Cynulliad Cenedlaethol Cymru

Good morning. Can I welcome Members and the public to this morning's meeting of the Committee for the Scrutiny of the First Minister? This will be our last committee meeting before the end of this sixth Senedd, so I want to put on record my thanks to all the committee team over the years we have been delivering this committee, for their support during that time—without that, I think we will have been always struggling. So, thank you very much for that.

Just to go through some housekeeping, please make sure that your phones or other electronic equipment are either on silent or switched off so that they don't interfere with our meeting this morning. We do have Mark Isherwood on Zoom and I hope, Mark, that the English translation is available for you and it's working well. Give us a thumbs up if it is.

Maybe not. We'll check that as we go through.

Just on other housekeeping, there is no scheduled fire alarm today, so if one does take place, please leave the room and follow the directions of the ushers to a safe location. If you require simultaneous translation in the room, then that's available on the headsets via channel 1. If you require amplification, that's available on the headsets via channel 0.

Can I welcome the First Minister to the meeting? Before we go into the meeting, just to confirm, does any Member have any declarations of interest to make? There are none.

First Minister, welcome. Would you like to introduce your officials for today's meeting, please?

Diolch yn fawr iawn. I've got three officials with me today: Andrew Jeffreys, who is director for finance; we've got Nick Wood, who is deputy director of the national health service; and Emma Williams, director of education.

Can I welcome you all? Just before we go into the business, would you like to make any introductory remarks, First Minister?

Yes. Thank you, first of all, for inviting me back. It's always a joy to undertake these sessions. I just think, actually, it's worth reflecting, very often in politics, what you're doing is you're just looking forward, 'What comes next? What comes next?' This was an opportunity, in preparing for this, to actually look back and to say, 'What have we done? What have we accomplished? How far have we got?' And I must say that I'm incredibly proud of what we've achieved over the past five years.

If you think about the context of how we went into this session, we weren't even allowed to campaign right at the beginning. We couldn't knock doors. We were still just coming out of the pandemic. And you think that feels like a long time ago now, but since then, don't forget, we've been contending with Brexit and the fallout of that. We've had, I think, four or five Prime Ministers. We've had global instability. We've had massive inflation as a result of the Ukraine war. We're now in another really volatile global situation. So, I just think we should remember the context over the past five years that we've been working in. And what I think is quite, quite extraordinary is the fact that, despite that context, despite the inflationary pressures, despite all of that volatility, we have delivered on the vast, vast majority of our programme for government. I just think that is something that we should be proud of.

Since I've come in, I've been really, really focused on delivery, because I think there's a real issue in politics today. There's a lack of trust. So, when you say you're going to do something, I do think it's important, as far as possible, that you try and follow through. And so delivery, for me, was absolutely key. You can see that delivery now, and you can see it when somebody gets a hospital appointment on a Sunday. You can see it when they've been called in to evening appointments. We've seen those waiting lists coming down, because I just thought that it's a really big issue for the public. It's been really, really challenging.

And then you think about how you're seeing scaffolding appearing in the middle of towns. It's because we're creating new homes for people and just making sure that families have somewhere to go. There's the frustration that I know lots of motorists are feeling at the moment, because they have road closures. Why have they got road closures? Because we're filling the potholes. So, all of those things are happening, I think, on a really consistent basis.

That focus that I've brought on better transport, better health, more jobs, more homes, that fairness you can feel—those are not abstract. What's important for me is they're real-world delivery, and we have managed to deliver. We've got waiting lists down 92 per cent from their peak on the longest waits. We've got record levels of social housing—20,000 by November; £800 million—the transformation in our railways is quite extraordinary. I think £1 billion on the core Valleys line, £800 million on new trains; 49,000 jobs supported in the private sector; 64,000 young people supported through the young person's guarantee; 100,000 apprenticeships delivered; 65 million free school meals served.

There's also landmark legislation that we've gone through and that we’ve introduced. Tackling homelessness, I think, is something that we’re particularly proud of, but also ending profit in children’s care. This legislation very much speaks to our values as a Government.

So, obviously, we always want to do more—we always want to do more—but in the context of what we were working with, I think we can be incredibly proud of what we’ve managed to deliver.

Thank you for a brief summary of the last five years, and perhaps pre‑empting one or two questions, but we’ll go into more detail, clearly, as the morning goes on. But before we go into some of those points, and particularly on programme of government commitments for the last five years, you mentioned there the word ‘trust’ and the trust with the public, effectively, around delivery. Of course, we’ve seen this week the publication of a leaked memo, which questions trust between Governments, in one sense, and I just wondered whether that memo, which highlights, perhaps, questions about the relationship between the Governments, between Wales and Westminster—how has that impacted? Do you see that as a reality, or actually are you seeing it differently to what that memo is implying?

So, I read the memo on Tuesday, and I was able to speak to the Prime Minister on Wednesday to get clarification on what he meant within that letter. He made it clear to me that when he was talking about direct delivery in the nations, he was talking about issues reserved to the responsibilities of the UK Government. That was something—. If you read the letter carefully, it doesn’t say in devolved areas, and I think if you think about what the devolved areas are—. Pensions, benefits, home affairs, immigration, foreign affairs, those kinds of areas—. I think, for me, just to give you an example of where, for example, if you had a Government in future that may say, ‘Do you know what, we don’t agree with getting rid of the cap on the two‑child benefit’, and if it was in a reserved area, the UK Government would say, ‘Do you know what, we still want to support 70,000 children in Wales.’ I think that is something that we should bear in mind, and in those circumstances, I would very much agree that that would be an approach where the reserved authority of the UK Government makes sense.

So, the issue for us in the past, I think, is that, actually, part of the problem is they haven’t done enough in our country. When the Tories were running Wales, you know, we didn’t get the kind of money we should have got for rail infrastructure. I’m really pleased now that we’ve been promised £14 billion of additional funding, and I want to see that money spent in Wales. I don’t want to see—that hasn’t been welcomed by all parties. I’d want to see that money spent. So, I just think it is important to think about that context as well.

So, in the sense that you are responsible for inter‑governmental relations, do you see those relations strained in any way, and does that memo highlight the strain between the Governments?

I speak as I find. I have been clear in terms of our relationships ministerially that our ministerial relationships are directly with the UK Government departments—we don’t go via the Wales Office—and that the relationships are considerably better than they have been under 14 years of Conservative Government. The fact that I can pick up the phone the day after this came out I think demonstrates that, actually, we can have, and we always do have, robust conversations and clear conversations. But also the fact that I can pick up the phone demonstrates that, actually, that relationship is in a very different place from where it has been for 14 years under the Conservatives.

Llyr.

Thank you, Chair. You’re right about that direct relationship between the Welsh Government and individual departments, not necessarily through the Wales Office. But do you agree with your Labour colleague Mick Antoniw, who said recently that he didn’t believe we need a Wales Office any more at Westminster?

I think there’s a role for the Wales Office. I think there are a lot of areas of reserved responsibility where actually having the voice of Wales at the Cabinet table, making the case for what the impact might be on Wales, what a difference it might make—. I think you can make a strong case for that. There are lots of areas of local government responsibility, for example, where we don't actually have the powers—they are non-devolved. So, I think there's a role. I think having a Wales voice at the Cabinet table is something that should be of help to us. What I don't want to see is the Wales Office being used as the voice of the UK Government in Wales. That is not how I see this role.

But some criticism of that role suggests that that's how it's perceived currently by many.

I can talk to you about how I see it and how our relationships work. Our relationship is directly with UK Government departments—that's how we work—and it's improved significantly. And the structures are also much better than they used to be. I think that's the other thing—that there was a kind of intergovernmental framework and scaffolding, but it wasn't really used, and now that is considerably better.

We had some of your backbench colleagues, in relation to the memo, speaking on the airwaves on Wednesday morning, describing the situation as almost like a re-emergence of backward, introverted politics—the sort of politics we had under the last Tory Government. It's been described as pretty disgraceful. You've given us your take on it. But that does follow just a few months after that letter from the backbenchers of your party complaining to the Prime Minister that he was rolling back devolution. They've been pretty vociferous in their criticisms. Why do you find it difficult to be as critical of some of these interventions that are being made that seem to undermine devolution?

I've read the letter closely. I'm not sure if they had read the letter closely. It talks about direct spending

'even when devolved governments may oppose this'.

I think there was an assumption that that meant 'in devolved areas', and that's not what it actually says.

Let me be clear that there are still issues in relation to the United Kingdom Internal Market Act 2020. We're continuing our discussions between our Governments, the Governments of the rest of the United Kingdom, and the Prime Minister, in terms of when and how financial assistance powers are used.

I want to bring Jenny in for a moment.

Moving away from a specific memo that was written in December, and a lot of water has gone under the bridge since then, I just want to ask you about certainly the frustration of the Equality and Social Justice Committee on the lack of progress on devolving any part of the criminal justice system. We've had no progress on creating the women's centre in Swansea, even though it's got planning permission, and similarly with youth justice.

I just think there's a real frustration that there just hasn't been any change since we had the previous Government on this. And it's not as if they're doing brilliantly either, with 79 per cent recidivism. You'd think they'd be keen to see if we could do something better and prove that we actually have a different approach to spending all these vast sums of money.

There has been a lot of discussion on this issue. And indeed, today, David Lammy, the Deputy Prime Minister, is in Cardiff having discussions with the relevant Government Ministers here in Wales about this issue.

Okay. Thank you. I suppose the other thing, though, is things like the devolution of the administration of welfare benefits. We'll come on later to youth unemployment, but it's incredibly important that we can have those conversations with all the young people who need help getting into work. And without the ability to do it at the time they're coming to sign on, it just makes life more difficult for us. We've got to go and chase them out in wherever they live.

There are conversations going on, and there's an agreement in principle that that will be coming our way. What we want is to make sure we get the money if they are coming. If we're getting the powers, we want the money, thank you. 

We'll come back to some of the issues on devolution of other aspects during this morning, I'm sure. But we're going to move on now to look at some of the programme for government commitments and the progress that's been made over the last five years, or perhaps not made over the last five years, it depends where we see it. Peter, I'll come to you first.

Thank you. Good morning, First Minister, and thank you for the preamble. I think we all recognise the context that the Government and Parliament has had to work under for the five years, especially coming out of COVID and various things like that. So, we recognise that there have been challenges. I also recognise some of the progress that has been made within the health service in reducing waiting lists. That has accelerated a little over the last few months, anyway; we see a little bit of difference. But there is still grave concern out there from the public, who are still really struggling to access the treatments they need. They're still waiting huge lengths of time. We are seeing cancer treatment times way off target, but also within that, a massive discrepancy in who is being treated or not, or diagnosed or not—gynaecological cancers, for instance, are down at under 40 per cent. People there are getting terrible things. We are seeing, in ophthalmology, huge waiting lists, where it's actually life damaging. There is no comeback from it. So, how are we going to make further progress on those harder to reach areas? We might be able to drop the wider waiting lists down and see a little bit altering there, but that masks some really challenging assessments of where we are in delivering certain services around cancer. How do you respond to that?

First of all, I think the most important thing is to be clear that we've got a strategy. It's a strategy we've had in place for a while. There have been circumstances that have knocked out our ability to deliver on that strategy, like a COVID pandemic. But we've revisited it. We're absolutely convinced that the strategy itself is what should be delivered. Generally speaking, the strategy is that you shift resources into primary care, you shift resources into the community and you modernise and digitise the NHS. Those are the three things. You need to get into the prevention space. That's how you stop as many cancers from coming forward. A lot of cancers are preventable. You've got to get into the prevention space. And that's not just about health. It's about well-being, it's about making sure people eat healthily. You've really got to get in at a very, very early stage. We are committed to that approach.

When you have as many people on waiting lists as we did coming out of the pandemic, clearly you have to put resources into that. It's the most expensive part of the NHS, secondary care in hospitals. What you've seen is a huge amount of additional resources going into secondary care in order to bring those waiting lists down. But that's not to say that we haven't continued to invest in primary care and in prevention and into that shift into the community. Just to give you an example of that, the money we've put into primary care in this Senedd has gone up by £300 million. So although, percentage-wise, it might not look balanced, there has been an increase in the amount of money that has gone in. What that means is that more patients are able to be seen. So, 19.4 million appointments delivered per year. This is a big, big number here of people who are getting a service. And that's before we talk about that shift into the community—things like optometry, we talked about what you do about that. Again, how do you stop that from happening? Early intervention. We have paid for 865,000 eye tests in the NHS. What's great about that is that 60 per cent of optometrists now in our communities are working for us as well. That didn't happen five years ago.

There is some good progress in optometry; I recognise that. But what we're hearing here in my committee work and things is that whilst we're hearing a lot of talk about the preventative agenda, and we're moving into the preventative agenda, we're investing in primary care, on the ground, the witnesses we've spoken to in various inquiries show that, actually, it's a different picture. The gap between primary and secondary is actually widening, and GP practices, for instance, are having to stop providing some things they used to provide because they could afford to carry those. They can't afford to carry them anymore, and they're presenting in secondary care, which is actually counterintuitive. It's a constant, I've found, that there's a mismatch between what the Government is saying and what the people are feeling on the ground, and that goes into social care as well. 

You're saying that you're focusing more on preventing, and you've got some evidence to show how that's happened, but there seems to be this—. On the ground, we're seeing dentists, for instance, who are really struggling to carry on providing the service they want for the NHS; they're going private. We're seeing pharmacists who are geared up to deliver more front-end primary stuff, and don't believe they're getting paid for it. They're struggling to carry on, with some pharmacists actually thinking of having to pack up because they can't make the whole job pay. So, there's this big gap. How do you square that circle, where the Government is saying that's where the focus is, but we're not actually seeing that on the ground, or the deliverers aren't seeing it on the ground?

I don't accept they're not seeing it. The question of whether they are feeling it, I think I accept. You've got to be able to feel the change. The demand on the service is extraordinary. You're aware of my figure of 2.75 million appointments—not contacts, appointments—every month in the NHS, with a population of 3.1 million. I think it's quite extraordinary.

Let's talk about some of those issues you've touched upon. You say they don't feel the difference, but the fact is that 0.5 million people in Wales now have had new NHS dental appointments in Wales. Do we need to go further? Of course we do. But that's 0.5 million more than were having it before—they are new patients. So, you're asking me for evidence; there's some evidence. 

You talk about pharmacy. You could go to a pharmacy before, and you'd get, five years ago, no support at all. Today, pharmacies give support for 28 different conditions. In England, I think it's about seven. A lot of them now are independent prescribers. So, 270 of those pharmacies are independent prescribers, with 470,000 consultations. All that takes pressure off GPs. I hope that demonstrates to you—. How people feel, I get it. I get that, because the demand is increasing all the time, that is difficult. 

I do want to mention mental health, if you don't mind, as well. Because, going into that election, I was Minister for mental health, and it was really difficult, the pressures. You can imagine, there were a lot of people in a bad way coming out of the pandemic, and the amount of time people had to wait for mental health support was not acceptable. What we've done is we've got a ring-fenced allocation for mental health, unlike other parts of the United Kingdom. We've introduced the '111 press 2' service, and that's received over 240,000 calls. Again, this is about 'get in there early, get access', so that people can get that. 

And what we see today is, for under-18s, 94 per cent of young people referred to local primary mental health services were assessed within 28 days. That definitely wasn't happening five years ago. I'm sure we'll come on to talk about youth unemployment and things. One of the key issues is mental health. You can't fix youth unemployment unless you sort out the mental health bit. So, all of these things actually fit together.

Can I come in for a second, Peter? You've talked about the preventative agenda, which I think a few colleagues will want to talk about, the preventative agenda. You're focusing on the GP and primary sector, focusing more on the community, but I've got patients on the cancer side—. I've got patients and constituents—I'm sure we all have—who have come to me and said, 'They've missed me in the surgery so often, and it's only when you end up in hospital that they find something.' So, there is a problem sometimes. You might have more primary care, but you're still missing conditions, and unless you do something with the diagnostic agenda, you're not going to get those. So, when is the focus going to be on diagnostics to ensure that if you move into primary care, they can refer into diagnostics quickly without having to go via consultants? So, the system needs changing, basically, and no offence, but Tassia Haines was a perfect example of this. We've got something to change the system—it still hasn't changed. Getting the system to change is torture. So, how are we putting things in place to get the system changes, so that you can deliver those primary changes of community care to actually deliver on the preventive agenda and early diagnosis?

We are shifting—trying to shift—diagnostics back into the community. I'm going to ask Nick to come in on this in a second. But things like the investment in the new diagnostic centre in Llantrisant, all of those kinds of things will make a difference, and we've got rapid responses to concerns about cancer, for example. I've seen that kind of example close up, and you can see people getting treated very, very quickly. So, there's an alternative path where we followed—was it the Danish model, I think? But if I can ask Nick to elaborate a bit on what we're doing in relation to diagnostics.

Yes. Thank you, First Minister. The point you make about access to diagnostics is ultra critical across a whole range of services, whether that's people who have presented at an emergency department, those who are presenting with cancer, or just a general planned diagnostic following a referral from a GP. Of the planned care plan for investment this year, which was £120 million, circa £17 million has been spent on additional diagnostic testing this year. So, we will deliver in the region of 30,000 extra diagnostic tests to patients who were on existing waiting lists. What that allows then, of course, is a release of some of the capacity that is in the system to support patients who are presenting with cancer, or suspected cancer, or are in an emergency situation. We've seen the volume of patients on the diagnostic waiting list go up, but the time that they're spending on that has now started to come down as that extra capacity has gone in.

As the First Minister's alluded to, we've also seen an increase in the number of GP practices having access to local, rapid diagnostic testing to support early signs and early symptoms of cancer, and that's proved quite successful in a number of areas, but there's still insufficient capacity in there to meet the extra demand that is coming through from a cancer perspective. I think we've probably discussed this in the Health and Social Care Committee, that the volume of patients who have suspected cancer or early signs has gone up exponentially in the last four years. The conversion rate—so, those that actually have cancer—has stayed broadly the same. It's around about 3 per cent to 4 per cent of all of the referrals. And the cancer target only measures those who have cancer. It doesn't measure the 10,000 to 15,000 every month who were told through the diagnostic test that they don't have cancer.

So, I absolutely recognise that access to cancer services is not as rapid as it needs to be. We're working with the health service to try and improve that by putting more diagnostic testing in, but that is, again, limited by the volumes that are coming through the system.

Peter.

When we talk about diagnostics as well, public health could do a lot more through screening. Why haven't we done more on screening? For instance, prostate cancer screening programmes that were in place decades ago, and very, very, very successful, yet we don't see those now. Many older men my age can't access those things without really trying hard to get into the doctor's surgery. And this is the trouble: getting into primary care, into doctors' surgeries. We've still got that 8.00 a.m. bottleneck, that real issue of people accessing the service. And they give up. They're not getting early diagnostics, they're not getting screened. So, there is a big part of this preventative agenda that is being missed. Surely there is a plan, so, how should we address that in the future?

So, 1.6 million of them don't give up every month. I am worried about the ones who aren't being pushy and staying on the phone. Those are the ones I'm more worried about, because those are the ones I don't want to see them miss, and then we have to deal with them much later, and it's more difficult to deal with them. Why hasn't it been done before? Look, to do screening, you need expensive kit quite often, and we haven't had the money to spend on expensive kit. We have been starved of capital funding for a very long time when it comes to the NHS, and now those taps are being turned on again, we are able to invest more in some of that kit that is necessary.

I think it's probably also worth saying that, actually, we're more transparent here in Wales about diagnostics and the waits for diagnostics. They don't even count them in England in the way we do, so they're not in the figures. When people keep on comparing Wales with England in terms of waits, therapies and diagnostics are not included in England. I just think we're clearer, more honest with the public about what's going on in Wales, and I do think it's probably worth just thinking about that. Ninety-six per cent of the people who are sent for screening are told they don't have it. So, we are screening a lot of people to get to those 4 per cent. I'm worried about the 4 per cent, how quickly we get to them. Nick, have you got anything to add to that?

Yes. I think the screening point is that—. Some of that is a public action point as well as a health service or Public Health Wales point. So, we have a really good bowel screening service in Wales where, over 50, you get sent the kit in the post. Whilst the take-up of that has gone up, it's still not where it needs to be. Now, that's a public choice to participate in that, so I think we've got to encourage take-up of screening. We've got a very good breast screening service. You reference prostate screening; that, of course, wasn't recommended through the public health system, the new prostate screening. You can access a prostate screening with your GP—

If you can get a GP.

—men of a certain age and all that. We've just agreed a business case to purchase considerable amounts of equipment for the lung screening process, which will commence in the next 12 months. So, we have absolutely got to push screening, but we've got to get the public to understand that they are responsible for their health as well as the NHS.

Thanks for that. I'll move—

I've got—. Sorry, I know you want to keep going, I've got three people wanting to come in at the moment.

Oh, right. Yes.

So, I'm going to start with John, then Mark, and then Carolyn.

I am interested in the preventative health agenda, First Minister, because it's easy to see how the health service is so reactive, in some ways from necessity, as you've described it, and the incredible demand that there is for those health services. With the political, public and the media's concentration on things like waiting times for elective surgery, waiting times at A&E, delayed discharges, ambulance response times, it's easy to see the heat that is generated and how the health service responds to that. The preventative agenda, I think, gets much less attention, and you can understand why. But if we're ever going to make the health service sustainable when we have such an ageing society, we have the obesity levels that we have, and so on, then we absolutely have to get on to that preventative agenda, difficult though it is.

It's hugely frustrating, I think, sometimes. I've arranged conferences and events in Newport for the last couple of years, bringing the health service together with leisure and sport and physical activity, the local authority, the voluntary sector, and although everybody signs up to the need for a change to be more preventative and get more investment into leisure services and other services, to be honest, little actually happens that delivers on that agenda. So, I'd just be interested in your thoughts, difficult though it is. Exercise is the miracle pill and it's free and some great things happen. Parkrun is amazing, I think, in terms of that free exercise that's on offer, and the take-up is very good. They do things like prescribing from GPs to the parkrun, Couch to 5k, and they have a cancer initiative as well, which is highly effective. So, some good things are happening through particular organisations, but in terms of the scale of change that we need to see, if we are truly going to be more preventative, I think there's not a lot of sign of that shift taking place in Wales.

It's not because of lack of Government effort. We've got a new approach now with the ‘Healthy Weight: Healthy Wales’ update, and there's been a huge amount of consultation that's gone into that to make sure that we understand the preventative agenda, particularly when it comes to obesity and overweight. Jenny is always very keen to make sure that we look at food, and it's a fundamental problem for us. So, I think we're trying to make sure that we address those issues within ‘Healthy Weight: Healthy Wales’. That approach is in there. We're trying to make sure, for example, in schools that there is a nutritional value, that that's improved. So, all of those things we are trying to do as well, and you're quite right: what happens is it doesn't get the attention. It doesn't get the attention because there are no big, red flashing lights or blue flashing lights outside a hospital. But I don't want you to think that that doesn't mean we're not giving it any attention. We are giving it the attention, but it's not getting the media attention, perhaps, that is happening quietly behind the scenes.

We're doing all kinds of other things. You think about investment. All of this is all connected. Investment in schools: we have massive, massive investment in twenty-first century schools, and they've got brand new pitches that are open to the community that the community can use. So, it speaks to that other agenda. I think this cross-Government understanding of the fact that everybody has got to get involved in the health agenda is something that is fairly unique to Wales, and in fact we now have a health impact assessment across Government that is unique globally.

And Jenny wanted to come in.

I just want to press you on how well you're doing to spread good practice. I went to a social prescribing conference this week, which actually was organised by the Welsh Government, and there's brilliant work going on with orthopaedic patients, both pre op and post op, in the swimming pool. It was fantastic, but why is it not being done systematically? It seems to me that the outcomes are better. And that is my concern, that the Welsh Government isn't being robust enough about ensuring that things that evidently are working very well, and saving money and improving outcomes, are just not happening. The Bevan exemplars: we get them every single year, brilliant proposals, all evaluated, and they never turn up anywhere other than the place where they were invented. So, I want to press you on this, that there is good work going on, you're just not embedding it in the system. And is it because you haven't got the powers, or you're just too overwhelmed by all the other issues that we've just been talking about? 

You have different demands and different experiences in different places. So, what's right for an area in the Valleys may be very different from what is appropriate in a deeply rural area, which is why you allow health boards to have that flexibility. You know, the age profile may be completely different, so—

Well, the Valleys still have swimming pools—

Hang on. Let me finish the point, Jenny. The point is that it's got to be the health boards that make the assessment of 'What are the health needs of this particular population?' because they may be very different in different parts of the country, and they need to make that judgment.

Now, you ask about things like social prescribing. Part of our programme for government was to make sure that we have a framework for social prescribing, precisely because what you were saying wasn't happening. It wasn't consistent across the same health board—

I acknowledge that.

—let alone across the country. And so, what you've got to do is put in, as far as you can, some guidelines and some rules so that GPs, for example, feel confident that, if they are going to refer highly vulnerable people into a service, into some support structure, there's an understanding of what is needed within that support structure. And that's why, actually, I'm really proud that, actually, that's one of the parts of the programme for government. There is a framework, now, that didn't exist five years ago, for social prescribing. So, that's an example of where we said we were going to do something and it's been done. Do we need to do more of, 'If it's done well somewhere else then why aren't we doing it across the rest of the NHS?' We now have the NHS executive—I don't know what it's called these days—

NHS Wales Performance and Improvement.

—performance and improvement, and part of what their role is is to scale up good practice across the NHS. Nick, have you got anything to add to that?

I think you make a really good point about the orthopaedic pre-operative and post-operative recovery, and that's very much part of the prevention programme that exists within the national planned care plan, which has been in existence for the last five years. There is too much variation in access arrangements to those services that are either socially prescribed or provided locally by health boards and local authorities. I think the difficulty is the balance between local and local response, as the First Minister's alluded to, for different types of population, and a national mandated solution. We talk a lot in Wales about the differences in communities and how we can support local initiatives, but, this year, we set out 38 what we called 'enabling actions', which were designed to reduce variation, and they were exactly as you described—38 things that we've got evidence to support, really good practice, and we've instructed the health boards to deliver those 38. Thirty-four have been delivered across all of the health boards and they span primary care, urgent and emergency care, planned care et cetera. So, they are a wide range of things.

But to give you an example, when we looked to implement those enabling actions and we presented them to the Cabinet Secretary, the list was 120, and there was no way we were going to implement 120 in 12 months. So, we have to move systematically through this, and that awareness, again going back to the public taking a degree of responsibility for their own health and the huge, wide determinants of health, which you were talking about in terms of the preventative agenda, is a cross-governmental thing. 'The NHS is there to fix you' is not—. We can't fix everything without assistance from you as a member of the public, or you as a service locally. So, we need to start to drive that message through. Reducing waiting times is a huge preventative measure for long-term sickness and illness. So, it is all combined.

But, yes, I think the variation—we haven't solved it, there's a long, long way to go and it's driven by a huge number of factors, but I think we've made a good start this year in terms of the 38 things that we set out that further have been added next year into the planning guidance that's gone out. We're working with the English Getting it Right First Time programme, which again looks at all of those sorts of things to really drive productivity, efficiency and improvement in outcomes for people, which is the most important thing.

Mark Isherwood. Oh, we've lost him, have we? Then, in that case, I'll go to Carolyn first, whilst we wait for Mark to come back.

I want to just touch on an earlier conversation about diagnostics. We had a petition regarding breast screening. At the moment, 69.1 per cent of women go for breast screening. Once you get up to 80 per cent, if it is, then you get another 156 more early cancers diagnosed. They're asking if Welsh Government could lead on a campaign.

I've also met with prostate cancer, the north Wales group. They are working with employers to do testing themselves through fundraising. Many in that group have had early detection because of that prostate specific antigen testing through their own initiatives. They're asking, and I don't understand, why the UK-wide health system will not roll out PSA testing through the NHS. Could you explain that to me?

Shall I answer that? 

Yes.

So, I can't explain why the UK health authorities decided not to introduce national screening for prostate. That's a policy decision that they've made. They've used what they've deemed to be the evidence to support that decision. There is—

How can we change it? Because it's obviously working, through private testing funded by these charities.

I think that's slightly different from the actual test that you go and have at your GP or in your local health centre. So, what you're referring to is screening, rather than testing. So, the testing is available. It's self-referral, isn't it, which is what you're talking about. I think there needs to be a wider public health message to men, because we know that men are not—I'm speaking as one who's not—very good at it, and I used to work in the health service. So, we need to encourage more men to present at their GP to take the test, and, as the Member alluded to earlier, access arrangements for that need to be improved, and how we do that.

I think we've done quite a lot of that for women's health. You referenced breast screening. This year, we've introduced women's health hubs, which is the first step on a journey, really, to really improve access for women and their specific health issues and concerns. I think the next step has got to be how do we move that forward for men, specifically around—. Prostate is the second biggest cancer in the UK. People are not getting tested early enough. They need to be given access, but also choose to take that access as well.

Okay. Thank you for the clarification.

Peter, I'll come back to you now. I need to move on to other sections, because—

Yes. I've got one on health, and I want to just touch on some social care stuff, if I can. I was posed a question last night at a Royal College of Nursing event. It was airing a lot of frustrations and different things. The question that was put to me was: with so many health boards in intervention, especially Betsi Cadwaladr and the issues there, is it the right shape? Should our health board system—? This was what they were asking us: should we rethink the health board system? Should there be something better in Wales? How would you have answered that? Because this has just been a millstone around every Minister's neck since I've been in this place, so there's something not right. How do we address the shortcomings in the health board system at the moment? Is it the best fit, and what can the next Government do to alter that?

Well, look, certainly when I was health Secretary, it was something that I considered. Is now the time to rethink the shape? You can certainly make the case for reorganising, and I think things are already changing. So, for example, the co-operation now between Hywel Dda health board and Swansea is much, much tighter. You can see the three south-east Wales health boards co-operating, working together. So, the new orthopaedic hub, for example, that will be opening in Llantrisant, will be for the three health boards; it won't just be for one. So, some of that is happening already. The question that you have to ask yourself as the health Secretary, or as the leader of the Government, is: 'What am I going to be focused on?' I looked at those waiting lists and thought, 'That's what I'm going to be focused on.' Those are coming down. I'm going to be spending my time on sorting that out as far as we can with the money we have available. It's only now that the taps have been turned on that you can see those coming down at the pace and scale that they should have been before, but we didn't have the money to address it.

So, you can reorganise; you could reorganise. I think that would take people's attention away from the front-line services, and that's what I'm focused on—how do you sort the front-line services. Because I just know that what would happen within those health boards is that people would be scrambling around to check out are their own jobs safe; they would not be focused on the front-line services. So, it is a judgment call—

So, it's the wrong time?

It's a judgment call in terms of whether you do that or not. I am focused on what is happening on the front line, and anything that takes attention away from that is something that I didn't want to get involved with. Other people may make a different judgment; that was my judgment, definitely during this term of Government.

Okay, thank you for that.

Before you ask the question on social care I know you want to ask, Mark Isherwood is back online now, so I'm going to call Mark, because he had put his hand up before we lost his connection.

Diolch. Thank you very much indeed. Yes, it's a bit windy here in Flintshire; I presume that might have been the cause.

A few years ago, after I'd been on a waiting list myself for three years, I was offered an appointment, which I attended in Wrexham Maelor. It was on a Saturday morning. The consultant was an NHS consultant from north-east England who'd been paid privately to attend and help clear the then backlog. After that sequence of actions, the waiting list went up again. Last month, a senior NHS consultant in north Wales told me the same thing was happening again, that primarily, but not exclusively, NHS consultants from other parts of Wales and the UK were being paid to provide evening and weekend surgeries to get the waiting lists down, but sustainable solutions were not being put in place.

Allied to that, you referred a number of times to the importance, quite rightly, of care close to home, primary care, early intervention and prevention. But you know, as I do, that the British Medical Association and the Royal College of General Practitioners have been running campaigns since 2012 calling for action to, quote, 'Save our Surgeries', the current campaign name, because the slice of the NHS cake going into GP practices to deliver not just GP services, but services by allied health professionals from GP practices, has shrunk. Therefore, many of the people in A&E, for example, needn't be there if we instead started reinstating the levels of funding back to primary care in the community that used to exist.

They also say—every time I speak to whether it's a hospital consultant or a GP—that we need to get the community bed levels, the step-down beds, the GP beds, the community care beds, back up if we're going to have care close to home, because that's the primary, or one of the primary, causes of so-called bed blocking or delayed transfers of care, that people aren't able to go straight back to their own homes.

And finally, I'm being contacted virtually daily now by voluntary sector organisations delivering key services to disabled and autistic children and their families that are either closing or having to shrink their services. These are charities that survived the pandemic, the cost-of-living crisis, and the previous decades when we've had all sorts of problems thrown at us. Yet, now, they're having to shrink their services or close. That again is impacting on prevention and early intervention and putting extra pressure on secondary care. How do you therefore respond to the statement they're all making to me, that there is a disparity between what the Welsh Government says and what it delivers?

Thanks. Well, let me be clear: I'm not going to apologise for bringing in people to bring down the waiting list, particularly in Betsi. There are people who've been suffering on waiting lists for way too long, and if it takes us to pay people to come in and clear people, to try and sort people out, who've been on the waiting list for a long time—I'm not going to apologise for that. This is a very short-term measure. We've put in a burst of money and I am not going to apologise for that.

Now, you ask about sustainability, and that is what I'm really interested in beyond this. And that's why, for example, we're opening a new orthopaedic hub in Llandudno. That is far more sustainable, making sure that that is one of, I think, eight surgical hubs that we now have in Wales. That will be an additional one. And let me be clear as well that you talked about the need for new step-down beds. That's precisely why we're going to be investing in the new Royal Alexandra Hospital.

You talked also about the NHS in primary care not getting the support it needs. Listen, all of it needs more support— there's no question about that—but it is simply not true, Mark, to suggest that they are getting less money than they used to. And I gave these figures at the beginning. At the beginning of the Senedd term, it was £1.5 billion. Now it's £1.8 billion—that's £300 million extra going into primary care. And I think it's really important that we stop continuing this myth. Is there a difference in terms of balance? Yes, but it's because we need to clear that backlog. And again, I'm not apologising for that.

On autism, can I ask Nick to come in on that?

Yes, I mean, I think the whole access to services in north Wales, and particularly in the community, around both children's mental health and younger people's mental health has gradually improved over the last 12, 18 months in terms of access to services. There's still a backlog of patients. I think the contract was put in place at the beginning of this year with a provider to provide an extra 500 appointments for those that had waited the longest. Unfortunately, that provider has been unable to provide all of those. So, the health board is now looking to other providers to seek to remove the backlog there. It's still too long, and I think we've said that all of those access arrangements are too long. But there has been quite a lot of improvement over the last 12, 18 months in terms of access arrangements and the number of patients who have waited a long time.

Okay. I'm going to go back to Peter, but just on surgical hubs, Neath Port Talbot Hospital has got one, and you've seen exactly those improvements. I'm all in praise of it, because it has made a big difference to patients in my area.

I mean, Neath Port Talbot used to be in a terrible state in terms of, in particular, orthopaedic waits. It was a real basket case for Wales. That new hub has transformed it. It's really made a difference. And that's what we're looking to see, and that's why we're opening more and more orthopaedic and surgical hubs across Wales.

Peter, on to care.

A couple of points on social care. We know Social Care Wales, for instance, have shared that, within the social care workforce, one in five members of staff are, sadly, considering leaving the service. Forty-two per cent of them are unhappy with the level of pay they get. There are clearly some big issues we have to deal with within the social care system. So, how do we start making some change in that? Should we be considering a deeper integration between health and social care? What have we missed that has led to this position?

Well, we were very proud of the fact that we introduced the real living wage at the beginning of the Senedd term. It wasn't something we were planning to introduce right at the beginning, but actually the situation became so critical very quickly, partly because of Brexit, by the way, which your party, of course, supported, and I just think it's—[Interruption.]. Well, part of your party supported it. The real living wage, for us, I think, was fundamental. It was really important to try and keep people in the system.

What we've done is we've introduced the social care workforce partnership, which is a negotiating mechanism. And also we've made sure that, within the Employment Rights Act 2025, we can now make sure that those fair pay agreements are actually followed through. So, whilst we can ask for the real living wage to be paid, if it's in the independent sector, for example, how do you enforce that? We need the Employment Rights Act to be able to enforce that. So, I think we're at something like 70 per cent or so, 65 per cent or so, of people who are actually being paid the real living wage; the ones who are not are beyond our reach until we get that new law in. And let's not forget that, actually, in Wales, our approach to care and support for care is very different from what they have in England. In Wales, you get to keep a lot more of your capital. I think it's £50,000—is it, Andrew—that you're able to keep in Wales, and we have a £100 weekly cap on how much you have to pay for care. We've got the first phase of the national social care academy for Wales. This is all trying to improve the opportunities and facilities to get more people into the system.

I recognise—

Final one, Peter, because I need to move on.

Okay. The final one, then. Unpaid carers—that was the most harrowing inquiry our committee has undertaken, and there is an absolutely total mismatch of understanding between what the Government say is the situation and what the people who were crying around this table were telling us. And there's something fundamentally wrong there. And I know that the Minister is trying to get to grips with it, but we're running out of time now. How do we make sure that local authorities carry out their statutory duties under carer assessments, but not only just do the assessments but deliver on what those assessments say they need?

These are the real unsung heroes of our communities, people who are actually looking after their loved ones, day in, day out, under incredible pressure. And I know how difficult that is one day a week. These are people who are doing it all the time. And I do think we need to give them the support that they deserve. There's a lot of them. There's an army of people who are doing this work, and if they weren't doing it, that would be a massive additional cost for the state. So, the people involved in this, the Ministers involved in this, have always been trying to champion the cause of unpaid carers and we try and give relief to those. I don't know if you've got anything else to add, Andrew or Nick. No. Okay, so I agree. I think we need to do that, and that's why we've expanded significantly the relief that we're trying to give to those people. Could we do more? I think we probably do need to do more because we can't afford for these people not to have the support, because if they don't support them, the state will have to step in and that will be very difficult.

Thank you. Thank you, Chair.

Thank you. I'm conscious of time, and I know we've spent over a third of the time on healthcare, but it does take over half of the budget.

Yes.

And it's probably the most important thing that the Welsh public consider as well, to ensure that we get the health and care system right for the people of Wales. We may come back to it, we'll see how time goes. We'll move on now to John on housing.

In terms of housing, First Minister, we know about the 20,000 target and the progress made to achieve that in terms of affordable social housing for rent. Many in the sector believe we need to get up to something like 60,000 additional affordable social homes for rent built over the period of the next Senedd and there needs to be a rebalancing so that a much greater percentage of the overall housing stock is made up of affordable social housing for rent, given its advantages in terms of security of tenure, affordability, and the more direct control, perhaps, that government and others can bring to bear. So, reflecting on progress with that 20,000 target, does Welsh Government accept that there nonetheless needs to be a ramping up of provision of those homes?

Well, I think that we should be really proud of what we've achieved in relation to social housing in Wales over the past five years. To have reached the target by the end of this year of what we set out, despite the fact that we've had massive inflationary costs—massive. So, I think I heard that, for every £1 million that we spent at the beginning of this term, we could get seven houses. That went down to three. Now, we're back up to four. And we've still delivered on the target. And that's because we have invested significantly in this area.

So, I think this is an area where we should be incredibly proud of what we've managed to deliver. I think that, if you look at affordable housing—this is affordable housing, not social housing—affordable housing in Wales has gone up by 12 per cent in Wales. It's gone up by 1 per cent in England, and it's gone down by 22 per cent in Scotland. That's affordable housing.

If you look at the social housing situation, we're much better again. So, this is an area where I think we should be really, really proud of the fact that, despite the fact that we've seen massive, massive inflationary pressures, we have still delivered on our commitment.

Would you accept, nonetheless, First Minister, that there is a need to go further and faster, as Governments often say, given the balance of housing stock that we have in Wales, and the percentage of that overall stock that's made up of affordable social homes for rent?

So, I think what's important is—. You've seen our homelessness legislation that's come in recently; we've just passed that. I think that is a pioneering piece of work that helps to intervene much, much earlier, so that people don't become homeless. And I think, for me, what's important is pretty obvious. It's about demand and supply. What is the demand and what is the supply? And the fact is we're not building enough homes, not just in the public sector, but also in the private sector. And if anything, what I would want to do is to make sure that we do more to encourage the private sector, also, to build more homes in Wales. 

It was interesting—I had a meeting with the Principality Building Society recently. They are working very closely with registered social landlords to increase their opportunities to loan money to those registered social landlords, so that they can also increase significantly the supply that they're able to deliver for the people of Wales. Anything to add?

Just for a bit of context, it may be stating the obvious, but building a new house is an expensive thing to do, and it's become a lot more expensive over the last four or five years. To build 15,000 homes a year, that would cost around £4 billion, which is more than the Welsh Government's capital budget. And that's mainly to say that, to get to really significantly increase the delivery of new homes, a lot of that is about finding ways of delivering those homes more cost-effectively, and finding other sources of finance, and there's a lot of work going on on both of those fronts. 

Okay. Thank you.

Before I bring Mark Isherwood in—

Can I ask Emma to come in as well? She'd like to say something. 

I was just going to reflect on that point about building right across the sector. So, the 20,000 target has deliberately been focused, particularly, on homes for rent and social rents. And over 80 per cent of what has been built in that 20,000 has been for social rent, which is the most affordable of all affordable homes. 

In other countries, you see the counting of affordable homes being much more skewed towards home ownership schemes, so first homes in England. But we haven't ceased to support those other ways of building as well. So, we've continued to have Help to Buy here in Wales, to promote market house building, to support builders in that sector and to support people who can afford, with a little bit of help, to own their home.

But also there's some of the innovation around what's happening around our own Welsh Government land, with some of the exemplar sites, where we're testing how we can work with commercial building companies in order to find new ways to build fully integrated, both owned and rented, estates, at the very highest standards, and proving that it can be cost-effective, so almost being a leader in that sector to bring our large companies along with us and know that they can do something much more innovative. 

Can I just add something else? This is an area where you need a long-term vision of where you're heading, because you can't just switch on bricklayers and plumbers. You need a plan—you need a long-term plan. This is the benefit of having the same Government in place for a long period of time. You can build up. You can say, 'No, we're going to continue to do this'. And that's what we've been trying to do with housing now, is to give that real long-term, 'Yes, we will continue to invest in this.' Because if you don't, they will not invest, and the building companies will not invest in the people, in the apprentices that we need. This is fundamental to everything: what is the long term? What does the long term look like, and why would people train people up if they can't see a pipeline coming down the track? So, we've established that pipeline now. We know what we want to do next. Who knows what will happen after May? But that's the kind of thing that stops people investing—not knowing what comes next.

Before I bring Mark in, I want to ask one question. You've talked about social housing, and everyone agrees there's a need for social housing, but as a consequence, that is a long-term project, and there's a shortage in supply. Many people end up in private rented properties. Some of those private rented properties have very high costs, whether they're people who can't afford properties, but there are also young families and young people who can't get on to the housing market because the costs are so high that they can't save deposits. Has the Government ever looked at thinking about capping or putting some control on private rented costs to allow people that short stopgap between social housing and private renting, or even private renting and moving into the housing market?

Fundamentally for me, it's about demand and supply. If you've got a limited supply, the demand and the costs are going to go up. So, that's why the answer has surely got to be that you expand the supply. I think, with those kinds of approaches, you've got to be really careful in terms of the unintended consequences. If you start capping things, then what you may see is people withdrawing the properties from the rental market. So, you've just got to be very, very clear-headed. I wouldn't want to go down that route without being absolutely clear about what the consequences could be, which could limit the number of rental properties on the market.

Mark.

Thank you. When I first came to the Senedd, I came straight from that sector. I worked at building societies, including financing housing, housing associations. I was a long-standing member of a housing association board, et cetera. I recommended what you're now talking about then, and I was disparaged, ignored and insulted. The reality is that Wales had the lowest proportional level of housing expenditure of any UK nation during the first three Senedd terms, and it's the only UK nation to see fewer housing registrations last year than in 2012.

How, therefore, do you respond to the statement in the most recent Welsh Refugee Council policy update that the latest statistics from the Welsh Government show that unmet housing need in Wales has increased by 64 per cent since 2019, with Welsh Housing Quarterly suggesting the true level of unmet need may be 'significantly more' than previously estimated, and to the review by Audit Wales, published on 18 February, which found a

'large increase in affordable homes but target will not be met'

and included the statement—this is from Audit Wales—that

'the true number of homes delivered that meet the full target definition—new-build, low carbon social homes to rent—is still not completely clear from the published data'?

Thanks very much. I understand that you do have significant experience in this world, but I would recommend that you look at the Wales Governance Centre's report in terms of how much we spend proportionately on social housing compared to how much they spend in England. And frankly, what we spend knocks the other parts of the United Kingdom out of the park. Could we do more? Yes. But are we doing more than the rest of the United Kingdom? Absolutely—a hell of a lot more. I quoted those figures to you earlier: 12 per cent increase in affordable housing in Wales, 1 per cent increase in England, down 22 per cent in Scotland. I am really proud of what we have delivered. And don't forget, this is not just about transforming people's lives, people living in very good, comfortable, well-appointed homes that are built because we have a Welsh quality standard to our social housing. But also, don't forget, this is also a massive job stimulation programme, giving support in every one of our communities. That's exactly what we should be doing: making sure we marry up these broader issues in terms of what we're trying to achieve socially, but also making sure that we can create jobs, in particular for young people.

Llyr. On this?

No. I was going to move on to—

I was wondering whether we should have a break at this point.

I'll be brief if you want me to be.

Okay. Very brief then, Llyr, before we move on.

I wanted to ask you about youth unemployment, because during your time as First Minister, youth unemployment has jumped up significantly, as has the number of those young people not in education, employment, and training. Why do you think that is?

I must say that I was disappointed to see those figures recently. I think there's a lot of volatility out there at the moment. If you look at the change over the course of a longer period, in 2012, youth unemployment stood at 24 per cent—eye-watering figures. And now we're at 16.3 per cent. So, we're in a better place, but it's gone down and it's come back up. So, I am very worried about that coming back up. That's why I'm really pleased that we at least have a very clear programme, this young person's guarantee, which has helped 64,000 young people in Wales and has secured employment for 10,000 young people. More than 900 have launched their own business. I think there's clearly work to do in this space. I was very disappointed to see those figures, but I think there's a lot of volatility. I might ask Andrew to come in to talk a little bit about how they do the figures and things, because—

There is volatility, but the Government's own release says that it is appropriate to use the annual population survey statistics. We're not seeing that volatility in the English or the UK-wide figures, with youth unemployment up 1.9 per cent compared to the year up to September 2025, but up 9.5 percentage points in Wales. And similarly with NEETs: up 0.5 per cent across the UK, but up 6.2 per cent in Wales. Something must account for that, despite the young person's guarantee, which, of course, is welcome. We're going on a different trajectory to the rest of the UK.

This is a question I've been asking, Llyr, I can assure you: what on earth is going on? Because we've got this young person's guarantee. Can I ask Andrew to talk us through some of that? 

Sorry to go into statistics, but I think it is relevant for this debate. There are some problems with the labour market stats now. The Office for National Statistics recognise this, and there is particular volatility in the Wales stats because the sample sizes are relatively small. And because of the general problem with response rates to surveys like this being much lower than they were, there tends to be a lot more volatility between periods. Our statistics service say we need to look at a range of measures in order to really see what's going on in the labour market. There definitely is an increase in youth unemployment and with numbers not in education, training, et cetera, but based on a range of indicators, it looks like what's happening in Wales is very similar to what's happening in other parts of the UK. It's a general UK-wide problem with the labour market, and it's particularly affecting young people, with fewer entry-level jobs being created in the market. Sectors of the economy where young people tend to go into employment are suffering particularly badly in the current economic condition. So, I don't think the data—. I think it's dangerous to look at one particular measure in one particular period if you want to draw robust conclusions about what's happening.

Okay, so there are caveats around the statistics and figures there. I think people would be forgiven for raising their own caveats around some of the figures that you’ve been quoting in terms of apprenticeship targets in Wales, because your original target as a Government, of course, was to achieve 125,000 apprenticeships during this Senedd. You then decided, presumably because you didn’t expect to meet that target, to drop that to 100,000 apprenticeships. You then, more recently, decided to change what you were counting to arrive at that 100,000, because previously it was a more robust target of those who were remaining in apprenticeships and not dropping out within eight weeks. You’ve subsequently decided to include those who actually drop out of apprenticeships within eight weeks, which, bizarrely, you still count as people doing apprenticeships. Are people right in being a bit cynical at your claim that you’ve achieved this target? Because clearly, you’ve moved the goalposts so many times.

The measure is clear in our programme for government. It says we are going to create 100,000 apprenticeships. We have always published both the numbers created and the numbers who are still there after eight weeks. They’ve always been available. I think it is probably worth emphasising that, when we set this out, we had EU funding, and a lot of that money has been taken away. We are now investing £151 million in apprenticeships. That’s the highest number in seven years. I think it is probably worth also stating that these organisations who undertake these apprenticeships don’t get paid until people on those courses make eight weeks. 

So you accept or admit that you have moved the goalposts and that you changed the way that you measure that 100,000 apprenticeships from when that target was set. 

Our programme for government is clear. It says—

Yes, I know what the programme for government says, but I'm talking about the way now that you've decided to count these apprenticeships. It's a 'yes' or 'no', really, isn't it? You’ve changed the way you count them. 

No. We said we’d create 100,000 apprenticeships. We’ve done that, and we’ve always published both sets of data. They’re both available. 

But the target was set against one, and now you say you have achieved it against the other set of statistics.

I go according to the programme for government. This is why we brought in people like the delivery unit, to really hone down on what exactly it is we are trying to achieve here. So all of that has been co-ordinated and worked through with the delivery unit. 

But the programme for government target was against one way of measuring it. Your claim to have achieved that target is against another way of measuring it. Why can't you just level with the people of Wales and be honest about that? 

We said we’d create 100,000 apprenticeships and we have. 

Your definition of ‘apprenticeships’ has changed since you set that target. That’s all you have to admit. It’s not a huge issue. 

No. Listen, there are two measurements, okay?

I know that. I've told you that, and you've told me it again.

Llyr, let the First Minister respond.

Do you create them, and are they still there eight weeks later, and those are different, right? And so, you're measuring one, and I'm telling you we said we'd create them, and they've been created. I also think we should not apologise for the fact that, actually, even if you look at the ones who are still there eight weeks later, you still get up to a figure of about 90,000 or 91,000, which is not something that we should apologise for. It’s an extraordinary result, something we should be incredibly proud of, and again, if you compare what we do compared to what they do in England, they look at us with envy, proportionately, on what we’ve managed to deliver over the past five years.

Unless someone else wants to ask a question on youth unemployment and the youth guarantee, then we’ll go on. Jenny and then Carolyn.

On the young person’s guarantee, the people who need the most help are those who are furthest from the labour markets. There was a scheme—I can’t remember if it’s called Jobs Growth Wales+ or something else—that particularly focused on young people with disabilities, to give them that extra support, both identifying the right post for them and also giving them extra support in employment. I just wondered where we are on that, because everybody should have the dignity of work.

I agree. For me, what is absolutely key in terms of how we make our country successful in future is that we need to get more people into work and they need to earn more money. That's how you address poverty, okay. You've got to get people into work. And what we've got to do is make sure that people are equipped to get into the workplace. And people will start from very, very different levels. The pandemic really affected a lot of young people, their mental health was really affected by it, which is why fixing that mental health issue before you get anywhere near—. You know, if you're not going to get out of your bedroom, you're not going to get a job. So, you've got to take these people by the hand, and that's why not only do we have programmes like Jobs Growth Wales and all of these, we've got a whole series of programmes that are employment programmes, and they vary from place to place. We're also working with the UK Government on the Trailblazer programme, and there are three of those being piloted, in Neath, in Denbighshire and in Blaenau Gwent, specifically targeted at young people with health issues. And I think that's what we're trying to do, and to make sure that we learn from best practice, because all of these programmes have different things.

At the end of the day, though, all of these people are individuals and they may need tailored support, and I think that that is actually the way we're going to have to go, which is to make sure that we are holding these people by the hand. You think about that investment early on and what that saves for not just that individual, but also for the country in terms of that early investment in getting them into work. So, for me, youth unemployment is absolutely critical.

Okay. Trailblazer sounds excellent, but I'm particularly focused on people with disabilities. I mean, some people—. In the Equality and Social Justice Committee inquiry, we found that some young people were not even being asked what they wanted to do with their lives when they left school, or they were being left out of the attachments in the workplace, because nobody put enough effort into finding the right placement for those individuals. Hefin David did a lot of work on this, and I just feel that we have a duty to ensure that those who need that extra help are actually getting it, because they're definitely not going to be the ones who are shouting loudest.

No, and I absolutely accept that. I think there are people who have really severe disabilities who will never be able to work, and our responsibility as a society is to stand with them. And then there are others who are desperate to work, who are disabled, who can't get a look in, because, actually, there are barriers in their way. And there are all kinds of barriers—there are employment barriers; employers put a barrier up, quite often.

But this is something that UK Government could do something about, with subsidies for employers for somebody who will need constant supervision because of their cognitive ability. Is that anything that the Welsh Government has had time to discuss?

So, the UK Government is looking at welfare reform, obviously, and part of what they are suggesting, in particular with things like the Trailblazer, is to target those people who may have disabilities to make sure that they are—. Before, they were just written off, and they were never asked again, 'Do you want support? Do you want to get back into work?' So, this kind of checking back in with them to see how they are getting on, I think is really important. We can't write off young people at the beginning of their lives and just think that that is okay for them and for society. It's not. Everyone can make a contribution in some small way, and it's remarkable how much actually helping other people can help people themselves as well.

Absolutely.

Carolyn.

The Children, Young People and Education Committee did an inquiry into pathways from post-16 education into employment, and there's a lack of work experience now, making sure that there are spaces in colleges as well—that's needed more—and the mapping of skills as well, so that they've got a path—mapping of skills with jobs that are in the area, so that they've got clear pathways, for children and parents, through education into the work that's in that area—and making it easier for sole traders to take on apprentices, as well as apprenticeships.

Yes, thanks. I think there's a huge amount of work already being done in this space. If you look at what's happening in post-16 education, you'll see that, during this five-year period, we have not only kept the education maintenance allowance, but we've increased it by £10—so, £40 a week—and they got rid of this in England, of course. That helps, in particular, poorer families to enable their children to stay on in college. We've seen an 8 per cent increase in the number of people attending further education—I hope that's right, Emma—which is wonderful, but also causing us a problem in the sense that we have to find the money for that. But, you know, we have to find the money; that is absolutely critical and important.

Job matching, making sure that we tighten up what are we teaching our kids compared with, actually, what is needed when they come out of college and that job matching—. We know there's going to be a revolution when it comes to digital, there's going to be a revolution when it comes to new energy, low-carbon energy, so we need to do that matching, and all of that is being undertaken now. Emma, would you like to add to that?

No, you've covered it pretty well, First Minister.

Mark, do you wish to come in on this point with a supplementary?

Just coming in on the comments about disability that the First Minister was responding to a few seconds ago on this matter, first, to say, as you know, that the social model of disability recognises that people are not disabled by their impairments, but by the barriers that society places in their way and that they should, therefore, be referred to as disabled people, not as people with disabilities, and conditions should be referred to rather than disabilities or disorders. However, in your response you rightly referred, in the context of employment, to mental health, but when I referred earlier to autistic people and their families, the response I got was instead relating to mental health. Can you confirm, for the record, that the Welsh Government understands—I know you personally do—the difference between mental health and autism and, if so, whether the strategies you're describing also provide differential approaches to encompass that?

Thanks very much, Mark. This has really come home to me in the past couple of days. When I've been working incredibly hard, I try and switch off by watching Netflix, actually. I should be going to the pub, but—. [Laughter.] I was watching I Swear, which is this great film about Tourette's syndrome. If ever you want to get an understanding of why the social model of disability is what we should be thinking about, watch that programme, because the problem is not with the person with Tourette's, it is about our response to it and our understanding of it. I do think that that, for me, explained it more than anything else anybody could have said in any committee. So, I would encourage you on this rare occasion to watch Netflix.

Just in terms of mental health, I think that there is clarity within Government of the difference between mental health issues and autism, and we need to tailor support differently and appropriately for the individual.

I also want to thank you for your leadership, because you're here, on the British Sign Language legislation that went through this week. It was just quite extraordinary. Your leadership on this has been wonderful. It was great to see the response of the people in the Chamber. It was wonderful that we had cross-Government and cross-party support for something that I hope will also help people in terms of managing to get support so that they can also enter the jobs market.

On that point, I will now call for a short break. We'll take a 10-minute break. We'll reconvene at 11:50.

Can I welcome everyone back to this morning's session of the scrutiny of the First Minister? And we'll move on with questions from Llyr Gruffydd.

Diolch, Cadeirydd. I'd like to ask you about the publication of the Government's bovine TB programme board position paper on Wednesday. It made it clear that evidence from the Welsh Government's own figures clearly shows that your target to eradicate bovine TB in Wales by 2041 will not be met. In fact, at the current trajectory, it's going to be well into the 2050s by the time we get to that point. Does that reflect poorly on your Government's strategy to tackle TB, and what do you think needs to happen that isn't happening currently to try and fix that?

Well, nature's hard to control, and we can intervene, but nature will quite often find its own way, and I think what was important for us is that we develop a response that is based on evidence as far as possible. And I think we have taken this issue seriously. I know the absolute trauma it causes within agricultural communities. It is a real issue, particularly in some parts of the world, including where I live, and the emotional strain on families of having to deal with this is enormous. So, we will keep going at this, but I do think that it needs to be evidence‑based as far as possible in terms of how we respond.

Which you'd presume is the current state of affairs, isn't it? Everybody would base an approach to tackling TB on evidence and make sure that it's science‑led. But that trauma that you mentioned—that sort of harrowing dark shadow that's hanging over the sector—under your current approach, and according to your own bovine TB programme board, is going to last 10 years longer than you'd anticipated.

Look, this is not something that's an easy fix. We recognise that we have to keep at this. We're trying to learn lessons from other countries, but this is something that we are determined to keep going at.

So, do you agree with your TB programme board that future policy must consider all three populations affected by bovine TB: cattle, people and wildlife?

Well, I think, of course we have to consider all three: cattle, people and wildlife. And I think there's an understanding that there are a lot of people who are concerned about a mass badger cull as well. That is something that causes a huge concern within communities as well, and so—

I'm not aware of proposals for a mass badger cull. I mean, there's talk of targeted interventions, clearly.

I think what's important is that we understand that it's—. We've brought experts in to advise us on this, and we need to take their recommendations seriously.

And they're currently saying that you're failing, or at least not meeting the target that's been set.

This is a challenging issue, there's no question about that. And we will follow the recommendations of the expert group.

Thank you.

Carolyn.

I believe there's clearer testing in Wales as well that is being used, and better biosecurity as part of the pilot scheme, which I think is the way forward. And I hope that continues, because Wales does lead the way in the environment and in animal welfare, and I do hope that continues, going forward.

I've got some questions to ask you on transport. So, earlier, we talked about young people. Transport is one of the biggest issues for young people, and colleges have been saying this as well, on transporting them as well. It was also part of building a stronger, greener economy as well, and towards decarbonisation. So, we've got various strands of transport policy being introduced this term. There was the public Bus Services (Wales) Act 2026 that's just been taken forward; work on fares and ticketing; the Burns recommendations; and Transport for Wales have launched the 'Today, Tomorrow, Together' programme—transport strategy. So, do you feel now that we're working at sufficient pace and integration to achieve Government's 2040 sustainable travel targets? You've introduced your own—. You're making sure that potholes are filled as well, and that roads are being done, which helps with cycling and walking as well, making sure that the pavements are in good order.

Thanks. Look, I think this is one of our proudest areas of delivery. It's been quite extraordinary, the transformation that's happened. And it's happened because we've stuck at an approach that we've been working on for a long time. So, this is where, again, it benefits to have the same Government in power over a prolonged period of time. You look at what's happened, in particular, in relation to rail—that billion-pound investment in the Valleys is absolutely critical. I left politics a while back to learn about business. What is it that they want? How do they grow? What do they need? And I became the chair of Cardiff Business Partnership, and the one thing that they said they wanted was a metro system, so that they could bring in those talented people from the Valleys, who were finding it difficult to get work. The businesses in Cardiff needed those people, but there was no means to get them there in a reasonable and cheap and affordable way. So, that was their No.1 issue.

You can't switch this stuff on overnight—it's taken us 15 years to get there. Because you think about how long it takes to get planning in place, how long it takes to make sure that you commission and procure the trains—it takes a long, long time. You've got to upskill people ready to deliver. And so, that's why I think we should be incredibly proud of the fact that, not only have we delivered that investment for the Valleys, but also we've seen new trains across the whole of Wales.

Now, of course, we've been given that promise of £14 billion additional funding for the future of rail. About time too, frankly. We were being short-changed. We have been short-changed. But again, we get back to this—where are you heading? What does the pipeline look like? How can you plan? And it's to get that assurance that, if a Labour Government leads in Westminster in future, that money will keep coming, that the tap will keep flowing—something you can't be assured of if other parties get in. I just think it's that long-term stability that means you can deliver. It's why, for example, we're the second-best recycling country in the world. It's because we've kept at it over a long period. You haven't seen chopping and changing. So, there are real benefits.

Just in terms of what we've delivered, I think it's probably worth reminding people that, in Wales, over-60s get free transport. People just assume that that is going to be there for them. It's not necessarily going to be there for them, unless people promise it will be. We've introduced that £1 fee for young people. That has been transformative for them. There have been 2 million journeys as a result of that, really taking the cost-of-living pressure off families who have younger people. Then, of course, we've made it clear that, if we come back in May as a Government, there'll be a £2 cap for everybody when it comes to bus journeys. Bus reform, of course, is critical also. We've now got that reform, which means we will be able to direct services better and, of course, to introduce 100 new routes within Wales, which will be determined in consultation with the public locally.

That's good. Thank you very much.

Okay. Jenny, do you want to ask questions on equality and diversity?

Yes. Thank you very much. I think I want to turn to the Well-being of Future Generations (Wales) Act 2015, initially, which you spoke about in your letter to the Chair. The Government is co-producing ways to improve collaboration. That's obviously essential and something that was highlighted by both the future generations commissioner and the auditor general, that simply consulting people isn't collaboration. And we can go back to the discussion we had earlier about social prescribing. I think that one of the concerns that the Equality and Social Justice Committee has had around its scrutiny of the Act, which is about to be published on Monday, is the alphabet soup of different bodies that we've got. So, we've got public services boards, regional partnership boards, corporate joint committees, 22 local authorities, seven health boards. I wonder what your recommendation would be to the next Government as to how we go about resolving that, as we are only a population of 3 million people.

First of all, on the future generations Act, I think this is an extraordinary Act. It is pioneering, it is world leading and it is making a difference in terms of the way we work across Government, but not just across Government, in terms of local authorities, in terms of health boards, in terms of the national parks—all kinds of people have to engage. And as you rightly say, this is not about meeting the well-being goals alone, it’s about how you do it, it’s about the ways of working, the five different ways of working, and collaboration is critical to that. In that way, you should be avoiding the kind of duplication that you may get with these multiple organisations. They should be talking together and they should be saying, 'No, we’re doing that already, so let’s not duplicate. Let's not do that in the same way.' If that's not happening, it means that the Act is not working properly. So, people need to engage more readily in the Act.

There are always measures and you can always make the case for reducing the number of organisations. You can do that. Again, I come back to this: if you’re going to reorganise, fine, but you will be taking your eye off the front line. I am absolutely determined to keep my eye on that front line. What difference does it make to the public? How are we going to tackle the cost of living? How do we make sure we bring that cap on bus fares? How do we make sure we expand childcare? What are we going to do about lowering energy bills? God knows we need to think about that with this world crisis going on. So, all of those things, I think, are critical. Obviously, they’re things that we certainly will be giving attention to in our manifesto.

Given that turkeys don't vote for Christmas, you're basically saying that we're just going to go on having a lot of duplication, because what we heard, in evidence from officials, was that they were spending far too much time in meetings, which is what I took from it—

Yes. 

—because they were having the same discussion in different places. And I just—. Anyway, you're saying—. I understand what you're saying, but you're saying it's too difficult to do. 

No, no, I'm certainly not saying that. And, listen, I think you can always make a case for rationalisation, simplification. I think we should always be open to that as an approach. I think the key thing for me, though, is to make sure that we just, as far as possible, keep our focus on what are the things that matter to the people out in our communities. Restructuring, talking about the constitution endlessly, all of those things—they're really important to us, but what difference is it going to make to the lives of the people on the ground, in the four years that you have to make a difference?

Okay. I just, lastly, want to talk about the 'Anti-racist Wales Action Plan', particularly in the context of community cohesion. It's a very ambitious programme, and it involves all sectors of Government, and not just Government, but the public, private and voluntary sectors. In the context of, obviously, things going on in other countries that we have no control over, how are we making the community cohesion co-ordinators, and other levers that the Government has, resilient to the tensions that inevitably will come to our communities, just as a result of terrible things going on elsewhere?

Well, I think we've got to be a country that celebrates diversity. I think the contribution to our communities has been extraordinary by people who've come from the outside. I think I saw recently how many people lived in the Rhondda—it went up from 500 to 150,000 in a century. So, we are a country that knows about migration. And if you think about that, with most of the people in those communities, we are only going back a few generations. So, I think we've just got to recognise the contribution, and also make sure that people feel that they can integrate here, including people from England. That's really important as well. I think we've got to make sure that we're seen as a welcoming country, and it makes a difference to those front-line public services. So, let me come back to that, because that's what keeps me going: what difference does it make on the ground?

In Hywel Dda health board, 48 per cent of the doctors and dentists were trained overseas. Now, when they're hearing, 'We don't want immigrants', what are the chances of us being able to recruit in future? This is really serious stuff, and the mood music—. If we, for example, get a big vote for Reform in our country, I think there will be consequences. And then people will say, 'What about my local service? Why can't you keep my local service open?' And the reason is: 'Because we can't recruit. We can't recruit because 48 per cent of them are already trained overseas.' And I'm not going to apologise for the fact that we've signed up loads of new nurses from Kerala. That's helped us to slash the amount of money we're spending on agency nurses. It's good. That's a good thing, and they're great nurses. They're making a valuable contribution. Ukrainian refugees—we're looking after them, 8,000 of them, and loads of them have become care workers. So, let's just be really careful about the mood music around these things. So, an anti-racist Wales I think is fundamental to our core beliefs. 

And how resilient do you think the Government is to the bad actors on the far right, who most definitely are wanting to stir things up in the opposite direction?

I think that this is where values matter. Whose side are you on? People will need to choose whose side they're on in this forthcoming election. And they need to understand that there'll be consequences, in the same way as there were during Brexit. There is a reason why we lost around 2,000 care workers. It was because of Brexit. And that has consequences. You can't get into an A&E department because the flow isn't there, because we haven't got enough care workers outside. It's all connected. People calling for intervention and saying, 'Let's get in, let's be aggressive in the middle east today', they're the ones who will be screaming when you see the refugees coming from places like Iran in future. There is a consequence to intervention, to action, and I think it's really important that people get a broader understanding that shouting over here makes a difference to your service right there in front of you. Do you want to come in, Emma?

Thank you, First Minister. I was just going to add that some of the very positive actions through the 'Anti-racist Wales Action Plan' do mean that we are seeing greater diversity within public appointments, within our schools, the teaching profession, et cetera, and we've also been quite instrumental in making sure that we have a far greater understanding of anti-racism objectives for civil servants, anti-racist Wales, training within universities, et cetera. So, we've done a lot to try and make sure that, actually, throughout the communities, we have a greater understanding.

And just also to reflect on the work of the expert group on cohesion, they've met three times so far. They will meet again later this month, and then produce a report of where they think the next steps are in terms of addressing not only anti-racism, but social cohesion generally.

Mark Isherwood.

Right. I'm just going to pick up on Jenny's comments regarding collaboration. The five ways of working champion collaboration, as does the Social Services and Well-being (Wales) Act 2014, placing many duties to co-produce, collaborate, involve, et cetera, with people, families and carers. However, the further we move away from that legislation, the greater has been the incidence of public bodies, in writing or in meetings I attend with constituents at their request, telling me, with straight faces, that of course they co-produce, or collaborate, or involve, because they consulted. And they're getting away with it, because every time I refer this to a Welsh Government Minister or a regulatory body in Wales, they tell me they don't consider individual cases. So, if I then send them several separate cases showing the same issue occurring repeatedly, it all goes very quiet, and then I get a reply, usually some months later, telling me they're not going to do anything about it.

So, how on earth are we going to hold public bodies to account that either don't understand or don't want to understand what they're supposed to be doing, and recognise that this would not only improve lives, but ultimately make better use of the resources they have available to them?

Thanks, Mark. I think you're right. I think there's a difference between consultation and collaboration and involvement, and I think we need to recognise the difference. I think, as a Government, generally, we are quite open to listening to what people within our communities have to say, and if you don't, if you impose from above, things don't tend to work as well. So, that's why, for example, with our women's health plan, we've taken a while to get there, but we've made sure it's owned by the NHS. So, in England, they imposed it from above. They said, 'The Government's going to do this, and you're going to do this.' And it's kind of not really worked. I don't know if that's fair, Nick. But what we've done is we've said, 'No. Let's get the NHS to work with us. They're the ones on the front line. They're the ones who know what's going to work or not.' So, when we work together, we get much better outcomes. And it was great this week, we said goodbye to Andrew Morgan, who's stepping down as Rhondda Cynon Taf leader very soon, and it was extraordinary just talking through what happened during the COVID pandemic, and that co-operation, that co-design, because we did it with local government, because we have those relationships, was quite, quite different from what was happening in England. And we managed to get things done much quicker. It was done in a way that interacted much better with people in our communities.

Llyr.

So, we're talking about governance here really, aren't we, and what good governance looks like. I'm just wondering, because, over the course of this Senedd, we've had three First Ministers, we've had three Secretaries for health, we've had four Secretaries for the economy, et cetera. So, do you think that that level of ministerial turnover actually makes for good governance?

Wow. Well, it's nothing compared to what we saw in England, and the changes we saw there. So, look, there was a difficult period for the Labour Party, there's no question about that. I think we've overcome that. Mark Drakeford was in power for not a short amount of time. He was there, thank goodness, during the pandemic, leading us through, and got rewarded by the public with a significant vote in the last election. I've come in and taken an approach that is absolutely focused on delivery above everything else, to make sure that we get things done that we said we were going to get done. We brought in the delivery unit. So, all of those things, I won't apologise for that. I think, if you compare the stability we've had in Wales compared to the United Kingdom—

That's a very low bar, though, isn't it, First Minister? It's a very, very low bar, I have to say.

Hey, listen, what you've had is consistency in terms of policy as well, and that makes a difference. It makes a difference to investment and it makes a difference to our ability to get things done. So, chopping and changing, people wanting to restructure all the time, reorganise, redevelop, all of that stuff causes—. Sometimes, it absolutely has to be done, but it's a distraction, I think, from the day-to-day delivery on the ground. There are times it absolutely needs to happen, there's no question about it. We can always do with a bit of streamlining. You have to work out how much energy you want to put into that and how much energy you want to put into making sure that Betsi, for example, bring their waiting list down. Because there are only so many hours in the day, what are you going to focus your attention on? And I've been very clear about where my attention is.

So, how have you sought to rebuild confidence in public standards at the top of Government following the departure, obviously, of your predecessor?

Well, I think we've been very clear that transparency is important. I think, as a Government, we have always been pretty clear about making sure that we can be as transparent as we can be. We have an open Government. We get a lot of questions that are asked of us very regularly. So, I don't think of us as a Government that is lacking in public standards. I know that the expectations I have of my Ministers are extremely high.

Mark, did you wish to ask a question on hospices?

Thank you. Yes. You'll be aware that the Welsh Government announced it would be declaring, or announcing, in April—so, presumably after the end of this term, hopefully before dissolution—its proposed future framework for hospice and palliative care funding. I met Hospices Cymru and Hospice UK on Monday of this week, and they're very concerned not to have received the assurances that they'd expected about this going forward. So, what is the current position? Will there be a framework for this, or not, this Senedd term? And if so, will it meet the co-produced requirements the sector has identified if it's to continue to meet the growing numbers of people passing away in Wales, and to support the NHS in delivering palliative care in a humane way?

Thanks, Mark. I think end-of-life care is something that absolutely needs to be done sensitively, and it's a really difficult time for the individual and for the families. That's why we have to make sure we get this right. I think there is a change that's happening. I think the pressure on hospices has been enormous, particularly during the pandemic, when a lot of the shops that raised money for hospices were under a lot of pressure, so that they saw a reduction in the funding coming in. And that's why the Welsh Government has stepped in to try and support them, has recognised that national insurance contributions have made a difference to their ability to pay their staff. It's been great to go and visit some of the places, like St David's Hospice in Newport. Most of their work is actually outreach within the community, and we need to recognise that, if it weren't there, it would back up onto our hospitals. So, we do need to take this really seriously, and that's why we have had this phased approach to how we deal with hospice funding in future.

There has been a huge amount of collaboration. I can't remember the name of the consultant who leads on hospices, but he's a remarkable man, and absolutely committed to this. So, the collaboration, I think, has definitely been something where we are listening to the sector very, very clearly—the sector, the NHS. I think, if I remember correctly, we had a discussion about that this week: £24 million we're now spending on hospices. So, I don't know, Nick, if you've got anything to add.

Yes, I think the point the Member’s made around the future framework is it is currently in discussion, and some of that is going to be discussed at what's known as the joint commissioning committee of the NHS, to set out that commissioning framework and to understand population need going forward for hospices and end-of-life care across the seven health board regions. There is—I was just looking it up now—a stabilisation grant that is being sought for this year to ensure that the shortfall, I think it is around £24 million, will be met in-year, as that commissioning programme works through over the next three to six months into next year. 

Can I just be clear? I don't think it's £24 million; I think it's £24 million overall that we support, and I think there's talk about £3 million or £4 million.

Sorry. It's £4.3 million. Sorry, my error.

It's £4 million or so, the stabilisation. Yes. 

Yes, Mark. 

Thank you. I think you were referring to Idris, the doctor who has been involved, who is an incredible man and I've got full, huge respect for him. But are you telling us that the promised framework, which would be published in April this year, is not going to be published in April this year? Yes or no? 

I'm going to have to go and check that, Mark. What I do know is that there is an intention to put that stabilisation money in, if we can, before the end of this Senedd term. But I can't give you an assurance on that at this point. 

Would you be able to write to the Member with confirmation of that? 

Sure, yes. 

Okay. Carolyn, you wanted to ask a question on this. 

I raised £7,000 for my local hospice, and that funded one day, 10 years ago. Nightingale House Hospice. It's amazing how much it costs to keep them going.

I met with Betsi Cadwaladr University Health Board recently, and they said they've got 24-hour district nurses available now, working with Marie Curie, so I'm just wondering if that's a model, because I know many would like to have their end-of-life care at home, with nursing.

There's been a large investment across all health boards into district nursing services, not essentially 24/7, but certainly seven days a week rather than 24 hours a day, to support that ability for people to die in their own home, or be supported to do so out of hospital. That is one of the key parts of the district nursing funding. 

That's good. Thank you. 

We are getting short of time, so has any Member got a final question they wish to ask? Because I'm going to take the Chair's prerogative if not. John.

I know we've dealt with education a lot in First Minister's scrutiny, but fundamental to the future of Wales is our school system, First Minister, and our young people too often are not being well served by the quality of teaching or the quality of leadership in our schools, and I think the latest Estyn inspection sets that out. So, I just wonder what your reflections are at this stage in this Senedd term, in terms of what more Welsh Government can do, working with the sector, to make sure that standards in our schools improve substantially. 

Thanks. We do have more to do when it comes to standards in our schools. I'm very pleased to see that, in our third annual statistics release on attainment patterns for reading and numeracy, years 2 to 9, we are seeing clear signs of improvements, particularly in numeracy, Welsh reading and English reading. So, we're absolutely heading in the right direction. Do I want to go further faster? Absolutely. That's why we've put a huge amount of money now into making sure that teachers are trained properly to know what the best techniques are, how best to do it, making sure that we're using synthetic phonics as a system. All of these things are critical, I think. And the thing I'm particularly concerned about is addressing the attainment gaps between disadvantaged pupils and their peers. But this year, we're providing £128 million to help schools to tackle that attainment gap and to make sure that we have that pupil development grant continuing.

Attendance is also another thing. We've spent a lot of time and energy and resources on attendance. It's getting better, but there's a lot of hand-holding to do, so that's why we've engaged a lot more family engagement officers. If you are not in school—. I think it is about 9 per cent who are not in school. You think about 9 per cent of the entire population, what's that going to do for them? That's quite a lot, so we've got to get them into school, that's the first thing. A lot of them have trauma, have issues that you need to deal with, so that's why we've put in that in-school child and adolescent mental health services inreach. The mental health support is all there, because you're not going to get those standards better if they're not in school, so you've got to make sure that, if they go to school, the support is there for them. Have you got anything to add, Emma?

Yes. Thanks, First Minister. A lot is going on in the education sector at the moment. I think the chief inspector's report was quite clear that there are many, many strengths within the system. I think in particular, consistency and how cohesively the various aspects of reform have been implemented was drawn out. Some of the many areas that we're working on at the moment are the change to the new school improvement policy, which has looked at what we do at a local level, led by local authorities and schools, versus what the new improvement body, Dysgu, will do in terms of national training and development and school improvement models. There's a lot of work happening there in terms of how we look for consistency, particularly around the teaching of literacy and numeracy.

We're also looking at how we develop age-related expectations in literacy and numeracy, so a lot of work ongoing at the moment in partnership with Estyn and with Swansea University around that. And looking at how we drive improvement, increase the data that's available for schools to use, to look at where they are doing well and who they may learn from. So, there's a huge amount of activity there. Obviously, there's been a lot of change. We've got the new curriculum, the introduction of the additional learning needs legislation, but that core focus on what does a high-quality, inclusive classroom look like remains at the core of what we're doing.

Just finally to add, on that importance of children actually being in school, there's the role of the family liaison officer, which has been transformed through the last few years, with significant investment there, making sure that family liaison officers aren't just focused on dealing with truancy, as it would have been called in the past, but actually engaging with families—what is it that the family needs in order to support them, to enable the children to come to school and be supported in their learning.

I think we should also underline the importance and the value of school support staff. There are more school support staff now than there are teachers, because the need has increased, and so we do need to give that additional support. We've been clear that we're losing talented people who have experience because they're only currently paid during term time. That's why we've been clear that, if we're here again in May, we will seek to address that issue and pay school support staff throughout the year.

Llyr, did you want to ask a quick question?

We have come to the end of our session. I'm going to ask the last question. Just a quick one, because I know you've got to go by 12:35. You talked about investment there and the economy. We haven't really talked about the economy this morning. I'm going back to perhaps my first question as to the relationship with the UK Government, in one sense, because a lot of the economy levers are still with the UK Government. During your time, have you seen how the Welsh influence on UK Government policy has taken place? I'll take my own constituency as an example. We've lost the blast furnaces in Port Talbot, we've seen electric arc coming in. We have the offshore wind as an opportunity. How have you managed to influence UK Government policy to ensure that Wales has its fair share and that the policies actually benefit Wales as much as possible?

I think we've seen a sea change since we've had a UK Government led by the Labour Party. It was very hit and miss before. There are now structures of Government that are engaged far more frequently than they were before. There's still work to do there. Clearly, it's the UK Government that has a lot of the levers when it comes to managing the economy, managing the inflation rate. I guess that's not even with them. It's the central bank that has some of those levers in terms of interest rates and things.

In terms of how we influence, I think the fact that I talk regularly to the Prime Minister in a way that wasn't done before under a previous administration is helpful. We can have a really honest, straight conversation, and anybody who knows me knows that that's how I work. It has, I think, made a difference.

We've always been consistent, for example, on the two-child benefit cap. We didn't change. We were clear when, under the Conservatives, we said, 'We don't like that.' We weren't going to change our mind because there's a Labour Government in Westminster. We remained consistent, and then they changed to our position. That's really good, and I'd like to think that we influenced that. The fact that they came and made that commitment here in Wales in the community where I grew up, supporting 70,000 children in Wales, I think that is an example of influence.

I think the fact that we've landed massive investment in nuclear power in Wylfa, transforming the north Wales economy; and it's not just Wylfa, it's two AI growth zones—not just one, but two—actually producing even more jobs than we're going to see in Wylfa. That is transformational, because I'm really keen to look to the future; we can't stand still. If we keep on investing in what we've done in the past, people are going to bypass us. We've got to try and look ahead, and that's why things like investing in renewable energy is critical. We are absolutely committed to that and making sure that we get the infrastructure that's needed for that.

I think probably one of the biggest wins is that rail investment promise, £14 billion. We've been asking for that. Other people have been saying what we need is £4 billion that we've missed out on—£14 billion is a very different scale of investment to what we've seen in the past, and what that means now is we can start planning. We can start gearing people up, we can start training people, we can make sure that businesses are ready to invest in Wales.

We've got a great track record already. We've demonstrated through the core Valleys lines that we're good at this. We can make this happen. We have the skills, we have the resources, and I think that is a demonstration of how we can influence the UK Government.

Is there more that I want and we could do? Absolutely. I'll always ask for more; that is my responsibility as the First Minister of Wales. My responsibility will always be to Wales first.

On that note, I think we've gone well beyond the time. Can I thank you very much for your time this morning, and your officials? As you know, First Minister, you will receive copies of the transcript to check for any factual inaccuracies. If there are any, please let the team know as soon as possible. As this is the last time, can I thank you for attending the various sessions we've held since you've become First Minister? And you can thank your predecessors on our behalf as well. Clearly, it is important we understand the direction of Government and the decisions Government take as to improving the lives of people in Wales.

Diolch yn fawr iawn. Thank you to you for all your work as well.

Before we move into private session, I will again put on record my thanks to the clerking team of the committee that has helped us undertake our duties and responsibilities over the last five years. Without them, without the clerking teams of all our committees, I think we would all find it difficult to do exactly that role, so thank you for that.

On that point, I propose, in accordance with Standard Order 17.42, that the committee resolves to exclude the public for the remainder of this meeting. Are Members content? They are. Therefore, we will now move into private session.