Y Pwyllgor Cyfrifon Cyhoeddus a Gweinyddiaeth Gyhoeddus

Public Accounts and Public Administration Committee

17/11/2021

Aelodau'r Pwyllgor a oedd yn bresennol

Committee Members in Attendance

Cefin Campbell MS
Mark Isherwood MS Cadeirydd y Pwyllgor
Committee Chair
Mike Hedges MS
Natasha Asghar MS

Y rhai eraill a oedd yn bresennol

Others in Attendance

Adrian Crompton Archwilydd Cyffredinol Cymru
Auditor General for Wales
Albert Heaney Prif Swyddog Gofal Cymdeithasol Cymru
Chief Social Care Officer for Wales
Andrew Sallows Cyfarwyddwr Cyflawni Rhaglen
Delivery Programme Director
Dave Thomas Archwilio Cymru
Audit Wales
Dr Frank Atherton Prif Swyddog Meddygol
Chief Medical Officer
Elin Gwynedd Dirprwy Gyfarwyddwr Brechlyn COVID-19
Deputy Director COVID-19 Vaccinations
Jo-Anne Daniels Cyfarwyddwr Iechyd Meddwl, Grwpiau Agored i Niwed a Llywodraethiant y GIG
Director of Health, Vulnerable Groups and NHS Governance
Jonathan Irvine Cyfarwyddwr Caffael a Gwasanaethau Negesydd Iechyd
Director of Procurement and Health Courier Services
Judith Paget Cyfarwyddwr Cyffredinol Iechyd / Prif Weithredwr GIG Cymru
Director General Health / NHS Chief Executive
Lisa Wise Cyflenwadau Llawdriniaeth (CDP)
Deputy Director, Operation Supplies (PPE)
Matthew Mortlock Archwilio Cymru
Audit Wales
Samia Saeed-Edmonds Cyfarwyddwr y Rhaglen Gynllunio
Planning Programme Director
Steve Elliot Cyfarwyddwr Cyllid
Director of Finance

Swyddogion y Senedd a oedd yn bresennol

Senedd Officials in Attendance

Angharad Roche Dirprwy Glerc
Deputy Clerk
Chloe Corbyn Ymchwilydd
Researcher
Claire Griffiths Dirprwy Glerc
Deputy Clerk
Fay Bowen Clerc
Clerk

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

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

Cyfarfu’r pwyllgor yn y Senedd a thrwy gynhadledd fideo.

Dechreuodd y cyfarfod am 09:15.

The committee met in the Senedd and by video-conference.

The meeting began at 09:15.

1. Cyflwyniadau, ymddiheuriadau a dirprwyon
1. Introductions, apologies and substitutions

Bore da a chroeso. Good morning and welcome to this 17 November meeting of the Public Accounts and Public Administration Committee in the Senedd, former National Assembly for Wales. Welcome, Members. No apologies—. Well, one apology for absence has been received from Rhianon Passmore; unfortunately, there's no substitute for her today. Do Members have any declarations of registrable interest? Thank you. Can I just confirm that everyone understands how to indicate if they wish to speak? Thank you. For participants in Tŷ Hywel in the room today, please note that headsets are available for translation and sound amplification. Remember to switch off, please, your electronic devices or ensure that they're on silent. Note that, in an emergency, an alarm will sound and ushers will direct us to an assembly point and exit.

2. COVID-19 a'i effaith ar faterion sy'n gysylltiedig â chylch gwaith y Pwyllgor Cyfrifon Cyhoeddus: Sesiwn dystiolaeth gyda Llywodraeth Cymru ynglyn â materion iechyd
2. COVID-19 and its impact on matters relating to the Public Accounts Committee’s remit: Evidence session with the Welsh Government on health issues

Our first session is focused on COVID-19 and its impact on matters relating to the public accounts committee's remit—or, should I say, the Public Accounts and Public Administration Committee's remit—and we have an evidence session with the Welsh Government on health issues. So, I begin by thanking the witnesses for attending this meeting. For the record, I'd be grateful if you could state your names and roles for the record, perhaps beginning with Judith Paget.

Bore da. Good morning. Judith Paget, director general for health and the NHS chief executive for Wales.

Bore da. Good morning. Yes, I'm Dr Frank Atherton. I'm the Chief Medical Officer for Wales.

Bore da. Good morning. Steve Elliott, director of finance for health and social services.

Bore da. Good morning. I'm Albert Heaney, Chief Social Care Officer for Wales.

Bore da. Good morning. I'm Jonathan Irvine, director of procurement services for NHS Wales Shared Services Partnership.

Bore da. Good morning. I'm Samia Saeed-Edmonds, I'm the planning programme director in health and social services.

Bore da. Good morning. I'm Andrew Sallows, I'm the director of delivery and performance in the health and social services group.

Good morning. Bore da. Lisa Wise. I head up the personal protective equipment activity for Welsh Government, the health and social services group.

That's later, Mark. That's the second session.

That's the second session.

Jo-Anne's not with us yet, Chair. She'll be here in the second half of the meeting.

Okay. Well, thank you, and, again, welcome, all.

As you'll expect, we have a number of questions and I'd be grateful if both Members and yourselves could be as succinct and concise as possible so that we can cover the wide range of issues that we seek to. The session is structured in four main areas and we will move across our questions on each. The initial questions, which will be for Ms Paget in particular, will be about key issues, challenges and priorities as she takes up her new role, both in general and given the wider COVID context, using the context of some of the Audit Wales 'Pictures of Public Services 2021' outputs as background, including enquiring about the mid-year financial position. We will then move on to questions about personal protective equipment, and then have a short break before moving on to our final session.

So, if I can just kick off with a few questions and ask Judith Paget if you could please indicate your priority areas of focus now that you've taken up your new post.

Diolch, Chair. Thank you. So, privileged to be in the role, meeting lots of people, listening and extensive reading in my first couple of weeks and this is my third week in the role. So, priorities for me as I join the group are, clearly, managing COVID. COVID continues to dominate activity in all parts of the NHS and social care and is a key feature of the work of health and social services group—issues such as overseeing the vaccination programme; ensuring a robust and reliable test, trace, protect service; clearly, the ongoing pressures in health and social care as a result of COVID-19; and supporting the delivery of scientific evidence and situation analysis to support the 21-day reviews. So, of my four priorities—key priorities—clearly, managing the current situation for COVID is clearly up there and important. 

In relation to my second area of focus, recovery planning and delivery across the health and care system is really important. We are heading into, if not already arrived in, a very challenging winter context. We have issued winter planning guidance out to health and social services, and the regional partnership boards will be submitting integrated winter plans to us next week for review. We have also issued planning guidance out to the NHS now to start developing their three-year integrated medium term plans, which will come into effect from 1 April next year. Members will recall that that process was suspended during the pandemic, but that has now restarted. Planning guidance has gone out, so we will be in receipt of those three-year plans at the beginning of the next calendar year. Planned care recovery is an important part of our recovery process. We have committed resources into the NHS this year in order to start addressing the backlog of patients who are waiting for planned care procedures, operations and out-patient appointments, and that is progressing, but clearly that commitment will continue into and through the next few years—so, making sure we've got robust plans for that. And clearly a focus on staff well-being is important. So, my second area is about recovery planning and delivery. 

The third area is about the key manifesto commitments, the programme for government. There are about 40 considerations in the programme for government that impact on the health and social services group. So, we are already paying attention to all of those and working through them to address them.

And then finally, there is a shaping-up programme for the adjustment of the structures within the health and social care group that I have inherited from my predecessor that we are working to deliver. 

So, four areas: managing COVID; recovery planning and delivery; the programme for government; and the shaping-up programme. Thank you, Chair. 

09:20

Thank you. That's quite an extensive and challenging menu. How resilient is the Welsh Government's own department of health and social services and how able is it to balance immediate COVID and the winter-related pressures referred to with progress on broader policy developments and implementing in the context of the new programme for government?

So, clearly, we're still in the planning response arrangements. They are still stood up. So, the team has done a phenomenal job to balance the immediate issues of the pandemic as well as looking ahead to the forward issues. We have an arrangement within the group to keep an eye on all of those issues and staff are paying attention to both the here and now and the broader programme for government. As I said, we may need to and will need to tweak the structures internally as we move forward, and are constantly prioritising and reprioritising work, but, generally, I think the team has done exceptionally well, continues to do exceptionally well, and we will ensure that balanced focus across all our commitments.

Well, I think we've done it for the last 18 months or so, nearly 20 months now. I think there is support from other groups where pressure is a particular issue. I think the other thing that is in the programme for government that we are paying serious attention to is the development of the NHS Executive. We do understand that there is a need to strengthen within the group in particular areas, and that suggestion of an NHS Executive gives us the opportunity to do that. 

Thank you. And given your reference to the development of the NHS Executive, where is the Welsh Government with the plans for that at the moment?

09:25

Yes, so we're in active discussion with Ministers on the creation of the NHS Executive. I'm very hopeful that we will be able to say something on that shortly. Within the programme for government, as I've said, there are over 40 commitments, which we have RAG rated. The NHS Executive development is one of two that are currently RAG rated as 'red', but I'm confident that we will be able to make progress on that over the next few weeks, and, as I say, are in active conversations with Ministers at the moment. 

So, when you—. Thank you. When you said 'shortly' you mean within the next few weeks.

I do, yes. So, it is an active issue that's receiving attention at the moment. Clearly, determining the options around how that could be delivered—we've given a lot of thought to that, and those discussions are current. So, yes.

Thank you. So, would it be fair for us to flag this up in the committee, say, early in the new year?

Happy to come back to give an update or provide a written submission as that progresses. 

Thank you very much. Could I invite Cefin, Cefin Campbell, to take over the questioning?

Diolch yn fawr iawn. Bore da, Judith. 

Thank you very much, and good morning, Judith. 

So, my question, or questions rather, are around the pressures and backlog in planned and unscheduled care. Could I first of all ask what the Welsh Government is doing to address the planned care backlog and current arrangements for prioritising non-COVID patients?

Bore da. Thank you. So, in the current financial year, the Welsh Government has committed resource out to NHS organisations to support planned care recovery. In March of this year, £100 million revenue was made available, and then later, in August, another £140 million—£100 million revenue and £48 million capital. Each organisation has plans in place to start to address the backlog of patients waiting that has developed during the pandemic, and, clearly, meeting with all NHS organisations on a regular basis to make sure that that is delivered. 

The Welsh Government has also committed £170 million on a recurring basis from next year onwards, and that's really important to give NHS organisations an assurance about their planning, so that they can plan in the full knowledge that there will be ongoing revenue available to them, and that will be consistent over the next couple of years.

There is a national planned care programme. There are clinical boards that draw in clinicians from across the NHS to give advice and guidance on how recovery should be organised. And, clearly, the most important thing is that we learn from what we've done during the pandemic in reshaping the way in which planned care is delivered. I think everybody accepts and recognises that we can't just go back to what we were doing before. We have to learn from the way in which we've adjusted the way in which services are delivered to move forward to take advantage of those.

So, we are expecting health boards to radically change and fundamentally change the way in which care is delivered, but making sure we're focused on some of those key areas such as endoscopy, cataract operations, orthopaedics, and access to diagnostics and imaging are key on our agenda. 

So, that work is progressing. I'm happy to answer any further questions on planned care. 

Yes, if I could just follow up on that, what action is the Welsh Government taking to try and improve unscheduled care performance, or at least prevent any further deterioration as we head into the winter?

Thank you. [Interruption.] Apologies, the fire alarm test is going off in the building here, so apologies for the noise behind me. 

So, the six goals for emergency care have been developed and shared across the NHS, with a huge focus on developing the urgent and emergency care system; making sure we're signposting people to the right place first time; ensuring that there are alternatives to hospital admission available in the community; where people do need rapid response, that is available; and, clearly, focusing on hospital discharge is a key aspect of that programme. The goals of emergency care do translate into a lot of activity within the NHS at the moment, and across health and social care, so we've developed urgent primary care centres. Clearly, we're working on the roll-out of 111 nationally. The ambulance service, working with the emergency ambulance services commissioner, has developed an action plan to address ambulance performance, in terms of delays that we know that we are seeing in some parts of the system. Same-day emergency care—clearly, working with social care as well. And just making sure that we're focused on the operational issues that give strength to the system. Resources have been made available, both to the NHS and to social care, via the regional partnership boards, and those resources are being used to supplement that plan.

I don't know if my colleague Andrew Sallows wants to add anything to that, because he's been personally involved in some of that work.

09:30

Thank you, Judith. Just to add to that really, I suppose it's just emphasising the challenge that we continue to see that COVID impacts on our system, our service. So, infection prevention controls, PPE, the workforce implications, really, are all continuing to impact on our ability to deliver our historic core capacity and productivity levels that we would have previously been able to undertake. So, alongside the schemes that Judith was pointing out, it is a challenged position, and one that we're working with the service, really, to try and improve, and transform as well, so that we can take the opportunity that COVID has brought, to a certain degree, to ensure that we've got a sustainable system and service for the future.

Okay. Thank you. Cefin, do you have any further comments?

Briefly—. I think Mike Hedges will be picking up on some of those points shortly. Before he does, can I slip in a question about the comments by the Association of Directors of Social Services—ADSS? What is the Welsh Government doing to respond to the concerns they recently raised about the situation in social care, including their diagnosis that the healthcare and social care systems are not in equilibrium, with a disconnect between the two, and the risk of system and market failure?

Probably, if I bring in Albert on that—yes, I can see Albert waving at me. Thank you.

Thank you, Judith, and thank you, Chair, for the question. I think that the first response is that Welsh Government, at a ministerial level, is responding by co-ordinating a weekly meeting with all partners across the sector, looking at measures that can be done immediately and carried out that can assist the flow across the health and social care system, and indeed, recently, allocated £42.7 million to assist in that flow during the winter process. Just to give a couple of examples, because I know time is precious this morning, but an additional £5.5 million going directly for direct payments to support unpaid carers, and also additional funding to support and scale up voluntary and local third sector organisations.

On a more strategic level, the longer term stability of the sector is absolutely crucial to all of us. And as part of that, regional partnership boards have been tasked with the responsibility to develop market oversight reports—market stability reports. And they will be producing those reports and working on them now; they will be producing those reports by 2022. And it's our intention to use that information then to assess this in our national framework for social care in terms of how we support and enable provider stability. Of course, this committee will be aware that, during the pandemic, we have supported funding for the care sector—care homes, especially—ensuring sustainability during the crisis, funding a hardship fund, in excess now of £185 million.

And just on that other point you raised, Chair, which was very helpful, there is a very strong commitment from Government. We recognise the different pressures on the health and social care system, but it's really important that they come together in partnership, so the regional partnership boards are an ideal opportunity to do that. Indeed, £9.8 million has been allocated to assist regional partnership boards and health and social care to respond to these winter pressures. And indeed, alongside that, I think it's really crucial that we, following the period of having to focus on the pandemic, really then deliver on 'A Healthier Wales', which is the 10-year strategy for health and social care, providing seamless services and improving outcomes for the people who we serve.

09:35

Okay, again, I repeat: do the regional partnership boards have the internal capacity and understanding of the goals and sharing of those goals and also, the ability to avoid conflicts of interest if some of their members sit in different sectors with different organisational priorities?

Yes, I met recently with the regional partnership board chairs and indeed can confirm for the committee that they share those goals—they're committed. And I think actually, by having the wealth of experience around regional partnership boards, coming from health, social care and the third sector, it gives them real opportunities to develop local services that are seamless and meet the needs of people. So, I think it's a strength, those different partners coming together.

Okay. If I can pass over please to Mike Hedges to pick up the questioning.

Diolch, Cadeirydd. What I want to talk about is joint working between health, including primary and secondary care, and social care. The first question is: enablement post discharge—too many mobile patients, when they go into hospital, get discharged into care homes. How can we enable them, when they are discharged, with primary care and social services working with them to enable them to return home and live at home, rather than ending up in a care home?

Thank you. I'll start and Albert might want to join in, responding to that question. I think it's a really important point you make. I think it comes down to assessment. So, clearly, individuals who are assessed when they leave hospital—clearly those who need long-term care in a care or residential home, are assessed appropriately and discharged appropriately to that environment. 

One of the issues that we're facing at the moment, which is a very practical issue in the here and now, is around the availability of domiciliary care to provide packages of care for people to be supported in their own home. The important thing is that we're focused on that, and I'll bring Albert in shortly to talk about some of the work that's being done to enhance domiciliary care availability. But I know, in the short term, there have been small numbers of patients who have been stepped down to care homes as an interim placement before being moved on. Clearly, that's done where appropriate—it's done through assessment and conversations with both patients and their families, but I do accept that the most important thing is that people go to their right destination—that's important for them. We want to promote independence and we want to keep people as independent as possible in their own home.

So, some of the work the regional partnership boards have been doing locally is around the co-ordination of work with their clusters—with their primary care clusters—to look at what services are available, how they can support more people at home and put in schemes involving sometimes the third sector as well as care providers, to ensure that people can be supported at home. It's a really important point and the service is absolutely focused on making sure that people are placed in the right environment with the right care and support around them. Albert, did you want to add to that?

Yes, thank you, Judith. Thank you for the question. Just probably a couple of points to add to Judith's excellent description. I think it's really important that the primary community and social care and health partners work together. So, one of the models that we're promoting is 'discharge to assess'—so, actually we move people out and assess in the right environment. And also, having 'home first' services, which therefore alleviate the pressure coming in to the acute sector.

Part of the challenge in social care—a second point I really would like to make—is about workforce. It really is that issue about the real living wage. So, Welsh Government is committed to introducing the real living wage and has asked, as Members may be aware, the social care fair work forum for advice. The fair work forum has provided that advice to Welsh Ministers now and Welsh Ministers are considering that advice. I think we recognise that, as we strengthen our systems, we will also have to create a stronger, better paid workforce for social care in terms of delivery and sustainability for both the workforce and for the sector transformation.

09:40

Thank you. We’ll talk about the workforce in a few seconds, but the point I would like to still make is that if somebody goes to orthopaedics, they get de-skilled while they’re in there—they get used to lying in bed, very little movement about—and they actually get them out as soon as possible. I like this idea that Swansea Council are doing of taking people into an intermediate place so they can see whether they can actually work at home. Is that done across Wales?

Yes, there are variations of the Swansea model across Wales. All health boards and local authorities, through regional partnership boards, have a range of facilities. I think the opportunity, going forward, will be to enhance the reablement capacity within those settings.

Okay. I don’t want to ask you a political question, so I’m just asking on an administrative basis: would it be easier for local authorities to directly provide community care rather than tendering it out, getting people in, getting people giving contracts back? If they’re actually dealing with their own employed workforce, they will have greater control, and they actually know how many people they have at any one time. It's an administrative question, not a political question.

Shall I pick that one up, Judith?

If you wouldn't mind. Thank you, Albert.

Thank you. Of course. Yes, indeed. I think that it’s very clear that we want a strong sector. So, in terms of terms and conditions, we want those terms and conditions to be across public and private, so it’s really important. As the public and private salaries and terms and conditions equalise and harmonise, then I think the rebalancing of public services/private services will be important, in terms of having the right balance to enable, then, the stability and market stability, as I mentioned earlier, going forward. So, having the market stability report will allow regional partnership boards and health and social care to plan for what provision they need, to develop that provision together, and to then consider how they balance that between both public service ownership and commissioned services.

Thank you. Again, really, I'm aware, from casework, notwithstanding COVID and other restrictions, that some local authorities, for example, are handling pressure on step-down provision more efficiently than others. How do you intervene if you identify—? Or are you identifying areas that, perhaps, need a bit of extra support to achieve what others appear to be? And are you aware of and acting on the concerns raised by the hospice sector that they’re suffering, in certain areas, particular problems with delayed discharges in terms of palliative care provision?

Albert, shall I hand back to you again on the first part of that question?

Okay. Thank you. Well, absolutely, we have monitoring processes in place that allow us to have the intelligence coming forward from regional partnership boards, health and social care. That allows us then to ask the right type of questions to also identify where things work well, and to ensure then those are shared across health and social care. We have a number of vehicles, a number of opportunities where we disseminate that learning quickly and ensure then that, through regional partnership boards especially, partners are able to identify and respond to those challenges.

It’s important, however, just to emphasise that this is about moving forward strategically, and assisting regional partnership boards strategically, whilst at the same time assisting through some of the workforce pressures that we’ve been currently doing. Just as an example around workforce pressures, and I know that that is a question you may be coming back to, but we have actually been able to support through recognition payments, and one of those recognition payments across health and social care as well.

Just, Judith, before you come back in, perhaps on the hospice, I’ve also met with the hospice sector myself to ensure that we’re looking, from a social care perspective, to reach across and support those people in the end-of-life stage. Thank you.

Yes, and just to come back on the hospice issue, at a local level, health boards will have very active engagement with their local hospice partners. Through both their palliative care boards and end-of-life boards, there are regular conversations around making sure that people can move very quickly from hospital to hospice care if they need to. There are fast-track arrangements often in place to make sure that happens without delay. It's a really important part of that joined-up system at a very difficult time for individuals, so, important work.

09:45

The question was more about releasing people from beds in hospices to go home and not having the package of support with the local authority, working with the health board, in place. Unfortunately, we don't have time to explore that further. We refer to workforce issues, and I invite Natasha Asghar to take over the questions.

Thank you so much, Chair, and good morning, everyone; it's a pleasure to meet you. I'm going to ask you some questions about the health and social care workforce, but before I do ask that question, there's something that I'd like to ask all of you, if that's okay. I'm going a bit rogue, just to let the committee know before I carry on. We've touched upon various issues, and I know we're going to be touching on more. We've touched on pressure backlogs, pressure on social care, working between social care and the healthcare workforce, and we'll touch upon PPE and many others. I accept and understand that you've had quite a difficult 20 months prior to today, but I just wanted to ask you—. A few of the terms that have been used in this meeting so far have been that you want to strengthen the NHS—I would love to see that too. You want to learn and plan for future pandemics—I don't wish a pandemic upon anyone, especially like we've just seen, but you never know, it could happen again. And you also talk about regional partnerships, which is great news and we'd love to see more of it. But I also wanted to ask you: based on what you've all seen, what you've experienced, many of you have been on the front line and had way more experience of COVID and the repercussions it's had on people's lives, people's health and people's futures, do you think, based on your own experiences, that we should have an all-Wales COVID inquiry?

I didn't expect everyone to go speechless after that, Chair. If you could answer that with just your personal perspectives. It's not a political question, but I just personally would like to know your feedback and your views on that first, before I carry on with my other questioning.

If this is a personal response to a question, my view is that the response to the pandemic across the UK was knitted together in many aspects, and so—this is my personal view—a UK approach would be appropriate, but I do think it's important, through that negotiation of the terms of reference, that we understand what specific issues we might want to focus on from a Welsh perspective. But I would say that this is my own personal view, and I'm not sure if any other colleagues would feel it appropriate to comment. Dr Atherton.

I would have a similar view, actually. There are questions, clearly, that need to be answered, but throughout the pandemic we have tried to keep very close to our counterparts across the four nations so that we have common restrictions. Obviously, there have been different policy decisions taken in different countries in some areas, but the reality is that many of the decisions and the challenges that we've faced were common challenges.

There's also a question of the resources that we would need if we did have a separate Welsh inquiry. We're still in the process of managing this, even though the UK inquiry, we understand, is going to start next spring. So, to have two separate inquiries running at the same time would be extremely difficult, I think, to manage, at the same time as we're still managing the tail end—hopefully the tail end—of the pandemic. If we are able to influence the UK inquiry so that the questions that rightfully are being asked in Wales can be addressed through that route, I think that's the best way. But that's a personal view.

Thank you so much; I do appreciate. I'll go back to my actual questions now. What is the Welsh Government doing to monitor and get ongoing assurance about staffing levels across the NHS and to address the staffing issues facing social care at the moment?

[Inaudible.]—if you want to join me in that response. So, from an NHS perspective particularly, clearly the Welsh Government has a role in resourcing the education and training of healthcare professionals, making sure that the pipeline of healthcare professionals coming in to training and available to work in the NHS is appropriate and based on the workforce plans generated by organisations, and the same, obviously, applies across social care as well. 

In relation to the role of Health Education and Improvement Wales, they've got the responsibility for developing those workforce plans, bringing them through to Welsh Government, informed by health boards, and, clearly, Welsh Government then commits resources to that. I think, this year, we've invested record amounts in training. I think it's in the region of £227 million, and an additional 4,300 individuals started their training in September of this year. So, strategically, that's what Welsh Government is doing, making sure that that pipeline of professionals is coming through into the system.

At a different level, clearly, there are regular discussions between the department and NHS organisations about issues that they're facing. Throughout the COVID pandemic, that's been really important so that we can make adjustments, understand pressures and find opportunities to resolve on an all-Wales basis some of those issues that are causing pressures in the service. Working in partnership has been really important to that. There has been a planning and response sub-group that's worked effectively to ensure that we identify and address some of those issues, and I can give some examples of those, if you would like. Clearly, at a professional level, colleagues like the chief medical officer and the chief nursing officer and others have that professional link with their colleagues in health boards and trusts as well, to make sure those issues are working effectively, and there is regular dialogue between the department here and the directors of workforce.

In relation to social care, those similar conversations take place. I think Albert's already described some of those in relation to the domiciliary care workforce, but I'm not sure if there's anything else he wants to add specifically from a social care perspective.

09:50

Thank you, Judith. I would just add we've invested in Social Care Wales, we have strongly supported the development of Social Care Wales in the professional development of the workforce. We have funded national tv advertising, social media promotion, We Care Wales, which has had a tremendous response, and, again, we relaunched the campaign at the beginning of November, extending it through to January. This takes it into a prime advertising spot, radio, tv, cinema, and has reached out to the public in a way that is extremely positive.

And then, just a final comment is that also we have provided additional investment to Social Care Wales to enable national roll-out of free introductory social care training to strengthen the workforce offer to the current workforce, but also to those new recruits joining the sector. Thank you.

Albert, thank you so much for your answer. Can I just go back to what you said? I was really interested, you mentioned that you ran a campaign that was really positive and you had a tremendous response. What's your key performance indicator for a tremendous response? Sorry, I may sound a little bit illiterate here, but I'd like to know what was the response, if you wouldn't mind sharing that with us. Just out of curiosity, I'd be very interested to know what that was.

Yes, of course, and we can also provide details outside the committee if that's helpful to the committee, as well, in writing. But it was a 27 per cent increase in applications, so we had, certainly, quite a high level of response. That was above and beyond previous recruitment campaigns.

Fantastic. Thank you so much for that. My following question is: how does the Welsh Government intend to respond to the auditor general's recommendations in his recent 'Taking Care of the Carers?' report? It stated that it should consider other national services and programmes that should be commissioned to ensure staff well-being continues to be supported throughout the recovery period and beyond. So, I'd be very much interested to know your views on that.

Thank you.  We were all really delighted to see the positive comments in the audit report about the work that had been done across the NHS, both in local organisations and nationally, to support the well-being of colleagues across the health and social care system during the pandemic. Clearly, people worked incredibly hard in often very difficult circumstances, and a focus on well-being was one of the things that everybody was very aware of from very early on, and the impact the pandemic had on individuals and groups.

So, there is a national workforce health and well-being network that has evolved from some of that work through the COVID pandemic. It's got representation from across the system, including social care. It's continuing to assist in national interventions, and some of the things that were put in place during the pandemic nationally have continued. So, we've extended things like the Samaritans listening helpline well into the next financial year. There is a three-year commitment to fund the Health for Health Professionals Wales service. That's a psychology support service for health professionals. And there are lots of resources available at the local level as well. So, this is about complementing the offer to make sure that, with both the national offer and local offer, these issues are complementary. And you will know that there is lots of access to free apps and support from Mind and other third sector organisations as well. So, it's about that complementary approach to making sure that that continues, and it will absolutely focus on—and our ongoing work is so important actually to this—the recovery of our people and the recovery of our services. And, as we know, as we're going into a difficult winter, that's going to continue to be very important. 

09:55

Right. Given time constraints, we'll have to move on to the next section, but we will write to you with any outstanding issues that we've not been able to question you on in this section. If we could move briskly to a section on personal protection equipment, or PPE, has the work stream of the UK review of the emergency preparedness advisory board got off the ground? And if so, to what extent has activity to learn lessons and update plans for a pandemic stockpile been progressed for completion by the end of this calendar year? 

The UK review is still ongoing. It has started, it's ongoing and will extend into next year. My colleague Lisa might want to add further to that. 

Good morning. Yes, thank you, Judith. The review is ongoing. There is a PPE-specific work stream, which was due to complete by the end of October, but is now likely to complete into the new year. We do have officials from Welsh Government attending the emergency preparedness advisory board, which is chaired by the Department of Health and Social Care. Public Health Wales are also engaged, and they will be providing advice on the PPE requirement needed going forward, on both the specification and also the volumes we might need to keep as a stockpile. However, whilst we wait for that review to complete, we have been doing lessons learned exercises throughout the pandemic and have advised shared services to continue to hold a stockpile of key PPE items for a minimum of 16 weeks' contingency, and that 16 weeks is based on the highest 16-week usage rate during the pandemic. So, whilst we wait for the overarching review to complete, we are ensuring that our plans are robust. 

Thanks. You referred there to lessons learned. What progress and what specific action is being taken to work with other public bodies in Wales to develop a clear framework for PPE governance arrangements, as we go forward?

That was an area that we did do lessons learned exercises on throughout the pandemic as well. I think the auditor general's report does reflect the fact that working collaboratively with stakeholders was a really key part of our response. So, specifically on the response to that recommendation, we have looked at all the Government's arrangements on PPE, including our links to health boards, trusts and through to local government. I think the views of our stakeholders were that the arrangements were good but had evolved as the pandemic progressed and, actually, it would have been really helpful to have had them set out at the outset so that they could be lifted and dropped and got up and running as soon as possible. We've also looked at the decisions and control frameworks and the terms of reference to make sure that they're complementary, and we will be keeping those arrangements under review as we go forward. So, following that review, we consolidated all the governance arrangements, we put it all into one place as a pack, and that will then be built into our contingency planning, going forward. 

Thanks. Does that include the independent care home sector and funeral directors?

We have the Welsh Local Government Association sat as part of our governance. I don't believe that we provided free PPE to funeral directors over the course of the pandemic, and so they're not a group of stakeholders that we have had much interaction with. 

Okay. I would like to declare that I'm chair of the cross-party group on funeral and bereavement. I, and the chair of our sister group in Westminster, had to pursue this with the Government early in the pandemic. So, it was a critical issue, and I hope you might consider revisiting that to see how they could contribute to planning, as we go forward. But, again, time is against us, so if I could please invite Cefin Campbell to pick up the questions.

10:00

Diolch yn fawr. Thank you. You've covered this already to an extent, but I'll just need some clarification specifically on the stockpiling of PPE, in particular the FFP3 respirators and the nitrile gloves. Could you just assure us that you are still keeping to the 16-week target level for those stocks?

Thank you. Yes, the PPE situation continues to be stable. Jonathan Irvine will have absolutely the current weeks in terms of stockpiling. I think it's a positive answer, but I will just double-check with him.

Thank you. The nitrile examination gloves are above the 16-week stock-in-hand level, and the outstanding deliveries we'd expected to come in arrived on time. And in relation to FFP3 respirators, in totality, we're above the 16-week stock-in-hand level. Specifically in relation to the 3M model, we're currently sitting at around about 13 weeks, but we continue to have large-volume deliveries land with us, so we expect to be above the 16-week level for the 3M brands by Christmas.

Okay. Thank you very much. Just to follow on from the stocking levels, could you just tell me about the progress you've made against the auditor general's recommendations about public reporting on PPE stock levels, including any final decisions on the format for this reporting?

Thank you. Jonathan, did you want to come back in on that?

Yes, I can. I think obviously we accept that confidence in the PPE stocks is critical for the public. We continue to publish through Welsh Government the monthly statistical release in terms of the issues of PPE across all core lines, and there is a commentary around that on the public-facing website that's available. I understand Ministers didn't feel it was proportionate to routinely publish national stock data, simply because it's a very variable position in terms of the total picture, with significant levels of stock continuing to be held locally, and that it wouldn't necessarily provide the assurance that it was intended to do. So, the monthly issues picture actually shows that we do have the volumes coming through, not only in stock, but in the inward supply chains where there is still product coming through to us. Where we need to publish stock data, then we've agreed that we'll publish it as needed rather than as a routine measure.

Thank you. If we go to the next brief set of questions, has there been any further collaborative procurement between Welsh Government and other UK Governments since the auditor general's report on further flows of mutual aid?

As you know, the health Ministers in all four nations are signed up to UK-wide PPE. As far as I'm aware, nothing further has been supplied since the AW report in terms of mutual aid to any of the other UK countries.

I'd have to check with Lisa or Jonathan on that. Jonathan has indicated. Thank you, Jonathan.

In terms of collaborative procurements, no, we haven't needed to, because the sourcing that we undertook within Wales and shared  services throughout the first and second waves of the pandemic secured our stocks. At the tail end of last year and into the start of this year, we did start to get some unlocking of central UK-wide supply of product, but that was really just to supplement what we already had in place. So, we continue to manage, as Judith has said, the position ourselves in Wales, but we do collaborate with the other four nations as and when we need to.

Okay. Thank you. With respect to the supply of £7.2 million-worth of PPE to Namibia, have those supplies now been passed on in full, and to what extent does the decision to provide that supply reflect general goodwill, or stock that would have gone beyond its use use-by date before it could be used in Wales anyhow?

Thank you. I know the stock is due to arrive in Namibia in early December, but I will need to check with Lisa on the arrangements that led to that decision, if that's okay, Chair. Lisa. 

10:05

Thank you, Judith and Chair. The donation to Namibia reflects an ongoing partnership we have through the Wales and Africa programme, and the donation was in response to direct requests from Namibia for help as a result of the desperate COVID-19 situation there. In order to make the donation we, along with shared services, made it on the basis of a reasonable assessment that the PPE would not be required in the event our own public health situation changed, and so that stock would ultimately be surplus. But I think it's also really key to note that it was mutually beneficial, so us not needing that PPE directly related across to Namibia, who had a need for those items, which is where the donation came to fruition. So, the items are on a number of different shipments. Some of those shipments have arrived, but it will complete in early December.

Okay. Thank you. Can I invite Natasha Asghar to take up the questions?

Thank you, Chair. I'd like to know, with regard to PPE—as we all know, it was quite a bone of contention for a lot of groups, organisations and individuals during the heat of the pandemic. So, is there now an updated plan that provides a strategic approach to the actual procurement of PPE now?

Jonathan, that sounds like a question for you from shared services.

Yes, thank you. Yes, there is a long-term PPE strategy plan now in place, and that addresses a number of issues, including the future sourcing requirements, should there be any, for new sourcing arrangements for PPE. It also gives consideration to our agreed stock-holding levels and what the future warehousing arrangements are for PPE around Wales, because as you can imagine, they are bulky products to stock and maintain at the levels that we've just been discussing. That strategic approach is also centred around the implementation of an all-Wales framework contract for future sourcing arrangements for PPE, so that we have established suppliers with proven resilience and capacity and capability to actually supply our needs in the future should a similar situation arise.

Okay. There was a framework contract that was due to go out to tender by the start of July. It's now up and running. How has it reflected the wider considerations above and current position on PPE prices compared with previous trends that we've seen here in Wales?

Yes, that framework tender was advertised, as you said. It's currently at the evaluation stage in terms of the bids that came back through, and that's through a technical evaluation, amongst other areas. In terms of those aspects that you refer to, those were included as criteria within the assessment and selection of suppliers, so, for example, foundational economy aspects in terms of dealing with local suppliers; we asked about supply chain resilience, the carbon footprint associated with it and then the modern slavery issues as well. All of those are almost like pre-qualification that you can get onto the framework in the first place, so for future sourcing arrangements, should we need to access them, then we will be dealing with suppliers and supply chains that meet all of those requirements.

Just a sub-question to that: how are you going to ensure quality control for PPE coming through now in future?

Part of the assessment of PPE now for the new framework, as well as right throughout the pandemic—we linked in quite closely with our colleagues in the surgical materials testing laboratory in NHS Wales shared services, and they ensured that the products were checked and tested where necessary against the relevant standards. We also worked collaboratively with the UK Government Cabinet Office, the Medicines and Healthcare Products Regulatory Agency, and the Health and Safety Executive, through a significant sort of triaging process. So, we've applied that to the current framework as well, in a smaller way, but in a much more focused way, to ensure that those quality standards aren't compromised.

That's really great to hear, but I just wanted to know: have you had any issues since the auditor general's report was published?

With quality?

No issues with quality as such. From time to time you will get some issues reported through in terms of specific individuals and maybe allergic reactions to some products, but there have been no issues that have been reported in terms of the quality of the products that we're supplying.

Okay. My final question is: has the Welsh Government decided on any specific changes that it intends to make having reviewed whether the Sell2Wales site needs more updating to allow bodies to publish retrospective contract award notices more efficiently without having to rely on suppliers to sign up, as opposed to the other way round?

Thank you. Lisa, I know you've been looking at this, so would you like to comment on what we found when we reviewed the site?

Yes, of course. We did undertake a review, and it did identify some potential options for publishing direct awards. However, they weren't necessarily more efficient, so it was very much a manual process that would need to be undertaken. I think in the meantime, shared services had already updated Sell2Wales to reflect all the direct awards that had been made. And also, the fact that shared services put the framework in place meant that, actually, the risk of there being direct awards in future was greatly reduced. And so, I think we concluded that whilst we had those options, because they weren't ideal, we haven't progressed them at this stage, but we'll keep them on the stocks, if you like, should they be needed in future.  

10:10

Thank you. Mike Hedges, could I hand over to you, please? 

I know very little about PPE but I know a lot about different protective equipment used in other areas from previous jobs where I wore protective equipment, depending on the level of danger. So, my question relates to that. How do you ensure that the right PPE goes to the right place? 

Jonathan, is that something—? Yes, I can see you're indicating. Thank you.

In terms of where the settings are that the PPE is supplied into, that's obviously a policy decision that comes out of UK central infection prevention and control and Welsh Government. In shared services, we ensure, from a physical point of view in terms of the internal supply chains that those products do go into those settings, as required and as requested by health boards, trusts and other NHS orgs. So, it's really a part of a much wider plan that's in place to ensure that the appropriate PPE product is used in the appropriate setting. 

I may be wrong on this, so please correct me, but my understanding is that Betsi Cadwaladr set a higher standard of PPE that it needs than the other health boards. How do you ensure that people get the right thing to the right place? Everybody can ask for the best PPE and the most effective PPE for every setting, but that might not be the best use of resources, and it might mean others missing out. Am I missing something? 

Jonathan's got his hand up. I was just about to say something, but I'll let Jonathan comment. 

Okay. Thank you. I'm not aware of any higher quality PPE being supplied to Betsi or anywhere else within Wales. In terms of quality, there is only one quality, if I could state it like that, in terms of the standards that products are required to comply with. So, in that respect, the quality and the relevant standards, regulations and testing requirements that PPE has to meet, our products meet it. There isn't a higher standard as such that I'm aware of. There may well be discussions and deliberations on a UK-wide basis in terms of maybe looking at introducing new products in the future, but again, within shared services in particular, we will react and facilitate those products as and when we're asked to do so. 

My experience, again, is that there are some people who have the full breathing apparatus, are fully covered, and others have what I would call the plastic PPE. Is that not the case? 

I can't comment on individuals. There is a clear and agreed pattern and presentation of PPE in terms of face masks, aprons, gloves, the type of face masks, full respirator or type IIR, et cetera, and the settings in which those are supposed to be used. I can't comment on whether individual health boards, for instance, have made additional products available to staff or not. It's not really my area. 

Thank you very much. To come back to the first question I asked, there are different standards. There are face masks and then there's the full breathing apparatus. 

There's two qualities of mask that we're supplying under PPE. There's a type IIR mask, which provides a filtration efficiency of, I think, around about 95 to 98 per cent. Then there's our P mask, which is the FFP3 type that I was asked a question on previously, which is used in aerosol-generating procedures. It's not that there are two qualities—there are two types of mask for two different settings. 

Either I'm not making myself clear or I'm not understanding you. The different masks are created against different standards. One is of a higher standard than the other in terms of the protection. 

Yes, that's correct, and we supply the mask appropriate to the setting where it's been deemed that that mask should be used.

Thank you. Now, to get back to the first question I asked, how do you decide that you get the right one to the right place? 

We don't make a decision as NHS Wales shared services. We supply the masks to those areas within the health boards that ask for them. 

Yes, I was going to say—. I was just about to add that this is drawing on my experience at a local level having just come from a health board. Within the local health boards, the requirements around infection control and prevention are really clear and they are nationally set. At a local level, the infection prevention and control teams are in regular contact with all the areas to make sure that the requirements are being properly adhered to, that staff have the right level of protection and are using the right equipment in the different settings. So, that's done at a local level.

10:15

I won't try and push it any further—we might send you a letter.

Okay, thank you, and if you do I'd be grateful if you could share the response with the committee, Mike.

Ie, diolch yn fawr. Dwi'n mynd i ofyn y cwestiynau yma yn Gymraeg, os caf i, ac mae'r cwestiynau yn mynd i fod ynglŷn â chleifion a staff sydd yn dal COVID mewn ysbytai. Mae'r cwestiwn cyntaf ynglŷn â chleifion yn dal COVID tra mewn ysbyty. Felly, a gaf i ofyn am ddata wrthych chi ynglŷn â faint o gleifion sydd wedi dal COVID-19 tra mewn ysbytai, a'r gwahaniaethau neu'r amrywiadau rhwng ysbytai a'i gilydd, a'r gwersi sydd wedi cael eu dysgu ynglŷn â sut rŷm ni'n rheoli trosglwyddiad y feirws yma o fewn sefyllfaoedd fel ysbytai?

Yes, thank you very much. I'm going to ask these questions in Welsh, if I may, and the questions are going to be about staff and patients who contract COVID in hospitals. The first is about patients contracting COVID while in hospital. So, could I ask for data from you about how many patients have contracted COVID-19 while in hospital, and the differences or the variations between hospitals, and the lessons that have been learnt about how we control the transmission of the virus within settings like hospitals?

Thank you. It's probably appropriate to draw in the chief medical officer on the issues around infection prevention and control. So, thank you, Frank.

Yes, thanks for that. There's a very clear link between community transmission and hospital transmission. We've seen, throughout each of the waves of the pandemic, a very clear correlation between those two things. Whenever community transmission is high, the rate of nosocomial, as we call it—you know, transmission within hospitals—goes up as well. That's true, actually, not just in hospitals, but in all closed settings. We see it in schools, we see it in care homes, we see it in prisons—we see it in all closed settings.

Over time, that correlation has changed. So, for example, in the first wave, thinking back to there, there was a very significant—. About 11 per cent of cases that we identified at that time were identified in hospital transmission environments. But of course, we have to remember that at that time, most of our testing was in hospitals. We weren't actually doing a lot of testing in the community. So, perhaps a more relevant contrast is between the second wave and the current wave that we're in. In the second wave, we think about 3 per cent of transmissions were in a hospital environment. In the current wave, it's probably about 1 per cent. And we also need to think about the route of transmission, because in the early days, the anxiety and the worry was about transmission from patients to staff, which is what you've just been talking about in terms of PPE, and also from staff to patients. In more recent waves, the transmission has largely been, we believe, from patients to patients.

I can't give you an immediate answer to your question about variations between health boards, but clearly different boards—. All of our hospitals have experienced outbreaks, and we've had to respond to those over the different waves of the pandemic. In terms of the lessons learnt, I suppose what I would say is that we've regularly updated our guidance to the sector, to the NHS, so that the lessons that—. As we've learnt more about coronavirus and how it spreads and how it transmits, we've been able to update our guidance. That comes back, partly, to your questions about PPE; we've followed very closely in Wales the recommendations of the infection prevention and control cell, which is a four-nation body. In fact, Wales—. One of my colleagues in Public Health Wales currently chairs that. So, we take that. But it's more than just PPE. PPE is important, but it's a part of the hierarchy of controls that we know can reduce hospital transmission. So, the other things that we need to think about: we've had to make changes to bed spacing; we've made changes to ventilation and provided guidance on that, and of course on cleaning and hygiene standards, both for personal hygiene and washing, et cetera, but also environmental cleaning. So, we've regularly updated all of that guidance.

Gaf i ddilyn lan gyda chwestiwn arall, mewn gwirionedd? Fe welais i eitem gyda'r BBC rhai misoedd yn ôl a oedd yn dangos bod yna dipyn o amrywiaeth rhwng pobl neu gleifion a oedd yn dal COVID mewn ysbytai mewn gwahanol fyrddau iechyd, felly byddai'n dda gweld rhyw fath o astudiaeth ynglŷn â hynny—p'un ai oes yna rai byrddau iechyd wedi rheoli'r haint yn well mewn ysbytai na rhai eraill. Ond, jest i ddilyn ymlaen, o ran niferoedd staff a gofalwyr sydd wedi dal yr haint o fewn ysbytai neu gartrefi gofal, ydych chi'n gallu rhoi rhyw syniad i ni o beth yw'r niferoedd yma a faint sydd, yn anffodus, wedi marw o COVID oherwydd hynny?

Could I follow up with another question? I saw an item on the BBC some months ago that showed that there is great variation between patients who contracted COVID in hospitals in different health boards, so it would be good to see some kind of study on that—whether some health boards have controlled the infection in some hospitals better than others. But, just to follow on, in terms of staff numbers and carer numbers who have contracted the virus within hospital settings or care homes, could you give us an idea of those numbers and how many have, unfortunately, passed away from COVID in the wake of that?

10:20

Shall I have a first stab at that, Judith? Would that be okay?

Yes, thanks, Frank.

Building on what I just said earlier, it's true that health and care staff have been affected by COVID, and sadly, some have become very severely infected and some people have died. But it's very difficult to disentangle where they contracted those infections, for the simple reason that, as I say, when rates are very high in the community, they're high in hospitals as well. So, we can't say that because a health care worker has been badly affected or has passed away that that was due to transmission in hospital.

The Office for National Statistics, the ONS, does report, of course, on every death and they collect death certificates. And death certification does have an occupational link, and so it is possible, through the ONS, to get a figure on the number of health and care workers who have passed away with COVID. That doesn't exactly answer your question, because it doesn't relate to the question of where they contracted the disease, of course.

In Wales, we do have a comprehensive system of collecting data from health boards, and so, whenever there is a COVID death, we collect and collate some of that information. So, there will be some information that will be available through that. So, to your point about whether there are questions we can ask and studies we can do, that would be a source of information that would help us in the future.

Diolch yn fawr. Jest yn olaf i ddilyn ymlaen o hwnna, mi fyddwch ch'n gwybod bod Pwyllgor Cyfrifon Cyhoeddus San Steffan wedi gofyn i'r Llywodraeth i ymgymryd ag astudiaeth i geisio deall y cysylltiad rhwng y prinder offer PPE ac infections a marwolaethau. Ydych chi'n bwriadu gwneud rhywbeth tebyg fan hyn yng Nghymru, ac ydych chi mewn deialog gyda PAC yn San Steffan er mwyn deall yn well beth yw'r sefyllfa o ran hynny?

Thank you very much. And finally, just to follow on from that, you'll know that the Public Accounts Committee in Westminster has asked the Government to undertake a study to try and understand the link between the shortage of PPE and infections and deaths. Do you intend to undertake a similar study in Wales, and are you in dialogue with the Public Accounts Committee in Westminster to better understand what the situation is in terms of that?

My understanding on that last point is that we have, as yet—and I will check with my colleagues as well—had no contact from the UK Government specifically on that issue. If we have, Frank will know. So, Frank, have you had any contact with the UK Government on that specifically?

No. There's been no dialogue through chief medical officers and none through any other route that I'm aware of at the moment. Of course, what we can say—. It would be very difficult to disentangle that issue. I think it's probably a research question, which would be quite tricky to do. We did have the audit report in Wales, which pointed out that you can't make a link between any individual's death and PPE or the relationship with PPE. So, I'm not sure that that would be a—. I don't know how UK Government is handling that, but we've not had any dialogue, as Judith said.

Ie. Dwi'n deall yn iawn ei bod hi'n amhosibl gwneud y cysylltiad uniongyrchol yna rhwng dal yr haint a marwolaeth posibl, ond o leiaf byddai rhyw fath o ymchwil yn dangos tueddiadau—rhyw trends—o ran y cysylltiad rhwng prinder PPE neu PPE anaddas, yn arbennig ar ddechrau'r pandemig, a thostrwydd a marwolaethau.

Yes. I understand that it is impossible to make that direct link between catching the virus and possible death, but at least some research would show some trends in terms of the link between the shortage of PPE or inappropriate PPE, particularly at the start of the pandemic, and illness and death.

10:25

Well, if I may, Chair, I think in your question you're implying that there was a shortage of PPE. We never ran out of PPE in Wales. We came close. It was very difficult during the first wave, and Jonathan can give you chapter and verse on that, but we never ran out. People had access to PPE. So, to imply that it was a shortage of PPE that led to deaths is nothing that I would recognise as a valid statement.

No. I'll just add that I think most of us will have had casework that would suggest that shortages in various sectors, certainly in the early months, did lead to infections and deaths, and clearly we've seen many cases of that reported in the media. In terms of hospital-acquired infections, I and I'm sure colleagues have had casework where people who were non-COVID patients were placed on and left on wards with patients who had tested positive for COVID. In one case when I intervened, I was told, 'He's been exposed anyhow.' It was only after my intervention that he was moved. He wouldn't have been moved otherwise. He never tested positive. He survived. Another one, some months later, same ward, not a COVID patient, COVID patients on the ward—he tested negative in NHS out-patients, he tested negative when admitted to the hospital, but when he was moved on to the next hospital, he was positive. He nearly died and he's now receiving palliative care. So, there is more than anecdotal evidence, I would suggest, of hospital-acquired infections, but that's something we'll have to explore on another day.

We'll now take a short comfort break. Could we be back for 10:31, please?

Gohiriwyd y cyfarfod rhwng 10:26 a 10:37.

The meeting adjourned between 10:26 and 10:37.

10:35

Good morning. Welcome to Jo-Anne Daniels and Elin Gwynedd, who have now joined us for this session. I'd be grateful if each of you could very briefly just introduce yourselves and tell us what your roles are, perhaps starting with Jo-Anne Daniels.

Bore da, good morning, everyone. My name is Jo-Anne Daniels. I'm the director with responsibility for test, trace, protect in the health and social services group.

Bore da. I am the deputy director for vaccine policy, specifically the COVID-19 vaccine policy.

Thank you. I'll jump straight to questions, if I may, and start with a very short question: does the Welsh Government intend to produce a longer term plan for vaccine roll-out in Wales, in the context of evolving scientific advice and political decisions, or will planning continue to be based around shorter term priorities?

So, if I could provide a short answer to that, clearly, the immediate focus is on the delivery of the campaign as it is at the moment in the vaccine programme. But, yes, we recognise that COVID-19 may be here to stay, so we are now giving thought to what that longer term strategy might look like.

Welcome to our new guests today. I just wanted to know whether the roll-out of the booster programme is indeed actually on track. We all know winter is coming, as they say—and sorry to sound like a role in the Game of Thrones when I say that. But I just wanted to know, are you on track to actually jab all of those people now who are actually eligible to receive it?

Thanks. I'm going to bring Elin in on that. Thank you.

Our plan and our strategy was to vaccinate the majority by 31 December, and based on the timing of the strategy and those eligible at that time, yes, we're confident we're going to reach between 80 per cent and 90 per cent of those before 31 December. The challenge we have, of course, is that the goalposts keep moving. On Monday just been, the Joint Committee on Vaccination and Immunisation added another cohort to those who are eligible for boosters. Now, the six-month interval guides us to know when they are due, but some of those might be due before 31 December. So, with those goalposts changing, it is a challenge to try and get to all of them. But, based on the time of the strategy and the intention in there, yes, we're confident we're going to reach it.

10:40

It's a great percentage and I'm really happy to hear that you're on track. But one concern that I, and I'm sure my colleagues, have are those people in care homes. So, I just wanted to know, have you managed to target all of the care homes all across Wales now? Are they all covered or are there still some that are yet to be done?

So, there are still some to be done, but only because there were infection rates there at the time. So, of those who could be vaccinated by 1 November, they were vaccinated. But you will see that percentage still going up because some care homes were closed at that time. So, health boards are revisiting those. So, we're on 77 per cent at the moment, but that will still be creeping up as they become eligible post 28 days.

Fantastic. If it's not too much trouble, can you please explain to me—I'd very much like to know, and I know that Wales has many different health boards, which is obviously a given—when it comes to actually rolling out, how does it work? How are they allocated? Are they all working in sync? Are the deadlines the same for all health boards when it comes to rolling them out? If you could just give me a little bit of background on it, I'd be very grateful.

Yes, so there is a national directive, really, to make sure that everybody is at the same pace and they're given, based on their population, a certain amount of vaccine. So, the national strategy aims to get everybody to the same place at the same time, which is that the majority will be vaccinated, in terms of a booster, by 31 December. It's the same with the 12 to 15-year-olds. The national aim was to offer a vaccination to all 12 to 15-year-olds by 1 November, and the same with care homes. So, there's a national approach to it, but there are variances in health boards because they're very different in terms of geography and in terms of population.

And just to clarify the 'national' that you're speaking about, is that UK wide or just Wales wide, just for my own general knowledge?

It's a little bit of both. So, we all follow the JCVI advice, and that's UK wide, but we have our own approach to it in Wales, as do the other nations. But they're very similar in how we follow the science and the evidence, it's just that the delivery is slightly different in various nations. 

So, can you just give me an example of how we're different to, say, England or Scotland, for example, please?

So, an example is maybe how we call people. So, in England, you have an opt-in system, where there's an online booking system and the onus is on the individual to book. In Wales, you have an opt-out system, in which they will be invited—everybody will be invited through a letter, and they have to opt-out of not coming to that appointment. So, an appointment is scheduled for them. But it's still the same approach in terms of who is invited because that's based on the JCVI advice.

Just to go on on this one, the system that we have here in Wales, does that not leave more room for people not taking it up, if it's not—? If you're being invited, for example, there is more leeway to not actually attend appointments, which perhaps leads to a lot of people sitting around waiting to jab those people who aren't coming. Has that been the case?

It is a risk, but actually, in terms of Wales, the turnout or the uptake has been phenomenal to date, which is why Wales was very much ahead in terms of not just the UK nations, but the world in phase one and phase two. But as people's lives open up now with more freedoms, this is why we are bringing in a digital system—not to take the place of the letters, but to allow people to reschedule. So, they will still get the letter of appointment, but the intention is to reschedule, so keeping to the opt-out system rather than putting the whole onus on people to opt in.

Okay, thank you for that. My final question now: are there any concerns for any of you that the roll-out of the booster jabs, specifically here in Wales, will not be quick enough actually to address waning immunity amongst vulnerable groups?

I think that's always a concern. We're looking at the science and the data. At the moment, the science and the data are in line with our intention to vaccinate people before 31 December. We are always going as fast as we can, and the NHS and the vaccinators and the pharmacists and all involved are doing a phenomenal job in trying to move as quickly as possible. We would always, and all the nations would agree, want to go as quickly as possible, but there are also limitations in terms of restrictions to that. We can't go quicker, for example, in vaccinating those that aren't six months from the second dose. That guides us, and that means that we couldn't go quicker even if we wanted to.

10:45

Diolch yn fawr iawn am eich atebion hyd yn hyn. Dwi jest eisiau dilyn i fyny gyda’r ateb roeoch chi ynglŷn â rhai sydd wedi cael y brechlyn atgyfnerthol—y booster jab—ac mae’n dda clywed bod yr ymateb wedi bod yn galonogol iawn. Ond, wrth gwrs, dwi’n cael pobl yn cysylltu gyda fi sydd ddim wedi derbyn y gwahoddiad ac yn awyddus iawn i gael y booster jab yna. Felly, dau gwestiwn mewn gwirionedd. Pam nad ydym ni’n agor y cyfle i’r bobl yma i wneud apwyntiad eu hunain yn hytrach nag aros i gael y gwahoddiad? A’r ail ran o hwnna, er mwyn trial cael mwy o bobl i dderbyn y brechlyn atgyfnerthol yma, oes modd agor lleoliadau cymunedol a lleoliadau cynradd, fel meddygfeydd ac ambell ddeintyddfa neu fferyllfa, fel bod pobl yn gallu mynd i mewn fanna i gael y booster jabs yma yn hytrach na jest i ganolfannau penodedig? Felly, dwy ran i’r cwestiwn.

Thank you very much for your responses so far. I just wanted to follow up with the response you gave regarding those who have received the booster jab, and it's good to hear that the response has been very heartening. But, of course, I have people getting in touch with me who haven't received the invitation and are very keen to have the booster jab. So, I have two questions, really. Why aren't we opening up the opportunities for these people to make the appointments themselves rather than waiting for the invitation? And the second part of that, in order to try and get more people to receive the booster vaccine, is there a way of opening up community facilities and primary care facilities, such as GP surgeries, dentist surgeries or pharmacies, so that people can go there to receive their booster jabs rather than just to specific centres? So, two parts to the question.

Okay. So, if I take the first question first, about why not move to walk-ins, which I think is what you’re asking, in terms of the booster, there is a risk with moving to walk-ins, which is that you end up vaccinating those less vulnerable first, rather than vaccinating the most vulnerable. So, our model in Wales is to vaccinate them in the order of vulnerability, the same as in phase one and phase two. If we were to open up vaccinations, especially with a digital system, then a healthy 41-year-old might be vaccinated ahead of a person who is more elderly and with more risk. So, we feel that the system now is fairer and actually follows the science and the data.

In terms of your second question, in terms of bringing primary care and community pharmacists online, that is happening in many places in Wales. It is a targeted approach, because GPs and community pharmacists have started to do the things that they couldn’t do in phase one and phase two, and go back to the day job, if you like. And there’s less time that they can give to do this. But there are lots of examples of, for example, GP clusters or community pharmacies that do additional work at weekends and hold clinics for the very reason you gave, which is to make it accessible for those, and also to go quicker. So, I think we will see even more of that in the coming weeks and months.

Iawn. Diolch yn fawr ichi. Y cwestiwn nesaf yw: ydych chi’n gweld cynnydd yn nifer y bobl sydd wedi dal COVID yn ein hysbytai ni neu’r rhai sydd yn cyflwyno eu hunain i feddygfeydd sydd wedi cael y ddau frechlyn yn barod?

Fine. Thank you very much. The next question is: are you seeing an increasing number of people who have contracted COVID in our hospitals or people who present themselves to surgeries who have received the first two doses already?

I'll ask Frank Atherton to come in on that, because I know his team have been looking at that particularly.

Yes. Thank you. Of course, we are seeing people in hospitals and, sadly, people are passing away who are vaccinated, who’ve had either one or two doses. But what we have to remember is that most people who are eligible in Wales, as Elin has just been saying, have been vaccinated. So, where you have very high levels of vaccination, inevitably, you will see people who are vaccinated coming to harm.

What I can say with absolute certainty is that people who are unvaccinated or people who have not received their full course of vaccine are far more likely to be suffering harm in terms of serious illness, in terms of hospitalisation, and in terms of death. There is no doubt that vaccines are holding the line. I mentioned earlier we have these enormous—. We still have very high levels of community transmission here in Wales, and it’s really only the vaccine programme that is stopping more harm accruing through our hospitals. So, I hope that answers your question. You’re far better off being vaccinated than not.  

I understand, clearly, the harm that’s been prevented by having the two vaccines, but I was asking specifically about whether you’ve seen an increase in the numbers of people affected by COVID who’ve had the two jabs already.

10:50

Well, there are two issues to that. One is the question of incidence—people acquiring coronavirus—and the other one is people coming to harm. On both of those issues, the waning immunity question arises. Vaccines originally were intended to stop serious harm—that was their prime goal—and as the immunity wanes, yes, we are seeing more people coming into harm, and that's really why the JCVI, looking at all the data across the whole of the UK, came to a conclusion that we should have a booster programme.

Diolch yn fawr. A'r cwestiwn olaf gen i yw: rŷn ni'n dod at y gaeaf ac mae yna lawer iawn ohonom ni yn cael ein brechlyn ar gyfer y ffliw, ac mae hynny ar gael mewn nifer fawr o fannau sydd yn gyfleus yn ein prif drefi ni; oes yna gyfle fan hyn, efallai, i gynnig y brechlyn atgyfnerthol, y booster yna, ochr yn ochr â chael brechlyn ar gyfer ffliw, fel bod pobl yn gallu cael y ddau ar yr un pryd er mwyn cynyddu'r niferoedd sydd yn derbyn y ddau?

Thank you very much. And my final question is: we're approaching winter and many of us will receive our flu vaccine, and that is available in a great number of places that are convenient in our towns; is there an opportunity here, perhaps, to offer the booster side by side with the flu vaccine, so that people can have both at the same time in order to increase the numbers who receive the two?

Shall I take that one?

Yes, thanks, Elin, because I know it's been part of our considerations at the moment, hasn't it?

Yes, very much so. There are definitely opportunities to explore this further. In fact, 11,500 front-line healthcare workers and some care home residents have already had co-administered flu and COVID jabs. I think there's definitely more scope to look at this, especially the planning that we've started for next winter, and looking at the opportunities to maximise both vaccines at that time.

Dwi'n derbyn eich bod chi'n meddwl ymlaen ar gyfer gaeaf nesaf, ond dwi jest yn meddwl am y gaeaf yma. Roeddech chi'n dweud bod yna botensial iddo fe, ond mae'n ganol mis Tachwedd. Oes yna rywbeth y gallwn ni ei wneud i gyflymu'r broses ac i wireddu'r posibilrwydd yna o gael y ddau frechlyn ar yr un pryd nawr ar gyfer y gaeaf yma?

I accept that you're thinking ahead for next winter, but I'm just thinking about this winter. You were saying that there is a potential for it, but it's now the middle of November. Is there something we can do to progress the system and get this possibility of having both at the same time now for this winter?

Dwi'n meddwl mai'r risg ydy ein bod ni'n arafu'r ddau, gan fod y broses o roi'r brechlyn ffliw yn eistedd efo GPs yn aml yn iawn, ac efo community pharmacists, lle mae'r broses o frechu efo COVID yn eistedd yn aml iawn yn y mass vaccination centres. So, o ran trio logistically rhoi hwnna at ei gilydd, mae yna beryg ac mae yna risg y buasai'n slofi'r ddwy broses i lawr. So, pan mae yna gyfle, yn unol â'r cyngor gan JCVI, rydyn ni'n ei gymryd o, ac yn aml iawn mae hwnna efo'r front-line health and social care workers, ac mae wedi bod yn gyfle inni destio hwnna. So, mae 11,500 o bobl wedi cael y ddau ar yr un un pryd yn gyfle da inni weld sut mae hwnna'n gweithio wrth fynd ymlaen.

I think the risk is that we decelerate the two, as the process of giving the flu vaccine sits with GPs very often, and with community pharmacists, whereas the process of vaccination with COVID sits with the mass vaccination centres. So, in terms of logistically putting that together, there is a risk that it would decelerate the process. So, when there is an opportunity, in accordance with the advice from the JCVI, we do take it, and very often that is with the front-line health and social care workers, and it has been an opportunity for us to test that. So, 11,500 people have had both vaccines at the same time, and that's a good opportunity for us to see how that works going forward.

Okay, Cefin. Thank you very much indeed. Mike Hedges, I believe you have a question.

Yes. Apologies, it's relatively long. The first thing is that I've been in contact with the British Society for Immunology, because I, like everybody else, have had loads of people saying, 'Vaccines don't work', 'People who have been vaccinated are catching COVID and passing it on.' The information I had from them—I'm just checking whether you agree with it—is that you have 50 per cent less chance of catching it if you're doubly vaccinated, and that it also gives you a 50 per cent reduction in passing it on. And they say that, using ONS data, the age-adjusted risk of death from COVID-19 was 32 times higher for the unvaccinated than the vaccinated. So, are those figures you recognise?

Frank, you probably want to comment on that.

Yes. We would need to—. Ballpark figures I would say 'yes'. It goes back to my point about the purpose of vaccines. Vaccine effectiveness, whether it's AZ or the Pfizer, is very high—very high indeed—against hospitalisation and death, at a level of 95 per cent. So, that probably relates to your age-adjusted risk that you have there. The vaccines are less good at stopping transmission—so, 40 to 50 per cent is probably about right. So, I recognise the order of magnitude of what you're saying without having the ability to work out the maths of it all.

10:55

The other thing, of course, is that they say that one of the vaccines has 92 per cent efficiency at stopping people being hospitalised with the delta variant, the other one 96 per cent, which I think is probably statistically not significant, so I won't name which one. But this idea that vaccination doesn't work is a real problem we have, we have as politicians and, I think, Dr Atherton, you have as doctors. What can you do to get GPs to explain to their patients just how important the vaccinations are?

May I do this? You're right that there are small differences in vaccine effectiveness, but some of that relates to the fact that the trials were conducted with different metrics. So, your point is absolutely right that we need to persuade everybody of the evidence, which is very strongly in favour of a benefit from vaccination. I think one of the challenges is keeping messages simple. So, everybody needs to be saying, 'You're better off to be vaccinated than not vaccinated if you don't want to end up in hospital or dying.'

The last point on this is: how do you get GPs to tell their patients? Because they seem to be losing something in GP surgeries—that nurses and GPs are not promoting double vaccination in every case as often as I would like.

My view is that—I don't know if you have specific examples, but we need to make sure that all healthcare professionals are providing those messages. You're well aware we've had particular concerns about pregnant women not having sufficient uptake of the vaccine, and we've taken specific action through midwives, through obstetricians in order to address that, but I'm not aware of any GP who is giving messages that are not consistent with the message that you should get vaccinated. But if you know of examples, then we'd be happy to hear of them and follow them up.

My problem was not giving the message—not telling people when they're seeing them about something else about how important it is. So, they're seeing me, perhaps for my bad finger, and they also say, 'You realise how important it is for you to be doubly vaccinated.' So, getting that message across every time they see a patient.

It's a good point. Thank you.

Thank you. I'd say that my GP's been brilliant in this area, but, Mike, would you like to ask your short question on COVID passes now?

Yes. I have concerns that a number of people just aren't going out; they're concerned about going into dangerous areas. I have examples of this. I go to a quiz on a Thursday night, and they've lost one team and another team is running on half their members. I used to go to a quiz on a Sunday night, which isn't taking place because the people are not happy going out. Can places that are not having to have a COVID pass ask for people to provide a COVID pass when they attend, because I think a lot of these older, vulnerable people may well be prepared to go out if they think everybody else in there has also been vaccinated?

Jo-Anne, did you want to come in on the COVID pass situation and what the current guidance and regulations are? 

As the Senedd Member points out, one of the potential benefits of the COVID pass is the confidence that it gives to people to attend events and to undertake social activities that are so important for their well-being and so important for moving on within the context of a pandemic. It is possible for venues to choose to use the COVID pass if they wish; the facility is there for them to do that. Again, Senedd Members may be aware that over the summer quite a number of events chose of their own volition to use the COVID pass, so, for example, the Green Man Festival required the COVID pass for people attending. So, it is, of course, available to events and organisers to use.

Within our set of reasonable measures that we expect all businesses to consider as part of their risk assessment, in our guidance, we do highlight that the COVID pass is one possible measure that they can choose to adopt if they feel that that's an appropriate way of managing the risk within their settings. But, again, as you've highlighted, it's not just about managing risk, but it is also about managing the confidence of those individuals attending. 

11:00

Thank you. If I can further expand on this area: what consideration, if any, have you given to the findings of our sister committee in Westminster, published in June, with regard to COVID status certification? They expressed concern that Government had not provided sufficient scientific justification or cost benefit analysis for the COVID pass approach, and also pointed to analysis by Public Health England suggesting that both vaccinated and unvaccinated people can carry the virus into any setting.

And in that context also, how will you be evaluating the impact of COVID passes, and whether they have the effect that you desire?

Jo, do you want to come in on that? Yes, okay, I can see you nodding. Thank you. 

So, again, as Senedd Members will be aware, since August, and through September, we've seen, and Frank has highlighted, an increase in community transmission within Wales. The Strategic Advisory Group of Experts on Immunization advice, which was published back in September, was very clear that Government should act early to slow down the growing increase in cases, and SAGE advice also indicated that low-cost interventions, a series of smaller, but nevertheless potentially positive interventions, would be appropriate and would help to avoid, potentially, the need for tougher restrictions at a later date.

So, I think this advice has obviously been taken very seriously. Nobody wants to see significant restrictions, closures of businesses, closures of parts of society again. And, so, for that reason, the COVID pass has been introduced. But it's important to highlight that the COVID pass is part of a series of measures to mitigate the spread of COVID through the community, and, obviously, the harms then that are associated with that.

And, as I mentioned as well, we have, of course, benefited from having had significant experience of the COVID pass being used on a voluntary basis, both as part of the research events that we did with a number of partners back in June and July, and then, as I say, over the summer, with a number of organisations choosing to use them as one of their risk-mitigation measures. 

In terms of evaluating the effectiveness, obviously it's still early days. The system's only been in place now for less than a month. We've had some quite positive feedback from stakeholders, and from people using the pass. So, we've had messages from organisations to say that, actually, the process of checking passes, the digital software, the verifier app that they use, has been really quite straightforward, and they haven't had the logistical challenges that perhaps some of them were concerned about, which has obviously been really positive. We've also had some positive feedback from individuals, saying that is has given them a bit more confidence sometimes to go to events that they might otherwise have been concerned about. 

So, we're working on a plan that will set out a programme of work for evaluating its introduction. That plan needs to consider an assessment of the impact, the costs and benefits, and any behavioural issues associated with its implementation.

I would highlight though that, of course, since the pass was introduced, there have also been other measures and other changes that have taken place, and so, of course, isolating the specific effects of the COVID pass will be very challenging. But we are also, of course, looking internationally, and again, Senedd Members will no doubt be aware that there is now very, very widespread use of equivalent systems right across Europe and in many other parts of the world, so we will continue also to monitor their experiences and the evidence that they gather.

11:05

Very well. We know from a Government report three weeks ago that, for example, masks, which are mandatory in Wales, are being worn less in Wales than in England, where they're non-mandatory. In terms of COVID passes, how, if at all, are you going to monitor and enforce their use, particularly where, as we've seen in the media today, businesses are stating that they won't apply them, even though, technically, according to the vote in the Senedd last week, they must, and, in that context, what support, if any, is the Welsh Government proposing to provide businesses to offset the possible costs that they will incur if they do administer this, as the Government requests?

Again, Jo, I think that's one for you, isn't it?

Yes. So, the enforcement arrangements that sit around the COVID pass are essentially the same as those that sit around the wider set of reasonable measures that businesses and settings are required to undertake. So, that enforcement regime, the monitoring of compliance, is led by local authorities—the really important work that their environmental health officer teams undertake. Obviously, there's an element of that compliance and enforcement that will potentially involve the police, and we're getting regular feedback from those enforcement agencies in terms of flagging any areas of concern that they might have. In terms of—. Sorry, there was a second part to your question, which I'm now slightly—.

It was what, if any, support is being proposed for business to offset their additional costs?

Yes, apologies. So, in terms of the support for businesses, we've got an extensive set of guidance, frequently asked questions, provision of communication materials. We've had a significant number of stakeholder meetings, both prior to the introduction of the pass and as we move forward. So, again, we're continually receiving feedback from stakeholders. It won't surprise you to know that they're not shy in telling us what they think and how they feel things are going. So, we're keeping in dialogue with them, but, of course, even for these organisations, sometimes it can be difficult to understand the impact that the pass is having on their business versus all the other dynamics of winter, the levels of community transmission, the general sort of move out of lockdown and what's happening to the economy.

We're running out of time. If you don't mind, we'll write to you with the remaining questions we have in this section, and we'll move finally to testing capacity, and, Cefin, could I ask you to take up with some questions?

Ie. Diolch yn fawr iawn. Mae'r cwestiwn cyntaf ynglŷn â'r lighthouse labs. Rŷn ni wedi gweld tystiolaeth bod y defnydd o'r lighthouse labs  dros y 18 mis diwethaf wedi cynyddu. Felly, y cwestiwn cyntaf yw: oes modd inni gynyddu'r capasiti o fewn y gwasanaeth iechyd yng Nghymru i ymgymryd â mwy o'r gwaith hwnnw a llai o'r lighthouse labs, ac ydych chi'n gallu rhoi rhyw asesiad i ni o'r manteision a'r anfanteision o ddefnyddio lighthouse labs yn hytrach na'i wneud e'n fewnol o fewn y gwasanaeth iechyd, yn arbennig o safbwynt y gost o ddefnyddio'r naill fodel neu'r model arall? Diolch.

Thank you very much. The first question is regarding the lighthouse labs. We've seen evidence that the use of the lighthouse labs over the last 18 months has increased. So, the first question is: is there a means for us to increase the testing capacity within NHS Wales to undertake more of that work and reduce the use of lighthouse labs, and can you provide us with some sort of assessment of the advantages and disadvantages of using lighthouse labs rather than doing it internally in the NHS, in particular from the perspective of the cost of using either model or other models?

Thank you. Jo-Anne, I know that's one that you've been looking at in terms of the capacity across NHS Wales and the use of the lighthouse labs, so I know you'll be able to address that issue.

I think there were a number of angles in terms of the question—so, could we increase capacity in Wales, is it feasible to do that, do we have the laboratory capacity, do we have the workforce, do we have the necessary components? I suppose then there's a question about whether we think it's necessary, and then, as you highlight in the context of costs and economies of scale, whether it would be beneficial. So, just to give you a sense of the scale at the moment, Public Health Wales's laboratory capacity on a daily basis is around 8,000 tests a day, but with the ability to surge to 15,000 tests if required. That 8,000 capacity is predicated on the fact that PHW of course has to deliver other laboratory services as well, and, as the NHS is undertaking more and more activity, then those other laboratory services are critically important to ensuring that we can support clinicians in their diagnostic and treatment plans.

The capacity in terms of the lighthouse labs—and obviously here I'm talking about PCR testing—is 30,000 tests a day, so it is significantly greater than we have available within Wales. We have, of course, invested in the NHS Wales capacity. So, back in the summer of 2020 we invested an additional £32 million into the PHW lab network to deliver 24/7 lab capacity and to deliver rapid testing within each of our major hospitals across Wales. The lighthouse network, of course, gives us a degree of flexibility to respond to surges in testing demand that, were we to operate entirely on our own, we wouldn't necessarily be able to accommodate. It's also inevitably the case that sometimes the machines that are used in the laboratories, they break down, they need to be repaired, they need to be rested, and so actually being part of a wider network that means we can manage the performance of those machines and those testing assets is also important.

When Audit Wales undertook their report, I think just over a year ago now, they highlighted, I think, some of the benefits that we'd gained from being part of this wider network, and of course the lighthouse labs are one part of the UK national testing programme that we are, as four nations, all part of. A significant element of that national testing programme is of course the new testing technologies that have been brought on stream and have been scaled up at a pretty rapid pace. So, again, Senedd Members will be very familiar, I'm sure, with lateral flow devices and the widespread use now of those for people to undertake testing at home and in the workplace. But we've also benefitted from point-of-care devices, in particular in our hospitals, so a range of rapid, new testing technologies that are helping the NHS, in particular at the front door, to identify patients who may have COVID and then stream them appropriately. These tests are quicker than the traditional PCR lab tests and so they facilitate that patient flow. So, I think there's a range of potential benefits from that four-nations approach.

11:10

Diolch yn fawr. Rwy'n gallu gweld yn glir beth yw'r manteision o ran y capasiti sydd gan y lighthouse labs, ond roedd fy nghwestiwn i hefyd yn gofyn am y budd ariannol, y cost benefit, i'r gwasanaeth iechyd yng Nghymru pe baen ni'n buddsoddi mwy yn y profi yna yng Nghymru. Licwn i, efallai, glywed mwy am hynny, achos mae'n amlwg, dros y 18 mis diwethaf, rŷn ni wedi gweld mwy o ddibyniaeth ar y lighthouse labs. Felly, hynny yw, rhywbryd mae'n rhaid inni fuddsoddi yn y gwasanaeth hwnnw yng Nghymru, a phryd mae'r pwynt yna yn mynd i ddod?

Thank you very much. I can see clearly what the advantages are in terms of capacity, and with regard to the lighthouse labs, but my question also asked about the cost benefit to the NHS in Wales if we invested more in that testing in Wales. I'd like perhaps to hear a little bit more about that, because it's clear, over the last 18 months, that we've seen more reliance on the lighthouse labs. So, at some point we're going to have to invest in that service in Wales, and when is that point going to arrive?

So, as you indicated, there is a cost advantage to a bigger network of laboratories, because the unit cost per test is lower.

In terms of whether we would—. I suppose there are two sides to trying to answer your question. There's a presumption that we would withdraw from the national testing programme or we would stop using the lighthouse labs. It's not clear exactly why we would need to do that, other than if it were out of choice. I think there's also a question about—inevitably, as we, hopefully, see the demise of COVID, or at least the reduction of COVID to much lower levels and a disease that we have to learn to live with—the role of testing and whether the current volumes of testing would continue to be appropriate and would continue to represent the best means of responding to the pandemic. And so I think it is a critical question for us, moving forward, as to what the right level of testing capacity is, but that is very much tied up with the epidemiology and the approach to managing the virus in the future.

So, I think that's a way of saying that it's very difficult at this point in time to tell which way COVID is going, and that will determine the best approach to how we deploy testing.

11:15

Ocê, diolch. Y cwestiwn olaf: beth yw dyfodol y profi gyda'r llif ochrol, y lateral flow tests? Pa mor gywir ydyn nhw i ddechrau, a beth yw dyfodol y rheini wrth i ni symud ymlaen? 

Okay, thank you. A final question: what is the future of the lateral flow tests? How accurate are they, first of all, and what is the future of them as we move forward?