The following amendments have been selected: amendments 1, 3 and 4 in the name of Darren Millar, and amendment 2 in the name of Lesley Griffiths. If amendment 2 is agreed, amendment 3 will be deselected

Item 8 is next: the Plaid Cymru debate on reducing NHS pressures. I call on Rhun ap Iorwerth to move the motion.

Motion NDM8188 Siân Gwenllian

To propose that the Senedd:

1. Notes the comments of the Welsh NHS Confederation that the Welsh NHS is facing pressures that ‘cannot be coped with’.

2. Supports the heroic efforts of health and care sector workers in Wales as they provide care in challenging circumstances.

3. Calls on the Welsh Government to bring forward a strategy to reduce the pressures facing the NHS with measures including, but not limited to:

a) resolving current pay disputes by awarding NHS workers in Wales an improved, substantive pay offer;

b) a clear delivery strategy with targets and full costing, for a new workforce plan, including steps to remove profit from agency working;

c) placing preventative health measures at the forefront of all Welsh Government health-related policy and activity, involving all Government departments;

d) improving resilience at the point of interaction between health and care, taking the pressure off social care through greater NHS step-down capacity, in addition to expanding social care provision for the longer term; and

e) improving partnership working, co-production of solutions and delivery within the NHS, including by giving the new NHS executive the power to make real change.

Motion moved.

Thank you very much, Llywydd. A week ago, we were discussing a motion from Plaid Cymru calling for the declaration of a health crisis in Wales. Just as the Labour leader has described the situation in England as a crisis, and Labour in Scotland have described the situation as a crisis, we were eager to see Labour in Government in Wales recognise this crisis. The Labour Ministers rejected that a week ago, and the First Minister said again yesterday why he refused to use the term 'crisis'. Those are just words, according to him, and there's no value to them. Well, likewise, you could argue that declaring a climate emergency was just words. But words have value—there's a recognition of the gravity of the situation. It is a means of providing renewed focus, and I explained in that debate a week ago that we wanted the motion to be seen in a positive light, as a means of empowering Government. 

Although they rejected that—and surely the Government needs to be empowered here—we're back today again proposing a positive motion. We have many roles as opposition parties. Our work is to hold Government to account, to assess how effective Government measures are—in this particular context, their efficiency in spending their budgets on health and care services, in developing policy, in supporting staff. That includes telling it as it is, and as constituents see it, even more importantly, and, necessarily, that will sometimes lead to conflict. But we on these benches do take our role of being proactive in putting alternative proposals on the table seriously, trying to influence the Government to move in a particular direction, not just outlining what we think is wrong with the direction that they've chosen.

In the context of a crisis in the health service, we, I think, all have to put our energy into finding solutions. And what we have before us today, published by Plaid Cymru this week, is a plan: a series of recommendations that we're asking the Welsh Government to implement. The risk is, of course, that the Government will say, 'Well, we're already doing all of this.' Well, sorry, but if the Welsh Government were operating effectively in these areas and were doing all of these things already, then a series of health professional bodies, royal colleges, staff representative bodies, would not have worked with us to draw up with this plan. They, like us, are entirely convinced that the Government is falling well short of what should be done. This is the product of collaboration. 

It's no secret that we in Plaid Cymru believe that the first step to create the foundations for a sustainable NHS is to pay workers fairly. The First Minister recently claimed that making an improved pay offer would mean taking away money from health, but that's such a false way of looking at the situation, because providing a credible and substantive—not a one-off, but a credible and substantive—pay award for NHS workers surely is the best possible investment that we could be making in creating a more sustainable and resilient health service. They're tough choices; of course they're tough choices. But this particular choice simply has to be made. I used the word 'foundations'. The foundations of the NHS currently are pretty unfirm. Those foundations are the workers. We need to firm up those foundations if we're to build a resilient NHS. That has to be step one. 

The second step in our plan is to address issues on workforce retention. Pay is one big part of workforce planning, but there's that wider issue. We need a wider strategy to retain the talented workforce at our disposal by making the NHS in Wales a more attractive and appealing place to work—3,000 NHS vacancies in Wales; 46 per cent of medical students in Wales relocating to England because they've got more foundation posts available. Now, the Government says that they have a workforce plan on the way, but a plan's nothing unless it's delivered, and we need a clear delivery strategy with targets and full costings for that new NHS workforce plan, and one that actually accurately reflects the needs—which is why we talk about the need for data on where exactly we do stand and where those vacancies are. We need clearly definable delivery metrics. 

We've got to ensure that opportunities for career development are more available, encouraging medical students studying in Welsh universities to stay in Wales, encouraging people and helping them through continuous professional development to be able to work at the top of their competence. These are the things that lead when they're not done well to people deciding, 'You know what, this career is really not what I thought it would be; I'm not able to push myself to my limits', and the failure to deliver on these bare essentials are holding back the NHS.

The other part of this is a desperate need for Welsh Government to address the increase that we have seen in agency spending—£260 million spent on agency spending in 2022. That's not a figure just bouncing along. There's been a 40 per cent increase in a very short period of time, and that means money leaking away from the NHS into the coffers of private companies as profits. We want and absolutely support having roles that are brought in as overtime, additional shifts, and that flexibility is something that we need to build into the NHS much more, actually, but we need to take the private profit-making from agency working. 

The third step in our plans is to give greater priority to preventative health measures right across the board, not just having preventative schemes—as, of course, Welsh Government has—but making the preventative the most important element in our attitude as a whole towards the health of the nation. Building a healthier Wales has to be a priority. We'll hear more from Sioned Williams about the fact that that means the kind of housing that people live in, the support that people are given to live healthy lives. It's not just a matter of the Minister deciding one week, 'You know what, people need to live healthier lives.' They need the support from Government to be able to do that, and I think the Well-being of Future Generations (Wales) Act 2015 provides the legislative framework in this respect.

We tend to think about that legislation more in terms of climate change. I think we need to focus on using that legislation in terms of our health as a nation, and we need clear ministerial responsibility. In Westminster, you'd have a Minister without portfolio perhaps just looking after delivering the preventative. You know, that's an idea. Is that something that we need to do here, not that I'm in favour of having more Ministers? And this is policy from me here rather than being policy. But that's the kind of way we need to think. We need to think about who has that ministerial responsibility within Government.

We have to, as point 4, look at that interaction between health and social care. We were talking there about integration. We all support integration as a principle, but it's what happens at the junction between the two as well that we've been focusing a lot on in recent weeks—the delayed transfers of care. We need to be building capacity at that point. Capacity can be physical capacity, it can be virtual capacity, it can be permanent capacity, it can be temporary capacity. We've worked in very effective temporary ways during the COVID pandemic. We absolutely have to look at what happens at that junction because currently we're falling short, and the decision, still questioned by medical professionals, to release people from hospital without the proper care packages in place is not the way forward, and I think it shows a misunderstanding of the kind of approach that Welsh Government should be taking on this.

Finally, we need to create a delivery mechanism for the recovery. I think the new NHS executive, and we think the new NHS executive, provides a model for that. Government Ministers and successive Labour Governments have had a very long time to create a more resilient and better-equipped health service. I think the Ministers could benefit from empowering that NHS executive in a way that can deliver real change right across the NHS. If we have that new organisation in place, let's use it properly, give it teeth and give it the power to drive forward change.

One of the things that I think the NHS executive could drive is action in relation to delivering elective surgery hubs. I visited one in Clatterbridge the other day. A project is in place, costing around £25 million in total, creating four theatres, 18 additional beds. It's a factory that will not be affected by winter pressures, and so on. That might not be the exact model because that's an elective hospital, but we have to find ways of delivering that kind of change here in Wales. That investment, yes, needs to be made, but a business plan for that saves you the money of sending patients otherwise to private hospitals for treatment now and, of course, quicker treatment of patients stops that worsening of health conditions that are painful for the patients, difficult for their families, and very, very costly for the NHS.

So, that's our five-point plan. As we say, they're not our ideas; they're the result of listening to people on the front line and the organisations that represent them. Our plan addresses the real concerns they have with the way the health service is currently being managed and offers five deliverable steps that will make a tangible difference to all involved, so that, together, we can start healing our NHS, which is what we all here want. I look forward to contributions today and for a signal that, if they wouldn't accept the word 'crisis', that they do accept that there needs to be a new direction. Diolch yn fawr.

I have selected the four amendments to the motion. If amendment 2 is agreed, amendment 3 will be deselected. I call on Russell George to move amendments 1, 3 and 4. Russell George.

Amendment 1—Darren Millar

Add as new point after point 2 and renumber accordingly:

Regrets that the Welsh Government's draft budget proposes to cut the health and social care budget in real terms in 2023-2024.

Amendment 3—Darren Millar

In sub-point 3(b), delete 'remove profit from agency working' and replace with 'cap agency pay rates'.

Amendment 4—Darren Millar

Add as new point at end of motion: 

Calls upon the Welsh Government to ensure that the health and social care budget is revised to ensure an increase in real terms in 2023-24.

Amendments 1, 3 and 4 moved.

Diolch, Llywydd, and I move the amendments in the name of my colleague Darren Millar. Can I thank Plaid Cymru for bringing forward this debate again? I say 'again' because we keep having health debates. It's very similar to a debate brought forward last week, and I don't think that we can have too many health debates in this Chamber. The Minister's looking, like, 'Please ease up a bit', but I think, seriously, I think we can't have too many debates around the challenges that our health service is facing. And the Welsh NHS is in a very unstable position, I would suggest, and I would agree with the Welsh NHS Confederation in their assessment of the pressures, as outlined in the motion today.

I also think it's important to stress that the issues that the NHS is facing, and some of our challenges, are in no way the fault of our fantastic health and care sector professionals who work across Wales. They're working in very challenging circumstances, and we of course thank them for all they do. And that's why I think the Welsh Government should bring forward a strategy to reduce the pressures on our NHS, and a start would be not to cut the health and social care budget in real terms, I would suggest.

One thing I did want to touch on in my contribution was—again, Andrew R.T. raised it with the First Minister yesterday—about the state of our infrastructure, the state of our hospitals, the poorly maintained state that they're in and the working environments that many have to work in. And, as Andrew pointed out yesterday, only 62 per cent of buildings owned by Bestsi Cadwaladr University Health Board are operationally safe, and that's not a rare position. Only 72 per cent of buildings owned by the Welsh health boards have been reported as operationally safe. Well, it's not too much to ask that our health workers, our nurses, have good working conditions to be in, and, of course, that's not to even mention the issues around patient safety. As the Welsh NHS Confederation pointed out ahead of today's debate, if we're going to have a workforce and we're going to improve the morale of our health professionals, and if we're going to retain nurses and be able to recruit more health professionals to our Welsh NHS, we've got to start by making sure that we've got a workplace that's fit for purpose. And I think it's absolutely crucial that we have that investment in our hospitals. I'm disappointed. I heard the First Minister yesterday, pointing the finger at Westminster. Well, hang on, it's been 25 years, a quarter of a century of a Labour-led Government that has been responsible for the Welsh NHS. I don't think that it's reasonable to be pointing the finger at Westminster when we've got the position that we're in, with only 62 per cent of buildings in Betsi being operationally safe.

But the other issue as well is investment in training, in terms of training new NHS staff. We have had some funding for that, and I think that's very welcome; I don't think that's enough, but I think that's very much welcomed. I think we all agree—we've talked about agency nursing a great deal in the Chamber—I think we're all on the same page to say that this is all going in the wrong direction. The spend on agency nursing has increased, as Rhun ap Iorwerth pointed out, and we cannot be in a position where the spend on agency nursing is increasing to the extent it is, which is why we've put forward one of our amendments today in terms of putting a cap on agency spend. That's not the solution; that's one part of the solution, but I would suggest that we need to make sure that we have a sustainable funding plan in place to recruit and train staff in both the health and social care sectors.

Just to talk briefly as well in terms of prevention. It's so important, prevention. It's not one of the Government's priorities. I do appreciate that you can't have too many priorities, otherwise there are no priorities, but prevention, I feel that that's been pushed down the list of priorities into the deprioritisation area. If we're going to enable us to have an NHS that meets some of our challenges, we've got to make sure that we're making sure that there's appropriate focus and spend on preventative measures as well.

Finally, Presiding Officer, I was very keen to support the last part of the motion that Plaid brought forward today in terms of the new NHS executive, and having power to make real change. I absolutely agree on that position. Certainly, in our Welsh Conservative manifesto in 2021, we pledged to create an NHS Wales as a separate organisation, independent from the Welsh Government, which would have, in my view, cut bureaucracy and made for quicker decisions to be made and to better equip the Welsh NHS. I can see the Minister sighing, but she'll probably, perhaps, address that in some of her closing remarks today. But, thank you, Presiding Officer.

The NHS workforce do heroic work every day. I'm sure that all of us have many reasons to thank them for the care that we've had personally, or members of our family have had, let alone our constituents. But, we can't deny the great stress on them or the fact that very experienced staff are leaving every week because they can't deal with the stress anymore.

Visiting hospitals, visiting picket lines, and speaking to NHS workers, they describe a system in crisis that is stopping them from being able to do their job to the best of their ability. They know that people are dying that they could save, and that is taking a toll on their health and well-being, meaning that retention is increasingly becoming a concern. That's why this is the second step of our five-point plan, to focus specifically on the workforce.

I have to address some of the things that were raised by the First Minister yesterday. Of course the NHS is doing fantastic work each day, but if we're speaking to staff and they say there's a crisis, then I am angry that there wasn't that acknowledgement. But they don't just want us to acknowledge there's a crisis; they want to see action taken. That's the purpose of this five-point plan. If we were accused of scaremongering or trying to create drama in politics with our calls last week to acknowledge the crisis, that wasn't the point of it. The point was to acknowledge the truth that everybody knows that our NHS is in crisis and we must take action if we truly value it.

Whilst pay is, of course, important in terms of retention, this isn't the only element that needs to be addressed. We need to recruit, retain, redesign and retrain the health and care workforce. The implementation of these four Rs will ensure the establishment of a resilient health and care workforce. We need a costed workforce plan that sets out a range of short, medium and long-term solutions to grow, train and retain the workforce, underpinned by the necessary funding and based on the latest vacancy data and projected patient demand. Last November, 36 organisations from across health and social care, including royal colleges, charities, patient groups and professional bodies, came together to sign a joint letter to the First Minister, calling on the Welsh Government to publish the long-awaited national workforce implementation plan for health and care.

The impact of workforce shortages on patient care cannot be underestimated, as waiting times reached record levels in Wales. Cancer lists and ambulance performance times are currently the worst on record, and overall waiting list numbers passed 750,000 for the first time in October 2022. Yet with little to no reliable up-to-date workforce data, no national implementation plan for recruitment and retention, no consistent approach to the collection of accurate vacancy data collated across health boards and trusts, and no transparency on staffing shortages and rota gaps, no method of comparing the lessons learnt on recruitment and retention, and no way of knowing when we will finally receive answers from the Welsh Government, we simply are uninformed about the scale of the workforce crisis. But the responses we have received from a number of healthcare organisations highlight that there is a clear staffing crisis, and we need a clear delivery strategy with targets and full costing for a new workforce plan.

The Royal College of Midwives stated that we could only drive improvement in maternity care if there are enough midwives working in the NHS in every part of Wales. The Royal College of Surgeons and the Royal College of Physicians have called for a renewed emphasis on workforce. The British Medical Association and the Royal College of General Practitioners are calling for the introduction of incentives for existing doctors and GPs to remain in the health service. The Royal College of Psychiatrists and the Royal College of Nursing are calling for a retention strategy. The Welsh Government must reform centralised data collection so that staffing needs can be identified earlier. In addition to expanding and establishing improved pathways to continued professional development, this will ensure that health workers can work at the top of their competence whilst retaining within the NHS.

We also note that the Welsh Government have spent £260 million on agency staff in the past year, and this is haemorrhaging the sustainability of our NHS. I was told in a local hospital that I visited in my region that staff were being blocked from appointing to that department and, instead, were regularly calling in agency staff. And some of those agency staff would willingly take on contracts. But that's what I was told, and they were angry because they saw that as wasted money—the fact that they had agency staff willing to take on contracts but were being blocked. This has to be looked at, because the over-reliance on agency staff is a symptom of the Welsh Government's mismanagement of the NHS in Wales. Yes, we'll always need ways of bringing in staff for additional shifts, but profit must be removed from agency working, and we can't face a situation when we aren't seeing people being appointed into the roles when there are shortages and then only reliance on agency staff. We need to see action. This is a plan. I am urging Welsh Government to get behind it, acknowledge there's a crisis, then we can find solutions to save our NHS.

I forgot to call on the Minister to move formally amendment 2.

Amendment 2—Lesley Griffiths

Delete point 3 and replace with:

Notes the actions being taken by the Welsh Government, NHS Wales and local government partners including:

a) the announcement of a record £281m investment in health professional education and training budgets on 18 January 2023;

b) the commitment to publish the workforce plan by the end of January 2023;

c) the ongoing work of the care action committee to create additional community beds;

d) the priority being given to discharge and working with local authorities;

e) the ongoing programme of contract reform underway across primary care;

f) the move towards an integrated community care service that is available to everyone across Wales;

g) the models being developed through the regional integration fund specifically aimed at creating community capacity;

h) the ongoing work to increase reablement capacity in the community; and

i) the implementation of the NHS Executive which will improve the quality and safety of care for people in Wales.

Amendment 2 moved.

Formally.

Formally, therefore that's been proposed. Jenny Rathbone.

Thank you, Llywydd. Well, it's 25 January today, and it feels like the twenty-fifth iteration of the debate by the opposition on what we should be doing but we're not doing in the NHS. But any real insights into what we should be doing seems to be lacking. It always just seems to be like groundhog day. So, I thought it was a really poor introduction by Rhun ap Iorwerth. As the health spokesperson, I would have expected some new ideas. If your five-point plan doesn't contain anything more than what you've told us today, then, really, it is not good enough.

Will you take just a brief intervention?

Yes.

I'm sorry if it wasn't made clear that this is a plan that has been co-produced with those professional health bodies who say that Welsh Government is not taking action on these.

Well, I haven't seen it, and we haven't had the opportunity to look at it, and there are no new ideas in anything that you said, Rhun. You want us to pay NHS staff more, and I absolutely agree that they deserve to be paid more, but you say nothing about where we're going to get it. Is it because we've got some Roneo machine in Cathays Park?

Will you take another intervention?

Yes.

I'll again emphasise that we have mapped out exactly how much and from where the money would come—the £175 million that we would bring in from unallocated funds and reprioritisation. We've made it very, very clear.

Unallocated? Well, I think it's not useful to continue that line of enquiry, simply because I haven't read what you've produced and we can have that debate another day.

But the reason why have vacancy levels is—. The fact that we have vacancy levels is serious, but the sole point of interest to me is to explore a bit further the point made by Heledd, which is a hospital in the South Wales Central region has been blocked from appointing to substantive post. That is a serious point and something that is worth unpicking. Now, we have to assume that that's because that health board, wherever it is, is trying not to overspend its budget for this year. We're in month 10 of a 12-month budget process. So, that is a really complex set of difficult circumstances. I appreciate what's going on there, and it must make it really difficult for the hospitals involved—

The Deputy Presiding Officer took the Chair.

Will you take an intervention?

Yes.

The hospital in question, I visited in August, and this is the situation I was told then. I visited again recently, and that was still the situation—just for some context.

Okay. It would be useful to know which health board, but, anyway, I'm sure you can tell the Minister after this debate. I really think that both the Conservatives and Plaid, who say they want to find more money to pay the nurses, need to say which bit of our budget we are going to raid in order to do that, unless there is movement from the UK Government who control the purse strings.

Now, a more important debate took place last Thursday here in the Senedd on Thursday evening, which the Minister was present at, as was I, as was Joyce Watson, as were several other Members. That was a grown-up debate, except that I was delighted to meet Katja Empson, who is a consultant in emergency medicine at the Heath hospital here in Cardiff, because it enabled me to say to her, to ask her, 'Why is it that Cardiff has been able to stop all these ambulances queuing up outside the hospital when other hospitals don't seem to have been able to do that? What is it that you've done that's different?' She gave me a really excellent answer about how it was really important to see the people waiting in the ambulances as part of the patients that they needed to treat, who were just as important as the people inside the building. So, that was owning the problem, which is that there were a lot of sick people outside who needed to come in. So, what did they do? It's a whole-system approach across the hospital to ensure that people are going through into the wards, where appropriate, and then leaving them when they've finished their medical treatment. She said that that is happening in Cardiff and it's not happening elsewhere. So, when I asked that question in the Q&A after the panel had spoken—'Why are other hospitals not actually achieving what Cardiff has achieved?'—he then passed me over to Katja Empson again. I already knew the answer and what she had to say. What I hadn't heard was what all the others might have said, who were from Bangor, from Wrexham and from the Princess of Wales and elsewhere.

I had a much better answer from the head of the Royal College of Emergency Medicine, who appeared before the health committee in the House of Commons yesterday morning. When he was asked that very same question—. No, not the same question; he was asked, 'Why are there so many people overrunning the emergency departments across the UK?' He said there are far too many people being sent to hospital or turning up at the emergency departments who don't need to be there. That resonates with me with some of the things I want to see happening, which is the roll-out of the neighbourhood nursing teams, inspired by Buurtzorg. I understand that, only today, the national specification for community nursing was published, which is part of a strategic programme for rolling it out across Wales. It's happening all too slowly. The only really positive thing about this—

Jenny, you'll need to conclude, please.

—just to complete on this, Deputy Presiding Officer—is that we are now using the electronic scheduling system that was tested in the pilot in Cwm Taf and elsewhere, so that we know exactly who is going to do what, all done by algorithm, as well as capturing the caseloads that are being managed in that community so we know exactly what resources we need to put into my constituency in Cardiff, or wherever it might be. This is a really, really important development, and I understand it is only happening in Wales, and therefore it's going to be a really important contribution to the system.

We have many speakers, and I'm trying to keep to time to ensure we hit as many as possible. Gareth Davies.

Diolch, Dirprwy Lywydd, and it's a pleasure to contribute to this debate this afternoon. As someone who worked in the NHS for 11 years prior to being elected to the Senedd, and someone who is deeply rooted in the Rhyl and Prestatyn area, I feel slightly qualified to share some history and truths about healthcare in Denbighshire and north Wales, and pressures, indeed.

The Royal Alexandra Hospital in Rhyl, or known locally as 'the Alex', was opened in 1872 and named this because Princess Alexandra of Wales became a patron of the hospital in 1882, and it was long believed in those times that fresh air treatment and the sea air were beneficial to patients, particularly with chest and breathing difficulties. To accommodate this, they had long, sprawling balconies so patients could breathe in that fresh air and do their lungs the world of good. And what they also had there were salt baths in the basement, which, according to folklore, are still there. And nowadays the room is used for storing equipment, but unfortunately I've never had the chance to go down there to see for myself, so I'll keep believing it's there, a little bit like the 'Little Venice' underground waterways, which reportedly hosted gondolas in the now-demolished Queen's building.

Now, I'll fast forward many, many years to the late 1970s and early 1980s, and thanks to Margaret Thatcher's devotion to Wales, the then Clwyd Health Authority built and opened the brand-new flagship Glan Clwyd Hospital in Bodelwyddan in 1980, hosting six operating theatres, an A&E department and numerous wards, costing in the region of £16 million—and how we'd love to see figures like that nowadays. And during the 1980s and early 1990s, Glan Clwyd Hospital was regarded as one of the best-performing hospitals in not only Wales but the whole of Great Britain, and attracted many healthcare professionals to the area so that they could become part of this great success story and the people of central and eastern north Wales could benefit from their expertise. And in the late 1990s and early 2000s, the Labour Government in Cardiff got their hands on it, and, since then, we've come to the situation we're in today, with spiralling waiting times, patients waiting up to 72 hours—yes, 72 hours—for ambulances and emergency treatment, and long waiting times for minor injuries, elective surgeries and clinical out-patient appointments. And I'm sure the founders of the hospital, if they are still with us, would be wincing at the current performance of Glan Clwyd Hospital.

And let me be clear, this is not the fault of hard-working front-line staff in the NHS; they are some of the best people you'll ever meet. It's the fault of successive Labour Governments in this place and endless tiers of useless middle managers, directors, bureaucrats and do-gooders who put their own careers and interests ahead of the health of the people of north Wales. And sometimes they're as much use as an ashtray on a motorbike. But the common theme here is that, in all of the history, major hospitals such as Glan Clwyd, Wrexham Maelor and Ysbyty Gwynedd were supported by smaller community or cottage hospitals, and, in years gone by, nearly every town had one. And slowly but surely, the agenda for centralisation took shape as local hospitals closed in Prestatyn, Flint and Mold, to name just a couple of examples. And one of the biggest lunacies of this agenda was when they closed Conwy community hospital in 2003. [Interruption.] Yes, I will. Sorry, I didn't see you there.

Okay. It's just regarding Flint hospital. I believe that it's going to be a state-of-the-art, fit-for-purpose modern care home, which will not only have long and short-term placements but will also be able to rehabilitate people after a stay in hospital to regain their confidence and independence in their own homes. So, it's a modern facility. Some of the old hospitals, like Flint previously, would not be fit for purpose in this current state. Do you not agree? So, it's good that we're having this modernisation now of Flint hospital.

Absolutely, it's a great thing, Carolyn, and I will touch on that later in my speech, about some of the intricacies of that.

One of the biggest lunacies of this agenda was when they closed the Conwy community hospital in 2003 to pave the way for the expansion of Llandudno General Hospital, which was subsequently downgraded to community status just a few years later. You couldn't make it up. Then, north Wales saw the introduction of Betsi Cadwaladr University Health Board in 2009, which took the place of the three localised health boards in North East Wales NHS Trust, Conwy and Denbighshire NHS Trust, and North West Wales NHS Trust. And, since the formation of Betsi Cadwaladr, we've seen many of the long-term issues compounded, and it's widely regarded that the size of the board is far too big for its needs. So, I'd be interested to see what the Government think on that point in responding to the debate, on how we manage this problem and make sure that the people of north Wales truly have a health service that represents the local people's health needs. You've been in charge of this for so many years down here in Cardiff, Minister, and it's time that you really think seriously about this, as north Wales's health board is disproportionately worse performing than any other in Wales, and possibly even the UK at a stretch. So, it's time to up our game and get real about the severity of the problems in north Wales. 

One success story was the opening of Holywell Community Hospital in 2009, complete with community wards, allied health professionals and a minor injuries unit. And this was widely seen as a model for the plans for the construction of north Denbighshire community hospital in Rhyl, which has been promised by Labour politicians—

Gareth, you need to finish as soon as possible please. Time is going on.

Okay. But with no tangible evidence and a spade not going in the ground, when will my constituents in Rhyl, Prestatyn, Rhuddlan, St Asaph and the surrounding areas be awarded this facility to take the pressures off Glan Clwyd Hospital?

I know I've run out of time, but I'd just encourage Members to support amendments 1, 3 and 4 as seen on the agenda. Thank you.

Opening the debate, Rhun ap Iorwerth said that preventative has to be the attitude we take towards health, and I want to speak to the part of our motion that calls for the placing of preventative measures at the heart of all health-related policy and activity involving all Government departments.

Plaid Cymru has emphasised time and again when we debate health in all its aspects the need to give preventative measures better prominence and greater priority. In addressing the current crisis, the health Minister spoke about the need for people to assume greater responsibility for their health and well-being. We agree, of course, that prevention is better than cure. So, why does our motion call for all Government departments to be involved in this aspect of our plan for the NHS? What the health Minister failed to take full account of while making that call was the role of deprivation and poverty in people’s ability to do so.

How are people meant to be looking after their diet when they can’t afford to turn the oven on, when they’re cutting down on food? How can they ensure they don’t exacerbate or cause health conditions when they live in cold, damp, draughty houses they can’t afford to heat? When you are thinking about where the next meal is coming from, how to be able to afford the hot water to clean yourself and wash your clothes, when you’re working two jobs, juggling childcare, worrying about that bill you know that’s going to land that you can’t pay, how do you have the means—let alone the headspace—to attend a gym or go for a run? And how can people access leisure and sporting facilities, libraries, theatres—crucial to well-being—as well as fitness, when they are facing extensive cuts to funding?

The relationship between health and poverty is well understood: deprivation causes ill health, causes inequality in health outcomes, increases the pressure on health services. Ill health is costly to society, puts pressure on our health service. And at a time of economic constriction, at a time of raging levels of poverty, the prevention agenda is absolutely key, and in Wales, where over a third of children are in poverty—the highest level in the UK—and 45 per cent of households are struggling and trapped in fuel poverty, the need to prioritise prevention is urgent.

If we are to truly embed a preventative approach to health, we must take account of the socioeconomic circumstances when building that approach. Poverty and inequality are cross-governmental issues. In addressing the NHS crisis, we must take full account of the differences in the opportunities people have to lead healthy lives, and that must be a cross-governmental responsibility. The Food Foundation’s most recent annual report, ‘The Broken Plate’, asks important questions around how free people are to make healthy food choices around diet, noting that the poorest fifth of UK households would need to spend 43 per cent of their disposable income on food to meet the cost of the most recommended healthy diet; that compares to just 10 per cent for the richest fifth.

Health inequalities can also be related to access to care or services, the quality and experience of care, and we know this to be a long-standing issue in Wales. Health Inspectorate Wales’s national review of mental health crisis prevention, for example, emphasised that services in Wales needed to be better designed and focused around the needs of the individual. It highlighted a gap in Wales between primary care and secondary mental health services, with people falling between the criteria of different services that can provide support.

The Welsh NHS Confederation Health and Wellbeing Alliance report, ‘Mind the gap: what's stopping change?’, also highlighted that addressing the factors that cause ill health in the first place should be a central focus for the Welsh Government and local government, and yet there remains an implementation gap in tackling the underlying health inequalities. The recent update to that report, in partnership with the Royal College of Physicians, ‘Everything affects health’, spells out why they are calling on the Welsh Government to take cross-Government action to tackle those health inequalities. The report gives details of many examples across Wales and Welsh health boards and local authorities of preventative measures in action, with many public and third-sector organisations helping to reduce ill health and health inequalities among the most vulnerable in our society, but it's a patchwork.

These are the people who are most at risk of harmful behaviours such a smoking, excessive drinking and drug use, or are most likely to be socially isolated, in poor or temporary housing, have poor access to transport and well-being opportunities, or digitally excluded. The conclusion of this report is that cross-sector working of this nature should be supported and encouraged by the Welsh Government, with a cross-Government action plan. We agree that a cross-Government delivery plan setting out what every department is doing to tackle poverty and health inequalities, how success would be measured and evaluated, and how Welsh organisations can collaborate to reduce ill health, is long overdue. Public Health Wales—

Sioned, can you conclude now, please?

Public Health Wales states in its recent report 'Cost of living crisis in Wales: A public health lens' that the cost-of-living crisis is not just a temporary economic squeeze, it is a long-term public health issue affecting the whole population. We will never achieve the fairer Wales we all desire to see if our health service continues to be a means to address the consequences of poverty and inequality that are contributing so greatly and so shamefully to the crisis in our NHS.

I stated yesterday in First Minister's questions that it is important that all of us here in Senedd Cymru, the Welsh Parliament, are candid about the very real challenges facing our beloved national health service right across the four nations of the United Kingdom. There is no corner of the United Kingdom that has not seen extensive pressures on each of its own constituent parts of the national health service. I stand addressing you as a proud Welsh Labour member. The national health service was created by the Labour Government of Clement Attlee, and it is the Labour Party's proudest moment, achievement and legacy to the people it was created to serve.

I know that in Wales its custodians, the Welsh First Minister and Welsh health Minister, understand and are dedicated to its survival and maintenance. Twenty-four hours ago, I asked the First Minister for his assurances that his Government would be devoted to the continuation of the reality of a universal, truly national public health service, free at the point of care, a principle based on experience of suffering, a holy grail battled for with the old BMA, and something my own grandfather fought for as his wife lay dying in childbirth, denied social insurance and subsequent medical care. It is that type of healthcare that I don't want here in Wales. The First Minister gave me his assurance in this Chamber, and I know that my constituents in Islwyn heard loud and clear that, no, we don't want that.

Does that mean, though, that the pressures facing the NHS today are not real? No, it doesn't. There is a clear and obvious danger at the front door of the national health service in primary care. How many of our constituents e-mail us, phone us or write to us as Members of the Senedd to express those concerns, their frustrations and worries about seeing a general practitioner? And yes, there are new ways we are doing things, they are embedding, but the demand of this moment is truly unprecedented since the birth of the national health service.

Community pharmacies play a role, as do our social prescribers, but it's the people of Wales who must be able to access without due hindrance a GP, because the alternatives on the ground are obvious. As we saw before Christmas with the rise in cases of strep A, worried parents with an ill child will, out of real, genuine fear, go to A&E if there are no alternatives. And what person will blame them? When your loved one is in pain and the diagnosis is unknown, who would take the risk of a single second lost? The national health service must exist for the people it was created for—its patients, our citizens.

Wes Streeting, the UK Labour shadow health Minister, has opened an initial exploratory discussion on whether, in the future, GPs should become salaried NHS staff. These are needed conversations with long-standing associations. Reluctance, institutionally, to change—

Jenny Rathbone rose—

Yes.

Thank you for that. Would you agree, though, that not every one of our constituents needs to see a GP? They can see the pharmacist, they can see the nurse, and if they've got diabetes they're much better off with a diabetes service. So, it really isn't about salaried or not salaried GPs, but that's an important discussion.

I absolutely agree with that, Jenny Rathbone; we have a whole host of different mechanisms of seeking healthcare. But this is an important discussion, and I'm going to develop it.

We know that another crucial facet of what we must address is ambulance waiting times in Wales. Nobody should die from an excessive wait for an ambulance. Now we know that new ambulance training posts are real. But it is right for us to challenge the status quo of consultants training for decades, subsidised by the state, to work, sometimes, three days a week in the private sector. Phoning 999 in an emergency should and must always be met with a rapid response. And the sight of queues of ambulances sat idle in hospital forecourts, as hospital handover waits occur, must be the exception and not the norm. Because the pressures and challenges are real for the NHS, and so are the consequences.

And so, to those of us, across this Chamber in this Senedd, who are committed to the model of the NHS as created by Labour's Aneurin Bevan, it is time for us to actually unite and not score political points on the solid principle of the NHS free at the point of care. If you believe that, and you want to fight for a free NHS, then the stakes have never, ever been so grave. The Tories are openly speculating about privatising the NHS—and actually, to be honest, have done for a very long time.

Will the Member take an intervention?

No. She hasn't got time.

I really want to finish, if you don't mind.

This has been advanced by former English health Minister Sajid Javid. These are your party's policies. He wants to explore people paying to see a GP—with everything that Sioned Williams has just articulated—and believes in opening up the NHS to the free market. This is what is at stake. With the Tories, it's always the same: they want to shrink the state, withdraw public finances—

Rhianon, you need to conclude now, please.

—and claim this so-called better way.

Rhianon, you need to conclude now, please.

And finally, Deputy Llywydd, I will be voting for the amendment as proposed by Lesley Griffiths. Thank you.

I was out on the ambulance service picket lines last Monday and Thursday, speaking to Unite members and discussing their experiences, and asked them why they decided to take industrial action. And the conversations with Fiona, Ludwig, Catrin, Robin and the others were very valuable indeed. Their answers were striking, and everyone said the same thing. Salary and recent inflation was part of the mix. Working conditions was another important part of that mix. But the one thing that they all felt strongly about was patient care—the need to ensure that we, the patients, are safe and are given the best-possible care. They experience the crisis in the health service on a daily basis, because of these concerns about patient health. They have chosen a career in care, and because of that care, which drives them, they are willing to lose days of pay and the benefits that come as a result of that in order to ensure that we get the best-possible care. That's what solidarity looks like, and thank goodness for them.

They were keen to analyse the health crisis, reporting their personal experiences, talking about starting a shift by going immediately to an ambulance that was stuck outside a general hospital, and finishing that shift in that same ambulance, in the same hospital, with the same patient. They talked about patients lying on trollies that weren't fit for patients, for hours on end. Their experiences all painted a picture of a crisis. But they were also quite clear on one of the main drivers of this problem, namely the fundamental problems in our ability to provide social care. Despite the fact that they wanted to see improvement in terms of their pay and conditions, they were entirely clear that social carers deserved a substantial increase in salary, and that there was a lack of respect towards them.

We really need to reform social care and tackle integrated care once and for all. Because there is one undeniable fact—Wales is growing older, and we will see a substantial increase in the percentage of older people over the coming years who will need more care in the community. We must face this and prepare for it by investing in hospital-at-home services and securing specialist medical care in the community across Wales. We've already lost many community hospital beds, which has placed more pressure on our general hospitals and which, in turn, leads to an increase in hospital-spread diseases—not C. difficile alone, but things such as flu and COVID too. And older people are more likely to catch these diseases because they are weaker, and bear in mind that a large percentage of people who got COVID, particularly in the more damaging second wave, actually contracted the disease in hospital, and two in five of those people had died. And that's why we must develop community capacity. At a time of pandemic, epidemic or even winter pressures, it is necessary to keep our older people out of our general hospitals and to keep them in their communities.

In order to improve the situation, we must expand the provision of social care in order to enable a more consistent service across Wales, aligned with the health service. So, let us look at one example of good practice: the Carmarthen integrated care team have broken new ground. Now, these are knights in the community, providing a range of health and care services, particularly for older and vulnerable people. The model works in a multidisciplinary way, including seamless integration between health and care, as well as other agencies and the third sector in Carmarthenshire, and their priority is prevention and securing early intervention. People can access community hubs for assessment, for advice, support and treatments, or the team can go out to people's homes. This is an example of those core principles at work, and this is good practice that can be spread across Wales, which will take pressure off our general hospitals.

If we are to have people home sooner and reduce the numbers going to hospital in the first place, then we also have to improve the facilities for patients who don't need acute care. In addition to this, we must also have better co-ordination with local authorities in order to ensure that timely care assessments are made. Without this, what we have is something that is similar to a revolving door, with patients sent home before having to return to hospital soon afterwards. Resolving the community element is crucial if we're to tackle the health crisis or we will continue to see staff growing disheartened, leaving the service, and health and care services being destroyed by the pressures. Thank you.

I thank Plaid Cymru for bringing this debate forward.

The Welsh NHS is facing pressures that 'cannot be coped with' and that's not me saying that; that's the Welsh NHS Confederation. And I'll be honest, it's no different in England, so, actually, we can't take any lessons from the Conservatives across there. We must work together here to acknowledge that, actually, we, as a small country of only 3 million people, can actually do something differently. We can actually resolve this together.

I found myself listening to this and actually reflecting on debate in the Senedd, and I feel that this is an adult, grown-up debate, and that's what our debates are. For those of us who've been in the other Chamber, as it were, that never happened. We never had the chance to put points across that were intervened with, where we could ask questions. And so, I do know that the health Minister probably again is feeling under siege, but this is an important issue, which we do need to debate, because we do need to hear ideas and also to be able to reflect the experiences of our constituents and places and people who we've spoken to. So, in that nature, I hope that the three points that I make this evening would be taken in that vein.

Firstly, the crisis in our social care sector here in Wales, which we've heard from Rhun ap Iorwerth about, we need to do more around that. National leaders in the NHS have directly stated that the pressures in our social care sector are driving up the demand for urgent care. It's happening at both ends. The preventative work that we want our social carers to do isn't happening, and the supportive work, and that means that people are going into crisis, and then, when they're coming out, there is just not enough for them there. So, I do hope that we'll be able to look at that issue—and I know I've raised this with the health Minister before.

We would like to see, in the Welsh Liberal Democrats, the implementation of the recommendations of the Holtham commission and work with professionals to introduce those reforms towards the creation of a single, national care service for Wales. Unless we move and work together in a more unified way, then it's going to be impossible to grapple with many of those issues.

The second issue for me—and again Rhun ap Iorwerth did mention this—is looking at the backlog of elective surgery. I've also met with the Royal College of Surgeons and heard about their proposals for surgical hubs, and I know that that's been mentioned by Russell George as well and also by the health Minister. I want to see this happening across Wales. It's happening in pockets, as I understand. The health Minister mentioned Abergele hospital, and there are other examples. But we need to see this being fairly and consistently applied across Wales, so that we can remove and reduce that pressure on our emergency care in our general hospitals.

And my final very brief point is this, and it is a question, which is why we have these debates and these discussions. I note that the Government amendment commits to a workforce plan to be delivered by the end of January. I've worked out that there are only six or seven days left until the end of January, so my question, a really positive question, I hope, is: could you tell us when the workforce will be delivered, because that's so important and touches on some of the areas that have been highlighted?

I just guess I come back to this issue of 'let's all work together'. Rhianon Passmore, you said a valid point, which is that these are needed conversations, and I guess that's how I see these debates and discussions in the Siambr. They are about us working together, listening to each other, not thinking that we've got the solutions because, actually, people come from places where those things are not happening. This is a real difficult issue and we need to work together to make sure that we do the best for the people we represent. Diolch yn fawr iawn.

We know from these debates and from our own experience, Dirprwy Lywydd, that the pressures on the NHS are immense. It is often a very reactive service of necessity in many ways because, obviously, the NHS has to cope with what is coming at it, and often, what is coming at it is extremely demanding on every last bit of its resource. But we also know, and as Jane Dodds said, we do need, hopefully, some degree of consensus and agreement in terms of some of the ways of dealing with these challenges. We all know that we do need to be more preventative. And despite these day-to-day pressures, it is necessary to get heads above parapets and look at how we can be more long term and preventative, but also deal with current pressures, because a lot of the health prevention agenda will deal with the current issues as well as the longer term.

I would just like to highlight one example of links that can be made to deal with these matters and that is park runs. It's an amazing, world-wide, free phenomenon. In Newport, at 9 o'clock on a Saturday morning, every Saturday morning, we often have several hundred people out running, aged from eight to 80, all degrees of physical fitness, often people who are running for rehabilitation having gone through or are going cancer treatment, for example, and many links made to other preventative groups—couch to 5K, or working with Move, which specifically relates to how exercise can help with cancer during and after treatment. Lots of really, really good links.

It is addictive, Dirprwy Lywydd, as many others will know when they do the park run. I hope to do my one hundred and fiftieth this Saturday in Newport. I also hope to be on the junior park run on the Sunday morning with my grandson, who's eight-years old, who is becoming addicted to the junior park run as well. People who help organise these park runs—and we have some 47 now in Wales—what they want is to link more strongly with the health sector. So, we do have links, we have GP practices prescribing the park run, and I think it's something like 24 per cent of park runs that have those links with practices. But we know that many more GP practices could have these links. Social prescribing is so important, and this is a significant part of that. The Welsh Government is out to consultation on all forms of social prescribing, and I do believe that that consultation could consider the collaboration that exists between park runs and their key stakeholders, including public health boards, third sector organisations, national governing bodies and practitioners.

We need to utilise all possible sources of help with the preventative agenda, Dirprwy Lywydd, and this, I believe, is an important part of that. There is such commitment and goodwill to these park runs, Dirprwy Lywydd. It is an amazing public health initiative, and it's one that we can utiliise more fully in meeting these challenges that we all acknowledge. 

I call on the Minister for Health and Social Services, Eluned Morgan. 

Diolch yn fawr, Dirprwy Lywydd. I'd like to thank Plaid Cymru for allowing me another opportunity to set out what we're already doing to reform and support the NHS, at a time when it's under more pressure than it's ever been in its history. And I'm pleased to see that, many of the points set out in the resolution, we are already delivering on through a whole series of actions, and actions that we too have developed with medical groups, and front-line workers, and the kinds of organisations that you have clearly engaged with. So, we're probably speaking to the same people, which is why we've come up with many of the same conclusions. And, if we're honest, in terms of the headlines—and I think you only published this plan yesterday, so I haven't had a chance to look at the detail—in terms of the headlines, if we're honest, it's not very original, but I look forward to reading some of the details. 

Now, in the first point of the resolution, Plaid points to comments made by the Welsh NHS Confederation, which suggest that the Welsh NHS is facing pressures that cannot be coped with. And I'd just like to point out that the NHS has 2 million contacts a month in a population of 3.1 million. So, the vast majority of the people who have contact with the NHS are receiving a good service. And, I think it's really, really important that we don't lose sight of that, and that's why I won't accept that the NHS is in crisis. But, the NHS, the confederation were referring to a specific period of time over Christmas when demand has never been as high. But, on top of that, I think it's really important to point out that, when they stated this, their comments didn't relate solely to Wales, they referred to the pressures in the NHS, and the director said that these pressures were being seen across the UK, in Northern Ireland, in Wales and in England.

Now, we know that our health and care services are under pressure, and, my God, it was unrelenting pressure over Christmas. We have never seen flu rates as high since the swine flu pandemic back in 2010. COVID rates—I was just looking at the wastewater signals, and, at Christmas time, they were through the roof. And all of these things came together, which is why we had that really, really pressurised time over Christmas. And, of course, we had a lot of parents concerned about strep A. So, that explains the pressure and the pressure has diminished considerably. Now, we're not out of it. Cold weather has an impact, so, constantly, we're looking out for what's coming next. But, it is clear that the pressure that we saw over Christmas has diminished significantly. 

Now, the official statistics show that nearly 400,000 hospital consultations were carried out in November, and over 110,000 patient pathways were closed. That's an increase of 4.7 per cent from the previous month. And it's important to note that we are now back to pre-pandemic levels, which is quite incredible. Let's not forget, we're still in the pandemic, but we are back to pre-pandemic levels. Now, November also saw a second consecutive fall in the number of patients waiting to start treatment. We are continuing to make progress on the longest waits, and the number of pathways waiting longer than one year for their first out-patient appointment dropped by 10.3 per cent—so, that's for the third month in a row. 

Now, the period referred to by the Welsh NHS was an exceptional month, as I say, and the highest number of calls to 111, and the most red calls for immediately life-threatening calls to the ambulance service ever made. But the system improvements that we're driving forward at pace are making a difference, and without these improvements it's clear that the pressures on services would have been even greater.

Our health and care sector workers are continuing to work tirelessly in exceptional circumstances, and I'd like to join many in the Chamber today in applauding their heroic efforts. Now, I'm very aware of the pressure on workforce and I'd very much like to pay them more money. We've been around the whole of Government to reprioritise, to look at our budgets, to see if there's more that we can put on the table, and we have put money on the table to try and help the situation this year. But I'm not seeing any hands going up from Plaid Cymru saying, 'We're going to reprioritise the co-operation agreements.' [Interruption.] You have not. You have not made any effort to reprioritise your budgets. We've done it and you haven't. You go and explain that to the ambulance workers and the nurses, because you haven't done it. The offer has not been there and you need to go and explain that to all the people who you say are on the front line with you. 

Will you take an intervention?

No, I won't take an intervention. The Welsh Government is committed to providing the NHS with the workforce it needs to meet ever-increasing demand. We're achieving this through increased training places, encouraging young people to take up health professions and recruiting outside Wales when necessary. Last week, I announced a £281 million investment—. Can you stop, please? Do you want to listen? Do you want to listen to this debate?

Minister, you continue.

Last week, I announced a £281 million investment package to support education and training programmes for healthcare professionals in Wales. For the ninth consecutive year, funding in Wales will increase, with an extra 8 per cent for 2023-24, and this will support the highest ever number of training opportunities in Wales. The NHS has more people working in it than at any time before in its history, focusing on prevention and care for members of society across every community in Wales. 

Now, I'm really pleased that there has been a discussion on the prevention approach, and I think actually we could do with a much broader debate on that. So, I'm not going to try and address that today, because I think it's so important. You heard some of the things yesterday that we're planning to do. I do think it's a complicated, it's a sensitive and it's a difficult debate, but we do have to have that debate. And, you know, headlines don't help things, actually. But we do need to make sure that there's an understanding, like John has said—actually, there are things that people can do that don't cost money. But we need that very sensitive, difficult conversation. [Interruption.] Well, we've been having those conversations, and Lynne is responsible for 'Healthy Weight: Healthy Wales'. A massive amount of research has gone into that in terms of how we best approach this issue. We don't pluck these things out of the air; we work with professionals to know what will work best. 

Now, I have said that, by the end of this month, I will be launching the health and care workforce plan. I've got it, I'm just making a few little tweaks—I've made several tweaks, I can assure you, as it's gone along. This has been tested with many of the organisations that I know you've been speaking to as well, and one of the things within that will be about reducing the bill for agency workers. I think we've got to be realistic, we're not going to be able to switch it off overnight, because we'd have to switch off hospitals, and I'm certainly not prepared to do that. 

Now, we know that hospital discharge is having an impact on patient flow. Work is ongoing in a number of areas to strengthen and make improvements so that people are not remaining in hospital beds any longer than is necessary. Now, I, along with Julie Morgan, have been jointly chairing a care action group of senior NHS and local government leaders to drive progress, and we have secured, this winter, 595 additional community beds for step-down care. That's this winter. It has taken huge pressure off—

Minister, you will need to conclude.

—the system. Whilst in England they made an announcement that they were going to deliver 7,000, I think they're just starting on sending the money out now. So, I think it's probably worth recognising, because I can't tell you how much work that has been—really granular work, working with every local authority, every health board, making that delivery happen. It's been really difficult. 

And just to conclude, because there's so much more that I could say, my No. 1 priority in the NHS planning framework that I've sent out to health boards is the requirement for NHS organisations to develop a closer relationship with local government in order to tackle the issues of delayed transfer of care and to push more care into the community. So, I wholeheartedly agree with Mabon on this: that's where we need to really focus our attention—we need to get the support out into our communities, particularly when we're looking at an ageing population. There's so much more I can say. I understand that we're under pressure, but thank you very much and I hope you'll support our amendment.

I call on Rhun ap Iorwerth to reply to the debate.

Diolch yn fawr iawn, Dirprwy Lywydd. Just to give us all a breather, I'll start with giving some attention to Gareth Davies's contribution, speaking as he did of Margaret Thatcher's devotion to Wales. It's only a few letters, but I'd rather remember her demolition of Wales in her time as Prime Minister. And you know what, on these benches, Labour and ourselves, we share a contempt towards the actions of that Prime Minister. And I was grateful for Rhianon Passmore's—

Will you take an intervention?

Gladly.

I'm glad you've mentioned Margaret Thatcher, one of the greatest Prime Ministers this nation has ever had. Unlike your party and the Labour Party, she had never voted to cut an NHS budget. Under her premiership, the NHS budget rose above and beyond the recommendations of the Labour Party leaders at the time and yet you, your party and the party of Government here in Wales, the Labour Party, voted to cut an NHS budget years ago. Do you regret that? 

I would like to listen to the Member's response to the intervention.

You have ensured having that on the record today. Margaret Thatcher's legacy will be on the record forever in her damage that was caused to Welsh communities.

Back to Rhianon Passmore's contribution, we do share a shared ideal about the principles of the NHS, the principles around which the NHS was based, and we want, together, to protect those key principles. She was right also to say that these were issues that are relevant to Scotland, to Northern Ireland, to England. Labour say it's a crisis in Scotland, it's a crisis in England. That's why we're saying, 'Admit it's a crisis in Wales.' So, I'm glad that she sees it in the same way as I do. She also said that this is a serious debate, and I'd like to thank individuals—

Will you take an intervention?

Of course.

With the greatest respect, I recognise the unprecedented challenges. I do not feel, in terms of the Royal College of Emergency Medicine, that it is helpful to label and use semantics about something that's of such great proportional interest to the people of Wales, and I did not say that.

In the opening remarks of that conference, the word 'crisis' was indeed used, and I'm sure your Labour colleagues in Scotland and England will note that you disagree with their assessment of the state of the NHS.

But you did say that we need a serious debate, and it is a serious debate. We heard serious contributions from Jane Dodds, from John Griffiths, from Members on my benches, Russell George. It's very, very important. I'll have to comment on Jenny Rathbone's not-so-serious comments—I think insulting comments. Not insulting to me—that's politics, that's fine—but insulting to those bodies that contributed towards these ideas, an attack on a plan she clearly knew nothing about and is less interested in learning about.

I looked at my social media during the debate, at some of the comments that have been made. The British Medical Association grateful to see some of their key calls on pay, workforce and social care reflected in the five-point plan. The Royal College of Midwives:

'Great to see the need for fair pay for NHS staff at the top of @Plaid_Cymru's 5-Point Plan.... Good too to see the plan prioritise the...retention of NHS staff'.

The Royal College of Surgeons:

'We are pleased to contribute to this work on #surgical hubs.'

I visited Clatterbridge with the Royal College of Surgeons on Monday. They were pleased, they were at our launch of our manifesto because they have contributed towards it. And of course the Minister says that she speaks to them as well, but maybe they can speak more candidly with us in wanting to make sure that it's emphasised that steps Government are saying—. I'm not saying Government's doing nothing; I'm just saying Government isn't doing what needs to be done, and isn't pushing the agenda as quickly as it can. For example, in response to the Minister's comments on the preventative, she said that this is sensitive, this is difficult. You know what, on the preventative, hit it hard—hit it hard: put it front and centre of everything the Government says. Every time you talk about health, talk about the preventative, doing today what makes us healthier tomorrow— the figurative tomorrow of 10 years from now, of course, but the actual tomorrow; you're getting ready today for that operation you've got next week. All that preventative agenda really needs to be prioritised.

So, on to the Minister's comments. I'll give her the benefit of the doubt when she said, 'Thanks for giving me another opportunity to explain what the Government is doing.' It could have been read as sarcasm; I will just see it as a tongue-in-cheek comment from a Minister who has to answer questions day in and day out. And you know what? We make no apologies for asking those questions. We make no apologies for working with partners across health and care in putting together a five-point plan that some Members might want to ridicule, but they're ridiculing the plan put forward by the workers themselves. 'Nothing to see here' isn't good enough from Government. I feared that it would be, 'We're doing this already.'

Rhun, you need to conclude, please.

Yes, yes. I take some positives in an acceptance from Government that we are making the right calls, that she thinks she is moving in the direction on agency staffing; you're saying things now that you weren't a week ago on agency staffing. 

That's just not true.

Well, it is. The First Minister refused to engage on agency workers in any negative way in the Senedd last week.

But let's continue with the serious debate. We'll keep on pushing, as will our partners, this five-point plan, because we need to bring all our ideas to the table to resolve the problems facing the NHS.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] There are objections. I will therefore defer voting until voting time.

Voting deferred until voting time.