We will now move to the short debate. This afternoon's short debate will be presented by Peter Fox, and he will make a start once Members have left the Chamber quietly—please do so quietly if you are leaving. Short debate—Peter Fox.

Diolch, Llywydd. I welcome the opportunity to introduce this debate today. Before I begin, I would like to mention that I have agreed to give a minute of my time to Russell George, Laura Anne Jones, Gareth Davies and Rhun ap Iorwerth, and I look forward to hearing your contributions later.

Llywydd, it’s no secret that the health and social care sector is under significant pressure, both in Wales and beyond. Waiting lists for treatment are ever increasing. Waiting times for ambulances in many cases are unacceptably long. We’ve all received casework from constituents detailing often harrowing experiences of seeing loved ones waiting in hospital corridors, or the lack of ambulances, or having to be driven to hospital by a loved one whilst seriously ill. Meanwhile, social care services are coming under increasing demand, with well-documented issues in staffing recruitment and retention stretching services.

I’m fully aware that these issues are not specific to Wales; you only have to turn the television on to see what is going on elsewhere in the UK, but it’s fair to say that issues seem more acute here in Wales. And it goes without saying that these issues are not down to the fantastic health and social care staff who work tirelessly day and night to help people as much as possible and provide excellent care and support. I know that the Welsh Government, and, indeed, the UK Government, have put in place various measures to try to tackle some of these issues. Only yesterday, we heard from the Minister about the winter pressures that the Welsh NHS is facing, and the steps that the Government is taking to try to ease some of these, such as securing an additional 500 community beds for step-down care, the regional integration fund and investing in urgent primary care centres, all of which I welcome, as I’m sure we all do across the Chamber.

The Deputy Presiding Officer (David Rees) took the Chair.

But what I want to do in this debate is to take the opportunity to look at a longer term transformation that is needed to help our health and social care system to build back more resiliently. Because throwing more money at a problem isn’t always the answer; we need to make sure that the resources are used in the right way. We need to deliver a health system that focuses on delivering the three rights: providing excellent healthcare to the right patient, at the right place, and at the right time.

Deputy Llywydd, I must thank the stakeholders and clinicians, and there were many of them, who helped me prepare for this debate. I've centred my thoughts as to how we can build back more resiliently around five key points, to which I will now speak, although, of course, these are not silver bullets and must be part of a much more extensive programme of reforms and collaboration with clinicians, service users, all tiers of Government and other stakeholders so that we can deliver the services that people need and expect.

The first one is equipping the NHS with reliable and efficient technology. Advances in technology can help to transform healthcare and support preventative actions, as well as providing patients with more avenues to access appointments and get the help that they need. We have already seen some progress being made in this regard as a result of the pandemic. But more can be done to embed new technologies into everyday practice to reduce pressures on out-patient clinics, and to improve data sharing to assist with diagnosis and treatment. For example, the Royal College of Physicians have suggested looking at improving access to wearable technology as part of a proactive prevention programme within community health settings. Meanwhile, the likes of the British Medical Association have suggested that the NHS IT and technology infrastructure could be upgraded to ensure that accurate and clear waiting times and diagnosis information is available for staff and patients. Of course, an over-reliance on technology could exclude some people, and so there should be a concerted effort to improve information provision so that patients and their families have the information that they need to support their care. Therefore, the British Red Cross have called for patients to be provided with clear, accessible guidance about the discharge process to ensure that they have the support that they need at home.

Secondly, to ensure a 24/7 local authority-led social care discharge service. We also know that issues with hospital discharge and a lack of social care spaces are leading to bottlenecks within the wider system, with a knock-on-effect to A&E and ambulance services. Establishing localised 24/7 discharge schemes would speed up assessments and support patients to go home sooner with the right package of care, or into an appropriate social care facility. To support this, there must be far better collaboration, integration and data sharing between all aspects of the health and social care system; something that stakeholders have pointed out must improve.

We also know that access to community care needs to be improved across the country, especially on weekends. For example, the Motor Neurone Disease Association Cymru have highlighted that, in north Wales, access and referral to occupational therapists is often unclear and inconsistent. And so we need to develop a health system that enables people to be treated closer to home, such as a 'hospital at home' service, as called for by the RCP. This would help to reduce hospital admissions and give people more choice as to where they can be treated.

We also need a longer term rethink as to how we deliver social care on a scale that meets the needs of an older population, including greater investment into facilities to increase capacity. And there are some existing innovative ideas that could be scaled up to help create a more sustainable social care sector, such as care communities led by local authorities in collaboration with social care providers, building on local IT platforms. We have massive potential within our communities to tap into existing human capital; we saw it through COVID, didn’t we—that members of the community can be mobilised to help provide basic care to neighbours, with social care staff freed up to focus on more specialist tasks.

Recruiting and retention: we have, of course, spoken at length about staffing recruitment and retention issues within the health and social care systems in the Senedd, but it’s a vital issue that needs to be addressed. We simply cannot do what we want to do without a properly staffed and equipped health service. Therefore, I back calls from BMA Cymru for the Welsh Government to increase the number of GPs in training. There must also be more accessible information on vacancy data from health boards and trusts so that we can better understand the needs and pressures faced by staff, and take a more focused approach to training and recruitment. Such a policy must come hand in hand with a properly funded national workforce implementation plan for health and social care, and to ensure synergies between this plan and the national clinical framework. As I’m sure we all agree, there must be parity between the health and social care workforces. Social care staff—sorry, I just think I’ve lost the—. That’s rather annoying. Right, so I’ve just lost a page that was quite an important one, and for some reason, it has disappeared. [Interruption.] Thank you very much. There we are; good supporting staff. So, we need to recognise that there needs to be parity between those two areas and the social care sector needs better pay and conditions, and more training routes for staff, such as through a national academy for care.

Creating a more modern and transparent NHS: it’s also important that people have a greater say in their care, and have access to more information, so that they know who is accountable to them, and how. NHS health boards and trusts must work together regionally across organisational boundaries to establish a more joined-up approach to the delivery of services, and legislation could be considered to ensure that this happens. There is also need a re-evaluate and streamline NHS structures so that there is a greater focus on delivery and quality rather than on bureaucracy to speed up the delivery of change. 

And finally, more focus on prevention. Ultimately, the way to ensure a more resilient, sustainable health and social care system is by investing and focusing on prevention. Reducing demand for services and helping people to stay healthier for longer is especially important as people continue to, thankfully, live a lot longer. The RCP have called for improved access to prevention programmes based in primary and community care, especially for those living in poverty, and greater investment in innovation, including screening and vaccination programmes. 

Deputy Llywydd, I hope that the Members and the Minister will take my contribution in the constructive manner I intended it to be made. Of course, I don't have all of the answers, and I know that the Minister and her officials will be working hard to respond to some of the challenges that I've set out today, but we need to know from the Government about what progress is being made and how their actions are translating into real-terms service improvements that patients can see and feel. The general public need to know what they can expect to see improve and when they're going to see it. I look forward to hearing the other contributions from Members today. Thank you very much.

Can I thank Peter Fox for using his debate time on this really important issue today? The cross-party group on medical research is currently doing a piece of work, leading an inquiry into the benefits of medical research in Wales. And perhaps I should declare an interest as the chair of that cross-party group. Research-active hospitals have really improved outcomes for patients, whilst many clinicians also view research as an important part of their job. The opportunity, I think, for NHS staff to undertake medical research is an excellent means by which to make a career in the health and social care system more attractive. And surely, with some of the issues that we've heard about and which Peter has explored in his contribution today, with the retention and recruitment issues that we're aware of, how particularly important this particular aspect is. I think Welsh Government investment into medical research can only work as a medium to long-term solution to the staffing crisis within the Welsh NHS, offering a really attractive environment to attract more expertise to those critical positions within our health and social care system. 

I, too, would like to thank my colleague, Peter Fox, for giving me a minute of his time and for bringing this important topic to the floor of the Senedd. It's not being overly dramatic when we say that we face a crisis in social care. The Aneurin Bevan health board in my region have said that, this month, they'd had around 400 patients who could have been discharged but were unable to be. Even a report by the Welsh NHS Confederation had most of the NHS leaders saying that the care system had a massive knock-on effect across the healthcare system, with the added pressures driving the increase in urgent care demand. They also agreed that the lack of social care capacity is having an impact on the ability to tackle the effective care backlog—something that, as we know, has been drastically increased due to the COVID lockdowns. It's clear to me that there needs to be far better integration between health and social care, as has been said, with more financial investment going into social care, and there needs to be enhanced partnership working, as you alluded to as well. 

It's also imperative that we ensure that social care is an attractive career—far more than is currently the case—and that there are enhanced career progression opportunities to improve recruitment and retention, otherwise this will be, sadly, a never-ending cycle. I could go on, if time was allowed, but as we've heard from the contributions so far and from the Member for Monmouth, there have been some really good ideas put forward and I hope that the Minister will listen to them. So, thank you very much. 

I'd like to thank Peter Fox for raising this important issue in his short debate today. I'm currently undertaking a programme of care home visits in my constituency, because I want to see for myself what some of the issues are locally in my patch and, indeed, the case across Wales. The emerging theme is that a lot of care homes can't meet their capacity because they're understaffed. They might have a capacity of 40 or 50 beds, but they can only operate 25 or 30 because of that lack of staff. I think we need to make the social care career more attractive to prospective candidates, and increase training opportunities. I'm pleased to see the uplift in the real living wage, but we need to give them the right training opportunities, and stop social care workers hitting the glass ceiling if they aspire to progress in their careers to address some of these problems and give people the care and treatment they so rightly deserve. Thank you very much.

I am very grateful to the Member for Monmouth for choosing this particular topic. It was a genuinely thoughtful and well-reasoned contribution. I'm sure that he himself would admit that these aren't entirely new ideas that he's mentioned. We do need to bring these ideas together in this way to the Senedd, because we do need to innovate in these ways to solve some of the issues that we're facing in the health service, because it's perfectly clear to all of us that we can't continue as we currently are.

I want to talk about one issue, the final point that was raised by Peter, namely the need to focus so much more on the preventative agenda. There are individual initiatives on the preventative agenda already happening, of course. We heard some in the debate on liver disease earlier on today. But I'm talking here about a change of culture. Yes, we need to change the culture within the population—the Minister referred to that yesterday—but the Government needs to lead that cultural change in everything that they do, across all parts of Government work, to make it the major ambition to make us a healthier nation, because we're not fit and healthy at the moment.

I call on the Deputy Minister for Social Services to reply to the debate. Julie Morgan.

Thank you. I welcome the opportunity to respond to this debate.

I'm really pleased to be here today, and I really welcome the constructive way that Peter Fox has introduced this debate and the proposals that he has made. We are all aware that our health and social services are facing extreme pressure this winter, and, as Peter said, this is the position across the whole of the UK.

As well as continuing to deal with COVID-19 patients, of whom there are currently more than 500 in hospitals across Wales, we're seeing significant numbers of other respiratory viruses, and an increase in people with serious illnesses coming forward for diagnosis and treatment, and I know we do continue to ask a lot of our health and care staff. They have worked tirelessly throughout the pandemic, and the current pressures mean that they're not always able to provide the level of care that they would like to. Our workforce also continues to be affected by COVID-related sickness absence and self-isolation requirements.

Our ambulance and 111 services are seeing unprecedented levels of demand, and I think you've probably heard these examples before, but they're worth repeating. On just one day, 27 December, the 111 telephone service received 8,500 calls—the highest ever number of calls in a day. The ambulance service received 210 immediately life-threatening calls. Over 550 people were admitted to hospital; 551 COVID patients were in acute hospital beds, which is over 5 per cent of our total bed capacity, and over 3 per cent of beds were occupied by patients with flu; and 12 per cent of beds were taken up by people who were awaiting discharge.

Our primary and community care services are experiencing similar levels of increased demand. Total contacts to GPs last week were over 12 per cent higher than this time last year. And along with the increased numbers of patients seeking medical care, one of our biggest challenges is making sure that people can leave hospital as soon as it is safe for them to do so. And pressures in the social care system, as has been illustrated already, are currently making this very difficult.

Austerity and the subsequent pressure on budgets have seen social care workforce pay decline in comparison to other sectors, and has exacerbated recruitment challenges. We have announced funding of £70 million, so that local authorities and health boards can implement the real living wage uplift, and I acknowledge that Gareth Davies welcomed this proposal, and we are striving to improve employment terms and conditions for the sector, because it's not just the pay, it's the terms and conditions as well, and we certainly share, Peter, your vision of having health and social care staff on a parity.

Our population is ageing, and this is a testament, of course, to the effectiveness of our NHS over many years. It's great that so many people are living so much longer, but obviously it does bring challenges. Patients aged 55 and over account for over 90 per cent of our emergency in-patient bed days. More than half of all bed days are for patients aged 75 and over, and we know that, for this cohort, being discharged as soon as they are medically fit is crucial to their recovery. They're less likely to pick up an infection from others. They'll sleep better in their own beds and get the rest they need, and they'll be more confident in moving around in their own surroundings, so will build up their strength quicker than in the hospital. So, it is really crucial that we do get people out of hospital as soon as we possibly can.

To support health boards during this incredibly busy time, we've issued guidance in the form of a revised local options framework, which gives them flexibility and support to respond to the multiple risks being faced at the moment. We've also written to clinical leaders to encourage them not to admit people to hospital unless absolutely necessary, and to help medically fit patients to return home, or to an alternative place of safety, as soon as they are able to. This will create much needed capacity within our hospitals and the ambulance service, to ensure we can provide care to people with serious illness and injuries. 

'A Healthier Wales' sets out our vision for integrated, seamless services, with a focus on community-based treatment, which I know Peter Fox highlighted in his contribution. Our aim has always been for people to go into hospital only when treatment cannot be provided safety elsewhere, and to reduce the time people spend in hospital when they do have to go. And the vision is more relevant today than ever. We have continued to build on the foundations of 'A Healthier Wales', creating an environment in which our partners and workforce have actively embraced and delivered service transformation at pace. Our strategic programme for primary care, six goals for urgent and emergency care, and regional integration fund are all working towards this vision within the context of our current pressures. 

In December, the Minister for Health and Social Services launched the optimal hospital patient flow framework, and this sets a clear expectation for health boards and regional partnership boards to make sure people are only in hospital for as long as they need to be.

We have secured over 500 additional community beds for step-down care, and we will continue to work to try to increase this capacity. We're also investing in alternative options to attendance at emergency departments, including urgent primary care centres and same-day services. The ongoing programme of contract reform under way across primary care remains focused on transforming services and contracts to support better access for patients and the longer term sustainability of services. Action at local and national level is under way to accelerate cluster working, including across the primary and community care professions, as well as social care and other partners. This transformation, scaled up, and collaborative approach to service planning and delivery is at the heart of the primary care model for Wales and our aim for an integrated health and care service that promotes health and well-being.

Professional collaboratives of GPs, pharmacists, optometrists, dentists, allied health professionals and nurses are embedding throughout Wales to optimise multi-professional service delivery in the community. Strengthening the quality of roles and enabling professionals to work at the top of their licence is a focus for this area, and one we will see comes together as a part of workforce planning. 

Significant funds have been provided through regional partnership boards to support health and social care partners to work closer together and develop national models of integrated care that will offer preventative, seamless services for people in the community. Now, these resources include the five-year regional integration fund, providing £144 million a year to support transformation, and the newly established £50 million integration and rebalancing capital fund, which is directly supporting our ambition to establish 50 integrated health and care hubs across Wales. And three of the models being developed through the regional integration fund are specifically aimed at creating community capacity. We have introduced new home from hospital services, enabled complex care to be provided close to home, we've invested in social prescribing, and have made progress with telecare support services. Many of the things that Peter Fox mentioned in his introduction to the debate are things that we are doing and we want to do more of.

Clusters and regional partnership boards are driving this agenda on, but we know we need to go further and faster with these reforms. In 2023, we want to make progress to an integrated community care service that is available to everyone across Wales. This is not a new organisation, but rather an ambitious agenda to move and deeply integrate health and social care services and orientate them to building a stronger, local web of support. I think, in his contribution, Peter Fox described the sort of community support that can be built up on a local level, and that is something that we are aspiring to do.

The NHS planning framework for 2023-24 requires NHS organisations to develop a closer relationship with local government to tackle the issue of delayed transfers of care. In making financial allocations to local health boards, the Minister for Health and Social Services has been clear about the requirement for them to work much more closely with local authorities to provide an integrated community care response. It is absolutely essential that this integrated working takes place. And we do see real opportunities here. Twenty-six per cent of complex patients pending discharge are known to social care at the point of admission, so we want to develop a graduated model of support, including harnessing the third sector and voluntary effort—because we think there is a clear role for the third sector—to enable people to maintain a level of independence and quality of life and to strengthen local services to avoid people being admitted to hospital. So, we want to do all we possibly can to invest in the third sector and volunteers in order to keep people at home and to help them at home, and to also develop the hospital-at-home services, which, of course, we do have some examples of here in Wales.

We also want to increase reablement capacity in the community, because 70 per cent of people who receive reablement when they leave hospital require no further long-term care, or a much smaller package than without reablement. People report better quality-of-life outcomes after reablement and live independently for longer in their own homes.

And of course, we need every opportunity to use digital technology to support people and care workers, and this is something the Minister for Health and Social Services is driving forward very strongly. Strides have been made using telecare and, alongside seeking to provide greater reward and an attractive career for care workers, it is ever more critical in a very tight labour market that we maximise the use of technology in the community.

We will continue to work on these opportunities and we'll provide further updates, but we expect to have a strong web of support available locally before next winter and, over the medium term, we'll see the emergence of an integrated community care service in Wales. So, I'd like to end by thanking Peter Fox for introducing this debate in such a constructive way, and I do appreciate all the suggestions that he has made. And of course, we will look at them closely—many of them are things that are very close to our own hearts. So, diolch yn fawr iawn.

Thank you, Deputy Minister, and thank you, all. That brings today's proceedings to a close.

The meeting ended at 18:58.