National Assembly for Wales

Thank you.

Diolch, Cadeirydd. Good morning, everyone. Care homes obviously have been very much in need of protection from the virus, and I know that the Welsh Government has taken steps to try and ensure that that is the case, so that residents and staff do not suffer as a consequence of catching the virus. But that's left loved ones very often not able to see their family members, not able to have that close relationship with their family members, and in particular for those members who may suffer with dementia or Alzheimer's, it's an area that is important.

I suppose what I'd like is an update on where we are with access to visits to care homes. I know the Welsh Government established a position before Christmas under tier 4, which indicated that it is up to the care home providers to make that decision, but I know in my own constituency, there are many providers that are not allowing those visits still. So, I suppose what I'm trying to find out is when do you believe care homes, and how many care homes across Wales—. I'll ask the first simple one: how many care homes across Wales are you aware of that are allowing visits, and how many are not? Do you have those numbers?

Ridiculous question.

Thank you very much for those questions, David. No, we don't have the numbers. As you know, there are 1,050 care homes, separate individual care homes, across Wales. Many of them, the vast majority, are independently owned, and we don't have any specific figures about how many care home visits are taking place. This is something that I have asked myself, to try to establish, but it is very difficult to establish how many are actually taking place. We know some are taking place, but to move on to the questions that you raised at first, we absolutely accept that this is one of the most difficult situations that we have had to deal with, really, as a Welsh Government during this pandemic, because it is an absolute tragedy that people who are in care homes, even if they've had some visits, they've been very limited and there has been this terrible gulf between care home residents and their relatives. But I want to say, and really pay tribute to the huge efforts that have been made by care home providers, because what they have done is they've used all the means, the technology that they've got, to try to keep in touch with video-conferencing, with iPads—they're trying to keep in touch the whole time, and they have made a huge effort to do that, but it's not the same. I think we all know it's not the same, and certainly what people want is a hug and a touch, and they haven't been able to have it.

So, the position at the moment is that we are at alert level 4, and that enables risk-assessed outdoor visits to take place. Of course, there are very few days when that is suitable at the moment, outdoor visits, but also visitors within a visitor pod, where there's a complete physical barrier between the visitor and the resident. I'm sure you know about the visitor pods that the Welsh Government has funded for a six-month period for a number of homes, and those visits can take place. But, of course, during the whole of the period we have allowed visits in exceptional circumstances, and those exceptional circumstances would cover, very sadly, end-of-life care, and they would also cover some of the things that you mentioned, David—people with dementia when they're in distress, it could cover that sort of circumstance, or if there'd been a bereavement in the family. There are exceptional circumstances when visits have been allowed, but it is a very difficult situation, and at alert level 4, as we are at the moment, that is the situation.

But we have done all that we possibly can to encourage and enable visits to take place safely. We have a multi-agency stakeholder group who have worked together to try to come up with good, reasonable guidelines, and I think that the position that the Welsh Government has taken is very clear, and I personally have done all I can to try to ensure that visits do take place safely. But it is a very difficult situation, and naturally, many of the care home providers are very nervous and anxious about having any visits.

I fully understand that the providers are risk averse, and I understand the reasons for that, because clearly they're looking after the care of all residents and want to ensure that the virus does not get into the home, which could impact upon not just a single resident, but many residents within the home, and staff. I understand those circumstances, but I suppose in a sense what we now need to have is—. Welsh Government doesn't know how many care homes are allowing visitors and how many aren't, and I think it would help if the Welsh Government worked with local authorities to identify those. Local authorities should have information on the ground, or could get it, anyway, and it would be helpful, so that we can have a picture across Wales as to how prevalent the challenges are, and the difficulties, because it's not just the well-being and the mental health of the residents, but also the family members— 

Yes.

—who sometimes need it as well, to be there. So, it's both sides of this visit that need that support.

If I move on a little bit, then, testing was used as an example that was possible. The lateral flow testing may be a means. I actually have a constituent who has access to lateral flow testing, and yet the care home in which his father resides still says, 'No, you can't visit.' The provider has said 'no'. So how are you, as a Government, really, ensuring that the guidance you give is getting out to the care homes, so that care homes can take an approach that balances it all, rather than it's too heavy on one side?

We're doing our utmost to keep in touch with the care home sector. I meet every week with the chair of Care Forum Wales and discuss in great detail all the issues that are taking place in care homes throughout Wales, and I have constantly done all I can to encourage the opportunity for visiting to take place safely. Albert Heaney, the deputy director general, meets with the directors of social services every single week to listen to any issues that come out, and I know that he has constantly pushed the fact that we must use all the means that we've got at our disposal to ensure that people can visit, and the lateral flow test is one of those ways of ensuring that visits can take place. The other means I've already mentioned are the pods, and the Welsh Government has invested money in this—£6 million for the pods to be leased—and I'm hoping that although during this period they may have been used less because we managed to get them in just before Christmas, their use will grow as the infection decreases.

But we have made every effort to make contact with the care home providers, but when you've got a huge group, the majority, 80 per cent, I think, in the private sector, it's very difficult to actually reach out to them. But Care Forum Wales is obviously one of our key partners, and they have a WhatsApp group with all the care home owners. They frequently talk and support each other, because I think one of the other points we'd want to make is what a drain all this has been on the care home staff. We've got the residents and their families, which you so rightly said—I have never had such sad letters as I've had from relatives of people in care homes—but then we've also got the staff. And so, there are these support mechanisms, but it's certainly more difficult to do that when you have a huge disparate group of care homes. But we are doing all we can to give guidance and encourage visits to take place.

Okay. Mr Heaney indicated. For old times' sake, Albert, welcome aboard.

Thank you, Minister. Thank you, Chair. Just to add to the Minister's response—a really important question—we've been working tirelessly over many months around visiting guidance, moving as the virus escalated in communities into the higher level tiers. I think the opportunity really presents itself now, as we begin to, hopefully, see a decline in community transmission rates. As that lowers, it gives us that ability then to move into a different visiting regime, because we all see the vital importance of being able to see your loved ones. 

Alongside that, then, Care Inspectorate Wales have done some intensive work. They're in regular contact with those care providers, having discussions around visiting arrangements, promoting the guidance. So, we're very closely aligned. And as the Member quite rightly raised the issue of how many visits are taking place, at the moment there's very few because of the status at level four. As we move forward, I have spoken to Care Forum Wales who are going to assist us in getting an accurate picture of visiting, going forward as well. So, alongside the directors, that's a real opportunity. Thank you, Chair.

Good. Angela at this point and I'll come back to you, David, all right? Angela.  

Just very quickly, Minister, I don't underestimate how incredibly difficult this situation is, and you are at the wrong end of the telescope in that you must be getting all sorts of letters from people worried about, and complaining about, how they perceive their loved ones have been treated. But it's not just the general public, and I just wonder if you could briefly comment on the Equality and Human Rights Commission's conclusion that equality and human rights—basic human rights—standards have not been upheld for care home residents, particularly in regard to admissions to care homes and access to visits, because, like you, I have received some pretty harrowing letters. 

I also picked up your point about how difficult it is to communicate with 1,050 care homes, but, actually, they all have licenses, they're all part of the fabric, and we should be able to get all your guidance, all your thoughts and actually compel—an element of compulsion—because a lot of them receive money from the state, they all have to be licensed, they all have standards that they have to uphold, and some of this, surely, comes under that. But if the EHRC are raising concerns, then I think we have every right to be concerned.

Yes. Thank you very much, Angela. We are in discussion with the Equality and Human Rights Commission, and we have been in correspondence with them about the rights of older people, and we've recently responded to some of those queries at great length, and we are in a dialogue with them. We're certainly looking at the issues that they have raised, but we are well aware of all those points that you have made, and we have—.

I know that, early on in the pandemic, there was this concern that people had been discharged from hospital to care homes and that there had been an element of trying to push patients out quickly, and we have had—. I mean, I'm sure at some point there will be an inquiry into all of this, and it will all be looked at in depth. Indeed, I think we would support that happening. We did get Swansea University to have a look at this issue, about whether discharges from hospital were linked to an increased likelihood of infection in a care home, and in fact, they said that what were the likely elements of causing an infection were not linked to hospital discharges but, in fact, linked to the size of the home. It was the size of the home that was the most likely thing to determine that an infection might take place. We are in dialogue with the EHRC about the concerns that they've raised.

Okay, back to David.

Thank you, Chair. Just two final questions from me, because I know my colleagues have others. On the care home visits, when will the Welsh Government update its guidance, particularly in light of the vaccination programme that's going on? We now know—and the Minister has indicated—that many care home residents are receiving vaccinations. In my own area, it's about 80 per cent of care home residents. By the end of this week, hopefully all care home residents will have received their vaccinations, which gives some protection—I appreciate there's a second dose to come, down the line—but it allows an opportunity for improved visits. So, when will the Welsh Government be updating its guidance to care homes to allow that scenario to take place?

We are in the process of updating the guidance at the moment, so that is taking place now. Obviously, the vaccination is the hope at the end of the tunnel, isn't it, and it should improve opportunities in the future, but of course, I think, as everybody has been saying, we're going to still have to observe the other ways of protecting the care residents, staff and families, even when the vaccinations have taken place, and we will be continuing with the testing, even when vaccinations have reached a high level, and it's very good to hear about 80 per cent in your area.

I think it's important to make sure, because you and I both know that the vaccine is about avoiding serious illness and death as a consequence of this illness, not necessarily about avoiding contracting the virus or even passing it on, and therefore the testing is important. But my constituents will actually want to know when they can see their loved ones, so the sooner we get that information out, and it's transparent and it's clear to people, the better. So, I'll just leave that one with you.

One final point from me. We've talked about staff. Care home staff shortages have been of some concern, because of illness and self-isolation. Neath Port Talbot and Swansea have actually come close, on certain occasions, where care homes may have had to close as a consequence of this, but that's not just—. I'm sure that's across Wales, as well; it's not just our own region. What are you doing to ensure that local authorities and health boards are able to be supported to ensure that care homes do not close, because if they close that's a huge problem for our health service, because they're transferred somewhere? What actions are you taking to support those, to avoid that?

We're doing absolutely all we can, and we were very aware of the problems, particularly before Christmas, where Swansea and Neath Port Talbot were in a very difficult situation, and they were worried that a number of care homes would not be able to function, that they didn't have enough staff. So, what they've done is to develop a rapid response team that is able to go into the care homes, provide the support needed, and do what is possible. But there are a lot of things that you can do in that situation. For example, the very close working between health and the social services, the local authorities, and that is something that did happen, so they're all working together on this. There are neighbouring authorities that are able to bring in help, because the very worst thing that would happen is for care homes to actually close down because of, as we all know, the huge disruption and upset that is caused to the residents, many of whom never recover if a care home is closed, and I think there is evidence of that.

So, there are things that we can do, and in the case of Swansea, Neath and Port Talbot, they have set up a system with this rapid response team, and fortunately, they were able to prevent the worst from happening. And there have been other incidents in Wales and we've got through them, shall we say? But it has been very difficult and there has been a lot of pressure and it has meant everybody working together. I think the key message is the barriers between local authorities, the private providers, the health service and neighbouring local authorities—everybody has to work together and that's how they've got through those difficult issues.

So, I assume that you're passing the good practices on across to all local authorities and the resources to go with that, because, of course, it takes resources out of the other—

Yes, of course. I see Albert has indicated that he'd like to speak, but Albert certainly meets with the local authorities every single week. We've had the local authority hardship fund, through which we have given a huge amount of money to the local authorities in order to deal with the additional pressures that they've got, so, certainly the money has gone in. It's a very difficult situation and we're getting through it. I know that Albert wants to come in.

Albert.

Yes, thank you. Thank you, Minister and thank you, Chair. Just to add to the response, as the Minister says, we've got very regular contact with the directors of social services; we're meeting weekly with them. Indeed, we do go through some of the challenges, but we also share best practice and make sure that that's quickly facilitated. I think it's really great when directors are able to speak together with ourselves and work through those issues. But I think, through a very difficult period, it has been truly a tremendous response by all partner organisations, by local authorities redeploying staff, by health boards redeploying staff and by providers themselves. So, it really has been a tremendous response by partners to keep the services going and ensure that those care home residents receive the care and support that they deserve. Thank you.

Jean White.

Thank you very much. If I can just go to the longer term solution here, obviously, there were issues around staffing in care homes before the pandemic. Social Care Wales has been doing some very active work to try to promote a career in social care as a place to think about going as a destination. The universities that prepare nurses have also been looking at placements of students to expose them to the benefits of having a career in social care. So, I think it's important to think not only of the here and now and the care homes that might be falling over through lack of staff through illness and so on, because actually, this is a longer term issue that needs to be addressed, and there is some action in that sense, which I'm sure you know about, but I just thought I would mention that work is also continuing in that area. Thank you.

Thank you for that. If I get started on the implications of leaving the EU on our workforce and training and career paths, I think I'd take up the rest of the hour, so, Chair, I'll leave it at this point.

Yes, very wise, David, because we haven't got the time—so many injustices, so little time. Anyway, on that point, of course, we do need some agility now, I notice the clock, and this morning's chief agility person is Rhun ap Iorwerth.

Julie.

Thank you very much, Rhun. Yes, 67 per cent tested and, well, I think it's very good that we've reached the 67 per cent tested level.

Vaccinated.

But, obviously, this is increasing and it does vary across Wales. One of the issues that has arisen has been about testing when there's an infection in the home. We've changed the guidance on that, because at the beginning it was thought that if an infection was in the home it wasn't possible to vaccinate. Of course, what we're asking people to do now is to look at it and to risk-assess, and it may be possible then for the vaccinations to go ahead in a home even if there may have been an isolated case or a case where some residents can be isolated from the rest. So, that will mean that that will speed up the number of vaccinations that can be carried out.

It's also worth noting as well, as we said in the Chamber yesterday, Rhun, that the figures are at least that many. You'll know from the articles that have already been published and the briefings that have been given that there is still a lag in the data and the entry, so we've done at least 67 per cent. On today's figures, I'm confident that there'll be another step forward. We're simply going at the rate of at least 1,000 residents a day, so there's real pace and urgency in protecting care home residents and, crucially, the staff who look after them as well. I think we're on track to do really well.

We expect to complete the care home part of the programme practically by the end of January. We may have a couple of care homes outstanding, exactly as the Deputy Minister has explained. If we have an active and significant outbreak, we may not be able to put a vaccination team in, but we think we will have practically completed the care home side of the programme by the end of this month and we're on track to do so.

Lovely, so you've got a couple of days left—well, four days, if you include the weekend. I was still concerned that the number was at 67 per cent, given that this was the top priority group.

Let's turn to testing—we used to talk a lot about testing, when we're talking so much about vaccines now. We're still hearing concerns about tests being delayed. What's being done to try to speed things up still?

To be fair, Rhun, I think that's slightly dated. You'll see the programme moves so quickly. This morning, we've already published updated information on the last week, and it does show a significant improvement in testing. So, if you were talking to providers, say, three weeks ago, then that may have been an issue, whereas, actually, within the last week we know that 87 per cent of tests have been turned around within 48 hours. As I say, there's a publication today that I think demonstrates about two thirds are done within a day as well, so we're actually on a much more rapid profile at present.

The organisation portal through lighthouse labs is now delivering a much more rapid turnaround. I think that's a matter of concerns at the time, but today, as we speak, we've had a more sustained and significant improvement in turnaround times. Like I said, there's a publication you may not have seen, because it was only published this morning at half past nine, when the committee started.

We'll look forward to comments about delays drying up from this point on; I'm glad we have that on the record. Questions are still being asked about the systems for asymptomatic testing, you know, among the wider workforce in social care. Domiciliary care workers weren't included until December. Maybe you have some thoughts on whether that was a sensible thing—not to include domiciliary care workers in asymptomatic testing until then. Can you give us an update on where we're at on the roll-out of asymptomatic testing for that group of care workers?

Well, unfortunately, there's a range of value judgements in there, Rhun, that I just don't think are fair or reasonable. It wasn't whether it was a sensible thing not to include domiciliary care workers in the asymptomatic testing programme, but it was about capacity and our ability to do so with the relatively new tools still available to us to do so. So, lateral flow testing on a regular basis does allow us to provide an element of certainty, in addition to the asymptomatic testing we're doing with the polymerase chain reaction tests for people in residential care. 

So, the decision was made in November to introduce testing for domiciliary care and other social care staff; that's going to be integrated into the healthcare and social care workforce testing programme. We've actually made progress on rolling that out, piloting that and trialling that, so that is now taking place at greater speed.

It also needed some regulatory change in the MHRA as well, because the initial lateral flow tests were originally intended for supervised testing, and this has been a point the committee have raised in the past, to be fair. And, so, we've had to look at permission, approval from the MHRA, specifically, to allow some of these tests to be used under a self-testing model, and we are there now, so we're in a better position. So, if you want to know more of the detail about the broader programme, then we can provide that, and the chief nursing officer can certainly update you on how we're testing regular parts of our health and care workforce.

It's not just about domiciliary care workers of course; it's all those mobile health and care workers as well, because we recognise that there are some concerns that the staff have about their own safety, but crucially, they're also concerned about potentially taking the virus between a range of different and vulnerable clients as well. So, the programme is in much better shape now than it was in November and December, because decisions were only made in November to make this significant step forward in the programme, as, indeed, the tools came on board. 

Jean White, you had name check there. Jean.

We are rolling out a programme of asymptomatic testing for health staff, and that includes community health staff. The pilots are going well; it's being well accepted across the health boards and the staff themselves. We have to be very careful; any footfall into any closed environment such as a care home or residential home has the danger of taking the infection with it, and particularly with the new variant being more easily transmitted, obviously caution has to be given. So, there is going to be some new guidance issued early next week—I believe it's being tested out this week with professionals to see how it will work on the ground—about how to make sure that anybody that's a professional entering a care home will actually have ability to have serial testing, so the care home will know the status of the health professionals going in. Asymptomatic testing is also happening within hospital settings and other healthcare settings. The pilots are going well, and that will be ramped up now that it's been proven to be effective. So, this is work in progress, I would say, with more guidance coming out. Thank you. 

Okay. Rhun. 

Thank you. I appreciate that. Back to the concerns about elements of testing in care homes—and I appreciate the Minister says those concerns no longer exist, but we'll go with the concerns that have been raised with us. The Association of Directors of Social Services, for example, pointed out that some care homes had been opting out of regular testing because of capacity issues, and because of lack of confidence also in the testing system. Are you worried that if delays weren't resolved, more homes would opt out? What are your thoughts on that? And given the importance of testing, and its usefulness as a part of the pandemic response, could mandatory testing be introduced?

[Inaudible.]—I've had a guest join me.

To be fair, I didn't say that the concerns don't exist. I just don't want to have words put into my mouth that I haven't said. I've pointed out there's been a significant improvement in turnaround times for testing, and the publication issued today bears that out. There will undoubtedly be some individual homes that may still have concerns, and that's about rebuilding confidence over a period of time. Of course, I don't want to see care homes come out of the testing programme, because I think care homes have really valued the additional reassurance about their levels of prevalence, and the additional concerns there will be. At a time of high community transmission, I'm afraid we can be confident that there will be members of staff somewhere who will come into contact with someone who has the virus, because of our continually high rates of transmission. So, that's a factor and a feature that means it's even more important now that we have a significant programme where we see full engagement from the residential care sector in the programme that is available. I would hope the confidence will be rebuilt, because we've seen a couple of weeks of improving performance and a much more rapid turnaround of the tests that have been provided.

We're not at the point where we need to consider making the testing mandatory, but any home that decides to opt out needs to consider what other control measures it's going to take, because it's the provider that has responsibility. They've got indivisible statutory responsibilities for their workforce and for their residents, and I don't think it would be an easy job for a care home to say it's opted out of the programme that's available if they then find that they have an outbreak and they haven't had an alternative control method in place. So, this really is about offering tools to help give reassurance, but it's a very practical method to try to remove people who are potentially there to transmit the virus to staff and residents. I think we'll continue to have a high level of engagement and value with the programme, particularly given the improvement in turnaround time to tests, which I think is good news that everyone should welcome.

One particularly concerning entry point for the virus into care homes, looking across the last year, has been people who have come back to homes from hospital with the virus. We have still heard concerns from the ADSS and Carers Wales about poor hospital discharge practices. There are still instances of health boards attempting to get a resident admitted back into a care home, perhaps in the middle of the night, without a negative test result. What actions are being and have been taken to try to really put an end to this practice?

We've issued very clear guidance based on the consensus statements that the technical advisory group provided. There's clear guidance, with an evidence base behind it, that's been issued and we expect all parts of our health and social care system to follow that guidance. The individual instances that you refer to—I can't really deal with those because I'm not aware of the detail, but it's something where local relationships should mean it can be dealt with. There shouldn't be instances where health boards are trying to release people into care homes in contravention of the guidance. I would expect the care homes to have the local relationship with the health service to be able to do so. Equally, if social services directors have those concerns, they certainly have direct relationships with health boards at a senior level to be able to take that up and to make sure it's resolved.

I don't really think it's a matter of Ministers looking to intervene and micromanage those areas. It's about our clear expectations for the whole system and guidance based on evidence. It's very clear that we expect the whole system to address that and that is obviously part of the conversations that we have across the whole system—so, the conversations that Julie Morgan has from her point of view, the conversations that Albert Heaney has with directors of social services. If there were serious issues to be raised, they can be raised either with myself and the health board chairs or Andrew Goodall and the chief executives as well, but we haven't needed to do so. So, if the committee has more significant concerns and evidence behind them, we'd be happy to take those on board to take them up with the local part of the health and care system.

Time to move on now. We've got the master of the quick-fire question now; we need to tap into your talents. Lynne.

Thank you, Chair. Good morning, everyone. Minister, the evidence the committee has heard from carers is that they've found it very difficult to access support during the pandemic and that particularly respite care services have been missing for many of them. How do you respond to those concerns and what assurances can you give the committee that things are going to improve going forward?

Thank you very much, Lynne, for that question. Unpaid carers are obviously some of the people who have suffered most in the pandemic and I think we all know the tremendous amount of work that they've had to put in for their loved ones. Many have taken on more responsibilities during this period. I know that some carers have not had additional help into the house that they've had before because they've been afraid of infection, and they're doing all they can to care for their loved ones. It is a matter of great concern and we are very concerned about how they are coping and have been doing all we can to support them.

I know that, Lynne, you'll be aware that the main funding comes to support carers through local government, and in addition to the local government settlement, we also have the local government hardship fund, which is available there to support local authorities with additional costs, and that is for their responsibility for unpaid carers. And we have had the local government, as you know, hardship fund, which we've put in in addition in order to help with social care. It has been very welcome and used very widely. So, that funding is there, and the additional funding we've put in for local authorities to carry out their duties towards unpaid carers. But, obviously, in addition to that, what Welsh Government puts in then is in addition to the statutory money that goes in.

You'll know that we do fund the carers organisations in the voluntary sector—Carers Wales, Carers Trust, the all-Wales forum of parents and carers, and Age Cymru. We fund them to provide a service to the carers. We do depend enormously on the third sector, because of their close contacts with carers. And we have put in additional funding as well. We set up the carers support fund, which started off with £1 million put into it, and we've just announced another £0.25 million. This provides small amounts of money and support for carers in order for them to manage their daily duties, so to speak. For example, they can buy white boards, laptops, help with food, help with heating. That has been a big help, I know.

I do know that the respite issue is very important, and even the respite that did exist before the pandemic—it's been almost impossible to take advantage of any respite that may have existed because of the dangers of infection. And so, what we are doing—we are looking at respite and we are looking to see if there is anything more that we can do to help with respite. So, we have put in additional things besides the statutory funding, but we are very aware—and we've got numerous forums where we're hearing cases and the direct voices of carers, and I've attended a number of them. I've listened directly to carers, and I've heard heartbreaking stories of the struggles that unpaid carers are going through. But one of the things that always comes over, though, is that they all want to do it, and they are doing it because of their commitment to the person that they're working with.

Thank you. One of the things that the Government did at the start of the pandemic was modify the care and support duties in the Social Services and Well-being (Wales) Act 2014 for adults, and we've been told that has been a problem for carers. I know that the Government has consulted on whether to retain that modification. Can you update us on the latest position on that?

Yes, we consulted on that, and we had a big response. I think it was about 100 responses. The majority felt strongly that we should change the modification that we had put in, and we have now written a letter—well, the letter has gone from Albert Heaney—to all the respondents to say that there is a clear indication from the respondents that we should change the position that exists at the moment. So, we have signalled that we intend to change it when it's possible for us to do it, but before the end of March.

Okay. And what is the reason for there not being immediate action on removing that modification, really?

Because we're at a very high state of the pandemic at the moment, local authorities have expressed concern and have been worried about changing it, because they want to have the safeguard of feeling that they can change the support that they're giving—have the flexibility of the support they've got. And so, the local authorities did ask us not to revert back to what is the normal run of things. So, it's really in consideration of trying to reach a balance that we've decided that, yes, we feel we must do this. But it does take time to set up in any case. So, we've indicated that we feel it should be done by the end of March.

But you told the committee before that the modifications haven't been used by any local authorities. So, do you think that's a reasonable position for the local authorities to take? And if they're not using it, and if it's worrying unpaid carers, do you not think that it would be good to listen to the consultation and move quickly on that?

We are listening to the consultation, and that's why we are moving. And we don't have individual examples of where the local authorities have modified any of the care that has been given, but we know that care has been modified and that some care packages have been reduced. But it is for a whole range of reasons, not because the local authority has necessarily removed the support. It is things like carers themselves removing them, but we do know that there have—. Our indication is—on the weekly returns that we have from the local authorities, it does look as if some care packages have been changed recently.

Okay. Thank you. Can I ask about young carers? We know that the pandemic has had a huge impact on their mental health, and, of course, for many, many young carers, the only respite for them is school, which many of them are now not able to attend, unless they're attending as a vulnerable child. Can I ask what discussions you've had with the education Minister about prioritising a return to face-to-face learning for young carers?

Well, as you say, young carers can attend as vulnerable children, and they definitely would be welcome to attend the hubs. I think many of them would choose not to go, and particularly not to go because maybe the worry about infection, as well, for people that they may be close to. But, yes, we have discussed the very vulnerable position of young carers and are doing, really, all we can to try to help them get through this very difficult period. The services from the local authorities have continued. They've had to go online, but, as you know, the local authorities do provide statutory services, and they have been continuing with the young carers support groups, and they have been doing them online. And I think those are really a lifeline for the young carers, because it's so important for them to be able to link up with people who are in a similar circumstance, and it does give them that support.

We have funded specific laptops for young adult carers. In a joint approach, which was funded by the Welsh Government, Digital Communities Wales, Carers Trust Wales and local authorities together are distributing up to 440 laptops to help young carers, young adult carers aged 16 or 18, who don't have access to a digital device, to carry out their caring roles. So, we have given some specific help there. We've also, as I mentioned earlier on, set out the carers support scheme, which is available to young carers, where we've just given another £0.25 million to deal with specific issues. And, obviously, young carers will benefit from the general support that we have increased for local authorities and for social services departments. But I absolutely recognise that they are in a very vulnerable position, and we are continuing to give what support we can.

Thank you. And the committee's heard that carers are facing very severe financial difficulty. You've referred to the extra funds that you've put into the fund for carers. Do you think that's sufficient, and how do you respond to calls from the Wales Carers Alliance that carers should have access to hardship funds?

I mentioned today the additional £250,000 that we've announced to add to the £1 million for the carers support scheme, and we do certainly feel that that is—well, it's a drop in the ocean, really, but it's what we are able to provide, because we know that there are a whole load of carers who will not be able to access that fund. We do know that carers are worried about their finances, so that's why we're trying to increase the help, via the local authorities and via the social services department, where we have given a considerable amount of money.

But we do know that people are being affected by the pressures of COVID-19. So, an extra £13.9 million has been invested in the discretionary assistance fund to help support individuals and families across Wales who are on low incomes and are experiencing severe financial hardship, and that fund is based purely on need. Advice services are available and they are very effective in helping people with their finances and helping them by supporting them to navigate through the benefit system. And when we established the single advice fund, we required providers to offer welfare benefit entitlement checks to all those who access their services, regardless of what was their presenting problem, and this does, often, reveal the opportunity for more money. And, actually, that single advice fund has helped people in Wales to claim over—I think it's £34 million of additional welfare benefit income, and that extra income does help, obviously, lift people out of poverty. We know that more needs to be done. I think my response to many of these questions is that we've done some, but we do know that more needs to be done, and we know that finance is a very key area.

Okay. Can I just finally ask about the vaccine, then? Carers are in priority group 6, but the committee notes from our previous work that many carers don't receive a carer's assessment. How does the Government intend to systematically identify those carers who are eligible for the vaccine?

Well, this is what we have got to decide, now, over the next few weeks, because, obviously, it's very important that we come up with a solution to this issue that is very clear and understandable. And we know that where carers are actually registered—where we've got a list of carers names—is very limited. And we know that we'll be able to get a list from the GP, and some of them will have the carer's allowance. But I think one of the important things is to work through the voluntary sector, through the carer support groups. So, I think they'll be in a very good position to give us information about carers. And we do want to have a degree of flexibility. We don't to want to be able to rigidly say, 'You can only have this if you're on a particular list of receiving a carer's allowance,' for example. So, that is work in progress, and that is what we are looking at at the moment in order to try to come up with advice.

And are you confident—[Interruption.]

I think it's worth highlighting that we have two potential approaches. One is to take the very hard approach of, 'You have to be on a list', and we know that that will produce an injustice for a range of carers who won't be on a specific list but will be undertaking significant caring responsibilities. Or we take an approach where we—as we are planning to—are working with carers' organisations, as well as those parts of our health and care system that can help us to identify carers, and we may have an element of leakage, because, unfortunately, we've already seen that some people are sharing, outside of the priority groups, the ability to potentially jump the queue. Now, the difficulty here is that if we accept we'll get leakage but it's still the right thing to do, then we know that there's the potential for criticism, but the alternative is we have a much tighter way of doing that, and we know that that will exclude carers who really should be getting through.

And equally, there are some people who have a caring responsibility but it's not extensive. So, I think I've given this example before, but I take my mother her shopping every week. So, I take the shopping to her door and I put it inside her house and that's it; I don't have any contact with her. So, it's a responsibility of a kind, and my mum can't go out and do her shopping, but actually that isn't what I think should get me into priority group 6. I almost certainly will be in priority group 6, but that's because I have a chronic kidney condition that is in remission, and that's why I get an NHS flu jab. So, it's about trying to work all those things through over the next couple of weeks, so before we get to the middle of February when we're expecting to complete the first four priority groups, we'll have a clearer understanding of how we'll go about this, and in a way that carers' organisations, I hope, will feel able to support.

And are you confident you're going to be able to do that on time? Because some carers are already contacting their GPs who are telling them that, no, they can't help with this. So, are you confident you're going to be able to get this done in time?

Yes, I'm as confident as possible, because, within the next two weeks, we'll have to agree a way to do this, and it's part of the challenge where we know that there are lots of people who are concerned, and understandably so. But GPs won't know the system that's going to be introduced, (a) because we haven't agreed it, but also it's a strategic choice that we'll need to make, and we'll then need to work with our system to deliver it. Again, we'll ask people not to contact their GPs or pharmacists to try to understand what's going on, because they're all incredibly busy with their normal work and delivering the vaccine, and so to allow us to get to people as quickly as possible, we'll ask people to have some patience and trust in what we're doing and to recognise that our NHS programme won't leave people behind. So, we're looking at how we'll get to an answer, not whether we need one, and we know we've got to do that before the middle of February.

Thank you. Thanks, Chair.

Thank you very much. Minister, I've got a couple of quite random questions, but I'd just like to ask if we can take a step back from the pandemic for a moment, because before we even entered into this pandemic, we knew that the social care sector was incredibly fragile. This committee did a report a couple of years ago that really highlighted the fact that we had real problems in getting residential care home places, and as we have seen, there is a shortage of staff. So, I know that you've probably got all hands to the pump in dealing with the current crises, but do you have a team looking at the bigger picture about how we might emerge from this pandemic and what we can do to protect what is already a very, very fragile sector? I am aware of and I will respond to the paper that you've issued on the future, but I think we're going to have a bit of a gap, actually, between what we have now, between care homes saying, 'We can't manage, we're going to go bust,' between domiciliary care organisations saying, 'We simply cannot get the carers to be able to look after people in their homes,' and whatever might come out of your paper in the future. So, I just wondered if there is a body of work about that space.

Julie.

Thank you. Can you hear me? Yes. Well, thank you for mentioning the White Paper, and I'll be very pleased if you respond to that. I think, looking at what's happened during this pandemic has made us even more aware of how fragile the social care sector is, and I know that this has been discussed by the committee before, and we know that the turnover rate is very high in terms of staff, and we know the wages are low, we know that there has been, perhaps, not enough emphasis given on the value of the work that is being done in social care. So, that is something that we have had ongoing for some time. So, for example, we've been developing the social care worker card, which has meant an awful lot to social care workers, that they have a recognition of their status, and that has been used during the pandemic to give them access to different benefits. One of the other things that we have done is to recognise them by means of registration, and that's a very important thing, I think, for the workforce. We have the domiciliary workforce, and the care staff will all end up being registered, which does, I think, also increase their status. So, a lot of this work has been going on, because, as you say, we have been aware of the fragility for a long time.

But for the future, in the White Paper, we have felt that, because of the disparate nature of the sector and the 1,050 private care homes, the domiciliary care that is mainly in the independent sector, we do need some sort of national entity that is able to look and plan and to look and see where the need is for the future, because the number of people who actually needed residential care, for example, had begun to shrink before this pandemic happened. That's because so many more people are able to stay at home with a much greater degree of disablement than they had in the past. We hear of people having packages of two people going in four times a day, and so people are able to stay in their homes where they want to be, and we certainly want to see more development of that. So, for the future, we may not need such a big residential care sector. So, all that work is going on, and also we've had the group that the Minister chairs looking at ways of paying for social care, because, of course, that is an absolutely key area in terms of developing the social care sector, which will need more money, and we have been discussing and we'll come up with a sort of statement of all the ways that are available before the end of this Assembly term.

So, there's a lot of thought going on about it, but, in terms of the present, what we are told by the people who are operating in the sector, the residential care sector in particular, is that the money that we've given through the hardship fund, which has helped cover the voids that have, sadly, occurred in many homes very suddenly, and with a lot, has been absolutely invaluable in keeping them going. And if we do end up with a sector that is more representative of what we need, we want to make sure that happens in a sustained way.

Thank you very much. Can I quickly jump in? Because I know Albert wants to come in, and this may be something that, Albert, you'll want to touch on as well. So, we've got the future, we've got the current, but we're going to have that gap as we transition out of pandemic. And there are some things that—for example, ADSS has said right now that social care workers should receive some of the specific benefits that the NHS workers receive, and they're saying this could happen now, such as free access to public transport, access to mental health support services, because, if you're the only one in the room trying to ease somebody's passage out of this life, this is an enormous pressure on you.

So, what can you do now, though, to help some of those people, some of those support workers, to enable them to be able to do their jobs well and to retain good mental health? But also it helps towards that whole story that social care workers are not an afterthought; they are just as important as a nurse or a doctor in a front-line hospital—the people we always hold up and cherish—we've got this vast army of people in the background who don't get paid as much, aren't recognised as much, who are sort of seen as a much lower job, and yet, without them, we would really, really crumble. And so if you can just give us an overview of why you haven't given those benefits to those people now, and when you might consider doing so.

Yes, certainly. I think you've put the position very well, Angela, and my role, I've always seen, in this job is to speak up for the social care workers, because they have been a hidden band of people who absolutely do such an invaluable job, and we have tried to recognise this. We recognised this by the £500 special payment we made to social care workers, which I know was appreciated, and seen that, 'Oh, we are recognised. They do know what a valuable job we're doing.'

We have provided access to mental and health services; we had a negotiation with the Samaritans, and we are providing a special helpline that will be available to social care workers. So, we have tried to address some of these issues. I think you're absolutely right; the NHS staff have always been seen as much more priority, but now we want the NHS and social care to be together and to get as many benefits as we can for both groups. But, certainly, the other issue is they are low-paid, and that is again something that we hope to address in the longer term. 

Parity of esteem, parity of pay.

Yes.

The final word to Albert Heaney, because, with apologies to both Angela and Jayne, we're out of time. All right. So, Albert, you can wrap it up and put the case for social care.

Thank you very much, Chair. I'll be very brief as well. The Minister has set up a social care fair work forum, and I really see that as a vital partnership working with employers, commissioners, unions and the Welsh Government to really find the route forward in terms of workforce fair terms, fair terms and conditions, fair pay. Importantly, that group is thinking very much across the public sector world. And then, very briefly, because I know time is out, alongside our pandemic response, our planning, our preparation, our strong engagement with stakeholders, we also have a recovery board framework to allow us then to have those discussions about moving in the transition phase from where we are now, dealing with a peak of the pandemic, to a time where we can get back to delivering good quality and high-quality services across the main, not just responding in terms of the pandemic response. Thank you, Chair. 

Excellent, Albert. 

Can I welcome everybody back to this reconvened meeting of the Health, Social Care and Sport Committee?

Thank you, Chair. Good morning, everybody, and Tracey, I only saw you on Monday, so it's nice to see you again. Can I just start by asking a really direct question? What do you think, or what do you estimate, the R rate is currently in Wales at present? 

Bore da, Angela, and nice to see you again. I'll hand you straight over to Giri. 

Bore da. Good morning, committee members. The R value currently estimated is around 0.75, with a range between 0.7 and 1.0, for Wales at this point in time. 

Do you have a feel of where the R rate is over 1—which areas of Wales that would cover? Is that something you're able to share?  

So, we publish the R values and the halving time or doubling time estimates every week on a Wednesday. So, as of last Wednesday, which is 20 January, the R value was closest to 1 in Powys, and the upper end of that was around 1.04, the mid-point estimate being 0.94. The caveat to add to that is that, where the numbers are small, the confidence interval will be wider, so those have to be interpreted with caution. At an all-Wales level, as I said, it's around the 0.75 mark, ranging between 0.62, which is the lowest, in Cwm Taf Morgannwg University Health Board, and all the way to 0.94 as a mid-point estimate in Powys, and a range of other values for other health boards. 

Now, we and the public have all been led to understand that if we can get our R rate below 1, we're on a successful curve, so that's excellent news—it really is. How low do you think the R rate would need to be below 1 for you to be able to have confidence that, actually, we could start to lift, perhaps, some of our restrictions? I'm assuming that you'd have to have it at a certain level for a while to make sure it's embedded, and it's not just a quick spike down. 

Absolutely, and, as we know, once the incidence of new cases in the community starts to drop, then there are some lag indicators, such as the hospitalisations and mortality that follow after a period of between four to six weeks. So, if you just recollect the position that we were in just before Christmas, our seven-day rolling incidence rate was just around 630 per 100,000 mark, which was the highest that it had gone to. This morning, that number is just over 200. So, we have seen that over a period of five weeks there's been a significant drop in the cases, but that is still a very high level. And I think if we go back a bit further to the time around October when we had the firebreak, the incidence rate at an all-Wales level was around 150 per 100,000. Even at that rate, with wide variation across Wales, it was proving to be challenging to keep it stagnant at that level. So, it's not only reaching a low level, but having confidence that we can maintain and sustain it at that level. That will then mean the pressure on the NHS is reduced and the critical care capacity is reduced. So, in our current assessment, and based on the two previous episodes of lockdown, we would think that we need to reach a very low level of incidence and hold that for at least four to six weeks before we can start to think about how we can reopen different sectors.

Wow, that's a tough ask to ask of people, isn't it? I wonder if you can perhaps just give us an update on—. Are you able to slice any of that data to assess how many of these cases are what we would call 'severe', even if they're severe and still at home, and how many are just barely noticeable? Could you also just let us know, are you monitoring and are you aware of any clutches of outbreaks anywhere, because I know in Hywel Dda, my area, we've gone from having 37 outbreaks and we've managed to shrink it quite far down, and I'm just wondering what the picture is across the whole of Wales?

As has been the case ever since the start of the pandemic, the spectrum of clinical presentation, and therefore the severity of manifestation, ranges quite variedly. So, we've got that significant proportion—a third of our cases—who've been diagnosed in an asymptomatic condition. Then we have the other end of the spectrum, where people are requiring intensive care support, and our hospitalisations are still very high, but it has come down. So, for example, in the latest report that we have, we currently have just over 1,660 confirmed patients in hospital, and if you add the suspected cases and the recovering cases on top of that, that's still a higher number, but the daily number of new hospital admissions has dropped. It had reached a peak of around 160 per day. At the moment, the latest report is 53 per day. Still, our intensive care capacity is quite high. So, the presentation is across those spectrums.

In terms of ongoing outbreaks, yes, there are outbreaks, and there will continue to be, because that is what is keeping the virus in circulation, and these outbreaks are across a variety of settings, whether it's in hospitals as in-hospital outbreaks, outbreaks in care homes, and outbreaks in certain workplaces. So, it's important that we sustain these current control efforts across all sectors so there is an additive and cumulative effect of those interventions, for us to be able to come down to a level and have confidence that we have created sufficient headroom, and then we start to relax or ease the restrictions in a sector-specific manner. Therefore, we don't see the situation we saw just as soon as we came out of the firebreak, because we made good progress after the firebreak, but that progress was very short lived. Within a matter of a couple of weeks, the case rates went up again, so we don't want to be in that position of seeing those sorts of high rates and going into further lockdown cycles: lockdown and release, lockdown and release cycles.

I understand the whole argument about trying to build up headroom so that we've then got that room to manoeuvre. Can you give us a view on what you're thinking about the new variants that are coming through? Because, we hear, and we heard again yesterday from the health Minister, that not only are they more contagious—and we knew that; I think 30 per cent more contagious—but that also they may be marginally, not hugely, but still marginally, more—. Well, going to kill more people, essentially. These new variants that are coming through; we know the ones, for example, from South Africa, but there are probably others brewing up around the world. What effect do you think they might have on that headroom? Do you think we're going to be able to push our numbers down so that we can still perhaps start easing restrictions, giving people the opportunity to resume slightly more activity in their lives and still accommodate any of these viruses coming in from left field? I know that must be a really difficult question to answer, because you don't know where stuff is coming from, but we've already learnt, haven't we, that there are mutations springing up all over the place.

Yes. That's a really challenging assessment to make, because viral mutations are not new, they've happened in the past and they'll continue to happen in the future as well. Currently, there are four mutations that are of concern that are being closely monitored, and one of the four, as we all know, originated in England, and therefore, our understanding of that is the best amongst all four of those variants. And we know that, in that particular variant, not only is it more transmissible, but as you said, the initial indications from studies suggest that the fatality rate could be slightly higher. So, our understanding will continue to evolve as we learn more about the characteristics of these variants, and therefore, assessments, headroom and then the impact and how the scenario may play out is constantly evolving.

What we then also have to be equally vigilant of are the imported strains that, as you said, one is from South Africa and two are of Brazilian origin—that is what we're currently monitoring. But a detailed understanding of the impact of those viruses will also take some time. While we try to understand what the implications are, we might see that new variants may still come up in time. Therefore, it is very difficult to predict exactly how much headroom we need to have in order to be able to cope with the new variants in place as well. 

Okay. I've just got two more quick questions, Chair, because I'm sort of doing a quick COVID-19 update before other Members come in. If you were to look at coronavirus as a whole in Wales, do you have a feeling for what percentage is old coronavirus and what percentage is various strains?

Yes. In Wales, the epidemiology is currently predominantly one, in the recent few weeks, that’s driven by the new variant, which is the UK variant of concern. But there is a geographical variation in that. Our current data suggest that the higher proportion of the new variant is in circulation in parts of north Wales, compared to south Wales. But we know that at least 30 per cent of the most recent new cases have been due to that particular variant, and that proportion seems to go up. And if you look at data from north Wales, that suggests that over 86 per cent of all the tests that have been done for that variant have come back positive for that particular variant. So, clearly, there's geographical variation. The new variant is the dominating circulating virus, and then the old variant, the wild virus type is also in circulation, but the new variant has overtaken the old one. We do have a handful of cases from the South African variant, but thankfully, so far, no cases confirmed of the Brazilian variant in Wales.

Well, that is at least good news, isn't it? Do you think—? It's kind of two questions, actually. Do you think now we're through the worst of it—? Dai is laughing—sorry, Chair. Do you think we're through the worst of it? Do you think we've had the peak that we thought we might have, post Christmas and all of the interactions at Christmas? Which leads me on to my final question, which is: how do you think public compliance, attitude and mental health, if you like, are holding up? Because it's been a year now; it's been such a long time, and, of course, we can't beat this without making sure that we take the public with us. Do you have any sense that people are beginning to fray, beyond what we expect and what we see in the papers, but anything deep-seated, or are people still really holding fast?

Yes. In response to the first part of the question, currently, we've certainly seen a significant reduction in the case numbers, compared to the pre-Christmas levels, but that may indicate that we've gotten over the peak, but I think what we haven't yet gotten over is the impact on hospitalisations and sadly, mortality. And we have all seen, every day, at least on average 50 new deaths reported, which is really quite a sobering picture. And I estimate that that trend will continue for a few more weeks now before being able to see. So, we haven't gotten over the mortality peak yet. We've gotten over the community peak probably, and that's because of the level 4 restrictions that we currently have in place. The question that then arises is: are we likely to see a third wave after we come out of lockdown? It's quite a possibility. There are certain other planting interventions that are still emerging and taking effect, such as the vaccination programme. 

So, leading on from that to the second part of your question around compliance and the impact on people's mental health, it's an incredibly challenging situation, and there has been so much emerging evidence of the adverse impacts on mental health and a whole host of non-COVID-related harm, which we are very much monitoring. And I'll just pass over to my chief exec, Dr Cooper who will just elaborate a bit more on that point. Thank you. 

Thanks, Giri. If I may, I think we've made reference previously with committee members to the weekly public engagement survey that we've been running through the pandemic. The version we published last week was really quite fascinating and it plays to exactly your question. So, just to share some of the statistics that came out of that. So, we asked people about compliance over Christmas; we also asked people about mental well-being, and we also asked people about further lockdown mindset. So, 95 per cent of people reported that they complied with the Christmas Day household mixing regulations, and 77 per cent said that they didn't meet with other households.

But, moving on to, if you like, the challenges around children and what people are worrying about. So, 64 per cent of people said that they were particularly worried, a lot, about their children's education, which was up 58 per cent from the previous survey—58 per cent to 64 per cent; 30 per cent of people worrying a lot about mental health and well-being, and that was up from 24 per cent within a week. And then looking at, if you like, healthy behaviours, so 40 per cent of people said they'd put on weight; 16 per cent they'd dropped weight; 45 per cent said that their physical fitness had reduced, which is quite a lot really, and 11 per cent that it had gone up; 48 per cent said that their mental health had worsened; 6 per cent said that it had gone up. So, that's just under 50 per cent of people, which is a statistically significant sample of the population. And then 66 per cent said that their social relationships had worsened, and 4 per cent said they'd improved.

Now, we're actually doing a trends report, which we'll be publishing soon, just so that we can map that because I've sat at committee previously and reported quite different statistics, and they are worsening. And perhaps one of the most interesting questions in that survey, we asked people about attitudes to lockdown. So, the question was: 'Starting from now, how many months of total lockdown would you be prepared to endure if it guaranteed the rest of the year free from the virus?' So, 24 per cent of people said three months; 24 per cent of people said 10 to 12 months, and then 18 per cent said six to nine months. And we'll ask that question in a serial way, so it's fascinating what you take from that, really. If you'd have been asked a year ago that this was the context that we'd be in, obviously, people's mindsets would be very different. So, I think going into this year, it's fascinating the wisdom and the anxiety. I think, Chair, if we send that on to you afterwards, we're about to publish another one tomorrow, and there are further questions in there that also paint people's views at the moment. 

Tracey, may I just ask one question or make one observation, because I think that's really fascinating, and I'd like to see that data? But when you asked the people about how long a lockdown they'd be prepared to endure, I wonder how many people think that by enduring a long lockdown they'll go back to life as it was. And if the question were, 'You'll endure a long lockdown but you're going back to a different life', if there'd be a different response there. Because, obviously, we're not going to be able to go back to the way it was because this is never ever going to disappear now, is it?

No, I absolutely agree, and I think people probably would have interpreted the rest of the year free from the virus, as you say, in different ways. And, actually, we'll take that away and see if we can ask that in a different way. There are other questions in there about what people are worried about and where the priorities are, and the concerns for people around mental health. The first one was coronavirus they thought the priorities for this year should be; the second was education; the third was mental health. And there are different elements in there about people's confidence that they're going to be free from virus, and that's shifting. So, it looks like there is a reality that plays to exactly your point. My sense personally is that it's a conversation that we're not quite having yet because people just don't really want to go there. But look, as Giri said, we're learning more and more and more about the virus. As the committee knows, we've been doing a lot around genomic sequencing, so that we're ahead of the pack in understanding what interventions we can play and how we safeguard Wales.

My final point—I know, Chair, you'll want to move on—is, we're one nation in the world and we are all as weak and strong as the weakest public health system in the world. So, the vaccination programme has got to be global; genomics, we're all linking in with colleagues internationally to try and, if you like, mutual aid countries to get on top of variants. Again, as you mentioned, there are a considerable number of variants coming through, it's just that they're not necessarily being sequenced at the moment. So, it's a moving picture and I would say that we are accelerating our knowledge, and I hope that in the first half of this year we'll be in a much better position to really understand what are the layering interventions that just can keep this dampened.

Thank you.

Tracey.

Thank you, Chair. If I kick off and then I'll hand over to Giri. I'm sure many people will have said this, but from a standing start, I think the infrastructure that's been established across the NHS is phenomenal really and it is accelerating through. Obviously, our role, as the committee knows, is around the advice, the resource, the support, the evidence, and our colleagues in health boards are responsible for the roll-out and the administration, and obviously it's subject as well to supply. I think it's been a considerable effort and I think, obviously, people will want to build as much momentum and accelerate as fast as possible to really get on top of maximising and optimising every single vaccine across the population. But I think it's been an amazing feat so far and I'm on chief executive calls with my health board chief executive colleagues every week and the whole focus for the NHS at the moment, obviously, is about maintaining other services as well, wherever possible, but is really about massive scale-up for the programme. But if I may, I'll hand over to Giri who can give you a little bit of clarity around our role in a bit more detail. Giri.

Diolch.

Yes, thank you very much for that. I think there were four main guiding principles when the vaccination programme was rolled out: first was to get as many people vaccinated, as quickly as possible, in a safe way, and with minimal wastage. So, those are the four key guiding principles that were underpinning the roll-out.

On 8 December, when we rolled out the Pfizer vaccine, it had, because of its characterises, certain limitations in terms of logistics and was more suitable for a mass-vaccination-type campaign. But with the approval of the second vaccine—the Oxford-AstraZeneca vaccine—from 4 January, that has actually facilitated the roll-out in a much wider and much more accessible way to a lot more vulnerable individuals. So, although the period between 8 December and 4 January was a comparatively good start, but not an accelerated start, with the addition of the second vaccine, I think it's picked up momentum.

The latest step, as you will have all seen, is that we've vaccinated across the NHS and social care sectors close to 290,000 first-dose vaccinations, and it continues to accelerate. So, it's a huge tribute to all the NHS staff who have been involved in this exercise, and let's not forget that this is the largest vaccination drive that we've ever done in the history of the NHS. So, it is really a challenge, but I think it's picking up really well. The most important thing was also to build sustainable infrastructure, so that when the vaccine supplies will be more smooth, the capacity is there to make sure that every dose is given out as quickly as possible.

Absolutely. I think the principle remains the same, that we shouldn't keep any vaccines in storage. Whatever there is, it needs to be pushed out as quickly as possible so that we reach a large proportion of our population safely in very quick time.

Specifically on the role of Public Health Wales in the vaccination programme, I would like to just let the committee members know that we have got representation from our colleagues in the team at the Joint Committee on Vaccination and Immunisation as one of the co-opted members. So, we are very much tuned into the discussions in JCVI, which, as we know, considers all available evidence in making the recommendations. And then, subject to those recommendations, the regulatory authorities grant approval for usage. So, we're plugged into the evidence.

Internally here in Wales, we're very closely linked in with the COVID vaccine board that is chaired by the senior responsible officer within the chief medial officer's team, and our role is mainly providing advice around the priority groups, around the evidence that underpins that. More importantly, as a system leader, we've got loads of experience, and the vaccination programme in Wales is a very mature programme, and it builds on some of the successes we've had in previous vaccine roll-outs, including the influenza vaccine programme, which, in this particular season, we've vaccinated a record 1 million people, which was 975,000 last year. We've crossed the 1 million mark this year.

In addition to that, our role is also in developing training and resource material. We provide public-facing information, professional information, we provide legal support on patient group directions, we do pharmacovigilance studies, we provide the statistics for surveillance reports, and answer any clinical questions from a range of stakeholders, including the public.

So, on that issue that I mentioned there on seeking new ways of using the Pfizer vaccine, for example, you would be actively trying to enable the use of Pfizer in community settings, something that we thought a couple of months ago—or just a month ago—wasn't really possible.

We wouldn't do that selectively just for the Pfizer vaccine; we would do that for all available vaccines. And then, as we know, the delivery of the vaccination programme is very much a health board responsibility, and each of the health boards have their own delivery plans, and we work very closely with them, including their immunisation co-ordinators, and try and problem solve as we encounter the roll-out.

On the Pfizer supplies in weeks to come, there was the controversy with the First Minister saying we will spread out what we have. Even though they're saying, 'No, we want to use it as quickly as possible now', we're still hearing regular messages, 'No, because of supply problems in weeks to come, we will need to make sure that the Pfizer supply does last us through the factory shut down, and that kind of thing that's coming.' Are you happy that it will be the usual practice to actually get this in people's arms as quickly as possible? Or will there still be an element of spreading out what we have? Because I'm still picking that up from Welsh Government.

I'm not close to that discussion. But, certainly, I haven't heard of any major supply-chain anticipated delays in supplies, and as things stand, if all goes to plan, I think we are on course to meet milestone No. 1 by mid February.

We certainly hope so. One concern that is still being raised quite seriously by people in the medical profession, certainly, is the question of the change from the three-week delay between dose one and two of Pfizer to now a maximum of 12 weeks. I'm seeing evidence that suggests this still is very problematic. I get the idea of trying to give as many people as possible some protection, but if it turns out that you are eroding the effectiveness of that vaccine so much, you're possibly starting again by the time you're administering that second dose in 12 weeks, which would mean your first dose was potentially wasted. Where do you stand on that?

So, our position on that is in alignment with what the JCVI evidence suggests. So, the priority is to save lives, and saving lives is primarily by vaccinating more individuals in the highest vulnerability groups. When the analysis of the evidence and the data of the trials were analysed at the JCVI, it became clear that, if you take the period after 15 days to 22 days post the first dose of vaccination, the amount of protection offered by the Pfizer vaccine was close to 90 per cent—it was 89 per cent—and that with the Oxford-AstraZeneca vaccine was around 73 per cent. And therefore, even with the manufacturers' recommendation for the Oxford-AstraZeneca, the interval between the first dose and the second dose is recommended as a range between four to 12 weeks, whereas in the Pfizer vaccine, there was an amendment to the regulatory authority's approval, which said the second dose should be at a minimum of three weeks and beyond. So, the pragmatic decision around the 12-week period was on the back of that discussion.

We don't yet have evidence that somebody who'd received the first dose of vaccine, by the time they're ready to receive the second dose of vaccine, around 12 weeks, would have lost the effectiveness of the first dose. We don't know that yet, so that's something that will be monitored. So, it would be inappropriate to comment on that at this stage.

Okay. On data, we still haven't got easily accessible data that can just show us how much of each vaccine has been shared out between the four UK nations, and the data following on from that, how much has been actually distributed to the different health boards in Wales. Do you think that we need that data publicly available for people like us to scrutinise as quickly as possible?

With regard to that, there are two broad components to it: one is data relating to the operational delivery, the roll-out of the vaccine; and second is data related to surveillance of the vaccination programme itself. Public Health Wales is very much focusing on the latter element, which is the data supporting the surveillance of the vaccination roll-out programme, whereas the operational delivery data is very much Welsh Government oversight, with the support from the chief operating officers.

So, as far as our role is concerned, we want to make sure that all the data we hold is transparently available to the public, because the public has the right to know what's the proportion of coverage across all the priority groups. And then, therefore, you will have noticed that we publish, on our public-facing dashboard, every day, a cumulative number of vaccinations given, up to 10 p.m. the day before. And on a weekly basis, we produce a weekly summary that covers not only the cumulative vaccinations given, but we break it down by health board of residents, as well as by the priority groups. The challenge currently with the surveillance data, in respect of the update coverage, is that, for certain categories of priority groups, we don't have valid denominator data, therefore it is difficult to work out percentage cover for that group.

But one of the things that we should be really proud of is that Public Health Wales really inputted into the linking of the vaccination data with the Welsh immunisation system, irrespective of where a vaccination gets given. Whether it's in a hospital, mass vaccination centre, mobile unit, community pharmacy or general practice, eventually all the data will come to it and we've got one solid source of information where we can do a lot of surveillance analysis, which, I think, is a unique feature for us here in Wales.

Okay, thank you. Diolch yn fawr iawn. Diolch, Gadeirydd.

David Rees, you had a supplementary. David Rees.

Thank you, Chair. Can I just go back to the question that Rhun asked you regarding the gap between the doses, and particularly the Pfizer one? And you indicated there is no evidence of that, because it wasn't clinically assessed in the trials—I understand that. And you talked about—. The minimum of three weeks was mentioned, but then you then said it was being monitored. Can you just give clarification as to who is monitoring it? Is Public Health Wales involved in it? Are you looking at a sample of individuals who have been vaccinated and doing blood tests of those samples to see what the impact is? I'd just like to have an understanding of how are we going to find out whether this gap has an impact on not.

Thank you for the question. This is a question that's not just relevant to us in Wales, but to everybody in the UK. So, our teams—our vaccination teams—are very closely linked with the four-nation groups, which they meet on a regular basis. There is a clinical monitoring group, as well as—. In terms of monitoring the effect and the effectiveness of vaccines, there are a number of groups involved who are looking at this. I don't have the specific details about the monitoring schedule, but I'd be very happy to provide those to the committee after the session.

Thank you for that. It would be helpful to understand what Public Health Wales's role is in all this as well.

Thanks, Chair. Can I ask about what assessment you've made of the likely impact of the new variants on the vaccine, and the potential for any of these new variants to be liable for vaccine escape?

So, the assessment we do—or the assessment that we are party to—is a part of the national assessment. You may be familiar that there is a national advisory group called NERVTAG, which is the New and Emerging Respiratory Virus Threats Advisory Group, and that considers all the impacts of the new variant and its impact on the vaccine, and then that group reports to SAGE, and then SAGE puts out the advice. So, as part of that NERVTAG group assessment, the recent analysis suggests that the UK variant of concern demonstrates that, in a small proportion of vaccinees, 21 days after their second dose, they had equivalent neutralisation titres, for example, similar to the original Wuhan reference strain. So, meaning to say that the vaccine did not—. The new variant did not blank the effect of the vaccine, whereas with the South African variant, there is still emerging information—it's not quite robust yet—that there may be between a one to threefold decrease in neutralising activity against that particular mutation that is in those strains. So, it is still an emerging picture, but there is some confidence, now—greater confidence—that at least the UK's variant is not going to make the vaccine ineffective.

Okay. Thank you. And you touched, in your answers to Rhun, on some of the issues around supply. Is there anything else that you think either the Welsh Government or the UK Government needs to be doing to ensure that we do guard against any supply problems or any potential delays with the vaccine?

Clearly, it's the UK Government who are procuring the vaccines on behalf of all the UK nations, and as I understand it there have been orders placed with at least six manufacturers for over 350 million doses between all the purchases. So, it is important to keep a close eye, and horizon scanning is the one phrase I would use for what Welsh Government and the UK Government have to do, because if there is any indication of potential disruption to vaccine supplies, we'll have to risk assess the impact on our vaccination programme, and if the disruption is of a significant magnitude, then appropriate amendments to our roll-out plans need to happen.

Okay. Thank you. Can I ask if you've modelled—? Have you done any modelling on people's behaviour in relation to receiving the vaccine? Because, obviously, what we don't want is for people to think that they're invincible once they've had it. What work are you doing in that area in order to safeguard against, and to ensure that people—? Because we know that it can still be transmitted, can't it, even if someone is vaccinated?

Yes, absolutely. And I think public communication around this is so important. There are two elements to it. One is that we want to make sure that people have the right information that it is beneficial to have the vaccine, and secondly, for those who have received the vaccine, to be mindful that just having a vaccine does not mean that they can go about their activities as pre-pandemic. Clearly, we do continue to work across a number of sectors for mythbusting. We provide lots of communications through public communication on our website, so professional communication, social media channels—we use those, and then we also reach out to certain groups, such as the black, Asian and minority ethnic groups through the First Minister's BAME advisory group, the outreach workers et cetera, so that we constantly reinforce and use community leaders to amplify the right message, so that everybody gets the right message about taking the vaccine and then the guidance to follow post vaccination. I'll just hand over to Tracey, as she may want to just add a bit on that.

Thanks, Giri. We've mentioned before in the committee about behavioural insights. So, we have a couple of people in the organisation who are experts in behavioural insights, and we're looking to expand that and set that unit up quite rapidly now and, in fact, it's something that Giri is very closely linked in with. All the way through this pandemic, and I think particularly going into 2021, given the earlier conversation, there is a science around working with different population cohorts, if you like, just to really understand what are the influences that make us make one decision or choose another path. Your point particularly around vaccine uptake, but also about the basics of social distancing, hand hygiene, masks et cetera. So, we're trying to fast track some work around the behavioural insights just to make sure—so, for example, with young people, I think we're being a bit traditional in the methods of the media that we're using. How do we influence through TikTok, how do we influence through Instagram, how do we engage with the bloggers that our young people are following? So, that's a particular focus for us and how we can pick the speed up on that, and we'd be happy at a future committee to perhaps talk in a little bit more detail around that.

Thank you, Chair.

Thank you, Chair. Good morning. Dr Shankar, you mentioned this morning the positive news around the uptake of the flu vaccination. Has COVID had an impact on the campaign and how the vaccinations are being delivered, especially in those key target groups? You said that the high figure was 1 million. Has there been any breakdown in terms of the target groups?

Yes, thank you. I think we do publish on a public-facing website our immunisation uptake data, and the last report we published was on 21 January this year. We know that in the at-risk group, the over-65s, the coverage is now 76.2 per cent, and then in the under-65s, but in the risk group, we've hit the 50 per cent coverage rate as well. What is also quite good news this time around is that with all the focus on COVID and the link to hygiene and social distancing, the flu activity hasn't taken off at all in Wales this year. In fact, there is no circulating flu in our latest surveillance data, both in the community cases as well as what we do in the intensive care sentinel surveillance, which, again, I think is a really good story, because that would have significantly reduced the impact of excess deaths from flu alone. That's not to say that COVID isn't causing those excess deaths, but there's an element of flu control that we had not seen before.

Thank you. How is that informing your planning for next winter? I know it's hard when we're still in this winter, but, obviously, it's really important we look ahead to next year as well.

Absolutely. I think the preparation and roll-out for flu vaccination cannot be lowered at all. We still have to maintain the same rigour, if not even more, to cover many more sectors of the population at higher levels of coverage. It would only be a supplementary, an addition. We would still—planning has already started. You may be aware that it's now about the strains—the composition of the vaccine will be determined, and orders will be placed in preparedness for the 2021-22 season.

Thank you. That's really positive. Moving on to some questions around COVID testing capacity, do you think there is sufficient testing capacity in the system, and is it accessible?

Can I just invite my colleague, Dr Robin Howe, to respond to that, please?

Thank you, and good morning to the committee. So, over the course of the pandemic, we've developed in Public Health Wales and across NHS Wales significant COVID testing capacity. It's actually a year ago today that we did the first tests for COVID in the laboratory in Cardiff, and over the course of the year we've rolled out, now, a model with a large central testing facility at Imperial Park 5, which has a capacity of 7,000 tests a day, and that went online in December and is now fully operational; three regional laboratories in Cardiff, Swansea and north Wales, which are servicing the coronavirus testing units for some of the more routine testing in the community; and then, following some further investment in the autumn, we've developed 16 hot labs, which are now serving almost all of the acute hospitals and giving access to rapid testing, so that the capacity within the NHS Wales network is a little over 15,000 tests per day, and there is the additional capacity for home testing and some of the routine screening testing through the lighthouse labs in England.

And there have been further developments in that network, with the opening of the lighthouse lab in Newport in Imperial Park 5, next door to the Public Health Wales laboratory. So, that's giving very significant capacity, and in fact, the demand that is coming into the system is significantly less than the capacity. So within the Public Health Wales laboratories last week, having a daily capacity of 15,000, we received about 30,000 samples coming through across the whole week. So, we feel confident that we have appropriate capacity for testing at the moment.

That's good to hear. But the percentage of test results delivered by labs within 24 hours still does remain low in some areas. What's being done to improve the turnaround performance in some key areas?

In fact, the turnaround time is improving, and the figures that we shared with you in the briefing, compared with previous briefings, we're now honing down to hourly figures whereas previously it's been calendar days. So, the data aren't quite comparable and don't show the improvement that there has been. So, in terms of returning results within one calendar day, that's gone up, from September, from 86 per cent up to 94 per cent. But there are still significant areas for improvement.

One of the things that we've been doing was the evolution of the hot labs, to give really rapid turnaround for hospital patients, and there, the median turnaround time within the laboratory is two hours. But the median turnaround time within the laboratory for other samples is 18 hours, and there is some variability, as I'm sure you know. We're working within the laboratories to improve that. We've got improvement colleagues who are working through our processes. But also, importantly, there are a number of elements outside the laboratories that impact both on the end-to-end turnaround of test results, largely to do with courier services and the timings of when samples are taken. And those factors also have some impact on the turnaround times within the laboratories, because if we get very large deliveries of tests, that then takes a while to work through in the laboratory. So, we're working with colleagues in Welsh Government and across the NHS to both improve the frequency of courier services, and to smooth out some of the demand, particularly where there's routine testing demand that doesn't necessarily always have to be done on a Monday, for example. 

Thank you, that's really helpful. We talked this morning a bit about the new variants as well. What's the capacity in Welsh laboratories to pick up those new variants?

There are a few ways in which we identify the new variants and, as was mentioned earlier, the key and definitive way of identifying them is through genomics, and Wales is world-leading in terms of its genomics capacity and how we're using that. But that still is a lower-volume test and also takes time. And the other key way of identifying the variant, particularly the UK or Kent variant, is by looking on specific platforms for what's called the S-gene target failure, which indicates with high confidence that that isolate would be one of the new variants. In Wales, the platforms that can detect S-gene target failure weren't being used, which was an advantage in some ways and a disadvantage in others, but they are used within the lighthouse labs. 

What we've done is to bring the specific platform into Cardiff, and so we're doing regular testing of positive samples from hospital in-patients to look for the S-gene target failure across Wales, so that we can monitor that situation and whether there's any changing epidemiology there in terms of in the hospital. In the community, the samples that go to lighthouse labs in north Wales tend to go to Alderley Park, which uses the platform. That's one reason why the confidence of our estimates of the variant in north Wales is stronger, because more samples are going through Alderley Park and through that platform. In south Wales, the majority of lighthouse lab testing goes to the Newport IP5 lighthouse lab, which doesn't use the platform that identifies the target failure. 

So, we've had less information in south Wales and so we've engaged with the Department of Health and Social Care, and we are diverting up to 1,000 tests per day from south Wales testing centres into the Milton Keynes or Birmingham lighthouse labs so that we can get the SGTF monitoring for that sector. 

Okay, thank you. And there's been some mixed evidence and views emerging on the value and accuracy of lateral flow tests. What's your view on the role of asymptomatic testing and the value and the reliability of lateral flow tests?

Thank you. So, there are two main elements to describing the characteristics of a test, and one is the specificity, which is essentially saying, 'Are positives reliably positive?' and the other is the sensitivity, which is saying, 'Are negatives reliably negative?' Our PCR tests have really good specificity of 99.96 per cent, which means that if you test 10,000 people, you might expect to get 10 false positive results. And they have a good sensitivity, which is around about 90 per cent, and impacted by a number of factors outside the test.

The lateral flow devices also have a very good specificity—actually very close to the PCR test at around 99.94 or 99.95 per cent—and so, a positive test with a lateral flow device is useful and reliable. But the sensitivity, and this has been widely reported, is not so good, and variable, variable dependent on the context of the test and where it's been done and by whom it's been done, so the sensitivity might be 40 per cent, and in some cases up to 80 per cent, but significantly lower.

The utility of a test with those characteristics really depends on what purpose it is being used for. You touched on asymptomatic testing, and it depends on the totality of the testing process. So, if you're in a situation where you have a population and they're not currently being tested, and if the prevalence of disease in that population is, say, 1 per cent, then one in 100 people have got the disease. If half of them are asymptomatic, then one in 200 people are wandering around the population and potentially spreading disease while not having any symptoms and not being identified. So, if you don't test this population of 200 people, you will have someone wandering around, potentially spreading disease. If you test with a test in that context, then anybody that you pick up who is positive is someone who you wouldn't otherwise have picked up, and so there is a benefit. If you pick up 40 per cent of the people who are infected or infectious, compared with none if you didn't test, picking up the 40 per cent is beneficial. It would be better if you had a system that would pick up 90 per cent of them, and then it becomes a logistic or operational issue as to whether, operationally, it is more beneficial to be able to roll out testing to large numbers through a test that is less sensitive and get some benefit, as opposed to not being able to roll out a more difficult to deliver test that might have a higher sensitivity.

That's really helpful, thank you. You're running some pilots of lateral flow testing with South Wales Police, and there's obviously been an intention to use those tests in schools and colleges. Do you think these tests can still play a role in getting children and young people back into the classroom?

Thank you. So, this is the daily contact testing and, as you say, there are a number of pilots ongoing across the UK. The principle is that by testing each day with a test that can identify, particularly, people who are infectious, with greater sensitivity than just the people who are infected, that identifying them and identifying people as being probably non-infectious with a daily test allows them to continue back at work.

As you're probably aware, that programme for schools has been put on hold in England. The reason for that is just to reassess the modelling in light of the new variant. Before the daily contact testing, or for contacts, the most reliable way of keeping contacts who may become infectious and infected out of mixing in the population is for them to isolate. Allowing them back with daily testing potentially is slightly more risky in that they might have a test in the morning that is negative but develop infectiousness later on in the day. That has to be balanced against the fact that the compliance with isolation amongst contacts is not 100 per cent. And in some studies, in adults, it's been suggested that it's as low as 20 per cent—you know, the absolute compliance. So, it's modelling compliance with contact isolation with the impact of daily testing and now the complication of new variants with increased transmissibility that just needs to be worked through.

Okay, thank you. What's been the learning from the mass testing exercise in Merthyr and the Cynon Valley? Will you be publishing a formal evaluation of that?

The evaluation is ongoing. Public Health Wales isn't leading on the evaluation, though, we're inputting into it. So, we're also waiting for the final evaluation report. I think it's already been reported that they've successfully tested a significant proportion of the population—50 to 56 per cent across Merthyr and lower Cynon. And they were able, through that process, to identify a number of positive individuals who were asymptomatic. So, that, then, enabled contact tracing for those individuals and public health interventions to take place.

The challenge is to then pick out exactly the key elements of the intervention to design how mass testing might be used in future. And I think that the greatest benefit in mass testing is probably seen when it is targeted at parts of the population where there's higher incidence of infection and also potentially higher transmission.

Yes, thank you very much. Thank you, Chair.

Because of weak chairing, we've now reached the red zone, in rugby terms, at the end of the game, so, the next forward pass or dropped ball means it's all over. David Rees, do you want to wrap things up?

Diolch, Gadeirydd. I appreciate that time wise—. It's just TTP: test, trace and protect. Are you confident, going forward, that we have sufficient resources in the months ahead of us? Because Dr Shankar has indicated that there's a third wave possibly coming. Hopefully, as a consequence of that and the vaccinations, that third wave will not be so traumatic upon hospitalisations, or individuals suffering serious illness or death, but it's still a possibility, and we need to minimise transmission as much as possible. So, test, trace and protect will be critical in any future approach. Are you confident that the resources in the future, not just today, but in three months or six months or next winter, will be sufficient to ensure that we don't find ourselves in a position where we can't do that, because it's been clearly stated by many people across the world that that is going to be critical to minimising any impact or transmission?

If I kick off—thank you for the question—and then I'll hand over to Giri. My answer is in two parts: there's us as an organisation and then there's your point, really, about the broader system and the capacity. Apologies, our lights are dimming on and off—if you keep getting flashes at my end.

As Robin outlined, we received significant additional investment across our laboratory services in August of last year in order for us to create a much more diversified and more accessible testing system, because, obviously, we're going to need that as well as we continue forward. Currently, we're in discussions with the Welsh Government around seeking additional resources for, if you like, our health protection elements—people like Giri and the team and all of our surveillance team—because it's just continued to expand.

As far as the wider system is concerned, there are ongoing recruitment processes for the local contact tracers and support individuals for that. I'll hand over to Giri, who's a little bit closer to that than me. Giri.

Thanks, Tracey. The number of individuals available to the local and regional contact tracing teams is constantly going up. People are making a lot of effort to recruit people. The last I heard was that we had close to 2,400 individuals in the system operating at various tiers.

There are two things to consider in responding to your answer specifically; one is that the current capacity and the increase in capacity are all predicated on what we know so far about the new variants, their ability to transmit and then the potential modelling scenarios they give us and the impact of the vaccine et cetera. It was a similar position back in September. We were not anticipating a new variant in December. Therefore, if you look at the situation we found in the first two weeks of December, case numbers were so high that they completely overwhelmed the test, trace and protect teams. Therefore, they had to adapt a level of prioritisation. But, taking on that learning experience, I think colleagues are, in the regional teams, putting forward their best plans to recruit in a resilient way.

I've also been party to discussions in the TTP programme board, where security about funding allocation to continue colleagues who've been recruited on a more long-term basis has been confirmed. Therefore, people who were on temporary contracts have been given indications that their services will be required for longer into the financial year 2021-22. So, there's that degree of certainty there. What is unknown in all of this is, if it's still—. Two things are really things that might still challenge. One is if we have more new variants that have different characteristics and are much more transmissible. Secondly, if the population compliance is not satisfactory and we still see that people don't pay enough attention to the regulations and guidance, we might see that the system can get overwhelmed. It would be really difficult to plan for a surge capacity for anticipating those two elements. But, given the current situation, given the current understanding of the new variants and the expansion of the teams, I think that should be adequate for us to manage.

Also to note is that the Cardiff and Vale team have very kindly agreed to host a national surge team, which has been in place in the last few weeks, to pick up any variation if particular teams are overwhelmed on a particular day or a couple of days of the week. They give this additional support by picking up cases from their contact tracing queues. That team currently can do up to 250 index cases and 400 contacts, but that's also being looked at and it's being expanded.

Chair, I know you want me to finish, because I'm sure that time is moving on, but are you confident and are you comfortable with the figures and the percentages being hit, at this point in time, of those you reach and those you monitor, and the timescales in which you're doing that? Because I'll be honest with you, I've experienced a delay in being contacted, and I think people who then—about self-isolation—they're getting, shall we say, fatigue, in one sense. So, how are you making sure that contact is as quick as possible, and that you monitor that as well? Because there's no point just saying to somebody, 'Oh, you've got to self-isolate'. How do you know they're doing that, and how do you know they're being given adequate information to ensure that they're understanding the needs and the issues and the challenges that are facing them?

I'll just stress two parts. The system was completely overwhelmed in the first fortnight of December, and there is no doubt about it. That meant that the target to reach over 80 per cent of contacts within 24 hours could not be met on a number of days, and therefore teams have had to prioritise. But that was in the backdrop of a new variant in circulation, people's increased social contact and mixing leading up to the Christmas period. But that phase is now over and, hopefully, that will be a bit more normal, and the figures around the percentage reached within 24 hours have certainly gone up from the start of this new year.

In terms of the second part of that question, how do we make sure that people are self-isolating, there is a feature in the contact tracing where, once contacts are identified, they're asked to indicate a preference of how they would like to be contacted for follow-ups. There's either a choice of text messaging or a phone call. Most people prefer to the text messaging. So, every day, starting from the day after the contact tracer has spoken to them over the phone, they get automatic text messages, and they have to indicate that they are self-isolating and they do not have any symptoms. If they fail to respond to texts on two consecutive days, automatically they'll come into a telephone queue, and they will be given a phone call. The second method by which we monitor that is also through our weekly survey, the adherence to contact tracing survey, abbreviated as ACTS. It’s a Public Health Wales initiative that is undertaken by our research and evaluation colleagues, who send text messages to people who have been identified and ask them to complete a questionnaire. Through that route also, we monitor the proportion of compliance.

Okay. Just to let you know, I was contacted two days after a positive test of somebody in the household, and I opted for the phone call. I never received another one, full stop. I didn't have any more. So, it's not working, there are still problems. We are in a situation where we are in lockdown and we are seeing large numbers reducing. My concern is, as you rightly pointed out, as we come out of lockdown, the numbers may increase as a consequence of the variant. Who knows? We just don't know. Will the system cope again? I think that’s the very important question we need to ask, and we need to have confidence that you're saying to us that, in fact, we will hit more and above our targets—not just simply trying to achieve our targets. That's a critical question I think we have to be confident with.

I will finish on this point, Chair—I know about the time—and it's long COVID. How much work are you doing into researching the impact of long COVID? And particularly, how are you developing policy for Welsh Government in this area?

If I may pick that up, Chair, thank you—and perhaps just coming back for clarity on the last question as well. We support the system around the TTP and contact tracing. So, those are led and managed and co-ordinated by colleagues in local authorities and health boards. So, it's just how we support them in that system, particularly around technology. We can share the ACTS survey—a couple of those—with you as well, and you can see that. 

As far as long COVID is concerned, we haven't had any specific direct involvement. It's not an area that we're focusing around research currently in Public health Wales. There are many other areas that we are. But, certainly, we are part of the broader NHS support, and I am aware that the Minister has quite strongly pushed the NHS in developing a common pathway that's particularly focused around rehabilitation for people who are going through long COVID. I think it's fair to say we're still learning a lot about it. As you know, it's really defined by 12 weeks and beyond, with progressive symptoms.

So, my understanding, with partners across the NHS is—as I say, the National Institute for Health and Care Excellence produced some guidance around long COVID. That's been taken and that's been adapted to develop a common pathway within the NHS that health boards are co-ordinating. The Minister has also asked and engaged with health boards to really look at the issue of people who incur long COVID who may never be hospitalised, who are in the community, who have progressive symptoms. They may not have had severe symptoms at the outset of the actual acute infection, but they then, subsequently, develop long COVID symptoms. So, I think, as a system, there's quite a lot going on; it's not something that we have been directly involved in.

Okay. It's worth pointing out that long COVID will have variations on it, and some will be more severe than others. I think you will find that there'll be a lot of people who have tested positive for COVID, and had some symptoms, and it will in fact have impacts upon their future health as a consequence.

Absolutely.

With long COVID, there'll be a variety of issues, I think, and the public health agenda has to be raised within that.

Can I make one final point, which is so focused on that? This is probably a bizarre request, but we did put it in the submission. It's just on David's point, really; it's the broader harms of COVID. If, at any point in time, the committee would like us to come and actually spend some concentrated time around the indirect harms around mental well-being, the impact of unemployment, the impact of long COVID, these are areas that we're doing quite a lot of work on—well, a considerable amount of work on—through other parts of the organisation. So, if that would be helpful—they will, in turn, create a greater harm to society than the actual infection in its own right, notwithstanding that there are many tragedies happening.

Chair, I'll stop there, because I'm aware of the time.