The next item, therefore, is item 3. That's a statement by the Minister for Health and Social Services on winter pressures on the NHS, and I call on the Minister to make her statement—Eluned Morgan. 

Diolch yn fawr, Llywydd. Thank you for the opportunity to update Members on NHS winter pressures. Members will appreciate this winter is proving to be particularly challenging for health and care services across the United Kingdom. This is our third winter of living with COVID. While we knew respiratory viruses would become more prevalent this year, the disruption of seasonal patterns has made the likely impact of these viruses much more difficult to predict. Despite this, we are still delivering around 376,000 consultations and procedures a month in secondary care, in hospitals. In December, we reached about 400,000 contacts in GP and primary care services. So, every single day, every week, there are thousands of people receiving excellent care in the NHS in Wales, but what we do accept is that there are many others who are not receiving the care that they deserve.    

We have asked a lot of our staff over the last two and a half years, and we know pressures have meant staff have often not been able to consistently provide the level of care that they want. We also recognise the strength of feeling amongst our workforce, as reflected in the announcement of further planned strike action amongst ambulance unions, as well as the continuing action by the Royal College of Nursing. It's important to note the impact on capacity as a result of recent industrial action, and that has placed additional pressures on our systems due to reduced staffing and, in some cases, limited or no availability of certain services during these periods.

We are dealing with an increasingly complex case mix of patients. We have more than 500 confirmed patients with COVID in our hospitals and we're seeing rapid increases in other respiratory viruses. In addition, other groups of patients are presenting with increased levels of serious illness, and, while the position has improved since Christmas, there are still over 900 people in hospital beds who are ready to leave but have had their discharge delayed for various reasons. Sickness absence rates among staff have also increased to 6.9 per cent. The result is greater prevalence of long delays for people trying to access care, and the risks of harm we know are associated with such delays. As a consequence, the experiences of people seeking urgent and emergency care across Wales have not always been to the standard that they deserve, and for that I am truly sorry.

We went into the winter having seen record levels of demand on the 111 and ambulance services in October and November, with every expectation that these pressures would increase further throughout the winter. But let me give you an example of the extreme pressure that we saw on our services on 27 December: the 111 telephone service received the highest number of calls ever reported for a single day; the ambulance service received 210 immediately life-threatening calls, amongst the highest daily figures on record. We think 100 is high, and we had 210 on that particular day. As the First Minister said earlier, over 550 people were admitted to hospital in one day. That's the equivalent of around 5 per cent of the available bed capacity in Wales. There were 551 COVID patients in acute hospital beds, which is over 5 per cent of total bed capacity, and around a further 3 per cent of beds were occupied by patients in hospital with influenza. There was also the equivalent of 12 per cent of the total bed capacity in Wales taken up due to delayed discharges.

Now, this level of pressure, at a time when staff illness and absence have had a significant impact, has created massive challenges for the system. Planning for winter started as early as April. We’ve worked hard, every fortnight meeting with local authorities to secure over 500 extra community beds for step-down care, and we’re working towards more over the coming months, which will help improve flow throughout the health system.

We must learn from the recent weeks and months, and we are committed to working with clinical leaders and professional bodies to support meaningful service redesign. We know one of the biggest challenges the health system faces is helping people to leave hospital as soon as it's safe for them to do so. Last month, I launched a new discharge planning guidance report, which sets clear expectations for health boards and regional partnership boards, and that is supported by a national flow programme. In April, we made a five-year commitment of £145 million through the regional integration fund to enable regional partnership boards to build on models of care developed to support rapid discharge and admission avoidance.

We’ve also made significant investments in urgent and emergency care this year, and if we hadn’t, the situation would be a great deal worse. Thanks to early investment made available in June, the Welsh ambulance service has been able to deliver a range of actions to increase capacity ahead of the winter. This includes recruitment of 100 additional front-line staff, who will be responding to calls within the next two weeks; new rota arrangements, which will equate to 72 whole-time equivalent staff; and new investment in triage and video consultation technology to support more confident decision making about whether a patient needs to be taken to hospital.

We have also invested in increasing capacity in urgent primary care centres and in expanding same-day emergency care services to provide people with alternatives to attending busy emergency departments, or admission to hospital. These interventions have supported around 7,000 people a month to access urgent care services away from the emergency department, and have helped to reduce and stabilise emergency admissions.

We know there is a lot more to do and there are no quick fixes. We share the public’s concern that our services remain under extreme and persistent strain. This is why we have established a five-year programme to transform urgent and emergency care services, which is supported by £25 million per annum, of which health boards received £3 million each in April. In addition to these interventions, and as the winter has progressed, we’ve issued further guidance to health boards through a revised local options framework similar to the approach we took at the peak of the COVID outbreak. We’ve also written to health board clinical leaders urging them to make every effort to keep people at home, and not to admit people to hospital unless absolutely necessary. Last week, we held a national discharge summit, and we have also asked clinical teams to return those in hospital to their homes or to an alternative place of safety as quickly as possible to help preserve our hospital capacity for those at greatest risk, and with the greatest chance of benefit.

We can expect the next few months to be really tough, but I really want to express my thanks and gratitude to staff for their continued efforts during what continues to be a really difficult time. Thanks also to families who have supported the discharge of their loved ones; this is going to really help us free up hospital beds for people who need the specialist care that only our hospitals can provide.

We’ve made extensive preparations for the winter, and whilst we have seen tremendous pressure over recent weeks, at levels we've never seen before, the actions that have been put in place have enabled us to broadly stabilise the position since the festive period. We’re now preparing for the next phase of pressure as children return to school and as life begins to go back to normal after the Christmas break, as well as changes in the weather, which we know often bring a new surge in the demand during this time of year. Thank you very much.

Happy new year, Minister, to you and thank you for your statement today, and I'd like to start by adding my own thanks and appreciation to our incredibly dedicated and hard-working Welsh NHS staff and professionals. Minister, over the last decade, your Government has failed to invest more than £400 million in the Welsh NHS compared to other Governments across the UK. Whilst COVID has caused significant harm to our NHS, your Government, of course, has been responsible for the Welsh NHS for nearly 25 years. So, do you accept that if you had used the funding correctly, we'd be in a better position than we are in now? And, to use a cliché that I don't like using, but I shall say it in this regard, why didn't you fix the roof whilst the sun was shining? 

Minister, you claim that planning for winter pressures started in—[Interruption.] I can hear the First Minister talking away. It was the First Minister in his statement yesterday to the press who told us that the first 10 years of devolution were wonderful under a Labour UK Government. So, if that's the case, why didn't you fix the roof then? Why have we got these problems that exist now?

Minister, you claim that planning for winter pressures started in April, but I'm concerned, as I relayed at the time, that the publication of the plan to tackle these pressures was late in coming forward. And it is clear that the process, I would suggest, isn't working. So, can I ask you what is it going to take for health boards and your Government to review the impact of winter pressures, and what immediate action can you take to fully utilise the summer months to prepare for another winter? 

Minister, I do welcome your points on the ambulance service—that's very welcome—but I do feel that they don't go far enough. In your last update, you told me that you will be making sure ambulance handover delays are reduced, but the chief executive of the Wales ambulance service, Jason Killens, said it is now not uncommon for in excess of 30 per cent of our available crews to be tied up outside hospital waiting to hand over patients to care, which means that they're unable, of course, to go back to support patients in the community, resulting in longer waiting times for them to arrive. So, what progress have you made in this area, Minister, because Wales continues to have, as we know, the slowest ambulance response times on record and the worst A&E waits, and the longest NHS treatment lists in Britain? 

I have given you a number of suggestions, Minister, for developing different areas. One is winter war rooms, and I would suggest we need winter war rooms that have 24/7 data-driven control centres to provide accurate information on bed capacity in hospitals and care homes, run by clinicians and experts who can identify pressure points and act to reduce deadly ambulance delays and lengthy waits in A&E. I wonder what consideration you've given to this policy, Minister. 

You talk about a five-year transformation plan. I kind of sigh when I hear about transformation plans. It's not that I disagree with transformation plans, but, since I've been here, I've heard about transformation plans over the past 10 years, but then we don't see the outcomes that are delivered from those transformation plans. I do wonder whether there's a lack of cultural change within the Welsh Government and a lack of trust in innovation that will only further add to the issues that we face within the Welsh NHS. 

Minister, you know I've constantly called for surgical hubs. We've got more than 50 further hubs in England coming, in addition to the 91 that are already in place. We're falling further behind in this regard. I welcome the addition in your statement, that you apologise to patients for the quality of service that they are receiving, however, I can't help thinking that we should have just been preparing—you should have been preparing—during the course of the pandemic for post-pandemic progress, and I wonder if you could update us, Minister, on your plans in terms of starting to build the hubs that I and my colleagues have been calling for. It's not just me saying that; the Royal College of Surgeons welcome the announcement of those surgical hubs to end the limbo that patients face. Minister, I'll end my questions there. 

Well, thanks very much, Russell, and a happy new year to you as well. Just in terms of how we compare to England, and I think it's really important, let's look at the figures here, because the Nuffield Trust—this is not us as a Welsh Government—the Nuffield Trust tells us that we spend more on health and care than they do in England, okay? So, if you look at the figures in Wales, we are spending 5 per cent more than England—that was pre COVID—and 30 per cent more than England if you include social care. So, don't talk to us about spending more compared to England. We are doing that; we do need to do that because we've got an older and sicker population. But the fact is it's really important that we talk, not just in general terms, but let's look at the facts, not produced by us but by an independent, acknowledged expert group. Part of the reason we're in this situation—and if you want to start playing politics, I'll play politics as well—is that we have had 10 years of austerity and that has starved us, compared to what was going on previous to that under Labour. It was a policy. It was a deliberate policy. Austerity was a policy. And do you know what, the real frustration of those people who are on the front line today—[Interruption.] The real frustration is that they were promised, they were told, 'Take a dose of austerity, but it'll be okay at the end of that', and the problem is that that bargain has just been broken, and that is part of the reason we're in the situation we're in today. And if you look at the number of GPs we have in Wales, we have more. According to the Nuffield Trust, we have 63 per 100,000 compared to 57 per 100,000 in England.

And you talk about preparing. My God did we prepare for this winter. We spent months and months and months preparing for this. And you talk about planning: we have planned. We had a transformation plan, we had the six goals for urgent and emergency care, and as a result of that, we now have the 111 service that has been rolled out across the whole of Wales, diverting only 20 per cent of the people who call to emergency services. Just imagine how many of them would have gone directly to A&E before. We have urgent primary care centres across the whole of Wales, we have same-day emergency care centres, we have pharmacies and we have—. And we've done this week after week. Every fortnight, Julie Morgan and I have been meeting with the leaders of local authorities to prepare for these 500 additional beds that are in the community. This is not something we've thought up now. They made an announcement yesterday in England on this. Yesterday. That's not going to be ready for months, because I can tell you that we have worked really, really hard to make this happen. They are in place in Wales. Proportionately, they're not nearly as ambitious as we have been in Wales. Not just ambition, but we've already delivered them and we are going to be delivering more. And do you know what's more? Do you know what's more is that, actually, we've now got health trusts in England asking to come and see and to learn from our six goals for urgent and emergency care? That is the reality in terms of us being prepared, and we have got a transformation plan. It's not going to be switched overnight, but it is already making a difference.

And you ask about waiting lists: well, just before Christmas, I'm sure you were as pleased as I was that, at last, the waiting lists are going down in Wales. They had gone down for the first time since the pandemic, and they're going up in England. Let's just be absolutely clear—[Interruption.] Let's just look at the facts—and I'd suggest that you go and do that.

You talk about winter war rooms, well, I can tell you, I feel like I'm in a constant winter war room when it comes to the NHS. Every fortnight we've been meeting to identify where exactly in the system the blockages are, what are we going to do about it, what do we put in place. I spent the day in the Heath hospital last Friday. It was fascinating to watch them identify exactly, 'Right, where is the problem, how do we get these people out, what is the blockage?' So, there's a lot of that that's already going on, and I can tell you that there is very sophisticated data that is being used to make sure that we improve the situation.

You keep on banging on about surgical hubs. I've been to the surgical hub that already exists in Abergele; I've been to the surgical hub that already exists in Llanelli; and I've been to the surgical hub that already exists in Cardiff, in the Vanguard hub where they're doing ophthalmology. They're happening, they exist, and they're seeing patients already. So, we are on it; it is happening. There's a long way to go, but it's really important, I think, for people to understand that we are getting through these waiting lists, and ours are going down while they're going up in England.

A very happy new year to you all. Clearly, it hasn't been a good start to the year for the NHS. I can only thank the staff for their work in circumstances that are becoming more and more impossible. 

This is not the statement that I had expected today; it's not the statement that I think the people of Wales needed to hear. This isn't a plan; this is a status report. It's a report on what Government has been doing to try to get the NHS ready for winter, to try to deal with current pressures, but frankly we know that what this Labour Government has done hasn't worked. What we want to know is what they're going to do differently. The results of the crisis are plain to see for patients; they're plain to see for staff. But where's the change of direction? In fact, where's the kind of action that shows that the Government is in genuine crisis mode here? Because this was only going to be a half-hour discussion—a half hour on what's clear from my postbag, and, I'm sure, everybody else's here, is no doubt the biggest health crisis, other than COVID itself, of course, that we have witnessed.

What I'm seeing is a Labour Minister finding blame for the crisis rather than suggesting new solutions to it. She has the audacity, frankly, to appear to blame the nurses, saying that their industrial action has placed additional pressure on systems, when it's pressure on them, on the nurses and others, together with a decade-long pay squeeze, that led them to vote to strike. And whilst I absolutely agree with the Minister on the injustice of the Conservative years of austerity, she has to recognise that this is Welsh Government's fault. Does the Minister recognise that the failure to support staff in particular is Welsh Labour Government's fault?

She points to the delayed transfer of care figures as a cause of lost capacity in the system, but it's her job to create that capacity. What we need is a more ambitious plan, frankly, to speed up patient flow through the health and care system. She mentioned today the creation of 500 extra community beds. That's positive, but we've lost thousands of beds. I wrote to her some weeks ago, asking for work to be done on the possibility of setting up COVID-style temporary community step-down facilities. The First Minister—rather patronisingly, I thought—said yesterday that those suggesting that are well-meaning, but that the problem is a lack of staff, not beds. Well, (a), it's both, and, (b), Welsh Government is responsible for both: both bed numbers and staffing capacity. And, frankly, woeful workforce planning, plus of course the current lack of meaningful engagement on resolving industrial disputes, is making staff shortages worse. Does the Minister recognise that the failure to resolve delayed transfers of care is the Labour Government's fault?

I have a few other points that I want to question you on briefly. It's clear that the combination of COVID and flu is causing problems. There's a target of vaccinating 75 per cent of everyone offered a vaccination. Only some 41 per cent, as I understand it, of healthcare staff have been vaccinated—41 per cent of those who are most vulnerable. Does the Minister accept that the Government is failing by a distance in reaching its targets in terms of the numbers that need to be vaccinated for COVID and flu?

I have to turn to preventative measures again. The Minister again refers to work that is being done in this area: £145 million, a five-year programme in order to actually avoid people having to go to hospital. But, the way of doing that in the long term is to make us a healthier nation. Where is the investment? And whilst I, of course, appreciate that funding is tight today, where are the plans to make that major investment in order to transform our attitude towards preventative and to take pressure off our health service in that way?

And finally, Llywydd, although winter pressures is the subject of this statement today, we now know, don't we, that there are pressures throughout the year; that's the case now. We must ensure that there is scope within the health service to flex, if you like. The health service should be running at something around 85 per cent of capacity. It seems to be running at 100 per cent, 110 per cent and 120 per cent of its capacity all the time. Can the Minister tell us when the NHS in Wales was running at around 85 per cent of its capacity last? And does she accept that it's the fault of the Welsh Labour Government in terms of failing to generate that capacity within the system?

Thank you very much. First of all, I think it is important to recognise not just what we've done, but what we intend to do. And you're quite right, just to give you some ideas of where we're going to be going next, we're going to be making sure that we try and expand the number of hours that those urgent primary care centres are open, so that will divert more people out of those normal hours. Certainly, what I was hearing from people in A&E last week is that, actually, the difficult time is when everything else is shut. So, opening those primary care centres for longer hours would be important. The same thing in relation to same-day emergency care centres. So, that's something else that we're working on.

We have those 100 new ambulance workers that are coming on stream this week and next week. So, that will make a big difference. And, of course, we will be pushing ahead to try and create more of those community beds on top of the 500 that we've already delivered. This is not easy stuff, because you still have to find people. Staffing is the big challenge, particularly when it comes to care, and that's why we have committed to making sure that we keep up with the real living wage as the No. 1 priority in our budget when it comes to health and social care.

Industrial action. Let's be clear: industrial action is going to lead to pressure on the NHS. That's the purpose of a strike, to make sure that people feel a bit of tension and to make their voices heard. So, I don't think I should apologise for that—I think they'd be a bit worried if they didn't think it was having an impact. I think it's really important that one of the issues that we will be discussing, I hope, with the unions later this week is a discussion around the pay review body, the independence of the pay review body, and what we can do to build more confidence into that. We've got to be very careful with this, because if we go away from that, then you're going to get into regional pay and that may not work out the way that some people would like to see in Wales. But I do recognise, I think, there are some issues that we need to look at in relation to the pay review body: when you take the temperature of inflation, for example. So, we saw inflation shoot up after the Ukraine war, and that didn't happen until about February. The temperature was taken of the NHS in terms of pay, inflation, in March/April, and that was at about 6 per cent. Well, now, of course, we know it's well over 10 per cent, so I think there are issues there where we need to see what more can be done in relation to the pay review body.

When it comes to beds, step-down facilities, I'm afraid I'm in the same place as the First Minister: there's no point in creating beds if you can't create the staffing that goes alongside them. One of the real challenges we've had in delivering these 500 extra beds is that, as soon as we're appointing people, some of them are leaving. So, we're losing people before they actually get to the job. This is the challenge. So, this is why I find it fascinating that, only today or yesterday, the UK Government think they're going to fix this for winter. That's not going to happen, because we have found this incredibly challenging, even to deliver on those 500 additional beds.

But there are other things that we can do, and one of the things, I think, we can learn from is the models that are happening in terms of hospital at home. So, it's great to see that's already happening in Cardiff: monitoring 60 people at home who would otherwise be in hospital, making sure that everything is available to them and, if there is an issue, that you can send somebody out to them. We're going to have to embrace new technology. We're going to have to do things differently as we become an ageing population with more complex needs.

We are employing more staff than we've ever employed in the NHS before. We employ now 105,000 people in the NHS in Wales. We are employing more nurses than ever before, so we are recruiting more than we're losing. I think it's really important for people to recognise that: that actually we are recruiting more than we're losing, which is not enough. We know it's not enough, and we know we need to do more, which is why we've seen a huge, huge increase in the number of people we are training with Health Education and Improvement Wales and others. And that's why we've given an additional sum to HEIW in the budget: £265 million to train the next generation of health workers.

When it comes to the targets in relation to vaccination, I'm very pleased. We had a target to reach 75 per cent when it came to COVID and the over-65s. We've reached 80 per cent. On flu, we're at 74.6 per cent, so we're nearly there, and we're very confident that we'll get to 75 per cent in the next few days. It is disappointing to see how few NHS and care workers have taken up the opportunity, and in particular for the flu vaccine. This is something that I have asked over and over again of the health boards to really promote with their members. It's very, very disappointing that that is the case, and again we would keep on asking them to take up that opportunity.

You talked about prevention. I think it's really important that we all understand that we have a role to play when it comes to prevention. We can all do what we can to keep ourselves fit, to eat healthily, to take exercise, to not smoke. All of those things are things that actually will make a big difference to our ability to provide what we can in the NHS in the future. We all know there's an obesity crisis, and it's something that we really need to address, because actually it will translate into complex care necessary in things like type 2 diabetes.

The other thing, I think, just to be clear, is that I have set out some very clear guidelines in terms of what I'm expecting from the NHS next year, and priorities. They are going to be far more targeted priorities to make sure that we focus our attention on the things that I think matter most to the people of Wales. One of those things that we've made very clear in our report and in our strategy, 'A Healthier Wales', is that actually we need to see more care in the community. We need to get more support out from our hospitals into our communities. When we're talking about discharge from hospitals, for example, a lot of those assessments at the moment are being done in hospitals. The clinical evidence suggests that you should be doing it in people's homes. So, that shift is something that again we'll be pushing the NHS hard on when it comes to them developing their strategies for the future.

I'm grateful to the Minister for her full statement this afternoon. I think all of us, on all sides of the Chamber and whatever our political differences may be, have a great well of gratitude to everybody who's working in the current circumstances across the national health service and in local government providing social care as well. I think we all recognise the enormous pressures that are on the national health service. We debated earlier, during First Minister's questions, the impact of austerity on the national health service and the ability of the service to respond, given successive issues around funding in the last decade or so. But you also said, in answer to, I think, Rhun ap Iorwerth, that the service itself has got to change to reflect changes in society and changes in need. I'd be interested, at the height of this winter crisis, if you could identify the issues that you're dealing with today that are long-term issues and aren't the short-term issues that we see creating the headlines, and how you believe we should be addressing those fundamental structural issues in the national health service as it approaches its seventy-fifth birthday.

Thanks very much, Alun. Certainly, I think there are major, major challenges for the NHS. It's important that we recognise and talk about them and that that's a conversation we need with the public. This is not something that should remain in this Chamber, because these are going to be really tough decisions that everyone's going to have to live with. So, if you think about the opportunities that are available to us today that weren't available in the past, which are incredible, I saw a baby in the Heath last Friday who was born at 21 weeks—an absolute miracle. And there's no question that that baby would have died in the past. We've got to understand that that's a miracle, it's wonderful, it's because the NHS works that that baby is alive today, but that comes with some choices that we have to make. And so I think we have to have a conversation about where our priorities are within the NHS.

There are also, of course, new developments all of the time. Some of that will be really helpful to us. Digital remote consultations I think are really positive things that have already happened and have transformed the way we deliver care already. But I think the key thing in terms of where the challenges are in future—. I think there are some issues around capital that we're going to have to deal with, how are we going to deliver with the facilities that we've got, but also I think we do have to have that conversation about changes in society. When Aneurin Bevan set up the NHS in 1948, people worked until they were about 65 and they died when they were about 68. And that's the reality. It's great that people live for much, much longer than that, but our structure has not fundamentally changed to reflect that difference.

The missing gap is what do we do within that care space. Obviously, local authorities are doing their very best in that space, but obviously they have limitations also on their economic abilities. So, that is the space, I think, that we need a very challenging conversation with the Welsh public around: what we're going to do to support people in an ageing population with more complex care needs. Because along with an ageing population comes a more challenging situation in relation to what kind of complex cases you're having to deal with. So, we're not just dealing with someone going into hospital, say, with cancer; they might have cancer and diabetes and a bad ear, or lots of things at the same time. And we just have to understand that those are the kind of challenges that we're facing in future. 

I have a number of Members who wish to question the Minister on this statement. If you keep your questions succinct and effective, then that will enable me to call other Members in your groups later on as well. So, I'll start with you, Gareth Davies, and see if you can do succinct and effective for me. 

As ever. Diolch yn fawr iawn, Llywydd, and thank you for your statement this afternoon, Minister. I wish you a happy new year, and to all Members of the Senedd. Yet again, we're—

Just one thing: thank you for wishing us all a happy new year; that's the last time we need to be wished it. Thank you very much for doing that, but we'll save on time if we all wish each other now a happy new year, smile at each other, be kind to each other, as Jack Sargeant always reminds us in this place, and carry on with our questions. Don't worry, I won't include that 30 seconds in your time allocation. Carry on, Gareth.

I was just trying to be nice. 

Yes, you were. 

Yet again, we're in a situation of talking about winter pressures when we're in the full throes of wintertime, which is a reactive measure rather than a proactive measure, Minister. Any prudent Government would be making this type of statement when the sun shines, when we're wearing shorts and sandals. But I want to focus my question on how winter pressures reflect on care homes. I visited Sandford Care Home in Prestatyn last Friday, where Sean, Nicky and the team do a fantastic job of caring for our most vulnerable and elderly people. But many of the problems they face are as a result of NHS pressures—long ambulance waiting times, delays in discharge—and not being able to fill their maximum capacity of 40 beds because of staff shortages, with the recruitment and retention issues that we're all too familiar with. So, will the Minister outline this afternoon what steps the Welsh Government is taking to address the knock-on effects of NHS pressures on the social care system and ensure that our most vulnerable people in society aren't left behind? Thank you.  

Excellent. 

Thank you very much. That was excellent; well done. I think it is important. I hope you have listened to the speech, which demonstrates that we have indeed been very proactive during the summer months in preparing. Obviously, we've never seen anything like the demand that we've encountered over this winter.

When it comes to care homes, I think it is important that we pay tribute to the incredible work that they do in looking after our elderly. Obviously, they're also in a situation where they're encountering long ambulance waiting times. I think it's important for us to recognise that there are times actually where we will need to try and support people in the homes. I've seen some fascinating statistics about, once you go into hospital for a period of more than a certain number of days, how likely you are to die if you're over a certain age. I think it's really, really important that people understand that, actually—. And most people don't want to die in hospital; it's not because they're going into hospital they're dying, it's because they were going to die anyway. So, I think it's really important that we try and understand what is it that matters to the patient, where is it that they'd like to have that compassionate care. Very often, that is in their homes.

I understand, and I know my colleague Julie Morgan understands very clearly, the difficulties in recruiting people in care homes, which is why we have once again acknowledged that we will be honouring the real living wage in the budget in April. That's really important, I think, for us to understand that there is an issue there that needs to be addressed. It's not going to be easy, because there's a lot of competition out there when it comes to jobs, but I think that is an area where we need to work very, very closely with our local government partners to make sure that we are making the very best possible offer, and that we look not just at pay, but also look at conditions around pay as well.

You say in your statement, Minister, that 12 per cent of bed capacity in the NHS is now full as a result of delayed discharges, and in response to that, of course, you say that you've secured an additional 500 community beds for step-down care. Clearly, that is to be welcomed. It would be good to hear where they are. As a Member in north Wales, I would be interested in hearing how many of those are in north Wales. But of course, we had a network of community hospitals that used to provide exactly this step-down service across Wales. That capacity was lost—the capacity that you are now trying to recreate and rebuild—when community hospitals were closed in Flint, Blaenau Ffestiniog, Prestatyn, Llangollen, and so on.

A number of us warned you at the time that you would regret doing that, because there's always a need for that step-down provision within the system, or—as we're currently seeing—the system is going to have blockages and we're going to end up with a situation where 12 per cent of the bed capacity has suffered as a result of delayed discharges. So, do you accept that it was a mistake to close those community hospitals, particularly those across north Wales? Do you regret that that happened? Because there's no doubt that that's contributing at least a little to the crisis that general hospitals are now facing.

Thank you very much. I'm happy to give you a list of where we found that capacity. The capacity of course is reliant on our ability to collaborate with local authorities in the area, and that's where we've been working with them closely, as well as with the NHS in those areas, too. When it comes to step-down facilities, I do think that generally speaking, people prefer to get the care that they need in their homes, and that's the direction of travel. We must also bear in mind that when it comes to community hospitals, they are very expensive to run. That's something that I've learnt. And if you look at how many hospitals we have in Wales in relation to our population, then I think it's important that we understand that we are in a situation where it is very expensive for us to run hospitals, and that is why stepping into our communities is something that we're trying to get the NHS to do, to provide far more within communities and in people's homes, where most people want to access that care.

Diolch, Minister, for your statement. And as you've already alluded to, there is a role for all citizens to play a part in alleviating the pressure on the NHS, whether it's in terms of our own health management or accessing appropriate services. But what is the Welsh Government doing to support citizens in doing this, and what more could we do as Members of the Senedd in our own constituencies to encourage people to take more responsibility for their own health outcomes?

Thanks very much. Well, this is an area where my colleague, Lynne Neagle, takes a leading role in terms of public health. We have, of course, got a very clear programme of activity—'Healthy Weight: Healthy Wales'—where we try and encourage people to make sure that they participate, and they understand what healthy food is and how they use it and how they cook it. We've put a lot of support, of course, into our schools. So free school meals have now gone into primary schools; making sure that that is the right kind of food is really important.

So, there's a huge amount that people can do, and, of course, we also give a significant amount of money to Sport Wales to make sure that they are helping in our communities, especially with young people, to get that idea of exercise in as early as possible. And it's great now that we have a relationship with the Football Association of Wales to make sure that we can roll that out across the whole of Wales, making sure that people understand their responsibilities when it comes to health as well. 

Thank you for your statement, Minister. I appreciate that these are challenging times, and, of course, we all thank the wonderful NHS staff who are working so tirelessly. However, Minister, seven health boards in Wales have nearly 1,800 patients medically well enough to be discharged from hospital. The Aneurin Bevan health board in my constituency have said that they have around 400 patients who could be discharged, but they are unable to. This is the second highest amount of the seven health boards. It's becoming clear that the only way that we're going to stop this crisis upon crisis is to reform and drastically improve social care in Wales. 

Minister, the UK Government health secretary has announced a winter package that will allow thousands of NHS patients to be moved into care homes, to enable the release of hospital beds for emergency patients. I understand that £250 million has been allocated to upgrade these hospitals and buy beds in care homes for patients medically sound enough to be discharged. Is this something that you'll look to do in Wales? And, at the end of your statement, you were talking about prevention and you recognised that there might be increased pressures now that schools have returned. From what I understand today, from what I've heard, there are already high levels of staff and pupil absences in Bridgend schools because of contagious illnesses. How are you working with the education Minister and local authorities to perhaps adopt local authority advice for schools to ensure that pupils stay at home when they have contagious illnesses? Thank you. 

Thanks very much. Well, I'm glad that you recognise that there are lots of people who are ready for discharge. It's very interesting that your leader earlier was saying, 'Actually, just be very careful about when you do ask people to leave who are medically fit for discharge.' So, it's about risk, isn't it? It's about where the risk is, and what's important for us is that we do get people out who are ready for discharge and who do have that support at home, so that we can get people who are in urgent need of support in through the front door. And, of, course, I think we all recognise that there is a need for fundamental reform when it comes to social care.

When it comes to winter packages, well, welcome to the party, UK Government. We've been doing this for months—we've been doing this for months. We put £25 million on the table last April to prepare for this, because what we were told time and again was: 'Don't give us that money—' . What usually happens is that it's given in September, which is too late—September is too late. They put that money on the table yesterday. There is no way that they're going to get people—. And you try and find those beds, because, I tell you what, we've been doing it week after week after week. We have been buying up that capacity in care already, in care homes. That's what we've been doing—these 500 beds in the community. That is precisely what we've been doing. So, it's a lovely idea; it's a shame that they didn't think about it earlier, because we are on it, we're delivering it, and I think it's going to take a lot longer—. In fact, they made an announcement in September that they were going to produce 7,000 of these. They've hardly scratched the surface of that, so this is really a rehash of a UK Government announcement that they made in September. 

A constituent of mine fell and broke her ankle recently, and she lives near a large A&E unit in Morriston Hospital and a minor injuries unit in Neath Port Talbot hospital. She went to MIU, thinking that the waiting times would be less. That's something that is guidance on many websites, but it was appointment only. She was told she'd have to go to Morriston and the wait for an x-ray, she was told, would be 48 to 72 hours. She's immunosuppressed, so she knew that waiting in a crowded A&E department in flu season wouldn't be a very good idea and would actually be dangerous for her health. She is now going to have her ankle re-broken and operated on—a problem that could probably have been fixed with a cast. So it's plain to see that the plan hasn't worked. You mentioned in your statement that you will learn the lessons of the past weeks and months. So, what are the lessons for Welsh Government?

Thanks very much. Well, I'm very sorry, of course, to hear about that individual case. There are examples where people are getting the support in some of our same-day emergency care centres, where they go in, they get an appointment, they know when they're going in, they get the cast done on the same day. I'm sorry that that hasn't happened in this case, but I can assure you that it is happening all over different parts of Wales.

Certainly, I think it is important that we learn lessons. Starting early was a good idea. I think we have to understand that our profiling of our expectations in relation to demand, after the pandemic, we probably didn't organise for quite as many people as we thought may become sick as a result of the flu. It came earlier than we expected, so we probably have to be ready a little bit earlier. And we got our 100 ambulance workers out, and they're ready, but they're ready this week—it would have been great if we had them ready just before Christmas. So all of those things would have been good to have had, to have been brought forward a little bit, but that modelling, it will be interesting, when we have time, to look back on where our modelling went wrong and what is it that's happening. Again, though, we've just come out of a pandemic, we've never been here before, so obviously people's immunity systems are down after a couple of years of not being exposed. And I guess none of us really knew quite how many people would get sick over this particular period. I don't know about you, but almost everybody I know has had some form of flu over Christmas—it's really affected huge, huge numbers of people. And obviously, whilst people like me have managed to get through it, just about, there are people who are much older who have really suffered and have finished up in our hospitals.

Thank you, Minister, for your statement. Every year, we have winter, every year, we have winter pressures, and we've not learned any lessons. The announcement made last week, which stated that patients could be discharged without the need for a care package, raises serious ethical, equalities and human rights concerns. Doctors have rightly condemned this policy as dangerous. What rights impact assessments were made prior to this new policy change? Minister, the Equality and Human Rights Commission made a string of recommendations in its 'Equality and human rights in residential care in Wales during coronavirus' report. Why have you ignored those recommendations and put the lives of older people and disabled people at risk?

Finally, Minister, what steps will you take to ensure that this and any future policy decisions regarding social care are fully assessed in terms of their impact upon the human rights of Welsh patients, and measures put in place to prevent any breaches? Thank you.

Thanks very much. Well, as I say, I think we've learned lots of lessons in the past, which is why we did all that preparation work much, much earlier. And I think the situation would have been a lot worse had we not had those urgent primary care centres, had we not had the 111 service, had we not had SDEC, had we not had pharmacies helping people out, had we not had those 500 extra beds in the community. So, we did do a huge amount of preparation; the demand was much greater than we expected.

When it comes to care packages, I think it's really important, if you look at the academic and the clinical evidence, it suggests that those assessments, in terms of care packages, should be made in people's homes, not in hospitals. It's not me saying this—this is clinical evidence. And so, what's important is that people understand that this is not trying to get a problem off our system into somewhere else, it's actually better for the patient. And on top of that, let's not forget that there's a lot of flu in our hospitals at the moment. People who are old and vulnerable are in hospital, and some of them are catching flu in hospital. We need to get them out so that they don't catch flu. So, all of these things are really important.

When you talk about human rights, I think we've got to talk about the human rights of those people who are having difficulty in getting an ambulance to them. A lot of those people are old, let's not forget. The people who are calling ambulances and who are not getting the service that they should be getting within a required time are old people as well. So, there's no discrimination here. The people who are suffering mostly are older people. So, I think it's really important that people understand that this is about the risk across the whole system. And getting that balance of risk a bit more shared out across the whole system, I think, makes sense.

I want to make two points and ask two questions, if possible. The Minister said earlier that Wales has more GPs than England. But, I'm concerned that this shows a lack of understanding of the situation that we're facing. The population density of England is far greater than Wales's is. It's far easier to access a doctor when you have 1,000 people per square mile than in south Meirionnydd, for example, when you only have 20 people per square mile and it's harder to access those services. So, that's the first point that I want to raise, and I want to ask whether you accept that there is a need for more investment in health services in our rural areas so that people can access those services they need.

I also note that you've said several times so far that flu and COVID are present in our hospitals. But, as Rhun said earlier, if the hospital bed occupancy rate goes above 82 per cent then these hospital-acquired infections, such as flu, such as COVID, are going to spread. But, occupancy in our hospitals is now over 100 per cent; of course those infections are going to be spread. Of course people are going to suffer, and that's because you haven't invested in the nurses and you've cut the number of beds. It appears that lessons aren't being learnt. One clear way of learning these lessons is by holding an official inquiry into COVID in Wales so that we can know the way forward and how not to make those mistakes in future. Will you now accept that there is an undeniable need for an inquiry of this kind in Wales?

Thank you very much. Just to make it clear, what we're trying to do when it comes to GPs is to ensure that we understand that there are many people who can help, not only GPs. So, increasing the numbers of physiotherapists, of pharmacists in our communities, more advanced nurse practitioners—. I know that there are some excellent examples on the Llŷn Peninsula, for example, of advanced ambulance practitioners helping in our communities there. So, there's no need to always—. Although we are doing better in terms of the number of GPs than England, I think it's important that we understand that we are trying to create a system where we use the skills of the whole team. I think it's very important that I make clear that we haven't cut the number of nurses; we have more nurses than ever before, and we are still recruiting more than we are losing. So, that simply isn't the case. In terms of an inquiry, well, you know our response to that.

I feel compelled to tell you a story that's positive. I live in a very rural area. On 17 December, I had to attend to a lady who'd fallen and had a serious head injury. We called the ambulance service. We were told it would be a two-hour wait. So, imagine our surprise when one turned up within 15 minutes. We must talk about those positive stories as well, and there are many. I do want to thank everybody who works in the health service.

I also just want to talk about a high-risk issue as well, that our UK Conservative Government are about to impose on our health workers: the shameful anti-strike legislation, which portrays our health workers as uncaring. That will do nothing to help them feel valued. Potentially, if I was them, I would leave. I would think, 'I am not being valued in my role'. 

The one issue I would like to raise with you, if I may, Minister, is about the pooling of budgets within health services and social care. We've heard a lot about the social care issues that are facing our health services, and I'd just like to say to you that, in Powys, we have a coterminous local authority with the health authority. I'm just wondering if you're able to think further and give us some information around how we could be looking at those, possibly piloting some really good initiatives in Powys, for example. Thank you. Diolch yn fawr iawn. 

Diolch yn fawr. Thanks for that, because I think it's really important that people understand that, although there are some examples of not great things happening in the NHS at the moment, there are also hundreds of thousands of great things happening in our NHS, and 376,000 consultations a month is a pretty good figure; 400,000 contacts in general medical services in a week. These are incredible figures, and certainly when I go around, very often what I get is people saying, 'Well, personally, I've had a great service', and I think it's really important that we do talk up that great service, because, frankly, it must be very demoralising, obviously not just for me, but for people working in the NHS, if all you hear is negativity.

In terms of the unions, I couldn't agree with you more. I think the anti-strike legislation that is being introduced is wholly unnecessary, and I think it was very provocative, the discussion yesterday, when they talked about productivity. You just think, 'My God, what world are these people living in?' Have they no idea how exhausted these people are? It was, I think, a huge insult, in particular, to start off negotiations with that. But, when you're talking about pooling budgets, well, you'll be aware, we've already pooled £144 million a year through the regional integration fund, which people can't access unless health and social care are working together, also with the voluntary sector. So, already we have that ring-fenced. I think we can and I think we should go further, and certainly my No. 1 priority, in terms of my guidance to the NHS for what they should be doing next year, is that they should be looking at what we can do in the space of working together in relation to care, with local authorities, and making sure we put more support from the NHS back into our communities. 

Minister, thank you so much for your statement this afternoon. Now, technology, without a doubt, is advancing at a rapid speed, with companies coming out with major developments to improve health outcomes. So, I'd be interested to know, Minister, what, if any, tech devices the Welsh Government is looking into to alleviate pressure on our health service this winter and going forward? The reason why I'm specifically asking this question is because I attended CES, the world's biggest tech conference, and managed to see some of these huge developments taking place in medical technology. Now, without sounding like a medical rep who's come back from the States, one company that really stood out was one called MedWand Solutions, which actually has recently launched its MedWand device, no bigger than a mouse, linked to your computer. But this handy device actually provides a ready-to-use system, which includes a tool that allows you to link a laptop to, in fact, a small device, which has sensors that can listen to your heart, measure heart rate, perform an electrocardiogram, listen to your lungs, measure blood pressure, oxygen levels, check temperature, and even listen to your abdomen. It can even look into your nose, throat, mouth and ears, as well as inspect your skin. Now, just this one device alone, Minister, has the potential to seriously change the landscape when it comes to providing healthcare from up close and afar, as well as alleviating pressure on our hardworking staff across the sector, including within hospitals, doctors' surgeries, and even make life easier for paramedics as well.

Now, patients with multiple health issues, the elderly, those with disabilities, alongside those who struggle to get out and about, would really benefit from this. I'm sure it's obviously a lot more intricate than what I've described here in front of you all today, but the main point I'm trying to make, Minister—. And I may be sounding, like I said, like a medical rep now, but similar devices to this would not only improve outcomes for patients across Wales, but would also alleviate pressure on our NHS, which is something you want to do and we want to see as well, not just for winter, but all year round as well.

As you've said, Minister, our health staff are under immense pressure, and it's going to keep on getting more challenging for us all. So, it might be a long and complicated process to get something like this rolled out here in Wales, but, Minister, will you commit to looking into this product and similar? And as I asked earlier, please can you kindly outline what other devices or tech solutions the Welsh Government is looking into to alleviate pressure on the NHS? And I'd really welcome the opportunity to talk with you further about this in more detail and provide you with contact details, if you so wish. Thank you. 

Thanks very much, Natasha, because I am absolutely wedded to the idea that, if we are going to transform the way we do, in particular, care, then we're going to have to rely more on technology, and I'm very much looking forward to going to see how the Delta system works in Hywel Dda next week. So, already some of this technology is being used in our communities, and certainly, when it comes to care in future and doing care in the community, I think we've got to start by saying it's digital by default, and if you can't do it with digital then you move into other areas. So, I think it's really important. None of this stuff is cheap, none of it is easy, but I'm absolutely committed to this.

If you look at digital, then we are investing more per head compared to England. We're investing £18 per head compared to £11.50 per head in England. So, we've got the digital priorities investment fund, which is £60 million. We have a digital medicines transformation portfolio as well, and that's going to make sure that we have roll-out of transformation in relation to prescription of medicine in primary care by the summer of 2023. We've got secondary care—amazing work being done already, but that needs to be rolled out, and then we'll have a central repository for all prescriptions, so that everybody can know what's happening across the service. We have the Wales community care information system. That has been rolled out in most health boards now, and that was one of the objectives that I set for the chairs of the health boards. We have the national data resource, we have the digital maternity record, we have the Welsh nursing care record. Technology Enabled Care, TEC, Cymru give us advice on all of this. We've got the national video consultation service that we've given money to. We've got the Welsh emergency department system, we have the cancer informatics programme—the list goes on and on and on. So, we are absolutely all over this space. One of the restrictions is that everybody wants these technicians, so we are competing in a very difficult market when it comes to this, because everybody wants these digital experts, and the NHS is having to compete in that space.

Thank you, Minister, for today's statement. Of course, there is excellent work happening every day in our NHS, but it's important that we all recognise today the huge pressures facing staff. I've received so much correspondence that has been heartbreaking over Christmas—and I'm sure everyone else has—from constituents who are patients, members of patients' families, but also from workers who say, 'We simply can't cope. Yes, we're doing our best, but we can't continue to work at this level', and they are talking about leaving the NHS, and we can't afford to lose these people. Also, there are heartbreaking stories about people who are dying whilst waiting for ambulances, or those who are taking your advice, as you mentioned on Radio Cymru, and taking responsibility for their own health, but who then ignore symptoms that are very serious indeed and reach that point of dying at home or dying when they're at crisis point. So, can we have an assurance too that we send a message to people that they should continue to contact the NHS when they need to?

Another point I'd like to make—you also referred on Radio Cymru this morning to diabetes. Now, we must also recognise that there is that strong link between poverty and diabetes. If you're poor, then you're twice as likely to have diabetes, so what Rhun mentioned in terms of preventative is so very important. But how will we support people who now are facing the cost-of-living crisis and can't afford to eat healthily, can't afford to exercise? So, how will we ensure—? This is a problem for the whole of Government, and there is a responsibility on the Labour Government. You are in charge of health and you have that responsibility. We have to see some action.

If the responsibility is entirely on our shoulders, and we are expected to care for everything without people taking responsibility for their own actions, then we're not going to cope. If you look at the situation—[Interruption.] If you look at the situation in terms of an ageing population, it won't be possible in future for us to provide the services that are required. So, we need to ask the Welsh people to help us in this.

We have put things in place, such as the help that we are offering in terms of Help us Help you, the help that we have provided through 'Healthy Weight: Healthy Wales'. A great deal of funding has gone into these schemes, and also the pre-diabetes funding that we've put into the system, which is making a difference. So, we are trying to ensure that we are providing the help where we can. We understand that the cost-of-living problems are going to have an impact on people, and we are aware that the people who are going to pay the greatest price are the poorest people in our society. That's why we've been targeting our funding towards those people. We have allocated a great deal of funding to help people through this crisis and, truth be told, it's the responsibility of Westminster to give us that funding, and to provide that funding, but we have stepped into the breach because the Westminster Government hasn't done its work.

Finally, Darren Millar.

Diolch, Llywydd. Minister, you've told us that we have a problem with not being able to attract sufficient staff—I accept that—but you don't seem to acknowledge that we do have a problem with having insufficient numbers of beds. Now, I've raised this issue a few times in the Senedd before, but I'm going to do so again. When will north Denbighshire get its promised community hospital? We saw beds axed in Rhyl, in Prestatyn, in St Asaph and in nearby Denbigh—scores of beds. And as a result of a loss of those beds, there is now extra pressure on Ysbyty Glan Clwyd. There's no denying that. That is a fact. Now, you tell us that we've got more staff working in the NHS than ever before. So, if we've got more staff and fewer beds, why can't we have some extra beds put in? 

Now, I heard the First Minister's response to me, and I've heard your responses to me on this issue before. You say that you don't have the capital to be able to invest and that there have been rising costs on that particular project. Now, I've checked the figures, okay. I've checked the figures. Within the period that you announced that you would deliver that hospital, which was back in 2013, nearly a decade ago, you did build a hospital, but you built one in south Wales, the Grange hospital, okay. The cost of that hospital was £360 million. It's original budget was £172 million, okay. So, a massive additional cost, in the order of £188 million. Now, I do not begrudge the delivery of that hospital for the people that it serves in Gwent; it's an important investment. But where is the investment in north Wales? You've closed hospital after hospital after hospital, and we still haven't seen our hospital. It's current estimated cost is £64 million—that's a fraction of the investment that you've spent in the south. When will we see our hospital in order that we can deliver the sorts of improvements in access to care that people in north Denbighshire require?

Can we finish the question now, and can we ask the Minister to respond?

Diolch yn fawr. I think it's really important that we recognise that the staffing challenge when it comes to healthcare is a global challenge, so people all over the world are looking for the same people, especially people like anaesthetists. So, we are in a very difficult and competitive environment.

When it comes to investment in north Wales, I think it's really important that you understand that, actually, we have made investments in north Wales. Ysbyty Gwynedd has had that accident and emergency department. I've recently signed off £70 million for a new mental health unit in north Wales. That's despite the fact that the capital challenges, in particular for us in health, are extremely difficult at the moment. But, obviously, if we see some proposals where we will see transformation—. Because that's what we need to look for now, transformation. More of the same is just not going to cut it any longer. What is important is that we look for transformation when it comes to capital investment in the NHS in future. 

I thank the Minister.