Questions now from party spokespeople. The Conservatives' spokesperson, Russell George.

Thank you, Presiding Officer. Can I wish you and colleagues across the Chamber a happy Christmas, Minister? 

Not a single surgical hub exists in Wales. Surgical hubs have been identified by the Royal College of Surgeons as essential to tackling the record treatment backlogs in the NHS, which now stands at over three quarters of a million cases in Wales. They've also proven central to reducing the backlog in England, which is why a further 50 are on the way, in addition to the 91 already in place. Minister, can I ask you why there aren't any surgical hubs in Wales when we have been telling you and your predecessor to put them in place for over two years?

Well, you may have noticed that, actually, where the populations are based in Wales, it's very different from what exists in England—they have big cities; they have places that are near each other. It's much easier for them to organise separate surgical hubs. What we are doing is we're ring-fencing elective surgery, which is effectively doing the same thing. So, making sure that elective surgery is not knocked out by the demands of urgent care. And in that sense, I think we have seen a lot of progress. Certainly, what we've got in Hywel Dda University Health Board is now two new modular places where, actually, we're expecting to see about 4,000 additional procedures occurring per year. In Cardiff and Vale University Health Board, there is, again, effectively a hub, it's the same thing; it's a ring-fenced facility, and there, you'll see 4,000 additional cataracts a year being done. And also the Cardiff and Vale Orthopaedic Centre, where there is, again, protected activity. So, you call them what you want, that's effectively what they do—they do the same thing as surgical hubs.

Thank you, Minister, for your answer. Of course, they're not effectively the same thing, because we're having a very different outcome in Wales. We've got 50,000 people, Minister, waiting over two years for treatment and the same figure in England and Scotland is zero—they've been wiped out. So, we're in a very different position. So, although you've set out a different position in Wales, I would suggest that that position is not working. We have one in four patients here waiting for over a year for treatment and the figure in England is one in 20. Average waiting times in Wales are 10 weeks longer than in England. So, I would say, look at what's working in England and do as England do when it is working. And I don't think it's safe to say—. I think it's very difficult for you to meet your targets this year, Minister; you've got a target to meet by the end of March and I think that it is more or less a reality now that you're not going to meet that target. I hope you do, but I don't think you're going to meet that target. I think it's going to be a very difficult target to meet even by the end of 2024. 

Well, thanks. Listen, we've put in stretching targets; I'm confident that we are going to meet the target in many areas of specialisms and obviously, we're going to be pushing everybody to try. But we always said that orthopaedics in particular would be a particular challenge.

I think you've got to just understand that, actually, when your capital budget has been cut, effectively, which is what's happened, it's very difficult for us to establish new centres. And so, the option that you have available to you is to reorganise what you already have. So, we could theoretically say, 'Okay, we're going to stop doing accident and emergency in a particular hospital and we'll ring-fence that', but you're going to be a brave politician if you do that at the moment. And I'm certainly not in a position where I'm prepared to do that when the pressures on our accident and emergency are so great. But actually, what they've done in England is they've closed huge numbers of hospitals where they were previously providing accident and emergency, and we haven't done that in Wales. Now, that comes at a cost—it's very, very expensive, but actually, I just think there is a political decision that is being made here. And the public, I think, are keen to see most of those accident and emergency places remain open.

Well, Minister, you've just got to look at the stats—the stats speak for themselves: in Wales, we are waiting 10 weeks longer for treatment than patients have to in England. So the stats do speak for themselves, and you can't get away from that.

But what my final question of the year would be to you, Minister, is: what do you believe is your biggest regret of 2022? And there is a bit of a shopping list here for you. Was it keeping in place the ineffective vaccine passports; recording the longest ambulance waiting times on record; the worst A&E waits in Britain; leaving a fifth of the population on an NHS waiting list; nurses on strike, ambulance workers on strike, midwives on strike; 1,200 further nurse vacancies and £130 million spent on agency nurses; NHS dentistry becoming a rare luxury; failing to support GPs to be more accessible and modernising NHS technology; or dodging accountability through a Wales-wide specific COVID inquiry? Is this what Keir Starmer means when he says, 'Look at Wales to see the good a Labour Government can do'?

Well, 'Happy Christmas' to you as well, Russell. [Laughter.] And I'm very pleased that that was your last question this year. Look, I've had better years, if I'm honest, and obviously, there are a lot of things that I wish that we'd seen improvements on and I wish we'd gone faster with some areas. Because for me, the key thing is to keep an eye on what is it that the public needs, and what they need is care in the right place at the right time. And I regret that we haven't been able to do more of that. And there are valid reasons for that: we have had a COVID pandemic; we have had massive inflationary impacts that have sucked £200 million out of the NHS budget; we have had massive, massive increases in demand; and we haven't seen some of the progress that I would have liked to have seen in relation to waiting times. But we're not at the point yet where we've hit the deadline, and I, as the Minister responsible, will continue to press the health boards, to make sure that they do everything they can to make sure that they work towards meeting those targets that we made very, very clear in April that we expect them to meet.

The Plaid Cymru spokesperson, Rhun ap Iorwerth.

Thank you very much. And in the final health questions of the year, may I take this opportunity to wish the Minister, the Senedd, and everyone working across the health and care services a very 'Merry Christmas'? But it sounds quite an empty greeting, when we look at the challenges that those services face. I truly didn't know what to ask today. There are so many things that I could pursue: the winter challenges; the staff recruitment and retention crisis; treatment waiting times in A&E; ambulance waiting times; the future of the air ambulance; strikes; I could have included the shortage of antibiotics—there's a topical question that's been accepted on that. Where does one start? But let me ask you this: what state does the Minister expect the NHS to be in by the time I can ask my next questions here in the Senedd? I fear that patients and staff have lost faith in the Government's ability to manage the NHS. Can I ask the Minister to give us something—anything—that we can see as improving, a corner turned, in order to prove that we can trust in the Minister?

Well, it's clear that we spend a great deal of time preparing for winter—we know that there will be pressures during the winter months. They've already started—we've seen how much pressure there was on the services over the past weekend. It doesn't help when we see rates of scarlet fever increasing—we didn't expect to see that. So, there are things arising that we don't expect to see. But of course, additional funding is available for next year, for the health service. That is going to be a difficult situation when you factor in inflation. But there are some areas where I do think we will see a difference over the winter. One of them will be the fact that we are going to see 100 additional ambulance workers starting in post during the Christmas period. They've been in training; I hope that will take away some of the pressure from the ambulance service. And, also, there will be an announcement on Friday from the Deputy Minister, on care, which also, hopefully—. We've been working on that for many months, together with local government, to provide additional help in our communities, but we'll make a more detailed announcement on that at the end of the week. 

Well, 'hope' was a word used there. I fear that that is the Minister hoping for the best; the NHS isn't going to overcome its problems if the Minister simply hopes for the best. And with more ambulance staff, of course, it's a problem of failing to get patients into hospital, so more staff isn't going to resolve that issue. 

I do turn, though, in my second question, to the various pay disputes—nurses in Wales striking for the first time this week, ambulance staff and midwives to strike too. I'm keen to find a way through this, but Welsh Government still isn't even engaging in meaningful negotiations. Now, the Minister says her hands are tied. Let me ask her this: does she even want those hands to be untied, because nurses tell me that what they see is a Minister seemingly happy to hide behind the inaction of UK Government? And I'm not talking about financial constraints; goodness me, I know it's tough, and the Conservatives on the UK level need to hang their heads in shame for the proactive role that they've played in helping create the economic mess we're in. But, currently, the Minister is able to avoid the reprioritising, the innovative thinking, the possibility of using devolved powers at the Government's disposal by saying that there's nothing she can do. Well, if she really isn't able to negotiate, as she suggests, what is she doing to try to be given the powers to do so, so that we can support our workers and avert these strikes?

Well, look, first of all, I think it's important that I set on record once again that we understand the strength of feeling felt by those people who feel like they've got no other option but to take industrial action. We believe that all our public sector workers should be fairly rewarded, and we think that the chaos that has been created by the Tory Government, and the increases that we've seen in terms of inflation, has eroded a lot of the money that actually would have gone into the pockets of those nurses.

And I think what's important is that we understand that it's not just money going into the pockets of the nurses that's been eroded, but the fact is that, this year, I have had a bill for £207 million for energy that we weren't expecting. Now, £200 million would be the equivalent of giving a 4 per cent increase to NHS workers. Now, I don't think that we can switch the lights off in our hospitals. I don't think that we can switch the heating off in our hospitals, but that might be an option that Plaid Cymru might want to take. But that's not an option that I feel that we can take. And that's the difference between lobbing grenades from the other side of the Chamber and actually being in power, because you have to make those difficult decisions. And I frankly think that we have to keep the lights on, and to keep patients warm when they come into hospital. That's a decision that we've made.