Questions now from party leaders. The leader of the Welsh Conservatives, Andrew R.T. Davies.

Thank you, Presiding Officer. It is remarkable that the First Minister says that this country needs a Government to invest in the NHS when he and his colleagues voted to cut the NHS budget in 2011 and 2012. The record shows that you're the only politicians in this Chamber who have ever voted to cut the NHS budget, First Minister. 

The other point of difference to other parts of the United Kingdom that has happened over the last week is you've brought forward a proposal and instructed the NHS to discharge patients without care plans and suitable provision within the community when they're discharged. Doctors and health professionals have said that patients could potentially die or come to serious harm. Do you agree with the doctors and health professionals on their assessment of your plans?

Llywydd, I completely reject the characterisation that the leader of the opposition has made, and he should know better. It is utterly irresponsible of him to misrepresent the advice not of the Welsh Government, but of the Deputy Chief Medical Officer for Wales and the Chief Nursing Officer for Wales. I have their letter in front of me and it does not in any way bear out the accusations that the leader of the opposition has just made. It refers throughout to safe discharge. But, what it does is to say to the system that the system has to attend to the balance of risk across all of those people for whom it seeks to provide care. We have people, as he well knows and often puts to me on the floor of the Senedd, who are struggling to get access to the front door of this system, often people with very significant needs. At the other end of the system, prior to Christmas, we had 1,200 patients in a health service bed in Wales who were medically fit to be discharged. Now, what the letter from the deputy chief medical officer and the Chief Nursing Officer for Wales does is to say to health boards that they have to balance those risks. If there are patients in a hospital bed waiting for tests to be done, they could be safely discharged and called back in when those tests are available. It may be that not every element of a care package is in place, but the care package that is there is safe enough to allow discharge to take place. Instead of a culture of perfection around discharge, and the culture of crisis at the front door of a hospital, the letter seeks to rebalance that and to do it in a clinically responsible way.

That was good advice to the health service in Wales; you will find parallel advice being prepared in other parts of the United Kingdom. I support what the chief nursing officer and the deputy chief medical officer have said to the service, and I think it will result in better care for many patients, who otherwise—with very critical needs—find themselves waiting too long to get access to the front door of a hospital.

First Minister, I'm not misrepresenting anyone's advice. The British Medical Association, the Royal College of General Practitioners, the Royal College of Emergency Medicine, practitioners on the front line, week after week, day after day, last week, were coming out saying that this advice is bad advice, and ultimately it puts patients at harm. That's not me saying it. A quick Google on any of the computers that everyone's on in here today will find that on the news stories that accompanied this particular announcement. If you say it's misrepresenting, why didn't you have the health professionals in before this announcement was made, to give the security and assurance that they would require to back up the advice that your deputy chief medical officer and chief nursing officer put out there last week, rather than rushing out the advice and causing concern, causing worry, and causing distress?

Llywydd, the advice was not rushed out in any way; it was given out on 30 December. The 27 December was the single busiest day in the 75-year history of the Welsh NHS. On that single day, 550 patients were admitted to a bed in the Welsh NHS. Five per cent of the whole of the bed capacity of the NHS used in a single day, and still with ambulances having to wait to discharge patients into A&E departments and people having to wait for treatment when they arrived. The letter responded in a sober and responsible way to that set of circumstances, advising clinicians of how they could safely make arrangements for people who are medically fit to be discharged—1,200 people in a hospital bed for whom the health service had already completed everything that the health service was intending to provide to those patients. I simply do not think it can be responsible to characterise that advice in the way that the leader of the opposition has sought to do this afternoon.

I have merely taken the comments and quotes and observations of health professionals, First Minister. I haven't added any of my own words. As I said, the evidence is there for people to see. You say this evidence wasn't rushed out. Twenty-seventh of December to 30 December, that's 72 hours. A fundamental principle was changed in the discharge process, which was having care plans in place for people who were discharged. What people want to know is, can you give an assurance that when people are discharged there will be that help, that support, and that guidance, so that people don't end up being readmitted because the circumstances that they have been discharged into are not good enough for them to be looked after for the condition they went into hospital originally for? Because otherwise, you will be betraying their confidence in the ability of the health and social care system here in Wales to put them back on the road to recovery and ultimately security in life.

Llywydd, the advice deals directly with ensuring that people are not discharged in circumstances that would lead to their rapid readmission. It talks about people who are, for example, waiting for an assessment, and suggests that it is better that someone might wait for an assessment at home, rather than waiting in a hospital bed—a hospital bed that is then not available for someone who is not in a medically stable condition waiting for assessment, but is waiting to get in through the hospital door to receive the treatment that they need. The balance of risk is something that the health service deals with day in and day out, and always has.

What the letter did was to make sure that the clinicians knew that, in making those decisions, they had the support of their most senior colleagues in the service in Wales behind them in making those difficult decisions. There is nothing in the letter at all that suggests that anybody should be unsafely discharged, that anybody should be discharged in circumstances where it would be known that that person would need to seek readmission. It simply sought, in a responsible way, to respond to the circumstances of the health service by saying that people who could be safely looked after at home could be accelerated in that journey in order to make sure, in one of the most basic principles of the whole of the NHS, that those with the greatest need were able to get to the front of the queue. 

Questions now from the leader of Plaid Cymru, Adam Price.

Diolch, Llywydd. On NHS pay, First Minister, we've estimated, based on figures that you've shared with us, that you could afford at least an additional 3 per cent extra pay award in this financial year. Now, I understand the health Minister has said that she does not recognise those figures, so can we assume that the pay award that you are intending to offer will be less than that figure? You said a month ago that there was no additional money available in this financial year, and now you've found it. You're now saying that there will be no additional money next year, so it can only be a one-off payment. But why can't you apply the same process that you have done to this year's budget to next year's budget? And even if that is not sufficient, do you accept that you do have tax-raising powers that could generate additional revenue? So, it's not right to say that your ability to turn a one-off payment into a recurrent pay rise is entirely determined by Westminster; it's a political choice.

Well, there are political choices here, Llywydd, and there are also hard facts, and it is simply a hard fact that you cannot spend one-off money to pay for recurrent bills. Now, the Welsh Government has written to our trade union colleagues making sure that we are able to go on talking to them. We've put a package of measures together. I'm glad that we will have a meeting with our trade unions on Thursday of this week.

One element of that package involves the offer of a one-off non-consolidated payment in this financial year. The amount of money that has been brought together for that has been hard-won over the Christmas period, in which Cabinet colleagues have all had to look at plans for spending in the final quarter of this year and agree to ways in which that could be reordered to release money to support that offer. But that is money available only in this financial year.

We will discuss with our trade union colleagues; that is the right place for us to discuss the quantum of money that is able to be found, and then we will discuss with them the best way in which that money could be dispersed amongst our public sector workers.

So, it is interesting that Plaid Cymru has joined the Welsh Conservatives in suggesting that the way to finance public sector pay in Wales is to raise taxes even further than they are already on the Welsh population. The leader of Plaid Cymru is right that that is a political choice, and that is a political choice that this Cabinet rehearsed in detail in the lead-up to the draft budget. There was a moment—a brief moment, as you know, when Liz Truss was Prime Minister—in which there were plans to reduce the level of income tax across the United Kingdom, and that did, I believe, open up a realistic possibility that we might have been able to raise income tax rates in Wales without disadvantaging Welsh citizens next year beyond the position they are this year.

Welsh citizens will pay higher taxes next year, Llywydd, than they have for the last 70 years. They're being asked to do that in the teeth of a cost-of-living crisis where they are already struggling to pay fuel bills, energy bills, food bills and other bills too. This Cabinet looked to see whether we should take more money out of their pockets by raising taxes, and decided that that was not a sensible course of action. That remains our view and, therefore, it's not a course of action we will follow, to find one-off money this year and to find recurrent money next year by raising tax levels even higher in Wales.

But the progressive use of income tax in order to defend public services from Tory austerity is a long-standing socialist position that we espouse in this party, and it's something you used to believe in as well.

You did recognise, in your comments yesterday, the collapse in trust in the pay review body process. How do you intend to rebuild this trust? Do you intend to change the nature of the remit by focusing squarely on what pay levels are necessary to recruit, retain and motivate staff, and leave the question of affordability for politicians to decide? And can you also say whether you're open to the union suggestion that any rise agreed for next year is backdated to January this year? That's a principle that you have accepted in your pay negotiations in Transport for Wales. And are you open to asking the pay review body to revisit its recommendations for this year, made before the huge hike in living costs, and reflect any higher award in a permanent pay rise?

Well, Llywydd, the Government will carry out our negotiations with trade unions with the trade unions. That is the right way for these matters to be resolved, and that, actually, is the way that I think is respectful to our trade union colleagues, that we discuss these matters directly with them, rather than by proxy on the floor of the Senedd. And that's what we will do.

We will, in doing so, talk to them, as I say, about how any sum of money we may be able to establish in this financial year can be dispersed amongst trade union members. We will certainly want to talk to them about ways in which trust could be re-established in the pay review process. There will be ideas that we will want to put on the table as to how that could be done, and I'm very keen indeed to hear from our trade union colleagues as to how they think that confidence in that process can be restored.

I think it is very important, from a Welsh worker's point of view, that we are able to do that, Llywydd. Over 20 years, and particularly in the last 12 years, we have been involved in seeing off a series of attempts by Conservative Chancellors to move to regional pay in public services. There is nothing they would like more than to see Welsh workers paid less than workers elsewhere. The pay review process protects Welsh workers from pay regionalisation, and that's why I believe that a real effort to re-establish trust in that process is worth making.

But the pay review process has led to a decade-long, real-terms cut in the wages of our NHS staff. So, the system is broken, and I make no apology for holding the Government to account and asking them to state what are your broad democratic principles. And we are here being the voice of NHS staff. We've been on the picket lines talking to them. We're making the points that they've asked us to share with you.

It's good to see that you are prepared to address, at long last, the massive increase in the use of private sector agency staff in delivering NHS services. Does this mean that you distance yourself from the position of the Labour Party in England, which is calling for the greater use of the private sector in the NHS—privatisation by proxy, essentially? Are you, as a Government, prepared to recommit to the principle you espoused 16 years ago, which was to completely phase out the use of the private sector in the NHS? Or is that promise to go the same way as Keir Starmer's 2020 leadership pledge, which was to end outsourcing in the NHS?

Well, Llywydd, I think it was the BMA that described the Welsh NHS as the NHS closest to the founding Bevanite principles of the health service of any of the four UK nations, and that is a position that I would wish to see us maintain. The impact of the pandemic meant that we have made greater use of private sector facilities than we would have prior to that, and there was no criticism of that, as I remember, during the pandemic period, because we needed to use all the facilities that we could put our hands on to make sure that people suffering from coronavirus had the treatment that they needed. In the aftermath of COVID, we will be making use of some private sector facilities to erode the backlog of people waiting for care that we talked about earlier this afternoon. Actually, I make no apologies for doing that. I regard it as a short-term measure to deal with a backlog. But when we have a backlog of the sort that we have seen—and we've heard this afternoon about people waiting in pain to get the treatment that they need—I make no apology for the fact that we will use facilities in the private sector here in Wales in that short-term way to erode those backlogs. At the same time, we want to build up the capacity of the health service itself, so that in the long run it is able to provide for all the needs that are there in Wales within the public service.