Y Cyfarfod Llawn

Plenary

01/12/2021

In the bilingual version, the left-hand column includes the language used during the meeting. The right-hand column includes a translation of those speeches.

The Senedd met in the Chamber and by video-conference at 13:30 with the Llywydd (Elin Jones) in the Chair.

Statement by the Llywydd and Announcement of the newly elected Members of the Welsh Youth Parliament

Welcome, all, to the Plenary session. Before we start, I want to set out a few points. This meeting will be held in a hybrid format, with some Members in the Senedd Chamber and others joining by video-conference. All Members participating in proceedings of the Senedd, wherever they may be, will be treated equally. A Plenary meeting held using video-conference, in accordance with the Standing Orders of the Welsh Parliament, constitutes Senedd proceedings for the purposes of the Government of Wales Act 2006. Some of the provisions of Standing Order 34 will apply for today's Plenary meeting, and these are noted on the agenda.

I have one announcement and one statement to make before we start our business this afternoon. The announcement is the announcement on Members of the Welsh Youth Parliament, who have just been elected, following the election campaign held in November. It is my privilege to announce the results for our second Youth Parliament. This is the culmination of many months of work by organisations, schools and the Senedd's dedicated Youth Parliament team, and we are indebted to all those who made this innovative project a success once again. There were 272 candidates and there was an election in each constituency seat, and we have 18 partner organisations, ensuring that diverse groups of young people are represented from across Wales.

The second term of the Welsh Youth Parliament will run for two years and the opening meeting will take place in February 2022. The first youth parliamentarians made a big impression on all of us and I'm sure that the new Members will be inspirational and will act with the same energy and vigour, ensuring that their peers see the relevance of the Youth Parliament by contributing to the work of our Senedd.

For those young people who stood for election but weren't successful on this occasion, I know you will be disappointed, but thank you for your hard-fought campaigns and for putting your names forward. We hope that you will continue to follow the Welsh Youth Parliament's work and get involved in the coming months and years. The story is not over for you, I'm sure. 

I'm very pleased therefore to announce the successful candidates for the second Welsh Youth Parliament, representing constituencies and partner organisations. Here are the names.

Here are the names of the young parliamentarians: Isaac Floyd-Eve, Poppy Jones, Owain Williams, Dylan Chetcuti, Finley Mills, Laura Green, Leaola Roberts-Biggs, Bartosz Firmaty, Rhys Rowlandson, Iago Llŷn Evans, Jake Dillon, Keira Bailey-Hughes, Samantha Ogbeide, Amir Alenezi, Lloyd Warburton, Tilly Jones, Finn Sinclair, Zach Davis, Iestyn Jones, Freddie Webber, Kelsey Hannah Brookes, Tegan Skyrme, Cerys Harts, Ffion Williams, Ruben Kelman, Ellis Peares, Qahira Shah, Andrew Millar, Kasia Tomsa, Tegan Davies, Tobias Baysting, Harriet Wright-Nicholas, Maddie Mai Malpas, Sonia Marwaha, Fatma Nur Aksoy, Ffred Hayes, Milly Floyd Evans, Fiona Garbutt, Hanna Mahamed, Hermione Vaikunthanathan-Jones, Bisan Ibrahim, Ella Kenny, Jake Dorgan, Stella Orrin, Roan Goulden, Ewan Bodilly, Ruby Cradle, Jack Lewis, Ffion Fairclough, Evie Kwan, Seth Burke, Georgia Miggins, Ollie Davies, Elena Ruddy, Shania Adams, Bowen Raymond Cole, Daniel Downton, Sultan Awolumate. 

And that's it—all Members. [Applause.] Two Members, from Llamau and Voices from Care, will be announced shortly in addition, making 60 Members of our new Senedd Ieuenctid, Welsh Youth Parliament. Wishing you all the very best of luck with your work, congratulating you all, and we hope very much that we will be able to welcome you to the Senedd for the inaugural meeting in February.

Many congratulations to you all on that work.

13:35
Statement by the Llywydd: The Co-operation Agreement between the Welsh Government and Plaid Cymru

I now have a statement for you on the co-operation agreement between the Welsh Government and Plaid Cymru. Members will be aware, via a written statement I have issued, that the First Minister and the leader of Plaid Cymru have signed a co-operation agreement today. The agreement makes arrangements that are novel and raise questions regarding the operation of Senedd business. I've therefore taken legal advice on the impact of the agreement on the status of Plaid Cymru as a group, and in particular whether they are a group with an executive role. Under the terms of the agreement, Plaid Cymru will not have any ministerial roles, and so my preliminary view is that it does not have an executive role. The Government of Wales Act 2006 definition of executive role also applies to our Standing Orders.

Notwithstanding the legal position, the details of the agreement raise issues for the operation of Senedd business and our current conventions. In particular, the introduction of a new role for designated Member requires careful consideration. I will now consult with the Business Committee and make a further statement on how the agreement is likely to impact the operation of Plenary and committee meetings.

1. Questions to the Minister for Economy

We are now ready to move on to questions to the Minister for Economy, and the first question is from Ken Skates.

Major Events in North Wales

1. What is the Welsh Government doing to support major events in north Wales? OQ57277

Thank you for the question. We're committed to building on Wales’s success in hosting major events. We work proactively with event owners across the whole of Wales, and I was pleased to see events like Focus Wales and the Curtis Cup delivering economic, cultural and social benefits to north Wales this year.

Thank you, Minister. Indeed, the Curtis Cup was a huge success, likewise Focus Wales, and of course we have some wonderful annual events that the Welsh Government supports in north Wales. And indeed, major events such as the Tour de France and the UEFA World Cup have the potential to hugely transform for the better communities in which they are located. Minister, what's your assessment of how a successful City of Culture bid by Wrexham Country Borough Council would help the entire county borough attract more major events and inward investment to the area?

Thank you for the question. And I should say, Wales has a good track record of not just attracting but gaining real benefit from major events, and there is real credit to the Member for his time in Government in helping to move that forward. We see the events that we help to fund having a return on the investment of around about 10:1, so it does provide significant economic benefit, but also, as we said, cultural and social. And I'm enthusiastic about Wrexham's bid for the UK City of Culture; they're the only Welsh entrant still left in the race. And we've seen from other UK cities of culture that it can be a catalyst for more investment and a greater understanding of that city and its near neighbours, and what that can do in terms of attracting more investment from both inward investors in business terms, as well as looking to build on a record of a sustainable visitor economy. So, I think it's a really positive aspect, and my officials will be happy to explore opportunities to collaborate to showcase events for 2025, should Wrexham be successful. And I hope that every Member in the Chamber—north, south, east and west—will wish Wrexham well in their bid to be the UK City of Culture in just a few years' time.

Minister, it goes without saying, really, that the past couple of years have been tough for major events in north Wales, and across Wales as a whole. Events have had to be cancelled at short notice. There is now some reluctance from events organisers to put on events because of the uncertainty over COVID reduction measures. But it hasn't all been that bad, really, because the pandemic meant more people holidaying in north Wales, which is great. We even saw major tv productions like I'm a Celebrity coming to the region—and it was good to see them back on ITV last night after a few days off because of storm Arwen. These events showcase what the region has to offer, and have increased visitors to my constituency. Minister, what assurances can you give to the events organisers in the Vale of Clwyd, and across the north Wales region, that there will be no more lockdowns and they should carry on organising events throughout 2022?

13:40

Well, I could agree with much of what the Member said and support it, until the last 'Give me a guarantee on the future.' Look, the reality is that if we see the new omicron variant, and if it is something that spreads much more rapidly than even the Delta variant, and if it has the same level of harm over the population and for each person, then, actually, by the fact that it spreads more rapidly, it is going to be a more dangerous variant. It's why every Government across the UK have implemented a series of new measures. 

I want, though, to be able to support the visitor economy across north Wales, across the south and the middle of Wales, to understand how we generate more activity and have the confidence to build on improving the visitor economy more broadly, because I certainly recognise it's an important economic sector for the future. And I want to build on the fact that more people have come to different parts of Wales over the last two years, and to have a genuinely sustainable visitor economy—one that is year round, and with good jobs within it and not simply seasonal jobs.

So, we will do everything we can to support the visitor economy, and the broader economy, and we will take all reasonable steps we can to avoid further measures that may need to be taken in the course of the pandemic, because we recognise that, if we go backwards, there's real harm to the economy, as well as physical and mental health. So, the Government will continue to be clear, consistent, balanced and open in the choices that we make. 

The Active Recreation Sector

2. What steps is the Welsh Government taking to support the active recreation sector in north Wales? OQ57289

Our programme for government makes clear our commitments to promote equal access to sport and leisure activities and our aims for a safe and welcoming tourism and leisure sector across Wales. North Wales features prominently in Visit Wales’s promotional activities and in our capital investment programme for tourism.

Diolch, Deputy Minister. I recently visited Plas y Brenin, which is a great facility for adventure sport and training in the heart of Snowdonia, and it's run by a Welsh charity, the Mountain Training Trust. They are looking for funding to bring their building and outdoor facilities up to full disability access to widen inclusiveness and expand the offer. What is Welsh Government doing to support this industry that is so crucial to both the economic and social well-being of north Wales to recover from the pandemic and grow, and would it be possible for you, Deputy Minister, and officials to meet with me to explore what can be done to help this fantastic facility grow and adapt? Thank you. 

Can I thank the Member for that supplementary question? Yes, I did see that you recently visited Plas y Brenin; I do follow you on Twitter. It clearly is an excellent facility, and I'm very pleased that you had a positive experience there. And I do fully recognise, of course, the importance of active recreation across Wales and, in this context, the importance of our programme for government commitment to supporting disabled people and removing the barriers and obstacles that might prevent people from enjoying those kinds of visitor attractions. I certainly hope that I'll get the chance to visit there myself soon, and I would be more than happy to have further conversations with you about that. 

However, Plas y Brenin is owned and run by Sport England. So, I would anticipate that capital funding for the facility would be something that Sport England would need to review as an organisation. But, having said that, across north Wales, Welsh Government is currently supporting nine public amenity projects through the Brilliant Basics scheme to enhance the visitor experience, and several of these will allow better access to our environments, such as the beach access at Dwygyfylchi beach in Conwy. It will see improved conveniences incorporating cycle storage and so on. And, of course, we are committed within the programme for government to a new national park for north Wales, the first in more than half a century, centred on the breathtaking Clwydian range and the Dee valley, which I know is very close to your heart. 

The Welsh Government also continues to consider capital development opportunities that support key visitor and leisure destinations—for example, in Denbighshire, to support the expansion and upgrading of facilities at the coastal Beaches Hotel in Prestatyn, and two phases of an £8 million investment in Adventure Parc, Snowdonia, and another £380,000 going into Plas Weunydd Hotel in Llechwedd to create a hotel that will complement the Zip World development. I could go on, but I think the point that you get here is that the Welsh Government is very serious about supporting the outdoor recreation facilities and centres, and does absolutely recognise the importance of it to the wider economy of north Wales. 

13:45

As highlighted, active recreation is, of course, essential to the health and prosperity of many people across north Wales. Not only does active recreation benefit people physically, it also has immense benefits for mental health as well. As, Minister, you will be aware, north Wales is an exceptional area for active recreation, with fantastic nature and scenery for all types of exercise, and, indeed, back in May, I was delighted, as you just mentioned Adventure Park Snowdonia, to actually be at the opening of the Hilton hotel there, a hub of award-winning indoor and outdoor adventures in north Wales, with the world-first inland surfing. So, yes, a great example of a site enabling active recreation—a really important stakeholder in the region. But just going back to the benefits, in terms of both physical and, of course, mental health, I wonder, Deputy Minister, what work you're doing with the health Minister to understand the benefits further, and how the north Wales health board—Betsi Cadwaladr health board—can also ensure that they're supporting the active recreation sector? 

Can I thank the Member for that question? And I think he is absolutely right: this is not something that is the responsibility or within the confines of one single portfolio. I've had conversations with my colleague the Deputy Minister for Mental Health and Well-being and with the Minister for health about how we can work across portfolio to deliver some of those health and well-being objectives, including some budgetary issues. Obviously, within my portfolio, we have lots of areas, whether it's arts, culture or sport, that can help deliver those kinds of activities. We don't necessarily have all the budget that goes with that, if it is specifically around a mental health and well-being objective, but we have a very clear objective within our programme for government about delivering social prescribing, and the areas within my portfolio really are there to enable that support to be given into the health sectors as well. So, it is absolutely something that we're considering on a regular basis.  

Questions Without Notice from Party Spokespeople

Questions now from the party spokespeople. The Conservative spokesperson, Paul Davies. 

Diolch, Llywydd. Minister, the new variant of COVID-19 has caused understandable worry, particularly given that we don't know yet how virulent the variant is, and therefore we can't accurately ascertain the threat of the virus to Wales. Nevertheless, the news of a new variant will cause some real worry for Welsh businesses, and so it's crucial that there is an ongoing dialogue with the Welsh Government about the impact of the new variant on how we live and work so that businesses are consulted on any new measures or any changes to existing measures and strategies. Now, I listened very carefully to the answer you gave my colleague the Member for the Vale of Clwyd, but, Minister, at this stage, can you tell us how is the new variant affecting the Welsh Government's economic recovery plans? And can you tell us whether the Welsh Government intends to announce any new measures targeted at businesses in Wales before Christmas? 

Thank you for the question. The difficulty with the omicron variant is that we don't have a fully formed picture of its overall impact. But we are genuinely concerned that it appears to spread even more rapidly than the delta variant. You'll have heard Conservative Ministers in the UK Government talk about that as well, but about the fact that collectively within the UK we don't understand the three main points of difficulty. On the first, we have some impacts, but we don't understand how much more rapidly than delta it appears to spread, but it appears to spread more rapidly; the second is whether it actually causes more harm than the delta variant, and I'll come back to that; and the third is whether it can escape the vaccine.

Now, if you put it this way: we have about 2,000-odd people every day in Wales who test positive for COVID—it's almost all delta—and we know that leads to a certain number of people coming to harm, going to hospital. Unfortunately, we know that a certain number of people won't survive. If omicron has the same impact in those, say, 2,000 people, then you'd say it's about what the scientists call the same sort of pathogenic capability. The problem is, if omicron spreads more rapidly, we'll see more people come in to our health and care system much more quickly, and that does have the real potential to cause a very serious impact, even if it doesn't actually escape the vaccine response. So, we're dealing with a good deal of uncertainty at present.

Our scientists across the UK expect to be able to provide politicians with some more information within the next two to three weeks to have an understanding of those extra factors. So, we're dealing with a point of real uncertainty at what is the most inconvenient time for many businesses, in the last few weeks in the run-up to Christmas. So, we don't plan to introduce more restrictions before Christmas, but, when we get more information on the omicron variant—not just what it entails and what it means, but also how widespread it already is within the UK. And we're not having a fully formed picture; of course, we have confirmed and probable cases, but, because a decision was made to no longer have PCR testing for international entrants about six weeks or so ago, that means we haven't been able to sequence in advance. So, it's likely that there is more omicron in the country and across the UK than we understand at present. Once we get a fuller picture of where it is and its particular impact, then not just this Government for Wales but, actually, across the UK, will need to make choices, and that's why the First Minister wrote jointly with the First Minister of Scotland to the UK Government to be clear that, if measures are needing to be taken, then we want to have the support of the UK Treasury in doing so if that impact is felt first in another part of the union that isn't England. We've seen that in the past, and I believe that a proper and sensible response to that would show the UK acting as it should do and its best to make sure that the risks and opportunities are shared equally with this latest twist in the ongoing tale of this pandemic. 

13:50

Well, Minister, the point I'm making is that it's crucial that, as more information comes out about this virus, the Welsh Government communicates clearly with Welsh businesses and sets out its intentions, and therefore I look forward to hearing more from you in the coming few weeks. Now, over the past few weeks, the Welsh Government has published several economic statements and allocated substantial funding, and it's important for us to better understand whether this new variant has any impact on the Welsh Government's plans going forward. For example, last week the Government announced a £45 million package of funding that aims to help small businesses across Wales to grow, and will hopefully support thousands of people across Wales to train to work in key sectors. That funding is vital in addressing skills gaps and upskilling the workforce. Indeed, you yourself told the Economy, Trade, and Rural Affairs Committee that every single sector of business that you talk to—small, medium or large—there's always a key skills challenge. Therefore, can you tell us more about this particular funding stream and how it'll be allocated across local authorities in Wales? And can you tell us how confident you are that this funding will be enough not only to safeguard 4,000 jobs, but also to help create 2,000 new jobs in Wales, as you outlined last week? 

Yes. So, on the additional funding that I was pleased to announce— and I'm particularly pleased to have announced that we'll be delivering that in partnership with local authorities, who will deliver the funding and they'll be able to make choices within the local authority area, so it will cover every single local authority in the country. And the figures that we provided on the number of new jobs we think it will create, as well as those safeguarded, come from our experience of working alongside local authorities and businesses during the pandemic. This, in particular, we think will be of real advantage to small and medium-sized businesses as well.

So, that's the basis on which we have allocated funding and why we have come up with figures about the impact we think it'll have, and I was very pleased to visit a business in the Caerphilly county borough, I believe in the Islwyn constituency, on the launch of the fund, and they've already indicated about the support they've had from previous rounds of support from the Welsh Government, and what that's allowed them to do in diversifying their business and actually managing to grow, and that growth is from local employment—so, decent jobs and the whole thing of, as we say in the Welsh Government, better jobs closer to home. It's a good example of that funding delivering on that. There's been a real appetite from businesses to do that. Part of the challenge has been unlocking business investment themselves. So, the fund allows people to apply for a grant, then to invest some themselves as well. It's a genuine example of 'something for something' that we think has every prospect of being successful. 

On your broader point about business communication regarding the path through the pandemic, I have regular conversations with a variety of different sectors within the economy. I talk with trade unions and I talk with business organisations. I'm having another round of conversations with business groups later this week. So, there is regular communication and business groups themselves say that they've never had a closer or better relationship with the Welsh Government. The necessity of the pandemic has driven some of that, but I actually think there's better understanding and a better sharing of information, trust and confidence.

So, I hope that gives the Member some of the assurance, which I think is reasonable for him to ask for, that there are both regular conversations going on between myself, my officials and business groups, and that those are in a good place to be able to do what we need to do, but I really do hope we don't need to introduce further restrictions. But myself and other Ministers in the Government will make the right choices to keep the people of Wales safe, and to do what we can to save livelihoods at the same time.

13:55

Well, I'm very pleased to hear, Minister, that you're having ongoing discussions with the business community, and I hope that will continue over the next few weeks in the run-up to Christmas. Now, in the same ministerial scrutiny session with the Economy, Trade, and Rural Affairs Committee, you also said that the pandemic recovery in business terms has certainly not been complete yet, but it's a matter of discussions between yourself and the finance Minister about the sort of support the Welsh Government will be able to provide businesses in the future.

Now, as you'll be aware, next Saturday is Small Business Saturday, and I hope, Minister, you'll be out sampling and enjoying everything our small businesses have to offer. Wales's small businesses are still in a precarious position, and the new variant could threaten that, as it's winter and we know that COVID-19 thrives in indoor environments. Now, in Scotland, a £25 million fund for ventilation of businesses was established and organisations like the Federation of Small Businesses have called on the Welsh Government to consider doing the same here in Wales. So, Minister, ahead of Small Business Saturday, can you give us an update on the discussions between yourself and the finance Minister in relation to business support, and in particular whether any decisions have been made regarding business rates? Secondly, can you tell us what short-term assistance the Welsh Government is offering to businesses to make their settings as safe as possible during the winter months, including a potential ventilation fund, as has been established in other parts of the United Kingdom?

Yes, I'll happily deal with those points. It will be of no surprise to you that I'm not going to preannounce the budget. The finance Minister and the First Minister would not be wonderfully happy if I attempted to preannounce parts of the budget that will be published at the end of the year, but I have heard, as indeed has the finance Minister, calls from a range of business organisations for further rate relief in the new year. We are, of course, in a place where in Wales we provided a much better rate of rate relief for a range of sectors compared to England, so we're already further ahead than those businesses having to work with the English levels of support, which have been reducing for some time now.

On the Scottish ventilation fund, we were interested in what they were doing, but we weren't convinced the fund as announced in Scotland would work for us here. I don't think that there was clarity in how it would be achieved and what would happen with the supply chain. What we have done now, though, with the £35 million fund that we've announced in tandem with local authorities, is that, actually, ventilation is the one of the purposes for which the fund can be accessed, because some businesses have already taken measures to improve ventilation within their premises, and I'm sure you've had contact from those who have done so. Others who haven't done so and want to further improve ventilation, that's one of the purposes for which they can apply for the fund that I have recently announced, and you've helped me highlight it earlier in questions today.

More broadly on your point on small businesses, I hope that there'll be an outbreak of agreement across the Chamber later this afternoon in the debate on small businesses—the short 30-minute debate that your group has tabled. I certainly do support small businesses within my own constituency and more generally, and I look forward to people right across the different politics of the Chamber doing so and highlighting within their regions and constituencies small businesses that we still want people to support. People did support small businesses at the height of the pandemic, when people had to shop local, and I hope that people will still choose to shop local and support your local high street and support your local small business.

Diolch, Llywydd. Business Wales currently has skills and training programmes over three areas: recruitment and staffing, workplace skills, and leadership. How does Business Wales choose which courses to offer, and are there any plans to introduce more courses to help boost businesses in Wales?

That would be a matter for discussion with business sectors themselves, about what courses they would offer directly and what our more broad offer is on the skills and training agenda. I'm interested in the future of work and young people coming into the world of work for the first time and are looking to move on. That's why, of course, we've launched the young person's guarantee. The young person's guarantee, of course, straddles apprenticeships, which aren't just for young people. It's also why the recent announcement on personal learning accounts is about investing in the current workforce, and it's why I'm so concerned about the challenges over the reduction in the ability to run a proper and robust skills programme with the changes to the levelling-up fund. It's a real concern for us. But I look forward to further conversations with me and with my officials on the spread of help and support that we should provide and how that meets business need. That will, of course, be driven by lots of work done by our regional skills partnerships, and that really is a key factor in planning how we will support businesses now and in the future.

Thank you for that response, Minister.

And I'm glad he said that that's a question for businesses. As Paul Davies has already highlighted, Small Business Saturday is fast approaching, and, as part of the run-up to Small Business Saturday, many of us in this Chamber have visited our own local businesses. Part of that for me has been visiting businesses in my own region of South Wales West.

One consistent suggestion that has been fed back to me relates to some of the courses provided by Business Wales. For example, one business raised a lack of support relating to SEO training, search engine optimisation, whilst another raised a lack of courses relating to growing their businesses. From my own research, it appears as though Business Wales's main course that focuses on growth is the 2020 leadership programme. However, according to the Business Wales website, that course is only provided in east Wales to businesses that operate there or employees who reside there. Is there any monitoring of how effective the selection of courses provided is, and what is the reasoning as to why there appears to be a significant amount of programmes on the operational and practical side of business, but little on growth and innovation? Would the Minister consider implementing the 2020 Business Wales leadership programme across Wales to provide greater growth and innovation focused courses throughout Wales?

14:00

Yes, I am of course interested in the assessment of impact of each of the courses that we run and how they're rolled out in different parts of Wales to meet business need that's assessed there. I think on your broader point around the sorts of courses that are run and the provision to help businesses to grow, actually, this is a point that came up in conversation with the Member for Cynon Valley about the change in not just helping to support businesses to start, but actually what we've been doing in our business support to help businesses to grow. It's been a key factor under the previous leadership of Ken Skates and now it's being continued, and you'll see this in the small business fund that's going out with local authorities. This is about how we help businesses to survive and to grow as well.

So, it's both about funding and it is also about some of the support and skills, but a range of that is also about businesses themselves identifying what they need to do to grow. Not all of those ideas are held centrally within the Government. So, it is about the sort of partnership we have with businesses themselves, with regional skills partnerships who tell us what we need to then provide, and where that's directly provided—there won't always be direct provision from Business Wales. But I'd be more than happy to engage in a more in-depth conversation with the Member about the variety of different courses that we provide directly and how we do so.

I should say, though, that when it comes to small businesses, I regularly go to small businesses within my own constituency. You may notice that I've had a recent haircut, that was a small business in my constituency; I go to a local butcher, the local fruit shop, I could mention more and more and more, but I'm sure that we'll hear lots of that praise of people's local businesses later on this afternoon as well, by name.

Of course, I will also be highlighting a lot of the businesses that I've been frequenting locally in the debate later on, and of course I'll be sharing my secret on where I get my hair cut as well. [Laughter.] And of course I'm very glad that the Minister says that he's engaging with businesses. More often than not, a lot of the ideas that solve a lot of the issues these businesses have come up on the coalface, so I'm glad that conversation is happening.

If I could turn to trade and the Northern Ireland protocol, threats from the UK Government to trigger article 16 are not only concerning with respect to stability, peace and trade in Northern Ireland, but the triggering of article 16 would negatively impact Welsh trading relations with the EU. While Wales is trying to recover from the effects of years of austerity, Brexit and COVID-19, and of course we've already seen disruptions to trade at Holyhead, we cannot risk causing further disruption to the Welsh economy. Has the Minister had any clarification as to how the UK Government would plan to implement article 16, if they do so, and what the role of the devolved Governments would be in that process? Will we, for example, be able to raise concerns about the impact on Welsh trade and the Welsh economy, and what preparations, if any, have the Welsh Government made to cushion the blow to the Welsh economy in case article 16 is triggered?

Toward the start of November, in the Economy, Trade, and Rural Affairs Committee, I asked the Minister about the timeline for an assessment of the cumulative impacts of the market-access provisions for agriculture in the New Zealand and Australia free trade agreements, and was told that it depends on the information provided and whether the agreements in principle become finalised. Has the Minister had any more details from the UK Government and is he able to share those details with me today?

I'll deal with your second point first, and that is with regard to the free trade agreements around Australia and New Zealand. We do think that the agreements in principle may change when it comes to final text. You will have seen there has been lots of speculation in public about that as well. I can't provide you with an updated statement at this point in time because they're not concluded. Once they are concluded, I've already committed that the Welsh Government will share an assessment with Members and the wider public of our assessment of the direct impacts. Some of that, of course, is forecasting, because, for example, the significant increase in the quotas for agricultural produce that can be imported is a concern about what happens now but also in the future, over time, as there's a significant increase in the tariff-rate quotas—the quotas that are agreed—with those two countries, and the bar that that sets the negotiations with other countries and other trading partnerships.

On article 16, we are genuinely concerned about what may happen if article 16 is triggered, but equally, we're concerned about the current period of time and the uncertainty that the diplomacy through headlines and speeches is causing in the current trading relationships. Whilst we were still within the European Union, I think there were a dozen direct ferry crossings from the island of Ireland to continental Europe, and that's now increased to over 40, so there's already been a significant increase in trade that is avoiding Welsh ports and going directly to mainland Europe. That affects trade and it affects jobs and we've seen a significant reduction in trade through our ports already. If article 16 is triggered, then it is almost certain that there will be retaliatory measures. We can't tell you what the impact of those will be, because we don't know what those measures would be. We've already raised our concerns about what it would do to Welsh jobs and businesses if article 16 were triggered, but we're not in a position where the UK Government are engaging us directly in those conversations. I've made clear that I think the Welsh Government should be part of those conversations because of the direct impact on arrangements with the whole island of Ireland—the Republic and Northern Ireland—and what it does to trade within Wales. The UK Government have not engaged us in that.

I'm hopeful that, given what appears to be a constructive offer from the European Union to change a range of requirements on goods checking, there can be a constructive and agreed way forward that does not cause the significant disruption and undoubted economic harm that would be caused if article 16 were triggered. But I'm not in a position to give the Member any kind of guarantees about that; as the Member knows, I'm not in control of those negotiations. But whatever does happen, the Welsh Government will continue to stay engaged and make clear the case for Welsh jobs and businesses and, of course, I'll continue to report back to the Senedd and the relevant subject committees.

14:05
The Legal Sector

3. What discussions has the Minister had with the Counsel General regarding the legal sector's contribution to the Welsh economy? OQ57269

The Counsel General and I have had a relatively recent discussion on the importance of the legal sector’s contribution to the economy. In terms of GVA, using a wider definition to include some accountancy services, the legal sector contributed £926 million to the Welsh economy in 2019. It is also, of course, of major social importance. And I should note that I'm a lawyer in recovery and I do happen to be married to a real lawyer with an actual practising certificate, so I have some personal interest in this too.

I should also declare an interest in this as a member of the Wales and Chester Circuit, being a barrister. Now, you're quite right about the contribution of the legal sector to the Welsh economy; it's a similar proportion to the agriculture sector's contribution to the Welsh economy. I'm sure, Minister, you'll agree with me that a full range of legal apprenticeships up to level 7 would boost the significant contribution of the legal sector to the Welsh economy. It would also help with sustainability with regard to rural and post-industrial areas; it would help with diversity and help encourage people who can't afford to go to university to join the profession. So, what work is the Welsh Government doing alongside the profession to use the full range of legal apprenticeships that are available to increase the already significant contribution that the legal sector is making to the Welsh economy? Diolch yn fawr.

Thank you. Actually, part of the conversation that I did have with the Counsel General was exactly on this basis: the potential to develop apprenticeships and for paralegal occupations as well. Some of the work for those paralegals is on track to be introduced in January. The qualification route for qualified lawyers is something that we're still examining. I understand—and I think this is reasonable—that law firms that were caught up in the apprenticeship levy do not feel that they've got value for money; there's been a tax with no return in apprenticeships and I understand that concern. It's a similar concern for a range of other businesses too. What's different, of course, about the legal profession is that we don't have an undersupply of lawyers; the challenge is who accesses the legal profession and what can be done about those people from relatively under-represented parts of our society within the profession.

The alternative challenge for us, in the Welsh Government, is a sense of priority. If we put funding into degree apprenticeships for lawyers when, for example, I self-funded—I took out a loan to undertake my own course—. I had the benefit and the comfort of a training contract, but I then repaid that during my working life—the loan that I had taken out. It's about whether or not we do need to have alternative routes to qualification; it's one of the recommendations of the Thomas commission. So, we're scoping that work out within the Government and we're looking to talk to the profession about it.

But, of course, the arrangements for law firms to support people into study, they're in a different place to other parts of life, where degree apprenticeships may make a larger difference. Degree apprenticeships themselves have a good track record of getting people into higher value, higher skilled jobs. We, of course, have a significant budgetary challenge to manage, given the smash and grab on our budgets with the way that the levelling-up funds have been allocated in future. So, there are very real practical questions about what we can do, not so much about what we want to do, but the Counsel General and I remain engaged in really constructive discussions to try and find a way forward.

14:10
Tourism Strategy

4. Will the Minister outline the Welsh Government's tourism strategy in South Wales West? OQ57280

Yes, our tourism recovery plan, published in March 2021, aims to bridge us back from the pandemic to the overarching tourism strategy, 'Welcome to Wales: Priorities for the visitor economy 2020-2025'. That aims to grow tourism and deliver benefits across the whole of Wales, with environmental sustainability and social and cultural well-being at its heart.

Thank you, Minister, for that answer. You'll know that tourism is a major employer in my region of South Wales West. It creates thousands of much-needed jobs and accounts for around 9.5 per cent of employment across Wales. However, after reading the coalition document agreed between Plaid Cymru and the Labour Party, which was signed today, I see a tourism tax that threatens to punish these businesses is very much still on the cards.

We know this tax would damage local economies and cost livelihoods, hitting taxpayers in the wallet in a time of economic uncertainty. With the industry already facing several issues, from COVID restrictions to the highest business rates in Great Britain, many will find Plaid Cymru and Labour even considering this tax completely unacceptable. The chief executive officer of North Wales Tourism, Jim Jones, described it as not listening to the people whom it will affect the most. He said,

'Back when it was proposed in 2017 it was unpopular. That’s why it was dropped. Nothing has changed.'

Now I read from your coalition agreement that this tourism tax will be rolled up into the local government finance reform legislation, potentially tying it up with local council tax reform and other ways that councils raise revenue. Therefore, can I ask, Minister, what economic impact assessment have you made of a tourism tax on our tourism economy and small businesses? In the light of that coalition agreement signed today, what discussions have you had with the Minister for Finance and Local Government to ensure that those councils that decide not to adopt a tourism tax are not punished financially by other means?

Well, I think there's an inaccuracy—I'll put it that politely—in the way the Member has presented this. The proposals to consult on a tourism levy are part of the manifesto that saw 30 Welsh Labour Members elected by the people of Wales to the Senedd. They already form part of the programme for government, and it's no surprise that they're there within the co-operation agreement that has been signed today.

We've been really clear on several occasions in the past, when the Member and others have asked about this, that we're looking to consult on this during the next year or so. That will be led by the finance Minister, as a potential new addition to taxation policy, and it would be on a permissive basis to give local authorities the ability to use the powers that we're looking to give them.

Now, some local authorities may decide not to proceed with that, and that would be a matter for them. It's a permissive power that we're looking to consult on, rather than requiring people to have a tourism levy. I do think that it's worth considering how people in the sector may see that as being positive, but also how it supports sustainable tourism, with the additional pressure that tourism causes to some communities around Wales and the services that exist for local people who live there year round as well as visitors. We want to have a proper balance in the way that the visitor economy functions, with good jobs year round, improving seasonality and making sure that local facilities and services aren't compromised.

It's worth, of course, noting that every time a Conservative stands up and says that a tourism levy would destroy jobs and be dreadful, actually, tourism levies are entirely normal in many parts of the world, including our near neighbours. Anyone who's holidayed in Spain has almost certainly paid a tourism levy; lots of people who go to France have almost certainly paid a tourism levy at some point. This is really quite mainstream in permitting local authorities to determine if they want to use it and, if so, at what level and for what purpose. It certainly hasn’t deterred Brits from going and travelling to different parts of world to contribute to the visitor economy in other parts of the world. I think this is a very sensible contribution, and it’s one we committed to consult on in our manifesto. It should be no surprise that it appears in the a co-operation agreement signed today.

14:15
Higher Paid Sectors

5. What is the Welsh Government doing to increase the number of people in Wales employed in higher paid sectors of the economy? OQ57262

Thank you. As the Member will know, on 18 October, I held an economic summit to discuss with stakeholders how we can work together to pursue a progressive economic policy that focuses on better jobs, narrowing the skills divide and tackling poverty. A prime example is the Swansea bay city deal, which aims to create over 9,000 skilled jobs and increase gross value added by £1.8 million.

Can I thank the Minister for that response? Anyone listening to discussion in the Senedd would think that the two key economic sectors were agriculture and tourism and, therefore, our ambition was to emulate the economic success of Greece. I would like to see more done to support three of the high-paid sectors, namely ICT, life science and highly skilled professional services. What is the Welsh Government doing to work with the Welsh universities to develop these economic sectors?

Thank you for the supplementary. I don’t think I’d share the Member’s characterisation of debates within the Senedd and the priorities of the Government. Today, we have, of course, heard about tourism from a number of questions, but it’s a significant part of our economy. We think it can grow sustainably in the future, year round. But, also, we've talked about other sectors too. We’ve heard a question about legal professional services today, and I myself have recently had a follow-up meeting in my role as the lead Minister for science in the Government with the life sciences hub around the corner from the Senedd. So, I am certainly interested in how we deliver high skills and good wages here within Wales. It’s been a key part of what I’ve discussed and, indeed, my predecessor has made clear during his time as the economy Minister as well.

I am optimistic about our ability to generate greater growth within these areas. We know digital innovation is key for small, medium and large businesses in the future. We know that, in life sciences, we already punch above our weight. The way that the health service is organised within Wales is a real benefit for generating more investment in that sector, as well as the excellence in research terms within the university sector. The Member will, of course, be aware that his local university, Swansea, have Pfizer, for example, where they chose to come to Swansea because of the excellence in the university and because of what the healthcare system offers in terms of having a whole-system analysis on improvement.

So, yes, we are already working with universities. They’re concerned about the loss of some of the research funding that European funds used to give them, but I am confident that we will continue to see greater return from what universities do in research, development and innovation to improve our economy, not just in the three areas the Member outlines, but in other areas too, and I look forward to working with the Member to do just that.

Minister, the question about more people in higher paid sectors is vital. There are some parts of Wales where people have not had the opportunity to be employed in those higher paid sectors because we have not seen the required growth. What is your ambition, and what proportion of jobs in Wales will be higher paid by the end of the parliamentary term? Thank you.

We don’t have a definition of what you mean by higher paid. We certainly think that our tax base in Wales is in the wrong shape. We need more people who are higher rate taxpayers. That’s both by growing the economy here in Wales, investing in skills and people, as well as understanding what we can do in some of those sectors where we have particular expertise in different regions within Wales. It’s why we've invested so much time and effort as a Government in having a proper framework for regional investment, because we think that will make a real difference. It’s why we’ve been proper and constructive partners in city and regional growth deals. There’s been a real response from businesses, local authorities and, indeed, trade unions on the mission that we have within the Government.

It’s why I’m interested in what we do to make sure that young people don’t need to leave the country—'You don’t need to get out to get on' has to be a reality, not just a slogan—and also why we’re interested in seeing if we can persuade more people to actually found themselves and their businesses here in Wales. There are real opportunities to do so. I’m not going to have a hostage to fortune in having a particular percentage indicator on growth. It’s about how successful we can be in doing what the mission of the Government sets out—to have a fairer, more prosperous and more sustainable Wales. I’m confident that, by the end of this term, we will have done just that.  

Minister, the aerospace industry is a source of well-paid employment in my constituency, in particular Airbus and its surrounding supply chain, but the benefits do go a lot further than just Alyn and Deeside—they stretch across every part of Wales. These skill sets based within this industry will stand us in good stead for the future, and I think we saw the very best of that skill set last year when we saw the workers turn their hands to ventilator production at a time of desperate need. It is my view that it's important now that we do send a clear signal that we support the aerospace sector and that there is political will to do so. Minister, do you agree with me about the importance of this clear message, and will you meet with me to discuss this topic further?

14:20

I've been really consistent since I've taken on this post, but even beforehand. My interest in the economy as health Minister was the reality that people who are in better-paid work are much more likely to have better health outcomes. It's not just about the taxes they pay to fund public services, but they are less likely to need healthcare as well. I had a number of conversations with Ken Skates in that former role about our joint interest in life sciences, our joint interest in helping employers to become better employers. Because the improvement of well-being in the workplace is a really important factor for the health service as well. When it comes to well-paid jobs in advanced manufacturing, aerospace is a good example, and I'm really keen that we don't see jobs leave Wales; I want to see this sector continue to have a good future and, indeed, a growing future in Wales. Part of that is the work that those companies are already engaged in, in looking at how they decarbonise the industry, how they take advantage of new methods of construction that can improve the products they provide, and, crucially, I think, the transition to new fuel technologies as well. Net-zero flight is likely to be a generation away, but between that time, there is a real imperative to reduce the carbon not just in the production process but in the way that aerospace operates, and we have a range of those examples within Wales. So, I'd be happy to meet with the Member to discuss that in more detail, because I am confident and positive about the future of the aerospace industry here in Wales.

The Young Person's Guarantee

6. What is the Minister's strategy for ensuring the young person's guarantee is helping to fill the most significant skills gaps that are holding back the economy? OQ57291

Thank you. Employers can fill their skills gaps through the young person's guarantee by offering an apprenticeship place, recruiting and training via our employability programmes, or by advertising their jobs through the Working Wales jobs bulletin. Employers can discuss their needs by contacting the Business Wales skills gateway.

There's a danger in that that we're simply putting out more journalists, for example, or hairdressers. Others have talked about the aerospace industry; I want to focus on the construction industry. We heard from the construction cross-party group earlier this week that there are 3,000 unfilled vacancies in the traditional construction skills, so there are clearly opportunities there. But also, the future generations commissioner has highlighted the thousands of jobs and skills that are needed, both to build the zero-carbon social housing that we have, as well as retrofitting all our existing homes, and that includes the need for nearly 3,000 retrofit engineer assessors. I'd like to understand what the Government's strategy is for ensuring that this fantastic young person's guarantee is leading into the specialist retrofit and construction work that is so urgently needed to ensure we deliver on the zero-carbon strategy that we've set ourselves.

I think it's both the work we do with the guarantee, as well as what we're doing on, more broadly, looking to generate better value from local supply chains. When we talked about the foundation economy and getting better jobs closer to home, actually, this is part of it, to make sure that we're investing in local businesses. The business that I visited to launch the £35 million fund is a good example in exactly this area. They provide energy-efficiency services, they retrofit houses, including solid-stone properties, to improve not just the bills for that person but, actually, what it means to have a genuinely decent and warm home. They're a good example of where they're already investing in their current workforce and their future workforce to provide exactly the skills that you refer to.

I mentioned earlier in answers today regional skills partnerships. They're really important to make sure we don't do what you suggested might be possible in simply generating a range of people for jobs that don't exist. It's really important to match up the skills that businesses are telling us they will need for the future, the skills we recognise we need for the future, and to make sure that the way that the courses are provided from providers actually match the skills that are needed. It is about a proper partnership—skills partnerships, local authorities, businesses, trade unions and the Government—and it all fits in with our approach on regional investment and support for our economy. I'm confident and optimistic that the young person's guarantee will fit in with that. The way that we're structuring the new Jobs Growth Wales+ programme, and, indeed, the announcement I'll make in the new year on ReAct plus, I think, will give the Member the sort of comfort that she is looking for that we are genuinely looking at skills for the future. 

14:25
International Trade

7. How is the Welsh Government promoting international trade? OQ57282

Thank you. Our export action plan sets out the measures we are taking to promote the benefits of international trade. This includes delivering a comprehensive range of export programmes to support businesses on their export journey. We want to build export capacity and inspire other businesses to export, to find overseas customers and to access overseas markets. We'll continue to do that work in tandem with my officials, and, indeed, business organisations themselves.

Thank you, Minister, for that response. As we know, the pandemic has had a substantial impact on the export market across the world. In Wales, for example, the value of goods exports has reduced by £2 billion in the year ending June 2021 compared to the previous year. I recognise the work that your Government is doing to support the export market, such as through the export action plan, as you've just mentioned. Whilst the plan states that the Government is focusing its support on priority sectors, it also notes that the existing strategy's focus on so-called enabling sectors, such as tourism and education, is being revised in light of the impact of the pandemic. Could you, Minister, provide an update on the implementation of the action plan, and the impact that current uncertainties, such as the omicron variant, may have on Welsh exports? Also, how is the Government supporting the development of enabling sectors to help promote them in the wider world? Thank you.

On the omicron variant, I think it's fair to say that we're living through a period of uncertainty, so it's hard to have a specific programme when we're not certain what the end outcome is going to be. I think that would be the same response for any Minister in any of the four administrations across the UK. I think it's really important that I don't try to set out an artificial level of certainty that will prove to be incorrect and may lead to people making choices that they then regret on the basis of what I've said. I'm sure the Member understands that.

On your point about enabling sectors, we already have support for tourism within the UK as a visitor economy, but also, going back, if you like, to one of Jack Sargeant's points about a sustainable future for aerospace, we still expect that there will be travel between different countries for leisure and for businesses, and how Wales is seen in the rest of the world is important for that. So, we are looking at international visitors in terms of what does that mean for a sustainable model of an international visitor economy, what does it mean for Wales's image around the world, not just in things like our sporting and cultural traditions, which are an important part of the offer. I think people sometimes underestimate the cultural offer that Wales has in itself. But, actually, in the last two years, I think Wales as a country has had a significant interest in other parts of the world more generally. I have done more international media in the last year and a half than I have done in the previous six or seven years as a Minister within the Government, and I think it's also true that the First Minister has done much more international media than his predecessor.

So, actually, the profile of Wales is on a different level now, and that's a good thing, because it's been broadly seen as being a positive as well. We're looking to then work alongside businesses to understand what their aspirations are, how we present Wales in some of the developing international fora—the world expo, for example, being a good example—but also working alongside businesses and organisations like the CBI. My recent speech to the CBI was exactly in this space about what we can do for British businesses, including Welsh businesses, to be much better at gaining new markets internationally. So, I don't think, on those points, the Member will find there's disagreement between us.

The Foundational Economy

8. How is the Welsh Government supporting the foundational economy in Wales? OQ57275

Thank you. The foundational economy is central to our economic resilience and reconstruction mission. We are supporting partners to deliver projects that nurture the foundational economy, and, of course, the backing local firms fund, which I announced earlier this month. We believe these will help businesses to overcome barriers to engaging in procurement, and deliver more jobs and better jobs closer to home.

Thank you for that answer. Of course, the foundational economy challenge fund has helped numerous businesses in my region of Mid and West Wales since its launch. One of the areas it has helped is Cyfle, who provide excellent apprenticeships and opportunities in the construction industry, and Jenny Rathbone has already mentioned this morning that that industry is in need of shoring up in terms of those apprenticeship opportunities. You've pre-empted the fact that I was going to go on to your announcement on the £1 million for the backing local firms fund that you've announced earlier. What I would like to know, Minister, is when you will be able to give any details on businesses in my region that will benefit from that new and very welcome fund.

14:30

Yes, I'd be happy to work with the Member as we go through, not just the announcement of the backing local firms fund, but then when we get to identifying those firms that have been successful, because we don't just want to see where they are, but then the impact of the money and how we will want to help them to engage within their local economy. So, I'd be more than happy to take up an opportunity to take the Member through that once we've had some of the outcomes. And who knows, we may be able to visit one of those firms within her region in the future.

2. Questions to the Minister for Health and Social Services

And that brings us to item 2, namely questions to the Minister for Health and Social Services, and the first question is from Rhys ab Owen.

GPs

1. What discussions has the Minister had regarding the capacity of GPs to respond to the demand on services in Cardiff? OQ57270

Thank you. All GP practices across Wales are working hard to respond to pressure and increased demand from patients. I have regular meetings with health board chairs to discuss how services are planned and delivered.

Thank you, Minister. In the first quarter of 2022, the Saltmead Medical Centre in Grangetown and the Albert Road Surgery in Penarth will close their doors to thousands of patients for the last time. In addition, if the Cardiff and Vale University Health Board gets its way and proceeds with its proposals, the same thing will happen in Pentyrch. This, despite the fact that hundreds of homes will have been built in that area recently.

I wrote to you back in October, raising concerns about the closure of that surgery, and despite the community health council's recommendations, the health board has not consulted the local community about that closure. There is to be a public meeting in Pentyrch on Monday, 13 December. Will you encourage representatives of the health board to attend that meeting, or if that is not possible, ensure that there is a full consultation with local residents so that they can raise their concerns and they don't feel like they are being ignored? Thank you.

Thank you very much. I am aware that the situation is causing concern for people who live in the Albert Road area and in Saltmead and Pentyrch and that's why the health board is looking into this situation. Of course, in terms of Albert Road, the people who attend that surgery will be able to continue to go there until 18 March, after which they will have access to another practice in the local area.

As you say, in terms of Pentyrch, I know they've been working with a third party to see where they will be able to build new premises, and of course I think it's important that people do take part in that consultation and that their voices are heard. And also in terms of Saltmead Medical Centre, services will be closing, as you say, on 25 February next year. What's happening is that the local teams and the local health board are very aware of the situation and they're putting things in place to ensure that people get the provision that they need.

A recent British Medical Association tracker survey has revealed that over half of the doctors surveyed in Wales have worked extra hours during the pandemic with a quarter of them reporting that these hours were unpaid. Over a third of the doctors who responded to the BMA's survey felt pressurised by their employer to work extra hours and over a third had also either skipped taking their allotted break time or had only taken it on rare occasions. This has unfortunately left many exhausted, with over half of the surveyed doctors reporting a higher than normal level of fatigue or exhaustion, and, worryingly, 76.6 per cent revealing that their stress levels had worsened since the start of the COVID-19 pandemic. Another survey commissioned by the BMA in April this year revealed that 51 per cent of members are currently suffering from depression, anxiety, stress, burnout, emotional distress, or another mental health condition, 16 per cent plan to leave the NHS altogether, and 47 per cent plan to work fewer hours after the pandemic. I'm sure that these percentages are reflected throughout the United Kingdom, and further afield, but they do indicate that the medical profession is under enormous strain, and this can only be made worse by the continuation of the pandemic and the new omicron strain. With this in mind, Minister, what measures are the Welsh Government taking to help support the health and well-being of GPs, as we begin another winter with COVID? Thank you.

14:35

Thanks very much for that question. I'm more than aware of the pressure that GPs have been under for an extended amount of time now. I know that many of them are absolutely exhausted, that they've seen far more patients than they've ever seen before, that the way they've had to change the way they facilitate access for patients very quickly has been difficult for many, and I'm aware that the sickness levels are at around 11 per cent, which is significantly higher than many other people working in the NHS. So, we're very aware of that, and my colleague who is responsible for mental health will be aware and is making sure that the help for health professionals is available for them. We've put £1 million into that over the course of the pandemic. And of course, we're trying to recognise with the announcement today that there will be a 3 per cent increase in terms of what we are giving in support to doctors, to recognise the work that they have been doing over this extremely difficult time.

It is going to be difficult. We've changed the way we work, and some of that has worked really well for patients, but GPs have had to adapt as well. And I think we do have to all make sure that we understand the pressure they've been under, which is why I would urge the people of Wales to consider if there are other mechanisms for them to get the support they need. And that could be through phoning 111; it could be through asking their pharmacy for support. So, just making sure people are aware of those alternatives.

Access to Primary Care

2. What action is the Welsh Government taking to improve access to primary care in Wales? OQ57287

Access to primary care services has changed dramatically across Wales over the past two years. Services have had to adapt so that patients can access primary care in a safe and effective manner. Many are using digital technology to help deliver these improvements.

Diolch yn fawr, Weinidog. A number of constituents regularly complain to me that they find it very difficult to obtain an appointment to see their GP. Typically, they ring up at 8 a.m. as required to, but are unable to get through for quite some time, they're constantly telephoning, and then, when they eventually get through to the practice, they're told that all the appointments for that day have been allocated and that they should ring back at 8 a.m. the next morning, when they may well have the same experience all over again. So, in light of those problems, Minister, I very much welcome the announcement you've made today of changes to the GP contract, so that new funding and new systems will be put in place for these telephone services, to enable better access, and we're no longer in this 8 a.m. situation, as it were. But I wonder if you could tell me when these new systems are likely to be in place, and also whether you will work with the health boards to ensure that those practices with the greatest problems are the first to receive this very necessary support?

Diolch yn fawr iawn, John. I'm pleased that we were able to make that announcement today. This has been several months of very sensitive negotiations with those people who have been on the front line for all that time. So, we had to get the balance right here, because, obviously, we have a responsibility to support the GPs, who are in a very difficult situation, but also to make sure that there is a decent provision and service for the people of Wales. And that's why we've really focused that GMS contract on the access issues that, as you have pointed out, so many of your constituents, and others, encounter, with that 8 a.m. bottleneck in particular a problem for so many, people trying time and time again to get through to their surgeries. 

So, we've announced today a £12 million contribution. Some of that will obviously go towards the 3 per cent pay rise, but also, we are ensuring that there will be additional support to invest in systems that will improve the way that people get through, but also, to get better planning in place in those surgeries so that they don't have that charge at a particular time of day. 

So, this is going to happen from April next year, but, obviously, we need to make sure that everything is in place and ready to go from April, which is why we made that announcement today. 

14:40

Minister, since primary care practitioners often care for people over extended periods of time, sometimes many years, the relationship between patient and doctor is particularly important. Now, when it comes to mental health issues, trusting relationships have been found wanting, because, simply, they can't get through to their GP. And in my own local health board, I'm seeing now many patients passed between department, between pillar and post, due to such a high turnover of staff in mental health services. 

Now, by having dedicated mental health support workers within their surgeries, or mental health nurses, GPs have found previously these have been really, really useful, and have actually been able to provide support there and then. Local GPs have asked me to raise this again as to when introductions of these nurses could be put back into GP surgeries. Will you confirm what steps you have taken to evaluate the training and recruitment costs required to place a mental health professional in every GP surgery across our constituencies, and will you listen to our GPs on the front line, who are simply asking for this? Diolch. 

Thanks very much. Well, obviously, mental health is an issue that my colleague, Lynne Neagle, leads on, and I know that you'll be aware of her incredible commitment to this cause over many, many years. It's absolutely clear that the number of people who are contacting their GPs for mental health support has increased significantly, and there are lots of ways for us to deal with this. I think one of the key things, though, is that we need to not overmedicalise mental health issues if they are not medical. So, social prescribing is something that we're very keen to encourage, but the early help in our community, I know, is exactly the kind of route that Lynne Neagle is very keen for us to focus on. 

When it comes to specific cases, nurses in our communities, I think what's more likely to happen is that we'll start that on a kind of cluster basis, and I think that's probably the route, so that we know that, at least in a particular area, there will be access. But, as I say, I think we absolutely need to get to the point where we understand that mental health issues are not all medical. Sometimes they're about social issues, they're about relationship issues; they are not medical issues. And we need to make sure that we don't overmedicalise mental health issues if it's unnecessary to do so. 

Good afternoon, Minister. I'm appreciative of all of the work that you've done; you have an incredibly busy job. But I just want to talk about teeth and dentists, specifically the teeth of people in mid and west Wales, and specifically the teeth of the people in the town of Llandrindod Wells. As you know, I've written to you on a number of occasions, but there are massive concerns around the lack of dentists, both across the region, and specifically, in Llandrindod Wells, which has been the case for a number of years, pre COVID. We know that there are significant challenges in COVID with treating people in dentists, but there is a massive difference here. If you go to a private dentist, you can be seen almost straight away. If you go to an NHS dentist, you can't. And that doesn't matter if we're in COVID times or not.

So, I just really want to ask you specifically: could you tell us what your plans are for dentists, both in mid and west Wales, and in Llandrindod Wells, and across the whole of Wales as well? Thank you very much. Diolch yn fawr iawn.  

Thanks very much, and thank you for your perseverance on this issue. And I know it's an issue that matters a huge amount to you in particular; I know that there is a particular problem in the Llandrindod area, and that's why we have been trying to focus our attention on that.

It's not an easy issue to resolve, but one of the things we have done is to make sure that we've injected an extra £2 million this year to try and encourage dentists to take up more opportunities to see those NHS patients that we're so anxious for them to extend their abilities to at the moment. So, that money has been put on the table. Part of the problem we have, frankly, is that lots of dentists won't come in and pick the money up. So, that is part of our problem, and so I think there is a longer term issue that we need to address here.

We need to have a situation, and I've asked my officials to start to develop a 10-year plan, to understand where are we heading with this, because it's absolutely clear to me that more people in Wales want access to NHS dentists than the places available, and, at the moment, the model is not providing for that to happen. So, we need to think fundamentally about how we change the model and what's possible here. So, it's not going to be a quick fix, I'm afraid, and it's not easy to do this whilst dentist services, of course, are still in amber. So, you're aware that, at this time, when COVID is still an issue, and that it is a case where we see the change and things being carried through aerosols, it is really problematic. And the cleaning in between, all of that does not help to speed the situation up. 

We've also got to make use of all of the dental technicians and people who have real skills, and I know a huge amount of good work's been done in Bangor University to demonstrate that actually we could be using those skills to a much broader extent than we are at the moment. But I'm meeting on a monthly basis now—. I've only picked on about five different things to just keep on coming back to to make sure we don't lose focus on this, and I can assure you that dentistry is something that I'm having monthly meetings on so that I keep that focus very clearly on what needs to happen.

14:45
Questions Without Notice from Party Spokespeople

Questions now from the party spokespeople. The Conservatives' spokesperson, Russell George.    

Diolch, Llywydd. Minister, are you confident that everything is being done, in your power, to ensure the speedy roll-out of the booster vaccination in Wales?    

Well, thanks very much, Russell. I am confident that all the stops are being pulled out, as we speak; that the NHS health boards are developing, and, today, are supposed to come back to us with what their proposals are to massively increase the booster roll-out in Wales. We're not just asking that of health boards; we know that we're getting offers of support from local government, from the fire brigade, and we may be looking to the army for more support as well. So, all of those things are being put in place. We know that there's no problem with supply, but we will be calling for a volunteer army as well, in particular those people who stepped up the first time and who won't need to be retrained. It is a short period of time that we're asking people to step up here. If we can get this done very quickly, before any possible omicron wave hits us, that would be very helpful. 

Thank you for your answer, Minister, and it's a positive reply, I think. I think that it's correct to use every tool in the toolbox and to call upon the army and the volunteer army that you talked about as well. I think it's welcome, and, of course, it's good news that we've got that supply as well.

But there's one area I would like to pick up, and this is, again, about walk-in centres for booster vaccinations. I raised this with you yesterday, and you cited the JCVI advice that each and every age group should be worked through in order, and you again claimed that it would be a free-for-all. Now, I think perhaps there's been a misunderstanding about what a walk-in centre is and how it operates. NHS England's advice is that letters, text messages and e-mails are automatically sent to those who need a booster, which can then be taken to the walk-in centre. And if you don't get one, then you can ask your GP. So, no letter, no jab. So, this is in order of the correct approach and taken in terms of need, but it also means those who are to receive the booster being able to do so as quickly as possible and as easy as possible for them. 

We're now at the point where the new variant has been, of course, identified in the UK, and I would say we must boost the booster programme. And the BMA this morning said that, 'If they want us to be involved'—talking about you—'If they want us to be involved in the COVID booster campaign, then, of course, something has to give.' So, to ensure that we have significant uptake of the booster, it's clear that we need to use every tool at our disposal. So, with GPs overstretched beyond their limits, can I ask you now to reconsider your rejection of walk-in centres as a means to support the booster jab roll-out?

14:50

I'm sorry if there's been some misunderstanding in terms of the situation with the BMA. My understanding is that, of course, they are aware that their members are under huge pressure already, but I don't think they were closing the door on the option of GPs being able to help out if they were called on to do so. What they were saying is, if we do that, then, obviously, something else will have to give. Now, there is an understanding of that. We believe that this is a priority now in order to make sure that we're not overwhelmed at a later date, and I know that there will be GP practices all over Wales that would be more than willing to step into this position.

When it comes to walk-in centres, well, maybe we're just getting terminology mixed up here. We obviously have mass vaccination centres, where people come in with their appointments. So, that sounds quite like a walk-in centre to me, if that's what you're talking about, and we do have those, of course, all over Wales. Obviously, we're looking at how we can increase massively the number of people who are admitted to those centres. 

Thank you, Minister. I appreciate, if this is a misunderstanding, that's positive—perhaps a step forward in terms of making sure that we do have those booster walk-in vaccination centres across Wales, because some health boards are already operating those. So, I think perhaps it would be helpful to provide health boards with clarification in terms of your views in regard to booster walk-in centres.

You and I both know, Minister, that we're facing, of course, an unprecedented level of demand on the NHS. We've got the worst accident and emergency waiting times, sadly, on record, alongside the slowest ambulance response times on record. On top of that, one in five of the Welsh population are stuck on a waiting list. Specifically, it's deeply concerning that 59 per cent of cancer patients were treated within 62 days of being suspected of having cancer. We also know from your own figures that 20,000 fewer people were urgently referred for a cancer diagnosis between March and November of last year, compared to the previous year, before the pandemic, and 1,700 fewer people began treatment in the first few years of the pandemic. So, the cancer workforce is also overstretched beyond capacity. Now, your predecessor published the quality statement for cancer in March, but this has been severely criticised by the Cancer Alliance for lacking detail and accountability, meaning we're soon going to be the only UK nation without a cancer strategy. So, I'm sure you'll be responding in more detail to the Member debate this afternoon. But, can I ask you how far you are with your plans to roll out rapid diagnosis centres across each health board, what progress you are making on regional surgical hubs, and when will you be publishing the cancer workforce strategy?

Thanks very much. Well, there's no question about it, our NHS services are under pressure like they've never seen before. We've seen a huge increase in terms of demand, but I can assure you that when it comes to cancer, this has always been an essential service; it has never been something we've switched off. We have invested significantly in new equipment, and I'll have a lot more to say about that in the debate later. The cancer pathway is a unique approach in the United Kingdom, making sure that we count people right from the beginning of the suspicion of cancer. It's a very different method, and that perhaps goes some way to explaining why we see significantly more on the waiting lists in Wales, because, actually, the way we count patients in Wales is very different. They're counted very differently, particularly in relation to cancer, in England. So, rapid diagnosis is, of course, really important, and developing an adequate workforce is key, as well, which is why we're investing in those as well.

Thank you very much, Llywydd. The Minister has enthusiastically described how she's going to create a vaccination army to accelerate the booster programme. We don't have many details yet; it's at an early stage. I look forward to seeing more of those details. And although I am aware of the statement published today on amending contracts for general practice, we have heard concerns from the British Medical Association today that there is a serious capacity problem among GPs in contributing to this work. So, how does the Minister intend to implement these vaccination plans, including in primary care, whilst simultaneously ensuring that primary care is sustainable?

14:55

Thank you very much. Of course, there will be a problem with capacity if we're going to throw everything at this in the next few weeks. Evidently, other things will have to take a back seat to that. In terms of primary care, we're very aware that there is great pressure on them, but it is interesting to see that some GPs have been willing to come to the fore and to take the reins. As you've seen in the Pen Llŷn area, they've already been helping with the booster delivery. I think that they do understand the situation, and I am very hopeful that GPs will step up, as well as people across Wales, those who are volunteers and, of course, people from local government and so forth.  

Thank you for that response. The Minister talks about some things taking a back seat, and that's what I'm concerned about. And there are serious implications—the most serious—when some things take a back seat, and I'm thinking particularly about cancer and the need for early cancer diagnosis, for example. There are many people who are still staying away from primary care. They may have a cough and they should be accessing treatment because it could be lung cancer, but for some reason they choose to stay away. I had a meeting with Tenovus yesterday, and they described what they saw as a devastating number, to quote them, of people who weren't discovering lung cancer until stage 4. A strategy to ensure that cancer is diagnosed early would be a crucial part of the new cancer plan for Wales that we truly need to see. But, what's the Minister going to do now to ensure that (1) people feel safe in going to their GP, (2) that they can see their GP, and, (3) when it comes to cancer, that the referral can still happen, even when we are facing this new variant that is such a cause for concern?  

Thank you very much. It is very important to underline the fact that cancer has always been prioritised and that it has always been an essential service, even at the outset of the pandemic. So, we've always prioritised that and have never taken that away from the plan. It's important for us to have clinical advice about what we will have to put in the back seat as we develop the vaccination programme over the coming weeks. That will have to be a clinical decision, and I will look forward to receiving advice on that. 

In terms of seeing a GP, you will have seen today that we have made a statement that more funding will be going in to ensure that people can have better access to see their GPs. Some £12 million will be going towards that, including new systems, and so that they can recruit more people in order to make those decisions and ensure that people are led to the right service and the right person. The GP isn't always the right person on every occasion. So, that's something we're very eager to see, and we're very pleased that we've had agreement from the GMC.

I want to change tack for my third question. There was a general welcome recently when the UK Government announced that a menopause taskforce would be created as part of the women's health strategy. It's not entirely clear where the boundaries lie in terms of devolution in this regard, but certainly there are greater expectations among women in Wales now, and that's a good thing, as a result of that announcement in Westminster.

At a meeting of the cross-party group on women's health in October, it became apparent that there was something of a postcode lottery when it comes to the services provided to women going through the menopause here in Wales. So, can the Minister tell us what steps she wants to see taken to improve menopause care in Wales? When will we see the impact of those steps? And how can we be confident that the resources will be available to provide this care that women need as they go through the menopause?

15:00

Thank you very much, and thank you for the question. As a woman who is of the age where we have to be concerned about such things, I'm pleased to see that the UK Government has followed what we've done in Wales. We've been offering free HRT for many years, so the revolution that's happening in England has been in place for many years here in Wales. You're quite right in terms of the postcode lottery, and one of the things that we need to do is ensure that women don't have to wait quite so long before people understand that that's the reason why they feel the way they do. That's why I've asked the women's implementation group, which is responsible for looking at health—. At present, they're looking at a few things in quite a narrow way, in terms of mesh and so forth. I've asked them to think about how they can broaden that out. One of the things that I'm determined to do is to look at a women's health programme, and you'll be hearing more about that in the weeks to come.

Hospital Capacity in South Wales East

3. What assessment has the Minister made of hospital capacity in South Wales East over the winter period? OQ57297

Thank you very much. Health boards are responsible for planning to meet the needs of their residents. There has been concerted work throughout the pandemic to forecast demand and develop surge capacity to meet anticipated peaks. Ensuring sufficient capacity for winter is a key priority and it's discussed regularly with health boards and included within winter plans.

Thank you, Minister. New data published in 2021 by the Welsh Government show that, within Welsh hospitals, there is an average of 10,340 beds available, a drop of over 200 beds recorded from the previous 12 months. Minister, when was it decided that slashing beds was the right course of action, especially during the pandemic? In 1999, when the Senedd was first established, there were 14,723.4 average daily beds available in Wales. That's a nearly 30 per cent decrease in hospital beds since Labour have had control in Wales. My region of South Wales East continues to be the worst affected area for COVID infections, with further concerns of flu levels obviously coming over the winter, and we see beds now still at levels lower than in 2009-10, by nearly 50 beds in my region. Can the Minister assure me that she will not make any further cuts to bed numbers and work with health boards to bring bed capacity up in South Wales East and the rest of Wales?

Well, I think it's really important for us to understand that actually we've got a programme, and the programme, 'A Healthier Wales', is trying to make sure that people get support as close to home as possible, and ideally that would be in the home. So, that's where we need to be heading. I think we've also got to understand that, actually, the way we do health is changing all of the time. So, a few years ago, if you had a problem with your eyesight, for example, you'd have to go into hospital, have an operation, and you'd be there for days. Well, today, you can go in and leave on the same day. So, obviously, there is no need for beds for that kind of operation in future. So, technology has helped us to move things on.

I think it's really important also for us to understand that, actually, if we can, we want to get people out of hospital as quickly as possible. The next question you're going to ask me is why we've got so many infections in hospitals. I don't want people in hospital. I'd like to get them home as soon as we can. So, that is the answer—we absolutely need to provide the care we can as much as we can at home.

Now, at the moment, we obviously are in a situation where we're stretched. The fact is that about 9 per cent of the hospital beds in Wales at the moment are taken up with COVID patients, many of whom have not had the vaccine. And I do think it's really important that the people of Wales are listening to this, particularly the people who haven't taken up that opportunity. You are taking up a bed that could have been avoided. There are people waiting in pain that could have had that bed, and it's really important that people understand their responsibility to the wider community to take up the opportunity to have the vaccination. 

15:05

Minister, I've heard various reports about the new Grange hospital in Cwmbran, and I would stress that this is in no way a criticism of heroic front-line staff. The Royal College of Physicians' recent report calls for an urgent review of the provision of care for the elderly; they raise concerns about chronic workloads and staffing problems and they spoke about parents—patients, forgive me—being moved between the Grange and three other hospitals in the area that don't have A&E departments, with elderly patients with dementia being moved eight times between different hospitals and wards. A senior doctor has recently warned that the hospital is struggling to get patients through the system safely and that the hospital is struggling to cope with emergency arrivals, with ambulances having to wait outside. I note, Minister, that you'd said in a recent written answer to Peter Fox that there have been nearly 8,500 ambulance patient handover delays since the hospital opened. Now, I know that we're going into a really difficult winter period, Minister, and this is concerning. I'd be grateful if you could set out what support the Government is able to offer the health board to improve patient safety as we enter these crucial winter months to root out these systemic issues and reassure staff that their concerns are being listened to.

Diolch yn fawr. I think it's—. I'm very aware of the Royal College of Physicians inquiry into the Grange hospital. I know that the health board has responded and are taking that very, very seriously, but I'm also aware that the community health council have written a report as well. They also highlight some of the challenges at the Grange, but they also have emphasised some examples of good patient care, and positive patient and staff experiences, so I think it's really important that we don't talk down the Grange hospital. This is an incredible facility; it's really important that people understand that, actually, it's a facility that is right at the heart of a huge area, it was very carefully thought through, but, obviously, what we're facing here is a huge amount of pressure, the likes of which we've never seen before, particularly when it comes to ambulance services. That's why we have made £25 million additional support funding to go to the transformation of urgent and emergency care services to make sure we deliver the right care in the right place at the right time. I know this is being used in the Grange hospital to see if we can do more work in cohorting multiple patients who've come in in ambulances—so, a lot of creative ideas coming through there.

So, I do hope that things, of course, will improve in the Grange. They are making sure, I think, that there's an electronic waiting-time board, so that people have more visibility on how long they've got to wait, but also there's a work stream on admission avoidance, and that's what we've got to see, to make sure that people are going to the right hospital at the right time. I know they've sent a leaflet to every household in the area, but it's important that people perhaps take the opportunity before they set out to make sure that they are going to the right hospital for their care.

Eating Disorder Services

4. What steps will the Welsh Government take to ensure that all eating disorder services are equipped to provide early intervention? OQ57288

We continue to prioritise support for eating disorder services in Wales and we've been increasing our investment each year since 2017. This funding aims to support the transformation of services towards early intervention, in line with the recommendations in the 2018 independent review.

Thank you, Deputy Minister. As you rightly point out, you did set out an ambitious vision for a world-class service in every part of Wales in the 2018 review and strategy. This called for a shift towards prevention and assertive early intervention and for access to evidence-based treatment and support being available equitably. Staff in eating disorder services are now under even greater pressure than before, due to the level of demand for treatment. Will the Welsh Government publish a new service model or framework, including timescales, to guide health boards in their response to the eating disorder service review? And will it ensure that there is an appropriate central resource in place to support this work?

15:10

Can I thank Heledd Fychan for that question? As I believe she's aware, health boards now receive, since 2017, an extra £3.8 million to support improvements in ED services and waiting times, and since 2019 funding has been provided to health boards specifically to reconfigure services towards early intervention to work towards achieving the National Institute for Health and Care Excellence standards on eating disorders within two years, and to develop plans to achieve a four-week waiting time across adult and children's services, as recommended in the review. We've also provided an additional £100,000 to the eating disorder charity Beat as a direct result of the pressures seen during the pandemic, which she has highlighted herself in her supplementary question.

Aside from the funding that we provided specifically for ED services, we're also improving primary care understanding through the dissemination of clinical resources for GPs, improving awareness within the paediatric community of the need for their skills and experience within eating disorder services, improving specialist knowledge on eating disorders amongst non-clinical staff, and including body image and relationship with food and body issues in the new well-being curriculum and the whole-school approach. We'll continue to use our whole-system approach across Government to build in early intervention support for young people, including at their schools and colleges.

Evidence shows that the impact of COVID on those living with eating disorders was very significant, and throughout the pandemic Welsh Government has released funding with flexibility to manage the increased demand within the eating disorder service. We know, of course, there will be more work to do, and she will be aware that there is an implementation lead in place who has been driving that change across Wales. 

Deputy Minister, social media's impacting young people massively, and apps such as Instagram are affecting the way that people view their bodies. For some young people they take inspiration from what they see online, but for many others the reality is that, due to a huge number of factors, including genetics, work-life balance and affordability, they will just not look like people do on social media and the way society expects them to. Subsequently, we've seen a rise in the number of people treated for anorexia and bulimia, and it's almost doubled in the last five years. Here in Wales, we don't have waiting time targets for those suffering with eating disorders or specialist centres to help people, and that cannot continue. So, what is the Welsh Government doing to ensure that young people are educated about the effects of social media? And what plans does the Government have to improve access for people suffering with eating disorders?

Thank you for that question, James. I think I've already set out the very significant investment we are putting into eating disorder services to transform those across Wales, with a very strong focus on early intervention. We are investing £3.8 million extra every year, and that has continued since 2017. It has been a really challenging time, because we did see during the pandemic an increase not just in the numbers of people suffering from eating disorders, but also an increase in the acuity of people at the time that they presented for support. That has been really challenging, and that's why our focus is on ensuring that, across the board, we've got that range of services from primary care up, including the eating disorder service provided by the charity Beat, which offers a range of really excellent online and telephone support for people with eating disorders and their families to try and make sure that there is support there across the board.

The issue that you've raised in relation to social media is really challenging, and I think one that we all recognise. I think it's vital, really, that through our whole-school approach we work with young people to make sure that they do understand that what they see on social media is not necessarily something that is going to be achievable for most of us. It's also really important that we, through the work in schools and the other work we're doing through the Nest framework, make sure that there is early help, and also encourage people to seek help. But the challenges with social media are real, they're large and, of course, they go well beyond Wales and include—. You know, I hope that you'll make some of those arguments to the UK Government on the work that they are doing to try and tackle some of the harms because of social media.

15:15

People on social media do not look like the people on social media in terms of their photograph. Many have been Photoshopped and many have used filters to make themselves look an awful lot better. Can I just say that eating disorders, like all other mental health services, are under increasing pressures? It has been reported that eating disorder services across Wales are experiencing unprecedented demand in referrals. So, the question that I've got is: when will we see the full implementation of the Welsh eating disorder service review recommendations, including the allocation of sufficient staff training and an implementation plan?

Thank you for that supplementary, Mike. We were clear when the Tan review was published that the changes wouldn't happen overnight, given the range and the breadth of the recommendations, and that's why we've continued to invest such a significant amount of funding in implementing the Tan recommendations year on year. As you've highlighted, the pressure that eating disorder services have seen as a result of the pandemic has created challenges with implementation. I'm very pleased that the increased demand in the latter part of 2020 now appears to have stabilised. However, we are continuing to monitor the situation closely, undertaking census days to quantify the volume and complexity of patients occupying a bed with eating disorders. 

In terms of the workforce issues that you've highlighted, recruiting to posts in eating disorder services is, unfortunately, a challenge felt across the UK. The eating disorder implementation lead confirms that all posts from 2020-21 funding were filled by the end of the financial year, but they were often slow to recruit to. As implementation lead, Dr Menna Jones has championed more creative solutions e.g. upskilling current staff to move the vacancy; lowering the structure, which may be easier to fill by less-skilled staff; and recruiting on a regional basis to ensure that an individual has a full-time contract, but across areas. This is, of course, not an issue that is confined to Wales; there are challenges recruiting for mental health across the UK, including in eating disorders. But, I'd just like to reassure the Member that the implementation of the Tan review remains a priority for me as Deputy Minister.

The Social Care Sector

5. What is the Welsh Government doing to help drive recruitment into the social care sector in north Wales? OQ57276

[Inaudible.]—funding a national advertising and social media campaign. We are supporting a range of targeted initiatives to encourage the take-up of employment in social care. We fund regional staff to support campaigns led by local authorities and by health boards.

Thank you, Minister, that's excellent to hear, and I'm sure you'd agree that throughout the pandemic, care homes in my constituency of Clwyd South have dealt incredibly well with the huge challenges that coronavirus has brought, often to the detriment of both the physical and the mental health of staff. On behalf of those care settings in my constituency, can I ask how the £42 million of extra funding announced by the Welsh Government will help them?

I thank Ken Skates for that question, and also thank him for his recognition of the tremendous work that has been done in the care sector during the pandemic. We were very pleased to allocate the additional £42 million allocation, and that was announced through the health and social care winter plan. And the winter plan sets out how this investment will provide community-based integrated responses, and additional support for carers and for families. I know that the recovery plan responses we have received from local authorities show that Clwyd South will benefit from targeted financial support for providers of social care, increasing the current number of volunteers and the recruitment of additional workforce for specific service areas, such as complex disability services, domiciliary care, children's services and supported living. Where providers have not been able to resume the provision of day-care services, for example, there will be financial support and also investment to support additional technology within residential facilities and more activities for residents.

15:20
Ambulance Service Response Times

6. Will the Minister make a statement on the response time of ambulance services in Blaenau Gwent? OQ57272

The Welsh Ambulance Services NHS Trust is working with Aneurin Bevan University Health Board to implement a range of actions to manage demand for the 999 service in Blaenau Gwent. This will lead to increased capacity, improved responsiveness to people with complaints that are time-sensitive, and the ability to hand over ambulance patients more quickly.

Can I say I welcome that from the Minister? The Minister will have seen the same reports as I've seen and listened to the same experiences of constituents that I represent and she represents, in different parts of the country. We know that there's a real crisis in the interface between the national health service and the people it serves at the moment, and we know that at the heart of that is the ambulance service. We know that people are working harder than perhaps they've ever worked before and that resources are under more pressure than perhaps they've ever been before. So, will the Welsh Government look specifically at how we do manage the ambulance service? Will the Welsh Government look specifically at the resources available to the ambulance service? And will the Welsh Government look at how emergency structures and processes can be put in place today and over the coming weeks and months to ensure that the ambulance service continues to deliver the service that people need, require and have a right to expect, wherever they happen to be?

Thanks very much, Alun, and there's no question that the ambulance service has been under huge pressure, and of course none of these things live in isolation from each other. I think it probably is worth emphasising that, actually, in terms of 999 calls, for example, this October has seen a 24 per cent increase compared to last October. So, it's not just about them not performing well; they're trying to deal with a massive increase in demand, and so I do think we have to understand what is happening here. What we're trying to do is to make sure that the Welsh ambulance service are getting much better at forecasting, that they implement the requirements of the independent demand and capacity review, which looked at the way things were managed, and that we're directing people to clinically safe alternatives to try and dissipate some of that 24 per cent. But you'll be aware that we've already injected £25 million of additional funding into trying to sort out this problem over the winter months; that, since October, 100 military colleagues have been providing support for the Welsh ambulance service; and the trust is committed to recruiting a further 127 staff this year. So, all of these things, I'm hoping, will start to make a difference soon. Obviously, it needs to be sooner rather than later, because we're just about to enter the even more pressurised winter months. So, we're more than aware of the need to fix this problem sooner rather than later.

Healthcare Staff Recruitment

7. What is the Welsh Government doing to encourage the recruitment of healthcare staff across the Hywel Dda University Health Board region? OQ57290

Thank you very much. The Welsh Government is working with NHS Wales organisations to increase the healthcare workforce in Hywel Dda, and in other parts of Wales. This includes measures to boost recruitment, to support retention to keep people working in the NHS, and to encourage professionals to return to their careers and return to practice.

Diolch, Weinidog. You'll be aware that Wales's second largest GP surgery is Argyle Medical Group, which is located in Pembroke Dock within my constituency of Carmarthen West and South Pembrokeshire. According to the latest data, over 22,000 patients fall under Argyle's care, making it one of five practices in Wales with over 20,000 registered patients; yet, the group has only nine registered GPs working from the centre. This is compared to 17 GPs at the Sketty and Killay Medical Centres in Swansea, which have a similar patient count. This means that the patient to GP ratio at the Argyle Street practice is a dangerous 2,506 patients per GP. Let's be clear, the Argyle Medical Group staff are working hard to deliver the best quality service they can. However, and as the stats show, their hands are tied by increasing recruitment pressures. Given this situation, can the Minister outline what steps she is taking to support Argyle Medical Group in the recruitment of further staff, including GPs, nurse practitioners, pharmacists and physiotherapists, to ensure that all staff members are supported in delivering the best care for their patients? Diolch.

15:25

Thanks very much, Sam. It's important to recognise that there have always been difficulties to recruit to some of our more remote areas. That's why we've had a very significant campaign, the 'Train. Work. Live.' campaign, which has been significant and we've managed to recruit significant numbers to west Wales because of that campaign—30 in 2020 and 26 in 2021. So, we also have Health Education and Improvement Wales, which have published their 10-year workforce strategy, but I think it's important that all GP practices look not just at the recruitment of GPs, but also other models of practice. There are different practices that are calling on other professionals who are able to provide some very, very high-level and quality clinical support not necessarily from GPs. But we are aware that there is always a need to increase the number of GPs in Wales. You'll be aware that, over the next five years, we have committed to training 12,000 additional doctors, nurses and health professionals in Wales.

The All-Wales Prior Approval Policy

8. Will the Minister make a statement on the impact of the all-Wales prior approval policy on communities located near the borders of health boards? OQ57268

Health boards are responsible for commissioning services to meet the needs of their local population. The all-Wales prior approval scheme ensures that patients are treated as close to their homes as possible within their own local health board areas.

I am grateful to the Minister. The national policy notes that patients shouldn't access medical treatment in another health board unless all local options are unable to provide that treatment. It has a real impact on communities on the borders of health boards. I'm thinking of Upper Brynamman, for example, in my constituency, where the village is split in two—Lower Brynamman is in the Swansea health board area and Upper Brynamman is in Hywel Dda—which means, of course, that the time to access Glangwili hospital from Upper Brynamman is three times as long as it would take to reach the nearest hospital in Swansea. Since the introduction of this national policy in 2018, local residents do feel that there has been a deterioration in their clinical treatment. So, isn't now the time, Minister, to review the policy in order to ensure that there is a solution that is fair to those communities that happen to be on the borders of our health boards?

Thank you very much. Health boards have to develop services on the basis of the local population, and if patients then ask to go somewhere else, that can have an impact and destabilise services in the two health boards. So, if they've planned for one thing and something else happens, evidently that is going to cause problems. I think that it is important to recognise that if, for example, someone wants to go from the Hywel Dda board area to Swansea, what that would mean in the long term for the hospital in Carmarthen. So, we have to think through the implications. So, what we're trying to do is to get health boards to work on a regional scale, but I do think it's important that people understand that we're doing these things not because we want to make life difficult for people, but to ensure that we can provide a service for everyone and ensure that we can plan services for everyone.

3. Topical Questions

The next item is the topical question. There is one topical question today and that is to be posed by Paul Davies.

The Co-operation Agreement

1. Will the First Minister make a statement on the mechanisms of the Co-operation Agreement between the Welsh Government and Plaid Cymru? TQ584

The First Minister and the leader of Plaid Cymru this morning signed the co-operation agreement. The agreement, the detailed policy programme and the mechanisms document that sets out how the agreement between the Welsh Government and Plaid Cymru will work have also been published.

15:30

Minister, the mechanisms of the co-operation agreement that have been published this morning make for some very interesting reading. And given the huge impact that this coalition will have on the people of Wales, it's very disappointing that the Welsh Government has chosen not to come forward with an oral statement to this Chamber outlining these mechanisms, so that Members can have the opportunity to scrutinise and ask questions. It's even more disappointing that the First Minister is not here to respond to this very important question. So, Trefnydd, can you explain to us why the Welsh Government has chosen not to make a statement on this agreement in this Chamber, and is instead being forced to respond to an opposition topical question? Because I'm sure even Labour backbenchers would welcome the opportunity to scrutinise this particular deal.

Turning to the details of the mechanisms, the document confirms that

'the Welsh Government agrees to take decisions jointly with Plaid Cymru across the agreed range of co-operation'

on 46 policy areas. However, the Welsh Government has given itself the flexibility to widen the scope of this agreement, as the document says that

'Any decision to widen the scope of co-operation in this agreement in the interim and any other amendment to it may be made by the joint agreement of the First Minister and the Leader of Plaid Cymru.'

And widening the scope of this agreement is even more explicit, as Plaid Cymru has agreed to facilitate the passing of annual and supplementary budgets in exchange for influence on other budgetary matters. Therefore, does the Welsh Government accept that this agreement covers more than just the 46 areas of policy that it initially set out to the people of Wales this morning?

Of course, the agreement will have an impact on Senedd business, and I note that both parties claim to respect the independence of the Senedd committee system and the distinctive roles and functions of the respective parties within the Senedd. So, Trefnydd, can you confirm what discussions have been had with the Presiding Officer regarding the impact of this agreement on Senedd business?

The document also makes it clear that the co-operation agreement will be supported by a civil service unit, known as the co-operation agreement unit. So, Trefnydd, can you tell us exactly how much taxpayers' money has been earmarked for this new unit, and indeed any other aspects of machinery that will be put in place to support this specific agreement?

The document also says that Plaid Cymru designated Members will have the same responsibilities as Welsh Government Ministers to respect the political impartiality of the civil service, and will be bound by aspects of the ministerial code. Can you tell us why that is the case, given the document makes it explicitly clear that they will not be represented by ministerial or deputy ministerial appointments in the Welsh Government? Trefnydd, did the leader of Plaid Cymru just forget to ask for Plaid ministerial appointments?

And finally, Trefnydd, this agreement says that the involvement of Plaid Cymru is recognised as part of normal Government communications, and, as such, this is a coalition in everything but name. So why won't the Welsh Government just come clean with the people of Wales and call it what it is—a coalition?

The First Minister is unable to be with us this afternoon, but I'm here, obviously, to answer on behalf of the Welsh Government, and I'm very pleased to answer your questions. That often happens with topical questions. You asked some very specific questions, which you're absolutely right to do, but I should point out that a lot of the arrangements in relation to the co-operation agreement are the functions of the Government, which clearly is not the responsibility of the Senedd—it is a matter for the Welsh Government to work through.

You ask about Plaid Cymru in relation to Senedd business. Well, that is absolutely a matter for the Llywydd, for the remuneration board, and for the Senedd Commission. You ask what discussions have taken place. You may be aware that the Llywydd has been in correspondence with the First Minister, and they continue to be in correspondence. And I know, prior to the announcement of the co-operation agreement, discussions were certainly undertaken at an official level.

This is not a coalition, it is a co-operation agreement. And if you look back at the last 22 years of the Senedd, and, prior to that, the Assembly, every Assembly since we've had devolution 22 years ago has involved a partnership arrangement of some sort. We haven't had a co-operation agreement before, but we do see many different arrangements, right across the world. This is not novel; it's different to what we've had before, but it's certainly not novel. And we absolutely have a history of working collaboratively, for the benefit of the people of Wales. We're very happy if the Tory party want to enter into informal arrangements with us. You know the First Minister wrote to the leader of the opposition around a clean air Bill, for instance. The trouble is, the Tories aren't interested in working collaboratively, and I think that says more about your party than it does about my party. 

You asked around funding for the co-operation agreement unit. Well, as you may have heard the First Minister say, money has been set aside, and that will be part of our draft budget, which we'll be publishing later this month, and, of course, you will be able to scrutinise that. 

In relation to your question around the code of conduct for Plaid Cymru designated Members, as you will have seen, that's been put into annex A, which was published as part of the mechanism document of the agreement this morning. But I do reiterate that this is not a coalition; it's an agreement to deliver a shared programme of work through the co-operation agreement for a three-year period.

15:35

It might not be a coalition, but it looks like one. I welcome the agreement. I welcome the publication of the documents today that underpin the agreement; I think that's important in terms of transparency. I welcome the politics of the agreement; I think it's a good thing to do. And I welcome the statement from the Presiding Officer this morning on the advice that she has taken. 

But this does raise questions for us as a Parliament, and I don't believe the Government can wipe that under any carpet and pretend it doesn't exist. The Government is already too powerful in this Chamber. It is powerful, and it does not receive the same scrutiny as other Governments receive, either in Westminster or Holyrood, or even in Stormont. So, there are questions here, because Plaid Cymru will have a role that goes beyond that of simply a budget agreement that we have experienced before. The fact that there is a finance committee within Government overseeing public expenditure I think is right, and I think is proper, and I welcome it, but it is different and it does put Plaid Cymru in a different situation. 

I welcome the fact that there are designated Members. I welcome Siân Gwenllian's appointment, which I saw on Twitter earlier this afternoon. I think it will empower the Welsh Government, and I think it will strengthen the Welsh Government, but again, it asks questions about scrutiny. I welcome the fact that there are agreements in place between the two parties to manage business in this Chamber. Again, that asks questions. It is not credible to argue that the agreement between the Welsh Government and Plaid Cymru means that Plaid Cymru does not have an executive role. That is simply not a credible argument to make. 

I do believe that we need to consider this matter. I'm not sure that the format of a topical question this afternoon is the best way of resolving these matters, but I do believe that the Presiding Office, and the Government, and all of us as Members, need to take the same approach to the scrutiny of Government as Plaid Cymru and the Welsh Government have taken to the delivery of Government. Good government is improved by better scrutiny. We need to ensure that the structures are in place within this Parliament to ensure that this Parliament is not made redundant and a bystander over the next three years.

I think we've been very open and transparent. We've published all the documentation this morning, which absolutely sets out how it will work. I don't think we could have been any more open and transparent, and, certainly, we have nothing to hide. I don't think anybody's arguing about the role of Plaid Cymru. The status of Plaid Cymru as a party in this Chamber, as I said in my answer to Paul Davies, is a matter for the Llywydd, for the Senedd Commission, and for the remuneration board. The working of Government is a matter for the Welsh Government—the internal workings—which, I have to say, are very dry; everybody suddenly seems very interested in them. The Member will know very much that this is not a coalition. He understands full well what a coalition is. 

4. 90-second Statements

Item 4 is next, the 90-second statements, and the first is from Adam Price. 

Diolch yn fawr, Llywydd. I wish to make a quick statement today on SUDEP, which is sudden unexpected death in epilepsy. In Wales, there are an estimated 32,000 people living with epilepsy. Twenty-one people a week or three people every day in the United Kingdom die from SUDEP, with a large percentage of them being young men between the age of 20 and 40. As a group, people living with epilepsy are at a one in 1,000 risk of SUDEP. However, this can change drastically for some people depending on their individual circumstances. For some of my constituents, this is a very real issue that they live with every day, and some of the experiences they have shared with me over the past few weeks have been truly inspiring.

I would particularly like to reference Hayden Brown, a young man from Ammanford who lost his life to SUDEP just over two years ago now. His mother, Helen, is working with Hywel Dda to produce a resource that can be given to people at the point of diagnosis to increase people's awareness and inform them on how they can minimise risks. She also gives out an award in his name every year at his old junior school, Ysgol Bro Banw.

SUDEP Action are an excellent charity, who are doing their utmost to raise awareness of SUDEP specifically, and I would encourage anyone who has had family or loved ones affected by the condition to visit their website. Also, Epilepsy Action Cymru do a fantastic job of raising awareness and increasing understanding of the condition here in Wales. I would like to thank these organisations for their excellent work on this issue. 

15:40

On Monday, a memorial service was held for the late Dame Cheryl Gillan at Westminster. For those of you who may not be aware, Cheryl was born in Llandaff, Cardiff, and raised in south Wales. Indeed, her family still runs a farm in Usk. She was educated at Elm Tree House, a former alma mater of mine, and Norfolk House primary school in Cardiff, before attending Cheltenham Ladies' College and the College of Law. In 1992, she was elected to Parliament as Member of Parliament for Chesham and Amersham, a seat she held until her sad and sudden passing in April this year. Cheryl was appointed Secretary of State for Wales, the first woman to hold this role, after the general election in 2010, a post that she held with sheer distinction and pride. I knew her for many years, and her passion and kindness always shone through. She was widely respected amongst the political spectrum, and admired for her dedication to Wales. Cheryl is greatly missed by all of her friends in Wales, who will always remember her good humour and kindness. Public life is certainly poorer without her. Thank you. 

Thank you for those words. We will now take a short break to allow for some changeovers in the Chamber, and we will return for item 5. 

Plenary was suspended at 15:42. 

15:50

The Senedd reconvened at 15:53, with the Deputy Presiding Officer (David Rees) in the Chair.

5. Member Debate under Standing Order 11.21(iv): Cancer diagnosis and treatment

We move now to item 5, a Member debate under Standing Order 11.21(iv): cancer diagnosis and treatment, and I call on Mabon ap Gwynfor to move the motion.

Motion NDM7842 Mabon ap Gwynfor

Supported by Altaf Hussain, Cefin Campbell, Heledd Fychan, James Evans, Jane Dodds, Janet Finch-Saunders, Joel James, Laura Anne Jones, Luke Fletcher, Mark Isherwood, Paul Davies, Peter Fox, Rhun ap Iorwerth, Rhys ab Owen, Sam Rowlands, Siân Gwenllian, Sioned Williams

To propose that the Senedd:

1. Welcomes the Welsh Government’s single cancer pathway approach.

2. Recognises:

a) that cancer is the leading cause of death in Wales and that 19,600 people are diagnosed with cancer every year in Wales (2016-2018).

b) that the challenges facing cancer services in Wales have been compounded by COVID-19, with around 1,700 fewer people beginning cancer treatment between April 2020 and March 2021.

c) that NHS Wales cancer waiting times for July 2021 show that the percentage of patients receiving their first treatment within 62 days of first being suspected of having cancer was at 61.8 per cent, which is well below the suspected cancer pathway performance target of 75 per cent.

d) that even before the pandemic, Wales was experiencing significant gaps in the workforce that diagnose and treat cancer, such as in imaging, endoscopy, pathology, non-surgical oncology and specialist nurses.

e) that without multi-year investment in training and employing more staff to fill current vacancies, Wales will not have the frontline staff and specialists needed to address the cancer backlog, cope with future demand, or make progress towards ambitions to diagnose and treat more cancers at an early stage.

f) that the Wales Cancer Alliance criticised the quality statement for cancer, published in March 2021, for not setting a clear vision to support cancer services to recover from the impact of the pandemic and further improve survival. 

g) that Wales will soon be the only UK nation without a cancer strategy, which the World Health Organization recommends all countries have.

3. Welcomes the successful rapid diagnostic clinic pilots in Swansea Bay University Health Board and Cwm Taf Morgannwg University Health Board, and that the Wales Cancer Network has provided funding to all other health boards to develop rapid diagnostic clinics.

4. Calls on the Welsh Government to:

a) provide an update on the next steps for the quality statement for cancer, including ambitious targets and mechanisms for tracking progress investment for staff, equipment and infrastructure;

b) address the long-standing staff shortages within cancer and diagnostic services;

c) consider how the recommendations in Professor Sir Mike Richards review of diagnostic services in England could be applied in Wales.

Motion moved.

Thank you very much, Deputy Presiding Officer, and thank you for the opportunity to table this motion today, and may I thank all the other Members who have supported it? The number of Members who have supported the motion is testament to the importance of the subject.

Cancer, of course, is something that is very close to us all—far too close, actually. My father is a cancer patient, and has been since late 2019. Back in the summer, my father had the good news that the cancer had disappeared, and that he was in remission. This was a cause for celebration, of course. Then, at the beginning of the autumn, when he went back for his tests, he found that the tumour had returned.

I can attest, therefore, to the fact that the diagnosis process, waiting for results, waiting for treatment, waiting for answers when something unexpected happens is very cruel, and I can't imagine the torment that my father and mother have had to endure through this without knowing whether this terrible thing is growing faster inside him, or if it's spreading.

However, I'm not alone in living these experiences. There are thousands of patients and families in Wales living these experiences every day and, of course, there are others in this Chamber who have also experienced it, I'm sure.

We all, of course, remember the late Steffan Lewis, who contributed so much in such a short time, and he was lost to cancer.

In tabling this motion today, I want to focus on the impact of COVID on cancer services, the workforce, waiting times and diagnosis.

Just under 20,000 people are diagnosed with cancer in Wales every year, and it's now widely known that cancer kills more people in Wales than any other disease. The good news is that the survival rate for this disease is increasing, with 60 per cent of patients diagnosed between 2014 and 2018 surviving their cancer for five years or longer, which shows that treatments are improving.

However, despite these steps forward, the impact of COVID-19 and the shortage of staff in the health service are likely to lead to a first decline in survival rates. The challenges facing cancer services in Wales have been compounded by COVID, as in all sectors within the health service. Welsh Government figures show that 20,000 fewer people were given urgent referrals for cancer diagnosis between March and November 2020, compared with the period before the pandemic. We now know that 1,700 fewer people started their cancer treatment in Wales in the year between April 2020 and March 2021. Cancer services were significantly disrupted in the wake of COVID, jeopardising diagnosis and making it more difficult to treat, which then led to a decline in their chances of survival.

We also know that health service staff are exhausted after responding to the pandemic, as well as trying to maintain cancer services, while also trying to carry out more infection control measures. However, while many cancer services have now largely returned to the levels where they were before COVID, the reality is that cancer outcomes in Wales were not good enough even before the pandemic. We can't therefore go back to how things were. There remains a need to transform services urgently to improve cancer outcomes in the long term.

That brings me to the workforce. I want to place on record our thanks to the workforce, who have gone the extra mile time and time again over the recent challenging period. As the son of a cancer patient, I wish to thank them personally, and I am sure that that gratitude is echoed by everyone here in the Senedd today. However, the inconvenient truth is that the health service has relied on the goodwill of the workforce to keep the service going, with more than one in four doctors working unpaid overtime. Even before the pandemic, Wales was experiencing significant gaps in the workforce for diagnostic and cancer services, such as imaging, endoscopy, pathology, and non-surgical oncology.

These gaps have significantly affected our ability to identify cancer early, provide the most effective form of treatment, and improve the chances of survival. For example, while there has been an increase in the consultant workforce for clinical oncology throughout the UK and Europe, there has been no increase in five years in the Betsi Cadwaladr University Health Board area. In 2020, there were only 7.8 radiologists per 100,000 people in Wales, while the European average is 12.8. Indeed, Wales has half as many radiologists per head of population as France and Spain. And north and west Wales have the lowest number of clinical radiologists per capita compared to the rest of the UK.

There are steps that can be taken in the short term to address this situation, such as mixing skills. Innovations with new technologies can also help to maximise the potential of the cancer workforce as well. And, of course, we must look at supporting the well-being of the workforce in order to retain them. But, while these steps can help, it is only by addressing the crisis in the real workforce that we can find a solution to the broader question of staffing. We must therefore see the Government increase staffing levels in key cancer professions by investing in training and employing more cancer staff to fill current vacancies, and ensuring that the workforce has the capacity to meet growing demand, as well as time to innovate and transform services.

This brings me to the next point, namely waiting times. It's fair to say, as we've mentioned, that COVID has had a detrimental impact on these cancer services. Data for September 2021 show that 59 per cent of patients had received their first treatment within 62 days of the suspicion of cancer. This is well below the target of 75 per cent. This worrying statistic tells us that far too many patients are waiting too long before being diagnosed or treated. But we can’t improve the results unless we see an increase in the workforce and the equipment required to catch it early enough.

Now, the suspected cancer pathway, which was announced back in the spring, is to be welcomed. But more needs to be done to reduce waiting times and to give patients the best possible chance of early diagnosis, early treatment and survival.

I also welcome the quality statement for cancer, which was published this year. But it is an inadequate statement. It's not a cancer strategy, and the previous cancer strategy has now come to an end. Wales will therefore be the only nation in the UK without a cancer strategy, something that the WHO says that every Government should adopt. We therefore must strengthen the quality statement for cancer, and we must develop a cancer strategy for Wales urgently.

Finally, I want to turn quickly to the Richards review, undertaken by the health service in England. One of the key recommendations of the review was having diagnostic hubs for elective diagnostics, and taking elements such as scanning and testing out of acute hospitals in order to build capacity. But, of course, we require additional investment to create these, together with workforce, equipment and so on. The Government therefore needs to consider this fully, and I would urge the Government to explore the possibility of establishing a pilot scheme, with a view to developing hubs of this kind here in Wales.

So, to close, we recognise that the COVID crisis has made things very difficult for the cancer services and health services in general, and we officially thank the workforce for their bravery and their work during this period. But things weren't right before then. We recognise that steps have been taken in the right direction, but we need much more. We have to see investment in the workforce, which means increasing the training opportunities and increasing the numbers, particularly the specialist workforce. We need a cancer strategy that's clear, building on the statement that was made in the spring, setting out a vision and clear targets and accountability. And finally, we need to see a commitment to trial and adopt some of the recommendations in the Richards report. After all, we don't need to reinvent the wheel. So, by implementing these, we can be confident that more patients will have a quick diagnosis and that survival rates will increase. Thank you very much, Dirprwy Lywydd.

16:00

I'd like to firstly thank Mabon for bringing forward such an important debate today, and also say that I'm sorry to hear what his family is going through and to hear the personal reasons for him bringing this debate to the Senedd today.

The points raised so far will be both concerning and upsetting to people the length and breadth of our country. The Welsh Government's announcement of the new single pathway for Welsh patients to ensure treatment begins, if cancer is suspected, within 62 days is welcome news after years of growing waiting lists for cancer diagnosis and treatment. It has been a shameful reflection on successive Labour Governments' historic inaction to tackle excessively long cancer diagnosis and treatment times. Despite the introduction of the new single pathway, horrendously long waiting lists still blight Wales and are still only getting longer. Quite clearly, far more is needed to rectify the current cancer crisis that we face. A significant portion of the problem has been caused by the chronic shortage of hospital staff across our health board departments. Once again, we've seen successive Labour Governments allow our NHS to go upstream without a paddle.

It's all well and good introducing new strategies to bring down waiting lists and improve outcomes for patients, but it's being set up to fail. If we don't ensure that there are enough staff to deliver results, then this new strategy will just become a sticking plaster for a very deep wound. We know that the pandemic has had a significant impact since its inception in March 2020. We've all heard stories of various people suspected of having cancer going undiagnosed for far too long, thus exacerbating historic backlogs. Sadly, most of these problems were here long before the pandemic struck. I find it extremely concerning that, despite the World Health Organization's recommendation that all countries should have a cancer strategy in place, Wales is still waiting for a clear, multi-pronged action plan that can tackle the heart of this issue.

This Welsh Government needs to act and it needs to act now. We're in dire need of a short-term strategy put in place to tackle the immediate staffing issues facing the NHS. Without this, there can be no hope of bringing down waiting lists. Indeed, we may only see waiting lists increase otherwise. This needs to be coupled with the introduction of a long-term plan to drive down waiting lists, so that patients can access treatment as soon as possible, preferably before that 62-day target. The Labour Government can no longer rest on its laurels and bury its head in the sand under the delusion that problems will fix themselves. They can't just revert to blaming Westminster either, because the buck stops here, Welsh Labour Government.

These issues demand urgent and targeted intervention now. Rapid diagnosis is absolutely key. The situation needs to be brought under control, otherwise we will continue to have excessively long waiting lists and increased deaths caused by cancer, many of which could be entirely avoidable with appropriate action. Wales being the only nation in the UK without a strategy is just not good enough; the time to act is the time now.

16:05

Thank you to Mabon for bringing this motion before us today. The people of Wales wait too long for cancer treatment, and that impacts on the likelihood of survival. That's the fundamental truth of the matter that is the background to this motion today, and at the heart of the solution is the need for a new national cancer plan for Wales. The Minister has heard those regular demands from various stakeholders that we need such a plan; the quality statement for cancer doesn't provide us with the strategy, the clear action plan, that we need. We needed such a strategy before the pandemic, and that is so much more the case now.

In the first year of the pandemic, 1,700 fewer people started cancer treatment than we would have expected from figures prior to that. The Minister can come to the Senedd, as she did earlier today in responding to questions from myself, and say that cancer has continued to be a priority throughout the pandemic. I don't doubt that that was the aspiration, but the statistics tell another story, don't they? The Welsh Government's own figures show that 20,000 fewer people had an urgent referral for a cancer diagnosis during the first nine months of the pandemic, as compared to the period prior to that. The pandemic had a substantial impact. One would expect that, of course, to a certain extent, but today we're discussing the response to that. So, we need not to do more of the same thing even; we need to transform services in order to recover from COVID, and we need a new national cancer plan in order to do that. We need diagnostic centres as a matter of urgency. We need to see early screening strengthened, such as the lung health checks, which we know work. We don't need any more evidence that they work; we just need to provide them in Wales. We need a workforce plan. There were large gaps in the workforce prior to the pandemic, and filling those gaps is even more critical than ever now. The workforce is excellent. Anyone who's come across them can't thank them enough for the work that they do, but there are gaps in that workforce and there is huge pressure on those within the workforce that is unsustainable. We need to invest in that workforce, and we need to do that urgently.

I do need to make this point too: we do need to ensure that we make the right investments for the long term for cancer services in Wales. I've written to the Minister recently asking her to look again at and to listen to the views of cancer specialists calling for the co-location of a new cancer centre in the capital city on the same site as the university hospital, following international patterns. Is she truly convinced that the decision taken so far is the best one? Because we must ensure that cancer patients in Wales today and for the future get the best possible services.

Deputy Llywydd, I'm very pleased to support this motion today, because it's another opportunity for us to emphasise the need for a clear focus on something that is such a key part of our health and care services. Mabon mentioned his own experience and his family's experience, and we wish your father well in his battle. Our experience as a family was that the diagnosis came too late for my mother, almost 10 years ago now, and there was no way of her having any treatment at all, so I wish anyone who has the opportunity to access treatment and to battle cancer well. But we can improve people's chance of having that early diagnosis and a timely referral and of having effective treatment and of surviving cancer, but it will only happen with uncompromising determination and a clear national plan.

16:10

Well, again, I wish to begin by extending my sincere thanks to Mabon ap Gwynfor MS for tabling this very important motion, as well as to the 15 Members who supported these important calls to address prolonged waits for cancer diagnosis and treatments. As this debate will make clear, NHS cancer waiting times for September 2021 show that 59 per cent of patients receive their first treatment within 62 days of being suspected of having cancer, and this is well below the cancer pathway target of 75 per cent.

Minister, March's quality statement for cancer was an opportunity for the Welsh Government to set out a strategy for improvements to cancer diagnoses, but it does lack further detail and accountability mechanisms. As Cancer Research UK have made clear, soon Wales will be the only UK nation without a cancer strategy, which the World Health Organization recommends that all countries have. I join with my colleagues in requesting an update on the next steps for the quality statement for cancer, and I ask that you detail what mechanisms are being considered for fast-tracking progress investment for staff, equipment and infrastructure.

Even before the pandemic, Wales was experiencing significant gaps in our workforce that diagnose and treat cancer, such as imaging, endoscopy, non-surgical, oncology and specialist nurses. These staffing gaps are resulting in concerning cases turning to my office for assistance, including instances where patients are being informed of such a life-changing cancer diagnosis simply by the telephone, rather than a personable, face-to-face discussion.

Alongside staff shortages, it is true for north Wales that the health board has to refer many patients back to England for necessary treatment. I know from assisting a constituent very recently that the process is not smooth, with delays encountered, for example, because multidisciplinary team meetings between Betsi board and the relevant English hospital sometimes only take place once a week. Devolution seems to be unnecessarily and unacceptably delaying cancer treatments. We need better cross-border and UK-wide NHS co-operation, so too that north Wales residents are not disadvantaged due to lack of specialism in the region. We know that disruption to services also risks later stage diagnoses, making it much harder to treat and worsening cancer survivals.

So, I wish to conclude by asking the Minister to use her reply to confirm whether and how the multi-year Welsh Government budget due shortly will be used as an opportunity for investment in the cancer workforce in Wales for the long term, and I strongly, strongly request that, certainly in north Wales, some action is taken on how patients are advised of such lifelong and life-changing illnesses. Thank you. Diolch.

I'd like to thank Mabon ap Gwynfor for bringing this debate forward today. I think it's an extremely important issue that I believe all parties care about in this Chamber, and I'm sorry I wasn't quick enough, actually, to put my name in support of the debate before it was tabled. But I'd like to put it on record that I will be supporting the motion today, and I agree with the points in the motion that Mabon has tabled. 

Cancer patients have been, I think, left behind in Wales, sadly. I think for too long we have delayed screening, delayed treatment, and the pandemic has placed significant strain on an already overburdened workforce, and a significant number of healthcare professionals are now suffering stress and burnout. If Wales wants to meet the growing demand and achieve world-leading outcomes for cancer patients, then it must invest in the NHS workforce as a matter of urgency. So, I strongly support the call on the Welsh Government to address shortages in the cancer workforce.

And I note that Wales is soon to be the only UK nation without a cancer strategy. And, as I think two Members have already pointed out, the World Health Organization recommends all countries should have a strategy. So, I hope the Minister, given that three Members have now mentioned that in this debate today, can address that point specifically. But I think the Welsh Government needs to act with some urgency in that regard, and Wales needs a vision that sets out how the Welsh Government is going to be working with the Welsh NHS and how it will support services to recover from the impact of the pandemic and improve cancer survival through innovation and transformation in the long term. 

Mabon pointed out at the beginning of this debate his own experience in terms of his own family situation, and it made me think that I suspect every Member of this Chamber has been affected by cancer in some way, and that will be the same for people across Wales. So, I think it's of great concern to us all, isn't it, when we have longer waiting lists, and I think that will impact on every person across Wales in terms of being concerned about longer waiting lists in terms of cancer. I know that colleagues will no doubt agree with that.

But, through the pandemic, we have seen, of course, record waiting times. NHS cancer waiting times for September showed 59 per cent of patients received their first treatment within 62 days of being suspected of having cancer, and this is well below the cancer pathway of 75 per cent. So, we won't improve cancer outcomes unless we reduce waiting times in Wales. And the Welsh Government, I think, has got to act urgently in investment in the staff and infrastructure needed to help more people get a timely diagnosis and treatment, as Mabon pointed out in his opening comments. So, I'll certainly be supporting the motion today, as tabled, and I hope that the Government will respond accordingly to this debate this afternoon. 

16:15

I very much like the tone of the discussion today, because this is a really emotive issue. We've all got family or friends who have had or have cancer, so it's really important we are very measured in the way we discuss this.

I think one of the biggest problems with cancer is that people are often very slow to come forward. People really do need to listen to their bodies and think, 'This is not normal, perhaps I need to go to the doctor.' And I think it's a well-known fact that men are much less likely to come forward quickly than women. But also I think people who have poor self-esteem, who have low expectations of what services are going to be able to do for them, just assume that it's part of their story and they just think, 'Well, I'm not feeling well, but nobody's going to do anything about it.' I think it must be really difficult for clinicians to be able to distinguish between the worried well and the reluctant visitor to the GP who may or may not be telling the clinician the full story and be thinking, 'Oh, I don't want to bother the doctor.' So, I think it is really, really difficult, and there's no point in everybody being sent off for a cancer test, because obviously that would completely clog up the services that people who really do have suspected cancer actually need. But it also requires the GP to think intellectually, 'Is this just something that a simple medication will resolve, or is there something more going on here? Has this person lost weight recently?'

So, I think it's a very difficult issue and, in the end, we all die of something, and often we die of cancer because we've outlived our usefulness. But clearly, the worst types of cancer are those that are suffered by very young people, including children and young people generally, because the cancer is so much more virulent. I know somebody who's been living with prostate cancer for 15 years; this is quite normal if you're elderly. People do live with cancer perfectly okay with the support of appropriate treatment.

I've got a friend, a close friend, who is dying of pancreatic cancer, which I'm aware is one of the most difficult cancers to treat, and so I was particularly interested in taking up the offer of a meeting with Pancreatic Cancer UK recently, and there was an expert witness involved who was the wife of somebody who had died of pancreatic cancer during the pandemic. It was really, really useful to listen to this person about the way in which her husband had been treated, how he had finally got round to seeing the GP during lockdown, but it was only at his insistence that he got to see the nutritionists, so I was very interested to read the national optimal pathway for pancreatic cancer, which unfortunately was published in February 2020—not a good month for instituting change, for reasons we're all aware of. But I am very pleased to see that that pathway states really, really clearly that people should not wait for a local multidisciplinary team discussion before referring somebody to the local upper gastrointestinal cancer group, but also to the nutritionists. This is absolutely key in order to consider the administration of pancreatic enzyme replacement therapy, because by nature of having pancreatic cancer, your body is not capable of digesting food. It seems blindingly obvious, but I want to understand from the Minister why she thinks it is that only three in five people—according to the Pancreatic Cancer UK organisation—are getting PERT, which is the prions that you need. Because although it didn't save the life of the person whose widow was in the discussion, it did enable this man to have a reasonable quality of life while he was able to, in order to share meals with his family, and I think that that is absolutely crucial and is a good illustration of how treating cancer isn't just for the physician who is a specialist in cancer, but is for a whole multidisciplinary team of people, because it affects so many people. Thank you.

16:20

Diolch yn fawr. I'd like to thank Mabon for bringing forward this Member's debate and say how sorry I am to hear about his father's situation. We do all wish him well with his situation.

Although the Government will abstain, it's a vitally important matter, as reflected by the contributions of Members today, most importantly in terms of how it affects our constituents, but also how it has affected the lives of families and friends of Members themselves. I think there are very few people who haven't had some kind of personal experience of seeing the effects of cancer, and we saw that all too clearly in the Chamber, as was mentioned, in the incredible contribution that Steffan Lewis made in the short time that he was with us in the Chamber. I sadly lost my sister-in-law, Polly, at a very young age to cancer two years ago, to this cruel disease.

Now, in more normal times, we would be talking about cancer as the leading cause of death, the leading cause of years of life lost as a result of premature death, and the leading cause of disability adjusted life years in terms of the ongoing physical impact amongst survivors of cancer. That's why it has such a significant profile and why it is such a major focus for any Government.

Cancer is, of course, more than 200 diseases rather than one thing. It's primarily a disease of the ageing process, but a significant proportion of cases are preventable, particularly through tackling rates of smoking and obesity. Prior to the pandemic we had a number of iterations of national strategies and delivery plans, and we saw many successive years of gradual improvement in cancer survival and mortality, as well as very high levels of positive patient experience. We had invested heavily in radiotherapy equipment, had introduced the UK's first complete overhaul of cancer waiting times, and had established excellent national leadership around cancer service development. And I'm pleased to note that part 3 of the motion recognises one notable success of this approach, which has been the establishment of the rapid diagnostic centre concept. This shows how a national approach can really help identify opportunities for new service models, fund high-quality pilots, develop an evidence base and then support the upscaling of this and spread it across Wales.

The pandemic has inevitably had a significant impact on cancer care. Early on in the pandemic, significantly fewer people came forward for investigation. The screening programmes were temporarily suspended, some people did not want to attend their appointments, and some people's therapy was altered to reduce their risk. We issued essential services guidance immediately, which included cancer investigations and treatment, and our cancer services rapidly came together to change how they delivered services.

Towards the end of 2020, thankfully referral activity recovered as people started to come forward in normal numbers, but figures indicated fewer people than would normally be expected were seen last year. From early 2021 we have seen referrals for most cancers increase significantly above normal levels, and this is combining with restricted capacity resulting from staff absence and infection prevention controls. This above-normal demand and below-normal capacity is what is driving the cancer waiting time performance described in the motion.

Our NHS staff continue to work incredibly hard to investigate and treat people with cancer, and they're treating more people than in previous years. As a Government, we're providing additional resources to the NHS to undertake as much cancer diagnostic and treatment activity as possible, and I've made cancer recovery a planning priority for the NHS, as reflected in our approach to recovery, 'COVID-19: Looking forward', supported by nearly £250 million of additional resources.

Although we don't currently have any clear evidence of poorer cancer outcomes, we think that the disruption of the pandemic is likely to have an impact in the years ahead. Pandemics, unfortunately, do much indirect harm in terms of access to normal healthcare, as the chief medical officer has set out at length.

As well as our wider approach to recovery, we published in March this year the quality statement for cancer, as many people have referred to. And can I just be clear that I understand the concerns that have been raised with regard to this new approach? But I think it's really important that we consider how we got to that point, and this goes back to the Organisation for Economic Co-operation and Development and parliamentary reviews, which led to commitments made in 'A Healthier Wales', and 'A Healthier Wales' committed us to introducing a series of quality statements for the NHS in Wales. We can't deliver this commitment and stay true to its rationale whilst clinging to the old way of doing things.

What we're trying to achieve is a better integrated, more effective, quality-based approach for a number of clinical services; an approach that is more attuned to the planning framework for local NHS bodies and better informs the accountability arrangements that we use with all local NHS bodies. And this approach is described in significant detail in the national clinical framework. This is the approach that we have determined will work best for Wales and for our health system. It's a completely new way of doing things, but it does build on what has been achieved in recent years.

The approach for cancer is grounded in enabling quality improvement. It has a heavy focus on enabling earlier detection and access to treatment. There’s also an important focus on introducing a new cancer informatics system, enabling better cancer workforce planning and supporting better service design.

The boards and health trusts will respond through their local plans to the quality statement. We, of course, will steer the development of those plans and also monitor the development. The Wales Cancer Network board will support the health boards with the pathways that work most effectively on a national level—those that need to be adopted. They will also assist health boards in drawing the data down to deliver services and bring them together. These national pathways are included in the quality statement and many of the service specifications have been included already.

We've already announced that around £100 million is to be invested in imaging equipment—equipment such as CT, MRI and PET/CT scanners. This is a huge investment, and to support this investment, there will be more training placements available for radiologists and radiographers. This is all possible thanks to our imaging academy. We have significantly increased the number of our training placements in oncology. This is also the case in related specialist areas that treat people who have cancer, such as urology and gastroenterology. There is more work still to be done in terms of cancer workforce planning and diagnostics, but the work is already under way through the relevant national plans.

We will invest almost £6.5 million in a new cancer information system. This is a very ambitious programme of work that touches upon every health board and trust. We want to introduce a robust integrated patient record for people affected by cancer. We are investing millions in new linear accelerators. These are devices that provide radiotherapy treatment. In addition to that, we are progressing with the development of a new cancer centre in the south-east of Wales and the possibility of establishing a sub-centre in the area for radiotherapy in order to increase access.

Next year, we will also introduce a new framework for health and social care outcomes and a health service delivery framework. As soon as the final agreement is in place, we will update the quality statement with the relevant targets and metrics on cancer. The Wales Cancer Network board will be part of the NHS executive. This will ensure that in the future, this agenda will benefit from the support of leaders working at a very high level and that all parts of the system will work in a more integrated manner. This is a very ambitious agenda—an agenda that I am confident will help mitigate the impact of the pandemic and allow us to improve outcomes for patients once again.

16:30

Thank you very much, Deputy Presiding Officer, and I thank everyone for their contributions to the debate this afternoon. We heard at the outset from Laura Anne Jones. I thank her for her very kind words, and she emphasised once again the lack of staff and the long historic waiting lists, but that things have not necessarily improved with people going without diagnosis for long periods.

Rhun then talked about a very sad family history, and I extend my sympathies to Rhun and to everyone else who talked about their personal circumstances. But he talked about the need for a national cancer plan and emphasised that need for a clear strategy and focus, and then that we see the need for diagnostic hubs, early screening and a clear workforce plan and so forth—that need to have the strategy in place.

Janet Finch-Saunders mentioned the number of people getting treatment being lower than the target, as we heard, and emphasising the need for a strategy and also emphasising the need to have clear advice for patients in this case.

Russell George—thank you very much, Russ, for your very kind words, again emphasising the impact of the pandemic and calling for the need to reduce waiting times and emergency responses in order to have a quick diagnosis, and to ensure that people do survive because of a rapid diagnosis. Thank you very much to Russell George. 

Jenny Rathbone made some very important points, particularly at the end, talking about the pancreatic cancer situation and the important role played by nutritionists and nutrition for patients, and multidisciplinary teams when it comes to detecting cancer.

And then, finally, I thank the Minister for her response. You mentioned the investment that is being made. Of course, we do recognise the impact of the pandemic and we offer great thanks, evidently, for any additional investment. You’re talking about figures that are beyond my understanding—£0.25 billion; very great figures—and you talked about a clinical framework, but, again, what we didn’t hear was the word ‘strategy’. We heard ‘framework’ and the different ‘frameworks’, but you didn’t talk about a national strategy, which does mean that Wales will be without a clear cancer strategy. Are these frameworks together going to constitute some kind of strategy? That’s not clear, so I’m looking forward to seeing what the cancer strategy of the Government will be in its entirety.

And despite this investment of millions of pounds in capital funding mainly—that’s what I think that is—there’s been no mention made of funding to fill this gap in the staffing, which continues. As we mentioned, the number of radiologists is far lower in Wales than in other countries on the continent, and we need to fill that gap and ensure that we have those staff. So, I’m looking forward to seeing what investment you will be putting in to this in order to fill that gap. Because if we are going to tackle this issue and ensure that people do have an early diagnosis and then can survive this illness, then we have to have the staff in place in order to recognise the illness in the first place.  

There was no mention made of the Richards review and the lessons that you’ve learned from that review in England. There are important lessons there, I think, that the Welsh Government should pick up on. So, could you give some consideration to those lessons? If you make another statement in the Senedd, maybe you can talk about the lessons that you’re learning from that review. Thank you very much, Deputy Presiding Officer. 

16:35

The proposal is to agree the motion. Does any Member object? [Objection.] Yes. I will therefore defer voting on the item until voting time. 

Voting deferred until voting time.

6. Welsh Conservatives Debate: Small businesses

The following amendment has been selected: amendment 1 in the name of Siân Gwenllian.

The next item is the Welsh Conservatives' first debate for today, on small businesses. I call on Paul Davies to move the motion. 

Motion NDM7854 Darren Millar

To propose that the Senedd:

1. Recognises small business Saturday in championing Wales’s small businesses.

2. Believes that small businesses are the beating hearts of the communities that they serve and are a vital part of the Welsh economy.

3. Encourages communities to shop local to support small businesses to grow and thrive, creating jobs for local people.

4. Calls on the Welsh Government to continue to support small businesses through changes in procurement policy across the public sector, helping them to recover from the COVID-19 pandemic.

Motion moved.