doing likewise, and the information is being provided to parents through schools. But what's the communication plan as we move forward? I think it's important that we understand that there is a communications plan in place in order to ensure that information is shared consistently, because this concern is not going to go away. And the other element I want to ask about is the additional pressure that I understand there is on A&E departments in hospitals. Because of a lack of understanding and information perhaps, it's quite easy to understand why more parents would take their children to A&E when there's any sign of something that they're concerned with, but, if that puts additional pressures on those departments, what plans does the Government have to ensure that there is additional support provided to enable hospitals to deal with that additional pressure? 

Thank you very much. Well, Public Health Wales is leading on ensuring that information is available to the public. I've contacted them today to ask them to simplify the language, because I think, sometimes, it becomes too technical in nature. People perhaps don't understand the difference between strep A and iGAS, and people use terms that the public don't understand. So, I've asked them to look again at that. I think it's important also to understand that scarlet fever does occur in Britain usually, but what we've seen is quite a large increase, and it's strange to see that kind of increase at this time of year. It usually happens in the spring. We're seeing this increase now, and the risk is when this happens when the children have other problems, so if they have chicken pox or another problem at the same time. That's when there are complications. 

Of course, there's great pressure on A&E departments at present. So, we will be ensuring that children have another route through the system. What we saw over the weekend was a very great increase in the numbers who were phoning 111 for support. I think it's important that people do call that number, because there is a difference between something that's simple and something that's looks a lot more complex, and 111 can help people though that system to understand what to look out for in terms of symptoms. 

So, regarding scarlet fever, people should be aware that you're talking about a sore throat, headache, a fever, nausea, being sick, and then you have a rash perhaps on your chest or on your stomach. But what happens with iGAS, which is a lot more complex, is that your temperature rises a lot, and you have muscle aches. So, it's important that people understand that that's when they should be perhaps getting more information from their local GP.  

I'd like to thank my colleague Laura Anne Jones for bringing this forward. Yesterday, I tried to bring forward an emergency question simply because of the fact that I was receiving so many enquiries. It's been touched upon, the availability of antibiotics. My concerns are it's not long now before the holiday period, and I know that parents and grandparents and carers are very concerned that if a child goes ill at the moment, it can take some time for certain symptoms to arise. Of course, we're in that season, aren't we, where children do go down with common ailments? So, it's how those can be distinguished and, just again, some reiteration that, with your working with the UK Government, we will not run out of any type of antibiotics for whichever strain they may be required for.

Also, I've heard the first-hand experience of a constituent of mine with two children who were waiting in A&E for nine and a half hours. At the moment, there's a hospital in north Wales whereby the board says 10 hours' waiting time. But, they were so worried they waited, to be told, 'You could have gone to see your GP', and then other parents are telling me that they're going to see the GP, who's saying, 'If you're that concerned'—because our GPs are overstretched as well—'then you're better going to A&E.'

So, would you be able to put out some clear guidelines? Like my colleague Rhun ap Iorwerth, I've shared your statement, but I'm sure there are other Members who are not here today who might appreciate, maybe next week, an update on where we're at then, because obviously the numbers have increased across the UK, per se. So, we want to be sure that people know exactly what they're dealing with, when to worry and when not to worry, so to speak, when to take action and when action at A&E isn't the right choice. I think that's it. Thank you.

Thanks very much. As I set out in my statement, parents who suspect their children have scarlet fever are advised that they should contact their GP or they should contact 111. Those facilities are available and people are using them. I would suggest at this point that they don't go to A&E, unless they are directed by 111 or their GP.

I've had complaints of delays on 111, I should say.

I think it's important, we've obviously put a lot of additional funding into 111. Obviously, as you say, we are working very closely with UK Government to make sure we don't run out of those antibiotics. We think this has happened because perhaps of the lack of social mixing over the past couple of years. What we're seeing now is a number of cases of this common bacterial infection—let's not forget, this is quite a common infection, it's something that many people just live with—circulating at the same time as that wide range of winter respiratory infections, and we think that's what's resulted in the increase in the number of those rarer and more serious invasive strep A diseases. Thankfully, we're still at fairly low numbers, but we don't know what's coming next, so it is obviously a very concerning time for people with young children.

The Minister for Health and Social Services will also respond to the final topical question. Rhun ap Iorwerth.