Y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon

Health, Social Care and Sport Committee

04/06/2020

Aelodau'r Pwyllgor a oedd yn bresennol

Committee Members in Attendance

Angela Burns AS
Dai Lloyd AS Cadeirydd y Pwyllgor
Committee Chair
David Rees AS
Jayne Bryant AS
Lynne Neagle AS
Rhun ap Iorwerth AS

Y rhai eraill a oedd yn bresennol

Others in Attendance

Alan Brace Llywodraeth Cymru
Welsh Government
Albert Heaney Llywodraeth Cymru
Welsh Government
Derin Adebiyi Coleg Brenhinol y Meddygon
Royal College of Physicians
Dr Olwen Williams Coleg Brenhinol y Meddygon
Royal College of Physicians
Dr Rob Orford Llywodraeth Cymru
Welsh Government
Jo-Anne Daniels Llywodraeth Cymru
Welsh Government
Samia Saeed-Edmonds Llywodraeth Cymru
Welsh Government
Vaughan Gething AS Y Gweinidog Iechyd a Gwasanaethau Cymdeithasol
Minister for Health and Social Services

Swyddogion y Senedd a oedd yn bresennol

Senedd Officials in Attendance

Claire Morris Ail Glerc
Second Clerk
Dr Paul Worthington Ymchwilydd
Researcher
Lowri Jones Dirprwy Glerc
Deputy Clerk
Sarah Beasley Clerc
Clerk

Cofnodir y trafodion yn yr iaith y llefarwyd hwy ynddi yn y pwyllgor. Yn ogystal, cynhwysir trawsgrifiad o’r cyfieithu ar y pryd. Lle mae cyfranwyr wedi darparu cywiriadau i’w tystiolaeth, nodir y rheini yn y trawsgrifiad.

The proceedings are reported in the language in which they were spoken in the committee. In addition, a transcription of the simultaneous interpretation is included. Where contributors have supplied corrections to their evidence, these are noted in the transcript.

Cyfarfu'r pwyllgor drwy gynhadledd fideo.

Dechreuodd y cyfarfod am 09:33. 

The committee met by video-conference.

The meeting began at 09:33.  

1. Cyflwyniad, ymddiheuriadau, dirprwyon a datgan buddiannau
1. Introductions, apologies, substitutions and declarations of interest

Felly, croeso i bawb i'r cyfarfod diweddaraf o'r Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon yma fesul Zoom a fideo gynadledda—dyna'r system newydd sydd gyda ni, rŵan, o dan yr amgylchiadau anarferol rydym ni gyd yn byw oddi tanyn nhw. 

Felly, o dan eitem 1: cyflwyniad, ymddiheuriadau, dirprwyon a datgan buddiannau, gallaf estyn croeso i'm cyd-Aelodau ar y pwyllgor yma, y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon, o bob ban Cymru. Gallaf bellach nodi, wrth gwrs, bod y cyfarfod yma, fel dŷch chi wedi darganfod eisoes, yn gyfarfod rhithwir, a gyda'r Aelodau a'r tystion i gyd yn cymryd rhan drwy fideo gynadledda.

Gallaf bellach esbonio bod y cyfarfod yma yn ddwyieithog—gwasanaeth cyfieithu ar y pryd ar gael o'r Gymraeg i'r Saesneg, wrth gwrs, ac mae yna ychydig bach o oedi cyn i'r system sain ddod yn ôl wedi i rywun fod yn siarad yn Gymraeg—rhyw oedi o ryw bum eiliad, felly mae eisiau ychydig bach o amynedd. Gallaf bellach atgoffa pawb bod y meicroffonau'n cael eu rheoli'n ganolog tu ôl i'r llenni, felly nid oes angen cyffwrdd ag unrhyw fotwm i ddiffodd y meicroffon yn unigol? Ac os bydd fy system rhyngrwyd i yn ffaelu ac y byddaf i'n diflannu o'r sgriniau, cyn hyn, rydym ni wedi penodi y bydd Rhun ap Iorwerth yn ddirprwy gadeirydd ac yn camu i'r bwlch os bydd angen gwneud hynny. Ac felly, gyda hynny, allaf i ofyn a oes unrhyw fuddiannau i'w datgan y bore yma? Diolch yn fawr.

So, welcome everyone to this latest meeting of the Health, Social Care and Sport Committee here via Zoom and video-conferencing—that's the new system that we have adopted under these unusual circumstances that we are all living in. 

So, under item 1: introductions, apologies, substitutions and declarations of interest, may I extend a warm welcome to my fellow Members of the committee—the Health, Social Care and Sport committee—from all parts of Wales? May I note, of course, as well that the meeting, as you know, is in a virtual capacity with Members and witnesses taking part via video-conferencing?

May I also explain that this meeting is bilingual and an interpretation facility is available from Welsh to English and there is a slight delay between the translation ending and the next speaker coming back up to full volume? That's a delay of around five seconds, so you will need to be a little bit patient, please. May I also remind everyone that the microphones are controlled centrally behind the scenes, so you don't need to touch any button to turn them on or off individually? And if there should be a missed connection or if my internet were to go down and I disappear from the screens, we have already decided as a committee that Rhun ap Iorwerth will temporarily chair and will step into the breach if he needs to do so. And so, with those few words, may I ask if there are any declarations of interests to make this morning? No. Thank you very much.

09:35
2. COVID-19: Sesiwn dystiolaeth gyda'r Gweinidog Iechyd a Gwasanaethau Cymdeithasol
2. COVID-19: Evidence session with the Minister for Health and Social Services

Mi wnawn ni symud yn syth ymlaen felly i eitem 2 a pharhad o'n craffu ac ymchwiliad i mewn i COVID-19. Yn rhan gyntaf y cyfarfod y bore yma, rydym ni yng nghwmni'r Gweinidog Iechyd a Gwasanaethau Cymdeithasol a swyddogion. Felly, i'r perwyl hynny, dwi'n falch iawn i groesawu: y Gweinidog, Vaughan Gething, y Gweinidog Iechyd a Gwasanaethau Cymdeithasol; hefyd Albert Heaney, dirprwy gyfarwyddwr cyffredinol y grŵp iechyd a gwasanaethau cymdeithasol; Dr Rob Orford, prif gynghorydd gwyddonol dros iechyd; Alan Brace, cyfarwyddwr cyllid; Samia Saeed-Edmonds, cyfarwyddwr y rhaglen gynllunio; a Jo-Anne Daniels, cyfarwyddwr iechyd meddwl, grwpiau agored i niwed a llywodraethiant y gwasanaeth iechyd gwladol. Diolch yn fawr iawn i chi i gyd am allu brwydro i mewn i'r system ac yn gallu bod ar ein sgriniau ni yn fan hyn fel cwmni diddan.

Felly, gyda chymaint â hynny o ragymadrodd, awn ni'n syth i mewn i gwestiynu yn ôl ein harfer yn y pwyllgor yma, a rydym ni'n mynd i ddechrau gyda materion ariannol a chyllidebol, ac mae Angela Burns yn mynd i ddechrau'r cwestiynu. Angela.

We'll go straight on to item 2 and a continuation of our scrutiny and our inquiry into COVID-19. In the first part of this meeting this morning we are joined by the Minister for Health and Social Services and officials. So, to that end, I'm very pleased to welcome: the Minister, Vaughan Gething, Minister for Health and Social Services; also Albert Heaney, who's deputy director general of the health and social services group; Dr Rob Orford, chief scientific adviser for health; Alan Brace, director of finance; Samia Saeed-Edmonds, planning programme director; and also Jo-Anne Daniels, director of mental health, vulnerable groups and national health service governance. Thank you very much to all of you for battling your way through the system this morning and being visible on our screens.

So, with those few words of introduction, we'll go straight to our questions as is customary in this committee, and we're going to start with financial issues, and Angela Burns is going to start the questions. Angela.

Diolch, Chair. Good morning, Minister. Good morning, everybody else.

I just wanted to ask some questions about the financial position that we find ourselves in within health and social care as a result of the COVID-19 crisis, and I noted that, in the supplementary budget, it was very clear about what's been diverted from where. And then, there was a lot of information in the supplementary budget about additional funds that have come in. So, for example, £763 million has been allocated to the health and social services portfolio out of the £2.2 billion funding from UK Government.

So, I just wanted to try to analyse a couple of particular areas that I'm interested in. One is around the issue of provision of support for mental health. I see that there was a diversion of £7 million from the mental health service improvement fund that was relating to planned but uncommitted service improvement activity. That’s, obviously, not been spent, but instead has been used for COVID-19 work. The question was: what was that £7 million going to do? I ask that because we know that mental health services are particularly stretched. We also recognise that mental health conditions may well be exacerbated by the pandemic, and we're also aware that there's a lot of understanding that there will be low-level mental health anxiety from all sorts of people just while we get through this.

Has that £7 million gone to support the £9.8 million that was announced within the £763 million allocated to the health portfolio? What you have, Minister, just for ease of memory, is that of the £763 million in the supplementary budget, £9.8 million was given for additional actions, including enhanced GP services for Easter, increased support for those experiencing anxiety or depression, and additional substance and misuse funding. So, I wanted to know if that was out of the new money or whether it was partially used from some of the £7 million taken out of the mental health service improvement fund, and how's that spend being monitored.

Okay. Well, fortunately, we've got Jo-Anne Daniels, the director, as partner, so she is, of course, taking a leading role on oversight for our testing programme, including contact tracing on NHS Wales's trace, test and protect service that we'll come on to later, I'm sure.

Just a note of caution—I don't think it's quite as easy to see the move that goes into the central pot and how that comes back out, because we're trying to balance all of the different areas of spend, but given the detail of the question you've asked, it's probably better if Jo-Anne comes in to respond to the specific points you've got, Angela. If we can't cover that now, then I'm sure we can follow that up in writing.

09:40

Thank you, Minister. The £7 million that you're referring to was funding that we'd allocated for this financial year in support of our mental health delivery plan. So there's a set of priorities articulated in that plan, which was published back in January, and that £7 million was to help health boards make progress on those areas set out. That included things like perinatal mental health, children and adolescent mental health services, neurodevelopmental services and the like.

With the advent of COVID, while we absolutely still want to see improvements in our mental health services around those priority areas, we recognise that that funding would be needed to maintain and enhance the mental health response to COVID, so that £7 million is still within the mental health budget, but has been, if you like, repurposed to support mental health services more generally in their response to COVID.

I think Angela's also asked a point about oversight, and we've been through this—it's a little confusing—we've been through this before with the Children, Young People and Education Committee in my last appearance about the mental health incident group and the role that that has, and also the monitoring tool that's been developed. So, there is a level of oversight and a weekly check-in, a weekly update on service capacity and capability, so that's to allow emerging issues to be picked up, but I think Angela did ask on the point about how is that reviewed and what progress has been made. So, there are deliberate measures that have been taken to have that regular oversight. In what is an extraordinary time, we know that we're likely to see a significant ongoing increase in demand on our mental health services, even when we finally get to a post-COVID world.

Sorry, Angela. Can I just—? Lynne wants to come in at this point. Lynne.

Yes. Thank you, Minister. You referred then to the letter that you sent me on the mental health services that was copied to all AMs, and it was helpful information, but I'd like to know whether you're planning on publishing any of this data that you are collecting, so that, you know—or at least sharing it with the committee, so that we can see for ourselves, really, the patterns that are emerging here.

That's a fair point and I think we do need to make sure that in the data we're getting, we're providing a regular and predictable update, so I'll happily talk with officials about how we do that, not if we do that. Because I do think that we're trying to be open about what we're doing; we're asking people to trust us with an enormous amount of extraordinary activity, and so, I think it is important that we find a way to give that data on a regular basis, so I'll happily work with officials to do that. And I think it probably does make sense to provide it to this committee and the partner committee, CYPE, and that essentially means that we put it into the public domain, so we'll come back to you. We can confirm that afterwards and write to both committees to set out what we're going to do, if that's helpful.

Yes, that would be very helpful, Minister, because some things are really obvious, so the £50 million that was meant to go to the performance fund on accident-and-emergency waiting times, we can all see that that's not necessary at the moment, because we're struggling to get people to go back into A&E, even for really vital things. But when it comes to something like mental health where we know that our services are already very stretched, to have that money redeployed—. I wanted to make sure firstly that, the £7 million might have stayed within the mental health ambit, and wasn't actually just used to prop up what looked like new money.

And I'm going to ask the same sort of question now about the care sector. Again, I saw that £244,000 was taken out of the care sector. I wasn't quite sure; I couldn't work out what it was being spent on, but when you take that into consideration, you'll see that there's been a drop, obviously, in workforce development, because that's obviously very difficult to do during COVID, about health improvement and healthy working, and yet, on the converse aside, we see that there is £10 million going to health and social care organisations for enhanced homecare packages for those recovering from COVID-19 as part of their £763 million allocation.

Again, I ask the question, if we take the money out of the care sector—. We know we're struggling to put people into the care sector in terms of human resource, we're not able to train them, hence that's why there's the drop in training. How are you going to spend that £10 million for enhanced home care packages if you can't get the people—if we're already struggling with that in the first instance? And then my second question on the care sector is: the £40 million that was designated by Welsh Government for local authorities, can you give us an update on that, because what we're hearing is that many local authorities are either saying, 'We spent it even before it came, so it didn't touch the sides.' And other local authorities are saying, 'We can't even start to deploy it because we've still not got it, we're still not sure of it,' and I wondered if you'd just give us an update on that, please.

09:45

Before I bring Albert Heaney in to deal with some of the detail on both points, the broader picture is still that we know that we need to provide support for people to recover in a setting outside of the hospital sector—sorry, the acute hospital sector. That'll be step-down; it'll also be the provision of support within people's own homes, and that's why I think the publication of the recent rehabilitation strategy is important, and I think that will help to indicate how we're going to spend some of that money to support people to return to their own homes and to recover well.

The broader point about the money for social care, the £40 million—I think it's important to recognise that is a material contribution, and I think, if anyone was trying to suggest that that's not really material, that's not a sensible way to describe it. But we have recognised some variance in the way that local authorities have been able to deploy that money, and we're in discussions not just with the WLGA and ADSS, but also in discussions with people like Care Forum Wales, on how we get that money to the parts of our care system that it's supposed to support. So, it isn't that local authorities don't have the money; it's about how that money is being deployed. I think Albert can give you a useful update on how we're looking to improve that and lessons learned, because I'm awfully and robustly confident that we'll need to provide more support into our social care system during the rest of the pandemic. So, it's certainly not that this £40 million is it; it's about how and when we're going to be able to provide even more funding for social care. So, I'll let Albert deal with some of the detail of your questions, Angela. 

Thank you, Minister. Good morning, committee. If I commence with the £40 million fund—a very significant amount of funding made available, which works through the hardship fund mechanism to local government. And that £40 million covers a wide range. It covers additional staffing costs, it covers food and additional costs that have been around the business of social care, especially for our care homes. It covers a wide range as well—assisting around additional costs for ICT as well during the pandemic crisis, making sure that we can keep contact between family members and their loved ones in care homes.

The funding itself—local authorities have been able to draw down the funding. The first period for drawing down was 20 May, for the committee to be aware. Since then, we've been working very closely with both the directors of local government and the WLGA to ensure that we maximise the spend, and that, importantly, that money goes to the front-line services to ensure that continuity of service. We have worked—. The next claim period coming up, for the committee to be aware, is 20 June, but, in advance of that, we have asked the WLGA and local authority directors—and, indeed, there's a conference call with the directors of the social services at 10 o'clock this morning—to actually look at the projected spends that they have and how that money is materially going into the front line. So, that information will be back with us in advance of 20 June to be collated for Ministers by next Monday. So, that will give us a very good picture of how that money is being utilised, and to really emphasise that we are stressing the need to ensure that goes directly to front-line delivery.

In relation to the £10 million, I think there have been different challenges presented to us during COVID-19 around discharge. We've been really sure around—in giving clear messages around not mixing COVID-19 and non-COVID-19. And, therefore, that £10 million allocation is being utilised in the regional partnership board around—. The work is really looking at different ways in which we can support those discharges, whether that be step-down, into different facilities, or, indeed, strengthening the domiciliary care sector.

Interestingly enough for the committee, thus far, and much to our relief and assurance, the actual domiciliary care service has been more resilient than we thought it might be at the beginning. So, there are some additional challenges that, perhaps, we wouldn't have expected, but, certainly, that service has come through very well during this crisis. Thank you. 

09:50

Yes, I've got two more quick questions, if I may, Chair—I'm conscious of time. The first is related to field hospitals, Minister. I see that £166 million has been provided to open the field hospitals, which, you know, I want to say on a personal level I thought was an outstanding performance and delivery by all of those involved. But can you tell me: is that just the capital costs of it, or is some of that £166 million for revenue costs of continuing to pay whatever the facility is that's currently being used? And is that just a one-off? I'm assuming—well, what I've heard from health boards is that they intend to mothball or repurpose those field hospitals, but they don't want to get rid of most of them, just in case. Therefore, who's going to pick up those long-term costs? And does that £166 million also cover any reparation costs for when we finally give back the field hospitals?

Okay. So, the £166 million is for what we've created thus far. There's obviously some revenue in there, because of the staff costs—there are NHS staff costs within that as well and costs we've had to bear, and there's a challenge, which I'll allow Alan Brace to describe, about how we actually describe that. That is about how much of that is capital and how much of that is revenue. 

We do expect the field hospital network to survive for some time. You've heard me and the chief medical officer and the chief executive of NHS Wales describe on more than one occasion the fact that it is entirely possible we'll get a further peak. If we have that during winter, we may need to make more use of field hospitals than we did in the first peak, so we're absolutely not going to see field hospitals decommissioned at the end of the summer. It's about how we make use of them and what role they have to play in restarting our health and social care. That's partly about the point you made earlier about the confidence for people to return to receive and take part in healthcare, but I certainly don't want to see field hospitals becoming full up. You can imagine that, if we had field hospitals fairly full and brimming with activity when it comes to September or October and we get into an upswing, we'd put ourselves in the position we've been trying to avoid of having the service overwhelmed.

But field hospitals in themselves aren't environments for all activity to take place. For those of you who've not just seen the pictures but have visited ones near you, you'll see that they're a different sort of environment, and it's about the recovery and rehabilitation and also some of the end-of-life care that might be taking place. So, if you think about how they're going to be appropriately used, that's why, in my statement yesterday, the review I referred to of field hospitals that will take place this month is important to give us a greater amount of intelligence and actually to then support a decision about how they'll be used in this period of time and how much of that capacity we'll need to protect.

That will, then, obviously have cost issues, and there's a broader issue about cost, because we're going to need to find more ways to support the health service with the extraordinary costs they've taken on. I agree with you: it was an extraordinary effort right across NHS Wales, in every single health board, to repurpose and rethink how we needed more capacity. I'm afraid that we may well still need some of that extra capacity later in the year, because we can't be certain about the course of this pandemic. 

Sorry, Angela, I've got Rhun for a supplementary—I'll come back to you. Rhun.

Yes, just a quick one, really. I think you're right: we have to be looking at how we keep the capacity up for any subsequent peaks, but, in practical terms, these field hospitals are in places that are quite likely going to be needed back by their owners. Are there plans to even move them to other locations, where they can be kept in situ for longer, perhaps?

I think it'd be very difficult to move field hospitals. You've got to decommission where they are—there's the costs of doing of that— and then to recreate them somewhere else. I think that's really difficult. We were talking yesterday about the schools decision, and not just about what happens from the end of June, but I think one of the important messages from that was that we're going to have to get used to that being a new sort of normal for some time to come.

Having field hospital provision that is available and is going to need to be maintained is going to be part of that new normal through the autumn into the winter. And, in terms of the decision making, I would much rather maintain that field hospital network rather than see them decommissioned or try to move them somewhere else and then find out that we're dealing with a further peak of coronavirus, which, as we know, can come quite quickly, and then have to explain how harm has been caused because I wanted to decommission those assets. So, for me, maintaining the capacity we have is the right thing to do, because otherwise I think we're taking unnecessary and, I think, unacceptable risks with the sort of capacity we still need to keep within our healthcare system in Wales. And that is part of the deliberately cautious approach that we're taking. So, I appreciate there are some people who want those units back, but that activity, if you like, Venue Cymru and the rugby stadia, they're not going to return to normal for some time to come.

09:55

Sorry, just quickly. And compensating for any financial losses may well be something that you'll have to accommodate, perhaps, as a Government.

Well, of course we need to think about what that means. So, we've had arrangements going into this and, of course, in terms of the lost income, well, that depends on what activity would otherwise have to take place and the agreements we've reached with those organisations. And I really am grateful to all those partners who helped to make it possible to create that network of field hospitals in every single part of Wales.

Yes. I totally understand that we're in unprecedented times and that you're going to have to move all the financial building blocks around, but I am very keen to try and learn from this, and field hospitals are a prime example, to ensure that this extraordinary cost is not going to have to be borne by the individual health boards in the long term. Already we have them struggling. Betsi, Hywel Dda and Swansea Bay have all got significant deficits, which have been long term; they've carried them forward year after year after year. I've suggested you write them off—it's only £92.3 million—and I understand you're not keen to do that. But, again, they're already beginning to build up new debt because of this COVID-19. There have been costs that they've incurred. There have been, actually, things like efficiencies and savings programmes that they haven't been able to run because of the pandemic, and they might have looked towards saving £2 million, £3 million, £4 million this year through a really comprehensive efficiency and savings programme. So, again, that's going to skew their plans sideways. And then, when you look at the field hospitals, although my understanding is that things like the reparation costs—. For example, in the Hywel Dda region, I know the reparation costs for those field hospitals will be about 14 million quid. If that, then, goes on to their bottom line, that really puts that health board next year and the year after in a financially difficult position.

So, that's what I'm trying to understand, Minister—how much support you're going to give these health boards to make sure that the extraordinary costs because of COVID are not ending up on their bottom line ad infinitum, because they will be struggling for the decades to come.

And, as I've said before, we're not going to see health boards put into that position because of the costs they have had to incur as a result of preparation for COVID-19. They responded to national guidance and our indication that they needed to plan for a certain capacity. They needed to change the way they were delivering a service. So, whilst some forms of activity haven't taken place and there's a saving there, the other forms of activity provide an extra cost. We need to understand what that looks like through the year, but health boards should take confidence in the statements I have made previously, and again today, that health boards won't individually be expected to bear these extraordinary costs.

We need to look at the system in the round, the money that's already gone out the door, and how additional costs you could not legitimately expect a health board to bear—how we cover those off across the whole Government. Because this really is a whole-Government choice that we've made, and you referred earlier to the choices we made in putting significant extra sums of money into the health service in this supplementary budget. We may well have to look at more than that as the pandemic progresses and the level of uncertainty that we're living with.

Okay. Okay, Angela? Right. Time to move on. David Rees—testing and PPE to kick off, and then we'll be discussing this in tracing a little bit later on. But testing and PPE, David.

Diolch, Cadeirydd. Good morning, Minister, and just to highlight what the Chair's just said, this is not about the test, trace and protect scheme. That'll be done later; this is more about testing. I want to go back a little bit, because, since you were last before the committee, the chief executive of Public Health Wales attended the committee and clearly gave an indication to the committee that she was unaware of the then targets that were set. Now, I understand the Welsh Government has no longer got those targets, it's taken the decision to remove them, but she subsequently wrote to try and backtrack on what she said. But the question, I suppose, that really arises is: who set those targets originally, on what evidence were they set and what role did Public Health Wales have in setting those targets?

10:00

Okay. To be as open and honest as possible, we never set a formal target as a performance measure, if you like. What I said was where I expected us to get to, and that was reported as a target, and that's the way of the world. But that came on the back of information from Public Health Wales about where they expected us to be able to get, and so, in good faith, I went and told the public where we expected to get and within what time frames.

We then found, and this came from the rapid review, that we weren't going to get there, because a range of the equipment that was going to be imported had actually been held up. Some countries, as I've said previously, had actually prevented the import, and in other countries it was significantly delayed. The reason why, in the last few weeks, we've seen such a material and significant jump up from about 2,000 and a bit, up to 5,000 initially, and then from the 5,000 to well over 9,000 in terms of our lab capacity for testing at this point in time is because those pieces of equipment have now arrived and they're part of our infrastructure. We expect to have more testing equipment available to further increase our capacity as well. And so that's the honest truth of what's happened, with where we've got to, not just the past, but about where we are today.

To be fair, the chief exec of Public Health Wales has indicated that she was aware of some of the issues around testing and capacity and how the measures had got into the public domain, and I think that's just the honest truth of where it is. People do make mistakes under the extraordinary pressure that we're in, and I don't particularly want to spend time trying to rerun the evidence that the chief exec gave, because she's written and explained the position, and we are now in a much better position in the clarity of understanding about the capacity we have now, the fact we expect more to come, and that is crucial to underpin the test, trace and protect points we're going to discuss later on.

So, the figures you're quoting now—you are more confident that they are realistic figures than perhaps the data you were given then.

Well, that was the understanding on the evidence and the information we had at that point in time, and the delays that then took place. There's a challenge here, isn't there, about how optimistic you are and how cautious you are and how realistic you are in giving an indication of what's possible?

As I said, the rapid review that was undertaken in mid April made very clear that we weren't going to reach the 5,000-odd tests that we had expected to and it set out the reasons why, and they were honest and truthful reasons. The fact that we've now significantly increased our capacity is because those imports have taken place, and so the figures that you see on the testing updates that we provide are the actual lab testing capacity. So, we do have more than 9,500 testing capacity available to us now. We expect to get more, and each week I'll continue to provide an update on what we're actually doing, and I think that matters. I think that matters to give people confidence.

We won't need to use all of those 9,500 tests every day at this point in time, but as we all want to see further unlocking from lockdown in a properly cautious and managed way, we may well need to make even more use of that capacity, and that's why it's been so important to build it up ahead of going, obviously, into the contact tracing system, plus the further unlocking of more activity for people right across Wales.

You just mentioned that we had the figure of 9,500 capacity in the labs. I understand that on 2 June, we actually only tested 2,400, so that's approximately 25 per cent of the capacity. Are you concerned that we're not actually being able to use more of that capacity? Because I appreciate that the question is we are testing people who are symptomatic, but we've also identified in care homes, for example, and perhaps in the health sector, those front-line staff who are asymptomatic. So, should we be looking at more approaches to cover a wider range and therefore using the capacity, particularly in key worker areas, to ensure that we can identify those who may be asymptomatic as well as those who are coming forward being symptomatic?

Well, I think it may be helpful to bring Rob Orford in to deal with some of the points around the advice we get, and the value and the purpose of asymptomatic testing. But I think the starting point is that the capacity that we're making use of is because that's the need that currently exists in accordance with our testing policy, and that's underpinned by the advice we get. So, that reflects the number of key and critical workers who need to be tested, and it's different for people in health and social care. It reflects the fact we're undertaking a care home testing programme, and that's the capacity we need to complete that within good time. It also reflects the fact that there is now public access to testing for symptomatic people—they can book their own test. They are able to go online to do so, they're able to get to our drive-through centres, or to book a home-testing kit. In the near future they'll be able to book online one of our community testing units as well. You would expect to see a change in that if we saw more people mixing with each other, and if, for example, we were in the autumn period when you'd expect there to be things that are similar symptoms to COVID-19 and expect more tests to be carried out. So, the figure to look for isn't necessarily the percentage of our capacity that's being used; it's really whether we're making appropriate use of that in line with the advice we get about what is the right thing to do, and then the number of confirmed cases and the number of hospital admissions. So, they're more important in so many ways than the number of tests we're using. The point about the tests we have is: are we making proper use of the capacity that we have, and do we have enough capacity to do everything that we need to do? 

I think it may be helpful if Rob deals with your point about asymptomatic testing and how to try to deploy tests in the right way, because I think it's a point that I don't want to avoid—[Inaudible.]

10:05

Thank you, Minister. From very early on in the outbreak, from February onwards, we created a technical advisory group where we bring in the best experts that we have available to us in Wales, and we work really closely with the scientific advisory group for emergencies that continue to reflect and look at the evidence that's emerging. I think it's fair to say, if you look back, our understanding of this pretty insidious disease has changed over time as evidence has come, and our approach has changed over time.

The SAGE group meets regularly, our technical advisory group meets three times a week, and as the evidence changes, so do our approaches and advice to policy makers and decision makers. I'm very proud of the response we've put together and the approach that we've taken. I think our policies reflect the changing nature of our understanding of the disease. Clearly, we know more now about asymptomatic individuals and the role that they play as well as paucisymptomatic people, who are as yet to become unwell, but are maybe carrying the virus. There's a lot more that we don't know in terms of how people transmit the virus at different stages when they have much lower levels of viral load, and I think that we've always taken a sensible approach to testing, and we've targeted areas where there's greatest utility. As the evidence emerges again, so will our advice change so it fits our understanding of the disease, and, importantly, reduces the harm arising from this disease. 

I accept that recognition, but we are moving into an area where lockdown is being eased. We were told yesterday, clearly, that schools are going to go back on 29 June. There have been many families concerned over the possibility of asymptomatic situations within that environment, and since we have the capacity, I just wonder whether you were looking at and considering expanding the testing process, particularly into school areas, over the next few weeks, to use the capacity you have to ensure that, as people go back to the schools, there is a greater confidence in the freedom from COVID-19 being present in those environments. 

I think we're getting back to the point of having contact tracing. We need to see an update on the evidence, which is regularly reviewed, on the level of asymptomatic testing, and then the asymptomatic transmission, and then how testing can play a useful part in helping to address that. Because I think if we just took an approach where, 'We've got the tests—let's use them', we could end up using them in a really scattergun way that doesn't provide value and doesn't provide the sort of assurance that I think people would be looking for. So, that's why taking a proper evidence-led approach really does matter. If the advice from Dr Orford and our technical advisory group and chief medical officer changes, then as we have done, for example, with care home testing, I will be happy to make different choices about how we use those tests, and I think that's just the honest truth. It doesn't provide, if you like, all of the certainty that everyone would like, but I think we can provide a false level of services that won't keep people safe, or we can follow the evidence and make difficult choices. And these choices won't get any easier, I think, as we move forward. I don't—[Inaudible.]—everything else in responding to Dai, but I want to make that point about the approach of Ministers. 

10:10

I understand the false confidence that could be raised, but it is important that we look at the opportunities that are available to us to give some form of confidence to people. Perhaps looking at teachers wouldn't necessarily be a scattergun approach, because you are targeting a particular group rather than a scattergun approach.

Can I move on to the care homes? Clearly, I very much welcome the decision of the Welsh Government to test all care home residents and care home staff. Are you now confident that that strategy is correct, because it took time to get to that point? We initially weren't doing it, then we were doing it only for those residents who were symptomatic or staff who were symptomatic. Then, we were doing it for homes where there was evidence, and now we're doing it for everyone irrespective of whether there's a symptomatic case or not. Are we now in a position where we are covering all care homes, and that we're confident that residents and staff in all care homes will be tested by, say, the end of next week—I think you've mentioned that—so that we can have that confidence that residents, families and family members are going to be in an environment again that has been scrutinised?

Yes, so we're now testing everyone in the care home environment because we have changed our policy. Over the course of six weeks, we made three different policy decisions. And it again highlights the rapid evolution and our understanding of not just the way that coronavirus behaves, but evidence around it as well. And at each of those points where I made a different decision, it was because the evidence base and the advice had changed. That's what I think is uncertain and unsettling for people, because normally you'd expect decisions to be made where you stick to a policy decision for much, much longer.

It's entirely possible that you can get new evidence on different areas of activity next week, and I will then have to make a different choice, or at least consider making a different choice, because, ultimately, Dr Orford and his colleagues advise but it's for me and my ministerial colleagues to make those choices. I'm very keen that we don't throw our scientists under the bus when we take seriously the evidence and advice they're giving us. That's why we shifted our position. It's why we now have a testing programme across care homes.

So, within the next two weeks, everyone—staff and residents within care homes across Wales—should have been tested, and I'm then looking forward to further advice that will then look forward to a re-testing programme, which is the question you asked in the Chamber yesterday. So, this isn't a static position. We're going to constantly evolve and need to adapt our choices as the evidence continues to change and, understandably, the advice that Dr Orford and his colleagues will change as our evidence base does.

Thank you for that, and thank you for the point on re-testing because, as you know, I'm very keen on a situation where, particularly, homes have had a positive result, and where it does mean there's a possibility of a resident or a staff member being positive later as a consequence, because they're not symptomatic at this point in time. So, I appreciate that.

But I will close with my last question on PPE. We've been very clear on the situation with PPE, and where there were some challenges early on. We now are being informed that there's far more sufficient levels of stock. I suppose my question is: are you comfortable that the care home settings are going to have sufficient levels of stock, because that is going to be very much an ongoing area? But also, are you now in a situation where you're building up your stock again, because the number of items you used clearly was large? You used a large element. What type of timescales are you anticipating to be able to restock to that level, so that in the autumn—many people have said you may be expecting a second spike in the autumn—you're going to have sufficient levels to manage not just then, but also through the winter? 

These are really important questions. So, we think we are in a much better position. This was my biggest anxiety for some time, as you know, and we came within having days of supplies of some items, rather than weeks. We're now in a position where we think we do have months of supply across most of our items. There's an issue about eye protectors—they're not in quite the same position, but we still have enough—and we're not in a position where we think that that supply chain is at a point where we should be worried about it immediately.

There's a broader point, though, about the fact that whilst we're now in a much better position, because we're buying and acquiring successfully large amounts of PPE that we do need, we're also seeing Welsh companies producing PPE as well. So, for example, you'll recall that fluid resistant gowns were a real issue for us. We expect helping manufacture those from people in Wales to make a significant difference us. We're still going to be in a position where we're buying lots of this from other parts of the world, and that, in itself, creates an element of uncertainty. And if we did see a further upswing in coronavirus and there was again even more competition in that world market, it's possible that our supply chains could become stressed.

But to give you an idea of how robust we are at this point in time, we received mutual aid significantly in April from other UK countries. We received just under 1.2 million type IIR masks from Scotland and 200,000 eye protectors from Northern Ireland in April. We then returned that mutual aid to Scotland for those type IIR masks. We've provided those masks—over 1 million of them—to Northern Ireland. We've provided 10.5 million masks of the type IIR ones to England in the month of May, and we've also provided over 100,000 fluid resistant gowns to the other three UK countries. So, it shows that we're actually now in a position where we can provide a significantly greater amount of mutual aid than we've actually received, in particular that very large delivery that we provided to England.

But we are still making sure that we're discussing with each other the four nations' arrangements. We're all trying to pursue our own deliveries as well as working collaboratively around UK procurement, because we need to make sure that we're not closing off any of our routes to market and supply chains, because the position could change, and I do not want to see us go back to the position that we were in in March and April. So, that means longer term manufacture for PPE, not just a few months, from companies in Wales and the rest of Britain, and it means getting ready for the fact that we may see further stress come onto our supply chains in the future. And easing out of lockdown is one of the factors where more PPE could be used. 

10:15

Okay, we'll come to that a little bit later. Moving on now to changes to local authority care and support. Jayne Bryant has got questions here. Jayne. 

Thank you, Char. Good morning. I just want to ask about the temporary modifications to the Social Services and Wellbeing (Wales) Act 2014. We heard from the British Association of Social Workers, who noted, at the time, that social workers in Wales currently have no framework or guidance on which to base their practice and decision making, and that a significant number—. From the older people's commissioner, we heard that a significant number of older people may no longer be able to receive the social care support that they need to maintain their health and well-being and independence. What's your assessment of the modifications on the impact of services and those who use that support? 

Well, again, I'll ask Albert to come in with some of the detail, but my understanding is that we haven't removed care packages from anyone. I know there was some concern at one point, and that was helpfully resolved, I think. So, we didn't see local authorities removing support from people, but they all had to go through a process of understanding how they would prioritise care if we had seen coronavirus take off in the way that it did in the first part of the peak, which we fortunately then managed to flatten and now reduce, of course. But I think people should take some confidence from where we have been, where we haven't had to make the sort of reductions across our health and social care system that were possible at the start of this peak. 

I think Albert can come in and tell us some more of the detail about what's actually happened, because I don't think the concerns that people had have actually matched up to the reality—what our local authorities have managed to do to carry on supporting people. Albert.

Thank you, Minister. The Act, as you quite rightly said, was implemented at the very beginning of the process, recognising the potential impact of COVID-19. We did produce statutory guidance and were explicit in the provisions around this. That guidance was constructed and we worked with organisations representing those most likely to receive care and support—so, learning disability, sight loss, older people, carers and parents of disabled children. The older people's commissioner, commissioning boards and safeguarding boards and others had an opportunity to inform. But importantly, the statutory guidance is explicit—it does not give authority or the right to block, restrict or withdraw services, but it enables local authorities, under certain conditions, to make temporary person-centred decisions and should only be exercised as a last resort.

As you quite rightly alluded to in the question, a concern was raised and, when the concern was raised, we sought assurances. We've had detailed discussions with the political leaders of local authorities and, indeed, those statutory directors of social services as well, and authorities have indicated that they have not needed to step in to the withdrawal of services, and to prioritise those in need [Inaudible.]

We are, obviously, working closely with directors still. One of the cases that we're aware of during COVID-19 [Inaudible.] committee is that some of the assessments are still taking place, but [Inaudible.] a quarter of local authorities, because of their local issues, assessment are taking slightly longer. So, there are some implications, but not to the extent that we originally had thought might be the case for local authorities in having to prioritise. So, it is, again, a better picture for us, but we'll continue to monitor.

And importantly as well, we did not relax on the legislation in relation to children's services, and I know that, currently, children's services are moving back into a more normal state as well. Thank you.

10:20

Thank you, Chair. It's really helpful and reassuring to know that you're continuing those discussions and monitoring that situation throughout Wales and all the local authorities.

What has your assessment been, Minister, of the voluntary support in Wales, and how do you see their role in supporting local authorities? Local authorities have been doing an amazing job in getting support out to people who are shielding and people who are vulnerable, but how do you see the volunteering schemes in Wales? Do you think there's enough resilience in that to fill gaps?

It's a good question, especially as we're in Volunteers Week, and all of us know, within our own constituencies and regions, of the value the voluntary sector provides in normal times across health and social care, and about the fact that we've needed social care organisations and volunteers to work together to help provide support to people because of the extraordinary times that they're in.

I think the way that local authorities have worked with not just community voluntary councils, but a range of voluntary organisations—not every voluntary organisation is necessarily part of that CVC set-up—has been a really good example of the country working together. So, I see them as an essential part of the response to COVID-19 and I expect them to carry on being so.

Now, there are always going to be challenges about what that means when turned into resourcing and supporting people, but much of that comes down to the practical relationship they have within their local social care and healthcare system. I know, for example—we were talking about mental health earlier—that lots of our tier 0 and tier 1 support comes from the third sector. And so, we need to think about how we continue to see that partnership work in the future, but it's an essential part of what we're going to need to carry on doing. And, as I said, that comes with the real practical challenges of making that work.

All right. 

Symud ymlaen rŵan i faterion dwys eto ynglŷn â phrofi ac olrhain a diogelu, a sut rydym ni'n mynd i ddod allan o'r cyfnod clo yma, rŵan. Mae Rhun ap Iorwerth yn mynd i arwain ar hyn. 

Moving on now to important issues related to test, trace and protect, and the exit strategy with regard to lockdown. Rhun ap Iorwerth has questions.

Diolch yn fawr iawn, Cadeirydd. Os caf i ofyn yn gyntaf, Weinidog, am eich argraffiadau—

Thank you very much, Chair. If I may ask first of all, Minister, for your impressions —

Mae'n ddrwg gen i, Cadeirydd. Oes yna broblem?

Sorry, Chair. Is there a problem?

Dyna fo. Eisiau gofyn am argraffiadau cyffredinol ydw i. Sut ydych chi'n teimlo mae pethau'n mynd ychydig ddyddiau i mewn i gyflwyno'r rhaglen genedlaethol o brofi ac olrhain?

Okay. I just wanted to ask for your general impressions about how you feel things are going in the first few days following the introduction of the national programme of test, trace and protect?

Sorry, Chair—my broadband has appeared to have gone down, so I missed almost all of what you were saying. I wondered if it was your broadband, but it was actually mine. So, I left the meeting and I've returned. So, if someone's asked me a question, then I've heard nothing of it.

I think it's your broadband, because there was only one frozen person on my screen and it was you, Minister. We'll try again. I was just asking for your general thoughts, first of all, a few days into the national roll-out of test and trace. What are your initial reflections on the positives and some concerns?

10:25

Well, three full days in, I'm really encouraged and cautiously positive—there's always going to be a an element of caution—that this new national NHS Wales test, trace and protect service is doing what we wanted it to do. We're in a position where we have fewer than 100 positive cases to follow up each day. We've got 600 staff in place across Wales, and we're in a position where I think the two-week trial has really served us well, and the training that we've provided to staff in that time and the learning that people have shared, I think, has been really important.

I'm looking to publish on a weekly basis figures on not just the numbers of people that come in, but some of the caveats around that as well. So, for example, I said we had fewer than 100 positive cases confirmed each day, but, for some of those, contact tracing won't take place. So, for example, people in a care home—it's a closed environment, we haven't got visitors going in. So, actually, that's a different position. And positive cases in prisons as well. You can see, in that overall figure, we'll then need to provide a different figure for the number we'd want to follow up contacts for, and we'll then need to indicate something about the amount of activity that takes place on contact tracing.

We're having conversations with other Governments in the UK to see if we can agree some common areas of activity to try to measure, because I understand that people in every part of the UK will want to understand, 'How well is my local service doing, and is there a comparison?' And our elected representatives in each of the parliaments in the UK will want to know that. So, we are trying to see if we can agree a way to present that information in a way that at least has some commonality to it, so you can assess and understand. But, again, I'm really grateful to people in local government and the health service who have worked to make this work, and the system's holding up.

Next week will be another point, where we have our back-end computer system. That should actually make reporting and providing data to the public easier, as well as then making sure we're not dealing with the manual workaround we've got at present with the very interim solutions. So, next week will be an important point, and then we'll have several more weeks of that running. So, I'm cautiously optimistic and positive about where we are now. There have certainly been no major blow-ups in the system, which I think, for a new national test rolled out at the pace that we have done, is pretty impressive.

And there is, as you say, a ramping up gradually. The tracing doesn't begin, of course, until after a positive test has been returned. Can you confirm that that's because of capacity issues, rather than that being the advice that you've been given as the best way to proceed?

Well, the advice we have is that if we can move to a system where we can trace on symptoms, that would be ideal, but we don't know if there's any country in the world that is tracing on symptoms. We're looking at what would happen—and I think Jo-Anne Daniels or Rob Orford will correct me if I'm wrong—and we're looking to our current position, which is common with every one of the other UK countries on tracing after a positive result. We want in the future to be in a position to trace on a positive result, or someone who is waiting 48 hours. Because it is possible, even if we have a high level of positive—the speed at which our system will move in terms of getting people from symptoms to booking their test, to getting the results—that there could still be people who fall outside that 48-hour window, and we want to be able to move to a position where, in the future, we can contact trace even if people haven't had their test results.

So, I know the pledge was given by Mr Johnson in Parliament that there should be a 100 per cent return within 24 hours. That's his pledge for England, and I think anyone who pledges 100 per cent compliance in a very large system is setting themselves up for problems. We're looking for a system that is effective but meets the advice and the guidance we've got, and provides for 80 per cent of the contacts to be traced and followed up, because that's the high watermark that we've been given by Dr Orford and his colleagues on the technical advisory group for a properly effective, robust contact tracing system.

So, when you announced on 13 May that the tracing would be done at the symptomatic stage, it was just that you hadn't quite got the full picture of how complicated that would be at that point. So, that's quite a significant change.

10:30

It was the aim of where we wanted to go, but, as I say, we're not aware that there's any other country in the world that effectively traces everything on symptoms. That's the ideal advice of if we could do that, and then the practical advice—so, what does that mean for the here and now—like I said, it's a unified position from the four chief medical officers that we want to be able to get to a position in each of the UK countries—certainly our ambition here—in terms of moving to that point of test on positive, but, if you can't get someone to get their test results within 48 hours, we want to start following those contacts up at that point. But we're—. The numbers are small enough now that we're able, with our group of 600 staff at present—where we should have some confidence in being able to follow up those contacts to the degree that we need and at the speed that we need. But that does result in—that does rely on the speed of the testing programme in turning around the results.

The 48 hour issue—I'm a bit concerned about what you said this morning. I was under the impression that we were already as of now saying, 'Listen, if we haven't got the result back within 48 hours, we'll start the tracing anyway.' Because I think that's very important; it keeps up the pressure, of course—a positive pressure to get those results back quickly. Also, I fear it disadvantages some parts of Wales, because it's here in the north, largely, that we have been waiting far too long, up to 72 hours or even more in far too many cases—not outliers; it's been far too common to wait that long. What you're saying, if you're not doing that already, is that some parts of Wales that have to wait longer for their test results are at greater risk of seeing outbreaks happen and not being controlled in time. Could you consider—given the spare capacity you have already in the system for more testing, for example—bringing forward to now that 48-hour start-the-tracing policy? 

Well, we'll consider the advice we get, not just the view of the chief medical officer and the chief scientific adviser on health, but working with policy officials in the Government, and indeed in local government and our health boards, about what we do in each area, and what the national position is. But I think the view about how many tests are being returned within 72 hours—we've actually made some improvements on that. So, we're in a better position than we were, say, a month or so ago. My understanding is that each of those positive cases are being followed up in the way that you'd expect them to be at this very early stage. We're on to day four now, but we haven't seen those sorts of concerns come to us yet, but that's why I think the weekly data will be important, about what we're actually doing and achieving as we move deeper into this.

And I think you're right; there has been an improvement. The introduction—too late, but better late than never—of testing facilities in the north, for example, has made a big, big difference. But, still, I think making that pledge now—'No, you know what, we will put some positive pressure on ourselves to get them back within 48 hours'— that would be good, and it could be done by saying, 'We'll start tracing if we don't get those results back in place.' So, that'd be good if you'd consider that. 

Public buy-in is very, very important, of course. How do you think the messaging is going in terms of the public's preparedness to take part in this test and trace regime? And how do you think that could suffer and be hit over time by, for example, people being asked to self-isolate time and time again, and the economic and financial costs that that could mean for them? 

I think there are two important points there. The first is that public buy-in is essential for contact tracing to work, and that's why it's really important that it's an NHS Wales test, trace, protect service. The NHS is still the most trusted public service in the country—and understandably so—so, people being contacted by the health service or people working with the health service I think matters, and that's an agreement from local government and the NHS that that's how the service is being described, because that's the reality of the service.

We need the public to respond when contacted by a contact tracer, to be open about their contacts. This isn't the health service looking to catch people out. You know, the people doing the calls aren't going to be looking to see if you've breached the regulations by seeing someone you shouldn't have been; we're interested in how we trace those contacts to keep people safe. And, actually, at this point in time, with both the trial and the first point of contact tracing, there has been a ready and willing response by the public thus far to give that information, because people who have a positive test, they're understandably concerned and they're worried about people that they've been in touch with and they know that this is a system to protect them. I'm concerned about the financial impact for people, especially our low-paid workers, because, for a number of them, statutory sick pay isn't great, and there's a challenge about people being able to pay their bills. Now, we're not in control of the rates of statutory sick pay, but what we have to reiterate to everyone is that the damage done from not taking part in contact tracing, not sharing that information, is likely to be much more significant. You know, we're talking about a system that we think will help to avoid harm, which includes the loss of life.

So, businesses that are concerned, potentially, about having groups of key workers, or, potentially, their business, not being able to function if people are self-isolating—well, I understand that's difficult, and I'm not saying it isn't. But, actually, the much greater harm to those people potentially coming into work when they shouldn't, and potentially spreading coronavirus to each other and customers of whatever business or service that is, is much, much greater. I think the public understand that at this point in time, but I think it'll be difficult the longer it goes on for. It's a big ask.

10:35

Yes, and it's not just those people who are being tested themselves, it's people saying, 'Gosh, I don't want to be traced', not because they've got anything to hide but because, you know, 'I'll take my chances, thank you very much, if I've come into contact with somebody, but I don't want to lose work; I can't afford to'. That kind of thing could grow over time, and I just want to know that that is something that you have in your sights.

It is and, to be fair, the messaging that we're considering coming up builds on that overwhelming public support, because, if someone says, 'Well, I'll take my chances', the point is that you're not just taking your chances, you're taking chances with other people—with other people you may not meet, in terms of the way transmission works, but also chances with the people you live with and people you work with.

So, it's actually that point about, 'You've got some responsibility yourself, because the Government can't do this for everyone.' But to understand the nature of the risks you're taking for yourself and for other people is an important part of the messaging. That's not to try to make people feel bad, but to actually re-engender this point that there really is a common endeavour here. The Government needs to play its part, absolutely, as do health and local government, but we need the public to play their part too in helping to make this choice for all of us. 

Just two quick questions from me to finish. Firstly, you've said that this is an NHS test and trace system. It's very much the case that local government feels a very strong sense of ownership over this too—they are the ones that have those tracing capabilities and always do, you know, for a food poisoning outbreak or measles or whatever it might be. Where do you see that responsibility lying, ultimately? Do you actually see it more as a shared scheme or—? A few weeks ago, you said that this would be something that would be in your portfolio and the local government Minister's, with you taking the lead. What are your thoughts on that partnership working and the need for people to see it as a local government thing as well as an NHS initiative?

The partnership working is essential and it's the reason why we're in the position we are, where we've got a level of confidence in the system that's been rolled out nationally. Local government is an essential part of the service, but all partners have agreed—. Because there's something just about the clarity and the simplicity. If you try to describe it as a joint partnership between different local governments and the health service, it'd be a mouthful to try to say anyway. Trying to say, 'test, trace, protect' on a repeated basis is pretty difficult, but, actually, to describe that to the public in a way that they understand and have confidence in what they're doing, I think that matters.

But no-one, certainly not me or any of our officials, is trying to underplay or ignore or avoid the reality that this would not work without local government being key partners in the design of how the service works as well as the delivery of it. As I've said many times before, I really am grateful for the very significant and constructive and grown-up partnership working in every part of Wales, across political boundaries. The political leadership of local government hasn't mattered in the way that this has worked. The way that local government and health have worked is an exemplary way, I think, to have examples of difficult conversations that have happened to get to the point where we have a system that everyone is signed up to.

Finally, tracing is very much roll up the sleeves and hit the phones and, you know, face to face—not face to face; virtual face-to-face tracing. But still, in the background, we have the possibility of using technology and apps and so on. We know about the pilots that have been going on on the Isle of Wight. Where are you now on the role that technology and apps and that kind of thing will play as part of the overall picture in Wales?

The NHSX app could be useful, and what I've always said still remains the position: if it works, if the data issues are resolved about the transfer of data into the Welsh system so it's useful for us, and the privacy issues are resolved, then we want to be part of it. I think that's the right position to take.

We think the privacy issues are largely resolved. There's the next version of the app that's being rolled out for trial next week, which will actually look to see—essentially, there are two versions in one of the app. One is this contact tracing and sharing of information—well, it's technically not contact tracing, it's sharing of information, which can be useful as part of what we want to do with contact tracing, and the other is whether the app could be a gateway to booking tests and other things. Now, that's not what it was originally designed for, but you can see a utility for that.

If these things work and they get properly integrated within our system, I still think they can play a helpful contribution, but they're not a replacement for what we're doing. And, frankly, if the app doesn't work and never gets rolled out, we should still have an effective contact tracing system here in Wales. I think that's really important as a message going out to Members and to the public—that the NHSX app is not the determinant part of whether contact tracing works; it's actually the system we've already got in place.

10:40

Chair, there is one other important matter, actually, that I just would like to ask the Minister to comment on: the protocol that you're trying to agree on between Wales and England for when tracing needs to cross borders—how are we getting on with that?

Practically, there's agreement between officials about how that should work and how information should take place with which contact tracing team of follow-up contacts and then how information will be shared between the two different systems. So, we're looking to sign off an agreement about that data sharing, because that's important, and that should then be, hopefully, a model for the way we'll need to work and interact with other systems. Because England and Wales obviously have the biggest transference and overlap, but, if we're phasing further out of lockdown, we know that—I'm not the only person with Irish family—there are people who travel to and from the island of Ireland, both the north and the south, and, of course, there's some transference in and out between Scotland and Wales as well. And, if we're in a post-COVID world where more travel within the UK is possible—not where we are now, where 'stay local' is still very much our message, but in the future—that may become a more material issue. But if we get the England-and-Wales data-sharing issue right on how we share information between the two systems, that, I hope, will be a useful model for us to work with other countries.

Okay. The final section is the one that's been hotly anticipated. Lynne Neagle's in charge of NHS care and emerging from the lockdown—Lynne.

Thank you, Chair. Minister, there have been a range of suggested areas that require immediate attention as we try and re-establish the NHS as we once knew it. We've talked about mental health, elective surgery, cancer, the need for rehab services for people who've had COVID. Can you tell us a bit about your thinking about how you intend to prioritise these areas going forward?

Well, for me, it's still about looking at the areas of harm and benefit. We've already had areas of essential service that have been carrying on in any event—so, emergency admissions, very obviously; urgent cancer has still always been there, mental health has always been an essential service. So, really, I think the starting point is how we give the public more confidence to make use of the services because, even in those urgent and essential areas that have always been available, the public have made different choices about not using the service to the same degree, and it is then about how we use the capacity that we've got.

So, in the quarter 1 plans, and going into the next quarter, I'll look to see more detail in some of those priorities. So, there have been questions about cancer screening, but it's not the only area. There'll be other services we need to adapt. I mentioned yesterday in the Chamber the diabetic retinopathy service for pregnant women and about the fact we now have a different way to deliver that service that means that can carry on, because of the real risk of permanent loss of sight if that service wasn't being delivered.

So, my priorities will be about not just harm reduction and avoidance, but how we deliver the greatest benefits and how we then understand what that means in terms of our use of resources. It's difficult to go beyond those broader terms of principle, because we set out in the statement that I delivered yesterday that we've got a range of essential services we're looking to bring back online. It's about how we then can safely manage those with the capacity we've got and, as I say, for the public to have the confidence to use them.

So, is it your intention to publish some sort of plan so that we can all see the road map to getting back to some sort of new normal in the NHS?

10:45

Well, I think trying to publish a national plan has some attractions, but the problem is that, what the new normal looks like, we can't be certain. And so, as we go through each quarter, we'll be able to understand, through each quarter, what the next stage should look like; what the next amount of activity should look like; what we're able to do. And so, the field hospital review that I indicated earlier in the statement yesterday, and again in evidence today, that will be important to set out how we think that capacity can be used to support NHS activity, and that may change again in quarter 2. But because we can't be certain about where the pandemic will be, I think trying to set out a national plan with national timescales is probably not the right thing to do, despite the fact that politicians and Ministers, a lot of us, would like to set out a national plan. But I think people understand why, and again, that sense of national purpose, but we're going to need to do things on a quarterly basis, but they will be published. So, in board papers already, the quarter one plans should be published. When we get through quarter 2 plans, we expect those to be published as well. So, they will all be visible to the public.

Thank you. In Plenary yesterday, there was lots of discussion about dentistry and, obviously, I heard your responses and I understand the challenges. But I am particularly worried about the implications of the dentistry situation for children and young people, because we know that we've already got huge challenges with children's oral health in Wales. And while I completely understand that you need to proceed on a safe basis, I'm wondering what else you're going to do to maybe reinforce the need for really good dental hygiene in this period. I can tell you that there's one 11-year-old in Wales who had a very stern talking to about his sweet tooth after I saw that letter from the chief dentist on Monday. What can we do to emphasise how important this is? Because we don't want children's dental health deteriorating, and we don't want children in pain either because of it and unable to see a dentist.

Yes. It is something that worries me, not just because I have a young son myself who has a sweet tooth too, and he's always keener to eat sweet things than his parents are to give them to him, but we are in a fortunate position, I think.

And in terms of our position in public life and where we are and what we're able to do, and then making choices for the country, where we recognise that our Designed to Smile programme has made a really big difference, a material difference, in improving the oral health of children and young people, and it's made the biggest difference for people with the biggest challenge as well, and that's been a really good thing. And we're not able to deliver that programme in the same way because of where we are in lockdown. You know, it's not going to be at the top of the education Minister's priorities to reintroduce Designed to Smile in schools and having to re-operate schools in a different way, but there are different opportunities to reinforce messages with the further contact that people are having. And as we go through wanting to restart, progressively, more areas of dentistry, children and young people are absolutely one of the areas that I'm most concerned about, because the harm done in those early years is often the most difficult to recover, and I'm very, very aware and sensitive to that, although I wouldn't want to be the 11-year-old you're referring to.

[Laughter.] Okay, thank you. Can I just ask about the benefits and drawbacks of some of the service changes we've seen during lockdown? I mean, we've heard people talk about the positives and the negatives. Can you just tell us what you think will happen in terms of maybe holding on to the positives, like the flexibility people have had with remote consultations, et cetera, at a time of their choice?

Yes. Well, I think that there are some really positive things to hold on to, and we gave some examples of those in the statement yesterday. Part of this is that it's difficult to see the new world until it's there, and yet, actually, in some of these areas, by necessity, we've had to change the way that our system delivers care. So, the remote consultations and the fact that you can see that, I think it was 90-odd per cent of people who thought they were good or better, and 85 per cent of clinicians thought they were good or better. So, actually, there's a lot of positivity about the fact that that way of working works in a lot of cases.

Now, I certainly don't want to see that lost, and I am just not going to go back to having an out-patient system where everyone is recalled on a six-month basis to go and queue up in different parts of our healthcare system. So, we can actually deliver more efficiency.

From my point of view, and I'm not atypical in this sense, when I go for a hospital out-patient appointment, I have to take time out of my working day, which is a frustration for my diary secretary and people who are trying to meet with me. I need to get to the hospital, I need to have the contact time with the clinician that I have, and I normally then need to do another test before I go. Now, that's normally half a day. It's either a whole morning or the whole afternoon, and, actually, the contact time that I have with clinicians is a very, very small part of that. So, it's about how we make sure that the contact that is useful and appropriate takes place. Does it need to be in person all the time? And it's how we re-engineer those different parts of our system, so, simple things, whether it's a urine or blood test, rather than a more complicated diagnostic test—how we deliver those in settings that aren't our big district general hospitals in ways that are more convenient. And, actually, there's a benefit for the public, the patient using that.

What we're seeing more and more is that it's a way that most members of our clinical group of staff actually want to work as well. Some of the concern about a different way of working is driven by people being used to doing something, when, as people get used to doing something in a very different way and recognising the benefits of that, we absolutely need to hold onto that.

10:50

I can totally get what you're saying about clinicians, maybe starting to like this way of working and finding it very convenient, and I'm sure the same is true for many members of the public, but would you agree with me then that it is also vital that if we're going to keep these changes that we do that in a co-produced way with the public? We wouldn't want, say, maybe older people who might feel very uncomfortable about some of this technology being pushed into a situation where they have to do it that way. Would you agree that we have to do that in partnership with the people who use the NHS?

Yes, and actually—. Part of the point for me is when you look at the projects that we've looked at and often win awards within health boards or within NHS Wales awards, it's because they're co-produced, because people talk with their patients about wanting to do things in a different way, and the patient feedback is essential to understanding whether it's the right way to deliver a service that's useful or not. This is a very old technology, like telephone appointments. Lots of people are quite happy to speak to a clinician over the phone, particularly if they've already done a test, and monitor what's going on and not have to travel a significant distance, often, to go to a site. It's a setting where people are more comfortable, as well. A lot of people feel very anxious about going into a hospital.

But, within that, of course, we need to make sure that, if we've got different technological solutions, they're not excluding people. So, if we're doing more and more telemedicine and telecare, as I think we could and should do—we're having to do it already—we need to think about, 'Does that rely on that person, the member of the public, having the right kit, or does it mean that we need to provide a different way for the person to go to a local setting where that kit will be available for them, but that isn't, for example, going into a hospital setting to do so?' All of those things should be possible, and we're accelerating those different ways of working, and, actually, we find that the feedback we get for all of those things that get to be reviewed, once you get over the initial hump of concern, the public are then really enthusiastic about a different way of working that is more flexible for them. It's actually a much better and more efficient use of NHS resources.

Thank you. Can I ask about 'A Healthier Wales' and clinical strategy? How do you feel now that the lockdown is going to have impacted on your implementation of that?

Well, it will have held some things up, and in other areas that we've just discussed, it will have driven them forward. I gave the example of the roll-out of Microsoft Teams. It'll have been compressed from a three-year programme to a one-year programme, because of the necessity for it. I actually think it will have accelerated the case for change, because, as ever, there are people who are evangelists for change and saying, 'We should all do this', and there are other people who take an awful lot of persuading that the world wasn't better at some point in the past, and that's natural in any human service or system. I actually think that the necessity of change will have driven forward that process and the acceptability of it.

We'll need to come back to provide a more measured statement on our assessment of 'A Healthier Wales', the progress we've made and to be able to set out those areas where we think we've accelerated that change. I think it'll be helpful for us then to set out the areas where we've had to pause that change.

So, for example, the work on the NHS executive has been an obvious and visible example where, actually, we haven't put all of the effort that we would have otherwise put into creating that new structure, because we've had to deal with practical examples. But I think the way we're working now has reinforced the fact that that NHS objective will be a good thing to have. It's on a more formal basis now, but we would otherwise have probably been knee-deep into creating that new special health authority, but that's been put off. But I think it would be helpful to say—. It's a useful question to have, about how we describe it not just to the committee, but for the public, where we are in 'A Healthier Wales', what's been accelerated, what's been paused, what's behind time and the reasons for that, but we need to be able to have the space to do it and that we're not trying to deal with all this still pretty furious activity that's going on within our health and social care system, and in doing so we need to make sure we have the conversation with local government and the third sector, as key partners in creating 'A Healthier Wales' as well as, of course, delivering it, because it is a joint plan for health and social care.

10:55

Thank you. Finally from me, then, you know that I'm very concerned about mental health generally, particularly in this pandemic, and I just wanted to ask about the consideration of mental health in the consideration of easing the lockdown. You said yesterday in Plenary that the education Minister had had to balance the public health concerns with the risks for children of remaining off school—and I agree that, yes, she did have to do that—but I am getting increasing numbers of constituents who are really suffering with social isolation, which we know is really bad for your mental health. We know that loneliness is a major risk factor for suicide. One particular constituent yesterday, her family live in England, and she can't see them. She can't see people in Cardiff. Now, I understand we've got to prevent the spread of this virus, but how are you taking into account the very real mental health impact on people of the decisions that are being taken to ease this lockdown?

It's a real consideration that we do discuss, and when we get advice from the chief medical officer and Dr Orford, in their advice there is always a discussion about people's mental health and well-being. The chief medical officer doesn't just look at physical health when he considers public health; he is very concerned about broader mental health and well-being, and that's why shielded people are now—partly because, of course, the risk is low risk, to go outside at this time of year, as long as they exercise social distancing, but it's certainly a material consideration for the chief medical officer in giving that advice. But it should also improve the mental health and well-being of that group of people, but all of us as well.

Missing the social interaction is a key part of who we are, not just children and young people, but people of all ages. Most of us want to be with and see other people. Having to restrict that is really difficult, so it's definitely part of our considerations on easing out of lockdown, both the burden that is being created by the continued lockdown measures, but it's also part of the point about thinking, 'What would be the impact of the next stage of easing, not just on physical health, but on improving mental health?' and we see some pretty shocking evidence from other parts of the country, and China and Italy for example, where we know there's a significant spike that's taken place, not just a rise in mental health challenges, but also in domestic violence and abuse as well, as people are cooped up. So, lockdown is saving lives, but for some people, it's making their lives difficult. For all of us, it's making our lives difficult in different degrees, but for some people, that burden is higher. And that's why I would like us to make as rapid progress as possible to ease out of lockdown, but it's got to be done on a safe basis, which is why I have continued to say that it has to be a cautious approach, that further freedoms on going outside and seeing other people are important, and I look forward to hopefully being able to see further easements and adjustments made.

But I hope it does give you some confidence that we're not just thinking about the physical issues about disease transmission, we're thinking about the broader impacts on all of us as people, and mental health and well-being is definitely a key part of that, and forms part of our discussions around each of our 21-day reviews. It's certainly not absent in our thoughts.

Diolch yn fawr. Dyna ddiwedd y sesiwn. Diolch i bawb am gyfrannu ac ateb y cwestiynau mewn ffordd mor aeddfed a manwl. Diolch yn fawr. Wrth gwrs, yn naturiol mi fyddwch chi yn derbyn trawsgrifiad o'r trafodaethau yma er mwyn i chi allu gwirio ei fod yn ffeithiol gywir. Ond gyda chymaint â hynna o ragymadrodd, gaf i ddiolch yn fawr iawn i Vaughan Gething, y Gweinidog Iechyd a Gwasanaethau Cymdeithasol, i Dr Rob Orford, i Alan Brace, i Albert Heaney, i Samia Saeed-Edmonds ac i Jo-Anne Daniels am eu presenoldeb? Diolch yn fawr iawn i chi gyd. Dyna ddiwedd y sesiwn yna, felly teimlwch yn rhydd i adael ein sgriniau ni.

Thank you very much. that brings us to the end of the session. Thank you very much for your contributions and for the questions, which have been so detailed. You will of course receive a transcript of the discussion to check for factual accuracy. With those few words, may I thank you very much, Vaughan Gething, Minister for Health and Social Services, Dr Rob Orford, Alan Brace, Albert Heaney, Samia Saeed-Edmonds and Jo-Anne Daniels for your attendance this morning? Thank you very much to you all. That brings us to the end of that session, so do feel free to leave our screens.

11:00
3. Cynnig o dan Reol Sefydlog 17.42 (ix) i benderfynu gwahardd y cyhoedd o'r cyfarfod ar gyfer eitem 4
3. Motion under Standing Order 17.42 (ix) to resolve to exclude the public from item 4 of today's meeting

Cynnig:

bod y pwyllgor yn penderfynu gwahardd y cyhoedd o'r cyfarfod ar gyfer eitem 4 yn unol â Rheol Sefydlog 17.42(ix).

Motion:

that the committee resolves to exclude the public from item 4 of the meeting in accordance with Standing Order 17.42(ix).

Cynigiwyd y cynnig.

Motion moved.

I aelodau'r pwyllgor, rydym ni wedi cyrraedd eitem 3 a'r cynnig o dan Reol Sefydlog 17.42(ix) i benderfynu gwahardd y cyhoedd o eitem 4 y cyfarfod yma heddiw. Ydy pawb yn gytûn? Dwi'n gweld bod pawb yn gytûn, felly fe wnawn ni symud i mewn i sesiwn breifat. Diolch yn fawr.  

To committee members, we've reached item 3 and a motion under Standing Order 17.42(ix) to resolve to exclude the public from item 4 of today's meeting. Is everyone agreed? I see that everyone is indeed agreed, so we'll go into private session. Thank you very much. 

Derbyniwyd y cynnig.

Daeth rhan gyhoeddus y cyfarfod i ben am 11:00.

Motion agreed.

The public part of the meeting ended at 11:00.

11:20

Ailymgynullodd y pwyllgor yn gyhoeddus am 11:21.

The committee reconvened in public at 11:21.

5. COVID-19: Sesiwn dystiolaeth gyda Choleg Brenhinol y Meddygon
5. COVID-19: Evidence session with the Royal College of Physicians

Croeso nôl i bawb sy'n gwylio'r sesiwn yma o'r Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon ar deledu byd-eang. Rydym ni wedi cyrraedd eitem 5 ar yr agenda rŵan, a pharhad o'n hymchwiliad a chraffu i mewn i'r argyfwng COVID-19 yma. Mae gyda ni sesiwn dystiolaeth rŵan gyda Choleg Brenhinol y Meddygon. Diolch yn fawr iawn i Goleg Brenhinol y Meddygon, yn gyntaf oll, am y dystiolaeth ysgrifenedig dŷch chi wedi ei chyflwyno ymlaen llaw—defnyddiol iawn, diolch yn fawr. Ar sail hynny a nifer o dystion a thystiolaeth arall rydym ni wedi ei derbyn, wrth gwrs, mae yna gyfres o gwestiynau gerbron i lonni calon pawb dros yr awr nesaf.

Felly, a allaf i groesawu, yn rhithwir, felly, i'r bwrdd rhithwir yma Dr Olwen Williams, is-lywydd Coleg Brenhinol y Meddygon yng Nghymru, a hefyd Derin Adebiyi, uwch-gynghorydd polisi ac ymgyrchoedd Cymru Coleg Brenhinol y Meddygon? Croeso i chi'ch dau. Yn naturiol, mi fyddwch chi'n ymwybodol bod y maes technegol i gyd yn digwydd yn awtomatig tu ôl i'r llenni. Does dim angen cyffwrdd â dim byd. Yn ôl ein harfer ar y pwyllgor yma, byddwn ni jest yn mynd yn syth i mewn i gwestiynau. Mae yna restr weddol hir ohonyn nhw, felly gofynnaf i fy nghyd-Aelodau fod yn gryno gyda'u cwestiynau ac efallai i sawl un arall fod yn gryno gyda'u hatebion hefyd. A allaf ofyn hynny'n garedig? Felly, i'r perwyl yna, rŷn ni'n hapus iawn i ddechrau gyda'r ymateb cyffredinol i'r pandemig yma sydd wedi bod yn y wlad, ac mae gan Jayne Bryant gyfres o gwestiynau—Jayne.  

Welcome back to everyone who is watching this meeting of the Health, Social Care and Sport Committee on global television. We have reached item 5 on the agenda and the continuation of our inquiry and scrutiny of the COVID-19 crisis. We have an evidence session now with the Royal College of Physicians. Thank you very much to the representatives of the Royal College of Physicians, first of all, for the written evidence that you have submitted ahead of time. It was very useful. Thank you very much. And on that basis, and the great deal of the evidence that we've already received, we have a series of questions to be asked, to gladden everyone's hearts, over the next hour. 

So, I welcome, in a virtual capacity, to the table, Dr Olwen Williams, vice-president for the Royal College of Physicians in Wales, and also Derin Adebiyi, senior policy and campaigns adviser for Wales at the Royal College of Physicians. Welcome to you both. Now, you will be aware that all of the technical issues are dealt with behind the scenes, as it were, so you don't need to touch any of the buttons on the screen and, according to our practice, we'll go straight into questions. We do have a relatively lengthy list of questions, so I'll ask my fellow Members to be succinct in their questions and perhaps you might be succinct in your responses too, please. So, to that end, we're very pleased to be able to start with the general response to this pandemic in the nation, and Jayne Bryant has a list of questions—Jayne.

Thank you, Chair, and good morning. On the basis of the outbreak, can you give us some of the key messages that you've had from your members who've been serving on the front line and their experience of dealing with the outbreak?

Thank you for that question. One of the biggest challenges for us as physicians is that we have the well-being of our workforce, as the royal college, as our mainstay. What we have been hearing from our members are in three areas that actually affect their well-being directly from being on the front line. But it's not just the physicians that are actually working on the front line; a third of our individuals have actually moved from their normal area of work to actually deliver acute care and are on wards and working in areas where they would not normally be working. 

We've also got a group of physicians who are unable to work on the front line who've had their services changed dramatically because of the outpatient services being changed, but also have had to shield and, for health reasons, are working remotely. So, there are a lot of areas where things have changed, and whilst everyone wants to hear about the front line, I would like to talk about our global well-being. 

What we've been hearing from our members are in three areas: one, access to testing; secondly, access to personal protective equipment; and, thirdly, the impact this has on them and their families. So, I think the first thing we'd say is around testing and the changes that we've found over the months. Since the beginning of April, the college has had three surveys—one that was held on 1 and 2 April, the second on 22 and 23 April, and then, finally, we had one on 13 and 14 May, where we asked our members across the UK whether or not they had access to testing, access to PPE, and latterly around their well-being. And what we found is that their well-being is directly linked to these two things—whether or not they're able to access testing in a timely manner, and whether their results come back in time, and whether their families are also able to access testing. And we've seen initially, at the beginning, there was good access for patients getting tested, but only 27 per cent of our respondents actually said, back in the first week of April, that they were able to access testing. Fortunately, that now has improved dramatically, where about 93 per cent are saying that they have timely access. They are a little bit concerned that the time to getting their results is very variable, and can be up to and over 72 hours. So, that, again, concerns us, that the turnaround isn't as fast as we would like. And what's interesting is that this is an issue not just in—. This is a pan-UK issue from our members. So, the survey that has members in England, Scotland, Northern Ireland and Wales—the results are equivalent from each area. 

The second thing that our members have told us is the access to PPE. I think there was confusion in the early days about the correct PPE for the different situations that physicians found themselves in. And we know that, initially, 22 per cent of our members told us that they were able to access the correct PPE for the correct situation. But when the amended guidelines came into place in mid-to-late April, our second survey showed that 27 per cent of people were having difficulty in accessing the correct PPE. Now, we've interpreted this as being the fact that PPE was being more widely used, and, of course, when we went into community transmission, most, well, practically all, face-to-face contact with patients now involves some form of PPE, whether it's just a surgical mask right through to the complete donning and doffing.

There are some worries at times that people are worried that they don't have the access to the correct PPE, and have to use, reuse, and 17 per cent have said that they have to actually do this. But we feel now that, in Wales, people generally feel that they have the correct equipment, and they have timely access and do not necessarily have to reuse it on an ongoing basis. But, of course, one of the things, if you're actually being exposed to a virus on a daily basis, is that you take that worry home with you, and none of us can escape from this pandemic's—[Inaudible.]—and it's so important that the well-being of those who care for us is actually managed in an appropriate way. We feel that—. What we've been hearing is that support from the college, the support from Health Education and Improvement Wales and the general health boards putting in a lot of well-being support for clinicians has been extremely good, but our concern is that our members may well not want to access them at this point in time, but maybe in three to five years, when their mental health takes a big hit. 

11:25

Thanks for that response. I know some of my colleagues will be asking some further questions around the testing and the PPE and the key points that you've raised.

What's the experience across health boards, because, obviously, some health boards have experienced it at different points, and they've all been at different stages? And do you think that—? What sorts of challenges have members seen on the delivery of services and the impact on them as well?

I think if we look at how it's spread from the north, the south-east, right up to the north-west—one of the things about the pandemic's pace has been very interesting, because what it has allowed us as clinicians to do is actually share experiences. So, for example, one of the things that we found was that, initially, we did not recognise that some people were presenting with common conditions who actually had COVID. And as a result of not being aware that those common conditions, like heart attacks, sometimes were linked to COVID, people didn't think about using protective equipment in the same way as they do now. So, to some extent that learning has been quite rich and powerful for our members, so that some of the lessons learnt in Gwent are not repeated up in Bangor. And I think that's one of the main things.

11:30

Do you have any current concerns about the way of working or communication that could improve management of the outbreak—like you say, some of the lessons that could have been learnt from Aneurin Bevan?

I think one of our challenges at the moment is that we all recognise that business-as-usual is never going to be the same again. And we also recognise, and we are very concerned obviously, that a significant amount of individuals have deferred or delayed presenting with conditions, and we're now seeing the fallout of that: people who have had the myocardial infarction now presenting with cardiac failure; people who have had their strokes and missed that opportunity for thrombolysis. So, there's that sort of wanting and being out there, saying, 'Please come in if you're got these symptoms; we will manage you safely.' And I think that fear that our population have had around seeing the hospitals as being unsafe places, that we've been able to build on reassuring people around that.

I think the other side of things that we will learn about is that we are concerned about running three systems. So, the system of managing the COVID pandemic; the system of trying to introduce 'business-as-usual', but also managing and ensuring that we have capacity in our field hospitals to look after individuals post COVID and the rehabilitation side. I think, sometimes, we cannot underestimate the huge amount of work and length of time it is going to take for individuals who've acquired and survived COVID to actually get themselves back into any sense of physical and psychological normality.

Thank you for that; that's really important. How confident are your members that they've got the access to all the most recent advice and guidance, because that's going to be so important?

From a college perspective, we've opened up our educational material free of charge to everyone. We've been putting on twice-weekly webinars for our teams and members as regards the latest research about all the epidemiology. And also, there's been a series of—. We've opened what we call 'RCP player', which is a series of 10-minute short topics around COVID, looking at the new changes and—[Inaudible.] But we've also got the platform in Wales, that's the NHS platform that's being updated with all the latest research that all of us can access and sign up to. So, I think there's been—. When we think about COVID, we've probably learnt so much about this new disease in a very, very short time and I'm confident that people have moved from the face-to-face education very much to the online platform.

Diolch, Jayne. Symud ymlaen i faterion—dwi'n gwybod ein bod ni wedi cyffwrdd â'r rhain ychydig ar y dechrau, sef materion profi a darpariaeth cyfarpar diogelwch personol. Mae gan David Rees rhai cwestiynau. David.

Thank you, Jayne. Moving on to issues—I know that we've already touched on these issues at the beginning, but with regard to testing and the provision of personal protective equipment. David Rees has a series of questions on this. David.

Diolch, Cadeirydd. Thank you. You've already answered some of the points in relation to your survey and the increase to 27 per cent who felt they were dissatisfied with the PPE, and that's probably down to the change of guidance in early April. That was probably a month ago. You might not have the data at this point in time, but do you have any views from your members or feelings from your members as to whether that has now improved again? Is there sufficient PPE for members?

Yes, I certainly haven't been told that people are lacking in access to PPE. What we are getting strong feedback through on is around the fit testing and the access to appropriate—well, to fit testing itself, but the appropriate masks, especially when it comes down to our female population.

11:35

Can I make a point on that, because, obviously, members of public will not understand what you mean by 'fit testing'? I've got a good idea, but just for clarification.

It's when you actually get put—. You put the mask on, you put a big hood over, and you can see whether or not there's any leakage from around the mask into the environment, so that it’s kind of sealed so that you're not breathing in any contaminated air.

Thank you. Now, you highlighted in your written evidence to us that you're worried about the fact that if any fit testing has been done, it's mainly aimed towards the male members. Is this the normal practice? Has this not been done before and been dealing and addressing the issues of female practitioners?

I think the good thing is that there has been a huge increase in the number of female doctors, and I think, probably, there has not been a pandemic or a situation like this where people have needed to be fit tested. Usually, when there's a flu pandemic, we do get fit tested, but, of course, it's a slightly different mask. So, it was about actually getting a range of masks to fit different people's faces. For some people it is impossible to get a good enough fit for them to be able to actually go into aerosol-exposed areas. So, they would be advised not to work in those areas.

Okay. And are you working with Welsh Government on that, or health boards, to ensure that, in future, when we look at this—? We've just been told by the Minister—he's indicating that many Welsh businesses are actually stepping up to the plate and helping. Are those types of discussions going on with Welsh Government to ensure that you get the right ones?

Yes, I think there is, probably, a global—. This is not just a Wales issue; this is a global issue. And along with that area is also the other issue around the masks, and that's the fact that, for people who are hard of hearing or deaf, you cannot see the lips—you can't lip-read when you've got these masks on as well.

That's the question of the hoods then, rather than the masks. Okay. And you said that 91 per cent, roughly, are happy with testing, access to testing.

I'm not sure what the issues have been with them. I think, sometimes, one has to have symptoms to get tested. Of course, some people will have wanted to get tested when they didn’t have symptoms, maybe as contacts or their household contacts.

Are you as a professional expecting—? Because, again, with the increase in testing capacity that's been identified, are you now expecting, perhaps, a greater testing of non-symptomatic members of the profession, so that the environment could be—I won't say certified—but given greater reassurances that those are less likely to be carrying the COVID?

I think there are some extreme challenges on testing and the pros and cons of testing. A test only tells you your situation at the point of the test. So, I can have a negative test today, but I also know that there is a high incidence of false negatives as well. So, 20 per cent can be false negatives in some particular tests. Therefore, the test is negative, but I might actually be carrying the virus. So, we've got to think about that.

I think there's another aspect around testing, and that's about antibody testing, because some of us will have been exposed to the virus and not be aware that we've been exposed to the virus, others of us will have had symptoms of the virus. And antibody testing is another area, and I believe that is due to be rolled out this week for the health service.

Okay. My final question is basically on PPE in different settings, and perhaps different health boards. Are you seeing differences across health boards in access and availability to PPE? And are you seeing different availability in different settings within the hospital environment?

Yes. I think early on in the pandemic we were seeing a significant difference and different advice and interpretation of the advice. But since the changes in the guidance came in in late April, there's been a lot more consistency and people, actually, not only having the access, but having the appropriate, for the appropriate setting. I think there are some areas at the moment where there are still some issues around maybe at what point does one go from just a surgical mask to the full PPE, but we're working with our specialist societies and Welsh Government to make sure that those areas, such as endoscopy, have the correct advice and the correct equipment.

11:40

Just a final question on this one. Obviously, you're representing physicians, but are your members also concerned about their colleagues, and to ensure that the whole team effectively is receiving the right protection?

Yes, I think probably one of the things the epidemic has done is that it has brought all the royal colleges together, so the Royal College of Physicians meet with the Academy of Medical Royal Colleges, and we have a weekly phone-in with the CMO, so we actually all discuss our concerns for all our members and share the issues. There are some areas of medicine that actually overlap with surgery and cancer service and palliative care, so, yes, we do work and share that experience and make sure that we all look after each other. I think it's so important at this time that we work as one.

Rhaid symud ymlaen rŵan i adran arall o gwestiynu a materion llesiant staff meddygol a chefnogaeth yn gyffredinol ac mae gan Lynne Neagle gwestiynau. Lynne.

Moving on now to another section of questions and issues with regard to staff well-being and support in general. Lynne Neagle has questions now.

Thank you, Chair. You've mentioned staff well-being already. Clearly, staff have experienced huge trauma during this pandemic and it was good to hear you saying that you feel the well-being support has been good. Do you think that's been good everywhere in Wales, or are there areas you've got concerns about? Is there a consistent approach to supporting staff well-being?

I think there is a good, consistent and driven-from-the-top desire to make sure that everybody's well-being is good. I think the difficulty is that some people will not admit that they're having problems, and I think that's our challenge, to make sure that as clinicians, as physicians, when we spot a colleague in trouble that we don't walk by and that we look after each other from that point of view. But from evidence that—. I've been doing some work for the college now around a sort of road map for well-being, because one of the things that is quite interesting is that sometimes, especially for clinicians, they will not present early with mental health problems, and it can be up to three to five years, so my piece of work will be around making sure that when this pandemic calms down that we continue that well-being support on an ongoing basis over the next three to five years.

Thank you, and it's like traumatic grief, isn't it? People need the support when they need it. They don't necessarily need it now. Can I just ask—and it's good that you're doing that work—can I just ask whether you've had any indication from Welsh Government whether there is any commitment from them to ensure that that support will be available in three years, five years, or whenever it's needed?

Yes. I had a meeting with Mr Vaughan Gething last week and with the deputy CMO, Chris Jones, and that was one of the topics that we discussed. Obviously, it's not in his gift at the moment to fund something five years down the line, but it was something that he certainly discussed and felt that it was something that needed to be supported.

Diolch yn fawr, Lynne. Symudwn ni ymlaen i'r adran nesaf. Cwestiynau ydy'r rheini i effaith y coronafeirws ar gyflawni gwasanaethau yn gyffredinol yn y gwasanaeth iechyd. Hynny yw, wrth gwrs, mae wedi cael effaith, cryn effaith; dyma gyfle i olrhain yr effeithiau hynny. Rhun ap Iorwerth efo cyfres o gwestiynau. Rhun.

Thank you very much, Lynne. We move on to the next section of questions and those discuss the impact of coronavirus on service delivery in the health service. It's had a major impact and this is an opportunity now to discuss those particular impacts, and Rhun has questions. Rhun.

Diolch yn fawr iawn a chyfle yn gyntaf i fod yn bositif iawn, dwi'n meddwl, achos er gymaint o heriau sydd wedi codi yn sgil y pandemig yma, mae yna gyfleon positif dwi'n gobeithio fydd efo ni'n hir iawn. Beth ydych chi'n meddwl ydy'r pethau gwirioneddol arloesol, da a fydd yn aros efo meddygaeth a'r gwasanaeth iechyd a gofal am yn hir iawn ar ôl i'r pandemig yma basio?

Thank you very much and an opportunity first of all to be very positive, I think, because despite all of the challenges that have arisen as a result of this pandemic, there have been positive opportunities that will be with us in the long term as well. So what do you think are the genuinely innovative, good things that will remain in terms of medicine and healthcare in the long term after this pandemic?

Ydych chi'n meindio os dwi'n siarad yn Saesneg?

Do you mind if I speak in English?

11:45

So, one of the—. There's been a phenomenal change in the way services have been delivered across Wales over the last two months. I don't think there has been such massive change ever in the health service, and some of the really positive aspects have been pieces of work that have been 25 years, probably, in the making, and that is around telemedicine. The rural health plan from about 20 years ago stated that we should be actually remote working and it's finally arrived, which is great.

I think the challenges from that, and I had been doing some work—the college in Wales have got an out-patients programme that they've been running, and we'd also had a project up in north-west Wales from the future hospitals RCP project called CARTREF—CARe delivered with Telemedicine to support Rural Elderly and Frail patients—looking at remote consultations for the frail and elderly. In that co-produced piece of work, we showed that individuals in their latter years of life had no issues with technology, and I think that was one of the real positives. But, we've also learnt from our colleagues in mental health, who've been doing the Cwtsh project, around the remote access video-telephone consultations, and now we've seen Attend Anywhere being rolled out for primary care. There are challenges with using video consultations and the Attend Anywhere in secondary care. It is part of the quarter 1 recovery plan from Welsh Government that the health boards have adopted, but there are issues around the technology, how you change what was an out-patients setting to your office base, because all the issues around equipment in different places and the environment, generally. But, I think there has been a real big positive test as well.

I think the other aspect of this that is quite positive is that maybe people are now readjusting to how they access healthcare, in the sense that they're not using the emergency departments in the same way as they were using them pre COVID. They're thinking about self-care, they're accessing online, they're possibly doing—maybe sometimes delaying care a little bit, but they're being more prudent about how they use that facility. And, as a result of that, that allows the people who really need that emergency care, that fast track through, to actually be seen in a very timely manner.

I think it's also an opportunity to actually put aside things that we don't want to do; the things that we've just always done that we don't need to do—the habits.

Well, I think things like if you're reviewing someone, how often do you need to review someone? Can we actually do a lot more shared care with primary care? Can we do remote testing? Can we use our community services a lot more to actually pick up on some of the things like the phlebotomy, the radiology services, the back-up, our secondary care, and really improve that communication, which is quite often on a letter, and, you know, do it more timely?

O'r pethau lle mae yna newid cyflym iawn wedi bod fel, er enghraifft, symud i feddygaeth drwy fideo, mae lot ohono fe'n digwydd mewn ffordd eithaf ad hoc, dwi'n meddwl, ar hyn o bryd, oherwydd bod pobl wedi jest gorfod 'gear-io' fyny i'w wneud o'n sydyn—fel rydym ni i gyd. Ydych chi'n gallu adnabod y math o fuddsoddiad bydd angen mynd i mewn rŵan er mwyn troi y gweithio sydd wedi digwydd yn gyflym i mewn i rywbeth sydd yn gweithio'n barhaol?

Of those things where there has been a very swift change, for example, moving to video medicine, a great deal of it happens in quite an ad hoc manner at the moment, I think, because people have just had to gear up and do it very quickly—as we've all had to adjust. Can you identify the kind of investment that will need to be made now to turn that very swift change into something that will happen and work continuously? 

I think one of the things there is really that we were rolling out our ICT much better than we had, and most people have actually got access to Microsoft Teams, but also the sort of—. It's realising that you might never have used your computer and your desktop to actually speak to anyone, but you realise you can actually video on it, but you can't have any sound on it, and it's actually just getting all that stuff checked out that's caused a problem. And also, there are some things that—it's not about the tech, but it's about the environment you work in. If you've got a shared office, if there are three of you in an office, you cannot do your remote clinic from that office without sending your colleagues somewhere else, so there are logistics around that. But also, I think for most of us as well, it's not as well as doing the other work, it's getting it recognised in our job plans as core work.

11:50

Ambell i elfen wahanol—dŷch chi'n cyfeirio at hyn yn y dystiolaeth dŷch chi wedi'i rhoi i ni: problemau o ran service delivery yn ystod y cyfnod diwethaf yma efo access at feddyginiaeth a'r math yna o beth. Pa fath o broblemau y mae hynny wedi'u creu, beth ydy'r camau sydd wedi cael eu rhoi mewn lle yn llwyddiannus i drio ymateb i hynny a ble mae'r problemau wedi parhau?

A few different elements—you refer to this in the evidence that you have submitted to us: issues with regard to service delivery during this past period, with access to medicines and so on. What kind of issues have arisen? What are the steps that have been put in place successfully to try to respond to that and where have the problems continued?

I think there was a point about two months ago where the realisation that renal problems and the need for dialysis and haemodialysis did cause a huge amount—there was a real concern around access to fluids and things like that at that time. In our last survey, we've had very little—the one that was two weeks ago—concerns raised. So, I think those flagging-up issues around that have been resolved, and I haven't been personally informed that anyone has a major issue at the moment.

Ocê. Peth arall dŷch chi wedi cyfeirio dipyn ato fo ydy'r busnes yma o bobl, wrth gwrs, ddim yn mynd i weld y meddyg pan ddylen nhw fod wedi mynd. Dwi'n deall, o siarad efo meddygon yn fy etholaeth i fan hyn a thu hwnt, bod pethau wedi prysuro erbyn hyn mewn meddygfeydd gofal sylfaenol a'r math yna o beth. Pa mor bryderus ydych chi y byddwn ni'n dal i fyny efo hynny am yn hir iawn a bod angen adnoddau i fynd i mewn i ddelio efo'r problemau sydd wedi cael eu creu gan bobl yn peidio cael triniaeth pan oedd ei hangen hi arnyn nhw?

One other issue that you've referred to a great deal is this issue of people not going to see the doctor when they should have done so. I understand from speaking to doctors in my constituency and beyond that things are busier now in primary care surgeries and that kind of setting. How concerned are you that we will be catching up with that for a very long time to come, and that resources will be needed to deal with the problems that have arisen because people have not accessed care?

Hopefully, it has been very short-lived, because those people who have acute conditions—so, strokes and myocardial infarctions—will have now developed problems because of the time phase. I think probably more concerning, and it's certainly a piece of work that the RCP in Wales is currently doing, is around cancer diagnoses and delayed diagnoses around cancer. I cannot give you any evidence at the moment of what we feel, but we are looking at that as part of a project that our doctors in training are doing.

Diolch yn fawr iawn. Yn sicr, mae rhai o'r elusennau a sefydliadau canser eraill yng Nghymru yn gwneud gwaith ymchwil manwl iawn yn y maes yma hefyd ac yn pasio gwybodaeth a thystiolaeth ymlaen i ni fel pwyllgor. Rwy'n hapus fel yna am y tro, Gadeirydd.

Thank you very much. Certainly, some of the charities and cancer organisations are doing very detailed research in this area as well and are passing evidence on to me and the committee. I'm happy with that for now. Thank you, Chair.

Diolch yn fawr, Rhun. Symudwn ymlaen i'r adran olaf o gwestiynu rŵan, byddwch chi'n falch o gael gwybod, o dan ofal Angela Burns, ar gefnogi adferiad gwasanaethau a dod allan o'r pandemig yma—mae'r llwyfan gydag Angela.

Thank you, Rhun. We'll move on to the final section of questions now, you'll be pleased to hear, with regard to supporting service recovery as we ease lockdown in this pandemic—Angela.

Thank you, Chair. Hello Olwen, hello Derin. I just wanted to talk a little bit about supporting the service recovery, moving out, now, in a post-COVID world, but can I just go back to something that you said to Rhun when you were talking about people adjusting to how they can handle their own healthcare? Of course, has the Royal College got a view or are you doing a piece of work on actually what that could translate to? Because one of the concerns that we obviously have is that people are doing it so much that they're not going for treatment, when, in fact, they should be. We've got people not turning up at A&E and going, 'Oh, this will be fine', or just putting off general stuff. You know, we've all read the stories of the person who goes to A&E because they've stubbed their toe, and that's what we want to stop, because, of course, you can manage that, but we don't want to throw the baby out with the bath water.

At the moment, I can say that we're not doing any particular pieces of work in Wales from the college perspective, but, no doubt, some of the other colleges, especially, probably, the Royal College of General Practitioners, might well be doing that, but I have no evidence on that, sorry.

No, okay, thank you. Can you, perhaps, outline to us any discussions that you're having with the local health boards about how we're going to go back to delivering normal services, whilst obviously keeping a weather eye on whether or not we may have a second COVID spike? I know, particularly, there are major concerns around the winter planning issue.

11:55

As a college, we won't have any direct discussion with the local health boards, but what we have been doing is contributing to the quarter 1 and quarter 2 plans that Andrew Goodall is developing as chief executive. One of the things that we're concerned about from a workforce point of view is that the workforce, certainly the physicians, are tired and we're really concerned about actually starting up business as normal. 

One of the things that we have highlighted is that, of the recruits, the return-to-work doctors who came in, very few of them were physicians, so members have not benefited from that increase in workforce that one would have expected. We're also very aware that the return-to-work people have been given notice to say that they're being stood down at the moment, and of course that concerns us because I hope there isn't going to be a second blip, but if there is we will need more individuals back into the service, because our current workforce will be unwell.

Sorry, I just want to clarify that. So, who's been told to stand down—the people who've come back in to help temporarily?

Yes. There was a group of individuals who were recruited who were on the list who never got appointed into roles; they've been asked to stand down.

Well, that's something we should take up with the Minister, because one of the things we know for a fact is that we have massive gaps in our service capability; we don't have the people. And it does seem to me to be so counterproductive, having grabbed them off the street and persuaded them to come and work for us during a pandemic, to simply stand them down, because we've got a massive backlog of patients for a start, if nothing else, forgetting the COVID element. I'm really—actually, I'm genuinely appalled to hear that, and I wondered if you might be able to provide us with any further information on the number of people, where they are, which health boards are standing them down.

So, it's the workforce group, and I have personal communication with individuals who've received e-mails saying, 'You're no longer required, can we contact you in the future?' I think one of the things here is that some of the individuals, obviously, may well not be able to work front-line, but, at a point when we want to return to some sort of normality, we would be able to use these individuals in an educational aspect, in actually supporting out-patients, and in a lot of roles that are not necessarily on the wards. I think we've got to be more imaginative about how we use these individuals.

I have asked around the health boards around how many—and this is physicians, now, that have been brought in, and there are very few. I know that, in Betsi, in one, there are three who've come back to work who've just recently retired and they've returned and gone on the wards, but mainly, a lot of them have been told, 'Well, we can't use you because you can't do the ward work.' But actually, there are so many other roles that useful clinicians can actually work in that we need to think about.

Yes, and it would be so useful, if it's at all possible, to have a little bit more of a briefing paper on that to give us some examples. So, for me, I don't understand the set up really well, but I'm assuming that if you're a physician you're obviously a highly trained and skilled individual. For you not to be able to do ward work, I'm assuming it must be perhaps that your registration isn't current or your continuing professional development is not current, or whatever it might be. But if you could perhaps give us a feeling, and as I say, not necessarily now, but a paper that would indicate the other kind of work that that individual might be able to do that would therefore take the pressure off of a current physician who would be able to do the ward work—. Especially when we've got things like the field hospitals, which I know many health boards are looking at how they might be used to do step-down capacity or to try to catch up on elective surgeries or any of those things. We need boots on the ground, and we've always been short of people, so to let people we've got go is just—well, as I said earlier, it's counterintuitive.

12:00

And I think one of the challenges here is probably people weren't thinking around recovery plans. It's now at the point of recovery that these individuals would have a major positive impact, especially because if some of them are in a risk group or needed not to be on the front line—the remote technology of the Attend Anywhere to be able to do the out-patient work and actually restore some out-patient services in their areas of expertise would be an excellent way of using them.

Yes. And could you tell me if the COVID issue has actually stopped the recruitment and training of—I assume they come under you—associate physicians?

No. Yes, they do come under us, and have been, although HEIW are now taking more, I think. There's been no real change. Ongoing recruitment of all aspects of health, of doctors and their PAs, has been ongoing.

Okay. So, apart from that, though, the royal college itself hasn't actually been involved in any of the real sort of nitty-gritty discussions with health boards about how we might get back to a new normal, or, more importantly, what a new normal might look like.

Well, not directly with the health boards. So, our specialist societies have all come up with recovery plans that are shared with our members across the UK, and we've been feeding them into the Welsh Government's plans. Our role isn't necessarily to work directly with health boards, but with our members, as such.

Yes. And are there any further comments that you would like to make about, you know, 'let's just look for the next six months to a year, two years out'—the kind of opportunities that we might be able to try and maximise on as we come out and into recovery mode? You talked earlier about the benefit of telemedicine, about changing some of the IT to support it; you talked about the logistics of not having the office space to have private and confidential discussions with patients. But are there any new initiatives? Because, of course, the one benefit of this pandemic is that it's accelerated the pace of development, hasn't it—the pace and scale of change. Are there any other benefits or possibilities that you as a college see that we could perhaps incorporate in going forward?

I think one of the things is around education and learning, and I think that the moving to remote learning is a really positive thing. But, on the other side, there is a flipside to that in that, actually, quite often our peer support and face-to-face meeting occurs at conferences and at meetings, and that is something that will probably not happen for months to come.

Reit, diolch yn fawr. Wel, dyna ni, dŷn ni wedi dod i ddiwedd y cwestiynu, felly diolch yn fawr iawn ichi am eich presenoldeb. Diolch eto am y dystiolaeth ysgrifenedig gwnaethoch chi ei chyflwyno ymlaen llaw—mae'n fendigedig. Mae wedi bod yn sail werthfawr i’n trafodaethau.

A allaf i bellach gadarnhau mi fyddwch chi yn derbyn trawsgrifiad o'r drafodaeth yma er mwyn ichi allu gwirio ei fod yn ffeithiol gywir? Ond gaf i orffen drwy ategu ein diolchiadau unwaith eto i Dr Olwen Williams, is-lywydd Coleg Brenhinol y Meddygon yma yng Nghymru, ac i Derin Adebiyi, uwch-gynghorydd polisi ac ymgyrchoedd Cymru, Coleg Brenhinol y Meddygon? Diolch yn fawr iawn i chi'ch dau. Teimlwch yn rhydd rŵan i wthio pa bynnag botwm yw e, achos dyna ddiwedd yr eitem yna. Diolch yn fawr.

Okay, thank you very much. Well, we've come to the end of the questions, so thank you very much for your presence. Thank you also for the written evidence that you submitted ahead of time. It's excellent, and it's been a very valuable basis for our discussions.

May I also confirm that you will receive a transcript of today's discussions so that you can check it for factual accuracy? And I'll conclude by thanking, once again, Dr Olwen Williams, RCP vice-president for Wales, and Derin Adebiyi, senior policy and campaigns adviser for the RCP in Wales. Thank you very much to you both. Do feel free to press whichever button it is to exit Zoom. Thank you very much.

Diolch yn fawr iawn.

Thank you very much.

6. Papurau i'w nodi
6. Paper(s) to note

Ac, i'm cyd-Aelodau, dŷn ni wedi cyrraedd eitem 6 rŵan a phapurau i'w nodi. Mi fyddwch wedi darllen llythyr gan Gadeirydd y Pwyllgor Cyfrifon Cyhoeddus ynghylch llesiant cenedlaethau'r dyfodol, adroddiadau statudol, a hefyd mi fyddwch wedi gweld y llythyr gan Gadeirydd y Pwyllgor Cyllid ynghylch gwaith craffu ar gyllideb ddrafft Llywodraeth Cymru ar gyfer y flwyddyn 2021-22. Hapus i nodi, neu os ydych chi eisiau codi—? Hapus i nodi. Diolch yn fawr.

And, to my fellow Members, we've reached item 6 and papers to note. You will have read the letter from the Chair of the Public Accounts Committee regarding the well-being of future generations statutory reports, and you'll also have seen the letter from the Chair of the Finance Committee regarding the scrutiny of the Welsh Government's draft budget for 2021-22. Are you happy to note those papers? I see that you are happy to note those papers.

7. Cynnig o dan Reol Sefydlog 17.42 (ix) i benderfynu gwahardd y cyhoedd o weddill y cyfarfod
7. Motion under Standing Order 17.42 (ix) to resolve to exclude the public from the remainder of this meeting

Cynnig:

bod y pwyllgor yn penderfynu gwahardd y cyhoedd o weddill y cyfarfod yn unol â Rheol Sefydlog 17.42(ix).

Motion:

that the committee resolves to exclude the public from the remainder of the meeting in accordance with Standing Order 17.42(ix).

Cynigiwyd y cynnig.

Motion moved.

Ac felly rŷn ni'n symud ymlaen rŵan i eitem 7, a chynnig o dan Reol Sefydlog 17.42(ix) i benderfynu gwahardd y cyhoedd o weddill y cyfarfod heddiw. Ydy pawb yn gytûn? Pawb yn gytûn, felly awn ni mewn i sesiwn breifat i drafod y dystiolaeth, a dyna ddiwedd y cyfarfod cyhoeddus, felly. Diolch yn fawr i bawb.

And then we'll move on to item 7, and a motion under Standing Order 17.42(ix) to resolve to exclude the public for the remainder of today's meeting. Is everyone agreed? I see that you are all agreed, so we will go into private session to discuss the evidence that we've heard, and that brings us to the end of the public meeting. Thank you, all.

12:05

Derbyniwyd y cynnig.

Daeth rhan gyhoeddus y cyfarfod i ben am 12:05.

Motion agreed.

The public part of the meeting ended at 12:05.