Item 7 is next, the Plaid Cymru debate, on management of NHS pressures. I call on Rhun ap Iorwerth to move the motion.

Motion NDM8181 Siân Gwenllian

Supported by Darren Millar

To propose that the Senedd:

1. Regrets the Welsh Government's mismanagement of the pressures facing the NHS.

2. Declares a health crisis in Wales.

Motion moved.

Thank you very much, Dirprwy Lywydd, and I'm pleased to have the opportunity to move this motion. To continue in the spirit that we've seen in the Senedd this afternoon, I will emphasise that this motion is intended to be constructive. Yes, it is critical of the Welsh Government's management of health and care services, and I'm afraid that is based on the clear evidence before us. But this effort to declare a health crisis in Wales is something that we hope can arm the Welsh Government to respond better to the challenges.

It's a former head of research at General Motors, Charles Kettering, who said nearly a century ago now that 'a problem well stated is half solved'. Now, when this Senedd declared a climate emergency, it was a declaration that the challenge we faced on climate change was so extraordinary that it needed to be elevated, to be elevated within our national psyche, to be elevated in terms of parliamentary importance, in terms of Government priority.

Now, perhaps Mr Kettering would be pushing it rather far if he said that that recognition of the scale of the climate challenge meant half the work had been done to address the issue, but it did mark a gear change, I think. It was a gear change that Welsh Government itself recognised had to be made, because, if I recall, the day before the Senedd took a vote on a motion declaring a climate emergency, Government made that declaration itself. Now, that declaration then represented a new context within which a whole host of decisions were taken, and are still being taken, from policy and funding priorities to the very structures of Government within which those decisions are made.

So, today, we’re asking for a declaration of a health crisis. Once again, this is because we’re facing challenges of such extraordinary gravity that we believe Government needs to be arming itself as well as it possibly can to deal with the situation, and just as with the declaration of a climate emergency, I think that making that declaration today could bring about a number of positive steps. It would help focus minds on finding new and innovative ways to address the problems we face. Similarly, I think it would help focus all spending powers, however scarce—and I see the finance Minister is here with us this afternoon—on the issues that matter, and nothing, of course, is more important at the moment than resolving the pay dispute. Finally, I’d hope it would make Government look again at its own structures, perhaps, and processes, to ensure they’re best geared to deal with this crisis.

Now, I’m looking forward to the Minister’s response to that stated intention. After all, whilst it’s a crisis for Government itself, the most important thing is that this is a crisis for everyone—for ordinary people the length and breadth of Wales, and of course it’s a crisis for our hard-working health and care staff, day in, day out, right across the health and care sector. Now, if Government doesn’t see fit to support our call and to agree to declare a health crisis then we need to know why. Is it that they don’t see the benefit of making that kind of formal declaration? Or that they still don’t agree that it is a crisis? The chief executive of the Welsh NHS told ITV News earlier this month that she would not describe it as a crisis, but acknowledges that the situation is hugely pressurised. The First Minister said last week that he didn’t think it was in a perpetual state of crisis, which may be slightly different, but there were undoubtedly days, he said, when front line staff could be forgiven for thinking it was.

Now, it’s always useful to look at definitions. Here are a few. Crisis: a time of intense difficulty or danger; a time when a difficult or important decision must be made. The Oxford dictionary—often a go-to—suggests, for 'crisis',

'a time of great danger, difficulty or doubt when problems must be solved or important decisions must be made'.

I don’t think there could be a better definition of where we are regarding health and care in Wales: a time when problems must be solved and hugely important decisions must be made. It is a crisis by any measure, and I can’t think of many more important decisions that Welsh Government could take now than those that could really start addressing that crisis that we face, starting with resolving the pay disputes to put that vital workforce at the heart of recovery, and then on to all those other elements that need a real gear change.

But we have to accept that there is a crisis first of all. I described the situation as it was at the time during health questions here in the Siambr in December, and I referred to a series of challenges, as I saw them that day, including winter pressures, the recruitment and retention of staff, waiting times for treatment in A&E, ambulance waiting times, and so on and so forth. I asked the Minister what state she expects the NHS to be in by the next question session, which will be within a week. The Minister referred to a number of steps that were to be put in place, and she said that she hoped for positive outcomes.

But let’s consider what we’ve seen since then. Industrial action intensified, with more strike days called by nurses and ambulance workers; ambulances stuck outside hospitals for 32,500 hours in December—the full capacity is 100,000 hours; and a decision to allow patients to leave hospitals without a care package, despite the grave concerns raised by medics, carers and others. I know that the Minister justifies that, saying that it’s based on evidence, but once again today I was in a meeting with doctors who raised serious concerns about that. Two critical incidents in Betsi Cadwaladr health board within a fortnight; Swansea bay health board encouraging people to stay away from hospital unless there was a real threat to life. And, of course, our post bags, those of each of us as Members of this Senedd, tells us a story, and it tells that story very clearly as to how problems within the health service and the unsustainability that has to be addressed are having a direct impact on people's lives, on patients and their experience, never mind, of course, all of the staff who contact us having reached the end of their tether. 

Dirprwy Lywydd, this is a crisis—there is no doubt about that—and that means that we have two choices: we can continue as we are or we seek a way of placing a new focus on these issues. It's important to recognise that I don't doubt for a second that the Government wants to tackle these challenges, but they are managerial, in my view, and I'm quite sure that there isn't a single Member in this Senedd who would like to resolve the problems more than the health Minister herself, but what's happening at the moment under her leadership isn't working. Indeed, one Minister after another has failed to create the kind of sustainability that we need within our health and care services, and that's why we do use the word 'mismanagement' in today's motion. 

But let us agree that there is a crisis, as an important and positive step, and I will make it clear by saying again that the first crucial step is to settle the pay disputes. I understand that the RCN is to write to the First Minister again today, asking why he hasn't responded, as he promised to do, to their letter of 19 December, calling on him to make an improved pay offer. He said that he would respond after the brief Christmas recess. It's almost the end of January now. We need a response that shows the scale of the crisis and we need to accept that we are in crisis as a starting point to a better and a more sustainable time for health, because it feels a very long way away at the moment.

Can I thank Plaid Cymru for tabling this motion today, and as Welsh Conservatives we'll be supporting the motion as it's tabled? The health service is in crisis, and they are serious words. When you are declaring a health crisis in Wales, they are serious words that you've got to think carefully about before stating them, and talking about mismanagement—serious words—but that is exactly the position we're in. And for the reasons that Rhun ap Iorwerth has outlined, you've got to recognise a problem in order to be able to move forward, as Rhun put it very well in his opening comments. 

I don't underestimate the challenge that you have, Minister, and there are huge pressures still to come, we're in the middle of winter, we've got worse months to come, and I'm under no illusion of the difficult pressures. There are difficult pressures in health services right across Europe, right across the UK. There are challenges in the NHS in every part of the country, and of course I recognise that. But we're in a worse and a more significant position in Wales. We've got the slowest ambulance response times on record, the longest treatment waiting list and the worst A&E waits in Britain. That is fact and that's what we've got to recognise. 

We've had some discussion about agency nursing in recent contributions, and it was very much mentioned in the Chamber yesterday, Minister, but agency staff have doubled in the last five years—doubled—costing the Welsh NHS £260 million in 2022 alone. The number of agency staff employed had risen by an unsustainable 36 per cent by 2021. So, I think the Welsh Government has really got to get to grips with this in particular, and I recognise that the Minister recognises that also. And, of course, I heard the First Minister say yesterday that this isn't something that can be done overnight. Yes, of course, I know that, but the point is it should have started five years ago. The workforce challenges that we have have been there for some time. 

As opposition parties in this Chamber, our job is to scrutinise, our job is to hold you, Minister, to account, but it's also to come forward with policy positions and how we could resolve some of the issues, and to put those to you, Minister. Now, I'm going to mention surgical hubs; you're going to have your hand on your head again and say, 'Oh no, he's going to go on about surgical hubs all over again.' But I'm happy to move on that conversation, Minister, as well. To me, I don't particularly care what something is called; it's about outcomes, and I know you agree with that as well.

But the outcomes at the moment, the position that we're in, is that two-year waits have virtually been wiped out in England and Scotland, and in Wales, we still have 55,000 people waiting over two years for treatment. That is the position. I know, Minister, you often say, 'Well, we're in a different position here, we've got an older and sicker population', but surely—surely—that's what devolution is about. If we can't have different policies and tailoring to the demographics of our nation, what on earth is devolution for? We've got to have different policy positions in order to deal with the challenges that we have.

And on specialist hubs, yes, I understand what you outlined yesterday, Minister, but the point is, if you have a specialist surgical hub in south Wales, that is an eight-hour round trip for somebody in north Wales. So, I would suggest that the model that is in England, where you have not specialist, but general surgical hubs, is better for a country that is more rural, and most health boards across Wales should have a surgical hub.

We've also outlined, Minister, our GP access plan for doctors. People need to see doctors in order to take the pressure off the NHS. There's more of a role for pharmacists to play in order to reduce the burden on our GPs. Modernising tech, supporting our GPs in that. But on technology, we've also put forward our NHS tech bundle, designed to modernise health services and bring them into line with the rest of the UK. E-prescriptions: we're still miles behind on e-prescriptions. We really should be getting on with this by now and keeping up with the rest of the UK. Developing an NHS app: that is available in other parts of the UK, not in Wales. And abolishing fax machines in our health boards. How are we still using fax machines in our Welsh NHS?

So, Minister, being the Minister in Wales for health is not an easy job, especially if you're a Labour Minister constantly being undermined by the Labour opposition in Westminster. So, I would say that there is no party that has the monopoly on ideas, and I hope that, across all political parties in this Chamber, we can constructively put ideas to you, Minister, for consideration. Diolch, Dirprwy Lywydd.

To solve a crisis, you have to acknowledge that there is a crisis. It's a lesson that we always tell our children, 'Be honest; we need to know the truth', but the same is true when it comes to public services. And the truth is that we know, all of us know, from our case work, about people who have lost their lives who would have lived. The headlines are there consistently, and that's what we need to focus on, namely the people who work in the health service and those people who are dependent on the health service who have been let down.

And it's not the fault of the staff; let us make it clear. Very often, the Minister refers rightly to all of the heroic work being done by employees in our health service every day, and there are a whole host of lives saved on a daily basis. We're not denying that. Even when there are health boards that have been in special measures, that heroic work continues, but those health boards have still remained in special measures.

And that is what we are asking for today, namely an acknowledgement and recognition of what we all know, what everyone we represent knows, and what the health workers know, that there is a crisis. We do have to acknowledge that. What is disappointing is that every single seat isn't full here, or that people have joined online, so that we reflect the scale of the correspondence we receive on a daily basis on this issue, because there isn't a greater crisis facing us. I'm sure of that, because it impacts everything and it aligns with the cost-of-living crisis—of course it does.

What we need to bear in mind is that this is happening in very challenging circumstances, and staff are openly admitting to being at breaking point. Visiting picket lines before Christmas, and speaking to nurses striking for the first time in their lives, they emphasised to me that patient safety was at the forefront of their minds when taking the decision to strike, even more so than pay. They recounted the horrors of what they'd experienced during the pandemic and the ongoing psychological impact, coupled with a crippling workload. They are doing their best, but know that the NHS they have always been proud to work for cannot currently do its best for patients. And every time they hear a Minister say there isn't a crisis, they ask, 'If this isn't a crisis, then how much worse are they expecting it to get?' It's not just bad every now and then—this is continuous for people working in our health services and for patients who rely on that crucial support.

Unfortunately, things are deteriorating. We're seeing examples of people saying, 'Well, there's no point for me to phone the doctor', 'There's no point for me to phone for an ambulance because I'm not going to get there.'

I'd like to focus specifically on the impact of the crisis on women, who, of course, count for over 50 per cent of the Welsh population. Again, studies show that the gender health gap continues to exist and that there are barriers facing women in terms of accessing the healthcare that they need.

The lack of investment in treatment for women's health conditions has resulted in cross-border agreement for treatment, but this does not always happen. Pregnant women, new mothers and those who have experienced pregnancy loss often need specialist mental health support, and, in Wales, even before the pandemic, these women have not always been well supported. Early research suggests that the need for these services has increased substantially, but it's again those who are always impacted, such as by the cost-of-living crisis, who are being affected by the lack of access now, including black, Asian and minority ethnic and poorer mothers.

We can only drive improvement to maternity care in Wales if there are enough midwives working in the NHS in every part of Wales. We must do more to retain the qualified and experienced staff we have, and we can look at staffing levels, but we have seen continuously that it's the retention of experienced staff that is the concern here, and very often it's new nurses being left in charge of wards not having that experience and so on. So, there is a matter about retaining those experienced staff as well. Whilst the Welsh Government has committed to producing a women's health plan for Wales, and we saw the discovery report being published in November 2022, we also now need to see the actions, key deliverables and measurable outcomes as a matter of urgency. After all, the future of our NHS depends on this. The health and care sector is primarily composed of women, and a women's health plan would help minimise avoidable ill health in this workforce. How can the Welsh Government improve the efficiency of its NHS if it cannot cater towards its workers?

The Welsh Government does need to take into account that mismanagement—. And we don't mean during the pandemic; this has been since devolution. It is within Welsh Labour's control in terms of health. We cannot avoid scrutiny here in Wales. As I said, if this isn't a crisis, what is? Can we be honest with those that we represent and the workforce, and then work together to improve things?

Our NHS is at breaking point. Something has to give. There have been long-standing problems with patient flow through hospitals. When you combine this with an increased pressure on our emergency service and more and more patients being added to waiting lists, our hard-working staff are being forced to work harder, and work harder in worse conditions.

There will be some in this Chamber that won't want to hear this; they refuse to believe it. Well, don't take my word for it—take the word of the British Medical Association Cymru Wales who recently released the findings of their NHS pressure portal, a place where doctors from across Wales have shared accounts of the state of their working conditions, and the pressures that they face on a daily basis. From treating patients in cupboards, on chairs, to working 12-hour shifts without breaks, doctors laid bare their experiences to highlight the risk to patient and staff safety. Other concerns include patients waiting for up to 14 hours in A&E being the new normal, patients needed cardiac monitors going unmonitored due to a lack of space, and patients being treated in the back of ambulances.

The recent strikes for nurses and ambulance workers are a last resort from dedicated staff who have patient safety at the heart of their actions. That was what came out loud and clear during my visits to picket lines: yes, pay is important, but so is patient safety. Staff should not have to go on strike to make safe their working conditions and the conditions for patients. Something has to give. As a party, we've always been on the side of workers fighting for fair pay and safe working conditions. There have been ample opportunities for the Welsh Labour Government to show their support for nurses. They have not taken them.

The biggest challenge to the Nurse Staffing Levels (Wales) Act 2016 is the sustainability of the nursing workforce. There are for more nurses leaving the NHS than can be matched by newly qualified nurses or internationally recruited nurses. Regrettably, there have been no actions by the Welsh Government since the RCN's last report in 2019 to address nursing retention issues. With more and more people being added to waiting lists every day, our NHS is locked into a vicious cycle. We can't speed the flow of patients through the system until that is addressed and, in the meantime, our overworked and under-resourced health and care staff are working around the clock to keep things moving, or, as many are doing, they are leaving the profession, never to return.

Over 60 per cent of people on the waiting list are waiting for their first outpatient appointment. It will take a whole-system effort to reduce these figures and ensure people are seen in a timely manner. The delays in out-patient appointments, diagnostic tests and surgery have catastrophic impact on those waiting, as well as their families and their carers. Clinicians are reporting examples including people presenting with late-stage cancer, more complex cataracts, and people who were walking with a stick now needing wheelchairs.

I have also previously mentioned in committee scrutiny meetings the inconsistency of the Welsh Minister calling for people to assume greater personal responsibility in terms of exercise and leading healthy lives at a time when council cuts are being made due to a lack of Welsh Government funding. In my region, the people of Pontllanfraith probably had a wry smile on their face when they heard the health Minister talk about people taking more responsibility for their health after the Labour-controlled local authority did everything in their power to shut the local leisure centre. Only a court challenge stopped them. After 25 years of running health in Wales, staff and patients need to know why they should have the confidence in Labour's ability to improve our NHS. This isn't just about clearing COVID backlogs—the issues I have mentioned have existed pre pandemic and they require urgent solutions. The current state of our NHS is unacceptable and cannot be defended. We are in a health crisis. I urge Members to vote for our motion. Diolch yn fawr.

The Llywydd took the Chair.

There is a health crisis right across the UK, not just in Wales, and all evidence shows this has worsened over the last 12 years since the start of austerity and cuts to public services, and will get worse under this UK Tory Government and their cost-of-living crisis. We can't look at the NHS in isolation. Adequate housing, food, education and fair work all contribute to good physical and mental health. Year after year, I've seen preventative services be squeezed and cut as councils look at anything non-statutory. However, many of these services have been saved, thanks to Welsh Government funding choices and European funding, which we will soon see the last of. Those that were saved under austerity 1 may be lost under austerity 2 and all the pressures they're all facing.

Damp and mould in homes is becoming more of an issue as people cannot afford to heat them. Healthy, hot, nourishing food is now a luxury for many. Increasing productivity beyond a reasonable limit, seeing people having to work 12-hour shifts, two days and then two nights, playing havoc with your body, your mental health and family, also has implications. When I spoke to nurses on the picket line and a police officer in England, it was the relentless 12-hour shifts and the lack of flexibility that was a huge issue, not just wages. And it's not just about the NHS—social healthcare funding needs to grow massively from central Government in line with the growing ageing population. That's a crisis we're facing. There is more advancing technology—

Will the Member take an intervention?

Yes, okay.

When you met the striking nurses on the picket line, did you inform them that health has been devolved to the Labour Goverment in Wales for nearly 25 years?

Actually, most of the nurses realised that colleagues across the border in England as well were on picket lines and they knew that it was an issue right across the UK. And that's what they're fighting for—for colleagues right across the UK.

Sorry, I've forgotten where I was after taking the intervention. There is more advancing technology, more medicines available to help people, and this needs adequate funding. I heard on the Jeremy Vine show a doctor say that when he practised, just 7 per cent of the budget went on drugs and medicine; now it's 19 per cent of the budget, but the budget's not grown with it.

We all hear of many issues, but there are also good reports as well. Each week, I hear of more being done differently in the community, and this seems a good forward step. This weekend, a resident told me he'd recently undergone major heart surgery. Wrexham Maelor worked closely with Broadgreen and he's now having weekly rehabilitation and assessment through a community facility in Connah's Quay. A nurse checks his medication and he's given exercises there, and she also phones him at home. Another resident told me how he e-mailed images of a spot that wouldn't heal to his doctor. He was able to look online, telephone him, and refer him to a specialist who removed the malignant melanoma, all dealt with quickly and only with one visit to hospital—all dealt with online. So, these are good ways forward.

Positive steps forward are being made, and more nurse and allied professional training places are being offered than ever before, with new courses at Glyndŵr, in north-east Wales, as well as Bangor, and a new medical school being developed as well as a dental academy. More community and reablement beds are being offered in Wales, such as at Marleyfield in Buckley, thanks to the ICF and housing funding, and I hope that continues as well. I recently visited a well-being hub in Wrexham town centre, which incorporates a consulting room for long COVID, and I believe another one is being built in Penygroes, which will incorporate a consulting room in the community.

The NHS 111 'press 2' is to launch in north Wales today. It's a dedicated mental health advice service, offering support for people of all ages via the established NHS 111 call number. At present, up to 40 per cent of GP appointments involve mental health concerns, and with primary care services continuing to face pressures, this new service will really help and give the support that's needed. A new, unique programme to transform the well-being and mental health of children and young people in north Wales has been recognised with a national award, which is the Missing Boys project from Denbighshire county council, which provided increased school-based counselling services for young boys and men between 11 and 18 years.

So, a lot is still being done, and I do understand that there is a crisis as well, but while recognising the challenges we face we should not forget the incredible work being done by our amazing public services. But we now need proper funding from the UK Government to support them. Thank you.

The experiences of the pandemic did perhaps reinforce something that we were all very aware of, namely that the nursing workforce within the health service was suffering in terms of lack of numbers, low pay, and even lower morale. We then of course see ambulance workers going on strike. We are likely to see doctors in Wales following suit by also going on strike, and it's clear that the current situation is unsustainable. Leaders within the health service are warning that the service is at a precipice, and are asking the Government to do everything it can to move away from that cliff edge, because we all know there would be serious implications to what might happen because of that.

As a party, we've always been on the side of health and care workers, advocating for fairer pay and sustainability within the profession. I'm sure many of you will recall how Plaid Cymru was a very lonely voice for many years, arguing for a medical school in Bangor—something that the Government has now, of course, supported. I, and many Members on these benches and other benches, have regularly raised over the past decade the need for better workforce planning within the health workforce, but here we are today, with one in eight nursing roles in north Wales being vacant. The upshot of that, of course, is a reliance on agency nurses and expenditure across Wales of hundreds of millions of pounds over recent years.

The Welsh Government can't abdicate responsibility from this. Yes, many of these pressures reach beyond Wales and afflict other parts of the United Kingdom, but nobody can say that the Welsh Government wasn't warned over many years about this ticking time bomb. Nobody can deny, also, that you have options to address this crisis. We can all see that the Government's handling of this so far has effectively led us to where we are today. Even prior to the strike action taking place by RCN members, the health Minister refused to meet with the Welsh partnership forum, despite the forum's long history of productive social partnership. The refusal to meet with the WPF was unnecessary brinkmanship, copied straight from the Tory playbook. But, subsequent meetings have been fruitless. The recent proposal of a one-off unspecified payment, rejected by the unions as unsatisfactory, speaks to a longer pattern of a lack of coherent strategy around the workforce by the current Minister and her predecessors as well, of course, because much of this isn't new. 

I feel as if the Government is becoming a broken record, blaming the UK Government. And of course the UK Government has a lot to answer for. Crikey, I get up often enough and say that in this Chamber. But, for me, every time the Labour Government here points the finger at the Westminster Government, it strengthens the argument that some of the powers they have there should therefore be devolved here so that we don't have to suffer and don't have to be beholden to the damaging decisions that they make. 

Now, one decision that lays fairly and squarely with the Welsh Government, of course, and it's something I raised last week, is the closure of community hospitals across Wales. We heard how 12 per cent of hospital beds are suffering from delayed discharges, and closing community hospitals, in my view, has made that situation worse. The Minister's retort was that community hospitals are more expensive; quite possibly. I've seen figures that tell a different story, but I've no reason to doubt the Minister's integrity in that respect. But, of course, we were told at the time, when that change was happening, that cost wasn't the driver. The driver was this need to move to a new, better model of care. We were promised enhanced home care, but that was never delivered as promised. We warned at the time of the implications. You will always need that step-down provision for people who are too well to be in hospital but maybe not well enough to be at home. There is that centre ground, that provision that is needed. When you lose that, why are we surprised that there is such a level of delayed discharge in the flow of the system, as it is now? And we graphically see how the closure of community hospitals is at least contributing to the crisis that we're currently in. 

I'm very grateful for this opportunity to contribute to today's debate, because it's vital that we draw attention to the challenges facing the health service to prevent those challenges from becoming normalised. And that's the big danger, that the current deficiencies become a normal part of the service in moving forward to the future. I also welcome this opportunity to call on the Welsh Government to use the full range of powers that it has to try to tackle the variety of problems in the health sector, as we've already heard. The people of Wales can and should expect better. 

We've already heard this evening about the variety of complex issues that face the health service. Ambulance waiting times remind us clearly of the huge pressure on the sector. In November alone, 4,600 red calls were made to the ambulance service—the highest ever number of red calls in a single month. Fewer than half of the ambulances arrived within the target time of eight minutes. Too many people therefore are having to wait hours for an ambulance, instead being encouraged to travel to their local A&E departments themselves. And, on several occasions, an ambulance isn't even available.

We've heard so many heartbreaking accounts this winter. Just before Christmas, we saw the very powerful image on the news platforms and social media of a 93-year-old woman, one of my constituents, lying on the floor having been left screaming in agony as she waited 25 hours for an ambulance. And it's important for us to remember, of course, that, behind these numerous stories and the bare facts and statistics are real people and real families having to watch their loved ones in pain.

Waiting for an ambulance is, of course, only the first part of the story. Critical delays in response times are being driven by overcrowding and a shortage of hospital beds at the other end, which means that patients are often having to wait for hours in cold ambulances outside emergency departments before they can be admitted. I was recently contacted by a constituent who told me about what had happened to their loved one, who is a cancer patient. Despite being on amber alert for an ambulance, she was nonetheless forced to wait six hours for an ambulance. She then had to wait a further six hours outside A&E before she could be transferred. In October, 28,143 'hours lost' were recorded due to crews having to stay with patients who were unable to be passed into the care of emergency units in Wales. That’s almost 30,000 hours in one month that could and should have been spent responding to other life-threatening calls. 

According to the head of the Welsh Ambulance Service NHS Trust, there have been some incidents where paramedics have started their shift, taken a patient to A&E, sat with them for the rest of their shift, finished work and gone home, only to return 12 hours later to see the same patient again in the same ambulance, because they had still not been able to go into A&E. I know that this is a source of immense frustration for paramedics—and I'm sure for the Minister as well—who want to be out there ensuring that life-saving care is given to all who need it.  

Amongst everything that is happening, the Welsh Government is in serious danger at present of losing the confidence and support of our health workers, and indeed the wider public, in its ability to manage the NHS. This is reflected in the fact that ambulance staff have now decided to take industrial action—something that I'm sure has weighed heavily on them. 

It's clear that we need to address pressures on the ambulance service at pace, because they are leading to a catastrophic impact on patients and staff. I urge the Welsh Government to redouble its efforts and to use every lever available to it to tackle this genuine crisis.

The Minister for Health and Social Services now to contribute to the debate, Eluned Morgan.

Diolch yn fawr, Llywydd. I wasn't exactly sure what Plaid Cymru hoped to achieve by getting the Welsh Government to declare a health crisis in Wales, so, I am pleased that I now know the three main points of what you wanted us to focus on, and I am grateful for those. So, one of them was to help focus minds on finding innovative ways to address the problems we face, focus all our spending powers on the issues that matter, and the main one is resolving pay disputes and also to look at Government structures.

Let me just take some of those in order. First of all, finding innovative ways to address the problems we face—we are doing that. We’ve got £144 million in the regional integration fund that does precisely that—looks for innovative ways of doing things. And then, the whole point for me is that you have to then scale up what works. So, for example, we’re looking in an innovative way at the way Cardiff is dealing with their A&E long waits at the moment, and it’s quite successful, and now we’re trying to scale that up and take it across the whole of Wales. We’ve got this new community bed capacity—that, again, is an innovative approach. And I’ve said time and again that the six goals for urgent and emergency care are really starting to bite: we have a whole load of measures this year that weren’t in place last year.

I was really fascinated to hear about the Government structures. I’m not sure if, in the middle of a very difficult time, restructuring is a good idea. We are absolutely focused on the job in hand, but what I will tell you is that I do accept that we do need to have a more comprehensive debate at a time when we know that care is becoming more complex and we have an ageing population.  

Thanks for taking an intervention. One suggestion would be to make sure that the NHS Executive for Wales that's been set up really is a body that can make a difference—that has teeth. That's the kind of focus that I mean in terms of Government structures. 

Yes, absolutely, and that's already happening. So, that's why we've been having these summits, which have been more or less organised by the NHS executive, which is in shadow form at the moment. 

But I was really interested in your point that you want us to focus all our spending powers on the issues that matter, and that's resolving the pay dispute. A lot of your colleagues have talked about other things—you know, that we've got to do community hospitals as well, and we've got to get more people to respond to ambulance calls and there's a shortage of beds. That's quite a long list, so I'm not quite sure whether you want us to focus everything on the pay dispute—

If the Minister will take an intervention, I'll gladly explain that again.

Okay.

What I said was top of the list was to resolve that pay dispute.

Okay. Well, that's fine. Well, if it is top of the list, I'm just quite intrigued, then—. I'm quite intrigued, we have a co-operation agreement; there is hardly a mention of health in your co-operation agreement. Mental health is there; not a word about health. And I think it's really important for people to understand that we have to release money from somewhere, and I can't see you sticking your hand up and telling us exactly where you want us to cut.

If the First Minister will allow me to reveal why health isn't included in the co-operation agreement, then I'm quite happy for those minutes of those discussions to be published.

You have a situation where we have a co-operation agreement, and there's money in the budget. If you're saying that we have to re-prioritise everything, then I think we've got to just be absolutely clear that you have made some decisions. You've made some political decisions, and you have to stand by those.

Now, the system, particularly over Christmas, was under pressure like the NHS has never experienced before. The demand was through the roof—we had COVID, we had flu, we had strep A, and they all coincided to add a significant extra demand on a service that was already under pressure. And let's not forget: we're still in a pandemic, and we're also trying to recover services at the same time. The First Minister suggested recently that there certainly were days when it must have felt like a crisis, both for those using the service, and for those delivering the service, but at the same time, as parts of the system felt under siege, other parts of the system were delivering on a scale that we've never seen before, and I'd like to thank the NHS and the staff for the incredible efforts that they're making.

So, just let me give you an idea of the scale of what we're talking about. The NHS management information for December suggests that, around 350,000 contacts took place in GP practices per week. For one week, this reached 400,000 contacts. In a month, 100,000 different people had an NHS dental appointment; there were around 127,000 eye appointments; 18,000 common ailments scheme consultations in community pharmacies; 2,000 sore throat tests were administered; and 4,000 consultations were undertaken by prescribing pharmacists. And on top of that—[Interruption.] No, if you don't mind, I'm going to carry on. On top of that, 375,000 consultations were undertaken in secondary care during October alone. So, yes, this is a system under strain, but the NHS is dealing with around 2 million contacts every month. Every month. So, yes, there are parts of it under strain, but let's not pretend that the whole system is in crisis. And on top of that, of course, we were doing other things. Eighty per cent of the adults in Wales over 65 were given their COVID boosters. Seventy-five per cent of the over 65s were given their flu vaccinations—measures that inevitably reduce the pressures that might otherwise have hit the system.

So, the vast majority of these people's experiences were positive, and I'm sure that most of them would not say that they felt that the system was in crisis in terms of their personal experience. But I do acknowledge that the pressure has been incredibly intense in some parts of the system, despite the huge amount of preparation that we put in place. All of the new services that we've put in place—the 111 service, new primary urgent care centres, new same-day emergency centres, 100 new ambulance staff, pharmacies that can give advice, additional 508 community beds—all of those services have diverted thousands of people away from A&E departments, and none of that existed last year.

Some people made points about digital. We need to go much further with digital. We're spending more on digital proportionately per head than they are in England. Women's health—it's very much that this is very high on my agenda. Surgical hubs—I responded to many of the points you made today earlier on in the week.

Llyr, I don't know where you got that idea that I wasn't meeting with the NHS workforce. I met them on Thursday, and I met some more people on Monday again. So, we actually have quite a good relationship with the unions. We don't always agree, but, actually, we do meet them very, very regularly. Let's not forget that we've still got COVID, and about 7 per cent of our workforce are off sick. Of course that puts pressure on the system.

In terms of waiting lists in general, there was a reduction in the total number of people awaiting treatment in October, and this is a trend that I hope will continue over the next few months. It's interesting to note that the total number of open pathways in England increased by 21 per cent over the past 12 months from October, whilst the number in Wales increased by only 10 per cent during that same period.

I'd just like to say something also about the HEIW education plan that was published today. It's absolutely right that we need more nurses, and that's why we've put an 8 per cent increase in terms of the money we're putting into training people: £281 million will be invested in training the next generation of NHS workers, and that includes the fact that we will have 400 more nurse training places created in 2023 and 2024. That's an increase, over the past five years or so, of 54 per cent. So, if you look at the detail of what we're doing in terms of training, obviously, it's not something we haven't been doing for years; this is year-on-year-on-year money that we've been putting into the system. We have a 54 per cent increase in the number of people working in the NHS compared to 20 years ago.

This is not something we haven't prepared for; it's just that the demand is increasing hugely, and what we saw was a confluence of COVID, of strep A, of flu all coming together for that difficult period, and we're not out of it. Let's just be clear about this—it's really cold weather, and I'm expecting to see an impact from the cold weather on the services. So, it will continue to be very, very tough. This is something that systems all over the world are confronting. But let's be absolutely clear that 10 years of Tory austerity has not helped, and the fact is that whilst there was an increase in the budget, from about 2010 to 2019, it was about 16 per cent in the UK; it was a 38 per cent increase in Germany. Now, there is a consequence to that; they recognise an ageing population. You know and everybody knows here that what you get additionally in terms of health spending in England, we get a proportionate, equal amount coming into Wales, and that hasn't happened—[Interruption.]—to the extent—. Okay, more, but I wouldn't mind a bit more than you've put in. Try and behave a little bit more like Germany, and we'd be in a lot better place. Diolch yn fawr.

Rhun ap Iorwerth now to reply to the debate.

Diolch yn fawr, Llywydd. My biggest fear this afternoon would be that I would hear the Minister saying, 'We're already doing everything that needs to be done to resolve the crisis.' What we heard was the Minister saying that everything is already in train, everything is already being done to resolve this crisis. It clearly isn't, and that runs contrary to all the evidence that we have in front of us. She refused to accept the word 'crisis'—

Will the Member take an intervention?

Yes, certainly.

I say this in all honesty and sincerity, do you not think, after 25 years of a Welsh Labour Government handling the health service here in Wales and, at times, propped up by Plaid Cymru—in fact, you've been in Government yourself here—do you not think that now is the time for a Welsh Conservative Government in Cardiff Bay?

I don't have enough time to describe the damage that I believe would be caused to the national health service if the Conservatives were in charge. I will move swiftly on, and back to the comments that we heard from the health Minister, who again deflected blame, time and time again, and said there had been unprecedented demand. Of course there's unprecedented demand, but that unprecedented demand is a part of what is creating the crisis. It's a failure to deal with that unprecedented demand, and it's those factors that have led to that unprecedented demand and years of mismanagement when it comes to the preventative agenda that we really need to see a gear change on or we'll be back here in 25 years' time again talking about the same issues.

The Minister wanted to blame the co-operation agreement. There's a very good reason why health—. Social care, very much, is in the co-operation agreement. There's a very good reason why health isn't in there, because we disagree with Welsh Government's approach on health, and that's why we cannot agree on a way forward on that. But, the Minister refused to use the word 'crisis', taking a similar attitude to the First Minister from a week ago: 'Sometimes it feels like a crisis', 'There are days when it's bad.' Carolyn Thomas was happy to admit that there is a crisis in Wales, as the rest of the UK, as she said. We heard your Labour leader saying today, Sir Keir Starmer, that there is a health crisis, calling on Rishi Sunak to stop blaming others and take some responsibility and just admit that, under his watch, the NHS is in crisis. Well, under your watch, the NHS is in crisis in Wales, and it worries me greatly that you won't admit to that.

Very important comments from Cefin Campbell, who said that we should never accept the normalisation of the current state of the NHS. That means not accepting that it has to be like this. That means accepting that these are extraordinary times and that, therefore, we need to step up to the plate, accept it for what it is, a crisis. Call it an 'emergency' if you like—in Welsh it's the same word probably. But, we need to have that admission that something different has to happen.

Russell George, like me, didn't underestimate the scale of the challenge. He also made the point that we use words carefully. 'Mismanagement' we use carefully, 'crisis' we use carefully. I will carefully measure my words and ask him to press on his Conservative masters to address the woeful underfunding of public services. I agree with the Labour Minister on that. But, she cannot hide behind that reality, because she has a responsibility to deliver for the NHS in Wales. As Llyr Gruffydd said, she cannot abdicate responsibility.

I'll finish with a quote from the world of business. The first half says,

'Management is about doing things right.'

I've accused Labour again today, as I have many times in the past, of being too managerial in its approach to running the NHS. So, management is about doing things right. Sadly, Welsh Government all too often has not been getting some of the key things right. But, there's a second half to that quote:

'Management is about doing things right; leadership is about doing the right things.'

We need the right things done now more than ever. That's the leadership people want to see from Welsh Government. That means doing things differently, admitting there's a crisis, or this crisis will only deepen.

The proposal is to agree the motion. Does any Member object? [Objection.] There is objection. We will, therefore, defer voting until voting time.

Voting deferred until voting time.

Unless three Members wish for the bell to be rung we will move immediately to voting time.