Item 6 this afternoon is a statement by the Minister for Health and Social Services, increasing allied health professionals in primary and community care. I call on the Minister to make the statement—Eluned Morgan.

Diolch yn fawr. 'Looking Forward Together: The Allied Health Professions Framework for Wales' identifies the changes required both by allied health professionals and their employers to ensure health and social care secures the highest quality and value from these important professions. 'A Healthier Wales' sets out our vision for enabling people to live at home, as independently as possible, for as long as possible. 

The allied health professionals, or AHPs, excel in delivering treatments that are particularly valuable in supporting the complex needs of people who are frail or living with long-term health conditions. They are a group of 13 unique professions, such as physiotherapists, occupational therapists, dietitians and psychologists. At present, too small a proportion of AHPs are accessible in the primary and community services described in the primary care model for Wales.

Many people who need the expertise of AHPs can't directly access them early enough to maximise their health and well-being or improve recovery. This may mean people are admitted to hospital when they could have been treated at home, or they cannot be discharged from hospital when their acute treatment is complete. Without community AHP services, people may end up moving to residential or nursing care earlier than might otherwise have been the case, adding to the pressure on our social care services.

Today, I'm announcing £5 million will be made available from April 2023 to create additional AHP posts in primary and community services to help provide alternatives to hospital admission and reduce reliance on long-term social care. This recurrent investment supports our programme for government commitments in primary and community care, including improving access to health professionals and bring a wider workforce together in a reformed primary care system. It'll create posts for both registered AHPs and support workers. For example, extra staff in community resource teams will help implement the community infrastructure programme or expand hospital-at-home-type services.

Increasing community rehabilitation and community-based therapy ensures people can be discharged with the right support to enable them to complete their recovery at home. Community rehabilitation or reablement helps people recover their ability and confidence to do the things that matter to them in their daily life, enabling more people to live independently without having to rely on unnecessary long-term social care. That will help us to provide these vital services to the people who need them most.

This investment can also be used to develop or expand services to prevent admission. For example, this could enable paramedics to directly refer to community falls or therapy response teams rather than conveying people to hospital if they don't need it.

There are many examples of innovative AHP services providing direct, early access to intervention, community rehabilitation and reablement and other complex treatments in the community. We need to provide these more consistently across Wales in line with all our national programmes. Local authority occupational therapy services and many NHS physiotherapy services are already directly accessible. In Swansea Bay University Health Board, podiatry, children’s speech and language therapy and children’s occupational therapy services are directly accessible.

We have already invested significantly in innovative community services. Our regional integration fund provides more than £144 million to support six national models of integrated care. These models include community-based prevention and community co-ordination, complex care closer to home and home-from-hospital services.

I am taking the opportunity today to reiterate my expectation that the investment we have already provided to the NHS, local authorities and regional partnership boards will also be used to bring together all local services involved in health and care, including AHPs.

Primary and community care must become the usual location for practice for AHPs. This workforce should be organised through well-integrated community services, including the full range of AHP skills. In order to deliver the accelerated cluster development programme, it's vital that a higher proportion of the AHP workforce works in integrated teams and hubs in primary and community services.

We know that many people who are older or who are living with frailty or comorbidities leave hospital less mobile and less independent than when they were admitted. This is why the recently published optimal hospital-flow guidance states that health and care services should embed 'home first' and discharge-to-recover-then-assess principles. This will enable people to return home as rapidly as possible, with access to the right community assessment and reablement.

The community resource teams that are already established in each of our health board regions, along with the reablement teams and wider community rehabilitation services, are the bedrock of the community infrastructure required to improve care for our population. If we can get it right for those with complex needs, we can get it right for everyone.

The purpose of this investment is to increase the AHP capacity in community-based rehabilitation and early intervention services. This will mean that clinically safe alternatives are available to admission. It will also support safe and effective discharge.

The timing of this announcement will support health and social care employers to maximise employment for the new graduates who will be entering the workforce in the summer. Expanding the capacity of community services with these additional allied health professional roles will enable us to provide well-integrated primary and community care, and help us tackle some of the current pressures facing our health and care system.

Can I thank the Minister for her statement today? I genuinely welcome the announcement today. I certainly support the increased funding for the number of allied health professionals within the primary and community care settings. I certainly think that’s the right move, particularly for the reasons you’ve outlined. I think it’ll free up resources and allow people to be treated much closer to home.

There are a number of questions I would ask following your statement today, Minister. Just to give us an understanding of how the funding’s going to be allocated across Wales, how it’s going to be allocated across the regions or the health boards. Just to give some assurance that the funding isn’t going to be earmarked for one part of Wales, and that it is fairly, appropriately dispersed across the country. Also to get a sense of how many allied health professionals this will fund, as well. I’m assuming that this is a fund that will be annual funding. Obviously, we’re creating these jobs, and it would have to be annual funding thereafter, I assume. So, just to get that confirmation.

And also to understand where new allied health professionals would be located. I know very much, as part of the Welsh Conservatives’ GP access plan, health and social care made some recommendations around allied health professionals being located in GP surgeries. So, just to get a sense of your understanding of where the allied health professionals would be located. Would they be in GP surgeries, community hospitals, a mixture? To get an understanding of that.

The biggest concern for me is that there is simply a lack of trained professionals working within the allied health professions in Wales, so already there are some reports around internal markets, where health boards are having to compete with one another to attract AHPs, as there are simply not enough to meet the complex physical and mental healthcare needs of the country. So, just to get your view on that, Minister. I do appreciate there’s a rise in funding for training placements, but that is quite small, so just to understand how you plan to fix the staffing gap within the workforce in order to reach the types of levels that Wales needs.

I’ve also raised—I think last week in the debate, actually, Minister—I’ve regularly raised the issues around modernising our NHS digital systems as well. So, that would be necessary, I think, in this regard, to make sure there are secure ways for health professionals to communicate with each other, especially if they’re moving home to home. I think what is needed is health professionals working on patients’ case studies, understanding the patients’ treatment plans for their outcomes. So, will there be any funding to upgrade these systems to create a more efficient service that will help allied health professionals?

Thank you very much. So, how it’s allocated, obviously this will be proportionate to the population, so we’ll make sure that that reflects the population needs, obviously. Just in terms of how many allied health professionals we’ve got in Wales, we’ve got about 9,267 at the moment. Just to give you an idea, we’ve got about 2,000 occupational therapists, we’ve got 2,455 physiotherapists, we’ve got 159 arts therapists, which I think is rather wonderful, and we’ve got 530 dieticians. So, there are lots and lots of them already, but what is clear is that this can take a lot of pressure off not just our primary services, but also our secondary services.

It is multi-annual funding, so this £5 million will be built in for the future. They will absolutely be based in the community. Where in the community depends on what structures exist in that community, obviously. So, there will be some very vibrant community hubs, there'll be others where there'll be GP surgeries, so it depends on what's right for that community.

Just in terms of trained people, obviously we published Health Education and Improvement Wales's improvement training plan last week, and just to let you know, for example, physiotherapist training places will increase next year to 180, occupational therapist training places to 197 and paramedics up to 120. All of that means that those are all new people who will be coming on, and, obviously, that's a pipeline that is already developed, so we're building on what's there. The great thing is they'll come out trained and now we can give them jobs, because that's what this funding does.

And then, just in terms of modernising digital systems, you're aware that I spend a lot of time on digital; I had another meeting with the digital team this week. I think getting a platform for work in the community will be something. There are lots of different platforms at the moment and what we need to do is to make sure that they all connect, so there's probably a bit of work to do around that. But we've got so much being done in the digital space already, I'd quite like to land what we've got first before going on to the next bit.

May I thank the Minister for the statement? Essentially, I welcome the intention here to invest in the workforce. The health workforce is very broad indeed, it's very diverse, and comprehensive health and care services that are sustainable do have to bring together that broad range of health professionals. It's good that we are now talking about these allied health professionals, something that wouldn't have happened years ago—it would have been doctors and nurses many years ago. But we do now appreciate that broader workforce, and it's good to see, amidst the pressure on health and care services, this investment being made. 

I'm thinking in terms of this five-point plan that we'll be discussing in the Senedd tomorrow—the plan that we as a party published today for the future of the NHS—and I do see in this announcement many elements being reflected. The first point that we make is on the need for fair wages. I wonder where the Minister considers the role of salary, because there are allied health professionals who are involved in pay disputes at the moment. I would appreciate the Minister's comments on where we set that fair salary level in that process of creating a contented workforce fit for the challenges of the future. 

I welcome the comments that we've just heard on training more workers. I would appreciate some comments too on providing further professional training for those already in the workforce. Allowing people to work at the highest point of their competence is very important, and the complaint we often hear is that people don't have the freedom to undertake the additional training necessary for continuous improvement, and to extend their skills. I would appreciate your comments on that.

The Minister will know how much emphasis I place on the importance of the preventative. I highlight the fact that the preventative can mean things a long way off in the future, but also preparing today for the challenges of tomorrow and next week, and the AHPs have a crucial role in that regard in preparing people for treatment, trying to prevent accidents, and so on. Perhaps the Minister could reflect on that preventative role. 

And finally, there's been a great deal of talk recently about that junction between health and care—delayed transfers of care have been given a great deal of coverage recently. We need to increase that capacity for bringing people out of the acute locations and hospitals. So, can I have a suggestion from the Minister as to where she sees the role of the allied health professionals in generating that capacity in order to help take people, not to put them back in their communities without a care package—there are certainly concerns about that—but to ensure that these particular workers can help people to leave hospital and move into other care locations, including their own homes, of course?

Thank you, Rhun, and it's lovely to have a positive response when we do talk about health, so thank you for that. These are new people who we're welcoming into the system. When you talk about funding, we have to make choices, and we have chosen to bring more people into this role. And evidently, therefore, you have to make a choice when you're making that choice, and we could have provided that funding towards increasing their salaries, so these things are very difficult, but you can't have both. And that's difference between governing and not governing; we have to make those difficult choices.

In terms of training more workers, there is training, as you've heard, in terms of HEIW. That's already in the pipeline. And additional training, well, we're in discussions, as you know, with the unions at present, and one of the things that they are very keen to see is to create time so that they can continue with their studies, and evidently that will be part of those discussions. I think it's important as well that we do emphasise that we're not just talking about allied health professionals here; there are support workers who are just as important. So, you have to have professional people to ensure that the support workers work in the right way. So, to me, that's going to be a very important element of this.

I was interested in seeing your five-point plan, and I've just noted that this does overlap with a lot of those points, certainly in terms of prevention. That is a part, as you said, of preventing problems. Trying to see who is likely to need hospital care, putting that help in place before they go to hospital, to me, is going to be vital in terms of where we go in the future. So, prevention, and these people will be vital to that.

Interaction between health and social care, well, yes, this is the area we're talking about. Social care—. We obviously need to build teams within our communities, and they will have to collaborate. They're already collaborating. So, £144 million is already being spent jointly between health and care. And in respect of the need to have robust care that is fit for the future, well, if you look at the demographic profile of our country in the future, we are going to need a lot of support in this area and, for me, this is going to be a vital step to ensure that we do prepare for that future, which is going to be very challenging.

And one of the other things that I think is worth noting is, if people do receive reablement support, we know, from the evidence, that the requirement for long-term care does reduce 70 per cent and that the care package reduces. So, this is the golden ticket for me; this is the way out, and we have to do a lot more in this area. That is part of this plan.

I join calls from opposition Members in welcoming today's announcement and statement from the Minister and its desired intentions, with the outcomes of reducing the pressures on our hospitals. Minister, you've mentioned funding within your statement today, but in order to achieve the desired outcomes that we all want to see, a sustainable funding package must be in place. Can you outline to the Chamber how you see allied health professionals being funded properly in the future, so we can achieve those desired outcomes that we all wish to see take place?

Thanks very much, Jack. And I can confirm that this £5 million is recurrent, and that means it's sustainable, that means managers can plan ahead with confidence, and that means that people will be able to feel confident, once they're appointed, that they will have a long-term future.

In addition to the wider investment that we're delivering in transformation, it's really important that we understand that this forms a part of that broader package that we're trying to develop within the community. For the ninth consecutive year, when it comes to training and investment, the announcements I made last week, which hardly anybody picked up on—. It's really important that people understand that we are making massive investments in training the next generation of the workforce: £281 million every year. This is huge, huge, money that's training the next workforce. That, this year, is the equivalent of an 8 per cent increase, because we know the pressures on the system and we know we need to get the pipeline going. So, I hope you'll be pleased to hear that.

Thank you very much for the statement, Minister. I think I join with the cross-party support for the announcements that you've made today.

Just two short points from me, if I may. It seems really important that this is both preventative and reactive so that we have the option of providing support to people before, and, indeed, hopefully avoiding, any hospital admissions. I'm sure that's the intention, as well as responding to helping them leaving hospital and being discharged. For that, it also seems important to work with local authority carers, because the team around the person includes medics but also the allied professionals and the carers as well. When I was in social work, we had a team around the family, the TAFs, and it seems important that there is that team. It sounds as if that's the direction, so it's really important to hear that. Thank you so much.

The question I do have is around pay and conditions, because we need to keep these people, they need to stay in their professions, hopefully here in Wales. So, I'd be interested to hear what thoughts you have around how we ensure that they get good pay, there's parity of pay, and that it equates to English pay as well, because we really want them to stay in Wales. Thank you. Diolch yn fawr iawn.

Thanks very much. I'd just like to confirm that I agree with you that this can't be just reactive; it can't be about, 'How do we get people out of hospital?' It's about avoiding hospital admission. That's key for me. But, if they do go into hospital, there's some great examples already around Wales where we have hospital to home, so support is there and they're being monitored digitally. So, you know, the twenty-first century is here. I know we've got a few fax machines, but I'll be getting rid of those soon. Some of this is happening already, and what we need to do is to roll out best practice, and then that monitoring. If you see that things are changing, you can send somebody in and it can be fixed. So, it's got to be reactive as well, but, for me, I think it's really important that we think about prevention as well. There's a lot of evidence to show that we kind of know the people who are going to take up the bed space. They're generally people who are known to us, and, if they go into hospital, they'll stay there for a long time. So, why don't we just put the support around them in the community to avoid that happening from the beginning?

It's part of the six goals programme. So, a lot of this is happening already, but this is all part of strengthening that. We've built these six goals with the professionals. This is not something we've made up in Government; this is a clinically led response to what they think needs to happen. We've been really systematic about it, and this is part of building that jigsaw. When it comes to building the team, this is happening in lots of places already, but, sometimes, I think the system's a little bit overcomplicated. So, what I don't want is to have teams of 20 people sitting around discussing Mrs Jones's needs. I think we've got to be able to trust each other professionally as well. So, you need to make an assessment and then it's shared out. But, I also think there's a lot to be said for actually—. Working in isolation is quite tough, so, actually, working in a team, I think, will help us to keep people in some of those areas, including carers. So, that's really important. And in terms of pay and conditions, they'll be getting the standard rates of pay for this profession.

Thank you for your statement this afternoon, Minister. Before I was elected to the Senedd, I worked in physiotherapy for Betsi Cadwaladr University Health Board, so I'm all too aware of the problems that AHPs face in delivering good-quality care in the community. I welcome today's statement and the announcement of the £5 million, because it really is a step in the right direction. I can't remember the amount of times that I'd say to patients, 'Look, I'm happy to give you a referral to community physio, but you do know you might not be seen for two weeks, and that's if you're lucky.' So, it is a step in the right direction, and I'd reiterate what Russell George mentioned in terms of how that will be spent across Wales so that nobody’s missing out, whether they live in Rhoose or in Rhyl.

I'd like to specifically focus on care homes, if I may, and the quality of discharges, as that plays a vital role in the patient flow and ensuring that we prevent bed blocking in step-down facilities. A lot of the problems that AHPs face in the community are due a lack of capacity to treat elderly care home residents, leading to a higher risk of deconditioning, readmission to hospital and a lack of good-quality rehab. So, what assurances can today's statement give that the £5 million announcement will provide a laser-like focus on increasing capacity for AHPs to regularly visit care homes in north Wales specifically, and provide the vital care that our local elderly people so rightly deserve? Thank you.  

Thanks very much, Gareth. I was aware that I was speaking with an AHP expert in our midst today, so I was a little bit nervous with you being in the audience here. So, there we go.

Physiotherapy is a key part of the treatment that we are hoping to offer here. For me, one of the key things we need to focus on is prehabilitation before surgery—and I've got another expert who will understand that—because what we know is that, actually, getting ready for surgery, you're outcomes are going to be so much better if you go in in the right state. So, I do think this is an area where I hope we can be doing a lot more work in this space. And, obviously, there will be a role for AHPs in that space as well. When it comes to visiting care homes, obviously, care homes are in the community. So, they will definitely be included in what our expectations would be in relation to this programme.

And finally, Carolyn Thomas.

Thank you very much. I recently visited the fantastic state-of-the-art facility at Wrexham Glyndŵr—its multi-million pound facility. I believe there's an open day a week on Friday there where they're offering courses on allied health and nursing courses, which is fantastic. I already know a couple of people that have had a change of career to do nursing and paramedics, including my niece, and really enjoying learning there in north-east Wales.

I've also learned that Coleg Llandrillo as well will be providing courses for support workers and care workers—that level just bellow nursing—which is really fantastic. I was wondering, will you encourage them to work with also the new medical facility that's being built in Bangor, and help to promote and publicise these new jobs and careers that are happening in north Wales? Very often, I travel across north Wales, and I think, 'There are no jobs here.' We talk about industry jobs, but there are jobs there for people working in public services and health and dentistry, nurses—all these that are growing. So I'd like you to work with the education Minister and the economy Minister to promote these fantastic jobs that are being created in north Wales. Thank you.

Thanks very much. It's great to hear that that facility in Wrexham is up and running, and that they're training those people in Llandrillo as well. As I mentioned earlier, I think support workers are going to be absolutely key, and once you get them on the path, then maybe they'll want to upgrade and whatever, but let's get them into that space first. So, I think that's very exciting.

The whole point of this programme is that it shouldn't be linked to a hospital or a medical school or whatever. This is about support in the community, in whichever community it is. This is about getting that support out of the hospitals, making sure that we understand that people, generally, don't want to go to hospital—they want to be supported in their communities. That's what we're trying to do with this.

In terms of promoting jobs, yes, I think that's fair. We need to work together to try and promote these jobs, and also with the economy Minister, just to make sure people know what's out there. It's amazing how few people know what jobs are available, so there is a job of work to do. Although HEIW have got a really great portal on this, where you can go in and it's a kind of 3D version—you can go in and kind of get experience of what it's like to do different jobs in the NHS. I'd encourage you to go and have a look at that.

Thank you, Minister.